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Cross-sectional studies have shown that the COVID-19 pandemic has had a significant impact on the mental health of healthcare staff. However, it is less well understood how working over the long term in successive COVID-19 waves affects staff well-being.
Aims
To identify subpopulations within the health and social care staff workforce with differentiated trajectories of mental health symptoms during phases of the COVID-19 pandemic.
Method
The COVID-19 Staff Wellbeing Survey assessed health and social care staff well-being within an area of the UK at four time points, separated by 3-month intervals, spanning November 2020 to August 2021.
Results
Growth mixture models were performed on the depression, anxiety and post-traumatic stress disorder longitudinal data. Two class solutions provided the best fit for all models. The vast majority of the workforce were best represented by the low-symptom class trajectory, where by symptoms were consistently below the clinical cut-off for moderate-to-severe symptoms. A sizable minority (13–16%) were categorised as being in the high-symptom class, a group who had symptom levels in the moderate-to-severe range throughout the peaks and troughs of the pandemic. In the depression, anxiety and post-traumatic stress disorder models, the high-symptom class perceived communication from their organisation to be less effective than the low-symptom class.
Conclusions
This research identified a group of health service staff who reported persistently high mental health symptoms during the pandemic. This group of staff may well have particular needs in terms of the provision of well-being support services.
Response to lithium in patients with bipolar disorder is associated with clinical and transdiagnostic genetic factors. The predictive combination of these variables might help clinicians better predict which patients will respond to lithium treatment.
Aims
To use a combination of transdiagnostic genetic and clinical factors to predict lithium response in patients with bipolar disorder.
Method
This study utilised genetic and clinical data (n = 1034) collected as part of the International Consortium on Lithium Genetics (ConLi+Gen) project. Polygenic risk scores (PRS) were computed for schizophrenia and major depressive disorder, and then combined with clinical variables using a cross-validated machine-learning regression approach. Unimodal, multimodal and genetically stratified models were trained and validated using ridge, elastic net and random forest regression on 692 patients with bipolar disorder from ten study sites using leave-site-out cross-validation. All models were then tested on an independent test set of 342 patients. The best performing models were then tested in a classification framework.
Results
The best performing linear model explained 5.1% (P = 0.0001) of variance in lithium response and was composed of clinical variables, PRS variables and interaction terms between them. The best performing non-linear model used only clinical variables and explained 8.1% (P = 0.0001) of variance in lithium response. A priori genomic stratification improved non-linear model performance to 13.7% (P = 0.0001) and improved the binary classification of lithium response. This model stratified patients based on their meta-polygenic loadings for major depressive disorder and schizophrenia and was then trained using clinical data.
Conclusions
Using PRS to first stratify patients genetically and then train machine-learning models with clinical predictors led to large improvements in lithium response prediction. When used with other PRS and biological markers in the future this approach may help inform which patients are most likely to respond to lithium treatment.
Throughout the coronavirus disease 2019 (COVID-19) pandemic, health and social care workers have faced unprecedented professional demands, all of which are likely to have placed considerable strain on their psychological well-being.
Aims
To measure the national prevalence of mental health symptoms within healthcare staff, and identify individual and organisational predictors of well-being.
Method
The COVID-19 Staff Wellbeing Survey is a longitudinal online survey of psychological well-being among health and social care staff in Northern Ireland. The survey included four time points separated by 3-month intervals; time 1 (November 2020; n = 3834) and time 2 (February 2021; n = 2898) results are presented here. At time 2, 84% of respondents had received at least one dose of a COVID-19 vaccine. The survey included four validated psychological well-being questionnaires (depression, anxiety, post-traumatic stress and insomnia), as well as demographic and organisational measures.
Results
At time 1 and 2, a high proportion of staff reported moderate-to-severe symptoms of depression (30–36%), anxiety (26–27%), post-traumatic stress (30–32%) and insomnia (27–28%); overall, significance tests and effect size data suggested psychological well-being was generally stable between November 2020 and February 2021 for health and social care staff. Multiple linear regression models indicated that perceptions of less effective communication within their organisation predicted greater levels of anxiety, depression, post-traumatic stress and insomnia.
Conclusions
This study highlights the need to offer psychological support to all health and social care staff, and to communicate with staff regularly, frequently and clearly regarding COVID-19 to help protect staff psychological well-being.
We present continuous estimates of snow and firn density, layer depth and accumulation from a multi-channel, multi-offset, ground-penetrating radar traverse. Our method uses the electromagnetic velocity, estimated from waveform travel-times measured at common-midpoints between sources and receivers. Previously, common-midpoint radar experiments on ice sheets have been limited to point observations. We completed radar velocity analysis in the upper ~2 m to estimate the surface and average snow density of the Greenland Ice Sheet. We parameterized the Herron and Langway (1980) firn density and age model using the radar-derived snow density, radar-derived surface mass balance (2015–2017) and reanalysis-derived temperature data. We applied structure-oriented filtering to the radar image along constant age horizons and increased the depth at which horizons could be reliably interpreted. We reconstructed the historical instantaneous surface mass balance, which we averaged into annual and multidecadal products along a 78 km traverse for the period 1984–2017. We found good agreement between our physically constrained parameterization and a firn core collected from the dry snow accumulation zone, and gained insights into the spatial correlation of surface snow density.
There is little evidence to guide pharmacological treatment in adults with Down syndrome and Alzheimer's disease.
Aims
To investigate the effect of cholinesterase inhibitors or memantine on survival and function in adults with Down syndrome and Alzheimer's disease.
Method
This was a naturalistic longitudinal follow-up of a clinical cohort of 310 people with Down syndrome diagnosed with Alzheimer's disease collected from specialist community services in England.
Results
Median survival time (5.59 years, 95% CI 4.67–6.67) for those on medication (n = 145, mainly cholinesterase inhibitors) was significantly greater than for those not prescribed medication (n = 165) (3.45 years, 95% CI 2.91–4.13, log-rank test P<0.001). Sequential assessments demonstrated an early effect in maintaining cognitive function.
Conclusions
Cholinesterase inhibitors appear to offer benefit for people with Down syndrome and Alzheimer's disease that is comparable with sporadic Alzheimer's disease; a trial to test the effect of earlier treatment (prodromal Alzheimer's disease) in Down syndrome may be indicated.
Declaration of interest
A.S. has undertaken consulting for Ono Pharmaceuticals, outside the submitted work. Z.W. has received a consultancy fee and grant from GE Healthcare, outside the submitted work.
An outbreak of respiratory diphtheria occurred in two health districts in the province of KwaZulu-Natal in South Africa in 2015. A multidisciplinary outbreak response team was involved in the investigation and management of the outbreak. Fifteen cases of diphtheria were identified, with ages ranging from 4 to 41 years. Of the 12 cases that were under the age of 18 years, 9 (75%) were not fully immunized for diphtheria. The case fatality was 27%. Ninety-three household contacts, 981 school or work contacts and 595 healthcare worker contacts were identified and given prophylaxis against Corynebacterium diphtheriae infection. A targeted vaccination campaign for children aged 6–15 years was carried out at schools in the two districts. The outbreak highlighted the need to improve diphtheria vaccination coverage in the province and to investigate the feasibility of offering diphtheria vaccines to healthcare workers.
Declining availability of prey is potentially a major factor limiting snow leopard Panthera uncia populations in Tajikistan and neighbouring states. Conservation initiatives to develop community-based trophy hunting programmes for ibex Capra sibirica and argali Ovis ammon polii aim to provide financial incentives for communities to limit poaching of wild ungulates. Such programmes could help to reverse local declines in ibex and argali populations, and consequently snow leopard populations, while simultaneously improving the economic status of local people. However, in practice the desired effect may not materialize. To investigate the premise, we estimated the population density of the snow leopard, using a spatial capture–recapture model based on camera trapping in two study areas (each c. 1,000 km2) in the Tajik Pamirs: a well-managed trophy hunting concession and an otherwise similar area where grazing and poaching are unmanaged. We used distance-truncated counts to assess relative densities of wild and domestic ungulates between sites, and faecal analyses to compare the dietary habits of snow leopards. Our data were limited in scope but suggested that the density of snow leopards and the relative density of wild and domestic ungulates may have been greater in the hunting concession, where wild ungulates accounted for a greater proportion of prey items. Our results provide preliminary evidence that trophy hunting of ungulates may be a viable tool for achieving snow leopard conservation goals; however, we conclude that further investigation is necessary to adequately address the question.
Continental deposits of the Early Jurassic East Berlin Formation in Holyoke, Massachusetts, have yielded an exceptional occurrence of the ichnogenus Treptichnus. Here, burrows are preserved in full relief within thin mud laminae between layers of fine-grained, cross-bedded sandstone. We studied these burrows to evaluate whether earlier explanations of burrow morphology are applicable to all Treptichnus. Our research focused on three questions. (1) Do the Holyoke Treptichnus have significant vertical relief? (2) Does the lack of projections in some of the Holyoke Treptichnus result from stratinomic sectioning through the bottom of the burrow? (3) Do expanded, bulbous ends of burrow segments result from sediment compaction? While addressing these questions, the Holyoke fossils were compared to syntype and topotype material of Treptichnus from the Carboniferous of Indiana. The Holyoke Treptichnus did not exhibit significant vertical relief, and the presence and absence of projections is explained by the positioning of new segments at different points along older ones. The bulbous ends of burrow segments resulted from trace-maker behavior, not sediment compaction. Drawing on the analysis of the Holyoke material, a new reconstruction is proposed that presents continental Treptichnus as a shallow mole-tunnel-like burrow produced just below the sediment surface. This reconstruction is consistent with the morphology of Recent Treptichnus-like burrows produced by fly (dipteran) larvae, which are considered the most likely makers of the Holyoke Treptichnus.
The availability of wild prey is a critical predictor of carnivore density. However, few conservation programmes have focused on the estimation and monitoring of wild ungulate populations and their trends, especially in the remote mountains of Central Asia. We conducted double-observer surveys to estimate the populations of ibex Capra sibirica and argali Ovis ammon in the mountainous regions of Tost Local Protected Area, South Gobi province, Mongolia, which is being considered for designation as a Nature Reserve. We also conducted demographic surveys of the more abundant ibex to examine their sex-ratio and the survival of young during 2012–2013. The estimated ibex population remained stable in 2012 and 2013 and the estimated argali population increased from 108 in 2012 to 230 in 2013. The biomass of wild ungulates was c. 6% that of livestock. Mortality in young ibex appeared to increase after weaning, at the age of 12 months. We estimated the population of wild ungulates was sufficient to support 14–18 adult snow leopards Panthera uncia. The adult snow leopard population in our study area during 2012–2013, estimated independently using camera-trap-based mark–recapture methods, was 12–14. Based on our results we identify the Tost Local Protected Area as an important habitat for the conservation of these ungulates and their predator, the Endangered snow leopard, and recommend elevation of its status to a Nature Reserve.
This volume of the Haskins Society Journal furthers the Society's commitment to historical and interdisciplinary research on the early and central Middle Ages, especially in the Anglo-Saxon, Anglo-Norman, and Angevin worlds but also on the continent. The topics of the essays it contains range from the curious place of Francia in the historiography of medieval Europe to strategies of royal land distribution in tenth-century Anglo-Saxon England to the representation of men and masculinity in the works of Anglo-Norman historians. Essays on the place of polemical literature in Frutolf of Michelsberg's Chronicle, exploration of the relationship between chivalry and crusading in Baudry of Bourgeuil's History, and Cosmas of Prague's manipulation of historical memory in the service of ecclesiastical privilege and priority each extend the volume's engagement with medieval historiography, employing rich continental examples to do so. Investigations of comital personnel in Anjou and Henry II's management of royal forests and his foresters shed new light on the evolving nature of secular governance in the twelfth centuries and challenge and refine important aspects of our view of medieval rule in this period. The volume ends with a wide-ranging reflection on the continuing importance of the art object itself in medieval history and visual studies. Contributors: H.F. Doherty, Kathryn Dutton, Kirsten Fenton, Paul Fouracre, Herbert Kessler, Ryan Lavelle, Thomas J.H. McCarthy, Lisa Wolverton, Simon Yarrow.