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Increasing evidence has shown that the Covid-19 outbreak has impacted adolescents’ mental health. Utilising a mixed-method design, the current study examined a total of 518 adolescent perspectives (60% female), in Scotland, on what has and could help their mental health in the context of Covid-19. A reflexive thematic analysis revealed three themes in relation to what has helped adolescents’ mental health since the Covid-19 outbreak. These related to findings about the value of: (1) engaging in recreational activities, (2) engaging with friends, and (3) the disruption to schooling. The remaining four themes related to what could have helped adolescents mental health and wellbeing since the Covid-19 outbreak. These focussed on (1) better support: in relation to mental health; school work; and communication, (2) contact with friends, and (3) more opportunities for recreational activities. Males were more likely to report recreational activities had helped and less likely to report better support could have helped. Adolescents who reached clinical threshold for depression and anxiety and those with elevated PTSD-like symptoms about Covid-19 were more likely to state more support could have helped, and adolescents who reached clinical threshold for depression were less likely to report that friends could have helped their mental health. The findings may inform mental health policy and interventions in the recovery from the Covid-19 pandemic.

Abstract. Background: People attending the emergency department (ED) for suicidal crisis are at significantly higher risk of taking their own lives in the week following discharge. Aims: We aimed to evaluate the acceptability and feasibility of implementing a brief clinical aftercare intervention provided through Allied Health Brief Therapies (AHBTs) Clinics. Method: Consecutive referrals ( n = 149) to the clinics following assessment in the ED for suicidal crisis formed the study group. This article details participant engagement and retention, service provision, therapeutic alliance, and participant satisfaction with the program. Suicidal ideation and ED utilization 3 months pre-/postintervention were used to assess short-term impact. Results: The study supports the feasibility of implementing a brief aftercare intervention for those presenting to the ED for suicidal crisis. High rates of therapeutic alliance and satisfaction with the clinic intervention were reported by participants. Impact assessments pointed to a significant reduction in both suicidal ideation and ED utilization following the intervention. Limitations: A substantial number of participants had missing follow-up data. Given this and the absence of a control group, findings must be interpreted with caution. Conclusion: The study supports the acceptability and feasibility of implementing AHBT Clinics as a potential adjunct in the aftercare of people in suicidal crisis.

Research within schools has taken place for decades, yet longstanding skepticism between researchers and practitioners has resulted in hesitation to work together to develop research partnerships. Two school-based leaders and one university researcher sought to conceptualize a foundation for their school–university research partnership. During the initial stages of the partnership development, terminology and interpretation of language used to describe research in schools emerged as both an area of concern and an opportunity for exploration. The partners recognized a need to revise their lexicon from terms that implied teachers needed assistance fixing “problems of practice” to terms promoting an approach embracing innovation and a strengths-based practice in schools. Through an action research approach, the authors draw on their meeting notes, reflections, and documentation to describe the process they used to develop a research-partnership model. Results from this inquiry explicate how partners reflected on their leadership approach, key moments, and a changing context to develop guiding principles and a partnership model with potential for sustainability.

Studies indicate that youth who experience homelessness are more likely than their peers to have mental health and substance use concerns. The objective of this study was to investigate youth views of ideal services and service provision environments that facilitate help seeking. Data were collected from two World Café events in Canada where youth (n=14) were asked to discuss their experiences with housing, mental health and addictions services. The discussions were captured visually by a graphic recorder and on paper tablecloths that were drawn and written on by the youth. These visual data, along with field notes prepared by the research team, were analyzed. The findings indicated that barriers to help seeking included stigma, institutional distrust and fear, negative relationships, and the lack of self-awareness. Facilitators included positive therapeutic relationships, services with the capacity to offer care, and non-judgmental environments. Youth wanted services that provide peer support, allow them to participate more in their care decisions, and use self-directed healing strategies. Service providers and policymakers should offer programming that facilitates youth access. They should consider the barriers that youth experience and seek to construct interventions for youth that are judgement free, confidential, and actively engage youth in their own care.

A retrospective analysis was performed to evaluate the prognostic significance of treatment delays (TDs) for oropharynx carcinoma patients treated with definitive radiotherapy (RT), comparing p16+ versus p16- disease.Patients treated between 2012 and 2016 were analyzed (n=763). TD was defined as the time from pathologic diagnosis to initiation of RT. TD thresholds of ≤60, 61 to 90, and90 days were used to stratify outcomes. Time on treatment (TOT) delays were estimated based on the RT fractionation. TOT delay of 1 to 3 days was compared with3 days. Predictors of cancer-specific survival (CSS) and locoregional recurrence (LRR) were evaluated on multivariable analysis.Six hundred fifty (85%) patients had p16+ disease. On multivariable analysis, TOT delay of 1 to 3 days versus1 day was associated with inferior CSS (hazard ratio [HR]=1.81; 95% confidence interval [CI]: 1.02-3.22). TD90 versus ≤60 days (HR=1.68; 95% CI: 0.98-3.04) and 61 to 90 versus ≤60 days (HR=0.94; 95% CI: 0.60-1.48) was not associated with CSS. TD90 versus ≤60 days (HR=1.29; 95% CI: 0.66-2.52), TD 61 to 90 versus ≤60 days (HR=0.98; 95% CI: 0.64-1.52), TOT 1 to 3 versus1 day (HR=0.91; 95% CI: 0.39-2.11), and TOT3 versus1 day (HR=1.79; 95% CI: 0.80-3.99) were not associated with LRR. There was no interaction between p16 status and TD in relation to LRR (P=0.27) or CSS (P=0.17).TDs were not significantly associated with CSS or LRR. TOT of 1 to 3 days was associated with inferior CSS. p16 status should not be a significant factor when triaging RT start dates.

The principle that church buildings constitute sacred spaces, set apart from the secular world and its laws, is one of the most enduring legacies of medieval Christianity in the present day. When and how church buildings came to be defined as sacred has consequently received a good deal of attention from modern scholars. What happened when that status was compromised, and ecclesiastical spaces were polluted by acts of violence, like the murder of Archbishop Thomas Becket in Canterbury Cathedral? This paper investigates the history of rites for the reconciliation of holy places violated by the shedding of blood, homicide or other public acts of ‘filthiness’ which followed instances such as Becket's murder. I first identify the late tenth and early eleventh centuries in England as crucial to the development of this rite, before asking why English bishops began to pay attention to rites of reconciliation in the years around 1000 ce. This paper thus offers a fresh perspective on current understandings of ecclesiastical responses to violence in these years, the history of which has long been dominated by monastic evidence from west Frankia and Flanders. At the same time, it reveals the potential of liturgical rites to offer new insights into medieval society.

OBJECTIVE This study aimed to provide female pelvic medicine and reconstructive surgery (FPMRS) providers with evidence-based guidance on opioid prescribing following surgery. METHODS A literature search of English language publications between January 1, 2000, and March 31, 2021, was conducted. Search terms identified reports on opioid prescribing, perioperative opioid use, and postoperative pain after FPMRS procedures. Publications were screened, those meeting inclusion criteria were reviewed, and data were abstracted. Data regarding the primary objective included the oral morphine milligram equivalents of opioid prescribed and used after discharge. Information meeting criteria for the secondary objectives was collected, and qualitative data synthesis was performed to generate evidence-based practice guidelines for prescription of opioids after FPMRS procedures. RESULTS A total of 6,028 unique abstracts were identified, 452 were screened, and 198 full-text articles were assessed for eligibility. Fifteen articles informed the primary outcome, and 32 informed secondary outcomes. CONCLUSIONS For opioid-naive patients undergoing pelvic reconstructive surgery, we strongly recommend surgeons to provide no more than 15 tablets of opioids (roughly 112.5 morphine milligram equivalents) on hospital discharge. In cases where patients use no or little opioids in the hospital, patients may be safely discharged without postoperative opioids. Second, patient and surgical factors that may have an impact on opioid use should be assessed before surgery. Third, enhanced recovery pathways should be used to improve perioperative care, optimize pain control, and minimize opioid use. Fourth, systemic issues that lead to opioid overprescribing should be addressed. Female pelvic medicine and reconstructive surgery surgeons must aim to balance adequate postoperative pain control with individual and societal risks associated with excess opioid prescribing.

Recent COVID-19-related federal legislation has resulted in time-limited increases in Mental Health Block Grant (MHBG) set-aside dollars for coordinated specialty care (CSC) throughout the United States. The state of Ohio has opted to apply these funds to establish a learning health network of Ohio CSC teams, promote efforts to expand access to CSC, and quantify the operating costs and rates of reimbursement from private and public payers for these CSC teams. These efforts may provide other states with a model through which they can apply increased MHBG funds to support the success of their own CSC programs.

Using collaborative inquiry as a methodology for investigation, this study examined the implementation of a model of generative leadership (Adams et al., 2019) to explore the question: In what ways can implementation of a generative leadership model of professional learning for school leaders influence their sense of efficacy? An adapted model of generative leadership was adopted by seven school leaders in Alberta, Canada over a period of three years. Data was collected at the end of each year through journal reflections (Bashan & Holsblat, 2017) to ascertain school leaders’ levels of efficacy. Findings revealed four themes that identified how a generative leadership model influenced participants’ effectiveness in their roles. These findings offer insight into how models of school leader professional learning might be re-imagined in order to positively influence their sense of efficacy.

Problem gambling and gambling disorder are serious public health issues that disproportionately affect persons experiencing poverty, homelessness, and multimorbidity. Several barriers to service access contribute to low rates of formal treatment-seeking for problem gambling compared with treatments for other addictions. Given these challenges to treatment and care, self-management may be a viable alternative or complement to formal problem gambling interventions. In this study, we described problem gambling self management strategies among persons experiencing poverty and homelessness. We conducted semi-structured interviews with 19 adults experiencing problem gambling and poverty/homelessness, and employed qualitative content analysis to code and analyze the data thematically. We identified five types of self-management strategies: (1) seeking information on problem gambling, (2) talking about gambling problems, (3) limiting money spent on gambling, (4) avoiding gambling providers, and (5) engaging in alternative activities. Although these strategies are consistent with previous research, the social, financial,housing, and health challenges of persons experiencing poverty and homelessness shaped their self-management experiences and approaches in distinct ways. Approaches to problem gambling treatment should attend to the broader context in which persons experience and attempt to self-manage problem gambling.

Adolescent and young adult (AYA) head and neck (HN) cancer survivors are at risk of long-term complications. A cross-sectional study of survivors recalled for clinical evaluation was performed to evaluate late effects in this population.Surviving patients who had been diagnosed with HN cancer between the ages of 15 and 39 years and treated with radiation therapy (RT) in British Columbia between 1970 and 2010 were invited to participate in this study. Survivors were assessed in consultation by a radiation oncologist for a complete history and physical exam. Comprehensive data collection of subjective and objective late effects of RT and screening investigations were completed.Of 36 AYA HN participants, the majority were female (61%), and the most common tumour sites were thyroid (28%), oropharynx (17%), salivary gland (14%) and larynx (14%). Dental extractions post treatment was performed for 33% and dental implants for 17%. The majority (72%) reported xerostomia, 50% had dysphagia to solids and 25% hearing loss. Of the non-thyroid cancer patients who underwent RT to their neck, 45% developed hypothyroidism. There were 28% of participants with asymptomatic carotid stenosis and 27% with thyroid nodules; all were diagnosed after recall screening.Survivors of AYA HN cancer treated with RT reported numerous long-term complications. Comprehensive follow-up and screening guidelines should be established for this at-risk population.AYA HN cancer survivors and their primary care practitioners should be educated on screening recommendations and the risk of late effects.

Study Objective The risks to surgeons of carrying out aerosol-generating procedures during the coronavirus disease 2019 (COVID-19) pandemic are unknown. To start to define these risks, in a systematic manner, we investigated the presence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus in the abdominal fluid and lower genital tract of patients undergoing surgery. Design Prospective cross-sectional observational study. Setting Single, large United Kingdom hospital. Patients Total of 113 patients undergoing abdominal surgery or instrumentation of the lower genital tract. Interventions We took COVID-19 swabs from the peritoneal cavity and from the vagina from all eligible patients. Results were stratified by preoperative COVID-19 status. Measurements and Main Results In patients who were presumed COVID-19 negative at the time of surgery, SARS-CoV-2 virus RNA was detected in 0 of 102 peritoneal samples and 0 of 98 vaginal samples. Both cohorts included 4 patients who were antibody positive but nasopharyngeal swab test negative at the time of surgery. Peritoneal and vaginal swabs were also negative in 1 patient who had a positive nasopharyngeal swab immediately before surgery. Conclusion The presence of SARS-CoV-2 RNA in the abdominal fluid or lower genital tract of presumed negative patients is nil or extremely low. These data will inform surgeons of the risks of restarting laparoscopic surgery at a time when COVID-19 is endemic in the population.

BACKGROUND This study assesses whether 90-day mortality differs between patients living in rural and urban areas, as lower access to supportive care services in rural areas could result in higher mortality. METHODS All patients with head and neck cancer (HNC) treated between 1998 and 2014 with radiotherapy in British Columbia were included. Patients were divided into rurality areas according to the Modified Statistics Canada (mSC) definition, which classifies a population

People experiencing poverty/homelessness have higher rates of problematic gambling than the general population. Yet, research on gambling among this population is sparse, notably among women. This study examined prevalence of problematic gambling among women using shelter and drop-in services in Ontario, Canada. The NORC Diagnostic Screen for Disorders was administered to women during visits to 15 sites using time/location methodology. Within a sample of 162 women, the prevalence of at-risk (6.2%), problem (9.3%), and pathological gambling (19.1%) was higher than the general population. Among women who scored at-risk or higher, 55.4% met criteria for pathological gambling. The findings suggest that women seeking shelter and drop-in services are vulnerable to problematic gambling. Creating awareness of this vulnerability within the shelter and drop-in service sector is an important first step to support women with gambling problems who face financial and housing precarity.

Schools often provide structure and safety to students but particularly for vulnerable children and young people. The Covid 19 pandemic has caused unprecedented upheaval across society as a whole but it is clear that the effects are uneven and that some groups have been more directly and negatively impacted, both in the UK and globally. While there are now much helpful quantitative data on the effects of Covid 19 on education, there has been little in-depth qualitative study which examines the experiences and attitudes of young people as students and specifically the effect of school closures and exam cancellations on their mental health and wellbeing. This paper discusses findings from online group interviews with a total of 45 young people and aims to understand the impact on mental health and wellbeing and what young people, themselves, suggest would help mitigate the effects of the global pandemic on their mental health and wellbeing in school.

Increasing evidence has shown that the Covid-19 outbreak, and subsequent school closures and exam cancellations that followed, has impacted adolescent mental health. The current cross-sectional study examined rates of depression, anxiety and Post Traumatic Stress Disorder (PTSD)-like symptoms about Covid-19 in adolescents and whether current or past mental health support, additional support in school, keyworker status, poorer household relationships since the outbreak of Covid-19 or reduced physical activity were associated with elevated levels of depression, anxiety or PTSD-like symptoms. Lastly, it examined perceived changes in mental health due to the Covid-19 pandemic, school closures and the cancellation of exams. A total of 899 adolescents (14–18 years) took part in the ’in isolation instead of in school’ (INISS) project. Findings indicated that older adolescents, females, those who currently or previously received mental health support or additional support in school and adolescents who reported poorer relationships at home since Covid-19 were more likely to meet clinical threshold levels for their mental health. Adolescents highlighted worsening of their mental health due to Covid-19 and school closures with mixed positive and negative impact of exam cancellations. Adolescents experiencing clinical threshold levels of depression and anxiety uniquely reported worsening of their mental health since the Covid-19 pandemic, school closures and exam cancellations. Understanding the rates, perceptions and factors associated with increases in depression, anxiety and PTSD-like symptoms in adolescents during the Covid-19 pandemic will inform national policy in supporting adolescent mental health and recovery from the Covid-19 pandemic.

The burden of gambling problems is felt more strongly among people who experience poverty. A small but emerging body of research is developing with no identified reviews exploring the scope of the ...

Purpose To evaluate the predictive value of FDG-PET/CT for detection of residual disease after radical radiotherapy for patients with squamous cell carcinoma (SCC) of the oropharynx, comparing p16 positive (+) versus p16 negative (−) disease. Methods and materials A retrospective analysis of patients with SCC of the oropharynx at our institution treated with radical radiotherapy between 2012 and 2016 was performed. The primary and lymph node metabolic responses were evaluated independently on the post-treatment FDG-PET/CT. The reference standard was pathology when available, subsequent post-treatment FDG-PET/CT results or clinical follow-up. Results Median follow-up time was 32 (30–34) months. 556 patients had p16+ disease and 92 had p16− disease. The median time of post-treatment FDG-PET/CT was 96 (45–744) days after radiotherapy completion: 68% had complete metabolic response (CMR) defined as mild non-focal or no uptake, 10% residual primary disease, 11% residual regional lymph node disease, 5% residual primary and regional disease, and 6% distant metastatic disease. The local positive predictive value (PPV) was 26% for p16+ versus 54% for p16− (p = 0.01) and the regional PPV was 31% for p16+ versus 58% for p16− (p = 0.01). The local negative predictive value (NPV) was 100% regardless of p16 status and the regional NPV was 100% for p16+ versus 99% for p16− (p = 0.33). For p16+ cases, regional specificity was 76.2% versus 91.1% (p = 0.0003), local PPV was 0 versus 30% (p = 0.06) and the regional PPV was 12% versus 35% (p = 0.06) for FDG-PET/CT scans performed at ≤12 weeks versus >12 weeks. Five-year overall survival for those with CMR was 87% versus 51% without CMR (p ≤ 0.001). Conclusions Metabolic response on post-treatment FDG-PET/CT has excellent NPV regardless of p16 status. The PPV is significantly lower in those with p16+ versus p16− disease, with a significantly reduced regional specificity and a trend towards inferior predictive value if performed ≤12 weeks. CMR predicts for a significantly improved overall survival.

Objective: Evaluation of a blended learning adaptation of the accreditation process for supervisors in the Royal Australian and New Zealand College of Psychiatrists’ (RANZCP) Competency-Based Fellowship Program. Method: The adaption of the accreditation process is described, and a mixed-methods approach was taken in its evaluation. Descriptive statistics are presented for participant responses to and engagement with interactive workshop elements. The Wilcoxon signed ranks test was applied to examine the change in participants’ confidence in their understanding of the expectations of a supervisor at the commencement and conclusion of the workshop. Free text evaluative responses were subject to qualitative content analysis. Results: Most participants expressed a preference for the blended learning workshop format and indicated that live polling improved the learning experience. Additionally, participants expressed greater confidence in their understanding of the expectations of the supervisor role following workshop completion. Conclusions: The blended learning approach to supervisor training was preferred by participants and may provide a model to be adopted by other training committees and institutions.

Problem gambling is a major public health concern, especially among persons who are precariously housed, living in poverty or have complex health and social needs. Problem gambling has been connected to negative health and social outcomes; however, current healthcare services rarely screen for problem gambling. With support from community partners, the purpose of this study was to understand factors related to screening for problem gambling. Concept mapping, a mixed-method approach driven by participatory involvement, was conducted with healthcare and social service providers from Ontario, Canada in 2019. Three phases were conducted with participants either in-person or online: Brainstorming, Sorting/Rating and Mapping. Brainstorming sessions were conducted to generate statements, guided by the focal prompt: "If you were directed to routinely screen for problem gambling, what would help you do this in your daily practice?" Participants sorted statements into categories and rated them based on their importance and feasibility. A mapping session was conducted with participants to co-create visual representations of the data. Thirty participants took part in the in-person or online concept mapping sessions. During the brainstorming sessions, participants generated 213 statements, which the research team condensed into a final list of 45 statements. Participants decided that the five-cluster map best represented these 45 statements and labelled the five clusters: (a) top level (macro), (b) screening tool, (c) staff skills and training, (d) screening, and (e) team resources and support. Staff skills and training was rated as the most important and the most realistic cluster to implement, while screening was rated relatively as the least important when compared to the other clusters. Team resources and support was rated relatively as the least realistic cluster. By identifying the needs of healthcare and social service providers, this study co-developed actionable suggestions that will assist providers in routinely screening for problem gambling.