The reliability of Hebb repetition learning and its association with language and reading in adolescents with intellectual disabilities.

Hebb repetition learning (HRL) refers to neurodevelopmental processes characterised by repeated stimulus exposure without feedback, which result in changes in behaviour and/or responses, e.g., long-term learning of serial order. Here, we investigate effects of HRL on serial order memory. The present research aimed to assess the reliability of new HRL measures and investigate their relationships with language and reading skills (vocabulary, grammar, word reading) in adolescents with intellectual disability (ID). A comparison group of children of similar mental age with typical development (TD) was also assessed. ID and TD groups were tested on HRL tasks, evaluating test-retest and split-half reliability. The relationship between HRL and language and reading was analysed after accounting for the influence of mental age and verbal short-term memory. The HRL tasks displayed moderate test-retest (and split-half) reliability, HRL tasks with different stimuli (verbal, visual) were related, and we identified issues with one method of HRL scoring. The planned regression analyses failed to show relationships between HRL and language/reading skills in both groups when mental age, a very strong predictor, was included. However, further exploratory regression analyses without mental age revealed HRL's predictive capabilities for vocabulary in the ID group and reading in the TD group, results which need further investigation and replication. HRL displays promise as a moderately reliable metric and exhibits varied and interpretable predictive capabilities for language and reading skills across groups.

Enhancing Pragmatic Language skills for Young children with Social communication difficulties (E-PLAYS-2) trial: study protocol for a cluster-randomised controlled trial evaluating a computerised intervention to promote communicative development and collaborative skills in young children.

BACKGROUND: A number of children experience difficulties with social communication and this has long-term deleterious effects on their mental health, social development and education. The E-PLAYS-2 study will test an intervention ('E-PLAYS') aimed at supporting such children. E-PLAYS uses a dyadic computer game to develop collaborative and communication skills. Preliminary studies by the authors show that E-PLAYS can produce improvements in children with social communication difficulties on communication test scores and observed collaborative behaviours. The study described here is a definitive trial to test the effectiveness and cost-effectiveness of E-PLAYS delivered by teaching assistants in schools. METHODS: The aim of the E-PLAYS-2 trial is to establish the effectiveness and cost-effectiveness of care as usual plus the E-PLAYS programme, delivered in primary schools, compared to care as usual. Cluster-randomisation will take place at school level to avoid contamination. The E-PLAYS intervention will be delivered by schools' teaching assistants. Teachers will select suitable children (ages 5-7 years old) from their schools using guidelines provided by the research team. Assessments will include blinded language measures and observations (conducted by the research team), non-blinded teacher-reported measures of peer relations and classroom behaviour and parent-reported use of resources and quality of life. A process evaluation will also include interviews with parents, children and teaching assistants, observations of intervention delivery and a survey of care as usual. The primary analysis will compare pragmatic language scores for children who received the E-PLAYS intervention versus those who did not at 40 weeks post-randomisation. Secondary analyses will assess cost-effectiveness and a mixed methods process evaluation will provide richer data on the delivery of E-PLAYS. DISCUSSION: The aim of this study is to undertake a final, definitive test of the effectiveness of E-PLAYS when delivered by teaching assistants within schools. The use of technology in game form is a novel approach in an area where there are currently few available interventions. Should E-PLAYS prove to be effective at the end of this trial, we believe it is likely to be welcomed by schools, parents and children. TRIAL REGISTRATION: ISRCTN 17561417, registration date 19th December 2022. PROTOCOL VERSION: v1.1 19th June 2023.

The Perfect Match! A Review and Tutorial on Issues Related to Matching Groups in Investigations of Children with Neurodevelopmental Conditions.

Research concerned with children and young people who have neurodevelopmental disabilities (ND) in relation to early language acquisition usually involves comparisons with matched group(s) of typically developing individuals. In these studies, several important and complex issues need to be addressed. Three major issues are related to: (1) the choice of a variables on which to carry out group matching; (2) recruiting children into the study; and (3) the statistical analysis of the data. To assist future research on this topic, we discuss each of these three issues and provide recommendations about what we believe to be the best course of action. To provide a comprehensive review of the methodological issues, we draw on research beyond the topic of early language acquisition. Our overall aim is to contribute to research that considers questions about delay or differences in development patterns of development and about identifying potentially causal variables.

See and Eat! The impact of repeated exposure to vegetable ebooks on young children's vegetable acceptance.

Vegetable consumption in young children in the UK is well below the recommended five child-sized portions per day. Effective and practical strategies are therefore needed to encourage vegetable consumption in young children. In this exploratory study, we examine the effects of visual familiarization to foods via See & Eat ebooks, which show vegetables on their journey from 'field to fork'. As part of a larger study, in which 242 British families completed a range of measures about their family's eating habits, child's food preferences and potential parent and child predictors of these (Masento et al., 2022), parents were invited to download a See & Eat ebook about a vegetable their child did not eat. Thirty-six families participated in the intervention, looking at the ebook with their child for two weeks and reporting on their child's willingness to taste, intake and liking of the vegetable targeted by the ebook and a matched control vegetable before and after the intervention period. Results showed significant increases in parental ratings of children's acceptance of the target vegetable. Willingness to taste and intake ratings improved for the target vegetable, but not the control vegetable, while liking was reported to increase for both vegetables. These results corroborate previous research demonstrating the benefits of familiarising children with vegetables before they are offered at mealtimes and suggest that ebooks can be added to the set of tools parents can use to support children's vegetable consumption.

Parent, child, and environmental predictors of vegetable consumption in Italian, Polish, and British preschoolers.

This study compared the vegetable intake of preschool children from three European countries [Italy, Poland, and the United Kingdom (UK)] and explored the parent, child, and environmental factors that predicted intake in each country. A total of 408 parents of preschoolers (Italy: N = 61, Poland: N = 124, and UK: N = 225; child mean age = 32.2 months, SD = 9.47) completed an online survey comprising a set of standardised questionnaires. For all three countries, the questionnaires included measures of children's vegetable intake (VegFFQ), child eating behaviour (CEBQ-FF), parents' mealtime goals (FMGs), and sociodemographic questions about family background and environment. In the UK and Italy, additional questionnaires were used to assess child temperament (EAS-T) and parents' feeding practices (CFPQ). The results showed that the number of child-sized portions of vegetables consumed per day varied significantly across countries; Polish children consumed the most (∼3 portions) and Italian children the least (∼1.5 portions). Between-country differences were seen in parents' goals for family mealtimes; compared to Italian parents, Polish and UK parents were more motivated to minimise mealtime stress, increase family involvement in meal preparation, and share the same foods with family members. British and Italian parents also adopted different feeding practices; parents in the UK reported more use of healthy modelling behaviours and more use of foods to support their child's emotion regulation. In terms of child factors, Italian children were reported to be more emotional and more sociable than British children. Analyses of the relationships between the parent, child, and environmental factors and children's vegetable intake revealed both similarities and differences between countries. Negative predictors of vegetable intake included child food fussiness in the UK and Poland, child temperament (especially, shyness) in Italy, and the use of food as a reward and child emotionality in the UK. Positive predictors included the parental mealtime goal of 'family involvement' in the UK. These results highlight differences in the extent to which European preschoolers achieve recommended levels of vegetable intake, and in the factors that influence whether they do. The results suggest a need to develop healthy eating interventions that are adopted to meet the specific needs of the countries in which they are implemented.

A Short and Engaging Adaptive Working-Memory Intervention for Children with Developmental Language Disorder: Effects on Language and Working Memory.

Recent research has suggested that working-memory training interventions may benefit children with developmental language disorder (DLD). The current study investigated a short and engaging adaptive working-memory intervention that targeted executive skills and aimed to improve both language comprehension and working-memory abilities in children with DLD. Forty-seven 6- to 10-year-old children with DLD were randomly allocated to an executive working-memory training intervention (n = 24) or an active control group (n = 23). A pre-test/intervention/post-test/9-month-follow-up design was used. Outcome measures included assessments of language (to evaluate far transfer of the training) and working memory (to evaluate near transfer of the training). Hierarchical multiple regression analyses controlling for pre-intervention performance and age found the group to be a significant predictor of sentence comprehension and of performance on six untrained working-memory measures at post-intervention and 9-month follow-up. Children in the intervention group showed significantly higher language comprehension and working-memory scores at both time points than children in the active control group. The intervention programme showed the potential to improve working memory and language comprehension in children with DLD and demonstrated several advantages: it involved short sessions over a short period, caused little disruption in the school day, and was enjoyed by children.

The structure of executive functioning in 11 to 14 year olds with and without special educational needs.

The structure and development of executive functioning (EF) have been intensively studied in typically developing populations, with little attention given to those with Special Educational Needs (SEN). This study addresses this by comparing the EF structure of 132 adolescents (11-14 years-old) with SEN and 138 adolescents not requiring additional support (Non-SEN peers). Participants completed verbal and non-verbal assessments of key components of EF: inhibition, working memory and switching. Confirmatory Factor Analysis on each group tested one-, two- and three-factor models of EF. In both groups, there was statistical support for the fit of one- and two-factor models with no model being clearly better than the others; there was little support for three-factor models. Parsimony suggests that the one-factor model best represents the structure of EF. In light of our results, the implications for the nature of EF in early adolescence in both SEN and Non-SEN groups are discussed.

Hebb repetition learning in adolescents with intellectual disabilities.

BACKGROUND: Hebb repetition learning is a form of long-term serial order learning that can occur when sequences of items in an immediate serial recall task are repeated. Repetition improves performance because of the gradual integration of serial order information from short-term memory into a more stable long-term memory trace. AIMS: The current study assessed whether adolescents with non-specific intellectual disabilities showed Hebb repetition effects, and if their magnitude was equivalent to those of children with typical development, matched for mental age. METHODS: Two immediate serial recall Hebb repetition learning tasks using verbal and visuospatial materials were presented to 47 adolescents with intellectual disabilities (11-15 years) and 47 individually mental age-matched children with typical development (4-10 years). RESULTS: Both groups showed Hebb repetition learning effects of similar magnitude, albeit with some reservations. Evidence for Hebb repetition learning was found for both verbal and visuospatial materials; for our measure of Hebb learning the effects were larger for verbal than visuospatial materials. CONCLUSIONS: The findings suggested that adolescents with intellectual disabilities may show implicit long-term serial-order learning broadly commensurate with mental age level. The benefits of using repetition in educational contexts for adolescents with intellectual disabilities are considered.

Decoding Abilities in Adolescents with Intellectual Disabilities: The Contribution of Cognition, Language, and Home Literacy.

Decoding abilities in individuals with intellectual disabilities (ID) are substantially lower than for typical readers. The underlying mechanisms of their poor reading remain uncertain. The aim of this study was to investigate the concurrent predictors of decoding ability in 136 adolescents with non-specific ID, and to evaluate the results in relation to previous findings on typical readers. The study included a broad range of cognitive and language measures as predictors of decoding ability. A LASSO regression analysis identified phonological awareness and rapid automatized naming (RAN) as the most important predictors. The predictors explained 57.73% of the variance in decoding abilities. These variables are similar to the ones found in earlier research on typically developing children, hence supporting our hypothesis of a delayed rather than a different reading profile. These results lend some support to the use of interventions and reading instructions, originally developed for typically developing children, for children and adolescents with non-specific ID.

Spatial Cognition in Children With Physical Disability; What Is the Impact of Restricted Independent Exploration?

Given the developmental inter-relationship between motor ability and spatial skills, we investigated the impact of physical disability (PD) on spatial cognition. Fifty-three children with special educational needs including PD were divided into those who were wheelchair users (n = 34) and those with independent locomotion ability (n = 19). This division additionally enabled us to determine the impact of limited independent physical exploration (i.e., required wheelchair use) on spatial competence. We compared the spatial performance of children in these two PD groups to that of typically developing (TD) children who spanned the range of non-verbal ability of the PD groups. Participants completed three spatial tasks; a mental rotation task, a spatial programming task and a desktop virtual reality (VR) navigation task. Levels of impairment of the PD groups were broadly commensurate with their overall level of non-verbal ability. The exception to this was the performance of the PD wheelchair group on the mental rotation task, which was below that expected for their level of non-verbal ability. Group differences in approach to the spatial programming task were evident in that both PD groups showed a different error pattern from the TD group. These findings suggested that for children with both learning difficulties and PD, the unique developmental impact on spatial ability of having physical disabilities, over and above the impact of any learning difficulties, is minimal.

Investigating Reading Comprehension in Adolescents with Intellectual Disabilities: Evaluating the Simple View of Reading.

Reading comprehension difficulties are common in individuals with intellectual disabilities (ID), but the influences of underlying abilities related to reading comprehension in this group have rarely been investigated. One aim of this study was to investigate the Simple View of Reading as a theoretical framework to describe cognitive and linguistic abilities predicting individual differences in reading comprehension in adolescents with non-specific ID. A second aim was to investigate whether predictors of listening comprehension and reading comprehension suggest that individuals with ID have a delayed pattern of development (copying early grade variance in reading comprehension) or a different pattern of development involving a new or an unusual pattern of cognitive and linguistic predictors. A sample of 136 adolescents with non-specific ID was assessed on reading comprehension, decoding, linguistic, and cognitive measures. The hypotheses were evaluated using structural equation models. The results showed that the Simple View of Reading was not applicable in explaining reading comprehension in this group, however, the concurrent predictors of comprehension (vocabulary and phonological executive-loaded working memory) followed a delayed profile.

Evaluating 'Enhancing Pragmatic Language skills for Young children with Social communication impairments' (E-PLAYS): a feasibility cluster-randomised controlled trial.

BACKGROUND: This article reports the results from a feasibility study of an intervention ('E-PLAYS') aimed at supporting children who experience difficulties with social communication. E-PLAYS is based around a dyadic computer game, which aims to develop collaborative and communication skills. A pilot study found that when E-PLAYS was delivered by researchers, improvements on communication test scores and on collaborative behaviours were observed. The aim of this study was to ascertain the feasibility of running a full-scale trial to test the effectiveness of E-PLAYS in a National Health Service (NHS) setting with delivery by speech and language therapists and teaching assistants. METHODS: The study was a two-arm feasibility cluster-randomised controlled trial of the E-PLAYS intervention with a treatment as usual control arm. Data relating to recruitment and retention, treatment fidelity, acceptability to participants, suitability of outcomes and feasibility of collecting health economic measures and of determining cost-effectiveness were collected. Speech and language therapists selected suitable children (ages 4-7 years old) from their caseload. E-PLAYS intervention (experimental group) was then delivered by teaching assistants overseen by speech and language therapists. The control group received usual care. Assessments included blinded language measures and observations, non-blinded teacher-reported measures of peer relations and classroom behaviour and non-blinded parent-reported use of health and education resources and quality of life. RESULTS: Planned recruitment was for 70 children, in the event, 50 children were recruited which was sufficient for feasibility purposes. E-PLAYS was very highly rated by children, teaching assistants and speech and language therapists and treatment fidelity did not pose any issues. We were able to collect health economic data which suggests that E-PLAYS would be a low-cost intervention. CONCLUSION: Based on recruitment, retention and adherence rates and our outcome measures, a full-scale randomised controlled trial estimated appears feasible and warranted to assess the effectiveness of E-PLAYS for use by the NHS and schools. TRIAL REGISTRATION: ISRCTN 14818949 (retrospectively registered).

Evaluating 'enhancing pragmatic language skills for young children with social communication impairments' (E-PLAYS): protocol for a feasibility randomised controlled trial study.

BACKGROUND: A number of children experience difficulties with social communication and this has long-term deleterious effects on their mental health, social development and education. The proposal presented in this article describes a feasibility study for a trial to test an intervention ('E-PLAYS') aimed at supporting children with social communication impairments. E-PLAYS harnesses technology in the form of a novel computer game in order to develop collaborative and communication skills. Preliminary studies by the authors show that when E-PLAYS was administered by the research team, children with social communication impairments showed improvements on communication test scores and on observed collaborative behaviours. The study described here is a pragmatic trial to test the application of E-PLAYS delivered by NHS speech and language therapists together with schools. METHODS: This protocol outlines a two-arm feasibility cluster-randomised controlled trial of the E-PLAYS intervention with treatment as usual control arm, with randomisation at the level of the speech and language therapist. The aim of this study is to ascertain whether it will be feasible to progress to running a full-scale definitive trial to test the effectiveness of E-PLAYS in an NHS setting. Data relating to recruitment and retention, the appropriateness of outcomes and the acceptability of E-PLAYS to participants will be collected.Speech and language therapists will select suitable children (ages 4-7 years old) from their caseloads and deliver either the E-PLAYS intervention (experimental group) or treatment as usual (control group). Assessments will include blinded language measures and observations, non-blinded teacher-reported measures of peer relations and classroom behaviour and parent-reported use of resources and quality of life. There will also be a qualitative process evaluation. DISCUSSION: The findings of this study will inform the decision as to whether to progress to a full-scale definitive randomised controlled trial to test the effectiveness of E-PLAYS when delivered by speech and language therapists and teaching assistants within schools. The use of technology in game form is a novel approach in an area where there are currently few available interventions. TRIAL REGISTRATION: ISRCTN 14818949 (retrospectively registered).

How to do the bottle suction method for removal of a silicone gel breast implant.

There is a growing prevalence of silicone breast implant rupture and need for removal. This article identifies a novel method of removing silicone gel breast implants which addresses issues identified with the current methods. Our technique is an efficient and effective method but most importantly complies to strict Therapeutic Goods Administration guidelines for equipment used in surgery.

The Modified Lateral Intercostal Artery Perforator Flap.

BACKGROUND: The main surgical options for treatment of breast cancer are breast-conserving surgery and mastectomy. BCS aims to achieve complete excision of the tumor while achieving a pleasing cosmetic result. Excision of tumors in the lateral aspect of the breast has been associated with issues such as contour deformities and asymmetry. Development of volume replacement techniques such as the lateral intercostal artery perforator flap (LICAP) aimed to address these issues. Our modification of the traditional LICAP offers a less visible scar, good access to the axilla, and no need to reposition the patient. METHODS: All patients undergoing a modified LICAP were identified from our database. The lateral intercostal artery perforators were marked with ultrasound and 2 "lazy S" lines were drawn to mark the flap. The wide local excision (with or without axillary surgery) was performed and the flap mobilized to fill the defect. RESULTS: Twenty-two patients underwent modified LICAP in 14 months. The mean specimen weight was 86 g. Four patients (18%) had a re-excision for positive margins. Nineteen patients had axillary surgery performed at the time of their modified LICAP flap. No patients had a scar that extended posterior to the posterior axillary line; no patients required a separate incision for axillary surgery; and no patients needed to be repositioned intraoperatively. CONCLUSIONS: Our early experience with this innovative procedure has been favorable. The perioperative complication rate is low. Due to the relatively short follow-up, longer term outcomes such as postradiotherapy appearance are yet to be determined.

Do children use different forms of verbal rehearsal in serial picture recall tasks? A multi-method study.

Use of verbal rehearsal is a key issue in memory development. However, we still lack detailed and triangulated information about the early development and the circumstances in which different forms of rehearsal are used. To further understand significant factors that affect children's use of various forms of rehearsal, the present study involving 108 primary school children adopted a multi-method approach. It combined a carefully chosen word length effect method with a self-paced presentation time method to obtain behavioural indicators of verbal rehearsal. In addition, subsequent trial-by-trial self-reports were gathered. Word length effects in recall suggested that phonological recoding (converting images to names - a necessary precursor for rehearsal) took place, with evidence of more rehearsal among children with higher performance levels. According to self-paced presentation times, cumulative rehearsal was the dominant form of rehearsal only for children with higher spans on difficult trials. The combined results of self-paced times and word length effects in recall suggest that "naming" as simple form of rehearsal was dominant for most children. Self-reports were in line with these conclusions. Additionally, children used a mixture of strategies with considerable intra-individual variability, yet strategy use was nevertheless linked to age as well as performance levels.

Delays in the reading and spelling of children with cerebral palsy: Associations with phonological and visual processes.

BACKGROUND: This investigation addresses the question of whether there exists a significant discrepancy in the cognitive abilities of children with cerebral palsy (CP) who, despite the presence of age appropriate communication and language, have reading and spelling delays. AIMS: We wanted to discover whether there was a relationship between the phonological and visual perceptual abilities of children with CP and their progress in reading and spelling. METHODS AND PROCEDURES: Fifteen children with CP (aged between 6:9 years and 11:6 years) were assessed on reading and spelling; communication and language; non-verbal reasoning; phonological processing; and visual perception. OUTCOMES AND RESULTS: Ten of the children had very weak reading and spelling skills. Five children had (mostly) age appropriate scores of reading and spelling. No differences were found between these two groups in non-verbal reasoning or communication and language. However, phonological abilities, visual sequential memory and perception of visuospatial relationships were found to be related to reading and spelling. CONCLUSIONS AND IMPLICATIONS: The findings suggest that children with CP are at risk for reading and spelling delays when they have poor phonological processing, visual sequential memory and perception of visuospatial relationships. The implications of the findings for classroom practice are discussed.

An Exploration of the Factor Structure of Executive Functioning in Children.

There has been considerable debate and interest in the factor structure of executive functioning (EF). For children and young people, there is evidence of a progression from a single factor to a more differentiated structure, although the precise nature of these factors differs between investigations. The purpose of the current study was to look at this issue again with another sample, and try to understand possible reasons for previous differences between investigations. In addition, we examined the relationship between less central EF tasks, such as fluency and planning, to the more common tasks of updating/executive working memory (EWM), inhibition, and switching/shifting. A final aim was to carry out analyses which are relevant to the debate about whether EF is influenced by language ability, or language ability is influenced by EF. We reasoned that if language ability affects EF, a factor analysis of verbal and non-verbal EF tasks might result in the identification of a factor which predominantly contains verbal tasks and a factor that predominately contains non-verbal tasks. Our investigation involved 128 typically developing participants (mean age 10:4) who were given EF assessments that included verbal and non-verbal versions of each task: EWM; switching; inhibition; fluency; and planning. Exploratory factor analyses on EWM, switching, and inhibition produced a structure consisting of inhibition in one factor and the remaining tasks in another. It was decided to exclude verbal planning from the next analyses of all the ten tasks because of statistical considerations. Analysis of the remaining nine EF tasks produced two factors, one factor containing the two inhibition tasks, and another factor that contained all the other tasks (switching, EWM, fluency, and non-verbal planning). There was little evidence that the verbal or non-verbal elements in these tasks affected the factor structure. Both these issues are considered in the discussion, where there is a general evaluation of findings about the factor structure of EF.

Visual perception, visual-spatial cognition and mathematics: Associations and predictions in children with cerebral palsy.

BACKGROUND: Previous research suggests that children with cerebral palsy (CP) have impairments in visual-spatial and mathematics abilities, although we know very little about the association between these two domains. AIMS: To investigate the extent of visual-spatial and mathematical impairments in children with CP and the associations between these two domains. METHOD AND PROCEDURE: Thirty-two children with predominantly quadriplegic spastic and/or athetoid (dyskinetic) CP (13 years 7 months) and a group of typically developing (TD) children (8 years 6 months) matched by receptive vocabulary were given a battery of visual-spatial and mathematics tasks. Visual-spatial assessments ranged from simple tests of perception to complex reasoning about these stimuli. A standardised test of mathematics ability was administered to both groups. OUTCOMES AND RESULTS: The children with CP had significantly poorer mathematical and visual-spatial abilities than the TD group. For the TD group age was the best predictor of mathematical ability, in the CP group receptive vocabulary and visual perception abilities were the best predictors of mathematical ability. CONCLUSION AND IMPLICATIONS: The CP group had extensive difficulties with visual perception; visual short-term memory; visual reasoning; and mental rotation all of which were associated with their mathematical abilities. These findings have implications for the teaching of visual perception and visual memory skills in young children with CP as these may help the development of mathematical abilities.

Neoadjuvant systemic therapy for breast cancer: the Westmead experience.

BACKGROUND: Neoadjuvant systemic therapy (NAST) can be used to treat breast cancer. Pathologic complete response (pCR) is a surrogate marker for improved survival. This study examined response in the breast and axilla to NAST and identified features associated with pCR. METHODS: Patients undergoing NAST and surgery between January 2012 and June 2016 by surgeons at Westmead Breast Cancer Institute were identified. Patients with inflammatory or metastatic disease were excluded. Data were analysed to identify factors predictive of pCR. RESULTS: Ninety-one patients were identified. Mean age was 49 years. Forty-one patients had axillary metastases identified prior to NAST. Eighty-three patients received chemotherapy alone, six endocrine therapy alone and two had both. Thirty-seven patients had mastectomy and 54 had breast-conserving surgery. The overall breast pCR rate was 29% higher in patients with triple-negative (50%) or HER2-positive (39%) disease and lower in luminal disease (11.6%, P = 0.001). Forty percent of node-positive patients became node negative. The only variable associated with pCR was tumour biology. Patients with HER2-positive breast cancer were more likely to have axillary pCR than those with luminal cancer (odds ratio: 28, P = 0.00005). CONCLUSION: pCR in either the breast or axilla was most likely to be achieved in patients with HER2-positive or triple-negative breast cancers. In patients with luminal cancers, the goal of NAST is best considered to facilitate surgical options rather than obtaining a pCR.