Maltreated children use more grammatical negations

Many studies reveal a strong impact of childhood maltreatment on language development, mainly resulting in shorter utterances, less rich vocabulary, or a delay in grammatical complexity. However, different theories suggest the possibility for resilience – a positive adaptation to an otherwise adverse environment – in children who experienced childhood maltreatment. Here, we investigated different measures for language development in spontaneous speech, examining whether childhood maltreatment leads to a language deficit only or whether it can also result in differences in language use due to a possible adaptation to a toxic environment. We compared spontaneous speech during therapeutic peer-play sessions of 32 maltreated and 32 non-maltreated children from the same preschool and equivalent in gender, age (2 to 5 years), home neighborhood, ethnicity, and family income. Maltreatment status was reported by formal child protection reports, and corroborated by independent social service reports. We investigated general language sophistication (i.e., vocabulary, talkativeness, mean length of utterance), as well as grammatical development (i.e., use of plurals, tense, grammatical negations). We found that maltreated and non-maltreated children showed similar sophistication across all linguistic measures, except for the use of grammatical negations. Maltreated children used twice as many grammatical negations as non-maltreated children. The use of this highly complex grammatical structure shows an advanced linguistic skill, which shows that childhood maltreatment does not necessarily lead to a language deficit. The result might indicate the development of a negativity bias in the structure of spontaneous language due to an adaptation to their experiences

Anxiety, concerns and COVID-19: Cross-country perspectives from families and individuals with neurodevelopmental conditions

BACKGROUND: The COVID-19 pandemic had a major impact on the mental health and well-being of children with neurodevelopmental conditions (NDCs) and of their families worldwide. However, there is insufficient evidence to understand how different factors (e.g., individual, family, country, children) have impacted on anxiety levels of families and their children with NDCs developed over time. METHODS: We used data from a global survey assessing the experience of 8043 families and their children with NDCs (mean of age (m) = 13.18 years, 37% female) and their typically developing siblings (m = 12.9 years, 45% female) in combination with data from the European Centre for Disease Prevention and Control, the University of Oxford, and the Central Intelligence Agency (CIA) World Factbook, to create a multilevel data set. Using stepwise multilevel modelling, we generated child-, family- and country-related factors that may have contributed to the anxiety levels of children with NDCs, their siblings if they had any, and their parents. All data were reported by parents. RESULTS: Our results suggest that parental anxiety was best explained by family-related factors such as concerns about COVID-19 and illness. Children’s anxiety was best explained by child-related factors such as children’s concerns about loss of routine, family conflict, and safety in general, as well as concerns about COVID-19. In addition, anxiety levels were linked to the presence of pre-existing anxiety conditions for both children with NDCs and their parents. CONCLUSIONS: The present study shows that across the globe there was a raise in anxiety levels for both parents and their children with NDCs because of COVID-19 and that country-level factors had little or no impact on explaining differences in this increase, once family and child factors were considered. Our findings also highlight that certain groups of children with NDCs were at higher risk for anxiety than others and had specific concerns. Together, these results show that anxiety of families and their children with NDCs during the COVID-19 pandemic were predicted by very specific concerns and worries which inform the development of future toolkits and policy. Future studies should investigate how country factors can play a protective role during future crises

Extracorporeal Membrane Oxygenation for Severe Acute Respiratory Distress Syndrome associated with COVID-19: An Emulated Target Trial Analysis.

RATIONALE: Whether COVID patients may benefit from extracorporeal membrane oxygenation (ECMO) compared with conventional invasive mechanical ventilation (IMV) remains unknown. OBJECTIVES: To estimate the effect of ECMO on 90-Day mortality vs IMV only Methods: Among 4,244 critically ill adult patients with COVID-19 included in a multicenter cohort study, we emulated a target trial comparing the treatment strategies of initiating ECMO vs. no ECMO within 7 days of IMV in patients with severe acute respiratory distress syndrome (PaO2/FiO2 <80 or PaCO2 ≥60 mmHg). We controlled for confounding using a multivariable Cox model based on predefined variables. MAIN RESULTS: 1,235 patients met the full eligibility criteria for the emulated trial, among whom 164 patients initiated ECMO. The ECMO strategy had a higher survival probability at Day-7 from the onset of eligibility criteria (87% vs 83%, risk difference: 4%, 95% CI 0;9%) which decreased during follow-up (survival at Day-90: 63% vs 65%, risk difference: -2%, 95% CI -10;5%). However, ECMO was associated with higher survival when performed in high-volume ECMO centers or in regions where a specific ECMO network organization was set up to handle high demand, and when initiated within the first 4 days of MV and in profoundly hypoxemic patients. CONCLUSIONS: In an emulated trial based on a nationwide COVID-19 cohort, we found differential survival over time of an ECMO compared with a no-ECMO strategy. However, ECMO was consistently associated with better outcomes when performed in high-volume centers and in regions with ECMO capacities specifically organized to handle high demand. This article is open access and distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives License 4.0 (http://creativecommons.org/licenses/by-nc-nd/4.0/)

A Solve-RD ClinVar-based reanalysis of 1522 index cases from ERN-ITHACA reveals common pitfalls and misinterpretations in exome sequencing

Purpose Within the Solve-RD project (https://solve-rd.eu/), the European Reference Network for Intellectual disability, TeleHealth, Autism and Congenital Anomalies aimed to investigate whether a reanalysis of exomes from unsolved cases based on ClinVar annotations could establish additional diagnoses. We present the results of the “ClinVar low-hanging fruit” reanalysis, reasons for the failure of previous analyses, and lessons learned. Methods Data from the first 3576 exomes (1522 probands and 2054 relatives) collected from European Reference Network for Intellectual disability, TeleHealth, Autism and Congenital Anomalies was reanalyzed by the Solve-RD consortium by evaluating for the presence of single-nucleotide variant, and small insertions and deletions already reported as (likely) pathogenic in ClinVar. Variants were filtered according to frequency, genotype, and mode of inheritance and reinterpreted. Results We identified causal variants in 59 cases (3.9%), 50 of them also raised by other approaches and 9 leading to new diagnoses, highlighting interpretation challenges: variants in genes not known to be involved in human disease at the time of the first analysis, misleading genotypes, or variants undetected by local pipelines (variants in off-target regions, low quality filters, low allelic balance, or high frequency). Conclusion The “ClinVar low-hanging fruit” analysis represents an effective, fast, and easy approach to recover causal variants from exome sequencing data, herewith contributing to the reduction of the diagnostic deadlock

Actualités et guide pratique d'utilisation de la procalcitonine dans les bactériémies

editorial reviewedLa procalcitonine (PCT) est une pro-hormone de la calcitonine, sécrétée par les cellules C de la thyroïde, dont une concentration négligeable circule dans le sang en condition physiologique. Initialement utilisée comme marqueur diagnostique et pronostique de l’évolution d’un sepsis traité aux soins intensifs, la PCT est intéressante car plus spécifiquement corrélée à une infection bactérienne comparée à d’autres marqueurs déjà utilisés en pratique clinique comme la CRP ou le taux de globules blancs. La PCT est également dotée d’un profil cinétique plus favorable que la CRP dans l’évaluation de la réponse thérapeutique au sepsis. La PCT a des indi- cations reconnues d’utilisation telles que la désescalade thérapeutique dans le traitement empirique du sepsis et du choc septique et l’initiation d’une antibiothérapie dans le cas d’une infection respiratoire basse en réanimation et en salle d’urgences. Des études plus récentes évaluent l’utilisation de la PCT dans les bactériémies. L’évidence actuelle est robuste en faveur d’une prédiction des Gram-négatifs (hors non-fermentants) et dans le contexte clinique des infections uro-génitales. La PCT s’est également avérée intéres- sante pour discriminer les bactériémies des contaminations. Enfin, comme tout biomarqueur, la PCT doit être utilisé comme un outil, parmi d’autres, dans une démarche diagnostique et thérapeutique multimodale, en tenant compte notamment du niveau de risque infectieux du patient considéré et du niveau de compliance au résultat de la PCT de la part du clinicien. C’est sa valeur prédictive négative qui s’avère en réalité la plus intéressante à utiliser

Des maisons en terre médiévales sur un îlot du quartier Saint-Mathieu, à Perpignan (Pyrénées-Orientales). Premiers éléments de réflexion.

Analysis of a complete block of buildings on the outskirts of the medieval city of Perpignan that has given opportunities to study earth constructions made with the techniques of pisé and cob, and to find out the original city planning of this suburb created at the end of the XIIIth or the beginning of the XIVth century.Analyse du bâti d'un îlot complet dans un faubourg médiéval de Perpignan ayant permis l'étude détaillée de constructions en pisé et en bauge, conservées sur trois niveaux, et de retrouver le parcellaire de la de la fin XIIIe-début XIVe s

Réponse des bassin-versants du Roussillon entre le XIIe et le XIXe siècle : un impact du Petit Age Glaciaire ?

During the second millennium, the hydrosystems of the Roussillon plain were dramatically transformed by human interventions on one hand and by climatic-controlled evolutions on the other (equilibrium OM/ LIA). Geoarchaeological researches carried out since the beginning of the 2000s also revealed the importance of the topographical modifications of the plain by sedimentary deposits and showed that the configuration of its current river system was profoundly modified during the second millennium. The relation between anthropological and climatic forcing of the evolution of plain is discussed in the light of recent data.Au cours du deuxième millénaire, les hydrosystèmes de la plaine du Roussillon ont été transformés de manière radicale par les interventions humaines d’une part et les évolutions sous contrôle climatique d’autre part (Bascule entre OM/ PAG). Les travaux de géoarchéologie menés depuis le début des années 2000 ont également montré l’importance des modifications de la topographie de la plaine par des dépôts sédimentaires et que la configuration de son réseau hydrographique actuel avait été profondément remaniée au cours du deuxième millénaire. La relation entre forçages anthropiques et climatiques de l’évolution de la plaine est discutée à la lumière des données récentes.Carozza Jean-Michel, Odiot Thierry, Valette Philippe, Puig Carole, Pequinot Claire, Alessandri Patrice, Passarius Olivier. Réponse des bassin-versants du Roussillon entre le XIIe et le XIXe siècle : un impact du Petit Age Glaciaire ?. In: Archéologie du Midi médiéval. Tome 27, 2009. pp. 207-215

Population Pharmacokinetics of Amikacin in Patients on Veno-Arterial Extracorporeal Membrane Oxygenation

International audienceVeno-arterial extracorporeal membrane oxygenation (V-A ECMO) support leads to complex pharmacokinetic alterations, whereas adequate drug dosing is paramount for efficacy and absence of toxicity in critically ill patients. Amikacin is a major antibiotic used in nosocomial sepsis, especially for these patients. We aimed to describe amikacin pharmacokinetics on V-A ECMO support and to determine relevant variables to improve its dosing. All critically ill patients requiring empirical antimicrobial therapy, including amikacin for nosocomial sepsis supported or not by V-A ECMO, were included in a prospective population pharmacokinetic study. This population pharmacokinetic analysis was built with a dedicated software, and Monte Carlo simulations were performed to identify doses achieving therapeutic plasma concentrations. Thirty-nine patients were included (control n = 15, V-A ECMO n = 24); 215 plasma assays were performed and used for the modeling process. Patients received 29 (24–33) and 32 (30–35) mg/kg of amikacin in control and ECMO groups, respectively. Data were best described by a two-compartment model with first-order elimination. Inter-individual variabilities were observed on clearance, central compartment volume (V1), and peripherical compartment volume (V2). Three significant covariates explained these variabilities: Kidney Disease Improving Global Outcomes (KDIGO) stage on amikacin clearance, total body weight on V1, and ECMO support on V2. Our simulations showed that the adequate dosage of amikacin was 40 mg/kg in KDIGO stage 0 patients, while 25 mg/kg in KDIGO stage 3 patients was relevant. V-A ECMO support had only a secondary impact on amikacin pharmacokinetics, as compared to acute kidney injury

Le couvent des Franciscains-hôpital militaire à Perpignan (Pyrénées-Orientales), tranche 1

Coll. A. Fontaile, O. Poisson, A. Huser (ASM),Rapport