Assessing parent interaction with deaf infants: A quantitative survey of UK professional practice.

BACKGROUND: Between 90% and 95% of deaf children are born to hearing parents who often need support with how to adapt their communication. Parent-child interaction (PCI) is an important predictor of deaf children's future language development. It is therefore necessary for professionals to assess parents' strengths and needs to identify areas for intervention. Qualified teachers of the deaf (QToDs), speech and language therapists (SLTs), psychologists, and national deaf child and adolescent mental health (NDCAMHS) professionals regularly support families with deaf children. With no current evidence-based tool available to assist with the assessment of PCI in deafness, it is important to gather information on current professional practice as this may differ from known practices within research. AIMS: To survey the practices of UK-based professionals in the assessment of PCI where the deaf infant is aged 0-3 years. Professionals were QToDs, SLTs, psychologists or psychiatrists and professionals working at NDCAMHS services. METHODS & PROCEDURES: After a pilot phase, an 85-item survey was distributed electronically through a range of professional and social media networks. Survey items were based on a systematic review of PCI with deaf infants. Survey questions were focused on parent behaviours that were assessed, methods of assessment, goal planning and service provision. Analysis was conducted using descriptive and inferential statistics. OUTCOMES & RESULTS: A total of 190 professionals from across the UK completed part 1 of the survey; this decreased to 148 in part 4. Respondents were primarily female, hearing, used spoken English and had 16 years or more experience. Results indicate that PCI is routinely assessed by a large proportion of professionals and there is a substantial overlap in which parent behaviours are assessed. Some parent behaviours are assessed that do not feature in the research. Methods of assessment are informal and predominantly consist of observation and note making, with professionals using their own skills and experience to analyse interaction. Goal setting practices were largely similar between professionals, with many jointly deciding goals with parents. CONCLUSIONS & IMPLICATIONS: This survey highlights the range of parent behaviours assessed by UK professionals in PCI with deaf children aged 0-3. This survey provides valuable information about and for professionals who assess PCI and set intervention goals with parents. Information from research and professional practice is important to consider in the design of a future PCI assessment. Implications are included for future research in this area. WHAT THIS PAPER ADDS: What is already known on this subject Parental involvement is one of the greatest predictors of deaf children's language outcomes. With many deaf children born to hearing parents, parents often need guidance with how to facilitate effective communication. A recent systematic review identified the range of parent behaviours and methods used to analyse PCI in international research studies, but little evidence or guidance exists on how professionals assess this phenomenon in practice. What this study adds This is the first survey to generate large, valuable practice-based evidence for the assessment of parents' communication behaviours as they interact with their deaf infants aged 0-3. The survey recruited a range of multidisciplinary professionals working on interaction within this field: SLTs, qualified teachers of the deaf, psychologists or psychiatrists, and professionals working within deaf child and adolescent mental health services. The study reports on which behaviours these professionals assess and how, and includes information on the goal setting behaviours of practitioners. Most respondents were highly experienced; the survey, therefore, reveals expert practice within the field. What are the potential or actual clinical implications of this work? We recommend the following practice: (1) incorporate a range of parent-based behaviours in PCI assessments, including establishing joint engagement and parental sensitivity, as well as communication-focused behaviours; (2) video record PCI assessments where possible to enable professionals and parents to watch and reflect together; (3) following assessment, set parent-focused goals in collaboration with families, ensuring parents' skills, particularly their strengths, are considered. All primary caregivers should be included in the process where possible; and (4) reassess PCI regularly (at least termly) to monitor and encourage families' progress. The timing of reviews should be discussed between parent and professional.

First North American fossil monkey and early Miocene tropical biotic interchange.

New World monkeys (platyrrhines) are a diverse part of modern tropical ecosystems in North and South America, yet their early evolutionary history in the tropics is largely unknown. Molecular divergence estimates suggest that primates arrived in tropical Central America, the southern-most extent of the North American landmass, with several dispersals from South America starting with the emergence of the Isthmus of Panama 3-4 million years ago (Ma). The complete absence of primate fossils from Central America has, however, limited our understanding of their history in the New World. Here we present the first description of a fossil monkey recovered from the North American landmass, the oldest known crown platyrrhine, from a precisely dated 20.9-Ma layer in the Las Cascadas Formation in the Panama Canal Basin, Panama. This discovery suggests that family-level diversification of extant New World monkeys occurred in the tropics, with new divergence estimates for Cebidae between 22 and 25 Ma, and provides the oldest fossil evidence for mammalian interchange between South and North America. The timing is consistent with recent tectonic reconstructions of a relatively narrow Central American Seaway in the early Miocene epoch, coincident with over-water dispersals inferred for many other groups of animals and plants. Discovery of an early Miocene primate in Panama provides evidence for a circum-Caribbean tropical distribution of New World monkeys by this time, with ocean barriers not wholly restricting their northward movements, requiring a complex set of ecological factors to explain their absence in well-sampled similarly aged localities at higher latitudes of North America.

Does Sentinel Lymph Node Biopsy Accurately Stage the Clinically Negative Neck in Early Oral Cavity Squamous Cell Carcinoma?

PURPOSE: Sentinel lymph node biopsy (SLNB) is being increasingly used worldwide as a minimally invasive option to stage the clinically node-negative neck (N0) in patients with early oral cavity squamous cell carcinomas (OCSCC). We performed this trial to assess the reliability and validity of the technique. METHODS: We did this prospective interventional nonrandomized study in patients with early (cT1-T2 OCSCC) and with negative neck. All patients underwent preoperative lymphoscintigraphy; SLNB was followed immediately by completion neck dissection (CND), thus each patient serving as their own control. The primary outcomes evaluated are sentinel lymph node (SLN) detection rate, SLN retrieval rate, and SLN status (positive or negative) compared with pathology of CND specimen to detect any false negatives. The secondary outcomes included SLN analyses (tumor burden, location in different levels of the neck, laterality, extracapsular spread, and total nodes positive) and overall survival. RESULTS: Of 60 patients, 59 (98%) had successful SLN detection with the lymphoscintigram failing to localize in 1 patient. Of the remaining 59 patients, 58 (96%) had all the SLNs retrieved, resulting in 96.4% sentinel node retrieval rate. In total, 24 (41%) SLNs were positive with 1 false negative. Using a combination of SLN and CND findings as the gold standard for lymph node involvement status, SLNB had a sensitivity of 96% (95% confidence interval [CI]: 80-100%), a specificity of 100% (95% CI: 90-100%), and negative predictive value of 97% (95% CI: 85-100%). CONCLUSION: The results of this study suggest that SLNB is an accurate technique to assess the nodal status in patients with cT1-T2 N0 OCSCC and should be considered for eligible patients.

Executive Function Training for Deaf Children: Impact of a Music Intervention.

Several studies have reported poor executive function (EF) development in deaf children with subsequent impacts on their social and academic attainment. This paper describes the results of a music-based EF intervention designed for deaf children and carried out in two sets of primary schools. This is the first classroom-based EF training study with deaf children, and it also incorporates a replication phase. The intervention was a within-subject crossover design, with 29 deaf children aged 7-11 years who participated in both an EF and an art class control activity, each lasting 10 hours over 5 weeks. Non-verbal EF skills were assessed at pre-test, the crossover point, and post-test. Findings indicated that the EF intervention led to an improvement in participants' working memory and inhibitory skills in comparison with their performance on the same tasks after the control activity. The findings were not uniform for all EFs targeted nor for all cognitive ability levels in the sample. We discuss the implications of our findings for deaf children with different ability levels and for how EF interventions can be further improved.

Expressive Vocabulary Predicts Nonverbal Executive Function: A 2-year Longitudinal Study of Deaf and Hearing Children.

Numerous studies suggest an association between language and executive function (EF), but evidence of a developmental relationship remains inconclusive. Data were collected from 75 deaf/hard-of-hearing (DHH) children and 82 hearing age-matched controls. Children were 6-11 years old at first time of testing and completed a battery of nonverbal EF tasks and a test of expressive vocabulary. These tasks were completed again 2 years later. Both groups improved their scores on all tasks over this period. DHH children performed significantly less well than hearing peers on some EF tasks and the vocabulary test at both time points. Cross-lagged panel models showed that vocabulary at Time 1 predicted change in EF scores for both DHH and hearing children but not the reverse.

"El nen s'ha menjat una aranya": The development of narratives in Catalan speaking children.

The production of a well-constructed narrative is the culmination of several years of language acquisition and is an important milestone in children's development. There is no current description of narrative development for Catalan speaking children. This study collected elicited narratives in Catalan from 118 children aged 4;0-10;11. Narratives were scored for macrostructure and microstructure. Narrative scores improved with age with maximum performance for macrostructure by 9 years. Children's ability to use micro-structural components of Catalan is variable with some developments continuing beyond 9 years. The results are discussed in relation to theoretical arguments about universal and specific features of narrative development. We conclude by highlighting the usefulness of the new test for future language assessment of children acquiring Catalan.

Understanding Pretend Emotions in Children Who Are Deaf and Hard of Hearing.

Children who are deaf and hard of hearing (DHH) and born to hearing parents have delays in their social-cognitive development and in particular in their theory of mind (ToM). These delays are often attributed to the difficulties they encounter in acquiring age-appropriate linguistic and communicative skills. The present study asks whether this developmental delay extends to problems with understanding pretend emotions and if linguistic difficulties are related to this area. A total of 173 children (82 DHH and 91 hearing) between 3 and 8 years of age received a set of emotion and language measures. Results showed that children who are DHH were delayed in understanding pretend emotions, and this was strongly related to their difficulties with expressive vocabulary and pragmatics. In summary, children who are DHH and have experienced reduced access to language and communicative interaction have a restricted understanding of the communicative intentions of emotional expressions. These delays may have implications for their social relationships with surrounding family and other children.

The Understanding of Communicative Intentions in Children with Severe-to-Profound Hearing Loss.

The ability to distinguish lies from sincere false statements requires understanding a speaker's communicative intentions and is argued to develop through linguistic interaction. We tested whether this ability was delayed in 26 children with severe-to-profound hearing loss who, based on vocabulary size, were thought to have relatively limited access to linguistic exchanges compared to typically hearing peers (n = 93). Children were presented with toy bears who either lied or made a false statement sincerely. Despite identifying speakers' knowledge/ignorance, deaf or hard of hearing (DHH) children were delayed in identifying lies and sincere false statements when matched for chronological age. When matched for receptive vocabulary, observed discrepancies diminished. Deaf children who experienced early access to conversations with their deaf parents demonstrated no delay. Findings suggest limited access to linguistic exchanges delays the development of a key pragmatic skill.

Mapping language to the world: the role of iconicity in the sign language input.

Most research on the mechanisms underlying referential mapping has assumed that learning occurs in ostensive contexts, where label and referent co-occur, and that form and meaning are linked by arbitrary convention alone. In the present study, we focus on iconicity in language, that is, resemblance relationships between form and meaning, and on non-ostensive contexts, where label and referent do not co-occur. We approach the question of language learning from the perspective of the language input. Specifically, we look at child-directed language (CDL) in British Sign Language (BSL), a language rich in iconicity due to the affordances of the visual modality. We ask whether child-directed signing exploits iconicity in the language by highlighting the similarity mapping between form and referent. We find that CDL modifications occur more often with iconic signs than with non-iconic signs. Crucially, for iconic signs, modifications are more frequent in non-ostensive contexts than in ostensive contexts. Furthermore, we find that pointing dominates in ostensive contexts, and suggest that caregivers adjust the semiotic resources recruited in CDL to context. These findings offer first evidence for a role of iconicity in the language input and suggest that iconicity may be involved in referential mapping and language learning, particularly in non-ostensive contexts.

The role of mechanical bowel preparation and oral antibiotics for left-sided laparoscopic and open elective restorative colorectal surgery with and without faecal diversion.

BACKGROUND: There is significant variation in the use of mechanical bowel preparation and oral antibiotics prior to left-sided elective colorectal surgery. There has been no consensus internationally. METHODS: This was a retrospective analysis of the 2015 American College of Surgeons National Surgical Quality Improvement Program database. Patients were divided into four groups: those who had mechanical bowel preparation with oral antibiotics, mechanical bowel preparation alone, oral antibiotics alone and no preparation. The main outcome measures included overall, superficial, deep and organ/space surgical site infections. Secondary outcomes included anastomotic leak, ileus and rate of Clostridium difficile. RESULTS: A total of 5729 patients were included for analysis. The overall surgical site infection rate (any superficial, deep or organ/space infection) was significantly lower in the mechanical bowel preparation and oral antibiotics approach when compared to no preparation (OR = 0.46, 95% CI 0.36-0.59, P < 0.0001). On multivariable logistic regression analysis, mechanical bowel preparation with oral antibiotics maintained a lower risk of overall surgical site infections. MBP and OAB also had a protective effect on anastomotic leak in both the laparoscopic and open cohorts (laparoscopic multivariable adjusted OR = 0.42 (0.19-0.94), P = 0.035; open multivariable adjusted OR = 0.3 (0.12-0.77), P = 0.012). Mechanical bowel preparation alone and oral antibiotics alone was not associated with a significant decrease in surgical site infections. There was no increase in C. difficile occurrences with the use of oral antibiotics. CONCLUSION: Mechanical bowel preparation with oral antibiotics significantly minimised surgical site infections and anastomotic leak following both laparoscopic and open left-sided restorative colorectal surgery. Mechanical bowel preparation alone did not reduce surgical site infections. There was a trend to reduction in surgical site infections with oral antibiotics alone.

Integration of speech and gesture in aphasia.

BACKGROUND: Information from speech and gesture is often integrated to comprehend a message. This integration process requires the appropriate allocation of cognitive resources to both the gesture and speech modalities. People with aphasia are likely to find integration of gesture and speech difficult. This is due to a reduction in cognitive resources, a difficulty with resource allocation or a combination of the two. Despite it being likely that people who have aphasia will have difficulty with integration, empirical evidence describing this difficulty is limited. Such a difficulty was found in a single case study by Cocks et al. in 2009, and is replicated here with a greater number of participants. AIMS: To determine whether individuals with aphasia have difficulties understanding messages in which they have to integrate speech and gesture. METHODS & PROCEDURES: Thirty-one participants with aphasia (PWA) and 30 control participants watched videos of an actor communicating a message in three different conditions: verbal only, gesture only, and verbal and gesture message combined. The message related to an action in which the name of the action (e.g., 'eat') was provided verbally and the manner of the action (e.g., hands in a position as though eating a burger) was provided gesturally. Participants then selected a picture that 'best matched' the message conveyed from a choice of four pictures which represented a gesture match only (G match), a verbal match only (V match), an integrated verbal-gesture match (Target) and an unrelated foil (UR). To determine the gain that participants obtained from integrating gesture and speech, a measure of multimodal gain (MMG) was calculated. OUTCOMES & RESULTS: The PWA were less able to integrate gesture and speech than the control participants and had significantly lower MMG scores. When the PWA had difficulty integrating, they more frequently selected the verbal match. CONCLUSIONS & IMPLICATIONS: The findings suggest that people with aphasia can have difficulty integrating speech and gesture in order to obtain meaning. Therefore, when encouraging communication partners to use gesture alongside language when communicating with people with aphasia, education regarding the types of gestures that would facilitate understanding is recommended.

Education and support needs in patients with head and neck cancer: A multi-institutional survey.

BACKGROUND: Head and neck cancer (HNC) encompasses a diverse group of tumors, and thus providing appropriate and tailored information to patients before, during, and after treatment is a challenge. The objective of the current study was to characterize the experience and unmet needs of patients with HNC with regard to information and support provision. METHODS: A 28-question, cross-sectional survey was completed by patients treated for HNC at 1 of 4 institutions in New South Wales, Australia (Chris O'Brien Lifehouse and Liverpool, Westmead, and Wollongong hospitals). It consisted of the adapted Kessler Psychological Distress Scale and questions assessing information quality, quantity, and format. RESULTS: A total of 597 patients responded. The mean age of the patients was 58 years (range, 21-94 years) with 284 men and 313 women (1:1.1). The majority of patients reported information concerning the disease process (76%), prognosis (67%), and treatment (77%) was sufficient, and approximately 50% reporting having received little or no information regarding coping with stress and anxiety. A substantial percentage of patients reported receiving minimal information concerning psychosexual health (56%) or the availability of patient support groups (56%). The majority of patients preferred access to multiple modes of information delivery (72%), with the preferred modality being one-on-one meetings with a health educator (37%) followed by internet-based written information (19%). CONCLUSIONS: Patients with HNC are a diverse group, with complex educational and support needs. Patients appear to be given information regarding survivorship topics such as psychological well-being, patient support groups, and psychosexual health less frequently than information concerning disease and treatment. Verbal communication needs to be reinforced by accessible, well-constructed, written and multimedia resources appropriate to the patient's educational level. Cancer 2017;123:1949-1957. © 2017 American Cancer Society.

Nonverbal Executive Function is Mediated by Language: A Study of Deaf and Hearing Children.

Studies have suggested that language and executive function (EF) are strongly associated. Indeed, the two are difficult to separate, and it is particularly difficult to determine whether one skill is more dependent on the other. Deafness provides a unique opportunity to disentangle these skills because in this case, language difficulties have a sensory not cognitive basis. In this study, deaf (n = 108) and hearing (n = 125) children (age 8 years) were assessed on language and a wide range of nonverbal EF tasks. Deaf children performed significantly less well on EF tasks, even controlling for nonverbal intelligence and speed of processing. Language mediated EF skill, but the reverse pattern was not evident. Findings suggest that language is key to EF performance rather than vice versa.

Prognostic Significance of Lymph Node Ratio in Metastatic Cutaneous Squamous Cell Carcinoma of the Head and Neck.

BACKGROUND: The prognostic variables in patients with metastatic cutaneous nodal squamous cell carcinoma (SCC) are well documented; however, the relationship between lymph node ratio (LNR) and outcome is not well researched. LNR represents the ratio of positive lymph nodes to total excised lymph nodes. We analyzed the correlation between LNR and outcome in patients who have undergone surgery for metastatic cutaneous nodal SCC of the head and neck. METHODS: Analysis was performed on retrospectively collected data, identifying patients who underwent surgery at Westmead Hospital, Sydney. Pathology reports were reviewed to ascertain LNR. A log-rank test identified a specific LNR value to compare time to disease progression (TTDP) and overall survival (OS). Multivariate proportional hazard regression models were used to review outcome. RESULTS: In total, 193 males and 45 females with a median of age 68 years were identified, with a mean recorded LNR of 0.15. On multivariate analysis, an LNR cutpoint of 0.21 was a significant predictor of decreased TTDP [hazard ratio (HR) 2.34, 95 % confidence interval (CI) 4.40-0.49; p = 0.009] and OS (HR 2.75, 95 % CI 1.57-4.82; p < 0.001). Forty-nine of 238 patients (21 %) developed recurrence, with most recurrences being regional (29 of 49; 59 %). A total of 17 % of patients with an LNR ≤0.21 recurred compared with 40 % for patients with an LNR >0.21. CONCLUSIONS: LNR is potentially an independent predictor of outcome in patients with metastatic cutaneous nodal SCC. The clinical relevance of this finding requires further validation.

The impact of input quality on early sign development in native and non-native language learners.

There is debate about how input variation influences child language. Most deaf children are exposed to a sign language from their non-fluent hearing parents and experience a delay in exposure to accessible language. A small number of children receive language input from their deaf parents who are fluent signers. Thus it is possible to document the impact of quality of input on early sign acquisition. The current study explores the outcomes of differential input in two groups of children aged two to five years: deaf children of hearing parents (DCHP) and deaf children of deaf parents (DCDP). Analysis of child sign language revealed DCDP had a more developed vocabulary and more phonological handshape types compared with DCHP. In naturalistic conversations deaf parents used more sign tokens and more phonological types than hearing parents. Results are discussed in terms of the effects of early input on subsequent language abilities.

The language-gesture connection: Evidence from aphasia.

A significant body of evidence from cross-linguistic and developmental studies converges to suggest that co-speech iconic gesture mirrors language. This paper aims to identify whether gesture reflects impaired spoken language in a similar way. Twenty-nine people with aphasia (PWA) and 29 neurologically healthy control participants (NHPs) produced a narrative discourse, retelling the story of a cartoon video. Gesture and language were analysed in terms of semantic content and structure for two key motion events. The aphasic data showed an influence on gesture from lexical choices but no corresponding clausal influence. Both the groups produced gesture that matched the semantics of the spoken language and gesture that did not, although there was one particular gesture-language mismatch (semantically "light" verbs paired with semantically richer gesture) that typified the PWA narratives. These results indicate that gesture is both closely related to spoken language impairment and compensatory.

Deficits in narrative abilities in child British Sign Language users with specific language impairment.

This study details the first ever investigation of narrative skills in a group of 17 deaf signing children who have been diagnosed with disorders in their British Sign Language development compared with a control group of 17 deaf child signers matched for age, gender, education, quantity, and quality of language exposure and non-verbal intelligence. Children were asked to generate a narrative based on events in a language free video. Narratives were analysed for global structure, information content and local level grammatical devices, especially verb morphology. The language-impaired group produced shorter, less structured and grammatically simpler narratives than controls, with verb morphology particularly impaired. Despite major differences in how sign and spoken languages are articulated, narrative is shown to be a reliable marker of language impairment across the modality boundaries.

Assessing parent-child interaction with deaf and hard of hearing infants aged 0-3 years: An international multi-professional e-Delphi.

INTRODUCTION: Most deaf babies are born to hearing families who do not yet have the skills to communicate effectively with their child. Adaptations to communication are important because the quality of parent-child interaction (PCI) predicts how a deaf child develops language. Teachers of Deaf children and Speech and Language Therapists support families with communication in the home. Currently, there are no assessments that appraise how a parent interacts with their deaf baby. Previous research has identified which parent behaviours and approaches are used in PCI assessments in research and practice. The current paper forms consensus on the core content and best practices of a new PCI tool for deaf children aged 0-3 years. METHODS: An international sample of expert academics and practitioners (n = 83) were recruited to take part in a two-round modified electronic Delphi study. Participants were presented with 69 statements focusing on (i) which parent behaviours were important in assessment (ii) the methods to be used in PCI assessment. Participants rated the extent to which they agreed or disagreed with each statement on a five-point Likert scale and gave comments to support their response. Consensus was defined as >80% of participants rating the statement as a (4) 'highly important' or a (5) 'essential'. If consensus was not reached, participant comments were used to generate new statements which were rated in the second round. This project involved a patient and public involvement (PPI) group of hearing and deaf parents and professionals to design and guide the study. RESULTS: Consensus was achieved on 52 statements and ranged from 80-99%. A further six statements were additionally included. Within the 58 statements included, 36 were parent behaviours which centred on the parent's observation of, and response to, their child's behaviour and/or language. The remaining 22 statements focused on methods used in the assessment such as parents having their PCI filmed, parents having the opportunity to review the video and assess themselves alongside a professional, and parents being involved in subsequent goal setting. CONCLUSIONS: This e-Delphi presented the parent behaviours and methods of assessment to be included in a new PCI tool for deaf children. Future co-production work and acceptability and feasibility testing are discussed.

"It doesn't matter if we're the most amazing professionals in the world " A qualitative study of professionals' perspectives on parent-child interaction assessment with deaf infants.

Introduction: Parent child interaction (PCI) is positively associated with deaf children's language development. However, there are no known, deaf-specific tools to observe how a parent interacts with their deaf child aged 0-3 years. Without a framework for professionals to use with families, it is unknown how professionals assess PCI, what they assess, why they assess, and how the assessment results relate to case management. Methods: Eighteen hearing and deaf professionals, who work with deaf and hard of hearing infants aged 0-3 years and their families, attended online focus groups. The aim of the study was to gain insight into the professional assessment of PCI. Data were analyzed using thematic analysis. Findings: Six themes were generated from the dataset. Professionals discussed how central parents were in the support offered to families in the home, the importance of knowing and understanding the individual family, and accounting for and supporting parental wellbeing. Descriptions on how to administer a best practice PCI assessment included which parent behaviors to assess and how to make adaptations for different populations. Professionals shared how the assessment and review process could be used to inform and upskill parents through video reflection and goal setting. Discussion: This study provides insight into the mechanisms and motivations for professionals assessing the interactive behaviors of parents who have deaf children aged 0-3. Professionals acknowledged that family life is multi-faceted, and that support is most meaningful to families when professionals worked with these differences and incorporated them into assessment, goal setting, and intervention plans.