Convergence and divergence in gesture repertoires as an adaptive mechanism for social bonding in primates

A key challenge for primates living in large, stable social groups is managing social relationships. Chimpanzee gestures may act as a time-efficient social bonding mechanism, and the presence (homogeneity) and absence (heterogeneity) of overlap in repertoires in particular may play an important role in social bonding. However, how homogeneity and heterogeneity in the gestural repertoire of primates relate to social interaction is poorly understood. We used social network analysis and generalized linear mixed modelling to examine this question in wild chimpanzees. The repertoire size of both homogeneous and heterogeneous visual, tactile and auditory gestures was associated with the duration of time spent in social bonding behaviour, centrality in the social bonding network and demography. The audience size of partners who displayed similar or different characteristics to the signaller (e.g. same or opposite age or sex category) also influenced the use of homogeneous and heterogeneous gestures. Homogeneous and heterogeneous gestures were differentially associated with the presence of emotional reactions in response to the gesture and the presence of a change in the recipient’s behaviour. Homogeneity and heterogeneity of gestural communication play a key role in maintaining a differentiated set of strong and weak social relationships in complex, multilevel societies

Evidence-based care for older people with colorectal cancer: a grey area

Colorectal cancer is primarily a disease of ageing. There is evidence that older patients are less likely to receive guideline-recommended treatment than younger patients based on their age alone. However, treatment decision-making for this group can be complex. This thesis presents a series of studies that explore the barriers to evidence-based care of older people with colorectal cancer in New South Wales (NSW), with a focus on the receipt of adjuvant chemotherapy and radiotherapy. Chapter 1 provides an introduction to the role of age in cancer care and outcomes. Chapter 2 examines issues in the measurement of patient-reported outcomes that may affect the care that older patients receive. Chapter 3 establishes current levels of adjuvant therapy use for colorectal cancer in NSW and identifies that patient age alone continues to impact treatment receipt. Surgeon knowledge and views and patient preferences for adjuvant therapy are explored in Chapters 4 and 5. A risk model that could be used by clinicians to assist treatment decision-making is developed in Chapter 6. The final chapter discusses implications of the work for clinical practice and for the future research that is needed to ensure greater understanding and improved outcomes for older people with colorectal cancer

Impressive clinical improvement and disappearance of neuropathic pain in an adult patient with hypophosphatasia treated with asfotase alfa

Hypophosphatasia (HPP) is a rare disorder, resulting from loss-of-function variants of the ALPL gene encoding non-tissue specific alkaline phosphatase (TNSALP). Presentation varies largely, with increased severity usually occurring with earlier disease onset. Here we describe the clinical improvement of a 57-year-old woman with childhood onset HPP, after initiating treatment with asfotase alfa (Strensiq®). This was started because of the rapid and progressive radiological deterioration of bone structure after placement of nails in both upper legs for spontaneous atypical femur fracture (AFF) - like fractures. Initiation of treatment, not only resulted in stabilization of bone structure on X-rays, but within a few weeks there was a dramatic reduction of burning pain sensations in the lower legs, attributed in retrospect to neuropathic pain, and also almost complete disappearance of headaches. Additionally, unhealed metatarsal fractures finally healed after almost 10 years. Drug efficacy was further evaluated through -quality of life questionnaires and multiple tests conducted by the physiotherapist, and showed clear improvements. Within 3 months after starting asfotase alfa, the patient was able to carry out her daily tasks indoors without relying on a walker and even started electric bike rides for 20 km/day. In conclusion, treatment with asfotase alfa, halted rapid radiological bone deterioration after bilateral intramedullary femoral pen placement and strongly increased quality of life, marked by rapid disappearance of neuropathic pain, reduction in headaches and musculoskeletal pains, and enhanced muscle strength and mobility. The quick and almost complete disappearance of neuropathic pain and headache suggests a relation with disturbed levels of metabolites in HPP.</p

Impressive clinical improvement and disappearance of neuropathic pain in an adult patient with hypophosphatasia treated with asfotase alfa

Hypophosphatasia (HPP) is a rare disorder, resulting from loss-of-function variants of the ALPL gene encoding non-tissue specific alkaline phosphatase (TNSALP). Presentation varies largely, with increased severity usually occurring with earlier disease onset. Here we describe the clinical improvement of a 57-year-old woman with childhood onset HPP, after initiating treatment with asfotase alfa (Strensiq®). This was started because of the rapid and progressive radiological deterioration of bone structure after placement of nails in both upper legs for spontaneous atypical femur fracture (AFF) - like fractures. Initiation of treatment, not only resulted in stabilization of bone structure on X-rays, but within a few weeks there was a dramatic reduction of burning pain sensations in the lower legs, attributed in retrospect to neuropathic pain, and also almost complete disappearance of headaches. Additionally, unhealed metatarsal fractures finally healed after almost 10 years. Drug efficacy was further evaluated through -quality of life questionnaires and multiple tests conducted by the physiotherapist, and showed clear improvements. Within 3 months after starting asfotase alfa, the patient was able to carry out her daily tasks indoors without relying on a walker and even started electric bike rides for 20 km/day. In conclusion, treatment with asfotase alfa, halted rapid radiological bone deterioration after bilateral intramedullary femoral pen placement and strongly increased quality of life, marked by rapid disappearance of neuropathic pain, reduction in headaches and musculoskeletal pains, and enhanced muscle strength and mobility. The quick and almost complete disappearance of neuropathic pain and headache suggests a relation with disturbed levels of metabolites in HPP.</p

Emerging Language: Cognition and Gestural Communication in Wild and Language Trained Chimpanzees (Pan troglodytes)

An important element in understanding the evolutionary origin of human language is to explore homologous traits in cognition and communication between primates and humans (Burling, 1993, Hewes, 1973). One proposed modality of language evolution is that of gestural communication, defined as communicative movements of hands without using or touching objects (de Waal, 2003). While homologies between primate calls and language have been relatively well explored, we still have a limited understanding of how cognitive abilities may have shaped the characteristics of primate gestures (Corballis, 2003). Chimpanzees (Pan troglodytes) are our closest living relatives and display some complex cognitive skills in various aspects of their gestural behaviour in captivity (de Waal, 2003, Pollick and de Waal, 2007). However, it is not yet currently clear to what extent these abilities seen in captive apes are typical of chimpanzees in general and to what extent cognitive capacities observed in captive chimpanzees have been enhanced by the socio-cultural environment of captivity such as language training. In this Ph.D. research, I investigated the cognitive skills underlying gestural communication in both wild and language trained chimpanzees, with a special focus on the repertoire and the intentionality of production and comprehension. The study of cognitive skills underlying the production of the repertoire and the role of intentionality is important because these skills are cognitively demanding and are a prerequisite in human infants for their ability to acquire language (Baldwin, 1995, Olson, 1993). My research suggests that chimpanzee gestural communication is cognitively complex and may be homologous with the cognitive skills evident in pre-verbal infants on the cusp of language acquisition. Chimpanzees display a multifaceted and complex signal repertoire of manual gestures. These gestures are the prototypes, within which there is variation, and between which the boundaries are not clear-cut, but there is gradation apparent along several morphological components. Both wild and language trained chimpanzees communicate intentionally about their perceived desires and the actions that they want the recipients to undertake. They do not just express their emotions, but they communicate flexibly by adjusting their communicative tactics in response to the comprehension states of the recipient. Whilst chimpanzees communicate their intentions flexibly, the messages conveyed are specific. However, recipients comprehend gestures flexibly in light of the signaller’s overall intentions. Whilst wild and language trained chimpanzee gestural communication revealed similar cognitive characteristics, language trained chimpanzees outperformed wild apes in that they had ability to use signals which made distinctions that human deictic words can make. Whilst these differences between wild and language trained chimpanzees may be due to the different methodological approaches used, it is conceivable that language training may have influenced captive ape cognitive skills in the representational domain. These results from wild and language trained chimpanzees indicate that chimpanzees possess some form of cognitive skills necessary for language development and that cognitive skills underlying repertoire and use in chimpanzees are a shared capacity between humans, other apes and a common ancestor. These findings render theories of the gestural origins of language more plausible. Related publications: 1. Roberts, A. I., Vick, S.-J., Roberts, S. G. B., Buchanan-Smith, H. M. & Zuberbühler, K. 2012. A structure-based repertoire of manual gestures in wild chimpanzees: Statistical analyses of a graded communication system. Evolution and Human Behavior, Published online: http://dx.doi.org/ 10.1016/j.evolhumbehav.2012.05.006 2. Roberts, A. I., Vick, S.-J. & Buchanan-Smith, H. 2012. Usage and comprehension of manual gestures in wild chimpanzees. Animal Behaviour, Published online: http://dx.doi.org/10.1016/j.anbehav.2012.05.02

Reproducibility of Facial Soft Tissue Thickness Measurements Using Cone-Beam CT Images According to the Measurement Methods

The purpose of this study was to establish the reproducibility of facial soft tissue (ST) thickness measurements by comparing three different measurement methods applied at 32 landmarks on three-dimensional cone-beam computed tomography (CBCT) images. Two observers carried out the measurements of facial ST thickness of 20 adult subjects using CBCT scan data, and inter- and intra-observer reproducibilities were evaluated. The measurement method of “perpendicular to bone” resulted in high inter- and intra-observer reproducibility at all 32 landmarks. In contrast, the “perpendicular to skin” method and “direct” method, which measures a distance between one point on bone and the other point on skin, presented low reproducibility. The results indicate that reproducibility could be increased by identifying the landmarks on hard tissue images, rather than on ST images, and the landmark description used in this study can be used in the establishment of reliable tissue depth data using CBCT images

The feasibility and acceptability of a physical activity intervention for older people with chronic musculoskeletal pain: The iPOPP pilot trial protocol

INTRODUCTION: This pilot trial will inform the design and methods of a future full-scale randomized controlled trial (RCT) and examine the feasibility, acceptability and fidelity of the Increasing Physical activity in Older People with chronic Pain (iPOPP) intervention, a healthcare assistant (HCA)-supported intervention to promote walking in older adults with chronic musculoskeletal pain in a primary care setting. METHODS AND ANALYSIS: The iPOPP study is an individually randomized, multicentre, three-parallel-arm pilot RCT. A total of 150 participants aged ≥65 years with chronic pain in one or more index sites will be recruited and randomized using random permuted blocks, stratified by general practice, to: (i) usual care plus written information; (ii) pedometer plus usual care and written information; or (iii) the iPOPP intervention. A theoretically informed mixed-methods approach will be employed using semi-structured interviews, audio recordings of the HCA consultations, self-reported questionnaires, case report forms and objective physical activity data collection (accelerometry). Follow-up will be conducted 12 weeks post-randomization. Collection of the quantitative data and statistical analysis will be performed blinded to treatment allocation, and analysis will be exploratory to inform the design and methods of a future RCT. Analysis of the HCA consultation recordings will focus on the use of a checklist to determine the fidelity of the iPOPP intervention delivery, and the interview data will be analysed using a constant comparison approach in order to generate conceptual themes focused around the acceptability and feasibility of the trial, and then mapped to the Theoretical Domains Framework to understand barriers and facilitators to behaviour change. A triangulation protocol will be used to integrate quantitative and qualitative data and findings