Computerised speechreading training for deaf children: A randomised controlled trial

Purpose: We developed and evaluated in a randomised controlled triala computerised speechreading training programme to determine a) whether it is possible to train speechreading in deaf children and b) whether speechreading training results in improvements in phonological and reading skills.Previous studies indicate a relationship between speechreading and reading skill and further suggest this relationshipmay be mediated by improved phonological representations. This is important since many deaf children find learning to read to be very challenging. Method: Sixty-six deaf 5-7 year olds were randomised into speechreading and maths training arms. Each training programme was comprised of10 minutesessionsa day, 4 days a week for 12 weeks. Children were assessed on a battery of language and literacy measures before training, immediately after training, 3 months and 10 months after training. Results: We found no significant benefits for participants who completed the speechreading training, compared to those who completed the maths training, on the speechreading primary outcome measure. However, significantly greater gains were observed in the speechreading training group on one of the secondary measures of speechreading. There was also some evidence of beneficial effects of the speechreading training on phonological representations, however these effects were weaker. No benefits were seen toword reading. Conclusions: Speechreading skill is trainable in deaf children. However, to support early reading, training may need to be longer or embedded in a broader literacy programme. Nevertheless, a training tool that can improve speechreading is likely to be of great interest to professionals working with deaf children

Safeguarding freshwater life beyond 2020: Recommendations for the new global biodiversity framework from the European experience

Plans are currently being drafted for the next decade of action on biodiversity-both the post-2020 Global Biodiversity Framework of the Convention on Biological Diversity (CBD) and Biodiversity Strategy of the European Union (EU). Freshwater biodiversity is disproportionately threatened and underprioritized relative to the marine and terrestrial biota, despite supporting a richness of species and ecosystems with their own intrinsic value and providing multiple essential ecosystem services. Future policies and strategies must have a greater focus on the unique ecology of freshwater life and its multiple threats, and now is a critical time to reflect on how this may be achieved. We identify priority topics including environmental flows, water quality, invasive species, integrated water resources management, strategic conservation planning, and emerging technologies for freshwater ecosystem monitoring. We synthesize these topics with decades of first-hand experience and recent literature into 14 special recommendations for global freshwater biodiversity conservation based on the successes and setbacks of European policy, management, and research. Applying and following these recommendations will inform and enhance the ability of global and European post-2020 biodiversity agreements to halt and reverse the rapid global decline of freshwater biodiversity

A Steep Faint-End Slope of the UV Luminosity Function at z~2-3: Implications for the Global Stellar Mass Density and Star Formation in Low Mass Halos

We use the deep ground-based optical photometry of the Lyman Break Galaxy (LBG) Survey to derive robust measurements of the faint-end slope (alpha) of the UV LF at redshifts 1.92000 spectroscopic redshifts and ~31000 LBGs in 31 spatially-independent fields over a total area of 3261 arcmin^2. These data allow us to select galaxies to 0.07L* and 0.10L* at z~2 and z~3, respectively. A maximum likelihood analysis indicates steep values of alpha(z=2)=-1.73+/-0.07 and alpha(z=3)=-1.73+/-0.13. This result is robust to luminosity dependent systematics in the Ly-alpha equivalent width and reddening distributions, is similar to the steep values advocated at z>4, and implies that ~93% of the unobscured UV luminosity density at z~2-3 arises from sub-L* galaxies. With a realistic luminosity dependent reddening distribution, faint to moderately luminous galaxies account for >70% and >25% of the bolometric luminosity density and present-day stellar mass density, respectively, when integrated over 1.9<z<3.4. We find a factor of 8-9 increase in the star formation rate density between z~6 and z~2, due to both a brightening of L* and an increasing dust correction proceeding to lower redshifts. The previously observed discrepancy between the integral of the star formation history and stellar mass density measurements at z~2 may be reconciled by invoking a luminosity dependent reddening correction to the star formation history combined with an accounting for the stellar mass contributed by UV-faint galaxies. The steep and relatively constant alpha of the UV LF at z>2 contrasts with the shallower value inferred locally, suggesting that the evolution in the faint-end slope may be dictated simply by the availability of low mass halos capable of supporting star formation at z<2. [Abridged]Comment: 29 pages, 15 figures, 7 tables; accepted for publication in Ap

Quenched Cold Accretion of a Large Scale Metal-Poor Filament due to Virial Shocking in the Halo of a Massive z=0.7 Galaxy

Using HST/COS/STIS and HIRES/Keck high-resolution spectra, we have studied a remarkable HI absorbing complex at z=0.672 toward the quasar Q1317+277. The HI absorption has a velocity spread of 1600 km/s, comprises 21 Voigt profile components, and resides at an impact parameter of D=58 kpc from a bright, high mass [log(M_vir/M_sun) ~ 13.7] elliptical galaxy that is deduced to have a 6 Gyr old, solar metallicity stellar population. Ionization models suggest the majority of the structure is cold gas surrounding a shock heated cloud that is kinematically adjacent to a multi-phase group of clouds with detected CIII, CIV and OVI absorption, suggestive of a conductive interface near the shock. The deduced metallicities are consistent with the moderate in situ enrichment relative to the levels observed in the z ~ 3 Ly-alpha forest. We interpret the HI complex as a metal-poor filamentary structure being shock heated as it accretes into the halo of the galaxy. The data support the scenario of an early formation period (z > 4) in which the galaxy was presumably fed by cold-mode gas accretion that was later quenched via virial shocking by the hot halo such that, by intermediate redshift, the cold filamentary accreting gas is continuing to be disrupted by shock heating. Thus, continued filamentary accretion is being mixed into the hot halo, indicating that the star formation of the galaxy will likely remain quenched. To date, the galaxy and the HI absorption complex provide some of the most compelling observational data supporting the theoretical picture in which accretion is virial shocked in the hot coronal halos of high mass galaxies.Comment: 20 pages, 9 figures, submitted to Ap

Astrophysical evidence for the existence of black holes

Following a short account of the history of the idea of black holes, we present a review of the current status of the search for observational evidence of their existence aimed at an audience of relativists rather than astronomers or astrophysicists. We focus on two different regimes: that of stellar-mass black holes and that of black holes with the masses of galactic nuclei.Comment: 23 pages, 3 figures, TeX forma

Constraining Jet/Disk Geometry and Radiative Processes in Stellar Black Holes XTE J1118+480 and GX 339-4

We present results from modeling of quasi-simultaneous broad band (radio through X-ray) observations of the galactic stellar black hole (BH) transient X-ray binary (XRB) systems XTE J1118+480 and GX 339-4 using an irradiated disc + compact jet model. In addition to quantifying the physical properties of the jet, we have developed a new irradiated disc model which also constrains the geometry and temperature of the outer accretion disc by assuming a disc heated by viscous energy release and X-ray irradiation from the inner regions. For the source XTE J1118+480, which has better spectral coverage of the two in optical and near-IR (OIR) wavelengths, we show that the entire broad band continuum can be well described by an outflow-dominated model + an irradiated disc. The best-fit radius of the outer edge of the disc is consistent with the Roche lobe geometry of the system, and the temperature of the outer edge of the accretion disc is similar to those found for other XRBs. Irradiation of the disc by the jet is found to be negligible for this source. For GX 339-4, the entire continuum is well described by the jet-dominated model only, with no disc component required. For the two XRBs, which have very different physical and orbital parameters and were in different accretion states during the observations, the sizes of the jet base are similar and both seem to prefer a high fraction of non-thermal electrons in the acceleration/shock region and a magnetically dominated plasma in the jet. These results, along with recent similar results from modeling other galactic XRBs and AGNs, may suggest an inherent unity in diversity in the geometric and radiative properties of compact jets from accreting black holes.Comment: Accepted for publication in MNRAS. Uses mn2e.cls. 17 pages, 4 figures, 3 table

Doctor–patient communication in a Southeast Asian setting: the conflict between ideal and reality

Doctor–patient communication has been extensively studied in non-Western contexts and in relation to patients’ cultural and education backgrounds. This study explores the perceived ideal communication style for doctor–patient consultations and the reality of actual practice in a Southeast Asian context. We conducted the study in a teaching hospital in Indonesia, using a qualitative and a quantitative design. In-depth interviews were conducted with ten internal medicine specialists, ten internal medicine residents, 16 patients in two groups based on education level and ten most senior medical students. The contributions of doctors and patients to the communication during consultations were observed and rated quantitatively by thirty internal medicine residents, 393 patients with different educational backgrounds and ten senior medical students. The ‘informed and shared decision making’ is the central observation in this quantitative study. The results of the interviews showed that Southeast Asian stakeholders are in favor of a partnership style of communication and revealed barriers to achieving this: doctors and patients are not prepared for a participatory style and high patient load due to an inefficient health care system does not allow sufficient time for this type of communication. The results of the quantitative study showed a sharp contrast between observed and ideal communication styles. A paternalistic style seems to prevail, irrespective of patients’ educational background. We found a sharp conflict between ideal and reality concerning doctor–patient communication in a Southeast Asian context. Further studies should examine ways to change the prevailing communication style in the desired direction

Geography of non-melanoma skin cancer and ecological associations with environmental risk factors in England.

This is the author's peer reviewed version of the article. Please cite the published, final version which is available via the DOI link in this record.This study investigates the geography of non-melanoma skin cancer (NMSC) in England, and ecological associations with three widespread environmental hazards: radon, arsenic and ultraviolet radiation from the sun.European Regional Development FundEuropean Social Fund Convergence Programme for Cornwall and the Isles of Scill

Systemic chemotherapy with or without cetuximab in patients with resectable colorectal liver metastasis (New EPOC): long-term results of a multicentre, randomised, controlled, phase 3 trial.

BACKGROUND: The interim analysis of the multicentre New EPOC trial in patients with resectable colorectal liver metastasis showed a significant reduction in progression-free survival in patients allocated to cetuximab plus chemotherapy compared with those given chemotherapy alone. The focus of the present analysis was to assess the effect on overall survival. METHODS: New EPOC was a multicentre, open-label, randomised, controlled, phase 3 trial. Adult patients (aged ≥18 years) with KRAS wild-type (codons 12, 13, and 61) resectable or suboptimally resectable colorectal liver metastases and a WHO performance status of 0-2 were randomly assigned (1:1) to receive chemotherapy with or without cetuximab before and after liver resection. Randomisation was done centrally with minimisation factors of surgical centre, poor prognosis cancer, and previous adjuvant treatment with oxaliplatin. Chemotherapy consisted of oxaliplatin 85 mg/m2 administered intravenously over 2 h, l-folinic acid (175 mg flat dose administered intravenously over 2 h) or d,l-folinic acid (350 mg flat dose administered intravenously over 2 h), and fluorouracil bolus 400 mg/m2 administered intravenously over 5 min, followed by a 46 h infusion of fluorouracil 2400 mg/m2 repeated every 2 weeks (regimen one), or oxaliplatin 130 mg/m2 administered intravenously over 2 h and oral capecitabine 1000 mg/m2 twice daily on days 1-14 repeated every 3 weeks (regimen two). Patients who had received adjuvant oxaliplatin could receive irinotecan 180 mg/m2 intravenously over 30 min with fluorouracil instead of oxaliplatin (regimen three). Cetuximab was given intravenously, 500 mg/m2 every 2 weeks with regimen one and three or a loading dose of 400 mg/m2 followed by a weekly infusion of 250 mg/m2 with regimen two. The primary endpoint of progression-free survival was published previously. Secondary endpoints were overall survival, preoperative response, pathological resection status, and safety. Trial recruitment was halted prematurely on the advice of the Trial Steering Committee on Nov 1, 2012. All analyses (except safety) were done on the intention-to-treat population. Safety analyses included all randomly assigned patients. This trial is registered with ISRCTN, number 22944367. FINDINGS: Between Feb 26, 2007, and Oct 12, 2012, 257 eligible patients were randomly assigned to chemotherapy with cetuximab (n=129) or without cetuximab (n=128). This analysis was carried out 5 years after the last patient was recruited, as defined in the protocol, at a median follow-up of 66·7 months (IQR 58·0-77·5). Median progression-free survival was 22·2 months (95% CI 18·3-26·8) in the chemotherapy alone group and 15·5 months (13·8-19·0) in the chemotherapy plus cetuximab group (hazard ratio [HR] 1·17, 95% CI 0·87-1·56; p=0·304). Median overall survival was 81·0 months (59·6 to not reached) in the chemotherapy alone group and 55·4 months (43·5-71·5) in the chemotherapy plus cetuximab group (HR 1·45, 1·02-2·05; p=0·036). There was no significant difference in the secondary outcomes of preoperative response or pathological resection status between groups. Five deaths might have been treatment-related (one in the chemotherapy alone group and four in the chemotherapy plus cetuximab group). The most common grade 3-4 adverse events reported were: neutrophil count decreased (26 [19%] of 134 in the chemotherapy alone group vs 21 [15%] of 137 in the chemotherapy plus cetuximab group), diarrhoea (13 [10%] vs 14 [10%]), skin rash (one [1%] vs 22 [16%]), thromboembolic events (ten [7%] vs 11 [8%]), lethargy (ten [7%] vs nine [7%]), oral mucositis (three [2%] vs 14 [10%]), vomiting (seven [5%] vs seven [5%]), peripheral neuropathy (eight [6%] vs five [4%]), and pain (six [4%] vs six [4%]). INTERPRETATION: Although the addition of cetuximab to chemotherapy improves the overall survival in some studies in patients with advanced, inoperable metastatic disease, its use in the perioperative setting in patients with operable disease confers a significant disadvantage in terms of overall survival. Cetuximab should not be used in this setting. FUNDING: Cancer Research UK