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Purpose of Review This review aims at reporting the current evidence of the impact of COVID-19 pandemic on grief in children. Recent Findings Evidence from the scientific literature shows that the severity of grief in children is impacted by numerous risk factors which can lead to prolonged grief disorder (PGD). Summary Among these risk factors are the unpredictability of the death, the lack of understanding about what is happening by the child, the global insecurity raised by the context of the pandemic or again the impossibility for the child to find comfort with his peers due to the lock-down. No medical-based approach has proven efficient on PGD in children. However, cognitive based therapy can lower the severity of the symptoms. Future efforts should focus on developing therapeutic strategies to specifically fit the needs of children with PGD, in the context of a major crisis such as this pandemic.

Background Current EU directives demand increased use of renewable fuels in the transportation sector but restrict governmental support for production of biofuels produced from crops. The use of intercropped lucerne and wheat may comply with the directives. In the current study, the combination of ensiled lucerne (Medicago sativa L.) and wheat straw as substrate for hydrogen and methane production was investigated. Steam-pretreated and enzymatically hydrolysed wheat straw [WSH, 76% of total chemical oxygen demand (COD)] and ensiled lucerne (LH, 24% of total COD) were used for sequential hydrogen production through dark fermentation and methane production through anaerobic digestion and directly for anaerobic digestion. Synthetic co-cultures of extreme thermophilic Caldicellulosiruptor species adapted to elevated osmolalities were used for dark fermentation. Results Based on 6 tested steam pretreatment conditions, 5 min at 200 °C was chosen for the ensiled lucerne. The same conditions as applied for wheat straw (10 min at 200 °C with 1% acetic acid) would give similar sugar yields. Volumetric hydrogen productivities of 6.7 and 4.3 mmol/L/h and hydrogen yields of 1.9 and 1.8 mol/mol hexose were observed using WSH and the combination of WSH and LH, respectively, which were relatively low compared to those of the wild-type strains. The combinations of WSH plus LH and the effluent from dark fermentation of WSH plus LH were efficiently converted to methane in anaerobic digestion with COD removal of 85–89% at organic loading rates of COD 5.4 and 8.5 g/L/day, respectively, in UASB reactors. The nutrients in the combined hydrolysates could support this conversion. Conclusions This study demonstrates the possibility of reducing the water addition to WSH by 26% and the phosphorus addition by 80% in dark fermentation with Caldicellulosiruptor species, compared to previous reports. WSH and combined WSH and LH were well tolerated by osmotolerant co-cultures. The yield was not significantly different when using defined media or hydrolysates with the same concentrations of sugars. However, the sugar concentration was negatively correlated with the hydrogen yield when comparing the results to previous reports. Hydrolysates and effluents from dark fermentation can be efficiently converted to methane. Lucerne can serve as macronutrient provider in anaerobic digestion. Intercropping with wheat is promising.

Serotonin is a neurotransmitter synthesized by the amino acid tryptophan, that has the potential to impact the behaviour and activity of dogs. The objective of this study was to assess the effects of supplemental tryptophan and a 12-week incremental training regimen on the voluntary activity and behaviour of client-owned Siberian Huskies. Sixteen dogs were blocked for age, BW and sex and then randomly allocated to either the control or treatment group. Both groups were fed the same dry extruded diet; however, the treatment group were supplemented with tryptophan to achieve a tryptophan: large neutral amino acid ratio of 0.075:1. Once a week, a 5-minute video recording was taken immediately pre- and post- exercise to evaluate dogs' behaviours. Activity monitors were used to record voluntary activity on both training and rest days. Linear regression analysis was used to assess the relationship between training week and time spent performing each behaviour. Additionally, a repeated measure mixed model was used to test differences between diet groups and training week for both behavioural and activity count data. The time spent performing agonistic behaviours prior to exercise was negatively associated with week for treatment dogs (β = -0.32, 95% CI [-0.55, -0.10], P < 0.05) and no change was observed for control dogs (β = -0.13, 95% CI [-0.41, 0.15], P > 0.10). Treatment did not have any effect on activity levels (P > 0.10). For all dogs, locomotive behaviours decreased prior to exercise as weeks progressed (P < 0.05), while run day voluntary activity depended on the distance run that day (P < 0.05). These data suggest that sled dogs experience an exercise-induced reduction in voluntary locomotion in response to both single bouts and repetitive bouts of exercise. Additionally, tryptophan supplementation may decrease agonistic behaviours, without having any effect on voluntary activity.

New surgical procedures can expose patients to harm and should be carefully evaluated before widespread use. The InSpace balloon (Stryker, USA) is an innovative surgical device used to treat people with rotator cuff tears that cannot be repaired. We aimed to determine the effectiveness of the InSpace balloon for people with irreparable rotator cuff tears. We conducted a double-blind, group-sequential, adaptive randomised controlled trial in 24 hospitals in the UK, comparing arthroscopic debridement of the subacromial space with biceps tenotomy (debridement only group) with the same procedure but including insertion of the InSpace balloon (debridement with device group). Participants had an irreparable rotator cuff tear, which had not resolved with conservative treatment, and they had symptoms warranting surgery. Eligibility was confirmed intraoperatively before randomly assigning (1:1) participants to a treatment group using a remote computer system. Participants and assessors were masked to group assignment. Masking was achieved by using identical incisions for both procedures, blinding the operation note, and a consistent rehabilitation programme was offered regardless of group allocation. The primary outcome was the Oxford Shoulder Score at 12 months. Pre-trial simulations using data from early and late timepoints informed stopping boundaries for two interim analyses. The primary analysis was on a modified intention-to-treat basis, adjusted for the planned interim analysis. The trial was registered with ISRCTN, ISRCTN17825590. Between June 1, 2018, and July 30, 2020, we assessed 385 people for eligibility, of which 317 were eligible. 249 (79%) people consented for inclusion in the study. 117 participants were randomly allocated to a treatment group, 61 participants to the debridement only group and 56 to the debridement with device group. A predefined stopping boundary was met at the first interim analysis and recruitment stopped with 117 participants randomised. 43% of participants were female, 57% were male. We obtained primary outcome data for 114 (97%) participants. The mean Oxford Shoulder Score at 12 months was 34·3 (SD 11·1) in the debridement only group and 30·3 (10·9) in the debridement with device group (mean difference adjusted for adaptive design –4·2 [95% CI –8·2 to –0·26];p=0·037) favouring control. There was no difference in adverse events between the two groups. In an efficient, adaptive trial design, our results favoured the debridement only group. We do not recommend the InSpace balloon for the treatment of irreparable rotator cuff tears. Efficacy and Mechanism Evaluation Programme, a Medical Research Council and National Institute for Health and Care Research partnership

Participation in repetitive endurance training decreases sled dogs’ voluntary activity and locomotive behaviours; however, the changes in their voluntary physical activity over consecutive rest days has not been examined to assess exercise-recovery. The objective of this study was to examine the changes in behaviour and voluntary activity of sled dogs throughout repetitive incremental conditioning and intermittent rest days. Fourteen dogs (6 males, 8 females; age 3.7 ± 2.7 years; BW 21.5 ± 2.8 kg) underwent 10 weeks of conditioning. Once a week, 5-min video recordings were taken pre- and post-exercise to measure the time spent performing agonistic behaviours, chewing on the gangline, digging, jumping, lunging, posture changing, sitting, standing and lying. Additionally, voluntary physical activity was measured on a day with an exercise bout during baseline, week 4, 5 and 7 and two consecutive rest days during baseline, week 1, 4, 5 and 7. A repeated-measures mixed model was used to analyse data in SAS (v 9.4.). As dogs progressed through their conditioning, the time spent changing posture prior to an exercise bout decreased (p < 0.05), suggesting that dogs may reduce their voluntary locomotive behaviours with increasing exercise. Additionally, dogs were more active during the second consecutive rest day than the first (p < 0.05), suggesting that rest days may provide a short-term recovery period.

Optimization of the insoluble:soluble fibers in the diets of dogs can improve gastrointestinal health by increasing commensal bacterial growth. A growing body of research suggests that improved gut health can influence behavior via the gut-brain axis. Therefore, the objectives of this study were to investigate the effects of an increased soluble fiber diet on the behavior and voluntary activity of actively training, client-owned Siberian huskies. Fourteen dogs were blocked for age, BW and sex and randomly allocated to either the control or treatment groups. The control group was fed a dry extruded diet that contained an insoluble:soluble fiber ratio of 4:1, and the treatment group was fed a dry extruded diet that contained an insoluble:soluble fiber ratio of 3:1. All dogs underwent eight weeks of incremental conditioning where they trained four days a week. Once a week, a 5-minute video recording was taken immediately pre- and post-exercise to evaluate behaviors. Activity monitors were used to record voluntary activity on two rest days and one active day during weeks -1, 1, 4, 5, and 7. All behavioral and physical activity count data were analyzed using a repeated measures mixed model to test for differences between dietary treatments and week. No differences were observed between treatment or control dogs for any behavior or voluntary physical activity levels (P > 0.05); however, all dogs experienced an exercise-induced reduction in locomotive behaviors prior to exercise throughout the 8-week conditioning period (P < 0.05). Additionally, all dogs were more active during the second consecutive day of rest relative to the first (P < 0.05). These data suggest that while increased soluble fiber in the diets of sled dogs may not affect their behavior, the exercise-related reduction in activity observed begins to recover within one rest day.

Optimization of the insoluble: soluble fibers in the diets of dogs can improve gastrointestinal health by increasing commensal bacterial growth. A growing body of research suggests that improved gut health can influence behavior via the gut-brain axis. Therefore, the objectives of this study were to investigate the effects of an increased soluble fiber diet on the behavior and voluntary activity of actively training, client-owned Siberian huskies. Fourteen dogs were blocked for age, BW and sex and randomly allocated to either the control or treatment groups. The control group was fed a dry extruded diet that contained an insoluble:soluble fiber ratio of 4:1, and the treatment group was fed a dry extruded diet that contained an insoluble:soluble fiber ratio of 3:1. All dogs underwent eight weeks of incremental conditioning where they trained four days a week. Once a week, a 5-minute video recording was taken immediately pre- and post-exercise to evaluate behaviors. Activity monitors were used to record voluntary activity on two rest days and one active day during weeks -1, 1,4, 5, and 7. All behavioral and physical activity count data were analyzed using a repeated measures mixed model to test for differences between dietary treatments and week. No differences were observed between treatment or control dogs for any behavior or voluntary physical activity levels (P > 0.05); however, all dogs experienced an exercise-induced reduction in locomotive behaviors prior to exercise throughout the 8-week conditioning period (P < 0.05). Additionally, all dogs were more active during the second consecutive day of rest relative to the first (P < 0.05). These data suggest that while increased soluble fiber in the diets of sled dogs may not affect their behavior, the exerciserelated reduction in activity observed begins to recover within one rest day.