Preserving Creativity in Medicine

Imagination and creativity are essential traits that medicine, and medical insurers, must again learn to recognize and rewar

Enhanced activation of the left inferior frontal gyrus in deaf and dyslexic adults during rhyming

Hearing developmental dyslexics and profoundly deaf individuals both have difficulties processing the internal structure of words (phonological processing) and learning to read. In hearing non-impaired readers, the development of phonological representations depends on audition. In hearing dyslexics, many argue, auditory processes may be impaired. In congenitally profoundly deaf individuals, auditory speech processing is essentially absent. Two separate literatures have previously reported enhanced activation in the left inferior frontal gyrus in both deaf and dyslexic adults when contrasted with hearing non-dyslexics during reading or phonological tasks. Here, we used a rhyme judgement task to compare adults from these two special populations to a hearing non-dyslexic control group. All groups were matched on non-verbal intelligence quotient, reading age and rhyme performance. Picture stimuli were used since this requires participants to generate their own phonological representations, rather than have them partially provided via text. By testing well-matched groups of participants on the same task, we aimed to establish whether previous literatures reporting differences between individuals with and without phonological processing difficulties have identified the same regions of differential activation in these two distinct populations. The data indicate greater activation in the deaf and dyslexic groups than in the hearing non-dyslexic group across a large portion of the left inferior frontal gyrus. This includes the pars triangularis, extending superiorly into the middle frontal gyrus and posteriorly to include the pars opercularis, and the junction with the ventral precentral gyrus. Within the left inferior frontal gyrus, there was variability between the two groups with phonological processing difficulties. The superior posterior tip of the left pars opercularis, extending into the precentral gyrus, was activated to a greater extent by deaf than dyslexic participants, whereas the superior posterior portion of the pars triangularis extending into the ventral pars opercularis, was activated to a greater extent by dyslexic than deaf participants. Whether these regions play differing roles in compensating for poor phonological processing is not clear. However, we argue that our main finding of greater inferior frontal gyrus activation in both groups with phonological processing difficulties in contrast to controls suggests greater reliance on the articulatory component of speech during phonological processing when auditory processes are absent (deaf group) or impaired (dyslexic group). Thus, the brain appears to develop a similar solution to a processing problem that has different antecedents in these two populations

Reversing downstream consequences of school hiatus on reading in disadvantaged, at-risk children

The spread of COVID-19 has led to the disruption of K-12 education for about 90% of the world's student population. The effects on children's academic development are unknown. We examined how disruption in schooling over three consecutive summers in disadvantaged minority children affects reading and whether an intensive intervention can ameliorate these effects. Our data were collected prior to the COVID-19 pandemic. We applied Latent Change Score models to examine developmental trends in a longitudinal study of reading in 111 economically disadvantaged children, assessed biannually from grades 1 to 4, including 3 summers (for a total of 6 months of school hiatus). The students fell behind the normative population in their ability to understand written texts, a decrease in their relative percentile of 0.25 of a standard deviation each summer, and an effect 3-4 times greater than prior studies suggested. Compared to children in a comparison group, children who received an evidence-based intervention during the school year were better able to maintain their reading scores. These findings provide evidence that disruptions in schooling, for example, those implemented to slow the spread of COVID-19, may have a significant detrimental effect on the reading abilities of disadvantaged children and that children who received a reading intervention were better able to maintain their reading scores during the hiatus. It is critical that policy makers prioritize the allocation of necessary resources to minimize the negative effects on reading this pandemic has wrought on these most disadvantaged children.Support for the work reported in this article was provided by: The Seedlings Foundation. EE was supported by the Ministry of Science and Innovation of Spain (ref. PID2019-107570GAI00 / AEI / doi: https://doi.org/10.13039/501100011033

Effect of Atomoxetine Treatment on Reading and Phonological Skills in Children with Dyslexia or Attention-Deficit/Hyperactivity Disorder and Comorbid Dyslexia in a Randomized, Placebo-Controlled Trial

OBJECTIVES: Evaluated the effects of atomoxetine on the reading abilities of children with dyslexia only or attention-deficit/hyperactivity disorder (ADHD) and comorbid dyslexia. METHODS: Children aged 10-16 years (N = 209) met Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision (DSM-IV-TR) criteria for dyslexia only (n = 58), ADHD and comorbid dyslexia (n = 124), or ADHD only (n = 27) and were of normal intelligence. Patients were treated with atomoxetine (1.0-1.4 mg/kg/day) or placebo in a 16-week, randomized, placebo-controlled, double-blind trial. The dyslexia-only and ADHD and comorbid dyslexia groups were randomized 1:1; the ADHD-only group received atomoxetine in a blinded manner. Reading abilities were measured with the Woodcock Johnson III (WJIII), Comprehensive Test of Phonological Processing (CTOPP), Gray Oral Reading Tests-4, and Test of Word Reading Efficiency. RESULTS: Atomoxetine-treated dyslexia-only patients compared with placebo patients had significantly greater improvement (p < 0.02) with moderate to approaching high effect sizes (ES) on WJIII Word Attack (ES = 0.72), Basic Reading Skills (ES = 0.48), and Reading Vocabulary (ES = 0.73). In the atomoxetine-treated ADHD and comorbid dyslexia group, improvement on the CTOPP Elision measure (ES = 0.50) was significantly greater compared with placebo (p < 0.02). Total, inattentive, and hyperactive/impulsive ADHD symptom reductions were significant in the atomoxetine-treated ADHD and comorbid dyslexia group compared with placebo, and from baseline in the ADHD-only group (p ≤ 0.02). ADHD symptom improvements in the ADHD and comorbid dyslexia group were not correlated with improvements in reading. CONCLUSIONS: Atomoxetine treatment improved reading scores in patients with dyslexia only and ADHD and comorbid dyslexia. Improvements for patients with dyslexia only were in critical components of reading, including decoding and reading vocabulary. For patients with ADHD and comorbid dyslexia, improvements in reading scores were distinct from improvement in ADHD inattention symptoms alone. These data represent the first report of improvements in reading measures following pharmacotherapy treatment in patients with dyslexia only evaluated in a randomized, double-blind trial

Irritability in Autistic Children Treated with Fenfluramine

Letter to the Editor in response to a report by Geller et al. The article presented preliminary results suggesting the possible usefulness of fenfluramine (a substituted phenylethylamine widely used as an appetite suppressant) in the treatment of infantile autism (July 15, 1982, issue). The rationale for the use of this agent rests on its ability to lower peripheral-blood levels of serotonin and on the observation that a substantial minority of autistic persons have elevated peripheral-blood serotonin levels. The report emphasized the preliminary nature of the results in a small sample of three young autistic boys with elevated serotonin levels

Global Health Governance: We Need Innovation not Renovation

Although the global health community widely accepts that WHO, as currently configured, is no longer fit-for-purpose, commentators cling to renovation (‘reform’), rather than innovation, at the expense of a global health governance system that reflects the needs of a very changed world.Collective action in a globalised world requires institutions that look very different from what we currently have. Rather than the renovation of outdated institutional forms—which are closed, territorially fixed and hierarchical—we need to harness innovations such as social networks, open-source systems and the sharing economy.One of the biggest forms of institutional innovation more broadly is ‘network governance’, by which collective action is achieved through interconnected institutions spanning government, business and civil society