Speech Production Analyses: Characterizing Typical Development versus Childhood Apraxia of Speech

Childhood Apraxia of Speech (CAS) is a controversial diagnosis that is frequently based on clinical perceptions, with treatment success based on the same perceptual measures. Because additional, less abstract diagnostic and treatment outcome procedures are needed, a series of quantitative trials were chosen for the current research to potentially assist in the diagnosis and evaluation of treatment for those with CAS. The study included two participants, one child with typically developing (TD) speech and one diagnosed and verified by current protocols as having CAS. Kinematic and acoustic measures were used to calculate spatiotemporal index, speech-pause time, and lexical stress. The spatiotemporal index was factored using kinematic data and computer-based algorithms. Acoustic data were used to evaluate speech versus pause time as well as lexical stress. Speech-pause time was calculated by measuring speech time in comparison with pause times both between and within words. Lexical stress was calculated by computing ratios involving vowel length, mean frequency, and mean amplitude of the first syllable over the second syllable.   The participant with CAS displayed greater inconsistency with both the lower and upper lip during repetitions of "Buy Bobby a puppy"; with a higher factored spatiotemporal index for both lips as compared to that of the TD participant. In a story retell task, acoustic analyses of participants' responses revealed increased total utterance time in addition to increased pause time percentage in the participant with CAS versus the TD participant. During repetition of eight trochaic words, the participant with CAS presented greater mean lexical stress while the TD participant displayed stress primarily on the initial syllable. These results provide feasibility for using the given measures to differentiate speech productions of TD children from those with CAS. Additional study of the current measures on a larger scale with TD speech participants as well as in comparison with participants exhibiting other speech sound disorders is recommended.  M.S

Severe and Multiple Disadvantage: A critical policy analysis

Severe and Multiple Disadvantage [SMD] only recently entered the lexicon of research, practice, and policy-making in 2015. However, it is embedded in a lineage of concepts and practices that have sought to intervene upon the lives of individuals who are deemed complex, or are socially excluded, and who represent a social problem. National and localised research have constituted an SMD demographic of individuals around which policies have been directed and services funded and which has culminated in the Changing Futures Programme, launched in 2020 by the Ministry for Housing, Communities and Local Government. By adopting a post-structural approach, the research unpicks the self-evidence of SMD as an objective social problem within policy and analyses the complex ways in which SMD has been produced, regulated and contested. Through critical policy analysis and creative, collaborative methods I have examined the power and knowledge relations that manifest in the regulation (and self-regulation) of people experiencing SMD. Through these methods I have undertaken an analysis that compares the representation of SMD in policy with the lived experience of people considered to be facing SMD, which has enabled a consideration of the effects of these representations. Though SMD is currently a popular topic of social research, none to date has sought to problematize the concept and ground it in a post-structural epistemology. Moreover, this doctoral research addresses an important gap by increasing the range of voices within SMD research through collaborative approaches that amplify the ‘subjugated knowledges’ of lived experience. This critical qualitative approach will therefore generate credible knowledge at a crucial time in the development and implementation of a concept, and as such aims to impact future policy development

Glucoregulation after canine islet transplantation:Contribution of insulin secretory capacity, insulin action, and the entero-insular axis

The physiological glucoregulatory mechanisms after islet transplantation have been incompletely investigated, We studied the insulin secretory capacity (ISC) by intravenous arginine stimulation during 35-mM glucose clamps, insulin action during hyperinsulinemic euglycemic clamps, and mixed-meal stimulation at 6-9 mo after intrasplenic islet autotransplantation in 8 dogs, as compared with 30 controls, The enteroinsular axis in the recipients was examined by infusion of porcine glucose-dependent insulinotropic polypeptide (GIP) and human glucagon-like peptide-1 (GLP-1) (7-36 amide) under 8.5-mM glycemic clamp conditions in order to mimic the postprandial glycemia after transplantation. The grafts comprised 25% of the native islet mass, and the ISC likewise averaged 25% of the control value, The postprandial insulin response, in contrast, had increased to 140% after transplantation-albeit with a concomitant glucose excursion to approximately 8.5 mM, Insulin action declined on average by 45% posttransplant. The ISC correlated both with the postprandial glucose excursion and insulin action in the grafted dogs, Insulin action did not correlate with the postprandial glucose excursion, Infusion of GIP had no effect, but GLP-1 nearly doubled glucose-stimulated insulin, Thus, a hyperglycemia-enhanced insulinotropic effect of GLP-1, and perhaps other gut hormones, may account for the difference in the insulin response to the intravenous and oral challenges, Because the ISC reflects the engrafted islet mass and appears to be the primary determinant of glucose tolerance, transplantation of higher islet doses should allow prolonged near-normal glucoregulation-at least, in the autotransplant setting. (C) 1997 Elsevier Science Inc

Infarct-related chronic total coronary occlusion and the risk of ventricular tachyarrhythmic events in out-of-hospital cardiac arrest survivors

Introduction: Chronic total coronary occlusion (CTO) has been identified as a risk factor for ventricular arrhythmias, especially a CTO in an infarct-related artery (IRA). This study aimed to evaluate the effect of an IRA-CTO on the occurrence of ventricular tachyarrhythmic events (VTEs) in out-of-hospital cardiac arrest survivors without ST-segment elevation. Methods: We conducted a post hoc analysis of the COACT trial, a multicentre randomised controlled trial. Patients were included when they survived index hospitalisation after cardiac arrest and demonstrated coronary artery disease on coronary angiography. The primary endpoint was the occurrence of a VTE, defined as appropriate implantable cardioverter-defibrillator (ICD) therapy, sustained ventricular tachyarrhythmia or sudden cardiac death. Results: A total of 163 patients from ten centres were included. Unrevascularised IRA-CTO in a main vessel was present in 43 patients (26%). Overall, 61% of the study population received an ICD for secondary prevention. During a follow-up of 1 year, 12 patients (7.4%) experienced at least one VTE. The cumulative incidence rate of VTEs was higher in patients with an IRA-CTO compared to patients without an IRA-CTO (17.4% vs 5.6%, log-rank p = 0.03). However, multivariable analysis only identified left ventricular ejection fraction < 35% as an independent factor associated with VTEs (adjusted hazard ratio 8.7, 95% confidence interval 2.2–35.4). A subanalysis focusing on CTO, with or without an infarct in the CTO territory, did not change the results. Conclusion: In out-of-hospital cardiac arrest survivors with coronary artery disease without ST-segment elevation, an IRA-CTO was not an independent factor associated with VTEs in the 1st year after the index event

2020 ESC Guidelines on acute coronary syndrome without ST-segment elevation Recommendations and critical appraisal from the Dutch ACS and Interventional Cardiology working groups

Recently, the European Society of Cardiology (ESC) has updated its guidelines for the management of patients with acute coronary syndrome (ACS) without ST-segment elevation. The current consensus document of the Dutch ACS working group and the Working Group of Interventional Cardiology of the Netherlands Society of Cardiology aims to put the 2020 ESC Guidelines into the Dutch perspective and to provide practical recommendations for Dutch cardiologists, focusing on antiplatelet therapy, risk assessment and criteria for invasive strategy.</p

Response shift after coronary revascularization

Purpose The aims of this study were to investigate (1) the extent to which response shift occurs among patients with coronary artery disease (CAD) after coronary revascularization, (2) whether the assessment of changes in health-related quality of life (HRQoL), controlled for response shift, yield more valid estimates of changes in HRQoL, as indicated by stronger associations with criterion measures of change, than without controlling for response shift, and (3) if occurrences of response shift are related to patient characteristics. Methods Patients with CAD completed the SF-36 and the Seattle Angina Questionnaire (SAQ7) at baseline and 3 months after coronary revascularization. Sociodemographic, clinical and psychosocial variables were measured with the patient version of the New York Heart Association-class, Subjective Significance Questionnaire, Reconstruction of Life Events Questionnaire (RE-LIFE), and HEXACO personality inventory. Oort's Structural Equation Modeling (SEM) approach was used to investigate response shift. Results 191 patient completed questionnaires at baseline and at 3 months after treatment. The SF-36 showed recalibration and reprioritization response shift and the SAQ7 reconceptualization response shift. Controlling for these response shift effects did not result in more valid estimates of change. One significant association was found between reprioritization response shift and complete integration of having CAD into their life story, as indicated by the RE-LIFE. Conclusion Results indicate response shift in HRQoL following coronary revascularization. While we did not find an impact of response shift on the estimates of change, the SEM approach provides a more comprehensive insight into the different types of change in HRQoL following coronary revascularization.Biological, physical and clinical aspects of cancer treatment with ionising radiatio

Diabetes Mellitus Is Associated with Shortened Activated Partial Thromboplastin Time and Increased Fibrinogen Values

OBJECTIVE: This study was designed to examine the relationship between shortened activated partial thromboplastin time (APTT) and increased fibrinogen values with diabetes mellitus. METHODS: APTT, prothrombin time (PT), fibrinogen, fasting plasma glucose (FPG) and glycosylated hemoglobin A1c (HbA1c) levels were measured in 1,300 patients. Patients were divided into three groups according to their HbA1c and FPG levels. RESULTS: When participants were grouped according to their HbA1c levels, we found significantly shorter APTT values (26.9±5.6 s) and increased fibrinogen levels (3.1, 1.9-6.3 g/L) in the diabetes group when compared with the other two groups. When participants were grouped according to their FPG levels, we found significantly shorter APTT values (26.9±6.2 s) and increased fibrinogen levels (3.1, 1.8-6.2 g/L) in the diabetes group when compared with the euglycemic group. CONCLUSIONS: Shorter APTT and increased fibrinogen levels might be useful hemostatic markers in patients with diabetes and in patients at high risk for diabetes

Platelet Inhibition, Endothelial Function, and Clinical Outcome in Patients Presenting With ST-Segment-Elevation Myocardial Infarction Randomized to Ticagrelor Versus Prasugrel Maintenance Therapy: Long-Term Follow-Up of the REDUCE-MVI Trial

Background Off-target properties of ticagrelor might reduce microvascular injury and improve clinical outcome in patients with ST-segment-elevation myocardial infarction. The REDUCE-MVI (Evaluation of Microvascular Injury in Revascularized Patients with ST-Segment-Elevation Myocardial Infarction Treated With Ticagrelor Versus Prasugrel) trial reported no benefit of ticagrelor regarding microvascular function at 1 month. We now present the follow-up data up to 1.5 years. Methods and Results We randomized 110 patients with ST-segment-elevation myocardial infarction to either ticagrelor 90 mg twice daily or prasugrel 10 mg once a day. Platelet inhibition and peripheral endothelial function measurements includi

A High Red Blood Cell Distribution Width Predicts Failure of Arteriovenous Fistula

In hemodialysis patients, a native arteriovenous fistula (AVF) is the preferred form of permanent vascular access. Despite recent improvements, vascular access dysfunction remains an important cause of morbidity in these patients. In this prospective observational cohort study, we evaluated potential risk factors for native AVF dysfunction. We included 68 patients with chronic renal disease stage 5 eligible for AVF construction at the Department of General and Vascular Surgery, Central Clinical Hospital Ministry of Internal Affairs, Warsaw, Poland. Patient characteristics and biochemical parameters associated with increased risk for AVF failure were identified using Cox proportional hazards models. Vessel biopsies were analyzed for inflammatory cells and potential associations with biochemical parameters. In multivariable analysis, independent predictors of AVF dysfunction were the number of white blood cells (hazard ratio [HR] 1.67; 95% confidence interval [CI] 1.24 to 2.25; p<0.001), monocyte number (HR 0.02; 95% CI 0.00 to 0.21; p = 0.001), and red blood cell distribution width (RDW) (HR 1.44; 95% CI 1.17 to 1.78; p<0.001). RDW was the only significant factor in receiver operating characteristic curve analysis (area under the curve 0.644; CI 0.51 to 0.76; p = 0.046). RDW>16.2% was associated with a significantly reduced AVF patency frequency 24 months after surgery. Immunohistochemical analysis revealed CD45-positive cells in the artery/vein of 39% of patients and CD68-positive cells in 37%. Patients with CD68-positive cells in the vessels had significantly higher white blood cell count. We conclude that RDW, a readily available laboratory value, is a novel prognostic marker for AVF failure. Further studies are warranted to establish the mechanistic link between high RDW and AVF failure