Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods: This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings: This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28–2·40], p\textless0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p\textless0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p\textless0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01–2·39], p=0·046), emergency versus elective surgery (1·67 [1·06–2·63], p=0·026), and major versus minor surgery (1·52 [1·01–2·31], p=0·047). Interpretation: Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding: National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research

Comparing growth in linguistic comprehension and reading comprehension in school-aged children with autism versus typically developing children.

Many children with autism spectrum disorders (ASD) struggle with reading comprehension. Linguistic comprehension is an important predictor of reading comprehension, especially as children progress through elementary school and later grades. Yet, there is a dearth of research examining longitudinal relations between linguistic comprehensions in school-age children with ASD compared to typically-developing peers (TD). This study compared the developmental trajectories of linguistic and reading comprehension in samples of children with ASD and age-matched TD peers. Both groups were administered measures of linguistic and reading comprehension multiple times over a 30-month period. Latent growth curve modeling demonstrated children with ASD performed at significantly lower levels on both measures at the first timepoint and these deficits persisted across time. Children with ASD exhibited growth in both skills comparable to their TD peers, but this was not sufficient to enable them to eventually achieve at a level similar to the TD group. Due to the wide age range of the sample, age was controlled and displayed significant effects. Findings suggest linguistic comprehension skills are related to reading comprehension in children with ASD, similar to TD peers. Further, intervention in linguistic comprehension skills for children with ASD should begin early and there may be a finite window in which these skills are malleable, in terms of improving reading comprehension skills. Autism Res 2018, 11: 624-635. © 2017 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY:There is relatively little research concerning reading comprehension development in children with ASD and how they compare to TD peers. This study found children with ASD began at lower achievement levels of linguistic comprehension and reading comprehension than TD peers, but the skills developed at a similar rate. Intervening early and raising initial levels of linguistic and reading comprehension may enable children with ASD to perform similarly to TD peers over time

Longitudinal stability of reading profiles in individuals with higher functioning autism.

The reading difficulties of individuals with autism spectrum disorders have been established in the literature, with particular attention drawn toward reading comprehension difficulties. Recent papers have highlighted the heterogeneous nature of reading abilities in this population by utilizing statistical methods that allow for investigations of unique reading profiles. This article extends this literature by investigating reading profiles longitudinally, to investigate the stability of reader profiles across time. Latent profile and transition analyses were conducted to establish categorically distinct reading profiles at two time points, 30 months apart. This study also examined whether age and autism symptom severity were related to the profiles at each time point. Finally, transitions between profiles at each time point were identified. Age did not predict profile membership, but there were significant differences in symptom severity that were largely stable over time. Results indicate that heterogeneous reading profiles exist within the autism population, ranging from average reading ability to severe difficulties across different reading subskills. The data from this study demonstrate that reading profiles of children and adolescents with autism spectrum disorders shift when examined across time

Growth in narrative retelling and inference abilities and relations with reading comprehension in children and adolescents with autism spectrum disorder

Background and aimsExtant research indicates that children and adolescents with autism spectrum disorder (ASD) without an intellectual disability (ID) often experience difficulty comprehending written texts that is unexpected in comparison with their cognitive abilities. This study investigated the development of two key skills, narrative and inference abilities, that support higher level text comprehension and their relation to lexical-semantic knowledge, ASD symptomatology, and age. Three questions were addressed: 1.) What was the nature of narrative and inference skill development over time? 2.) What was the relation between narrative or inference development and lexical-semantic knowledge, ASD symptomatology, and age? 3.) Did initial narrative and inferencing skills, and the development of these skills, predict reading comprehension outcomes? Methods: Data from 81 children and adolescents with ASD without ID (FIQ ≥ 75) between the ages of 8-16-years-old at timepoint 1 were collected at 15-month intervals across three timepoints. ASD symptomatology was assessed with the ADOS-2. Standardized narrative retelling, inference, reading comprehension, lexical-semantic knowledge and cognitive assessments were administered. Latent growth curve models were conducted to examine narrative and inference skill development, and conditional growth models were fit to examine the relation between growth trajectories and covariates (lexical-semantic knowledge, ASD symptomatology, age) as well as with the reading comprehension distal outcome.ResultsNarrative retelling skills followed a linear trajectory of growth and were a relative strength in this sample, while inference skills were well below average and declined over time relative to age-normed standard scores. Lexical-semantic knowledge explained significant heterogeneity in initial narrative and inference skills, whereas ASD symptomatology was only related to initial narrative retelling abilities and age was only related to initial inference abilities. Timepoint 3 reading comprehension skill (in the below average range) was significantly explained by initial narrative retelling and inference abilities.ConclusionsThe results of this study indicate that narrative retelling and inference skills are important for successful reading comprehension for individuals with ASD without ID and that lexical-semantic knowledge underpins these skills. Furthermore, the observation that ASD symptom severity was associated with narrative retelling skills is consistent with the hypothesis that problems in narrative reading skills are associated with the autism phenotype. Finally, inference skill was a particular challenge for individuals in this sample, although age was positively associated with better performance on the assessment.Implications: These findings suggest that narrative and inference skills, in addition to lexical-semantic knowledge, are important to target beginning in elementary grades to improve reading comprehension outcomes for children and adolescents with ASD without ID

A Yoga Intervention for Young Children: Self-Regulation and Emotion Regulation

Yoga-based interventions have been implemented in schools and demonstrated promising results on students' self-regulation outcomes. Nevertheless, there is limited literature on the effects that yoga may have for children in the early primary grades, despite the evidence demonstrating that this is an opportune period in development for early self-regulation. Few studies have focused on young children living in the context of economic difficulty, which can hinder children's development of self-regulatory skills and educational trajectories. The effects of an eight-week yoga intervention on economically disadvantaged pre-kindergarten and kindergarten children's self-regulation and emotion regulation were examined via a paired within-subjects comparison study. Nine classrooms were assigned to the yoga intervention (Treatment First, TxFirst; n = 90) or a wait-list control group (Treatment Second, TxSecond; n = 64). All children were assessed at pre-intervention (Time 1), post-intervention assessment for TxFirst (Time 2), and post-intervention assessment for TxSecond (Time 3). Children demonstrated significant predicted gains on a behavioral task of self-regulation and declines in teacher-rated submissive venting and total behavior problems. Implications for future research are discussed, with a focus on including follow-up assessments and multiple dimensions of fidelity of implementation

A Comprehensive Examination of Reading Heterogeneity in Students with High Functioning Autism: Distinct Reading Profiles and Their Relation to Autism Symptom Severity.

The goal of this study was to identify unique profiles of readers in a sample of 8-16 year olds with higher functioning autism spectrum disorders (HFASD) and examine the profiles in relation to ASD symptom severity. Eighty-one students were assessed utilizing a comprehensive reading battery that included basic word reading, language, and comprehension. Using Latent Profile Analysis, four empirically distinct profiles of readers emerged. Next, using the Autism Diagnostic Observation Schedule, Second Edition (Lord et al., Autism diagnostic observation schedule, 2nd edn, Western Psychological Services, Torrance, CA, 2012), analyses were conducted to determine if significant differences existed between profiles as a result of ASD symptomatology. Findings demonstrate the heterogeneous nature of reading profiles in students with HFASD and significant differences between the reading profiles and ASD symptom severity

A Comprehensive Examination of Reading Heterogeneity in Students with High Functioning Autism: Distinct Reading Profiles and Their Relation to Autism Symptom Severity.

The goal of this study was to identify unique profiles of readers in a sample of 8-16 year olds with higher functioning autism spectrum disorders (HFASD) and examine the profiles in relation to ASD symptom severity. Eighty-one students were assessed utilizing a comprehensive reading battery that included basic word reading, language, and comprehension. Using Latent Profile Analysis, four empirically distinct profiles of readers emerged. Next, using the Autism Diagnostic Observation Schedule, Second Edition (Lord et al., Autism diagnostic observation schedule, 2nd edn, Western Psychological Services, Torrance, CA, 2012), analyses were conducted to determine if significant differences existed between profiles as a result of ASD symptomatology. Findings demonstrate the heterogeneous nature of reading profiles in students with HFASD and significant differences between the reading profiles and ASD symptom severity

The Scope and Nature of Reading Comprehension Impairments in School-Aged Children with Higher-Functioning Autism Spectrum Disorder.

This study of 8-16-year-olds was designed to test the hypothesis that reading comprehension impairments are part of the social communication phenotype for many higher-functioning students with autism spectrum disorder (HFASD). Students with HFASD (n = 81) were compared to those with high attention-deficit/hyperactivity disorder symptomatology (ADHD; n = 39), or typical development (TD; n = 44), on a comprehensive battery of oral language, word recognition, and reading comprehension measures. Results indicated that students with HFASD performed significantly lower on the majority of the reading and language tasks as compared to TD and ADHD groups. Structural equation models suggested that greater ASD symptomatology was related to poorer reading comprehension outcomes; further analyses suggested that this relation was mediated by oral language skills