Understanding and Addressing the Individualized Emotional Impact of Aphasia: A Framework for Speech-Language Pathologists.

Emotion plays an integral role in communication and has long been considered relevant to aphasia rehabilitation. Speech-language pathologists (SLPs), however, may sometimes wonder how or whether to address emotional responses. The purpose of this article was to (1) present a framework that clinicians can use to understand individualized emotional responses in aphasia and (2) discuss examples of how the framework informs practical strategies that SLPs can use to provide emotional support to people with aphasia (PWA). Drawing upon a cognitive-motivational-relational theory of emotions perspective combined with emerging research in aphasia, I show that emotion impacts and is impacted by both language processing and social participation, but this impact should be interpreted in light of individual variability. Personal characteristics, environmental conditions, and cognitive appraisal, considered within a specific cultural context, help account for individualized emotional responses. SLPs should consider interactions among emotional response, language processing, and social participation in aphasia while recognizing each person's unique perception of the situation and resources to cope with it. Additionally, the presented framework provides insights about how SLPs could offer emotional support to PWA. Specific examples related to harnessing situational demands to improve communication, employing active listening, facilitating reappraisal, and strengthening social support are discussed.

Prehospital Predictors of Atypical STEMI Symptoms.

Introduction: Rapid prehospital identification of patients with ST-elevation myocardial infarction (STEMI) is a critical step to reduce time to treatment. Broad screening with field 12-lead ECGs can lead to a high rate of false positive STEMI activations due to low prevalence. One strategy to reduce false positive STEMI interpretations is to limit acquisition of 12-lead ECGs to patients who have symptoms strongly suggestive of STEMI, but this may delay care in patients who present atypically and lead to disparities in populations with more atypical presentations. We sought to assess patient factors associated with atypical STEMI presentation.Methods: We retrospectively analyzed consecutive adult patients for whom Los Angeles Fire Department paramedics obtained a field 12-lead ECG from July 2011 through June 2012. The regional STEMI receiving center registry was used to identify patients with STEMI. Patients were designated as having typical symptoms if paramedics documented provider impressions of chest pain/discomfort, cardiac arrest, or cardiac symptoms, otherwise they were designated as having atypical symptoms. We utilized logistic regression to determine patient factors (age, sex, race) associated with atypical STEMI presentation.Results: Of the 586 patients who had STEMI, 70% were male, 43% White, 16% Black, 20% Hispanic, 5% Asian and 16% were other or unspecified race. Twenty percent of STEMI patients (n = 117) had atypical symptoms. Women who had STEMI were older than men (74 years [IQR 62-83] vs. 60 years [IQR 53-70], p < 0.001). Univariate predictors of atypical symptoms were older age and female sex (p < 0.0001), while in multivariable analysis older age [odd ratio (OR) 1.05 per year, [95%CI 1.04-1.07, p < 0.0001] and black race (OR vs White 2.18, [95%CI 1.20-3.97], p = 0.011) were associated with atypical presentation.Conclusion: Limiting prehospital acquisition of 12-lead ECGs to patients with typical STEMI symptoms would result in one in five patients with STEMI having delayed recognition, disproportionally impacting patients of older age, women, and Black patients. Age, not sex, may be a better predictor of atypical STEMI presentation.

Automated Speech Recognition in Adult Stroke Survivors: Comparing Human and Computer Transcriptions.

OBJECTIVE: Speech sound errors are common in people with a variety of communication disorders and can result in impaired message transmission to listeners. Valid and reliable metrics exist to quantify this problem, but they are rarely used in clinical settings due to the time-intensive nature of speech transcription by humans. Automated speech recognition (ASR) technologies have advanced substantially in recent years, enabling them to serve as realistic proxies for human listeners. This study aimed to determine how closely transcription scores from human listeners correspond to scores from an ASR system. PATIENTS AND METHODS: Sentence recordings from 10 stroke survivors with aphasia and apraxia of speech were transcribed orthographically by 3 listeners and a web-based ASR service. Adjusted transcription scores were calculated for all samples based on accuracy of transcribed content words. RESULTS: As expected, transcription scores were significantly higher for the humans than for ASR. However, intraclass correlations revealed excellent agreement among the humans and ASR systems, and the systematically lower scores for computer speech recognition were effectively equalized simply by adding the regression intercept. CONCLUSIONS: The results suggest the clinical feasibility of supplementing or substituting human transcriptions with computer-generated scores, though extension to other speech disorders requires further research.

Safety and Outcomes in 100 Consecutive Donation After Circulatory Death Liver Transplants Using a Protocol That Includes Thrombolytic Therapy.

Donation after circulatory death (DCD) liver transplantation (LT) reportedly yields inferior survival and increased complication rates compared with donation after brain death (DBD). We compare 100 consecutive DCD LT using a protocol that includes thrombolytic therapy (late DCD group) to an historical DCD group (early DCD group n = 38) and a cohort of DBD LT recipients (DBD group n = 435). Late DCD LT recipients had better 1- and 3-year graft survival rates than early DCD LT recipients (92% vs. 76.3%, p = 0.03 and 91.4% vs. 73.7%, p = 0.01). Late DCD graft survival rates were comparable to those of the DBD group (92% vs. 93.3%, p = 0.24 and 91.4% vs. 88.2%, p = 0.62). Re-transplantation occurred in 18.4% versus 1% for the early and late DCD groups, respectively (p = 0.001). Patient survival was similar in all three groups. Ischemic-type biliary lesions (ITBL) occurred in 5%, 3%, and 0.2% for early DCD, late DCD, and DBD groups, respectively, but unlike in the early DCD group, in the late DCD group ITBL was endoscopically managed and resolved in each case. Using a protocol that includes a thrombolytic therapy, DCD LT yielded patient and graft survival rates comparable to DBD LT.

Blockade of CaMKII depresses conduction preferentially in the right ventricular outflow tract and promotes ischemic ventricular fibrillation in the rabbit heart.

Calcium/calmodulin-dependent protein kinase II (CaMKII) regulates the principle ion channels mediating cardiac excitability and conduction, but how this regulation translates to the normal and ischemic heart remains unknown. Diverging results on CaMKII regulation of Na+ channels further prevent predicting how CaMKII activity regulates excitability and conduction in the intact heart. To address this deficiency, we tested the effects of the CaMKII blocker KN93 (1 and 2.75 µM) and its inactive analog KN92 (2.75 µM) on conduction and excitability in the left (LV) and right (RV) ventricles of rabbit hearts during normal perfusion and global ischemia. We used optical mapping to determine local conduction delays and the optical action potential (OAP) upstroke velocity (dV/dtmax). At baseline, local conduction delays were similar between RV and LV, whereas the OAP dV/dtmax was lower in RV than in LV. At 2.75 µM, KN93 heterogeneously slowed conduction and reduced dV/dtmax, with the largest effect in the RV outflow tract (RVOT). This effect was further exacerbated by ischemia, leading to recurrent conduction block in the RVOT and early ventricular fibrillation (at 6.7 ± 0.9 vs. 18.2 ± 0.8 min of ischemia in control, P < 0.0001). Neither KN92 nor 1 µM KN93 depressed OAP dV/dtmax or conduction. Rabbit cardiomyocytes isolated from RVOT exhibited a significantly lower dV/dtmax than those isolated from the LV. KN93 (2.75 µM) significantly reduced dV/dtmax in cells from both locations. This led to frequency-dependent intermittent activation failure occurring predominantly in RVOT cells. Thus CaMKII blockade exacerbates intrinsically lower excitability in the RVOT, which is proarrhythmic during ischemia.NEW & NOTEWORTHY We show that calcium/calmodulin-dependent protein kinase II (CaMKII) blockade exacerbates intrinsically lower excitability in the right ventricular outflow tract, which causes highly nonuniform chamber-specific slowing of conduction and facilitates ventricular fibrillation during ischemia. Constitutive CaMKII activity is necessary for uniform and safe ventricular conduction, and CaMKII block is potentially proarrhythmic.

Causes of Prehospital Misinterpretations of ST Elevation Myocardial Infarction.

OBJECTIVES: To determine the causes of software misinterpretation of ST elevation myocardial infarction (STEMI) compared to clinically identified STEMI to identify opportunities to improve prehospital STEMI identification. METHODS: We compared ECGs acquired from July 2011 through June 2012 using the LIFEPAK 15 on adult patients transported by the Los Angeles Fire Department. Cases included patients ≥18 years who received a prehospital ECG. Software interpretation of the ECG (STEMI or not) was compared with data in the regional EMS registry to classify the interpretation as true positive (TP), true negative (TN), false positive (FP), or false negative (FN). For cases where classification was not possible using registry data, 3 blinded cardiologists interpreted the ECG. Each discordance was subsequently reviewed to determine the likely cause of misclassification. The cardiologists independently reviewed a sample of these discordant ECGs and the causes of misclassification were updated in an iterative fashion. RESULTS: Of 44,611 cases, 50% were male (median age 65; inter-quartile range 52-80). Cases were classified as 482 (1.1%) TP, 711 (1.6%) FP, 43371 (97.2%) TN, and 47 (0.11%) FN. Of the 711 classified as FP, 126 (18%) were considered appropriate for, though did not undergo, emergent coronary angiography, because the ECG showed definite (52 cases) or borderline (65 cases) ischemic ST elevation, a STEMI equivalent (5 cases) or ST-elevation due to vasospasm (4 cases). The sensitivity was 92.8% [95% CI 90.6, 94.7%] and the specificity 98.7% [95% CI 98.6, 98.8%]. The leading causes of FP were ECG artifact (20%), early repolarization (16%), probable pericarditis/myocarditis (13%), indeterminate (12%), left ventricular hypertrophy (8%), and right bundle branch block (5%). There were 18 additional reasons for FP interpretation (<4% each). The leading causes of FN were borderline ST-segment elevations less than the algorithm threshold (40%) and tall T waves reducing the ST/T ratio below threshold (15%). There were 11 additional reasons for FN interpretation occurring ≤3 times each. CONCLUSION: The leading causes of FP automated interpretation of STEMI were ECG artifact and non-ischemic causes of ST-segment elevation. FN were rare and were related to ST-segment elevation or ST/T ratio that did not meet the software algorithm threshold.

Whole-Genome Sequencing Analysis Accurately Predicts Antimicrobial Resistance Phenotypes in Campylobacter spp.

The objectives of this study were to identify antimicrobial resistance genotypes for Campylobacter and to evaluate the correlation between resistance phenotypes and genotypes using in vitro antimicrobial susceptibility testing and whole-genome sequencing (WGS). A total of 114 Campylobacter species isolates (82 C. coli and 32 C. jejuni) obtained from 2000 to 2013 from humans, retail meats, and cecal samples from food production animals in the United States as part of the National Antimicrobial Resistance Monitoring System were selected for study. Resistance phenotypes were determined using broth microdilution of nine antimicrobials. Genomic DNA was sequenced using the Illumina MiSeq platform, and resistance genotypes were identified using assembled WGS sequences through blastx analysis. Eighteen resistance genes, including tet(O), blaOXA-61, catA, lnu(C), aph(2″)-Ib, aph(2″)-Ic, aph(2')-If, aph(2″)-Ig, aph(2″)-Ih, aac(6')-Ie-aph(2″)-Ia, aac(6')-Ie-aph(2″)-If, aac(6')-Im, aadE, sat4, ant(6'), aad9, aph(3')-Ic, and aph(3')-IIIa, and mutations in two housekeeping genes (gyrA and 23S rRNA) were identified. There was a high degree of correlation between phenotypic resistance to a given drug and the presence of one or more corresponding resistance genes. Phenotypic and genotypic correlation was 100% for tetracycline, ciprofloxacin/nalidixic acid, and erythromycin, and correlations ranged from 95.4% to 98.7% for gentamicin, azithromycin, clindamycin, and telithromycin. All isolates were susceptible to florfenicol, and no genes associated with florfenicol resistance were detected. There was a strong correlation (99.2%) between resistance genotypes and phenotypes, suggesting that WGS is a reliable indicator of resistance to the nine antimicrobial agents assayed in this study. WGS has the potential to be a powerful tool for antimicrobial resistance surveillance programs.

Mitochondrial depolarization and asystole in the globally ischemic rabbit heart: coordinated response to interventions affecting energy balance.

Mitochondrial membrane potential (ΔΨm) depolarization has been implicated in the loss of excitability (asystole) during global ischemia, which is relevant for the success of defibrillation and resuscitation after cardiac arrest. However, the relationship between ΔΨm depolarization and asystole during no-flow ischemia remains unknown. We applied spatial Fourier analysis to confocally recorded fluorescence emitted by ΔΨm-sensitive dye tetramethylrhodamine methyl ester. The time of ischemic ΔΨm depolarization (tmito_depol) was defined as the time of 50% decrease in the magnitude of spectral peaks reflecting ΔΨm. The time of asystole (tasys) was determined as the time when spontaneous and induced ventricular activity ceased to exist. Interventions included tachypacing (150 ms), myosin II ATPase inhibitor blebbistatin (heart immobilizer), and the combination of blebbistatin and the inhibitor of glycolysis iodoacetate. In the absence of blebbistatin, confocal images were obtained during brief perfusion with hyperkalemic solution and after the contraction failed between 7 and 15 min of ischemia. In control, tmito_depol and tasys were 24.4 ± 6.0 and 26.0 ± 5.0 min, respectively. Tachypacing did not significantly affect either parameter. Blebbistatin dramatically delayed tmito_depol and tasys (51.4 ± 8.6 and 45.7 ± 5.3 min, respectively; both P < 0.0001 vs. control). Iodoacetate combined with blebbistatin accelerated both events (tmito_depol, 12.7 ± 1.8 min; and tasys, 6.5 ± 1.1 min; both P < 0.03 vs. control). In all groups pooled together, tasys was strongly correlated with tmito_depol (R(2) = 0.845; P < 0.0001). These data may indicate a causal relationship between ΔΨm depolarization and asystole or a similar dependence of the two events on energy depletion during ischemia. Our results urge caution against the use of blebbistatin in studies addressing pathophysiology of myocardial ischemia.

Visual analog rating of mood by people with aphasia.

BACKGROUND: Considerable attention has been given to the identification of depression in stroke survivors with aphasia, but there is more limited information about other mood states. Visual analog scales are often used to collect subjective information from people with aphasia. However, the validity of these methods for communicating about mood has not been established in people with moderately to severely impaired language. OBJECTIVE: The dual purposes of this study were to characterize the relative endorsement of negative and positive mood states in people with chronic aphasia after stroke and to examine congruent validity for visual analog rating methods for people with a range of aphasia severity. METHODS: Twenty-three left-hemisphere stroke survivors with aphasia were asked to indicate their present mood by using two published visual analog rating methods. The congruence between the methods was estimated through correlation analysis, and scores for different moods were compared. RESULTS: Endorsement was significantly stronger for "happy" than for mood states with negative valence. At the same time, several participants displayed pronounced negative mood compared to previously published norms for neurologically healthy adults. Results from the two rating methods were moderately and positively correlated. CONCLUSIONS: Positive mood is prominent in people with aphasia who are in the chronic stage of recovery after stroke, but negative moods can also be salient and individual presentations are diverse. Visual analog rating methods are valid methods for discussing mood with people with aphasia; however, design optimization should be explored.

The Acceptability of Relationship-Centered Communication Partner Training for Couples Impacted by Aphasia: A Mixed-Methods Pilot Investigation.

PURPOSE: This study explored the acceptability and impact of relationship-centered communication partner training (RC-CPT) in couples impacted by aphasia. In particular, couples considered whether discussing their relationship roles and responsibilities was important and relevant to the changes they desire. Preliminary quasi-experimental data regarding perceived communication confidence and the marriage relationship were also obtained. METHOD: Three couples participated in RC-CPT across two sessions. Surveys were used to measure communication confidence and the marital relationship before and after participation in RC-CPT. The quantitative findings were analyzed using descriptive statistics. Couples also participated in a semistructured interview about the acceptability of RC-CPT during a third session. The interviews were transcribed and analyzed using reflexive codebook analysis. RESULTS: Quantitative data indicated that participants generally maintained or improved self-rated accessibility, responsiveness, engagement, conflict resolution, and communication within their marriage after participating in RC-CPT. Additionally, individuals with aphasia demonstrated enhanced communication confidence scores. Qualitative analysis revealed three themes: (a) Impact on Communication, (b) Impact on Relationship, and (c) Impact on Psychosocial Well-Being. Feedback from participants regarding future development was also included. CONCLUSIONS: The convergence of quantitative and qualitative data supports the conclusion that couples experienced positive changes in their communication, relationship, and psychosocial well-being during the intervention, suggesting that RC-CPT has the potential to positively impact both communicative and psychosocial effects of aphasia on couples. Moreover, this study highlights the promise of RC-CPT as a relationship-centered counseling tool, warranting further exploratory and experimental research. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.25937383.

Recovery of arterial blood pressure after chest compression pauses in patients with out-of-hospital cardiac arrest.

BACKGROUND AND AIMS: Chest compressions generating good perfusion during cardiopulmonary resuscitation (CPR) in cardiac arrest patients are critical for positive patient outcomes. Conventional wisdom advises minimizing compression pauses because several compressions are required to recover arterial blood pressure (ABP) back to pre-pause values. Our study examines how compression pauses influence ABP recovery post-pause in out-of-hospital cardiac arrest. METHODS: We analyzed data from a subset of a prospective, randomized LUCAS 2 Active Decompression trial. Patients were treated by an anesthesiologist-staffed rapid response car program in Oslo, Norway (2015-2017) with mechanical chest compressions using the LUCAS device at 102 compressions/min. Patients with an ABP signal during CPR and at least one compression pause >2 sec were included. Arterial cannulation, compression pauses, and ECG during the pause were verified by physician review of patient records and physiological signals. Pauses were excluded if return of spontaneous circulation occurred during the pause (pressure pulses associated with ECG complexes). Compression, mean, and decompression ABP for 10 compressions before/after each pause and the mean ABP during the pause were measured with custom MATLAB code. The relationship between pause duration and ABP recovery was investigated using linear regression. RESULTS: We included 56 patients with a total of 271 pauses (pause duration: median = 11 sec, Q1 = 7 sec, Q3 = 18 sec). Mean ABP dropped from 53 ± 10 mmHg for the last pre-pause compression to 33 ± 7 mmHg during the pause. Compression and mean ABP recovered to >90% of pre-pause pressure within 2 compressions, or 1.7 sec. Pause duration did not affect the recovery of ABP post-pause (R2: 0.05, 0.03, 0.01 for compression, mean, and decompression ABP, respectively). CONCLUSIONS: ABP generated by mechanical CPR recovered quickly after pauses. Recovery of ABP after a pause was independent of pause duration.

Detection of mitochondrial depolarization/recovery during ischaemia--reperfusion using spectral properties of confocally recorded TMRM fluorescence.

Timing and pattern of mitochondrial potential (m) depolarization during no-flow ischaemia-reperfusion (I-R) remain controversial, at least in part due to difficulties in interpreting the changes in the fluorescence of m-sensitive dyes such as TMRM. The objective of this study was to develop a new approach for interpreting confocal TMRM signals during I-R based on spatial periodicity of mitochondrial packaging in ventricular cardiomyocytes. TMRM fluorescence (FTMRM) was recorded from Langendorff-perfused rabbit hearts immobilized with blebbistatin using either a confocal microscope or an optical mapping system. The hearts were studied under normal conditions, during mitochondrial uncoupling using the protonophore FCCP, and during I-R. Confocal images of FTMRM were subjected to spatial Fourier transform which revealed distinct peaks at a spatial frequency of ∼2 µm(-1). The area under the peak (MPA) progressively decreased upon application of increasing concentrations of FCCP (0.3-20 µm), becoming undetectable at 5-20 µm FCCP. During ischaemia, a dramatic decrease in MPA, reaching the low/undetectable level comparable to that induced by 5-20 µm FCCP, was observed between 27 and 69 min of ischaemia. Upon reperfusion, a heterogeneous MPA recovery was observed, but not a de novo MPA decrease. Both confocal and wide-field imaging registered a consistent decrease in spatially averaged FTMRM in the presence of 5 µm FCCP, but no consistent change in this parameter during I-R. We conclude that MPA derived from confocal images provides a sensitive and specific indicator of significant mitochondrial depolarization or recovery during I-R. In contrast, spatially averaged FTMRM is not a reliable indicator of m changes during I-R.

Does the combination of hyperkalemia and KATP activation determine excitation rate gradient and electrical failure in the globally ischemic fibrillating heart?

Ventricular fibrillation (VF) in the globally ischemic heart is characterized by a progressive electrical depression manifested as a decline in the VF excitation rate (VFR) and loss of excitability, which occur first in the subepicardium (Epi) and spread to the subendocardium (Endo). Early electrical failure is detrimental to successful defibrillation and resuscitation during cardiac arrest. Hyperkalemia and/or the activation of ATP-sensitive K(+) (KATP) channels have been implicated in electrical failure, but the role of these factors in ischemic VF is poorly understood. We determined the VFR-extracellular K(+) concentration ([K(+)]o) relationship in the Endo and Epi of the left ventricle during VF in globally ischemic hearts (Isch group) and normoxic hearts subjected to hyperkalemia (HighK group) or a combination of hyperkalemia and the KATP channel opener cromakalim (HighK-Crom group). In the Isch group, Endo and Epi values of [K(+)]o and VFR were compared in the early (0-6 min), middle (7-13 min), and late (14-20 min) phases of ischemic VF. A significant transmural gradient in VFR (Endo > Epi) was observed in all three phases, whereas a significant transmural gradient in [K(+)]o (Epi > Endo) occurred only in the late phase of ischemic VF. In the Isch group, the VFR decrease and inexcitability started to occur at much lower [K(+)]o than in the HighK group, especially in the Epi. Combining KATP activation with hyperkalemia only shifted the VFR-[K(+)]o curve upward (an effect opposite to real ischemia) without changing the [K(+)]o threshold for asystole. We conclude that hyperkalemia and/or KATP activation cannot adequately explain the heterogeneous electrical depression and electrical failure during ischemic VF.

Metal-cyclopentadienyl bond energies in metallocene cations measured using threshold collision-induced dissociation mass spectrometry.

Metal-cyclopentadienyl bond dissociation energies (BDEs) were measured for seven metallocene ions (Cp(2)M(+), Cp = η(5)-cyclopentadienyl = c-C(5)H(5), M = Ti, V, Cr, Mn, Fe, Co, Ni) using threshold collision-induced dissociation (TCID) performed in a guided ion beam tandem mass spectrometer. For all seven room temperature metallocene ions, the dominant dissociation pathway is simple Cp loss from the metal. Traces of other fragment ions were also detected, such as C(10)H(10)(+), C(10)H(8)(+), C(8)H(8)(+), C(3)H(3)(+), H(2)M(+), C(3)H(3)M(+), C(6)H(6)M(+), and C(7)H(6)M(+), depending on the metal center. Statistical modeling of the Cp-loss TCID experimental data, including consideration of energy distributions, multiple collisions, and kinetic shifts, allow the extraction of 0 K [CpM(+)- Cp] BDEs. These are found to be 4.85 ± 0.15, 4.02 ± 0.14, 4.22 ± 0.13, 3.51 ± 0.12, 4.26 ± 0.15, 4.57 ± 0.15, and 3.37 ± 0.12 eV for Cp(2)Ti(+), Cp(2)V(+), Cp(2)Cr(+), Cp(2)Mn(+), Cp(2)Fe(+), Cp(2)Co(+), and Cp(2)Ni(+), respectively. The measured BDE trend is largely in line with arguments based on a simple molecular orbital picture, with the exception of the anomalous case of titanocene, most likely attributable to its bent structure. The new results presented here are compared to previous literature values and are found to provide a more complete and accurate set of thermochemistry.

Physiological Arousal, Attentiveness, Emotion, and Word Retrieval in Aphasia: Effects and Relationships.

PURPOSE: This study aimed to (a) compare physiological arousal and attentiveness during a confrontational naming task between participants with aphasia and a control group across four conditions that varied according to emotionality of presented stimuli and (b) explore relationships among physiological arousal, attentiveness, perceived arousal, and naming performance. We hypothesized that participants with aphasia would show lower levels of arousal and attentiveness than control participants and that emotional conditions would lead to increased physiological arousal and attentiveness. METHOD: Eight participants with aphasia and 15 control participants completed a confrontational naming task under positive, negative, and neutral conditions and rated their perceived arousal after each. Electrophysiological recordings were taken during the entire experiment to obtain measures of heart rate (HR), HR variability, and skin conductance (SC). Videos of confrontational naming trials were rated based on visual signs of participant attentiveness during each trial. RESULTS: Statistically significant group differences were found for HR, SC, and attentiveness ratings, but no differences were found in these measures among conditions. Correlational analyses revealed statistically significant relationships between attentiveness and response time, HR, and naming accuracy. Significant correlations were also found for HR and naming accuracy as well as perceived arousal and naming accuracy. CONCLUSIONS: Findings suggest that decreased physiological arousal or attentiveness may contribute to naming deficits for people with aphasia (PWA). Assisting PWA to fully attend to and engage in therapy tasks may be important for accurate assessment of language functions and for achieving optimal benefit in treatment.

Telling Stories in Noise: The Impact of Background Noises on Spoken Language for People With Aphasia.

PURPOSE: The purpose of this study was to determine how different background noise conditions affect the spoken language of participants with aphasia during a story retell task. METHOD: Participants included 11 adults with mild to moderate aphasia and 11 age- and gender-matched controls. Participants retold stories in a silent baseline and five background noise conditions (conversation, monologue, phone call, cocktail, and pink noise). Dependent measures of speech acoustics (fundamental frequency and mean intensity), speech fluency (speech rate and disfluent words), and language production (correct information units [CIUs], lexical errors, lexical diversity, and cohesive utterances) were compared between groups and across conditions. RESULTS: Background noise resulted in higher fundamental frequency (fo) and increased mean intensity for control participants across all noise conditions but only across some conditions for participants with aphasia. In relation to language production, background noise interfered significantly more with communication efficiency (i.e., percent CIUs) for participants with aphasia than the control group. For participants with aphasia, the phone call condition led to decreased lexical diversity. Across groups, condition effects generally suggested more interference on speech acoustics in conditions where continuous noise was present and more interference on language in conditions that presented continuous informational noise. CONCLUSIONS: Although additional research is needed, preliminary findings suggest that background noise interferes with narrative discourse more for people with aphasia (PWA) than neurologically healthy adults. PWA may benefit from therapy that directly addresses communicating in noise. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.23681703.

Do People With Apraxia of Speech and Aphasia Improve or Worsen Across Repeated Sequential Word Trials?

PURPOSE: During motor speech examinations for suspected apraxia of speech (AOS), clients are routinely asked to repeat words several times sequentially. The purpose of this study was to understand the task in terms of the relationship among consecutive attempts. We asked to what extent phonemic accuracy changes across trials and whether the change is predicted by AOS diagnosis and sound production severity. METHOD: One hundred thirty-three participants were assigned to four diagnostic groups based on quantitative metrics (aphasia plus AOS, aphasia-only, and aphasia with two borderline speech profiles). Each participant produced four multisyllabic words 5 times consecutively. These productions were audio-recorded and transcribed phonetically and then summarized as the proportion of target phonemes that was produced accurately. Nonparametric statistics were used to analyze percent change in accuracy from the first to the last production based on diagnostic group and a broad measure of speech sound accuracy. RESULTS: Accuracy on the repeated words deteriorated across trials for all groups, showing reduced accuracy from the first to the last repetition for 62% of participants. Although diagnostic groups differed on the broad measure of speech sound accuracy, severity classification based on this measure did not determine degree of deterioration on the repeated words task. DISCUSSION: Responding to a request to say multisyllabic words 5 times sequentially is challenging for people with aphasia with and without AOS, and as such, performance is prone to errors even with mild impairment. For most, the task does not encourage self-correction. Instead, it promotes errors, regardless of diagnosis, and is, therefore, useful for screening purposes.

Automated external defibrillator electrode size and termination of ventricular fibrillation in out-of-hospital cardiac arrest.

Smaller electrodes allow more options for design of automated external defibrillator (AED) user interfaces. However, previous studies employing monophasic-waveform defibrillators found that smaller electrode sizes have lower defibrillation shock success rates. We hypothesize that, for impedance-compensated, biphasic truncated exponential (BTE) shocks, smaller electrodes increase transthoracic impedance (TTI) but do not adversely affect defibrillation success rates. METHODS AND RESULTS: In this prospective before-and-after clinical study, Amsterdam police and firefighters used AEDs with BTE waveforms: an AED with larger electrodes in 2016-2017 (113 cm2), and an AED with smaller electrodes in 2017-2020 (65 cm2). We analyzed 157 and 178 patient cases with an initial shockable rhythm where the larger and smaller electrodes were used, respectively. A single 200-J shock terminated ventricular fibrillation (VF) in 86% of patients treated with large electrodes and 89% of patients treated with smaller electrodes. Small electrodes had a non-inferior first shock defibrillation success rate compared to large electrodes, with a difference of 3% (95% CI: -3% -9%) with the lower confidence limit remaining above the defined non-inferiority threshold. TTI was significantly higher for the smaller electrodes (median: 100 Ω) compared to the larger electrodes (median: 88 Ω) (p < 0.001). CONCLUSIONS: For AEDs with impedance-compensating BTE waveforms, TTI was higher for smaller electrodes than the large electrode electrodes. Overall defibrillation shock success for AEDs with smaller electrodes was non-inferior to the AEDs with larger electrodes.

Role of KATP channel in electrical depression and asystole during long-duration ventricular fibrillation in ex vivo canine heart.

Long-duration ventricular fibrillation (LDVF) in the globally ischemic heart is characterized by transmurally heterogeneous decline in ventricular fibrillation rate (VFR), emergence of inexcitable regions, and eventual global asystole. Rapid loss of both local and global excitability is detrimental to successful defibrillation and resuscitation during cardiac arrest. We sought to assess the role of the ATP-sensitive potassium current (I(KATP)) in the timing and spatial pattern of electrical depression during LDVF in a structurally normal canine heart. We analyzed endo-, mid-, and epicardial unipolar electrograms and epicardial optical recordings in the left ventricle of isolated canine hearts during 10 min of LDVF in the absence (control) and presence of an I(KATP) blocker glybenclamide (60 µM). In all myocardial layers, average VFR was the same or higher in glybenclamide-treated than in control hearts. The difference increased with time of LDVF and was overall significant in all layers (P < 0.05). However, glybenclamide did not significantly affect the transmural VFR gradient. In epicardial optical recordings, glybenclamide shortened diastolic intervals, prolonged action potential duration, and decreased the percentage of inexcitable area (all differences P < 0.001). During 10 min of LDVF, asystole occurred in 55.6% of control and none of glybenclamide-treated hearts (P < 0.05). In three hearts paced after the onset of asystole, there was no response to LV epicardial or atrial pacing. In structurally normal canine hearts, I(KATP) opening during LDVF is a major factor in the onset of local and global inexcitability, whereas it has a limited role in overall deceleration of VFR and the transmural VFR gradient.

Effects of Positive and Negative Emotions on Picture Naming for People With Mild-to-Moderate Aphasia: A Preliminary Investigation.

PURPOSE: The purpose of the study is to investigate how emotional arousal and valence affect confrontational naming accuracy and response time (RT) in people with mild-to-moderate aphasia compared with adults without aphasia. We hypothesized that negative and positive emotions would facilitate naming for people with aphasia (PWA) but lead to slower responses for adults with no aphasia. METHOD: Eight participants with mild-to-moderate aphasia, 15 older adults (OAs), and 17 young adults (YAs) completed a confrontational naming task across three conditions (positive, negative, and neutral) in an ABA (where A = neutral and B = negative) case series design. Immediately following each naming condition, participants self-reported their perceived arousal and pleasure. Accuracy and RT were measured and compared. RESULTS: As expected, PWA performed significantly less accurately and with longer RTs than both YA and OA groups across all conditions. However, opposite our hypothesis for the aphasia group, the negative condition resulted in decreased accuracy for the aphasia and the OA group and increased RT across all groups. No statistically significant differences were found between the positive and any other condition. Participants with aphasia who demonstrated an effect in the negative condition were observed to produce a larger proportion of semantically related errors than any other error types. CONCLUSIONS: Findings suggest that strong negative emotions can interfere with semantic-lexical processing by diverting attentional resources to emotion regulation. Both clinicians and researchers should be aware of the potential influence of negative stimuli and negative emotional states on language performance for PWA, and these effects should be disentangled in future research. Further research should also be conducted with a larger number of participants with aphasia across a broader range of severity to replicate and extend findings. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.19119356.