Atmospheric Impacts of COVID-19 on NOx and VOC Levels over China Based on TROPOMI and IASI Satellite Data and Modeling

China was the first country to undergo large-scale lockdowns in response to the pandemic in early 2020 and a progressive return to normalization after April 2020. Spaceborne observations of atmospheric nitrogen dioxide (NO2) and oxygenated volatile organic compounds (OVOCs), including formaldehyde (HCHO), glyoxal (CHOCHO), and peroxyacetyl nitrate (PAN), reveal important changes over China in 2020, relative to 2019, in response to the pandemic-induced shutdown and the subsequent drop in pollutant emissions. In February, at the peak of the shutdown, the observed declines in OVOC levels were generally weaker (less than 20%) compared to the observed NO2 reductions (−40%). In May 2020, the observations reveal moderate decreases in NO2 (−15%) and PAN (−21%), small changes in CHOCHO (−3%) and HCHO (6%). Model simulations using the regional model MAGRITTEv1.1 with anthropogenic emissions accounting for the reductions due to the pandemic explain to a large extent the observed changes in lockdown-affected regions. The model results suggest that meteorological variability accounts for a minor but non-negligible part (~−5%) of the observed changes for NO2, whereas it is negligible for CHOCHO but plays a more substantial role for HCHO and PAN, especially in May. The interannual variability of biogenic and biomass burning emissions also contribute to the observed variations, explaining e.g., the important column increases of NO2 and OVOCs in February 2020, relative to 2019. These changes are well captured by the model simulations.

BONE MARROW ASPIRATE CONCENTRATE INJECTION OF THE ACHILLES TENDON IN A COMPETITIVE DISTANCE RUNNER

Achilles tendon disorders, including tendinopathy and ruptures, are common among competitive runners. Relatively high complication rates, recurring injuries, and the need to return to sport have led to the use of regenerative medical treatment in tendon disorders in competitive athletes. Biologic therapies, including bone marrow aspirate concentrate (BMAC) injections, have been effective in restoring injured tissue in a limited number of cases. In this case, a collegiate cross country runner with Achilles tendon pain underwent years of failed, non-surgical conservative management. The patient’s MRI demonstrated moderate distal calcaneus tendinosis with high-grade partial thickness tearing of the anterior fibers of the Achilles tendon (50% tear). The patient underwent peritendinous injection of BMAC. Post-procedure MRI demonstrated minimal tendinosis of the distal and lateral margins of the Achilles tendon, and no evidence of Achilles tendon tear. The patient followed a progressive return to running program, ultimately training 40 miles per week with minimal Achilles tendon pain.

Current concepts of natural course and in management of frozen shoulder: A clinical overview

Frozen Shoulder (FS) by many specialists is still considered a benign, self-limiting condition, which usually resolves without intervention. This concept originated in the 70’, stating that FS will proceed from “the freezing” phase, with the predominance of inflammation and pain to “the frozen” phase with marked stiffness in the joint and “the thawing” phase, with a progressive return to the normal Range Of Motion (ROM) and function. Nevertheless, numerous authors have recently challenged this concept, arguing that most patients with FS will never fully recover, and suffer from residual pain and loss of function. Lack of early intervention, when a patient does not improve with conservative treatment, might lead to disability. We have discussed the recent concepts in the natural course of the disease and discussed both noninvasive and surgical methods in the treatment of FS.

“Qualifying Peripheries” or “Repolarizing the Center”: A Comparison of Gentrification Processes in Europe

Reflecting a broader form of neo-liberal urban policy underlying the progressive return of capital investment, gentrification is a key issue in urban studies. Although earlier definitions of “gentrification” focused mostly on socio-cultural processes, recent works have qualified gentrification as a mixed political–economic issue. Clarifying whether inner city gentrification should be supported, controlled, constricted, or prevented is a key debate in urban sustainability and metabolism, contributing to managing and, possibly, enhancing metropolitan resilience. To define the causes and consequences of gentrification, understanding the intrinsic linkage with different social contexts is crucial. There are no universal and comprehensive gentrification processes, displaying similarities and differences at the same time. A comparative analysis of different forms of gentrification and urban change provides basic knowledge to delineate complex, non-linear paths of socioeconomic development in cities, shedding light on the increased socioeconomic complexity and the most appropriate policies to fuel metropolitan sustainability in a broader context of global change. From this perspective, our commentary focuses on the main issues at the base of gentrification in Europe, starting from basic definitions and providing a regional vision distinguishing three “gentrification ideal-types” (northern, eastern, and Mediterranean). The implications of these different socioeconomic processes for the policy and governance of sustainable and resilient cities were discussed, evidencing new lines of investigation to frame (or re-frame) the increasing complexity of urbanization patterns and processes.

Use of the Progressive Return to Activity Guidelines May Expedite Symptom Resolution After Concussion for Active Duty Military

Background: Clinical recommendations for concussion management encourage reduced cognitive and physical activities immediately after injury, with graded increases in activity as symptoms resolve. Empirical support for the effectiveness of such recommendations is needed. Purpose: To examine whether training medical providers on the Defense and Veterans Brain Injury Center’s Progressive Return to Activity Clinical Recommendation (PRA-CR) for acute concussion improves patient outcomes. Study Design: Cohort study; Level of evidence, 2. Methods: This study was conducted from 2016 to 2018 and compared patient outcomes before and after medical providers received an educational intervention (ie, provider training). Patients, recruited either before or after intervention, were assessed at ≤72 hours, 1 week, 1 month, 3 months, and 6 months after a concussion. The participant population included 38 military medical providers and 106 military servicemembers with a diagnosed concussion and treated by one of the military medical providers: 58 patient participants received care before the intervention (ie, provider training) and 48 received care after intervention. The primary outcome measure was the Neurobehavioral Symptom Inventory. Results: The patients seen before and after the intervention were predominantly male (89.7% and 93.8%, respectively) of military age (mean ± SD, 26.62 ± 6.29 years and 25.08 ± 6.85 years, respectively) and a mean ± SD of 1.92 ± 0.88 days from injury. Compared with patients receiving care before intervention, patients receiving care after intervention had smaller increases in physical activities (difference in mean change; 95% CI, 0.39 to 6.79) and vestibular/balance activities (95% CI, 0.79 to 7.5) during the first week of recovery. Although groups did not differ in symptoms at ≤72 hours of injury ( d = 0.22; 95% CI, –2.21 to 8.07), the postintervention group reported fewer symptoms at 1 week ( d = 0.61; 95% CI, 0.52 to 10.92). Postintervention patients who completed the 6-month study had improved recovery both at 1 month ( d = 1.55; 95% CI, 5.33 to 15.39) and 3 months after injury ( d = 1.10; 95% CI, 2.36 to 11.55), but not at 6 months ( d = 0.35; 95% CI, 5.34 to 7.59). Conclusion: Training medical providers on the PRA-CR for management of concussion resulted in expedited recovery of patients.

Treatment using the Progressive Return to Activity Clinical Recommendation may return individuals with elevated symptomatology to normal levels at an expedited rate

Objective To determine whether the use of a clinical recommendation (CR) for activity progression to treat concussion will benefit symptom profile months post-injury beyond what is seen with usual care. Methods This study included 58 individuals who participated in the Defense and Veterans Brain Injury Center Progressive Return to Activity (PRA) Study. Eligibility included sustaining a concussion within 72 hours of study enrollment and no previous concussion within 12 months of injury. Poisson regression with robust error variance was used to evaluate the relationship between treatment group assignment (usual care versus PRA-CR) and having normal symptomatology (Neurobehavioral Symptom Inventory score below the upper 10th percentile) at the 1-, 3-, and 6-month follow-up. Participants with normal symptomatology within 72 hours post-injury were excluded from analyses. Results Among participants with abnormal symptoms within 72 hours post-concussion, those receiving the PRA-CR to treat concussion had a 70% (CI = 1.06, 2.72) greater prevalence of normal symptomatology by 1 month post-injury, and a 39% (CI = 1.04, 1.87) greater prevalence of normal symptomatology by 3 months post-injury compared to those receiving usual care. By 6 months post-injury, there was no difference in the prevalence of having normal symptoms between groups. Conclusion The findings of this study show that participants with abnormal symptomatology decreased in symptom level to normal at a faster rate among those receiving the PRA-CR compared to those receiving usual care, providing evidence for the use of the PRA-CR as a means to enhance treatment of patients with concussion.

Survey of Child Neurologists on Management of Pediatric Post-traumatic Headache

Traumatic brain injury causes significant morbidity in youth, and headache is the most common postconcussive symptom. No established guidelines exist for pediatric post-traumatic headache management. We aimed to characterize common clinical practices of child neurologists. Of 95 practitioners who completed our survey, most evaluate <50 pediatric concussion patients per year, and 38.9% of practitioners consistently use International Classification of Headache Disorders criteria to diagnose post-traumatic headache. Most recommend nonsteroidal anti-inflammatory drugs as abortive therapy, though timing after injury and frequency of use varies, as does the time when providers begin prophylactic medications. Amitriptyline, topiramate, and vitamins/supplements are most commonly used for prophylaxis. Approach to rest and return to activities varies; one-third recommend rest for 1 to 3 days and then progressive return, consistent with current best practice. With no established guidelines for pediatric post-traumatic headache management, it is not surprising that practices vary considerably. Further studies are needed to define the best, evidence-based management for pediatric post-traumatic headache.

A Perceptual Framework for Conservative Treatment and Rehabilitation of Ankle Sprains: An Evidence-Based Paradigm Shift

Lateral ankle sprains are the most common injuries sustained during physical activity. The epidemiologic trends associated with chronic ankle instability (CAI) suggest that current rehabilitation approaches may be inadequate. We sought to synthesize best-practices evidence for the rehabilitation of patients with acute ankle sprains and CAI through the integration of emerging paradigms in perception, the dynamics of skill acquisition, and the biopsychosocial model of function, disability, and health. From the best available evidence, 4 key factors emerged for effective treatment and rehabilitation strategies: pain reduction, external ankle support for up to 1 year, progressive return to motion, and coordination training. We combined these factors into a meta-theoretical framework that centers on the perceptual interdependence of the cellular, local, and global functioning levels by linking insights from the body-self neuromatrix, the dynamics of skill acquisition, and the biopsychosocial model. Based on the best-practice recommendations from systematic reviews, ankle-sprain rehabilitation represents a multidimensional phenomenon governed by perception. The impairments, activity limitations, and participation restrictions associated with CAI may be linked to perceptual-interdependence alterations. Pain and edema reduction, the use of external ankle support for up to 1 year, progressive return to motion, and coordination training foster enhanced perceptual interdependence from cells to society. Using the perceptual-interdependence framework for ankle-sprain rehabilitation, we offer new insights for charting the course of effective strategies for enhancing function, reducing disability, and preventing the long-term sequelae associated with CAI.

Managing the transition from concussion to return to learn in postsecondary education: strategies based on principles of UDL

Concussion is a functional brain injury that can produce physical, cognitive, emotional and sleep-related symptoms. With correct management, most symptoms will resolve within a month and a gradual, progressive return to activity (cognitive and physical) that allows students to stay below the thresholds that make symptoms worse, can be started after the immediate post-impact rest period of 24-48 hours. The 6-step Return-to-Learn protocol works well to manage the return to the classroom for elementary and high school-aged students, however it is difficult to implement in a postsecondary setting, as it requires a level of monitoring not generally available through college or university student wellness centres. As a result, course instructors are often given the task of providing accommodations to help students recovering from concussion manage and master the content and complete the required work to pass their course. This paper will discuss the challenges facing the postsecondary student recovering from concussion and provide accommodation ideas and examples, with resources, that instructors may find helpful.