Early Start Research Articles

Étude exploratoire de la mise en place de l’Early Start Denver Model en France

BackgroundThe Early Start Denver model is one of the interventions recommended by the French High Authority on Health since 2012 for the very early care of children with Autism Spectrum Disorders. This program, developed in the United States, has shown the best evidence of effectiveness in an intensive form of delivery that is difficult to generalize to other culturally different contexts. Consequently, its implementation in the French health care system has required some adaptations that have not yet been evaluated. After a summary of the method's features and the results of studies of its effectiveness, this first retrospective descriptive observational study aims to characterize the implementation and practice of this intervention in France. In doing so, it also aims to better understand the potential obstacles to the implementation of early intervention and thus propose avenues for improvement. Material and methodA census of French units offering the Denver model was conducted from June to October 2020. A questionnaire sent to the participating units made it possible to explore different dimensions: first, the characteristics of these units, including their composition. Secondly, their integration into the care network and the children's care pathway. Practice and delivery modalities were also assessed. Finally, the objective was to highlight the difficulties that the teams may have faced when implementing the model. The data were collected in Microsoft Excel® software in order to perform a descriptive statistical analysis. ResultsIn total, 92% of the units surveyed participated in the study and returned the questionnaire. Our results highlight a significant heterogeneity in the deployment of the Denver method at the national level and underline the limit of resources available in the territory, particularly in its intensive delivery form. ConclusionFurther research is still needed to study the feasibility and effectiveness of ESDM interventions deployed in the specific context of the French healthcare system. In addition, significant work remains to be done to establish rapid and identifiable pathways for early intervention in young children with ASD.

Implications of Sleep Health Policy: Daylight Saving and School Start Times.

Two proposed public policies, ending seasonal clock change with a transition to permanent Standard Time and moving middle school and high school start times later, are population-based initiatives to improve sleep health. Daylight Saving Time and early school start times are associated with reduced sleep duration and increased circadian misalignment, the effects of which impact not only long-term health outcomes including obesity, cerebrovascular and cardiovascular disease, and cancer, but also mental health, academics, workforce productivity, and safety outcomes. This article highlights studies that led to the endorsement of these public policies by multiple scientific and medical organizations. Neurologists should advocate at the state and federal levels and educate the population about the importance of sleep health.

Randomized, controlled trial of a mixed early start Denver model for toddlers and preschoolers with autism.

The early start Denver model (ESDM) has been extensively studied as a promising early intervention approach for young children with autism spectrum disorder (ASD). Various methodological drawbacks from earlier ESDM investigations must be rectified to expand the application scopes. For this purpose, the present study recruited a very large sample of 249 autistic children (aged 24-47 months), and used a randomized controlled design to compare outcomes from a mixed ESDM (M-ESDM) intervention with a mixed discrete trial teaching (M-DTT) intervention which remains one of the most commonly-used programming for early intervention. Over the course of a 12-week period, both groups (i.e., M-ESDM and M-DTT groups) received 25 h of intensive intervention per week using individual, group, and parent coaching techniques. Findings showed that: (i) the M-ESDM significantly outperformed the M-DTT in enhancing children's developmental abilities in gross motor and personal-social skills for toddlers and preschoolers, as well as in language for preschoolers with mild/moderate ASD and toddlers; and (ii) the M-ESDM dramatically reduced the severity of autistic symptoms in toddlers with severe ASD only, when compared to the M-DTT. However, the M-ESDM did not outperform the M-DTT in terms of improving children's developmental abilities in adaptability and fine motor for toddlers and preschoolers, as well as in language for preschoolers with severe ASD. In addition, when compared to the M-DTT, the M-ESDM did not show an advantage in reducing the severity of autistic symptoms in toddlers with mild/moderate ASD and preschoolers. Clinical Trial Registration: Chinese Clinical Trial Registry. Registration number ChiCTR200039492.

Diagnosis of the Diseases Using Resampling Methods with Machine Learning Algorithms

The rapid diagnosis of diseases is very important for the early start of the treatment process. Pneumonia is a disease that affects the lungs and can cause death in advanced cases. Pneumonia is still today diagnosed by doctors while examining chest X-ray images. As diagnosis of the diseases using machine learning algorithms will be useful. In addition, high success of rate will be obtained while classifying balanced dataset by using machine learning algorithms. Resampling methods are used to balance the dataset by using under-sampling or over-sampling methods. In literature, there is no study comparing under-sampling and over-sampling methods. In the study, an open source dataset was used which included two classes published through the Kaggle data store. The data set includes 1341 healthy and 3875 pneumonia chest X-ray images. Two different resampling methods named Random under-sampling (RU) and ADASYN (Adaptive Synthetic) over-sampling were used while balancing healthy and pneumonia images. After this operation obtained data were used for training machine learning algorithms. In the study, first and second level attributes of the X-ray images in the dataset were used. Logistic Regression (LR) and Support Vector Machine (SVM) algorithms were used for classification of dataset. According to the results obtained, 93.109% accuracy rate of classification success was achieved of X-ray image dataset which balanced by ADASYN over-sampling method with SVM algorithms.

Modern approach to transfusion therapy of massive hemorrhage due to abnormally invasive placenta

Abnormally invasive placenta (AIP), or according to modern terminology PAS (placenta accrete spectrum disorders), is one of the most dangerous obstetric pathologies of pregnancy. It is quite often accompanied by massive blood loss during childbirth. Indicators of placenta accretion are increasing sharply, taking into account the frequency of delivery by cesarean section (CS).The objective: to determine the effectiveness of the blood loss recovery program in the case of delivery of pregnant women with AIP according to modern principles of transfusion therapy of massive blood loss with the use of innovative methods of surgical hemostasis.Materials and methods. At the clinical bases of the Department of Obstetrics and Gynecology N 1 of the Shupyk National Healthcare University of Ukraine during 2018–2023, 49 pregnant women with Placenta рercreta 3a,b were operated by fundal SC.The main group included 19 pregnant women with antenatally diagnosed Placenta percreta, who were delivered by fundal SC followed by hysterectomy with fallopian tubes and restoration of blood loss according to the principles of Damage Control Resuscitation – DCR (during 2021–2023) with priority given to transfusion with blood products with minimization infusion therapy; the comparison group included 30 pregnant women with a similar diagnosis and surgical approach, who had the recovery of massive blood loss in accordance with order No. 205 of the Ministry of Health of Ukraine “Obstetric bleeding” with the priority of rapid infusion therapy with crystalloids (2018-2020).Results. All pregnant women from Pl. percreta were delivered by CS and had hysterectomy at 35–37 weeks of pregnancy with lower median laparotomy and endotracheal anesthesia. The study groups did not differ in terms of the volume of surgery, but differed in the program of transfusion therapy to restore blood loss.In the main group, in which the early start of transfusion therapy using single-group fresh-frozen plasma and erythrocyte mass was applied, a significantly lower frequency of the development of the syndrome of disseminated intravascular blood coagulation, relaparotomy, cases of severe postoperative anemia and a shorter length of stay in the obstetric hospital were determined (p<0.05).Conclusions. The use of innovative surgical technologies, tranexamic acid preparations and early initiation of transfusion therapy with blood preparations with minimization of crystalloid infusion, according to the Damage Control Resuscitation strategy, in the development of massive intraoperative bleeding in cases of Placenta percreta allows to reduce the volume of blood loss and to prevent severe intra- and postoperative complication.

Oral treatment with the all-d-peptide RD2 enhances cognition in aged beagle dogs – A model of sporadic Alzheimer’s disease

Disease-modifying therapies to treat Alzheimer's disease (AD) are of fundamental interest for aging humans, societies, and health care systems. Predictable disease progression in transgenic AD models favors preclinical studies employing a preventive study design with an early pre-symptomatic treatment start, instead of assessing a truly curative approach with treatment starting after diagnosed disease onset. The aim of this study was to investigate the pharmacokinetic profile and efficacy of RD2 to enhance short-term memory and cognition in cognitively impaired aged Beagle dogs - a non-transgenic model of truly sporadic AD. RD2 has previously demonstrated pharmacodynamic efficacy in three different transgenic AD mouse models in three different laboratories. Here, we demonstrate that oral treatment with RD2 significantly reduced cognitive deficits in cognitively impaired aged Beagle dogs even beyond the treatment end, which suggests in combination with the treatment dependent CSF tau oligomer decrease a disease-modifying effect of RD2 treatment.

Exploring Perspectives and Reform Dynamics

In this study, our objective was to delve into the perspectives of Tunisian public elementary school English as a Foreign Language (EFL) teachers regarding the merits of introducing English at a younger age. We sought to test the hypothesis that an early start in English language instruction, following the "the younger the better" notion (Lenneberg, 1967; Penfield, 1959), would yield positive outcomes. To accomplish this, we collected data through a quantitative approach, involving a sample of 30 teachers, and conducted interviews with five English language inspectors representing different regions of Tunis.
 The analysis of the data revealed that a significant number of teachers in the observed Tunisian elementary schools acknowledged the importance of initiating English education at an earlier stage, recognizing the pivotal role English plays in the curriculum, and acknowledging children's remarkable enthusiasm for foreign language learning. However, despite this recognition, the Ministry of Education has not taken substantial steps towards implementing changes in the educational system.
 The findings of this study underscore the significance of English language instruction in Tunisian schools, and both educators and policymakers concur that lowering the age at which English is introduced offers distinct advantages to young second language learners by increasing their exposure to the language. The growing prominence of English education in public schools indicates its potential influence on future educational enhancements in Tunisian public schools.

Characterization of the central nervous system penetrant and selective purine P2X7 receptor antagonist JNJ-54175446 in patients with major depressive disorder

JNJ-54175446 is a selective purine P2X7 receptor (P2X7R) antagonist that attenuates microglial IL-1β/IL-18 release. In healthy volunteers, JNJ-54175446 suppressed peripheral interleukin (IL)-1β release, and attenuated dexamphetamine-induced improvements of mood and (visuo)motor performance in a human dexamphetamine-challenge paradigm. In depression, P2X7R inhibition may dampen immune-related dysregulation of mood. These results suggest that the impact of P2X7R inhibition is most prominent in situations where mood regulation is disrupted. Total sleep deprivation (TSD) results in an acute emotional perturbation, which yields a transient antidepressant effect. In the current study, TSD was applied as a behavioral challenge to investigate whether such effects could be modulated by JNJ-54175446. This was a double-blind, placebo-controlled, randomized study to assess the safety and pharmacokinetics of JNJ-54175446 and explore its effects in patients with single episode and recurrent major depressive disorder (MDD) (N = 69) and baseline total Inventory of Depressive Symptomatology Clinician Rated (IDS-C) > 30. Patients were randomized to receive JNJ-54175446 throughout the 10-day treatment period, placebo for days 1–3 followed by JNJ-54175446 or placebo throughout. All patients underwent 36 h of TSD starting on day three until the evening of day four. The early start group was hypothesized to experience a reduced effect from TSD whilst the late starting group was hypothesized to experience prolonged effects from the TSD. JNJ-54175446 was well-tolerated and adverse events were mild to moderate. JNJ-54175446 reduced IL-1β release by LPS-stimulated peripheral white blood cells in the presence of the P2X receptor agonist benzyl adenosine triphosphate (BzATP). JNJ-54175446 did not have a significant effect on mood as assessed using the Hamilton Depression Rating Scale, 17 items (HDRS17) and the Self-rated Quick Inventory of Depressive Symptoms (QIDS-SR). However, JNJ-54175446 blunted an acute reduction of anhedonia that occurred as a result of TSD, assessed by the Snaith-Hamilton Pleasure Scale (SHAPS) and the Probabilistic Instrumental Learning Task (PILT).

Importance of nutrient balance in severe congenital diaphragmatic hernia: A retrospective case–control study

Growth retardation is a common morbidity in infants with severe congenital diaphragmatic hernia (CDH). This study aimed to investigate the appropriate amount of nutrition and nutrient balance in early infants with severe CDH. This was a retrospective case-control study. Isolated CDH patients with more than half of the chest wall devoid of diaphragmatic tissue and treated between 2006 and 2022 were included. The patients were divided into positive (n=16) or negative (n=8) weight gain velocity groups in early infancy (from 1 to 3 months of age). Clinical variables and amount of nutrition were compared between the two groups. The earlier start of enteral nutrition (EN) and higher replacement rate of the naso-duodenal (ND) tube were observed more frequently in the positive group than in the negative group. Regarding daily intake by both EN and parenteral nutrition (PN), total caloric intake and caloric intake of proteins and lipids were significantly higher in the positive group than in the negative group at 1 month of age. At 2 months, total caloric intake and caloric intake of lipids were significantly higher in the positive group than in the negative group. At 3 months of age, only caloric intake of lipid was significantly higher in the positive group than in the negative group. The early replacement of the ND tube may contribute to the early start of EN, which may subsequently lead to appropriate nutrient supplementation including adequate lipid administration, resulting in early catch-up growth.

Abbreviating the Early Start Denver Model for community-based family-centered care.

Parent-mediated approaches for young children with or with a higher likelihood of autism have gained traction, with mounting evidence of efficacy, but a research-to-gap practice exists, and community effectiveness remains to be firmly established. Using a community-participatory framework, a total of 10 parent-child dyads received a five-day workshop and six follow-up sessions of ESDM parent coaching. Intervention was implemented across two phases with in-person and telehealth delivery. From pre to post intervention across both phases, parents improved in their fidelity of intervention implementation and children maid gains on proximal measures of social communication. Community delivery of an evidence-based parent-mediated interventions for toddlers on the autism spectrum is feasible and promising. Giving resource efficiencies associated with parent-mediated approaches, particularly when delivered through government-funded programs, findings bolster current efforts to promote earlier and more widespread community access to necessary interventions. Facilitators and barriers to supporting parent learning and behavior change via interactive strategies are discussed.

How Early Head Start Home Visitors Foster or Impede Shared Decision-Making with Families

ABSTRACT Rather than professional-driven decisions, shared decisions are central to family-centered philosophy and practices. This qualitative study investigated how four home visitors and 12 families engaged in institutional decision-making about 16 infants and toddlers enrolled in Early Head Start. The following research question was addressed: How do home visitor discursive strategies contribute to family participation during institutional decision-making about their child? Discourse analysis of detailed home visit transcripts focused on two phases of decision-making: (1) how home visitors opened decision-making, and (2) how home visitors signaled the opportunity for families to participate in making a choice. Although eight approaches were identified across both phases, only two aligned with features of shared decision-making. Instead, home visitors predominantly used unilateral approaches that drew on professional and curricular authority to narrow how families could participate in decision-making about their child. Unilateral approaches set the stage to enact professional recommendations without meaningful family participation, and created a context where home visitors could subtly exert decision-making control over families. Examining details of how decision-making unfolded contributes nuanced information about what shared decisions do – and do not – sound like, and offers insight into discursive strategies that better enact equitable partnerships with families.

EARLY INTERVENTION IN AUTISM SPECTRUM DISORDER: EXPLORING NEURODEVELOPMENTAL CONTEXT, THERAPEUTIC APPROACHES, AND TREATMENT OUTCOMES

Objective: This manuscript explores the neurodevelopmental context of early intervention for Autism Spectrum Disorder (ASD) and discusses the optimal timing for initiating intervention, primary intervention approaches, and predictors of treatment outcomes. It also provides an overview of various therapies commonly used for autism. The Early Start Denver Model is highlighted as an evidence-based early intervention approach.
 Methods: This comparative study involved 30 subjects randomly divided into Group A (early intervention) and Group B (late intervention). The study duration was six weeks, with four training sessions per week. Pre and post-treatment evaluations were conducted. The sample size was 15 participants in each group, and materials such as informed consent, assessment forms, and measuring tape were used. The study employed a random sampling method and set inclusion and exclusion criteria.
 Results: The distribution of cases according to age revealed that Group A had a higher proportion of individuals in the 4-6 y age group (40%), while Group B had the majority in the 9-14 y age group (73.33%). In terms of cognitive ability, Group A had a higher proportion of cases in the Poor (46.67%) and Very Poor (46.67%) categories, while Group B had more cases in the Good (33.33%) and Mild (33.33%) categories. However, the chi-square test did not yield statistically significant differences between the two groups for cognitive ability.
 Conclusion: This study highlights the importance of early intervention for individuals with ASD, as indicated by the higher proportion of younger individuals in Group A. However, the lack of statistical significance in the chi-square test emphasizes the need for further investigation and consideration of other influencing factors. The study contributes to the growing body of knowledge on early intervention for ASD and calls for larger sample sizes and rigorous study designs in future research to provide more robust evidence.

Remote Intensive Intervention for Young Children on the Autism Spectrum During COVID-19: the Experience of Caregivers and Service Providers

ObjectivesCommunity-based early autism intervention programs in Geneva, Switzerland, converted their in-person services to a telehealth format during the COVID-19 home confinement period. The current study was aimed at measuring the engagement and satisfaction of service providers and caregivers as they experienced telehealth services for the first time and at monitoring child progress.MethodsForty-five families from diverse backgrounds and their 45 service providers had daily videoconferencing sessions of primarily parent-mediated intervention. Satisfaction questionnaires were completed at three time points over a 2-month period. Session frequency and program participation were recorded. Caregiver and service provider’s answers were compared. Results were also analyzed by family annual income. Child progress was monitored using the Early Start Denver Model Curriculum Checklist.ResultsCaregivers and service providers maintained high levels of participation and satisfaction throughout the telehealth service period and appreciated how the telehealth format allowed them to meet more frequently. Lower-income families tended to be more unanimously positive about the services when compared with mid- and high-income families. We found significant group differences in service providers’ and caregivers’ perceptions of each other’s comfort level with the remote sessions. Child progress followed a pattern of continued significant improvement across most developmental domains during the telehealth service period.ConclusionsThese findings underscore the potential of telehealth as a promising and appreciated approach for delivering intensive early autism interventions in community settings. Further research is needed to determine optimal session frequency for remote parent-mediated intervention and to determine ways to make telehealth services more accessible for low-income families.

Efficacy of ivabradine in heart failure patients with a high-risk profile (analysis from the SHIFT trial).

Early start and patient profile-oriented heart failure (HF) management has been recommended. In this post hoc analysis from the SHIFT trial, we analysed the treatment effects of ivabradine in HF patients with systolic blood pressure (SBP)<110mmHg, resting heart rate (RHR)≥75b.p.m., left ventricular ejection fraction (LVEF)≤25%, New York Heart Association (NYHA) Class III/IV, and their combination. The SHIFT trial enrolled 6505 patients (LVEF≤35% and RHR≥70b.p.m.), randomized to ivabradine or placebo on the background of guideline-defined standard care. Compared with placebo, ivabradine was associated with a similar relative risk reduction of the primary endpoint (cardiovascular death or HF hospitalization) in patients with SBP<110 and ≥110mmHg [hazard ratio (HR) 0.89, 95% confidence interval (CI) 0.74-1.08 vs. HR 0.80, 95% CI 0.72-0.89, P interaction=0.34], LVEF≤25% and >25% (HR 0.85, 95% CI 0.72-1.01 vs. HR 0.80, 95% CI 0.71-0.90, P interaction=0.53), and NYHA III-IV and II (HR 0.83, 95% CI 0.74-0.94 vs. HR 0.81, 95% CI 0.69-0.94, P interaction=0.79). The effect was more pronounced in patients with RHR≥75 compared with <75 (HR 0.76, 95% CI 0.68-0.85 vs. HR 0.97, 95% CI 0.81-0.1.16, P interaction=0.02). When combining these profiling parameters, treatment with ivabradine was also associated with risk reductions comparable with patients with low-risk profiles for the primary endpoint (relative risk reduction 29%), cardiovascular death (11%), HF death (49%), and HF hospitalization (38%; all P values for interaction: 0.40). No safety concerns were observed between study groups. Our analysis shows that RHR reduction with ivabradine is effective and improves clinical outcomes in HF patients across various risk indicators such as low SBP, high RHR, low LVEF, and high NYHA class to a similar extent and without safety concern.

Constraining the Triassic–Jurassic boundary carbon cycle perturbations using high-resolution δ 13 C org records from the Haojiagou section in northwestern China

Abstract Large magnitude and rapid negative carbon isotope (δ 13 C) excursions in the Triassic–Jurassic boundary (TJB) interval have been proposed as critical evidence for the hypothesis that the emplacement of the Central Atlantic Magmatic Province (CAMP) triggered global carbon cycle perturbations and the end-Triassic mass extinction (ETE). However, the pattern and timing of δ 13 C variations during the ETE remain poorly constrained. Here I present high-resolution organic carbon isotope (δ 13 C org ) records from a terrestrial TJB succession continuously exposed along the Haojiagou valley on the southern margin of the Junggar Basin, northwestern China. The δ 13 C chemostratigraphic correlations, combined with the palynological data, indicate that the position of the TJB should be placed at the base of bed 53. Importantly, the results show that two rapid negative carbon isotope excursions at the end Triassic roughly coincide with two episodes of variations in the palynological records. This observation supports the hypothesis that two pulses of biotic crisis during the ETE may have been triggered by two major episodes of CAMP magmatic activity. In addition, the data in this study support an early start for CAMP magmatic activity in the early Rhaetian, which may have led to a global carbon cycle perturbation and the related biotic crisis or turnover.

Application of response surface methodology to optimize the emissions and performance of a dual fuel engine using diesel and dimethyl ether

AbstractIn this study, the combustion and exhaust emission characteristics of a single‐cylinder, water‐cooled, four‐stroke VCR engine at a fixed CR were evaluated using DME and diesel with timed manifold injections of 2, 3, 4, and 5 ms for DME and conventional diesel settings. The investigational trials showed that DME has the capability to reduce NOx and OP while used in an optimized range and to have clean combustion characteristics. Induction of DME under low to medium load conditions resulted in a reduction in NOx, OP, and BTE with an increase in HC, whereas at higher load settings, NOx increased with an increase in diesel energy share. The dual fuel combustion was characterized by a short ignition delay, an early start of combustion, and increased in‐cylinder pressure due to the increased compression work input during the cycle. The absence of carbon–carbon bonds in DME molecules caused low soot emissions during dual fuel combustion. After experimentation, RSM was applied to the results for parametric optimization and found to be a useful tool for reducing the error as well as minimizing the number of trials. The optimum settings were achieved at 2 kW load and 4 ms duration, where the desirability function reached a value of 0.94189. The regression equations developed by the model were validated by 9 random experiments, and the error is found to be acceptable. The engine should be operated at medium load to control NOx, and the DME energy share should be low and near 50%.

Case report peripheral ulcerative keratitis with nodular scleritis, presents as the primary manifestation of granulomatosis with polyangiitis.

A 38-year-old female complaining of recurrent deep boring pain with redness in her left eye for many years, which was diagnosed as nodular scleritis with peripheral ulcerative keratitis. The patient also has recurrent bouts of epistaxis and in suspicion of GPA laboratory investigations were carried out and later diagnosed. She was started on cyclophosphamide and is currently under maintenance with rituximab. Ocular involvement has been shown to occur in 20-50% of the population in several studies. It causes conjunctivitis, episcleritis, scleritis, necrotizing keratitis, corneoscleral perforation, posterior uveitis, and optic neuritis. The positive C-ANCA and high PR3 autoantibody have high sensitivity and association with GPA. Cyclophosphamide has been shown to be an effective treatment in multiple studies whereas rituximab has been emerging as a new treatment modality for maintenance, which in turn helps in the remission and relapse of GPA cases. Scleritis and peripheral ulcerative keratitis can be the manifestation of a GPA. Careful evaluation, diagnosis, and management with a multidisciplinary medical team, early start of cyclophosphamide, and rituximab have a huge role in decreasing the disease activity and is life-saving.

Application of the International classification of functioning, disability and health in medical rehabilitation of children with severe traumatic brain injury

BACKGROUND: The problem of rehabilitation of patients with severe traumatic brain injury has been and remains very important and relevant for both adults and children. Patients with severe traumatic brain injury often develop severe physical, mental, emotional and cognitive impairments, which are often difficult to correct and require long-term treatment, including rehabilitation, relying solely on the body's potential, which is accompanied by a heavy financial burden for the patient, his family, and society in general. The introduction of new diagnostic methods, the improvement of resuscitation measures, the use of modern methods of neurosurgical intervention and timely rehabilitation can increase the proportion of children who survived after severe traumatic brain injury and their quality of life.&#x0D; AIM: to evaluate the effectiveness of medical rehabilitation of children with severe traumatic brain injury with the participation of a multidisciplinary rehabilitation team and relatives of patients.&#x0D; MATERIALS AND METHODS: The study included 50 children with severe traumatic brain injury. Two groups were distinguished by the randomization method: the main group 25 patients (50%) and the control group, which included 25 patients (50%). The follow-up period was 1 year after the onset of severe traumatic brain injury. In the main group, an individual plan for early rehabilitation was drawn up on the 2nd day after a severe traumatic brain injury in intensive care. At the first stage of rehabilitation, which is carried out in the intensive care unit and the neurosurgery department, an individual medical rehabilitation plan was developed for the children of the main group, depending on somatic indicators and the severity of the condition, and a rehabilitation diagnosis based on the International classification of functioning, disability and health was established. In the control group, after transfer from the intensive care unit to the specialized neurosurgical department, patients received basic rehabilitation therapy: articular gymnastics, paraffin therapy, and psychological support.&#x0D; RESULTS: In the main group, more effective changes were noted in domains associated with impaired structure and function of the nervous system, which led to improved activity and participation, self-service. In patients of the control group, there were no significant changes in the state of functions, activity and participation.&#x0D; CONCLUSION: The early start of complex medical rehabilitation of children with severe traumatic brain injury reduces disability and accelerates the process of the patient's socialization, which is more clearly demonstrated by the International classification of functioning, disability and health approach. The use of International classification of functioning, disability and health for with severe traumatic brain injury in children in medical rehabilitation departments is a good tool for setting rehabilitation goals, choosing rehabilitation measures and assessing the effectiveness of rehabilitation.

From Closure to Gradual Release: Evidence from the Spatial Evolution and Causal Mechanism of EGS Industry in the Main Town Area of Wuhan, China

With the economic impact and increasing popularity of the electronic gaming industry, EGS (Electronic Gaming Sports) had become an important topic of debate in sports academia regarding its conceptual delineation and attribute characteristics. This paper jumped out of the hotpot academic perspective of the concept, characteristics, and impacts of EGS. In response to the gaps in the spatial development of the EGS industry and the lack of empirical research findings, an interpretive empirical research method was adopted, focusing on Wuhan as the study area to gain insight into the situation where the spatial development of the EGS industry was unclear. The spatial evolution of the EGS industry in the main town area of Wuhan was interpreted through a quantitative approach and based on the spatial data of EGS companies from 2006 to 2022 using Average Nearest Neighbor (ANN), Kernel Density Estimation (KDE), and Ordinary Kriging (OK) of geospatial analysis. The results indicated closure to the gradual release of the EGS industry, with specific findings as follows. (1) The EGS industry in the main town area of Wuhan from 2006 to 2022 developed rapidly, and the overall spatial distribution showed a process from discrete to cluster, accompanied by an apparent deepening of aggregation in recent years. The local aggregation of the EGS industry transformed from dual to multiple cores, and the multiple cores formed stronger groups of aggregation as the cluster spread and merged. (2) The spatial interpolation of the registered capital of companies predicted the hot spot of high- capital distribution of EGS companies in the Optics Valley vice town area of Hongshan to the southeast, indicating that more competitive EGS companies and larger EGS industry groups might emerge in Optics Valley in the future. (3) The spatial evolution of the EGS industry in the main town area of Wuhan could be divided into an early start phase from 2006-2010, a rapid development phase from 2010-2014, an aggregate explosion phase from 2014-2018, and a cluster integration phase from 2018-2022. (4) The spatial evolution of the EGS industry was influenced not only by the main factors of industrial economic agglomeration, industrial chain derivation, and industrial policy environment but also by the other factors of land and talent market, adjacent infrastructure support, city industrial promotion, and globalization dissemination. The future development of the EGS industry could be guided by the government's industrial policies, supported by high-quality talent teams, and driven by local promotion and international communication to provide an essential impetus for the optimal EGS industry.

O-130 Initiation of ovarian stimulation in the late follicular phase, a randomized controlled trial

Abstract Study question Does late follicular phase stimulation yield similar outcomes compared with conventional early follicular phase stimulation in a GnRH antagonist protocol in oocyte donors? Summary answer Late follicular phase stimulation is not inferior in terms of number of oocytes compared to early follicular phase stimulation in a GnRH antagonist protocol. What is known already In patients undergoing fertility preservation for medical reasons, late follicular phase stimulation has been effectively used, resulting in similar numbers of total and mature oocytes obtained, oocyte maturation rate, mature oocyte yield, and fertilization rates compared to conventional early follicular phase ovarian stimulation. Because of LH suppression by endogenous progesterone in the luteal phase, there is less need for the use of a GnRH antagonist. Study design, size, duration This is an open label, phase 3, non-inferiority, randomized controlled trial using a two-arm design with 1:1 allocation ratio. The study included 71 oocyte donors between 18 and 36 years, with a regular menstrual cycle length and BMI 19-35 kg/m2, who underwent ovarian stimulation between November 2018 and May 2022. Patients were allocated to either early follicular start (Group A, n = 36), or to late follicular start (Group B, n = 35). Participants/materials, setting, methods In Group A, patients followed a fixed GnRH antagonist protocol with r-FSH 225IU daily. In Group B, r-FSH 225IU daily was initiated when a dominant follicle and late follicular hormonal values were observed, a GnRH antagonist was added if serum LH-levels were &amp;gt;10IU/L. The primary outcome was number of cumulus-oocyte-complexes (COCs). Secondary endpoints included number of mature oocytes, consumption of gonadotropins, duration of ovarian stimulation, days of GnRH antagonist used, and cost of the stimulation. Main results and the role of chance Using an intention-to-treat analysis, the total number of oocytes did not differ between Group A and Group B (17.7±10.0 vs 17.2±9.1, p = 0.82, difference 0.49 ,95% CI (-4.04 to 5.03)). In the per protocol analysis, after excluding 4 patients, there was no difference between Group A and Group B (18.2±9.7 vs 18.8±7.8, p = 0.62, difference -0.6, 95% CI (-4.9 to 3.7)).The number of mature oocytes did not differ between Group A and Group B (14.1±8.1 vs 12.7±8.5, p = 0.48). In none of the treatment arms OHSS was observed. The duration of stimulation was shorter in Group A than in Group B (10.0±1.6 vs 10.9±1.5 days, p = 0.01). The total amount of r-FSH used was lower in group A than in Group B (2240.7±313.9 IU vs 2453.9±330.1 IU p = 0.008). A GnRH antagonist was used for approximately 6 days in Group A, while in group B, only in one patient a GnRH antagonist was prescribed for 4 days (6.0±1.4 days vs 0.13±0.7 days p &amp;lt; 0.001). There was a significant difference in total medication cost per cycle between both protocols (1147.9±182.8 € in Group A, vs 979.9±129.0 € in group B, p &amp;lt; 0.001), i.e. a cost reduction of 15% for Group B as compared with Group A. Limitations, reasons for caution A limitation of the study is the lack of embryology data. Because of adaptations in the oocyte donation program in our center over the years, this study contains a mix of fresh and frozen donation cycles, leading to a very heterogenous group, making correct interpretation of the embryology data difficult. Wider implications of the findings Late follicular phase stimulation is as efficient as early follicular phase stimulation in terms of number of oocytes. It is patient-friendly, with reduced cost and reduced number of injections. Trial registration number NCT03767218