Piperacillin/tazobactam versus cefepime or carbapenems for cefoxitin-non-susceptible Enterobacter cloacae, Klebsiella aerogenes, Citrobacter freundii, Serratia marcescens and Morganella morganii bacteraemia in immunocompromised patients.

BACKGROUND: The role of piperacillin/tazobactam for treatment of serious infections due to AmpC-producing organisms remains debatable, particularly in immunocompromised patients. METHODS: This was a retrospective cohort study in immunocompromised patients that investigated the effect of definitive treatment with either piperacillin/tazobactam versus cefepime or carbapenems for bacteraemia caused by cefoxitin-non-susceptible Enterobacterales. The primary endpoint was a composite of clinical and microbiological failure. A logistic regression model was constructed to assess the impact of definitive treatment choice on the primary endpoint. RESULTS: A total of 81 immunocompromised patients with blood cultures positive for cefoxitin-non-susceptible Enterobacterales were included for analysis. There was more microbiological failure in the piperacillin/tazobactam arm compared with the cefepime/carbapenem arm (11.4% versus 0.0%, P = 0.019). Definitive treatment with cefepime or a carbapenem was associated with a decreased odds of clinical or microbiological failure (OR 0.303, 95% CI 0.093-0.991, P = 0.048) when controlling for baseline characteristics. CONCLUSIONS: In immunocompromised patients with bacteraemia due to cefoxitin-non-susceptible Enterobacterales, definitive treatment with piperacillin/tazobactam was associated with an increased risk of microbiological failure and higher odds of clinical or microbiological failure compared with cefepime or carbapenems.

What affects gestural learning in children with and without Autism? The role of prior knowledge and imitation.

The present study examined whether prior knowledge to the learning target and imitation during learning affected learning outcomes in preschool children with autism spectrum disorder (ASD, N = 22) compared to their typically developing (TD, N = 15) peers. Children's gestural skills in recognizing and producing the target gestures before and after the training, as well as their imitative behavior during the training were coded. Results showed that consistent prior knowledge benefited gestural learning in both groups. Besides, only children with ASD were hindered by inconsistent prior knowledge. Notably, the effect of imitation was not significant in the ASD group. In conclusion, the learning process in children with ASD may differ from those with typical development, suggesting special-designed interventions are required.

Gestures in Storytelling by Preschool Chinese-Speaking Children With and Without Autism.

Previous findings on gestural impairment in autism are inconsistent, while scant evidence came from Chinese-speaking individuals. In the present study, preschool Chinese-speaking children with typical development and with autism were asked to generate stories from a set of wordless Cartoon pictures. Two groups were matched in chronological age and language developmental age. Their speech and gestures were coded. Compared to children with typical development, children with autism produced fewer gestures and showed lower gesture rate. Besides, children with autism produced fewer emblems and fewer supplementary gestures compared to their TD peers. Unlike children with typical development, children with autism tend to produce emblems for reinforcing, rather than supplementing information not conveyed in speech. Results showed the impairments in integrating the cross-modal semantic information in children with autism.

Who is a better teacher for children with autism? Comparison of learning outcomes between robot-based and human-based interventions in gestural production and recognition.

BACKGROUND: Individuals with autism spectrum disorder (ASD) tend to show deficits in engaging with humans. Previous findings have shown that robot-based training improves the gestural recognition and production of children with ASD. It is not known whether social robots perform better than human therapists in teaching children with ASD. AIMS: The present study aims to compare the learning outcomes in children with ASD and intellectual disabilities from robot-based intervention on gestural use to those from human-based intervention. METHODS AND PROCEDURES: Children aged six to 12 with low-functioning autism were randomly assigned to the robot group (N = 12) and human group (N = 11). In both groups, human experimenters or social robots engaged in daily life conversations and demonstrated to children 14 intransitive gestures in a highly-structured and standardized intervention protocol. OUTCOMES AND RESULTS: Children with ASD in the human group were as likely to recognize gestures and produce them accurately as those in the robot group in both training and new conversations. Their learning outcomes maintained for at least two weeks. CONCLUSIONS AND IMPLICATIONS: The social cues found in the human-based intervention might not influence gestural learning. It does not matter who serves as teaching agents when the lessons are highly structured.

Experience of Stress and Coping Strategies among Pastors' Wives in China.

A qualitative study was conducted to examine the experience of stress and coping strategies among 15 pastors' wives from a city in mainland China. Results indicated that nearly all interviewees experienced financial stress and loneliness, a phenomenon consistent with that seen in literature in the West. However, stress arising from role expectations among the spouses' congregations was low. Most interviewees coped with stress through family and social support, as well as through praying.

Robot-based intervention may reduce delay in the production of intransitive gestures in Chinese-speaking preschoolers with autism spectrum disorder.

Background: Past studies have shown that robot-based intervention was effective in improving gestural use in children with autism spectrum disorders (ASD). The present study examined whether children with ASD could catch up to the level of gestural production found in age-matched children with typical development and whether they showed an increase in verbal imitation after the completion of robot-based training. We also explored the cognitive and motor skills associated with gestural learning. Methods: Children with ASD were randomly assigned to two groups. Four- to 6-year-old children with ASD in the intervention group (N = 15) received four 30-min robot-based gestural training sessions. In each session, a social robot, NAO, narrated five stories and gestured (e.g., both hands clapping for an awesome expression). Children with ASD were told to imitate the gestures during training. Age-matched children with ASD in the wait-list control group (N = 15) and age-matched children with typical development (N = 15) received the gestural training after the completion of research. Standardized pretests and posttests (both immediate and delayed) were administered to assess the accuracy and appropriateness of gestural production in both training and novel stories. Children's language and communication abilities, gestural recognition skills, fine motor proficiencies, and attention skills were also examined. Results: Children with ASD in the intervention condition were more likely to produce accurate or appropriate intransitive gestures in training and novel stories than those in the wait-list control. The positive learning outcomes were maintained in the delayed posttests. The level of gestural production accuracy in children with ASD in the delayed posttest of novel stories was comparable to that in children with typical development, suggesting that children with ASD could catch up to the level of gestural production found in children with typical development. Children with ASD in the intervention condition were also more likely to produce verbal markers while gesturing than those in the wait-list control. Gestural recognition skills were found to significantly predict the learning of gestural production accuracy in the children with ASD, with such relation partially mediated via spontaneous imitation. Conclusions: Robot-based intervention may reduce the gestural delay in children with ASD in their early childhood.

Absence of delay in spontaneous use of gestures in spoken narratives among children with Autism Spectrum Disorders.

BACKGROUND: Gestures are spontaneous hand movements produced when speaking. Despite gestures being of communicative significance, little is known about the gestural production in spoken narratives in six- to 12-year-old children with Autism Spectrum Disorders (ASD). AIMS: The present study examined whether six- to 12-year-old children with ASD have a delay in gestural production in a spoken narrative task, in comparison to their typically-developing (TD) peers. METHODS AND PROCEDURES: Six- to-12-year-old children with ASD (N=14) and their age- and IQ-matched TD peers (N=12) narrated a story, which could elicit spontaneous speech and gestures. Their speech and gestures were then transcribed and coded. OUTCOMES AND RESULTS: Both groups of children had comparable expressive language skills. Children with ASD produced a similar number of pointing and marker gestures to TD children and significantly more iconic gestures in their spoken narratives. While children with ASD produced more reinforcing gestures than their TD counterparts, both groups of children produced comparable numbers of disambiguating and supplementary gestures. CONCLUSIONS: Our findings indicate that children with ASD may be as capable as TD children in gestural production when they engage in spoken narratives, which gives them spontaneity in producing gestures.

Using a social robot to teach gestural recognition and production in children with autism spectrum disorders.

While it has been argued that children with autism spectrum disorders are responsive to robot-like toys, very little research has examined the impact of robot-based intervention on gesture use. These children have delayed gestural development. We used a social robot in two phases to teach them to recognize and produce eight pantomime gestures that expressed feelings and needs. Compared to the children in the wait-list control group (N = 6), those in the intervention group (N = 7) were more likely to recognize gestures and to gesture accurately in trained and untrained scenarios. They also generalized the acquired recognition (but not production) skills to human-to-human interaction. The benefits and limitations of robot-based intervention for gestural learning were highlighted. Implications for Rehabilitation Compared to typically-developing children, children with autism spectrum disorders have delayed development of gesture comprehension and production. Robot-based intervention program was developed to teach children with autism spectrum disorders recognition (Phase I) and production (Phase II) of eight pantomime gestures that expressed feelings and needs. Children in the intervention group (but not in the wait-list control group) were able to recognize more gestures in both trained and untrained scenarios and generalize the acquired gestural recognition skills to human-to-human interaction. Similar findings were reported for gestural production except that there was no strong evidence showing children in the intervention group could produce gestures accurately in human-to-human interaction.

Gesture is more effective than spatial language in encoding spatial information.

The present research investigates whether producing gestures with and without speech facilitates route learning at different levels of route complexity and in learners with different levels of spatial skills. It also examines whether the facilitation effect of gesture is stronger than that of spatial language. Adults studied routes with 10, 13, and 16 steps and reconstructed them with sticks, either without rehearsal or after rehearsal by producing gestures with speech, gestures alone, or speech only. For all levels of route complexity and spatial skills, participants who were encouraged to gesture (with or without speech) during rehearsal had the best recall. Additionally, we found that number of steps rehearsed in gesture, but not that rehearsed in speech, predicted the recall accuracy. Thus, gesture is more effective than spatial language in encoding spatial information, and thereby enhancing spatial recall. These results further corroborate the beneficial nature of gesture in processing spatial information.

The development of co-speech gesture and its semantic integration with speech in 6- to 12-year-old children with autism spectrum disorders.

Previous work leaves open the question of whether children with autism spectrum disorders aged 6-12 years have delay in producing gestures compared to their typically developing peers. This study examined gestural production among school-aged children in a naturalistic context and how their gestures are semantically related to the accompanying speech. Delay in gestural production was found in children with autism spectrum disorders through their middle to late childhood. Compared to their typically developing counterparts, children with autism spectrum disorders gestured less often and used fewer types of gestures, in particular markers, which carry culture-specific meaning. Typically developing children's gestural production was related to language and cognitive skills, but among children with autism spectrum disorders, gestural production was more strongly related to the severity of socio-communicative impairment. Gesture impairment also included the failure to integrate speech with gesture: in particular, supplementary gestures are absent in children with autism spectrum disorders. The findings extend our understanding of gestural production in school-aged children with autism spectrum disorders during spontaneous interaction. The results can help guide new therapies for gestural production for children with autism spectrum disorders in middle and late childhood.