Therapy for Auditory Processing Impairment in Aphasia: An evaluation of two approaches

Purpose: This study evaluated two forms of discrimination therapy for auditory processing impairment in aphasia. It aimed to determine whether therapy can improve speech perception and/or help participants use semantic information to compensate for their impairment. Changes in listening were also explored by recording the level of facilitation needed during therapy tasks. Finally the study examined the effect of therapy on an everyday listening activity: a telephone message task. Method: The study employed a repeated measures design. Eight participants received 12 sessions each of phonological and semantic-phonological therapy. Both programmes used minimal pair judgement tasks, but the latter embedded such tasks within a meaningful context, so encouraged the strategic use of semantic information (semantic bootstrapping). Experimental measures of auditory discrimination and comprehension were administered twice before therapy, once after each programme, and again six weeks later. The telephone message task was also administered at each time point. Test data were subjected to both group and individual analyses. Records of progress during therapy (i.e changes in support needed to carry out therapy tasks) were completed during treatment and analysed across the group. Results: Group analyses showed no significant changes in tests of word and nonword discrimination as a result of therapy. One comprehension task improved following therapy, but two did not. There was also no indication that therapy improved the discrimination of treated words, as assessed by a priming task. The facilitation scores indicated that participants needed less support during tasks as therapy progressed, possibly as a result of improved listening. There was a significant effect of time on the telephone message task. Across all tasks there were few individual gains. Conclusions: The results offer little evidence that therapy improved participants’ discrimination or semantic bootstrapping skills. Some changes in listening may have occurred, as indicated by the facilitation scores. Reasons for the null findings are discussed

Disciplined doctors: Does the sex of a doctor matter? A cross-sectional study examining the association between a doctor's sex and receiving sanctions against their medical registration.

To examine the association between doctors' sex and receiving sanctions on their medical registration, while controlling for other potentially confounding variables

A Child with Chronic Manganese Exposure from Drinking Water

The patient's family bought a home in a suburb, but the proximity of the house to wetlands and its distance from the town water main prohibited connecting the house to town water. The family had a well drilled and they drank the well water for 5 years, despite the fact that the water was turbid, had a metallic taste, and left an orange-brown residue on clothes, dishes, and appliances. When the water was tested after 5 years of residential use, the manganese concentration was elevated (1.21 ppm; U.S. Environmental Protection Agency reference, < 0.05 ppm). The family's 10-year-old son had elevated manganese concentrations in whole blood, urine, and hair. The blood manganese level of his brother was normal, but his hair manganese level was elevated. The patient, the 10-year-old, was in the fifth grade and had no history of learning problems; however, teachers had noticed his inattentiveness and lack of focus in the classroom. Our results of cognitive testing were normal, but tests of memory revealed a markedly below-average performance: the patient's general memory index was at the 13th percentile, his verbal memory at the 19th percentile, his visual memory at the 14th percentile, and his learning index at the 19th percentile. The patient's free recall and cued recall tests were all 0.5-1.5 standard deviations (1 SD = 16th percentile) below normal. Psychometric testing scores showed normal IQ but unexpectedly poor verbal and visual memory. These findings are consistent with the known toxic effects of manganese, although a causal relationship cannot necessarily be inferred

The Rise and Fall of Debris Disks: MIPS Observations of h and chi Persei and the Evolution of Mid-IR Emission from Planet Formation

We describe Spitzer/MIPS observations of the double cluster, h and $\chi$ Persei, covering a $\sim$ 0.6 square-degree area surrounding the cores of both clusters. The data are combined with IRAC and 2MASS data to investigate $\sim$ 616 sources from 1.25-24 $\mu m$. We use the long-baseline $K_{s}$-[24] color to identify two populations with IR excess indicative of circumstellar material: Be stars with 24 $\mu m$ excess from optically-thin free free emission and 17 fainter sources (J$\sim$ 14-15) with [24] excess consistent with a circumstellar disk. The frequency of IR excess for the fainter sources increases from 4.5 $\mu m$ through 24 $\mu m$. The IR excess is likely due to debris from the planet formation process. The wavelength-dependent behavior is consistent with an inside-out clearing of circumstellar disks. A comparison of the 24 $\mu m$ excess population in h and $\chi$ Per sources with results for other clusters shows that 24 $\mu m$ emission from debris disks 'rises' from 5 to 10 Myr, peaks at $\sim$ 10-15 Myr, and then 'falls' from $\sim$ 15/20 Myr to 1 Gyr.Comment: 48 pages, 15 figures, accepted for publication in The Astrophysical Journa

Receiving Aphasia Intervention in a Virtual Environment: The Participants’ Perspective

Background: Digital technology is making an increasing contribution to aphasia therapy. However applications of virtual reality are rare. EVA Park is a virtual island developed with and for people with aphasia. It is a multi-user environment, which enables people with aphasia to interact with support workers, therapists and each other. The first study to use EVA Park in aphasia rehabilitation demonstrated significant gains in functional communication. This paper augments the findings of that study, by reporting results from qualitative interviews conducted with the 20 study participants. Aims: This study aimed to determine the views of participants about the intervention that they received in EVA Park, and the impacts of that intervention. Long-term retrospective views were also explored. Methods & Procedures: Participants took part in 1:1, semi-structured interviews two weeks before (Entry) and to weeks after (Exit) the intervention. Questions focussed on activities undertaken by participants, communication, changes since the stroke and uses of technology. Exit interviews additionally explored participants’ views and experiences of EVA Park and any perceived impacts of the intervention. A sub-set of 5 participants was interviewed at least one year later, to explore long term recollections of the EVA Park intervention and any perceived long term impacts. Interview data were transcribed and subject to framework analysis. Outcomes & Results: The thematic framework comprised 10 parent themes and 33 sub-themes. Following ‘affect’, the largest single theme related to EVA Park, with 636 coded references. Comments were overwhelmingly positive. EVA Park intervention was strongly associated with fun and enjoyment. Participants particularly valued their relationship with the support workers who delivered the intervention. The virtual locations and activities in EVA Park were also appreciated, together with the contact with other participants. Perceived impacts related to communication, activity, computer use and confidence. Most participants in the long term interviews described maintained impacts. Conclusions: These interview results indicate that the first intervention delivered in EVA Park was highly acceptable to participants and perceived as beneficial. They augment the findings of our experimental study and suggest that EVA Park could be a valuable addition to the resources available to practising clinician

Sex differences in medico-legal action against doctors: a systematic review and meta-analysis

The relationship between male sex and poor performance in doctors remains unclear, with high profile studies showing conflicting results. Nevertheless, it is an important first step towards understanding the causes of poor performance in doctors. This article aims to establish the robustness of the association between male sex and poor performance in doctors, internationally and over time

The academic backbone: longitudinal continuities in educational achievement from secondary school and medical school to MRCP(UK) and the specialist register in UK medical students and doctors

Background: Selection of medical students in the UK is still largely based on prior academic achievement, although doubts have been expressed as to whether performance in earlier life is predictive of outcomes later in medical school or post-graduate education. This study analyses data from five longitudinal studies of UK medical students and doctors from the early 1970s until the early 2000s. Two of the studies used the AH5, a group test of general intelligence (that is, intellectual aptitude). Sex and ethnic differences were also analyzed in light of the changing demographics of medical students over the past decades. Methods: Data from five cohort studies were available: the Westminster Study (began clinical studies from 1975 to 1982), the 1980, 1985, and 1990 cohort studies (entered medical school in 1981, 1986, and 1991), and the University College London Medical School (UCLMS) Cohort Study (entered clinical studies in 2005 and 2006). Different studies had different outcome measures, but most had performance on basic medical sciences and clinical examinations at medical school, performance in Membership of the Royal Colleges of Physicians (MRCP(UK)) examinations, and being on the General Medical Council Specialist Register. Results: Correlation matrices and path analyses are presented. There were robust correlations across different years at medical school, and medical school performance also predicted MRCP(UK) performance and being on the GMC Specialist Register. A-levels correlated somewhat less with undergraduate and post-graduate performance, but there was restriction of range in entrants. General Certificate of Secondary Education (GCSE)/O-level results also predicted undergraduate and post-graduate outcomes, but less so than did A-level results, but there may be incremental validity for clinical and post-graduate performance. The AH5 had some significant correlations with outcome, but they were inconsistent. Sex and ethnicity also had predictive effects on measures of educational attainment, undergraduate, and post-graduate performance. Women performed better in assessments but were less likely to be on the Specialist Register. Non-white participants generally underperformed in undergraduate and post-graduate assessments, but were equally likely to be on the Specialist Register. There was a suggestion of smaller ethnicity effects in earlier studies. Conclusions: The existence of the Academic Backbone concept is strongly supported, with attainment at secondary school predicting performance in undergraduate and post-graduate medical assessments, and the effects spanning many years. The Academic Backbone is conceptualized in terms of the development of more sophisticated underlying structures of knowledge ('cognitive capital’ and 'medical capital’). The Academic Backbone provides strong support for using measures of educational attainment, particularly A-levels, in student selection

Rekindling the love of books - a pilot project exploring whether e-readers help people to read again after a stroke

Background E-readers may facilitate reading in aphasia through “aphasia-friendly” features such as altering text size and formatting (Worrall et al, 2005), and text-to-speech functions. However, no previous research has examined whether e-readers help people with aphasia to read. Aims This project explored: • whether people with aphasia can learn to use e-readers following a brief period of training • whether e-reader training improves reading comprehension • whether e-readers increase participation in and enjoyment of reading activities Method and procedures In phase one, available e-readers were compared using an expert evaluation against a set of criteria, to identify the model with optimum accessibility features and fewest potential barriers. The Kindle Keyboard 3G TM (Amazon) was selected for trialling in phase two. Four people with self-reported reading difficulties post-stroke participated in phase two. All had mild or mild-moderate aphasia. Four one-hour training sessions aimed to trial accessibility features, identify helpful features, and teach independent operation of these. A repeated measures design was used. Outcome measures assessed reading comprehension (Gray Oral Reading Tests, Bryant & Wiederholt, 2001) and confidence and emotions associated with reading (Reading Confidence and Emotions Questionnaire, Cocks et al., 2013). Matched texts were used to compare reading comprehension using printed texts and the e-reader. Usability evaluations explored independence in e-reader use and acceptability of the technology. Participation in reading activities and reading enjoyment were explored using qualitative exit interviews. Outcomes and results Participants’ reading comprehension on the Kindle, as measured by the GORT-4, did not improve following training and did not exceed comprehension of printed texts. However, reading confidence improved significantly for three of the participants (RCEQ: p<.05, p<.01 and p<.005). Analysis of exit interviews and usability evaluations indicates that three out of four participants preferred reading on the Kindle to printed texts. These participants read more frequently on the Kindle than they had done before the training, and the technology enabled them to access more challenging texts (e.g. novels). They appreciated different features of the Kindle. Two participants experienced difficulties operating the technology, one of whom would have benefited from a longer training period. Conclusions This pilot study suggests that a short block of e-reader training led to improvements in reading confidence, participation and enjoyment. E-readers were not shown to enhance reading comprehension. Larger-scale investigations are warranted to further investigate whether and how e-readers facilitate reading for people with aphasia

The MultiSite Spectroscopic Telescope campaign: 2m spectroscopy of the V361 Hya variable PG1605+072

We present results and analysis for the 2m spectroscopic part of the MultiSite Spectroscopic Telescope (MSST) campaign undertaken in May/June 2002. The goal of the project was to observe the pulsating subdwarf B star PG1605+072 simultaneously in velocity and photometry and to resolve as many of the >50 known modes as possible, which will allow a detailed asteroseismological analysis. We have obtained over 150 hours of spectroscopy, leading to an unprecedented noise level of only 207m/s. We report here the detection of 20 frequencies in velocity, with two more likely just below our detection threshold. In particular, we detect 6 linear combinations, making PG1605+072 only the second star known to show such frequencies in velocity. We investigate the phases of these combinations and their parent modes and find relationships between them that cannot be easily understood based on current theory. These observations, when combined with our simultaneous photometry, should allow asteroseismology of this most complicated of sdB pulsators.Comment: 9 pages, 5 figures, accepted for publication in A&A; Figure 1 at lower resolution than accepted versio