Does Diglossia Impact Brain Structure? Data from Swiss German Early Diglossic Speakers.

(1) Background: Bilingualism has been reported to shape the brain by inducing cortical changes in cortical and subcortical language and executive networks. Similar yet different to bilingualism, diglossia is common in Switzerland, where the German-speaking population switches between an everyday spoken Swiss German (CH-GER) dialect and the standard German (stGER) used for reading and writing. However, no data are available for diglossia, defined as the use of different varieties or dialects of the same language, regarding brain structure. The aim of our study is to investigate if the presence of this type of diglossia has an impact on the brain structure, similar to the effects seen in bilingualism. (2) Methods: T1-weighted anatomical MRI scans of participants were used to compare the grey matter density and grey matter volume of 22 early diglossic CH-GER-speaking and 20 non-diglossic French-speaking right-handed university students, matched for age, linguistics and academic background. The images were processed with Statistical Parametric Mapping SPM12 and analyzed via voxel- and surface-based morphometry. (3) Results: A Bayesian ANCOVA on the whole brain revealed no differences between the groups. Also, for the five regions of interest (i.e., planum temporale, caudate nucleus, ACC, DLPFC and left interior parietal lobule), no differences in the cortical volume or thickness were found using the same statistical approach. (4) Conclusion: The results of this study may suggest that early diglossia does not shape the brain structure in the same manner as bilingualism.

The processing of stress in a foreign language modulates functional antagonism between default mode and attention network regions.

Lexical stress is an essential element of prosody. Mastering this prosodic feature is challenging, especially in a free-stress foreign language for individuals native to a fixed-stress language, a phenomenon referred to as stress deafness. By using functional magnetic resonance imaging, we elucidated the neuronal underpinnings of stress processing in a free-stress foreign language, and determined the underlying mechanism of stress deafness. Here, we contrasted behavioral and hemodynamic responses revealed by native speakers of a free-stress (German; N = 38) and a fixed-stress (French; N = 47) language while discriminating pairs of words in a free-stress foreign language (Spanish). Consistent with the stress deafness phenomenon, French speakers performed worse than German speakers in discriminating Spanish words based on cues of stress but not of vowel. Whole-brain analyses revealed widespread bilateral networks (i.e., cerebral regions including frontal, temporal and parietal areas as well as insular, subcortical and cerebellar structures), overlapping with the ones previously associated with stress processing within native languages. Moreover, our results provide evidence that the structures pertaining to a right-lateralized attention system (i.e., middle frontal gyrus, anterior insula) and the Default Mode Network modulate stress processing as a function of the performance level. In comparison to the German speakers, the French speakers activated the attention system and deactivated the Default Mode Network to a stronger degree, reflecting attentive engagement, likely a compensatory mechanism underlying the "stress-deaf" brain. The mechanism modulating stress processing argues for a rightward lateralization, indeed overlapping with the location covered by the dorsal stream but remaining unspecific to speech.

Determining the Association Between Emergency Department Crowding and Debriefing After Pediatric Trauma Resuscitations.

BACKGROUND: Debriefing in the pediatric emergency department (PED) is an invaluable tool to improve team well-being, communication, and performance. Despite evidence, surveys have reported heavy workload as a barrier to debriefing leading to missed opportunities for improvement in an already busy ED. The study aims to determine the association between the incidence of debriefing after pediatric trauma resuscitations and PED crowding. METHODS: A total of 491 Trauma One activations in Riley Children's Hospital Pediatric Emergency Department that presented between April 2018 to December 2019 were included in the study. Debriefing documentations, patient demographics, time and date of presentation, mechanism of injury, injury severity score, disposition from PED, and length of stay (LOS) were collected and analyzed. The National Emergency Department Overcrowding Scale score at arrival, Average LOS, total PED census, total PED waiting room census, and rates of left without being seen were compared between groups. RESULTS: Of 491 Trauma One activations presented to our PED, 50 (10%) trauma evaluations had documented debriefing. The National Emergency Department Overcrowding Scale score at presentation was significantly lower in those with debriefing versus without debriefing. In addition, the PED hourly census, waiting room census, average LOS, and left without being seen were also significantly lower in the group with debriefing. In addition, trauma cases with debriefing had a higher proportion of patients with profound injuries and discharges to the morgue. CONCLUSIONS: Pediatric emergency department crowding is a significant barrier to debriefing after trauma resuscitations. However, profound injuries and traumatic pediatric deaths remain the strongest predictors in conducting debriefing regardless of PED crowding status.

Neural correlates of lexical stress processing in a foreign free-stress language.

INTRODUCTION: The paper examines the discrimination of lexical stress contrasts in a foreign language from a neural perspective. The aim of the study was to identify the areas associated with word stress processing (in comparison with vowel processing), when listeners of a fixed-stress language have to process stress in a foreign free-stress language. METHODS: We asked French-speaking participants to process stress and vowel contrasts in Spanish, a foreign language that the participants did not know. Participants performed a discrimination task on Spanish word pairs differing either with respect to word stress (penultimate or final stressed word) or with respect to the final vowel while functional magnetic resonance imaging data was acquired. RESULTS: Behavioral results showed lower accuracy and longer reaction times for discriminating stress contrasts than vowel contrasts. The contrast Stress > Vowel revealed an increased bilateral activation of regions shown to be associated with stress processing (i.e., supplementary motor area, insula, middle/superior temporal gyrus), as well as a stronger involvement of areas related to more domain-general cognitive control functions (i.e., bilateral inferior frontal gyrus). The contrast Vowel > Stress showed an increased activation in regions typically associated with the default mode network (known for decreasing its activity during attentionally more demanding tasks). CONCLUSION: When processing Spanish stress contrasts as compared to processing vowel contrasts, native listeners of French activated to a higher degree anterior networks including regions related to cognitive control. They also show a decrease in regions related to the default mode network. These findings, together with the behavioral results, reflect the higher cognitive demand, and therefore, the larger difficulties, for French-speaking listeners during stress processing as compared to vowel processing.

Native listeners rely on rhythmic cues when deciding on the nativeness of speech.

Foreign-accented speech typically deviates segmentally and suprasegmentally from native-accented speech. Two experiments were conducted to investigate the role of amplitude envelope (ENV), segment duration (DUR), and speech rate (SR) on Italian listeners' ability to identify native-accented Italian in utterances produced by Zurich German speakers. In experiment 1, listeners judged in a two-alternative forced-choice perception task which of the two stimuli in a trial they perceived as more native-like. Stimuli in each trial only varied in ENV and DUR, which were retrieved either from a native Italian speaker [first language (L1) donor] or from a German speaker of Italian [second language (L2) donor]. Results revealed that listeners make use of both DUR and ENV to identify the more native-like stimuli, but the effect of ENV was more subtle. In experiment 2, SR differences (resulting from native and non-native segment duration differences in experiment 1) were normalized for. It was found that this drastically reduced the effect of segment durations in terms of perceived nativeness; however, the ENV effect still remained. This was not the case in a control group of listeners without competence in Italian. Though effects were subtle, the study shows that ENV cues contribute to the percept of nativeness in L2 speech.

Intonation and talker variability in the discrimination of Spanish lexical stress contrasts by Spanish, German and French listeners.

The perception of stress is highly influenced by listeners' native language. In this research, the authors examined the effect of intonation and talker variability (here: phonetic variability) in the discrimination of Spanish lexical stress contrasts by native Spanish (N = 17), German (N = 21), and French (N = 27) listeners. Participants listened to 216 trials containing three Spanish disyllabic words, where one word carried a different lexical stress to the others. The listeners' task was to identify the deviant word in each trial (Odd-One-Out task). The words in the trials were produced by either the same talker or by two different talkers, and carried the same or varying intonation patterns. The German listeners' performance was lower compared to the Spanish listeners but higher than that of the French listeners. French listeners performed above chance level with and without talker variability, and performed at chance level when intonation variability was introduced. Results are discussed in the context of the stress "deafness" hypothesis.

Severe hemolytic crisis after ceftriaxone administration.

Ceftriaxone is a commonly administered antibiotic, and hemolytic crisis is a dangerous potential adverse event. We describe 2 children with sickle cell disease who developed severe hemolytic crisis after ceftriaxone administration. Both subsequently demonstrated the presence of anticeftriaxone antibodies that may have been responsible for the massive hemolysis.

Relationship between speech rate perceived and produced by the listener.

The present research examines the impact of listeners' own rate of speech production on their perception of speech rate. We recorded 28 native French speakers reading a passage at normal, fast and slow rates. The same speakers then assessed the rate of production of these samples by all speakers and at all rates (normal, fast and slow), using a magnitude estimation task. We show that there is an inverse relationship between listeners' own rate of production and their judgment of rate, so that listeners with slower rates tend to overestimate sample rates relative to faster speakers. This effect of listeners' own rate was present in the magnitude estimation results at slow and normal rates, but not at fast rates. Furthermore, listeners with a slow rate are more sensitive to rate differences within a given rate category (normal, fast and slow). The listener's own rate should therefore be considered as a critical factor in speech rate perception.

Stevens-Johnson syndrome and toxic epidermal necrolysis: consequence of treatment of an emerging pathogen.

We report a case of Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN) secondary to trimethoprim-sulfamethoxazole (TMP-Sx) therapy for presumed community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) infection. Although the association between SJS/TEN and the sulfonamide class of antibiotics is well established, the increasing prevalence of CA-MRSA has left practitioners with limited regimens to effectively treat skin and soft tissue infections (SSTIs) in the outpatient setting. In the case of SSTIs, alternative treatment of these infections should be considered, especially when the bacterial pathogen is unknown. Future investigations evaluating the efficacy of adjunctive antibiotics for purulent SSTIs and monitoring the incidence of SJS/TEN in the era of CA-MRSA are necessary to reduce unnecessary use of sulfonamide drugs. The potential development of SJS/TEN, a severe life-threatening illness, emphasizes the need for judicious use of TMP-Sx and close monitoring and follow-up for patients who were given TMP-Sx for SSTIs.

Diagnostic value of immature neutrophils (bands) in the cerebrospinal fluid of children with cerebrospinal fluid pleocytosis.

OBJECTIVE: We evaluated the diagnostic utility of the presence and number of cerebrospinal fluid (CSF) bands in distinguishing bacterial from aseptic meningitis among children with CSF pleocytosis. METHODS: We identified retrospectively a cohort of children 29 days to 19 years of age with CSF pleocytosis (> or =10 x 10(6) leukocytes per L) who were treated in the emergency departments of 8 pediatric centers between January 2001 and June 2004 and whose CSF was evaluated for the presence of bands. We performed bivariate and multivariate analyses to determine the ability of CSF bands to distinguish bacterial from aseptic meningitis. RESULTS: Among 1116 children whose CSF was evaluated for the presence of bands, 48 children (4% of study patients) had bacterial meningitis. Bacterial meningitis, compared with aseptic meningitis, was associated with a greater CSF band proportion (0.03 vs 0.01; difference: 0.02; 95% confidence interval: 0.00-0.04) and CSF absolute band count (392 x 10(6) cells per L vs 3 x 10(6) cells per L; difference: 389 x 10(6) cells per L; 95% confidence interval: -77 x 10(6) cells per L to 855 x 10(6) cells per L). In addition, 29% of patients with bacterial meningitis, compared with 18% of patients with aseptic meningitis, had any bands detected in the CSF. After adjustment for other factors associated with bacterial meningitis, however, CSF band presence, CSF absolute band count, and CSF band proportion were not independently associated with bacterial meningitis. CONCLUSION: In this multicenter study, neither the presence nor quantity of CSF bands independently predicted bacterial meningitis among children with CSF pleocytosis.

Effect of antibiotic pretreatment on cerebrospinal fluid profiles of children with bacterial meningitis.

OBJECTIVE: The goal of this study was to evaluate the effect of antibiotic administration before lumbar puncture on cerebrospinal fluid profiles in children with bacterial meningitis. METHODS: We reviewed the medical records of all children (1 month to 18 years of age) with bacterial meningitis who presented to 20 pediatric emergency departments between 2001 and 2004. Bacterial meningitis was defined by positive cerebrospinal fluid culture results for a bacterial pathogen or cerebrospinal fluid pleocytosis with positive blood culture and/or cerebrospinal fluid latex agglutination results. Probable bacterial meningitis was defined as positive cerebrospinal fluid Gram stain results with negative results of bacterial cultures of blood and cerebrospinal fluid. Antibiotic pretreatment was defined as any antibiotic administered within 72 hours before the lumbar puncture. RESULTS: We identified 231 patients with bacterial meningitis and another 14 with probable bacterial meningitis. Of those 245 patients, 85 (35%) had received antibiotic pretreatment. After adjustment for patient age, duration and severity of illness at presentation, and bacterial pathogen, longer duration of antibiotic pretreatment was not significantly associated with cerebrospinal fluid white blood cell count, cerebrospinal fluid absolute neutrophil count. However, antibiotic pretreatment was significantly associated with higher cerebrospinal fluid glucose and lower cerebrospinal fluid protein levels. Although these effects became apparent earlier, patients with >or=12 hours of pretreatment, compared with patients who either were not pretreated or were pretreated for <12 hours, had significantly higher median cerebrospinal fluid glucose levels (48 mg/dL vs 29 mg/dL) and lower median cerebrospinal fluid protein levels (121 vs 178 mg/dL). CONCLUSIONS: In patients with bacterial meningitis, antibiotic pretreatment is associated with higher cerebrospinal fluid glucose levels and lower cerebrospinal fluid protein levels, although pretreatment does not modify cerebrospinal fluid white blood cell count or absolute neutrophil count results.

Effect of speaking rate on the identification of word boundaries.

Two experiments were conducted to determine whether listeners' ability to use allophonic variation to identify word boundaries is influenced by speaking rate. Listeners in both experiments were presented two-word sequences (such as great eyes) spoken by naturally fast and naturally slow talkers; in one experiment the sequences were presented in quiet and in the other they were presented in noise. The listeners' task was to identify the intended sequence from among four choices with alternative segmentations (e.g. great eyes, gray ties, great ties, gray eyes). In both experiments performance was worse for the sequences produced by the naturally fast talkers than for those produced by the naturally slow talkers. This finding suggests that the extent to which allophonic variation contributes to the identification of word boundaries may depend on the rate at which the speech was produced.

Clinical prediction rule for identifying children with cerebrospinal fluid pleocytosis at very low risk of bacterial meningitis.

CONTEXT: Children with cerebrospinal fluid (CSF) pleocytosis are routinely admitted to the hospital and treated with parenteral antibiotics, although few have bacterial meningitis. We previously developed a clinical prediction rule, the Bacterial Meningitis Score, that classifies patients at very low risk of bacterial meningitis if they lack all of the following criteria: positive CSF Gram stain, CSF absolute neutrophil count (ANC) of at least 1000 cells/microL, CSF protein of at least 80 mg/dL, peripheral blood ANC of at least 10,000 cells/microL, and a history of seizure before or at the time of presentation. OBJECTIVE: To validate the Bacterial Meningitis Score in the era of widespread pneumococcal conjugate vaccination. DESIGN, SETTING, AND PATIENTS: A multicenter, retrospective cohort study conducted in emergency departments of 20 US academic medical centers through the Pediatric Emergency Medicine Collaborative Research Committee of the American Academy of Pediatrics. All children aged 29 days to 19 years who presented at participating emergency departments between January 1, 2001, and June 30, 2004, with CSF pleocytosis (CSF white blood cells > or =10 cells/microL) and who had not received antibiotic treatment before lumbar puncture. MAIN OUTCOME MEASURE: The sensitivity and negative predictive value of the Bacterial Meningitis Score. RESULTS: Among 3295 patients with CSF pleocytosis, 121 (3.7%; 95% confidence interval [CI], 3.1%-4.4%) had bacterial meningitis and 3174 (96.3%; 95% CI, 95.5%-96.9%) had aseptic meningitis. Of the 1714 patients categorized as very low risk for bacterial meningitis by the Bacterial Meningitis Score, only 2 had bacterial meningitis (sensitivity, 98.3%; 95% CI, 94.2%-99.8%; negative predictive value, 99.9%; 95% CI, 99.6%-100%), and both were younger than 2 months old. A total of 2518 patients (80%) with aseptic meningitis were hospitalized. CONCLUSIONS: This large multicenter study validates the Bacterial Meningitis Score prediction rule in the era of conjugate pneumococcal vaccine as an accurate decision support tool. The risk of bacterial meningitis is very low (0.1%) in patients with none of the criteria. The Bacterial Meningitis Score may be helpful to guide clinical decision making for the management of children presenting to emergency departments with CSF pleocytosis.

[The perception of the second language production]. / La perception du débit en langue seconde.

Non-native speakers of a second language often report that the speech rate in that language is faster than the rate in their own language. So as to compare speech rate perception by native (French) and non-native (Swiss German) speakers, and to determine if rate estimation by non-native speakers is correlated with their level of comprehension, we asked two groups of 96 participants, native and non-native speakers of French, to listen to short stories read at slow, medium and fast rates. They were asked to answer a few comprehension questions and to give an estimate of the speech rate. The results obtained show that there is indeed a difference between the two groups: the faster the physical speech rate, the greater the impression of speed in the non-native speakers as compared with the native speakers. In addition, when speech rate is slow and normal, there is a significant negative correlation between oral comprehension and perceived rate: the lower the comprehension, the higher the estimated rate.