An innovative and collaborative method to develop a model care and service trajectory for the assessment, diagnosis, and support of children with developmental disabilities.

This paper documents an innovative research approach undertaken to co-develop an integrated assessment, diagnosis, and support service trajectory for children suspected of having a developmental disability. It employed data-driven practices and involved multiple stakeholders such as parents, professionals, managers, and researchers. It emphasized the importance of incorporating experiential knowledge adopting an integrated care and service trajectory perspective, and using an implementation science framework. The first part of this article presents the theoretical roots and the collaborative method used to co-construct the model trajectory. The second part of this article presents the results of a survey in which participating stakeholders shared their point of view on the value and impact of this approach Overall, this article provides a step-by-step operationalization of participative research in the context of public health and social services. This may help guide future initiatives to improve services for developmental disabilities in partnership with those directly concerned by these services.

Prospective observational study investigating the effectiveness, safety, women's experiences and quality of life at 3 months regarding cervical ripening methods for induction of labor at term-The MATUCOL study protocol.

BACKGROUND: The purposes of successful induction of labor (IOL) are to shorten the time for IOL to delivery, increase the vaginal delivery rate, and reduce the rate of maternal and neonatal morbidity. In cases of unfavorable cervix (Bishop score <6), cervical ripening is advised to improve vaginal delivery rate. It may be initiated by mechanical (double balloon catheter (DBC), synthetic osmotic dilator) or pharmacologic (prostaglandins) methods, and the problem is complex due to the multitude of cervical ripening methods. We are constantly looking for the optimal protocol of cervical ripening for each woman. The present study aims to elucidate whether cervical ripening method is associated with increase rate of vaginal delivery, good women's experience and unaltered long-term quality of life after cervical ripening at term regarding maternal and obstetric characteristics. METHODS AND DESIGN: The MATUCOL study is a monocentric, prospective, observational study of all consecutive women who required cervical ripening (Bishop score <6) using different methods (DBC, vaginal dinoprostone, oral misoprostol) with a live fetus at term (≥37 weeks) between January 2020 and August 2021. The outcomes will be mode of delivery, maternal and neonatal morbidity, discomfort/pain assessments during cervical ripening, women's experience and satisfaction, and the impact of cervical ripening on the health-related quality of life at 3 months. If it reports a significant efficacy/safety/perinatal morbidity/women's satisfaction/quality of life at 3 months post-delivery associated with a method of cervical ripening in a specific situation (gestational and/or fetal disease) using a multivariate analysis, its use should be reconsidered in clinical practice. DISCUSSION: This study will reveal that some cervical ripening methods will be more effectiveness, safe, with good women's experiences and QOL at 3 months compared to others regarding maternal and obstetric characteristics. TRIAL REGISTRATION: This study is being performed at La Roche sur Yon Hospital following registration as GNEDS on January 8, 2020.

Consequences of the COVID-19 Pandemic on Children's Mental Health: A Meta-Analysis.

Background: The COVID-19 pandemic has exacerbated mental health problems in many individuals, including children. Children with pre-existing socio-demographic or developmental risk factors may be particularly vulnerable to the negative effects of the pandemic and associated public health preventive measures. Objective: This systematic review and meta-analysis explored the impacts of the COVID-19 pandemic on the mental health of children aged 5-13 years-old, while highlighting the specific difficulties experienced by children with neurodevelopmental issues or chronic health conditions. Methods: A systematic search of the published literature was conducted in Medline, ERIC, PsycINFO, and Google Scholar, followed by a quantitative meta-analysis of the eligible studies. Results: Out of the 985 articles identified, 28 empirical studies with prospective or retrospective longitudinal data were included in the quantitative synthesis. COVID-19 lockdown measures were associated with negative general mental health outcomes among children (g = 0.28, p < 0.001, and k = 21), but of small magnitude. Sleep habits were also changed during the pandemic, as sleep duration significantly increased in children (g = 0.32; p = 0.004, and k = 9). Moreover, results did not differ between children from the general population and those from clinical populations such as children with epilepsy, oncology, neurodevelopmental disorders, or obesity. Effect sizes were larger in European vs. Asian countries. Conclusions: Studies included in this review suggest that children's mental health was generally negatively impacted during the COVID-19 pandemic. More research is needed to understand the long-term effects of the COVID-19 pandemic on children's mental health and the influence of specific risks factors as they evolve over time.

Advance Directive for Research: How Do They Compare with Surrogates' Predictions of Older Adults' Preferences?

Surrogates' decisions and advance directives currently offer the best opportunities for people to participate in research at times of decisional incapacity. We investigated which of these options better reflects an older adult's willingness to engage in research should he or she be solicited to enroll in a study after losing the capacity to consent. Data were drawn from a recently completed trial in which older adults were invited to record their research advance directives in a booklet designed for that purpose. Three vignettes describing hypothetical studies were later used to elicit older adults' willingness to engage in these studies. Statistical analyses involved comparing surrogates' and advance directives' ability to predict the older adults' answers. No significant differences in agreement with older adults' hypothetical choices were found between surrogates and advance directives (p-values ranged from 0.164 to 0.720). Future studies could test whether more specific forms of research advance directives would assist surrogates in making research-related decisions for their loved ones.

Effects of advance care planning on confidence in surrogates' ability to make healthcare decisions consistent with older adults' wishes: Findings from a randomized controlled trial.

OBJECTIVE: To investigate how confidence in surrogates' ability to make consistent decisions in the future change over time, in the context of an ACP intervention that did not improve surrogates' ability to predict an older adult's hypothetical treatment preferences. METHODS: The study involved 235 older adults and surrogates, randomly allocated to an ACP or control intervention. At baseline, end of intervention, and six months later, participants were asked how confident they were in the surrogate making decisions in the future that would match the older adult's wishes. RESULTS: By the end of the intervention, confidence had increased among older adults and surrogates involved in ACP (OR = 3.1 and 5.8 respectively, p < 0.001), while less change occurred among controls. Over the following six months, confidence remained stable among older adults but decreased among surrogates (OR = 0.5, p = 0.005). CONCLUSION: ACP increases confidence in surrogates' ability to make consistent decisions, which may lighten the burden of substitute decision making. Efforts to improve substitute decision-making must continue so that participants' confidence is not based on the mistaken assumption that surrogates can make consistent decisions. PRACTICE IMPLICATIONS: Professionals involved in ACP should inform participants that confidence in the surrogate may increase in the absence of enhanced predictive ability.

Regulation of pel genes, major virulence factors in the plant pathogen bacterium Dickeya dadantii, is mediated by cooperative binding of the nucleoid-associated protein H-NS.

Dickeya dadantii is a pathogen infecting a wide range of plant species. Soft rot, the visible symptom, is mainly due to production of pectate lyases (Pels) that can destroy plant cell walls. Previously, we found that nucleoid-associated protein (NAP) H-NS is a key regulator of pel gene expression. The primary binding sites of this NAP have been determined here by footprinting experiments on the pelD gene, encoding an essential virulence factor. Quantitative analysis of DNAse I footprints and surface plasmon resonance imagery experiments further revealed that high-affinity binding sites initiate cooperative binding to establish the nucleoprotein structure required for gene expression silencing. Mutations in the primary binding sites resulted in reduction or loss of repression by H-NS. Overall, these data suggest that H-NS represses pelD, and by inference, other pel genes, by a cooperative binding mechanism, through oligomerization of H-NS molecules.

Role of the LysR-type transcriptional regulator PecT and DNA supercoiling in the thermoregulation of pel genes, the major virulence factors in Dickeya dadantii.

Bacteria are colonizers of various environments and host organisms, and they are often subjected to drastic temperature variations. Dickeya dadantii is a pathogen infecting a wide range of plant species. Soft rot, the visible symptom, is mainly due to the production of pectate lyases (Pels) that destroy plant cell walls. The production of Pels is controlled by a complex regulation system that responds to various stimuli, such as the presence of pectin, growth phase and temperature. Despite numerous regulatory studies, the thermoregulation mechanism of Pel production remains unexplained. Here, we show that PecT, a previously identified repressor, modulates pel gene expression in a temperature-dependent manner, and we demonstrate that PecT binding on pel promoters increases concomitantly with temperature. High temperatures relax the DNA in D. dadantii, and remarkably, artificial relaxation of DNA at low temperatures increases PecT binding to DNA. Deletion of pecT augmented the capacity of D. dadantii to initiate soft-rot symptoms at high temperatures. These results reveal that DNA topology and PecT act in concert to fine-tune D. dadantii virulence in response to temperature. This novel combination between DNA topology and a conventional transcriptional regulator extends our understanding of the thermoregulation mechanisms involved in bacterial virulence.