Child abuse and neglect in a pediatric emergency department: epidemiology and outcome.

INTRODUCTION: Managing child abuse and neglect in pediatric emergency departments (PEDs) is difficult because of the complexity of screening and the prolonged care process. This study's main objective was to measure the child protection activity in a PED. METHODS: A retrospective, single-center study was conducted in the PED of the Lille University Hospital from 16 September∫2017 to 11 February 2019. All patients who required a social evaluation by the PED staff were included. Children admitted at first to the PED but for whom social management was exclusively performed by other units were not included. The whole population was analyzed first and then by type of abuse. The primary endpoint was the rate of patients who needed social management in the PED. The length of stay in the PED, the number of reports for investigation by child protective services, and reports to a judge were secondary assessment criteria. RESULTS: The study involved 245 patients (median age, 5 years; interquartile range [IQR], 2-13; boys, 49%), accounting for 0.6% of the PED visits. The main reasons for visiting the PED were somatic complaints (31%), sexual assault (23%), and behavioral disorders (20%). The median length of care in the PED was 5 h (IQR, 3-13). Thirty-three percent of the patients were monitored in the short-stay unit of the PED; 78% returned home. The main social measures taken were reports to child protective services (34%) and reports to a judge (24%); 51% of the patients required further actions by the PED physician after discharge. CONCLUSION: Management of child abuse in the PED is important and time-consuming. A hospital team specialized in child protection is essential for the initial care and monitoring of child victims.

C-Halide bond cleavage by a two-coordinate iron(i) complex.

Iron(i) species are debated as key intermediates during the C-halide activation step in Kumuda type C-C cross-coupling catalysis. However, there is only limited knowledge on the reactivity of isolable iron(i) complexes towards organohalides. Using the known two-coordinate iron(i) complex K{18c6}[FeI(N(SiMe3)2)2] we disclose its proficiency to rapidly cleave different types of carbon halide bonds including even C-F bonds. Mechanistic studies indicate stepwise one-electron processes with the involvement of organoradicals.

ortho-Phenyl dialkylphosphonium sulfonate compounds: two rotamers in equilibrium.

Two known and two new ortho-phenyl phosphonium-sulfonate compounds have been synthesized and analyzed in solution and in the solid state. When the phosphonium moiety bears alkyl substituents, two rotamers are in equilibrium in solution. These two rotamers have been entirely characterized and are shown to differ by the spatial arrangement of the phosphonium proton relative to the sulfonate moiety. The phosphonium proton chemical shift and the 1JPH coupling constant are characteristic values for each rotamer. The kinetic and thermodynamic constants have been determined by means of NMR and DFT studies.

Extended-spectrum ß-lactamase-producing Enterobacteriaceae, national study of antimicrobial treatment for pediatric urinary tract infection.

OBJECTIVE: To evaluate clinical practices for ESBL-producing urinary tract infection (UTI) in France. METHODS: We performed an observational, retrospective, cross-sectional, hospital-based study in 22 pediatric departments of university or secondary care hospitals. We collected data of the last five patients presenting with ESBL-producing UTI in 2012 and the physicians' therapeutic approach to two case vignettes of acute non-septic ESBL-producing pyelonephritis (7-month-old girl) and cystitis (30-month-old girl). The adequacy of the therapeutic decision was analyzed by a panel of independent infectious disease experts. RESULTS: A total of 80 case patients of ESBL-producing UTI were collected: 54 with acute pyelonephritis (mean age: 28 months, female: 66%), of whom 98% received an intravenous ESBL-adapted antibiotic treatment and 55% a two-drug antibiotic therapy. Carbapenems were used in 56% of cases and aminoglycosides in 36%. Of the 26 cystitis patients (mean age: 5 years, female: 73%), 85% were treated with antibiotics, including three intravenously (carbapenems=2). For the case vignettes, physicians (n=85) would have treated the pyelonephritis patient with carbapenems (76%) and/or aminoglycosides (68%); 71% would have used a two-drug antibiotic treatment. The cystitis patient would have been treated intravenously by 29% of physicians; 8% would have used a two-drug antibiotic treatment, 16% would have prescribed carbapenems, and 11% aminoglycosides. Antibiotic treatments were deemed appropriate in 37% of cases. CONCLUSIONS: Antimicrobial treatment for ESBL-producing UTI greatly varies, and carbapenems are excessively prescribed. Specific guidelines for ESBL infections are required.

Far-infrared observations of a massive cluster forming in the Monoceros R2 filament hub⋆.

We present far-infrared observations of Monoceros R2 (a giant molecular cloud at approximately 830 pc distance, containing several sites of active star formation), as observed at 70 µm, 160 µm, 250 µm, 350 µm, and 500 µm by the Photodetector Array Camera and Spectrometer (PACS) and Spectral and Photometric Imaging Receiver (SPIRE) instruments on the Herschel Space Observatory as part of the Herschel imaging survey of OB young stellar objects (HOBYS) Key programme. The Herschel data are complemented by SCUBA-2 data in the submillimetre range, and WISE and Spitzer data in the mid-infrared. In addition, C18O data from the IRAM 30-m Telescope are presented, and used for kinematic information. Sources were extracted from the maps with getsources, and from the fluxes measured, spectral energy distributions were constructed, allowing measurements of source mass and dust temperature. Of 177 Herschel sources robustly detected in the region (a detection with high signal-to-noise and low axis ratio at multiple wavelengths), including protostars and starless cores, 29 are found in a filamentary hub at the centre of the region (a little over 1% of the observed area). These objects are on average smaller, more massive, and more luminous than those in the surrounding regions (which together suggest that they are at a later stage of evolution), a result that cannot be explained entirely by selection effects. These results suggest a picture in which the hub may have begun star formation at a point significantly earlier than the outer regions, possibly forming as a result of feedback from earlier star formation. Furthermore, the hub may be sustaining its star formation by accreting material from the surrounding filaments.

[Innovative instruction for assisting patients with arterial hypertension]. / Une formation innovante sur l'accompagnement du patient atteint d'hypertension artérielle.

The MOOC In The Heart of Hypertension is an innovative online training for students and health providers. Its aim is to strengthen skills for professionals caring people suffering from hypertension. A MOOC is a free online training aiming unlimited participation. It widely promotes a high quality education. Medical and paramedical training recently seized upon this powerful tool, for initial and continuing training. Indeed, MOOC responds to several pedagogic challenges, particularly through educational strategies focused on the learner's skills: mastery of pedagogy, retrieval practice and peer grading. This MOOC about hypertension aims at responding to the needs of caregivers to enhance their therapeutic support skills.

Three bonding modes of bis(2-picolyl)phenylphosphine at iron: isolation of a dinuclear iron complex featuring dearomatized pyridine moieties.

The coordination ability of the bis(2-picolyl)phenylphosphine (NPN) compound has been probed toward the iron precursor [Fe{N(SiMe3)2}2]. By a careful control of the experimental conditions we were able to isolate and characterize three complexes displaying different coordination modes of the NPN ligand as revealed in particular by X-ray diffraction, and multinuclear solution and solid state NMR analyses. It is shown that NPN can be used as a proton-responsive ligand with enough flexibility to allow the formation of the dinuclear complex [Fe{P(CH2(C5H4N))(CH(C5H4N))}(N(SiMe3)2)]2 with two NPN ligands spanning the two metal centres.

[Management of urinary tract infections in children. Evaluation of clinical practice]. / Évaluation des pratiques de prise en charge des infections urinaires de l'enfant.

OBJECTIVE: To determine the rate of therapeutic management satisfying the institutional protocol for children with urinary tract infection (UTI) in the context of the emergence of extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae. METHODS: A retrospective, single-center, observational study was carried out for 1 year (2010-2011). Data from all children admitted to the emergency department with a diagnosis of UTI were analysed. Adherence to the protocol was evaluated for the initial management and at re-evaluation with the definitive result of the urine culture. Risk factors for nonadherence were analysed. RESULTS: Among the children, 393 were included. An ESBL Enterobacteriaceae-related UTI was identified in 2.2% of urine analyses. The initial therapeutic management satisfied the protocol for 95% of children and at re-evaluation for 80%. Nonadherence was related to poorly adapted treatment (59%) and an erroneous indication of dual antibiotic therapy (20%). Variables associated with the inadequacy of the initial management were age less than 3 months (adjusted OR [aOR]: 9.3; 95%CI: 3.5-24.8) and at re-evaluation age under 3 months (aOR: 12.8; 95%CI: 5.5-29.9) and an unconfirmed infection in the final urine culture (aOR: 30.8; 14.7-64.3). CONCLUSION: Adherence to the protocol was good but could be increased by a better re-evaluation procedure with the result of the urine culture. ESBL Enterobacteriaceae-related UTIs were still rare enough to influence the efficacy of management.

Copper(I) complexes derived from mono- and diphosphino-boranes: Cu-->B interactions supported by arene coordination.

The monophosphino-boranes o-iPr(2)P(C(6)H(4))BR(2) (1: R = Ph and 3: R = Cy) and diphosphino-boranes [o-R(2)P(C(6)H(4))](2)BPh (5: R = Ph and 6: R = iPr) readily react with CuCl to afford the corresponding complexes {[o-iPr(2)P(C(6)H(4))BPh(2)]Cu(mu-Cl)}(2) 2, {[o-iPr(2)P(C(6)H(4))BCy(2)]Cu(mu-Cl)}(2) 4, {[o-Ph(2)P(C(6)H(4))](2)BPh}CuCl 7, and {[o-iPr(2)P(C(6)H(4))](2)BPh}CuCl 8. The presence of Cu-->B interactions supported by arene coordination within complexes 2, 7, and 8 has been unambiguously evidenced by NMR spectroscopy and X-ray diffraction studies. The unique eta(2)-BC coordination mode adopted by complexes 7 and 8 has been thoroughly analyzed by density-functional theory (DFT) calculations.

[Sequelae in the knee extensor system following graft removal for the "Mac in Jones" type procedure]. / Les séquelles survenant au niveau du système extenseur, après le prélèvement d'un transplant pour intervention de type "Mac in Jones".

PURPOSE OF STUDY: The aim of this study was to evaluate clinical and radiological sequelae following removal of part of the patellar tendon for A.C.L. reconstruction. MATERIALS AND METHODS: A consecutive and homogenous series of 100 patients operated for chronic anterior instability (66 men, 34 women; age 16 to 55 years, average: 28.5 years) was studied. The procedure involved a free patellar tendon graft harvested from the mid third of the tendon and including its bony attachments, and in particular a long strip from the patella and a strip 10 centimeters long from the rectus femoris tendon for extra-articular reconstruction. Tendon graft sites were closed. Patellae and tibial tunnels were filled with bone debris from the drilling, and the pre-patellar fascia was closed. The mean follow-up period was 35 months. pain and radiological alterations (with pre-operative X-rays as reference) were studied, particularly for: calcifications, patellar height changes using the Insall, Blackburne and Caton methods, increase in patella tip length, femoro-patellar joint alteration. RESULTS: Calcification were found in: quadriceps tendon: 24 per cent of cases (always painless), Pre-patellar: 16 per cent of cases (usually less than 5 mm), Superior patellar tendon: 47 per cent of cases (only 2 cases being painful, no unaffected tendons were painful), Inferior patellar tendon: 7 per cent of cases (1 in the mid), Tibia tunnel: 26 per cent of cases. No cases required surgical removal. Patellar tip length did not increased significantly. Patellar tendon length decreased by 1.37 mm. Patellar height measured by the Insall, Blackburne and Caton methods was not significantly affected. The femoro-patellar joint was normal in 95 per cent of cases. There were five cases of remodelling, one being painful. CONCLUSION: Graft harvested from the extension system for A.C.L. reconstruction frequently resulted in radiological sequelae but were usually asymptomatic. In most cases these calcifications concerned the superior patellar tendon, quadricipital tendon and pre-patellar zone. Patella height was not affected.