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Réserve cognitive et vieillissement de la mémoire : mécanismes cognitifs et cérébraux.
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Influence de la structure prosodique sur les productions phonologiques d'enfants avec Trouble du Spectre de l'Autisme (TSA)
No full textInternational audienceThe prosodic structure of French is based on discrete accentuation, which supports linguistic organization, in particular phonological one. A primary accent is placed on the final syllable of words as a syllabic lengthening. This primary accent persists on each lexical word, even inside the group, but in a less prominent form than on the very final syllable. In addition to this final accent, a secondary, initial accent is identified on lexical words. This secondary accent is expressed by a rise in the F0, and a lengthening of the vowel. It signals a clear syllabic demarcation at the beginning of a lexical word and is very well perceived by French speakers (Astésano, 2001; Astésano et al., 2013; Aguilera et al., 2014). These accent alternations (strong-weak/lengthening-F0) constitute the rhythm of French and support the phonological structure (fig.1). In autism, prosodic alterations are often noted (e.g. Peppé et al. 2007). However, the literature on prosody in autism does not lead to any consensus. This can be explained by the diversity of variables measured, tools used, and subjects tested. As heterogeneity is central in the definition of autism, it seems difficult to reach a consensus without considering more specifically the characteristics of the population studied, and first of all their language abilities.The present study aims to analyze the prosodic patterns of children with and without phonological difficulties, whether or not they have autism. The general idea is to understand the dependency between phonological and prosodic structures in these children.Mean F0 and duration of the vowels /a, i, u/ produced during a non-word repetition task containing items of 1 to 3 syllables of different phonological complexity (Anonymized name of the task, author & author, 2018) were measured in four groups of children aged 6 to 12: two groups of autistic children with or without phonological difficulties (ASD-PI N=8 ; ASD-PN N=7), and two groups of control children with or without language development disorder (DLD N=14 ; TD N=15). Significant differences between children with and without phonological disorders, whether autistic or not, existed for the score on the non-word repetition test. Overall, the mean F0 was significantly higher in children with ASD-PI than in children without phonological deficits (ASD-PN, TD and DLD), particularly for the 1st vowel on trisyllabic items. As regards duration, children with ASD, whether or not they have phonological difficulties, generally present longer vowels than control children. For trisyllabic nonwords, we observe a significant lengthening of the 2nd vowel for ASD-PI children, but of the 3rd vowel for ASD-PN, whereas neurotypical children (DLD and TD) present an identical pattern in line with the expected prosodic structure. Thus, in autistic children without phonological deficits, strong-weak syllabic alternation is indeed present, but the lengthening of the duration of the last vowel, which is greater than that observed in children without autism, indicates a proper prosodic pattern but is too large. In autistic children with phonological deficits, not only is the increase in the F0 of the first vowel too important, but the vowel lengthening is not on the right syllable, generating an atypical prosodic pattern, not centered on the last vowel. The prosodic rhythm is thus completely erased. The case of children without autism but with DLD is also noteworthy: they always behave like TD children. The phonological disorder therefore does not seem to be the source of an altered prosodic structure. The differences observed suggest that prosodic difficulties in autism are not systematically due to the same processes, but moreover that they are not due to the presence of a phonological disorder. We can therefore hypothesize that, in these children, the prosodic deficit could be a possible cause of the alteration of the phonological structures. These results are encouraging, but need to be supplemented, in particular to increase the number of participants and thus statistical power
De l'autorité médicale aux autorités urbaines
No full textInternational audienceChartres a connu de nombreuses épidémies de peste au xvie siècle et, au fil des épidémies, les autorités ont développé un répertoire d’actions pour combattre la maladie en s’appuyant sur les autorités médicales mais aussi sur leur propre expérience. L’ensemble de ce corpus de texte fait état des conceptions étiologiques des autorités municipales et de la population, mais témoigne aussi d’une montée en expertise de ces autorités tout au long du siècle
Autonomisation politique des femmes et instabilité politique dans les pays d’Afrique subsaharienne
No full textInternational audienceDespite the widespread recognition of political instability as a major constraint to economic development in sub-Saharan Africa, our understanding of the key factors influencing these countries’ ability to achieve a more stable political environment remains limited. Drawing on a sample of thirty-four sub-Saharan African countries, this study provides robust evidence of the importance of women’s political empowerment in reducing political instability. This finding is supported by accounting for potential biases, including reverse causality, the effect of observed or unobserved confounders on this relationship, and measurement errors. In-depth analyses reveal that reductions in military expenditures and improvements in democratic governance serve as key mechanisms through which women’s political empowerment influences political instability. These findings strengthen the case for policies promoting women’s political empowerment as a means of fostering political stability in sub-Saharan Africa.Malgré la reconnaissance globale de l’instabilité politique comme une contrainte majeure au développement économique en Afrique subsaharienne, nos connaissances demeurent limitées quant aux facteurs clés influençant la capacité de ces pays à établir un environnement politique plus stable. A partir d’un échantillon de 34 pays d’Afrique subsaharienne, cette étude offre une démonstration solide de l’importance de l’autonomisation politique des femmes dans la réduction de l’instabilité politique. Ce résultat est étayé par la prise en compte des biais potentiels, notamment la causalité inverse, l’effet des facteurs de confusion observés ou non sur cette relation, ainsi que les erreurs de mesure. Des analyses approfondies révèlent que la réduction des dépenses militaires ainsi l’amélioration de la démocratie constituent des mécanismes par lesquels l’autonomisation politique des femmes influe sur l’instabilité politique. Ces conclusions renforcent l’argument en faveur de politiques visant à promouvoir l’autonomisation politique des femmes pour la stabilité politique en Afrique subsaharienne
A disaggregated analysis of the impact of corruption on tax revenue mobilization in developing countries : Evidence of a nonlinear relationship,"
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Post-intensive care syndrome. What clinicians and researchers must know
No full textInternational audienceThe COVID-19 pandemic has highlighted intensive care as a cornerstone of modern medicine. In spite of global aging and the increase of comorbidities in the general population, a large proportion of patients survive their hospitalization in the Intensive Care Unit (ICU). Nevertheless, these positive results are challenged by the higher mortality rates than other non-critically ill populations after discharge. Moreover, there is growing evidence that ICU survivors display a high rate of mental health disorders (anxiety and depression symptoms, post-traumatic stress disorders), somatic impairment (muscle atrophy, neuropathy, and myopathy with persistent muscle weakness, chronic kidney disease, chronic respiratory failure), or cognitive impairment. Patient’s relatives also suffer from mental health disorders (anxiety and depression symptoms, complicated bereavement). All these chronic health issues significantly impair the quality of life and increase healthcare costs. Post-Intensive Care Syndrome (PICS) is a term that encompasses all these complications. The COVID-19 pandemic has highlighted PICS as a public health concern. This review summarizes the most recent findings on PICS. It addresses epidemiological data about the frequency of somatic disorders, cognitive impairment, and mental health problems in both patients and their relatives and describes the pathophysiology mechanisms underlying PICS. The review also provides insights into management experimentations and treatment interventions that have been tested so far to improve the outcome of critically ill survivors. Finally, the review proposes measures to implement PICS management in follow-up centers and a research agenda to pave the future research on this topic
Career Trajectories After Palliative Care Training: A National E-Survey of Medical Interns in France
No full textInternational audiencePalliative care has become a crucial component of healthcare, with an increasing need for specialized training. In France, a new one-year palliative care diploma was introduced in 2019 to disseminate palliative care knowledge across various medical specialties. Offered in the final year of medical residency, the program includes 2 six-month internships in palliative care settings and four national seminars covering topics such as symptom management, ethics, and communication. However, the impact of this training on physicians' career paths remains underexplored.AimThis study aimed to assess the current practices of physicians trained in palliative care, and how the training influenced their career choices.MethodsA national e-survey was conducted, aimed at all physicians who completed the palliative care training course between 2019 and 2023. Data were collected through a 36-question survey covering training completion and current practices.ResultsWe contacted 179 physicians. After excluding 40 responses from those who had not completed their diploma, the eligible sample consisted of 139 respondents. Of these, 81 complete responses were obtained, yielding a 58% response rate (81/139). Of these, 52 were currently practicing in specialized palliative care settings. Interestingly, 88.5% of those not practicing directly in palliative care still integrated a palliative dimension into their daily work. The proportion of physicians intending to work exclusively in palliative care tripled after the training course compared to before.ConclusionThis study highlights the significant role of the palliative care training in shaping physicians' career paths and disseminating palliative care practices across medical specialties
Minimal tori in R^4
No full textWe describe tools for the study of minimal surfaces in R^4; some are classical (the Gauss maps) and some are newer (the link/braid/writhe at infinity). Then we look for complete proper non holomorphic minimal tori with total curvature −8π and a single end immersed in R^4. We translate the problem into a system of 10 quadratic or linear equations in 11 real variables with coefficients in terms of the Weierstrass function ℘ and give explicit solutions for these equations if T is a rectangular torus. For the square torus, we have a complete answer with a unique family of solutions generalizing the Chen-Gackstetter torus in R3. On the other hand, we show that there is no solution on the equianharmonic torus.30 pages, 4 figure
Heterogeneity of professional goals among residents enrolled in a palliative care track: results of a national online survey in France
No full textInternational audienceBackground: Palliative care (PC) is recognized as a universal right, aimed at improving the quality of life for patients and their families facing life-threatening conditions. Training healthcare professionals, particularly physicians, is crucial for high-quality PC. Currently, France lacks a Palliative Medicine residency or fellowship (PMR-F), offering only a Palliative Care tracks (PCT) for voluntary postgraduate students. The aim of this study was to describe motivations and career plans of students enrolled in the PCT and to identify the proportion of those who would have preferred a PMR-F if it had been available.Methods: A national online survey was conducted between April and August 2024 among 128 students enrolled in PCT. A 12-item questionnaire, using a 10-point Likert scale, was designed and pilot-tested by PC educators and former students. The questionnaire was sent to identify their motivations and career plans.Results: The response rate was 76% (97/128). For 76% (74/97) of students, the purpose was to acquire skills complementary to their original specialty. While 48% (47/97) also aimed to gain skills for future specialist PC practice, only 10% (10/97) enrolled due to the lack of a specialized certificate. Career plans varied, with 30% intending to practice in their original discipline and 31% in PC facilities. Finally, 23% of students aiming to work in specialized PC facilities planned to continue their training with a continuing medical education program in PM (7/30).Discussion: The findings align with the official objectives of a track, emphasizing complementary skills acquisition. Our study reveals the coexistence of a variety of professional goals and projects within the same class of residents, which does not seem relevant for the same training program. It highlights the opportunity for setting up, in addition to PCT, a specialized PM curriculum in France, to better address specialized training needs for future PM experts
Gaps in the Ottawa Statement on the Ethical Design and Conduct of Cluster Randomized Trials: a citation analysis reveals a need for updated ethics guidelines
No full textInternational audienceBackgroundAlthough commonly used to evaluate health interventions, cluster randomized trials raise difficult ethical issues. Recognizing this, the Ottawa Statement on the Ethical Design and Conduct of Cluster Randomized Trials, published in 2012, provides 15 recommendations to address ethical issues across seven domains. But due to several developments in the design and implementation of cluster randomized trials, there are new issues requiring guidance. To inform the forthcoming update of the Ottawa Statement, we aimed to identify any gaps in the Ottawa Statement discussed within the literature.MethodsWe searched Google Scholar, Scopus, and Web of Science using the ‘cited by’ function on 11 November 2022.We included all types of publications, including articles, book chapters, commentaries, editorials, ethics guidelines, theses and trial-related publications (i.e., primary reports, protocols, and secondary analyses), that cited and engaged with the Ottawa Statement, the Ottawa Statement précis, or one or more of its four background papers. Data were extracted by four reviewers working in rotating pairs. Reviewers captured relevant text verbatim and recorded whether it reflected a gap relating to one or more of the Ottawa Statement domains. Using a thematic analysis approach, semantic coding was used to summarize the content of the data into distinct gaps within the Ottawa Statement domains, which was subsequently expanded in an inductive manner through discussion.ResultsThe qualitative analysis of the text from 53 articles resulted in the identification of 24 distinct gaps in the Ottawa Statement: 4 gaps about justifying the cluster randomized design; 2 gaps about research ethics committee review; 3 gaps about identifying research participants; 4 gaps about obtaining informed consent; 3 gaps about gatekepeers; 6 gaps about assessing benefits and harms; 1 gap about protecting vulnerable participants; and 1 gap about equity-related issues in cluster randomized trials.ConclusionIdentifying 24 gaps reveals a need to update the Ottawa Statement. Alongside additional gaps identified in ongoing empirical work and through engagement with our patient and public partners, the gaps identified through this citation analysis should be considered in the forthcoming Ottawa Statement update