Trends in pediatric ambulatory community acquired infections before and during COVID-19 pandemic: A prospective multicentric surveillance study in France.

Background: Covid-19 pandemic control has imposed several non-pharmaceutical interventions (NPIs). Strict application of these measures has had a dramatic reduction on the epidemiology of several infectious diseases. As the pandemic is ongoing for more than 2 years, some of these measures have been removed, mitigated, or less well applied. The aim of this study is to investigate the trends of pediatric ambulatory infectious diseases before and up to two years after the onset of the pandemic. Methods: We conducted a prospective surveillance study in France with 107 pediatricians specifically trained in pediatric infectious diseases. From January 2018 to April 2022, the electronic medical records of children with an infectious disease were automatically extracted. The annual number of infectious diseases in 2020 and 2021 was compared to 2018-2019 and their frequency was compared by logistic regression. Findings: From 2018 to 2021, 185,368 infectious diseases were recorded. Compared to 2018 (n=47,116) and 2019 (n=51,667), the annual number of cases decreased in 2020 (n=35,432) by about a third. Frequency of scarlet fever, tonsillopharyngitis, enteroviral infections, bronchiolitis, and gastroenteritis decreased with OR varying from 0·6 (CI95% [0·5;0·7]) to 0·9 (CI95% [0·8;0·9]), p<0·001. In 2021, among the 52,153 infectious diagnoses, an off-season rebound was observed with increased frequency of enteroviral infections, bronchiolitis, gastroenteritis and otitis with OR varying from 1·1 (CI95% [1·0;1·1]) to 1·5 (CI95% [1·4;1·5]), p<0·001. Interpretation: While during NPIs strict application, the overall frequency of community-acquired infections was reduced, after relaxation of these measures, a rebound of some of them (enteroviral infections, bronchiolitis, gastroenteritis, otitis) occurred beyond the pre-pandemic level. These findings highlight the need for continuous surveillance of infectious diseases, especially insofar as future epidemics are largely unpredictable. Funding: ACTIV, AFPA, GSK, MSD, Pfizer and Sanofi.

Access to healthcare for undocumented migrants in France: a critical examination of State Medical Assistance.

In France in 2012, of the total population of 65.2 million, 8.7 % were migrants. After being the third principal host country, France is now the 6th highest host country in the OECD. Since the 1980's numerous Acts have been passed by parliament on immigration issues. In 2000 the Universal Health Cover (Couverture Maladie Universelle) was created as health coverage for all residents of France. At the same time the State Medical Assistance (Aide Médicale de l'Etat) was created as health protection for undocumented migrants. Since the creation of this scheme, it has been the object of many political debates which call it into question, on account of its cost, perceived fraud, and the legitimacy of a social protection for undocumented migrants. Recently, access to State Medical Assistance has been made difficult by introducing conditions of residence and financial contributions. After a reports' analysis on institutional, associative, research studies and European recommendations, we note that all reports converge on the necessity of health protection for undocumented migrants. The major reasons are humanitarian, respect of European and International conventions, for public health, and financial. Moreover, fraud allegations have proved to be unfounded. Finally, State Medical Assistance is underused: in 2014 data from Médecins du Monde shows that only 10.2 % of undocumented migrant patients in their health facilities have access to this scheme. We conclude that the political debate concerning the State Medical Assistance should be about its under-utilisation, its improvement, its merger with the Universal Health Cover, and not its elimination. Moreover, the current debates regarding this scheme stigmatize this population, which is already precarious, making it more difficult for migrants to access healthcare, and generally, weaken national social cohesion.

[Development of multidisciplinary community-based health care centres in Germany]. / Le développement de centres de santé pluridisciplinaires de proximité en Allemagne : les Medizinische Versorgungszentren.

MVZ provide community-based health care services improving integrated primary care and specialist care and allow hospital to outsource outpatient activities. They also provide patient-centered care and promote internal and external multidisciplinary coordination. MVZ can provide an example for possible changes to private specialist organisation and structuring of hospital services in France, while MSP mainly focus on primary care and only a few specialist CS have been created..

From charge transport parameters to charge mobility in organic semiconductors through multiscale simulation.

This review introduces the development and application of a multiscale approach to assess the charge mobility for organic semiconductors, which combines quantum chemistry, Kinetic Monte Carlo (KMC), and molecular dynamics (MD) simulations. This approach is especially applicable in describing a large class of organic semiconductors with intermolecular electronic coupling (V) much less than intramolecular charge reorganization energy (λ), a situation where the band description fails obviously. The charge transport is modeled as successive charge hopping from one molecule to another. We highlight the quantum nuclear tunneling effect in the charge transfer, beyond the semiclassical Marcus theory. Such an effect is essential for interpreting the "paradoxical" experimental finding that optical measurement indicated "local charge" while electrical measurement indicated "bandlike". Coupled MD and KMC simulations demonstrated that the dynamic disorder caused by intermolecular vibration has negligible effect on the carrier mobility. We further apply the approach for molecular design of n-type materials and for rationalization of experimental results. The charge reorganization energy is analyzed through decomposition into internal coordinates relaxation, so that chemical structure contributions to the intramolecular electron-phonon interaction are revealed and give helpful indication to reduce the charge reorganization energy.

Jacobsen and Beckwith-Wiedemann syndromes in a child with mosaicism for partial 11pter trisomy and partial 11qter monosomy.

We report on a child with Jacobsen syndrome (JBS, OMIM 147791) and abnormalities consistent with Beckwith-Wiedemann syndrome (BWS, OMIM 130650). The constitutional karyotype was apparently normal, but FISH analysis with probes specific for the short and long arms of chromosome 11 found 11qter deletion with 11pter trisomy in 80% of the cells studied. Array-CGH identified breakpoints in the 11p15.3 and 11q24.1 regions consistent with Jacobsen and Beckwith-Wiedemann syndromes. We suggest that this chromosome imbalance results from a pericentric inversion of chromosome 11 inherited from the father, with mosaicism resulting from meiotic recombination of a paternal inversion followed by mitotic recombination during the first embryonic divisions. This hypothesis is supported by the results of microsatellite marker analysis. Three previous cases of pericentric inversion and recombination of chromosome 11 have been reported. Our case is unusual in that it combines the Jacobsen and Beckwith-Wiedemann syndromes with mosaicism.

Kinematics in the terminal swing phase of unilateral transfemoral amputees: microprocessor-controlled versus swing-phase control prosthetic knees.

OBJECTIVES: To analyze the spatiotemporal parameters in the terminal swing phase of the prosthetic limb in unilateral transfemoral amputees (TFAs) compared with a group of asymptomatic subjects, and to identify a latency period (LP) in the TFA between the full extension of the prosthetic knee and the initial ground contact of the ipsilateral foot. To study the correlation between the LP and the duration of the swing phase. To evaluate the influence of the type of knee, the time since amputation, and the amputation level on the latency period. DESIGN: Three-dimensional gait analysis with an optoelectronic device. SETTING: Gait analysis laboratory of a re-education and functional rehabilitation service. PARTICIPANTS: TFA (n=29) and able-bodied (n=15) subjects. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Spatiotemporal and kinematics gait parameters. RESULTS: The swing phase and the LP of the prosthetic limb, associated with a consequently longer single-limb stance phase in the intact limb, were significantly longer than those measured in the intact limbs of these subjects, as well as those measured on both lower limbs of the able-bodied subjects (P<.05). There is a positive correlation (P<.05; r(2)=.58 between the LP and the swing phase on the TFA's prosthetic side. The LP measured in the prosthetic limb of TFA with a swing-phase control prosthetic knee is significantly greater than in those using the microprocessor-controlled prosthetic knee (P<.05). CONCLUSIONS: Of negligible duration in able-bodied subjects and in the intact limb of TFA, the LP is significantly greater in the prosthetic limb. It can explain the lengthened swing phase on the prosthetic side of those subjects. The use of a microprocessor-controlled prosthetic knee allows the LP to be reduced. This LP appears to be necessary to insure the stability of the prosthetic knee. We suggest calling this time "confidence time."

High frequency of RUNX1 biallelic alteration in acute myeloid leukemia secondary to familial platelet disorder.

Familial platelet disorder (FPD), a rare autosomal dominant disorder characterized by quantitative and qualitative platelet abnormalities, is considered as a model of genetic predisposition to acute myeloid leukemia (AML). So far, monoallelic RUNX1 germline mutations have been found in 19 of 20 families with reported FPD, and the analysis of blast cells from only 5 patients at acute leukemia (AL) stage has shown no additional RUNX1 abnormality. Here, we performed RUNX1 analysis at constitutional and somatic levels in 8 persons with FPD who developed AL from 4 independent families. In addition to the germline RUNX1 mutation, we identified a second RUNX1 alteration in 6 AML cases (acquired point mutations in 4 cases and duplication of the altered RUNX1 allele associated with acquired trisomy 21 in 2 other cases). Although haploinsufficiency of RUNX1 causes FPD, our findings suggest that a second genetic event involving RUNX1 is often associated with progression to AML.

Specular right-left disorientation, finger-agnosia, and asomatognosia in right hemisphere stroke.

OBJECTIVE: To search for specular disorders of body representations in right hemisphere stroke. BACKGROUND: Mirror self-misidentification, asomatognosia, and personal confabulation are similar to body illusions or changes in sensorial or sensorimotor perceptions generated by mirror in right brain damage patients with body image disorders. METHOD: Prospective study. Ten consecutive right-handed patients (1) performed body part naming and localization tasks and (2) were examined for asomatognosia at the acute phase of stroke, then at least 3 months after stroke, under 3 test conditions: without a mirror, with a conventional mirror, and with an inverted mirror. Video recordings of the tests were analyzed to assess performance. RESULTS: Analysis of variance of the data confirmed that the interaction of mirror's conditions (specifically without a mirror vs. an inverted mirror) with subtest type was significant. The errors are symmetrically distributed. Asomatognosia was "reactivated" in 10 patients who experienced asomatognosia during the acute phase. No particular pattern characterized the clinical manifestations of asomatognosia. CONCLUSIONS: A causal conflict of sensorial input is proposed. The specific symptoms observed would suggest the existence of an incomplete specular Gerstmann syndrome and/or Anton Babinski syndrome. These results emphasize the role of specular input in the generation of body representations and self-awareness.

Influence of terrain on metabolic and temporal gait characteristics of unilateral transtibial amputees.

The difficulties confronted by amputees during overground walking are rarely investigated. In this study, we evaluated, in real-world situations, the influence of ground surface on walking in young, active amputees by measuring temporal and spatial gait parameters (free walking speed [FWS], step length [SL], step rate), energy expenditure (EE) (e.g., oxygen uptake, oxygen cost [O(2)C]), and Rating of Perceived Exertion (RPE). Ten active transtibial amputees and ten nondisabled control subjects walked at self-selected speeds on three types of ground surface (asphalt, mown lawn, and high grass). No significant differences were observed between the two groups on asphalt and mown lawn. Differences between nondisabled subjects and amputees occurred for FWS (p = 0.03) and O(2)C (p = 0.04) on asphalt and mown lawn and for all variables in high grass. When amputees (even though very active) were exposed to a particularly difficult environment, their FWS decreased (p = 0.008) and their EE and RPE increased (p = 0.005) compared with nondisabled subjects. In high grass, both groups reduced their self-selected speeds (-15% for control subjects and -16% for amputees). Control subjects reduced their velocity by reducing both SL (-8.7%) and cadence (-7.1%), whereas amputees reduced their velocity by reducing SL (-17%) only.

TD-DFT investigation of the UV spectra of pyranone derivatives.

The UV absorption spectra of more than 80 substituted coumarins and chromones have been investigated with the PCM-TD-DFT theoretical scheme using three hybrid functionals (O3LYP, B3LYP, and PBE0) and taking into account methanol or ethanol solvation effects. For most of the studied derivatives, there are at least two allowed excited states presenting a strong oscillator strength in the UV region. The first allowed excitation is associated to a HOMO-LUMO transition whereas the second corresponds to a transition from the HOMO-1 to the LUMO. Both involve a charge transfer from the benzenic cycle to the pyranone moiety. Statistically treating the PBE0 results allows a prediction of the lambda(max) with small standard deviations: in methanol, 6 nm (0.07 eV) for the first excitation (lambda(max)(1)) and 5 nm (0.08 eV) for the second one (lambda(max)(2)), whereas in ethanol 6 nm (0.08 eV) for (lambda(max)(1)) and 6 nm (0.13 eV) for (lambda(max)(2)).

An ab initio study of the absorption spectra of indirubin, isoindigo, and related derivatives.

The UV/visible spectra of a series of indirubin, isoindigo, and other indigo/thioindigo related dyes have been evaluated in various solvent environments by using the time-dependent density functional theory in conjunction with the polarizable continuum model. Even for molecules of the same family, significant differences in the excitation processes have been noted. Two hybrid functionals have been selected: B3LYP and PBE0. For a set of the 50 selected molecular cases, both functionals provide accurate lambda(max), with mean absolute deviations limited to 0.1 eV. Actually, isoindigo is the main challenging series, with systematically underestimated excitation energies, due to the different nature of the excitation process. In most cases, we found that PBE0 is more efficient in reproducing the experimental values than B3LYP for sulfur-containing dyes not featuring internal hydrogen bonds, the reverse assertion being also true. In addition, the spectra of a series of unknown dyes have been predicted.

Assessment of several hybrid DFT functionals for the evaluation of bond length alternation of increasingly long oligomers.

We have optimized the ground-state geometry of nine series of increasingly long oligomers, using six hybrid density functionals (O3LYP, B3LYP, B97-1, B98, PBE0, and BHHLYP) combined with three different atomic basis sets. In each case, the obtained bond length alternation (BLA) is compared to the corresponding MP2 values. Three phenomenological categories have been set up. In the first, the BLA exponentially decreases, in which case all the tested functionals give results in very good agreement with MP2. In the second category fall the symmetric oligomers that, due to the Peierls theorem, show large BLA. For these chains, BHHLYP tends to give too large and quickly converging BLA wrt chain length, while O3LYP often leads to the opposite misjudgments, and the remaining hybrids provide valuable results. In the third category, one finds asymmetric compounds presenting significantly unequal bond lengths, for which the divergence between DFT and wave function approaches can be dramatic. Indeed, all hybrids yield too small BLA values, especially for long chain lengths. We also study the effect of chain conformation on the BLA.

Initial experience with successful totally robotic laparoscopic cystoprostatectomy and ileal conduit construction in tetraplegic patients: report of two cases.

PURPOSE: To evaluate the feasibility and safety of totally robotic laparoscopic cystoprostatectomy for neurogenic bladder, with intracorporeal ileal-conduit urinary diversion in tetraplegic patients with severe neurogenic bladder complications. PATIENTS AND METHODS: Two men, 41 and 38 years old, with complete post-traumatic C7-C8 quadriplegia and poor lower urinary-tract condition underwent totally transperitoneally performed cystoprostatectomy and ileal-conduit urinary diversion with robotic assistance (Da Vinci). RESULTS: The procedures were completed without open conversion. The total surgical time was 9.25 and 6.75 hours, respectively. There were no intraoperative complications. In the postoperative period, both patients had mild complications (pulmonary and urinary infections) that were treated successfully medically. The postoperative hospital stay was 13 days in both cases. CONCLUSIONS: Our results demonstrate the safety and feasibility of robot-assisted laparoscopic cystoprostatectomy with ileal-conduit urinary diversion in two tetraplegic patients.

Acquired Glanzmann's thrombasthenia associated with acute lymphoblastic leukemia.

Acquired Glanzmann's thrombasthenia is an uncommon event in association with leukemia. The authors describe a patient with acute lymphoblastic leukemia (ALL) who presented with severe hemorrhagic syndrome, without disseminated intravascular coagulation. The patient's course was complicated by the occurrence of severe hemorrhagic episodes, with a thrombasthenia-like profile, requiring multiple transfusions with packed red cells, platelets, and fresh-frozen plasma. Biological explorations detected anti-GPIIb/IIIa complex antibodies. The patient finally died with refractory disease and persistent bleeding. This case is the first reported of autoantibodies to GPIIb/IIIa in ALL. Such paraneoplastic syndrome is potentially responsible for severe life-threatening hemorrhage.

Mixed electric-magnetic second-order nonlinear optical response of helicenes.

The mixed electric-magnetic second-order nonlinear optical responses of oriented films of helicenes have been computed ab initio using the random phase approximation method and compared to the pure electric-dipole counterpart. It turns out that the mixed electric-magnetic responses can be of the same order of magnitude as the pure electric-dipole counterpart when there is no donor/acceptor (D/A) substituent or these D/A pairs are weak, i.e., when the pure electric-dipole response is small. When adding strong D/A substituents, the pure electric-dipole response increases substantially and much more than its mixed electric-magnetic counterpart. Consequently, the ratio between the mixed electric-magnetic and pure electric responses decreases. Although there is no general rule, the mixed responses evolve as a function of substitution quasi similarly to the pure electric contribution. This study confirms therefore the possibility of tuning the mixed electric-magnetic response by employing appropriate chiral molecules.

Second-order Møller-Plesset evaluation of the bond length alternation of several series of linear oligomers.

We investigate, at the second-order Møller-Plesset level, the bond length alternation of 30 series of increasingly long linear oligomers for a total of more than 250 compounds, polyacetylene, polymethineimine, polyphosphinoborane, polyaminoborane, polyphosphazene, etc., for which, often for the first time, an accurate estimate of the polymeric bond length alternation is given. The variations induced either by chemical substitution of the backbone atoms or conformational modifications are discussed. Only three polymers present a large bond length alternation (>0.03 A). Systematic basis set effects have been unravelled, i.e., MP2/6-311G(2d) always overshoots the bond length alternation. Best estimates of the bond length alternation are provided for more than a dozen of polymers.

Geometry, dipole moment, polarizability and first hyperpolarizability of polymethineimine: an assessment of electron correlation contributions.

We have investigated the geometries as well as the longitudinal dipole moment (micro), polarizability (alpha), and first hyperpolarizability (beta) of polymethineimine oligomers using different approaches [Hartree-Fock (HF), second-order Møller-Plesset (MP2), and hybrid density functional theory (DFT) methods (B3LYP and PBE0)] for evaluating the geometries and the nonlinear optical properties. It turns out that (i) HF and the selected DFT methods provide the incorrect sign for beta of short and medium size oligomers. (ii) The B3LYP and PBE0 electron correlation correction are too small for micro, too large for alpha, and for some oligomer lengths, they are in the wrong direction for beta. (iii) On the contrary to polyacetylene, the hybrid-DFT geometries are in poor agreement with MP2 geometries; the former showing much smaller bond length alternations.

Second-order nonlinear optical coefficient of polyphosphazene-based materials: a theoretical study.

The second-order nonlinear optical coefficient of polyphosphazene oligomers of increasing size has been determined by using ab initio methods taking into account electron correlation and frequency dispersion effects. The calculated first hyperpolarizability per unit cell converges rapidly with respect to chain length. It attains an amplitude of about one-third of the one of classical push-pull systems. This amplitude can be strongly increased by replacing the nitrogen of the backbone by silicon. The effects of the side groups (H, CH3, F, Cl, Br, and OH) on the first hyperpolarizability have been investigated as well. The different results have been rationalized in terms of alternations of bond lengths and atomic charges.