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Objectives The SARS‐CoV‐2 global pandemic has subjected healthcare workers (HCWs) to high risk of infection through direct workplace exposure, coupled with increased workload and psychological stress. This review aims to determine the impact of SARS‐CoV‐2 on mental health outcomes of hospital‐based HCWs and formulate recommendations for future action. Methods A systematic review was performed between 31st December 2019 and 17th June 2020 through Ovid Medline and Embase databases (PROSPERO ID CRD42020181204). Studies were included for review if they investigated the impact of SARS‐CoV‐2 on mental health outcomes of hospital‐based HCWs and used validated psychiatric scoring tools. Prevalence of ICD‐10 classified psychiatric disorders was the primary outcome measure. Results The initial search returned 436 articles. Forty‐four studies were included in final analysis, with a total of 69,499 subjects. Prevalence ranges of six mental health outcomes were identified: depression 13.5%‐44.7%; anxiety 12.3%‐35.6%; acute stress reaction 5.2%‐32.9%; post‐traumatic stress disorder 7.4%‐37.4%; insomnia 33.8%‐36.1%; and occupational burnout 3.1%‐43.0%. Direct exposure to SARS‐CoV‐2 patients was the most common risk factor identified for all mental health outcomes except occupational burnout. Nurses, frontline HCWs, and HCWs with low social support and fewer years of working experience reported the worst outcomes. Conclusion The SARS‐CoV‐2 pandemic has significantly impacted the mental health of HCWs. Frontline staff demonstrate worse mental health outcomes. Hospitals should be staffed to meet service provision requirements and to mitigate the impact onmental health. This can be improved with access to rapid‐response psychiatric teams and should be continually monitored throughout the pandemic and beyond its conclusion.

Study Design A single surgeon case series and meta-analysis of literature Objective To evaluate the clinical outcome and patient satisfaction following coccygectomy for coccygodynia in adults and children using a curvilinear paramedian skin incision and to conduct a meta-analysis of the literature to determine the associated infection rate with different surgical factors. Methods 45 consecutive patients (40 adults and 5 children) underwent surgical coccygectomy for persistent coccygodynia symptoms using a paramedian curvilinear incision. Postoperative clinical outcome scores, patients’ satisfaction and wound complications were assessed. A systematic literature search using specific MesH terms was then conducted covering the period from 1980 to 2020. Only those studies reporting infection rates post coccygectomy were included in a meta-analysis. Results The average age of patients was 39 years with a mean duration of symptoms prior to surgery of 7.4 years. The mean Oswestry Disability Index improved from 29 to 7.7 (P < .001). The mean pain Visual analogue scale improved from 8 to 2 (P < .001) and the median patient satisfaction score was 8 (out of 10) suggesting good to excellent outcome. The clinical improvement was the same in children and adults. There was a total of 5 (11%) wound infections, 2 of which needed surgical debridement. Meta-analysis of the included studies showed that the use of prophylactic antibiotics for 24 hours, nonabsorbable skin sutures and glue were associated with low infection rate. Conclusions Coccygectomy using curvilinear paramedian skin incision for chronic coccygodynia is an effective procedure with similar or lower complication rates as reported in the literature.

IntroductionThere is a huge variation in the depth and breadth of content taught regarding orthopaedic examinations. Undergraduate students are often confused by the variability in examination teaching, therefore increasing concerns for upcoming objectively structured clinical examinations (OSCEs). Doctors, despite being expected to teach, rarely receive formal preparation, with only a handful of institutions providing necessary training. The Clinical Orthopaedic Teaching programme for Students (COTS) was designed to equip medical students with the knowledge to perform orthopaedic examinations and to synergistically provide senior students with the necessary experience for the future teaching required of them.MethodsSix fortnightly sessions were delivered, each focusing on a specific joint examination. Student and tutor recruitment were voluntary. Pre-session and post-session multiple-choice questions (MCQs) were provided to students to assess improvement in knowledge. Anonymous feedback forms were provided to both students and tutors.ResultsFrom 61 student responses, 98.4% of students stated that COTS met the learning outcomes, with content relevant for their medical curriculum. 96.7% supported COTS’ near-peer teaching (NPT) style for OSCE preparation. Based on a five-point Likert scale, students displayed a mean improvement in confidence (1.7±1.2, p<0.001) and MCQ scores (1.3±1.2, p<0.001). All 10 tutors perceived an improvement of their teaching skills and confidence to teach (1.0±0.9, p=0.016).ConclusionCOTS shows that an NPT style can be used to effectively teach orthopaedic examinations, with benefits for students and tutors. With our aim to refine and upscale this programme, we publish our pilot study findings to encourage similar teaching programmes to be adopted at other universities.

IntroductionThe COVID-19 pandemic has impacted students learning, with the time off resulting in students ‘de-skilling’, increasing concerns for upcoming observed structured clinical examinations. Foundation Year 1 (F1) doctors (F1s), despite being expected to teach, rarely receive formal preparation, with COVID-19 exacerbating opportunities to practice. As such, a national orthopaedic teaching programme was designed to provide F1s with opportunities to develop their teaching skills and to synergistically teach medical students how to perform clinical orthopaedic examinations.MethodsSix weekly sessions, each delivered by two newly qualified F1 tutors, on each joint examination were delivered online via Zoom Video Communications (USA). Presession and postsession multiple choice questions (MCQs) were provided to students to assess improvement in knowledge. Anonymous feedback forms were provided to both students and tutors.ResultsOf the 341 students that attended, 87.1% provided feedback. 86.2% felt that they had de-skilled due to time off, with a mean 15 weeks off from placement. Based on a 5-point Likert scale, students displayed a mean improvement in confidence (1.9±1.1, p<0.001) and MCQ scores (1.4±1.3, p<0.001) before and after the sessions. 91.6% and 95.3% agreed that the use of online teaching increased attendance and laid the foundation for practice. Of the six tutors, all reported improvement in confidence to teach and teaching skills.ConclusionWe demonstrate that online delivery of clinical orthopaedic examinations is effective, increasing the knowledge and confidence of students, while providing opportunities for F1s to teach. We present our findings to encourage similar teaching programmes to be adopted at other locations and specialties, to synergistically benefit students, doctors and ultimately, patients.

BackgroundA clinical audit measures specific clinical outcomes or processes against a predefined standard. However, many clinicians are unable to carry out audits given their time constraints. Alternatively, medical students may often wish to complete audits early in their career to strengthen their portfolios. As such, the student clinical audit platform was designed to connect willing supervisors and these medical students.MethodsProject supervisors were members of a regional trainee-led network. Interested students were familiarised with the various aspects of an audit and allocated to supervisors with similar interests. There was regular communication to track progress and anonymised feedback forms were distributed to all students and supervisors after a year.ResultsA total of 17 responses were received from the 19 students who were involved in a project. Based on a 5-point Likert scale, students displayed a mean improvement in their understanding of a clinical audit (1.18±1.07, p<0.001), the confidence to approach a supervisor (1.29±1.21, p<0.001) and the ability to conduct an audit by themselves in the future (1.77±1.15, p<0.001). Of the seven affiliated supervisors, five provided feedback with 80% indicating they had projects which remained inactive and all happy with the quality of work produced by their students.ConclusionDespite limitations to this programme, the platform produced projects which were disseminated both locally and nationally, demonstrating positive collaboration between medical students and clinicians. We present our findings and evaluations to encourage similar audit platforms to be adopted at other locations.

Introduction Despite trauma accounting 9% of global mortality, it has been demonstrated that undergraduate trauma teaching is inadequate nationally and worldwide. With COVID-19 exacerbating this situation, a scalable, accessible, and cost-effective undergraduate trauma teaching is required. Methods Our Continual Professional Development United Kingdom (CPUDK)-accredited University Hospitals Birmingham (UHB) Major Trauma Service (MTS) affiliated programme consisted of seven biweekly pre-recorded sessions that were delivered online through the Moodle educational platform to University of Birmingham students. Pre- and post-randomised session-specific multiple-choice questions (MCQs) and anonymous feedback forms were administered. Results There were 489 student responses, with 63 students completing all seven sessions. On an 8-point scale, students’ objective knowledge scores increased by a mean of 1.2 ( p  < 0.001). Using a 5-point Likert scale, students also showed improvement in subjective outcomes including their confidence in assessing trauma patient (absolute difference (AD) 1.38, p  < 0.001), advising initial investigations and formulating initial management plans (AD 1.78, p  < 0.001) and thereby their confidence to manage a trauma patient overall (AD 1.98, p  < 0.001). A total of 410 student responses endorsed the online delivery of SATMAS through Moodle and recommended SATMAS to future medical students. Conclusion SATMAS has demonstrated positive student feedback and extensive recruitment from only one centre, demonstrating that our programme can be an indispensable low-cost learning resource that prepares undergraduate medical students for their trauma exams and informs the implementation of clinical skills required by all doctors. We publish our pilot study findings to encourage similar teaching programmes to be adopted at other universities nationally and internationally, to synergistically benefit students, tutors, and ultimately patients, on a larger scale.

The COVID-19 pandemic has impacted students learning, with the time off resulting in students 'de-skilling', increasing concerns for upcoming observed structured clinical examinations. Foundation Year 1 (F1) doctors (F1s), despite being expected to teach, rarely receive formal preparation, with COVID-19 exacerbating opportunities to practice. As such, a national orthopaedic teaching programme was designed to provide F1s with opportunities to develop their teaching skills and to synergistically teach medical students how to perform clinical orthopaedic examinations. Six weekly sessions, each delivered by two newly qualified F1 tutors, on each joint examination were delivered online via Zoom Video Communications (USA). Presession and postsession multiple choice questions (MCQs) were provided to students to assess improvement in knowledge. Anonymous feedback forms were provided to both students and tutors. Of the 341 students that attended, 87.1% provided feedback. 86.2% felt that they had de-skilled due to time off, with a mean 15 weeks off from placement. Based on a 5-point Likert scale, students displayed a mean improvement in confidence (1.9±1.1, p<0.001) and MCQ scores (1.4±1.3, p<0.001) before and after the sessions. 91.6% and 95.3% agreed that the use of online teaching increased attendance and laid the foundation for practice. Of the six tutors, all reported improvement in confidence to teach and teaching skills. We demonstrate that online delivery of clinical orthopaedic examinations is effective, increasing the knowledge and confidence of students, while providing opportunities for F1s to teach. We present our findings to encourage similar teaching programmes to be adopted at other locations and specialties, to synergistically benefit students, doctors and ultimately, patients.

Despite the shift towards consultant-led care, many patients with trauma are still seen by junior doctors. Previous research has demonstrated that junior doctors feel unprepared to work in acute care but there is a paucity of recent research in trauma specifically. Thus, a national study is required to investigate the current state of undergraduate trauma teaching and identify specific areas for improvement. Between August and September 2020, a 35-item structured questionnaire was distributed among doctors who graduated from UK medical schools within the last 4 years. The questionnaire retrospectively assessed their experience of trauma teaching at medical school and their confidence to diagnose and manage patients with trauma. 398 responses were recorded from graduates of 39 UK medical schools. With 79.6% reporting only 0-5 hours of bedside trauma teaching and 51.8% reporting less than 20 hours in Accident and Emergency, graduates reported that trauma teaching was deficient compared with other specialties (78.1%). The majority of graduates were not confident in the initial assessment (72.9%) of a patient with trauma and almost all felt that a short course in trauma would be useful (93.7%). 77.4% of students felt that online learning would be beneficial and 92.9% felt that simulation would be useful. There is lack of standardised undergraduate trauma teaching nationally; a formal undergraduate teaching to ensure that new graduates are competent in the management of trauma would be supported by students. It is likely that a blended learning approach, incorporating e-learning with traditional teaching and clinical experience would be well received.

Carausius morosus, the Indian stick insect, is a slender twig-like insect endemic to India. Though widely introduced through captivity around the world and commonly used in laboratories or kept as a household pet, standardized animal husbandry laboratory protocols are lacking. Here we report detailed laboratory culture conditions for C. morosus. We maintain stocks at 23C, 70% relative humidity, and a 12:12 hour light-dark photoperiod. This culture has been successfully sustained under these conditions for over two years, with standardized protocols in place for dietary and cage setup conditions. We also report methods for egg and hatchling care to support ongoing experiments with C. morosus. These standardized methods improve reproducibility and accessibility, enabling the broader use of C. morosus as a laboratory model system for developmental, behavioral, and physiological studies.Competing Interest StatementThe authors have declared no competing interest.Funder Information DeclaredU.S. National Science Foundation, IOS-22207477Howard Hughes Medical Institute, https://ror.org/006w34k90

Although bacterial genomes encode numerous potential toxins, it is unclear how evolution drives the specificity of these important virulence factors. Using an insect CRISPR screen, we identified the transmembrane protein Attractin (ATRN) as the receptor for Nigritoxin (Ntx), a Vibrio toxin that causes seasonal shrimp pandemics. We found that Ntx's effector \"warhead\" inhibits translation via a previously uncharacterized mechanism. Moreover, we show that two related toxins require ATRN for entry but possess unrelated effector domains. One has a Rho-GTPase AMPylation function and the other an actin-targeting/proteolysis function. Our findings reveal the mechanism of Ntx entry and toxicity and show that the ATRN-targeting domain can deliver disparate effector domains, strongly indicating that this class of exotoxins can evolve as modular proteins using a common entry domain.