Concussion Management, Education, and Return-to-Play Policies in High Schools: A Survey of Athletic Directors, Athletic Trainers, and Coaches

Background: Concussions represent 8.9% to 13.2% of all high school athletic injuries. How these injuries are managed is currently unknown. Hypothesis: There are differences in concussion management and awareness between boys football, boys ice hockey, and boys and girls soccer. Study Design: Descriptive epidemiologic study. Methods: High school athletic directors were contacted via email and asked to complete an online survey with four separate sections for athletic directors, head coaches, team physicians, or certified athletic trainers. Results: According to coaches, concussion awareness education was provided for football (97%), hockey (65%), and boys and girls soccer (57% and 47%, respectively) (P \u3c 0.01). Use of sideline screening tools was significantly greater for football (P = 0.03). All participants agreed that a player who has suffered a concussion cannot return to play the same day. Conclusion: There is a difference in concussion management and awareness between the four sports. Concussion education is well promoted in football but should be expanded in soccer and hockey. Players are not allowed to return to play the same day, and the majority are referred to a physician. Clinical Relevance: Study results highlight the differences in concussion education between sports. Healthcare providers should address these gaps

Biomarkers of aging associated with past treatments in breast cancer survivors.

Radiation and chemotherapy are effective treatments for cancer, but are also toxic to healthy cells. Little is known about whether prior exposure to these treatments is related to markers of cellular aging years later in breast cancer survivors. We examined whether past exposure to chemotherapy and/or radiation treatment was associated with DNA damage, telomerase activity, and telomere length 3-6 years after completion of primary treatments in breast cancer survivors (stage 0-IIIA breast cancer at diagnosis). We also examined the relationship of these cellular aging markers with plasma levels of Interleukin (IL)-6, soluble TNF-receptor-II (sTNF-RII), and C-reactive protein (CRP). Ninety-four women (36.4-69.5 years; 80% white) were evaluated. Analyses adjusting for age, race, BMI, and years from last treatment found that women who had prior exposure to chemotherapy and/or radiation compared to women who had previously received surgery alone were more likely to have higher levels of DNA damage (P = .02) and lower telomerase activity (P = .02), but did not have differences in telomere length. More DNA damage and lower telomerase were each associated with higher levels of sTNF-RII (P's < .05). We found that exposure to chemotherapy and/or radiation 3-6 years prior was associated with markers of cellular aging, including higher DNA damage and lower telomerase activity, in post-treatment breast cancer survivors. Furthermore, these measures were associated with elevated inflammatory activation, as indexed by sTNF-RII. Given that these differences were observed many years after the treatment, the findings suggest a long lasting effect of chemotherapy and/or radiation exposure

La vacuna contra la Covid-19: ¿Garantía, esperanza o amenaza?

Esta es una síntesis del diálogo organizado por REDICIRE el 24 de junio de 2021. La actividad está grabada en video (REDICIRE, 2021). Se presentan distintas perspectivas a favor y en contra de la vacunación.Red para el Diálogo entre Ciencia y Religión (REDICIRE) de la Universidad de Costa RicaUniversidad de Costa Rica/[VI 245-B8-369]/UCR/Costa RicaUCR::Vicerrectoría de Docencia::Ciencias Sociales::Facultad de Educación::Escuela de Educación FísicaUCR::Vicerrectoría de Investigación::Unidades de Investigación::Ciencias Sociales::Instituto de Investigaciones Psicológicas (IIP

Discordant Zika Virus Findings in Twin Pregnancies Complicated by Antenatal Zika Virus Exposure: A Prospective Cohort.

BACKGROUND: There are limited data on the natural history of antenatal Zika virus (ZIKV) exposure in twin pregnancies, especially regarding intertwin concordance of prenatal, placental, and infant outcomes. METHODS: This prospective cohort study included twin pregnancies referred to a single institution from September 2015 to June 2016 with maternal ZIKV. Polymerase chain reaction (PCR) testing of maternal, placental, and neonatal samples was performed. Prenatal ultrasounds were completed for each twin, and histomorphologic analysis was performed for each placenta. Abnormal neonatal outcome was defined as abnormal exam and/or abnormal imaging. Two- to three-year follow-up of infants included physical exams, neuroimaging, and Bayley-III developmental assessment. RESULTS: Among 244 pregnancies, 4 twin gestations without coinfection were identified. Zika virus infection occurred at 16-33 weeks gestation. Zika virus PCR testing revealed discordance between dichorionic twins, between placentas in a dichorionic pair, between portions of a monochorionic placenta, and between a neonate and its associated placenta. Of the 8 infants, 3 (38%) had an abnormal neonatal outcome. Of 6 infants with long-term follow-up, 3 (50%) have demonstrated ZIKV-related abnormalities. CONCLUSIONS: Neonatal PCR testing, placental findings, and infant outcomes can be discordant between co-twins with antenatal ZIKV exposure. These findings demonstrate that each twin should be evaluated independently for vertical transmission

TRY plant trait database – enhanced coverage and open access

Plant traits - the morphological, anatomical, physiological, biochemical and phenological characteristics of plants - determine how plants respond to environmental factors, affect other trophic levels, and influence ecosystem properties and their benefits and detriments to people. Plant trait data thus represent the basis for a vast area of research spanning from evolutionary biology, community and functional ecology, to biodiversity conservation, ecosystem and landscape management, restoration, biogeography and earth system modelling. Since its foundation in 2007, the TRY database of plant traits has grown continuously. It now provides unprecedented data coverage under an open access data policy and is the main plant trait database used by the research community worldwide. Increasingly, the TRY database also supports new frontiers of trait‐based plant research, including the identification of data gaps and the subsequent mobilization or measurement of new data. To support this development, in this article we evaluate the extent of the trait data compiled in TRY and analyse emerging patterns of data coverage and representativeness. Best species coverage is achieved for categorical traits - almost complete coverage for ‘plant growth form’. However, most traits relevant for ecology and vegetation modelling are characterized by continuous intraspecific variation and trait–environmental relationships. These traits have to be measured on individual plants in their respective environment. Despite unprecedented data coverage, we observe a humbling lack of completeness and representativeness of these continuous traits in many aspects. We, therefore, conclude that reducing data gaps and biases in the TRY database remains a key challenge and requires a coordinated approach to data mobilization and trait measurements. This can only be achieved in collaboration with other initiatives

TRY plant trait database – enhanced coverage and open access

Plant traits—the morphological, anatomical, physiological, biochemical and phenological characteristics of plants—determine how plants respond to environmental factors, affect other trophic levels, and influence ecosystem properties and their benefits and detriments to people. Plant trait data thus represent the basis for a vast area of research spanning from evolutionary biology, community and functional ecology, to biodiversity conservation, ecosystem and landscape management, restoration, biogeography and earth system modelling. Since its foundation in 2007, the TRY database of plant traits has grown continuously. It now provides unprecedented data coverage under an open access data policy and is the main plant trait database used by the research community worldwide. Increasingly, the TRY database also supports new frontiers of trait-based plant research, including the identification of data gaps and the subsequent mobilization or measurement of new data. To support this development, in this article we evaluate the extent of the trait data compiled in TRY and analyse emerging patterns of data coverage and representativeness. Best species coverage is achieved for categorical traits—almost complete coverage for ‘plant growth form’. However, most traits relevant for ecology and vegetation modelling are characterized by continuous intraspecific variation and trait–environmental relationships. These traits have to be measured on individual plants in their respective environment. Despite unprecedented data coverage, we observe a humbling lack of completeness and representativeness of these continuous traits in many aspects. We, therefore, conclude that reducing data gaps and biases in the TRY database remains a key challenge and requires a coordinated approach to data mobilization and trait measurements. This can only be achieved in collaboration with other initiatives.Rest of authors: Decky Junaedi, Robert R. Junker, Eric Justes, Richard Kabzems, Jeffrey Kane, Zdenek Kaplan, Teja Kattenborn, Lyudmila Kavelenova, Elizabeth Kearsley, Anne Kempel, Tanaka Kenzo, Andrew Kerkhoff, Mohammed I. Khalil, Nicole L. Kinlock, Wilm Daniel Kissling, Kaoru Kitajima, Thomas Kitzberger, Rasmus Kjøller, Tamir Klein, Michael Kleyer, Jitka Klimešová, Joice Klipel, Brian Kloeppel, Stefan Klotz, Johannes M. H. Knops, Takashi Kohyama, Fumito Koike, Johannes Kollmann, Benjamin Komac, Kimberly Komatsu, Christian König, Nathan J. B. Kraft, Koen Kramer, Holger Kreft, Ingolf Kühn, Dushan Kumarathunge, Jonas Kuppler, Hiroko Kurokawa, Yoko Kurosawa, Shem Kuyah, Jean-Paul Laclau, Benoit Lafleur, Erik Lallai, Eric Lamb, Andrea Lamprecht, Daniel J. Larkin, Daniel Laughlin, Yoann Le Bagousse-Pinguet, Guerric le Maire, Peter C. le Roux, Elizabeth le Roux, Tali Lee, Frederic Lens, Simon L. Lewis, Barbara Lhotsky, Yuanzhi Li, Xine Li, Jeremy W. Lichstein, Mario Liebergesell, Jun Ying Lim, Yan-Shih Lin, Juan Carlos Linares, Chunjiang Liu, Daijun Liu, Udayangani Liu, Stuart Livingstone, Joan Llusià, Madelon Lohbeck, Álvaro López-García, Gabriela Lopez-Gonzalez, Zdeňka Lososová, Frédérique Louault, Balázs A. Lukács, Petr Lukeš, Yunjian Luo, Michele Lussu, Siyan Ma, Camilla Maciel Rabelo Pereira, Michelle Mack, Vincent Maire, Annikki Mäkelä, Harri Mäkinen, Ana Claudia Mendes Malhado, Azim Mallik, Peter Manning, Stefano Manzoni, Zuleica Marchetti, Luca Marchino, Vinicius Marcilio-Silva, Eric Marcon, Michela Marignani, Lars Markesteijn, Adam Martin, Cristina Martínez-Garza, Jordi Martínez-Vilalta, Tereza Mašková, Kelly Mason, Norman Mason, Tara Joy Massad, Jacynthe Masse, Itay Mayrose, James McCarthy, M. Luke McCormack, Katherine McCulloh, Ian R. McFadden, Brian J. McGill, Mara Y. McPartland, Juliana S. Medeiros, Belinda Medlyn, Pierre Meerts, Zia Mehrabi, Patrick Meir, Felipe P. L. Melo, Maurizio Mencuccini, Céline Meredieu, Julie Messier, Ilona Mészáros, Juha Metsaranta, Sean T. Michaletz, Chrysanthi Michelaki, Svetlana Migalina, Ruben Milla, Jesse E. D. Miller, Vanessa Minden, Ray Ming, Karel Mokany, Angela T. Moles, Attila Molnár V, Jane Molofsky, Martin Molz, Rebecca A. Montgomery, Arnaud Monty, Lenka Moravcová, Alvaro Moreno-Martínez, Marco Moretti, Akira S. Mori, Shigeta Mori, Dave Morris, Jane Morrison, Ladislav Mucina, Sandra Mueller, Christopher D. Muir, Sandra Cristina Müller, François Munoz, Isla H. Myers-Smith, Randall W. Myster, Masahiro Nagano, Shawna Naidu, Ayyappan Narayanan, Balachandran Natesan, Luka Negoita, Andrew S. Nelson, Eike Lena Neuschulz, Jian Ni, Georg Niedrist, Jhon Nieto, Ülo Niinemets, Rachael Nolan, Henning Nottebrock, Yann Nouvellon, Alexander Novakovskiy, The Nutrient Network, Kristin Odden Nystuen, Anthony O'Grady, Kevin O'Hara, Andrew O'Reilly-Nugent, Simon Oakley, Walter Oberhuber, Toshiyuki Ohtsuka, Ricardo Oliveira, Kinga Öllerer, Mark E. Olson, Vladimir Onipchenko, Yusuke Onoda, Renske E. Onstein, Jenny C. Ordonez, Noriyuki Osada, Ivika Ostonen, Gianluigi Ottaviani, Sarah Otto, Gerhard E. Overbeck, Wim A. Ozinga, Anna T. Pahl, C. E. Timothy Paine, Robin J. Pakeman, Aristotelis C. Papageorgiou, Evgeniya Parfionova, Meelis Pärtel, Marco Patacca, Susana Paula, Juraj Paule, Harald Pauli, Juli G. Pausas, Begoña Peco, Josep Penuelas, Antonio Perea, Pablo Luis Peri, Ana Carolina Petisco-Souza, Alessandro Petraglia, Any Mary Petritan, Oliver L. Phillips, Simon Pierce, Valério D. Pillar, Jan Pisek, Alexandr Pomogaybin, Hendrik Poorter, Angelika Portsmuth, Peter Poschlod, Catherine Potvin, Devon Pounds, A. Shafer Powell, Sally A. Power, Andreas Prinzing, Giacomo Puglielli, Petr Pyšek, Valerie Raevel, Anja Rammig, Johannes Ransijn, Courtenay A. Ray, Peter B. Reich, Markus Reichstein, Douglas E. B. Reid, Maxime Réjou-Méchain, Victor Resco de Dios, Sabina Ribeiro, Sarah Richardson, Kersti Riibak, Matthias C. Rillig, Fiamma Riviera, Elisabeth M. R. Robert, Scott Roberts, Bjorn Robroek, Adam Roddy, Arthur Vinicius Rodrigues, Alistair Rogers, Emily Rollinson, Victor Rolo, Christine Römermann, Dina Ronzhina, Christiane Roscher, Julieta A. Rosell, Milena Fermina Rosenfield, Christian Rossi, David B. Roy, Samuel Royer-Tardif, Nadja Rüger, Ricardo Ruiz-Peinado, Sabine B. Rumpf, Graciela M. Rusch, Masahiro Ryo, Lawren Sack, Angela Saldaña, Beatriz Salgado-Negret, Roberto Salguero-Gomez, Ignacio Santa-Regina, Ana Carolina Santacruz-García, Joaquim Santos, Jordi Sardans, Brandon Schamp, Michael Scherer-Lorenzen, Matthias Schleuning, Bernhard Schmid, Marco Schmidt, Sylvain Schmitt, Julio V. Schneider, Simon D. Schowanek, Julian Schrader, Franziska Schrodt, Bernhard Schuldt, Frank Schurr, Galia Selaya Garvizu, Marina Semchenko, Colleen Seymour, Julia C. Sfair, Joanne M. Sharpe, Christine S. Sheppard, Serge Sheremetiev, Satomi Shiodera, Bill Shipley, Tanvir Ahmed Shovon, Alrun Siebenkäs, Carlos Sierra, Vasco Silva, Mateus Silva, Tommaso Sitzia, Henrik Sjöman, Martijn Slot, Nicholas G. Smith, Darwin Sodhi, Pamela Soltis, Douglas Soltis, Ben Somers, Grégory Sonnier, Mia Vedel Sørensen, Enio Egon Sosinski Jr, Nadejda A. Soudzilovskaia, Alexandre F. Souza, Marko Spasojevic, Marta Gaia Sperandii, Amanda B. Stan, James Stegen, Klaus Steinbauer, Jörg G. Stephan, Frank Sterck, Dejan B. Stojanovic, Tanya Strydom, Maria Laura Suarez, Jens-Christian Svenning, Ivana Svitková, Marek Svitok, Miroslav Svoboda, Emily Swaine, Nathan Swenson, Marcelo Tabarelli, Kentaro Takagi, Ulrike Tappeiner, Rubén Tarifa, Simon Tauugourdeau, Cagatay Tavsanoglu, Mariska te Beest, Leho Tedersoo, Nelson Thiffault, Dominik Thom, Evert Thomas, Ken Thompson, Peter E. Thornton, Wilfried Thuiller, Lubomír Tichý, David Tissue, Mark G. Tjoelker, David Yue Phin Tng, Joseph Tobias, Péter Török, Tonantzin Tarin, José M. Torres-Ruiz, Béla Tóthmérész, Martina Treurnicht, Valeria Trivellone, Franck Trolliet, Volodymyr Trotsiuk, James L. Tsakalos, Ioannis Tsiripidis, Niklas Tysklind, Toru Umehara, Vladimir Usoltsev, Matthew Vadeboncoeur, Jamil Vaezi, Fernando Valladares, Jana Vamosi, Peter M. van Bodegom, Michiel van Breugel, Elisa Van Cleemput, Martine van de Weg, Stephni van der Merwe, Fons van der Plas, Masha T. van der Sande, Mark van Kleunen, Koenraad Van Meerbeek, Mark Vanderwel, Kim André Vanselow, Angelica Vårhammar, Laura Varone, Maribel Yesenia Vasquez Valderrama, Kiril Vassilev, Mark Vellend, Erik J. Veneklaas, Hans Verbeeck, Kris Verheyen, Alexander Vibrans, Ima Vieira, Jaime Villacís, Cyrille Violle, Pandi Vivek, Katrin Wagner, Matthew Waldram, Anthony Waldron, Anthony P. Walker, Martyn Waller, Gabriel Walther, Han Wang, Feng Wang, Weiqi Wang, Harry Watkins, James Watkins, Ulrich Weber, James T. Weedon, Liping Wei, Patrick Weigelt, Evan Weiher, Aidan W. Wells, Camilla Wellstein, Elizabeth Wenk, Mark Westoby, Alana Westwood, Philip John White, Mark Whitten, Mathew Williams, Daniel E. Winkler, Klaus Winter, Chevonne Womack, Ian J. Wright, S. Joseph Wright, Justin Wright, Bruno X. Pinho, Fabiano Ximenes, Toshihiro Yamada, Keiko Yamaji, Ruth Yanai, Nikolay Yankov, Benjamin Yguel, Kátia Janaina Zanini, Amy E. Zanne, David Zelený, Yun-Peng Zhao, Jingming Zheng, Ji Zheng, Kasia Ziemińska, Chad R. Zirbel, Georg Zizka, Irié Casimir Zo-Bi, Gerhard Zotz, Christian Wirth.Max Planck Institute for Biogeochemistry; Max Planck Society; German Centre for Integrative Biodiversity Research (iDiv) Halle-Jena-Leipzig; International Programme of Biodiversity Science (DIVERSITAS); International Geosphere-Biosphere Programme (IGBP); Future Earth; French Foundation for Biodiversity Research (FRB); GIS ‘Climat, Environnement et Société'.http://wileyonlinelibrary.com/journal/gcbhj2021Plant Production and Soil Scienc

GPS PrecipitableWater Vapor Estimations over Costa Rica: A Comparison against Atmospheric Sounding and Moderate Resolution Imaging Spectrometer (MODIS)

Abstract: The quantification of water vapor in tropical regions like Central America is necessary to estimate the influence of climate change on its distribution and the formation of precipitation. This work reports daily estimations of precipitable water vapor (PWV) using Global Positioning System (GPS) delay data over the Pacific region of Costa Rica during 2017. The GPS PWV measurements were compared against atmospheric sounding and Moderate Resolution Imaging Spectrometer (MODIS) data. When GPS PWV was calculated, relatively small biases between the mean atmospheric temperatures (Tm) from atmospheric sounding and the Bevis equation were found. The seasonal PWV fluctuations were controlled by two of the main circulation processes in Central America: the northeast trade winds and the latitudinal migration of the Intertropical Convergence Zone (ITCZ). No significant statistical di erences were found for MODIS Terra during the dry season with respect GPS-based calculations (p > 0.05). A multiple linear regression model constructed based on surface meteorological variables can predict the GPS-based measurements with an average relative bias of 0.02 0.19 mm/day (R2 = 0.597). These first results are promising for incorporating GPS-based meteorological applications in Central America where the prevailing climatic conditions offer a unique scenario to study the influence of maritime moisture inputs on the seasonal water vapor distribution.La cuantificación del vapor de agua en regiones tropicales como Centroamérica es necesaria para estimar la influencia del cambio climático en su distribución y formación de precipitaciones. Este trabajo reporta estimaciones diarias de vapor de agua precipitable (PWV) utilizando datos de retardo del Sistema de Posicionamiento Global (GPS) sobre la región del Pacífico de Costa Rica durante 2017. Las mediciones del GPS PWV se compararon con datos de sondeo atmosférico y espectrómetro de imágenes de resolución moderada (MODIS). Cuando se calculó el GPS PWV, se encontraron desviaciones relativamente pequeñas entre las temperaturas atmosféricas medias (Tm) del sondeo atmosférico y la ecuación de Bevis. Las fluctuaciones estacionales del VOP fueron controladas por dos de los principales procesos de circulación en Centroamérica: los vientos alisios del noreste y la migración latitudinal de la Zona de Convergencia Intertropical (ZCIT). No se encontraron diferencias estadísticas significativas para MODIS Terra durante la estación seca con respecto a los cálculos basados ​​en GPS (p> 0.05). Un modelo de regresión lineal múltiple construido en base a variables meteorológicas de superficie puede predecir las mediciones basadas en GPS con un sesgo relativo promedio de 0.02 0.19 mm / día (R2 = 0.597). Estos primeros resultados son prometedores para incorporar aplicaciones meteorológicas basadas en GPS en Centroamérica, donde las condiciones climáticas predominantes ofrecen un escenario único para estudiar la influencia de los aportes de humedad marítima en la distribución estacional del vapor de agua.Universidad Nacional, Costa RicaEscuela de Químic

Cirugía cardiaca en Costa Rica: caracterización de los pacientes en el Hospital San Juan de Dios del 2010 al 2015

Resumen: Introducción y objetivos: En Costa Rica existe limitada literatura en cirugía cardiaca. Este estudio pionero en el país caracteriza clínica y sociodemográficamente los pacientes tratados mediante cirugía cardiaca en el Hospital San Juan de Dios, con el objetivo de comunicar a la comunidad científica los resultados de este centro en el contexto de la Seguridad Social de Costa Rica. El estudio pretende además identificar factores de riesgo que inciden sobre la mortalidad global y con ello optimizar los cuidados perioperatorios de los pacientes. Métodos: Estudio observacional y retrospectivo, a partir de la base de datos del Servicio de Cirugía Cardiaca del Hospital San Juan de Dios, entre enero del 2010 y diciembre del 2015. Se registraron y analizaron estadísticamente variables de antecedentes clínicos, quirúrgicos y evolución hospitalaria. Resultados: Seiscientos noventa y dos pacientes, predominio sexo masculino (63,9%); edad media 57,1 ± 13,9 años; al menos una complicación postoperatoria en el 41% y mortalidad del 14,9%. Distribución de cirugías realizadas: valvular (47,8%), revascularización miocárdica (31,5%), aorta ascendente y cayado (6,9%), combinada coronario-valvular (5,8%), cardiopatía congénita en el adulto (4,2%) y cardiaca miscelánea (3,8%). Resultaron predictores de mortalidad: EuroSCORE, péptido natriurético tipo B y escala funcional de New York Heart Association. Puntos de inflexión con respecto a mortalidad: 250 pg/ml para péptido natriurético tipo B preoperatorio, 149 min para tiempo de circulación extracorpórea y 84 min para tiempo de pinzamiento aórtico. Conclusiones: A través de este estudio de caracterización de los pacientes tratados mediante cirugía cardiaca durante el periodo del 2010 al 2015, se permite analizar el desempeño del Servicio en el Hospital San Juan de Dios, lo que resulta esencial en la evaluación y la mejora de la calidad del tratamiento quirúrgico brindado a los pacientes con enfermedad cardiaca dentro de la Seguridad Social de Costa Rica. Abstract: Introduction and objectives: In Costa Rica there is limited literature on cardiac surgery. This pioneering study in the country characterizes, clinically and sociodemographically, patients who underwent cardiac surgery at Hospital San Juan de Dios, with the aim of communicating to the scientific community the results of this center in the context of Costa Rica's Social Security. The study also aims to identify risk factors that affect global mortality and thereby optimize patients’ perioperative care. Methods: Observational, retrospective study, from the Cardiac Surgery Department database at Hospital San Juan de Dios, between January 2010 and December 2015. Clinical history, surgical and hospital evolution variables were recorded and statistically analyzed. Results: 692 patients, male predominance (63.9%); mean age 57.1 ± 13.9 years; at least one postoperative complication in 41% and mortality of 14.9%. Surgical distribution: valvular (47.8%), coronary artery bypass grafting (31.5%), ascending aorta and arch (6.9%), combined coronary artery bypass grafting - valvular (5.8%), adult congenital heart disease (4.2%), and cardiac miscellaneous (3.8%). EuroSCORE, preoperative B-type natriuretic peptide and New York Heart Association functional scale resulted in mortality predictors. Inflection points for mortality: 250 pg/mL for preoperative B-type natriuretic peptide, 149 min for extracorporeal circulation time and 84 min for aortic clamping time. Conclusions: Through this characterization study of patients who underwent cardiac surgery during the period between 2010 and 2015, it is possible to evaluate the performance of the Department at Hospital San Juan de Dios, which is essential for analysis and improvement of quality of surgical treatment provided to patients with cardiac pathology within Costa Rica's Social Security System. Palabras clave: Cirugía cardiaca, Registro, Base de datos, Keywords: Cardiac surgery, Registry, Databas

Outlet Biceps Tenodesis: A New Technique for Treatment of Biceps Long Head Tendon Injury

Degeneration and tearing of the long head of the biceps brachii tendon (LHBT) are common intra-articular findings, and surgical intervention including tenodesis or tenotomy is beneficial. A new arthroscopic shoulder technique may be performed through an anterior portal while one is viewing from a posterior portal: (1) Visualize the intra-articular biceps tendon. (2) Identify the segment of the LHBT to be enlarged. (3) Use a tissue modulation wand to enlarge the tendon. (4) Evaluate the diameter of the enlarged segment. It should be twice the original diameter. (5) Cut the biceps tendon at the proximal end of the enlarged segment. (6) View the tendon within the tunnel. (7) Identify and cut the remaining stump of the biceps tendon. Seventeen cadaveric shoulders were used to compare the pullout force, stiffness, and displacement of outlet tenodesis versus tenotomy. There was a significant increase in pullout force for the outlet tenodesis group when compared with tenotomy. This technique is used to operatively treat LHBT intra-articular pathology in patients who would benefit from tenotomy and traditional biceps tenodesis and may minimize the retraction of the biceps tendon distally

Emotions and family interactions in childhood: Associations with leukocyte telomere length emotions, family interactions, and telomere length.

Conceptualizations of links between stress and cellular aging in childhood suggest that accumulating stress predicts shorter leukocyte telomere length (LTL). At the same time, several models suggest that emotional reactivity to stressors may play a key role in predicting cellular aging. Using intensive repeated measures, we tested whether exposure or emotional "reactivity" to conflict and warmth in the family were related to LTL. Children (N=39; 30 target children and 9 siblings) between 8 and 13 years of age completed daily diary questionnaires for 56 consecutive days assessing daily warmth and conflict in the marital and the parent-child dyad, and daily positive and negative mood. To assess exposure to conflict and warmth, diary scale scores were averaged over the 56 days. Mood "reactivity" was operationalized by using multilevel modeling to generate estimates of the slope of warmth or conflict scores (marital and parent-child, separately) predicting same-day mood for each individual child. After diary collection, a blood sample was collected to determine LTL. Among children aged 8-13 years, a stronger association between negative mood and marital conflict, suggesting greater negative mood reactivity to marital conflict, was related to shorter LTL (B=-1.51, p<.01). A stronger association between positive mood and marital affection, suggesting positive mood reactivity, was related to longer LTL (B=1.15, p<.05). These effects were independent of exposure to family and marital conflict and warmth, and positive and negative mood over a two-month period. To our knowledge, these findings, although cross-sectional, represent the first evidence showing that link between children's affective responses and daily family interactions may have implications for telomere length