A qualitative dyadic approach to explore the experiences and perceived impact of COVID-19 restrictions among adolescents and their parents

Background

While evidence exists for the negative and positive effects of the COVID-19 pandemic and associated lockdown on the mental health and well-being of adolescents and parents separately, the potential impact of lockdown, and the effective coping strategies that have been used have so far, by both children and their parents still needs to be explored.

Method

A dyadic approach was used to explore the perceived impact of COVID-19 restrictions among early adolescents and their parents in Northwest England. Nine parents (8 female and 1 male) and their 10 children (6 boys and 4 girls) aged 11-13, were recruited from 4 secondary schools to be interviewed. Remote interviews took place between October and December 2020 for the adolescents and between March and May 2021 for their parents. Inductive thematic analysis was used.

Results

Five inter-related themes were identified: (1) overcoming barriers for learning at home; (2) juggling a work-life balance; (3) loss of experiences; (4) caring for other family members; and (5) adopting new self-care and coping strategies during the pandemic.

Conclusion

Themes identified will help to inform policy and practice for supporting adolescents and parents in the future, including the promotion of positive coping strategies and the provision of resources for adolescents, schools and families.

Size-dependent influence of NOx on the growth rates of organic aerosol particles

Atmospheric new-particle formation (NPF) affects climate by contributing to a large fraction of the cloud condensation nuclei (CCN). Highly oxygenated organic molecules (HOMs) drive the early particle growth and therefore substantially influence the survival of newly formed particles to CCN. Nitrogen oxide (NOx) is known to suppress the NPF driven by HOMs, but the underlying mechanism remains largely unclear. Here, we examine the response of particle growth to the changes of HOM formation caused by NOx. We show that NOx suppresses particle growth in general, but the suppression is rather nonuniform and size dependent, which can be quantitatively explained by the shifted HOM volatility after adding NOx. By illustrating how NOx affects the early growth of new particles, a critical step of CCN formation, our results help provide a refined assessment of the potential climatic effects caused by the diverse changes of NOx level in forest regions around the globe.

Ion-induced sulfuric acid-ammonia nucleation drives particle formation in coastal Antarctica

Formation of new aerosol particles from trace gases is a major source of cloud condensation nuclei (CCN) in the global atmosphere, with potentially large effects on cloud optical properties and Earth's radiative balance. Controlled laboratory experiments have resolved, in detail, the different nucleation pathways likely responsible for atmospheric new particle formation, yet very little is known from field studies about the molecular steps and compounds involved in different regions of the atmosphere. The scarcity of primary particle sources makes secondary aerosol formation particularly important in the Antarctic atmosphere. Here, we report on the observation of ion-induced nucleation of sulfuric acid and ammonia-a process experimentally investigated by the CERN CLOUD experiment-as a major source of secondary aerosol particles over coastal Antarctica. We further show that measured high sulfuric acid concentrations, exceeding 10⁷ molecules cm^-3, are sufficient to explain the observed new particle growth rates. Our findings show that ion-induced nucleation is the dominant particle formation mechanism, implying that galactic cosmic radiation plays a key role in new particle formation in the pristine Antarctic atmosphere.

Effect of dimethylamine on the gas phase sulfuric acid concentration measured by Chemical Ionization Mass Spectrometry

Sulfuric acid is widely recognized as a very important substance driving atmospheric aerosol nucleation. Based on quantum chemical calculations it has been suggested that the quantitative detection of gas phase sulfuric acid (H₂SO₄) by use of Chemical Ionization Mass Spectrometry (CIMS) could be biased in the presence of gas phase amines such as dimethylamine (DMA). An experiment (CLOUD7 campaign) was set up at the CLOUD (Cosmics Leaving OUtdoor Droplets) chamber to investigate the quantitative detection of H₂SO₄ in the presence of dimethylamine by CIMS at atmospherically relevant concentrations. For the first time in the CLOUD experiment, the monomer sulfuric acid concentration was measured by a CIMS and by two CI-APi-TOF (Chemical Ionization-Atmospheric Pressure interface-Time Of Flight) mass spectrometers. In addition, neutral sulfuric acid clusters were measured with the CI-APi-TOFs. The CLOUD7 measurements show that in the presence of dimethylamine (<5 to 70 pptv) the sulfuric acid monomer measured by the CIMS represents only a fraction of the total H₂SO₄, contained in the monomer and the clusters that is available for particle growth. Although it was found that the addition of dimethylamine dramatically changes the H₂SO₄ cluster distribution compared to binary (H₂SO₄-H₂O) conditions, the CIMS detection efficiency does not seem to depend substantially on whether an individual H₂SO₄ monomer is clustered with a DMA molecule. The experimental observations are supported by numerical simulations based on A Self-contained Atmospheric chemistry coDe coupled with a molecular process model (Sulfuric Acid Water NUCleation) operated in the kinetic limit.

Interpretation of pediatric lung function: impact of ethnicity

RATIONALE

To evaluate the appropriateness of spirometric and plethysmographic reference equations in healthy young children according to ethnic origin.

METHODS

Spirometry data were collated in 400 healthy children (214 Black and 186 White) aged 6-12 years. Of these children, 68 Black and 115 White children also undertook plethysmography. Results were expressed as percent predicted according to commonly used equations for spirometry and plethysmography.

RESULTS

Black children had lower lung function for a given height compared to White children. The magnitude and direction of these differences varied according to specific outcome. In the studied age range (6-12 years) the ethnic-specific Wang equations were adequate for spirometry (mean results approximating 100% predicted in both ethnic groups). By contrast, significant differences were found between observed and % predicted plethysmographic lung volumes according to published equations derived from White children: Among the Black children, function residual capacity (FRC) and total lung capacity (TLC) were on average, 14 and 6% lower than predicted, whereas mean residual volume (RV) and RV/TLC were 4 and 10% higher. Among White children, the Rosenthal equations gave the best fit, with the exception of FRC which was, on average, 9% lower than predicted.

CONCLUSION

Spirometry equations may suffice in Black children; however, interpretation of static lung volumes in Black children is limited due to inappropriate reference equations. More appropriate plethysmographic reference equations that are applicable to all ethnic groups across the entire age range are urgently needed.

Accessing packaged food and beverages in hospital. Exploring experiences of patients and staff

Food and beverage packaging has been identified as a contributing factor to malnutrition among elderly patients in hospitals. The focus of this research was to describe the types of food and beverage packaging used in NSW hospitals, determine the 'problematic' packaging from the users' perspective, investigate the effect of hand strength on the ability to open the packaging and to survey users' (patients and staff) views on the 'accessibility' of the packaging. The study was conducted in the Illawarra region of NSW, Australia. Participants (140 mostly elderly inpatients and 64 staff members) were recruited from four local public hospitals. Data were collected using interviews, questionnaires, observations and grip strength testing. Several food and beverage packages were found difficult to open by at least 40% of patients. These included milk and juices (52%), cereal (49%), condiments (46%), tetra packs (40%) and water bottles (40%). The difficulties were attributed to 'fiddly' packaging, hand strength and vision; however, only tetra packs demonstrated a relationship between time taken to open and hand strength, suggesting other aspects of hand function may be more important than strength when opening food and beverage packages.

Nature and severity of lung function abnormalities in extremely pre-term children at 11 years of age

Advances in neonatal care have resulted in increased survival of children born extremely pre-term (EP). Nevertheless the incidence of bronchopulmonary dysplasia and long-term respiratory morbidity remains high. We investigated the nature of pathophysiological changes at 11 yrs of age to ascertain whether respiratory morbidity in EP children primarily reflects alterations in the lung periphery or more centralised airway function in this population. Spirometry, plethysmography, diffusing capacity, exhaled nitric oxide, multiple-breath washout, skin tests and methacholine challenge were used during laboratory-based assessments in a subgroup of the 1995 EPICure cohort and in controls. Results were obtained in 49 EP and 52 control children. Lung function abnormalities were found in 78% of EP children, with evidence of airway obstruction, ventilation inhomogeneity, gas trapping and airway hyperresponsiveness. Levels of atopy and exhaled nitric oxide were similar between the groups. Prior wheeze was associated with significant reductions in forced flows and volumes. By contrast, abnormalities of the lung periphery appear to be mediated primarily through EP birth per se. The prevalence of lung function abnormalities, which is largely obstructive in nature and likely to have long-term implications, remains high among 11-yr-old children born EP. Spirometry proved an effective means of detecting these persistent abnormalities.

Reference equations for specific airway resistance in children: the Asthma UK initiative

Plethysmographic specific airway resistance (sR(aw)) is a useful research method for discriminating lung disease in young children. Its use in clinical management has, however, been limited by lack of consensus regarding equipment, methodology and reference data. The aim of our study was to collate reference data from healthy children (3-10 yrs), document methodological differences, explore the impact of these differences and construct reference equations from the collated dataset. Centres were approached to contribute sR(aw) data as part of the Asthma UK initiative. A random selection of pressure-flow plots were assessed for quality and site visits elucidated data collection and analysis protocols. Five centres contributed 2,872 measurements. Marked variation in methodology and analysis excluded two centres. sR(aw) over-read sheets were developed for quality control. Reference equations and recommendations for recording and reporting both specific effective and total airway resistance (sR(eff) and sR(tot), respectively) were developed for White European children from 1,908 measurements made under similar conditions. Reference sR(aw) data collected from a single centre may be misleading, as methodological differences exist between centres. These preliminary reference equations can only be applied under similar measurement conditions. Given the potential clinical usefulness of sR(aw), particularly with respect to sR(eff), methodological guidelines need to be established and used in prospective data collection.

The EPICure study: comparison of pediatric spirometry in community and laboratory settings

RATIONALE

Accuracy of spirometry testing is a prerequisite for its use as an objective outcome measure in large epidemiological studies. We compared spirometry measurements obtained by trained pediatricians in a variety of school settings with those obtained in the laboratory by respiratory physiologists.

METHODS

Following a 3-day training course, three pediatricians carried out spirometry in children born extremely preterm (EP) and age matched controls in schools across the UK and Ireland (The EPICure study). A subgroup had repeated measurements in the laboratory. Spirometric flows and volumes were expressed as Z-scores. Bland-Altman analysis was used to calculate within-subject differences.

RESULTS

Fifty children (40% boys), 37 (74%) of whom were born EP, with a mean age 10.8 years had paired spirometry results (average interval between tests: 20.3 weeks). There was no statistically significant difference between any of the outcome variables: mean (95% CI of difference) in Z-scores [school-laboratory]) being 0.0 (-0.1; 0.1) for FEV(1), 0.1 (-0.1; 0.3) for FVC, -0.1 (-0.3; 0.1) for FEF(25-75), and 0.0 (-0.3; 0.1) for FEV(1)/FVC. Within individuals, the 95% limits of agreement for repeated measures were within +/- 1 Z-score for FEV(1) and FVC, and within +/- 1.5 Z-score for FEF(25-75) and FEV(1)/FVC.

CONCLUSION

With appropriate training, quality control, and support, pediatric spirometry can reliably be performed outside the lung function laboratory.

Cosmic rays, clouds, and climate

It has been proposed that Earth's climate could be affected by changes in cloudiness caused by variations in the intensity of galactic cosmic rays in the atmosphere. This proposal stems from an observed correlation between cosmic ray intensity and Earth's average cloud cover over the course of one solar cycle. Some scientists question the reliability of the observations, whereas others, who accept them as reliable, suggest that the correlation may be caused by other physical phenomena with decadal periods or by a response to volcanic activity or El Niño. Nevertheless, the observation has raised the intriguing possibility that a cosmic ray-cloud interaction may help explain how a relatively small change in solar output can produce much larger changes in Earth's climate. Physical mechanisms have been proposed to explain how cosmic rays could affect clouds, but they need to be investigated further if the observation is to become more than just another correlation among geophysical variables.

Patient-controlled sedation using propofol during interventional neuroradiologic procedures

Patient-controlled sedation (PCS) using propofol has been reported to provide safe and effective sedation during a variety of procedures performed under regional or local anesthesia. In a prospective, randomized fashion, this study evaluated propofol PCS compared to anesthesiologist-administered midazolam-fentanyl sedation during interventional neuroradiologic (INR) procedures. Nineteen patients undergoing 24 INR procedures received propofol PCS (PCS dose, 0.5 mg/kg; lockout interval, 3 min) or anesthesiologist-administered midazolam-fentanyl sedation. Study parameters included discomfort, sedation and anxiety visual analogue scores (VAS), cognitive function, patient satisfaction, and complications. No difference was found between the two sedation techniques with respect to the levels of sedation and anxiolysis. Cognitive function was well preserved in both groups. Patient satisfaction was similarly high in both groups. Complications were similar between groups. These included ventilatory depression (two patients in each group) and excessive sedation (two patients in each group). Three patients in the propofol group became excessively restless, resulting in brief interruptions during the respective procedures. Propofol PCS offers a safe sedation technique during INR procedures with a sedation and anxiolysis profile that was not distinguishable from anesthesiologist-administered midazolam-fentanyl sedation.

Propofol sedation during awake craniotomy for seizures: electrocorticographic and epileptogenic effects

This prospective study evaluated the effects of propofol sedation on the incidence of intraoperative seizures and the adequacy of electrocorticographic (ECoG) recordings during awake craniotomy performed for the management of refractory epilepsy. Thirty patients scheduled for temporal or frontal lobectomy for epilepsy under bupivacaine scalp block were randomized to receive patient-controlled propofol sedation (PCS) combined with a basal infusion of propofol (n = 15) or neurolept analgesia using an initial bolus dose of fentanyl (0.7 microg/kg) and droperidol (0.04 mg/kg) followed by a fentanyl infusion (n = 15). Propofol administration was suspended 15 min before ECoG recording in the PCS group. The occurrence of inappropriate intraoperative seizures was noted and, based on blind review, the adequacy of ECoG recordings was compared. A higher incidence of intraoperative seizures was noted among the neurolept patients (6 vs 0, P = 0.008). Intraoperatively, ECoG recordings were adequate to proceed with resection in both groups. Evidence of low spike activity on ECoG did not correlate with the type of sedation administered. Higher frequency background ECoG activity was noted among patients who received propofol, but this did not interfere with ECoG interpretation. The use of propofol sedation does not appear to interfere with ECoG during epilepsy surgery, provided administration is suspended at least 15 min before recording.

Propofol sedation during awake craniotomy for seizures: patient-controlled administration versus neurolept analgesia

This prospective study evaluated the safety and efficacy of patient-controlled sedation (PCS) using propofol during awake seizure surgery performed under bupivacaine scalp blocks. Thirty-seven patients were randomized to receive either propofol PCS combined with a basal infusion of propofol (n = 20) or neurolept analgesia using an initial bolus dose of fentanyl and droperidol followed by a fentanyl infusion (n = 17). Both groups received supplemental fentanyl and dimenhydrinate for intraoperative pain and nausea, respectively. Comparisons were made between groups for sedation, memory, and cognitive function, patient satisfaction, and incidence of complications. Levels of intraoperative sedation and patient satisfaction were similar between groups. Memory and cognitive function were well preserved in both groups. The incidence of transient episodes of ventilatory rate depression (<8 bpm) was more frequent among the propofol patients (5 vs 0, P = 0.04), particularly after supplemental doses of opioid. Intraoperative seizures were more common among the neurolept patients (7 vs 0, P = 0.002). PCS using propofol represents an effective alternative to neurolept analgesia during awake seizure surgery performed in a monitored care environment.

Propofol patient-controlled sedation during hip or knee arthroplasty in elderly patients

PURPOSE

Little information is available regarding the use of patient-controlled sedation (PCS) among the elderly. This study evaluated the safety and efficacy of propofol PCS among elderly patients undergoing hip or knee arthroplasty.

METHODS

Forty patients, aged 65-78 yr, undergoing hip or knee arthroplasty under regional anaesthesia were randomized to receive propofol PCS (dose = 0.3 mg.kg-1, delay = three min; n = 20) or anaesthetist-administered midazolam-fentanyl sedation (n = 20). Sedation, anxiety and discomfort visual analogue scores (VAS) were measured, by an independent observer, preoperatively, immediately at the end of surgery and one hour following admission to the postanaesthetic care unit (PACU). Cognition was evaluated, using an abbreviated Mini Mental Status Examination, preoperatively and in the PACU. Patient satisfaction, based on VAS and a brief questionnaire, was measured in the PACU. The incidence of intraoperative complications was also compared.

RESULTS

Patient satisfaction was high in each group. Sedation and anxiety VAS were similar in each group. A high incidence of pain with drug injection was noted among patients receiving propofol (80%). Transient deeper levels of sedation (6 vs 1; P = 0.05) were observed more commonly in the propofol PCS group.

CONCLUSION

Propofol PCS provides effective sedation. Using a propofol dose of 0.3 mg.kg-1, transient episodes of deeper sedation were noted more frequently among patients receiving PCS. These episodes did not require intervention but, suggest that this propofol PCS dose approaches the limit of safety and should be further reduced for some elderly patients.

Patient-controlled propofol sedation for elderly patients: safety and patient attitude toward control

PURPOSE

Little information is available regarding the use of patient-controlled sedation (PCS) among elderly patients undergoing operative procedures under local or regional anaesthesia. This prospective, randomized study evaluated the safety of propofol PCS, and the attitude among elderly patients toward self-administration of sedation during cataract surgery.

METHODS

Prospective, randomized study conducted in a University affiliated, tertiary-care hospital. Fifty-five elderly patients (aged 65-79 yr) were randomized to receive propofol patient-controlled sedation (PCS) (n = 28) or no intraoperative sedation (n = 27) during cataract surgery performed under peribulbar block. The PCS parameters consisted of a lockout interval of three minutes and a PCS dose of 0.3 mg.kg-1. Study groups were compared with respect to sedation, anxiety and discomfort visual analogue scores (VAS), cognitive functioning, patient satisfaction and the incidence of intraoperative complications.

RESULTS

Patients in the PCS group administered a mean propofol dose of 65 +/- 49 mg during procedures with a mean duration of 46 min. The incidence of intraoperative complications and sedation, anxiety and discomfort VAS were similar between groups. Patient satisfaction with PCS was high. In the PCS group, 10 (35%) of the 28 patients did not use the device because they were comfortable and did not feel they needed sedation. Satisfaction was higher in the PCS group (P = 0.02), whether or not they used the PCS device, compared with patients who did not receive a PCS device.

CONCLUSIONS

Propofol PCS represents a safe sedation technique among elderly patients in a monitored care setting. Elderly patients appear to prefer the option of receiving some form of intraoperative sedation and respond favourably to the opportunity to control administration.

Postoperative cognitive impairment in the elderly. Choice of patient-controlled analgesia opioid

This study evaluated the safety and cognitive impact of patient-controlled analgesia with fentanyl compared to patient-controlled analgesia with morphine among elderly postoperative patients. In addition, two screening tests for cognitive impairment, the Mini Mental Status Exam and the Short Portable Mental Status Questionnaire, were compared. Ninety-six elderly patients were randomly allocated to receive patient-controlled analgesia with either fentanyl or morphine following hip or knee arthroplasty. Patients were evaluated postoperatively for clinical confusion, cognitive function test results, adequacy of analgesia, drug use and complications. Fentanyl produced less depression in postoperative cognitive function compared to morphine. The incidence of clinical confusion was not statistically different between groups (4.3% for fentanyl versus 14.3% for morphine). Fentanyl patients used more opioid based on a dose ratio of 100:1 suggesting that this dose ratio is inadequate. The incidence of urinary retention was lower in the fentanyl group. A poor agreement between the two tests of cognitive impairment mandates caution when peri-operative cognitive function is compared using different tests.