Treatment for preschool age children who stutter: Protocol of a randomised, non-inferiority parallel group pragmatic trial with Mini-KIDS, social cognitive behaviour treatment and the Lidcombe Program-TreatPaCS.

Stuttering is a speech disorder in which the flow of speech is disrupted by involuntary repetitions of sounds, syllables, words or phrases, stretched sounds or silent pauses in which the person is unable to produce sounds and sound transitions. Treatment success is the highest if stuttering is treated before the age of 6 years, before it develops into "persistent" stuttering. Stuttering treatment programs that focus directly on the speech of the child, like the Lidcombe Program, have shown to be effective in this age group. Mini-KIDS is also a treatment that focuses directly on the speech of the child. It is possible that capturing the increased brain plasticity at this age in combination with creating optimal conditions for recovery underlie these treatments' success rate. A treatment focusing on the cognitions, emotions and behaviour of the child, the social cognitive behaviour treatment (SCBT), is also frequently delivered in Belgium. In this study we want to compare, and collect data on the effectiveness, of these three treatment programs: Mini-KIDS, SCBT and the Lidcombe Program (protocol registered under number NCT05185726). 249 children will be allocated to one of three treatment groups. Stuttering specialists will treat the child (and guide the parents) with Mini-KIDS, the SCBT or the Lidcombe Program. They will be trained to deliver the programs meticulously. At 18 months after randomisation, the speech fluency of the child and the attitude of the child and parent(s) towards speech will be measured. It is expected that the three programs will achieve the same (near) zero levels of stuttering in nearly all children and a positive attitude towards speech at 18 months after the start of treatment. The amount of treatment hours to reach the (near) zero levels of stuttering will be compared between the different programmes. For families as well as for the health system this could generate important information.

Interventions That Target or Affect Voice or Speech Production During Public Speaking: A Scoping Review.

OBJECTIVES: Public speaking (PS) is frequently necessary in many professional, educational, and personal settings. Mastering this communication skill is particularly important in today's society. Training techniques for PS have been described in the literature. Given that PS anxiety affects performance, especially voice characteristics and speech fluency, the purpose of this scoping review is to examine, map, and narratively summarize the available evidence on PS interventions that target or affect voice or speech. METHODS: An extensive literature search was conducted in three bibliographic databases: Medline ALL/Ovid, PsycINFO/Ovid, and Eric/Ovid. Of the 850 studies identified, 22 met the eligibility criteria, and one was added from the reference lists of the included studies. RESULTS: A total of 23 studies were included. The interventions identified aim to improve speaking skills either by explicitly targeting the voice or speech (direct intervention, n = 15) or by targeting the cognitive, behavioral, psychological, or physical environment impacting the speaker's production (indirect intervention, n = 8). CONCLUSIONS: This scoping review provides the first published methodological summary of the characteristics of existing PS interventions that target or affect voice and speech. Heterogeneous characteristics were observed. Further studies are needed to determine which interventions are most effective.

Predictive factors of the risk of rehospitalization and loss of autonomy in elderly people admitted to the emergency department: a pilot study / Facteurs prédictifs du risque de réhospitalisation et de perte d'autonomie chez des personnes âgées admises aux urgences : une étude pilote.

Introduction: The number of elderly patients admitted to emergency departments (EDs) continues to rise each year. However, due to time and structural constraints, these facilities do not allow for optimal identification of patients at risk of rehospitalization and loss of independence. Objective: To identify the characteristics of patients over the age of 75 discharged from the ED without indications for hospitalization, and to illustrate the importance of advanced practice nurses (APN) in identifying predictive factors of loss of independence. Method: A prospective, single-center, observational pilot study of a cohort of 67 patients in an emergency department. Results: The study allowed the researchers to characterize a female, aging, and vulnerable patient population. Re-evaluation at the six-month mark revealed a functional decline in 23% of patients. Relevant predictive autonomy loss factors including recent cognitive decline, hearing impairment, and weight loss are put forward for future research. Discussion: These results, in line with the findings of previous studies, highlight the potential added value of APNs in indentifying the functional decline within this patient population. Conclusion: Given the diverse, complex, and fragile health condition of elderly patients when discharged from the emergency department, APNs play a key role in improving care and preventing loss of independence within this patient population.

Introduction: Un nombre croissant de personnes âgées sont admises aux urgences chaque année, mais les contraintes temporelles et structurelles de ces services ne permettent pas de repérer de façon optimale les personnes à risque de réhospitalisation et de perte d'autonomie. Objectif: Décrire la population des personnes de plus de 75 ans sortant des urgences sans indication d'hospitalisation, montrer la contribution d'une infirmière en pratique avancée (IPA) en regard des facteurs prédictifs de perte d'autonomie identifiés. Méthode: Étude pilote, prospective, monocentrique, descriptive d'une cohorte de 67 patients, menée aux urgences. Résultats: L'étude a permis de décrire une population féminine, vieillissante et fragile. La réévaluation à six mois a permis d'observer un déclin fonctionnel pour 23 % des patients. Des facteurs prédictifs de perte d'autonomie, pour cette population d'étude, sont proposés. Discussion: Ces résultats, cohérents avec ceux de la littérature, montrent la plus-value que pourrait avoir l'IPA en regard du déclin fonctionnel de cette population. Conclusion: La population âgée des urgences rentrant au domicile étant hétérogène, complexe et fragile, l'intervention d'une IPA a été mise en place pour améliorer la prise en soins des personnes et prévenir leur perte d'autonomie.

Implementing advanced practice nursing in France: A country-wide survey 2 years after its introduction.

OBJECTIVES: To examine the characteristics of the first Advanced Practice Nurses in France and to compare the French model to international standards. BACKGROUND: Common barriers and facilitators to their integration in healthcare provision have been identified internationally. In France, the legislative framework was introduced in 2016, and the first graduates entered the workforce in 2019. METHODS: The French model was examined in comparison with Hamric's conceptual framework and to the International Council of Nurses' guidelines and definitions. A cross-sectional survey was also conducted, using three self-administered online questionnaires. Two were distributed to 2019 and 2020 graduates and a third to the accredited programme directors. The characteristics of advanced practice nursing graduates were described and compared based on employment status and field of practice (primary vs secondary/tertiary care). RESULTS: Although the French model of advanced practice nursing meets Hamric's primary criteria and core competencies, it does not differentiate between Nurse Practitioner and Clinical Nurse Specialist roles. Of the 320 students enrolled in one of the 11 accredited training programmes 165 participated in the survey. Mean age was 40, and mean prior nursing experience was 15 years. By February 2021, 30% of respondents were still employed as Registered Nurses. Barriers to practice included insufficient income generation (primary care), the lack of position creation (secondary/tertiary care), the physician-dependent patient referral process and delays in prescription credentials approval. CONCLUSIONS: The implementation of advanced practice nursing in France faces several barriers. Legislative adjustments and greater financial incentives to practice seem warranted. RELEVANCE TO CLINICAL PRACTICE: as in other countries, France introduced advanced practice nursing to respond to the Public Health challenge of improving access to quality health care in the context of increasing chronic disease prevalence and limited resource allocation. Facilitating its integration in the healthcare provision landscape seems paramount.

Real and virtual classrooms can trigger the same levels of stuttering severity ratings and anxiety in school-age children and adolescents who stutter.

PURPOSE: Many school-age children and adolescents who stutter experience the fear of public speaking. Treatment implications include the need to address this problem. However, it is not always possible to train repeatedly in front of a real audience. The present study aimed to assess the relevance of using a virtual classroom in clinical practice with school-age children and adolescents who stutter. METHODS: Ten children and adolescents who stutter (aged 9-17 years old) had to speak in three different situations: in front of a real audience, in front of a virtual class and in an empty virtual apartment using a head-mounted display. We aimed to assess whether the self-rated levels of anxiety while speaking in front of a virtual audience reflect the levels of anxiety reported while speaking in front of a live audience, and if the stuttering level while speaking to a virtual class reflects the stuttering level while speaking in real conditions. RESULTS: Results show that the real audience creates higher anticipatory anxiety than the virtual class. However, both the self-reported anxiety levels and the stuttering severity ratings when talking in front of a virtual class did not differ from those observed when talking to a real audience, and were significantly higher than when talking in an empty virtual apartment. CONCLUSION: Our results support the feasibility and relevance of using a virtual classroom to expose school-age children and adolescents who stutter to a feared situation during cognitive behavioral therapy targeting the fear of public speaking.

Nurse coordinator roles in the management of patients with hepatocellular carcinoma: A French national survey.

Hepatocellular carcinoma (HCC) mostly occurs in patients with chronic liver disease (CLD). HCC treatment may have a direct impact on CLD prognosis. HCC management can therefore become complex, involving multiple health care providers, such as oncologists, hepatologists, radiologists, and surgeons. In France, dedicated nurses have been involved in patient care pathways. Their impact is poorly documented. PURPOSE: To determine the country-wide distribution of HCC nurse coordinators in French health care settings and to describe their roles and responsibilities. PATIENTS AND METHODS: A survey using a multi-item questionnaire (including center characteristics, nurse coordinator characteristics, and quality indicators such as patient care pathway initiation timeline, scheduled length of hospital stay, diagnostic disclosure process) was conducted. All French liver cancer centers planning to participate in a prospective national cohort study for patients with HCC (CHIEF Cohort) were invited to take part in the survey. Bivariate analysis compared centers with a nurse coordinator to those without. RESULTS: Among the 42 of 72 centers that replied, 14 treated fewer than 75 HCC patients. Treatment mostly took place in hepatology units (34/42). Sixteen nurse coordinators were part of the health care team in 13 of the 42 centers. Among these 13 centers, 11 were university hospitals and 11 followed more than 75 patients per year. The median number of patients followed in these centers was 300 (min-max 44-600) in 2017. All nurse coordinators were involved in providing patient information and counseling. Other roles included treatment monitoring (13/16), care coordination (12/16), psychological support (12/16) and treatment planning (11/16). Thirteen nurse coordinators conducted diagnostic disclosure nurse consultations; seven conducted initial patient contact consultations; and six held outpatient nurse consultations, with wide heterogeneity between centers. The presence of a nurse coordinator was associated with completion of the full diagnostic disclosure process (p = 0.045). CONCLUSION: In France, nurse coordinators for HCC patient pathway management are present mainly in university hepatology units with a caseload of more than 75 patients per year. All provide patient information and counseling but their roles in care coordination, patient support and holistic assessment are heterogeneous and not standardized.

Beyond stuttering: Speech disfluencies in normally fluent French-speaking children at age 4.

The aim of this study was to establish normative data on the speech disfluencies of normally fluent French-speaking children at age 4, an age at which stuttering has begun in 95% of children who stutter (Yairi & Ambrose, 2013). Fifty monolingual French-speaking children who do not stutter participated in the study. Analyses of a conversational speech sample comprising 250-550 words revealed an average of 10% total disfluencies, 2% stuttering-like disfluencies and around 8% non-stuttered disfluencies. Possible explanations for these high speech disfluency frequencies are discussed, including explanations linked to French in particular. The results shed light on the importance of normative data specific to each language.

A Methodology for Concomitant Isolation of Intimal and Adventitial Endothelial Cells from the Human Thoracic Aorta.

BACKGROUND: Aortic diseases are diverse and involve a multiplicity of biological systems in the vascular wall. Aortic dissection, which is usually preceded by aortic aneurysm, is a leading cause of morbidity and mortality in modern societies. Although the endothelium is now known to play an important role in vascular diseases, its contribution to aneurysmal aortic lesions remains largely unknown. The aim of this study was to define a reliable methodology for the isolation of aortic intimal and adventitial endothelial cells in order to throw light on issues relevant to endothelial cell biology in aneurysmal diseases. METHODOLOGY/PRINCIPAL FINDINGS: We set up protocols to isolate endothelial cells from both the intima and the adventitia of human aneurysmal aortic vessel segments. Throughout the procedure, analysis of cell morphology and endothelial markers allowed us to select an endothelial fraction which after two rounds of expansion yielded a population of >90% pure endothelial cells. These cells have the features and functionalities of freshly isolated cells and can be used for biochemical studies. The technique was successfully used for aortic vessel segments of 20 patients and 3 healthy donors. CONCLUSIONS/SIGNIFICANCE: This simple and highly reproducible method allows the simultaneous preparation of reasonably pure primary cultures of intimal and adventitial human endothelial cells, thus providing a reliable source for investigating their biology and involvement in both thoracic aneurysms and other aortic diseases.

Complexity markers in morphosyntactic productions in French-speaking children with specific language impairment (SLI).

The usage-based theory considers that the morphosyntactic productions of children with SLI are particularly dependent on input frequency. When producing complex syntax, the language of these children is, therefore, predicted to have a lower variability and to contain fewer infrequent morphosyntactic markers than that of younger children matched on morphosyntactic abilities. Using a spontaneous language task, the current study compared the complexity of the morphological and structural productions of 20 children with SLI and 20 language-matched peers (matched on both morphosyntactic comprehension and mean length of utterance). As expected, results showed that although basic structures were produced in the same way in both groups, several complex forms (i.e. tenses such as Imperfect, Future or Conditional and Conjunctions) were less frequent in the productions of children with SLI. Finally, we attempted to highlight complex linguistic forms that could be good clinical markers for these children.

The impact of attentional allocation capacities on nonword repetition in children with specific language impairment.

This study aimed at directly assessing the hypothesis that attentional allocation capacity influences poor nonword repetition (NWR) performances in children with specific language impairment (SLI), using an attention demanding visual search task given concurrently with the NWR task. Twenty-one children with SLI, 21 typically developing children matched on age and 21 typically developing children matched on nonword span performed an immediate serial recall task of nonwords. The nonword lists were presented either alone or concurrently with the visual search task. Overall, results revealed a resource-sharing trade-off between the two tasks. Children with SLI were affected to the same extent as their span-matched controls by the necessity to allocate their attentional resources between the two tasks. Interestingly, nonword processing strategies seemed to differ among groups: age-matched controls allocated a larger part of their attentional resources to the encoding stage, whereas nonword recall was more attention demanding in children with SLI and younger controls.

ALK5 and ALK1 play antagonistic roles in transforming growth factor ß-induced podosome formation in aortic endothelial cells.

Transforming growth factor ß (TGF-ß) and related cytokines play a central role in the vascular system. In vitro, TGF-ß induces aortic endothelial cells to assemble subcellular actin-rich structures specialized for matrix degradation called podosomes. To explore further this TGF-ß-specific response and determine in which context podosomes form, ALK5 and ALK1 TGF-ß receptor signaling pathways were investigated in bovine aortic endothelial cells. We report that TGF-ß drives podosome formation through ALK5 and the downstream effectors Smad2 and Smad3. Concurrent TGF-ß-induced ALK1 signaling mitigates ALK5 responses through Smad1. ALK1 signaling induced by BMP9 also antagonizes TGF-ß-induced podosome formation, but this occurs through both Smad1 and Smad5. Whereas ALK1 neutralization brings ALK5 signals to full potency for TGF-ß-induced podosome formation, ALK1 depletion leads to cell disturbances not compatible with podosome assembly. Thus, ALK1 possesses passive and active modalities. Altogether, our results reveal specific features of ALK1 and ALK5 signaling with potential clinical implications.

The sentence repetition task: a powerful diagnostic tool for French children with specific language impairment.

This study assesses the diagnostic accuracy and construct validity of a sentence repetition task that is commonly used for the identification of French children with specific language impairment (SLI). Thirty-four school-aged children with a confirmed, diagnostically based diagnosis of SLI, and 34 control children matched on age and nonverbal abilities performed the sentence repetition task. Two general scoring measures took into account the verbatim repetition of the sentence and the number of words accurately repeated. Moreover, five other scoring measures were applied to their answers in order to separately take into account their respect of lexical items, functional items, syntax, verb morphology, and the general meaning of the sentence. Results show good to high levels of sensitivity and specificity at the three cut-off points for all scoring measures. A principal component analysis revealed two factors. Scoring measures for the respect of functional words, syntax and verb morphology provided the largest loadings to the first factor, while scoring measures for the respect of lexical words and general semantics provided the largest loadings to the second factor. Sentence repetition appears to be a valuable tool to identify SLI in French children, and the ability to repeat sentences correctly is supported by two factors: a morphosyntactic factor and a lexical factor.

Importance of RhoGTPases in formation, characteristics, and functions of invadosomes.

Podosomes and invadopodia (collectively known as invadosomes) are specialized plasma-membrane actin-based microdomains that combine adhesive properties with matrix degrading and/or mechanosensor activities. These organelles have been extensively studied in vitro and current concerted efforts aim at establishing their physiological relevance and subsequent association with human diseases. Proper functioning of the bone, immune, and vascular systems is likely to depend on these structures while their occurrence in cancer cells appears to be linked to tumor metastasis. The elucidation of the mechanisms driving invadosome assembly is a prerequisite to understanding their role in vivo and ultimately to controlling their functions. Adhesive and soluble ligands act via transmembrane receptors that propagate signals to the cytoskeleton via small G proteins of the Rho family, assisted by tyrosine kinases and scaffold proteins to induce invadosome formation and rearrangements. Oncogene expression and cell-cell interactions may also trigger their assembly. Manipulation of the signals that regulate invadosome formation and dynamics could therefore be a strategy to interfere with their functions in a multitude of pathological settings, such as excessive bone breakdown, infections, vascular remodeling, transendothelial diapedesis, and metastasis.

The impact of lexical frequency on sentence comprehension in children with specific language impairment.

Children with SLI generally exhibit poor sentence comprehension skills. We examined the specific impact of grammatical complexity and lexical frequency on comprehension performance, yielding contrasting results. The present study sheds new light on sentence comprehension in children with SLI by investigating a linguistic factor which has attracted little research interest: the impact of the lexical frequency of known words on sentence comprehension. We also examined the impact of grammatical complexity and sentence length by independently varying these two factors. Fifteen children with SLI, 15 age- and IQ-matched controls, and 15 controls matched on lexical and grammatical skills, performed sentence comprehension tasks in which three linguistic factors were manipulated: lexical frequency (sentences containing words of either low or high lexical frequency), grammatical complexity (sentence containing either a subject relative clause or an object relative clause) and sentence length (either short or long sentences). Results indicated that children with SLI performed more poorly overall compared to age- and IQ-matched children and to lexical and morphosyntactic age-matched children. However, their performance was not more affected by either sentence length or clause type than that of control children. Only lexical frequency affected sentence comprehension to a greater extent in children with SLI relative to the control groups, revealing that SLI children's sentence comprehension abilities are particularly affected by the presence of low-frequency but familiar words.

The impact of dual tasking on sentence comprehension in children with specific language impairment.

PURPOSE: In this study, the authors assessed the hypothesis of a limitation in attentional allocation capacity as underlying poor sentence comprehension in children with specific language impairment (SLI). METHOD: Fifteen children with SLI, 15 age-matched controls, and 15 grammar-matched controls participated in the study. Sixty sentences were presented in isolation, and 60 sentences were presented with a concurrent choice reaction time task in which colored stimuli randomly appeared at the center of the computer screen. RESULTS: Sentence comprehension was affected by the dual-task condition to a greater extent in children with SLI relative to age controls but not relative to grammatical controls. CONCLUSION: This study does not support limitations in attentional allocation capacity as representing a core deficit in SLI. Rather, the data show that these children show attentional allocation capacity comparable to that of younger children having similar language level, suggesting that SLI is characterized by a slowed development of both attentional and language domains.

The impact of visual complexity on visual short-term memory in children with specific language impairment.

Many studies have assessed visual short-term memory (VSTM) abilities in children with specific language impairment (SLI), with contrasting results: some studies observed preserved VSTM capacities, while others reported impaired VSTM. The present study explores the hypothesis that the complexity of the visual information to be encoded and stored might underlie these discrepancies. Four VSTM conditions were administered to a group of 15 children with SLI, as well as to two groups of typically developing children, matched for chronological age and for VSTM capacity for visually simple stimuli, respectively. The stimuli to be remembered varied in their visual similarity and in the number of their visual features. Across the four VSTM conditions, children with SLI showed significantly reduced performance relative to an age-matched control group, and they were more strongly affected by visual similarity and number of features when compared to a control group matched for VSTM capacity for visually simple stimuli. The present results support the hypothesis that stimulus complexity is a determining factor of the poor VSTM performances in children with SLI.

Fibrinolytic activity is associated with presence of cystic medial degeneration in aneurysms of the ascending aorta.

AIMS: Thoracic ascending aortic aneurysms (TAA) are characterized by elastic fibre breakdown and cystic medial degeneration within the aortic media, associated with progressive smooth muscle cell (SMC) rarefaction. The transforming growth factor (TGF)-ß/Smad2 signalling pathway is involved in this process. Because the pericellular fibrinolytic system activation is able to degrade adhesive proteins, activate matrix metalloproteinase (MMP), induce SMC disappearance and increase the bioavailability of TGF-ß, the aim was to investigate the plasminergic system in TAA. METHODS AND RESULTS: Ascending aortas [21 controls and 19 TAAs (of three different aetiologies)] were analysed. Immunohistochemistry showed accumulation of t-PA, u-PA and plasmin in TAAs, associated with residual SMCs. Overexpression of t-PA and u-PA was confirmed by reverse transcription-polymerase chain reaction (RT-PCR), immunoblotting and zymography on TAA extracts and culture medium conditioned by TAA. Plasminogen was present on the SMC surface and inside cytoplasmic vesicles, but plasminogen mRNA was undetectable in the TAA medial layer. Plasmin-antiplasmin complexes were detected in TAA-conditioned medium and activation of the fibrinolytic system was associated with increased fibronectin turnover. Fibronectin-related material was detected immunohistochemically in dense clumps around SMCs and colocalized with latent TGF-ß binding protein-1. CONCLUSIONS: The fibrinolytic pathway could play a critical role in TAA progression, via direct or indirect impact on ECM and consecutive modulation of TGF-ß bioavailability.