In Michigan, the COVID-19 pandemic severely impacted Black and Latinx communities. These communities experienced higher rates of exposure, hospitalizations, and deaths compared to Whites. We examine the impact of the pandemic and reasons for the higher burden on communities of color from the perspectives of Black and Latinx community members across four Michigan counties and discuss recommendations to better prepare for future public health emergencies.

Using a community-based participatory research approach, we conducted semi-structured interviews (n = 40) with Black and Latinx individuals across the four counties. Interviews focused on knowledge related to the pandemic, the impact of the pandemic on their lives, sources of information, attitudes toward vaccination and participation in vaccine trials, and perspectives on the pandemic’s higher impact on communities of color.

Participants reported overwhelming effects of the pandemic in terms of worsened physical and mental health, financial difficulties, and lifestyle changes. They also reported some unexpected positive effects. They expressed awareness of the disproportionate burden among Black and Latinx populations and attributed this to a wide range of disparities in Social Determinants of Health. These included racism and systemic inequities, lack of access to information and language support, cultural practices, medical mistrust, and varied individual responses to the pandemic.

Examining perspectives and experiences of those most impacted by the pandemic is essential for preparing for and effectively responding to public health emergencies in the future. Public health messaging and crisis response strategies must acknowledge the concerns and cultural needs of underrepresented populations.

Many available facepiece filtering respirators contain ferromagnetic components, which may cause significant problems in the magnetic resonance imaging (MRI) environment. We conducted a randomized crossover trial to assess the effectiveness, usability, and comfort of 3 types of respirators, judged to be “conditionally MRI safe” with an aluminum nosepiece (Halyard 46727 duckbill-type respirators and Care Essentials MSK-002 bifold cup-type respirators) or “MRI safe” completely metal free (Eagle AG2200 semirigid cup-type respirators).

We recruited 120 participants to undergo a quantitative fit test (QNFT) on each of the 3 respirators in a randomized order. Participants then completed a usability and comfort assessment of each respirator.

There were significant differences in the QNFT pass rates (51% for Halyard 46727, 73% for Care Essentials MSK-002, and 86% for Eagle AG2200, P < .001). The first-time fit test pass rate and overall fit factor were significantly higher for Eagle AG2200 compared with the other 2 respirators. Eagle AG2200 scored the lowest ratings in the ease of use and overall comfort. There were no significant differences in other modalities, including the seal rating, breathability, firmness, and overall assessment.

Our study supports the utility of the Eagle AG2200 and Care Essentials MSK-002 respirators for healthcare professionals working in an MRI environment, based on their high QNFT pass rates and reasonably good overall usability and comfort scores. Eagle AG2200 is unique because of its metal-free construction. However, its comparatively lower usability and comfort ratings raise questions about practicality, which may be improved by greater user training.

Profiling patients on a proposed ‘immunometabolic depression’ (IMD) dimension, described as a cluster of atypical depressive symptoms related to energy regulation and immunometabolic dysregulations, may optimise personalised treatment.

To test the hypothesis that baseline IMD features predict poorer treatment outcomes with antidepressants.

Data on 2551 individuals with depression across the iSPOT-D (n = 967), CO-MED (n = 665), GENDEP (n = 773) and EMBARC (n = 146) clinical trials were used. Predictors included baseline severity of atypical energy-related symptoms (AES), body mass index (BMI) and C-reactive protein levels (CRP, three trials only) separately and aggregated into an IMD index. Mixed models on the primary outcome (change in depressive symptom severity) and logistic regressions on secondary outcomes (response and remission) were conducted for the individual trial data-sets and pooled using random-effects meta-analyses.

Although AES severity and BMI did not predict changes in depressive symptom severity, higher baseline CRP predicted smaller reductions in depressive symptoms (n = 376, βpooled = 0.06, P = 0.049, 95% CI 0.0001–0.12, I2 = 3.61%); this was also found for an IMD index combining these features (n = 372, βpooled = 0.12, s.e. = 0.12, P = 0.031, 95% CI 0.01–0.22, I2 = 23.91%), with a higher – but still small – effect size compared with CRP. Confining analyses to selective serotonin reuptake inhibitor users indicated larger effects of CRP (βpooled = 0.16) and the IMD index (βpooled = 0.20). Baseline IMD features, both separately and combined, did not predict response or remission.

Depressive symptoms of people with more IMD features improved less when treated with antidepressants. However, clinical relevance is limited owing to small effect sizes in inconsistent associations. Whether these patients would benefit more from treatments targeting immunometabolic pathways remains to be investigated.

White matter hyperintensity (WMH) burden is greater, has a frontal-temporal distribution, and is associated with proxies of exposure to repetitive head impacts (RHI) in former American football players. These findings suggest that in the context of RHI, WMH might have unique etiologies that extend beyond those of vascular risk factors and normal aging processes. The objective of this study was to evaluate the correlates of WMH in former elite American football players. We examined markers of amyloid, tau, neurodegeneration, inflammation, axonal injury, and vascular health and their relationships to WMH. A group of age-matched asymptomatic men without a history of RHI was included to determine the specificity of the relationships observed in the former football players.

240 male participants aged 45-74 (60 unexposed asymptomatic men, 60 male former college football players, 120 male former professional football players) underwent semi-structured clinical interviews, magnetic resonance imaging (structural T1, T2 FLAIR, and diffusion tensor imaging), and lumbar puncture to collect cerebrospinal fluid (CSF) biomarkers as part of the DIAGNOSE CTE Research Project. Total WMH lesion volumes (TLV) were estimated using the Lesion Prediction Algorithm from the Lesion Segmentation Toolbox. Structural equation modeling, using Full-Information Maximum Likelihood (FIML) to account for missing values, examined the associations between log-TLV and the following variables: total cortical thickness, whole-brain average fractional anisotropy (FA), CSF amyloid ß42, CSF p-tau181, CSF sTREM2 (a marker of microglial activation), CSF neurofilament light (NfL), and the modified Framingham stroke risk profile (rFSRP). Covariates included age, race, education, APOE z4 carrier status, and evaluation site. Bootstrapped 95% confidence intervals assessed statistical significance. Models were performed separately for football players (college and professional players pooled; n=180) and the unexposed men (n=60). Due to differences in sample size, estimates were compared and were considered different if the percent change in the estimates exceeded 10%.

In the former football players (mean age=57.2, 34% Black, 29% APOE e4 carrier), reduced cortical thickness (B=-0.25, 95% CI [0.45, -0.08]), lower average FA (B=-0.27, 95% CI [-0.41, -.12]), higher p-tau181 (B=0.17, 95% CI [0.02, 0.43]), and higher rFSRP score (B=0.27, 95% CI [0.08, 0.42]) were associated with greater log-TLV. Compared to the unexposed men, substantial differences in estimates were observed for rFSRP (Bcontrol=0.02, Bfootball=0.27, 994% difference), average FA (Bcontrol=-0.03, Bfootball=-0.27, 802% difference), and p-tau181 (Bcontrol=-0.31, Bfootball=0.17, -155% difference). In the former football players, rFSRP showed a stronger positive association and average FA showed a stronger negative association with WMH compared to unexposed men. The effect of WMH on cortical thickness was similar between the two groups (Bcontrol=-0.27, Bfootball=-0.25, 7% difference).

These results suggest that the risk factor and biological correlates of WMH differ between former American football players and asymptomatic individuals unexposed to RHI. In addition to vascular risk factors, white matter integrity on DTI showed a stronger relationship with WMH burden in the former football players. FLAIR WMH serves as a promising measure to further investigate the late multifactorial pathologies of RHI.

Sleep problems associated with poor mental health and academic outcomes may have been exacerbated by the COVID-19 pandemic.

To describe sleep in undergraduate students during the COVID-19 pandemic.

This longitudinal analysis included data from 9523 students over 4 years (2018–2022), associated with different pandemic phases. Students completed a biannual survey assessing risk factors, mental health symptoms and lifestyle, using validated measures. Sleep was assessed with the Sleep Condition Indicator (SCI-8). Propensity weights and multivariable log-binomial regressions were used to compare sleep in four successive first-year cohorts. Linear mixed-effects models were used to examine changes in sleep over academic semesters and years.

There was an overall decrease in average SCI-8 scores, indicating worsening sleep across academic years (average change −0.42 per year; P-trend < 0.001), and an increase in probable insomnia at university entry (range 18.1–29.7%; P-trend < 0.001) before and up to the peak of the pandemic. Sleep improved somewhat in autumn 2021, when restrictions loosened. Students commonly reported daytime sleep problems, including mood, energy, relationships (36–48%) and concentration, productivity, and daytime sleepiness (54–66%). There was a consistent pattern of worsening sleep over the academic year. Probable insomnia was associated with increased cannabis use and passive screen time, and reduced recreation and exercise.

Sleep difficulties are common and persistent in students, were amplified by the pandemic and worsen over the academic year. Given the importance of sleep for well-being and academic success, a preventive focus on sleep hygiene, healthy lifestyle and low-intensity sleep interventions seems justified.

To undertake a healthcare-based multimodal evaluation of the combination of filtering facepiece respirator (FFR) with the elastic-band beard cover technique, including quantitative fit test (QNFT) results, skills assessment, and usability assessment.

We conducted a prospective study through the Respiratory Protection Program at the Royal Melbourne Hospital from May 2022 to January 2023.

Healthcare workers who required respiratory protection and could not shave for religious, cultural, or medical reasons.

Online education and personal face-to-face training on the use of FFR with the elastic-band beard cover technique.

Among 87 participants (median beard length 38 mm; interquartile range [IQR], 20–80), 86 (99%) passed 3 QNFTs consecutively with the elastic-band beard cover under a Trident P2 respirator and 68 (78%) passed 3 QNFTs consecutively with a 3M 1870+ Aura respirator. The first QNFT pass rate and the overall fit factors were significantly higher when using the technique than without the elastic-band beard cover. Most participants displayed a high skill level in their donning, doffing, and user seal-check techniques. Of 87 participants, 83 (95%) completed the usability assessment. The overall ease of use, comfort, and overall assessment were rated highly.

The elastic-band beard cover technique can provide safe and effective respiratory protection for bearded healthcare workers. The technique was easily taught, comfortable, well tolerated and accepted by healthcare workers, potentially allowing them full participation in the workforce during pandemics with airborne transmission. We recommend further research and evaluation of this technique in a broader health workforce.

Our Care Improvement System is an integrated quality and performance system designed to develop co-ordinated approach to managing performance at all levels of the organisation, ensuring everything we do is aligned to achieving our goals set out in our Trust strategy. The aim of this programme is to help the team move away from typical firefighting routines, towards a more structured routine of problem solving, applying quality improvement tools and methodology.

Five members of multidisciplinary team (MDT) in a Lewisham Community Mental Health Team were chosen as the core working team. They underwent four-month training programme which was one day per month plus weekly team coaching sessions from the Trust's Quality Improvement lead. One targeted measure was identified. This was to focus on improving patient discharges for more manageable caseloads, and ultimately provide a better staff and patient experience. A3 methodology was adopted to provide a structured framework for thinking through the problem. This included: problem statement, current situation, aims statement, root cause analysis, change ideas, actions, progress and benefits, and insights. In parallel, daily improvement huddles (15-minute long team meetings) were adopted to enable the team to problem solve other identified improvement work. The huddles follow a set structure of reviewing work in progress, new improvement opportunities, work that needs to be escalated and celebrated. This work was gradually widened to include the entire team.

The team's caseload was observed to be continuously going up from 200 in September 2021 to 264 in October 2022. We aimed to increase the number of safe discharges and to sustain a steady team caseload. Root cause analysis utilising a fishbone diagram identified barriers to discharge, such as lack of MDT approach and structure to discharge planning. Change ideas included creation of standard work, describing how an MDT discharge meeting would work. Actions were agreed to implement structured weekly MDT discharge meetings where four cases are discussed and safe discharge plans agreed, sharing responsibility for discharge decision. This has allowed us to reduce and maintain a steady caseload with 258 patients in January 2023.

Implementing Our Care Improvement System has not only provided a structure to our improvement work and improved our caseload but has also consolidated our team in working together for a common goal. We have naturally implemented structure to all other team meetings, which have now become more focused and productive, making our team a more rewarding place to work.

In difficult-to-treat depression (DTD) the outcome metrics historically used to evaluate treatment effectiveness may be suboptimal. Metrics based on remission status and on single end-point (SEP) assessment may be problematic given infrequent symptom remission, temporal instability, and poor durability of benefit in DTD.

Self-report and clinician assessment of depression symptom severity were regularly obtained over a 2-year period in a chronic and highly treatment-resistant registry sample (N = 406) receiving treatment as usual, with or without vagus nerve stimulation. Twenty alternative metrics for characterizing symptomatic improvement were evaluated, contrasting SEP metrics with integrative (INT) metrics that aggregated information over time. Metrics were compared in effect size and discriminating power when contrasting groups that did (N = 153) and did not (N = 253) achieve a threshold level of improvement in end-point quality-of-life (QoL) scores, and in their association with continuous QoL scores.

Metrics based on remission status had smaller effect size and poorer discrimination of the binary QoL outcome and weaker associations with the continuous end-point QoL scores than metrics based on partial response or response. The metrics with the strongest performance characteristics were the SEP measure of percentage change in symptom severity and the INT metric quantifying the proportion of the observation period in partial response or better. Both metrics contributed independent variance when predicting end-point QoL scores.

Revision is needed in the metrics used to quantify symptomatic change in DTD with consideration of INT time-based measures as primary or secondary outcomes. Metrics based on remission status may not be useful.

Some manufacturers provide information on similar-fit model pairings of filtering facepiece respirators (FFRs), suggesting that fit-test outcome of one model helps predict the other. This guidance may be useful during crisis capacity when FFR supplies and/or fit tests are constrained. The purpose of this study was to compare quantitative fit-test (QNFT) results and concordance between a pair of similar-fit 3M Aura FFRs: the 3M 9320A+ and 3M 1870+.

All participants completed online training and a QNFT with both respirators. The order of the respirator being examined first was randomly allocated. The outcomes included QNFT pass rate, concordance between the 2 models, overall and individual fit factors, and percentage of male and female participants who passed or failed the QNFT.

We recruited 1,000 participants (668 females and 332 males). The QNFT pass rate, overall fit factors, and individual fit factors were significantly higher for the 3M 9320A+ than the 3M 1870+ FFR. The concordance between the models was “fair” (κ coefficient, 0.38). Male participants who passed a QNFT with either of the FFRs had 96% chance of passing the QNFT for the alternate model. Female participants who passed the 3M 1870+ had 97% chance of passing the QNFT for the 3M 9320A+ model. However, ∼1 in 12 females who passed the QNFT for the 3M 9320A+ failed the QNFT for the 3M 1870+ FFR.

Similar-fit paired FFR models may provide a consequentially different level of respiratory protection, especially for women. Our findings are important for FFR stockpiling and fit-testing strategies, especially during crisis capacity.