Fatigue-related symptom clusters and functional status of older adults in hospice.

BACKGROUND: Fatigue is frequently co-existing with other symptoms and is highly prevalent among patients with cancer and geriatric population. There was a lack of knowledge that focus on fatigue clusters in older adults with cancer in hospice care. OBJECTIVES: To identify fatigue-related symptom clusters in older adult hospice patients and discover to what extent fatigue-related symptom clusters predict functional status while controlling for depression. METHOD: This was a cross-sectional study in a sample of 519 older adult hospice patients with cancer, who completed the Memorial Symptom Assessment Scale, the Center for Epidemiological Studies Depression, Boston Short Form Scale, and the Palliative Performance Scale. Data from a multi-center symptom trial were extracted for this secondary analysis using exploratory factor analysis and hierarchical multiple regression analysis. RESULTS: Data from 519 patients (78 ± 7 years) with terminal cancer who received hospice care under home healthcare services revealed that 39% of the participants experienced fatigue-related symptom clusters (lack of energy, feeling drowsy, and lack of appetite). The fatigue cluster was significantly associated positively with depression (r = 0.253, p < 0.01), and negatively with functional status (r = -0.117, p < 0.01) and was a strong predictor of participants' low functional status. Furthermore, depression made a significant contribution to this predictive relationship. CONCLUSION: Older adult hospice patients with cancer experienced various concurrent symptoms. The fatigue-specific symptom cluster was identified significantly associated with depression and predicted functional status. Fatigue should be routinely monitored in older adults, especially among hospice cancer patients, to help reduce psychological distress and prevent functional decline.

Computer-tailored intervention increases colorectal cancer screening among low-income African Americans in primary care: Results of a randomized trial.

INTRODUCTION: Although African Americans have the highest colorectal cancer (CRC) incidence and mortality rates of any racial group, their screening rates remain low. STUDY DESIGN/PURPOSE: This randomized controlled trial compared efficacy of two clinic-based interventions for increasing CRC screening among African American primary care patients. METHODS: African American patients from 11 clinics who were not current with CRC screening were randomized to receive a computer-tailored intervention (n = 335) or a non-tailored brochure (n = 358) designed to promote adherence to CRC screening. Interventions were delivered in clinic immediately prior to a provider visit. Univariate and multivariable logistic regression models analyzed predictors of screening test completion. Moderators and mediators were determined using multivariable linear and logistic regression analyses. RESULTS: Significant effects of the computer-tailored intervention were observed for completion of a stool blood test (SBT) and completion of any CRC screening test (SBT or colonoscopy). The colonoscopy screening rate was higher among those receiving the computer-tailored intervention group compared to the nontailored brochure but the difference was not significant. Predictors of SBT completion were: receipt of the computer-tailored intervention; being seen at a Veterans Affairs Medical Center clinic; baseline stage of adoption; and reason for visit. Mediators of intervention effects were changes in perceived SBT barriers, changes in perceived colonoscopy benefits, changes in CRC knowledge, and patient-provider discussion. Moderators of intervention effects were age, employment, and family/friend recommendation of screening. CONCLUSION: This one-time computer-tailored intervention significantly improved CRC screening rates among low-income African American patients. This finding was largely driven by increasing SBT but the impact of the intervention on colonoscopy screening was strong. Implementation of a CRC screening quality improvement program in the VA site that included provision of stool blood test kits and follow-up likely contributed to the strong intervention effect observed at that site. The trial is registered at ClinicalTrials.gov as NCT00672828.

Systematic Review of Interventions to Increase Stool Blood Colorectal Cancer Screening in African Americans.

African Americans experience colorectal cancer (CRC) related disparities compared to other racial groups in the United States. African Americans are frequently diagnosed with CRC at a later stage, screening is underutilized, and mortality rates are highest in this group. This systematic review focused on intervention studies using stool blood CRC screening among African Americans in primary care and community settings. Given wide accessibility, low cost, and ease of dissemination of stool-based CRC screening tests, this review aims to determine effective interventions to improve participation rates. This systematic review included intervention studies published between January 1, 2000 and March 16, 2019. After reviewing an initial search of 650 studies, 11 studies were eventually included in this review. The included studies were studies conducted in community and clinical settings, using both inreach and outreach strategies to increase CRC screening. For each study, an unadjusted odds ratio (OR) for the CRC screening intervention compared to the control arm was calculated based on the data in each study to report effectiveness. The eleven studies together recruited a total of 3334 participants. The five studies using two-arm experimental designs ranged in effectiveness with ORs ranging from 1.1 to 13.0 using interventions such as mailed reminders, patient navigation, and tailored educational materials. Effective strategies to increase stool blood testing included mailed stool blood tests augmented by patient navigation, tailored educational materials, and follow-up calls or mailings to increase trust in the patient-provider relationship. More studies are needed on stool blood testing interventions to determine effectiveness in this population.

Exercise Interventions in Cardio-Oncology Populations: A Scoping Review of the Literature.

BACKGROUND: Cardiac toxicity in patients with cancer results from treatment-related damage to the cardiovascular system by chemotherapy, targeted agents, or thoracic radiation. Cardio-oncology patients with co-occurring cancer and cardiovascular disease frequently experience fatigue. Exercise is recommended in clinical guidelines to manage fatigue during or after cancer treatment. PURPOSE: The purpose of this article is to conduct a scoping review of the exercise randomized clinical trials in cardio-oncology patients, focusing on the components and effects of exercise interventions on patient cardiovascular and fatigue outcomes. METHODS: A scoping review methodological framework was deemed appropriate and used. Key words for search included "cancer," "oncology," "cardio-oncology," "heart failure," "physical activity," and "exercise." Search involved systematic searches of large databases (PubMed, MEDLINE, Cochrane Review, and CINAHL) and hand searches of reference lists, key journals, webpages, and experts in the field using snowballing techniques. RESULTS: There were 12 randomized clinical trials included in this review. Study characteristics, accordance of exercise protocols with recommendations, specific exercise training components, and cardiovascular and fatigue outcomes were mapped. CONCLUSIONS: Recommendations for addressing the gaps included focusing on non-breast-cancer patients with cardiac toxicity risks, developing precision-based prescriptions based on various medical and physiological characteristics, and adding fatigue symptom experience as an outcome variable.

The pre-efficacy phase testing for PAfitME™-A behavioral physical activity intervention to manage moderate and severe symptoms among advanced stage cancer patients.

Fatigue and pain are the most frequently reported symptoms among advanced-stage cancer patients. Although physical activity (PA) is known to improve the aforementioned symptoms, few patients demonstrate the physically active behavior that adheres to the clinical guidelines regarding PA. The current article presents an exemplar that used the National Institute of Health's Obesity-Related Behavioral Intervention Trial (ORBIT) model and developed a behavioral intervention known as the personalized Physical Activity intervention with fitness graded Motion Exergames (PAfitME™). There were two phases of testing in the ORBIT model presented in the current paper. In Phase I testing, a standardized exergame prescription was evaluated by an advisory board and a single-case study was used to evaluate the personalized exergame prescription with personalization of the fitness levels. In Phase IIa, a within-group pre- and posttest design was used to evaluate the personalized exergame prescriptions with personalization of the fitness levels, self-efficacy, and variation in fatigue/pain. Subsequently, a complete intervention package was developed in accordance with a logic model, driven from the result of the Phase IIa testing with clinically significant findings. Currently, PAfitME™ is under Phase IIb testing in a randomized clinical trial with a control group. PAfitME™ employs a personalized approach to initiate and promote physically active behavior, to facilitate the management of fatigue and pain in cancer patients. Positive results from an efficacy trial would support the use of PAfitME™ in the management of fatigue and pain in advanced-stage cancer patients.

Feasibility of the mobile mindfulness-based stress reduction for breast cancer (mMBSR(BC)) program for symptom improvement among breast cancer survivors.

OBJECTIVE: The purpose of this pilot study was to test the feasibility of delivering the mobile mindfulness-based stress reduction for breast cancer (mMBSR(BC)) program using an iPad and to evaluate its impact on symptom improvement. METHODS: A single group, pre-posttest design was implemented among female stages 0-III breast cancer survivors (BCS) who completed treatment. Data were collected at baseline and week 6 on measures of psychological and physical symptoms and quality of life. The mMBSR(BC) program is a standardized, stress-reducing intervention that combines sitting and walking meditation, body scan, and yoga and is designed to deliver weekly 2-hour sessions for 6 weeks using an iPad. RESULTS: The mean age of the 15 enrolled BCS was 57 years; one participant was non-Hispanic black, and 14 were non-Hispanic white. Of the 13 who completed the study, there were significant improvements from baseline to 6 weeks post-mMBSR(BC) in psychological and physical symptoms of depression, state anxiety, stress, fear of recurrence, sleep quality, fatigue, and quality of life (P's < .05). Effect sizes for improvements of multiple symptoms ranged from medium to large. CONCLUSIONS: These results provide preliminary support that the mMBSR(BC) program may be feasible and acceptable, showing a clinical impact on decreasing psychological and physical symptoms. This mobile-based program offers a delivery of a standardized MBSR(BC) intervention to BCS that is convenient for their own schedule while decreasing symptom burden in the survivorship phase after treatment for breast cancer.

Spatial configuration processing in visual word form perception and reading abilities in Chinese.

The analysis of spatial relations among components of a character is important in identifying visual word forms. We investigated such spatial configuration processing for Chinese characters in dyslexic children (aged 9-12 years) and two groups of typically developing children, matched according to chronological age or reading level. In this study, we used real characters and noncharacters to manipulate the spatial configuration between character components while preserving their local features. Both characters were displayed either in an upright or inverted position. Participants were asked to quickly determine whether the two presented stimuli were identical. A significant interaction between character type and character orientation showed children's matching performance was better in upright real characters than in the inverted version, but such effect was absent in noncharacters. This indicated that regardless of reading skills, children developed the ability to use local configuration information to visually identify words. Dyslexic children performed poorly in both real-character and noncharacter conditions. Furthermore, compared with control groups, dyslexic children performed worse in real-character conditions, which were close to the noncharacter performance of other groups. This reflected an impairment of global visual word-form processing (i.e., spatial configuration between components) in dyslexia.

Understanding Cancer Worry Among Patients in a Community Clinic-Based Colorectal Cancer Screening Intervention Study.

BACKGROUND: To reduce colorectal cancer (CRC) screening disparities, it is important to understand correlates of different types of cancer worry among ethnically diverse individuals. OBJECTIVES: The current study examined the prevalence of three types of cancer worry (i.e., general cancer worry, CRC-specific worry, and worry about CRC test results) as well as sociodemographic and health-related predictors for each type of cancer worry. METHODS: Participants were aged 50-75, at average CRC risk, nonadherent to CRC screening guidelines, and enrolled in a randomized controlled trial to increase CRC screening. Participants completed a baseline questionnaire assessing sociodemographics, health beliefs, healthcare experiences, and three cancer worry measures. Associations between study variables were examined with separate univariate and multivariable logistic regression models. RESULTS: Responses from a total of 416 participants were used. Of these, 47% reported experiencing moderate-to-high levels of general cancer worry. Predictors of general cancer worry were salience and coherence (aOR = 1.1, 95% CI [1.0, 1.3]), perceived susceptibility (aOR = 1.2, 95% CI [1.1, 1.3), and social influence (aOR = 1.1, 95% CI [1.0, 0.1]). Fewer (23%) reported moderate-to-high levels of CRC-specific worry or CRC test worry (35%). Predictors of CRC worry were perceived susceptibility (aOR = 1.4, 95% CI [1.3, 1.6]) and social influence (aOR = 1.1, 95% CI [1.0, 1.2]); predictors of CRC test result worry were perceived susceptibility (aOR = 1.2, 95% CI [1.1, 1.3) and marital status (aOR = 2.0, 95% CI [1.1, 3.7] for married/partnered vs. single and aOR = 2.3, 95% CI [1.3, 4.1] for divorced/widowed vs. single). DISCUSSION: Perceived susceptibility consistently predicted the three types of cancer worry, whereas other predictors varied between cancer worry types and in magnitude of association. The three types of cancer worry were generally predicted by health beliefs, suggesting potential malleability. Future research should include multiple measures of cancer worry and clear definitions of how cancer worry is measured.

Heart Failure Self-care Within the Context of Patient and Informal Caregiver Dyadic Engagement: A Mixed Methods Study.

BACKGROUND: Recent heart failure (HF) patient and informal caregiver (eg, dyadic) studies have either examined self-care from a qualitative or quantitative perspective. To date, the 2 types of data have not been integrated. OBJECTIVE: The aim of this study was to understand HF self-care within the context of dyadic engagement. METHODS: This was a cross-sectional, mixed methods (quantitative/qualitative) study. Heart failure self-care was measured with the Self-care of Heart Failure Index (v.6) dichotomized to adequate (≥70) or inadequate (<69). Dyadic symptom management type was assessed with the Dyadic Symptom Management Type scale. Interviews regarding self-care were conducted with both dyad members present. Content analytic techniques were used. Data were integrated using an information matrix and triangulated using Creswell and Plano Clark's methods. RESULTS: Of the 27 dyads, HF participants were 56% men, with a mean age of 77 years. Caregivers were 74% women, with a mean age of 66 years, representing spouses (n = 14) and adult children (n = 7). Quantitatively, few dyads scored as adequate (≥70) in self-care; the qualitative data described the impact of adequacy on the dyads' behavior. Dyads who scored higher, individually or both, on self-care self-efficacy and self-care management were less likely to change from their life course pattern. Either the patient or dyad continued to handle all self-care as they always had, rather than trying new strategies or reaching out for help as the patient's condition deteriorated. CONCLUSIONS: Our data suggest links that should be explored between dyadic adequacy and response to patients' symptoms. Future studies should assess dyadic adequacy longitudinally and examine its relationship to event-free survival and health services cost.

Issues Faced by Family Caregivers of Hospice Patients with Head and Neck Cancers.

PURPOSE: The purpose of this study was to explore issues reported by caregivers of Head and Neck cancer (HNC) patients newly admitted to hospice homecare. METHODS: 26 caregivers providing hospice homecare to patients with HNC were induded. Caregiver depressive symptoms, social support and perceived health data were analyzed. RESULTS: The caregivers reported few depressive symptoms, good perceived social support, and good perceived health; however, there was large variation in the group with some individuals having significant problems. DISCUSSION: Caregivers appeared to be doing well physically, emotionally and socially, but baseline data were used, so follow-up data are needed. Further research is warranted. CONCLUSIONS: Family caregivers also are affected by the experience of cancer and may have depressive symptoms needing assessment and management. Hospice patients with HNC have a variety of symptoms specific to their disease and treatment that need assessment and management by their family caregivers. Caregivers of HNC patients in hospice and palliative care need and deserve attention from hospice providers as they care for patients.

Key functional circuitry altered in schizophrenia involves parietal regions associated with sense of self.

There is still no clear consensus as to which of the many functional and structural changes in the brain in schizophrenia are of most importance, although the main focus to date has been on those in the frontal and cingulate cortices. In the present study, we have used a novel holistic approach to identify brain-wide functional connectivity changes in medicated schizophrenia patients, and functional connectivity changes were analyzed using resting-state fMRI data from 69 medicated schizophrenia patients and 62 healthy controls. As far as we are aware, this is the largest population reported in the literature for a resting-state study. Voxel-based morphometry was also used to investigate gray and white matter volume changes. Changes were correlated with illness duration/symptom severity and a support vector machine analysis assessed predictive validity. A network involving the inferior parietal lobule, superior parietal gyrus, precuneus, superior marginal, and angular gyri was by far the most affected (68% predictive validity compared with 82% using all connections) and different components correlated with illness duration and positive and negative symptom severity. Smaller changes occurred in emotional memory and sensory and motor processing networks along with weakened interhemispheric connections. Our findings identify the key functional circuitry altered in schizophrenia involving the default network midline cortical system and the cortical mirror neuron system, both playing important roles in sensory and cognitive processing and particularly self-processing, all of which are affected in this disorder. Interestingly, the functional connectivity changes with the strongest links to schizophrenia involved parietal rather than frontal regions.

Frequency-specific alternations in the amplitude of low-frequency fluctuations in schizophrenia.

Schizophrenia has been associated with abnormal task-related brain activation in sensory and motor regions as well as social cognition network. Recently, two studies investigated temporal correlation between resting-state functional magnetic resonance imaging (R-fMRI) low-frequency oscillations (LFOs) in schizophrenia but reported mixed results. This may be due to the different frequency bands used in these studies. Here we utilized R-fMRI to measure the amplitude of low-frequency fluctuations (ALFF) and fractional ALFF (fALFF) in three different frequency bands (slow-5: 0.01-0.027 Hz; slow-4: 0.027-0.08 Hz; and typical band: 0.01-0.08 Hz) in 69 patients with schizophrenia and 62 healthy controls. We showed that there were significant differences in ALFF/fALFF between the two bands (slow-5 and slow-4) in regions including basal ganglia, midbrain, and ventromedial prefrontal cortex. Importantly, we also identified significant interaction between frequency bands and groups in inferior occipital gyrus, precuneus, and thalamus. The results suggest that the abnormalities of LFOs in schizophrenia is dependent on the frequency band and suggest that future studies should take the different frequency bands into account when measure intrinsic brain activity.

Care-Resistant Behavior Trajectories During Mouth Care Among Nursing Home Residents With Dementia.

BACKGROUND AND OBJECTIVES: This study examined day-to-day variation in care-resistant behaviors (CRBs) exhibited by persons living with dementia during mouth healthcare and the potential influence of time of day on CRB trajectories. RESEARCH DESIGN AND METHODS: A secondary analysis was conducted on a sample of 75 nursing home-dwelling persons living with dementia who exhibited CRBs during mouth care activities. Over 21 days, CRBs were measured using the revised Resistiveness to Care scale (RTC-r) during morning and afternoon mouth care sessions. Group-based trajectory modeling was used to identify trajectory patterns and assess differences between morning and afternoon CRB patterns. RESULTS: Three trajectory patterns were identified: morning CRB trajectory patterns showed 50.6% of persons living with dementia had consistently low RTC-r scores, 37.5% of persons living with dementia exhibited fluctuating, moderate RTC-r scores, and 11.9% exhibited RTC-r scores that started high and then decreased over time. Similarly, CRB trajectory patterns during afternoon mouth care showed a consistently low RTC-r score for 54.5% and a fluctuating moderate RTC-r score for 38.6% of persons living with dementia. However, the third CRB trajectory group followed a high-increasing trajectory, with RTC-r scores starting high and continuing to increase for 6.9% of persons living with dementia. DISCUSSION AND IMPLICATIONS: CRBs are dynamic and vary within days and over time; however, the time of the day is often not considered in interventions to manage CRBs. Thus, it is important to consider the timing of providing mouth care for persons living with dementia. Based on the characteristics of the trajectories, we suggest that morning mouth activities may be more efficient.

The Effect of Self-efficacy-Enhancing Interventions on Quality of Life of Cancer Survivors: A Systematic Review.

BACKGROUND: The influence of self-efficacy-enhancing interventions on quality of life (QOL) is not clear with recent randomized controlled trials (RCTs) because current reviews only evaluated self-efficacy as an outcome. OBJECTIVES: We conducted a systematic review to examine the effect of self-efficacy-enhancing interventions on QOL among patients with cancer and to summarize the effective determinants for designing self-efficacy-enhancing interventions. METHODS: A systematic search was performed on studies published from January 2003 to May 2023 using PubMed, CINAHL, PsycINFO, and Web of Science. Included studies were RCTs, adults diagnosed with cancer, interventions with explicit self-efficacy components, and QOL as the outcome. RESULTS: Nineteen RCTs were included. Risk-of-bias assessment revealed 12 studies with some concerns and 7 with high risk of bias. The mean intervention adherence rate was 88.2%; the most frequently listed reason for dropout was medical conditions and mortality. Self-efficacy interventions were shown to significantly improve at least 1 subscale of QOL in 9 of 19 studies, of which 7 studies used Bandura's 4 sources of self-efficacy. The interventions with between-session intervals shorter than 2 weeks, of 12-week duration, and with an in-person delivery approach were the most effective. CONCLUSIONS: Self-efficacy-enhancing interventions show potential beneficial effects on QOL among cancer survivors. Interventions that use Bandura's 4 sources of self-efficacy strategies and have between-session intervals shorter than 2 weeks, an in-person approach, and 12-week intervention duration are recommended. IMPLICATIONS FOR PRACTICE: Properly designed self-efficacy-enhancing interventions can facilitate behavioral change and improve QOL in cancer survivors.

Cognitive intra-individual variability in breast cancer survivors: A systematic review.

Subjective and objective cognitive impairments in Breast Cancer Survivors (BCS) often do not correlate. One important contribution to the reported disparities may be the reliance on mean-based cognitive performance. Cognitive intra-individual variability (IIV) may provide important insights into these reported disparities. Cognitive IIV refers to the fluctuation in performance for an individual on either one cognitive task across a trial or dispersed across tasks within a neuropsychological test battery. The purpose of this systematic review was to search for and examine the literature on cognitive IIV in BCS. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) approach was used to search for all articles related to cognitive IIV in BCS. MEDLINE (via PubMed), Embase, and Scopus databases were searched using detailed search terms and strategies. Initially, 164 articles were retrieved but only 4 articles met the criteria for this systematic review. BCS differed from healthy controls in similar ways across the four studies, generally demonstrating similar performance but showing increased cognitive IIV for the more difficult tasks. Differences were enhanced later during chemotherapy. The four studies provide support for cognitive IIV as a useful measure to detect the subtle objective cognitive change often reported by BCS but frequently not detected by standard normed-based cognitive testing. Unexpectedly, measures of cognitive IIV were not consistently associated with self-reported measures of cognition.

Predictors of cancer-related pain improvement over time.

OBJECTIVE: To determine the predictors of pain improvement among patients being treated for cancer-related pain over 12 months. METHODS: A secondary analysis of the telephone care Indiana Cancer Pain and Depression trial was performed. Patients (n = 274) were interviewed at baseline and after 1, 3, 6, and 12 months. Pain improvement outcomes included both a continuous measure (Brief Pain Inventory score) and a categorical measure (pain improved versus pain not improved). Predictor variables included change in depression, age, sex, race, marital status, socioeconomic disadvantage, medical comorbidity, type of cancer, and phase of cancer. Multivariable repeated measures were conducted, adjusting for intervention group assignment, baseline pain severity, and time in months since baseline assessment. RESULTS: Factors significantly predicting both continuous and categorical pain improvement included participating in the intervention group (ß = -0.92, p < .001, odds ratio [OR] = 2.53, 95% confidence interval [CI] = 1.65-3.89), greater improvement in depression (ß = -0.31, p = .003, OR = 1.84, 95% CI = 1.35-2.51), higher socioeconomic status (Socioeconomic Disadvantage index; ß = 0.25, p = .034; OR = 0.73, 95% CI = 0.56-0.94), and fewer comorbid conditions (ß = 0.20, p = .002; OR = 0.84, 95% CI = 0.73-0.96). Patients with more severe pain at baseline or with recurrent or progressive cancer were less likely to experience continuous or categorical pain improvement, respectively. CONCLUSIONS: Effective management of depression and comorbid conditions along with improvement of social services could be critical components of a comprehensive pain management. Patients with more severe pain or with recurrent or progressive cancers may require closer monitoring and adequate treatment of pain. Trial Registration clinicaltrials.gov Identifier: NCT00313573.

Computer-delivered tailored intervention improves colon cancer screening knowledge and health beliefs of African-Americans.

We conducted a randomized controlled trial among African-American patients attending a primary-care provider visit to compare efficacy of a computer-delivered tailored intervention to increase colorectal cancer (CRC) screening (n = 273) with non-tailored print material-an American Cancer Society brochure on CRC screening (n = 283). Health Belief Model constructs were used to develop tailored messages and examined as outcomes. Analysis of covariance models were used to compare changes between CRC knowledge and health belief scores at baseline and 1 week post-intervention. At 1 week, patients who received the computer-delivered tailored intervention had greater changes in CRC knowledge scores (P < 0.001), perceived CRC risk scores (P = 0.005), FOBT barriers scores (P = 0.034) and colonoscopy benefit scores (P < 0.001). Findings show that computer-delivered tailored interventions are an effective adjunct to the clinical encounter that can improve knowledge and health beliefs about CRC screening, necessary precursors to behavior change.

Investigating the white matter correlates of reading performance: Evidence from Chinese children with reading difficulties.

PURPOSE: Reading comprehension is closely associated with word recognition, particularly at the early stage of reading development. This association is reflected in children with reading difficulties (RD) who demonstrate poor reading comprehension along with delayed word recognition or reduced recognition accuracy. Although the neural mechanisms underlying reading comprehension and word recognition are well studied, few has investigated the white matter (WM) structures that the two processes potentially share. METHODS: To explore the issue, behavioral scores (word recognition & reading comprehension) and diffusion spectrum imaging (DSI) were acquired from Chinese-speaking children with RD and their age-matched typically developing children. WM structures were measured with generalized fractional anisotropy and normalized quantitative anisotropy to optimize fiber tracking precision. RESULTS: The children with RD performed significantly poorer than the typically developing children in both behavioral tasks. Between group differences of WM structure were found in the right superior temporal gyrus, the left medial frontal gyrus, the left medial frontal gyrus, and the left caudate body. A significant association between reading comprehension and Chinese character recognition and the DSI indices were found in the corpus callosum. The findings demonstrated the microstructural difference between children with and without reading difficulties go beyond the well-established reading network. Further, the association between the WM integrity of the corpus callosum and the behavioral scores reveals the involvement of the WM structure in both tasks. CONCLUSION: It suggests the two reading-related skills have partially overlapped neural mechanism. Associating the corpus callosum with the reading skills leads to the reconsideration of the right hemisphere role in the typical reading process and, potentially, how it compensates for children with reading difficulties.

Improving the Intelligibility of Speech for Simulated Electric and Acoustic Stimulation Using Fully Convolutional Neural Networks.

Combined electric and acoustic stimulation (EAS) has demonstrated better speech recognition than conventional cochlear implant (CI) and yielded satisfactory performance under quiet conditions. However, when noise signals are involved, both the electric signal and the acoustic signal may be distorted, thereby resulting in poor recognition performance. To suppress noise effects, speech enhancement (SE) is a necessary unit in EAS devices. Recently, a time-domain speech enhancement algorithm based on the fully convolutional neural networks (FCN) with a short-time objective intelligibility (STOI)-based objective function (termed FCN(S) in short) has received increasing attention due to its simple structure and effectiveness of restoring clean speech signals from noisy counterparts. With evidence showing the benefits of FCN(S) for normal speech, this study sets out to assess its ability to improve the intelligibility of EAS simulated speech. Objective evaluations and listening tests were conducted to examine the performance of FCN(S) in improving the speech intelligibility of normal and vocoded speech in noisy environments. The experimental results show that, compared with the traditional minimum-mean square-error SE method and the deep denoising autoencoder SE method, FCN(S) can obtain better gain in the speech intelligibility for normal as well as vocoded speech. This study, being the first to evaluate deep learning SE approaches for EAS, confirms that FCN(S) is an effective SE approach that may potentially be integrated into an EAS processor to benefit users in noisy environments.

Neural Responses to Musical Rhythm in Chinese Children With Reading Difficulties.

The perception of the musical rhythm has been suggested as one of the predicting factors for reading abilities. Several studies have demonstrated that children with reading difficulties (RD) show reduced neural sensitivity in musical rhythm perception. Despite this prior evidence, the association between music and reading in Chinese is still controversial. In the present study, we sought to answer the question of whether the musical rhythm perception of Chinese children with RD is intact or not, providing further clues on how reading and music might be interlinked across languages. Oddball paradigm was adapted for testing the difference of musical rhythm perception, including predictable and unpredictable omission, in elementary school children with RD and typically developing age-controlled children with magnetoencephalography (MEG). We used the cluster-based permutation tests to examine the statistical difference in neural responses. The event-related field (ERF) components, mismatch negativity (MMNm) and P3a(m), were elicited by the rhythmical patterns with omitted strong beats. Specifically, differential P3a(m) components were found smaller in children with RD when comparing the rhythmical patterns between predictable and unpredicted omission patterns. The results showed that brain responses to the omission in the strong beat of an unpredicted rhythmic pattern were significantly smaller in Chinese children with RD. This indicated that children with RD may be impaired in the auditory sensitivity of rhythmic beats. This also suggests that children with reading difficulties may have atypical neural representations of rhythm that could be one of the underlying factors in dysfluent reading development.