Safe inhalation pipe provision (SIPP): protocol for a mixed-method evaluation of an intervention to improve health outcomes and service engagement among people who use crack cocaine in England.

BACKGROUND: Over 180,000 people use crack cocaine in England, yet provision of smoking equipment to support safer crack use is prohibited under UK law. Pipes used for crack cocaine smoking are often homemade and/or in short supply, leading to pipe sharing and injuries from use of unsafe materials. This increases risk of viral infection and respiratory harm among a marginalised underserved population. International evaluations suggest crack pipe supply leads to sustained reductions in pipe sharing and use of homemade equipment; increased health risk awareness; improved service access; reduction in injecting and crack-related health problems. In this paper, we introduce the protocol for the NIHR-funded SIPP (Safe inhalation pipe provision) project and discuss implications for impact. METHODS: The SIPP study will develop, implement and evaluate a crack smoking equipment and training intervention to be distributed through peer networks and specialist drug services in England. Study components comprise: (1) peer-network capacity building and co-production; (2) a pre- and post-intervention survey at intervention and non-equivalent control sites; (3) a mixed-method process evaluation; and (4) an economic evaluation. Participant eligibility criteria are use of crack within the past 28 days, with a survey sample of ~ 740 for each impact evaluation survey point and ~ 40 for qualitative process evaluation interviews. Our primary outcome measure is pipe sharing within the past 28 days, with secondary outcomes pertaining to use of homemade pipes, service engagement, injecting practice and acute health harms. ANTICIPATED IMPACT: SIPP aims to reduce crack use risk practices and associated health harms; including through increasing crack harm reduction awareness among service providers and peers. Implementation has only been possible with local police approvals. Our goal is to generate an evidence base to inform review of the legislation prohibiting crack pipe supply in the UK. This holds potential to transform harm reduction service provision and engagement nationally. CONCLUSION: People who smoke crack cocaine in England currently have little reason to engage with harm reduction and drug services. Little is known about this growing population. This study will provide insight into population characteristics, unmet need and the case for legislative reform. TRIAL REGISTRATION: ISRCTN12541454  https://doi.org/10.1186/ISRCTN12541454.

Profiles of Pornography Use Based on Addictive Mechanisms and Psychopathological Features.

Studies using person-centered approaches to further explore the profiles of pornography users throw their psychiatric features are lacking. This study was designed to examine the different profiles of pornography users based on the addictive dimensions of Problematic Pornography Use (PPU) and to characterize these profiles according to psychopathological variables such as depression, anxiety, attention deficit hyperactivity disorder (ADHD) and obsessive-compulsive disorder (OCD). A sample of 1001 French adults participated to a survey containing scales related to psychopathological variables, cybersexual addiction and PPU. PPU was assessed with the French Version of Problematic Pornography Consumption Scale (Fr-PPCS-18). An Agglomerative Hierarchical Classification was performed on the basis of FR-PPCS-18. A student's t-test was used to observe PPU and psychopathological differences between profiles. Findings revealed three profiles of users: non-problematic users (66.5%), at-risk users (29.9%), and problematic users (3.6%). There were significant differences between the three profiles concerning levels of global PPU, PPU mechanisms, cybersexual addiction symptoms, ADHD symptomatology and depressive symptomatology. Results confirmed the existence of different levels of severity of pornography use corresponding to three different profiles. Also, findings revealed the influence of ADHD symptoms, obsessive-compulsive symptoms and depressive symptoms on PPU.

Early survival after acute myocardial infarction with ST-segment elevation: What could be improved? Insights from France PCI French registry.

Early mortality post-ST-segment elevation myocardial infarction (STEMI) in France remains high. The multicentre France Percutaneous Coronary Intervention Registry includes every patient undergoing coronary angiography in France. We analyzed the prevalence and impact of unmodifiable and modifiable risk factors on 30-day survival in patients experiencing STEMI. Patients admitted for STEMI between 01/2014 and 12/2016 were included in the analysis. Patients with nonobstructive coronary artery disease, with cardiogenic shock or cardiac arrest without STEMI, were excluded. Prehospital, clinical and procedural data were collected prospectively by the cardiologist in the cath lab using medical reporting software. Information on outcomes, including mortality, was obtained by a dedicated research technician by phone calls or from medical records. Marginal Cox proportional hazards regression was used to test the predictive value for survival at 30 days in a multivariable analysis. Included were 2590 patients (74% men) aged 63 ± 14 years. During the first month, 174 patients (6.7%) died. After adjustment, unmodifiable variables significantly associated with reduced 30-day survival were: age > 80 years (prevalence 15%; hazard ratio [HR] 2.7; 95% confidence interval [CI] 1.5-4.7), chronic kidney disease (2%; HR 5.3; 95% CI 2.6-11.1), diabetes mellitus (14%; HR 1.6; 95% CI 1.0-2.5), anterior or circumferential electrical localization (39%; HR 2.0; 95% CI 1.4-2.9), and Killip class 2, 3, or 4 (7%; HR 3.4; 95% CI 1.9-5.9; 2%; HR 10.1; 95% CI 5.3-19.4; 4%; HR 18; 95% CI 10.8-29.8, respectively). Among modifiable variables, total ischemic time > 3 hours (68%; HR 1.8; 95% CI 1.1-3.0), lack of appropriate premedication (18%; HR 2.2; 95% CI 1.5-3.3), and post-PCI TIMI < 3 (6%; HR 4.9; 95% CI 3.2-7.6) were significantly associated with reduced 30-day survival. Most predictors of 30-day survival post-STEMI are unmodifiable, but outcomes might be improved by optimizing modifiable factors, most importantly ischemic time and appropriate premedication.

Impact of the Lubrizol factory fire in Rouen on coronary events: A retrospective study from the France PCI registry.

BACKGROUND: On 26 September 2019, an industrial fire occurred in the Lubrizol factory in Rouen (France), exposing the population to the inhalation of many volatile toxic agents secondary to combustion. AIM: To assess the impact of the Lubrizol factory fire on the incidence of coronary artery events. METHODS: All coronary angiograms performed in Rouen (exposed) and Le Havre (unexposed) from May 2019 to December 2019 were extracted from the prospective France Percutaneous Coronary Intervention (France PCI) registry. To study the impact of the fire on coronary events, an interrupted time series analysis was performed in Rouen, with adjustment on Le Havre in an autoregressive moving average (ARMA)(1,1) model with the precision of 1 week. The primary outcome was the incidence of acute coronary syndrome, and the secondary outcome was the incidence of ST-segment elevation myocardial infarction. RESULTS: The mean number of acute coronary syndromes per week in the exposed zone (Rouen) increased non-significantly from 37.5±9.4 before the fire to 43.2±6.2 after the fire, for an estimated effect of +5.5 (95% confidence interval -0.7 to 11.8; P=0.09) events per week. In municipalities exposed to the plume of smoke (subgroup of Rouen), the mean number of acute coronary syndromes increased non-significantly from 7.3±2.8 before the fire to 8.7±3.6 after the fire, for an estimated effect of +1.0 (95% confidence interval -2.0 to 4.0; P=0.51) events per week. The results were similar when taking into account only ST-segment elevation myocardial infarctions or all coronary events. CONCLUSIONS: Our study did not find a significant effect of the Lubrizol factory fire on the incidence of acute coronary syndrome. Further studies are needed to investigate the impact of industrial accidents on air pollution and coronary events.

Incidence, delays, and outcomes of STEMI during COVID-19 outbreak: Analysis from the France PCI registry.

Objectives: The aim of this study was to assess the impact of the coronavirus disease 2019 (COVID-19) outbreak on incidence, delays, and outcomes of ST-elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PPCI) in France. Methods: We analyzed all patients undergoing PPCI <24 hours STEMI included in the prospective France PCI registry. The 2 groups were compared on mean monthly number of patients, delays in the pathway care, and in-hospital major adverse cardiac events (MACE: death, stent thrombosis, myocardial infarction, unplanned coronary revascularization, stroke, and major bleeding). Results: From January 15, 2019 to April 14, 2020, 2064 STEMI patients undergoing PPCI were included: 1942 in the prelockdown group and 122 in the lockdown group. Only 2 cases in the lockdown group were positive for COVID-19. A significant drop (12%) in mean number of STEMI/month was observed in the lockdown group compared with prelockdown (139 vs 122, P < 0.04). A significant increase in "symptom onset to first medical contact" delay was found for patients who presented directly to the emergency department (ED) (238 minutes vs 450 minutes; P = 0.04). There were higher rates of in-hospital MACE (7.7% vs 12.3%; P = 0.06) and mortality (4.9% vs 8.2%; P = 0.11) in the lockdown group but the differences were not significant. Conclusion: According to the multicenter France PCI registry, the COVID-19 outbreak in France was associated with a significant decline in STEMI undergoing PPCI and longer transfer time for patients who presented directly to the ED. Mortality rates doubled, but the difference was not statistically significant.

Caused motion across child languages: a comparison of English, German, and French.

Previous research on motion expression indicates that typological properties influence how speakers select and express information in discourse (Slobin, 2004; Talmy, 2000). The present study further addresses this question by examining the expression of caused motion by adults and children (three to ten years) in French (Verb-framed) vs. English and German (Satellite-framed). Participants narrated short animated cartoons showing an agent displacing objects and varying along several dimensions (Path, Manner). A significant increase with age was found in the number of expressed motion components in all languages, as well as an influence of Path (vertical > boundary crossing). However, at all ages, participants encoded more information in English and German than in French, where more variation and structural changes occurred with increasing age. These findings highlight both cognitive and typological factors impacting the expression of caused motion in development. Implications of our findings are sketched in the 'Discussion'.

Influence of early maladaptive schemas, depression, and anxiety on the intensity of self-reported cognitive complaint in older adults with subjective cognitive decline.

BACKGROUND: Subjective cognitive decline (SCD) designates a self-reported cognitive decline despite preserved cognitive abilities. This study aims to explore, in older adults with SCD, the association between intensity of self-reported cognitive complaint and psychological factors including Young's early maladaptive schemas (EMSs) (i.e. enduring cognitive structures giving rise to beliefs about oneself and the world), as well as depression and anxiety. METHODS: Seventy-six subjects (69.22 years ± 6.1) with intact cognitive functioning were recruited through an advertisement offering free participation in an intervention on SCD. After undergoing a neuropsychological examination (including global cognition (MMSE) and episodic memory (FCSRT)) and a semi-structured interview to assess depressive symptoms (MADRS), they completed a set of online self-reported questionnaires on SCD (McNair questionnaire), Young's EMSs (YSQ-short form), depression (HADS-D), and anxiety (HADS-A and trait-STAI-Y). RESULTS: The McNair score did not correlate with the neuropsychological scores. Instead, it was highly (r > 0.400; p < 0.005) correlated with trait anxiety and three EMSs belonging to the "Impaired autonomy and performance" domain: Dependence/incompetence, Failure to achieve and Vulnerability to harm or illness. Our final regression model comprising depression, anxiety, and these three EMSs as predictors (while controlling for age, gender, and objective cognition) accounted for 38.5% of the observed variance in SCD intensity. CONCLUSIONS: The level of cognitive complaint is significantly associated with Young's EMSs in the category of "Impaired autonomy and performance". We assume that SCD may primarily be driven by profound long-term inner beliefs about oneself that do not specifically refer to self-perceived memory abilities.

Altered synchrony of right ventricular contraction in borderline pulmonary hypertension.

Imaging studies have shown that pulmonary hypertension (PH) is associated with inhomogenous right ventricular (RV) regional contraction, or dyssynchrony, and that this is of prognostic relevance. This study aimed at the identification and functional significance of RV dyssynchrony in borderline PH defined by a mean pulmonary artery pressure between (mPAP) 20 and 25 mmHg. RV dyssynchrony was measured by 2-dimensional speckle tracking echocardiography in 17 patients with pulmonary arterial hypertension (PAH), 13 patients with borderline PH and 14 controls. Dyssynchrony was defined as the R-R interval-corrected standard deviation of the times to peak-systolic strain for the basal and medium segments of the RV. All the PH patients underwent a right heart catheterization. RV dyssynchrony amounted to 69 ± 34 ms in PAH, 47 ± 23 ms in borderline PH and 8 ± 6 ms in controls, all different from each other (p < 0.05). RV dyssynchrony in borderline PH was the only parameter of RV systolic dysfunction in 11 of 13 (85%) of the patients. RV dyssynchrony was accompanied by postsystolic shortening and correlated to RV fractional area change, not to mPAP or pulmonary vascular resistance. RV dyssynchrony occurs in borderline PH and may reflect early RV-arterial uncoupling.

How should "ambidexterity" be estimated?

Weak and absent hand preferences have often been associated with developmental disorders or with cognitive functioning in the typical population. The results of different studies in this area, however, are not always coherent. One likely reason for discrepancies in findings is the diversity of cut-offs used to define ambidexterity and mixed right- and mixed left-handedness. Establishing and applying a common criterion would constitute an important step on the way to producing systematically comparable results. We thus decided to try to identify criteria for classifying individuals ambidextrous, mixed right- or left-handed or strong right- or left-handed. For that purpose, we first administered a handedness questionnaire to 716 individuals and performed multiple correspondence analyses to define handedness groups. Twenty-four participants were categorized as ambidextrous (3.3%), as opposed to mixed (29.2%) and strong (56%) right-handers, and to mixed (9.1%) and strong (2.4%) left-handers. We then compared this categorization with laterality index (LI)-based categories using different cut-offs and found that it was most correlated with LI cut-offs at -90, -30, +30 and +90, successively delimiting strong left-handedness, mixed left-handedness, ambidexterity (-30 to +30), mixed right-handedness and strong right-handedness. The characteristics of ambidextrous and lateralized individuals are also compared.

Identity-expression interaction in face perception: sex, visual field, and psychophysical factors.

We investigated the psychophysical factors underlying the identity-emotion interaction in face perception. Visual field and sex were also taken into account. Participants had to judge whether a probe face, presented in either the left or the right visual field, and a central target face belonging to same person while emotional expression varied (Experiment 1) or to judge whether probe and target faces expressed the same emotion while identity was manipulated (Experiment 2). For accuracy we replicated the mutual facilitation effect between identity and emotion; no sex or hemispheric differences were found. Processing speed measurements, however, showed a lesser degree of interference in women than in men, especially for matching identity when faces expressed different emotions after a left visual presentation probe face. Psychophysical indices can be used to determine whether these effects are perceptual (A') or instead arise at a post-perceptual decision-making stage (B"). The influence of identity on the processing of facial emotion seems to be due to perceptual factors, whereas the influence of emotion changes on identity processing seems to be related to decisional factors. In addition, men seem to be more "conservative" after a LVF/RH probe-face presentation when processing identity. Women seem to benefit from better abilities to extract facial invariant aspects relative to identity.

The predictive value of a maculopapular rash in children hospitalized for dengue fever in Cayenne, French Guiana.

In order to determine the predictive value of a rash during dengue fever, a cohort study was conducted in children hospitalized for dengue during an epidemic in French Guiana. A rash was predictive of uncomplicated dengue: the HR of developing a severe form of disease was 0.43 (95% CI 0.21-0.88; p-value=0.021) for patients with rash.

Constitutional NRAS mutations are rare among patients with Noonan syndrome or juvenile myelomonocytic leukemia.

Recently, germline mutations of NRAS have been shown to be associated with Noonan syndrome (NS), a relatively common developmental disorder characterized by short stature, congenital heart disease, and distinctive facial features. We report on the mutational analysis of NRAS in a cohort of 125 French patients with NS and no known mutation for PTPN11, KRAS, SOS1, MEK1, MEK2, RAF1, BRAF, and SHOC2. The c.179G>A (p.G60E) mutation was identified in two patients with typical NS, confirming that NRAS germline mutations are a rare cause of this syndrome. We also screened our cohort of 95 patients with juvenile myelomonocytic leukemia (JMML). Among 17 patients with NRAS-mutated JMML, none had clinical features suggestive of NS. None of the 11 JMML patients for which germline DNA was available had a constitutional NRAS mutation.

Quality of care for myocardial infarction at academic and nonacademic hospitals.

BACKGROUND: Whether academic hospitals provide better quality of care for patients with acute myocardial infarction is widely debated. The aim of this study was to compare processes of care and mortality between academic and nonacademic hospitals in the contemporary era of acute myocardial infarction management. METHODS: We analyzed the original data from a prospective cohort study of 3059 patients, including 1714 with ST-segment elevation and 1345 with non-ST-segment elevation myocardial infarction, enrolled at 39 and 183 academic and nonacademic hospitals, respectively, in France. RESULTS: Unadjusted 1-year mortality for academic and nonacademic hospitals was 10% versus 15% for patients with ST-segment elevation myocardial infarction (P=.01) and 13% versus 14% for patients with non-ST-segment elevation myocardial infarction (P=.75). Patients treated in academic or nonacademic hospitals with percutaneous coronary intervention capability were more likely to receive reperfusion and recommended drug therapies than those treated in nonacademic hospitals without percutaneous coronary intervention capability. After adjusting for baseline characteristics, the hazards of death associated with admission to nonacademic hospitals with and without percutaneous coronary intervention capability relative to academic hospitals were 1.13 (95% confidence interval [CI], 0.79-1.62) and 1.65 (95% CI, 1.09-2.49) for those with ST-segment elevation myocardial infarction and 0.95 (95% CI, 0.66-1.36) and 1.06 (95% CI, 0.72-1.58) for those with non-ST-segment elevation myocardial infarction, respectively. Further adjustment for receipt of acute reperfusion and recommended drug therapies eliminated all differences in mortality between the study groups. CONCLUSION: Admission to academic hospitals was associated with a more frequent use of recommended therapies, conveying a survival advantage for patients with ST-segment elevation myocardial infarction.

On-line sentence processing in Swedish: cross-linguistic developmental comparisons with French.

This study examined on-line processing of Swedish sentences in a grammaticality-judgement experiment within the framework of the Competition Model. Three age groups from 6 to 11 and an adult group were asked to detect grammatical violations as quickly as possible. Three factors concerning cue cost were studied: violation position (early vs. late), violation span (intraphrasal vs. interphrasal) and violation type (agreement vs. word order). Developmental results showed that children were always slower at detecting grammatical violations. Irrespective of age, participants were faster at judging sentences with late violations, especially in the younger groups. Intraphrasal violations were more rapidly detected than interphrasal ones, particularly in adults. Finally, agreement violations and word order ones did not differ. The hierarchy of cue cost factors indicated that violation span was the dominant one. A cross-linguistic analysis with French (Kail, 2004) underlines the developmental processing abilities and the interdependence between cue cost and cue validity.

Phenomenology, psychopathology, and short-term therapeutic outcome of 102 infants aged 0 to 12 months consecutively referred to a community-based 0 to 3 mental health clinic.

Infants ages 0 to 1 year consecutively referred for psychiatric treatment during the year 2005 were followed, and variables associated with diagnosis and short-term outcome were assessed. Infants were evaluated using the Psychiatric Infant Navigator Chart and Evaluation that includes nosological diagnoses [Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood, (DC 0-3), Zero to Three, 1994] as well as risk and protective factors, treatment procedure, and outcomes. Seventy-six percent of the infants had an Axis I diagnosis, with anxiety disorders and a mixed disorder of emotional expressiveness being the most frequent. Twenty-five percent had an Axis II diagnosis. Multiple correspondence analyses showed that two dimensions corresponding grossly to DC 0-3 Axes I and II emerged. They emphasized three clinical profiles characterized by (a) good infant functioning, parent's awareness of their own difficulties, and a good outcome; (b) moderate child symptoms, overinvolved relating, and a good/intermediate outcome; (c) severe child symptoms, underinvolved relating, and a less favorable short-term outcome, signaling the risk for developmental disorders. Among the associated risk factors were cumulative parental stress, maternal psychopathology, and family dysfunction. Clinical implications of these findings indicated that infants under the age of 1 year who are referred for mental health evaluation and intervention are a heterogeneous group in terms of both severity and prognosis. Clinicians should differentiate subgroups of young children to detect those infants at risk for persistent psychopathology.

Motion in first language acquisition: Manner and Path in French and English child language*.

ABSTRACTTwo experiments compared how French vs. English adults and children (three to seven years) described motion events. Given typological properties (Talmy, 2000) and previous results (Choi & Bowerman, 1991; Hickmann, 2003; Slobin, 2003), the main prediction was that Manner should be more salient and therefore more frequently combined with Path (MP) in English than in French, particularly with four types of 'target' events, as compared to manner-oriented 'controls': motion up/down (Experiment I, N=200) and across (Experiment II, N=120), arrivals and departures (both experiments). Results showed that MP-responses (a) varied with events and increased with age in both languages, but (b) were more frequent in English at all ages with all events, and (c) were age- and event-specific among French speakers, who also frequently expressed Path or Manner alone. The discussion highlights several factors accounting for responses, with particular attention to the interplay between cognitive factors that drive language acquisition and typological properties that constrain this process from early on.