How are medical schools supporting student’s mental wellbeing during the COVID-19 pandemic?

Introduction

The COVID-19 pandemic has impacted medical students in many ways. They are not exempt from personal struggles caused by the health crisis, and many have faced similar challenges adapting to a new learning experience. The University of East Anglia (UEA) has initiatives in place to support medical students including the society Headucate UEA and the Wellbeing Champions scheme established by Norwich Medical School (NMS).

Objectives

Headucate aims to improve mental wellbeing by educational online webinars and social events aimed at university students. NMS Wellbeing Champions offer support and signpost students to resources and the wider student support system at the UEA.

Methods

Headucate was established in 2012 by NMS students that began running workshops at local secondary schools. Their work has expanded to include wellbeing workshops, social events for students and mental health first aid training, so members can provide peer support. Wellbeing Champions are medical student representatives responsible for completing mental health first aid training, communication between students and faculty, providing resources and signposting, creating mental health bulletin newsletters, and running socials exclusively for medical students.

Results

100% of Headucate workshop attendees who completed anonymous feedback agreed that they enjoyed it and that it was useful. No feedback has been collected regarding the success of the Wellbeing Champions. This should be carried out to assess and enhance the project further.

Conclusions

More data is needed to establish the success of the initiatives at NMS and their impact on medical student’s wellbeing.

Disclosure

No significant relationships.

The Success of Headucate: The Student-Led Mental Health Society

Introduction

Headucate: University of East Anglia, a university student-led society, was founded almost 10 years ago by medical students to promote mental health education and raise awareness and funds for mental health causes.

Objectives

Headucate aims to spread mental health awareness and reduce stigma by working with schools, universities, other societies and charities internationally.

Methods

Headucate delivers workshops for children aged 4-18 in primary and secondary schools, community and youth groups and university students. These sessions were delivered in-person pre-COVID and online as interactive webinars since 2020, to spark discussion around mental health, and provide information about the variety of supports available for young people.

Results

In the past decade, Headucate UEA has grown to become one of UEA’s largest student-led groups boasting over 175 members in 2020-2021 from all courses. Within the online world, Headucate’s events have reached worldwide. The initiative has received national recognition, won national student awards and has expanded to set up three further Headucate branches nationwide. Outreach has accelerated and the school workshops reached over 1,000 students in the past year.

Conclusions

Headucate has grown from strength to strength and has plans to continue to develop, with passionate student drivers behind the project. Expansion of the project could include a national mental health university directory, bringing together like-minded mental health advocate students around the country and creating new Headucate branches across the country. To further develop, Headucate could expand outreach to the elderly community as discussed by previous committee.

Disclosure

No significant relationships.

Is TikTok increasing the number of self-diagnoses of ADHD in young people?

Introduction

TikTok is a free mobile application, that enables users to create short videos. TikTok has an estimated one billion monthly active users, comprised of a mostly younger audience. There has been a noticed rise in content discussing ADHD – hashtag ADHD on TikTok has 6.3 billion views. The discussions continue on Twitter, where users are reporting watching TikTok content explaining ADHD symptomatology, subsequently relating to the condition and requesting referrals to specialist psychiatry services. This study aims to identify key themes in discussions around TikTok and ADHD, and its ramifications.

Objectives

This study’s objective is to discuss the relationship between viewing ADHD content of TikTok and self-diagnoses of ADHD in young people.

Methods

In our study, Twitter posts were identified with the words ‘ADHD’ and ‘TikTok’ and established key themes relating to self-diagnosis of ADHD.

Results

Numerous tweets were found discussing individual’s experiences of self-diagnosis of ADHD after watching TikTok videos and relating with the symptomology. Furthermore, many users discussed their efforts to seek diagnosis from psychiatrists. These posts highlighted positive discussion of mental health, and the improvement in quality of life since diagnosis.

Conclusions

Many young people are self-diagnosing ADHD after viewing TikTok videos. This may improve mental health stigma, however the expertise of the video creators should be scrutinised. Furthermore, the impact on already stretched waiting lists should be considered, with individuals who’s perceived ADHD traits are not impacting on their quality of life.

Disclosure

No significant relationships.

The impact of COVID-19 on mental health charity fundraising: An account from the perspective of fundraisers

Introduction

The dawn of COVID-19 brought new rules, restrictions, and lockdowns but this led to the unlikely fall of many sectors, including the charitable sector. There has been a significant decline in funding received by mental health charities, especially during the pandemic. This study looks at the subsequent impact on fundraisers and mental health promotion during COVID-19.

Objectives

The main aim was to uncover how the COVID-19 pandemic has affected the way that mental health charities fundraise, raise awareness, and promote mental health. This aimed to look at the impact of the COVID-19 pandemic on fundraisers supporting mental health charities and their opinion on whether fundraising has either helped or hindered mental health promotion.

Methods

Accounts from fundraisers and local representatives for mental health charities during the COVID-19 pandemic were analysed. Common themes looked at the impact, adaptation, and reasons why fundraisers decided to help during a tough period for the charitable sector.

Results

Mental health charities expressed difficulty in sourcing funds to support their users, especially in a vulnerable time. Fundraisers tried innovative ways to promote mental health and raise money for charities.

Conclusions

Altruism and understanding how precious services such as mental health charities are for the population was the main driver for fundraisers. Mental health charities adapted by turning to online communication and reached out to fundraisers to continually highlight the importance of mental health to their users and fundraisers.

Disclosure

No significant relationships.

The impact of Gender Identity Clinic waiting times on the mental health of transitioning individuals

Introduction

Waiting times for gender identity services, even before the Covid-19 pandemic, have been a cause of concern. Despite the waiting time standard for planned elective care in the NHS being a maximum of 18 weeks, the average waiting time for a first appointment with a gender identity clinic is 18 months. This study aims to analyse the effect that these timings have on the transgender community, and whether they impact the risk of developing mental health conditions such as depression or anxiety.

Objectives

This study’s main aim is to analyse the correlation between waiting times and mental health burden in the transgender community.

Methods

A literature review and analysis on a transgender individual’s mental health and waiting times for Gender Identity Clinics; looking at any key themes and conclusions. Research papers were taken from MEDLINE, The International Journal of Transgender Health, Oxford Academic, SpringerLink and Emerald Insight, with studies publishing date ranging from 2014 – 2021.

Results

The transgender population were found to have higher rates of suicidal ideation, depression and self harm compared to the general population. Longer waiting times were found to contribute to feelings of low mood and suicidal ideation, as well as decreasing overall quality of life.

Conclusions

Longer waiting times can decrease a transgender individual’s quality of life and impact their overall mental wellbeing: especially with the impact of COVID-19 and the rise in referrals.

Disclosure

No significant relationships.

SAT0003 ELEVATED BASELINE AND INCREASING AUTOANTIBODY LEVELS ARE ASSOCIATED WITH INCREASED RISK FOR IMMINENT ONSET OF INFLAMMATORY ARTHRITIS IN A PROSPECTIVELY STUDIED ANTI-CITRULLINATED PROTEIN ANTIBODY POSITIVE COHORT: THE TIP-RA COLLECTIVE

Background:

The Targeting Immune Responses for Prevention of RA (TIP-RA) Collaborative prospectively studies individuals at high risk for developing RA because of serum ACPA positivity in absence of baseline inflammatory arthritis (IA).

Objectives:

The objective of the analyses presented herein is to evaluate the role of baseline and changing levels of ACPA and rheumatoid factor (RF) in relationship to incident IA/RA.

Methods:

ACPA+ subjects and ACPA- controls were identified who did not have baseline historical or examination evidence of IA. ACPA+ was defined by serum elevation of anti-CCP3 ≥20 units (Inova). Subjects were evaluated annually or sooner if they had changes in joint symptoms. Factors including RFIgM and RFIgA (Inova) were also assessed, and relationships between autoantibody levels at baseline and over time and incident IA/RA were evaluated using t-tests, with paired testing where applicable.

Results:

Baseline characteristics of ACPA+ and ACPA- subjects are in Table 1. Sixteen of the 94 (17%) ACPA+ subjects developed IA/RA a mean of 518 days from the baseline visit; 14 of these met 2010 ACR/EULAR criteria for RA at the time of detection of IA. There was a trend for ACPA+ subjects who later developed IA/RA to have higher baseline levels of anti-CCP3 compared to those who did not develop IA/RA (Table 2). In addition, those who developed IA/RA had significantly higher mean levels of RFIgM and RFIgA compared to those who did not. While not statistically significant, in longitudinal analyses in the ACPA+ subjects with incident IA/RA, anti-CCP3 levels increased from baseline to identification of IA (mean [SD] of 119 [102] to 126 [100], p=0.42). Furthermore, RFIgM levels increased from 36 [49] at baseline to 43 [51] at the time of IA (p=0.31), and RFIgA levels increased from 16 [29] to 21 [31] (p=0.10). In contrast, in ACPA+ subjects who did not develop IA/RA, anti-CCP3 levels increased only slightly over follow-up of a mean of 712 days: 75 [75] to 80 [76], p=0.70 while the levels of RFIgM and RFIgA decreased slightly during the same follow-up: for RFIgM mean [SD] levels went from 9 [22] to 8 [19], p=0.74; for RFIgA, 5 [16] to 3 [12], p=0.67.

Table 1.

Baseline characteristics of ACPA+/- subjects

ACPA-(n=162)ACPA+(n=94)p-valueAge, mean58580.90% Female69680.67% Ever smoker33340.87RF-IgM, mean (SD)3.2 (10.0)13.5 (30.2)<0.01RF-IgA, mean (SD)0.3 (0.6)6.5 (19.1)<0.01Table 2.

Baseline characteristics of 16 ACPA+ subjects who developed incident IA/RA vs. 78 ACPA+ who did not

Did not develop IA/RA (n=78)Developed IA/RA (n=16)p-valueDays from baseline to IA/RA or follow-up, mean (SD)712 (124)518 (295)–% Meeting 2010 criteria at time of IA-88–CCP3, mean (SD)74.5 (75.3)119.1 (102.1)0.05RFIgM, mean (SD)9 (22)36 (49)<0.01RFIgA, mean (SD)4 (16)16 (29)0.03

Conclusion:

In this prospectively followed cohort of ACPA+ subjects, higher levels of RFIgM and RFIgA at baseline were significantly associated with development of IA/RA within the follow-up period. Furthermore, there was a trend for rising levels of anti-CCP3 and RFIgM and A to be associated with development of IA/RA. These finding support the use of higher and/or rising levels of autoantibodies as additional features to predict imminent onset of IA/RA in ACPA+ individuals as well as potentially to use as outcomes of success of preventive interventions. Furthermore, the trend of increasing levels of RFIgM and RFIgA over time in individuals who developed IA/RA suggests that targeting pathways of RF development may lead to preventive interventions in a subset of RA.

References:

None

Disclosure of Interests:

Kevin Deane Grant/research support from: Janssen, Consultant of: Inova, ThermoFisher, Janseen, BMS and Microdrop, Gary Firestein Grant/research support from: Lilly, Janssen, Abbvie, David Boyle: None declared, Jane Buckner Grant/research support from: Bristol-Myers Squibb, Janssen, Eddie A. James Grant/research support from: Janssen, Pfizer, Sanofi, Novartis, Sylvia Posso Grant/research support from: Janssen, William Robinson Grant/research support from: Janssen, Laurie K. Moss Grant/research support from: Janssen, Jennifer Seifert Grant/research support from: Janssen, Roger Gilmore Grant/research support from: Janssen, Saman Barzideh Grant/research support from: Janssen, Navin Rao Shareholder of: Janssen Pharmaceuticals, Employee of: Janssen Pharmaceuticals, Frederic Baribaud Shareholder of: Janssen Research & Development, LLC, Employee of: Janssen Research & Development, LLC, Sunil Nagpal Shareholder of: Janssen Pharmaceuticals, Employee of: Janssen Pharmaceuticals, Alyssa Johnsen Employee of: Janssen, V. Michael Holers Grant/research support from: Janssen, Celgene, and BMS

‘TAG, You’re It!’ The high-stakes game of handovers in the Emergency Department – Improving handover quality using a new ‘TAG’ Protocol

Aim To assess handover quality amongst Emergency Department (ED) physicians and improve quality by implementing a unique protocol entitled ‘TAG, You’re It!’ (TAG protocol). Methods Patient charts assessed using set parameters prior to implementation of the ‘TAG’ protocol. ‘TAG’ protocol developed based on gaps in current practice and recommendations from literature. Identical parameters applied post-intervention, and results compared to those pre-intervention. Results ‘TAG’ protocol yielded positive impact on ED handover practices. A significant difference (p<0.05) between pre and post-TAG intervention values was seen across all parameters i.e. including the accepting physician’s name in the computer system and ED chart, documenting a handover plan in the ED chart, and including a handover plan deemed sufficient by standards developed from relevant literature. Conclusion Shift-to-shift handover in the ED is a high risk time for patient safety. The ‘TAG’ protocol ensures that essential information is documented and communicated in a succinct and rapid way.

Dressed return maps distinguish chaotic mechanisms

Chaotic data generated by a three-dimensional dynamical system can be embedded into R(3) in a number of inequivalent ways. However, when lifted into R(5) they all become equivalent, indicating that they all belong to a single universality class sharing a common chaos-generating mechanism. We present a complete invariant determining this universality class and distinguishing attractors generated by distinct mechanisms. This invariant is easily computable from an appropriately "dressed" return map of any particular three-dimensional embedding.

Coagulation factor activity and clinical bleeding severity in rare bleeding disorders: results from the European Network of Rare Bleeding Disorders

BACKGROUND

The European Network of Rare Bleeding Disorders (EN-RBD) was established to bridge the gap between knowledge and practise in the care of patients with RBDs.

OBJECTIVES

To explore the relationship between coagulation factor activity level and bleeding severity in patients with RBDs.

PATIENTS/METHODS

Cross-sectional study using data from 489 patients registered in the EN-RBD. Coagulation factor activity levels were retrieved. Clinical bleeding episodes were classified into four categories according to severity.

RESULTS

The mean age of patients at data collection was 31 years (range, 7 months to 95 years), with an equal sex distribution. On linear regression analysis, there was a strong association between coagulation factor activity level and clinical bleeding severity for fibrinogen, factor (F) X, FXIII, and combined FV and FVIII deficiencies. A weaker association was present for FV and FVII deficiencies. There was no association between coagulation factor activity level and clinical bleeding severity for FXI. The coagulation factor activity levels that were necessary for patients to remain asymptomatic were: fibrinogen, > 100 mg dL(-1); FV, 12 U dL(-1); combined FV + VIII, 43 U dL(-1); FVII, 25 U dL(-1); FX, 56 U dL(-1) ; FXI, 26 U dL(-1); FXIII, 31 U dL(-1). Moreover, coagulation factor activity levels that corresponded with Grade III bleeding were: undetectable levels for fibrinogen, FV and FXIII, < 15 U dL(-1) for combined FV + VIII; < 8 U dL(-1) for FVI; < 10 U dL(-1) for FX; and < 25 U dL(-1) for FXI.

CONCLUSIONS

There is a heterogeneous association between coagulation factor activity level and clinical bleeding severity in different RBDs. A strong association is only observed in fibrinogen, FX and FXIII deficiencies.

Complete set of representations for dissipative chaotic three-dimensional dynamical systems

Embeddings are diffeomorphisms between some dynamical phase space and a reconstructed image. Different embeddings may or may not be equivalent under isotopy. We regard embeddings as representations of the dynamical phase space. We determine the topological labels required to distinguish inequivalent representations of three-dimensional dissipative dynamical systems when the embeddings are into R(k), k=3,4,5,…. Three representation labels are required for embeddings into R³, and only one is required in R⁴. In R⁵ there is a single "universal" representation.

Deuterium nuclear magnetic resonance investigation of the effects of proteins and polypeptides on hydrocarbon chain order in model membrane systems

Deuterium Fourier-transform nuclear magnetic resonance spectra have been obtained of 1-myristoyl 2-(14,14,14-trideutero)myristoyl phosphatidylcholine bilayers at 34.1 MHz by using the quadrupole echo pulse technique. Thereby, we have investigated the effects upon the deuterated dimyristoyl phosphatidylcholine bilayers of the following proteins and polypeptides: gramicidin A, bacteriophage f1 coat protein, beef brain myelin proteolipid apoprotein, cytochrome b(5), and cytochrome c oxidase (ferrocytochrome c:oxygen oxidoreductase, EC 1.9.3.1). Above T(c), the transition temperature between the gel and liquid crystal phases, the quadrupole splitting of the deuterium-labeled methyl group is reduced or collapsed in the presence of protein or polypeptide. No evidence has been found for ordered "boundary lipid." Below T(c), the spectra show that the hydrocarbon chains are prevented from crystallizing by the protein (or polypeptide) incorporated in the membrane. Similar disordering effects above T(c) are also seen when an unsaturated lipid, 1-(16,16,16-trideutero)palmitoyl 2-palmitoleyl phosphatidylcholine is complexed with cytochrome oxidase.

Differential embedding of the Lorenz attractor

Ideally an embedding of an N -dimensional dynamical system is N -dimensional. Ideally, an embedding of a dynamical system with symmetry is symmetric. Ideally, the symmetry of the embedding is the same as the symmetry of the original system. This ideal often cannot be achieved. Differential embeddings of the Lorenz system, which possesses a twofold rotation symmetry, are not ideal. While the differential embedding technique happens to yield an embedding of the Lorenz attractor in three dimensions, it does not yield an embedding of the entire flow. An embedding of the flow requires at least four dimensions. The four dimensional embedding produces a flow restricted to a twisted three dimensional manifold in R4. This inversion symmetric three-manifold cannot be projected into any three dimensional Euclidean subspace without singularities.

Representation theory for strange attractors

Embeddings are diffeomorphisms between some unseen physical attractor and a reconstructed image. Different embeddings may or may not be equivalent under isotopy. We regard embeddings as representations of the attractor, review the labels required to distinguish inequivalent representations for an important class of dynamical systems, and discuss the systematic ways inequivalent embeddings become equivalent as the embedding dimension increases until there is finally only one "universal" embedding in a suitable dimension.

Activated protein C resistance, factor V Leiden and assessment of thrombotic risk

Venous thromboembolism comprises deep vein thrombosis (DVT) and pulmonary embolism (PE). Acute venous thromboembolism (VTE) is a serious and potentially fatal disorder which often complicates the course of hospitalized patients, but also affects ambulatory and otherwise healthy people. The annual incidence of venous thromboembolism is 1 to 2 cases per 1000 person and the risk of the disorder rises exponentially with age, from an annual rate of less than 5 per 100,000 children to greater than 400 per 100,000 adults older than 80 years.

Comparison of tests for embeddings

It is possible to compare results for the classical tests for embeddings of chaotic data with the results of a recently proposed test. The classical tests, which depend on real numbers (fractal dimensions, Lyapunov exponents) averaged over an attractor, are compared with a topological test that depends on integers. The comparison can only be done for mappings into three dimensions. We find that the classical tests fail to predict when a mapping is an embedding and when it is not. We point out the reasons for this failure, which are not restricted to three dimensions.

When are projections also embeddings?

We study an autonomous four-dimensional dynamical system used to model certain geophysical processes. This system generates a chaotic attractor that is strongly contracting, with four Lyapunov exponents lambdai that satisfy lambda1+lambda2+lambda3<0 , so the Lyapunov dimension is DL=2+|lambda3|/lambda1<3 in the range of coupling parameter values studied. As a result, it should be possible to find three-dimensional spaces in which the attractors can be embedded so that topological analyses can be carried out to determine which stretching and squeezing mechanisms generate chaotic behavior. We study mappings into R3 to determine which can be used as embeddings to reconstruct the dynamics. We find dramatically different behavior in the two simplest mappings: projections from R4 to R3 . In one case the one-parameter family of attractors studied remains topologically unchanged for all coupling parameter values. In the other case, during an intermediate range of parameter values the projection undergoes self-intersections, while the embedded attractors at the two ends of this range are topologically mirror images of each other.

Pol I transcription and pre-rRNA processing are coordinated in a transcription-dependent manner in mammalian cells

Pre-rRNA synthesis and processing are key steps in ribosome biogenesis. Although recent evidence in yeast suggests that these two processes are coupled, the nature of their association is unclear. In this report, we analyze the coordination between rDNA transcription and pre-rRNA processing in mammalian cells. We found that pol I transcription factor UBF interacts with pre-rRNA processing factors as analyzed by immunoprecipitations, and the association depends on active rRNA synthesis. In addition, injections of plasmids containing the human rDNA promoter and varying lengths of 18S rDNA into HeLa nuclei show that pol I transcription machinery can be recruited to rDNA promoters regardless of the product that is transcribed, whereas subgroups of pre-rRNA processing factors are recruited to plasmids only when specific pre-rRNA fragments are produced. Our observations suggest a model for sequential recruitment of pol I transcription factors and pre-rRNA processing factors to elongating pre-rRNA on an as-needed basis rather than corecruitment to sites of active transcription.

Effectiveness of vagus nerve stimulation in epilepsy patients

A retrospective review of the safety, tolerability, and efficacy of vagus nerve stimulation (VNS) in 48 patients with intractable partial epilepsy was performed. Side effects were few and mild to moderate. Mean seizure frequency decreased by 26% after 1 year, 30% after 5 years, and 52% after 12 years with VNS treatment.

Treatment of oro-facial hypersensitivity following brain injury

A 56 year old man who was 10 months post-severe traumatic brain injury was unable to tolerate oral hygiene. He had oro-facial hypersensitivity, oral dyspraxia and limited oral function. Poor oral hygiene with coating of oral structures and infection was present. An intensive systematic desensitization programme over 2 weeks, even at this late stage post-injury, increased oral tolerance and allowed full oral hygiene. Participation in oral hygiene and functional patterns of movement also improved, enabling some oral nutritional intake. This case study provides controlled evidence, very little of which exists in the literature, to demonstrate the effectiveness of these treatment techniques

MMPI-2 profiles of patients with intractable epilepsy

MMPI-2 profiles of 93 presurgical intractable epilepsy patients were examined using Ward's method of cluster analysis. Three clusters were identified. The means of each cluster suggest that 45% of the sample had minimal psychological complaints, 30% presented with generalized clinical elevations, and 25% of the patients had profiles of intermediate elevations with a tendency to emphasize somatic complaints and/or depression. Gender, age of seizure onset, and seizure laterality were not found to be uniquely associated with the cluster profiles. Further examination of correlates of group membership is warranted to provide information for treatment planning.

Allosteric regulation provides a molecular mechanism for preferential utilization of the fully assembled dolichol-linked oligosaccharide by the yeast oligosaccharyltransferase

The oligosaccharyltransferase (OST) preferentially utilizes the fully assembled dolichol-linked oligosaccharide Glc(3)Man(9)GlcNAc(2)-PP-Dol as the donor for N-linked glycosylation of asparagine residues in N-X-T/S consensus sites in newly synthesized proteins. A wide variety of assembly intermediates (Glc(0-2)Man(0-9)GlcNAc(2)-PP-Dol) can serve as the donor substrate for N-linked glycosylation of peptide acceptor substrates in vitro or of nascent glycoproteins in mutant cells that are defective in donor substrate assembly. A kinetic mechanism that can account for the selection of the fully assembled donor substrate from a complex mixture of dolichol-linked oligosaccharides (OS-PP-Dol) has not been elucidated. Here, the steady-state kinetic properties of the OST were reinvestigated using a proteoliposome assay system consisting of the purified yeast enzyme, near-homogeneous preparations of a dolichol-linked oligosaccharide (Glc(3)Man(9)GlcNAc(2)-PP-Dol or Man(9)GlcNAc(2)-PP-Dol) and an (125)I-labeled tripeptide as the acceptor substrate. The K(m) of the OST for the acceptor tripeptide was only slightly enhanced when Glc(3)Man(9)GlcNAc(2)-PP-Dol was the donor substrate relative to when Man(9)GlcNAc(2)-PP-Dol was the donor substrate. Evaluation of the kinetic data for both donor substrates showed deviations from typical Michaelis-Menten kinetics. Sigmoidal saturation curves, Lineweaver-Burk plots with upward curvature, and apparent Hill coefficients of about 1.4 suggested a substrate activation mechanism involving distinct regulatory (activator) and catalytic binding sites for OS-PP-Dol. Results of competition experiments using either oligosaccharide donor as an alternative substrate were also consistent with this hypothesis. We propose that binding of either donor substrate to the activator site substantially enhances Glc(3)Man(9)GlcNAc(2)-PP-Dol occupancy of the enzyme catalytic site via allosteric activation.