Conceptualising quality of life for older people with aphasia

Background: There is an increasing need in speech and language therapy for clinicians to provide intervention in the context of the broader life quality issues for people with aphasia. However, there is no descriptive research that is explicitly focused on quality of life (QoL) from the perspectives of older people with aphasia. Aims: The current study explores how older people with chronic aphasia who are living in the community describe their QoL in terms of what contributes to and detracts from the quality in their current and future lives. The study is descriptive in nature, and the purpose is to conceptualize the factors that influence QoL. Methods & Procedures: Thirty older participants (16 women, 14 men) with mild to moderate aphasic impairment took part. All participants had adequate communication skills to participate: demonstrating reliable yes/no response and moderate auditory comprehension ability. Participants were interviewed in their own homes using six brief unprompted open questions about QoL, in a structured interview. The first five questions were drawn from previous gerontological research (Farquhar, 1995), and a sixth question specifically targeting communication was added. Content analysis was used, identifying discrete units of data and then coding these into concepts and factors. Additional demographic information was collected, and participants’ mood on day of interviewing was assessed using the Geriatric Depression Scale (Sheikh & Yesavage, 1986). Outcomes & Results: Activities, verbal communication, people, and body functioning were the core factors in QoL for these participants, and they described how these factors both contributed quality in life as well as detracted from life quality. Other factors that influenced QoL included stroke, mobility, positive personal outlook, in/dependence, home and health. Whilst the findings are limited by the lack of probing of participants’ responses, the study does present preliminary evidence for what is important in QoL to older people with aphasia. Conclusions: Quality of life for older people with predominantly mild to moderate chronic aphasia who are living in the community is multifactorial in nature. Some factors lie within the remit of speech and language therapy, some lie beyond the professional role, but all are relevant for consideration in rehabilitation and community practice. Further qualitative research is implicated to better understand QoL with aphasia, using in-depth interviewing with a broader range of people with aphasia

Enhancing Inhibition-Induced Plasticity in Tinnitus – Spectral Energy Contrasts in Tailor-Made Notched Music Matter

Chronic tinnitus seems to be caused by reduced inhibition among frequency selective neurons in the auditory cortex. One possibility to reduce tinnitus perception is to induce inhibition onto over-activated neurons representing the tinnitus frequency via tailor-made notched music (TMNM). Since lateral inhibition is modifiable by spectral energy contrasts, the question arises if the effects of inhibition-induced plasticity can be enhanced by introducing increased spectral energy contrasts (ISEC) in TMNM. Eighteen participants suffering from chronic tonal tinnitus, pseudo randomly assigned to either a classical TMNM or an ISEC-TMNM group, listened to notched music for three hours on three consecutive days. The music was filtered for both groups by introducing a notch filter centered at the individual tinnitus frequency. For the ISEC-TMNM group a frequency bandwidth of 3/8 octaves on each side of the notch was amplified, additionally, by about 20 dB. Before and after each music exposure, participants rated their subjectively perceived tinnitus loudness on a visual analog scale. During the magnetoencephalographic recordings, participants were stimulated with either a reference tone of 500 Hz or a test tone with a carrier frequency representing the individual tinnitus pitch. Perceived tinnitus loudness was significantly reduced after TMNM exposure, though TMNM type did not influence the loudness ratings. Tinnitus related neural activity in the N1m time window and in the so called tinnitus network comprising temporal, parietal and frontal regions was reduced after TMNM exposure. The ISEC-TMNM group revealed even enhanced inhibition-induced plasticity in a temporal and a frontal cortical area. Overall, inhibition of tinnitus related neural activity could be strengthened in people affected with tinnitus by increasing spectral energy contrast in TMNM, confirming the concepts of inhibition-induced plasticity via TMNM and spectral energy contrasts

Distributed representations of dynamic facial expressions in the superior temporal sulcus.

Previous research on the superior temporal sulcus (STS) has shown that it responds more to facial expressions than to neutral faces. Here, we extend our understanding of the STS in two ways. First, using targeted high-resolution fMRI measurements of the lateral cortex and multivoxel pattern analysis, we show that the response to seven categories of dynamic facial expressions can be decoded in both the posterior STS (pSTS) and anterior STS (aSTS). We were also able to decode patterns corresponding to these expressions in the frontal operculum (FO), a structure that has also been shown to respond to facial expressions. Second, we measured the similarity structure of these representations and found that the similarity structure in the pSTS significantly correlated with the perceptual similarity structure of the expressions. This was the case regardless of whether we used pattern classification or more traditional correlation techniques to extract the neural similarity structure. These results suggest that distributed representations in the pSTS could underlie the perception of facial expressions

Distributed representations of dynamic facial expressions in the superior temporal sulcus.

Previous research on the superior temporal sulcus (STS) has shown that it responds more to facial expressions than to neutral faces. Here, we extend our understanding of the STS in two ways. First, using targeted high-resolution fMRI measurements of the lateral cortex and multivoxel pattern analysis, we show that the response to seven categories of dynamic facial expressions can be decoded in both the posterior STS (pSTS) and anterior STS (aSTS). We were also able to decode patterns corresponding to these expressions in the frontal operculum (FO), a structure that has also been shown to respond to facial expressions. Second, we measured the similarity structure of these representations and found that the similarity structure in the pSTS significantly correlated with the perceptual similarity structure of the expressions. This was the case regardless of whether we used pattern classification or more traditional correlation techniques to extract the neural similarity structure. These results suggest that distributed representations in the pSTS could underlie the perception of facial expressions

Gaze cueing elicited by emotional faces is influenced by affective context

When we observe someone shift their gaze to a peripheral event or object, a corresponding shift in our own attention often follows. This social orienting response, joint attention, has been studied in the laboratory using the gaze cueing paradigm. Here, we investigate the combined influence of the emotional content displayed in two critical components of a joint attention episode: The facial expression of the cue face, and the affective nature of the to-be-localized target object. Hence, we presented participants with happy and disgusted faces as cueing stimuli, and neutral (Experiment 1), pleasant and unpleasant (Experiment 2) pictures as target stimuli. The findings demonstrate an effect of ‘emotional context’ confined to participants viewing pleasant pictures. Specifically, gaze cueing was boosted when the emotion of the gazing face (i.e., happy) matched that of the targets (pleasant). Demonstrating modulation by emotional context highlights the vital flexibility that a successful joint attention system requires in order to assist our navigation of the social world

Relaxation Methods for Mixed-Integer Optimal Control of Partial Differential Equations

We consider integer-restricted optimal control of systems governed by abstract semilinear evolution equations. This includes the problem of optimal control design for certain distributed parameter systems endowed with multiple actuators, where the task is to minimize costs associated with the dynamics of the system by choosing, for each instant in time, one of the actuators together with ordinary controls. We consider relaxation techniques that are already used successfully for mixed-integer optimal control of ordinary differential equations. Our analysis yields sufficient conditions such that the optimal value and the optimal state of the relaxed problem can be approximated with arbitrary precision by a control satisfying the integer restrictions. The results are obtained by semigroup theory methods. The approach is constructive and gives rise to a numerical method. We supplement the analysis with numerical experiments

Suppression of HBV by Tenofovir in HBV/HIV coinfected patients : a systematic review and meta-analysis

Background: Hepatitis B coinfection is common in HIV-positive individuals and as antiretroviral therapy has made death due to AIDS less common, hepatitis has become increasingly important. Several drugs are available to treat hepatitis B. The most potent and the one with the lowest risk of resistance appears to be tenofovir (TDF). However there are several questions that remain unanswered regarding the use of TDF, including the proportion of patients that achieves suppression of HBV viral load and over what time, whether suppression is durable and whether prior treatment with other HBV-active drugs such as lamivudine, compromises the efficacy of TDF due to possible selection of resistant HBV strains. Methods: A systematic review and meta-analysis following PRISMA guidelines and using multilevel mixed effects logistic regression, stratified by prior and/or concomitant use of lamivudine and/or emtricitabine. Results: Data was available from 23 studies including 550 HBV/HIV coinfected patients treated with TDF. Follow up was for up to seven years but to ensure sufficient power the data analyses were limited to three years. The overall proportion achieving suppression of HBV replication was 57.4%, 79.0% and 85.6% at one, two and three years, respectively. No effect of prior or concomitant 3TC/FTC was shown. Virological rebound on TDF treatment was rare. Interpretation: TDF suppresses HBV to undetectable levels in the majority of HBV/HIV coinfected patients with the proportion fully suppressed continuing to increase during continuous treatment. Prior treatment with 3TC/FTC does not compromise efficacy of TDF treatment. The use of combination treatment with 3TC/FTC offers no significant benefit over TDF alone