bluuebunny/crossref_metadata_2025 huggingface dataset:
Preoperative Considerations for Teenagers Undergoing Orthopaedic Surgery: VTE Prevention, Mental Health Assessment, Vaping, and Drug Addiction
Authors: Shore Benjamin J. , Flaugh Rachel , Shannon Brett A. , Curran Patrick , Hogue Grant
Published: June 2021

Introduction:

Adolescents undergoing pediatric orthopaedic surgery typically experience an uncomplicated postoperative course. However, adolescence represents a unique transition period from pediatric to adult physiology. As a result, the astute pediatric orthopaedic surgeon will be aware of unique medical and social scenarios which are relevant to adolescents during the perioperative course including the risk of venous thromboembolism (VTE), prevalence of mental health conditions, and rising use of electronic cigarettes or “vaping” to consume nicotine and cannibas.

Discussion:

Adolescents are at a greater risk of VTE after pediatric orthopaedic surgery. In particular, adolescent females with a family history of blood clotting disorders and those with a change in mobility after surgery should be considered for prophylaxis. The prevalence of adolescent mental health conditions including anxiety, depression, and behavioral issues is increasing in the United States. Higher levels of preoperative anxiety and the presence of mental health pathology are associated with slower recovery, higher levels of postoperative pain, and the increased likelihood for chronic pain. Several quick screening instruments are available to assess adolescents for preoperative anxiety risk, including the Visual Analogue Scale for Anxiety or the Amsterdam Perioperative Anxiety Information Scale. Unfortunately, electronic cigarettes have become increasingly popular for the consumption of nicotine and cannabis among adolescents. Preoperative use of combustive cigarettes (nicotine/cannabis) represents perioperative risks for induction/anesthesia, postoperative pain, and analgesia requirements and issues with delayed wound and fracture healing.

Conclusions:

VTE, underlying mental health conditions, and usage of nicotine and cannabis are clear detriments to the recovery and healing of adolescent patients following orthopaedic surgery. Therefore, standardized screening for adolescents before orthopaedic surgery is indicated to identify perioperative risk factors which have negative impacts on functional outcomes.
Radius Shaft Fractures—What Alignment is Acceptable at What Age? Plates or Flexible Nails?
Authors: Ho Christine A.
Published: June 2021

Introduction:

The transition from pediatric to adolescent fractures can lead to uncertainty on what level of surgical correction is warranted as remodeling is limited in these older patients.

Discussion:

Adolescent diaphyseal radial shaft fractures present several unique challenges; the radial bow must be restored to preserve forearm rotation and there are several clinical scenarios where plating, even in the skeletally immature child, is strongly recommended and will have more reliable results over flexible intramedullary nails. In addition, judging how much angulation, rotation, and displacement will remodel in the older child can be a challenging decision, even for experienced pediatric orthopaedists.

Conclusion:

This overview discusses parameters for acceptable alignment in these fractures, when surgical fixation should be considered, and circumstances where plating should be considered over flexible nails.
A Foot to Last a Lifetime—Is Hindfoot Fusion Ever Appropriate for Pediatric Orthopaedic Conditions?
Authors: Kelly Derek M.
Published: June 2021

Introduction:

Hindfoot deformities in the pediatric population can be painful and result in severe limitations. Although arthrodesis is known to relieve pain, there are concerns over its use because of the risk that adjacent joint degenerative disease could result, leading to a new source of pain, dysfunction, and additional surgical procedures later in life.

Methods:

A literature review of hindfoot fusions in children focused on articles with the highest levels of evidence and those of particular historical significance. Case examples were obtained by querying the billing records of the local clinic system for Current Procedural Terminology (CPT) codes of hindfoot arthrodeses. Surgery procedures were performed by both fellowship-trained pediatric orthopaedists and fellowship-trained foot and ankle orthopaedic surgeons.

Results:

The medical literature for this topic generally is divided into 2 main types of articles: those that describe hindfoot fusion procedures for a specific type of deformity or disease process and those that provide the indications and results of a single type of arthrodesis. Long-term follow-up studies are limited.

Discussion:

The long-term risk of degeneration to adjacent joints has been studied, with mixed results. Other problems, such as recurrent deformity, overcorrection, pseudarthrosis, osteonecrosis, and foot shortening also may be encountered over intermediate-term follow-up. Nevertheless, in properly chosen patients, hindfoot fusion can offer a great improvement over the damaging and destructive deformities of the feet caused by a variety of diseases and traumatic injuries. Hindfoot fusions have been used for the treatment of foot deformities secondary to severe trauma, hemophilia, tarsal coalition, clubfoot, and neurological disease such as polio, static encephalopathy, hereditary motor and sensory neuropathies, and myelodysplasia.

Conclusions:

Hindfoot fusion in a child or adolescent should be considered only for the most extreme cases when all other options, short of amputation, have been considered or exhausted. While these procedures can offer improvement in the challenging cases, the surgeon should be aware of their long-term implications, including adjacent joint degeneration.
What Happens to Our Neuromuscular Patients in Adulthood: Pathway to Independence and Maximal Function
Authors: Koop Steven E. , Shrader M. Wade
Published: June 2021

Background:

Children with neuromuscular disorders regularly seek care from pediatric orthopaedic surgeons. These conditions can have a significant impact on the growth and development of children and their function and well-being as adults. Questions exist about the long-term outcomes of musculoskeletal interventions performed during childhood.

Methods:

A search of recent literature pertaining to the musculoskeletal and functional consequences of cerebral palsy, spina bifida, Duchenne muscular dystrophy, and spinal muscle atrophy was performed. Information from those articles was combined with the experience of the authors and their institutions.

Results:

Neuromuscular conditions can result in limb and spine deformities that lead to impaired physical function. Orthopaedic interventions during childhood can improve function and well-being and can be durable into adulthood. Unfortunately, many individuals with these conditions transition to adult health care that lacks the informed, collaborative multidisciplinary care they received as children. This can lead to unmet health care needs and a shortage of long-term natural history and outcome studies that would inform the care of children today.

Conclusions:

Adults with childhood-onset neuromuscular conditions need, and deserve, dedicated health care systems that include the best aspects of the care they received as children. Pediatric orthopaedic surgeons have a role in promoting the development of such systems and a responsibility to learn from their adult patients.

Level of Evidence:

Expert Opinion.
Treatment Options for End-Stage Hip Disease in Adolescents: To Replace, Fuse, or Reconstruct?
Authors: Novais Eduardo N.
Published: June 2021

Introduction:

This paper aims to review the indications criteria for the surgical treatment of adolescents with hip osteoarthritis and summarize the contemporary techniques that orthopaedic surgeons can apply for hip reconstruction.

Discussion:

Hip osteoarthritis remains a concerning burden to North American society. While the rate of total hip replacement (THR) in younger patients has increased in the last decades, younger patients may have a higher risk of revision hip replacement because of their increased level of activity and expected patient longevity compared with the elderly. Increased demand for multiple revision surgeries is a concern for the adolescent patient. Although in general THR has been increasingly recommended for the treatment of end-stage osteoarthritis secondary to pediatric hip disorders, hip arthrodesis remains a beneficial alternative for the treatment of severe hip disease secondary to infection and for patients who desire to engage in a very active lifestyle. Hip preservation procedures are ideally performed in the prearthritic stage or in hips with minimal degeneration to preserve the joint and achieve the most optimal outcomes. However, adolescents and young adults with moderate and rarely advanced arthritis may benefit from surgical treatment using hip preservation techniques.

Conclusions:

Treatment of adolescents with pain and dysfunction because of end-stage hip disease is challenging and controversial. THR and arthrodesis are the 2 principal alternatives. However, in particular circumstances, hip reconstruction may be recommended.
Prospective Study on Tension Band Plating: Most Patients are Not Returning to Normal Activities 1 Month Following Surgery
Authors: Grégoire Vanessa , Skaggs David L. , Jalloh Hulaimatu , Stevens Peter M. , Anesi Trevor , Holmes Stephanie , Heagy Victoria , Andras Lindsay M.
Published: June 2021

Background:

Tension band plating for temporary hemiepiphysiodesis has been reported by several authors as simple and effective for treating angular deformities of the lower limb. Anecdotally, patients have reported higher pain levels than expected given the small size of incision and relatively minimal amount of dissection, and we sought to investigate this further.

Methods:

Patients 16 years old or less with lower extremity angular deformities or limb length inequality were prospectively enrolled before tension band plating from 2 pediatric institutions from July 2016 to December 2018. Participants completed postoperative questionnaires regarding their pain and activity level. Pain was assessed using the FACES Pain Scale. Patients were included if they completed the 1 month survey.

Results:

Of the 48 patients that met inclusion criteria (mean age at surgery: 13.1 y; range: 7 to 16 y), 39 patients completed the survey at 3 months postoperatively. There was a significant change in pain level between 1 week and 1 month postoperatively (P<0.001). Eighty-three percent (34/41) of patients were still taking pain medication at 1 week, which decreased to 38% (18/48) at 1 month. At 3 months, 21% (8/39) patients reported they were still using pain medication. At 1 month, 65% of patients (31/48) had not returned to their prior activity level. Of the 39 patients who played sports, 59% (23/39) still had not fully returned to sports at 1 month.

Conclusion:

At 1 month following tension band plating, 65% of patients had not returned to their preoperative activity level, and 38% were taking pain medications. Although the tension band plate and surgical incision is small in size, patients and parents should be counseled that there are significant activity limitations and pain levels for a month or longer in many patients.

Level of Evidence:

Level II.
Bacteriological features of implant-related infection after fracture operation and methods to identify pathogenic bacteria
Authors: Ma Xianzhi , Qi Wanle , Chao Shilan , Wang Zhendong
Published: June 2021

Background:

This study summarizes the clinical features of bacterial cultures collected from infection after fracture fixation (IAFF), compares the results of bacterial culture from debridement versus sinus tract samples, and examines the relationship between the number of culture samples and success in identifying pathogenic bacteria.

Methods:

A retrospective analysis of 255 patients (202 males and 53 females) with IAFF from August 2017 to April 2020 was done. Common infection sites were femur, tibiofibular, hip joint, ankle, and humerus. Debridement was performed 438 times. Samples collected during debridement were sent for bacterial culture 295 times, with a variable number of culture samples taken. All samples were sent for general bacterial culture; results were summarized and success identifying pathogenic bacteria was compared for different culture sample sizes. Results from sinus tract samples (n=57) were also compared with pathogenic bacteria found in debridement samples.

Results:

In patients with IAFF, debridement samples had more gram-positive than gram-negative bacteria; the top 5 bacteria presented were: Staphylococcus aureus, Staphylococcus epidermis, Pseudomonas aeruginosa, Enterobacter cloacae, and Escherichia coli. Bacteria were found in 75.6% of culture samples from debridement. Five samples showed the highest rate of detection (90.6%) and 82.8% were identified with pathogenic bacteria. The cultural results from the sinus tract matched with those from the debridement samples 67.30% of the time, while 42.10% matched the pathogenic bacteria.

Conclusions:

For bacterial culture, 5 or more samples can improve the pathogen detection rate. Bacterial culture of sinus tract samples is not recommended as the basis for choosing appropriate antibiotics.
Testing for Implicit Gender Bias among Plastic Surgeons
Authors: Bucknor Alexandra , Ngaage Ledibabari M. , Taylor Kirsten J. , Kamali Parisa , Rakhorst Hinne A. , Mathijssen Irene M. J. , Furnas Heather
Published: June 2021

Background:

The aim of this study was to examine for the presence of implicit bias within the field of plastic surgery using a gender-specific Implicit Association Test (IAT), specifically looking at gender and career stereotypes.

Methods:

A Gender-Career/Family Implicit Association Test was developed and distributed to the international plastic surgery community. Mean scores were calculated. Respondents were provided with an automated summary interpretation of their results, categorizing association for a particular grouping of gender and career/family as a little or no, slight, moderate, or strong. Respondents were also asked a series of demographic and post-IAT questions.

Results:

Ninety-five responses were available for analysis. Overall, respondents showed a moderate-to-strong association of male + career / female + family compared with the reverse, which was statistically significant. Nearly half of the respondents thought they might have an implicit gender-related bias; however, 50% post-test would not change their behavior based on results, while 9.5% would.

Conclusions:

Plastics surgeons may have an unconscious tendency to associate men with a career and women with a family. Further steps must be taken to increase awareness and mitigate the impact of implicit gender bias.
A Case of Giant Congenital Melanocytic Nevus Treated with Combination Therapy of Autologous Mesh-skin Grafts and Cultured Epithelial Autografts
Authors: Im Seongwang , Yamanaka Hiroki , Tsuge Itaru , Katsube Motoki , Sakamoto Michiharu , Morimoto Naoki
Published: June 2021

Surgical excision of a giant congenital melanocytic nevus (GCMN) results in a full-thickness skin defect that is usually difficult to reconstruct even with tissue expansion or skin grafting. Here, we report the first case of GCMN treated with a combination of cultured epithelial autografts (CEAs) and mesh-skin grafts to reconstruct a large skin defect after surgical excision. A 14-month-old girl had a GCMN occupying 20% of the total body surface area of her neck and back. A 5-stage, full-thickness excision was performed between the age of 14 and 25 months. In each intervention, the wound after excision was covered with 1:6 mesh-skin grafts and CEAs, except for the neck, where patch skin grafts and CEAs were used. The skin grafts and CEAs were engrafted without shedding and epithelialization was completed within 3-4 weeks. Eighteen months after the last surgery, a mesh-like scar remained, with no recurrence or severe contracture observed. The cosmetic appearances of the donor sites (the scalp and lower abdomen) were acceptable. The application of CEAs with mesh-skin grafts has been established for the treatment of severe burns. This combined method also provides a possible option for the treatment of GCMNs.
A Review and Measurement Study of the Central Mound Pedicle for Breast Reduction
Authors: Swanson Eric
Published: June 2021

Background:

The central mound approach to breast reduction has been the subject of recent interest in the literature. However, quantitative evaluation using measurements is lacking. This review was undertaken to objectively evaluate changes in breast dimensions, and to compare the results to a popular alternative method, vertical mammaplasty.

Methods:

An electronic search was performed using PubMed to identify all publications endorsing the central mound technique. Published lateral photographs were matched for size and orientation, with computer assistance. Measurements included breast projection, upper pole projection, lower pole level, breast mound elevation, nipple level, and breast parenchymal ratio. Results were compared with published measurement data for the vertical technique.

Results:

Twenty-three manuscripts were identified. Ten included photographs suitable for analysis. On average, breast projection decreased 1.1 cm after central mound breast reduction (P < 0.05). Upper pole projection dropped 0.4 cm (not significant). The lower pole level was raised 2.6 cm (P < 0.05). The nipple level was over-elevated 0.6 cm, on average. The breast parenchymal ratio increased by 0.54. A central mound dissection decreased breast projection. In contrast, publications using a vertical breast reduction demonstrated maintenance of upper pole and breast projection and a modest (<1 cm) increase.

Conclusions:

For each measurement comparison, the vertical method outperforms the central mound. Because of its anatomy and geometry, measurements show that the vertical method for breast reduction is more favorable than a central mound dissection. This method can also be used safely for secondary breast reductions.
Invasive Group A Streptococcus Infection in Children in Central Israel in 2012–2019
Authors: Canetti Michal , Carmi Amit , Paret Gideon , Goldberg Lior , Adler Amos , Amit Sharon , Rokney Assaf , Ron Merav , Grisaru-Soen Galia
Published: June 2021

Background:

Group A Streptococcus can cause serious and sometimes life-threatening disease in children. The past few years have witnessed a rise in invasive group A Streptococcus infection (iGASi) for unclear reasons. This study attempted to describe the epidemiology, the clinical and demographic characteristics and the outcomes associated with iGASi in hospitalized children in central Israel

Methods:

We retrospectively analyzed the medical records of children <18 years old discharged with a diagnosis of iGASi between January 2012 and December 2019. Clinical, laboratory and microbiologic data, and immunization status were retrieved. The patients were divided into severe and nonsevere groups based on their clinical presentation. The emm type was determined at the national reference center.

Results:

A total of 167 patients with 206 positive cultures for group A Streptococcus were identified. Hospitalizations for iGASi increased from 701 to 958 per 100,000 admissions between 2012–2015 and 2016–2019, respectively, representing an increase of 37%. The majority of the isolates were from the otolaryngologic system followed by blood, deep soft tissue and respiratory sites. Uncomplicated mastoiditis was the most common diagnosis, followed by bacteremia. Pneumonia was the main diagnosis in the severe group (39.4%).

Conclusions:

The admissions because of iGASi in children <18 years old increased during the last 8 years. Surveillance systems and prospective studies should be conducted to expend our understanding of the epidemiology of iGASi in children, better assess the pathogenesis and specific risk factors and monitor changes in emm-type distribution.
Stable Incidence of Invasive Pneumococcal Disease in Children in Northern France From 2014 Through 2018
Authors: Coronas Emilie , Martinot Alain , Varon Emmanuelle , Wallet Frédéric , Dubos François
Published: June 2021

Background:

The 13-valent pneumococcal conjugate vaccine (PCV13) has been recommended in France since June 2010. The aim of this study was to evaluate the trends in the incidence of invasive pneumococcal disease (IPD) resulting in hospitalization of children younger than 18 years of age, to identify the vaccination status of these patients and to analyze the serotypic evolution of the pneumococci involved in the various types of IPD.

Methods:

This multicenter retrospective study reviewed all admissions of children younger than 18 years of age for IPD from 2014 through 2018 in all hospitals with a pediatric or neonatal unit in northern France. Data completeness was obtained by matching 3 independent databases. The incidence of IPD resulting in hospitalization was calculated per age group. The clinical course and the vaccine and nonvaccine types were described overall and by the IPD type.

Results:

One hundred thirty cases of IPD were identified: 51 with bacteremia, 45 meningitis, 28 pneumonia or pleuropneumonia and 6 arthritis. The IPD incidence ranged from 2.4 to 3.0/100,000 in children under 18 years of age (95% confidence intervals, 1.4–3.3 and 1.9–4.1, respectively), and from 9.5 to 15.9/100,000 in children under 2 years of age, with no significant differences over time. Nonvaccine types were predominant (81%), mainly 24F, 23B and 10A. Vaccine serotype 3 was involved in 10 cases of IPD, 2 of which were in correctly vaccinated children. Two cases of IPD could have been prevented by vaccination. Neurologic sequelae affected 26% of these children (62% of those with meningitis). Six children died from IPD (5%).

Conclusion:

The incidence of IPD resulting in hospitalization remained stable in northern France during the study period, with no significant increase in nonvaccine types. Further surveillance is needed to adjust the vaccination strategy if necessary.
Special MRI Techniques to Suss out Spontaneous Cerebrospinal Fluid Leaks
Authors: Yushvayev Ernest , Delman Bradley N. , Kirsch Claudia F.E.
Published: June 2021

Anterior skull base cerebrospinal fluid (CSF) fistulas result from skull base osteodural defects, allowing subarachnoid space CSF to escape into pneumatized cavities such as the paranasal sinuses and nasal fossa. Precise localization, characterization, and effective treatment of CSF leaks is essential to prevent meningitis, treatment failure, or recurrence. Advances in magnetic resonance imaging have improved radiologists’ ability to localize and characterize anterior skull base CSF fistulas. This article reviews new imaging techniques enabling diagnostic location of CSF fistulas, with an emphasis on magnetic resonance imaging–based techniques.
A rare-event study of frequency regulation and contingency services from grid-scale batteries
Authors: Patrice Goodridge Maldon , Moriarty John , Pizzoferrato Andrea
Published: June 2021

We perform a rare-event study on a simulated power system in which grid-scale batteries provide both regulation and emergency frequency control ancillary services. Using a model of random power disturbances at each bus, we employ the skipping sampler, a Markov Chain Monte Carlo algorithm for rare-event sampling, to build conditional distributions of the power disturbances leading to two kinds of instability: frequency excursions outside the normal operating band, and load shedding. Potential saturation in the benefits, and competition between the two services, are explored as the battery maximum power output increases.

This article is part of the theme issue ‘The mathematics of energy systems’.
Characterisation of Staphylococcus argenteus carried by healthy Royal Marines: a molecular epidemiology case-study
Authors: Jauneikaite Elita , Pichon Bruno , Mosavie Mia , Fallowfield Joanne L. , Davey Trish , Thorpe Neil , Nelstrop Andrew , Sriskandan Shiranee , Lamb Lucy E
Published: June 2021

Objectives

During a prospective study of S. aureus carriage in Royal Marines (RM) recruits, six S. argenteus strains were identified in four recruits undertaking military training together. As S. argenteus sepsis leads to mortality similar to S. aureus, we determined the potential for person-to-person transmission, to evaluate future outbreak risk.

Methods

We used whole-genome sequencing to characterise S. argenteus and investigate phylogenetic relationships between isolates. Participant colonisation with S. aureus and skin and soft tissue infection acquisition were recorded.

Results

All six S. argenteus strains were spa-type t5078, ST2250. Strains were detected in 4/40 recruits in the same troop (training cohort) in weeks 1, 6 or 15 of training. No mec, tsst or LukPV genes were detected. We identified differences of 10-35 core SNPs between S. argenteus from different recruits. In two recruits, two S. argenteus strains were isolated; these could be distinguished by 3 and 15 core SNPs in each case. S. argenteus was not identified in any one of the other 21 participating troops (1,012 recruits).

Conclusions

The identification of S. argenteus within a single troop from the total recruit population supports a common source for transmission, supported by SNP analysis. The high number of SNPs between some isolates may indicate a common source of diverse isolates or a high level of S. argenteus mutation in carriage. S. argenteus ST2250 is a newly recognised lineage; a better understanding of the frequency of genetic changes during transmission and transition from asymptomatic carriage to disease is required.
Outcomes of SARS-CoV-2 Infection in Patients with Chronic Liver Disease and Cirrhosis: a N3C Study
Authors: Ge Jin , Pletcher Mark J. , Lai Jennifer C. ,   for the N3C Consortium
Published: June 2021

Background and Aims

In patients with chronic liver diseases (CLD) with or without cirrhosis, existing data on the risk of adverse outcomes with SARS-CoV-2 infection have been mixed or have limited generalizability. We used the National COVID Cohort Collaborative (N3C) Data Enclave, a harmonized electronic health record (EHR) dataset of 5.9 million nationally-representative, diverse, and gender-balanced patients, to describe outcomes in patients with CLD and cirrhosis with SARS-CoV-2.

Methods

We identified all chronic liver diseases patients with and without cirrhosis who had SARS-CoV-2 testing documented in the N3C Data Enclave as of data release date 5/15/2021. The primary outcome was 30-day all-cause mortality. Survival analysis methods were used to estimate cumulative incidences of death, hospitalization, and mechanical ventilation, and to calculate the associations of SARS-CoV-2 infection, presence of cirrhosis, and demographic and clinical factors to 30-day mortality.

Results

We isolated 217,143 patients with CLD: 129,097 (59%) without cirrhosis and SARS-CoV-2 negative, 25,844 (12%) without cirrhosis and SARS-CoV-2 positive, 54,065 (25%) with cirrhosis and SARS-CoV-2 negative, and 8,137 (4%) with cirrhosis and SARS-CoV-2 positive. Among CLD patients without cirrhosis, 30-day all-cause mortality rates were 0.4% in SARS-CoV-2 negative patients and 1.8% in positive patients. Among CLD patients with cirrhosis, 30-day all-cause mortality rates were 4.0% in SARS-CoV-2 negative patients and 9.7% in positive patients.

Compared to those who tested SARS-CoV-2 negative, SARS-CoV-2 positivity was associated with more than two-fold (aHR 2.43, 95% CI 2.23-2.64) hazard of death at 30 days among patients with cirrhosis. Compared to patients without cirrhosis, the presence of cirrhosis was associated with a three-fold (aHR 3.39, 95% CI 2.96-3.89) hazard of death at 30 days among patients who tested SARS-CoV-2 positive. Age (aHR 1.03 per year, 95% CI 1.03-1.04) was associated with death at 30 days among patients with cirrhosis who were SARS-CoV-2 positive.

Conclusions

In this study of nearly 220,000 CLD patients, we found SARS-CoV-2 infection in patients with cirrhosis was associated with 2.43-times mortality hazard, and the presence of cirrhosis among CLD patients infected with SARS-CoV-2 were associated with 3.39-times mortality hazard. Compared to previous studies, our use of a nationally-representative, diverse, and gender-balanced dataset enables wide generalizability of these findings.
Individual-based modeling of COVID-19 transmission in college communities
Authors: Huang Qimin , Ndeffo-Mbah Martial , Mondal Anirban , Lee Sara , Gurarie David
Published: June 2021

The ongoing COVID-19 pandemic has created major public health and socio-economic challenges across the United States. Among them are challenges to the educational system where college administrators are struggling with the questions of how to reopen in-person activities while prioritizing student safety. To help address this challenge, we developed a flexible computational framework to model the spread and control of COVID-19 on a residential college campus. The modeling framework accounts for heterogeneity in social interactions, activities, disease progression, and control interventions. The relative contribution of classroom, dorm, and social activities to disease transmission was explored. We observed that the dorm has the highest contribution to disease transmission followed by classroom and social activities. Without vaccination, frequent (weekly) random testing coupled with risk reduction measures (e.g. facial mask,) in classroom, dorm, and social activities is the most effective control strategy to mitigate the spread of COVID-19 on college campuses. Moreover, since random screening testing allows for the successful and early detection of both asymptomatic and symptomatic individuals, it successfully reduces the transmission rate such that the maximum quarantine capacity is far lower than expected to further reduce the economic burden caused from quarantine. With vaccination, herd immunity is estimated to be achievable by 50% to 80% immunity coverage. In the absence of herd immunity, simulations indicate that it is optimal to keep some level of transmission risk reduction measures in classroom, dorm, and social activities, while testing at a lower frequency. Though our quantitative results are likely provisional on our model assumptions, extensive sensitivity analysis confirms the robustness of their qualitative nature.

Highlights

Individual-based model for college communities with structured students’ interactions.

We evaluated COVID-19 control measures needed for in-person college reopening.

Without vaccination, high testing frequency is paramount for outbreak control.

With high vaccination coverage, some NPIs are still needed for outbreak control.

General access website tool was developed for the public to explore simulations.

Graphic Abstract
NEW CORONAVIRUS IN PREGNANT WOMEN. Maternal and perinatal outcomes
Authors: Sánchez Jaime , Espinosa Jorge , Caballero Luis Carlos , Campana B Sara , Quintero Arelys , Luo Carlos , Ng C Jorge , de Gracia Rafael , Vigil-De Gracia Paulino
Published: June 2021

Objectives

To report the maternal and neonatal results of patients infected with COVID-19 in Panama.

Methods

The study is based on the analysis of pregnant women with COVID-19, in 5 hospitals in the Republic of Panama. The inclusion criteria were: Patients with or without symptoms, positive RT-PCR for SARS-CoV-2 in the period from March 23 to 6 months after, whose births were attended in one of those 5 hospitals and who signed the consent. Data was obtained at the time of diagnosis of the infection and at the time of termination of pregnancy for the mother and newborn.

Results

253 patients met the inclusion criteria. Most were diagnosed in the third trimester (89.3%). 10.3% of the patients presented in a severe form of COVID-19. The most frequent complication was pre-eclampsia and if we add gestational hypertension they represent 21.2%; most of the patients terminated the pregnancy by caesarean section (58%). 26.9% (95% CI 21.3-32.9%) of the births were premature, and perinatal mortality was 5.4% (95% CI 3.0-9.0%). There was a need for mechanical ventilation in 5.9% (95% CI 3.6-9.6%) of the cohort and there were four maternal deaths (1.6% - 95% CI 0.6-4.0%).

Conclusions

This study of pregnant women infected with COVID-19 and diagnosed with RT-PCR shows serious maternal complications such as high admission to the ICU, need for mechanical ventilation and one death in every 64 infected. Frequent obstetric complications such as hypertension, premature rupture of membranes, high rate of prematurity and perinatal lethality were also seen.
Caregiver Perspectives of Pre-Transplant Evaluation in Children
Authors: Salmon Eloise C. , Barr Laura G. , Hill Douglas L. , Shea Judy A. , Amaral Sandra
Published: June 2021

Pre-transplant evaluation is mandated by Centers for Medicare and Medicaid Services, but there is wide institutional variation in implementation, and the family experience of the process is incompletely understood. Current literature largely focuses on adult transplant recipients. This qualitative study begins to fill the knowledge gap about family experience of the pre-transplant evaluation for children through interviews with caregivers at a large pediatric transplant center. Prominent themes heard from caregivers include (1) the pre-transplant evaluation is overwhelming and emotional, (2) prior experiences and background knowledge frame the evaluation experience, and (3) frustration with communication among teams is common. These findings are relevant to efforts by transplant centers to optimize information delivery, minimize concrete barriers, and address healthcare systems issues.
The Relative Importance of Mindfulness Facets and Their Interactions: Relations to Psychological Symptoms in Chronic Pain
Authors: Azizi Zahra , Jandaghi Gholamreza , Firoozi Manijeh , Zia-Tohidi Ali , Ebnerasouli Shahrokh
Published: June 2021

Objectives

This study had three objectives: first, to investigate the relative importance of the five mindfulness facets to negative affect (NA) among patients with chronic musculoskeletal pain; second, to test the hypothesis that observing is associated with lower NA only if occurs in an accepting manner; and third, to investigate the relation between mindfulness and obsessive–compulsive symptoms (OCS).

Methods

One hundred and nineteen patients with chronic musculoskeletal pain filled the Five-Facets Mindfulness Questionnaire (FFMQ), the Depression, Anxiety, Stress Scale (DASS), and the Obsessive– compulsive Inventory-Revised (OCI-R). A latent variable was constructed to represent NA. Multiple regression analysis was conducted, and several indices of relative importance were calculated.

Results

Except for Observing, all mindfulness facets had significant bivariate and unique relation with NA. Acting with Awareness was the most important predictor, followed by Nonjudging and Describing. The contribution of Nonreactivity was small. Regarding the second objective, the Observing × Nonjudging and Observing × Nonreactivity interactions were not significant. Finally, the five facets of mindfulness explained about one-half of the variance in obsession and one-fifth of the variance in compulsion. After excluding the shared variance between obsession and compulsion, mindfulness was only related to obsession.

Conclusions

Except for Observing, all mindfulness facets seem to have unique contributions to psychological symptoms; among them, Acting with Awareness seems most important. Current evidence is inconsistent in supporting the moderating role of acceptance in the influence of observing. Finally, in the context of OCS, it seems that mindfulness is more related to obsession than compulsion.
Sociodemographic factors associated with Public knowledge of dementia in a Cuban population
Authors: Fernández-Fleites Zoylen , Broche-Pérez Yunier , Eccleston Claire , Jiménez-Puig Elizabeth , Castillo Evelyn Fernández
Published: June 2021

Objectives

To explore knowledge and beliefs among a cross-section of the Cuban adult population with regard to dementia risk factors and to determine the demographic variables related with it.

Study design

A cross-sectional survey was carried out on 1004 Cubans.

Methods

The survey measured the importance placed on dementia, risk reduction knowledge and the actions to prevent it. Logistic regression was undertaken to identify variables associated with knowledge.

Results

Most respondents (47.5%) believe that dementia risk reduction should start before age of 40. Cognitive stimulation and physical activities were selected with major frequency. Being older than 48 years, having previous contact with dementia and university education increases the probability of having healthy lifestyles.

Conclusions

The exploration of demographic variables allows the prediction of likelihood to know about or have positive beliefs in relation to dementia. They should be contemplated into strategies for dementia prevention in Cuban population.
The effect of pre-anaesthetic assessment clinic: a systematic review of randomised and non-randomised prospective controlled studies
Authors: Kristoffersen Eirunn Wallevik , Opsal Anne , Tveit Tor , Berg Rigmor C , Fossum Mariann
Published: June 2021

Objectives

The aim of this systematic review was to examine the effectiveness of pre-anaesthetic assessment clinics (PACs) implemented to improve quality and patient safety in perioperative care.

Design

Systematic review.

Data sources

The electronic databases CINAHL Plus with Full Text (EBSCOhost), Medline, and Embase (OvidSP) were systematically searched from 1st April, 1996 to 4th February, 2021.

Eligibility criteria

The main inclusion criterion was that the study, using empirical quantitative methods, addressed the effectiveness of PACs.

Data extraction and synthesis

Titles, abstracts, and full texts were screened in duplicate by two authors. Risk of bias assessment, using the Joanna Briggs Institute critical appraisal checklist for quasi-experimental studies, and data extraction were performed by one author and checked by the other author. Results were synthesised narratively owing to the heterogeneity of the included studies.

Results

Seven prospective controlled studies were conducted. Most studies had a high risk of bias. Three studies reported a significant reduction in the length of the hospital stay, and two studies reported a significant reduction in cancellation of surgery for medical reasons when patients were seen in the PAC. In addition, the included studies presented mixed results regarding anxiety in patients.

Conclusion

This systematic review demonstrated a reduction in the length of hospital stay and cancellation of surgery when the patients had been assessed in the PAC. There is a need for high-quality prospective studies to gain a deeper understanding of the effectiveness of PACs.

PROSPERO registration number

CRD42019137724

ARTICLE SUMMARY

Strengths and Limitations of this study

Only prospective studies were included in this systematic review.

The systematic review was conducted in accordance with international guidelines.

Only seven studies were identified, highlighting the need for further research on pre-anaesthetic assessment clinics.

Overall, the quality of the included studies was low, and the current practice possesses limited evidence base.
Ambient air pollution and COVID-19 in National Capital Territory of Delhi, India: a time-series evidence
Authors: Singh Abhishek
Published: June 2021

Objectives

This study aimed to explore the short-term health effects of ambient air pollutants PM2.5, PM10, SO2, NO2, O3, and CO on COVID-19 daily new cases and COVID-19 daily new deaths.

Study design

A time-series design used in this study. Data were obtained from 1 April 2020 to 31 December 2020 in the National Capital Territory (NCT) of Delhi, India.

Methods

The generalized additive models (GAMs) were applied to explore the associations of six air pollutants with COVID-19 daily new cases and COVID-19 daily new deaths. We also conducted sensitivity analysis using the population mobility variable in terms of lockdowns.

Results

The GAMs revealed statistically significant associations of ambient air pollutants with COVID-19 daily new cases and COVID-19 daily new deaths. Besides, in sensitivity analysis after controlling for the population mobility, these associations became more prominent.

Conclusions

These findings suggest that governments need to give greater considerations to regions with higher concentrations of PM2.5, PM10, SO2, NO2, O3, and CO, since these areas may experience a more serious COVID-19 pandemic or, in general, any respiratory disease.
How does literacy affect speech processing? Not by enhancing cortical responses to speech, but by promoting connectivity of acoustic-phonetic and graphomotor cortices
Authors: Hervais-Adelman Alexis , Kumar Uttam , Mishra Ramesh K. , Tripathi Viveka N. , Guleria Anupam , Singh Jay P. , Huettig Falk
Published: June 2021

Previous research suggest that literacy, specifically learning alphabetic letter-to-phoneme mappings, modifies online speech processing, and enhances brain responses to speech in auditory areas associated with phonological processing (Dehaene et al., 2010). However, alphabets are not the only orthographic systems in use in the world, and hundreds of millions of individuals speak languages that are not written using alphabets. In order to make claims that literacy per se has broad and general consequences for brain responses to speech, one must seek confirmatory evidence from non-alphabetic literacy. To this end, we conducted a longitudinal fMRI study in India probing the effect of literacy in Devanagari, an abubgida, on functional connectivity and cerebral responses to speech in 91 variously literate Hindi-speaking individuals. Twenty-two completely illiterate participants underwent six months of reading and writing training. Devanagari literacy increases functional connectivity between acoustic-phonetic and graphomotor brain areas, but we find no evidence that literacy changes the way speech is processed, either in cross-sectional or longitudinal analyses. These findings shows that a radical reconfiguration of the neurofunctional substrates of online speech processing is not a universal result of learning to read, and raise the possibility that writing, not only reading, may be instrumental in moulding literate speech perception.

Significance Statement

It has come to be accepted that a consequence of being able to read is enhanced auditory processing of speech, reflected by increased cortical responses in areas associated with phonological processing. Here we find no relationship between literacy and the magnitude of brain response to speech stimuli in individuals who speak Hindi, which is written using a non-alphabetic script, Devanagari - an abugida. We propose that the exact nature of the script under examination must be considered before making sweeping claims about the consequences of literacy for the brain. Further, we find evidence that literacy enhances functional connectivity between auditory processing areas and graphomotor areas, suggesting a mechanism whereby learning to write, not only to read, might influence speech perception.
Mangrove forests mitigate coral bleaching under thermal stress from climate change
Authors: Johnson Jack V. , Dick Jaimie T.A. , Pincheira-Donoso Daniel
Published: June 2021

Anthropogenic marine heatwaves are progressively degrading coral reef ecosystems worldwide via the process of coral bleaching (the expulsion of photosynthetic endosymbionts which reveals the coral skeleton). Corals from mangrove lagoons are hypothesised to increase resistance and resilience to coral bleaching, highlighting these areas as potential natural refuges for corals. Our study, the first conducted at a global-scale, reveals that coral reefs associated with mangrove forests are less likely to bleach under thermal stress, and thus, under scenarios of climate warming. The onset of severe bleaching occurred after 3.6 Degree Heating Weeks (DHW) in mangrove-associated reefs, compared to 2.23 DHW for non-mangrove associated reefs. These findings highlight the critical role of mangrove forests for coral reef persistence under climate change. Accordingly, conservation actions targeting the protection of mangroves are expected to contribute to the resilience and resistance of reef corals from bleaching as marine heatwaves continue to become more common.
Depth of sedation with dexmedetomidine modulates cortical excitability non-linearly
Authors: Cardone Paolo , Bodart Olivier , Kirsch Murielle , Sanfilippo Julien , Virgillito Alessandra , Martial Charlotte , Simon Jessica , Wannez Sarah , Sanders Robert D. , Laureys Steven , Massimini Marcello , Bonhomme Vincent , Gosseries Olivia
Published: June 2021

Background

Cortical excitability changes across conscious states, being higher in unconsciousness compared to normal wakefulness. Anaesthesia offers controlled manipulation to investigate conscious processes and underlying brain dynamics. Among commonly used anaesthetic agents, dexmedetomidine (DEX) effects are not completely known. In this study, we investigated cortical excitability as a function of DEX sedation depth.

Methods

Transcranial magnetic stimulation coupled with electroencephalography was recorded in 20 healthy subjects undergoing DEX sedation in four conditions (baseline, light sedation, deep sedation, recovery). Frontal and parietal cortices were stimulated using a neuronavigation system. Cortical excitability was inferred by slope, amplitude, positive and negative peak latencies of the first component (0-30 ms) of the TMS-evoked potential. Four Generalized Linear Mixed Models (GLMM) were used to test the effect of condition and brain region over cortical excitability.

Results

Dexmedetomidine modulated amplitude (P<0.001), slope (P=0.0001) and positive peak (P=0.042), while the targeted brain region affected amplitude (P<0.001), slope (P<0.001), and negative peak (P=0.001). The interaction between dexmedetomidine and region had an effect over amplitude (P=0.004), and slope (P=0.009) such that cortical excitability was higher during all conditions where DEX was present as compared to the baseline.

Conclusions

Cortical excitability changes non-linearly as a function of the depth of DEX sedation, with a paradoxical non dose-dependent increase. The effect is region-specific, being present in the frontal but not in the parietal region. Future research should extend the current results with other anaesthetics to better understand the link between cortical excitability and depth of sedation.
Characterizing the middle-age neurophysiology using EEG/MEG
Authors: Gula Justyna , Moiseeva Victoria , Ruiz Maria Herrojo , Cappelletti Marinella
Published: June 2021

Middle adulthood – the period of life between 40 and 60 years of age – is accompanied by important physical and emotional changes, as well as cognitive and neuronal ones. Nevertheless, middle age is often overlooked in neuroscience under the assumption that this is a time of relative stability, although cognitive decline, as well as changes in brain structure and function are well-established by the age of 60.

Here we characterized the middle-aged brain in the context of healthy younger and older adults by assessing resting-state electrophysiological and neuromagnetic activity in two different samples (N = 179, 631). Alpha and beta oscillations – two key ageing signatures – were analyzed in terms of spectral power and burst events. While posterior alpha power and burst rate features changed linearly with age, similarly to behavioral measures, sensorimotor beta power and burst rate properties varied non-linearly, with inflection points during middle age. The findings suggest that ageing is characterized by distinct spatial and temporal brain dynamics, some critically arising in middle age.