Status of prosody in the practices of speech-language pathologists in France: A survey on theoretical and clinical dimensions

PURPOSE

Many populations in the scope of speech and language pathologists (SLPs) are at risk of prosodic disorders that can impact communicative ability. While a few studies have examined the importance of prosody in the clinical practice of English-speaking SLPs, there is a lack of similar research in non-English-speaking countries. The current study aimed to establish an overview of the situation in France and to determine factors that might be associated with assessing and treating prosody.

METHOD

We collected data about the theoretical and clinical dimensions related to prosody from SLPs in France using an online survey.

RESULTS

One hundred and twenty-eight valid responses were analyzed. Results suggest that both emotional and linguistic prosodies are examined by SLPs. Some aspects of prosody seem to be mastered better than others. While they are aware of the major prosodic difficulties in various pathologies and their negative impact, most SLPs in France rarely or never assess prosody. They feel more uncomfortable with it than with other speech-language domains and often do not consider it as a therapeutic target. Importantly, the perception of prosody as a therapeutic tool is associated with the frequency of assessing and addressing prosodic impairment.

CONCLUSIONS

Further studies should focus on identifying the factors that could improve practices and developing comprehensive assessment tools and evidence-based intervention methods in French. Providing better training in prosody and setting up more collaborations between SLPs and researchers in linguistics and psycholinguistics would be keys in developing this field.

Learning from others' experience: Social fear conditioning deficits in patients with severe alcohol use disorder

BACKGROUND

Alcohol use disorder (AUD) is a significant public health problem. A better understanding of the psychosocial factors contributing to AUD is important for developing public health policy. The purpose of this study was to identify social mechanisms involved in AUD and, more specifically, to determine whether vicarious learning deficits are related to the disorder. A secondary objective was to evaluate the role of empathy in social fear conditioning.

METHODS

Patients with severe AUD (n = 30) and healthy participants (n = 30) performed a social fear learning (SFL) task. The task assesses how an association between a stimulus and an aversive consequence is acquired through social means. Specifically, participants observed a person receiving an electric shock (unconditioned stimulus; US) that was associated (conditioned stimulus; CS+) or not (CS-) with a neutral CS. The skin conductance response was used to measure the effect of learning.

RESULTS

Individuals with severe AUD showed a deficit in SFL, indicating that they had difficulty learning from another's negative experience. Patients also evaluated the emotional experience as less unpleasant than healthy participants.

CONCLUSIONS

This study is the first to show that patients with severe AUD have social learning deficits. The findings suggest that these individuals do not learn from another's negative experience. At a fundamental level, the findings demonstrate the importance of understanding the role of social mechanisms in AUD. At a clinical level, the study highlights the potential for using social learning enhancement to prevent relapse in individuals with severe AUD.

Representational Processes of Actions Toward and Away from the Body

The aim of the present study was to investigate the role of mental representation processes during the planning, reaching, and use phases of actions with tools commonly used toward the body (TB, e.g., toothbrush) or away from the body (AB, e.g., pencil). In the first session, healthy participants were asked to perform TB (i.e., making circular movements with the toothbrush near the mouth) and AB (i.e., making circular movements with the pencil near the desk) actions both with (i.e., actual use) and without the tool in hand (i.e., the pantomime of tool use). In the second session, the same participants performed a series of mental rotation tasks involving body- (i.e., face and hands) and object-related (i.e., abstract lines) stimuli. The temporal and kinematic analysis of the motor actions showed that the time required to start the pantomimes (i.e., the planning phase) was shorter for the AB action than for the TB action. In contrast, the reaching phase lasted longer for the AB action than for the TB action. Furthermore, the TB pantomime was associated with the performance in the mental rotation of body-related stimuli, especially during the planning and reaching phases, whereas the AB pantomime was more related to the performance in the mental rotation of object-related stimuli, especially during the tool use phase. Thus, the results revealed that the direction of a goal-directed motor action influences the dynamics of the different phases of the motor action and can determine the type of mental images involved in the planning and execution of the action.

Monitoring the emotional facial reactions of individuals with antisocial personality disorder during the retrieval of self-defining memories

While a deficit in the recognition of facial expression has been demonstrated in persons with antisocial personality disorder (ASPD), few studies have investigated how individuals with ASPD produce their own emotional facial expressions. This study examines the production of facial emotional expressions of male inpatients with ASPD in a forensic hospital compared with a control group as they retrieve autobiographical memories. This design constitutes a specific ecological experimental approach fostering the evocation of personal feelings. Two indicators characterizing the activation of facial expression were used: activation of emotional action units and emotional dominance. The results showed that individuals with ASPD 1) activated angrier facial expressions than control participants for both indicators, 2) displayed a higher dominance of angry facial expressions during the retrieval of positive self-defining memories than control participants and 3) recalled significant memories that were less associated with neutral facial states than the control sample, regardless of the valence of their memories. These findings highlight the core role of anger in ASPD and the possible development of pathological anger, which would distinguish trajectories toward anxious or mood disorders and trajectories characterized by external disorders.

Can the early visual processing of others' actions be related to social power and dominance?

Although goals often drive action understanding, this ability is also prone to important variability among individuals, which may have its origin in individual social characteristics. The present study aimed at evaluating the relationship between the tendency to prioritize goal information over grip information during early visual processing of action and several social dimensions. Visual processing of grip and goal information during action recognition was evaluated in 64 participants using the priming protocol developed by Decroix and Kalénine (Exp Brain Res 236(8):2411-2426, 2018). Object-directed action photographs were primed by photographs sharing the same goal and/or the same grip. The effects of goal and grip priming on action recognition were evaluated for different prime durations. The same participants further fulfilled questionnaires characterizing the way individuals deal with their social environment, namely their sense of social power, dominance, perspective taking, and construal level. At the group level, results confirmed greater goal than grip priming effects on action recognition for the shortest prime duration. Regression analyses between the pattern of response times in the action priming protocol and scores at the questionnaires further showed that the advantage of goal over grip priming was associated with higher sense of social power, and possibly to lower dominance. Overall, data confirm that observers tend to prioritize goal-related information when processing visual actions but further indicate that this tendency is sensitive to individual social characteristics. Results suggest that goal information may not always drive action understanding and point out the connection between low-level processing of observed actions and more general individual characteristics.

Volatility of subliminal haptic feedback alters the feeling of control in schizophrenia

It has been proposed that agency disorders found in schizophrenia rely on aberrant processing of prediction error. Overreactivity to nonpertinent prediction errors may lead to the attribution of one's own actions to an external source. When applied to perception, this could explain hallucinations. However, experiments in motor control or perception have mainly suggested deficient prediction errors. Using a novel approach based on the manipulation of temporal delays, 23 patients with schizophrenia, 18 patients with bipolar disorder, and 22 healthy participants performed a pointing task with a haptic device that provided haptic feedback without or with delays, which were processed consciously (65 ms) or unconsciously (15 ms). The processing of prediction errors was measured via the adaptation of the hand trajectory, that is, the deceleration in anticipation of the surface, and its modulation as a function of recent history (stable or unstable sensory feedback). Agency was evaluated by measuring the participants' feeling of controlling the device. Only patients with schizophrenia reported a decrease in the feeling of control following subliminally delayed haptic feedback and adapted deceleration durations following subliminally delayed haptic feedback. This effect was correlated with positive symptoms. The overreactivity to subliminal delays was present only when delays occurred repeatedly in an unpredictable way, that is, with a volatile distribution. The results suggest that small temporal uncertainties that should be held as negligible, trigger an aberrant overreactivity which could account for hallucinations and alterations of the patients' conscious feeling of control. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

A general procedure to measure the pacing of body movements timed to music and metronome in younger and older adults

Finger-tapping tasks are classically used to investigate sensorimotor synchronization in relation to neutral auditory cues, such as metronomes. However, music is more commonly associated with an entrained bodily response, such as toe tapping, or dancing. Here we report an experimental procedure that was designed to bridge the gap between timing and intervention studies by directly comparing the effects of metronome and musical cue types on motor timing abilities across the three naturalistic voluntary actions of finger tapping, toe tapping, and stepping on the spot as a simplified case of whole body movement. Both pacing cues were presented at slow, medium, and fast tempi. The findings suggested that the task of stepping on the spot enabled better timing performances than tapping both in younger and older adults (75+). Timing performances followed an inverse U shape with best performances observed in the medium tempi that were set close to the spontaneous motor tempo in each movement type. Finally, music provided an entrainment effect in addition to pace setting that enabled better motor timing and greater stability than classically reported using a metronome. By applying time-stamp analyses to kinetic data, we demonstrate that tapping and stepping engage different timing modes. This work details the importance of translational research for a better understanding of motor timing. It offers a simple procedure that strengthens the validity of applying academic work and contributes in knowledge towards a wide range of therapeutic interventions.

Characterisation of self-defining memories in criminals with antisocial personality disorder

Early aversive events are key factors in the development of antisocial personality disorder (ASPD) and are known to impact the ability to produce specific autobiographical memories and to modify self-construction. The present study assessed identity construction in forensic inpatients suffering from ASPD by comparing the characteristics (specificity, integration, valence, topic and period) of self-defining memories (SDM) of persons with ASPD hospitalised in a forensic hospital to those of control participants. Offenders with ASPD had difficulty in retrieving purely specific single events and tended to recall memories comprising multiple events. In addition, they produced significantly less meaning-making from their past experiences (low integration). These characteristics of SDM could be due to a defensive process used by offenders with ASPD in which they do not integrate aversive experiences, thereby creating a vicious circle where maladjustment of their personality is maintained.

The influence of attachment styles on autonomic correlates of perspective-taking

This study examined the effects of attachment styles on physiological responses during a perspective-taking task. Sixty-eight participants were selected according to attachment styles. Physiological responses were assessed using skin conductance responses (SCRs) in the three attachment groups (secure, insecure-anxious and insecure-avoidant) during the presentation of attachment-based pictures (distress, comfort or neutral) in two different perspective-taking conditions: self perspective-taking (i.e. imagine how you would feel in the given situation) or other perspective-taking (i.e. imagine how that person could feel in this situation). In the self perspective-taking condition, insecure-anxious individuals displayed higher SCRs than secure individuals for distress pictures. In the other perspective-taking condition, insecure-anxious individuals showed higher SCRs than secure individuals for comfort pictures. The results also showed a strong negative association between self-reported perspective-taking tendencies and SCRs in secure individuals. The findings suggest that perspective-taking plays an important role in the modulation of physiological responses in reaction to attachment-related pictures, which varies according to attachment styles.

The influence of facial expression at perceptual threshold on electrodermal activity and social comfort distance

Interpersonal distance, an essential component of social interaction, is modulated by the emotion conveyed by others and associated physiological response. However, in modern societies with overcrowded and hyperstimulating environments, we can only surreptitiously glimpse the faces of others in order to quickly make behavioral adjustments. How this impacts social interactions is not yet well understood. In the present study, we investigated this issue by testing whether facial expressions that are difficult to identify modify the physiological response (Electrodermal Activity, EDA) and subsequent judgment of interpersonal comfort distance. We recorded participants' EDA while they provided comfort judgments to interpersonal distances with a Point-Light Walker (PLW). The PLW, with an emotionally neutral gait, moved toward and crossed participants at various distances after the latter were exposed to a negative (anger), positive (happiness) or neutral facial expression presented at the perceptual threshold. Bayesian analyses of the data revealed an increase versus decrease of interpersonal comfort distance with the PLW depending on the negative versus positive emotional valence of the facial expression. They also showed an increase in EDA when the approaching PLW violated interpersonal comfort distance after participants were exposed to an angry facial expression. These effects correlated with the subjective assessment of the arousal of facial expressions. Thus, previous exposure to barely visible facial expressions can alter the representation of social comfort space and the physiological response associated with a violation of interpersonal comfort distances, depending on the valence and arousal of the emotional social stimuli.

Effect of marital satisfaction on self-regulation efforts in couples: Value of heart rate variability measurements

This study explored self-regulatory efforts during the viewing of couple interactions and their association with relationship satisfaction. High-frequency heart rate variability (HF-HRV) was measured for each participant during a video recall of a recent couple interaction to quantify the self-regulatory processes governed by parasympathetic activity. Among 30 couples, HF-HRV was measured continuously during three specific periods to explore its change over time using a video-recall procedure: (1) resting state; (2) viewing of couple interactions (expressing daily life situations and conflictual interactions); and (3) recovery. Results of multilevel models revealed a u-shaped pattern of HF-HRV responses for men and women across the three periods with a nadir at the midway through the process. This pattern of physiological change (vagal suppression) reflects a flexible response to a stressful situation. Nevertheless, the pattern of physiological responses varied according to the level of relationship satisfaction. Men who were more satisfied in their couple relationship presented greater vagal suppression than dissatisfied men. In contrast, no significant HF-HRV changes were found in women over the different periods of the video-recall procedure and no moderating effect of relationship satisfaction. We discuss the different patterns of physiological responses observed both for men and women in terms of interindividual variability according to the level of their relationship satisfaction. The present study highlights the important role of relationship satisfaction in regulatory processes.

What effort is required in retrieving self-defining memories? Specific autonomic responses for integrative and non-integrative memories

Self-defining memories (SDM) are autobiographical memories associated with the construction and maintenance of identity, and which play a core role in establishing and achieving goals in life. The aim of this study was to evaluate the effort required in retrieving SDM as reflected by physiological activity. We examined the neurovegetative responses associated with three dimensions of SDM: specificity, integrative meaning and emotional valence. Electrodermal activity (skin conductance response frequency, phasic driver) and the high frequency component of heart rate variability (HF-HRV) were recorded during the retrieval of SDM in 36 healthy participants to assess the activation of the sympathetic and parasympathetic systems, respectively. SDM were characterized by three independent investigators with satisfactory inter-rater reliability. Linear mixed effects analyses showed that only the integrative meaning dimension led to a main effect on electrodermal activity. In addition, an interaction effect showed that the retrieval of non-integrative and specific memories was associated with a higher level of electrodermal activity than the retrieval of integrative specific memories. No effects were obtained regarding the HRV indicators. The higher activation of the sympathetic nervous system associated with the retrieval of non-integrative SDM suggests that the ability to derive meaning from personal experiences plays a regulatory role and is a fundamental component in personal adjustment.

Does the motor system contribute to the perception of changes in objects visual attributes? The neural dynamics of sensory binding by action

The contribution of the motor system to perception has been highlighted in research investigating the effect of performing an action on the conscious processing of information received from the sensory systems. For example, the perceptual temporal asynchrony observed when passively reporting changes in visual object attributes (e.g., colour and position) was found to disappear virtually when the changes resulted from a voluntary motor action. Although the spatio-temporal constraints of sensory binding by action have been broadly investigated, the underlying neural correlates are still largely unknown. In the present study, participants performed temporal order judgments of changes in the colour and position of a visual stimulus, while adapting to a 750 ms delay between a sound (perceptual condition) or the end of a manual reaching action (motor condition), and the visual changes. Behavioural observations indicated that temporal asynchrony (-30.2 ms) decreased in the motor condition (2.7 ms), as a result of sensorimotor adaptation, but not in the perceptual condition (-29.6 ms). EEG-evoked potentials on posterior visual regions showed that early components were altered by sensorimotor adaptation, with in particular a broad reduction in the amplitude of the early P1 component. Furthermore, time-frequency analysis of EEG signals during the 350 ms period preceding the visual changes revealed an increase of the 15-25 Hz frequency band amplitude in the central region and a decrease of the 8-12 Hz frequency band amplitude in the posterior region. Overall the results suggest that sensory binding by action depends on an early top-down modulation of the visual regions by the motor system - in agreement with the pre-activation theory of action-perception coupling - associated with an increase of attentional resources.

Body-centred and Object-centred Motor Imagery in Alzheimer's Disease

OBJECTIVE

Autonomy in patients with Alzheimer's disease (AD) in daily life depends on the preservation of neurocognitive and motor abilities, which decline over time. So far, very few studies have investigated motor representations and their contribution to perception and cognition in AD.

METHODS

In the present study, we compared the performance of AD patients to age-matched healthy participants in perceptual and cognitive tasks involving motor imagery. Experiment 1 tested explicit motor and visual imagery through an imagined movement task. Experiment 2 tested body-centred implicit motor imagery through a mental rotation of visual hand task. Finally, Experiment 3 tested object-centred implicit motor imagery through a reachability judgment task.

RESULTS

The results showed that, compared to age-matched controls, conscious imagination of a body movement or the movement of a visual stimulus was much longer in AD patients, with no specific difficulty in the motor condition (Experiment 1). Furthermore, response time in AD patients was strongly affected by the angle of rotation of the visual stimuli in the mental rotation of hand task (Experiment 2). Likewise, response time in AD patients increased substantially in the reachability judgment task, but predominantly for stimuli located at the boundary of peripersonal space (Experiment 3).

CONCLUSION

As a whole, the data suggested a decline in AD of implicit, but not explicit, motor imagery capacities affecting processing time, but not performance accuracy, in motor-related perceptual and cognitive tasks.

Idiosyncratic representation of peripersonal space depends on the success of one's own motor actions, but also the successful actions of others!

Peripersonal space is a multisensory representation of the environment around the body in relation to the motor system, underlying the interactions with the physical and social world. Although changing body properties and social context have been shown to alter the functional processing of space, little is known about how changing the value of objects influences the representation of peripersonal space. In two experiments, we tested the effect of modifying the spatial distribution of reward-yielding targets on manual reaching actions and peripersonal space representation. Before and after performing a target-selection task consisting of manually selecting a set of targets on a touch-screen table, participants performed a two-alternative forced-choice reachability-judgment task. In the target-selection task, half of the targets were associated with a reward (change of colour from grey to green, providing 1 point), the other half being associated with no reward (change of colour from grey to red, providing no point). In Experiment 1, the target-selection task was performed individually with the aim of maximizing the point count, and the distribution of the reward-yielding targets was either 50%, 25% or 75% in the proximal and distal spaces. In Experiment 2, the target-selection task was performed in a social context involving cooperation between two participants to maximize the point count, and the distribution of the reward-yielding targets was 50% in the proximal and distal spaces. Results showed that changing the distribution of the reward-yielding targets or introducing the social context modified concurrently the amplitude of self-generated manual reaching actions and the representation of peripersonal space. Moreover, a decrease of the amplitude of manual reaching actions caused a reduction of peripersonal space when resulting from the distribution of reward-yielding targets, while this effect was not observed in a social interaction context. In that case, the decreased amplitude of manual reaching actions was accompanied by an increase of peripersonal space representation, which was not due to the mere presence of a confederate (control experiment). We conclude that reward-dependent modulation of objects values in the environment modifies the representation of peripersonal space, when resulting from either self-generated motor actions or observation of motor actions performed by a confederate.

Physiological Response to Facial Expressions in Peripersonal Space Determines Interpersonal Distance in a Social Interaction Context

Accurate control of interpersonal distances in social contexts is an important determinant of effective social interactions. Although comfortable interpersonal distance seems to be dependent on social factors such as the gender, age and activity of the confederates, it also seems to be modulated by the way we represent our peripersonal-action space. To test this hypothesis, the present study investigated the relation between the emotional responses registered through electrodermal activity (EDA) triggered by human-like point-light displays (PLDs) carrying different facial expressions (neutral, angry, happy) when located in the participants peripersonal or extrapersonal space, and the comfort distance with the same PLDs when approaching and crossing the participants fronto-parallel axis on the right or left side. The results show an increase of the phasic EDA for PLDs with angry facial expressions located in the peripersonal space (reachability judgment task), in comparison to the same PLDs located in the extrapersonal space, which was not observed for PLDs with neutral or happy facial expressions. The results also show an increase of the comfort distance for PLDs approaching the participants with an angry facial expression (interpersonal comfort distance judgment task), in comparison to PLDs with happy and neutral ones, which was related to the increase of the physiological response. Overall, the findings indicate that comfort social space can be predicted from the emotional reaction triggered by a confederate when located within the observer’s peripersonal space. This suggests that peripersonal-action space and interpersonal-social space are similarly sensitive to the emotional valence of the confederate, which could reflect a common adaptive mechanism in specifying theses spaces to subtend interactions with both the physical and social environment, but also to ensure body protection from potential threats.

Heart rate variability changes and emotion regulation abilities in short- and long-term abstinent alcoholic individuals

INTRODUCTION

Difficulties in identifying and regulating emotion are recognized as major factors of relapse in alcohol use disorders (AUD). This study aimed to evaluate the differences of emotion regulation processes in AUD patients with short-term (STA, less than one month) and long-term abstinence (LTA, at least six months) by recording the high frequency of Heart Rate Variability (HF-HRV) in response to emotional and neutral stimuli.

METHOD

Emotional induction constituted the presentation of highly emotional and neutral pictures (IAPS data base) presenting human interactions. HF-HRV was recorded before (at rest), during (pictures) and after emotional induction (recovery).

RESULTS

The results showed higher phasic HF-HRV in the STA group in comparison to the LTA and C groups for negative, positive and neutral stimuli. In the LTA group, we observed a normalization of HRV, in response to emotional stimuli. However, for negative valence stimuli in the recovery period, LTA participants are no more different from STA group. A main positive correlation was observed for both patient groups between craving scores and increased HF-HRV during and after the emotion induction.

CONCLUSION

The data support the hypothesis of emotion regulation impairment after STA but also show a partial improvement with prolonged abstinence. This impairment in patients may correspond to the maintenance of negative feedback that accentuates the difficulties in the emotional physiological process and limits the ability to engage in or maintain other processes. HF-HRV is a good indicator of emotion regulation processes related to the intensity of the craving even after long-term abstinence.

Ethanol gas-phase ammoxidation to acetonitrile: the reactivity of supported vanadium oxide catalysts

The gas-phase ammoxidation of ethanol, a bio-based platform molecule, has been investigated as a possible more sustainable route for the production of acetonitrile, using supported vanadium oxide catalysts. The nature of the interaction between the support and the active species greatly affected the catalytic performance.

Changes in heart rate variability to emotional information in short- and long-term alcohol abstinent patients

Introduction

Severe alcohol use disorders (AUD, DSM5 criteria, 2013) are associated with changes in the dynamics of emotional processes and emotional experience [1]. The aim of the study was to compare emotional information processing in patients with AUD in short-term abstinence (STA, less than 1 month) and in long-term abstinence (LTA, at least 6 months) with control participants (C). We studied the parasympathetic branch of the autonomic nervous system with the heart rate variability (HRV) and more particularly high frequencies (HF). This indicator is recognized as a reliable marker of physiological activation in reaction to emotional stimuli and as a good marker of vulnerability to AUD [2].

Method

The recording was performed for all participants during presentation of high emotional inducing stimuli presenting human interactions [3]. For each participant HRV was recorded before, during and after induction. Participants were asked to evaluate the intensity and the valence of emotional stimuli. In addition, a clinical and cognitive assessment was performed. We proposed in this study for abstinence in short- and in long-term to combine both behavioral and cognitive measures to this physiological indicator.

Results

We observed:

– significant differences in HF-HRV between LTA and STA groups, controls and STA groups but not between LTA and C groups;

– significant correlations between craving scores [4] and HF-HRV results in LTA and STA groups.

Prospect

The results support the relationship between the ability to process emotional information and the risk of relapse. HF-HRV results indicate specific deficits in regulation in STA group and also recoveries in LTA group. It suggests specific different therapeutic interventions in preventing the risk of relapse or maintenance of addiction.

Feeling of control of an action after supra and subliminal haptic distortions

Here we question the mechanisms underlying the emergence of the feeling of control that can be modulated even when the feeling of being the author of one's own action is intact. With a haptic robot, participants made series of vertical pointing actions on a virtual surface, which was sometimes postponed by a small temporal delay (15 or 65 ms). Subjects then evaluated their subjective feeling of control. Results showed that after temporal distortions, the hand-trajectories were adapted effectively but that the feeling of control decreased significantly. This was observed even in the case of subliminal distortions for which subjects did not consciously detect the presence of a distortion. Our findings suggest that both supraliminal and subliminal temporal distortions that occur within a healthy perceptual-motor system impact the conscious experience of the feeling of control of self-initiated motor actions.

Effects of emotion regulation difficulties on the tonic and phasic cardiac autonomic response

Background

Emotion regulation theory aims to explain the interactions between individuals and the environment. In this context, Emotion Regulation Difficulties (ERD) disrupt the physiological component of emotions through the autonomic nervous system and are involved in several psychopathological states.

Objective

We were interested in comparing the influence of a film-elicited emotion procedure on the autonomic nervous system activity of two groups with different levels of emotion regulation difficulties.

Methods

A total of 63 women (undergraduate students) ranging from 18 to 27 (20.7±1.99) years old were included. Using the upper and lower quartile of a questionnaire assessing the daily difficulties in regulating emotions, two groups, one with low (LERD) and one with high (HERD) levels of emotion regulation difficulties, were constituted and studied during a film-elicited emotion procedure. Cardiac vagal activity (HF-HRV) was analyzed during three periods: baseline, film-elicited emotion, and recovery.

Results

The cardiovascular results showed a decrease in HF-HRV from baseline to elicitation for both groups. Then, from elicitation to recovery, HF-HRV increased for the LERD group, whereas a low HF-HRV level persisted for the HERD group.

Conclusions

The HERD group exhibited inappropriate cardiac vagal recovery after a negative emotion elicitation had ended. Cardiac vagal tone took longer to return to its initial state in the HERD group than in the LERD group. Prolonged cardiac vagal suppression might constitute an early marker of emotion regulation difficulties leading to lower cardiac vagal tone.

Joystick interfaces are not suitable for robotized endoscope applied to NOTES

BACKGROUND

NOTES has changed the working environment of endoscopy, leading to new difficulties. The limitations of conventional endoscopes call for the development of new platforms. Robotics may be the answer.

MATERIALS AND METHODS

The authors compared human to robotized manipulation of a flexible endoscope into the abdominal cavity, in an animal model. Thirty-two participants were enrolled. Results were analyzed according to the clinical background of the participants: experienced endoscopists, experienced laparoscopists, and medical students. Two single-channel gastroscopes were used. Whereas one was not modified, the other had the handling wheels replaced by motors controlled through a computer and a joystick. A NOTES transgastric approach was used to access the peritoneal cavity. The time to touch previously positioned intra-abdominal numbered plastic targets was recorded 3 times with each endoscope.

RESULTS

Mean time to complete the tasks was significantly shorter using the conventional endoscope (2.71 vs 6.96 minutes, P < .001). When the robotized endoscope was used, the mean times of endoscopists (7.42 minutes), laparoscopists (6.84 minutes), and students (6.77 minutes) were statistically identical. No differences were found between laparoscopists and students in both techniques.

DISCUSSION

Applying robotics to a flexible endoscope fails to enhance ability to move into the abdominal cavity, partly because of the interface. To overcome the limitations of endoscope when performing complex NOTES tasks, robotics may be useful, especially to control the instruments and to stabilize the endoscope itself.

CONCLUSION

Robotized endoscope with joystick interface is not sufficient to enhance immediate intuitiveness of flexible endoscopy applied to NOTES.

Simultaneous physiological motion cancellation and depth adaptation in flexible endoscopy

Flexible endoscopes are used in many diagnostic exams and surgical procedures in gastroenterology as well as in natural orifice transluminal endoscopic surgery. In order to assist the surgeon during these difficult procedures, physiological motion cancellation has been successfully applied on a robotized endoscope. However, the stability and performance of the classical controllers were ensured only on a small working area, thus preventing the surgeon to manually move the endoscope during motion rejection. In this paper, we propose original methods to improve the physiological motion rejection while taking into account manual depth changes performed by the surgeon. For this purpose, an adaptive repetitive controller based on depth estimation is proposed. The validity of the approach is demonstrated in in vitro experiments.

Postpyloric enteral feeding costs for patients with severe head injury: blind placement, endoscopy, and PEG/J versus TPN

This study describes the advantages and disadvantages of several forms of enteral nutrition for patients with severe head injury (Glasgow Coma Scale Score [GCS], <12). Included in the study are nasoenteric nutrition delivery using blind, endoscopic, percutaneous endoscopic gastrostomy (PEG) and PEG with jejeunostomy (PEG/J), and open jejeunostomy tube placement methods. These methods are compared with parenteral delivery of nutrition. The study constituted a retrospective analysis of the success rate of early enteral feedings by blind, endoscopic PEG and PEG/J and by open jejeunostomy placement of small-bowel feeding tubes for 57 patients with severe head injury. The delivery cost of enteral nutrition per intensive care unit day was compared to the delivery cost of parenteral nutrition per intensive care unit day in the same group of patients. Fifty-three percent of patients were adequately maintained nutritionally with nasoenteric delivery alone and did not require parenteral feeding. The average number of days for initiation of either enteral or parenteral feedings was 1.8 +/- 0.2 days from injury [standard error of mean (SEM); range, 0-10 days]. An average of 3.3 days (range, 0-23 days) was required for feeding tube placement in all patients. For 70% of patients, tube placement was completed within 48 h after injury. Full-strength, full-rate enteral feedings were achieved by a mean of 4.9 days after injury. A total of 128 feeding tubes were placed while the patients were in the intensive care unit (ICU; 2.2 +/- 0.2 tubes per patient). Blind placement of feeding tubes into the small bowel was rarely achieved without repositioning. Endoscopic tube placement into the duodenum was achieved in 50% of patients, into the jejunum for 33% of patients, and into the stomach for 18% of patients. While in the intensive care unit, patients received an average of 77 +/- 2% of their measured energy expenditure (range, 57-114%). Eleven percent of patients experienced severe gastrointestinal problems. Other problems were associated with the inability to achieve or maintain access: dislodged tubes (30%), clogged or kinked tubes (21%), and mechanical access problems (7 %). Seventy-one percent of patients in barbiturate coma were able to tolerate early nasoenteric feedings. Aspiration pneumonitis occurred equally among patients fed nasogastrically and those fed nasoenterically. The overall aspiration rate was 14%. The cost of acute enteral feeding was $170 per day and that for parenteral feeding, $308 per day. We conclude that blind transpyloric feeding tube placement is difficult to achieve in patients with severe head injury; endoscopically guided placement is a better option. Endoscopic feeding tube placement most consistently allows for early enteral nutritional support in severe head injured patients. Limitations include the inability to establish and/or maintain enteral access, increased intracranial pressure, unstable cervical spinal injuries, facial fractures, and dedication of the physician to tube placement and monitoring.

Determination of the scattering coefficient and the anisotropy factor from laser Doppler spectra of liquids including blood

Laser Doppler measurements were performed on scattering liquids flowing through a highly scattering static medium to determine the scattering coefficient and the anisotropy factor of the liquids. Monte Carlo simulations of light propagation in the static and moving media were used to calculate the Doppler spectra for suspensions of polystyrene spheres in water, and these spectra were in excellent agreement with experimental results. A faster Monte Carlo code was developed so that nonlinear regressions to the measured laser Doppler spectra could be used to determine the anisotropy factor of other liquids. This approach was used to deduce the scattering properties of Intralipid and blood at λ = 820 nm. It was found that the anisotropy factor of blood is well described by Mie theory in contradiction to results reported in the literature that were obtained by goniometric measurement of the phase function.

Zinc supplementation is associated with improved neurologic recovery rate and visceral protein levels of patients with severe closed head injury

Sixty-eight patients were entered into a randomized, prospective, double-blinded controlled trial of supplemental zinc versus standard zinc therapy to study the effects of zinc supplementation on neurologic recovery and nutritional/metabolic status after severe closed head injury. One month after injury, the mortality rates in the standard zinc group and the zinc-supplemented group were 26 and 12%, respectively. Glasgow Coma Scale (GCS) scores of the zinc-supplemented group exceeded the adjusted mean GCS score of the standard group at day 28 (p = 0.03). Mean motor GCS score levels of the zinc-supplemented group were significantly higher on days 15 and 21 than those of the control group (p = 0.005, p = 0.02). This trend continued on day 28 of the study (p = 0.09). The groups did not differ in serum zinc concentration, weight, energy expenditure, or total urinary nitrogen excretion after hospital admission. Mean 24-h urine zinc levels were significantly higher in the zinc-supplemented group at days 2 (p = 0.0001) and 10 (p = 0.01) after injury. Mean serum prealbumin concentrations were significantly higher in the zinc-supplemented group (p = 0.003) at 3 weeks after injury. A similar pattern was found for mean serum retinol binding protein level (p = 0.01). A significantly larger number of patients in the standard zinc group had craniotomies for evacuation of hematoma; thus a bias may have been present. The results of this study indicate that zinc supplementation during the immediate postinjury period is associated with improved rate of neurologic recovery and visceral protein concentrations for patients with severe closed head injury.

Cytokines and metabolic dysfunction after severe head injury

Patients with head injury must overcome central as well as peripheral metabolic insults. In addition to specific tissue damage to the brain, a cellular biochemical cascade occurs that can negatively affect organ function, cause a systemic response to injury, and may cause secondary tissue injury. The metabolites involved in this cascade are numerous and complex. Cytokines are important cell-to-cell communication mediators during injury. It is speculated that cytokines, such as interleukin 1 (IL-1), interleukin 6 (IL-6), tumor necrosis factor (TNF), and interleukin 8 (IL-8), which are found in elevated amounts in both human and basic trials after head injury, play a role in the cellular cascade of injury. Some of the metabolic events produced by small doses of cytokine infusion in animals, as well as humans, include fever, neutrophilia, muscle breakdown, altered amino acid metabolism, depression of serum zinc levels, production of hepatic acute phase reactants, increased endothelial permeability, and expression of endothelial adhesion molecules. These are all known sequelae of severe head injury. Cytokines have also been implicated in organ failure. Infusion of cytokines in basic science trials revealed that organ functions of the gut, liver, and lung are negatively altered by high-dose cytokine infusion. Infusion of certain cytokines has been shown to cause death of brain cells, increase blood-brain barrier permeability, and cause cerebral edema. This suggests that cytokines may also play a role in the sequelae of organ demise. These effects of cytokines have been attenuated in basic trials by blocking the initial signaling system of cytokines or by decreasing serum cytokine activity. We hypothesize that cytokines that are elevated after head injury play a role in the pathology of injury, including altered metabolism and organ demise.

Nutritional and metabolic variables correlate with amino acid forearm flux in patients with severe head injury

OBJECTIVE

To measure the arterial-venous amino acid flux across the forearm muscle in patients with severe head injury.

DESIGN

Prospective, interventional study.

SETTING

Level I trauma hospital in the neurosurgery intensive care unit (ICU) at a university medical center.

PATIENTS

Eight nonsteroid-treated patients with severe head injury.

INTERVENTIONS

Patients were prospectively randomized to receive either standard or supplemental intravenous zinc therapy.

MEASUREMENTS AND MAIN RESULTS

Net forearm alanine, glutamine, tyrosine, phenylalanine, and branch-chain amino acid forearm flux were measured and compared with metabolic markers of energy expenditure and nitrogen excretion. There was a significant inverse relationship between the measured energy expenditure/predicted energy expenditure ratio and glutamine flux (r2 = .62; p < .05). The patients with the highest measured energy expenditure/predicted energy expenditure ratio had the greatest release of glutamine from forearm muscle. Nitrogen balance was significantly correlated with leucine flux (r2 = .53; p < .05) and with isoleucine flux (r2 = .67; p < .05). The patients with the most positive nitrogen balance had the least release of branch-chain amino acids from skeletal muscle. Tyrosine flux was highly correlated with net amino acid flux (r2 = .76; p < .01). Tyrosine flux was therefore indicative of overall muscle catabolism. Four patients had an overall negative flux of amino acids from skeletal muscle. Three patients had an overall negative flux of branch-chain amino acids.

CONCLUSIONS

This preliminary descriptive report suggests that increased skeletal muscle efflux of amino acids correlates significantly with metabolic variables of hypermetabolism and hypercatabolism in nonsteroid-treated, head-injured patients.

Institutional respite care: benefits and risks for dementia patients and caregivers

Thirty-seven dementia patients and their caregivers were studied before and after a two-week in-hospital respite stay. Institutional respite care did not alter behavior problems in dementia patients, nor did changes in performance of activities of daily living (ADLs) by Alzheimer's disease (AD) patients exceed those expected from disease progression. Caregivers exhibited an improvement in burden and depression during the respite study, but levels returned to baseline following the patient's return home.

The MEE/PEE ratio as a predictor of excess weight loss for up to 1 year after vertical banded gastroplasty

Thirteen morbidly obese individuals were studied prospectively for 1 year after vertical banded gastroplasty (VBG) to determine the relationships between energy balance equation parameters and excess weight loss. The measured energy expenditure (MEE), as determined by indirect calorimetry, was not correlated with weight loss. However, when this parameter was expressed as a ratio to the predicted energy expenditure (PEE), the ratio was significantly correlated with the postoperative excess weight loss at 2, 6, and 12 months. The mean daily energy intake after the VBG was 2715 +/- 865 kJ. The postoperative energy intake was not correlated with the excess weight loss. Diet-induced thermogenesis was studied in eight patients. The mean diet-induced thermogenesis was 10.31% +/- 13.92%. The diet-induced thermogenesis was not correlated with the postoperative excess weight loss. The preliminary findings of this trial suggest that the MEE/PEE ratio is useful in predicting excess weight loss after VBG.

Nutrition and brain injury

The patient with head injury must overcome central and systemic insults. In addition to the head injury itself, the patient suffers a systemic metabolic response to injury. Both of these insults can affect the patient's ability to survive and recover. During the past decade, investigators have described the systemic metabolic result identified by hypermetabolism, hypercatabolism, the acute-phase response, decreased immunocompetence, hyperglycemia, increased counterregulatory hormone levels, increased ventricular fluid and serum cytokine levels, and altered gastric function. During the next decade, investigators will attempt to modulate this response by manipulating the types of nutrients administered, use of pharmacologic and physiological agents, and administration of growth factors.