Learning from your mistakes: The functional value of spontaneous error monitoring in aphasia

Self-monitoring of errors in picture naming has been shown to correlate positively with aphasia treatment outcomes (Marshall et al., 1994). To explore potential explanations, we took advantage of aphasics’ item-level inconsistency in naming accuracy, e.g., in the baseline phase of treatment studies. We looked for a “monitoring benefit” such that items erroneously named on baseline 1 would be more likely to be named correctly on baseline 2 if accompanied by spontaneous monitoring, relative to unmonitored errors. Such a monitoring benefit might reflect learning (e.g., in response to the self-generated error signal) and/or the differential strength (e.g., proximity to threshold) of monitored items compared to those that are not monitored. To implicate learning requires evidence that the monitoring benefit is directionally asymmetric, i.e., the monitoring-related change in accuracy from baseline 1 to 2 (forward direction) is greater than the monitoring-related change from baseline 2 to trial 1 (backward). Twelve participants with chronic stroke aphasia participated. All were mild-to-moderate in aphasia severity and naming impairment. Each participant named the same 615 pictures, without feedback, on two occasions (2 “baselines”) in separate weeks. On each trial, we scored the accuracy of the first attempt and the type of error; additionally, each error was assigned a monitoring code: DetNoCorr (detected without correction; Ex. 1, 3); DetCorr (detected with correction (Ex., 2, 4); or NoDet (not detected). Ex. 1. (T = squirrel) “chipmunk, no”: Semantic error; DetNoCorr Ex. 2. (T = squirrel) “chipmunk, no, squirrel”: Semantic error; DetCorr Ex. 3. (T = umbrella) “umbelella, that’s not right”: Phonological error; DetNoCorr Ex. 4. (T = umbrella) “umbelella, umbrella”: Phonological error; DetCorr We used mixed effects logistic regression to assess whether the log odds of changing from error to correct was predicted by monitoring status of the error (DetCorr vs. NoDet; DetNoCorr vs. NoDet); whether the monitoring benefit interacted with direction of change (forward, backward); and whether effects varied by error type. Figure 1 (top) shows that the proportion accuracy change was higher for DetCorr, relative to NoDet, consistent with a monitoring benefit. The difference in log odds was significant for semantic errors in both directions (forward: coeff. = -1.73; z= -7.78; p < .001; backward: coeff = -0.92; z= -3.60; p < .001), and for phonological errors in both directions (forward: coeff. = -0.74; z= -2.73; p=.006; backward : coeff. = -.76; z = -2.73; p = .006). The difference between DetNoCorr and NoDet was not significant in any condition. Figure 1 (bottom) shows that for Semantic errors, there was a directional asymmetry favoring the Forward condition (interaction: coeff. = .79; z = 2.32; p = .02). Phonological errors, in contrast, produced comparable effects in Forward and Backward direction. The results demonstrated a benefit for errors that were detected and corrected. This monitoring benefit was present in both the forward and backward direction, supporting the Strength hypothesis. Of greatest interest, the monitoring benefit for Semantic errors was greater in the forward than backward direction, indicating a role for learning

Real-life prevalence of progressive fibrosing interstitial lung diseases.

The concept of progressive fibrosing interstitial lung disease (PF-ILD) has recently emerged. However, real-life proportion of PF-ILDs outside IPF is still hard to evaluate. Therefore, we sought to estimate the proportion of PF-ILD in our ILD cohort. We also determined the proportion of ILD subtypes within PF-ILD and investigated factors associated with PF-ILDs. Finally, we quantified interobserver agreement between radiologists for the assessment of fibrosis. We reviewed the files of ILD patients discussed in multidisciplinary discussion between January 1st 2017 and December 31st 2019. Clinical data, pulmonary function tests (PFTs) and high-resolution computed tomography (HRCTs) were centrally reviewed. Fibrosis was defined as the presence of traction bronchiectasis, reticulations with/out honeycombing. Progression was defined as a relative forced vital capacity (FVC) decline of ≥ 10% in ≤ 24 months or 5% < FVC decline < 10% and progression of fibrosis on HRCT in ≤ 24 months. 464 consecutive ILD patients were included. 105 had a diagnosis of IPF (23%). Most frequent non-IPF ILD were connective tissue disease (CTD)-associated ILD (22%), hypersensitivity pneumonitis (13%), unclassifiable ILD (10%) and sarcoidosis (8%). Features of fibrosis were common (82% of CTD-ILD, 81% of HP, 95% of uILD). After review of HRCTs and PFTs, 68 patients (19% of non-IPF ILD) had a PF-ILD according to our criteria. Interobserver agreement for fibrosis between radiologists was excellent (Cohen's kappa 0.86). The main diagnosis among PF-ILD were CTD-ILD (36%), HP (22%) and uILD (20%). PF-ILD patients were significantly older than non-F-ILD (P = 0.0005). PF-ILDs represent about 20% of ILDs outside IPF. This provides an estimation of the proportion of patients who might benefit from antifibrotics. Interobserver agreement between radiologists for the diagnosis of fibrotic ILD is excellent

Women's Knowledge of Future Cardiovascular Risk Associated With Complications of Pregnancy: A Systematic Review

Background: Several common pregnancy conditions significantly increase a woman’s risk of future cardiovascular diseases (CVD). Patient education and interventions aimed at awareness and self-management of cardiovascular risk factors may help modify future cardiovascular risk. The aim of this systematic review was to examine education interventions for cardiovascular risk after pregnancy, clinical measures/scales, and knowledge outcomes in published qualitative and quantitative studies. Methods: Five databases were searched (from inception to June 2023). Studies including interventions and validated and nonvalidated measures of awareness/knowledge of future cardiovascular risk among women after complications of pregnancy were considered. Quality was rated using the Mixed Methods Appraisal Tool. Results were analyzed using the Synthesis Without Meta-analysis reporting guideline. Characteristics of interventions were reported using the Template for Intervention Description and Replication. Fifteen studies were included; 3 were randomized controlled trials. Results: In total, 1623 women had a recent or past diagnosis of hypertensive disorders of pregnancy, gestational diabetes mellitus, and/or premature birth. Of the 7 studies that used online surveys or questionnaires, 2 reported assessing psychometric properties of tools. Four studies used diverse educational interventions (pamphlets, information sheets, in-person group sessions, and an online platform with health coaching). Overall, women had a low level of knowledge about their future CVD risk. Interventions were effective in increasing this knowledge. Conclusions: In conclusion, women have a low level of knowledge of risk of CVD after pregnancy complications. To increase this level of knowledge and self-management, this population has a strong need for psychometrically validated tailored education interventions. Résumé: Contexte: Plusieurs problèmes médicaux liés à la grossesse augmentent significativement le risque d’une maladie cardiovasculaire (MCV) ultérieure chez les femmes. L’éducation des patients et les interventions axées sur la sensibilisation aux facteurs de risques cardiovasculaire et sur l’autoprise en charge pourraient aider à limiter le risque de MCV. La présente analyse des études qualitatives et quantitatives publiées visait à examiner les interventions éducatives au sujet des risques cardiovasculaires après la grossesse, les mesures et échelles cliniques qui y sont associées, et les résultats de ces interventions sur le plan des connaissances. Méthodologie: Des recherches ont été réalisées dans cinq bases de données (de leur date de création jusqu’à juin 2023). Les études considérées incluaient des interventions et des mesures validées ou non de la sensibilisation des femmes au sujet des risques de MCV après des complications liées à la grossesse ou de leurs connaissances à ce sujet. La qualité des études a été évaluée avec l’Outil d’évaluation de la qualité méthodologique des études incluses dans une revue mixte, et les résultats ont été évalués à l’aide de la méthodologie Synthesis Without Meta-analysis. Les caractéristiques des interventions ont été relevées selon le modèle Template for Intervention Description and Replication. Quinze études ont été retenues, dont 3 essais contrôlés randomisés. Résultats: Au total, 1623 femmes avaient reçu récemment ou auparavant un diagnostic de trouble hypertensif lié à la grossesse, de diabète gestationnel et/ou de travail prématuré. Parmi les 7 études ayant eu recours à des questionnaires ou des sondages en ligne, 2 mentionnaient l’évaluation des propriétés psychométriques des outils. Dans 4 études, plusieurs interventions éducatives ont été utilisées (dépliants, feuillets informatifs, séances de groupe en personne et plateforme en ligne offrant un accompagnement en matière de santé). De manière générale, le niveau de connaissance des femmes au sujet de leur risque de MCV était faible, mais les interventions se sont révélées efficaces pour améliorer ces connaissances. Conclusions: En conclusion, les femmes ne connaissent pas bien les risques de MCV associés aux complications survenues au cours de la grossesse. Pour améliorer le niveau des connaissances et l’autoprise en charge, des interventions conçues pour cette population et validées sur le plan psychométrique sont indispensables

Analysis of Ugandan cervical carcinomas identifies human papillomavirus clade-specific epigenome and transcriptome landscapes.

Cervical cancer is the most common cancer affecting sub-Saharan African women and is prevalent among HIV-positive (HIV+) individuals. No comprehensive profiling of cancer genomes, transcriptomes or epigenomes has been performed in this population thus far. We characterized 118 tumors from Ugandan patients, of whom 72 were HIV+, and performed extended mutation analysis on an additional 89 tumors. We detected human papillomavirus (HPV)-clade-specific differences in tumor DNA methylation, promoter- and enhancer-associated histone marks, gene expression and pathway dysregulation. Changes in histone modification at HPV integration events were correlated with upregulation of nearby genes and endogenous retroviruses