Electrocardiographic Changes at the Early Stage of Status Epilepticus: First Insights From the ICTAL Registry.

OBJECTIVES: To describe early electrocardiogram (ECG) abnormalities after status epilepticus (SE) and evaluate their association with 90-day neurological outcomes. DESIGN: Retrospective analysis of a multicenter, national prospective registry between February 2018 and June 2020. SETTING: Sixteen ICUs in France, IctalGroup Research Network. PATIENTS: Adults with available ECG performed less than or equal to 24 hours after the onset of SE and less than or equal to 12 hours after its resolution. INTERVENTION: Double-blinded review of all ECGs was performed by two independent cardiologists. ECGs were categorized as normal/abnormal and then with minor/major early ECG abnormalities according to the Novacode ECG Classification system. MEASUREMENTS AND MAIN RESULTS: Among 155 critically ill patients with SE, early ECG abnormalities were encountered in 145 (93.5%), categorized as major in 91 of 145 (62.8%). In addition to sinus tachycardia, the main abnormalities were in the ST segment (elevation [16.6%] or depression [17.9%]) or negative T waves (42.1%). Major early ECG abnormalities were significantly associated with respiratory distress and sinus tachycardia at the scene and hyperlactatemia at ICU admission. By multivariable analysis, three variables were significantly associated with 90-day poor outcome: age, preexisting ultimately fatal comorbidity, and cerebral insult as the cause of SE. Early major ECG abnormalities were not independently associated with 90-day functional outcome. CONCLUSIONS: In our study, early ECG abnormalities in the acute phase of SE were frequent, often unrecognized and were associated with clinical and biological stigma of hypoxemia. Although they were not independently associated with 90-day functional outcome, ECG changes at the early stage of SE should be systematically evaluated. TRIAL REGISTRATION: https://clinicaltrials.gov/ct2/show/NCT03457831 .

Positive association of angiotensin II receptor blockers, not angiotensin-converting enzyme inhibitors, with an increased vulnerability to SARS-CoV-2 infection in patients hospitalized for suspected COVID-19 pneumonia.

BACKGROUND: Angiotensin-converting enzyme 2 is the receptor that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) uses for entry into lung cells. Because ACE-2 may be modulated by angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs), there is concern that patients treated with ACEIs and ARBs are at higher risk of coronavirus disease 2019 (COVID-19) pneumonia. AIM: This study sought to analyze the association of COVID-19 pneumonia with previous treatment with ACEIs and ARBs. MATERIALS AND METHODS: We retrospectively reviewed 684 consecutive patients hospitalized for suspected COVID-19 pneumonia and tested by polymerase chain reaction assay. Patients were split into two groups, according to whether (group 1, n = 484) or not (group 2, n = 250) COVID-19 was confirmed. Multivariable adjusted comparisons included a propensity score analysis. RESULTS: The mean age was 63.6 ± 18.7 years, and 302 patients (44%) were female. Hypertension was present in 42.6% and 38.4% of patients in groups 1 and 2, respectively (P = 0.28). Treatment with ARBs was more frequent in group 1 than group 2 (20.7% vs. 12.0%, respectively; odds ratio [OR] 1.92, 95% confidence interval [CI] 1.23-2.98; P = 0.004). No difference was found for treatment with ACEIs (12.7% vs. 15.7%, respectively; OR 0.81, 95% CI 0.52-1.26; P = 0.35). Propensity score-matched multivariable logistic regression confirmed a significant association between COVID-19 and previous treatment with ARBs (adjusted OR 2.36, 95% CI 1.38-4.04; P = 0.002). Significant interaction between ARBs and ACEIs for the risk of COVID-19 was observed in patients aged > 60 years, women, and hypertensive patients. CONCLUSIONS: This study suggests that ACEIs and ARBs are not similarly associated with COVID-19. In this retrospective series, patients with COVID-19 pneumonia more frequently had previous treatment with ARBs compared with patients without COVID-19.

Development of handedness, anatomical and functional brain lateralization.

The present chapter offers a report on the recent literature on the neural bases of hemispheric specialization (HS), anatomical and functional developmental timecourse of HS, and on the available knowledge of their relationships with the development of handedness. Strong anatomical asymmetries can be seen located along the end of the sylvian fissure and the superior temporal sulcus (STS) as soon as the 23rd gestational week. They correspond to a leftward sulcal depth asymmetry of the Sylvian fissure coupled with a rightward asymmetry of STS. These neonatal asymmetries targeting speech processing areas do not further change with development. Different from these anatomical asymmetries, the functional asymmetries of language areas develop during childhood. Such a development is characterized at birth by a predominant interhemispheric intrinsic connectivity between homotopic areas that will evolve toward left hemisphere intrahemispheric intrinsic connectivity between anterior and posterior language poles. The development of such a typical architecture of language networks in the left hemisphere dominant for language in more than 90% of humans translates into a continuous increase in the leftward asymmetries of activation during language production throughout childhood. With regard to the rightward cerebral lateralization for visuospatial functions, neuroimaging studies tend to indicate an increase in rightward lateralization of frontal-parietal network with age during visuospatial memory and visuospatial search tasks. In addition, the spatial-attentional behavioral asymmetries emerge early (in preschool children) and, then, can be modulated by factors linked to motor asymmetry and handedness. Finally, the study of manual lateralization in relation to language development has shown the importance of considering several characteristics of manual activities. In particular, the dissociation between manipulative activities and communicative gestures in young children may open further perspectives for future research on HS.

Is Conceptual Diversity an Advantage for Scientific Inquiry? A Case Study on the Concept of 'Gesture' in Comparative Psychology.

Growing scientific fields often involve multidisciplinary investigations in which the same concepts may have different meanings. Here, we examine the case of 'gesture' in comparative research to depict how conceptual diversity hidden by the label 'gesture' can lead to consistently divergent interpretations in humans and nonhuman primates. We show that definitions of 'gesture' drastically differ regarding the forms of a gesture and the cognitive processes inferred from it, and that these differences emerge from implicit assumptions which have pervasive consequences on the interpretations claimed by researchers. We then demonstrate that implicit assumptions about scientific concepts can be made explicit using a finite set of operational criteria. We argue that developing theoretical definitions systematically associated with operational conceptual boundaries would allow to tackle both the challenges of maintaining high internal coherence within studies and of improving comparability and replicability of scientific results. We thus offer an easy-to-implement conceptual tool that should help ground valid comparisons between studies and serve scientific inquiry.

Acquisition of joint attention by olive baboons gesturing toward humans.

Joint attention is a core ability of human social cognition which broadly refers to the coordination of attention with both the presence and activity of social partners. In both human and non-human primates, joint attention can be assessed from behaviour; gestures and gaze alternation between the partner and a distal object are standard behavioural manifestations of joint attention. Here we examined the acquisition of joint attention in olive baboons as a function of their individual experience of a human partner's attentional states during training regimes. Eleven olive baboons (Papio anubis) were observed during their training to perform food-requesting gestures, which occurred either by (1) a human facing them (face condition), or (2) by a human positioned in profile who never turned to them (profile condition). We found neither gestures nor gaze alternation were present at the start of the training but rather developed over the training period. Only baboons in the face condition showed an increase in the number of gaze alternations, and their gaze pattern progressively shifted to a coordinated sequence in which gazes and gestures were coordinated in time. In contrast, baboons trained by a human in profile showed significantly less coordination of gazes with gestures but still learned to request food with their gestures. These results suggest that the partner's social attention plays an important role in the acquisition of visual joint attention and, to a lesser extent, in gesture learning in baboons. Interspecific interactions appear to offer rich opportunities to manipulate and thus identify the social contexts in which socio-communicative skills develop.

Contribution of Developmental Psychology to the Study of Social Interactions: Some Factors in Play, Joint Attention and Joint Action and Implications for Robotics.

Children exchange information through multiple modalities, including verbal communication, gestures and social gaze and they gradually learn to plan their behavior and coordinate successfully with their partners. The development of joint attention and joint action, especially in the context of social play, provides rich opportunities for describing the characteristics of interactions that can lead to shared outcomes. In the present work, we argue that human-robot interactions (HRI) can benefit from these developmental studies, through influencing the human's perception and interpretation of the robot's behavior. We thus endeavor to describe some components that could be implemented in the robot to strengthen the feeling of dealing with a social agent, and therefore improve the success of collaborative tasks. Focusing in particular on motor precision, coordination, and anticipatory planning, we discuss the question of complexity in HRI. In the context of joint activities, we highlight the necessity of (1) considering multiple speech acts involving multimodal communication (both verbal and non-verbal signals), and (2) analyzing separately the forms and functions of communication. Finally, we examine some challenges related to robot competencies, such as the issue of language and symbol grounding, which might be tackled by bringing together expertise of researchers in developmental psychology and robotics.

Where have all the (ape) gestures gone?

Comparative analysis of the gestural communication of our nearest animal relatives, the great apes, implies that humans should have the biological potential to produce and understand 60-70 gestures, by virtue of shared common descent. These gestures are used intentionally in apes to convey separate requests, rather than as referential items in syntactically structured signals. At present, no such legacy of shared gesture has been described in humans. We suggest that the fate of "ape gestures" in modern human communication is relevant to the debate regarding the evolution of language through a possible intermediate stage of gestural protolanguage.

Communication in the second and third year of life: Relationships between nonverbal social skills and language.

We aimed to investigate developmental continuities between a range of early social and communicative abilities (including gestural communication) and language acquisition in children aged between 11 and 41 months. Initiation of joint attention and imitation were strongly correlated to language comprehension and production. Moreover, the analysis of different communicative gestures revealed significant relationships between language development and the production of symbolic gestures, declarative pointing (declarative informative pointing in particular), and head nodding. Other gestures such as imperative pointing, showing, and head shaking were not found to correlate with language level. Our results also suggest that distinct processes are involved in the development of language comprehension and production, and highlight the importance of considering various characteristics of children's early communicative skills.

Manual asymmetries and hemispheric specialization: Insight from developmental studies.

The objective of this review is to obtain a better understanding of the relationship between manual asymmetries and hemispheric specialization by focusing on the development of hand preference and cerebral lateralization of language. We first sought to describe the development of manual asymmetries for different activities (i.e., grasping and manipulating objects vs. communicating through gestures), and the development of cerebral asymmetries, before examining available data on the association between hand preference and HS for language. We also analyzed behavioral studies on the relation between hand preference and language development, as well as more specific studies on the relation between the cerebral control of gestures and language. Finally, we aimed at providing a wider view on functional asymmetries by emphasizing the need to study hemispheric specialization for functions other than language, and in particular for visual attention.

Hand preferences in preschool children: Reaching, pointing and symbolic gestures.

Manual asymmetries emerge very early in development and several researchers have reported a significant right-hand bias in toddlers although this bias fluctuates depending on the nature of the activity being performed. However, little is known about the further development of asymmetries in preschoolers. In this study, patterns of hand preference were assessed in 50 children aged 3-5 years for different activities, including reaching movements, pointing gestures and symbolic gestures. Contrary to what has been reported in children before 3 years of age, we did not observe any difference in the mean handedness indices obtained in each task. Moreover, the asymmetry of reaching was found to correlate with that of pointing gestures, but not with that of symbolic gestures. In relation to the results reported in infants and adults, this study may help deciphering the mechanisms controlling the development of handedness by providing measures of manual asymmetries in an age range that has been so far rather neglected.

Morphological differences between imperative and declarative pointing: hand shape, arm extension, and body posture.

The authors used frame-by-frame video analyses to describe the features of imperative and declarative pointing gestures produced by young children, in comparison to reaching actions. First, the results showed that imperative pointing shared common features with reaching actions (hand shape, arm extension), but body posture observed in reaching differed from the one observed in pointing, both in imperative and declarative contexts. Second, hand shape was influenced by precision constraints: imperative gestures shifted from whole-hand pointing to index-finger pointing when the target was surrounded by distractors. This study is the first of its kind to highlight the effect of several variables on morphological features of pointing using quantitative measures and may provide insights into the nature of imperative and declarative pointing.

Deictic gestures and symbolic gestures produced by adults in an experimental context: hand shapes and hand preferences.

The objective of this study was to gain new insights into the processes underlying gestural communication in adults by examining hand shapes and hand preference patterns associated with different types of gestures. Several communicative situations eliciting pointing gestures and symbolic gestures were presented to 81 participants in an experimental context. Results have highlighted some differences in hand shapes depending on the function of pointing: contrary to results reported in children, the proportion of index-finger gestures was higher in imperative situations than in declarative situations. The distance between the gesturer and the referent was also found to influence hand shapes, proximal pointing being more frequently associated with index-finger gestures than distal pointing. The comparison of hand preferences revealed a greater right-sided asymmetry for declarative pointing than for non-communicative activities, whereas there was no difference between imperative pointing and non-communicative activities, or between symbolic gestures and non-communicative activities. The present study thus sheds some light on the features and the roles of communicative gestures in adults. Results are discussed in relation to the ontogenetic and phylogenetic origins of communication.

Evolutionary origins of human handedness: evaluating contrasting hypotheses.

Variation in methods and measures, resulting in past dispute over the existence of population handedness in nonhuman great apes, has impeded progress into the origins of human right-handedness and how it relates to the human hallmark of language. Pooling evidence from behavioral studies, neuroimaging and neuroanatomy, we evaluate data on manual and cerebral laterality in humans and other apes engaged in a range of manipulative tasks and in gestural communication. A simplistic human/animal partition is no longer tenable, and we review four (nonexclusive) possible drivers for the origin of population-level right-handedness: skilled manipulative activity, as in tool use; communicative gestures; organizational complexity of action, in particular hierarchical structure; and the role of intentionality in goal-directed action. Fully testing these hypotheses will require developmental and evolutionary evidence as well as modern neuroimaging data.

Hand preference for pointing and language development in toddlers.

The aim of this study was to investigate the relationship between hand preference for communicative gestures and language during development. Hand preference for pointing gestures and level of language were assessed in 46 toddlers between 12 and 30 months of age. Results showed a right-hand preference for pointing and the use of a developmental quotient (DQ) for language revealed a significant correlation between the degree of hand preference and DQ for language in children with a quotient above 100. Thus, these children were more right-handed for pointing gestures as DQ increased. These results highlight the close association between the development of hand preference for pointing and the speed of language development, suggesting a new direction for studies of language-gesture links in toddlers.

Development of hand preference for object-directed actions and pointing gestures: a longitudinal study between 15 and 25 months of age.

The development of hand preferences for object-directed actions and pointing gestures was investigated in toddlers sampled bimonthly between 15 and 25 months of age. Language level was also assessed, in an attempt to examine the relationship between handedness and language development. Results did not reveal any changes over the study period in the mean Handedness Index of the whole sample, both for bimanual manipulative activities and pointing gestures. However, the categorization of participants as left-handers, right-handers, or non-lateralized revealed that most of children presented nonlinear individual trajectories in the development of hand preference. Moreover, the only significant correlations observed between hand preferences for manipulation and pointing were negative correlations between the strength of hand preferences at 19 and 21 months of age, suggesting that manipulative actions and communicative gestures are controlled by different networks in the left cerebral hemisphere. These findings are discussed in relation to the development of speech-gesture links in infancy.

Hand preferences in human adults: non-communicative actions versus communicative gestures.

Hand preferences for pointing gestures and bimanual manipulative activities were investigated in 127 adult participants. Pointing gestures were produced in two different conditions: a speech condition, in which the gestures were accompanied by speech, and a silent condition. Although the classification of participants as left- or right-handers, or ambidextrous, was consistent across the manipulation and pointing tasks for 85% of participants, results showed only moderate correlations between handedness scores for bimanual manipulation and pointing gestures. Moreover, results did not reveal any difference in the degree of hand preference between pointing gestures produced along with speech and gestures produced on their own. The implications of these findings are discussed in relation to the lateralization of non-communicative manual actions, communicative gestures and speech.

Hand preference for pointing gestures and bimanual manipulation around the vocabulary spurt period.

This study investigated the development of hand preference for bimanual manipulative activities and pointing gestures in toddlers observed longitudinally over a 5-month period, in relation to language acquisition. The lexical spurt was found to be accompanied by an increase in the right-sided bias for pointing but not for manipulation. Moreover, results revealed a significant correlation between hand preference for imperative pointing gestures and manipulative activities in children who did not experience the lexical spurt during the observational period. By contrast, measures of handedness for declarative pointing were never correlated with those of handedness for manipulation. This study illustrates the complex relationship between handedness and language development and emphasizes the need to take the different functions of pointing gestures into account.

Pointing gestures produced by toddlers from 15 to 30 months: different functions, hand shapes and laterality patterns.

Three experimental designs were implemented in day nurseries in order to elicit imperative, declarative expressive, and declarative informative pointing gestures (Tomasello, Carpenter, & Liszkowski, 2007) among a population of 48 toddlers aged 15-30 months. Several features were recorded for each situation, including gesture form, gaze direction, and vocalizations. A unimanual reaching task was also administered, in order to compare laterality patterns for each type of gesture. Main results revealed that imperative gestures were associated with whole-hand pointing, whereas declarative gestures were more frequently characterized by an extended index finger. Moreover, declarative gestures were more frequently accompanied by vocalizations than imperative gestures were. Finally, different degrees of manual preference were observed, especially for informative pointing gestures, which tended to be more right-handed than reaching actions. Results of the study are discussed in relation to the nature and development of each kind of pointing gesture.