Oculomotor differences in adults with and without probable developmental coordination disorder.

Adults with Developmental Coordination Disorder (DCD), sometimes referred to as dyspraxia, experience difficulties in motor development and coordination, which impacts on all aspects of their daily lives. Surprisingly little is known about the mechanisms underlying the difficulties they experience in the motor domain. In childhood DCD, aspects of oculomotor control have been shown to be altered. The purpose of this study was to determine whether oculomotor differences are present in adults with and without probable DCD. Visual fixation stability, smooth pursuit, and pro-and anti-saccade performance were assessed in 21 adults (mean age 29 years) with probable DCD/dyspraxia (pDCD) and 21 typically-developing (TD) adults (mean age 21 years). Eye tracking technology revealed that oculomotor response preparation in the pro- and anti-saccade tasks was comparable across groups, as was pursuit gain in the slower of the two smooth pursuit tasks. However, adults with pDCD made significantly more saccades away from the fixation target than those without DCD and significantly more anti-saccade errors. Further, compared to TD adults, adults with pDCD demonstrated difficulties in maintaining engagement and had lower pursuit gain in the faster pursuit task. This suggests that adults with pDCD have problems with saccadic inhibition and maintaining attention on a visual target. Since this pattern of results has also been reported in children with DCD, oculomotor difficulties may be persistent for those with DCD across the lifespan. An awareness of the impact of atypical oculomotor control in activities of daily living across the lifespan would support clearer understanding of the causes and impacts of these difficulties for those with DCD.

Evaluation of the accuracy of the IDvet serological test for Mycoplasma bovis infection in cattle using latent class analysis of paired serum ELISA and quantitative real-time PCR on tonsillar swabs sampled at slaughter.

Mycoplasma bovis (Mbovis) was first detected in cattle in New Zealand (NZ) in July 2017. To prevent further spread, NZ launched a world-first National Eradication Programme in May 2018. Existing diagnostic tests for Mbovis have been applied in countries where Mbovis is endemic, for detecting infection following outbreaks of clinical disease. Diagnostic test evaluation (DTE) under NZ conditions was thus required to inform the Programme. We used Bayesian Latent Class Analysis on paired serum ELISA (ID Screen Mycoplasma bovis Indirect from IDvet) and tonsillar swabs (qPCR) for DTE in the absence of a gold standard. Tested samples were collected at slaughter between June 2018 and November 2019, from infected herds depopulated by the Programme. A first set of models evaluated the detection of active infection, i.e. the presence of Mbovis in the host. At a modified serology positivity threshold of SP%> = 90, estimates of animal-level ELISA sensitivity was 72.8% (95% credible interval 68.5%-77.4%), respectively 97.7% (95% credible interval 97.3%-98.1%) for specificity, while the qPCR sensitivity was 45.2% (95% credible interval 41.0%-49.8%), respectively 99.6% (95% credible interval 99.4%-99.8%) for specificity. In a second set of models, prior information about ELISA specificity was obtained from the National Beef Cattle Surveillance Programme, a population theoretically free-or very low prevalence-of Mbovis. These analyses aimed to evaluate the accuracy of the ELISA test targeting prior exposure to Mbovis, rather than active infection. The specificity of the ELISA for detecting exposure to Mbovis was 99.9% (95% credible interval 99.7%-100.0%), hence near perfect at the threshold SP%=90. This specificity estimate, considerably higher than in the first set of models, was equivalent to the manufacturer's estimate. The corresponding ELISA sensitivity estimate was 66.0% (95% credible interval 62.7%-70.7%). These results confirm that the IDvet ELISA test is an appropriate tool for determining exposure and infection status of herds, both to delimit and confirm the absence of Mbovis.

Acclimation to water stress improves tolerance to heat and freezing in a common alpine grass.

Alpine plants in Australia are increasingly exposed to more frequent drought and heatwaves, with significant consequences for physiological stress responses. Acclimation is a critical feature that allows plants to improve tolerance to environmental extremes by directly altering their physiology or morphology. Yet it is unclear how plant performance, tolerance, and recovery are affected when heat and water stress co-occur, and whether prior exposure affects responses to subsequent climate extremes. We grew a common alpine grass species under high or low watering treatments for three weeks before exposure to either none, one, or two heat stress events. We determined photosynthetic heat and freezing tolerance (LT50, mean temperature causing 50% irreversible damage to photosystem II) and growth. Physiological adjustments to low watering, including more negative water potentials and reduced growth, were also characterised by improved tolerance to high and low-temperature extremes. Shifts to higher heat tolerance were also evident with increasing exposure to heat stress events, though freezing tolerance was not affected. Acclimation effects were mostly short-term, however; prior exposure to heat and/or water stress had little to no effect on growth and thermal tolerance following the six-week recovery period. We conclude that rapid acclimation to water and heat stress that co-occur during summer enhances the capacity of alpine plants to tolerate increasingly frequent temperature extremes.

Survival and growth of a high-mountain daisy transplanted outside its local range, and implications for climate-induced distribution shifts.

Field transplant experiments can improve our understanding of the effects of climate on distributions of plants versus a milieu of biotic factors which may be mediated by climate. We use a transplant experiment to test how survival and growth of a mountain-top daisy (Podolepis robusta), when planted within and outside its current local range, varies as a function of individual plant size, elevation, aspect and the presence of other vegetation. We expected a home-site advantage for the species, with highest survival and growth within the species' current elevational limits, and a decline in vital rates above (due to physiological limitations) and below (due to competition with near-neighbours) these limits. Transplant survival during the beginning of the census was high (89 %), though by the third growing season, 36 % of initial transplants were remaining. Elevation had a significant negative effect on individual mortality rates; plants growing at higher elevations had a lower estimated hazard rate and thus, higher survival relative to those planted at elevations below the current lower limit of the distribution. By contrast, we detected no significant effect of elevation on growth rates. Small vegetation gaps had no effect on growth rates, though we found a negative, but non-significant, effect on mortality rates. Aspect had a very strong impact on growth. Plants transplanted to cool aspects had a significantly lower growth rate relative to transplants growing on a warm aspect. Conversely, aspect was not a significant predictor of individual mortality rates. Restrictions on the local distribution of P. robusta appear to be governed by mortality drivers at lower elevation and by growth drivers associated with aspect. We highlight that our ability to understand the drivers of distributions in current and future climates will be limited if contextual- and individual-level plant responses remain understudied.

Use of MRP8/14 in clinical practice as a predictor of outcome after methotrexate withdrawal in patients with juvenile idiopathic arthritis.

The objective of this study was to determine the effectiveness of MRP8/14 as a predictor of disease flare in patients with juvenile idiopathic arthritis (JIA) following the withdrawal of methotrexate (MTX) in a routine clinical setting. All MRP8/14 tests performed at a single centre in a 27-month period were considered for analysis. Patients were assessed against criteria for inactive disease and subsequent disease flare. Decisions on whether or not to stop treatment were recorded. MRP8/14 results were assessed in conjunction with clinical information. Clinicians were also surveyed to investigate if MRP8/14 influenced their decision to discontinue MTX where this was available at that time point. One hundred four cases met the inclusion criteria during the study period. Although there was no significant difference in flares between patients with an elevated or low MRP8/14 value, in those who stopped MTX (n = 22), no patients with a low MRP8/14 (≤ 4000 ng/ml) result flared (follow-up time 12 months). Clinicians reported that for patients with clinically inactive disease and an elevated MRP8/14 result (> 4000 ng/ml), none would advise withdrawal of MTX. Low MRP8/14 was interpreted favourably when considering stopping MTX treatment in patients with JIA. Implementation of MRP8/14 testing has changed clinical practice at this centre. However, the observation that some patients in our cohort who had an elevated MRP8/14 value did not flare after stopping MTX for non-disease-related reasons highlights the need for further biomarkers to predict the risk of flare off medication in JIA and aid clinicians in treatment decisions. Key Points • First study of serum MRP8/14 measurement in clinical practice to inform treatment decisions in patients with JIA. • No patients with a low MRP8/14 test result went on to suffer a disease flare in 12 months of follow follow-up. • Further biomarkers are needed to predict the risk of flare off medication in JIA and treatment decisions.

Low-fidelity simulation for management of postpartum haemorrhage in a Ghanaian teaching hospital.

We conducted a pre/post study of a post-partum hemorrhage (PPH) simulation exercise at Korle Bu Hospital, using a low-fidelity birthing simulator and questionnaires. We aimed to evaluate low-fidelity simulation as a feasible and effective method of improving resident knowledge and confidence in a low-resource setting. Knowledge and confidence in PPH management were measured before and after using 5-point Likert scales and multiple-choice questions. A feedback survey was administered. Descriptive statistics were calculated to summarize demographics, confidence, and knowledge, with frequencies, means and standard deviations reported. Statistical significance of the change in scores was assessed using paired t tests. Statistically significant improvements in knowledge and confidence in managing PPH were evident following the simulation exercise. All participants agreed the simulation was educational, relevant and realistic, and 94% felt it could be incorporated into their training.

Examining academic confidence and study support needs for university students with dyslexia and/or developmental coordination disorder.

Higher education providers are seeing a shift from externally funded support for students with specific learning difficulties (SpLD), to a need to develop more inclusive practices generally. However, the precise needs of students with different SpLD diagnoses is unknown. A total of 367 students in England and Wales (163 students with dyslexia, 50 students with developmental coordination disorder [DCD/"dyspraxia"], 62 students with dyslexia and DCD, and 92 non-SpLD students) completed an online questionnaire to determine: (a) how confident they are with their study-related capabilities, (b) the types of support they access, and (c) their views on current inclusive practices. Students with dyslexia and students with dyslexia/DCD reported lower confidence in their grades and studying than non-SpLD students, and accessed more technology-related support than students with DCD only. Examination accommodations supporting writing were common for all SpLD students. Inclusive practices were perceived positively, although different priorities were seen across groups. The findings demonstrate the complexities inherent in providing effective support for all students at university, with the varied profiles across and within SpLD groups suggesting that an individualized approach is necessary. Practical implications are discussed.

Overcoming the hurdles: Understanding motivation and supporting adult learners with poor literacy and dyslexia in the homelessness sector.

Literacy difficulties are often reported by adults with experience of homelessness. Yet, research on their learning experiences and clarity on how best to support this group is lacking. The present study explored the experience of homeless literacy learners (HLLs) and asked what motivated them to engage with literacy support and the teaching-related factors perceived to be most effective. Semi-structured interviews were conducted with 10 HLLs (aged 31-68) engaged in literacy provision at a homelessness charity in the United Kingdom. Thematic analysis of the data revealed five key themes: challenging early experiences; barriers to improving literacy; the perceived impact of poor literacy; current motivation to improve literacy; and approaches that support literacy in adulthood. A significant majority of HLLs reported early traumatic learning experiences and 7 out of 10 (70%) disclosed a diagnosis of dyslexia. Specialist dyslexia support was reported to help HLLs feel understood and positive relationships with teachers helped self-esteem and self-efficacy related to their literacy learning. Recommendations are made for specialist teachers to be made more readily available to support HLLs, as well as to advise service providers and professionals engaging with adult learners with experience of homelessness across the sector.

Writing and Revision Strategies of Students With and Without Dyslexia.

Previous work suggests that written text produced by university students with dyslexia is scored lower than that produced by their peers. The present study used a digital writing tablet to examine the writing process and the quality of text written by university students with dyslexia. Revision behavior during and after writing was also investigated. Thirty-two university students with dyslexia (mean age, 20 years), were compared with 32 typically developing (TD) students matched by age. Students composed a written text in response to an expository essay prompt. In line with previous research, students with dyslexia made a higher number of spelling errors and their essays were rated as poorer than TD students. However, students with dyslexia were comparable to their peers on measures of time spent writing, amount of text produced, and the temporal analyses (handwriting execution, pause times). Students with dyslexia made significantly more revisions to spelling during and after transcription than their peers, although other revision behavior was similar across groups. Explanations for the finding of poor writing quality are explored. Importantly, the findings suggest that continued support with spelling and writing is needed for university students with dyslexia. Instruction directed toward effective revision strategies may also prove useful. Limitations and directions for future research are discussed.

Comparing Attention to Socially-Relevant Stimuli in Autism Spectrum Disorder and Developmental Coordination Disorder.

Difficulties with social interaction have been reported in both children with an autism spectrum disorder (ASD) and children with developmental coordination disorder (DCD), although these disorders have very different diagnostic characteristics. To date, assessment of social skills in a DCD population has been limited to paper-based assessment or parent report. The present study employed eye tracking methodology to examine how children attend to socially-relevant stimuli, comparing 28 children with DCD, 28 children with ASD and 26 typically-developing (TD) age-matched controls (aged 7-10). Eye movements were recorded while children viewed 30 images, half of which were classed as 'Individual' (one person in the scene, direct gaze) and the other half were 'Social' (more naturalistic scenes showing an interaction). Children with ASD spent significantly less time looking at the face/eye regions in the images than TD children, but children with DCD performed between the ASD and TD groups in this respect. Children with DCD demonstrated a reduced tendency to follow gaze, in comparison to the ASD group. Our findings confirm that social atypicalities are present in both ASD and to a lesser extent DCD, but follow a different pattern. Future research would benefit from considering the developmental nature of the observed findings and their implications for support.

Oculomotor atypicalities in Developmental Coordination Disorder.

Children with Developmental Coordination Disorder (DCD) fail to acquire adequate motor skill, yet surprisingly little is known about the oculomotor system in DCD. Successful completion of motor tasks is supported by accurate visual feedback. The purpose of this study was to determine whether any oculomotor differences can distinguish between children with and without a motor impairment. Using eye tracking technology, visual fixation, smooth pursuit, and pro- and anti-saccade performance were assessed in 77 children that formed three groups: children with DCD (aged 7-10), chronologically age (CA) matched peers, and a motor-match (MM) group (aged 4-7). Pursuit gain and response preparation in the pro- and anti-saccade tasks were comparable across groups. Compared to age controls, children with DCD had deficits in maintaining engagement in the fixation and pursuit tasks, and made more anti-saccade errors. The two typically developing groups performed similarly, except on the fast speed smooth pursuit and antisaccade tasks, where the CA group outperformed the younger MM group. The findings suggest that children with DCD have problems with saccadic inhibition and maintaining attention on a visual target. Developmental patterns were evident in the typically developing groups, suggesting that the pursuit system and cognitive control develop with age. This study adds to the literature by being the first to systematically identify specific oculomotor differences between children with and without a motor impairment. Further examination of oculomotor control may help to identify underlying processes contributing to DCD. A video abstract of this article can be viewed at: https://youtu.be/NinXa2KlB4M. [Correction added on 27 January 2017, after first online publication: The video abstract link was added.].

Emotional and behavioural problems in children with Developmental Coordination Disorder: Exploring parent and teacher reports.

BACKGROUND: Although characterised by motor impairments, children with Developmental Coordination Disorder (DCD) also show high rates of psychopathology (anxiety, depression, low self-esteem). Such findings have led to calls for the screening of mental health problems in this group. AIMS: To investigate patterns and profiles of emotional and behavioural problems in children with and without DCD, using the Strengths and Difficulties Questionnaire (SDQ). METHODS AND PROCEDURES: Teachers and parents completed SDQs for 30 children with DCD (7-10 years). Teacher ratings on the SDQ were also obtained from two typically-developing (TD) groups: 35 children matched for chronological age, and 29 younger children (4-7 years) matched by motor ability. OUTCOMES AND RESULTS: Group and individual analyses compared parent and teacher SDQ scores for children with DCD. Teacher reports showed that children with DCD displayed higher rates of emotional and behavioural problems (overall, and on each subscale of the SDQ) relative to their TD peers. No differences were observed between the two TD groups. Inspection of individual data points highlighted variability in the SDQ scores of the DCD group (across both teacher and parent ratings), with suggestions of elevated hyperactivity but comparably lower levels of conduct problems across this sample. Modest agreement was found between teacher and parent ratings of children with DCD on the SDQ. CONCLUSIONS AND IMPLICATIONS: There is a need to monitor levels of emotional and behavioural problems in children with DCD, from multiple informants.

Oncocytic adrenocortical carcinoma: a rare adrenal tumor subtype.

Oncocytic tumors arising from the adrenal gland are rare. Oncocytic adrenal neoplasms (OAN) may mimic adrenocortical carcinoma (ACC) at presentation, and can only be definitively diagnosed histologically. Most OANs are benign, and carry a favorable prognosis. We report on an 83-year-old female who, while being investigated for anemia and weight loss, was found to have a 23 cm adrenal mass concerning for ACC. Adrenalectomy and histopathology confirmed a malignant OAN, based on the Lin-Weiss-Bisceglia criteria. We report on the largest non-functional, malignant OAN cited in the literature to date. OAN's, though rare, can be considered in the differential diagnosis of large adrenal tumors.

Wheelchair donation in a low-resources setting: Utilization, challenges and benefits of wheelchairs provided through a specialized seating programme in Haiti.

OBJECTIVE: To describe a 6-month follow-up of a specialized paediatric wheelchair and seating programme in Haiti. DESIGN: Descriptive design using a structured survey and open-ended questions. METHODS: Concurrent with a seating and wheelchair programme conducted in northern Haiti, beneficiaries and their families were introduced to the study, and 86 of 91 consented to future contact. A survey was developed with input from international and local partners, and administered by face-to-face or telephone interviews. Donated wheelchairs were assessed in 5 categories: wheelchair utilization, maintenance, fit, environmental access, and perceived benefits of wheelchair use. RESULTS: A total of 57 beneficiaries (age range < 2-31 years) were located 6 months after receiving their custom-fit wheelchair and consented to the survey. All respondents still had the wheelchair, 70.2% were using it a minimum of 3-5 days/week, 17.5% were using it < 3 days/week and 12.3% were not using it at all. Primary reasons for not using the wheelchair were that it was broken, uncomfortable, or difficult to transport. The commonly reported benefits were improved mobility, independence, participation and social interaction. CONCLUSION: The majority of people who received customized wheelchairs continued to use their equipment 6 months later, with predominantly beneficial outcomes. In future seating initiatives in low-resource settings, efforts to optimize equipment durability and training of local technicians should be supported and evaluated.

Examining the cognitive profile of children with Developmental Coordination Disorder.

BACKGROUND: While primarily a motor disorder, research considering the cognitive abilities in children with Developmental Coordination Disorder (DCD) is limited; even though these children often struggle academically. AIMS: The present study aimed to characterise the IQ profile of children with and without DCD, and to identify whether children with DCD exhibit specific cognitive weaknesses. METHODS AND PROCEDURES: 104 children participated in the study. Fifty-two children (mean age, 9 years) with a diagnosis of DCD were matched to 52 typically-developing children by age and gender. Cognitive ability was assessed using the Wechsler Intelligence Scale for Children (WISC-IV). OUTCOMES AND RESULTS: Children with DCD performed poorer than their peers on processing speed and working memory measures. Individual analyses revealed varied performance in the DCD group across all cognitive indices, despite displaying Full-Scale IQs in the typical range. Discriminant function analyses show processing speed and working memory performance predicted only 23% of between-group variability. CONCLUSIONS: Children with DCD present with a heterogeneous cognitive profile, lending support to individual case analyses in research and when designing educational assistance plans. The motorically-demanding nature of the WISC-IV processing speed tasks raises specific concerns about using this index of the IQ assessment in this population. Research and practical implications are raised.

Overlapping Phenotypes in Autism Spectrum Disorder and Developmental Coordination Disorder: A Cross-Syndrome Comparison of Motor and Social Skills.

Motor and social difficulties are often found in children with an autism spectrum disorder (ASD) and with developmental coordination disorder (DCD), to varying degrees. This study investigated the extent of overlap of these problems in children aged 7-10 years who had a diagnosis of either ASD or DCD, compared to typically-developing controls. Children completed motor and face processing assessments. Parents completed questionnaires concerning their child's early motor and current motor and social skills. There was considerable overlap between the ASD and DCD groups on the motor and social assessments, with both groups more impaired than controls. Furthermore, motor skill predicted social functioning for both groups. Future research should consider the relationships between core symptoms and their consequences in other domains.

The Influence of Spelling Ability on Vocabulary Choices When Writing for Children With Dyslexia.

Spelling is a prerequisite to expressing vocabulary in writing. Research has shown that children with dyslexia are hesitant spellers when composing. This study aimed to determine whether the hesitant spelling of children with dyslexia, evidenced by frequent pausing, affects vocabulary choices when writing. A total of 31 children with dyslexia, mean age 9 years, were compared to typically developing groups of children: the first matched by age, the second by spelling ability. Oral vocabulary was measured and children completed a written and verbal compositional task. Lexical diversity comparisons were made across written and verbal compositions to highlight the constraint of having to select and spell words. A digital writing tablet recorded the writing. Children with dyslexia and the spelling-ability group made a high proportion of spelling errors and within-word pauses, and had a lower lexical diversity within their written compositions compared to their verbal compositions. The age-matched peers demonstrated the opposite pattern. Spelling ability and pausing predicted 53% of the variance in written lexical diversity of children with dyslexia, demonstrating the link between spelling and vocabulary when writing. Oral language skills had no effect. Lexical diversity correlated with written and verbal text quality for all groups. Practical implications are discussed and related to writing models.

The influence of spelling ability on handwriting production: children with and without dyslexia.

Current models of writing do not sufficiently address the complex relationship between the 2 transcription skills: spelling and handwriting. For children with dyslexia and beginning writers, it is conceivable that spelling ability will influence rate of handwriting production. Our aim in this study was to examine execution speed and temporal characteristics of handwriting when completing sentence-copying tasks that are free from composing demands and to determine the predictive value of spelling, pausing, and motor skill on handwriting production. Thirty-one children with dyslexia (Mage = 9 years 4 months) were compared with age-matched and spelling-ability matched children (Mage = 6 years 6 months). A digital writing tablet and Eye and Pen software were used to analyze handwriting. Children with dyslexia were able to execute handwriting at the same speed as the age-matched peers. However, they wrote less overall and paused more frequently while writing, especially within words. Combined spelling ability and within-word pausing accounted for over 76% of the variance in handwriting production of children with dyslexia, demonstrating that productivity relies on spelling capabilities. Motor skill did not significantly predict any additional variance in handwriting production. Reading ability predicted performance of the age-matched group, and pausing predicted performance for the spelling-ability group. The findings from the digital writing tablet highlight the interactive relationship between the transcription skills and how, if spelling is not fully automatized, it can constrain the rate of handwriting production. Practical implications are also addressed, emphasizing the need for more consideration to be given to what common handwriting tasks are assessing as a whole.