MRI Findings in 77 Children with Non-Syndromic Autistic Disorder

International audienceBACKGROUND: The clinical relevance of MR scanning in children with autism is still an open question and must be considered in light of the evolution of this technology. MRI was judged to be of insufficient value to be included in the standard clinical evaluation of autism according to the guidelines of the American Academy of Neurology and Child Neurology Society in 2000. However, this statement was based on results obtained from small samples of patients and, more importantly, included mostly insufficient MRI sequences. Our main objective was to evaluate the prevalence of brain abnormalities in a large group of children with a non-syndromic autistic disorder (AD) using T1, T2 and FLAIR MRI sequences. METHODOLOGY: MRI inspection of 77 children and adolescents with non-syndromic AD (mean age 7.4+/-3.6) was performed. All met the DSM-IV and ADI -R criteria for autism. Based on recommended clinical and biological screenings, we excluded patients with infectious, metabolic or genetic diseases, seizures or any other neurological symptoms. Identical MRI inspections of 77 children (mean age 7.0+/-4.2) without AD, developmental or neurological disorders were also performed. All MRIs were acquired with a 1.5-T Signa GE (3-D T1-FSPGR, T2, FLAIR coronal and axial sequences). Two neuroradiologists independently inspected cortical and sub-cortical regions. MRIs were reported to be normal, abnormal or uninterpretable. PRINCIPAL FINDINGS: MRIs were judged as uninterpretable in 10% (8/77) of the cases. In 48% of the children (33/69 patients), abnormalities were reported. Three predominant abnormalities were observed, including white matter signal abnormalities (19/69), major dilated Virchow-Robin spaces (12/69) and temporal lobe abnormalities (20/69). In all, 52% of the MRIs were interpreted as normal (36/69 patients). CONCLUSIONS: An unexpectedly high rate of MRI abnormalities was found in the first large series of clinical MRI investigations in non-syndromic autism. These results could contribute to further etiopathogenetic research into autism

Les disparités territoriales dans l'accès aux formations d'élite: La situation des Pays de la Loire au regard des autres régions françaises

La formation des élites demeure un sujet controversé entre les partisans de la suppression des grandes écoles, de leur fusion au sein des universités ou de leur maintien. Alors que dans la plupart des autres pays l’Université assure seule la formation des élites, le système français est organisé de telle sorte qu’une partie des futures élites administratives, managériales, intellectuelles, politiques et scientifiques est sélectionnée, préparée et formée dans des structures non universitaires : les « grandes écoles » et les classes préparatoires aux grandes écoles (CPGE). Autre particularité du système : ces classes préparatoires relèvent de l’enseignement supérieur alors qu’elles se situent dans des établissements d’enseignement secondaire. Instituées au XVIIIe siècle (Belhoste, 2003), elles accueillent actuellement 81135 étudiants, soit 3,5% des étudiants (RERS, 2010). Leur représentation n’a quasiment pas évolué depuis 1970 (3,8%), malgré une croissance forte des effectifs, notamment durant la période 1985-1995 avec la création de nouvelles divisons, essentiellement dans les filières scientifiques et dans une moindre mesure, économiques et commerciales.Ces classes suscitent de vives critiques : plus coûteuses – le coût moyen d’un préparationnaire était en 2007 de 15080 euros contre 9120 euros pour un étudiant des universités – , faisant preuve d’une faible ouverture sociale (Euriat et Thélot, 1995 ; Duru-Bellat et Kieffer, 2008) – 51,1% d’enfants de cadre supérieur en 2009 vs 29,7% à l’Université – , territorialement inéquitables (Bodin, 2007) – les effectifs sont concentrés en Ile-de-France et dans les grandes métropoles régionales – et d’une « productivité » moyenne (Michaut, à paraître) – sur 100 néo-inscrits en CPGE scientifiques , seuls 50% intégreront une grande école en deux années de préparation et la situation est bien plus problématique dans la filière littéraire avec seulement 8% d’intégrés (Lemaire, 2008). A l’inverse, les « gardiens du temple » défendent un modèle d’excellence à la française qui favorise l’apprentissage de certaines compétences chez les étudiants, leur assurant ainsi une meilleure insertion professionnelle et de meilleurs salaires (Adangnikou, 2007 ; Giret, 2009).Les recherches se sont, jusqu’à présent, essentiellement focalisées sur le territoire national, sans faire apparaitre les éventuelles spécificités des « prépas de proximité » ou des CPGE des établissements privés. De même, les caractéristiques, les conditions de travail et les représentations des enseignants qui font souvent figure d’élites dans le corps professoral du secondaire ont été peu étudiées. Ce rapport offre des éléments de réponse en s’appuyant sur les recherches entreprises par des chercheurs du Centre de recherche en éducation de Nantes (CREN-Université de Nantes), du Centre Nantais en sociologie (CENS-Université de Nantes), du Laboratoire de Recherche en Education et Formation (LAREF-Université Catholique de l’Ouest), du Laboratoire d'Economie et de Sociologie du Travail (LEST-CNRS) et de l’Observatoire sociologique du changement (OSC- Sciences.Po). Il éclaire également les débats sur les projets de réformes en cours (30% de boursiers en CPGE, dispositif d’ouverture sociale) et aborde de nouvelles problématiques, notamment l’endorecrutement des établissements.La recherche est articulée autour de quatre axes :- les disparités territoriales de recrutement des classes préparatoires aux grandes écoles ;- les conditions d’études et les parcours scolaires des étudiants des filières d’excellence ;- Les stratégies des personnels des lycées ;- Les politiques d'ouverture sociale et les dispositifs innovants de l’Education nationale, des collectivités territoriales et des établissements d'enseignement

Front Psychiatry

OBJECTIVE: During the COVID-19 pandemic, older people and patients with psychiatric disorders had an increased risk of being isolated. The French National Authority for Health has recommended a reinforced follow-up of these patients. Cross-sectional studies reported an increased risk of developing anxiety and depression during pandemic. The aim of our study was to identify factors associated with higher anxiety during the pandemic in older patients with psychiatric disorders. METHODS: STERACOVID is a multicenter cohort study with 117 patients followed-up by phone in two French geriatric psychiatry units. In this work, we used cross-sectional data from a prospective follow-up conducted between January and May 2021. RESULTS: We found that coping strategies, personality, and living conditions were associated with general anxiety (GA) level during the pandemic period. Higher GA was associated with less positive thinking coping strategy, more avoidance strategies, a lower level of extraversion, a higher level of neuroticism, more time spent watching the news, a higher feeling of loneliness, and a lack of physical contact. FINDINGS: Our study identified factors associated with a poorer experience of pandemic crisis. Special attention should be paid to patients with a high level of neuroticism and a high feeling of loneliness. Support could aim to help patients use more functional strategies: reducing avoidance strategies and increasing positive thinking. Finally, reducing time watching news could also be an interesting prevention perspective. CLINICAL TRIAL REGISTRATION: clinicaltrials.gov, identifier NCT04760795

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Biome awareness disparity is BAD for tropical ecosystem conservation and restoration

We introduce the concept of Biome Awareness Disparity (BAD)—defined as a failure to appreciate the significance of all biomes in conservation and restoration policy—and quantify disparities in (a) attention and interest, (b) action and (c) knowledge among biomes in tropical restoration science, practice and policy. By analysing 50,000 tweets from all Partner Institutions of the UN Decade of Ecosystem Restoration, and 45,000 tweets from the main science and environmental news media world-wide, we found strong disparities in attention and interest relative to biome extent and diversity. Tweets largely focused on forests, whereas open biomes (such as grasslands, savannas and shrublands) received less attention in relation to their area. In contrast to these differences in attention, there were equivalent likes and retweets between forest versus open biomes, suggesting the disparities may not reflect the views of the general public. Through a literature review, we found that restoration experiments are disproportionately concentrated in rainforests, dry forests and mangroves. More than half of the studies conducted in open biomes reported tree planting as the main restoration action, suggesting inappropriate application of forest-oriented techniques. Policy implications. We urge scientists, policymakers and land managers to recognise the value of open biomes for protecting biodiversity, securing ecosystem services, mitigating climate change and enhancing human livelihoods. Fixing Biome Awareness Disparity will increase the likelihood of the United Nations Decade on Ecosystem Restoration successfully delivering its promises.This article also appears in: Cross Society Special Feature on the Decade of Ecosystem Restoration.DATA AVAILABILITY STATEMENT: Data available via the Dryad Digital Repository https://doi.org/10.6084/m9.figshare.16778200.v1 (Silveira et al., 2021).Conselho Nacional de Desenvolvimento Científico e Tecnológico; Fundação de Amparo à Pesquisa do Estado de Minas Gerais; CNPq; CAPES; NERC-FAPESP; USDA-NIFA Sustainable Agricultural Systems; USDA-NIFA McIntire-Stennis Project; National Science Foundation.http://www.wileyonlinelibrary.com/journal/jpe2022-10-15hj2022Zoology and Entomolog

The quasi-universality of nestedness in the structure of quantitative plant-parasite interactions

Understanding the relationships between host range and pathogenicity for parasites, and between the efficiency and scope of immunity for hosts are essential to implement efficient disease control strategies. In the case of plant parasites, most studies have focused on describing qualitative interactions and a variety of genetic and evolutionary models has been proposed in this context. Although plant quantitative resistance benefits from advantages in terms of durability, we presently lack models that account for quantitative interactions between plants and their parasites and the evolution of these interactions. Nestedness and modularity are important features to unravel the overall structure of host-parasite interaction matrices. Here, we analysed these two features on 32 matrices of quantitative pathogenicity trait data gathered from 15 plant-parasite pathosystems consisting of either annual or perennial plants along with fungi or oomycetes, bacteria, nematodes, insects and viruses. The performance of several nestedness and modularity algorithms was evaluated through a simulation approach, which helped interpretation of the results. We observed significant modularity in only six of the 32 matrices, with two or three modules detected. For three of these matrices, modules could be related to resistance quantitative trait loci present in the host. In contrast, we found high and significant nestedness in 30 of the 32 matrices. Nestedness was linked to other properties of plant-parasite interactions. First, pathogenicity trait values were explained in majority by a parasite strain effect and a plant accession effect, with no parasite-plant interaction term. Second, correlations between the efficiency and scope of the resistance of plant genotypes, and between the host range breadth and pathogenicity level of parasite strains were overall positive. This latter result questions the efficiency of strategies based on the deployment of several genetically-differentiated cultivars of a given crop species in the case of quantitative plant immunity

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

COVID-19 symptoms at hospital admission vary with age and sex: results from the ISARIC prospective multinational observational study

Background: The ISARIC prospective multinational observational study is the largest cohort of hospitalized patients with COVID-19. We present relationships of age, sex, and nationality to presenting symptoms. Methods: International, prospective observational study of 60 109 hospitalized symptomatic patients with laboratory-confirmed COVID-19 recruited from 43 countries between 30 January and 3 August 2020. Logistic regression was performed to evaluate relationships of age and sex to published COVID-19 case definitions and the most commonly reported symptoms. Results: ‘Typical’ symptoms of fever (69%), cough (68%) and shortness of breath (66%) were the most commonly reported. 92% of patients experienced at least one of these. Prevalence of typical symptoms was greatest in 30- to 60-year-olds (respectively 80, 79, 69%; at least one 95%). They were reported less frequently in children (≤ 18 years: 69, 48, 23; 85%), older adults (≥ 70 years: 61, 62, 65; 90%), and women (66, 66, 64; 90%; vs. men 71, 70, 67; 93%, each P &lt; 0.001). The most common atypical presentations under 60 years of age were nausea and vomiting and abdominal pain, and over 60 years was confusion. Regression models showed significant differences in symptoms with sex, age and country. Interpretation: This international collaboration has allowed us to report reliable symptom data from the largest cohort of patients admitted to hospital with COVID-19. Adults over 60 and children admitted to hospital with COVID-19 are less likely to present with typical symptoms. Nausea and vomiting are common atypical presentations under 30 years. Confusion is a frequent atypical presentation of COVID-19 in adults over 60 years. Women are less likely to experience typical symptoms than men

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/)

Zusammenfassungen

Buisson Catherine. Zusammenfassungen. In: Repères, recherches en didactique du français langue maternelle, n°30, 2004. Les pratiques langagières en formation initiale et continue, sous la direction de Jacques Triegnier et Bertrand Daunay. pp. 250-254