Development of the Escalation of Therapy or Intervention (ETI) Calculator for Patients with Ulcerative Colitis Using ePROMs.

BACKGROUND AND AIMS: Digital collection of patient-reported outcome measures [PROMs] is largely unexplored as a basis for follow-up for patients with ulcerative colitis [UC]. Our aim was to develop a model to predict the likelihood of escalation of therapy or intervention at an outpatient appointment that may be used to rationalize follow-up. METHODS: TrueColours-IBD is a web-based, real-time, remote monitoring software that allows longitudinal collection of ePROMs. Data for prediction modelling were derived from a Development Cohort, guided by the TRIPOD statement. Logistic regression modelling used ten candidate items to predict escalation of therapy or intervention. An Escalation of Therapy or Intervention [ETI] calculator was developed, and applied in a Validation Cohort at the same centre. RESULTS: The Development Cohort [n = 66] was recruited in 2016 and followed for 6 months [208 appointments]. From ten items, four significant predictors of ETI were identified: SCCAI, IBD Control-8, faecal calprotectin, and platelets. For practicality, a model with only SCCAI and IBD Control-8, both entered remotely by the patient, without the need for faecal calprotectin or blood tests was selected. Between 2018 and 2020, a Validation Cohort of 538 patients [1188 appointments] was examined. A 5% threshold on the ETI calculator correctly identified 343/388 [88%] escalations and 274/484 [57%] non-escalations. CONCLUSIONS: A calculator based on digital, patient-entered data on symptoms and quality of life can predict whether a patient with UC requires escalation of therapy or intervention at an outpatient appointment. This may be used to streamline outpatient appointments for patients with UC.

Air pollution mitigation assessment to inform Cambodia's first clean air plan.

Cambodia's 16.5 million people are exposed to air pollution in excess of World Health Organisation guidelines. The Royal Government of Cambodia has regulated air pollutant emissions and concentrations since 2000, but rapid economic growth and energy consumption means air pollution continues to impact human health. In December 2021, the Ministry of Environment of Cambodia published Cambodia's first Clean Air Plan that outlines actions to reduce air pollutant emissions over the next decade. This work presents the quantitative air pollution mitigation assessment underpinning the identification and evaluation of measures included in Cambodia's Clean Air Plan. Historic emissions of particulate matter (PM2.5, black carbon, organic carbon) and gaseous (nitrogen oxides, volatile organic compounds, sulphur dioxide, ammonia, and carbon monoxide) air pollutants are quantified between 2010 and 2015, and projected to 2030 for a baseline scenario. Mitigation scenarios reflecting implementation of 14 measures included in Cambodia's Clean Air Plan were modelled, to quantify the national reduction in emissions, from which the reduction in ambient PM2.5 exposure and attributable health burdens were estimated. In 2015, the residential, transport, and waste sectors contribute the largest fraction of national total air pollutant emissions. Without emission reduction measures, air pollutant emissions could increase by between 50 and 150% in 2030 compared to 2015 levels, predominantly due to increases in transport emissions. The implementation of the 14 mitigation measures could substantially reduce emissions of all air pollutants, by between 60 and 80% in 2030 compared to the baseline. This reduction in emissions was estimated to avoid approximately 900 (95% C.I.: 530-1200) premature deaths per year in 2030 compared to the baseline scenario. In addition to improving air pollution and public health, Cambodia's Clean Air Plan could also to lead to additional benefits, including a 19% reduction in carbon dioxide emissions, simultaneously contributing to Cambodia's climate change goals.

Autistic children who create imaginary companions: Evidence of social benefits.

LAY ABSTRACT: Research on neurotypical children with imaginary friends has found that those with imaginary friends have better social skills and are more able to think about how other people's minds work compared to children without imaginary friends. Research shows that some autistic children also create imaginary friends. This article is the first to look at whether or not autistic children with imaginary friends have stronger social skills and an improved ability to think about others' minds than those without imaginary friends. We asked parents to report about their children aged 5 to 12. Finding almost half reported their child had an imaginary friend, a much larger number than previous research with younger children. Our findings also suggested that autistic children with imaginary friends were better able to understand others' minds and had stronger social skills than their peers without imaginary friends. The children's language ability did not influence this. The findings of this study add to the evidence that with respect to the creation imaginary friends and their potential benefits, the play profiles of autistic children are similar to the general population. It also provides more evidence that the understanding of others' minds is not all or nothing in autism and gives reason for researchers to investigate whether the causes of these differences are the same or different for autistic children.

Integrated climate change and air pollution mitigation assessment for Togo.

Togo, in west Africa, is vulnerable to the impacts of climate change, but has made a negligible contribution to causing it. Togo ratified the Paris Agreement in 2017, committing to submit Nationally Determined Contributions (NDCs) that outline Togo's climate change mitigation commitment. Togo's capital, Lomé, as well as other areas of Togo have ambient air pollutant levels exceeding World Health Organisation guidelines for human health protection, and 91 % of Togolese households cook using solid biomass, elevating household air pollution exposure. In Togo's updated NDC, submitted in 2021, Togo acknowledges the importance and opportunity of achieving international climate change mitigation targets in ways that improve air quality and achieve health benefits for Togo's citizens. The aim of this work is to evaluate priority mitigation measures in an integrated assessment of air pollutant, Short-Lived Climate Pollutant (SLCP) and Greenhouse Gas (GHG) emissions to identify their effectiveness in simultaneously reducing air pollution and Togo's contribution to climate change. The mitigation assessment quantifies emissions for Togo and Grand Lomé from all major source sectors for historical years between 2010 and 2018, for a baseline projection to 2030 and for mitigation scenarios evaluating ten mitigation measures. The assessment estimates that Togo emitted ~21 million tonnes of GHG emissions in 2018, predominantly from the energy and Agriculture, Forestry and Other Land Use sectors. GHG emissions are projected to increase 42 % to 30 million tonnes in 2030 without implementation of mitigation policies and measures. The implementation of the ten identified priority mitigation measures could reduce GHG emissions by ~20 % in 2030 compared to the baseline, while SLCPs and air pollutants were estimated to be reduced more, with a more than 75 % reduction in black carbon emissions in 2030. This work therefore provides a clear pathway by which Togo can reduce its already small contribution to climate change while simultaneously achieving local benefits for air quality and human health in Togo and Grand Lomé.

Can electroencephalography (EEG) identify ADHD subtypes? A systematic review.

Attention Deficit/Hyperactivity Disorder (ADHD) has been associated with atypical patterns of neural activity measured by electroencephalography (EEG). However, the identification of EEG diagnostic biomarkers has been complicated by the disorder's heterogeneity. The objective of this review was to synthesize the literature investigating EEG variation in patients diagnosed with ADHD, addressing the following questions: 1) Are the diagnostic ADHD subtypes associated with different EEG characteristics? 2) Are EEG measures correlated with ADHD traits and/or symptom severity? and 3) Do classification techniques using EEG measures reveal different clinical presentations of ADHD? Outcomes highlight the potential for electrophysiological measures to provide meaningful insights into the heterogeneity of ADHD, although direct translation of EEG biomarkers for diagnostic purposes is not yet supported. Key measures that show promise for the discrimination of existing ADHD subtypes and symptomatology include: resting state and task-related modulation of alpha, beta and theta power, and the event-related N2 and P3 components. Prescriptions are discussed for future studies that may help to bridge the gap between research and clinical application.

Using a coupled LES aerosol-radiation model to investigate the importance of aerosol-boundary layer feedback in a Beijing haze episode.

Haze episodes, characterised by extremely high aerosol concentrations and a reduction in visibility to less than 10 km, are a frequent occurrence in wintertime Beijing, despite policy interventions leading to an overall improvement in average annual air quality. The main drivers in the onset of haze episodes in wintertime Beijing are changing synoptic conditions, however, aerosol-radiation interactions and their feedback on boundary layer meteorology are thought to play an essential role in the intensity and longevity of haze episodes. In this study we use a coupled LES aerosol-radiation model (UCLALES-SALSA), which we have recently configured for the urban environment of Beijing. The model's high resolution and control over meteorological and aerosol conditions as well as atmospheric processes means we can directly elucidate and quantify the importance of specific aspects of the aerosol-radiation-meteorology feedback in the cumulative stage of Beijing haze. The main results presented here show (a) synoptic scale meteorology has a larger impact on boundary layer suppression than high aerosol concentrations and (b) unlike previous results obtained using regional models or observationally driven analyses, there is no threshold value at which the aerosol-radiation-meteorology feedback has a significant effect on PBL height. Rather, our work shows that for the aerosol composition in this case study, the role of the feedback effect in reducing PBL height increases under shallow boundary layer conditions and with increasing pollution loading in an almost linear fashion. This lack of a threshold found for our case study has important policy implications since interventions based on such a value will not result in large reductions associated with turning off the feedback process. Furthermore, this work directly shows that although the right synoptic changes are a prerequisite for pollution episodes in Beijing, local and regional emissions drive increases in aerosol load that are sufficient to initiate the aerosol feedback loop. This further drives suppression of the boundary layer top and promotes stagnation of air and increased stability, which can be self-sustaining. This results in higher surface aerosol concentrations for extended periods of time, with severe consequences for human health [Lv et al., Atmos. Environ., 2016, 124, 98-108; Wang et al., Atmos. Chem. Phys., 2019, 19(10), 6949-6967].

Respiratory syncytial virus prevalence in children admitted to five Kenyan district hospitals: a cross-sectional study.

Acute respiratory infections (ARIs) are a leading cause of under-five mortality globally. In Kenya, the reported prevalence of respiratory syncytial virus (RSV) infections in single-centre studies has varied widely. Our study sought to determine the prevalence of RSV infection in children admitted with ARI fulfilling the WHO criteria for bronchiolitis. This was a prospective cross-sectional prevalence study in five hospitals across central and highland Kenya from April to June 2015. Two hundred and thirty-four participants were enrolled. The overall RSV positive rate was 8.1%, which is lower than in previous Kenyan studies. RSV-positive cases were on average 5 months younger than RSV-negative cases.

Timing Deficits in ADHD: Insights From the Neuroscience of Musical Rhythm.

Everyday human behavior relies upon extraordinary feats of coordination within the brain. In this perspective paper, we argue that the rich temporal structure of music provides an informative context in which to investigate how the brain coordinates its complex activities in time, and how that coordination can be disrupted. We bring insights from the neuroscience of musical rhythm to considerations of timing deficits in Attention Deficit/Hyperactivity Disorder (ADHD), highlighting the significant overlap between neural systems involved in processing musical rhythm and those implicated in ADHD. We suggest that timing deficits warrant closer investigation since they could lead to the identification of potentially informative phenotypes, tied to neurobiological and genetic factors. Our novel interdisciplinary approach builds upon recent trends in both fields of research: in the neuroscience of rhythm, an increasingly nuanced understanding of the specific contributions of neural systems to rhythm processing, and in ADHD, an increasing focus on differentiating phenotypes and identifying distinct etiological pathways associated with the disorder. Finally, we consider the impact of musical experience on rhythm processing and the potential value of musical rhythm in therapeutic interventions.

Got Rhythm? Better Inhibitory Control Is Linked with More Consistent Drumming and Enhanced Neural Tracking of the Musical Beat in Adult Percussionists and Nonpercussionists.

Musical rhythm engages motor and reward circuitry that is important for cognitive control, and there is evidence for enhanced inhibitory control in musicians. We recently revealed an inhibitory control advantage in percussionists compared with vocalists, highlighting the potential importance of rhythmic expertise in mediating this advantage. Previous research has shown that better inhibitory control is associated with less variable performance in simple sensorimotor synchronization tasks; however, this relationship has not been examined through the lens of rhythmic expertise. We hypothesize that the development of rhythm skills strengthens inhibitory control in two ways: by fine-tuning motor networks through the precise coordination of movements "in time" and by activating reward-based mechanisms, such as predictive processing and conflict monitoring, which are involved in tracking temporal structure in music. Here, we assess adult percussionists and nonpercussionists on inhibitory control, selective attention, basic drumming skills (self-paced, paced, and continuation drumming), and cortical evoked responses to an auditory stimulus presented on versus off the beat of music. Consistent with our hypotheses, we find that better inhibitory control is correlated with more consistent drumming and enhanced neural tracking of the musical beat. Drumming variability and the neural index of beat alignment each contribute unique predictive power to a regression model, explaining 57% of variance in inhibitory control. These outcomes present the first evidence that enhanced inhibitory control in musicians may be mediated by rhythmic expertise and provide a foundation for future research investigating the potential for rhythm-based training to strengthen cognitive function.

Speech-in-noise perception is linked to rhythm production skills in adult percussionists and non-musicians.

Speech rhythms guide perception, especially in noise. We recently revealed that percussionists outperform non-musicians in speech-in-noise perception, with better speech-in-noise perception associated with better rhythm discrimination across a range of rhythmic expertise. Here, we consider rhythm production skills, specifically drumming to a beat (metronome or music) and to sequences (metrical or jittered patterns), as well as speech-in-noise perception in adult percussionists and non-musicians. Given the absence of a regular beat in speech, we hypothesise that processing of sequences is more important for speech-in-noise perception than the ability to entrain to a regular beat. Consistent with our hypotheses, we find that the sequence-based drumming measures predict speech-in-noise perception, above and beyond hearing thresholds and IQ, whereas the beat-based measures do not. Outcomes suggest temporal patterns may help disambiguate speech under degraded listening conditions, extending theoretical considerations about speech rhythm to the everyday challenge of listening in noise.

Variations on the theme of musical expertise: cognitive and sensory processing in percussionists, vocalists and non-musicians.

Comparisons of musicians and non-musicians have revealed enhanced cognitive and sensory processing in musicians, with longitudinal studies suggesting these enhancements may be due in part to experience-based plasticity. Here, we investigate the impact of primary instrument on the musician signature of expertise by assessing three groups of young adults: percussionists, vocalists, and non-musician controls. We hypothesize that primary instrument engenders selective enhancements reflecting the most salient acoustic features to that instrument, whereas cognitive functions are enhanced regardless of instrument. Consistent with our hypotheses, percussionists show more precise encoding of the fast-changing acoustic features of speech than non-musicians, whereas vocalists have better frequency discrimination and show stronger encoding of speech harmonics than non-musicians. There were no strong advantages to specialization in sight-reading vs. improvisation. These effects represent subtle nuances to the signature since the musician groups do not differ from each other in these measures. Interestingly, percussionists outperform both non-musicians and vocalists in inhibitory control. Follow-up analyses reveal that within the vocalists and non-musicians, better proficiency on an instrument other than voice is correlated with better inhibitory control. Taken together, these outcomes suggest the more extensive engagement of motor systems during instrumental practice may be an important factor for enhancements in inhibitory control, consistent with evidence for overlapping neural circuitry involved in both motor and cognitive control. These findings contribute to the ongoing refinement of the musician signature of expertise and may help to inform the use of music in training and intervention to strengthen cognitive function.

Beyond Words: How Humans Communicate Through Sound.

Every day we communicate using complex linguistic and musical systems, yet these modern systems are the product of a much more ancient relationship with sound. When we speak, we communicate not only with the words we choose, but also with the patterns of sound we create and the movements that create them. From the natural rhythms of speech, to the precise timing characteristics of a consonant, these patterns guide our daily communication. By examining the principles of information processing that are common to speech and music, we peel back the layers to reveal the biological foundations of human communication through sound. Further, we consider how the brain's response to sound is shaped by experience, such as musical expertise, and implications for the treatment of communication disorders.

The role of rhythm in perceiving speech in noise: a comparison of percussionists, vocalists and non-musicians.

The natural rhythms of speech help a listener follow what is being said, especially in noisy conditions. There is increasing evidence for links between rhythm abilities and language skills; however, the role of rhythm-related expertise in perceiving speech in noise is unknown. The present study assesses musical competence (rhythmic and melodic discrimination), speech-in-noise perception and auditory working memory in young adult percussionists, vocalists and non-musicians. Outcomes reveal that better ability to discriminate rhythms is associated with better sentence-in-noise (but not words-in-noise) perception across all participants. These outcomes suggest that sensitivity to rhythm helps a listener understand unfolding speech patterns in degraded listening conditions, and that observations of a "musician advantage" for speech-in-noise perception may be mediated in part by superior rhythm skills.

Music training improves speech-in-noise perception: Longitudinal evidence from a community-based music program.

Music training may strengthen auditory skills that help children not only in musical performance but in everyday communication. Comparisons of musicians and non-musicians across the lifespan have provided some evidence for a "musician advantage" in understanding speech in noise, although reports have been mixed. Controlled longitudinal studies are essential to disentangle effects of training from pre-existing differences, and to determine how much music training is necessary to confer benefits. We followed a cohort of elementary school children for 2 years, assessing their ability to perceive speech in noise before and after musical training. After the initial assessment, participants were randomly assigned to one of two groups: one group began music training right away and completed 2 years of training, while the second group waited a year and then received 1 year of music training. Outcomes provide the first longitudinal evidence that speech-in-noise perception improves after 2 years of group music training. The children were enrolled in an established and successful community-based music program and followed the standard curriculum, therefore these findings provide an important link between laboratory-based research and real-world assessment of the impact of music training on everyday communication skills.

Music and language: relations and disconnections.

Music and language provide an important context in which to understand the human auditory system. While they perform distinct and complementary communicative functions, music and language are both rooted in the human desire to connect with others. Since sensory function is ultimately shaped by what is biologically important to the organism, the human urge to communicate has been a powerful driving force in both the evolution of auditory function and the ways in which it can be changed by experience within an individual lifetime. This chapter emphasizes the highly interactive nature of the auditory system as well as the depth of its integration with other sensory and cognitive systems. From the origins of music and language to the effects of auditory expertise on the neural encoding of sound, we consider key themes in auditory processing, learning, and plasticity. We emphasize the unique role of the auditory system as the temporal processing "expert" in the brain, and explore relationships between communication and cognition. We demonstrate how experience with music and language can have a significant impact on underlying neural function, and that auditory expertise strengthens some of the very same aspects of sound encoding that are deficient in impaired populations.

Music training relates to the development of neural mechanisms of selective auditory attention.

Selective attention decreases trial-to-trial variability in cortical auditory-evoked activity. This effect increases over the course of maturation, potentially reflecting the gradual development of selective attention and inhibitory control. Work in adults indicates that music training may alter the development of this neural response characteristic, especially over brain regions associated with executive control: in adult musicians, attention decreases variability in auditory-evoked responses recorded over prefrontal cortex to a greater extent than in nonmusicians. We aimed to determine whether this musician-associated effect emerges during childhood, when selective attention and inhibitory control are under development. We compared cortical auditory-evoked variability to attended and ignored speech streams in musicians and nonmusicians across three age groups: preschoolers, school-aged children and young adults. Results reveal that childhood music training is associated with reduced auditory-evoked response variability recorded over prefrontal cortex during selective auditory attention in school-aged child and adult musicians. Preschoolers, on the other hand, demonstrate no impact of selective attention on cortical response variability and no musician distinctions. This finding is consistent with the gradual emergence of attention during this period and may suggest no pre-existing differences in this attention-related cortical metric between children who undergo music training and those who do not.

Neural processing of speech in children is influenced by extent of bilingual experience.

Language experience fine-tunes how the auditory system processes sound. Bilinguals, relative to monolinguals, have more robust evoked responses to speech that manifest as stronger neural encoding of the fundamental frequency (F0) and greater across-trial consistency. However, it is unknown whether such enhancements increase with increasing second language experience. We predict that F0 amplitude and neural consistency scale with dual-language experience during childhood, such that more years of bilingual experience leads to more robust F0 encoding and greater neural consistency. To test this hypothesis, we recorded auditory brainstem responses to the synthesized syllables 'ba' and 'ga' in two groups of bilingual children who were matched for age at test (8.4 ± 0.67 years) but differed in their age of second language acquisition. One group learned English and Spanish simultaneously from birth (n=13), while the second group learned the two languages sequentially (n=15), spending on average their first four years as monolingual Spanish speakers. We find that simultaneous bilinguals have a larger F0 response to 'ba' and 'ga' and a more consistent response to 'ba' compared to sequential bilinguals and we demonstrate that these neural enhancements track with years of bilingual experience. These findings support the notion that bilingualism enhances subcortical auditory processing.

Longitudinal effects of group music instruction on literacy skills in low-income children.

Children from low-socioeconomic backgrounds tend to fall progressively further behind their higher-income peers over the course of their academic careers. Music training has been associated with enhanced language and learning skills, suggesting that music programs could play a role in helping low-income children to stay on track academically. Using a controlled, longitudinal design, the impact of group music instruction on English reading ability was assessed in 42 low-income Spanish-English bilingual children aged 6-9 years in Los Angeles. After one year, children who received music training retained their age-normed level of reading performance while a matched control group's performance deteriorated, consistent with expected declines in this population. While the extent of change is modest, outcomes nonetheless provide evidence that music programs may have value in helping to counteract the negative effects of low-socioeconomic status on child literacy development.