Perceived Stress and Self-Care in Graduate Students Amidst the COVID-19 Pandemic

Introduction: This study examines the perceived stress and self-care behaviors of graduate students as impacted by the COVID-19 pandemic. Students who participated had varying degree concentrations, with the majority of participants having a Clinical Mental Health Counseling, Couples and Family Therapy, Dance Movement Therapy, or Clinical Psychology focus. This study is particularly relevant to health care workers, especially those whose focus is mental health. Markedly elevated prevalence of reported adverse mental and behavioral health conditions associated with the COVID-19 pandemic highlight the broad impact of the pandemic and the need to prevent and treat these conditions. This study sought to examine the presence and significance of a relationship between perceived stress, self-care strategies, and participant characteristics and the impact of COVID-19. Methods: Utilizing a quantitative approach, data were collected via survey method using related questionnaires and assessments; approximately 700 surveys were disseminated to the student-body, with a response rate of 24% yielding 170 initial participants. Pearson bivariate and multiple regression were used to determine the statistical significance of any potential relationship as posed by the research questions. Results: A statistically significant relationship was found between perceived stress and the impact of COVID-19 for the students. Also, using multiple regression, age (p = .005) and race/ethnic identity (p = .006) contributed to the reported levels of perceived stress. Racial identity was a significant predictor of the reported scores on the impact of COVID-19 (p = .01). There was also a significant relationship (p \u3c.001) between adequate sleep and eating nutritiously (p = .016) and reported perceived stress and the impact of COVID-19. Lastly, engaging in social activism was related to an increased impact of COVID-19 (p=.037), specifically for the subscale of hyperarousal (p=.016). Conclusion: A summary of our findings indicates a significant relationship between participant’s perceived stress and the impact of COVID-19; specifically, as the level of perceived stress increased for our participants, so did the impact of the COVID-19 pandemic. Seemingly, those who experience greater daily stress in their lives reported a more significant impact of COVID-19 on their daily lives. These results point to the need for wellness strategies specific to stress reduction strategies to also help in alleviating the distress associated with COVID-19. As universities transition to online learning, online accessible interventions aimed at helping students address stress, depression, and wellbeing, may prove beneficial

Does electronic consent improve the logistics and uptake of hpv vaccination in adolescent girls? A mixed methods theory informed evaluation of an intervention

Abstract Background Technological solutions may improve the logistics of obtaining parental consent in school-based immunisation programmes. In 2018/19 a health care organisation in London, England, piloted an electronic consent intervention in the adolescent girls’ HPV vaccination programme. We conducted a mixed-methods evaluation to examine the usability and acceptability of the intervention and assess its impact on consent form returns and HPV vaccine uptake. Methods The intervention was implemented in 14 secondary schools in seven South London boroughs. Each e-consent school was matched with a school that used standard paper consent. Matching was based on location and the proportion of students: i. with English as a second language, ii. receiving free school meals (socio-economic status proxy). Consent form return rates and HPV vaccine uptake were compared quantitatively between intervention and matched schools. Data from immunisation session observations (n=7), school feedback forms (n=14), individual and group interviews with implementers (n=8), parents and adolescents (n=12) and a focus group discussion with adolescents was analysed thematically to document user’s experiences investigate the implementation of the intervention. Results HPV vaccination uptake did not differ between e-consent and matched paper consent schools, but timely consent form return was significantly lower in the e-consent schools (73.3% (n=11) vs 91.6% (n=11), p=0.008). The transition to using the system was not straightforward, whilst schools and staff understood the potential benefits, they found it difficult to adapt to new ways of working which removed some level of control from schools. Part of the reason for lower consent form return in e-consent schools was that some parents found the intervention difficult to access and use. Adolescents highlighted the potential for e-consent interventions to by-pass their information needs. Conclusions The e-consent intervention did not improve consent form return or vaccine uptake due to challenges encountered in transitioning to a new way of working. New technologies require embedding before they become incorporated in everyday practice. The intervention is undergoing further iterative development to improve its usability, ensure schools are appropriately involved and adolescents receive tailored immunisation information. A re-evaluation once stakeholders are accustomed to e-consent may be required to understand its impact.</jats:p

Digital undergraduate medical education and patient and carer involvement: a rapid systematic review of current practice

BACKGROUND: Involving patients and carers in medical students' learning aims to centralise the perspective of healthcare users and supports our future medical workforce in the development of key skills. Medical schools are increasingly using digital technology for teaching and it is timely to understand how to maintain patient and carer involvement in this context. METHODS: Ovid MEDLINE, Ovid EMBASE and medRxiv were searched in October 2020 and reference lists of key articles were hand searched. Eligible studies reported authentic patient or carer involvement in undergraduate medical education where technology was also used. Study quality was assessed by the Mixed Methods Appraisal Tool (MMAT). Levels of patient or carer involvement were assessed using Towle et al.'s (2010) taxonomy, from Level 1 (lowest level) to Level 6 (highest level). RESULTS: Twenty studies were included in this systematic review. In 70% of studies, patients and carers featured in video or web-based case scenarios with no interaction between healthcare users and students. The remaining 30% of studies reported real-time interactions between students and patients via remote clinical encounters. Digital teaching sessions involving patients or carers were perceived to be valuable by students and educators, and increased student engagement, patient-centred attitudes, clinical knowledge, and communication skills. No studies reported the perspective of patients or carers. DISCUSSION: Digital technology has not yet driven higher levels of patient and carer involvement in medical training. "Live" interactions between students and patients are becoming more common but challenges need addressing to ensure positive experiences for all involved. Future teaching should enhance the role of patients and carers in medical education and support them to overcome any potential barriers to doing so remotely

An Assessment of the Security and Transparency Procedural Components of the Estonian Internet Voting System

The I-Voting system designed and implemented in Estonia is one of the first nationwide Internet voting systems. Since its creation, it has been met with praise but also with close scrutiny. Concerns regarding security breaches have focused on in-person election observations, code reviews and adversarial testing on system components. These concerns have led many to conclude that there are various ways in which insider threats and sophisticated external attacks may compromise the integrity of the system and thus the voting process. In this paper, we examine the procedural components of the I-Voting system, with an emphasis on the controls related to procedural security mechanisms, and on system-transparency measures. Through an approach grounded in primary and secondary data sources, including interviews with key Estonian election personnel, we conduct an initial investigation into the extent to which the present controls mitigate the real security risks faced by the system. The experience and insight we present in this paper will be useful both in the context of the I-Voting system, and potentially more broadly in other voting systems

An Independent Assessment of the Procedural Components of the Estonian Internet Voting System

The I-Voting system that was designed and implemented in Estonia in 2005 is the first Internet voting system to have been adopted anywhere in the world. Since its inception, it has been met with both praise and scrutiny. Concerns include in-person election observations, code reviews, and adversarial testing on system components. As a result of these concerns, some parties have concluded that there are various ways in which insider threats and sophisticated external attacks could compromise the system’s integrity and thus the voting process. This paper examines the procedural components of the I-Voting system, with an emphasis on the controls related to procedural security mechanisms, high-level operational security aspects, and system transparency measures. The methodological approach is based on both primary and secondary data sources, including interviews with key Estonian election personnel, in order to determine the extent to which the present controls mitigate the security risks faced by the system. This study makes three main arguments. First, we found procedural controls to be fundamentally important to the design of the I-Voting system. While these mechanisms go a long way toward preventing cyberattacks, problems in the system still exist. For instance, some security situations appear to be addressed in informal ways which rely heavily on the knowledge, experience, and professional relationships between officials. Second, in terms of operational controls, we were generally impressed by the state of the controls adopted, particularly the incident handling processes during elections, as well as checks and investigations during and after elections. Our main concern regarding resilience is the increasing potential for more highly sophisticated attacks. As time progresses, attackers will naturally become stronger, and the system will have to adapt in order to accommodate this evolution. Third, the system’s transparency measures have had a noteworthy impact on building confidence and trust in the I-Voting system, both locally and internationally. Challenges still exist, however, especially pertaining to the difficulty in running voter awareness campaigns, as well as increasing voter usage of transparency measures

Does electronic consent improve the logistics and uptake of HPV vaccination in adolescent girls? A mixed-methods theory informed evaluation of a pilot intervention.

OBJECTIVES: To evaluate the usability and acceptability of an electronic consent pilot intervention for school-based immunisations and assess its impact on consent form returns and human papilloma virus (HPV) vaccine uptake. DESIGN: Mixed-methods theory-informed study applying qualitative methods to examine the usability and acceptability of the intervention and quantitative methods to assess its impact. SETTING AND PARTICIPANTS: The intervention was piloted in 14 secondary schools in seven London boroughs in 2018. Intervention schools were matched with schools using paper consent based on the proportion of students with English as a second language and students receiving free school meals. Participants included nurses, data managers, school-link staff, parents and adolescents. INTERVENTIONS: An electronic consent portal where parents could record whether they agreed to or declined vaccination, and nurses could access data to help them manage the immunisation programme. PRIMARY AND SECONDARY OUTCOME MEASURES: Comparison of consent form return rates and HPV vaccine uptake between intervention and matched schools. RESULTS: HPV vaccination uptake did not differ between intervention and matched schools, but timely consent form return was significantly lower in intervention schools (73.3% vs 91.6%, p=0.008). The transition to using electronic consent was not straightforward, while schools and staff understood the potential benefits, they found it difficult to adapt to new ways of working which removed some level of control from schools. Reasons for lower consent form return in e-consent schools included difficulties encountered by some parents in accessing and using the intervention. Adolescents highlighted the potential for electronic consent to by-pass their information needs. CONCLUSIONS: The pilot intervention did not improve consent form return or vaccine uptake due to challenges encountered in transitioning to new working practice. New technologies require embedding before they become incorporated in everyday practice. A re-evaluation once stakeholders are accustomed with electronic consent may be required to understand its impact

Daratumumab, Cyclophosphamide, Bortezomib, Lenalidomide, and Dexamethasone as Induction and Extended Consolidation Improves Outcome in Ultra-High-Risk Multiple Myeloma

Purpose: The multicenter OPTIMUM (MUKnine) phase II trial investigated daratumumab, low-dose cyclophosphamide, lenalidomide, bortezomib, and dexamethasone (Dara-CVRd) before and after autologous stem-cell transplant (ASCT) in newly diagnosed patients with molecularly defined ultra–high-risk (UHiR) multiple myeloma (NDMM) or plasma cell leukemia (PCL). To provide clinical context, progression-free survival (PFS) and overall survival (OS) were referenced to contemporaneous outcomes seen in patients with UHiR NDMM treated in the recent Myeloma XI (MyeXI) trial.Methods: Transplant-eligible all-comers NDMM patients were profiled for UHiR disease, defined by presence of ≥2 genetic risk markers t(4;14)/t(14;16)/t(14;20), del(1p), gain(1q), and del(17p), and/or SKY92 gene expression risk signature. Patients with UHiR MM/PCL were offered treatment with Dara-CVRd induction, V-augmented ASCT, extended Dara-VR(d) consolidation, and Dara-R maintenance. UHiR patients treated in MyeXI with carfilzomib, lenalidomide, dexamethasone, and cyclophosphamide, or lenalidomide, dexamethasone, and cyclophosphamide, ASCT, and R maintenance or observation were identified by mirrored molecular screening. OPTIMUM PFS at 18 months (PFS18m) was compared against MyeXI using a Bayesian framework, and patients were followed up to the end of consolidation for PFS and OS.Results: Of 412 screened NDMM OPTIMUM patients, 103 were identified as UHiR or PCL and subsequently treated on trial with Dara-CVRd; 117 MyeXI patients identified as UHiR formed the external comparator arm, with comparable clinical and molecular characteristics to OPTIMUM. Comparison of PFS18m per Bayesian framework resulted in a 99.5% chance of OPTIMUM being superior to MyeXI. At 30 months' follow-up, PFS was 77% for OPTIMUM versus 39.8% for MyeXI, and OS 83.5% versus 73.5%, respectively. Extended post-ASCT Dara-VRd consolidation therapy was highly deliverable, with limited toxicity.Conclusion: Our results suggest that Dara-CVRd induction and extended post-ASCT Dara-VRd consolidation markedly improve PFS for UHiR NDMM patients over conventional management, supporting further evaluation of this strategy.</p

Publisher Correction: Biodiversity, environmental drivers, and sustainability of the global deep-sea sponge microbiome

The original version of the Description of Additional Supplementary Files associated with this Article contained errors in the legends of Supplementary Data 5–8 and omitted legends for the Source Data. The HTML has been updated to include a corrected version of the Description of Additional Supplementary Files; the original incorrect version of this file can be found as Supplementary Information associated with this Correction

Biodiversity, environmental drivers, and sustainability of the global deep-sea sponge microbiome

In the deep ocean symbioses between microbes and invertebrates are emerging as key drivers of ecosystem health and services. We present a large-scale analysis of microbial diversity in deep-sea sponges (Porifera) from scales of sponge individuals to ocean basins, covering 52 locations, 1077 host individuals translating into 169 sponge species (including understudied glass sponges), and 469 reference samples, collected anew during 21 ship-based expeditions. We demonstrate the impacts of the sponge microbial abundance status, geographic distance, sponge phylogeny, and the physical-biogeochemical environment as drivers of microbiome composition, in descending order of relevance. Our study further discloses that fundamental concepts of sponge microbiology apply robustly to sponges from the deep-sea across distances of >10,000 km. Deep-sea sponge microbiomes are less complex, yet more heterogeneous, than their shallow-water counterparts. Our analysis underscores the uniqueness of each deep-sea sponge ground based on which we provide critical knowledge for conservation of these vulnerable ecosystems

Smartwatch games: Encouraging privacy-protective behaviour in a longitudinal study

While the public claim concern for their privacy, they frequently appear to overlook it. This disparity between concern and behaviour is known as the Privacy Paradox. Such issues are particularly prevalent on wearable devices. These products can store personal data, such as text messages and contact details. However, owners rarely use protective features. Educational games can be effective in encouraging changes in behaviour. Therefore, we developed the first privacy game for (Android) Wear OS watches. 10 participants used smartwatches for two months, allowing their high-level settings to be monitored. Five individuals were randomly assigned to our treatment group, and they played a dynamically-customised privacy-themed game. To minimise confounding variables, the other five received the same app but lacking the privacy topic. The treatment group improved their protection, with their usage of screen locks significantly increasing (p = 0.043). In contrast, 80% of the control group continued to never restrict their settings. After the posttest phase, we evaluated behavioural rationale through semi-structured interviews. Privacy concerns became more nuanced in the treatment group, with opinions aligning with behaviour. Actions appeared influenced primarily by three factors: convenience, privacy salience and data sensitivity. This is the first smartwatch game to encourage privacy-protective behaviour