Mitigation measures against Coronavirus Disease 2019 (COVID-19) in overnight faith-based camps: summer 2021.

OBJECTIVE: In this study, we describe community-based nonpharmaceutical interventions (NPIs) incorporated into COVID-19 mitigation protocols, and SARS-CoV-2 incidence at five faith-based summer camps in the US. STUDY DESIGN: Retrospective cohort study. METHODS: Six southeastern states within the United States (13 sites) were assessed from May 30 to August 14, 2021 (13 sites; N = 13,132; May-August 2021). Camp mitigation policies and NPIs (including masking, vaccinations, meal arrangements, physical distancing, pre-arrival testing, symptom screening, quarantine/isolation, and ventilation upgrades), and SARS-CoV-2 infections were tracked at each site. RESULTS: The symptomatic primary case attack rate was 24.7 (range: 0.0-120.0) cases per 100,000 people per week. Fewer infections were observed in camps with greater mitigation protocols. CONCLUSION: These findings suggest that nonpharmaceutical mitigation can promote stable access to youth programs for historically vaccine-hesitant subgroups. Policy recommendations for nonpharmaceutical interventions to prevent respiratory viral transmission in overnight youth faith-based camp settings may include outdoor activities, accessible symptomatic tests, prearrival testing, indoor mask use, small cohorts, physical distancing, and protocols to minimize staff exposures during time off.

Lift and VAAFT for high trans-sphincteric anal fistula: a single center retrospective analysis.

PURPOSE: The management of complex anal fistulas remains a challenge, mainly due to the considerable risk of incontinence. We compared LIFT and VAAFT in the treatment of complex anal fistulas in terms of healing time, recurrence, continence, morbidity, and postoperative pain, focusing also on patients with local abscess at the time of surgery. METHODS: We include all patients with high trans-sphincteric anal fistula even with abscess at the time of surgery. Anorectal manometry, endoanal ultrasound, Cleveland Clinic fecal incontinence score, VAS score, and number of previous fistula treatment were recorded. The clinical examination defined healing, insufficiency or recurrence of the fistula. RESULTS: Fifty-four consecutive patients are undergoing surgery: 26 patients underwent LIFT and 28 underwent VAAFT. During the 18 months of follow-up there were no differences in terms of AM, CCFIS and VAS scores. Days of healing, failure, and recurrence rate were comparable in both groups. The subgroup of patients with local abscess undergoing LIFT showed worse results in terms of failure and recurrence rate (p < 0.05). CONCLUSIONS: Both techniques are safe and effective and can offer long-term benefits. LIFT should not be used as a first treatment in high trans-sphincteric fistula with perianal abscess.

Effect of participation in a park-based afterschool program on cardiovascular disease risk among severely obese youth.

OBJECTIVES: The prevalence of severe obesity in youth is rising, despite reports of obesity rates stabilizing overall. While reports on treatment outcomes for youth with severe obesity (bariatric surgery, behavioral and pharmacological treatments) exist, very few community-based programs have reported changes in health outcomes in this population. We assessed changes in cardiovascular health risk profiles among racial/ethnic minority youth with severe obesity who participated in Fit2Play™, a park-based afterschool health promotion program. STUDY DESIGN: A longitudinal cohort study. METHODS: Children aged 6-14 years (N = 1546, 51% Hispanic, 44% non-Hispanic black) who participated in the Fit2Play™ in one of 34 urban park sites for one school year over five separate school years (2010-2015) had height, weight, four-site skinfold thicknesses, systolic blood pressure (SBP)/diastolic blood pressure (DBP), fitness tests, and a health/wellness knowledge test collected at the beginning and end of the school year. Two-level repeated measures mixed models examined changes in cardiovascular health outcomes (body mass index [BMI], skinfold thickness, systolic/diastolic blood pressure percentile [SBPP/DBPP], cardiorespiratory fitness [PACER]) in youth with severe obesity over 1- and 2-year follow-up. RESULTS: Compared with baseline, BMI decreased 13% (incidence rate ratio [IRR] 95% confidence interval [CI]: 0.83-0.90), sumof skinfold thicknesses decreased 5% (IRR 95% CI: 0.91-0.99), SBPP decreased 5% (IRR 95% CI: 0.90-0.99), DBPP decreased 19% (IRR 95% CI: 0.77-0.86), and PACER scores increased 12% (IRR 95% CI: 1.0-1.27) after two years of participation in the Fit2Play™ program. CONCLUSIONS: Findings here support community/park-based youth programs as effective and accessible treatment options for reducing cardiovascular disease risk among youth with severe obesity.

A spectroscopic study of the chromatic properties of GafChromicEBT3 films.

PURPOSE: This work provides an interpretation of the chromatic properties of GafChromicEBT3 films based on the chemical nature of the polydiacetylene (PDA) molecules formed upon interaction with ionizing radiation. The EBT3 films become optically less transparent with increasing radiation dose as a result of the radiation-induced polymerization of diacetylene monomers. In contrast to empirical quantification of the chromatic properties, less attention has been given to the underlying molecular mechanism that induces the strong decrease in transparency. METHODS: Unlaminated GafChromicEBT3 films were irradiated with a 6 MV photon beam to dose levels up to 20 Gy. The optical absorption properties of the films were investigated using visible (vis) spectroscopy. The presence of PDA molecules in the active layer of the EBT3 films was investigated using Raman spectroscopy, which probes the vibrational modes of the molecules in the layer. The vibrational modes assigned to PDA's were used in a theoretical vis-absorption model to fit our experimental vis-absorption spectra. From the fit parameters, one can assess the relative contribution of different PDA conformations and the length distribution of PDA's in the film. RESULTS: Vis-spectroscopy shows that the optical density increases with dose in the full region of the visible spectrum. The Raman spectrum is dominated by two vibrational modes, most notably by the ν(C≡C) and the ν(C=C) stretching modes of the PDA backbone. By fitting the vis-absorption model to experimental spectra, it is found that the active layer contains two distinct PDA conformations with different absorption properties and reaction kinetics. Furthermore, the mean PDA conjugation length is found to be 2-3 orders of magnitude smaller than the crystals PDA's are embedded in. CONCLUSIONS: Vis- and Raman spectroscopy provided more insight into the molecular nature of the radiochromic properties of EBT3 films through the identification of the excited states of PDA and the presence of two PDA conformations. The improved knowledge on the molecular composition of EBT3's active layer provides a framework for future fundamental modeling of the dose-response.

Doppler-guided transanal haemorrhoidal dearterialization for haemorrhoids: results from a multicentre trial.

AIM: This multicentre study, based on the largest patient population ever published, aims to evaluate the efficacy of Doppler-guided transanal haemorrhoidal dearterialization (THD Doppler) in the treatment of symptomatic haemorrhoids and to identify the factors predicting failure for an effective mid-term outcome. METHOD: Eight hundred and three patients affected by Grade II (137, 17.1%), III (548, 68.2%) and IV (118, 14.7%) symptomatic haemorrhoidal disease underwent THD Doppler, with a rectal mucopexy in patients with haemorrhoidal prolapse. The disease was assessed through a specifically designed symptom questionnaire and scoring system. A uni- and multivariate analyses of the potential predictive factors for failure were performed. RESULTS: The morbidity rate was 18.0%, represented mainly by pain or tenesmus (106 patients, 13.0%). Acute bleeding requiring surgical haemostasis occurred in seven patients (0.9%). No serious or life-threatening complications occurred. After a mean follow-up period of 11.1 ± 9.2 months, the overall success rate was 90.7% (728 patients), with a recurrence of haemorrhoidal prolapse, bleeding, and both symptoms in 51 (6.3%), 19 (2.4%) and 5 (0.6%) patients, respectively. Sixteen out of 47 patients undergoing re-operation had a conventional haemorrhoidectomy. All the symptoms were significantly improved in each domain of the score (P < 0.0001). At multivariate analysis the absence of morbidity and performance of a distal Doppler-guided dearterialization were associated with a better outcome. CONCLUSION: THD Doppler is a safe and effective therapy for haemorrhoidal disease. If this technique is to be employed, an accurate distal Doppler-guided dearterialization and a tailored mucopexy are mandatory to contain and reduce the symptoms.

Characterisation of OSL and OSLN droplets for dosimetry.

In spite of considerable progress in neutron dosimetry, there is no dosemeter that is capable of measuring neutron doses independently of the neutron spectrum with good accuracy. Carbon-doped aluminium oxide (Al2O3:C) is a sensitive material for ionising radiation (beta-ray, X ray and electron) and has been used for applications in personal and medical dosimetry as an optically stimulated luminescence (OSL) dosemeter. Al2O3:C has a low sensitivity to neutron radiation; this prevents its application to neutron fields, representing a disadvantage of Al2O3:C-OSL when compared with LiF, which is used as a thermoluminescent detector. Recently an improvement for neutron dosimetry (Passmore and Kirr. Neutron response characterisation of an OSL neutron dosemeter. Radiat. Prot. Dosim. 2011; 144: 155-60) uses Al2O3:C coated with (6)Li2CO3 (OSLN),which gives the high-sensitive response as known for Al2O3:C with the advantage of being also sensitive to thermal neutrons. In this article, the authors compare small-size detectors (droplets) of Al2O3:C (OSL) and of Al2O3:C+(6)Li2CO3 (OSLN) and discuss the advantages and drawbacks of both materials, regarding size vs. response.

Monte Carlo tools to supplement experimental microdosimetric spectra.

Tissue-equivalent proportional counters (TEPCs) are widely used in experimental microdosimetry for characterising the radiation quality in radiation protection and radiation therapy environments. Generally, TEPCs are filled with tissue-equivalent gas mixtures, at low gas pressure, to simulate tissue site sizes similar to the cell nucleus (1 or 2 µm). The TEPC response using Monte Carlo (MC) codes can be applied to supplement experimental measurements. Most of general-purpose MC codes currently available recourse to the condensed-history approach to model the electron transport and do not transport low-energy electrons (<1 keV), which can lead to systematic errors, especially in thin layers and in gas-condensed medium interfaces. In this work, a comparison between experimental microdosimetric spectra of (60)Co and (137)Cs radiation at different simulated sizes (from 1.0 to 3.0 µm) in pure propane versus simulated spectra obtained with two general-purpose codes FLUKA and PENELOPE, which include a detailed simulation of electron-photon transport in arbitrary materials, including gases, is presented.

The usefulness of 111indium-oxine autologous platelet gel graft imaging to evaluate osteoinduction in patients undergoing surgery of jaw bone defects.

Autologous platelet gel (AGP) is a source of concentrated growth factors contained in the platelet granules used to enhance bone quality and, especially, quicken bone formation in regeneration techniques, and also ameliorate the haemostasis in anti-coagulated patient management. The purpose of this study is to describe a technique to perform labelling of autologous platelet-gel with 111In -Oxine and to evaluate its usefulness, as a marker of bone osteoinduction by means of scintigraphy, after in vivo application in patients with jaw bone defects following cystic lesion enucleation and the extraction of deeply impacted lower third molar. All patients included in the study presented mandible bone defects following cyst enucleation or deeply impacted lower third molar extraction. In sterile conditions, 111In-Oxine AGP was added during the bone-milling phase of the graft preparation and then applied to the bone defects. The scintigraphy was performed 2 hours after the application of labelled AGP (early scan) and at 24, 48, 72, 384 hours (delayed scan). At early scan all the patients presented a high concentration of 111In-Oxine AGP, which was easily recognized at the level of jaw defect. Limited diffusion of AGP was seen in the tissue surrounding the bone defect; this activity was attributed to the presence, in the PRP, of a quote of autologous granulocytes, as marker of inflammatory process, which was labelled with 111In-Oxine. In order to demonstrate the persistence and stability of labelling AGP, abdominal scintigraphies were performed to assess the presence of activity in the liver, spleen and bone marrow. None of the patients presented appreciable activity in these organs. The labelled AGP topically applied showed high uptake values, without statistically significant activity in the surrounding tissues or in critical organs during the early phase, as well as in delayed controls, and confirmed a very low grade of loss of 111In-Oxine from the bone defect. The scintigraphy represents a useful method of assessing the success of surgical procedure for jaw bone defects performed with autogenous grafts. It is well accepted by the patients, offering at the same time a sensitive method of studying uptake of topically applied AGP and to follow up kinetics of AGP in order to correlate quantitative data of the platelet gel life span with evolution of the bone remodelling process. Finally, the labelled granulocytes around the bone defect allow to assess the inflammatory process evolution derived from the surgical technique.

Syncope: is it a misunderstood syndrome?

Syncope is a frequent reason for emergency department visits and the overall admissions of the elderly. The causes of syncope are diverse and clinicians use a wide range of investigations to try to achieve a diagnosis. Moreover, syncope in the elderly should be considered as a symptom of the neuro-cardiovascular instability (NCVI) syndrome even though it has not to be excluded as the expression of an underlying disease. The aim of the study was to assess care setting in over 75-year old population admitted to emergency room for syncope and its complications to improve their management, both in the in-patient and the out-patient settings. Despite syncope is the most frequent cause of emergency room admittance in the elderly, in our study it seems to be underestimated as a symptom denouncing high morbidity and mortality disease such as heart disease and stroke. A stronger attention and a new age-tailored strategy for the management of in-patient and out-patient care of syncope is envisaged.

[Assessment of cognitive and functional status in hospitalized elderly]. / Valutazione dello stato cognitivo e funzionale in anziani ospedalizzati.

In 1745 elderly patients (971 men and 774 women), consecutively admitted to University Geriatric Ward in San Giovanni Battista Hospital of Torino, cognitive status (SPMSQ) was evaluated. Moderate-severe and mild cognitive impairment were respectively present in 26.8% and 15.8% of the sample. Subjects affected by moderate-severe cognitive impairment were older (80.7 +/- 8.0 yrs) than patients with mild deterioration (79.5 +/- 7.8 yrs) and patients without cognitive problems (75.3 +/- 8.3 yrs). The number of pathologies and the length of hospital stay were not related to severe cognitive impairment. Lower schooling was associated with cognitive alteration. Among subjects affected by moderate-severe cognitive deterioration 15.6% was living with assistance before hospitalization. The prevalence of functional impairment (ADL) was higher (70.9%) among patients with moderate-severe cognitive impairment. In-hospital mortality was higher (21.2%) among patients with moderate-severe cognitive deterioration.

Absorption of lidocaine following subarachnoid and epidural administration.

The absorption of lidocaine into the vascular system from the epidural and subarachnoid spaces was determined in 20 patients. Seventy-five milligrams (1.5 ml of a 5% solution) of lidocaine was administered intrathecally to 10 patients for spinal anesthesia and 75 mg (3.75 ml of a 2% solution) was injected epidurally. Venous plasma levels of lidocaine were determined at 2, 5, 10, 15, and 30 minutes after subarachnoid or epidural injection. No significant differences existed between the maximum venous plasma concentrations of lidocaine following epidural injection (0.41 +/- 0.07 microgram/ml) and following subarachnoid injection (0.32 +/- 0.07 microgram/ml). However, the rate of vascular absorption of lidocaine from the subarachnoid space was significantly slower than from the epidural space. By 2, 5, and 10 minutes after injection, venous plasma concentrations of lidocaine were significantly higher following epidural injection than they were after subarachnoid injection. This variation was not attributable to differences in blood pressure folloiwng injection. The differential rate of absorption is probably related to the anatomical arrangement of the venous plexuses in the epidural and subarachnoid spaces.