Children with cerebral palsy (CP) often present with chronic respiratory symptoms. Pseudomonas aeruginosa (PA), is a known pathogen associated with more severe respiratory disease. Preventive actions to eradicate this bacterium and to improve the respiratory condition of children with CP could be very valuable. Therefore, we assessed the prevalence of PA and its association with respiratory disease. Throat swabs were taken in children with CP, aged 0–18 years. Data from patient records were extracted from the electronic medical records. Follow-up of respiratory symptoms was done by the Liverpool respiratory symptom questionnaire (LRSQ) after 3 months. The prevalence of PA in our population of children with CP is low, gram-negative bacteria were most commonly found. The respiratory consequences of being colonized with these bacteria were limited. These results may have been affected by the COVID-19 pandemic. Further research is recommended. Volume 11 - 2023 | https://doi.org/10.3389/fped.2023.1267345 Introduction: Children with cerebral palsy (CP) often present with chronic respiratory symptoms is a known pathogen associated with more severe respiratory disease Preventive actions to eradicate this bacterium and to improve the respiratory condition of children with CP could be very valuable we assessed the prevalence of PA and its association with respiratory disease Methods: Throat swabs were taken in children with CP Data from patient records were extracted from the electronic medical records Follow-up of respiratory symptoms was done by the Liverpool respiratory symptom questionnaire (LRSQ) after 3 months Results: A throat swab and a completed LRSQ after 3 months were received from 79 children with CP Twenty-eight patients (35.4%) were found to have at least one positive respiratory culture Only 4 patients (5.1%) were contaminated with PA Gram negative bacteria were isolated in 21.5% of the positive throat swabs Most pathogens were found in patients with higher GMFCS score (GMFCS IV and V) Results of the LRSQ showed that 52.1% of these patients reported having 1 cold in the past 3 months Discussion: The prevalence of PA in our population of children with CP is low gram-negative bacteria were most commonly found The respiratory consequences of being colonized with these bacteria were limited These results may have been affected by the COVID-19 pandemic From experience in children with cystic fibrosis, it is known that chronic colonization of the lower airways with PA is a risk factor for repeated lung infections, deterioration in lung function and shortened survival (6). It is also known that early therapy will prevent chronic colonization (6) Preventive actions to eradicate this bacterium and to improve the respiratory condition of children with CP could therefore be of interest We assessed the prevalence of PA and its association with respiratory disease in a prospective study including patients with a diagnosis of CP who attended either specialized day care centers in Flanders and/or the Antwerp Reference Centre of Cerebral Palsy in the Antwerp University Hospital Exclusion criteria included a known presence of PA defined as a throat swab with a positive culture for PA and eradication treatment in the last month before inclusion First inclusion was done between August 2017 and January 2018 new inclusions were done from January 2020 to September 2020 Data from patient records were extracted from the electronic medical records by three reviewers The first six domains assess respiratory symptoms during daytime The remaining two assess the impact of symptoms on the child and family Results of the LRSQ showed that 52% of these patients reported having 1 cold in the past 3 months Six patients (8.5%) had a lower respiratory tract infection Antibiotics were prescribed in 13 of 71 patients (18%) Only three patients were admitted to the hospital only one of these patients had a positive culture (e.g. none of these patients were colonized with PA No statistically significant relation could be found between the number of colds and/or pneumonia, the use of antibiotics or hospitalization and having a positive culture Descriptive statistics and chi square tests for positive culture It is often used in children who are not able to expectorate sputum or in young children Our study showed that there is a correlation between GMFCS score and colonization with gram-negative bacteria The short-term respiratory consequences of being colonized with these bacteria were limited in our prospective study there were also few or no reported complaints such as wheezing We could not demonstrate a statistically significant correlation between number of colds the use of antibiotics or hospitalization with having a positive culture One possible explanation for this effect during the second inclusion period could be the COVID-19 pandemic with two lockdowns and therefore less exposure to pathogens due to less social contact and extensive hygienic measures no visitors in specialized day-care centers and closed schools Another possible explanation regarding the limited findings of PA and respiratory symptoms is that the inclusion of the two parts of the study took place in different seasons The first part was included from August through January and the second part was included from January through September the LRSQ was conducted in the spring/summer with possibly less circulation of pathogens causing respiratory tract infections we chose to detect chronic colonization in children without known chronic lung disease and then seasonal variation of pathogens may have less of an impact As we know life expectancy in CP can improve by both preventive measurements as initiation of early therapy concerning respiratory morbidity The prevalence of PA in this prospective study of children with CP is low it is recommended to repeat and expand this study since the prevalence of respiratory tract infections is again increasing in the post-covid era The original contributions presented in the study are included in the article/Supplementary Material further inquiries can be directed to the corresponding author The studies involving humans were approved by Ethisch Comité Universitair Ziekenhuis Antwerpen The studies were conducted in accordance with the local legislation and institutional requirements Written informed consent for participation in this study was provided by the participants’ legal guardians/next of kin The author(s) declare that no financial support was received for the research patient’s parents and healthcare workers for their participation in this research The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher Respiratory morbidity in children with cerebral palsy: an overview Reasons for hospital admissions among youth and young adults with cerebral palsy Nomogram for pneumonia prediction among children and young people with cerebral palsy: a population-based cohort study Prevention and management of respiratory disease in young people with cerebral palsy: consensus statement Association between chronic aspiration and chronic airway infection with pseudomonas aeruginosa and other gram-negative bacteria in children with cerebral palsy Pseudomonas aeruginosa infection in patients with cystic fibrosis: scientific evidence regarding clinical impact Assessing the liverpool respiratory symptom questionnaire in children with cystic fibrosis Detection of pseudomonas aeruginosa in patients with cystic fibrosis Van Hoorenbeeck K and Verhulst S (2023) Pseudomonas aeruginosa in children with cerebral palsy: a prospective study Received: 26 July 2023; Accepted: 19 October 2023;Published: 6 November 2023 © 2023 Romaen, Van Ussel, Van Rossem, Kenis, Ceulemans, Van Hoorenbeeck and Verhulst. 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publish a single carriage pulls into the little town of Ussel The station has scarcely changed since it was built in 1880 Passengers still step over the rails to cross to the platform opposite Clumps of grass and tall weeds sprout between the tracks This article appeared in the Europe section of the print edition under the headline “Two-speed nation” Discover stories from this section and more in the list of contents A low-tech fix is delivering high-impact results George Simion will face Nicusor Dan, a mainstream candidate, in a run-off There are five luxuries it can no longer feasibly afford Friedrich Merz’s career is one of unforced errors and puzzling missteps Both Donald Trump and Ukraine’s diplomats will consider it a success It’s been seven years since JóiPé & Króli became an overnight sensation Their 2017 single B.O.B.A became the country’s most-played song rushing the then-18-year-olds under the national spotlight mixing modern-day hip-hop production in between snippets of musician Bubbi Morthens commentating on a boxing match Having written music together for just about a year at the time B.O.B.A.’s breakthrough moment spurred a long-lasting collaboration between the two artists the pair have branched out into separate avenues — Króli in acting they’re always interested in returning to their productive Lennon/McCartney dynamic JóiPé and Króli kick off the upcoming concert series ‘Söngvaskáld’ in Kópavogur’s Salurinn the series highlights some of Iceland’s most beloved contemporary artists inviting audiences to five intimate evenings of performances and artist talks Kristinn Óli Haraldsson (Króli) and Jóhannes Damian Patreksson (JóiPé) are currently in Akureyri as Kristinn takes part in Leikfélag Akureyrar’s production of the Little Shop of Horrors “I’m heading back to school in January to finish my acting degree,” Kristinn says as he takes a bite out of his lunch “It’s funny we decided on calling it volume one,” he continues “I didn’t imagine us creating a larger collection.” Jóhannes adds jokingly Collaborating with the Copenhagen-based artist USSEL — who previously worked with Icelandic artist Daniil — SCANDIPAIN vol 1 is the duo’s first release since the 2020 Í miðjum kjarnorkuvetri Supported by nonstop momentum throughout its six tracks the album exhibits a sense of newfound joy among the duo The connection to the Danish USSEL (Emil Mercedes Baadsgaard) was suggested by the group’s friend and Copenhagen-based events promoter Snorri Ástráðsson who incidentally was selected as one of the top 20-under-30 music professionals by IQ magazine “Snorri knew of Emil who set it up and brought us together,” explains Jóhannes “We went over a weekend to Copenhagen and wrote a bunch of songs We were playing around and getting to know each other we allowed ourselves to be a bit careless.” the album came as a breath of relief amidst speculation of the two discontinuing future music releases Those speculations were intensified by the release of JóiPé’s 2022 debut solo album Fram í rauðan dauðann and Kristinn’s submersion into theatre projects “I was planning to quit or at least take a break,” Kristinn admits but we always kept in touch,” he continues “I never felt that we stopped working together,” says Jóhannes — a feeling perhaps influenced by the duo’s constant performances “A month didn’t pass that we didn’t have a show or meet up,” adds Kristinn Coming up on their eighth year working together neither Kristinn nor Jóhannes show any interest in quitting the collaboration “Our relationship has been in constant development since we first started working together no matter whether we stop trying to be pop stars we think we’ll continue doing something,” Kristinn says confidently the pair find opportunities to explore their separate interests together Jóhannes worked on a musical for Kristinn’s school project in 2022 paving the way for their collaboration on a production at the National Theatre the children’s play Orri Óstöðvandi premiering in March “That’s something we both enjoy,” Kristinn says of the project “Jói has been writing theatre music for a lot of projects at the Iceland University of Arts At the heart of the duo’s collaboration lies their love of performing “We’re going to try all kinds of new things and challenge ourselves,” Jóhannes says of their upcoming Salurinn show “We’re stripping down playback and changing up the arrangements We’re playing songs we haven’t played in a long time.”  JóiPé & Króli have been supported by a combination of a backing band and pre-recorded playback One of the challenges Jóhannes refers to includes arranging their songs for a fully-formed support band “It’s something we’ve been planning to do for a long time,” says Kristinn this will be a completely different show.”  Focusing on less-represented songs from their catalogue JóiPé & Króli will honour Salurinn’s audience with performances of brand-new material from their forthcoming releases Söngvaskáld premieres September 28 at Salurinn, Kópavogur, with a performance by JóiPé & Króli. Other artists featured in the series include JFDR, Bríet, Gugusar, and Emmsjé Gauti. For tickets and more information, visit salurinn.kopavogur.is Tourist Sexually Harassed In Blue Lagoon Tourist Held Hostage On May Day Culture Night Killer Sentenced To Prison Starbucks To Open In Reykjavík Soon An Ode to Flateyri Grapevine Events: The Clock, Other-Grounds Film Festival, Icelandic Sorcery Festival & More Police Officers Spied On Citizens For Iceland’s Richest Man From Army Brats To Luxury Flats In summer 2013 I decided the time had come to check it out and discover the area's potential historical problems needed cleaning but I didn't think I'd unearth anything new That summer I spent every day wandering through the forest until my attention was caught by an 8m high boulder overhanging prow seemed climbable and as I began to clean it holds literally appeared from below the moss That's how "Amélie" (7B+) saw the light of day A series of slopers and precise heel and toe hooks lead to the top of the arete a difficult mantle and then the final 3 easy metres Thanks to this problem I realised that I have to look at the entire area from a different perspective and I began to clean the moss-covered rock and quickly put up a series of new problems "Revelation" seemed unclimbable at first: to the left of "Rosa Canina" a thin tufa seemed impossible to hold but in the end a foothold appeared thanks to some brushing and the moves became possible at 7C I also got to work on an old project dating back to the 80's a boulder located at the top of the hill with a 6C stand start but in the end I finally worked out the beta and sent "Butterfly effect" (7C+) but it's currently the hardest problem at Ussel EnglishEspañol This is the first agribusiness deal where one of the signatories refers its own suppliers to the bank as candidate borrowers BBVA Mexico and Nestlé are expanding their "Crediproveedores" agreement to extend credit to up to 1,500 Nestlé suppliers in the agribusiness sector BBVA Mexico will consider granting credit on favorable terms to primary-sector suppliers designated by Nestlé as part of its value chain The arrangement sets the stage for up to 300 million pesos in new credit Head of Corporate and Investment Banking at BBVA Mexico "The expansion of the Crediproveedores scheme with Nestlé represents a milestone in the commitment of both institutions to foster the development of SMEs that seek to support the environment and society We appreciate Nestlé's strong commitment to its suppliers said: "This is one more step in our commitment to the sustainable development of the Mexican countryside and in the transition to regenerative food systems This alliance allows us to reaffirm our commitment to sustainability and to be very proud to continue driving positive change in small and medium-sized enterprises" commented: "The bank's lending process accommodates this agreement and enables us to offer terms that suit the agribusiness sector's specific features while helping companies transition to sustainable production systems.” To offer effective coverage BBVA Mexico has developed a specialized structure and a robust array of credit solutions to support the agribusiness The goal is to support the Mexican farming sector with a special focus on the wellbeing of society The signing of this partnership agreement demonstrates both companies' commitment to promote the Mexican farming sector and to support small and medium-sized companies that work every day to fulfill their engagements while respecting the environment and their responsibility to society The initial “Crediproveedores” arrangement with Nestlé was signed in July of last year 3,000 million pesos have been mobilized through a factoring line BBVA is committed to mobilizing €300 billion from 2018 to 2025 Nearly 77 percent has been allocated to the fight against climate change and 23 percent to promoting inclusive growth Argentina Colombia Switzerland Belgium Mexico United Kingdom Uruguay Peru Venezuela Metrics details An Author Correction to this article was published on 20 April 2023 This article has been updated SARS-CoV-2 infection triggers profound and variable immune responses in human hosts Chromatin remodeling has been observed in individuals severely ill or convalescing with COVID-19 but chromatin remodeling early in disease prior to anti-spike protein IgG seroconversion has not been defined We performed the Assay for Transposase-Accessible Chromatin using sequencing (ATAC-seq) and RNA-seq on peripheral blood mononuclear cells (PBMCs) from outpatients with mild or moderate symptom severity at different stages of clinical illness Early in the disease course prior to IgG seroconversion modifications in chromatin accessibility associated with mild or moderate symptoms were already robust and included severity-associated changes in accessibility of genes in interleukin signaling regulation of cell differentiation and cell morphology single-cell analyses revealed evolution of the chromatin accessibility landscape and transcription factor motif accessibility for individual PBMC cell types over time The most extensive remodeling occurred in CD14+ monocytes where sub-populations with distinct chromatin accessibility profiles were observed prior to seroconversion Mild symptom severity was marked by upregulation of classical antiviral pathways these classical antiviral signals diminished suggesting dysregulated and less effective responses these observations offer novel insight into the epigenome of early mild SARS-CoV-2 infection and suggest that detection of chromatin remodeling in early disease may offer promise for a new class of diagnostic tools for COVID-19 limited data are available examining the peripheral blood immune responses early in disease progression and prior to seroconversion To test the hypothesis that the landscape of chromatin accessibility contains biomarkers that define early molecular mechanisms that underpin divergent immunologic responses in SARS-CoV-2 infection we performed bulk and single-cell Assay for Transposase-Accessible Chromatin using sequencing (ATAC-seq) and RNA-seq on longitudinal PBMC samples from patients before and after seroconversion and fatigue were most common in the moderate group Coughing was most common in the mild group and runny nose was most common in the close contacts Differential gene expression in peripheral blood mononuclear cells (PBMCs) distinguishes COVID-19 symptom severity (A) Volcano plot depictions of differential gene expression from comparisons of healthy controls to IgG− subjects with mild symptoms (left) and healthy controls to IgG− subjects with moderate symptoms (right) Differential expression in genes with p ≤ 0.05 are plotted in red (B) Principal component analysis (PCA) using differentially expressed genes identified in IgG− subjects with mild symptoms (green) and moderate subjects (blue) show distinct separation from healthy controls (red) (C) Volcano plot depictions of differential gene expression from comparisons of healthy controls to IgG+ subjects with mild symptoms (left) and healthy controls to IgG+ subjects with moderate symptoms (right) (D) PCA using differentially expressed genes identified in IgG+ subjects with mild symptoms (green) and moderate subjects (blue) show distinct separation from healthy controls (red) (E) Log fold change (LFC) in differentially expressed genes in IgG− subjects with mild symptoms as a function of IgG− subjects with moderate symptoms (left) and likewise in IgG+ subjects (right) Genes differentially expressed in mild compared to healthy are green moderate compared to healthy are red and genes differentially expressed in mild or moderate compared to healthy controls are blue Remodeling of the chromatin landscape identifies gene regulatory markers associated with symptom severity comparing healthy controls to mild symptom IgG− subjects (left) and healthy to moderate symptom IgG− subjects (center) and IgG− mild to moderate symptoms (right) Regions that are significantly different in each comparison at p ≤ 0.05 are red; regions not significantly different are black A loess curve fit to the results is plotted in blue comparing healthy controls to mild symptom IgG+ subjects (left) healthy controls to moderate symptom IgG+ subjects (center) and mild to moderate IgG+ subjects (right) (C,D) Heat map depiction of differentially accessible regions (DARs) that compares healthy to mild symptoms (left column) healthy to moderate symptoms (center column) and mild to moderate symptoms (right column) in IgG− subjects (C) and in IgG+ (D) (E,F) Functional enrichment analysis of DARs in the TRANSFAC database (purple) and gene ontologies (GO) in categories of biological processes (BP DARs identified comparing healthy to mild symptoms (top) or healthy compared to moderate symptoms (bottom) are shown for IgG− (E) and IgG+ (F) subjects Epigenetic signatures in cells collected from COVID-19 subjects evolve with disease progression (A) Uniform manifold approximation and projection (UMAP) plot of single-cell ATAC-seq data generated from healthy controls and COVID-19 subjects with mild or moderate symptoms (left) Relative abundance of cell types represented in the scATAC-seq data are plotted for each group at IgG− and IgG+ timepoints for COVID-19 subjects and collection day 0 and 14 for close contacts (right) (B) Transcription factor motif accessibility and binding activity measured by footprint depth (left) or average per-cell gene expression (right) in COVID-19 subjects with mild or moderate symptoms Distribution of accessibility and gene expression are plotted as histograms along the axes (gray) The red circle is the average of all points; the dark blue circle is 50% of all data; the light blue circle is 75% of all data Motifs with the top 5% change in flanking accessibility are plotted in red (C) Differentially accessible chromatin between IgG− and IgG+ timepoints in all cells and (D) CD14+ monocytes Differentially accessible chromatin observed across the IgG− mixed and IgG+ timepoints in COVID-19 subjects is shown where significance is defined as p ≤ 0.05 and absolute LFC ≥ 0.5 (top); Changes in differentially accessible chromatin are shown across time (bottom) Domains of regulatory chromatin (DORCs) are enriched in myeloid cells indicating epigenetic control of cell fate (A) Number of peak-to-gene linkages in cells from IgG− subjects is shown by a plot of rank sorted genes as a function of number of correlated peaks Genes with > 10 linkages are defined as DORCs Labeled genes are known to be regulated by a super-enhancer (B) DORC gene activity for 1109 loci plotted for each cell type (right) Labeled DORC genes are known to be regulated by a super-enhancer (top) (C) Super-enhancer regulated DORC genes for nuclear receptor corepressor 2 (NCOR2 Peak-to-gene linkages in CD14+ monocytes and other myeloid cells are plotted with a correlation cutoff of 0.5 CD14+ monocytes undergo extensive chromatin remodeling prior to seroconversion and harbor severity-specific epigenetic biomarkers (A) scRNA-seq UMAP of all CD14+ monocytes collected from mild and moderate IgG− subjects UMAP colored by disease severity (left) and cluster number (right) (B) Heat map depiction of regulon activity computed for each scRNA-seq cluster using SCENIC Activity of the top 10 regulons (right) is plotted for each cluster of cells from the UMAP (bottom) The black box indicates clusters of interest (C) scATAC-seq UMAP of all CD14+ monocytes collected from IgG− mild and moderate subjects (D) Heat map depiction of transcription factor motif enrichment of identified regulons (right) plotted for each scATAC-seq cluster (bottom) (E) Correlation plot using regulon activity to link clusters between scRNA-seq (columns) and scATAC-seq (rows) (F) Enrichment of gene expression in monocyte-related pathways for CD14+ monocyte subsets from IgG− mild and moderate subjects Pathway scores were computed for cell subsets from two published datasets for comparison Hierarchical clustering was applied to samples within each dataset Our future studies will determine association between epigenetic biomarkers and specific symptoms that reflect damage to the CNS or peripheral nervous systems The study was approved by the Duke University Institutional Review Board Protection of human subjects was in accordance with research protocols approved by the Duke University Institutional Review Board consistent with the Declaration of Helsinki Written informed consent was obtained from all research subjects or their legally authorized representatives Subjects with confirmed or suspected SARS-CoV-2 infection or their close contacts were identified in the outpatient setting and enrolled into the Molecular and Epidemiological Study of Suspected Infection protocol (MESSI All close contacts and subjects with mild or moderate COVID-19 were longitudinally sampled from enrollment to convalescent phase Biological samples and demographic information were collected prospectively at first visit (Day 0) and at weekly intervals on Day 7 and Day 14 infection with SARS-CoV-2 was confirmed using quantitative polymerase chain reaction (qPCR) of nasopharyngeal (NP) swab samples and serology testing was performed for IgG against the SARS-CoV-2 spike domain All subjects with mild or moderate COVID-19 progressed from seronegative (IgG−) to seropositive (IgG+) Close contacts were qPCR negative and IgG− at all time points; healthy controls were enrolled pre-pandemic and were not tested for SARS-CoV-2 or spike protein IgG Self-reported symptom surveys were performed at each visit was determined from symptom onset through each longitudinal sample collection SARS-CoV-2 q-PCR tests used virus RNA extracted from NP samples in 140 µL of viral transport medium (VTM) using QIAamp Viral RNA Mini Kit (QIAGEN Cat# 52904) according to manufacturer’s instructions SARS-CoV-2 nucleocapsid (N1) and human RNase P (RPP30) RNA copies were determined using 5 µL of isolated RNA in the CDC-designed kit (CDC-006-00019 Integrated DNA Technologies 2019-nCoV kit) SARS-CoV-2 IgG ELISA tests for antibody response were performed using the anti-SARS-CoV-2 spike S1 domain IgG ELISA assay (EUROIMMUN Medizinische Labordiagnostika AG Peripheral blood mononuclear cells (PBMCs) were purified using the Ficoll-Hypaque density gradient method according to manufacturer’s instructions whole blood was collected in ACD Vacutainer tubes (Becton Dickinson Cat# 364606) and processed within 8 h by dilution 1:2 in PBS layered onto the Ficoll-Hypaque (Sigma Aldrich Cat# D8537) by centrifugation at 400 × g for 10 min to isolate PBMCs which were assessed for viability and cell count using a Vi-Cell automated cell counter (Beckman-Coulter) PBMCs were adjusted to 10 × 106 cells/ml in cryopreservation media (90% FBS frozen at − 80 °C using CoolCell LX (BioCision) for 12–24 h and stored in liquid nitrogen vapor phase Detailed methods for qPCR and antibody tests 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Methods 16, 397–400. https://doi.org/10.1038/s41592-019-0367-1 (2019) Download references We thank Eric van Gieson and Thomas Thomou for their advice throughout the project and their teams at the Duke Regional Biocontainment Laboratory for COVID IgG serology and PCR viral load testing and Jorge Prado Balcazar for technical expertise We wish to express our deep appreciation to the participants and their families for their generosity in collaborating with us in this work N66001-09-C-2082 and HR0011-17-2-0069) to XS and CWW the Veterans Affairs Health System and Virology Quality Assurance (VQA) 75N93019C00015 to CWW and NIH/NIAID UC6AI058607 to the Duke Biocontainment Laboratory This work used a high-performance computing facility supported by grants 2016-IDG-1013 and 2020-IIG-2109 from the North Carolina Biotechnology Center Center for Applied Genomics and Precision Medicine Durham Veterans Affairs Health Care System Department of Pharmacology and Cancer Biology Department of Molecular Genetics and Microbiology Duke Human Vaccine Institute and Department of Medicine Department of Civil and Environmental Engineering collected samples and generated data; N.S.G. MTM reports grants on biomarker diagnostics from the Defense Advanced Research Projects Agency (DARPA) TWB reports grants from DARPA and is a consultant for and holds equity in Predigen and Biomeme and CWW report patents pending on Molecular Methods to Diagnose and Treat Respiratory Infections ELT reports grants on biomarker diagnostics from DARPA the NIH/Antibacterial Resistance Leadership Group (ARLG); an ownership stake in Predigen and Biomeme; consultancy fees from bioMerieux; GSG reports an ownership stake in Predigen and Biomeme; CWW reports grants on biomarker diagnostics from DARPA and Sanofi; and has received consultancy fees from bioMerieux BDK and XS have no competing interests to report Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations The original online version of this Article was revised: The original version of this Article contained errors where a study participant was omitted in the mild COVID-19 experimental group for “bulk” analysis Full information regarding the corrections made can be found in the correction for this Article Download citation DOI: https://doi.org/10.1038/s41598-022-15668-8 Anyone you share the following link with will be able to read this content: Sorry, a shareable link is not currently available for this article. Sign up for the Nature Briefing: Translational Research newsletter — top stories in biotechnology, drug discovery and pharma. Fitchburg High School held commencement Friday at Crocker Field. Method: This cross-sectional survey-based study collected demographic data and mental health measurements from 1,010 volunteers (838 women) who consented online to participate, from March 24 to June 28, 2020, in France. Participants filled out online questionnaires and visual analogic scales that evaluate affective symptoms related to the COVID-19 sanitary crisis, namely symptoms of post-traumatic stress, burnout, emotion regulation abilities, and coping abilities. Conclusion: Post-traumatic and burnout symptoms were highly prevalent among French healthcare workers at the beginning of the COVID-19 crisis. Exposure to COVID-19 is a determining factor. We can thus promote both coping training and a good environment to limit the emotional consequences of exposure to COVID-19. Volume 12 - 2021 | https://doi.org/10.3389/fpsyt.2021.701127 Background: COVID-19 sanitary crisis is associated with emotional difficulties such as depression anxiety and reactional post-traumatic symptoms among healthcare workers healthcare workers were particularly exposed to COVID-19 sanitary crisis This study aimed to investigate the effects of exposure to COVID-19 sanitary crisis on affective symptoms (anxiety burnout) among French healthcare workers and the mediating role of cognitive emotion regulation strategies (positive re-evaluation and set in perspective) and coping strategies (active coping Method: This cross-sectional survey-based study collected demographic data and mental health measurements from 1,010 volunteers (838 women) who consented online to participate Participants filled out online questionnaires and visual analogic scales that evaluate affective symptoms related to the COVID-19 sanitary crisis Results: The majority (57.8%) of the participants presented post-traumatic symptoms a proportion of participants reported moderate (25.9–31.2%) to severe (17.2–40.7%) burnout symptoms We found a significant effect of the level of exposure to COVID-19 on affective symptoms having a lower job position and having less experience were associated with higher level of affective symptoms coping strategies had a mediating effect on the relation between stress and burnout Conclusion: Post-traumatic and burnout symptoms were highly prevalent among French healthcare workers at the beginning of the COVID-19 crisis Exposure to COVID-19 is a determining factor We can thus promote both coping training and a good environment to limit the emotional consequences of exposure to COVID-19 a repeated cross-sectional study set out an increased prevalence of depression among health workers over time after the crisis the present study aimed to investigate the effects of exposure to COVID-19 sanitary crisis on mental health among French healthcare workers we were interested in the effect of COVID-19 exposure on anxiety post-traumatic stress and burnout symptoms This study aimed also to identify the mediating role of cognitive emotion regulation strategies (positive re-evaluation and set in perspective) and coping strategies (active coping behavioral disengagement) on the relation between stress exposure and burnout we recruited 1,010 participants using social media (Facebook Twitter and LinkedIn) and mailing lists from ten main university hospitals across the country (e.g. All healthcare workers working at university hospitals were eligible to answer the study Participation required reading an information note online and choosing to either continue with the study or decline to proceed The experiment and consent procedures were approved by the ethics committee of the University (Comité d'Ethique de la Recherche Tours-Poitiers) Participants did not receive any compensation for the study participants answered socio-demographic questions and indicated their level of exposure to COVID-19 with multiple-choice questions We distinguished first-line workers who worked with patients infected by COVID-19 second-line workers who worked with potentially infected patients and third-line workers who had no contact with infected or potentially infected patients Participants also reported the number of suspected confirmed and severe cases of coronavirus in their hospital unit and the number of deaths We evaluated if the participants and their relatives were infected or had risk factors participants filled out successively a series of online self-questionnaires Data were collected between March 24 and June 28 We also found a good internal consistency within our sample: exhaustion (α = 0.90) depersonalization (α = 0.66) and accomplishment (α = 0.74) an exhaustion-score under 18 is considered as low A depersonalization-score under 3 is considered as low An accomplishment-score under 34 is considered as low The CERQ (27) is a self-reported questionnaire that evaluates cognitive emotion regulation strategies. We used two sub-dimensions of this scale: positive re-evaluation and set in perspective. Each sub-dimension is composed of 4 items. Participants had to answer on a Likert scale from 1 (almost never) to 5 (almost always). The French version demonstrated good psychometric properties for the different subscales (28) (Cronbach α between 0.68 and 0.87) We also found a good internal consistency in our sample for the two sub-dimensions (positive re-evaluation α = 0.73 The IES-6 (29, 30) is a self-reported questionnaire that was used to evaluate post-traumatic symptoms related to the COVID-19 outbreak. Participants had to answer questions related to the main events they identified, on a 5 points Likert scale. Experimental studies demonstrated good psychometric properties (Cronbach α = 0.80), similar in our sample (α = 0.81). The cut-off is 10.5 for post-traumatic stress disorder (29) Participants answered 30 analogic visual questions to assess the effect of COVID-19 on their mental health. Questions were developed by the authors based on a clinical consideration of symptoms experienced by healthcare workers during the crisis. Participants were asked to respond on a Likert scale from 0 to 10. The questions evaluated stress, worries, powerlessness, guilt, anger and other emotional difficulties related to the sanitary crisis (see Supplementary Material 1) This COPE (31) is a self-reported questionnaire evaluates coping strategies Each dimension is evaluated with two questions The scale demonstrated good psychometric properties 43.9% of the participants had close relatives with suspected COVID-19 infection; 40.8% had close relatives with a risk factor disease (e.g. respiratory disease); 31.2% had close relatives tested positive for COVID-19; 13.9% were infected by coronavirus and 21.2% presented risk factor diseases for COVID-19 A majority (52.9%) of the participants were in first-line with COVID-19 patients 39.5% were in second-line with potential contact with infected patients and 7.6% of the participants were in third-line (no contact with infected patients) The median numbers of COVID-19 cases reported by the participants in their hospital department were as follows: 3 suspected cases 1 death due to COVID-19 and none non-accepted patient due to a lack of space we considered 7–10 as an important level A majority (77%) of the participants had an important level of worries about close relatives' health; 64.9% described an important level of fear to contaminate a close relative; 42.6% worried about their children health; 41.7% were afraid to contaminate their children; and 19.4% were worried about finding a baby-sitter A quarter (27.3%) of the participants reported a high level of powerlessness at work 31.9% reported a high level of powerlessness at home 24.4% had important feelings of not responding to patients demands 51.6% reported an important lack of material and 49,7% had an important feeling of putting lose relatives in danger The percentages of high level of guilt feelings were 21.4% for guilt at work and 19.8% for guilt in the personal life A quarter (24.6%) of the participants strongly blamed themselves for not being able to protect their close relations 4.6% thought that they have strongly set patients' life in danger 6.1% described an important increase of mistakes at work Over half (52.3%) of the participants reported high level of anger at work 68.8% of the participants strongly blamed the state the delay in information 69% thought firmly that the state did not manage the crisis as good as possible 64.7% thought strongly that the citizens do not respect the quarantine and 55.7% strongly blamed the state for not helping health workers The great majority of the participants (80.8%) behaved respectfully toward the patients 73.2% thought their colleagues had an important exemplarily behavior 47.3% thought strongly that the hospital reacted as best as possible 29.9% thought strongly that the hospital managed well its materials Participants reported an important level of stress since the beginning of the crisis (40.9%) We found that 57.8% of the participants presented significant PTSD symptoms we found that 25.9% of the participants presented moderate exhaustion and 40.7% of the participants presented severe exhaustion We also found 30.6% of moderate and 21.2% of severe depersonalization we found 31.2% of moderate and 17.1% of severe lack of accomplishment The results of the different scales and subscales are presented in Table 1 We found a significant effect of sex on IES-6 scores (t = −5.96; p < 0.001) but not on MBI scores We did not find any effect for having a close relative suspected of being infected We found a positive effect of having a close relative infected by COVID-19 on IES-6 scores (t = 3.06; p = 0.002) Participants with a close relative infected have a higher level of PTSD We found a significant effect of having a close relative with a risk factor on IES-6 scores (t = 4.91; p < 0.001) and MBI-exhaustion scores (t = 3.49; p = 0.001) Participants with a close relative with a risk factor tend to have more emotional difficulties We did not find a significant effect of being infected on the IES-6 and MBI scores Emotional difficulties depending on the level of exposure Maslach Burnout Inventory-Exhaustion; MBI-D Maslach Burnout Inventory-Depersonalization; MBI-A We found a significant effect of job on IES-6 scores (F = 6.84; p < 0.001) and MBI scores: exhaustion (2.43; p = 0.013), depersonalization (F = 5.80; p < 0.001), and accomplishment (F = 6.06; p < 0.001). The descriptive results are presented in Figure 2 We completed the analysis by performing post-hoc contrast for job group with a sample size equal or superior to 50 post hoc comparisons set out a significant contrast between doctors and nurses (95% IC = −3.99 to −0.29) and nursing assistants (95% IC = −5.26 to −0.98) and between psychologists and nursing assistants (95% IC = 0.63–7.16) We found a significant contrast between psychologists and nurses (95% IC = −7.81 to −0.50) and nursing assistants (95I% C = −8.29 to −0.56) for the depersonalization subscale We found a significant contrast between psychologists and nurses (IC% 95 = 0.1–8.52) and doctors and nurses (95 IC = 0.12–5.22) for the accomplishment subscale doctors and psychologists tend to have less traumatic and burnout manifestations than nurses and nursing assistants Emotional difficulties depending on the job position We entered IES-6 scores in a linear regression to predict MBI-exhaustion scores showing IES-6 scores as a significant predictor (β = 0.9; p < 0.001) When adding the different coping strategies significantly associated with both IES-6 scores and MBI-exhaustion scores we found a significant model (R = 0.923; R2 = 0.852; F = 823.232; ddl = 7; p < 0.001) the beta value of IES-6 is lower than in the first model (β = 0.457; p < 0.001) The other significant predictive factors are behavioral disengagement (β = 0.247; p < 0.001); blame (β = 0.156; p < 0.001); substance use (β = 0.91; p = 0.001); positive reinterpretation (β = −148; p < 0.001) emotional support (β = 0.90; p = 0.022) and denial (β = 0.065; p = 0.038) Direct and indirect effect of stress on burnout the observed results are close to the results identified in another meta-analysis (34.4% Italian workers seem to have a higher percentage of severe burnout but a lower level of moderate burnout This could be explained by the severity of the crisis that tended to be greater in Italy as compared to France Additionally, we found an effect of COVID-19 exposure on PTSD and burnout symptoms. This is congruent with previous results who identified that being first-line worker as a risk factor for emotional difficulties (11, 33). We can assume though that front-line workers have greater time pressure and workload, resulting in more important level of emotional difficulties (20) We highlighted that higher age and experience are associated with less emotional difficulties Finally, we assessed the mediation effect of coping strategies on the link between stress and burnout. We found that the relationship between stress and burnout is partly mediated by coping strategies. This is congruent with the coping reserve model (24) suggesting that stress drains coping abilities emotional difficulties have been evaluated with self-reported questionnaires semi-structured interviews are gold standard evaluations to formally assess emotional difficulties There is an imbalance between men and women that limits the extension of our conclusions we did not get enough participants to evaluate the effect of work localization the French region “Grand Est” was especially affected by COVID-19 but we did not have enough participants from this region to perform special analysis on those participants We do not know if participants suffered or had an history of psychiatric conditions This could have influenced the results of the study Data were gathered during the first months following the beginning of the crisis in France data reflects only the psychological state of healthcare workers during this period because only participants who had access to the link of the study could take part in the study this study is cross-sectional and cannot set out causal relationships There is an important prevalence of post-traumatic and emotional burnout symptoms among French healthcare workers during COVID-19 crisis Exposure to sanitary crisis seems to be a determining factor The more healthcare workers are exposed to COVID-19 the more they present emotional difficulties having a lower job position and having less experience are consistent significant risk factors for emotional difficulties across studies We identified multiple coping strategies associated with emotional difficulties and the mediating effect of coping strategies on the link between stress and burnout This suggests the relevance of both coping training and a good environment to prepare healthcare workers to future sanitary crisis and to limit the emotional consequences The raw data supporting the conclusions of this article will be made available by the authors The studies involving human participants were reviewed and approved by CERNI (Comité de la recherche Tours-Poitiers) The patients/participants provided their written informed consent to participate in this study AV performed the statistical analysis and wrote the first version of the manuscript All authors took part in the development of the methodology and data gathering process We would like to thank the University of Tours for the material support We are grateful to Association Française de Psychiatrie Biologique et de Neuropsychopharmacologie (AFPBN) who contributed to the collection of the survey data The Supplementary Material for this article can be found online at: https://www.frontiersin.org/articles/10.3389/fpsyt.2021.701127/full#supplementary-material 1. 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This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY) *Correspondence: Alexis Vancappel, YS52YW5jYXBwZWxAY2h1LXRvdXJzLmZy We hope it’s your favourite time of the week because it sure is ours Apart from getting a list of some of the newest Icelandic music you’ve got the whole weekend to unwind until the cogs have to start turning again on Monday morning Featuring both established and upcoming artists there’s surely something for everyone in this week’s Friday new music roundup After her debut at Iceland Airwaves this year KUSK hasn’t slowed down or stopped working for a minute The artist just released the first single from her upcoming album “1000” is produced by her longtime collaborator Hrannar Máni and arranged by Hrannar and Kolbrún herself “1000” feels very intimate with a dash of nostalgia for something And while the language barrier still prevents me from understanding what the song is about I hope there are at least a 1000 more songs by KUSK the artist creates a context where it’s all distinctly Jónfrí “Andalúsía” brings an element of funk otherwise nonexistent on the album The title track has the singer pining for a red Ford Bronco under breathy Then there’s the strange maritime references in the album tracks —”Freðin ýsa” (haddock) “Sumarið er silungur” (trout) “Rækjubátar” (shrimp) — almost as if the artist has recently finished a stint as a fisherman Jónfrí has managed to release an enjoyable album filled with many memorable hooks you’ll also be dreaming of a red Ford Bronco Spearheaded by filmmaker Styrmir Sigurðsson Geislar consists of some of the most top-drawer musicians in Iceland including the nation’s favourite funeral singer Sigríður Thorlacious when they released their debut Containing the Dark “Sunspot” is their latest single off the forthcoming Supernature where every piece moves in perfect synchronicity There’s an unmistakable FÍH air over the track — effortlessly intricate but curious enough to pique one’s interest artist-extraordinaire Emilíana Torrini embraces dancehall rhythm “Let’s Keep Dancing” is a snapshot of two lovers enjoying their last meeting together Inspired by long-lost letters from Emilíana’s friend’s deceased mother the artist took to writing an album based on Geraldine’s stories will be Emilíana’s first solo record in 10 years “Let’s Keep Dancing” is partly constructed from a song by the enigmatic Harold Prieto adding an otherworldly atmosphere to Emilíana’s beckoning chorus It’s been no less than seven whole years since hip-hop duo Jóipé and Króli enchanted Icelandic listeners with the colossal “B.O.B.A.” As time goes by the artist duo have branched out to include other projects while JóiPé is writing advertisement jingles they’ve been releasing three LPs since their debut SCANDIPAIN vol.1 sees the duo continue their catchy pop music tradition with JóiPé and Króli pour their lyrical hearts out Please enable JS and disable any ad blocker World 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Inside Chanel's French leather workshops Culture Subscribers only The marvelous bronzes of Angkor on display at the Musée Guimet in Paris relieved himself of a burden he was the last to bear: On June 12 a group of French Resistance fighters executed 47 German soldiers and a Frenchwoman Excavations to recover the bodies are to begin on August 16 known as "Papillon" in the maquis movement of Corrèze It was at an ordinary veterans' reunion in Meymac a town in Corrèze where he had returned to spend his retirement after a long professional exile in the Paris region All items on the agenda of the meeting had been treated Members were already heading for the reception when Réveil cleared his throat "I've got something to tell you," he declared he had witnessed the summary execution of 47 German prisoners and a French collaborator The soldiers had been shot one by one and buried in a pit they had dug themselves The National Office for Veterans and Victims of War (ONAC-VG) has taken charge of the case in conjunction with the German War Graves Commission (VDK) the German organization whose mission is to find the bodies of soldiers that disappeared during various conflicts around the world The site of the executions has been identified radar surveys detected anomalies in the terrain and the presence of buried metal objects You have 91.9% of this article left to read Lecture du Monde en cours sur un autre appareil Vous pouvez lire Le Monde sur un seul appareil à la fois Ce message s’affichera sur l’autre appareil Parce qu’une autre personne (ou vous) est en train de lire Le Monde avec ce compte sur un autre appareil Vous ne pouvez lire Le Monde que sur un seul appareil à la fois (ordinateur En cliquant sur « Continuer à lire ici » et en vous assurant que vous êtes la seule personne à consulter Le Monde avec ce compte Que se passera-t-il si vous continuez à lire ici Ce dernier restera connecté avec ce compte Vous pouvez vous connecter avec votre compte sur autant d’appareils que vous le souhaitez mais en les utilisant à des moments différents Nous vous conseillons de modifier votre mot de passe Votre abonnement n’autorise pas la lecture de cet article merci de contacter notre service commercial The Uribe served as a patrol boat for the Mexican navy for nearly three decades the 220-foot battleship covered in GoPros is set on a new course: 90 feet below sea serving as Baja California’s very first artificial reef The long-term vision of the project is to create a sentiment in which people are going to see Mexico not just as a place to drink margaritas. Rather, Mexico wishes to create an underwater park that would serve as a focal point for diving It would also bring tourists during off-peak months it will take at least two years for a mature underwater habitat to flourish Since natural reefs are being damaged by overfishing artificial reefs like this one will help create coastal ecosystems that were once desolate ocean floors “The sinking of the ship will be the beginning of a dream,” said Francisco Ussel, a 60-year-old architect and president of the 45-member Baja California Divers. Ussel, who had a heavy hand in the execution of the project, told the San Diego Tribune, “It’s a passion to see this growth, to see these fish, to see the colors, to see God’s hand here.” move 2 arrested there in Perry Hall killing By Elaine Tassy Sun Staff Writer The two men suspected in the slaying of a Perry Hall Christmas tree dealer planned to rob him were arrested Christmas Day 1 in Jacksonville Beach and charged with firstdegree murder in the Dec A county homicide detective and another police official went to Jacksonville Beach Christmas night to interview the suspects who yesterday waived their right to extradition in a hearing in Florida The two will be transported back to Maryland today at Baltimore County's expense Ussel revealed parts of the plan to several witnesses according to charging documents filed in District Court in Towson whose last known address was in the 1200 block of Bridge Crossing Road in Essex told witnesses he spent his last $400 on crack cocaine and planned to rob Mr Zinkhan "because he needed the money to get to Florida to live with his brother," the documents said Ussel what he would do if caught robbing Mr he replied: "What do you think I'm going to do I'm going to kill him," according to the documents Ussel's former girlfriend used to clean for the victim "It appeared the victim had been securing the door to the A to Greenery at the time he was attacked," the charging documents said Zinkhan owned the business in the 9700 block of Belair Road and lived in a trailer on the property He sold plants and produce in the summer and Christmas trees during the holidays Ussel told a witness he was going to have Mr whose last known address was in the 1900 block of Madison Road in Dundalk "do all of his dirty work," charging documents said county police put out bulletins asking officers in the eastern United States to be on the lookout for Mr Jacksonville Beach officers arrested them in a phone booth Tony Lee looks into the casket of William Isaiah Munford who was Child's senseless death By Joan Jacobson 'It's time for us to Sun Staff Writer Ten-year-old William Isaiah Munford Jr was remembered yesterday for his exuberant smile and mourned for his senseless death from a gun allegedly fired by another child Several hundred people packed the Whitestone Baptist Church in West Baltimore for his funeral where he was described as a religious child a smiling Cub Scout and a student who excelled in math and science at Robert W the boy's death symbolized society's escalating violence was Baltimore's 19th homicide victim under age 14 this year "It used to be at the nighttime when crooks and robbers came out," the Rev This is an everybody thing drugs are on all the corners We used to say we're going to move to the county but the trouble followed us to the county." William Munford's body was laid out in a small white casket sur- The Political Game column will not appear today rounded by dozens of red and white carnations A bouquet of baby's breath sat by his head The photograph used on the memorial program showed a boy with a big grin four white and purple banners carried the words Hope." Speakers at the funeral asked mourners to support the Munford family and a few also asked them to show sympathy to the family of the' 10-year-old boy the accused boy's mother sat in the back of the church and wept Her son was charged as a juvenile last week with killing the Munford youth with a sawed -off shotgun the boys had found in an alley near their Northwest Baltimore homes Police said the child aimed the gun at the Munford boy's chest and it went off at close range Because The Sun's policy is to not publish the names of juveniles accused of a crime the accused child and his mother have not been named a preacher devoted to ending street violence in Baltimore noted that the two families are not bitter toward each other New delegate is told he may not hold both firefighter and State House jobs By Larry Carson a loss of extra pension benefits Sun Staff Writer that county police and firefighters receive of Arbutus has been told by the that is "too high a burden" to bear Maryland attorney general's office administration lobbyist Pat Roddy that he may not be a Baltimore told the council County firefighter and a member Regular county employees may of the House of Delegates at the retire at age 60 a lieutenant in fits at 1.8 percent per year of servthe fire marshal's office and an as- ice But firefighters accrue a pensistant state fire marshal said yes- sion at the rate of 2 percent per terday that he never thought that year and may retire after 25 years holding the two jobs would be a at age 55 or after 20 years at age problem until he was contacted 50 who failed to win one of two DisThe Democrat a 13-year Fire trict 12A seats after finishing fewDepartment veteran said he sympathized with his which covers parts of southwest- rival but objects to what Mr Rupern Baltimore County and extends persberger "I really feel for Jimmy," he A letter to Mr says he was "blown away" by paint houses and cut grass" to serve in Zarnoch said a county firefighter the legislature holds an "office of profit" under the "What Ruppersberger is trying state Constitution Dutch Ruppers- politics as usual," he charged and same time serve as a a state legisla- berger Ill has launched a rescue that amounts to "changing the tor and as either an assistant fire mission struggling to find a way to rules after the fact." marshal or Baltimore County fire preserve the new delegate's Fire Mr a salesman for fighter," the letter said Department career and pension MCI in McLean Zarnoch left before the General Assembly leves that having both jobs would the door open for a solution by say- opens Jan amount to a conflict of interest for ing that "there may be positions in One element of that rescue is Mr who does fire safety the fire department to which a per- an attempt to preserve Mr Ma- inspections of county buildings son can be administratively trans- lone's firefighter pension if his and can issue citations for unsafe ferred that are not 'fire fighter' po- county job status can be adminis- conditions sitions." he also suggested that a tratively redefined to satisfy the Several County Council memlegislator's firefighting post A bill to do that bers seemed worried yesterday is defined as a public office under was discussed yesterday by a wary about the implications of preservthe state Constitution could be le- County Council at an informal ing for Mr Malone the special pengally changed to make him an em- work session The measure is to be sion benefits of county firefighters ployee rather than the holder of a voted Tuesday night "What type of Pandora's box are public office Becoming a county employee we opening up?" Councilman KevMeanwhile Baltimore County instead of a firefighter would mean in 1 Kamenetz said cost of health care found Hopkins studies Md clinics By Jonathan Bor Sun Staff Writer A study of doctors and clinics that care for many Medicaid patients in Maryland has found that the lowestcost providers are not necessarily the worst When it comes to the overall health of patients researchers at the Johns Hopkins School of Hygiene and Public Health and the state health department found that there was really no relationship between cost and quality of care The findings suggest that policymakers don't have to compromise care in their zeal to trim expenses as long as they monitor the work done by providers "The implication of this is that basically the payer has to monitor care you can't make predictions about quality based on cost." said Dr a Hopkins professor of health policy and the study's lead author the state is spending about $1.4 billion on Medicaid Although the study appears in today's Journal of the American Medical Association the findings have already triggered a state effort to identify low-cost medical practices that provide good care consultants at the University of Maryland Baltimore County are drawing up a list of low-cost highquality practices to which Medicaid recipients can be assigned the consultants are using the same techniques used in the study Costs included doctors' fees as well as associated bills for tests hospital admissions and referrals to specialists "The kinds of things they were looking for was whether a doctor was doing the right types of preventive care for a diabetic or an asthmatic child," said Mary Stuart director of policy and health statistics for the state health department ANDRE STAFF PHOTO shot to death this month is mourned save our children' And when City Council President Mary Pat Clarke thanked the Munford family "for the kindness they showed toward the other family" and asked mourners to show their sympathy "It's time for us to save our children a gun kills relatives of both the victim and the accused said they be- BOE at funeral lieved the shooting was an accident and insisted that the suspect did not mean to kill his friend when the gun went off But a city Circuit Court judge refused last week to release the boy to his mother's custody pending a February trial "William had some very special gifts," said Addie Johnson "Nothing can compare to the loss of a child." Outside the church after the service "Guns really do kill and other children will see it." 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