The Impact of Pregnancy in Patients with Thoracic Aortic Disease: Epidemiology, Risk Assessment, and Management Considerations.

Thoracic aortic disease (TAD) poses substantial risks during pregnancy, particularly for women with genetic conditions such as Marfan syndrome, Loeys-Dietz syndrome, and vascular Ehlers-Danlos syndrome. This review examines the epidemiology, risk assessment, and management of TAD in pregnancy. Preconception counseling is vital considering the hereditary nature of TAD and potential pregnancy-related complications. Genetic testing and imaging surveillance aid in risk assessment. Medical management, including beta-blockade and strict blood pressure control, is essential throughout pregnancy. Surgical interventions may be necessary in certain cases. A multidisciplinary approach involving cardiologists, obstetricians, cardiac surgeons, anesthesiologists, and other specialists with expertise in cardio-obstetrics is essential for optimal outcomes. Patient education and shared decision-making play vital roles in navigating the complexities of TAD in pregnancy and improving maternal and neonatal outcomes.

Developing and Evaluating a School-Based Tobacco and E-Cigarette Prevention Program for Deaf and Hard-of-Hearing Youth.

School-based programs are an important tobacco prevention tool. Yet, existing programs are not suitable for Deaf and Hard-of-Hearing (DHH) youth. Moreover, little research has examined the use of the full range of tobacco products and related knowledge in this group. To address this gap and inform development of a school-based tobacco prevention program for this population, we conducted a pilot study among DHH middle school (MS) and high school (HS) students attending Schools for the Deaf and mainstream schools in California (n = 114). American Sign Language (ASL) administered surveys, before and after receipt of a draft curriculum delivered by health or physical education teachers, assessed product use and tobacco knowledge. Thirty-five percent of students reported exposure to tobacco products at home, including cigarettes (19%) and e-cigarettes (15%). Tobacco knowledge at baseline was limited; 35% of students knew e-cigarettes contain nicotine, and 56% were aware vaping is prohibited on school grounds. Current product use was reported by 16% of students, most commonly e-cigarettes (12%) and cigarettes (10%); overall, 7% of students reported dual use. Use was greater among HS versus MS students. Changes in student knowledge following program delivery included increased understanding of harmful chemicals in tobacco products, including nicotine in e-cigarettes. Post-program debriefings with teachers yielded specific recommendations for modifications to better meet the educational needs of DHH students. Findings based on student and teacher feedback will guide curriculum development and inform next steps in our program of research aimed to prevent tobacco use in this vulnerable and heretofore understudied population group.

Do People With Apraxia of Speech and Aphasia Improve or Worsen Across Repeated Sequential Word Trials?

PURPOSE: During motor speech examinations for suspected apraxia of speech (AOS), clients are routinely asked to repeat words several times sequentially. The purpose of this study was to understand the task in terms of the relationship among consecutive attempts. We asked to what extent phonemic accuracy changes across trials and whether the change is predicted by AOS diagnosis and sound production severity. METHOD: One hundred thirty-three participants were assigned to four diagnostic groups based on quantitative metrics (aphasia plus AOS, aphasia-only, and aphasia with two borderline speech profiles). Each participant produced four multisyllabic words 5 times consecutively. These productions were audio-recorded and transcribed phonetically and then summarized as the proportion of target phonemes that was produced accurately. Nonparametric statistics were used to analyze percent change in accuracy from the first to the last production based on diagnostic group and a broad measure of speech sound accuracy. RESULTS: Accuracy on the repeated words deteriorated across trials for all groups, showing reduced accuracy from the first to the last repetition for 62% of participants. Although diagnostic groups differed on the broad measure of speech sound accuracy, severity classification based on this measure did not determine degree of deterioration on the repeated words task. DISCUSSION: Responding to a request to say multisyllabic words 5 times sequentially is challenging for people with aphasia with and without AOS, and as such, performance is prone to errors even with mild impairment. For most, the task does not encourage self-correction. Instead, it promotes errors, regardless of diagnosis, and is, therefore, useful for screening purposes.

Articulation Rate, Pauses, and Disfluencies in Professional Fighters: Potential Speech Biomarkers for Repetitive Head Injury.

OBJECTIVE: As part of a larger study dedicated to identifying speech and language biomarkers of neurological decline associated with repetitive head injury (RHI) in professional boxers and mixed martial artists (MMAs), we examined articulation rate, pausing, and disfluency in passages read aloud by participants in the Professional Athletes Brain Health Study. SETTING: A large outpatient medical center specializing in neurological care. PARTICIPANTS, DESIGN, AND MAIN MEASURES: Passages read aloud by 60 boxers, 40 MMAs, and 55 controls were acoustically analyzed to determine articulation rate (the number of syllables produced per second), number and duration of pauses, and number and duration of disfluencies in this observational study. RESULTS: Both boxers and MMAs differed from controls in articulation rate, producing syllables at a slower rate than controls by nearly half a syllable per second on average. Boxers produced significantly more pauses and disfluencies in passages read aloud than MMAs and controls. CONCLUSIONS: Slower articulation rate in both boxers and MMA fighters compared with individuals with no history of RHI and the increased occurrence of pauses and disfluencies in the speech of boxers suggest changes in speech motor behavior that may relate to RHI. These speech characteristics can be measured in everyday speaking conditions and by automatic recognition systems, so they have the potential to serve as effective, noninvasive clinical indicators for RHI-associated neurological decline.

Analysing Mechanically Evoked Currents at Cell-Substrate Junctions.

The precise study of mechanically activated ion channels requires a combination of electrophysiology to directly measure channel-mediated ionic flux and a means to apply meaningful mechanical stimuli to activate the channel. In metazoans, individual cells in vivo experience mechanical inputs at the cell-substrate interface where cells form connections to the local microenvironment. To study such processes in vitro, a technique is required where mechanical stimuli can be applied to cells via connections with an underlying substrate. Here, we outline the methodology for combining whole-cell patch-clamp electrophysiology (to monitor transmembrane currents) with elastomer pillar arrays that can be deflected (to apply stimuli to cells). This quantitative technique can be used to assess changes in sensitivity and kinetics of mechanically evoked currents when cell intrinsic or cell extrinsic factors are manipulated.

Developing a novel device, Eggcell, to improve temperature stability during oocyte collection for IVF.

RESEARCH QUESTION: What temperature fluctuations are oocytes exposed to during oocyte retrieval? Can an alternative method of oocyte retrieval be designed to minimize these fluctuations? DESIGN: Mock oocyte retrieval procedures were performed to investigate the change in temperature when the follicular fluid is drained into collection tubes and when the fluid is subsequently poured into dishes to allow identification of the cumulus-oocyte complex (COC). A new device, the Eggcell, has been designed that addresses the problem of these temperature fluctuations. To confirm its safety and demonstrate the clinical applicability of Eggcell, laboratory validation was performed prior to use with human participants (n = 15). RESULTS: Eggcell meets its design specification to provide temperature stability within the physiological range for aspirated follicular fluid. The COC can be successfully retained within the chamber (n = 180) without evidence of loss or damage to the oocytes or compromise of fertilization rate, blastocyst development or clinical outcome. CONCLUSIONS: This study has demonstrated the successful first stages of development of a new medical device. Further studies are needed for comparative evaluation of clinical outcome with standard technology.

Transcranial direct current stimulation modulates working memory and prefrontal-insula connectivity after mild-moderate traumatic brain injury.

Background: Persistent posttraumatic symptoms (PPS) may manifest after a mild-moderate traumatic brain injury (mmTBI) even when standard brain imaging appears normal. Transcranial direct current stimulation (tDCS) represents a promising treatment that may ameliorate pathophysiological processes contributing to PPS. Objective/Hypothesis: We hypothesized that in a mmTBI population, active tDCS combined with training would result in greater improvement in executive functions and post-TBI cognitive symptoms and increased resting state connectivity of the stimulated region, i.e., left dorsolateral prefrontal cortex (DLPFC) compared to control tDCS. Methods: Thirty-four subjects with mmTBI underwent baseline assessments of demographics, symptoms, and cognitive function as well as resting state functional magnetic resonance imaging (rsfMRI) in a subset of patients (n = 24). Primary outcome measures included NIH EXAMINER composite scores, and the Neurobehavioral Symptom Inventory (NSI). All participants received 10 daily sessions of 30 min of executive function training coupled with active or control tDCS (2 mA, anode F3, cathode right deltoid). Imaging and assessments were re-obtained after the final training session, and assessments were repeated after 1 month. Mixed-models linear regression and repeated measures analyses of variance were calculated for main effects and interactions. Results: Both active and control groups demonstrated improvements in executive function (EXAMINER composite: p < 0.001) and posttraumatic symptoms (NSI cognitive: p = 0.01) from baseline to 1 month. Active anodal tDCS was associated with greater improvements in working memory reaction time compared to control (p = 0.007). Reaction time improvement correlated significantly with the degree of connectivity change between the right DLPFC and the left anterior insula (p = 0.02). Conclusion: Anodal tDCS improved reaction time on an online working memory task in a mmTBI population, and decreased connectivity between executive network and salience network nodes. These findings generate important hypotheses for the mechanism of recovery from PPS after mild-moderate TBI.

Understanding Veteran Suicide Risk and Mitigation Strategies During the COVID-19 Pandemic.

U.S. Veterans experience a significantly higher risk for suicide compared to the general population. Understanding the challenges associated with coronavirus disease 2019 (COVID-19) enables providers to mitigate the risk of suicide among Veterans. Evidence supports access and utilization of U.S. Department of Veterans Affairs (VA) mental health services as they are a protective factor associated with lower suicide rates. During the ongoing COVID-19 pandemic, the VA has worked to further decrease deaths by suicide in the Veteran population by rapid expansion of current interventions and implementation of new evidence-based interventions. These interventions include mental health and coaching applications, consistent use of measurement-based care across multiple disciplines, and greater use of telehealth services. Through these efforts, despite increased risk for suicide due to additional stressors from COVID-19, suicide rates among Veterans are decreasing. [Journal of Psychosocial Nursing and Mental Health Services, 60(12), 25-29.].

Effects of a microplastic mixture differ across trophic levels and taxa in a freshwater food web: In situ mesocosm experiment.

The ubiquitous presence of microplastics (MP) in aquatic ecosystems can affect organisms and communities in multiple ways. While MP research on aquatic organisms has primarily focused on marine ecosystems and laboratory experiments, the community-level effects of MP in freshwaters, especially in lakes, are poorly understood. To examine the impact of MP on freshwater lake ecosystems, we conducted the first in situ community-level mesocosm experiment testing the effects of MP on a model food web with zooplankton as main herbivores, odonate larvae as predators, and chironomid larvae as detritivores for seven weeks. The mesocosms were exposed to a mixture of the most abundant MP polymers found in freshwaters, added at two different concentrations in a single pulse to the water surface, water column and sediment. Water column MP concentrations declined sharply during the first two weeks of the experiment. Contrary to expectations, MP ingestion by zooplankton was low and limited mainly to large-bodied Daphnia, causing a decrease in biomass. Biomass of the other zooplankton taxa did not decrease. Presence of MP in the faecal pellets of odonate larvae that fed on zooplankton was indicative of a trophic transfer of MP. The results demonstrated that MP ingestion varies predictably with MP size, as well as body size and feeding preference of the organism, which can be used to predict the rates of transfer and further effects of MP on freshwater food webs. For chironomids, MP had only a low, short-term impact on emergence patterns while their wing morphology was significantly changed. Overall, the impact of MP exposure on the experimental food web and cross-ecosystem biomass transfer was lower than expected, but the experiment provided the first in situ observation of MP transfer to terrestrial ecosystems by emerging chironomids.

Aided Language Measures: Establishing Observer Agreement for Communicators in Early Language Phases.

PURPOSE: Although many valid, reliable, and developmentally sensitive measures exist to monitor the language gains of children who rely on spoken language to communicate, the same is not true for graphic symbol communicators. This study is a first step in developing such measures by examining the interobserver agreement (IOA) and within-observer agreement of 13 measures designed to monitor the language progress of children who use aided augmentative and alternative communication (AAC). These measures are based on the Graphic Symbol Utterance and Sentence Development Framework (Binger et al., 2020) and are hypothesized to capture various phases of graphic symbol communication. METHOD: Four graduate student observers coded 13 measures across 57 different play-based sessions of children with Down syndrome ages 3;0-5;11 (years;months). For IOA, sessions were coded by two different observers. For within-observer agreement, all sessions were recoded by the same coders. Corpus-level analyses were completed to characterize the nature of the samples (e.g., average mean length of utterance for the samples). IOA and within-observer agreement were examined for each utterance. RESULTS: Across all observers and measures, acceptable levels of IOA and within-observer agreement were achieved, with most measures yielding relatively high levels of agreement. Some differences were noted across measures, with the less experienced coders demonstrating less agreement on select measures. CONCLUSIONS: Results provide initial evidence that many measures based on the Graphic Symbol Utterance and Sentence Development Framework can be reliably coded. These findings are a first step in developing psychometrically sound measures to monitor the expressive language progress of children who use AAC. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.19601551.

Assessment of language impairment and function.

This chapter is written for the qualified neurologist or related professional working with persons who have had a stroke or other sudden brain injury. It is critical that the presence of aphasia is detected, no matter how mild the presentation, and to support that assertion, this chapter highlights the plight of persons with latent aphasia. At the individual level, the impact of aphasia is devastating, with overwhelming evidence that aphasia negatively impacts psychosocial outcomes. At the global level, sensitive detection and accurate diagnosis of aphasia are critical for accurate characterization and quantification of the global burden of aphasia. The word "LANGUAGE" is leveraged as an acronym to create a useful and memorable checklist to guide navigation of aphasia screening and assessment: it begins with the definition of language (L), followed by the definition and diagnostic criteria for aphasia (A). Then language abilities and characteristics to be considered in assessment are presented: naming (N); grammar and syntax (G); unintelligible words, jargon, and paraphasias (U); auditory comprehension and repetition (A); graphemic abilities-reading and writing (G); and everyday communication and discourse (E). Recommendations for improving procedural adherence are provided, and a list of potential brief assessment measures are introduced.

From stretch to deflection: the importance of context in the activation of mammalian, mechanically activated ion channels.

The ability of cells to convert mechanical perturbations into biochemical information is an essential aspect of mammalian physiology. The molecules that mediate such mechanotransduction include mechanically activated ion channels, which directly convert mechanical inputs into electrochemical signals. The unifying feature of these channels is that their open probability increases with the application of a mechanical input. However, the structure, activation profile and sensitivity of distinct mechanically activated ion channels vary from channel to channel. In this review, we discuss how ionic currents can be mechanically evoked and monitored in vitro, and describe the distinct activation profiles displayed by a range of mammalian channels. In addition, we discuss the various mechanisms by which the best-characterized mammalian, mechanically activated ion channel, PIEZO1, can be modulated. The diversity of activation and modulation of these mammalian ion channels suggest that these molecules may facilitate a finely controlled and diverse ability to sense mechanical inputs in mammalian cells.

A study of the healthcare resource use for the management of postpartum haemorrhage in France, Italy, the Netherlands, and the UK.

OBJECTIVE: Postpartum haemorrhage (PPH) complicates approximately 5% of births worldwide and is a leading direct cause of maternal death. Rates of PPH are increasing in many developed countries, particularly PPH related to uterine atony. There is a lack of published up-to-date information about healthcare resource use associated with management of PPH following vaginal birth. The objective of this study was to describe healthcare resource use for the management of minor PPH (blood loss 500-1,000 ml) and major PPH (blood loss > 1,000 ml) compared to uncomplicated birth (no PPH) following hospital vaginal birth in France, Italy, the Netherlands, and the UK. STUDY DESIGN: In-depth interviews with two midwives from each participating country were conducted to establish differences in resource use for the management of minor PPH, major PPH, and uncomplicated birth. A web-survey was then developed and one obstetrician per participating country reviewed the survey. In total, 100 midwives (25 per country) completed the survey. Results were discussed at a multi-professional consensus meeting of midwives and obstetricians/gynaecologists (n = 6). RESULTS AND CONCLUSIONS: Midwives participating in the survey estimated that 80% of women receive Active Management of the Third Stage of Labour (AMTSL) and 93% of participants specified that uterotonics would routinely be used during AMTSL. Most participants (84%) reported that blood loss is routinely measured in their hospital, using a combination of methods. PPH is associated with increased healthcare resource use, including administration of additional uterotonics and use of additional medical interventions, such as urinary catheter, intravenous fluids, and possible requirement for surgery. The number of nurses, obstetricians/gynaecologists, and anaesthetists involved in the management of PPH increases with the occurrence and severity of PPH, as well as the proportion of healthcare personnel providing continuous care. Women may spend an additional 24 h in hospital following major PPH compared to uncomplicated birth. The results of this study highlight the burden of PPH management on healthcare resources. To reduce costs associated with PPH, prevention is the most effective strategy and can be enhanced with the use of an effective uterotonic as part of the active management of the third stage of labour.

Repeated word production is inconsistent in both aphasia and apraxia of speech.

PURPOSE: There is persistent uncertainty about whether sound error consistency is a valid criterion for differentiating between apraxia of speech (AOS) and aphasia with phonemic paraphasia. The purpose of this study was to determine whether speakers with a profile of aphasia and AOS differ in error consistency from speakers with aphasia who do not have AOS. By accounting for differences in overall severity and using a sample size well over three times that of the largest study on the topic to date, our ambition was to resolve the existing controversy. METHOD: We analyzed speech samples from 171 speakers with aphasia and completed error consistency analysis for 137 of them. The experimental task was to repeat four multisyllabic words five times successively. Phonetic transcriptions were coded for four consistency indices (two at the sound-level and two at the word-level). We then used quantitative metrics to assign participants to four diagnostic groups (one aphasia plus AOS group, one aphasia only group, and two groups with intermediate speech profiles). Potential consistency differences were examined with ANCOVA, with error frequency as a continuous covariate. RESULTS: Error frequency was a strong predictor for three of the four consistency metrics. The magnitude of consistency for participants with AOS was either similar or lower compared to that of participants with aphasia only. Despite excellent transcription reliability and moderate to excellent coding reliability, three of the four consistency indices showed limited measurement reliability. DISCUSSION: People with AOS and people with aphasia often produce inconsistent variants of errors when they are asked to repeat challenging words several times sequentially. The finding that error consistency is similar or lower in aphasia with AOS than in aphasia without AOS is incompatible with recommendations that high error consistency be used as a diagnostic criterion for AOS. At the same time, group differences in the opposite direction are not sufficiently systematic to warrant use for differential diagnosis between aphasia with AOS and aphasia with phonemic paraphasia. Greater attention should be given to error propagation when estimating reliability of derived measurements.

Upper and Lower Limb Motor Function Correlates with Ipsilesional Corticospinal Tract and Red Nucleus Structural Integrity in Chronic Stroke: A Cross-Sectional, ROI-Based MRI Study.

BACKGROUND: Structural integrity of the ipsilesional corticospinal tract (CST) is important for upper limb motor recovery after stroke. However, additional neuromechanisms associated with motor function poststroke are less well understood, especially regarding the lower limb. OBJECTIVE: To investigate the neural basis of upper/lower limb motor deficits poststroke by correlating measures of motor function with diffusion tensor imaging-derived indices of white matter integrity (fractional anisotropy (FA), mean diffusivity (MD)) in primary and secondary motor tracts/structures. METHODS: Forty-three individuals with chronic stroke (time poststroke, 64.4 ± 58.8 months) underwent a comprehensive motor assessment and MRI scanning. Correlation and multiple regression analyses were performed to examine relationships between FA/MD in a priori motor tracts/structures and motor function. RESULTS: FA in the ipsilesional CST and red nucleus (RN) was positively correlated with motor function of both the affected upper and lower limb (r = 0.36-0.55, p ≤ 0.01), while only ipsilesional RN FA was associated with gait speed (r = 0.50). Ipsilesional CST FA explained 37.3% of the variance in grip strength (p < 0.001) and 31.5% of the variance in Arm Motricity Index (p = 0.004). Measures of MD were not predictors of motor performance. CONCLUSIONS: Microstructural integrity of the ipsilesional CST is associated with both upper and lower limb motor function poststroke, but appears less important for gait speed. Integrity of the ipsilesional RN was also associated with motor performance, suggesting increased contributions from secondary motor areas may play a role in supporting chronic motor function and could become a target for interventions.

Spectral Resting-State EEG (rsEEG) in Chronic Aphasia Is Reliable, Sensitive, and Correlates With Functional Behavior.

We investigated spectral resting-state EEG in persons with chronic stroke-induced aphasia to determine its reliability, sensitivity, and relationship to functional behaviors. Resting-state EEG has not yet been characterized in this population and was selected given the demonstrated potential of resting-state investigations using other neuroimaging techniques to guide clinical decision-making. Controls and persons with chronic stroke-induced aphasia completed two EEG recording sessions, separated by approximately 1 month, as well as behavioral assessments of language, sensorimotor, and cognitive domains. Power in the classic frequency bands (delta, theta, alpha, and beta) was examined via spectral analysis of resting-state EEG data. Results suggest that power in the theta, alpha, and beta bands is reliable for use as a repeated measure. Significantly greater theta and lower beta power was observed in persons with aphasia (PWAs) than controls. Finally, in PWAs theta power negatively correlated with performance on a discourse informativeness measure, while alpha and beta power positively correlated with performance on the same measure. This indicates that spectral rsEEG slowing observed in PWAs in the chronic stage is pathological and suggests a possible avenue for directly altering brain activation to improve behavioral function. Taken together, these results suggest that spectral resting-state EEG holds promise for sensitive measurement of functioning and change in persons with chronic aphasia. Future studies investigating the utility of these measures as biomarkers of frank or latent aphasic deficits and treatment response in chronic stroke-induced aphasia are warranted.

Making waves. Bridging theory and practice towards multiple stressor management in freshwater ecosystems.

Despite advances in conceptual understanding, single-stressor abatement approaches remain common in the management of fresh waters, even though they can produce unexpected ecological responses when multiple stressors interact. Here we identify limitations restricting the development of multiple-stressor management strategies and address these, bridging theory and practice, within a novel empirical framework. Those critical limitations include that (i) monitoring schemes fall short of accounting for theory on relationships between multiple-stressor interactions and ecological responses, (ii) current empirical modelling approaches neglect the prevalence and intensity of multiple-stressor interactions, and (iii) mechanisms of stressor interactions are often poorly understood. We offer practical recommendations for the use of empirical models and experiments to predict the effects of freshwater degradation in response to changes in multiple stressors, demonstrating this approach in a case study. Drawing on our framework, we offer practical recommendations to support the development of effective management strategies in three general multiple-stressor scenarios.

Main Concept, Sequencing, and Story Grammar Analyses of Cinderella Narratives in a Large Sample of Persons with Aphasia.

Recently, a multilevel analytic approach called Main Concept, Sequencing, and Story Grammar (MSSG) was presented along with preliminary normative information. MSSG analyses leverage the strong psychometrics and rich procedural knowledge of both main concept analysis and story grammar component coding, complementing it with easy-to-obtain sequencing information for a rich understanding of discourse informativeness and macrostructure. This study is the next critical step for demonstrating the clinical usefulness of MSSG's six variables (main concept composite, sequencing, main concept+sequencing, essential story grammar components, total episodic components, and episodic complexity) for persons with aphasia (PWAs). We present descriptive statistical information for MSSG variables for a large sample of PWAs and compare their performance to a large sample of persons not brain injured (PNBIs). We observed significant differences between PWAs and PNBIs for all MSSG variables. These differences occurred at the omnibus group level and for each aphasia subtype, even for PWAs with very mild impairment that is not detected with standardized aphasia assessment. Differences between PWAs and PNBIs were also practically significant, with medium to large effect sizes observed for nearly all aphasia subtypes and MSSG variables. This work deepens our understanding of discourse informativeness and macrostructure in PWAs and further develops an efficient tool for research and clinical use. Future research should investigate ways to expand MSSG analyses and to improve sensitivity and specificity.