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      Editorial. Putting pen to paper during a pandemic: increased manuscript submissions to the JNS Publishing Group

      editorial
      , MD, FRCSC 1 , , MD, PhD 2 , , MD, PhD, FRCSC 3 ,
      Journal of Neurosurgery
      American Association of Neurological Surgeons

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          Abstract

          As the COVID-19 pandemic took hold of virtually all societies around the world, necessitating stringent lockdown measures as a means of preventing catastrophic spread of the virus, the Journal of Neurosurgery quickly published a collection of editorials on the impact of COVID-19 on the practice of neurosurgery (https://thejns.org/collection/covid19). In keeping with best practices in business, all members of the journal editorial office in Charlottesville began a “work from home” schedule on March 15, 2020. This could be facilitated seamlessly given that all journal office departments, from peer review to production, were set up with online connectivity to ensure that the requisite daily work could be completed without delays. In February 2020, we began to see a rise in manuscript submissions to the journal as compared to preceding years. At first it was almost imperceptible, but in the ensuing weeks it became quite clear that we were being challenged with a very significant number of new submissions across all print journals (Fig. 1). From February to June 2020, the Journal of Neurosurgery received 576 more manuscripts than those during the same 4 months in 2019; the Journal of Neurosurgery: Spine received 345 more manuscripts; and the Journal of Neurosurgery: Pediatrics received 170 more manuscripts. All told, for these 4 months, there were 1091 more new manuscript submissions to the print journals than had been seen in 2019 (Fig. 2). A similar increase in manuscript submissions was also found for the topic-based issues of Neurosurgical Focus. FIG. 1. Numbers of manuscripts submitted to each of the print journals of the JNSPG from February to June 2020 with comparisons to the same timeframe for 2019. In total, 1091 more new manuscripts were received and processed for these 4 months in 2020 versus 2019. Figure is available in color online only. FIG. 2. Bar graph depicting the differences between manuscripts received in 2019 and 2020 for all print journals combined. The number of new manuscript submissions peaked in April and has shown evidence of some decline since. Figure is available in color online only. Interestingly, such a sudden rise in manuscript submissions has been noted in academic publishing in the fields of science and healthcare. At the recent European Association of Science Editors Virtual Conference held on June 12, 2020, the conference theme was Editors and Editing in Times of Crisis (https://ease.org.uk/ease-events/virtual-conference-2020/). Some journals had noted a near 5-fold increase in manuscript submissions during the months of the pandemic. 1 This has required several scientific journals to provide appropriate wording to authors to alert them of potential delays in the peer-review process. In our journal office, there are two full-time staff in the Peer Review Department for the print journals, Samantha Geouge and Rhonda Jeffers. They are responsible for processing all new submissions, ensuring that the manuscripts are formatted according to journal style, and providing correspondence to all authors. Needless to say, they have felt the heavy weight of these new manuscript submissions the most (Fig. 3). FIG. 3. With more than 1000 more new submissions for the first 6 months of 2020 as compared to the number in 2019, it is easy to understand how the Peer Review Department, the editors in chief, the associate editor, and members of the editorial board could be overwhelmed by the sheer number of new manuscript submissions. Figure is available in color online only. Once these new manuscript submissions have passed the journal formatting requirements, the associate editor and editors in chief review each paper to determine which manuscripts should be sent out for peer review. During the peak of the pandemic, our workload increased considerably as we read, triaged, and assigned for peer review more than 175 manuscripts per week. Prior to the pandemic, our typical volume of new manuscript submissions was approximately 90 per week. So, in effect, we handled twice the volume of new manuscript submissions during the COVID-19 period. Why this episodic increase in manuscript submissions? As has been pointed out in numerous articles in the journal’s COVID-19 collection, neurosurgeons were unable to perform a good portion of their routine clinical duties. During the lockdown, most neurosurgical services were reduced to caring for patients with emergency conditions, such as ruptured aneurysms, traumatic brain injury, brain tumors, and hydrocephalus. Patients with non-urgent neurosurgical conditions, such as degenerative spine disease, epilepsy, movement disorders, and unruptured arteriovenous malformations or aneurysms, were unable for the most part to receive treatment. It is tempting to speculate that neurosurgeons who were unable to carry out their usual clinical duties were motivated to write new papers on their research, complete papers that had been started, or redirect papers to the journal if they had not been accepted elsewhere. On the whole, we are inspired by the notion that neurosurgeons would use the time provided by the pandemic to work diligently on these academic projects. While many of these new submissions were excellent and worthy of undergoing peer review, we confide that some were not. We could tell quite readily that some of the manuscripts submitted to the journal had been reviewed elsewhere and that these authors had rather quickly decided to send these studies to the journal without due attention to our formatting requirements. As mentioned in a previous editorial, with well over 5000 manuscripts submitted to the journal annually, we are able to publish a small fraction of the total each year. 2 We are continuously seeking the best science and the highest-quality studies in our specialty. Naturally, we encountered many new submissions relating to the impact of COVID-19 on the practice of neurosurgery. 3 In this regard, we received reports daily from around the globe, beginning in mid-March, first from China and then sequentially from other countries that were hit hardest by the virus. Most of these reports were limited case observations, many reporting on patient triage, neurosurgical preparation and technique, safety, and COVID-19–related neurological complications such as intracranial thrombosis and hemorrhage. While these reports were initially intriguing, our global readers were experiencing the same events at their own centers. Thus, what initially appeared novel in March or early April 2020 became somewhat more routine by May. This shared adaptation to the shutdown of elective neurosurgical procedures influenced our own peer-review decisions on manuscripts related to COVID-19. At the apex of the pandemic, it became quite clear to us that the number of editorial board members for the journal was likely out of balance with the number of manuscripts received. Each member of the editorial board reviews between 100 and 175 manuscripts annually. The co-chairs of the editorial board review even more. Given the annual steady rise in manuscript submissions to the journal, which has not yet plateaued, at our recent virtual editorial board meeting on April 26, 2020, we reviewed and accepted the nominations of 14 new members for the editorial board (Table 1). In previous years, we would have typically accepted approximately 8 new editorial board members. TABLE 1. New editorial board members, the JNS Publishing Group 2020–2021 Name Institution Area of Expertise Print Journal Manish Aghi University of California, San Francisco Brain tumors, neuroendoscopy, brain mapping JNS Andrew Carlson University of New Mexico Vascular/endovascular, neurocritical care, skull base JNS Elizabeth Claus Yale University Brain tumors, epidemiology, databases JNS Kai-Ming Fu Weill Cornell Medicine Deformity, minimally invasive spine, oncology JNS: Spine Gerald Grant Stanford University Brain tumors, epilepsy, traumatic brain injury JNS: Peds Stephanie Greene University of Pittsburgh Vascular, spinal dysraphism, hydrocephalus JNS: Peds Christoph Hofstetter University of Washington Spinal cord injury, minimally invasive spine JNS: Spine Mark Krieger University of Southern California Brain tumors, healthcare systems JNS: Peds Sean Lew Medical College of Wisconsin Epilepsy, cervical spine, craniocervical JNS: Peds David Limbrick Washington University in St. Louis Chiari malformation, spine, brain tumors, hydrocephalus JNS: Peds Daniel Lu University of California, Los Angeles Spinal cord injury, degenerative spine, deformity JNS: Spine William Mack University of Southern California Vascular/endovascular JNS Daniel Prevedello The Ohio State University Skull base, neuroendoscopy, brain tumors JNS Wilson Z. Ray Washington University in St. Louis Cervical, minimally invasive, peripheral nerve JNS: Spine We were delighted to see neurosurgeons around the globe putting pen to paper during the pandemic and using their time wisely to enhance the academic mission of their programs and institutions in these most uncertain times. Being academically productive in a challenging environment is a true testament to the fortitude, resiliency, and adaptability of neurosurgeons around the world, in addition to their prodigious work ethic. It will be interesting to track and follow the increased number of papers that are being published from the period of the pandemic to determine if the sudden influx of novel ideas and applications of new technologies stimulate advances in neurosurgery to the great benefit of our patients. Disclosures The authors report no conflict of interest.

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          Introduction. On pandemics: the impact of COVID-19 on the practice of neurosurgery

          On January 8, 2020, a prescient scientific article was submitted for publication to the Journal of Travel Medicine on a pneumonia of unknown etiology that was identified in patients in Wuhan, China, and the potential for its international spread through commercial air travel. 1 This article was in direct response to a communication from the World Health Organization, which reported on 44 patients with pneumonia from Wuhan City, Hubei province, China. 2 On January 8, 2020, the pathogen causing this form of pneumonia was identified as the newest member of the coronavirus family confirmed to cause disease in humans. 3 Clinical epidemiological studies and characterization of affected patients soon followed. 4 Prior to the identification of this new virus, there were 6 known human coronaviruses, of which 4 cause only minor cold-like symptoms, but 2 cause more serious illnesses: Severe Acute Respiratory Syndrome coronavirus (SARS-CoV) and Middle East Respiratory Syndrome coronavirus (MERS-CoV). In the relatively short time span of 3 months since the new coronavirus was identified, the literature on COVID-19 has grown exponentially, from not a single scientific report to over 1600 publications at the time of this writing, across numerous disciplines in the field of medicine, including infectious disease, virology, epidemiology, immunology, critical care medicine, pediatrics, medical education, psychiatry, and surgery. Just now, neurosurgical programs from Wuhan, China, are submitting articles to the Journal describing their experiences combating COVID-19 in their hospitals. According to these reports, endoscopic endonasal skull base procedures should be avoided as much as possible given the high likelihood of aerosolizing virus particles within the nasal sinuses and infecting operating room staff. In 2003, SARS-CoV gripped the world. More than 8000 total cases of SARS-CoV were reported following the initial outbreak of cases in the Guangdong province of China in 2002. In 2003, the city of Toronto was the site of a large cluster of infected individuals, with over 400 cases documented. Large international meetings planned in Toronto, such as the American Association of Cancer Research annual meeting, the largest cancer research meeting of its kind in the world, were cancelled due to the SARS epidemic. Now, with the COVID-19 pandemic, virtually all the conferences of organized neurosurgical associations and societies around the world have been either cancelled or postponed. International airplane travel is forbidden in most countries. National travel is being discouraged. Practices of self-isolation and social distancing have become the norm. As the numbers of new COVID-19 cases appear to be flattening in China at the time of the writing of this introduction, a wave of new COVID-19 infections is striking Europe, South America, and North America at an alarming rate. While COVID-19 has limited neurovirulence, its reproductive number (R0) is high, indicating that its transmissibility gives it the potential to infect large proportions of the world population, with enough patients with severe symptoms to overwhelm our healthcare systems, as has been demonstrated in jurisdictions such as northern Italy. The many COVID-19 patients requiring admission to critical care and intensive care units have already led to the prioritization of neurosurgical cases throughout North America. For these reasons, we thought it prudent to share up-to-date information regarding the best neurosurgical practices during the COVID-19 pandemic. We hope these timely communications will lead to better preparedness for taking care of our patients and maintaining the safety and well-being of all healthcare workers on the front lines, while enabling us to continue to promote innovations through educational and teaching opportunities that may take place outside the operating room. In addition, perhaps there will be an increased focus on basic and translational viral science that will lead to more rapid therapeutic responses. Accordingly, a series of rapid-communication editorials has been commissioned by the Journal of Neurosurgery Publishing Group (JNSPG) from neurosurgeons in regions severely affected by COVID-19, such as China, South Korea, Singapore, and Italy. We provide communications on the impact of COVID-19 on the practice of particular aspects of neurosurgery (Fig. 1), such as general and specialized adult neurosurgery, spine surgery, and pediatric neurosurgery. The effects of the COVID-19 pandemic on annual neurosurgical meetings, such as the American Association of Neurological Surgeons (AANS), are discussed by Kathleen Craig, Chief Executive Officer, and Chris Shaffrey, President of the AANS. The downstream effects of a reduction in operative experience and formal in-person conferencing on resident education are described in an editorial prepared by neurosurgery residency program directors. In this regard, the importance of web-based conferencing systems has emerged and reached primacy. The effects of COVID-19 on large academic neurosurgical units versus small private neurosurgical practices are compared and contrasted. Members of the Editorial Board of the JNSPG for all three print journals were asked to collate and prepare their experiences in the form of an editorial from across the United States and beyond. And finally, as issues arise when allocating scarce medical resources during pandemics, we present an editorial on the ethics of prioritizing and rationing neurosurgical care during the COVID-19 pandemic. FIG. 1. Impact of COVID-19 on the practice of neurosurgery. Clinical care, neurosurgical procedures, resident/fellow education, neurosurgical research, neurosurgical organizations, national and international travel, and the world economy have all been dramatically altered by the pandemic. New systems are being designed and implemented to offset many of the downstream, deleterious effects of COVID-19. Figure is available in color online only. In a Ted Talk delivered in 2014, Bill Gates warned that we were ill prepared for the next global catastrophic event, which he predicted would be from another uncontrolled viral epidemic. 5 Despite what we learned from prior epidemics, such as SARS, Ebola, and MERS, the words of Gates and others now appear to have been prophetic. While it is important to recognize the impact of COVID-19 on the practice of neurosurgery through this series of rapid communications in the Journal, it will be equally important to “debrief” on where we will be 6 to 12 months from now. It is our strong hope that we will be able to codify systems of containment so that we can immediately prevent or minimize the spread of diseases such as COVID-19; that we develop standardized systems of care so that a necessary and required stock of personal protective equipment (PPE) is always available; and that we work together to ensure that the prioritization of the care of acutely ill neurosurgical patients is forever seamless, even at times of limited inpatient hospital resources. Through arduous training processes and previous experiences, neurosurgeons are by nature a resilient group of surgical specialists. Accordingly, we hope to demonstrate that our responses to the COVID-19 pandemic will make our specialty stronger, and better prepared for the future. Addendum On the day this piece was submitted, March 30, 2020, we learned of the passing of fellow neurosurgeon Dr. James T. Goodrich, Chief of Pediatric Neurosurgery, Montefiore Medical Center, New York City, from complications related to COVID-19. Disclosures The authors report no conflict of interest.
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            Editorial: A concerted effort to publish the best studies in neurosurgery.

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              Author and article information

              Journal
              J Neurosurg
              J. Neurosurg
              J Neurosurg
              Journal of Neurosurgery
              American Association of Neurological Surgeons
              0022-3085
              1933-0693
              July 2020
              24 July 2020
              24 July 2020
              : 1-3
              Affiliations
              [1 ]Associate Editor, Journal of Neurosurgery Publishing Group;
              [2 ]Editor-in-Chief, Neurosurgical Focus; and
              [3 ]Editor-in-Chief, Journal of Neurosurgery Publishing Group, Charlottesville, Virginia
              Author notes
              Correspondence James T. Rutka: james.rutka@ 123456sickkids.ca .

              INCLUDE WHEN CITING Published online July 24, 2020; DOI: 10.3171/2020.7.JNS202691.

              Disclosures The authors report no conflict of interest.

              Article
              2020.7.JNS202691
              10.3171/2020.7.JNS202691
              7393803
              32707559
              89d98306-55ee-4f2d-a711-176f1d608d26
              Copyright held by the American Association of Neurological Surgeons. You may not sell, republish, or systematically distribute any published materials without written permission from JNSPG.

              This article is made available via the PMC Open Access Subset for unrestricted re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the COVID-19 pandemic or until permissions are revoked in writing. Upon expiration of these permissions, PMC is granted a perpetual license to make this article available via PMC and Europe PMC, consistent with existing copyright protections.

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              Figures: 3, Tables: 1, References: 3, Pages: 0
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