Optimizing Communication in Ataxia: A Multifaceted Approach to Alternative and Augmentative Communication (AAC)

The progression of multisystem neurodegenerative diseases such as ataxia significantly impacts speech and communication, necessitating adaptive clinical care strategies. With the deterioration of speech, Alternative and Augmentative Communication (AAC) can play an ever increasing role in daily life for individuals with ataxia. This review describes the spectrum of AAC resources available, ranging from unaided gestures and sign language to high-tech solutions like speech-generating devices (SGDs) and eye-tracking technology. Despite the availability of various AAC tools, their efficacy is often compromised by the physical limitations inherent in ataxia, including upper limb ataxia and visual disturbances. Traditional speech-to-text algorithms and eye gaze technology face challenges in accuracy and efficiency due to the atypical speech and movement patterns associated with the disease.In addressing these challenges, maintaining existing speech abilities through rehabilitation is prioritized, complemented by advances in digital therapeutics to provide home-based treatments. Simultaneously, projects incorporating AI driven solutions aim to enhance the intelligibility of dysarthric speech through improved speech-to-text accuracy.This review discusses the complex needs assessment for AAC in ataxia, emphasizing the dynamic nature of the disease and the importance of regular reassessment to tailor communication strategies to the changing abilities of the individual. It also highlights the necessity of multidisciplinary involvement for effective AAC assessment and intervention. The future of AAC looks promising with developments in brain-computer interfaces and the potential of voice banking, although their application in ataxia requires further exploration.

Artificial intelligence for predictive biomarker discovery in immuno-oncology: a systematic review

BACKGROUND

The widespread use of immune checkpoint inhibitors (ICIs) has revolutionised treatment of multiple cancer types. However, selecting patients who may benefit from ICI remains challenging. Artificial intelligence (AI) approaches allow exploitation of high-dimension oncological data in research and development of precision immuno-oncology.

MATERIALS AND METHODS

We conducted a systematic literature review of peer-reviewed original articles studying the ICI efficacy prediction in cancer patients across five data modalities: genomics (including genomics, transcriptomics, and epigenomics), radiomics, digital pathology (pathomics), and real-world and multimodality data.

RESULTS

A total of 90 studies were included in this systematic review, with 80% published in 2021-2022. Among them, 37 studies included genomic, 20 radiomic, 8 pathomic, 20 real-world, and 5 multimodal data. Standard machine learning (ML) methods were used in 72% of studies, deep learning (DL) methods in 22%, and both in 6%. The most frequently studied cancer type was non-small-cell lung cancer (36%), followed by melanoma (16%), while 25% included pan-cancer studies. No prospective study design incorporated AI-based methodologies from the outset; rather, all implemented AI as a post hoc analysis. Novel biomarkers for ICI in radiomics and pathomics were identified using AI approaches, and molecular biomarkers have expanded past genomics into transcriptomics and epigenomics. Finally, complex algorithms and new types of AI-based markers, such as meta-biomarkers, are emerging by integrating multimodal/multi-omics data.

CONCLUSION

AI-based methods have expanded the horizon for biomarker discovery, demonstrating the power of integrating multimodal data from existing datasets to discover new meta-biomarkers. While most of the included studies showed promise for AI-based prediction of benefit from immunotherapy, none provided high-level evidence for immediate practice change. A priori planned prospective trial designs are needed to cover all lifecycle steps of these software biomarkers, from development and validation to integration into clinical practice.

Neural Changes in Children With Residual Speech Sound Disorder After Ultrasound Biofeedback Speech Therapy

PURPOSE

Children with residual speech sound disorders (RSSD) have shown differences in neural function for speech production, as compared to their typical peers; however, information about how these differences may change over time and relative to speech therapy is needed. To address this gap, we used functional magnetic resonance imaging (fMRI) to examine functional activation and connectivity on adaptations of the syllable repetition task (SRT-Early Sounds and SRT-Late Sounds) in children with RSSD before and after a speech therapy program.

METHOD

Sixteen children with RSSD completed an fMRI experiment before (Time 1) and after (Time 2) a speech therapy program with ultrasound visual feedback for /ɹ/ misarticulation. Progress in therapy was measured via perceptual ratings of productions of untreated /ɹ/ word probes. To control for practice effects and developmental change in patterns of activation and connectivity, 17 children with typical speech development (TD) completed the fMRI at Time 1 and Time 2. Functional activation was analyzed using a region-of-interest approach and functional connectivity was analyzed using a seed-to-voxel approach.

RESULTS

Children with RSSD showed a range of responses to therapy. After correcting for multiple comparisons, we did not observe any statistically significant cross-sectional differences or longitudinal changes in functional activation. A negative relationship between therapy effect size and functional activation in the left visual association cortex was on the SRT-Late Sounds after therapy, but it did not survive correction for multiple comparisons. Significant longitudinal changes in functional connectivity were observed for the RSSD group on SRT-Early Sounds and SRT-Late Sounds, as well as for the TD group on the SRT-Early Sounds. RSSD and TD groups showed connectivity differences near the left insula on the SRT-Late Sounds at Time 2.

CONCLUSION

RSSD and treatment with ultrasound visual feedback may thus be associated with neural differences in speech motor and visual association processes recruited for speech production.

Case report: a giant cell-rich gnathic bone lesion in a child with pycnodysostosis

Pycnodysostosis is a skeletal dysplasia characterized by short stature, generalized osteosclerosis, acro-osteolysis, and recognizable facial features. Oral manifestations are commonly described and include a high-arched palate with dental crowding and malocclusion, hypoplastic enamel, and retained deciduous teeth with impacted permanent teeth, and there is an increased risk of developing osteomyelitis of the jaw. We report here the history of a 9-year-old male with the typical facial and skeletal phenotype of pycnodysostosis but novel oral features. He presented with bilateral progressive facial swelling, which caused functional impairment with chewing and contributed to his severe obstructive sleep apnea (OSA). The severity of his OSA required surgical intervention, and the lesions were resected. Extensive bone remodeling and replacement by fibrous tissue were noted on submucosal dissection, and bilateral subtotal maxillectomies were required. The histopathology of the biopsied lesion was consistent with a giant cell-rich lesion. Genetic testing identified a pathogenic homozygous variant in the CTSK gene, c.953G > A, p. (Cys318Tyr). The proband had a good postsurgical response with sustained improvement in his sleep OSA. We present here the history and clinical characteristics of a patient with typical features of pycnodysostosis and an unusual presentation and histopathology of gnathic bone lesions. This report adds to the body of literature on this rare condition and also highlights the finding of giant cell-rich lesions of the gnathic bones. Giant cell-rich lesions in pycnodysostosis have previously been reported in two cases in the literature. While there is not enough evidence to support a certain association with pycnodysostosis, it is prudent to consider regular oral dental reviews in affected individuals to identify pathology early and avoid such life-threatening complications.

Classification of accurate and misarticulated /r/ for ultrasound biofeedback using tongue part displacement trajectories

Ultrasound biofeedback therapy (UBT), which incorporates real-time imaging of tongue articulation, has demonstrated generally positive speech remediation outcomes for individuals with residual speech sound disorder (RSSD). However, UBT requires high attentional demands and may therefore benefit from a simplified display of articulation targets that are easily interpretable and can be compared to real-time articulation. Identifying such targets requires automatic quantification and analysis of movement features relevant to accurate speech production. Our image-analysis program TonguePART automatically quantifies tongue movement as tongue part displacement trajectories from midsagittal ultrasound videos of the tongue, with real-time capability. The present study uses such displacement trajectories to compare accurate and misarticulated American-English rhotic /ɑr/ productions from 40 children, with degree of accuracy determined by auditory perceptual ratings. To identify relevant features of accurate articulation, support vector machine (SVM) classifiers were trained and evaluated on several candidate data representations. Classification accuracy was up to 85%, indicating that quantification of tongue part displacement trajectories captured tongue articulation characteristics that distinguish accurate from misarticulated production of /ɑr/. Regression models for perceptual ratings were also compared. The simplest data representation that retained high predictive ability, demonstrated by high classification accuracy and strong correlation between observed and predicted ratings, was displacements at the midpoint of /r/ relative to /ɑ/ for the tongue dorsum and blade. This indicates that movements of the dorsum and blade are especially relevant to accurate production of /r/, suggesting that a predictive parameter and biofeedback target based on this data representation may be usable for simplified UBT.

Clinical management guidelines for Friedreich ataxia: best practice in rare diseases

BACKGROUND

Individuals with Friedreich ataxia (FRDA) can find it difficult to access specialized clinical care. To facilitate best practice in delivering healthcare for FRDA, clinical management guidelines (CMGs) were developed in 2014. However, the lack of high-certainty evidence and the inadequacy of accepted metrics to measure health status continues to present challenges in FRDA and other rare diseases. To overcome these challenges, the Grading of Recommendations Assessment and Evaluation (GRADE) framework for rare diseases developed by the RARE-Bestpractices Working Group was adopted to update the clinical guidelines for FRDA. This approach incorporates additional strategies to the GRADE framework to support the strength of recommendations, such as review of literature in similar conditions, the systematic collection of expert opinion and patient perceptions, and use of natural history data.

METHODS

A panel representing international clinical experts, stakeholders and consumer groups provided oversight to guideline development within the GRADE framework. Invited expert authors generated the Patient, Intervention, Comparison, Outcome (PICO) questions to guide the literature search (2014 to June 2020). Evidence profiles in tandem with feedback from individuals living with FRDA, natural history registry data and expert clinical observations contributed to the final recommendations. Authors also developed best practice statements for clinical care points that were considered self-evident or were not amenable to the GRADE process.

RESULTS

Seventy clinical experts contributed to fifteen topic-specific chapters with clinical recommendations and/or best practice statements. New topics since 2014 include emergency medicine, digital and assistive technologies and a stand-alone section on mental health. Evidence was evaluated according to GRADE criteria and 130 new recommendations and 95 best practice statements were generated.

DISCUSSION AND CONCLUSION

Evidence-based CMGs are required to ensure the best clinical care for people with FRDA. Adopting the GRADE rare-disease framework enabled the development of higher quality CMGs for FRDA and allows individual topics to be updated as new evidence emerges. While the primary goal of these guidelines is better outcomes for people living with FRDA, the process of developing the guidelines may also help inform the development of clinical guidelines in other rare diseases.

Speech Perception Variability in Childhood Apraxia of Speech: Implications for Assessment and Intervention

PURPOSE

Beyond hallmark production deficits characterizing childhood apraxia of speech (CAS), largely attributed to disruption(s) in speech motor planning, children with CAS often present with co-occurring speech perception and language difficulties. Thus, careful consideration of the potential for speech perception difficulties to have cascading downstream effects on intervention responsiveness and real-life functioning for some children with CAS is highly important. The purpose of this tutorial was to consider the impact of speech perception abilities in children with CAS, which carries implications for caring for the needs of the whole child.

METHOD

This tutorial summarizes the current literature on speech perception and how it relates to speech production, language, and reading abilities for children with CAS. We include case illustrations that are adapted from real clinical scenarios illustrating how speech perception difficulties may impact some children with CAS and provide recommendations for incorporating speech perception into assessment and intervention practices.

RESULTS

Although speech perception difficulties do not seem to be a core deficit of CAS, they are strongly linked to language difficulties, which are highly prevalent among children with CAS. Speech perception and language difficulties are also associated with reading difficulties and risk for lower academic achievement.

CONCLUSIONS

Children with CAS who have co-occurring language difficulties likely also demonstrate speech perception deficits, which puts them at heightened risk for reading difficulties and struggles with academic achievement. Comprehensive assessment of children with CAS should address speech perception and production, language, and reading abilities, which carries important implications for multifaceted approaches to intervention.

Personal factors understood through the Ecological-Enactive Model of Disability and implications for rehabilitation research

The International Classification of Functioning, Disability and Health (ICF) recognizes that disability arises from the interaction between an individual with a medical condition and the context in which they are embedded. Context in the ICF is comprised of environmental and personal factors. Personal factors, the background life and lifestyle of an individual, are poorly understood in rehabilitation. There is limited knowledge about how personal and environmental factors interact to shape the contextual conditions critical for explaining functioning and disability. In this paper, we explore how a newly proposed model of disability, the Ecological-Enactive Model of Disability, can enhance understanding of personal factors across multiple rehabilitation disciplines. We draw from a review of evidence and phenomenological interviews of individuals with Friedreich's Ataxia. We consider the practical impact of this understanding on disability and rehabilitation research and pathways for the future focusing on representative design.

Neuroimaging of the Syllable Repetition Task in Children With Residual Speech Sound Disorder

Purpose This study investigated phonological and speech motor neural networks in children with residual speech sound disorder (RSSD) during an overt Syllable Repetition Task (SRT). Method Sixteen children with RSSD with /ɹ/ errors (6F [female]; ages 8;0-12;6 [years;months]) and 16 children with typically developing speech (TD; 8F; ages 8;5-13;7) completed a functional magnetic resonance imaging experiment. Children performed the SRT ("SRT-Early Sounds") with the phonemes /b, d, m, n, ɑ/ and an adapted version ("SRT-Late Sounds") with the phonemes /ɹ, s, l, tʃ, ɑ/. We compared the functional activation and transcribed production accuracy of the RSSD and TD groups during both conditions. Expected errors were not scored as inaccurate. Results No between-group or within-group differences in repetition accuracy were found on the SRT-Early Sounds or SRT-Late Sounds tasks at any syllable sequence length. On a first-level analysis of the tasks, the TD group showed expected patterns of activation for both the SRT-Early Sounds and SRT-Late Sounds, including activation in the left primary motor cortex, left premotor cortex, bilateral anterior cingulate, bilateral primary auditory cortex, bilateral superior temporal gyrus, and bilateral insula. The RSSD group showed similar activation when correcting for multiple comparisons. In further exploratory analyses, we observed the following subthreshold patterns: (a) On the SRT-Early Sounds, greater activation was found in the left premotor cortex for the RSSD group, while greater activation was found in the left cerebellum for the TD group; (b) on the SRT-Late Sounds, a small area of greater activation was found in the right cerebellum for the RSSD group. No within-group functional differences were observed (SRT-Early Sounds vs. SRT-Late Sounds) for either group. Conclusions Performance was similar between groups, and likewise, we found that functional activation did not differ. Observed functional differences in previous studies may reflect differences in task performance, rather than fundamental differences in neural mechanisms for syllable repetition.

Observations during the COVID-19 pandemic in chronic heart failure patients with complex devices in a tertiary care cardiac centre using the HeartLogic software

Funding Acknowledgements

Type of funding sources: None.

Introduction

Decompensation of heart failure leading (HF) to hospitalisation is the single most important drain on healthcare resources when managing patients with left ventricular systolic dysfunction. Cardiac resynchronisation therapy with/without defibrillators (CRT-P/D) decreases hospitalisation due to HF and improves survival while implantable cardiac defibrillators (ICD"s) have a favourable effect on the former. Proprietary software algorithms embedded in these complex devices give an early warning to clinicians when decompensation of HF is imminent allowing preventative action to be undertaken.

HeartLogic (HL) is one such new algorithm in Boston Scientific CRT-D/ICD devices using multiple sensors to track 5 physiological parameters, combining them into one composite Index, with an Alert being triggered if the Index is >16. The COVID-19 pandemic, due to multiple reasons, resulted in a significant decrease in availability of routine HF services in the United Kingdom, especially during the initial lockdown period from 23rd March to 1st July 2020.

Aim

To assess the impact of the COVID-19 pandemic, using HL, in patients with HF and complex devices. 

Materials and Methods

Retrospective analysis of patients in a tertiary care cardiac centre in whom the HL software had been activated in March/April 2019 (n = 49) and comparison of those with (Group A n = 21) and without (Group B n = 28) an Alert (HLA) during the COVID-19 pandemic. 

Results (Table): Whole cohort n = 49. Age:  72 ± 12 years, Median: 75, Range: 36-95. 36/49 (73.5%) males. Type of device implanted: Resonate X4 CRT-D: 28/49 (57.1%); Momentum CRT-D: 8/49 (16.3%); Resonate ICD: 13/49 (26.5%). Ischaemic aetiology of HF: 35/49 (71.4%), Total duration of HL monitoring: 632 ± 7 days (median: 632; range: 626-672).  There was no difference in the age, gender, and type of device implanted between Group A and Group B. Over nearly ∼1 year of monitoring in each of the groups, Group A had more unstable HF with 10/21 (47.6%) having their first HLA during the pandemic. Multiple HLA"s, longer period in HLA and those with ischaemic aetiology of HF were higher in Group A. 17/40 (42.5%) HLA"s in Group A were within the first lockdown period (March - July). 24/28 (85.7%) patients in Group B had no HLA"s either before or during the pandemic. There was no difference in the HLA score between Groups A and B.

Conclusion

In this limited group of patients with a medium term follow-up, using the HeartLogic software, patients with ischaemic aetiology of HF and those with more HLA"s prior to the pandemic did worse than those who no HLA"s. First HLA"s, multiple alerts and longer duration of alerts in this group of patients suggests a lack of access to adequate HF services during the pandemic. It has implications with regard to how HF services are configured in future whenever resources are constrained.

Auditory-perceptual acuity in rhotic misarticulation: baseline characteristics and treatment response

The rhotic sound /r/ is one of the latest-emerging sounds in English, and many children receive treatment for residual errors affecting /r/ that persist past the age of 9. Auditory-perceptual abilities of children with residual speech errors are thought to be different from their typically developing peers. This study examined auditory-perceptual acuity in children with residual speech errors affecting /r/ and the relation of these skills to production accuracy, both before and after a period of treatment incorporating visual biofeedback. Identification of items along an /r/-/w/ continuum was assessed prior to treatment. Production accuracy for /r/ was acoustically measured from standard/r/stimulability probes elicited before and after treatment. Fifty-nine children aged 9-15 with residual speech errors (RSE) affecting /r/ completed treatment, and forty-eight age-matched controls who completed the same auditory-perceptual task served as a comparison group. It was hypothesized that children with RSE would show lower auditory-perceptual acuity than typically developing speakers and that higher auditory-perceptual acuity would be associated with more accurate production before treatment. It was also hypothesized that auditory-perceptual acuity would serve as a mediator of treatment response. Results indicated that typically developing children have more acute perception of the /r/-/w/ contrast than children with RSE. Contrary to hypothesis, baseline auditory-perceptual acuity for /r/ did not predict baseline production severity. For baseline auditory-perceptual acuity in relation to biofeedback efficacy, there was an interaction between auditory-perceptual acuity and gender, such that higher auditory-perceptual acuity was associated with greater treatment response in female, but not male, participants.

Teaching Visually Impaired Children to Make Distance Judgments from a Tactile Map

This article reports on two experiments that investigated 59 children's ability to estimate distances from a map. In Experiment 1, totally blind children, children with residual vision, and sighted children were given a map showing the position of three objects on a path, two of which were present on the actual path. The children were asked to use the map to work out the position of the third object. The visually impaired children performed less well than did the sighted children, and an analysis of the children's strategies indicated that the majority of visually impaired children did not know an effective way to work out distances from the map. In Experiment 2, the visually impaired children were given a brief training in how to calculate distances from a map and then they were retested. After training, the children's performance improved.

Cortical and subcortical volume differences between Benign Epilepsy with Centrotemporal Spikes and Childhood Absence Epilepsy

OBJECTIVE

Benign Childhood Epilepsy with Centrotemporal Spikes (BECTS) and Childhood Absence Epilepsy (CAE) are the most common childhood epilepsy syndromes and they share a similar age-dependence. However, the two syndromes clearly differ in seizures and EEG patterns. The aim of this study is to investigate whether children of the same age with BECTS, CAE and typically-developing children have significant differences in grey matter volume that may underlie the different profiles of these syndromes.

METHODS

Twenty one patients with newly-diagnosed BECTS and 18 newly diagnosed and drug naïve CAE were included and compared to 31 typically-developing children. Voxel-based morphometry was utilized to investigate grey matter volume differences among BECTS, CAE, and controls. We also examined the effect of age on grey matter volume in all three groups. In addition to the whole brain analysis, we chose regions of interest analysis based on previous literature suggesting the involvement of these regions in BECTS or CAE. The group differences of grey matter volume was tested with 2-sample t-test for between two groups' comparisons and ANOVA for three group comparisons.

RESULTS

In the whole brain group comparisons, the grey matter volume in CAE was significantly decreased in the areas of right inferior frontal and anterior temporal compared to BECTS and controls (F_2,67  = 27.53, p < 0.001). In the control group, grey matter volume in bifrontal lobes showed a negative correlation with age (r=-0.54, p < 0.05), whereas no correlation was found in either CAE or BECTS. With ROI analyses, the grey matter volume of posterior thalami was increased in CAE compared to other 2 groups (p < 0.05).

SIGNIFICANCE

This study shows that there are grey matter volume differences between CAE and BECTS. Our findings of grey matter volume differences may suggest that there may be localized, specific differences in brain structure between these two types of epilepsy.

Tongue Part Movement Trajectories for /r/ Using Ultrasound

Purpose

Because it shows the movement of different parts of the tongue in real time, ultrasound biofeedback therapy is a promising technology for speech research and remediation. One limitation is the difficulty of interpreting real-time ultrasound images of tongue motion. Our image processing system, TonguePART, tracks the tongue surface and allows for the acquisition of quantitative tongue part trajectories.

Method

TonguePART automatically identifies the tongue contour based on ultrasound image brightness and tracks motion of the tongue root, dorsum, and blade in real time. We present tongue part trajectory data from 2 children with residual sound errors on /r/ and 2 children with typical speech, focusing on /r/ (International Phonetic Alphabet ɹ) in the phonetic context /ɑr/. We compared the tongue trajectories to magnetic resonance images of sustained vowel /ɑ/ and /r/.

Results

Measured trajectories show larger overall displacement and greater differentiation of tongue part movements for children with typical speech during the production of /ɑr/, compared to children with residual speech sound disorders.

Conclusion

TonguePART is a fast, reliable method of tracking articulatory movement of tongue parts for syllables such as /ɑr/. It is extensible to other sounds and phonetic contexts. By tracking tongue parts, clinical researchers can investigate lingual coordination. TonguePART is suitable for real-time data collection and biofeedback. Ultrasound biofeedback therapy users may make more progress using simplified biofeedback of tongue movement.

Can Visually Impaired Children Use Tactile Maps to Estimate Directions?

This article reports on three experiments in which totally blind children and children with residual vision were asked to estimate directions between landmarks in a large-scale layout of objects. The children experienced the layout either directly, by walking around it, or indirectly by examining a tactile map. The authors found that the use of tactile maps considerably facilitated the performance of the totally blind children. The theoretical and practical implications of these findings are discussed.

Peer-Reviewed Validation of a Comprehensive Framework for Disaster Evaluation Typologies

INTRODUCTION

The Comprehensive Framework for Disaster Evaluation Typologies, developed in 2017 (CFDET 2017), aims to unify and facilitate agreement regarding the identification, structure, and relationships between various evaluation typologies found in the disaster setting. A peer-reviewed validation process sought input from international experts in the fields of disaster medicine, disaster/emergency management, humanitarian/development, and evaluation. This paper discusses the validation process, its results, and outcomes.Research Problem:Previous frameworks, identified in the literature, lack validation and consistent terminology. To gain credibility and utility, this unique framework needed to be validated by international experts in the disaster setting.

METHODS

A mixed methods approach was designed to validate the framework. An initial iterative process informed an online survey which used a combination of a five-point Likert scale and open-ended questions. Pre-determined consensus thresholds, informed by a targeted literature review, provided the validation criteria.

RESULTS

A sample of 33 experts from 11 countries responded to the validation process. Quantitative measures largely supported the elements and relationships of the framework, and strongly supported its value and usefulness for supporting, promoting, and undertaking evaluations, as well as its usefulness for teaching evaluation in the disaster setting. Qualitative input suggested opportunities to strengthen and enhance the framework. There were limited responses to better understand the barriers and enablers of undertaking disaster evaluations. A potential for self-selection bias of respondents may be a limitation of this study. The attainment of high consensus thresholds, however, provides confidence in the validity of the results.

CONCLUSION

For the first time, a framework of this nature has undergone a rigorous validation process by experts in three related disciplines at an international level. The modified framework, CFDET 2018, provides a unifying framework within which existing evaluation typologies can be structured. It gives evaluators confidence to choose an appropriate strategy for their particular evaluation in the disaster setting and facilitates consistency in reporting across the different phases of a disaster to better understand the process, outcomes, and impacts of the efficacy and efficiency of interventions. Future research could create a series of toolkits to support improved disaster evaluation processes and to evaluate the utility of the framework in the real-world setting.

Cortical morphology, epileptiform discharges, and neuropsychological performance in BECTS

OBJECTIVES

The aim of this study was to understand the relationship between cortical morphology, centrotemporal spike (CTS), and neuropsychological functioning in children with BECTS compared to their typically developing peers.

MATERIALS AND METHODS

To examine whole-brain differences in cortical thickness between groups, a general linear model approach was applied to T1-weighted structural magnetic resonance imaging (MRI) in children with BECTS and typically developing children. Further region-of-interest (ROI) analyses were performed to examine the effects of frequency and lateralization of CTS. In addition, the relationship between Processing Speed Index (PSI) and cortical thickness was investigated.

RESULTS

Twenty-three patients with BECTS and thirty-two controls were included. There was no statistically significant difference in global cortical thickness between groups. With ROI analyses, we found significantly thinner cortex within right pars opercularis when comparing children with right predominant CTS, and with very frequent right CTS (>10/min) to the control group (P = 0.028 and P = 0.026, respectively). A statistically significant interaction of group (controls vs BECTS) and PSI was seen in bilateral frontal and right superior parietal cortices, indicating a positive relationship between cortical thickness and PSI in healthy controls but not BECTS.

CONCLUSION

A region of cortex where right CTS may originate was thinner in BECTS compared to children without BECTS. Typically developing children with faster processing speed had thicker cortices in regions supporting visuomotor integration, motor, and executive function, but this relationship was not observed in BECTS. These results suggest that BECTS is associated with atypical cortical morphology that may underlie poorer neuropsychological performance.

Empowerment in nurse leader groups in middle management: a quantitative comparative investigation

AIMS AND OBJECTIVES

The aim was to investigate structural empowerment in nurse leaders in middle management positions. Objectives were to determine levels of empowerment of nurse leaders and to compare levels of empowerment between nurse leader groups.

BACKGROUND

Access to formal and informal power, opportunity, resources, information and support are determinants of structural empowerment. Empowerment of nurse leaders in middle management positions is vital given their roles in enabling nursing teams to deliver high-quality care, benefitting both patient and workforce outcomes.

DESIGN

Quantitative component of a mixed methods study using survey principles.

METHODS

The Conditions of Work Effectiveness Questionnaire II was distributed to the total population (n = 517) of nurse leaders in an NHS Foundation Trust in England. Nurse leader groups comprised unit leaders (sisters, matrons) and senior staff nurses. Quantitative data entered on spss v 17/18, were analysed using descriptive and inferential statistics.

RESULTS

Overall, the unit response rate was 44·1% (n = 228). Levels of total and global empowerment were moderate and moderate to high respectively. Groups did not differ significantly on these parameters or on five elements of total empowerment, but significantly higher scores were found for unit leaders' access to information. Significantly higher scores were found for senior staff nurses on selected aspects of informal power and access to resources, but scores were significantly lower than unit leaders for components of support.

CONCLUSIONS

A moderately empowered population of nurse leaders differed in relation to access to information, aspects of support, resources and informal power, reflecting differences in roles, spheres of responsibility, hierarchical position and the constraints on empowerment imposed on unit leaders by financial and resource pressures.

RELEVANCE TO CLINICAL PRACTICE

Empowerment of nurse leaders in middle management is vital in enabling nursing teams to deliver high-quality care. Roles, spheres of responsibility, hierarchical position and constraints imposed by financial and resource pressures influence nurse leader empowerment. Administrative support is needed to sustain practice engagement.

Defining disaster resilience: comparisons from key stakeholders involved in emergency management in Victoria, Australia

Three years after the introduction of the National Strategy for Disaster Resilience there remains no unanimously adopted definition of disaster resilience within Australia's emergency management sector. The aim of this study is to determine what the concept means to key stakeholders in the emergency management sector in the Australian State of Victoria, and how these conceptualisations overlap and diverge. Via an online survey, 113 people were asked how they define disaster resilience in their work in the emergency management sector. A data mining software tool, Leximancer, was employed to uncover the relationships between the definitions provided. The findings show that stakeholders see resilience as an 'ability' that encompasses emergency management activities and personal responsibility. However, the findings also highlight some possible points of conflict between stakeholders. In addition, the paper outlines and discusses a number of potential consequences for the implementation and the success of the resilience-based approach in Australia.

Impact of frequency and lateralization of interictal discharges on neuropsychological and fine motor status in children with benign epilepsy with centrotemporal spikes

Despite a positive prognosis for seizure remission, children with benign epilepsy with centrotemporal spikes (BECTS) have been reported to exhibit subtle neuropsychological difficulties. We examined the relationship between patterns of centrotemporal spikes (the typical electroencephalography [EEG] finding in BECTS) and neuropsychological and motor outcomes in children with new-onset BECTS. Thirty-four patients with new-onset BECTS (not taking antiepileptic medication) and 48 typically developing children participated in the study. In BECTS patients, centrotemporal spikes (CTS) were evaluated in the first hour awake and first 2 h of sleep in a 24-h EEG recording and left or right-sided origin was noted. General intellectual function, language, visuospatial skill, processing speed, and fine motor skill were assessed in all participants. We found no significant difference between BECTS patients and controls on measures of general intellectual function, or visuospatial or language testing. There were significant differences in processing speed index and nondominant hand fine motor scores between groups. Significant negative relationships were observed between rates of left-sided CTS and right hand fine motor scores. This suggests that psychomotor and fine motor speed are affected in BECTS, but the extent of affected domains may be more limited than previously suggested, especially in untreated patients early in the course of their epilepsy.

Longitudinal stability of interictal spikes in benign epilepsy with centrotemporal spikes

OBJECTIVE

To describe the natural history of electroencephalography (EEG) changes in patients with benign epilepsy with centrotemporal spikes (BECTS) over 1 year.

METHODS

Centrotemporal spikes were visually evaluated based on 24-h ambulatory EEG studies to determine the total, left, right, and bilateral centrotemporal spikes patients were awake and asleep. These spike rates were then used to compare the entire night of sleep to the first 2 h of sleep, the repeatability of spike frequency over two recordings (done within days to weeks), and longitudinal changes in spike rate over 6 and 12 months.

RESULTS

Nineteen children with newly diagnosed and untreated BECTS were included in this analysis. An excellent correlation was found between the centrotemporal spike rate during the entire duration of sleep and the first 2 h of sleep (intraclass correlation [ICC] 0.87, 95% confidence interval [CI] 0.67-0.95). In addition, an excellent correlation was found between two recordings completed an average of 23 days apart while patients were asleep (ICC 0.92, 95% CI 0.80-0.97) and good correlation while patients were awake (ICC 0.70, 95% CI 0.39-0.87). The average change in spike rate between recordings at baseline and at 6 months was a decrease of 64.7% (range -100% to +51.5%, p = 0.01) and the average change in rate between recordings at baseline and at 12 months was a decrease of 57.7% (range -100% to +29.1%, p = 0.01). In addition, within 6 months, most children had decreased centrotemporal rates, with 30% of children being spike-free. This absence of spikes did not continue in all children, since the majority (60%) had some spikes at 1 year following diagnosis.

SIGNIFICANCE

Centrotemporal spike rates during sleep are stable when compared over days to weeks; however, when comparing spike rates over months there is a larger degree of variability.

Lactating mothers infected with Ebola virus: EBOV RT-PCR of blood only may be insufficient

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The transition from staff nurse to ward leader

Moving from the staff nurse to ward sister role involves acquiring a range of skills to lead and motivate a team and ensure standards of care are high. Recognising new ward sisters' need for support, a trust developed a training programme to enable them to develop the necessary skills and provide mutual support. This article discusses the development of the programme and offers the reflections of three ward sisters who participated in it.

Preschool speech articulation and nonword repetition abilities may help predict eventual recovery or persistence of stuttering

PURPOSE

In preschool children, we investigated whether expressive and receptive language, phonological, articulatory, and/or verbal working memory proficiencies aid in predicting eventual recovery or persistence of stuttering.

METHODS

Participants included 65 children, including 25 children who do not stutter (CWNS) and 40 who stutter (CWS) recruited at age 3;9-5;8. At initial testing, participants were administered the Test of Auditory Comprehension of Language, 3rd edition (TACL-3), Structured Photographic Expressive Language Test, 3rd edition (SPELT-3), Bankson-Bernthal Test of Phonology-Consonant Inventory subtest (BBTOP-CI), Nonword Repetition Test (NRT; Dollaghan & Campbell, 1998), and Test of Auditory Perceptual Skills-Revised (TAPS-R) auditory number memory and auditory word memory subtests. Stuttering behaviors of CWS were assessed in subsequent years, forming groups whose stuttering eventually persisted (CWS-Per; n=19) or recovered (CWS-Rec; n=21). Proficiency scores in morphosyntactic skills, consonant production, verbal working memory for known words, and phonological working memory and speech production for novel nonwords obtained at the initial testing were analyzed for each group.

RESULTS

CWS-Per were less proficient than CWNS and CWS-Rec in measures of consonant production (BBTOP-CI) and repetition of novel phonological sequences (NRT). In contrast, receptive language, expressive language, and verbal working memory abilities did not distinguish CWS-Rec from CWS-Per. Binary logistic regression analysis indicated that preschool BBTOP-CI scores and overall NRT proficiency significantly predicted future recovery status.

CONCLUSION

Results suggest that phonological and speech articulation abilities in the preschool years should be considered with other predictive factors as part of a comprehensive risk assessment for the development of chronic stuttering.

EDUCATIONAL OBJECTIVES

At the end of this activity the reader will be able to: (1) describe the current status of nonlinguistic and linguistic predictors for recovery and persistence of stuttering; (2) summarize current evidence regarding the potential value of consonant cluster articulation and nonword repetition abilities in helping to predict stuttering outcome in preschool children; (3) discuss the current findings in relation to potential implications for theories of developmental stuttering; (4) discuss the current findings in relation to potential considerations for the evaluation and treatment of developmental stuttering.

[2+3] Cycloaddition Reactions of Azido Metal Complexes and Crystal Structure of the Cycloadduct of (Ρh3Ρ)2Pd(Ν3)2 with Benzonitrile

Cycloaddition reactions of (R3P) 2M(N3)2 (M = Pd, Pt) with organic nitriles, thiocyanates, isothiocyanates, dimethylacetylenedicarboxylate and carbon disulphide are described; an X-ray analysis of the crystal structure of bis (5-phenyltetrazolato) -bis (triphenylphosphine) palladium (II) is summarised and related to isomerism of the complex in solution.

Experimental validation of a novel compact focusing scheme for future energy-frontier linear lepton colliders

A novel scheme for the focusing of high-energy leptons in future linear colliders was proposed in 2001 [P. Raimondi and A. Seryi, Phys. Rev. Lett. 86, 3779 (2001)]. This scheme has many advantageous properties over previously studied focusing schemes, including being significantly shorter for a given energy and having a significantly better energy bandwidth. Experimental results from the ATF2 accelerator at KEK are presented that validate the operating principle of such a scheme by demonstrating the demagnification of a 1.3 GeV electron beam down to below 65 nm in height using an energy-scaled version of the compact focusing optics designed for the ILC collider.