Gaze-speech coordination during social interaction in Parkinson's disease.

BACKGROUND: Parkinson's disease (PD) can affect social interaction and communication as well as motor and cognitive processes. Speech is affected in PD, as is the control of voluntary eye movements which are thought to play an important role in 'turn taking' in conversation. AIMS: This study aimed to measure eye movements during spoken conversation in PD to assess whether differences in patterns of eye gaze are linked to disrupted turn taking and impaired communication efficiency. METHODS & PROCEDURE: Eleven participants with mild PD and 14 controls completed a two-player guessing game. During each 3 min game turn, one of the players had to guess the names of as many objects as possible based only on the other player's description. Eye movements were recorded simultaneously in both participants using mobile eye trackers along with speech onset and offset times. OUTCOMES & RESULTS: When people with PD played the role of describer, the other player guessed fewer objects compared to when controls described objects. When guessing objects, people with PD performed just as well as controls. Analysis of eye fixations showed that people with PD made longer periods of fixation on the other player's face relative to controls and a lower number of such 'gaze on face' periods. CONCLUSIONS & IMPLICATIONS: A combination of oculomotor, cognitive and speech abnormalities may disrupt communication in PD. Better public awareness of oculomotor, speech and other deficits in the condition could improve social connectedness in people with Parkinson's. WHAT THIS PAPER ADDS: What is already known on this subject? Parkinson's disease is known to affect the control of voluntary eye movements. Direction of eye gaze is important in spoken conversation as a cue to turn-taking, but no studies have examined whether eye movements are different during communication in people with Parkinson's. What this paper adds to existing knowledge? People with Parkinson's showed longer periods of eye fixation during conversations compared to controls. Delays and overlaps between speech turns were also affected in patients. What are the clinical implications of this work? Better knowledge of the effect of the disease on eye gaze control amongst clinicians may help improve communication and social connectedness for patients in the future.

Assessing the Human Rights Framework on Private Health Care Actors and Economic Inequality.

Private actors' involvement in health care financing, provision, and governance contributes to economic inequality. This paper provides an overview of emerging normative trends regarding private actors' involvement in health care by reviewing and critically analyzing international and regional human rights standards on the right to the highest attainable standard of physical and mental health. Specifically, we survey statements from United Nations human rights treaty bodies and recent jurisprudence of the African Commission on Human and Peoples' Rights that discuss private actors' involvement in health care. We then identify strengths and weaknesses of the current international human rights law framework to address the human rights and inequality impacts of private health care actors, before concluding with a series of recommendations to further develop existing standards.

Pastoral Narrative Disclosure: The Development and Evaluation of an Australian Chaplaincy Intervention Strategy for Addressing Moral Injury.

This paper describes the development and initial chaplaincy user evaluation of 'Pastoral Narrative Disclosure' (PND) as a rehabilitation strategy developed for chaplains to address moral injury among veterans. PND is an empirically informed and integrated intervention comprising eight stages of pastoral counselling, guidance and education that was developed by combining two previously existing therapeutic techniques, namely Litz et al's (2017) 'Adaptive Disclosure' and 'Confessional Practice' (Joob & Kettunen, 2013). The development and results of PND can be categorized into five phases. Phase 1: PND Strategy Formation-based upon extensive international research demonstrating that MI is a complex bio-psycho-social-spiritual syndrome with symptoms sufficiently distinct from post-traumatic stress disorder. The review also provided evidence of the importance of chaplains being involved in moral injury rehabilitation. Phase II: Development and Implementation of 'Moral Injury Skills Training' (MIST)-which involved the majority of available Australian Defence Force (ADF) Chaplains (n = 242/255: 94.9%) completing a basic 'Introduction to Moral Injury' (MIST-1) as well as an 'Introduction to PND' (MIST-2). Phase III: MIST-3-PND-Pilot evaluation-involved a representative chaplaincy cohort (n = 13) undergoing the PND eight-stage strategy to ensure the integrity and quality of PND from a chaplaincy perspective prior to wider implementation. The pilot PND evaluation indicated a favourable satisfaction rating (n = 11/13: 84.6%; M = 4.73/5.0 satisfaction). Phase IV: MIST-3-PND Implementation-involved a larger cohort of ADF Chaplaincy participants (n = 210) completing a revised and finalized PND strategy which was regarded favourably by the majority of ADF Chaplains (n = 201/210: 95.7%; M = 4.73/5.0 satisfaction). Phase V: Summation. In conclusion the positive satisfaction ratings by a significant number of ADF chaplaincy personnel completing MIST-3-PND, provided evidence that chaplains evaluated PND as a suitable counselling, guidance and education strategy, which affirmed its utilisation and justifies further research for using PND to address MI among veterans, that may also prove valuable for other chaplains working in community health and first responder contexts.

You are in charge now: exploration of educational relationships between anaesthetic trainees and their supervising specialists.

Background: Much of the education during anaesthesia training occurs in the workplace where trainees work under the close supervision of a more senior anaesthetist. Trainee anaesthetists are exposed to multiple supervisors with whom they form educational and supervisory relationships over the course of their training. Surprisingly little research has been conducted to explore the factors behind the development and maintenance of these relationships. This study explores the process of how education occurs in the workplace by examining the relationship from the perspective of both trainees and specialists. Methods: This is an exploratory qualitative study. Eight trainee and 10 specialist anaesthetists participated in an individual semi-structured interview. The data were analysed thematically by each of the authors to generate themes. Results: Six themes were identified in the analysis: (1) sizing up; (2) negotiated autonomy; (3) working closely together; (4) workplace practices; (5) education being valued; and (6) gender. A conceptual model to illustrate the relationships between the six themes was developed. Conclusions: Supervisory relationships were viewed positively by participants despite impediments such as lack of continuity and busy clinical environments. But there were tensions, particularly in balancing trainee autonomy with patient safety. A nuanced 'sizing up' process, with negotiation of autonomy, was described by both supervisors and trainees. Our findings may support supervisory relationships to reach this ideal more effectively.

Leprosy rash precipitated by immunotherapy for suspected inflammatory neuropathy.

Leprosy is a chronic granulomatous infection caused by Mycobacterium leprae complex, causing skin and nerve lesions with potential for permanent disability. Leprosy can be overlooked in Western settings, as it is more prevalent in low-income and middle-income countries. We describe a 38-year-old woman with a 4-year history of progressive numbness of the left hand incorrectly diagnosed as multifocal acquired demyelinating sensory and motor neuropathy on the basis of clinical and neurophysiological findings. Treatment with empirical weekly corticosteroid followed by intravenous immunoglobulin resulted in the sudden development of a widespread rash; we then diagnosed borderline lepromatous leprosy on skin biopsy. We postulate that the immune treatments induced a temporary state of immune tolerance followed by a rebound of a T cell-mediated immune response resulting in a type 1 immunological response.

Moral Injury, Betrayal and Retribution: Australian Veterans and the Role of Chaplains.

This paper presents additional qualitative results from Phase 1 of a larger study examining potentially morally injurious events/experiences (PMIE) and/or moral injury (MI) among Australian veterans (Hodgson et al. in J Relig Health 60(5):3061-3089, 2021). It makes specific reference to (1) betrayal and (2) retribution experienced or perpetrated by Australian military veterans during military conflicts and peacekeeping missions. During two veteran seminars conducted in Adelaide, South Australia, a total of 50 veterans were recruited, 10 of whom were willing to be interviewed and audio-recorded about their deployment experiences. Narrative data analysis of veteran transcripts indicated that all participants had engaged in or were exposed to a PMIE/MI of one kind or another, and all had experienced betrayal and/or witnessed or perpetrated retribution. Given the ethical, moral and spiritual issues involved, the role of chaplains in addressing moral injury for the benefit of veterans through the use of 'Pastoral Narrative Disclosure' (PND) is suggested-with a specific focus upon 'restoration' and 'ritual'. Additional research is recommended with regard to acts of betrayal and retribution among veterans, as well as the further development of PND to address PMIE/MI.

Patient-reported symptoms and experience following Guillain-Barré syndrome and related conditions: Questionnaire development and validation.

BACKGROUND: Guillain-Barré syndrome (GBS) is a rare inflammatory peripheral nerve disorder with variable recovery. Evidence is lacking on experiences of people with GBS and measurement of these experiences. OBJECTIVE: We aimed to develop and validate an instrument to measure experiences of people with GBS. DESIGN: We used a cross-sectional design and online self-administered questionnaire survey. Question domains, based on a previous systematic review and qualitative study, covered experiences of GBS, symptom severity at each stage, healthcare and factors supporting or hindering recovery. Descriptive, exploratory factor and reliability analyses and multivariable regression analysis were used to investigate the relationships between variables of interest, explore questionnaire reliability and validity and identify factors predicting recovery. SETTING AND PARTICIPANTS: People with a previous diagnosis of GBS were recruited through a social media advert. RESULTS: A total of 291 responders, of different sexes, and marital statuses, were included, with most diagnosed between 2015 and 2019. Factor analysis showed four scales: symptoms, information provided, factors affecting recovery and care received. Positive social interactions, physical activity including physiotherapy and movement, changes made at home and immunoglobulin treatment were important for recovery. Multivariable models showed that immunoglobulin and/or plasma exchange were significant predictors of recovery. Employment and recovery factors (positive interactions, work support and changes at work or home, physical activity and therapy), though associated with recovery, did not reach statistical significance. CONCLUSION: The questionnaire demonstrated good internal reliability of scales and subscales and construct validity for people following GBS. PATIENT CONTRIBUTION: Patients were involved in developing and piloting the questionnaire.

Applying the British picture vocabulary scale to estimate premorbid cognitive ability in adults.

Estimating premorbid cognitive ability is an essential part of assessment as well as being an important consideration in research. The most widely used approach to premorbid assessment, The National Adult Reading Test (NART), relies on word reading ability. However, this can be problematic in patients where communication is impaired. This research assessed the effectiveness of a receptive vocabulary test, the British Picture Vocabulary Scale II (BPVS) as an alternative. Correlations were found between the BPVS, NART and the Weschler Abbreviated Scale of Intelligence (WASI) in 87 healthy participants. Regression equations were calculated relating NART and BPVS raw scores to IQ scores in the healthy sample. WASI, NART and BPVS scores were also obtained in 19 patients with varying neurological etiology as part of their routine assessment. Results showed that 18 out of 19 patients obtained BPVS derived IQ scores similar to or higher than their WASI IQ. Whereas mean BPVS derived IQ did not differ significantly between the standardization and clinical samples, WASI IQ scores were lower in the patient group. The findings suggest that the BPVS II 'holds' after acquired cognitive impairment and is a promising alternative method for estimating premorbid IQ in patients who have difficulties reading or verbalizing.

Visual Attention and Cognitive Archaeology: An Eye-Tracking Study of Palaeolithic Stone Tools.

The study of lithic technology can provide information on human cultural evolution. This article aims to analyse visual behaviour associated with the exploration of ancient stone artefacts and how this relates to perceptual mechanisms in humans. In Experiment 1, we used eye tracking to record patterns of eye fixations while participants viewed images of stone tools, including examples of worked pebbles and handaxes. The results showed that the focus of gaze was directed more towards the upper regions of worked pebbles and on the basal areas for handaxes. Knapped surfaces also attracted more fixation than natural cortex for both tool types. Fixation distribution was different to that predicted by models that calculate visual salience. Experiment 2 was an online study using a mouse-click attention tracking technique and included images of unworked pebbles and 'mixed' images combining the handaxe's outline with the pebble's unworked texture. The pattern of clicks corresponded to that revealed using eye tracking and there were differences between tools and other images. Overall, the findings suggest that visual exploration is directed towards functional aspects of tools. Studies of visual attention and exploration can supply useful information to inform understanding of human cognitive evolution and tool use.

Moral Injury, Australian Veterans and the Role of Chaplains: An Exploratory Qualitative Study.

Military personnel deployed to war zones or assigned to other morally challenging military duties are likely to be exposed to potentially morally injurious events (PMIE) that may inflict a moral injury (MI). This qualitative study formed 'Phase 1' of a larger study into PMIEs experienced by Australian veterans and the potential pastoral/spiritual care role of chaplains. Two seminars were conducted that involved 10 veterans being interviewed and audio recorded about their deployment experiences to evaluate whether there was any evidence among Australian veterans of a PMIE. Narrative data analysis indicated that all participants had been exposed to, or were involved in, a PMIE of one kind or another. Seven key themes were identified from the analyzed qualitative data: (i) immoral acts, (ii) death and injury, (iii) betrayal, (iv) ethical dilemmas, (v) disproportionate violence, (vi) retribution and (vii) religious/spiritual issues. Given this preliminary PMIE evidence identified, there is a need for further research, as well as the development of a suitable moral injury assessment scale appropriate for Australian veterans. Furthermore, given the ethical, moral, and spiritual issues involved, the implementation of a rehabilitation program suitable for Australian veterans which can be provided by chaplains is also suggested-namely 'Pastoral Narrative Disclosure.' It is argued that moral injury needs to be recognized, not just as an issue affecting individual personnel and their families, but is also a community health, organizational and government responsibility.

Decolonising human rights: how intellectual property laws result in unequal access to the COVID-19 vaccine.

The recent rapid development of COVID-19 vaccines offers hope in addressing the worst pandemic in a hundred years. However, many countries in the Global South face great difficulties in accessing vaccines, partly because of restrictive intellectual property law. These laws exacerbate both global and domestic inequalities and prevent countries from fully realising the right to health for all their people. Commodification of essential medicines, such as vaccines, pushes poorer countries into extreme debt and reproduces national inequalities that discriminate against marginalised groups. This article explains how a decolonial framing of human rights and public health could contribute to addressing this systemic injustice. We envisage a human rights and global health law framework based on solidarity and international cooperation that focuses funding on long-term goals and frees access to medicines from the restrictions of intellectual property law. This would increase domestic vaccine production, acquisition and distribution capabilities in the Global South.

The effect of directional social cues on saccadic eye movements in Parkinson's disease.

There is growing interest in how social processes and behaviour might be affected in Parkinson's disease. A task which has been widely used to assess how people orient attention in response to social cues is the spatial cueing task. Socially relevant directional cues, such as a picture of someone gazing or pointing to the left or the right have been shown to cause orienting of visual attention in the cued direction. The basal ganglia may play a role in responding to such directional cues, but no studies to date have examined whether similar social cueing effects are seen in people with Parkinson's disease. In this study, patients and healthy controls completed a prosaccade (Experiment 1) and an antisaccade task (Experiment 2) in which the target was preceded by arrow, eye gaze or pointing finger cues. Patients showed increased errors and response times for antisaccades but not prosaccades. Healthy participants made most anticipatory errors on pointing finger cue trials, but Parkinson's patients were equally affected by arrow, eye gaze and pointing cues. It is concluded that Parkinson's patients have a reduced ability to suppress responding to directional cues, but this effect is not specific to social cues.

Deficits in saccadic eye movements differ between subtypes of patients with mild cognitive impairment.

Introduction: Mild cognitive impairment (MCI) is known to be heterogeneous in its cognitive features and course of progression. Whilst memory impairment is characteristic of amnestic MCI (aMCI), cognitive deficits other than memory can occur in both aMCI and non-amnestic MCI (naMCI) and accurate assessment of the subtypes of MCI is difficult for clinicians without the application of extensive neuropsychological testing. In this study, we examine metrics derived from recording of reflexive and voluntary saccadic eye movements as a potential alternative method for discriminating between subtypes and assessing cognitive functions in MCI.Method: A total of 29 MCI patients and 29 age- and education-matched healthy controls (HCs) participated in the cross-sectional study. We recorded horizontal and vertical pro-saccades and anti-saccade responses. All the participants also completed a comprehensive neuropsychological tests battery.Results: Significant differences in saccadic eye movement were found between the subtypes of MCI and HCs. Patients with aMCI had a higher percentage of short latency "express" saccades than HCs. We found strong associations between saccadic reaction times and cognitive domains, including executive functions and attention. The mini-mental state examination (MMSE) was also found to correlate with uncorrected errors in the anti-saccade task.Conclusions: The increased proportion of saccades in the express latency range in aMCI may be indicative of problems with cognitive inhibitory control in these patients. A focus on this and other saccade metrics in the preclinical and prodromal stages of dementia may help to predict the clinical progression of the disease and direct interventions for the management of MCI. The clinical significance of saccadic eye movement impairments in MCI is not yet fully understood and should be investigated in further studies using larger samples.

Patients' experiences and perceptions of Guillain-Barré syndrome: A systematic review and meta-synthesis of qualitative research.

BACKGROUND: Guillain-Barré syndrome (GBS) is an immune-mediated polyradiculoneuropathy, with an incidence of 1-2/100,000 per year. Its severity is variable, ranging from very mild cases with brief weakness to severe paralysis, leading to inability to breathe independently, or even death. Currently there is limited evidence exploring the experiences of GBS patients. The aim of this study was to review patients' experiences and perceptions of GBS and its variants at diagnosis, discharge and during recovery, by conducting a systematic review and thematic meta-synthesis of qualitative studies of patients' experiences of GBS (and its variants). METHODS: We searched twelve electronic databases, supplemented with internet searches and forward and backward citation tracking from the included studies and review articles. Data were synthesised thematically following the Thomas and Harden approach. The CASP Qualitative Checklist was used to assess the quality of the included studies of this review. RESULTS: Our search strategy identified a total of 5,282 citations and after removing duplicates and excluding citations based on title and abstract, and full-text screening, five studies were included in the review and meta-synthesis; all included studies were considered of acceptable quality. Through constant discussions and an iterative approach, we developed six analytical themes following a patient's journey from suspecting that they had a health problem, through to being hospitalised, experiencing ongoing difficulties, slowly recovering from GBS, adjusting to their new circumstances, and re-evaluating their lives. CONCLUSIONS: Despite the variety of experiences, it was evident from all included studies that being diagnosed with and surviving GBS was a life-changing experience for all participants. TRIAL REGISTRATION: Protocol was registered (CRD42019122199) on the International Prospective Register of Systematic Reviews (http://www.crd.york.ac.uk/PROSPERO).

Exploring the experiences of having Guillain-Barré Syndrome: A qualitative interview study.

BACKGROUND: Guillain-Barré syndrome (GBS) is a rare inflammatory disorder affecting the peripheral nerves. Although typically there is full neurological recovery, some people continue to experience residual physical, psychological or social problems longer term. Evidence describing the experiences of people with GBS is limited. OBJECTIVE: We aimed to explore the experiences of people with GBS in the UK. DESIGN: We used qualitative (face-to-face and telephone) interviews to explore experiences of people with GBS. Audio-recorded data were transcribed verbatim and analysed using the Framework Method supported by NVivo 11. SETTING AND PARTICIPANTS: We purposively recruited a sample of 16 volunteers with a prior diagnosis of GBS of varying age, sex, ethnicity, location, marital status, time since diagnosis and length of hospital stay to maximize differences in experience. Interviewees were required to have been discharged from hospital, able to give informed consent, able to speak and understand English and currently resident in the United Kingdom. RESULTS: The key themes arising from the analysis were as follows: the importance of early diagnosis; the experiences of inpatient care; the importance of active support for recovery; the need for communication throughout the course of the illness; the need for greater awareness, knowledge and provision of information by health-care staff; and path to achieving function. CONCLUSION: This is the first qualitative study exploring experiences of people with GBS in the UK through their whole illness journey from onset to recovery. The findings contribute to our understanding of the experiences and support needs of people recovering from GBS.

Eye Movements in Neuropsychological Tasks.

This chapter reviews how recording and analysis of eye movements have been applied to understanding cognitive functioning in patients with neurological disease. Measures derived from the performance of instructed eye movement tests such as the anti-saccade and memory-guided saccade tasks have been shown to be associated with cognitive test performance and the early stages of neurodegenerative disorders including Alzheimer's and Parkinson's disease. Other researchers have taken an ecological approach and recorded the uninstructed pattern of saccades made by patients during performance of established neuropsychological tasks. Studies that have analysed the eye movement strategies used in a number of widely used tests are reviewed, including the Corsi blocks, Tower of London, 'CANTAB' Spatial Working Memory and Brixton Spatial Anticipation test. The findings illustrate that eye movements are not purely in the service of vision, but support visuospatial working memory and forward action planning. Eye movement tests and measures also have potential for application in the assessment and diagnosis of neurological disease and cognitive impairment. Establishing large-scale normative data sets in healthy older adults and use of machine learning multivariate classifier algorithms may be key to further developing eye tracking applications in neuropsychological assessment.

Eye Movements in the "Morris Maze" Spatial Working Memory Task Reveal Deficits in Strategic Planning.

Analysis of eye movements can provide insights into processes underlying performance of cognitive tasks. We recorded eye movements in healthy participants and people with idiopathic Parkinson disease during a token foraging task based on the spatial working memory component of the widely used Cambridge Neuropsychological Test Automated Battery. Participants selected boxes (using a mouse click) to reveal hidden tokens. Tokens were never hidden under a box where one had been found before, such that memory had to be used to guide box selections. A key measure of performance in the task is between search errors (BSEs) in which a box where a token has been found is selected again. Eye movements were found to be most commonly directed toward the next box to be clicked on, but fixations also occurred at rates higher than expected by chance on boxes farther ahead or back along the search path. Looking ahead and looking back in this way was found to correlate negatively with BSEs and was significantly reduced in patients with Parkinson disease. Refixating boxes where tokens had already been found correlated with BSEs and the severity of Parkinson disease symptoms. It is concluded that eye movements can provide an index of cognitive planning in the task. Refixations on locations where a token has been found may also provide a sensitive indicator of visuospatial memory integrity. Eye movement measures derived from the spatial working memory task may prove useful in the assessment of executive functions as well as neurological and psychiatric diseases in the future.

Chaplaincy, Spiritual Care and Moral Injury: Considerations Regarding Screening and Treatment.

Moral injury is a complex trauma related syndrome involving a correlation of biological, psychological, social, and spiritual symptoms that can have substantial impact upon health and well-being. This paper argues for a holistic bio-psycho-social-spiritual approach to moral injury, by including chaplaincy in the screening and treatment of moral injury among actively serving military members and retired veterans. As part of the moral injury treatment process, and in alignment with the World Health Organization's Spiritual Intervention Codings, a new technique is proposed, "Pastoral Narrative Disclosure" (PND), as a guide for chaplains and others trained in spiritual care to assist those suffering from moral injury.

The effect of COMT Val158Met and DRD2 C957T polymorphisms on executive function and the impact of early life stress.

INTRODUCTION: Previous research has indicated that variation in genes encoding catechol-O-methyltransferase (COMT) and dopamine receptor D2 (DRD2) may influence cognitive function and that this may confer vulnerability to the development of mental health disorders such as schizophrenia. However, increasing evidence suggests environmental factors such as early life stress may interact with genetic variants in affecting these cognitive outcomes. This study investigated the effect of COMT Val158Met and DRD2 C957T polymorphisms on executive function and the impact of early life stress in healthy adults. METHODS: One hundred and twenty-two healthy adult males (mean age 35.2 years, range 21-63) were enrolled in the study. Cognitive function was assessed using Cambridge Neuropsychological Test Automated Battery and early life stress was assessed using the Childhood Traumatic Events Scale (Pennebaker & Susman, 1988). RESULTS: DRD2 C957T was significantly associated with executive function, with CC homozygotes having significantly reduced performance in spatial working memory and spatial planning. A significant genotype-trauma interaction was found in Rapid Visual Information Processing test, a measure of sustained attention, with CC carriers who had experienced early life stress exhibiting impaired performance compared to the CC carriers without early life stressful experiences. There were no significant findings for COMT Val158Met. CONCLUSIONS: This study supports previous findings that DRD2 C957T significantly affects performance on executive function related tasks in healthy individuals and shows for the first time that some of these effects may be mediated through the impact of childhood traumatic events. Future work should aim to clarify further the effect of stress on neuronal systems that are known to be vulnerable in mental health disorders and more specifically what the impact of this might be on cognitive function.