Community-based screening and triage connecting First Nations children and youth to local supports: a cross-sectional study.

BACKGROUND: First Nations children in Canada experience health inequities. We aimed to determine whether a self-report health app identified children's needs for support earlier in their illness than would typically occur. METHODS: Children (aged 8 to 18 yr) were recruited from a rural First Nation community. Children completed the Aaniish Naa Gegii: the Children's Health and Well-being Measure (ACHWM) and then met with a local mental health worker who determined their risk status. ACHWM Emotional Quadrant Scores (EQS) were compared between 3 groups of children: healthy peers (HP) who were not at risk, those with newly identified needs (NIN) who were at risk and not previously identified, and a typical treatment (TT) group who were at risk and already receiving support. RESULTS: We included 227 children (57.1% girls), and the mean age was 12.9 (standard deviation [SD] 2.9) years. The 134 children in the HP group had a mean EQS of 80.1 (SD 11.25), the 35 children in the NIN group had a mean EQS of 67.2 (SD 13.27) and the 58 children in the TT group had a mean EQS of 66.2 (SD 16.30). The HP group had significantly better EQS than the NIN and TT groups (p < 0.001). The EQS did not differ between the NIN and TT groups (p = 0.8). INTERPRETATION: The ACHWM screening process identified needs for support among 35 children, and the associated triage process connected them to local services; the similarity of EQS in the NIN and TT groups highlights the value of community screening to optimize access to services. Future research will examine the impact of this process over the subsequent year in these groups.

Modulation of type I interferon responses potently inhibits SARS-CoV-2 replication and inflammation in rhesus macaques.

Type I interferons (IFN-I) are critical mediators of innate control of viral infections but also drive the recruitment of inflammatory cells to sites of infection, a key feature of severe coronavirus disease 2019. Here, IFN-I signaling was modulated in rhesus macaques (RMs) before and during acute SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) infection using a mutated IFN-α2 (IFN-modulator; IFNmod), which has previously been shown to reduce the binding and signaling of endogenous IFN-I. IFNmod treatment in uninfected RMs was observed to induce a modest up-regulation of only antiviral IFN-stimulated genes (ISGs); however, in SARS-CoV-2-infected RMs, IFNmod reduced both antiviral and inflammatory ISGs. IFNmod treatment resulted in a potent reduction in SARS-CoV-2 viral loads both in vitro in Calu-3 cells and in vivo in bronchoalveolar lavage (BAL), upper airways, lung, and hilar lymph nodes of RMs. Furthermore, in SARS-CoV-2-infected RMs, IFNmod treatment potently reduced inflammatory cytokines, chemokines, and CD163+ MRC1- inflammatory macrophages in BAL and expression of Siglec-1 on circulating monocytes. In the lung, IFNmod also reduced pathogenesis and attenuated pathways of inflammasome activation and stress response during acute SARS-CoV-2 infection. Using an intervention targeting both IFN-α and IFN-ß pathways, this study shows that, whereas early IFN-I restrains SARS-CoV-2 replication, uncontrolled IFN-I signaling critically contributes to SARS-CoV-2 inflammation and pathogenesis in the moderate disease model of RMs.

The unsanitary other and racism during the pandemic: analysis of purity discourses on social media in India, France and United States of America during the COVID-19 pandemic.

The global rise of populism and concomitant polarizations across disenfranchised and marginalized groups has been magnified by so-called echo chambers, and a major public health crisis like the COVID-19 pandemic has only served to fuel these intergroup tensions. Media institutions disseminating information on ways to prevent the propagation of the virus have reactivated a specific discursive phenomenon previously observed in many epidemics: the construction of a defiled 'Other'. With anthropological lenses, discourse on defilement is an interesting path to understand the continuous emergence of pseudo-scientific forms of racism. In this paper, the authors focus on 'borderline racism', that is the use of an institutionally 'impartial' discourse to reaffirm the inferiority of another race. The authors employed inductive thematic analysis of 1200 social media comments reacting to articles and videos published by six media in three different countries (France, United States and India). Results delineate four major themes structuring defilement discourses: food (and the relationship to animals), religion, nationalism and gender. Media articles and videos portrayed Western and Eastern countries through contrasting images and elicited a range of reaction in readers and viewers. The discussion reflects on how borderline racism can be an appropriate concept to understand the appearance of hygienic othering of specific subgroups on social media. Theoretical implications and recommendations on a more culturally sensitive approach of media coverage of epidemics and pandemics are discussed.

Modulation of type I interferon responses potently inhibits SARS-CoV-2 replication and inflammation in rhesus macaques.

Type-I interferons (IFN-I) are critical mediators of innate control of viral infections, but also drive recruitment of inflammatory cells to sites of infection, a key feature of severe COVID-19. Here, and for the first time, IFN-I signaling was modulated in rhesus macaques (RMs) prior to and during acute SARS-CoV-2 infection using a mutated IFNα2 (IFN-modulator; IFNmod), which has previously been shown to reduce the binding and signaling of endogenous IFN-I. In SARS-CoV-2-infected RMs, IFNmod reduced both antiviral and inflammatory ISGs. Notably, IFNmod treatment resulted in a potent reduction in (i) SARS-CoV-2 viral load in Bronchoalveolar lavage (BAL), upper airways, lung, and hilar lymph nodes; (ii) inflammatory cytokines, chemokines, and CD163+MRC1-inflammatory macrophages in BAL; and (iii) expression of Siglec-1, which enhances SARS-CoV-2 infection and predicts disease severity, on circulating monocytes. In the lung, IFNmod also reduced pathogenesis and attenuated pathways of inflammasome activation and stress response during acute SARS-CoV-2 infection. This study, using an intervention targeting both IFN-α and IFN-ß pathways, shows that excessive inflammation driven by type 1 IFN critically contributes to SARS-CoV-2 pathogenesis in RMs, and demonstrates the potential of IFNmod to limit viral replication, SARS-CoV-2 induced inflammation, and COVID-19 severity.

Assessing Responsiveness of the Trapeziometacarpal Arthrosis Symptoms and Disability Questionnaire.

BACKGROUND: This study aimed to assess the responsiveness of the Trapeziometacarpal Arthrosis Symptoms and Disability (TASD) questionnaire after corticosteroid injections and operative management for trapeziometacarpal osteoarthritis (TMC-OA). METHODS: This longitudinal cohort study included patients with TMC-OA who underwent treatment (corticosteroid injection or surgery). Measurements occurred at baseline and follow-up time points: 6 weeks, 3 months, 6 months, and 1 year. Patient measures were collected electronically using a data repository platform. The TASD is a validated psychometric patient-administered scale. We examined responsiveness by correlating the TASD scores with another known effective indicator of change (shortened Disabilities of the Arm, Shoulder, and Hand [QuickDASH]). Repeated score measurements over time were analyzed using analysis of variance, and correlations between questionnaires were reported with repeated measures correlation and Pearson correlation coefficients. RESULTS: The nonsurgical cohort undergoing corticosteroid injections included 31 (66%) women and 16 (34%) men, and the surgical cohort included 29 (71%) women and 12 (29%) men. Both the QuickDASH and the TASD captured a statistically significant improvement in symptom burden postoperatively (P < .0001 for both questionnaires), whereas no statistical significance was noted after corticosteroid injections (P = .45 and P = .34, respectively). There was a strong correlation between QuickDASH and TASD questionnaires (r = 0.87, P < .0001). CONCLUSIONS: The TASD is a promising TMC-OA-specific questionnaire to capture responsiveness following treatment, particularly following surgery. The responsiveness of TASD was demonstrated in the TMC-OA cohort. Further research is needed to define a minimal clinically important difference.

Time to surgical closure of complex infectious wounds: a single-center retrospective cohort study.

INTRODUCTION: Surgical management of NSTIs can result in complex wounds, and closure of these wounds is often difficult or complicated. Although surgical factors influencing mortality and LOS have been well described, little is known about patient, wound, and surgical factors associated with time to closure. OBJECTIVE: The purpose of this study is to identify patient, wound, and surgical factors that may influence time to closure of NSTIs. MATERIALS AND METHODS: The records of patients who presented to a tertiary care center over an 11-year period (2007-2017) with an NSTI requiring surgical closure were retrospectively reviewed. RESULTS: Forty-seven patients met the inclusion criteria. The average time to closure was 31.1 days, with an average of 4.8 procedures. Most patients were middle aged (mean, 50.3 years; range, 20-81 years), immunocompetent, and nondiabetic upon admission. Closure was achieved mainly with autograft. The percent TBSA was described in 19 cases (40%). There was no association between substance use (alcohol, smoking, or other), anticoagulant medication use, or medical comorbidities and time to closure. On multivariable analysis, flap closure (P =.02) and increased number of surgical procedures (P =.003)-the latter reflecting the need for an increased number of debridements-were associated with increased time to closure. CONCLUSIONS: The data in this study suggest that use of local flaps for wound closure and increased number of surgical procedures (particularly debridements) may be predictors of time to closure in patients with an NSTI.

Management of Sagittal and Lambdoid Craniosynostosis: Minimally Invasive Approaches.

The resurgence of strip craniectomies began in the mid-1990s with advances in surgical technique and anesthesia coupled with the critical observation that earlier interventions benefitted from an easily molded skull. Jimenez and Barone's pioneering introduction of endoscopic approaches to strip craniectomies coupled with postoperative helmeting in newborns and young infants and Claes Lauritzen's introduction of spring-mediated cranioplasty began the era of minimally invasive approaches in the surgical correction of craniosynostosis. This article provides technical descriptions of these treatment modalities, a comparative literature review, and our institutional algorithms for the correction of sagittal craniosynostosis and unilambdoid craniosynostosis.

Evaluation of the Morbidity of Routine Cystoscopy Performed Intraoperatively During Total Laparoscopic Hysterectomies.

STUDY OBJECTIVES: The primary objective is to determine the rate of morbid events (urinary tract infection, hematuria, urinary retention, false positive, incidental finding) associated with routine cystoscopies performed intraoperatively during total laparoscopic hysterectomies (TLH). The secondary objectives are 1) to determine the rate of urinary complications during TLHs in our centers and 2) to determine the detection rate of urinary complications using cystoscopy during TLHs. METHOD: Descriptive retrospective multicenter study. The study took place in Obstetrics & Gynecology departments of 2 university centers in Montreal. Patients underwent a routine cystoscopy during their TLH for a benign reason in our centers. Five hundred thirty-one charts from January 1, 2012 to January 31, 2018 were reviewed. RESULTS: The morbidity rate of routine cystoscopies during TLHs is 4.19% (22/524 cases) in our centers. Our urinary complication rate is 2.45% (13/531 cases). Of these 13 complications, 4 were detected by cystoscopy. CONCLUSION: The usefulness of routine cystoscopies performed intraoperatively during TLHs is questionable due to the number of morbid events and the low rate of urinary trauma in our centers. However, it is hard to establish a direct causality link between certain morbid events and cystoscopy. More studies should be conducted on this subject.

NEOURETEROCYSTOSTOMY AND URETHRAL STENT PLACEMENT IN A BLACK-HANDED SPIDER MONKEY (ATELES GEOFFROYI).

A 27-y-old female black-handed spider monkey (Ateles geoffroyi) was evaluated 13 d after an ovariohysterectomy because of abdominal distension, anorexia, and absent urination. The animal was diagnosed with a uroabdomen and urethral obstruction from computed tomographic findings and fluid creatinine levels. During exploratory laparotomy, a defect in the right ureter was confirmed as the source of the uroabdomen. Utilizing intraoperative fluoroscopy, a urethral obstruction with an irregular luminal filling defect was evident. A self-expanding nitinol urethral stent was placed, and a ureteral transposition was performed. Two months after the procedure, the animal developed dysuria, a urinary tract infection, recurrent bladder distension and a partial urethral obstruction. Treatment with prazosin 1 mg/kg PO q12h improved urination. Reobstruction of the urethra occurred 17 mo postsurgery, and the animal was euthanatized. On postmortem examination, the animal had ingrowth into the stent with proliferative granulation tissue, detrusor muscle degeneration, pelvic adhesions, cystitis, pyelonephritis, and hydronephrosis.

Evaluation of cabergoline for lactation inhibition in women living with HIV.

We wished to evaluate the efficacy, safety, and acceptability of cabergoline for lactation inhibition in women who live with HIV. In this multicenter prospective observational study, cabergoline was offered as a single oral dose of 1 mg within the first 48 h postpartum. Women were recruited if they delivered a live infant after 35 weeks of gestational age. Participants filled out a questionnaire regarding symptoms of lactation and cabergoline adverse effects on day 2 and day 14 postpartum. On day 14, they also completed a questionnaire about their satisfaction with cabergoline treatment. Prolactin serum level was measured on both visits. Among 68 participants, all but one received cabergoline. The overall effectiveness defined by partial or complete success at day 14 was 98.3% (confidence intervals: 89.5-99.9). At day 14, 67.4% of women who received cabergoline had prolactin serum levels <25 mcg/L (threshold necessary for galactopoiesis). Mild nonspecific adverse effects were experienced by 24 (29.9%) women on day 2 and 24 (41.4%) on day 14, and lasted 48 h or less. Overall, 96% of women were satisfied with cabergoline's ability to prevent postpartum lactation symptoms. In conclusion, cabergoline is an effective, well-accepted, and well-tolerated medication for lactation inhibition in WLWH.

The Toronto Sarcoma Flap Score: A Validated Wound Complication Classification System for Extremity Soft Tissue Sarcoma Flap Reconstruction.

BACKGROUND: Flap reconstruction plays an important role in limb preservation after wide resection of extremity soft tissue sarcoma (ESTS), but can be associated with high rates of postoperative wound complications. Currently, no standardized system exists for the classification of these complications. This study aimed to develop a standardized classification system for wound complications after ESTS flap reconstruction. METHODS: Outcomes of ESTS flap reconstructions were analyzed in a retrospective cohort of 300 patients. All wound- and flap-related complications were identified and categorized. Based on these data, a scoring system was developed and validated with a prospective cohort of 100 patients who underwent ESTS flap reconstruction. RESULTS: A 10-point scoring system was developed based on the level of intervention required to treat each complication observed in the retrospective cohort. Raters applied the scoring system to the prospective patient cohort. Validation studies demonstrated excellent inter-rater and intra-rater reliability (weighted Cohen's kappa range, 0.82 [95% CI, 0.5-1.0] to 0.99 [95% CI, 0.98-1.0] and 0.95 [95% CI, 0.84-1.0] to 0.97 [95% CI, 0.92-1.0], respectively). The majority of the raters reported the score to be simple, objective, and reproducible (respective mean scores, 4.76 ± 0.43, 4.53 ± 0.62, and 4.56 ± 0.56 on 5-point Likert scales). CONCLUSION: The Toronto Sarcoma Flap Score (TSFS) is a simple and objective classification system with excellent inter- and intra-rater reliability. Universal adoption of the TSFS could standardize outcome reporting in future studies and aid in the establishment of clinical benchmarks to improve the quality of care in sarcoma reconstruction.

Using Multisource Feedback to Assess Resident Communication Skills: Adding a New Dimension to Milestone Data.

Background: The Accreditation Council for Graduate Medical Education (ACGME) requires evaluation of residents' communication skills. These evaluations should involve assessments from a variety of persons with different perspectives and opportunities to observe resident behavior. Our objectives with this study were to determine if parents, nurses, and physicians significantly differed in their ratings of residents' communication skills; to ascertain the degree of association between these evaluations and ACGME milestone data; and to elicit feedback from residents about the specificity and usefulness of this type of evaluation compared to the evaluations they were typically provided. Methods: During the 2016-2017 academic year, parents of patients ready for discharge, nurses, and attending physicians completed evaluations of resident communication skills. A repeated measures multivariate analysis of variance compared communication skills scores across the 3 groups of raters. Resident ACGME milestone ratings for interpersonal and communication skills were correlated with the communication skills evaluations. Residents rated the specificity and usefulness of the 360-degree evaluations. Results: Parents rated residents' communication skills significantly higher than nurses and physicians rated them. We found no significant difference between the nurse and physician ratings. A significant correlation was found between resident ratings by physicians and ACGME milestone data. Residents found the feedback from these evaluations to be more specific and useful in delineating their communication strengths and weaknesses than typical milestone feedback. Conclusion: Parents added a unique perspective about residents' communication and should be included in resident evaluation when feasible. Residents appreciated the specificity and usefulness of the evaluation instrument.

Diagnosis and clinical outcome following surgical resection of an intracranial grade III anaplastic gemistocytic astrocytoma in a cat.

CASE SUMMARY: A 10-year-old Maine Coon cat was presented for acute onset seizures and cerebrothalamic signs. An intracranial mass, suspected to be a meningioma, was diagnosed on MRI and surgically excised. Histopathology appeared consistent with an atypical meningioma. However, following rapid regrowth of the neoplasm, the patient was humanely euthanized 3 months later. On post-mortem histopathology, the neoplasm was diagnosed as a grade III anaplastic gemistocytic astrocytoma. RELEVANCE AND NOVEL INFORMATION: Gemistocytic astrocytomas are rare brain tumors in the feline patient. This case represents the first report of a feline grade III anaplastic gemistocytic astrocytoma in the cerebrum of a cat with surgical excision and recurrence. The challenging nature of ante-mortem diagnosis and the guarded prognosis, despite surgical intervention, are presented in this report.

Sexual transmission of Zika virus on Twitter: A depoliticised epidemic.

During global health crises, different narratives regarding infectious disease epidemics circulate in traditional media (e.g. news agencies, television channels) and social media. Our study investigated the narratives related to sexual transmission of Zika virus that circulated on Twitter during a public health emergency and analyzed the relationship between information on Twitter and on traditional media. We examined 10,748 tweets posted during the peaks of Twitter activity between January and March 2016. Posts in English, Spanish, French, and Portuguese and websites linked to tweets were manually reviewed and analyzed thematically. During the study period, there were three peaks of Twitter activity related to the sexual transmission of Zika. Most tweets in the first peak (n = 412) had humorous/sarcastic content (55%). Most tweets in the second and third peaks (n = 5,154 and n = 5,182, respectively) disseminated information (>93%). Across languages, textual and visual content on the websites were predominantly placed online by traditional media and highlighted epidemiological narratives published by public health agencies, with little or no mention of the concerns or experiences of individuals most affected by Zika. Prioritising epidemiological/clinical aspects of epidemics may have a depoliticising effect and contribute to overlooking socio-economic determinants of the Zika epidemic and issues related to reproductive justice.

Development and Evaluation of a Machine Learning Prediction Model for Flap Failure in Microvascular Breast Reconstruction.

BACKGROUND: Despite high success rates, flap failure remains an inherent risk in microvascular breast reconstruction. Identifying patients who are at high risk for flap failure would enable us to recommend alternative reconstructive techniques. However, as flap failure is a rare event, identification of risk factors is statistically challenging. Machine learning is a form of artificial intelligence that automates analytical model building. It has been proposed that machine learning can build superior prediction models when the outcome of interest is rare. METHODS: In this study we evaluate machine learning resampling and decision-tree classification models for the prediction of flap failure in a large retrospective cohort of microvascular breast reconstructions. RESULTS: A total of 1012 patients were included in the study. Twelve patients (1.1%) experienced flap failure. The ROSE informed oversampling technique and decision-tree classification resulted in a strong prediction model (AUC 0.95) with high sensitivity and specificity. In the testing cohort, the model maintained acceptable specificity and predictive power (AUC 0.67), but sensitivity was reduced. The model identified four high-risk patient groups. Obesity, comorbidities and smoking were found to contribute to flap loss. The flap failure rate in high-risk patients was 7.8% compared with 0.44% in the low-risk cohort (p = 0.001). CONCLUSIONS: This machine-learning risk prediction model suggests that flap failure may not be a random event. The algorithm indicates that flap failure is multifactorial and identifies a number of potential contributing factors that warrant further investigation.

Scapula fracture secondary to metastatic pulmonary carcinoma in a horse: Clinical, sonographic, radiographic, computed tomographic, and pathologic findings.

A 20-year-old Quarter horse gelding was referred for evaluation of an acute onset non-weight-bearing right forelimb lameness. Marked soft tissue swelling was apparent over the right scapula and shoulder region; no crepitus was palpable. A complete transverse fracture of the scapular neck was suspected based on ultrasonography and radiographs were obtained to confirm the presumptive diagnosis. A complete, oblique fracture of the right scapular neck with mild cranial and proximal displacement of the distal fragment was detected. Computed tomography of the upper right forelimb was performed post-mortem; lytic bony destruction of the scapular neck with a secondary pathologic fracture was observed. The lesion was considered most likely neoplastic. At necropsy a complete, comminuted fracture of the right scapula was confirmed, secondary to neoplastic invasion of the bone. A solitary, dorsally located, neoplastic mass was also observed within the parenchyma of the right caudal lung. Histopathologically, the lung and scapula lesions were similar, characteristic of a well-differentiated pulmonary carcinoma.

Fracture de l'omoplate secondaire à un carcinome pulmonaire métastasique chez un cheval : trouvailles cliniques, échographiques, radiographiques, par tomodensitométrie et pathologiques. Un cheval hongre Quarter horse âgé de 20 ans fut référé pour évaluation d'une boiterie de non-appui de la patte avant droite d'apparition aiguë. Une enflure marquée des tissus mous était apparente par-dessus l'omoplate droite et la région de l'épaule; aucun crépitement n'était palpable. Une fracture transverse complète du col de l'omoplate était suspectée sur la base de l'échographie et des radiographies furent obtenues pour confirmer le diagnostic présomptif. Un examen par tomodensitométrie de la portion supérieure du membre droit fut effectué post-mortem; une destruction osseuse lytique du col de l'omoplate avec une fracture pathologique secondaire fut observée. La lésion fut considérée comme fort probablement néoplasique. Lors de la nécropsie, une fracture comminutive complète de l'omoplate droite fut confirmée, secondaire à l'invasion néoplasique de l'os. Une masse néoplasique solitaire, localisée dorsalement fut également observée dans le parenchyme du poumon caudal droit. À l'examen histopathologique, les lésions du poumon et de l'omoplate étaient similaires, caractéristiques d'un carcinome pulmonaire bien différencié.(Traduit par Dr Serge Messier).