Opportunities For Intervention Research Articles

Beyond the diagnosis of drug-resistant Tuberculosis in Norway: patients’ experiences before, during and after treatment

BackgroundThis study aims to explore the varied experiences of patients with drug-resistant tuberculosis in Norway. The study emphasizes challenges and implications of being diagnosed with drug-resistant tuberculosis, including the impact on psychosocial health during the diagnosis, disease, treatment, isolation and recovery phases.Norway is a low endemic country of tuberculosis. Most patients are immigrants, and some of them have recently arrived in the country. Patients undergoing treatment for drug-resistant tuberculosis endure prolonged and demanding treatment that could affect their psychosocial health.MethodsThis qualitative study conducted 16 in-depth interviews with individuals aged 18 years and above who were diagnosed with drug-resistant tuberculosis. All participants completed the treatment between 2008 and 2020. Fourteen participants were immigrants, and eight of them had resided in Norway for less than four years before diagnosis. Data analysis followed the six-phase reflexive thematic analysis framework, focusing on identifying patterns in participants’ experiences, thoughts, expectations and attitudes.ResultsThe narratives of the participants highlighted the complexities of navigating the diagnosis of drug-resistant tuberculosis, treatment, side effects and life after treatment. Immigrants encountered additional challenges, including language barriers and adapting to new social environments. All participants reported experiencing physical health issues that additionally affected their mental health and social activity. Several participants had a delayed or prolonged diagnosis that complicated their disease trajectory. Participants with suspected or confirmed contagious pulmonary tuberculosis underwent hospital isolation for periods ranging from weeks to six months. The participants reported mental health issues, social isolation and stigma, however few were offered follow-up by a psychologist. Many participants had persistent problems at the time of the interviews. Three main themes emerged from the analysis: Delayed and prolonged diagnosis; Psychosocial impact of isolation during treatment; The life after tuberculosis.ConclusionThis study highlights the enduring impact of drug-resistant tuberculosis on patients and the significance of timely diagnosis, psychosocial support and post-treatment follow-up. The participants universally faced serious implications of the disease, including stigma and isolation. Participants who experienced delayed diagnosis, reflected on missed early intervention opportunities. We recommend further research in low endemic countries to evaluate the international and local recommendations on psychosocial support.

Senescence in the bone marrow microenvironment: A driver in development of therapy-related myeloid neoplasms

Therapy-related myeloid neoplasms (t-MN) are a growing concern due to the continued use of cytotoxic therapies to treat malignancies. Cytotoxic therapies have been shown to drive therapy-induced senescence in normal tissues, including in the bone marrow microenvironment (BMME), which plays a crucial role in supporting normal hematopoiesis. This review examines recent work that focuses on the contribution of BMME senescence to t-MN pathogenesis, as well as offers a perspective on potential opportunities for therapeutic intervention.

Cancer Survivorship Care in the United States at Facilities Accredited by the Commission on Cancer

Since 2021, American College of Surgeons Commission on Cancer (CoC) accreditation standards require providing a survivorship program for patients with adult-onset cancer treated with curative intent. Since more than 70% of all patients with cancer in the US are treated at CoC-accredited facilities, this presents an opportunity for a landscape analysis of survivorship care availability. To determine the prevalence, types, and outcomes of cancer survivorship services at CoC-accredited facilities. This survey study used an anonymous, online, cross-sectional survey conducted from May 4 to 25, 2023. Participants were CoC-accredited facilities in the US representing diverse CoC program categories, institutional characteristics, geographic regions, and practice types. Department of Veterans Affairs cancer programs were excluded due to data usage restrictions. Data were analyzed from July to October 2023. CoC Survivorship Standard 4.8 was released in October 2019 and programs were expected to adhere to the Standard beginning January 1, 2021. Questions included self-reported survivorship program characteristics, availability of services aligned to CoC Survivorship Standard 4.8, and perceived program impacts. Response frequencies and proportions were determined in aggregate and by CoC program category. There were 1400 eligible programs, and 384 programs participated (27.4% response rate). All regions and eligible program categories were represented, and most had analytic caseloads of 500 to 4999 patients in 2021. Most survivorship program personnel included nurses (334 programs [87.0%]) and social workers (278 programs [72.4%]), while physical (180 programs [46.9%]) and occupational (87 programs [22.7%]) therapists were less common. Services most endorsed as available for all survivors were screening for new cancers (330 programs [87.5%]), nutritional counseling (325 programs [85.3%]), and referrals to specialists (320 programs [84.7%]), while treatment summaries (242 programs [64.7%]), and survivorship care plans (173 programs [43.0%]), sexual health (217 programs [57.3%]), and fertility (214 programs [56.9%]) were less common. Survivorship services were usually delivered by cancer treatment teams (243 programs [63.3%]) rather than specialized survivorship clinics (120 programs [31.3%]). For resources needed, additional advanced practice clinicians with dedicated survivorship effort (205 programs [53.4%]) and electronic health record enhancements (185 programs [48.2%]) were most endorsed. Lack of referrals and low patient awareness were endorsed as the primary barriers. A total of 335 programs (87.2%) agreed that Survivorship Standard 4.8 helped advance their programs. These findings of this survey study of CoC-accredited programs establish a benchmark for survivorship care delivery in the US, identify gaps in specific services and opportunities for intervention, contribute to longitudinal reevaluation for tracking progress nationally, and suggest the value of survivorship care standards.

Pregnancy As Window of Opportunity? A Danish RCT on Physical Activity During Pregnancy

ABSTRACT Pregnancy is seen as a window of opportunity for health interventions, with the potential to produce long-term health changes for mother and child. The RCT FitMum investigates the effects of different regimes of physical activity during pregnancy. We suggest that rather than hitting a window of opportunity, the trial works in choreography with different timescapes through the processes of management of time. These timescapes are characterized by linear progression and futurity, alongside composite, complex time. We reconceptualize the intervention as a navigation of flows and passages in collective efforts, providing a situated and sustainable approach to interventions.

Designing a core data set for benign hysterectomy registration system and its implementation in a referral teaching hospital in Northwest Iran

Background and aimsAlthough minimally invasive hysterectomy offers advantages, abdominal hysterectomy remains the predominant surgical method. Creating a standardized dataset and establishing a hysterectomy registry system present opportunities for early interventions in reducing volume and selecting benign hysterectomy methods. This research aims to develop a dataset for designing benign hysterectomy registration system.MethodsBetween April and September 2020, a qualitative study was carried out to create a data set for enrolling patients who were candidate for hysterectomy. At this stage, the research team conducted an information needs assessment, relevant data element identification, registry software development, and field testing; Subsequently, a web-based application was designed. In June 2023the registry software was evaluated using data extracted from medical records of patients admitted at Al-Zahra Hospital in Tabriz, Iran.ResultsDuring two months, 40 patients with benign hysterectomy were successfully registered. The final dataset for the hysterectomy patient registry comprise 11 main groups, 27 subclasses, and a total of 91 Data elements. Mandatory data and essential reports were defined. Furthermore, a web-based registry system designed and evaluated based on data set and various scenarios.ConclusionCreating a hysterectomy registration system is the initial stride toward identifying and registering hysterectomy candidate patients. this system capture information about the procedure techniques, and associated complications. In Iran, this registry can serve as a valuable resource for assessing the quality of care delivered and the distribution of clinical measures.

297 Exploring Risk Factors for Acute Kidney Injury in Patients Undergoing Cardiac Surgery

Abstract Aim Acute Kidney Injury (AKI) is an important complication following cardiac surgery that has been associated with adverse outcomes. The aim of this work was to investigate the incidence and risk factors for AKI in patients undergoing cardiac surgery at our centre. Method This is a retrospective analysis of 1441 patients who underwent elective or urgent (but not emergency) cardiovascular surgery with use of cardiopulmonary bypass over a 1-year period. Our exclusion criteria were heart transplant, single CABG, congenital repairs or patients on dialysis or renal transplant pre-operatively. Data analysis was performed in R studio. Results The mean age of the patients was 67.7 years. Mean creatinine from a 7-day period before surgery was 90µmol/L compared with the mean peak post operative creatinine of 127 µmol/L (95% CI 33-42, p-value <0.05). As defined by the KDIGO AKI stages, 27% developed an AKI stage 1, 11% developed AKI stage 2 and 1% AKI stage 3. The following variables correlated strongly (P-value <0.001) with post-operative risk of AKI: The comorbidities of diabetes, smoking, and peripheral vascular disease; pre-operative medications: diuretics, calcium channel blockers and SGLT-2 inhibitors and receiving FFP or RBC transfusion postoperatively. Conclusions AKI is a common complication following cardiac surgery. Having an insight into the risk factors for AKI allows an opportunity for intervention preoperatively and can also highlight patients that may require extra vigilance in the perioperative period to reduce its incidence, which may lead to an improvement in outcomes following surgery.

Tele-health coaches’ responses to clients' emotional cues and concerns and engagement with the Bump to Baby and Me Intervention

ObjectiveTo explore the relationship between health coaches’ responses to emotional cues/concerns and women’s subsequent engagement with the health coaching mHealth platform. Methods24 face-to-face video-mediated initial conversations between participants and their health coaches were coded using the VR-CoDES-P method. Women with high risk of developing Gestational Diabetes Mellitus were selected from the study, based on their engagement with the smartphone health coaching platform. 12 women with very low engagement and 12 women with high engagement were identified. ResultsIn interactions with women with high goal engagement, coaches had significantly more counseling codes with prior other codes and no instances of non-explicit response codes that reduce space for further disclosure. Analysis showed that interactions with women with high goal engagement were more frequently met by the coach with affect-acknowledging and empathic responses prior to the counseling speech act. ConclusionHigh goal engagement among women with Gestational Diabetes Mellitus may appear to be associated with coaches facilitating the frequent use of empathy. Practice implicationsFindings can draw coaches’ attention to the impact that their counseling has on goal engagement, increasing the opportunity for intervention to be person-centered and effective.

Current Status on Management of Primary Plasma Cell Leukemia.

Plasma Cell Leukemia (PCL) is a very rare and highly aggressive form of plasma cell dyscrasia. This review seeks to evaluate the outcomes of PCL in the context of combination novel agent therapy and stem cell transplant (SCT) protocols. The diagnostic criteria for PCL have now evolved to include patients with 5% circulating PC. While management remains challenging, the incorporation of novel agent-based induction regimen has significantly improved early mortality and reduced attrition of patients proceeding to SCT. In recent prospective clinical trials, patients with PCL demonstrated an overall response rates of 69% to 86%, with progression-free and overall survival ranging from 13.8 to 15.5months and 24.8 to 36.3months, respectively. B-cell lymphoma 2 (BCL2) inhibitors, such as venetoclax present a targeted intervention opportunity for patients with PCL with t(11;14). Dedicated clinical trials tailored to PCL are crucial, integrating newer therapies in the frontline setting to further optimize responses and enhance overall outcomes.

Antiviral potential of spirulina in individuals with human immunodeficiency virus or Hepatis C virus infections: A systematic review and meta-analysis

BackgroundSpirulina, a cyanobacterium or blue-green algae that contains phycocyanin, nutritional supplementation has been evaluated in patients living with human immunodeficiency virus (HIV) and hepatitis C virus (HCV) due to its antiviral properties. This supplementation may be beneficial in low resource settings when awaiting antiretroviral therapy (ART) for HIV. This review aimed to evaluate the effectiveness of Spirulina supplement in antiviral-naïve HIV- and HCV-infected patients by assessing its immunological effect (Cluster of Differentiation 4 or CD-4 T-cell count) and disease progression (viral load). MethodsWe searched PubMed, Cochrane Library, Scopus, and Web of Science from inception through January 23, 2024. Two authors independently performed the study selection, data extraction, and risk of bias assessment. We pooled data by using a random-effects model and evaluated publication bias by a funnel plot. ResultsWe identified 5552 articles, 5509 excluded at the title and abstract stage with 44 studies making it to the full text review. Of these 6 studies met the eligibility for inclusion in the final analysis as follows:4 randomized controlled trials (RCTs) and 2 non-RCTs. The pooled results of the Spirulina intervention found significant improvements in biomarkers of clinical outcomes, viral load (VL) and CD4 T-cell (CD4) counts, in participants of the treatment group compared to controls; the VL had an overall Cohen’s d effect size decrease of -2.49 (-4.80, -0.18) and CD4 had an overall effect size increase of 4.09 (0.75, 7.43). [Cohen’s d benchmark: 0.2 = small effect; 0.5 = medium effect; 0.8 = large effect]. ConclusionsFindings from this systematic review showed a potential beneficial effect of Spirulina supplementation in HIV- and HCV-infected patients by increasing CD4 counts and decreasing viral load. However, further research in larger controlled clinical trials is needed to fully investigate the effect of this nutritional supplement on clinically relevant outcomes, opportunities for intervention, optimal dose, and cost-benefit of Spirulina supplementation.

Identification of a Human Trafficking Victim: A Simulation.

This case was designed for emergency medicine interns and residents. Human trafficking is unfortunately an ever-growing and wide-reaching problem in the United States as well as the rest of the world. The International Labor Organization estimates 49.6 million people were affected by this modern-day slavery worldwide in 2021.1,2 The emergency department represents an opportunity to identify and provide aid to victims of human trafficking. Studies have shown that 63.3% of survivors interacted with the emergency department during their time of exploitation; however, most of these patients are not identified as human trafficking victims and opportunities for intervention are missed.3,4. By the end of this simulation, participants will be able to: (1) Identify signs of human trafficking. (2) Demonstrate the ability to perform a primary and secondary assessment of a patient when there is concern for human trafficking. (3) Demonstrate the ability to appropriately separate an at-risk patient from a potential trafficker. (4) Identify resources and a reliable course of action to permanently remove the patient from the harmful situation. A hybrid teaching model was employed that included both a lecture and a standardized patient simulation session followed by a structured debriefing session. A simulation with a standardized participant was implemented at an urban academic emergency department with a three-year EM residency program. Participants were evaluated with a survey prior to and after the simulation, where they responded to questions regarding human trafficking patients on a scale of 1 to 5, where 5 represented the greatest level of agreement. Nineteen emergency medicine interns and residents participated in this project. Prior to simulation training, and after the lecture, residents were surveyed on their confidence in identifying and treating patients who are affected by trafficking, their level of previous training in this topic, and whether they considered trafficking an important issue in emergency medicine. When asked if human trafficking is an important issue faced by the emergency department, 15 of the 19 of residents who completed the survey rated the importance a 5/5 on a Likert scale ranging from 1-not important to 5. Residents were also asked if they had received prior training in human trafficking on a scale of never (1) to often (5). Eight residents responded with either never or close to never. Two months after the simulation, the residents were again sent an optional survey. Ten residents responded. All who participated in the simulation now rated themselves a 4/5 on a scale from not confident to very confident. Of those who did not attend the simulation, the median value was a 3/5. Out of the residents who attended the simulation training, every resident rated the experience 5 out of 5 in terms of usefulness. One hundred percent of residents would recommend simulation training on human trafficking to other emergency medicine residents. This was an effective educational initiative because this education model allowed the residents to feel more comfortable identifying individuals affected by human trafficking, and all the residents who responded to the survey stated that they would recommend the use of simulation to others for education on human trafficking. High-fidelity simulation, human trafficking identification, human trafficking response.

Public awareness about common ocular diseases among a sample of Egyptian population

Background Globally, the most common causes of blindness in adults are cataracts, glaucoma, age-related macular degeneration, and diabetic retinopathy. Inadequate knowledge of these conditions leads to lag in medical advice requisition, losing the opportunity for prevention and early intervention with an increased rate of disease complications. Aim This study aimed to detect the level of public awareness about common eye problems in Egypt to help build strategies to prevent complications related to these eye problems. Patients and methods This is a prospective cross-sectional analytical study that used a pre-tested e-questionnaire to collect data from the study participants during the period from September 2022 to June 2023 at Kasr Alainy School of Medicine, Cairo, Egypt. A Google form was created, and participants were invited through social media. It included four sections: socio-demographic characteristics, medical history of study participants, knowledge about common ocular diseases, and sources of gaining knowledge. Results The study included 802 participants, 54.2% of them were females, more than 55% of them were between the ages of 18–30 years, and 74.4% were university graduates. Awareness of cataracts, glaucoma, corneal opacity, diabetic retinopathy, and age-related macular degeneration was reported in 45.7, 34.8, 38.3, 80, and 77.5% of the study participants, respectively. Physicians and social media were the most common efficient sources of gaining knowledge. Higher education and working in a medical profession, especially physicians and pharmacists were associated with higher knowledge scores. Conclusion Low levels of knowledge of most of the blinding conditions among the study participants raise the importance of adopting health education programs by our healthcare systems taking into consideration that physicians and social media were among the most convenient routes to reach the targeted population.

Transforming place-based management within watersheds in Fiji: The watershed interventions for systems health project

Watersheds offer opportunities for place-based interventions to transform systems health via preventative versus reactive approaches to management that achieve multiple co-benefits for public and environmental health. The Watershed Interventions for Systems Health in Fiji (WISH Fiji) project embraced participatory knowledge co-production and action-oriented research to identify risks to public and ecosystem health, prioritize interventions to address risks, and monitor responses of the system to interventions. We used screening filters and local knowledge to collaboratively identify five watersheds for action with high prior incidence of water-related diseases (Fiji’s “three plagues” of leptospirosis, typhoid and dengue) and high risk to downstream environmental health. We reviewed literature to identify disease risk factors, evaluated overlaps with risks for downstream environmental impact, and designed 13 instruments to collect information about baseline risk. Following consultations to obtain free, prior and informed consent, we enrolled 311 households across 29 communities. We synthesized data to identify key risks at the household, community, and landscape level, which were communicated to community water and resource management committees and government leaders as part of developing water and sanitation safety plans for each community. Local committees identified 339 priority risk reduction actions across nine main categories: animal management; drainage; health systems surveillance; hygiene; integrated planning; land use management; sanitation systems; waste management; and water systems. As of October 2022, 154 interventions were implemented in the five watersheds across different risk categories and scales. While we can track changes to factors that reduce risk of water-related disease and improve environmental health, direct evaluation of impacts to public health is limited due to poor geolocation of case records. The WISH Fiji project is a model of cross-sectoral coordination that efficiently progresses multiple Sustainable Development Goals, but scaling requires sustained investment in interventions to realize full benefits, particularly for nature-based solutions that exhibit lagged responses.

Atopic diseases-Diagnostics, mechanisms, and exposures.

Epidemiological data suggest that atopic diseases begin in early life and that most cases present clinically during early childhood. The diseases are highly prevalent and increase as communities adopt western lifestyles. Disentangling the pathophysiological mechanisms leading to disease debut is necessary to identify beneficial/harmful exposures so that successful prevention and treatment can be generated. The objective of this review is to explore the definition of atopy and mechanisms of atopic diseases, and to investigate the importance of environmental factors in early life, prior to disease development. First, the distribution of sIgE levels in children is investigated, as this is one of the main criteria for the definition of atopy. Thereafter, it is explored how studies of parental atopic status, sensitization patterns, and early debut and severity of atopic dermatitis have substantiated the theory of an early-life window of opportunity for intervention that precedes the development of atopic diseases in childhood. Then, it is examined whether early-life exposures such as breastfeeding, dogs, cats, and house dust mites in the home perinatally constitute important influencers in this crucial time of life. Finally, it is discussed how these findings could be validated in randomized controlled trials, which might prepare the ground for improved diagnostics and prevention strategies to mitigate the current atopic pandemic.

Just-in-time adaptive interventions for adolescent and young adult health and well-being: protocol for a systematic review

IntroductionHealth behaviours such as exercise and diet strongly influence well-being and disease risk, providing the opportunity for interventions tailored to diverse individual contexts. Precise behaviour interventions are critical during adolescence...

Cervical spine positioning patterns amongst hand surgeons: A critical analysis of surgical posture

AimThis study aims to assess the cervical spine positioning of consultant and trainee hand surgeons during standardised hand surgeries, focusing on the prevalence of sustained end-range postures, particularly cervical spine flexion. BackgroundSurgeons often perform procedures that require maintenance of sustained postures for prolonged periods of time. Hand surgeons may be at increased risk of sustained end of range postures, particularly cervical spine flexion. This can lead to strain on the musculoskeletal structures of the neck. Recent evidence suggests a higher incidence of neck dysfunction in hand surgeons, leading to an associated morbidity. MethodsWe examined hand surgeons of all experience levels during 40 common hand surgery procedures. We used real-time dynamic goniometric measurements of neck flexion using the “UPRIGHT GO 2” device and accompanying smartphone app. Neck flexion exceeding 40° was used as the threshold for defining an acceptable neck position. ResultsAnalysis included 20 total subjects at various levels of medical training (SHO n ​= ​6, Registrar n ​= ​9, Consultant n ​= ​5) performing surgeries under different conditions. Maladaptive neck positions were prevalent, with junior surgeons exhibiting such postures for 71 ​% of procedure time compared to 60 ​% for consultants. This underscores the potential contribution of sustained end-range postures to cervical spine dysfunction in hand surgeons, highlighting an early intervention opportunity. Notably, participants reported varied experiences with neck pain and expressed unanimous interest in integrating biofeedback posture devices into surgical training, with a single consultant expressing reservations.

Latent Class Analysis of Dietary Intake and Organic Food Consumption in a Midwest Cohort of Pregnant Individuals

Introduction: The objective of the study was to describe food consumption patterns over the trimesters throughout pregnancy in a prospective obstetric cohort. We planned to characterize patterns of overall food and organic food consumption into groups using a latent class analysis (LCA). Methods: A Midwest pregnancy cohort self-reported dietary food intake and percent of foods of each type that they consumed which were organic on a questionnaire. This was administered multiple times during pregnancy. The food frequency questionnaire was designed for this study and contained questions related to 89 food categories. The questionnaire was completed once in each trimester, after they were enrolled into the study. The cohort has responses across the 13 food domains were grouped by a LCA process demonstrating separation of the cohort by higher or lower consumption of fruits, vegetables, and berries and percentage of those foods where organics were consumed. The organic percentage in each food was categorized as low (0-10%) and significant (anything > 10%). Demographic characteristics were compared between LCA groups. Results: Valid responses were analyzed from 359 participants. The LCA best model grouped participants into 3 groups: I- high fruits, vegetables and berries, with significant organic use; II- high fruits, vegetables, and berries, with low or no organic use; and III- low fruits, vegetables, and berries with low organic use . Using this grouping, there were 84 (23.4%) in Class I, 153 (42.6%) in Class II, and 122 (34.0%) in Class III. There were significant differences in racial distribution in the groups, with lower rates of Caucasians in Class II and higher rates of Hispanic women in reporting Class I. We observed that 50% of African American women were grouped into Class III. Women in class III tended to be younger (p=0.01), unmarried (52.4%, p<0.001), have less than college degree attainment (p=0.0005), be of lower income (p<0.001), and be a current smoker (p=0.03). -While not statistically significant, living in an urban area was higher for those in Class III than in Class I or II. - Participants living in rural areas were reported significant organic food consumption 18.6%, compared to 24.1% of those in suburban areas and 23.1% in urban areas (p=0.36). 23.1% of rural-dwelling participants were grouped in Class III compared to 31.9% of those in suburban areas and 35.3% of those in urban areas. (p=0.36). Conclusion: Self-reported food consumption in this pregnancy cohort was categorized in 3 classes based on consumption of fruits, vegetables, and berries and the percentage of foods consumed that were organic. These Classes were associated with multiple maternal characteristics. This may indicate opportunities for dietary education interventions for pregnant individuals.

Children and adolescents rectify unequal allocations of leadership duties in the classroom.

Little is known about how children and adolescents evaluate unequal teacher allocations of leadership duties based on ethnicity-race and gender in the classroom. U.S. boys and girls, White (40.7%), Multiracial (18.5%), Black/African American (16.0%), Latine (14.2%), Asian (5.5%), Pacific Islander (0.4%), and other (4.7%) ethnic-racial backgrounds, 8-14 years, N = 275, evaluated teacher allocations of high-status leadership positions favoring specific ethnic-racial or gender groups during 2018-2021. Adolescents, more than children, negatively evaluated unequal teacher allocations of leadership duties that resulted in group-based inequalities, expected peers who shared the identity of a group disadvantaged by the teacher's allocation to view it more negatively than others, and rectified inequalities. Understanding perceptions of teacher-based bias provides an opportunity for interventions designed to create fair and just classrooms that motivate all students to achieve.

Is screening for motor skill deficits in Tyrolean preschool children warranted and feasible? A protocol for a two-stage cross-sectional study

IntroductionChildren with developmental coordination disorder (DCD) show deviations in motor development and motor skills in early childhood where the learning and execution of coordinated motor skills are below the level...

Back to the roots of perceived burdensomeness: The potential role of perceived contribution.

The Interpersonal-Psychological Theory of Suicide (IPTS), identifies perceived burdensomeness as a critical factor in the development of suicidal ideation. Measurement of perceived burdensomeness using the INQ in research has predominantly focused on liability toward others. Recent studies have demonstrated the role of perceived contribution toward others as an aspect of perceived burdensomeness. This study proposes a hypothesized transactional model of perceived burdensomeness, in which perceived burdensomeness can be viewed as the balance between perceived contributions and perceived liability to others. Participants (n = 1112) were college students (M age = 18.86 years, SD = 1.50) who completed survey measures. Participants were predominantly cisgender women (73.6%), heterosexual (78.8%), and white (58.3%). Perceived contribution was negatively associated with perceived burdensomeness, suicidal ideation, and psychological pain after controlling for perceived liability. Further, the difference between perceived contributions and perceived liability accounted for variability in suicidal ideation after controlling for INQ perceived burdensomeness. The inclusion of perceived contribution as an element of perceived burdensomeness may offer new opportunities for clinical formulation and intervention. Future research is needed to further evaluate the proposed transactional model of perceived burdensomeness.

Differential Gene Expression in the Upper Respiratory Tract following Acute COVID-19 Infection in Ambulatory Patients That Develop Long COVID.

Background: Post-acute sequelae of COVID-19, or long COVID, is a condition characterized by persistent COVID-19 symptoms. As long COVID is defined by clinical criteria after an elapsed period, an opportunity for early intervention may aid in future prophylactic approaches; however, at present, the pathobiological mechanisms are multifactorial. By analyzing early virally infected upper respiratory tract tissue prior to eventual clinical diagnosis, it may be possible to identify biomarkers of altered immune response to facilitate future studies and interventions. Methods: This is a sub-group analysis of samples collected from those with confirmed COVID-19. RNA extraction from nasopharyngeal/mid-turbinate samples, sequencing, and bioinformatic analysis were performed to analyze long COVID and non-long COVID cohorts at day 14 post infection. Differences in mean viral load at various timepoints were analyzed as well as serological data. Results: We identified 26 upregulated genes in patients experiencing long COVID. Dysregulated pathways including complement and fibrinolysis pathways and IL-7 upregulation. Additionally, genes involved in neurotransmission were dysregulated, and the long COVID group had a significantly higher viral load and slower viral clearance. Conclusions: Uncovering early gene pathway abnormalities associated with eventual long COVID diagnosis may aid in early identification. We show that, post acute infection, in situ pathogenic deviations in viral response are associated with patients destined to meet consensus long COVID diagnosis that is entirely dependent on clinical factors. These results identify an important biological temporal window in the natural history of COVID-19 infection and long COVID pathogenesis amenable to testing from standard-of-care upper respiratory tract specimens.