Internalizing and externalizing symptoms in children during the COVID-19 pandemic: a systematic mixed studies review.

Introduction: Given the vulnerability of children during the COVID-19 pandemic, paying close attention to their wellbeing at the time is warranted. The present protocol-based systematic mixed-studies review examines papers published during 2020-2022, focusing on the impact of the COVID-19 pandemic on children's internalizing/externalizing symptoms and the determinants thereof. Method: PROSPERO: CRD42022385284. Five databases were searched and the PRISMA diagram was applied. The inclusion criteria were: papers published in English in peer-reviewed journals; papers published between January 2020 and October 2022 involving children aged 5-13 years; qualitative, quantitative, and mixed studies. The standardized Mixed Method Appraisal Tool protocol was used to appraise the quality of the studies. Results: Thirty-four studies involving 40,976 participants in total were analyzed. Their principal characteristics were tabulated. The results showed that children's internalizing/externalizing symptoms increased during the pandemic, largely as a result of disengagement from play activities and excessive use of the internet. Girls showed more internalizing symptoms and boys more externalizing symptoms. Distress was the strongest parental factor mediating children's internalizing/externalizing symptoms. The quality of the studies was appraised as low (n = 12), medium (n = 12), and high (n = 10). Conclusion: Gender-based interventions should be designed for children and parents. The studies reviewed were cross-sectional, so long-term patterns and outcomes could not be predicted. Future researchers might consider a longitudinal approach to determine the long-term effects of the pandemic on children's internalizing and externalizing symptoms. Systematic review registration: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022385284, identifier: CRD42022385284.

Association of autoantibodies targeting endothelin type-A receptors with no-reflow in ST-elevation myocardial infarction.

BACKGROUND AND AIMS: No-reflow (NR), where the coronary artery is patent after treatment of ST-elevation myocardial infarction (STEMI) but tissue perfusion is not restored, is associated with worse outcomes. We aimed to investigate the relationship between autoantibodies activating endothelin-1 receptor type A (ETAR-AAs) and NR after primary percutaneous coronary intervention (PPCI) in STEMI. METHODS: We studied 50 patients (age 59 ± 11 years, 40 males) with STEMI who underwent PPCI within 6 h after the onset of symptoms. Blood samples were obtained from all patients within 12 h following PPCI for ETAR-AA level measurement. The seropositive threshold was provided by the manufacturer (>10 U/ml). NR was assessed by cardiac magnetic resonance imaging (MVO, microvascular obstruction). As a control group, 40 healthy subjects matched for age and sex were recruited from the general population. RESULTS: MVO was observed in 24 patients (48%). The prevalence of MVO was higher in patients with ETAR-AAs seropositivity (72% vs. 38%, p = 0.03). ETAR-AAs were higher in patients with MVO (8.9 U/mL (interquartile range [IQR] 6.8-16.2 U/mL) vs. 5.7 U/mL [IQR 4.3-7.7 U/mL], p = 0.003). ETAR-AAs seropositivity was independently associated with MVO (OR 3.2, 95% CI 1.3-7.1; p = 0.03). We identified ≥6.74 U/mL as the best cut-off for prediction of MVO (sensitivity 79%; specificity 65%; NPV 71%; PPV 74%; accuracy 72%). CONCLUSIONS: The ETAR-AAs seropositivity is associated with NR in STEMI patients. These findings may open up new options in the management of myocardial infarction even if confirmation in a larger trial is needed.

The promotion of mature theory of mind skills in educational settings: a mini-review.

After formal school entry, theory of mind development encounters a blooming period of growth intertwined with social and academic achievements and challenges. Within this framework, in last years researchers have proposed training programs to foster mature ToM skills, but also, to test causal pathways for the role that ToM development may have in broader cognitive and social outcomes. In the current mini-review we examine which training programs have been developed so far to enhance three key aspects of mature ToM skills: second-order false belief reasoning, the ability to put one's own ToM knowledge into use, and the mentalization of thoughts and emotions. We also illustrate effects of these activities on intra- and inter- personal competence. In its conclusion the paper provides considerations of both first achievements of research in this area and gaps to be addressed in future works.

Engineering Multicolor Radiative Centers in hBN Flakes by Varying the Electron Beam Irradiation Parameters.

Recently, hBN has become an interesting platform for quantum optics due to the peculiar defect-related luminescence properties. In this work, multicolor radiative emissions are engineered and tailored by position-controlled low-energy electron irradiation. Varying the irradiation parameters, such as the electron beam energy and/or area dose, we are able to induce light emissions at different wavelengths in the green-red range. In particular, the 10 keV and 20 keV irradiation levels induce the appearance of broad emission in the orange-red range (600-660 nm), while 15 keV gives rise to a sharp emission in the green range (535 nm). The cumulative dose density increase demonstrates the presence of a threshold value. The overcoming of the threshold, which is different for each electron beam energy level, causes the generation of non-radiative recombination pathways.

Teachers during the COVID-19 Era: The Mediation Role Played by Mentalizing Ability on the Relationship between Depressive Symptoms, Anxious Trait, and Job Burnout.

BACKGROUND: The COVID-19 outbreak caused severe changes in school activities over the past two years. Teachers underwent a re-planning of their teaching approaches, shifting from face-to-face teaching formats to remote ones. These challenges resulted in high levels of burnout. The identification of risk/protective factors contributing to burnout is crucial in order to inform intervention programs. Thus, we hypothesized a mediation role of teachers' mentalizing ability (processing of emotions, a component of mentalized affectivity) on the relationship between depression, anxiety, and depersonalization (burnout dimension). Two reverse models were computed. Job satisfaction, teachers' age and gender, school grade, and length of teaching experience served as covariates. METHODS: 466 (M(sd) = 46.2 (10.4) years) online questionnaires were completed by Italian teachers of primary (n = 204) and middle (n = 242) schools. Measures of burnout, depression, anxiety, and mentalization were administered. RESULTS: The findings corroborated our hypotheses: in all models, processing emotions served as a mediator on the relationship between depression, anxiety, and depersonalization, and on the reciprocal one. Job satisfaction positively impacted processing emotion, and negatively impacted depression and depersonalization; women teachers reported high levels of the anxious trait. CONCLUSIONS: Overall, it can be concluded that the ability to mentalize has a beneficial impact on teachers' well-being. Policymaking, clinical, and research implications were discussed.

Hyperthermic intraperitoneal chemotherapy (HIPEC) as adjuvant and therapeutic options for patients with advanced gastric cancer at high risk of recurrence or established peritoneal metastases: a single-centre experience.

Peritoneal metastases from gastric cancer (PM-GC) have a detrimental prognostic impact on survival and there is a lack of consensus regarding treatment. Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) may offer a chance for prolonged survival as compared to standard chemotherapy. This study aims to present our experience in the management of GC with CRS and HIPEC. This is a single-centre retrospective study. Patients were divided into two groups: patients with GC at high risk for developing PM-GC (adjuvant HIPEC group) and patients with PM-GC or positive peritoneal cytology (therapeutic CRS and HIPEC group). Overall survival (OS) and disease-free survival (DFS) were considered as outcome measures. A total of 41 patients with a GC primary received surgery and HIPEC: 14 patients (34.1%) were in the adjuvant HIPEC group, while 27 patients (65.9%) were in the therapeutic CRS and HIPEC group. In the adjuvant HIPEC group, the 1- and 3-year OS were 85.7% and 71.4%, while 1- and 3-year DFS were 71.4% and 64.3%, respectively. In the therapeutic CRS and HIPEC group, OS was 60.3% and 35.1% at 1 and 3 years, whereas 1- and 3-year DFS were 38% and 32.6%, respectively. Univariate survival analysis of patients in the therapeutic CRS and HIPEC group showed that the presence of lymph node metastasis and signet ring cell histology predicted worse OS, while PCI > 12 and lymph node metastasis were associated with decreased DFS. Treatment of highly selected patients with GC at high risk of peritoneal recurrence or established PM with CRS and HIPEC showed satisfactory results in terms of OS and DFS.

Periodic Structural Defects in Graphene Sheets Engineered via Electron Irradiation.

Artificially-induced defects in the lattice of graphene are a powerful tool for engineering the properties of the crystal, especially if organized in highly-ordered structures such as periodic arrays. A method to deterministically induce defects in graphene is to irradiate the crystal with low-energy (<20 keV) electrons delivered by a scanning electron microscope. However, the nanometric precision granted by the focused beam can be hindered by the pattern irradiation itself due to the small lateral separation among the elements, which can prevent the generation of sharp features. An accurate analysis of the achievable resolution is thus essential for practical applications. To this end, we investigated patterns generated by low-energy electron irradiation combining atomic force microscopy and micro-Raman spectroscopy measurements. We proved that it is possible to create well-defined periodic patterns with precision of a few tens of nanometers. We found that the defected lines are influenced by electrons back-scattered by the substrate, which limit the achievable resolution. We provided a model that takes into account such substrate effects. The findings of our study allow the design and easily accessible fabrication of graphene devices featuring complex defect engineering, with a remarkable impact on technologies exploiting the increased surface reactivity.

Children's representations of the COVID-19 lockdown and pandemic through drawings.

The COVID-19 pandemic and the measures to face it have placed children and their caregivers in front of many challenges that could represent sources of stress. This work aims to explore the point of view of children through drawing, as a spontaneous means of expression, relating it to parents' perceptions of children's difficulties, strengths, and mentalization skills. The sample consists of 18 children (mean age = 8.22, SD = 1.79). Parents were asked to complete: a socio-demographic questionnaire with information on the impact of COVID-19 on the family, the Strengths and Difficulties Questionnaire, and the Everyday Mindreading Scale. Children were asked to draw three moments: "Before" the pandemic, "During" the lockdown, and "After," when the COVID-19 will be passed. The drawings were coded by constructing a content and expressive analysis grid, adapting coding systems found in the literature. Data were collected at the beginning of the summer of 2020, just after the first lockdown period (from March to May 2020 in Italy). The results of the present work are in line with previous studies that reported experiences of wellbeing and tranquility of children in time spent at home with family during the pandemic. From the drawings emerges that children feel sufficiently able to master the situation, as reflected by including themselves in drawings and providing many details of the house in "During" drawings. The literature also reports a feeling of sadness/loneliness caused by the lack of friends, an element that we also find in the tendency to represent friends significantly more in the drawings concerning the future. Some contents of drawings (inclusion of friends, relatives, and parents) appeared associated with emotional, interpersonal, and mentalizing abilities of children, as perceived by parents. Exploring children's representations of a stressful event like the pandemic through drawings allows to focus both on their difficulties and on their resources, with useful implications for the educational support.

Supporting mentalizing in primary school children: the effects of thoughts in mind project for children (TiM-C) on metacognition, emotion regulation and theory of mind.

Mentalization is a useful ability for social functioning and a crucial aspect of mentalizing is emotion regulation. Literature suggests programmes for children and adults to increase mentalizing abilities useful both for emotional and social competences. For this reason, the issue of how to prompt children's mentalization has started to attract researchers' attention, supporting the importance of the interpersonal dimension for the individual differences in the developmental of mentalization. The TiM (Thoughts in Mind) Project, a training programme based on the explanation of mentalization mechanisms and designed for adults, deals with emotion regulation. Starting from the TiM Project, this study tests the effects of the TiM Child (TiM-C) training programme, over a control training programme, a conversational training designed for the school context, in children attending Year 2 of primary school. We designed a training based on narratives, followed by multiple-choice questions and conversations about mental states. Our results revealed significant improvements over the training period only in the TiM-C Project group for Metacognition, Emotion Regulation Strategies and a Theory of Mind task. As far as the educational implications, our findings suggest that it is possible to enhance mentalization through activities at school by promoting not only the understanding of the relations between mind and emotion, but also metacognitive skills.

Continuous wave vertical emission from terahertz microcavity lasers with a dual injection scheme.

Quantum cascade lasers (QCLs) represent a most promising compact source at terahertz (THz) frequencies, but efficiency of their continuous wave (CW) operation still needs to be improved to achieve large-scale exploitation. Here, we demonstrate highly efficient operation of a subwavelength microcavity laser consisting of two evanescently coupled whispering gallery microdisk resonators. Exploiting a dual injection scheme for the laser cavity, single mode CW vertical emission at 3.3 THz is obtained at 10 K with 6.4 mA threshold current and 145 mW/A slope efficiency up to 320 µW emitted power measured in quasi-CW mode. The tuning of the laser emission directionality is also obtained by independently varying the pumping strength between the microdisks. By connecting the resonators through a suspended gold bridge, the laser out-coupling efficiency in the vertical direction is strongly enhanced. Owing to the high brightness, low-power consumption and CW operation, the proposed microcavity laser design could allow the realization of high-performance CW THz QCLs ready for massive parallelization.

Maternal Psychological Distress and Children's Internalizing/Externalizing Problems during the COVID-19 Pandemic: The Moderating Role Played by Hypermentalization.

In order to explore the psychological impact of the COVID-19 outbreak on the caregiver-child relationship, we investigated the interplay among COVID-19 exposure and children's internalizing/externalizing problems during the Italian lockdown, hypothesizing a mediation effect played by maternal distress. Additionally, we included maternal reflective functioning (i.e., hypermentalization) as a moderator factor among this interplay. A total of 305 Italian mothers of children aged 6-13 years (M = 10.3; SD = 2.4) filled in an online survey. Findings revealed an indirect effect of maternal COVID-19 exposure on children's anxious/depressed (k2 = 0.46) and attention problems (k2 = 0.32) via maternal distress. Hypermentalization moderated the impact of maternal COVID-19 exposure on children's anxious/depressed problems (ß = -1.08, p = 0.04). Hypermentalization moderated both the relation between maternal distress and children's aggressive behaviors (ß = 12.226; p < 0.001) and between maternal distress and children's attention problems (ß = 5.617, p < 0.001). We found pivotal significant effects of maternal hypermentalization on children's anxious/depressed and attention problems, indicating that the higher the mother's hypermentalization was, the higher the children's problems were. Our results broaden what we knew on the role of maternal reflective and emotional functioning on children's emotional/behavioral adjustment during stressful situations.

Hospital length of stay among COVID-19-positive patients.

BACKGROUND AND AIM: This study aims to determine COVID-19 patient demographics and comorbidities associated with their hospital length of stay (LOS). METHODS: Design: Single-site, retrospective study. Setting: A suburban 700-bed community hospital in Newark, Delaware, USA. Patients: Patients admitted to the hospital from March 11, 2020, to August 11, 2020, with a positive COVID-19 status. We followed a time-to-event analysis approach and used Kaplan-Meir curves and log-rank tests for bivariate analyses, and an accelerated failure time model for a multivariable model of hospital LOS. RESULTS: Six hundred and eighty-seven patients discharged alive (mean [SD] age, 60.94 [18.10] years; 339 men [49.34%]; 307 Black/African-American [44.69%]; and 267 White [38.86%]) were included in the investigation. Bivariate analysis using Kaplan-Meir curves showed that patients' age, sex, ethnicity, insurance type, comorbidity of fluid and electrolyte disorder, hypertension, renal failure, diabetes, coagulopathy, congestive heart failure, peripheral vascular disease, neurological disorder, coronary artery disease, and cardiac arrhythmias to be significantly associated with LOS (P<0.05). In the multivariable analysis, patients' age, sex, ethnicity, number of Elixhauser comorbidities, and number of weeks since onset of the pandemic was significantly associated with LOS (P<0.05). Fluid and electrolyte disorder is the only comorbidity independently associated with LOS after adjusting for patients' age, sex, race, ethnicity, number of Elixhauser comorbidities, and weeks since onset of pandemic. CONCLUSION: COVID-19 patients LOS vary based on multiple factors. Understanding these factors are crucial to improving the prediction accuracy of COVID-19 patient census in hospitals for resource planning and care delivery. RELEVANCE FOR PATIENTS: Understanding of the factors associated with LOS of the COVID-19 patients may help the care providers and the patients to better anticipate the LOS, optimize the resources and processes, and prevent protracted stays.

Psychological Impact of COVID-19 Outbreak on Families of Children with Autism Spectrum Disorder and Typically Developing Peers: An Online Survey.

BACKGROUND: When COVID-19 was declared as a pandemic, many countries imposed severe lockdowns that changed families' routines and negatively impacted on parents' and children's mental health. Several studies on families with children with autism spectrum disorder (ASD) revealed that lockdown increased the difficulties faced by individuals with ASD, as well as parental distress. No studies have analyzed the interplay between parental distress, children's emotional responses, and adaptive behaviors in children with ASD considering the period of the mandatory lockdown. Furthermore, we compared families with children on the spectrum and families with typically developing (TD) children in terms of their distress, children's emotional responses, and behavioral adaptation. METHODS: In this study, 120 parents of children aged 5-10 years (53 with ASD) participated. RESULTS: In the four tested models, children's positive and negative emotional responses mediated the impact of parental distress on children's playing activities. In the ASD group, parents reported that their children expressed more positive emotions, but fewer playing activities, than TD children. Families with children on the spectrum reported greater behavioral problems during the lockdown and more parental distress. CONCLUSIONS: Our findings inform the interventions designed for parents to reduce distress and to develop coping strategies to better manage the caregiver-child relationship.

Magnetic Sphincter Augmentation Placement for Recalcitrant Gastroesophageal Reflux Disease Following Bariatric Procedures: A Systematic Review and Bayesian Meta-Analysis.

Background: This study aims to consolidate all available articles on this topic and evaluate MSA effectiveness in the management of gastroesophageal reflux disease (GERD). Matherials and Methods: We conducted an electronic systematic search using MEDLINE databases (PubMed), EMBASE, and Web of Science. An electronic systematic search of articles comparing preoperative and postoperative health-related quality of life (GERD-HRQL) scores in patients who underwent MSA placement for management of GERD following bariatric surgery was performed. Three retrospective studies totaling 33 patients met the inclusion criteria and were included in this meta-analysis. Results: The pooled mean difference in change from preoperative GERD-HRQL score was 17.5 (95% CrI; -22.88 to -12.20) and it was statistically significant. The between-study variability is 3.621 (95% HPD; 1.39 4.99) with low heterogeneity (I2 = 15%; 95% HPD; 2.1 26.2%). Conclusions: MSA for refractory GERD following bariatric surgery appears feasible. Prospective randomized controlled with standardized surgical technique and objective follow-up evaluation is needed to better assess short- and long-term efficacy.

Prosthetic Reinforcement in Hiatal Hernia Repair, Does Mesh Material Matter? A Systematic Review and Network Meta-Analysis.

Background: Hiatal hernia repair (HHR) is a complex surgical procedure and its management is not standardized. Several meta-analyses have compared cruroplasty with hiatus reinforcement with mesh, and crura augmentation appears to have better outcomes. However, heterogeneity in type of mesh and placement techniques has differed significantly. Materials and Methods: A systematic review and network meta-analysis were carried out. An electronic systematic research was carried out throughout Pubmed, CENTRAL, and Web of Science, of articles analyzing HHR with cruroplasty, nonabsorbable mesh (NAM), and absorbable mesh (AM) reinforcement. Results: Seventeen articles based on 1857 patients were enrolled in this article. The point estimation showed that when compared against the control group (NAM), the HH recurrence risk in AM and cruroplasty group was higher (relative ratio [RR] 2.3; CrI 0.8-6.3, RR 3.6; CrI 2.0-8.3, respectively). Postoperative complication rates were alike in all groups. The prevalence of mesh erosion after HHR is low. Conclusions: This network meta-analysis showed that prosthetic reinforcement significantly reduced HH recurrence when compared with cruroplasty alone. However, there is not enough evidence to compare different mesh compositions.

Maternal Distress/Coping and Children's Adaptive Behaviors During the COVID-19 Lockdown: Mediation Through Children's Emotional Experience.

The present study focused on the psychological impact that the lockdown due to coronavirus disease-19 (COVID-19) had on families in Italy. During the COVID-19 pandemic, the Italian government imposed a strict lockdown for all citizens. People were forced to stay at home, and the length of the lockdown was uncertain. Previous studies analyzed the impact of social distance measures on individuals' mental health, whereas few studies have examined the interplay between the adults' functioning, as parents, during this period and the association with the child's adjustment. The present study tested if maternal distress/coping predicts children's behaviors during the COVID-19 lockdown, hypothesizing a mediation effect via children's emotional experience. Participants were 144 mothers (M age = 39.3, 25-52, SD = 5.6) with children aged 5-10 years (M age = 7.54, SD = 1.6, 82 boys); mothers answered to an online survey. Results indicated that mothers with higher exposure to COVID-19 showed higher levels of distress and higher display of coping attitudes, even if in the structural equation modeling model, the COVID-19 exposure was not a predictor of mothers' distress. Compared with mothers with good coping skills, mothers with higher stress levels were more likely to attribute negative emotions to their children at the expense of their positive emotions. Moreover, children's emotions acted as mediators between maternal distress/coping and children's adaptive/maladaptive behaviors. In conclusion, it is important to support parents during pandemic emergence, by providing them with adequate information to manage the relationship with their children, to reduce their level of distress and to enhance their coping abilities.

Systemic review and network meta-analysis comparing minimal surgical techniques for rectal cancer: quality of total mesorectum excision, pathological, surgical, and oncological outcomes.

BACKGROUND: Minimal invasive surgery has revolutionized recovery in rectal cancer patients. However, there has been debate on its effect on quality of total mesorectal excision (TME) and oncological outcomes. This network meta-analysis compares laparoscopic, robotic-assisted, and transanal TMEs. This study shows that All three surgical techniques are comparable across TME quality and oncological outcomes. Ultimately, good outcomes are based on each individual surgeon choosing an approach based on their expertise.

Theory of mind plasticity in aging: The role of baseline, verbal knowledge, and executive functions.

Theory of Mind (ToM) refers to the ability to attribute mental states to the self and others in order to explain and predict social behaviour. Meta-analytic results have shown a decline in ToM abilities in healthy older adults. Recent research has also highlighted the possibility of enhancing older adults' ToM performance through group conversations focused on mental states. Our aim was to determine whether the extent to which older people benefited from a ToM training was predicted by performance on a battery of executive functioning tasks, on baselines in ToM tasks, on verbal knowledge. Forty-three older adults (60-84 years) participated in a three-session ToM training programme that has previously shown to be effective in improving ToM ability. Results showed that verbal knowledge predicted training gains in practiced ToM tasks. In addition, age, executive functions and baseline performance predicted training gains in non-practiced ToM tasks. Results are discussed in light of the amplification model.

Symmetry enhanced non-reciprocal polarization rotation in a terahertz metal-graphene metasurface.

In the present article we numerically investigated the magneto-optical behaviour of a sub-wavelength structure composed by a monolayer graphene and a metallic metasurface of optical resonators. Using this hybrid graphene-metal structure, a large increase of the non-reciprocal polarization rotation of graphene can be achieved over a broad range of terahertz frequencies. We demonstrate that the symmetry of the resonator geometry plays a key role for the performance of the system: in particular, increasing the symmetry of the resonator the non-reciprocal properties can be progressively enhanced. Moreover, the possibility to exploit the metallic metasurface as a voltage gate to vary the graphene Fermi energy allows the system working point to be tuned to the desired frequency range. Another peculiar result is the achievement of a structure able to operate both in transmission and reflection with almost the same performance, but in a different frequency range of operation. The described system is hence a sub-wavelength, tunable, multifunctional, effective non-reciprocal element in the terahertz region.

Relations between theory of mind and executive function in middle childhood: A short-term longitudinal study.

Studies with preschool children have shown significant links between children's executive function (EF) and theory of mind (ToM), but few studies have examined these associations in primary school children. To address this gap, we designed a three-wave cross-lagged longitudinal study in which we followed a group of 113 children (61 boys) across three time points from age 9.5-10.5years (mean age at Time 1=112.3months, SD=4.18; mean age at Time 2=118.3months, SD=4.15; mean age at Time 3=124.7months, SD=4.06). At each time point, we measured EF (working memory and inhibitory control), ToM, and language. Our analyses showed (a) moderate rank-order stability of individual differences in both EF and ToM and (b) growth in ToM task performance across time. Cross-lagged longitudinal analyses revealed an asymmetric developmental relation between ToM and working memory. Early working memory predicted later ToM but not vice versa. Our results suggest a specific role for working memory in the ongoing development of ToM in middle childhood.