You may point, but do not touch: Impact of gesture-types and cognition on language in typical and atypical development

[EN] Background Evidence shows that the relation with the referent (object manipulation, contact/no contact pointing) and the different hand features (index finger/open palm) when pointing indicate different levels of cognitive and linguistic attainment in typical development (TD). This evidences the close link between pointing, cognition and language in TD, but this relation is understudied in autism. Moreover, the longitudinal pathway these abilities follow remains unexplored and it is unclear what specific role (predictor or mediator) pointing and cognition have in both typical and atypical language development. Aims The first aim was to investigate whether pointing hand features (index finger/open palm) and relation with the referent (manipulation, contact and no contact pointing) similarly predict language in children with and without autism. The second aim was to explore whether cognition mediates the longitudinal relationship between pointing and language development. Methods & Procedures Sixteen children with autism, 13 children at high risk (HR) for autism and 18 TD children participated in an interactive gesture-elicitation task and were tested on standardised cognitive and expressive language batteries in a longitudinal design. A two-step analysis consisted of a stepwise linear regression and mediation analyses. First, the linear regression identified which hand features and types of relation with the referent predicted expressive language in all groups. Second, three mediation analyses (one per group) assessed the predictor/mediator role of the variables that met significance in the regression analysis. Outcomes & Results Both cognition and index finger pointing were direct longitudinal predictors of further expressive language skills in the autism group. In TD and HR groups this relation was mediated by age. Conclusions & Implications Findings highlight the role of age in communicative development, but suggest a key role of cognition and index finger use in the longitudinal relationship between pointing gestures and expressive language development in children with autism. This has important clinical implications and supports the view that index finger pointing production might be a useful tool in the intervention for communicative and language abilities in autism. What this paper adds What is already known on the subject There is evidence that no contact pointing is associated with complex socio-cognitive abilities that underpin communication in TD. Similarly, studies in TD show that index finger pointing is closely linked with language acquisition. However, it is unclear whether these associations are present in autism. In addition, the mediating (or predictive) role of cognition in the pointing-language relation has not yet been explored neither in typical nor in atypical development. What this paper adds to existing knowledge This paper shows that index finger pointing and cognition are direct longitudinal predictors of expressive language in the autism group. In the other groups this relation is mediated by age. This suggests that there is a window of opportunity for pointing to predict expressive language whereas the predictive value of cognition expands in development. Based on this, children with autism would share the same language predictors as TD children, but with delays. What are the potential or actual clinical implications of this work? This study reveals that index finger, age and cognition reliably predict spoken language in autism, which may indicate that early prelinguistic intervention based on pointing production and the improvement of cognitive skills might have a positive impact on spoken language in this population.H2020Marie Sklodowska-CurieActions, Grant/Award Number: 676063

Gesture and Language Trajectories in Early Development: An Overview From the Autism Spectrum Disorder Perspective

The well-documented gesture-language relation in typical communicative development (TD) remains understudied in autism spectrum disorder (ASD). Research on early communication skills shows that gesture production is a strong predictor of language in TD, but little is known about the association between gestures and language in ASD. This review focuses on exploring this relation by addressing two topics: the reliability of gestures as predictor of language competences in ASD and the types of potential differences (quantitative, qualitative, or both) in the gesture-language trajectory in children on the autism spectrum compared to typically developing children. We find evidence that gesture production is indeed a reliable predictor of early communicative skills and that both quantitative and qualitative differences have been established in research in the development of verbal and non-verbal communication skills in ASD, with lower gesture rates at the quantitative level, and a trajectory that starts deviating from the TD trajectory only at some point after the first year of life

Automatic imagine analyzer to assess retinal vessel caliber (Altair) tool validation for the analysis of retinal vessels

Objective: To assess the reliability and validity of the tool Automatic image analyzer to assess retinal vessel caliber (ALTAIR) to analyze the vascularization of the retina and cardiovascular risk prediction. Design and method: Cross-sectional of tools validation study. We included 250 subjects in total, aged 62 +/- 9 years, 51% males. We have made a validation of reliability analyzing the intraclass correlation (ICC) intra observer, inter observer and inter device (compared with AVindex calculator) to the thickness, area and length of arteries and veins of the retina in 3 concentric circles from the disc in 120 retinographies. The concurrent validity was performed with 250 subjects and 497 retinographies, analyzing the relationship with age, blood pressure, parameters of vascular structure and function, renal function and cardiovascular risk estimated with scales. Results: In the sample, the 32% are obese, 68% hypertensive and 17% diabetic. The interobserver ICC for thickness, area and length of veins and arteries ranged from 0.809 to length of arteries to 0.916 to veins area. The intra observer ICC for intra thickness, area and length of veins and arteries ranged from 0.640 for the length of the veins and 0.906 for the area of the arteries and the inter device ICC was for arteriovenous ratio (AVR) 0.887, thickness of arteries 0.590 and veins thickness 0.677. We found a moderate correlation of the age (r between 0.30 and 0.50, p < 0.001) with the retinal vascular parameters analyzed. In multiple linear regression analysis after adjusting for age and sex, the association of AVR and arterial thickness with the diastolic blood pressure and albumin creatinine ratio and arterial area and length with systolic arterial blood pressure and carotid intima-media thickness remains. Also the thickness area and length of the vessels show an association with cardiovascular risk estimated SCORE scale. Conclusions: The ALTAIR tool shows a good reliability in the concordance inter observers, intra observer and inter device measurements and a concordant validity to show an association with vascular parameters, target organ damage and cardiovascular risk

CIBERER : Spanish national network for research on rare diseases: A highly productive collaborative initiative

Altres ajuts: Instituto de Salud Carlos III (ISCIII); Ministerio de Ciencia e Innovación.CIBER (Center for Biomedical Network Research; Centro de Investigación Biomédica En Red) is a public national consortium created in 2006 under the umbrella of the Spanish National Institute of Health Carlos III (ISCIII). This innovative research structure comprises 11 different specific areas dedicated to the main public health priorities in the National Health System. CIBERER, the thematic area of CIBER focused on rare diseases (RDs) currently consists of 75 research groups belonging to universities, research centers, and hospitals of the entire country. CIBERER's mission is to be a center prioritizing and favoring collaboration and cooperation between biomedical and clinical research groups, with special emphasis on the aspects of genetic, molecular, biochemical, and cellular research of RDs. This research is the basis for providing new tools for the diagnosis and therapy of low-prevalence diseases, in line with the International Rare Diseases Research Consortium (IRDiRC) objectives, thus favoring translational research between the scientific environment of the laboratory and the clinical setting of health centers. In this article, we intend to review CIBERER's 15-year journey and summarize the main results obtained in terms of internationalization, scientific production, contributions toward the discovery of new therapies and novel genes associated to diseases, cooperation with patients' associations and many other topics related to RD research

Gesture and Language Trajectories in Early Development: An Overview From the Autism Spectrum Disorder Perspective

The well-documented gesture-language relation in typical communicative development (TD) remains understudied in autism spectrum disorder (ASD). Research on early communication skills shows that gesture production is a strong predictor of language in TD, but little is known about the association between gestures and language in ASD. This review focuses on exploring this relation by addressing two topics: the reliability of gestures as predictor of language competences in ASD and the types of potential differences (quantitative, qualitative, or both) in the gesture-language trajectory in children on the autism spectrum compared to typically developing children. We find evidence that gesture production is indeed a reliable predictor of early communicative skills and that both quantitative and qualitative differences have been established in research in the development of verbal and non-verbal communication skills in ASD, with lower gesture rates at the quantitative level, and a trajectory that starts deviating from the TD trajectory only at some point after the first year of life

You may point, but do not touch: Impact of gesture-types and cognition on language in typical and atypical development

Background Evidence shows that the relation with the referent (object manipulation, contact/no contact pointing) and the different hand features (index finger/open palm) when pointing indicate different levels of cognitive and linguistic attainment in typical development (TD). This evidences the close link between pointing, cognition and language in TD, but this relation is understudied in autism. Moreover, the longitudinal pathway these abilities follow remains unexplored and it is unclear what specific role (predictor or mediator) pointing and cognition have in both typical and atypical language development. Aims The first aim was to investigate whether pointing hand features (index finger/open palm) and relation with the referent (manipulation, contact and no contact pointing) similarly predict language in children with and without autism. The second aim was to explore whether cognition mediates the longitudinal relationship between pointing and language development. Methods & Procedures Sixteen children with autism, 13 children at high risk (HR) for autism and 18 TD children participated in an interactive gesture-elicitation task and were tested on standardised cognitive and expressive language batteries in a longitudinal design. A two-step analysis consisted of a stepwise linear regression and mediation analyses. First, the linear regression identified which hand features and types of relation with the referent predicted expressive language in all groups. Second, three mediation analyses (one per group) assessed the predictor/mediator role of the variables that met significance in the regression analysis. Outcomes & Results Both cognition and index finger pointing were direct longitudinal predictors of further expressive language skills in the autism group. In TD and HR groups this relation was mediated by age. Conclusions & Implications Findings highlight the role of age in communicative development, but suggest a key role of cognition and index finger use in the longitudinal relationship between pointing gestures and expressive language development in children with autism. This has important clinical implications and supports the view that index finger pointing production might be a useful tool in the intervention for communicative and language abilities in autism

Weaning from mechanical ventilation in intensive care units across 50 countries (WEAN SAFE): a multicentre, prospective, observational cohort study

Background Current management practices and outcomes in weaning from invasive mechanical ventilation are poorly understood. We aimed to describe the epidemiology, management, timings, risk for failure, and outcomes of weaning in patients requiring at least 2 days of invasive mechanical ventilation. Methods WEAN SAFE was an international, multicentre, prospective, observational cohort study done in 481 intensive care units in 50 countries. Eligible participants were older than 16 years, admitted to a participating intensive care unit, and receiving mechanical ventilation for 2 calendar days or longer. We defined weaning initiation as the first attempt to separate a patient from the ventilator, successful weaning as no reintubation or death within 7 days of extubation, and weaning eligibility criteria based on positive end-expiratory pressure, fractional concentration of oxygen in inspired air, and vasopressors. The primary outcome was the proportion of patients successfully weaned at 90 days. Key secondary outcomes included weaning duration, timing of weaning events, factors associated with weaning delay and weaning failure, and hospital outcomes. This study is registered with ClinicalTrials.gov, NCT03255109. Findings Between Oct 4, 2017, and June 25, 2018, 10 232 patients were screened for eligibility, of whom 5869 were enrolled. 4523 (77·1%) patients underwent at least one separation attempt and 3817 (65·0%) patients were successfully weaned from ventilation at day 90. 237 (4·0%) patients were transferred before any separation attempt, 153 (2·6%) were transferred after at least one separation attempt and not successfully weaned, and 1662 (28·3%) died while invasively ventilated. The median time from fulfilling weaning eligibility criteria to first separation attempt was 1 day (IQR 0–4), and 1013 (22·4%) patients had a delay in initiating first separation of 5 or more days. Of the 4523 (77·1%) patients with separation attempts, 2927 (64·7%) had a short wean (≤1 day), 457 (10·1%) had intermediate weaning (2–6 days), 433 (9·6%) required prolonged weaning (≥7 days), and 706 (15·6%) had weaning failure. Higher sedation scores were independently associated with delayed initiation of weaning. Delayed initiation of weaning and higher sedation scores were independently associated with weaning failure. 1742 (31·8%) of 5479 patients died in the intensive care unit and 2095 (38·3%) of 5465 patients died in hospital. Interpretation In critically ill patients receiving at least 2 days of invasive mechanical ventilation, only 65% were weaned at 90 days. A better understanding of factors that delay the weaning process, such as delays in weaning initiation or excessive sedation levels, might improve weaning success rates

Weaning from mechanical ventilation in intensive care units across 50 countries (WEAN SAFE): a multicentre, prospective, observational cohort study

Background: Current management practices and outcomes in weaning from invasive mechanical ventilation are poorly understood. We aimed to describe the epidemiology, management, timings, risk for failure, and outcomes of weaning in patients requiring at least 2 days of invasive mechanical ventilation. Methods: WEAN SAFE was an international, multicentre, prospective, observational cohort study done in 481 intensive care units in 50 countries. Eligible participants were older than 16 years, admitted to a participating intensive care unit, and receiving mechanical ventilation for 2 calendar days or longer. We defined weaning initiation as the first attempt to separate a patient from the ventilator, successful weaning as no reintubation or death within 7 days of extubation, and weaning eligibility criteria based on positive end-expiratory pressure, fractional concentration of oxygen in inspired air, and vasopressors. The primary outcome was the proportion of patients successfully weaned at 90 days. Key secondary outcomes included weaning duration, timing of weaning events, factors associated with weaning delay and weaning failure, and hospital outcomes. This study is registered with ClinicalTrials.gov, NCT03255109. Findings: Between Oct 4, 2017, and June 25, 2018, 10 232 patients were screened for eligibility, of whom 5869 were enrolled. 4523 (77·1%) patients underwent at least one separation attempt and 3817 (65·0%) patients were successfully weaned from ventilation at day 90. 237 (4·0%) patients were transferred before any separation attempt, 153 (2·6%) were transferred after at least one separation attempt and not successfully weaned, and 1662 (28·3%) died while invasively ventilated. The median time from fulfilling weaning eligibility criteria to first separation attempt was 1 day (IQR 0-4), and 1013 (22·4%) patients had a delay in initiating first separation of 5 or more days. Of the 4523 (77·1%) patients with separation attempts, 2927 (64·7%) had a short wean (≤1 day), 457 (10·1%) had intermediate weaning (2-6 days), 433 (9·6%) required prolonged weaning (≥7 days), and 706 (15·6%) had weaning failure. Higher sedation scores were independently associated with delayed initiation of weaning. Delayed initiation of weaning and higher sedation scores were independently associated with weaning failure. 1742 (31·8%) of 5479 patients died in the intensive care unit and 2095 (38·3%) of 5465 patients died in hospital. Interpretation: In critically ill patients receiving at least 2 days of invasive mechanical ventilation, only 65% were weaned at 90 days. A better understanding of factors that delay the weaning process, such as delays in weaning initiation or excessive sedation levels, might improve weaning success rates. Funding: European Society of Intensive Care Medicine, European Respiratory Society

Erratum to: Guidelines for the use and interpretation of assays for monitoring autophagy (3rd edition) (Autophagy, 12, 1, 1-222, 10.1080/15548627.2015.1100356

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