The COVID-19 pandemic impact on continuity of care provision on rare brain diseases and on ataxias, dystonia and PKU. A scoping review

One of the most relevant challenges for healthcare providers during the COVID- 19 pandemic has been assuring the continuity of care to patients with complex health needs such as people living with rare diseases (RDs). The COVID-19 pandemic accelerated the healthcare sector's digital transformation agenda. The delivery of telemedicine services instead of many face-to-face procedures has been expanded and, many healthcare services not directly related to COVID-19 treatments shifted online remotely. Many hospitals, specialist centres, patients and families started to use telemedicine because they were forced to. This trend could directly represent a good practice on how care services could be organized and continuity of care could be ensured for patients. If done properly, it could boast improved patient outcomes and become a post COVID-19 major shift in the care paradigm. There is a fragmented stakeholders spectrum, as many questions arise on: how is e-health interacting with 'traditional' healthcare providers; about the role of the European Reference Networks (ERNs); if remote care can retain a human touch and stay patient centric. The manuscript is one of the results of the European Brain Council (EBC) Value of Treatment research project on rare brain disorders focusing on progressive ataxias, dystonia and phenylketonuria with the support of Academic Partners and in collaboration with European Reference Networks (ERNs) experts, applying empirical evidence from different European countries. The main purpose of this work is to investigate the impact of the COVID-19 pandemic on the continuity of care for ataxias, dystonia and phenylketonuria (PKU) in Europe. The analysis carried out makes it possible to highlight the critical points encountered and to learn from the best experiences. Here, we propose a scoping review that investigates this topic, focusing on continuity of care and novel methods (e.g., digital approaches) used to reduce the care disruption. This scoping review was designed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews (PRISMA-ScR) standards. This work showed that the implementation of telemedicine services was the main measure that healthcare providers (HCPs) put in place and adopted for mitigating the effects of disruption or discontinuity of the healthcare services of people with rare neurological diseases and with neurometabolic disorders in Europe.

The Arcuate Fasciculus and language origins: Disentangling existing conceptions that influence evolutionary accounts

The Arcuate Fasciculus (AF) is of considerable interdisciplinary interest, because of its major implication in language processing. Theories about language brain evolution are based on anatomical differences in the AF across primates. However, changing methodologies and nomenclatures have resulted in conflicting findings regarding interspecies AF differences: Historical knowledge about the AF originated from human blunt dissections and later from monkey tract-tracing studies. Contemporary tractography studies reinvestigate the fasciculus' morphology, but remain heavily bound to unclear anatomical priors and methodological limitations. First, we aim to disentangle the influences of these three epistemological steps on existing AF conceptions, and to propose a contemporary model to guide future work. Second, considering the influence of various AF conceptions, we discuss four key evolutionary changes that propagated current views about language evolution: 1) frontal terminations, 2) temporal terminations, 3) greater Dorsal- versus Ventral Pathway expansion, 4) lateralisation. We conclude that new data point towards a more shared AF anatomy across primates than previously described. Language evolution theories should incorporate this continuous AF evolution across primates.

Lost in the matrix: Dialectical tensions in facilitating virtual video groups during COVID-19 pandemic

The research phenomenologically explored the experience of facilitating virtual video groups during the COVID-19 pandemic. Research questions addressed relational processes in virtual video groups, including emotional presence, interpersonal communication, and intimacy. Specifically, we asked how facilitators can intervene effectively to promote these processes in the virtual space, within the context of social distancing. Semi-structured group interviews were held with 26 female group facilitators from various professional backgrounds during the first wave of COVID-19 in Israel in May 2020. Phenomenological analysis yielded five main themes addressing dialectical tensions that operate simultaneously in the virtual space, both enabling and hindering relational processes in virtual video groups: intimacy and intrusion in the domestic space; sharp transitions from presence to absence; fragmented processing despite abundant information; sterility and clarity in group communication; and the hyper-aware self - being a participant and an observer at the same time. Moving groups into a virtual sphere challenged the traditional role of facilitators, who struggled to create a safe space in an unstable virtual setting where the boundaries between personal and professional lives were reduced. Findings also point to the potential of the domestic space to promote closeness and intimacy and suggest the virtual space requires facilitators to embrace multiplicity as a state of mind when intervening. Facilitators must work with permeable boundaries between inner and outer group spaces, accept discontinuity as a basic property of the virtual, and acknowledge the limitations caused by multiple stimuli.

Mode conversion of SH guided waves with symmetry inversion in plates

When shear horizontal ultrasonic guided waves interact with thickness discontinuities in plates, the reflected and transmitted wavefields can be composed of several modes due to mode conversion. It is known that in a plate with a symmetric discontinuity, with respect to the plate's mid-plane, mode conversion is restricted to modes that share the same symmetry as the incident mode. In this paper, we use an analytical model based on the reciprocity principle and finite element analysis to investigate mode conversion due to the interaction with different types of discontinuity, namely, non-symmetric, symmetric and geometrically symmetric but with opposite boundary conditions, that is one side of the discontinuity free and the other rigidly fixed. We show that the reflected field due to interaction with the latter is virtually restricted to modes with the opposite symmetry of the incident one, acting as a symmetry inverter discontinuity. Unlike fully symmetric discontinuities, the effectiveness of a symmetry inverter discontinuity depends on the frequency. This was proved with aid of the analytical model for a full-depth discontinuity and verified for partial depth discontinuities. Finally, symmetry inversion of SH waves was experimentally verified in acrylic plates which were symmetrically machined and filled with steel in one side to mimic a fixed boundary condition.

Anxiety and Depression During Childhood and Adolescence: Testing Theoretical Models of Continuity and Discontinuity

The present study sought to clarify the trajectory (i.e., continuous vs. discontinuous) and expression (i.e., homotypic vs. heterotypic) of anxiety and depressive symptoms across childhood and adolescence. We utilized a state-of-the-science analytic approach to simultaneously test theoretical models that describe the development of internalizing symptoms in youth. In a sample of 636 children (53% female; M _age = 7.04; SD _age = 0.35) self-report measures of anxiety and depression were completed annually by youth through their freshman year of high school. For both anxiety and depression, a piecewise growth curve model provided the best fit for the data, with symptoms decreasing until age 12 (the "developmental knot") and then increasing into early adolescence. The trajectory of anxiety symptoms was best described by a discontinuous homotypic pattern in which childhood anxiety predicted adolescent anxiety. For depression, two distinct pathways were discovered: A discontinuous homotypic pathway in which childhood depression predicted adolescent depression and a discontinuous heterotypic pathway in which childhood anxiety predicted adolescent depression. Analytical, methodological, and clinical implications of these findings are discussed.

Continuity of Learning in Discontinuous Conditions: Children Experience of Transition in Irreversible Time

In this theoretical paper, I propose that in certain conditions children's subjective continuity (irreversible time) of experience could be sustained by objective discontinuity in reference to instruments like the clock that is used to sequentialize time in school. I suggest that it happens through intervals-as-transitions (c.f., breaks in school) that Min (2018; this special issue) undermines for epistemological reasons but insisted upon by Bergson. I use Bergson to epistemologically reframe Min's (2018) interesting suggestions -that I partially use- with respect to irreversible time. Yet, my epistemological and theoretical suggestion contrasts with both authors' perspective, for instance Bergson's critic of objective discontinuity as contaminating subjective experience while paradoxically tackling intervals that are constructed in discontinuous conditions. In this regard, I use Bergson's as well as He Min's conceptual contradictions with respect to subjective and objective time as zones for theoretical development enabling the extension of their approach. I mainly use ethnographic examples I made and secondarily from McLaren's (1999) analysis of the intersection of school, family and community rituals to illustrate my epistemological and theoretical propositions.

The S-curve discontinuity theory predicts the path towards a "well" society and increased longevity

The logistic function or logistic growth curve is an "S" shape (sigmoid curve) that has been applied to numerous fields, including geology, physics, biology, mathematics, chemistry, economics, sociology, oncology, and statistics. The S-curve initiates with exponential growth, followed by slowing of growth as saturation occurs, and completion of growth at maturity. The S-curve follows the law of natural growth with a limiting factor, whether it be a competition for resources, investigation and demand for new products, or an economic bubble. The concept of the S-curve has been utilized in medicine to describe the advancements in the 20th century based on the diagnosis and treatment of disease (the "illness" curve [first S-curve]) and predict the future focused on disease prevention and health promotion (the "wellness" curve [second S-curve]). Herein, we propose a third S-curve that we are labeling the "longevity" curve.

Age and other risk factors related to reentry to care from kin guardian homes

Although kinship guardianship is an increasingly important foster care exit pathway for children in the United States, research on the factors leading to kinship guardianship breakdown is lacking. This study examines the factors associated with guardianship breakdown for children who exited foster care to kinship guardianship in California between 2003 and 2010 (N = 18,831). Specifying time-dependent Cox relative risk models, children's age trajectories are directly accounted for in the analysis. This allows differentiation between duration dependence (i.e., time spent in guardianship) and children's development (expressed as age). Overall, 17.3% of children reentered care by 2017. Early adolescents, age 13-15 years (HR = 1.63, p < .001), and late adolescents, age 16-17 years (HR = 1.93, p < .001), had an increased hazard of reentry compared with children under the age of six. Children with a history of mental health concerns had more than twice the hazard of reentering than children without such a history (HR = 2.18, p < .001). Our findings indicate that transition to adolescence was associated with increased risk of reentry into care, highlighting the need for guardianship support services leading up to, and during, this child developmental stage.

Effect of discontinuity dip direction on hard rock pillar strength

Discontinuities are geologic occurrences in rock and when present within a pillar, reduce the strength of the pillar. Empirical formulas that are commonly used to determine pillar strength do not explicitly take into account the presence of discontinuities and thus can overestimate the pillar strength. The effect of discontinuities on the strength of pillars has been investigated using numerical models, but in these models, the discontinuity strike was parallel with the pillar faces. In this study, fully three-dimensional hard rock pillars were simulated using numerical modeling to understand the effect of the discontinuity dip direction on square and rectangular hard rock pillars. Based on the results, recommendations to assess a pillar's strength in the presence of a discontinuity are discussed.

Continuity for children after guardianship versus adoption with kin: Approximating the right counterfactual

Over the past two decades there has been a rapid increase in the number of children and youth living in guardianship and adoptive homes who were previously in foster care. Further, previous studies compared outcomes for children in guardianship homes to those for children in adoptive homes, despite the fact that many factors likely affect the selection of foster youth into different types of permanent placements. This study examined two counterfactuals for guardianship as a permanent placement type: adoption only and adoption or long-term-fostercare (A+LTFC). Longitudinal outcomes were tracked for children who exited foster care with relatives through guardianship (N=4,884) or adoption (N=12,163), as well as children in long-term foster care with relatives (N=4,840). Propensity scores were used to match children on key indicators. In the matched sample of guardianship versus adoption cases only, children who exited to guardianship were more likely to experience discontinuity than children who exited through adoption, 11% vs. 6% respectively. However, when guardianship was compared to the combination of adoption or long-term foster care, children in guardianship experienced the same proportion of discontinuity, 11% vs. 11% respectively. These results suggest that simply matching guardianship to adoption without taking into account LTFC may be the wrong way to estimate the "what if" counterfactual if children were not discharged to guardianship. Findings also support the use of guardianship as a potential solution for children in LTFC whose caregivers are not planning to adopt.

Review and proposal of regional surgical management for melanoma: revisiting of integumentectomy and incontinuity dissection in treatment of skin melanoma

BACKGROUND

Past studies showed that integumentectomy and incontinuity could be effective procedures in the surgical management of melanoma patients. The present study reports on the historical background of these procedures. In addition, we analyze the ICG assisted integumentectomy and incontinuity techniques and algorithms that we had created when performing this procedure.

METHOD

In accordance with our algorithm, we performed ICG assisted integumentectomy/incontinuity procedures on 17 patients with stage III melanomas between 2008 and 2016. We also investigated the locoregional recurrence rate in a control group comprising 60 patients at stage III without using the algorithm.

RESULTS

The former group exhibited a tendency of locoregional recurrence rate suppression. Melanoma cells in the dissected intervening tissue were microscopically identified in 2 out of 17 cases.

CONCLUSIONS

Our ICG assisted integumentectomy or incontinuity procedures could be effective in controlling locoregional recurrence rates in melanoma cases. Moreover, our method can be generally applied because the dissection is only performed within the lymphatic pathway region identified using indocyanine green.

A template model of embodiment while dreaming: Proposal of a mini-me

Dreams are usually centered around a dream self capable of tasks generally impossible in waking, e.g. flying or walking through walls. Moreover, the bodily dream self appears relatively stable and insensitive to changes of the embodied wake self, raising the question of whether and to what extent the dream self is embodied. To further explore its determinants, we tested whether the dream self would be affected by either pre-sleep focused attention to a body part or by its experimental alteration during the day. Choosing a repeated-measures design, we analyzed how often key words reflecting the experimental manipulations appeared in the dream reports. Results suggest that the dream self is not affected by these manipulations, strengthening the hypothesis that, in the majority of dreams, the dream self is only weakly embodied, utilizing a standard template of embodiment akin to a prototype of self operating independently from the physical waking self.

Unfavorable bioresorbable vascular scaffold resorption, a cause of restenosis?

We report a case of bioresorbable vascular scaffold restenosis which could be caused by abnormal resorption 17months after implantation.

[Role of rhythmicity in infant development]

This article deals with rhythm in the experiences of infants, focusing in particular on the function of rhythmicity in the baby's sense of being and its continuity. Infants are inevitably subjected to experiences of discontinuity. These experiences are necessary to development, but they expose the child to chaotic experiences when a basic rhythmicity is not ensured. The rhythmicity of childcare experiences gives the illusion of permanence and enables anticipation. This nourishes the basic feeling of security and supports the development of thought. Interactive and intersubjective exchanges must be rhythmic and must be in keeping with the rhythm of the baby, who needs to withdraw regularly from the interaction to internalize the experience of the exchange. Without this retreat, the interaction is over-stimulating and prevents internalization. Object presence/ absence must also be rhythmic, to enable the infant to keep the object alive inside him/ herself. Observation of babies has demonstrated their ability to manage experiences of discontinuity: they are able to sustain a continuous link via their gaze, look for clues indicating the presence of a lost object, search for support in sensations, and fabricate rhythmicity to remain open to the self and the world. The author gives some examples of infant observations that provide evidence of these capacities. One observation shows how a baby defends itself against a discontinuity by actively maintaining a link via his/her gaze. Another example shows an infant holding on to "hard sensations" in order to stay away from "soft" ones, which represent the fragility of the separation experience. This example pertains to a seven-month-old's prelanguage and "prosodic tonicity". The author takes this opportunity to propose the notion of "psychic bisensuality" to describe these two sensation poles, which must be harmoniously articulated to guarantee an inner sense of security. Such repairs of discontinuity are only possible if the experience of discontinuity is not overly disorganizing. For instance, if an object is absent for more than a certain amount of time, it is no longer alive in the infant's mind and despair is inevitable. This prompts us to think carefully about the separation experiences we impose upon babies and their duration. Rhythms of security set in right from the beginning of early childhood, or even in utero. The author gives an example of recourse to inner rhythmicity in an 8 - or 9-month-old baby, which serves to ground the baby's sense of security. In infants, as in each one of us, rhythmicity organizes a foundation of permanence and bridges the gap created by separation. If leaning on sensations and creating neo-rhythms fails to repair the discontinuities, the baby will plunge into experiences of chaos and confusion, as seen, for example, in inconsolability. Even in this latter case, one can find a rhythmicity in the infant's crying, for example, as if the baby didn't want to be separated from the sorrow, a sort of paradoxical companion. Traces of all these primitive defenses can be found in the older child and in adult psychopathology. The importance of rhythmicity is stressed in relation to learning, which involves the experience of otherness and reality, and the rhythmic patterns of engagement and withdrawal support the integration process. The same holds true for the caretaking relationship: rhythmic involvement supports coming together, sharing, and understanding. In all of these situations, the parent, the teacher, the caregiver, must adapt to the child, the pupil, the patient; the external rhythms must fit the internal rhythm of the subject.

Motor and language abilities from early to late toddlerhood: using formalized assessments to capture continuity and discontinuity in development

Developmental tests reflect the premise that decreases in skills over time should be a sign of atypical development. In contrast, from a psychological perspective, discontinuity may be viewed as a normal part of typical development. This study sought to describe the variability in patterns of continuity and discontinuity in developmental scores over time. Seventy-six toddlers (55% boys) from a larger screening study were evaluated at 13 and 30 months using the Mullen Scales of Early Development (MSEL) in five areas: gross motor, fine motor, visual perception, receptive language, and expressive language. Parents completed the First Year Inventory (FYI) at 12 months as well. At 30 months, 23.68% of the sample received a clinical diagnosis (e.g., developmental delay, autism spectrum disorder [ASD]). Toddlers were classified as stable, increasing, or decreasing by at least 1.5 standard deviations (SD) on their scores in each of the five MSEL areas from 13 to 30 months. Between 3.9% and 51.3% of the sample was classified as increasing and 0-23.7% as decreasing across areas. Decreases in motor areas were associated with increases in language areas. None of the toddlers showed decreases greater than 1.5 SD on their MSEL composite scores. There was no single pattern that characterized a certain diagnosis. Higher FYI sensory-regulatory risk was associated with decreases in gross motor. Lower FYI risk was linked with increases in receptive language. Developmental discontinuity in specific developmental areas was the rule rather than the exception. Interpretations of decreases in developmental levels must consider concurrent increases in skill during this emerging period.

Rhythmicity in infants' experiences and their development

This article deals with the importance of rhythm in infants' experiences, underscoring its function in relation to sense of being and the continuity of that sense. Although some discontinuity is inevitable, and indeed necessary for development, it can expose infants to chaotic experiences if there is no underlying rhythmicity. Observations of infants have highlighted their ability to manage their experiences of discontinuity (providing these are not too disorganizing) by finding supports and manufacturing a rhythmicity that enables them to remain open to self and to the world. Rhythmicity of experience is important not just in infant development, but also - and more generally - in learning contexts and psychological care settings. In every situation, external rhythms must be attuned to the individual's inner one.