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IntroductionDespite a growing body of research on the risks of SARS-CoV-2 infection during pregnancy, there is continued controversy given heterogeneity in the quality and design of published studies.MethodsWe screened ongoing studies in our sequential, prospective meta-analysis. We pooled individual participant data to estimate the absolute and relative risk (RR) of adverse outcomes among pregnant women with SARS-CoV-2 infection, compared with confirmed negative pregnancies. We evaluated the risk of bias using a modified Newcastle-Ottawa Scale.ResultsWe screened 137 studies and included 12 studies in 12 countries involving 13 136 pregnant women.Pregnant women with SARS-CoV-2 infection-as compared with uninfected pregnant women-were at significantly increased risk of maternal mortality (10 studies; n=1490; RR 7.68, 95% CI 1.70 to 34.61); admission to intensive care unit (8 studies; n=6660; RR 3.81, 95% CI 2.03 to 7.17); receiving mechanical ventilation (7 studies; n=4887; RR 15.23, 95% CI 4.32 to 53.71); receiving any critical care (7 studies; n=4735; RR 5.48, 95% CI 2.57 to 11.72); and being diagnosed with pneumonia (6 studies; n=4573; RR 23.46, 95% CI 3.03 to 181.39) and thromboembolic disease (8 studies; n=5146; RR 5.50, 95% CI 1.12 to 27.12).Neonates born to women with SARS-CoV-2 infection were more likely to be admitted to a neonatal care unit after birth (7 studies; n=7637; RR 1.86, 95% CI 1.12 to 3.08); be born preterm (7 studies; n=6233; RR 1.71, 95% CI 1.28 to 2.29) or moderately preterm (7 studies; n=6071; RR 2.92, 95% CI 1.88 to 4.54); and to be born low birth weight (12 studies; n=11 930; RR 1.19, 95% CI 1.02 to 1.40). Infection was not linked to stillbirth. Studies were generally at low or moderate risk of bias.ConclusionsThis analysis indicates that SARS-CoV-2 infection at any time during pregnancy increases the risk of maternal death, severe maternal morbidities and neonatal morbidity, but not stillbirth or intrauterine growth restriction. As more data become available, we will update these findings per the published protocol.

We urgently need answers to basic epidemiological questions regarding SARS-CoV-2 infection in pregnant and postpartum women and its effect on their newborns. While many national registries, health facilities, and research groups are collecting relevant data, we need a collaborative and methodologically rigorous approach to better combine these data and address knowledge gaps, especially those related to rare outcomes. We propose that using a sequential, prospective meta-analysis (PMA) is the best approach to generate data for policy- and practice-oriented guidelines. As the pandemic evolves, additional studies identified retrospectively by the steering committee or through living systematic reviews will be invited to participate in this PMA. Investigators can contribute to the PMA by either submitting individual patient data or running standardized code to generate aggregate data estimates. For the primary analysis, we will pool data using two-stage meta-analysis methods. The meta-analyses will be updated as additional data accrue in each contributing study and as additional studies meet study-specific time or data accrual thresholds for sharing. At the time of publication, investigators of 25 studies, including more than 76,000 pregnancies, in 41 countries had agreed to share data for this analysis. Among the included studies, 12 have a contemporaneous comparison group of pregnancies without COVID-19, and four studies include a comparison group of non-pregnant women of reproductive age with COVID-19. Protocols and updates will be maintained publicly. Results will be shared with key stakeholders, including the World Health Organization (WHO) Maternal, Newborn, Child, and Adolescent Health (MNCAH) Research Working Group. Data contributors will share results with local stakeholders. Scientific publications will be published in open-access journals on an ongoing basis.

As of 2021, more than 80 million people worldwide have been displaced by war, violence, and poverty. An estimated 30 to 34 million of these are under age 18, and many are at risk of interrupting their education permanently--a situation aggravated in recent years by the global COVID-19 pandemic. In this article, we adopt an intersectional conceptual framework to explore the roles gender and other social inequalities have played in shaping adolescents' access to education during the COVID-19 pandemic. We examine two refugee populations: the Rohingya, who have been excluded from formal education opportunities in Bangladesh, and Syrian refugees in Jordan, who have access to formal education in their host country. We provide novel empirical data, as well as insights into the adolescent refugee experience and the short-term consequences for education resulting from the pandemic. In the article, we draw from quantitative survey data on 3,030 adolescents, and from in-depth qualitative interviews we conducted in the spring of 2020 with a subset of 91 adolescents who are part of an ongoing longitudinal study. We also conducted 40 key informant interviews with community leaders and service providers.

As governments around the world are shaping policy responses to advance adolescent well-being and protect their rights, the tools and resources to strengthen policy foundations, and ultimately improve their effectiveness, remain limited. This paper proposes a framework to support policy action with an explicit adolescent focus and applies it to two illustrative case studies to unpack the underlying policy conditions for success. We develop an analytic framework with an adolescent lens that focuses on the full policy life-course, from development, to implementation, to evaluation. We then choose two illustrative case studies to apply this framework — 1) abolition of secondary school fees policy in Kenya and 2) age of marriage law in Mexico. These cases were chosen based on the existence of rigorous causal evidence of effect, alignment of salience with expert opinions, broad-based implications for adolescents across contexts, and varied levels of success at achieving intended outcomes. Our framework identified six key components as critical foundations for adolescent-focused policies: (1) policy features and costs, (2) implementation considerations, (3) participatory approach, (4) inclusion and coverage, (5) policy appropriateness, and (6) monitoring and evaluation, each with key adolescent-specific elements. We find that the majority of the essential policy elements are addressed in the school fees abolition policy (Kenya), but are sparser in the age of marriage law (Mexico). The results also highlight the lack of decentralized monitoring as well as meaningful adolescent engagement at any level of policy development as potential drivers of ineffectiveness of adolescent-centric policies. Our adolescent policy analysis framework can serve as an important tool to define principles in the development of effective adolescent policies. It also can serve as a useful evaluation tool to unpack the 'black box' of policy effectiveness when combined with robustly estimated effects. [ABSTRACT FROM AUTHOR]

Brain-computer interfaces (BCIs) promise to restore independence for people with severe motor disabilities by translating decoded neural activity directly into the control of a computer. However, recorded neural signals are not stationary (that is, can change over time), degrading the quality of decoding. Requiring users to pause what they are doing whenever signals change to perform decoder recalibration routines is time-consuming and impractical for everyday use of BCIs. We demonstrate that signal nonstationarity in an intracortical BCI can be mitigated automatically in software, enabling long periods (hours to days) of self-paced point-and-click typing by people with tetraplegia, without degradation in neural control. Three key innovations were included in our approach: tracking the statistics of the neural activity during self-timed pauses in neural control, velocity bias correction during neural control, and periodically recalibrating the decoder using data acquired during typing by mapping neural activity to movement intentions that are inferred retrospectively based on the user's self-selected targets. These methods, which can be extended to a variety of neurally controlled applications, advance the potential for intracortical BCIs to help restore independent communication and assistive device control for people with paralysis.

A goal of brain-computer interface research is to develop fast and reliable means of communication for individuals with paralysis and anarthria. We evaluated the ability of an individual with incomplete locked-in syndrome enrolled in the BrainGate Neural Interface System pilot clinical trial to communicate using neural point-and-click control. A general-purpose interface was developed to provide control of a computer cursor in tandem with one of two on-screen virtual keyboards. The novel BrainGate Radial Keyboard was compared to a standard QWERTY keyboard in a balanced copy-spelling task. The Radial Keyboard yielded a significant improvement in typing accuracy and speed-enabling typing rates over 10 correct characters per minute. The participant used this interface to communicate face-to-face with research staff by using text-to-speech conversion, and remotely using an internet chat application. This study demonstrates the first use of an intracortical brain-computer interface for neural point-and-click communication by an individual with incomplete locked-in syndrome.

BACKGROUND:Multiple types of neural signals are available for controlling assistive devices through brain-computer interfaces (BCIs). Intracortically recorded spiking neural signals are attractive for BCIs because they can in principle provide greater fidelity of encoded information compared to electrocorticographic (ECoG) signals and electroencephalograms (EEGs). Recent reports show that the information content of these spiking neural signals can be reliably extracted simply by causally band-pass filtering the recorded extracellular voltage signals and then applying a spike detection threshold, without relying on "sorting" action potentials. NEW METHOD:We show that replacing the causal filter with an equivalent non-causal filter increases the information content extracted from the extracellular spiking signal and improves decoding of intended movement direction. This method can be used for real-time BCI applications by using a 4ms lag between recording and filtering neural signals. RESULTS:Across 18 sessions from two people with tetraplegia enrolled in the BrainGate2 pilot clinical trial, we found that threshold crossing events extracted using this non-causal filtering method were significantly more informative of each participant's intended cursor kinematics compared to threshold crossing events derived from causally filtered signals. This new method decreased the mean angular error between the intended and decoded cursor direction by 9.7° for participant S3, who was implanted 5.4 years prior to this study, and by 3.5° for participant T2, who was implanted 3 months prior to this study. CONCLUSIONS:Non-causally filtering neural signals prior to extracting threshold crossing events may be a simple yet effective way to condition intracortically recorded neural activity for direct control of external devices through BCIs.

BackgroundMultiple types of neural signals are available for controlling assistive devices through brain-computer interfaces (BCIs). Intracortically recorded spiking neural signals are attractive for BCIs because they can in principle provide greater fidelity of encoded information compared to electrocorticographic (ECoG) signals and electroencephalograms (EEGs). Recent reports show that the information content of these spiking neural signals can be reliably extracted simply by causally band-pass filtering the recorded extracellular voltage signals and then applying a spike detection threshold, without relying on "sorting" action potentials.New methodWe show that replacing the causal filter with an equivalent non-causal filter increases the information content extracted from the extracellular spiking signal and improves decoding of intended movement direction. This method can be used for real-time BCI applications by using a 4ms lag between recording and filtering neural signals.ResultsAcross 18 sessions from two people with tetraplegia enrolled in the BrainGate2 pilot clinical trial, we found that threshold crossing events extracted using this non-causal filtering method were significantly more informative of each participant's intended cursor kinematics compared to threshold crossing events derived from causally filtered signals. This new method decreased the mean angular error between the intended and decoded cursor direction by 9.7° for participant S3, who was implanted 5.4 years prior to this study, and by 3.5° for participant T2, who was implanted 3 months prior to this study.ConclusionsNon-causally filtering neural signals prior to extracting threshold crossing events may be a simple yet effective way to condition intracortically recorded neural activity for direct control of external devices through BCIs.

Professional development for biomedical doctoral and postdoctoral trainees is vital, especially due to the increase in individuals pursuing non-faculty career paths. We created a professional development-focused discussion group between trainees and faculty/staff by utilizing a book club format in which monthly small group meetings occurred over an 8-month period. A pre- and post-survey consisting of Likert and free-response questions was completed by participants. Results demonstrated that after the book club, trainees: 1) were more knowledgeable about a variety of career paths; 2) had improved awareness of their interests in relation to their career; 3) were more knowledgeable of their transferrable skills; 4) were more comfortable engaging with their PI and completing/updating an Individual Development Plan; 5) were more likely to find mentors in addition to their PI to address career specific needs; and 6) were more likely to seek opportunities to conduct informational interviews or experiential learning. Additionally, we found that faculty/staff: 1) were more knowledgeable about careers outside of academia; 2) had greater consideration for their mentee's values and interests in relation to their career; 3) had a better understanding of their mentee's transferable skills; and 4) were more comfortable engaging with their mentee about their career path and addressing an Individual Development Plan. Overall, we found that the utilization of a book club consisting of trainees and faculty/staff as a professional development tool was beneficial for both groups of participants, and this format is feasible for use in biomedical education professional development., Competing Interests: The authors declare no conflict of interest., (© 2021 The Author(s).)