Artisanal and small-scale gold mining and biodiversity: a global literature review.

Artisanal and small-scale gold mining (ASGM) is crucial to the livelihoods of close to 20 million people in over 80 countries, including 4-5 million women, mainly in rural areas with limited alternative economic prospects, particularly in developing countries. ASGM is largely informal, which can add to the challenge of addressing negative social and environmental effects including impacts on biodiversity. However, with proper guidance, ASGM can operate in a responsible manner, using cleaner production methods that minimize impacts on human health and the environment. This study presents and analyzes the interactions between ASGM and biodiversity based on new findings from 27 ASGM National Action Plans (NAPs) developed within the framework of Article 7 and Annex C of the Minamata Convention on Mercury, as well as a global literature review of more than 100 publications. In terms of key findings according to the literature reviewed, alongside other human occupation such as agriculture and industrial activities, ASGM also has an impact on the environment and biodiversity. The interrelationship between ASGM and biodiversity, including protected areas, is pervasive at every stage of ASGM operations, from extraction to mine closure, and generates significant impacts on the surrounding ecosystems. These impacts include, in descending order of most reported impacts: deforestation, soil degradation, chemical contamination of aquatic and terrestrial systems, and changes to the turbidity of watercourses. Tropical regions and key species such as amphibians and freshwater fish are among the most affected. Singly or combined, these environmental stressors lead to loss or deterioration of habitat and, by extension, indigenous biodiversity and ecosystem services. In addition, legal, institutional, and regulatory frameworks and related measures, inadequate or non-existent in some cases, may not necessarily support sustainable practices, often resulting in exploited sites abandoned without remediation, reclamation, rehabilitation, or restoration measures. To mitigate such impacts a key recommendation arising from the literature review is to strengthen the integration of the interrelationship between ASGM and biodiversity in the implementation of existing relevant national strategies, including those developed under the NAPs. The global literature review also highlights the importance of a multi-stakeholder, systemic approach combining the use of geospatial analysis, scientific and local knowledge, as well as the adaptation of the relevant frameworks, capacity building, and awareness raising. This approach can inform decision making with a view to developing sustainable initiatives that prevent and reduce the impacts of artisanal and small-scale gold mining on ecosystems, and that preserve biodiversity.

Modeling of the effect of cerebrospinal fluid flow modulation on locally delivered drugs in the brain.

Cerebrospinal fluid (CSF) plays a vital role in maintaining brain homeostasis and recent research has focused on elucidating the role that convective flow of CSF plays in brain health. This paper describes a computational compartmental model of how CSF dynamics affect drug pharmacokinetics in the rat brain. Our model implements a local, sustained release approach for drug delivery to the brain. Simulation outputs highlight the potential for modulating CSF flow to improve overall drug pharmacokinetics in the central nervous system and suggest that concomitant CSF modulation and optimized drug release rates from implantable depots can be used to engineer the duration of action of chemotherapeutics. As an example, the tissue exposure of temozolomide, the standard of care treatment for glioblastoma, was modeled in conjunction with two CSF-modulating drugs: acetazolamide and verapamil. Simulations indicate that temozolomide exposure in the interstitial fluid is increased by 25% when using local sustained release delivery systems and concomitant acetazolamide delivery to reduce CSF production. This computational model can be used to produce insight on how to appropriately modulate CSF production and engineer drug release to tailor drug exposure in the brain while limiting off-target effects. As new research continues to elucidate the dynamic roles of CSF, this model can be further improved and leveraged to provide information on how CSF modulation may play a beneficial role in treating a wide variety of neurological disease.

A systematic mixed studies review of women's experiences of perineal trauma sustained during childbirth.

AIM: To explore the quantitative/qualitative literature on women's experiences of perineal trauma sustained during childbirth and the impact it may have on psychological/emotional wellbeing BACKGROUND: Obstetric complications during childbirth can be a risk factor for postpartum psychological distress. Perineal trauma is one of the most frequent obstetric complications and it is important to understand any impact on psychological/emotional wellbeing. DESIGN: A convergent qualitative design using a hybrid deductive-inductive thematic synthesis approach to data transformation was used. DATA SOURCES: Web of knowledge, CINAHL, MEDLINE, AMED, PsyArticles, PsycInfo until May 2017. REVIEW METHODS: Stage 1: transforming findings from the qualitative, quantitative and mixed methods studies into themes using thematic synthesis. Stage 2: integrating themes from the quantitative studies into those derived from the qualitative studies RESULTS: Records (N=2152) found of which 11 qualitative 22 quantitative and 1 mixed methods were included in this review. Five themes were derived from thematic synthesis of qualitative studies 'The mystery of perineal trauma', 'The misery of perineal suturing', 'The postnatal perineum', 'Normalisation and feeling dismissed' and 'Adjusting to a new normal - Coping and compromise' and five themes identified from the quantitative studies, experience of birth (N=4), Sexual functioning (N=12), Social functioning (N=2), Psychological health (N=8) and Quality of Life (N=5). CONCLUSION: Perineal trauma can have a negative impact on psychological/emotional wellbeing, however the literature is conflicted and in need of clarification. Future research should clearly describe the perineal status of the women in the sample, use validated measures and consider the timing of such measures. This article is protected by copyright. All rights reserved.

Characterization and optimization of actuating poly(ethylene glycol) diacrylate/acrylic acid hydrogels as artificial muscles.

Large volume deficiencies in skeletal muscle tissue fail to heal with conservative treatments, and improved treatment methods are needed. Tissue engineered scaffolds for skeletal muscle need to mimic the optimal environment for muscle development by providing the proper electric, mechanical, and chemical cues. Electroactive polymers, polymers that change in size or shape in response to an electric field, may be able to provide the optimal environment for muscle growth. In this study, an electroactive polymer made from poly(ethylene glycol) diacrylate (PEGDA) and acrylic acid (AA) is characterized and optimized for movement and biocompatibility. Hydrogel sample thickness, overall polymer concentration, and the ratio of PEGDA to AA were found to significantly impact the actuation response. C2C12 mouse myoblast cells attached and proliferated on hydrogel samples with various ratios of PEGDA to AA. Future experiments will produce hydrogel samples combined with aligned guidance cues in the form of electrospun fibers to provide a favorable environment for muscle development.

Delivery of Soluble Heme Oxygenase 1 Cell-Penetrating Peptide into Liver Cells in in vitro and ex vivo Models of Cold Ischemia.

BACKGROUND/PURPOSE: Liver transplantation is the treatment of choice in patients with end-stage liver disease. During liver transplantation, ischemia-reperfusion injury (IRI) occurs, which is an inevitable consequence of the transplantation process. To reduce the extent of cellular injury, one of the proteins that have been extensively investigated is heme oxygenase 1 (HO-1), which plays an important role in protecting the organs against IRI. The aim of this study was to introduce an active and functional HO-1 protein conjugated to a cell-penetrating peptide (CPP) in vitro and ex vivo into liver cells in hypothermic and anoxic conditions and to assert its cytoprotective effects. METHODS: We generated an enzymatically active soluble (s)HO-1-CPP recombinant protein. The ability of the sHO-1-CPP protein to penetrate McA-RH7777, Clone 9, and Hep G2 cells, primary hepatocytes, and Kupffer and human umbilical vein endothelial cells in vitro, as well as its ability to penetrate a whole liver ex vivo under hypothermic and anoxic conditions, was assessed. An in vitro hypoxia-reoxygenation (HR) model was used to determine the cytoprotective effect of the sHO-1-CPP protein. RESULTS: We showed that our recombinant protein sHO-1-CPP can cross cell membranes into rodent and human liver cells in vitro, and the results were further validated ex vivo, where rodent livers were perfused with an organ preservation solution supplemented with sHO-1-CPP under anoxic and hypothermic conditions. Immunohistochemistry revealed an intracellular localization of sHO-1-CPP in zones 1-3 of the perfused livers. The CPP did not exert any significant toxicity on the cells. Treating cells with sHO-1-CPP showed significant cytoprotection in the in vitro HR model. CONCLUSIONS: Our findings show that the recombinant protein sHO-1-CPP can be successfully delivered to cells of a whole organ in an ex vivo hypothermic and anoxic perfusion model and that it provides cytoprotection to hepatocytes in an in vitro HR model. These results hold great potential for future repair and protection of donor organs. Future experiments are planned to confirm these data in in vivo models of IRI.

Patient Experiences of Swallowing Exercises After Head and Neck Cancer: A Qualitative Study Examining Barriers and Facilitators Using Behaviour Change Theory.

Poor patient adherence to swallowing exercises is commonly reported in the dysphagia literature on patients treated for head and neck cancer. Establishing the effectiveness of exercise interventions for this population may be undermined by patient non-adherence. The purpose of this study was to explore the barriers and facilitators to exercise adherence from a patient perspective, and to determine the best strategies to reduce the barriers and enhance the facilitators. In-depth interviews were conducted on thirteen patients. We used a behaviour change framework and model [Theoretical domains framework and COM-B (Capability-opportunity-motivation-behaviour) model] to inform our interview schedule and structure our results, using a content analysis approach. The most frequent barrier identified was psychological capability. This was highlighted by patient reports of not clearly understanding reasons for the exercises, forgetting to do the exercises and not having a system to keep track. Other barriers included feeling overwhelmed by information at a difficult time (lack of automatic motivation) and pain and fatigue (lack of physical capability). Main facilitators included having social support from family and friends, the desire to prevent negative consequences such as long-term tube feeding (reflective motivation), having the skills to do the exercises (physical capability), having a routine or trigger and receiving feedback on the outcome of doing exercises (automatic motivation). Linking these findings back to the theoretical model allows for a more systematic selection of theory-based strategies that may enhance the design of future swallowing exercise interventions for patients with head and neck cancer.

Reliability of Identification of Behavior Change Techniques in Intervention Descriptions.

PURPOSE: The aim of this paper is to assess the frequency of identification as well as the inter-coder and test-retest reliability of identification of behavior change techniques (BCTs) in written intervention descriptions. METHODS: Forty trained coders applied the "Behavior Change Technique Taxonomy version 1" (BCTTv1) to 40 intervention descriptions published in protocols and repeated this 1 month later. RESULTS: Eighty of 93 defined BCTs were identified by at least one trained coder, and 22 BCTs were identified in 16 (40 %) or more of 40 descriptions. Good inter-coder reliability was observed across 80 BCTs identified in the protocols: 66 (80 %) achieved mean prevalence and bias-adjusted kappa (PABAK) scores of 0.70 or greater, and 59 (74 %) achieved mean scores of 0.80 or greater. There was good within-coder agreement between baseline and 1 month, demonstrating good test-retest reliability. CONCLUSIONS: BCTTv1 can be used by trained coders to identify BCTs in intervention descriptions reliably. However, some frequently occurring BCT definitions require further clarification.

"Getting Autism": Educators, Parents, and Autistic Adults and Teens Reflect on the Importance of Teachers Who Understand.

PURPOSE: To explore the perspectives of educators, parents, and individuals on the autism spectrum regarding the qualities of teachers best equipped to support autistic students. METHODS: In qualitative interviews parents of autistic adults (n = 35) discussed experiences they and their child faced during the school years, as did young autistic adults (n = 12) and teens (n = 11). Nineteen educators were also interviewed regarding how autistic students and their teachers were faring in public schools as well as what qualities and skills teachers needed to best support these students. RESULTS: A critical emergent theme was the importance of educators who possess a deep, intuitive understanding of autistic individuals. "Getting autism" involved autism knowledge, obtained through training or experience; an intuitive ability to read, respond to, and appreciate autistic students; and flexibility adapting to these students' needs. Autistic students, parents, and educators alike experienced a stigmatizing judgement and lack of support from unenlightened individuals in the schools. In contrast, there was great appreciation for those who "got autism" and were able to ease the way of autistic students, or support autism-friendly teachers, in whatever grade or situation. CONCLUSION: Research investigating how to cultivate, support, and reward autism-affirming teachers is needed. This will likely involve both didactic and experiential autism-focused training as well as recognition of the importance of high emotional intelligence and other qualities of teachers who "get autism." Future research should also explore the effects on these teachers and their students of larger systems, policies, and practices.

Positive and negative emotions during the COVID-19 pandemic: A longitudinal survey study of the UK population.

The COVID-19 pandemic has had a profound impact on society; it changed the way we work, learn, socialise, and move throughout the world. In the United Kingdom, policies such as business closures, travel restrictions, and social distance mandates were implemented to slow the spread of COVID-19 and implemented and relaxed intermittently throughout the response period. While negative emotions and feelings such as distress and anxiety during this time of crisis were to be expected, we also see the signs of human resilience, including positive feelings like determination, pride, and strength. A longitudinal study using online survey tools was conducted to assess people's changing moods during the pandemic in the UK. The Positive and Negative Affect Schedule (PANAS) was used to measure self-reported feelings and emotions throughout six periods (phases) of the study from March 2020 to July 2021. A total of 4,222 respondents participated in the survey, while a sub-group participated in each of the six study phases (n = 167). The results were analysed using a cross-sectional study design for the full group across each study phase, while prospective cohort analysis was used to assess the subset of participants who voluntarily answered the survey in each of the six study phases (n = 167). Gender, age and employment status were found to be most significant to PANAS score, with older people, retirees, and women generally reporting more positive moods, while young people and unemployed people generally reported lower positive scores and higher negative scores, indicating more negative emotions. Additionally, it was found that people generally reported higher positive feelings in the summer of 2021, which may be related to the relaxation of COVID-19-related policies in the UK as well as the introduction of vaccines for the general population. This study is an important investigation into what allows for positivity during a crisis and gives insights into periods or groups that may be vulnerable to increased negative states of emotions and feelings.

Assessing Performance of Contemporary Plant-Based Diets against the UK Dietary Guidelines: Findings from the Feeding the Future (FEED) Study.

Uncertainty remains about the composition of contemporary plant-based diets and whether they provide recommended nutrient intakes. We established Feeding the Future (FEED), an up-to-date online cohort of UK adults following different plant-based diets and diets containing meat and fish. We recruited 6342 participants aged 18-99 [omnivores (1562), flexitarians (1349), pescatarians (568), vegetarians (1292), and vegans (1571)] between February 2022 and December 2023, and measured diet using a food frequency questionnaire and free text. We compared personal characteristics and dietary intakes between diet groups and assessed compliance with dietary guidelines. Most participants met UK dietary recommendations for fruit and vegetables, sodium, and protein, although protein intakes were lowest among vegetarians and vegans. Omnivores did not meet the fibre recommendation and only vegans met the saturated fat recommendation. All diet groups exceeded the free sugars recommendation. Higher proportions of vegetarians and vegans were below the estimated average requirements (EARs) for zinc, iodine, selenium, and, in vegans, vitamins A and B12, whereas calcium intakes were similar across the diet groups. People following plant-based diets showed good compliance with most dietary targets, and their risk for inadequate intakes of certain nutrients might be mitigated by improved dietary choices and/or food fortification.

The behavior change technique taxonomy (v1) of 93 hierarchically clustered techniques: building an international consensus for the reporting of behavior change interventions.

BACKGROUND: CONSORT guidelines call for precise reporting of behavior change interventions: we need rigorous methods of characterizing active content of interventions with precision and specificity. OBJECTIVES: The objective of this study is to develop an extensive, consensually agreed hierarchically structured taxonomy of techniques [behavior change techniques (BCTs)] used in behavior change interventions. METHODS: In a Delphi-type exercise, 14 experts rated labels and definitions of 124 BCTs from six published classification systems. Another 18 experts grouped BCTs according to similarity of active ingredients in an open-sort task. Inter-rater agreement amongst six researchers coding 85 intervention descriptions by BCTs was assessed. RESULTS: This resulted in 93 BCTs clustered into 16 groups. Of the 26 BCTs occurring at least five times, 23 had adjusted kappas of 0.60 or above. CONCLUSIONS: "BCT taxonomy v1," an extensive taxonomy of 93 consensually agreed, distinct BCTs, offers a step change as a method for specifying interventions, but we anticipate further development and evaluation based on international, interdisciplinary consensus.

Comparing factors influencing seasonal influenza vaccine acceptance and intentions among Chinese university students residing in China and UK: A cross-sectional study.

University students, who face an elevated risk of influenza due to close living quarters and frequent social interactions, often exhibit low vaccine uptake rates. This issue is particularly pronounced among Chinese students, who encounter unique barriers related to awareness and access, emphasizing the need for heightened attention to this problem within this demographic. This cross-sectional study conducted in May-June 2022 involved 1,006 participants (404 in the UK, 602 in Mainland China) and aimed to explore and compare the factors influencing influenza vaccine acceptance and intentions between Chinese university students residing in the UK (C-UK) and Mainland China (C-M). The study employed a self-administered questionnaire based on the Theoretical Domains Framework and Capability Opportunity Motivation-Behavior model. Results revealed that approximately 46.8% of C-UK students received the influenza vaccine in the past year, compared to 32.9% of C-M students. More than half in both groups (C-UK: 54.5%, C-M: 58.1%) had no plans for vaccination in the upcoming year. Knowledge, belief about consequences, and reinforcement significantly influenced previous vaccine acceptance and intention in both student groups. Barriers to vaccination behavior included insufficient knowledge about the influenza vaccine and its accessibility and the distance to the vaccine center. Enablers included the vaccination behavior of individuals within their social circles, motivation to protect others, and concerns regarding difficulties in accessing medical resources during the COVID-19 pandemic. The findings of this study offer valuable insights for evidence-based intervention design, providing evidence for healthcare professionals, policymakers, and educators working to enhance vaccination rates within this specific demographic.

COVID-19 pandemic impact on food insecurity among college students: A mixed methods study.

Objectives: This study explores whether the COVID-19 pandemic exacerbated the prevalence of food insecurity (FI) among US college students. Participants: College students (n = 489) enrolled at a Mid-Atlantic university. Methods: A mixed methods design was utilized for data collection and analysis through an electronic survey and semi-structured interviews. Multiple regression was used to assess predictors of FI before and during COVID-19. The McNemar test determined if significant differences in FI existed. The interviews were used to explore students' personal experience with FI during the pandemic. Results: Black students (p = 0.045) and students moving in with their parents due to campus closures (p = 0.032) exhibited a higher degree of FI during the pandemic than before. Three main themes emerged from the interviews: decreased food autonomy, limited access to food, and limited access to healthful food. Conclusions: The pandemic increased the prevalence of FI among college students. Race and living arrangements were strong predictors of FI.

Gamified antimicrobial decision support app (GADSA) changes antibiotics prescription behaviour in surgeons in Nigeria: a hospital-based pilot study.

AIMS: Surgical Antibiotic Prophylaxis (SAP) in Nigeria is often not evidence based. The aim of this study is to test if the GADSA application can change prescription behaviour of surgeons in Nigeria. In addition, the study aims to identify AMS strategies and policies for the future. METHODS: The GADSA gamified decision support app uses WHO and Sanford prescribing guidelines to deliver real-time persuasive technology feedback to surgeons through an interactive mentor. The app can advise on whether clinician's decisions align with SAP recommendations and provides the opportunity for clinicians to make adjustments. Twenty surgeons actively participated in a 6-month pilot study in three hospitals in Nigeria. The surgeons determined the risk of infection of a surgical procedure, and the need, type and duration of SAP. The study used a longitudinal approach to test whether the GADSA app significantly changed prescribing behaviour of participating surgeons by analysing the reported prescription decisions within the app. RESULTS: 321 SAP prescriptions were recorded. Concerning the surgical risk decision, 12% of surgeons changed their decision to be in line with guidelines after app feedback (p < 0.001) and 10% of surgeons changed their decision about the need for SAP (p = 0.0035) to align with guidelines. The change in decision making for SAP use in terms of "type" and "duration" to align with guidelines was similar with 6% and 5% respectively (both p-values < 0.001). CONCLUSION: This study suggests that the GADSA app, with its game based and feedback feature, could significantly change prescribing behaviour at the point of care in an African setting, which could help tackle the global challenge of antibiotic resistance.

Vaccine hesitancy and behavior change theory-based social media interventions: a systematic review.

It is widely acknowledged that vaccine hesitancy is a multifaceted problem that cannot be addressed by a single strategy. Behavior change theories and social media tools may together help to guide the design of interventions aimed at improving vaccination uptake. This systematic review aims to identify the breadth and effectiveness of such theories and tools. The systematic review search was performed in PubMed, Scopus, ACM, Cochrane Library, ProQuest, and Web of Science databases for studies between January 2011 and January 2021 that applied social media tools to increase vaccine confidence or improve vaccination uptake. The literature search yielded a total of 3,065 publications. Twenty articles met the eligibility criteria, 12 of which were theory-based interventions. The result shows that the Health Belief Model was the most frequently deployed theory, and the most common social media tool was educational posts, followed by dialogue-based groups, interactive websites, and personal reminders. Theory-based interventions were generally more measurable and comparable and had more evidence to trigger the positive behavior change. Fifteen studies reported the effectiveness in knowledge gain, intention increase, or behavior change. Educational messages were proved to be effective in increasing knowledge but less helpful in triggering behavior change. Dialogue-based social media intervention performed well in improving people's intention to vaccinate. Interventions informed by behavior change theory and delivered via social media platforms offer an important opportunity for addressing vaccine hesitancy. This review highlights the need to use a multitheory framework and tailoring social media interventions to the specific circumstances and needs of the target audience in future interventions. The results and insights gained from this review will be of assistance to future studies.

A survey of physicians' treatment switching practice in people on long-term prophylaxis for hemophilia in five European countries.

OBJECTIVE: Recombinant factor VIII and factor IX Fc fusion proteins (rFVIIIFc and rFIXFc) were developed with an extended half-life (EHL) to improve the management of people with hemophilia A (PwHA) and B (PwHB), respectively. METHODS: This survey gathered physician-reported treatment decisions and physician views on outcomes in PwHA or PwHB who switched to rFVIIIFc or rFIXFc in the 12 months prior to study completion. RESULTS: Physicians (N = 37) considered bleeds, pharmacokinetic parameters, joint health and adherence the most important factors to assess both in routine care and when deciding to switch to an EHL therapy. In the 12 months prior to study completion, 37 physicians switched 113 PwHA to rFVIIIFc and 25 physicians switched 36 PwHB to rFIXFc. Most PwH (>90%) had moderate or severe hemophilia and many (>60%) switched within 6 months of the survey. The main reason for switching PwHA to rFVIIIFc was to allow fewer injections (49%), while the main reason for switching PwHB to rFIXFc was the product becoming available for use (36%). Overall, 96% of PwHA and 89% of PwHB who were switched remained on these EHL products at the time of survey. Mean total weekly dose, injection frequency and annualized bleeding rate were reported to have reduced following switching. CONCLUSION: This survey provides valuable insight into reasons for, and challenges to, the use of EHL products in clinical practice. Physicians perceived that switching to treatment with rFVIIIFc or rFIXFc can improve quality of life, treatment burden, disease control and adherence.

To Zoom or not to Zoom: A longitudinal study of UK population's activities during the COVID-19 pandemic.

This longitudinal study determines the frequency and way of people doing activities from Spring 2020 to Summer 2021 during different phases of the COVID-19 pandemic in the UK. Six online surveys were carried out between April 2020 and July 2021. 4,992 participants were engaged in the cross-sectional study and 203 participants who provided repeat responses were included in the subset sample of prospective cohort analysis. Primary outcomes measured were the frequency and the mode of doing the activities (online or in-person) across sixteen selected activity groups, as defined by the UK National Time Use Survey. The results show that cultural activities, spending time with others, and travelling, were the activities with the largest proportions of frequency and mode changes. The most significant changes occurred from March to June 2020, a period that included the first lockdown. Survey results from this period show a significant decrease among most of the sixteen measured activities. From March to October 2020, a period which spans the first lockdown and its subsequent ease of restrictions, showed the most significant shift from accessing activities in-person to online. Despite 'Freedom Day', the July 19th 2021 date in which all restrictions were abolished, it was found that people do cultural activities and group activities at a significantly lower frequency than before the pandemic. In addition, despite a lack of restrictions after this date, more than half of participants access many activities, such as spending time with others, shopping, work and studying, online or hybrid. This study provides an invaluable insight into understanding how people in the UK changed their lifestyle, including what activities they do, and how they accessed those activities in light of the COVID-19 pandemic and related public health policy implemented to address the pandemic. These results may serve as unique evidence for policymakers.

Mental health impacts of the COVID-19 pandemic on college students.

The COVID-19 pandemic is having profound effects on college students, and those with mental health conditions are more vulnerable to the impact of this stress. Objective: To study the impact of the COVID-19 pandemic on college students' mental health. Participants: Participants (n=489) were mostly female, undergraduate, and aged 18-25. Methods: Participants completed an online survey assessing symptoms of mental health problems including hopelessness, loneliness, sadness, anxiety, sadness, and anger. Results: Approximately 81.6 % self-reported at least one negative mental health symptom. Students reported increased feelings of hopelessness (+7.8%), loneliness (+6.7%), sadness (+8.8%), depression (+2.6%), anxiety (+5.2%), and anger (+14.6%) during the pandemic than before. LGBTQ students and Black students had significantly more mental health symptoms during the pandemic than straight and White students. Conclusions: Results of this study highlight the negative impact of the pandemic and resultant changes on college students' mental health.

Exploring barriers to guideline implementation for prescription of surgical antibiotic prophylaxis in Nigeria.

Background: In Nigeria, the prescription of surgical antibiotic prophylaxis for prevention of surgical site infection tends to be driven by local policy rather than by published guidelines (e.g. WHO and Sanford). Objectives: To triangulate three datasets and understand key barriers to implementation using a behavioural science framework. Methods: Surgeons (N = 94) from three teaching hospitals in Nigeria participated in an online survey and in focus group discussions about barriers to implementation. The theoretical domains framework (TDF) was used to structure question items and interview schedules. A subgroup (N = 20) piloted a gamified decision support app over the course of 6 months and reported barriers at the point of care. Results: Knowledge of guidelines and intention to implement them in practice was high. Key barriers to implementation were related to environmental context and resources and concern over potential consequences of implementing recommendations within the Nigerian context applicable for similar settings in low-to-middle-income countries. Conclusions: The environmental context and limited resource setting of Nigerian hospitals currently presents a significant barrier to implementation of WHO and Sanford guidelines. Research and data collected from the local context must directly inform the writing of future international guidelines to increase rates of implementation.