Scalp wound management: a narrative review from a neurosurgical perspective.

OBJECTIVE: This article aims to present a narrative review of current literature about the anatomical characteristics of the scalp as well as current practices in the management of surgical, traumatic and pressure injuries in the scalp, which are common in neurosurgery practice. METHOD: We searched PubMed for publications and book chapters in English from 2011 to 2021. We also included commonly referenced papers that we considered relevant to the subject with publication before these dates. We used the search terms 'laceration,' and/or 'neurosurgery' and/or, 'pressure injury,' and/or 'craniotomy,' and/or 'surgical incision' in combination with 'scalp,' and/or 'wound care.' We also searched the reference lists of publications identified by the search strategy and selected those that we judged relevant. RESULTS: We pre-selected 52 articles that covered various aspects of anatomy, pathophysiology, scalp wound management, or general wound care that we considered applied to the anatomical region of our interest. After abstract review, we selected 34 articles that met our search criteria and were included in our review. CONCLUSION: There is limited evidence regarding classification and care of scalp wounds. As a result, many of the current practices for scalp wound management are based on evidence derived from studies involving different anatomical regions, not considering its particular anatomy, vasculature and microbiome. Further research is needed for more comprehensive and effective protocols for the management of scalp injuries. However, this present review proposes responses to the identified gaps concerning the management of scalp wounds.

Patients' knowledge about their involvement in clinical trials. A non-randomized controlled trial.

Background: Nowadays, good clinical practice should be established in human research. Patient's rights and autonomy must be respected above the interest of the researcher, making mandatory to raise patient's awareness on the implications of participating in a clinical study. Contrary to popular belief, this is not always the case. This means that, after signing the informed consent form, some patients have difficulties understanding their responsibilities as participants. Materials and methods: This study is a prospective, multicenter, non-randomized controlled trial comparative survey conducted on patients enrolled in a clinical trial to evaluate and improve their understanding after an educational intervention was applied to the research staff. Results: Females were underrepresented in the clinical trials performed in this study, 21.5%. Most of the participants had a low educational level (74.4%). Around 5 and 10% of the research participants were not aware they were part of a clinical study, and more 24% just trusted in the medical decision to be enrolled. After the interventional education, the following items: "given time and resolution of the patient doubts" (p-value = 0.003), "enough written information" (p-value = 0.006), "explanation of the risks of participating in the study," (p-value = 0.047) and understanding of the information provided to them showed an improvement regarding the study in which they were participating. Conclusion: The research participants understanding of their involvement in clinical trials is limited. An educational intervention on the research team can improve the process of empowerment and transit of information.

Scaling SARS-CoV-2 Wastewater Concentrations to Population Estimates of Infection

Monitoring the progression of SARS-CoV-2 outbreaks requires accurate estimates of infection rates. Estimation methods based on observed cases are biased due to changes in testing over time. Here we report an approach based upon scaling daily concentrations of SARS-CoV-2 RNA in wastewater to infections that produces representative estimates due to the consistent population contribution of fecal material to the sewage collection system.

Predicting daily COVID-19 case rates from SARS-CoV-2 RNA concentrations across a diversity of wastewater catchments

We assessed the relationship between municipality COVID-19 case rates and SARS-CoV-2 concentrations in the primary sludge of corresponding wastewater treatment facilities. Over 1,000 daily primary sludge samples were collected from six wastewater treatment facilities with catchments serving 18 cities and towns in the State of Connecticut, USA. Samples were analyzed for SARS-CoV-2 RNA concentrations during a six-month time period that overlapped with fall 2020 and winter 2021 COVID-19 outbreaks in each municipality. We fit a single regression model to estimate reported case rates in the six municipalities from SARS-CoV-2 RNA concentrations collected daily from corresponding wastewater treatment facilities. Results demonstrate the ability of SARS-CoV-2 RNA concentrations in primary sludge to estimate COVID-19 reported case rates across treatment facilities and wastewater catchments, with coverage probabilities ranging from 0.94 to 0.96. Leave-one-out cross validation suggests that the model can be broadly applied to wastewater catchments that range in more than one order of magnitude in population served. Estimation of case rates from wastewater data can be useful in locations with limited testing availability or testing disparities, or delays in individual COVID-19 testing programs.

Changes COVID-19 Post-Quarantine Behaviors, Hygiene and Expectations in Colombia: Population Survey from 1st to 13th September, 2020.

This study by Profamilia Association focuses on the social response to COVID19 by reporting and analyzing the answers to two surveys carried out between April 16 and 25, and throughout September 2020. The study aims to identify changes in behaviors and immediate expectations after the quarantine was lifted. In general, results show that people have adopted behavioral changes such as wearing face masks, avoiding people with symptoms, and reducing mobility. However, it also shows that peoples concerns have doubled for many reasons, ranging from mental health issues, neglected sexual and reproductive health needs, the burden of care for others, and working from home. Similarly, it was found that some people would accept significant long-term changes such as accepting most children continuing to be homeschooled or employees choosing whether to work or not, targeted quarantines in neighborhoods that show high number of cases; and making the use of face masks mandatory in case a vaccine or treatment for Covid-19 does not become available. This means that during the quarantine and compared to April, many people consider these options to be acceptable in the long term. The survey was filled out online via SurveyMonkey by 1,735 people in Colombia between 1st and 11th September, 2020. Overall, 17% mentioned that they had participated in the previous survey, Estudio Solidaridad I early stage of quarantine (April 2020). The following is a summary of the main findings based on the comparison of the two surveys in hopes to show evidence for changes in behavior, hygiene, levels of measure compliance, unmet needs, and to show people[s] immediate expectations after six months of strict quarantine. O_LIThe most common concerns among the findings were: a vaccine or treatment for COVID-19 not arriving Colombia soon enough (79%), a vaccine or treatment not being developed soon enough (79%) and also a concern that once the vaccine arrives in Colombia, it will not be accessible (74%). 50% of people think it is likely to get the COVID-19 vaccine once it becomes readily available. C_LIO_LI62% get information about COVID-19 through social media, 55% through official websites, and 51% through television. C_LIO_LI43% say that in their neighborhood, community, social group, or town, measures and campaigns have been carried out to prevent the spread of the COVID-19. C_LIO_LI25% say they would like to support local communities respond to the outbreak. C_LIO_LI82% agree with most children remaining home-schooled. C_LIO_LI85% think parents should be able to choose whether or not to send their children to school. C_LIO_LI95% agree that people should be forced to wear face masks outside the home. C_LIO_LI90% agree with neighborhoods, districts, or municipalities which experience outbreaks adopting more restrictive measures compared to the country as a whole. C_LIO_LI86% think employees should choose whether to work in their office or work from home. C_LIO_LI44% think that people will be able to be vaccinated against COVID-19 in a year or a year and a half. C_LIO_LI26% think life will return to "normal" in two years or more. C_LI

Spatiotemporal variation in Lepidochelys olivacea sea turtle nests and their influence on the abundance and reproductive phenology of the sapro-necrophagous beetle Omorgus suberosus.

The olive ridley sea turtle, Lepidochelys olivacea (Eschscholtz, 1829), nests en masse in the protected natural area of La Escobilla, Mexico. On this beach, Omorgus suberosus (Fabricius, 1775), a sapro-necrophagous beetle, feeds on the sea turtles' decomposing and live eggs and is considered to be a threat for the conservation of L. olivacea. However, the abundance and reproductive phenology of O. suberosus in relation to the spatial and temporal availability of this food resource are unknown. We tested two alternative hypotheses during the 2013-2014 nesting season of L. olivacea: (i) abundance and female reproductive phenology of beetles are determined by the spatial and temporal availability of decomposing eggs that accumulate during the turtle nesting season, and (ii) abundance and female reproductive phenology of beetles are related to the increase in the concentration of seasonal and/or new turtle nests. Twenty-four plots (1 m2) were sampled in three areas with different turtle nesting densities. Spatially, beetle abundance was greater where turtle nest density was high and decomposed eggs were abundant. At the temporal level, old nests (> 45 days after egg deposition) were abundant and the presence of seasonal and new nests (~ 45 or fewer days after egg deposition) appeared to trigger sexual maturation in female beetles. Immature female beetles were more abundant throughout the turtles' nesting season, and mature females were only abundant during the turtle arribadas with the highest number of seasonal nests. We conclude that abundance and female reproductive phenology of O. suberosus females are influenced by the quantity and quality of the resource. These findings are useful to understand the interaction of L. olivacea with other species and to strengthen the conservation plans of this turtle species.

Social response to early-stage government control measures of COVID-19 in Colombia: population survey, April 8-20 2020.

On Monday, March 16, 2020, the government of Colombia announced actions to control COVID-19. These recommendations directly affected the entire population and included: reducing physical contact; reducing mobility and cancelling unnecessary travel; working from home; cancelling mass events; a 14 day at-home isolation period for people who arrived from international trips, or in cases in which someone in the household experienced a high temperature and sustained coughing; as well as increasing the frequency of hand washing and the use of face masks on public transport. In order to understand the public sentiment around these recommendations, Asociacion Profamilia developed an online survey through SurveyMonkey(R). The survey was completed by 3549 adult people in Colombia (+18 years) between April 8 and April 20, 2020. In this report, we present the results of the survey: O_LI98% think that the COVID-19 pandemic is a serious problem in Colombia. C_LIO_LI90% are concerned that someone in their family will get COVID-19. C_LIO_LI88% are concerned that someone in their family may have an emergency and not receive medical care. C_LIO_LI46% believe they will likely get infected under the current Colombian government measures. C_LIO_LI92% of adults reported taking at least one of the following measures to protect themselves from the COVID-19 infection: O_LI85% of senior citizens (60 years and older) voluntarily isolated or complied with governments mandatory isolation measures. C_LIO_LI82% cut down on their mobility (avoided going out, using public transportation, and traveling). C_LIO_LI79% of those showing symptoms voluntarily isolated themselves and complied with government isolation measures. C_LIO_LI78% increased the frequency in which they use disinfectants, alcohol, and sanitizing gel, and how often they wash their hands. C_LIO_LI73% refrained from going out to social events and crowded places. C_LIO_LI70% avoided kissing and shaking hands. C_LIO_LI69% immediately complied with the governments mandatory preventive isolation measures. C_LIO_LI63% avoided using public transportation. C_LIO_LI46% went into self-isolation (voluntary quarantine) before the government decreed it. C_LIO_LI32% started working from home. C_LI C_LIO_LIThis study reveals that there are at least three groups of people in the country who are responding to the pandemic and physical distancing measures in different forms: those who resist the situation (34%), those who suffer from it (26%), and those who accept it (40%). O_LIIn the group of people who are resisting 40% are men; 68% are under 39 years old; 40% have savings and one out ten reported mental health problems; and 64% supported the government measures. C_LIO_LIIn the group of people suffering from the pandemic, 73% are women, 64% are under 29 years old, 55% have an average family income over 2 million pesos COP (roughly 417 GBP), 61% have had some chronic disease or somebody in the family; 73% reported mental problems. This group had the higher support and adherence to the government measures (68%). C_LIO_LIIn the group of people who are adapting to the situation, 76% are women, 43% are over 49 years old, 36% have savings, and 63% have not had chronic illnesses and 73% reported mental problems. This group had the lower support and adherence to the government measures (63%). C_LI C_LIO_LI69% complied with governments mandatory preventive isolation measures. This percentage was lower (64%) among young adults (25-29 years old). C_LIO_LIOverall, 83% are complying with preventive isolation and physical distancing. 77% feel that complying with isolation contributes to stopping COVID-19. C_LIO_LIHygiene practices such as hand washing (78%), avoiding kissing and hand-shaking (70%), as well as using face masks (69%) were perceived as more effective measures to prevent the spread of the virus compared to physical distancing measures like cancelling travelling (46%), avoiding contact with people with fever or respiratory symptoms (43%), and avoiding contact with people who have travelled in the last month (35%). C_LIO_LI80% live in the five cities with the highest spread of COVID-19. O_LI50% are responsible for the care of a family member; 16% are women heads of household. C_LIO_LI68% mentioned do not have savings. C_LIO_LI25% did not work before COVID-19. C_LI C_LIO_LIThe top three concerns among the respondents were that someone in their family may get infected with COVID-19 (79%), that someone in their family may have an emergency and not receive medical care. (74%) and the fate of the poorest and most vulnerable people (71%). C_LIO_LIDuring quarantine, 75% have experienced issues with their mental health: 54% felt nervous; 52% have felt tired for no reason; 46% felt restless and impatient, and 34% felt anger and rage; 20% have experienced a need for sexual and reproductive health in the last 21 days which has not been met. 17% are concerned about their childrens bad behaviour and domestic violence. C_LIO_LI63% get informed about COVID-19 through official websites; 52% have found false information about COVID-19 and the pandemic. 40% have experienced or witnessed jokes about the spread of COVID-19, and 25% have experienced or witnessed discrimination against health care personnel. C_LIO_LI38% believe that the National Governments response to control the virus was clear and consistent and 29% believe that it acted in a timely and swift manner; 46% believe that the Local Governments response was clear and consistent and 42% believe that it acted in a quick and timely manner. C_LI

Synchronous Closure of A Large Medial Perforator-Based Superficial Circumflex Iliac Artery Perforator Free Flap Donor Site Using an Ipsilateral Lateral Perforator-Based Superficial Circumflex Iliac Artery Perforator Propeller Flap.

A superior advantage of the superficial circumflex iliac artery perforator flap is that any donor site residue can easily be hidden by clothing. Usually designed as narrow or moderate-sized flaps based on medial perforators of the superficial branch, this readily allows primary donor site closure. However, for larger flaps, tension-free closure requires that the thigh remain flexed or even a skin graft used. Another alternative would be to use an adequate lateral perforator of the deep branch, if available, as the vascular hub of a propeller flap that extended into the adjacent flank, that could then be rotated into the medial groin to facilitate simultaneous direct closure of both flap donor sites.