ABSTRACT
BACKGROUND: Launched in 2014, the national screening program for permanent neonatal deafness has reconfigured the care of Deaf children. By bringing forward the age of the start of care, it promotes language development and allows these children to be referred to dedicated services more quickly. OBJECTIVE: In this context of epidemiological reorganization and technological change (cochlear implantation in particular), the Family Support and Early Education Services of the Loire (Safep 42) propose a reflection of the type “evaluation of professional practices” around the mediations proposed in its service and the “educational garden” framework. METHOD: This mixed-method work combines composite data: activity reports, observations, interviews, experience capture, evaluation of professional practices. RESULTS: A decrease in the age of entry (linked to early detection) and an increase in the age of exit (due to the prevalence of children with associated disorders or complexity factors) led Safep 42 to adapt by creating new mediation, while maintaining the support provided for older children, particularly the educational garden. Safep is currently reaching its maximum capacity: in addition to this tension, there is a shortage of outpatient speech therapists and an increase in the number of deafness situations associated with multiple disabilities. The service has had to give up some of its tasks in order to be able to continue to provide proper care for the children in its care. DISCUSSION: The rehabilitation and family support program is accompanied by a longer period of care for the children and this data must be recorded by the funding authorities.
Subject(s)
Cochlear Implantation , Deafness , Hearing Loss , Adolescent , Child , Deafness/epidemiology , Humans , Infant, NewbornABSTRACT
The ontogeny of pectoralis muscle bioenergetics was studied in growing Adélie penguin chicks during the first month after hatching and compared with adults using permeabilized fibers and isolated mitochondria. With pyruvate-malate-succinate or palmitoyl-carnitine as substrates, permeabilized fiber respiration markedly increased during chick growth (3-fold) and further rose in adults (1.4-fold). Several markers of muscle fiber oxidative activity (cytochrome oxidase, citrate synthase, hydroxyl-acyl-CoA dehydrogenase) increased 6- to 19-fold with age together with large rises in intermyofibrillar (IMF) and subsarcolemmal (SS) mitochondrial content (3- to 5-fold) and oxidative activities (1.5- to 2.4-fold). The proportion of IMF relative to SS mitochondria increased with chick age but markedly dropped in adults. Differences in oxidative activity between mitochondrial fractions were reduced in adults compared with hatched chicks. Extrapolation of mitochondrial to muscle respirations revealed similar figures with isolated mitochondria and permeabilized fibers with carbohydrate-derived but not with lipid-derived substrates, suggesting diffusion limitations of lipid substrates with permeabilized fibers. Two immunoreactive fusion proteins, mitofusin 2 (Mfn2) and optic atrophy 1 (OPA1), were detected by Western blots on mitochondrial extracts and their relative abundance increased with age. Muscle fiber respiration was positively related with Mfn2 and OPA1 relative abundance. Present data showed by two complementary techniques large ontogenic increases in muscle oxidative activity that may enable birds to face thermal emancipation and growth in childhood and marine life in adulthood. The concomitant rise in mitochondrial fusion protein abundance suggests a role of mitochondrial networks in the skeletal muscle processes of bioenergetics that enable penguins to overcome harsh environmental constraints.