Courts, Crisis, and Contestation: Democratic Judicial Decision-Making in Times of Crisis

Klink, B.M.J. van [Promotor]Veraart, W.J. [Promotor

Treating reading difficulties with colour [Editorial]

yesAround 3-6% of children in the United Kingdom have substantial difficulties learning to read, a condition often referred to as dyslexia. They are at high risk of educational underachievement. In a 1996 editorial in The BMJ, Margaret Snowling argued that dyslexia is a verbal (not a visual) disorder.1 An accumulation of evidence supports this position and shows that reading difficulties are best dealt with by interventions that target underlying weaknesses in phonological language skills and letter knowledge.2 The 2009 Rose report, which provides guidance for professionals in schools on identifying and teaching young people with dyslexia and reading difficulties, stresses the importance of early, phonological interventions.3 Despite this evidence, dyslexia is often associated with subjective experiences of visual distortions that lead to discomfort during reading (sometimes termed visual stress). It has been argued that these symptoms can be alleviated by using coloured overlays and lenses.4 Symptoms of visual stress are not unique to dyslexia, and proponents do not claim that the use of colour directly addresses the underlying cause of the reading difficulty. However, they argue that the reduction in visual distortion brought about by a change in colour can improve reading accuracy and fluency.

Treating reading difficulties with colour: Authors’ reply to Evans and Allen

yesWe thank Professors Evans and Allen for their interest in our article.1 2 The charity websites we reviewed refer to colour as though it offers a scientific, evidence based treatment; none referred to feedback from the membership. For example, one charity website makes the claim that “Research in the UK and in Australia shows that people who need coloured filters, who are said to have visual stress, need to have exactly the right colour.” This is incorrect. The research overwhelmingly shows little advantage, or at best conflicting results.3 4

A sequence learning impairment in dyslexia? It depends on the task

Language acquisition is argued to be dependent upon an individuals’ sensitivity to serial-order regularities in the environment (sequential learning), and impairments in reading and spelling in dyslexia have recently been attributed to a deficit in sequential learning. The present study examined the learning and consolidation of sequential knowledge in 30 adults with dyslexia and 29 typical adults matched on age and nonverbal ability using two tasks previously reported to be sensitive to a sequence learning deficit. Both groups showed evidence of sequential learning and consolidation on a serial response time (SRT) task (i.e., faster and more accurate responses to sequenced spatial locations than randomly ordered spatial locations during training that persisted one week later). Whilst typical adults showed evidence of sequential learning on a Hebb repetition task (i.e., more accurate serial recall of repetitive sequences of nonwords versus randomly ordered sequences), adults with dyslexia showed initial advantages for repetitive versus randomly ordered sequences in the first half of training trials, but this effect disappeared in the second half of trials. This Hebb repetition effect was positively correlated with spelling in the dyslexic group; however, there was no correlation between sequential learning on the two tasks, placing doubt over whether sequential learning in different modalities represents a single capacity. These data suggest that sequential learning difficulties in adults with dyslexia are not ubiquitous, and when present may be a consequence of task demands rather than sequence learning per se

Broadened Eligibility for Lung Cancer Screening: Challenges and Uncertainty for Implementation and Equity

In 2013, the US Preventive Services Task Force (USPSTF) recommended annual lung cancer screening with low-dose computed tomography (CT) in US adults aged 55 to 80 years who currently smoke or formerly smoked with a 30 pack-year history, and for those who formerly smoked, quitting within the past 15 years (grade “B” recommendation). In this issue of JAMA, the USPSTF updates this recommendation, proposing 2 significant changes, both related to the population recommended to undergo screening. The first change reduces the age at which to initiate annual screening from 55 to 50 years. The second change reduces the smoking intensity from 30 to 20 pack-year history. Thus, the USPSTF now “recommends annual screening for lung cancer with LDCT [low-dose CT] in adults aged 50 to 80 years who have a 20 pack-year smoking history and currently smoke or have quit within the past 15 years. Screening should be discontinued once a person has not smoked for 15 years or develops a health problem that substantially limits life expectancy or the ability or willingness to have curative lung surgery. (B recommendation)

Cognitive changes in patients with epilepsy identified through the MoCA test during neurology outpatient consultation

Introduction Epilepsy is a chronic neurological disorder that may occur alongside cognitive changes, with effects on multiple cognitive domains. Objective To compare the cognitive performance of patients with epilepsy and healthy controls through Montreal Cognitive Assessment (MoCA) during outpatient consultation at a reference diagnostic center in Colombia and analyze and the influencing factors. Materials and methodology One-hundred and four patients during neurology outpatient consultation in the city of Cartagena, Colombia, were assessed with the (MoCA) test, i.e., 54 people who consulted for headache and have not been diagnosed with epilepsy (NEP) and 50 with a diagnosis of epilepsy (EPs) according to the diagnostic criteria of the International League Against Epilepsy (ILAE). Results Significant differences were found in the total mean scores of the (MoCA) between (EPs) and (NPE) groups (t = 4.72; p < 0.01), particularly in attention (t = 3.22; p < 0.02) and memory (t = 5.04; p < 0.01) dimensions. Additionally, a significant association was observed between years of schooling and (MoCA) scores (p = 0,019) but not between socioeconomic level (p = 0,510), age (p = 0,452) and the frequency of seizures (p = 0,471). Discussion Patients with epilepsy show lower scores in several cognitive domains in respect of the control group. The (MoCA) has proven its appropriateness for cognitive screening in the contexts of clinical neurology outpatient consultation

Opinions and Practices of Lung Cancer Screening by Physician Specialty

BACKGROUND In response to the National Lung Screening Trial, numerous professional organizations published guidelines recommending annual lung cancer screening with low-dose computed tomography (LDCT) for high-risk patients. Prior studies found that physician attitudes and knowledge about lung cancer screening directly impacts the number of screening exams ordered.METHODS In 2015, we surveyed 34 pulmonologists and 186 primary care providers (PCPs) to evaluate opinions and practices of lung cancer screening in a large academic medical center. We compared PCP and pulmonologist responses using t-tests and χ2 tests.RESULTS The overall survey response rate was 40% (39% for PCPs and 50% for pulmonologists). Pulmonologists were more likely than PCPs to report lung cancer screening as beneficial for patients (88.2% versus 37.7%, P < .0001) and as being cost-effective (47.1% versus 14.3%, P = .02). More pulmonologists (76%) reported ordering a LDCT for screening in the past 12 months compared to PCPs (41%, P = .012). Pulmonologists and PCPs reported similar barriers to referring patients for lung cancer screening, including patient costs (82.4% versus 77.8%), potential for emotional harm (58.8% versus 58.3%), high false positive rate (47.1% versus 69.4%), and likelihood for medical complications (47.1% versus 59.7%).LIMITATIONS Our results are generalizable to academic medical centers and responses may be susceptible to recall bias, non-response bias, and social desirability bias.CONCLUSION We found significant differences in opinions and practices between PCPs and pulmonologists regarding lung cancer screening referrals and perceived benefits. As lung cancer screening continues to emerge in clinical practice, it is important to understand these differences across provider specialty to ensure screening is implemented and offered to patients appropriately

Opinions, practice patterns, and perceived barriers to lung cancer screening among attending and resident primary care physicians

Introduction: The US Preventive Services Task Force recommended annual lung cancer screening with low-dose computed tomography (LDCT) for high-risk patients in December 2013. We compared lung cancer screening-related opinions and practices among attending and resident primary care physicians (PCPs). Methods: In 2015, we conducted a 23-item survey among physicians at a large academic medical center. We surveyed 100 resident PCPs (30% response rate) and 86 attending PCPs (49% response rate) in Family Medicine and Internal Medicine. The questions focused on physicians’ opinions, knowledge of recommendations, self-reported practice patterns, and barriers to lung cancer screening. In 2015 and 2016, we compared responses among attending versus resident PCPs using chi-square/Fisher’s exact tests and 2-samples t-tests. Results: Compared with resident PCPs, attending PCPs were older (mean age =47 vs 30 years) and more likely to be male (54% vs 37%). Over half of both groups concurred that inconsistent recommendations make deciding whether or not to screen difficult. A substantial proportion in both groups indicated that they were undecided about the benefit of lung cancer screening for patients (43% attending PCPs and 55% resident PCPs). The majority of attending and resident PCPs agreed that barriers to screening included limited time during patient visits (62% and 78%, respectively), cost to patients (74% and 83%, respectively), potential for complications (53% and 70%, respectively), and a high false-positive rate (67% and 73%, respectively). Conclusion: There was no evidence to suggest that attending and resident PCPs had differing opinions about lung cancer screening. For population-based implementation of lung cancer screening, physicians and trainees will need resources and time to address the benefits and harms with their patients

Atomic Force Microscopy of height fluctuations of fibroblast cells

We investigated the nanometer scale height fluctuations of 3T3 fibroblast cells with the atomic force microscope (AFM) under physiological conditions. Correlation between these fluctuations and lateral cellular motility can be observed. Fluctuations measured on leading edges appear to be predominantly related to actin polymerization-depolymerization processes. We found fast (5 Hz) pulsatory behavior with 1--2 nm amplitude on a cell with low motility showing emphasized structure of stress fibres. Myosin driven contractions of stress fibres are thought to induce this pulsation.Comment: 6 pages, 5 figures, 1 tabl