Publications by authors named "Nicole Müller"

76 Publications

The latest development of the DELAD project for sharing corpora of speech disorders.

Clin Linguist Phon 2021 Apr 23:1-9. Epub 2021 Apr 23.

School of Languages, Literatures and Linguistics, Bangor University, Bangor, UK.

Corpora of speech of individuals with communication disorders (CSD) are invaluable resources for education and research, but they are costly and hard to build and difficult to share for various reasons. DELAD, which means 'shared' in Swedish, is a project initiated by Professors Nicole Müller and Martin Ball in 2015 that aims to address this issue by establishing a platform for researchers to share datasets of speech disorders with interested audiences. To date four workshops have been held, where selected participants, covering various expertise including researchers in clinical phonetics and linguistics, speech and language therapy, infrastructure specialists, and ethics and legal specialists, participated to discuss relevant issues in setting up such an archive. Positive and steady progress has been made since 2015, including refurbishing the DELAD website (http://delad.net/) with information and application forms for researchers to join and share their datasets and linking with the CLARIN K-Centre for Atypical Communication Expertise (https://ace.ruhosting.nl/) where CSD can be hosted and accessed through the CLARIN B-Centres, The Language Archive (https://tla.mpi.nl/tools/tla-tools/) and TalkBank (https://talkbank.org/). The latest workshop, which was funded by CLARIN (Common Language Resources and Technology Infrastructure) was held as an online event in January 2021 on topics including Data Protection Impact Assessments, reviewing changes in ethics perspectives in academia on sharing CSD, and voice conversion as a mean to pseudonomise speech. This paper reports the latest progress of DELAD and discusses the directions for further advance of the initiative, with information on how researchers can contribute to the repository.
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http://dx.doi.org/10.1080/02699206.2021.1913514DOI Listing
April 2021

Perioperative urinary NT-ProBNP values and their usefulness as diagnostic and prognostic markers in children with congenital heart disease.

Clin Chim Acta 2021 Jul 17;518:28-32. Epub 2021 Mar 17.

Department of Paediatric Cardiology, Childrens Hospital, University of Bonn, Germany.

Introduction: NT-proBNP and especially the changes in values are important markers in patients with congenital heart disease (CHD). NT-proBNP values determined from a urine sample correlate well with the plasma values of NT-proBNP. This study investigated the perioperative development of plasma and urinary values, examining their diagnostic and prognostic value.

Methods: 83 children undergoing cardiac surgery for a myriad of CHDs were included. Urine and plasma samples were collected at different points in time. Urinary values were corrected for urine creatinine concentration and transformed into Lg10-values.

Results: The correlation between urine and plasma is weaker postoperatively (r = 0.70-0.80) in comparison to preoperatively (r = 0.87). Neonates had higher urinary values than older children. A ROC-analysis for the differentiation between complex and simple CHD showed an area under the curve of 0.854 for zlog-NT-proBNP plasma values and 0.826 for creatinine corrected urine values. A decline of NT-proBNP plasma values from the day before surgery to the time after intubation correlated with the duration of postoperative non-invasive ventilation (r = 0.9, sig. < 0.001).

Conclusion: Urinary NT-proBNP shows potential in discriminating between complex and simple CHD. This study is the first to show a prognostic role of NT-proBNP in establishing spontaneous respiration postoperatively in children with CHD.
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http://dx.doi.org/10.1016/j.cca.2021.03.005DOI Listing
July 2021

Opioid requirements after locoregional anaesthesia in dogs undergoing tibial plateau levelling osteotomy: a pilot study.

Vet Anaesth Analg 2021 May 3;48(3):398-406. Epub 2021 Feb 3.

Vetsuisse Faculty, Department of Clinical Veterinary Medicine, Bern, Switzerland.

Objective: To determine the intraoperative and early postoperative opioid requirement after ultrasound-guided sciatic and/or femoral nerve block or epidural anaesthesia in dogs undergoing tibial plateau levelling osteotomy (TPLO).

Study Design: Prospective, masked, pilot, randomized, clinical trial.

Animals: A total of 40 client-owned dogs undergoing TPLO.

Methods: Each dog was randomly assigned to group SF (combined sciatic and femoral nerve block), group S (sciatic nerve block), group F (femoral nerve block) or group E (epidural anaesthesia). A total of 0.3 mL kg of ropivacaine 0.5% was administered to each nerve or in the epidural space. Intraoperatively, fentanyl (2 μg kg) was administered intravenously when heart rate, mean arterial pressure or respiratory rate increased by >30% compared with baseline values. Postoperatively, a visual analogue scale (VAS) and a modified German version of the French pain scale (4AVet) were used to assess pain every 30 minutes for 150 minutes and again once the morning after surgery. Methadone (0.1 mg kg) was administered intravenously if the VAS was ≥ 4 cm [maximal value 10 cm; median (interquartile range)] or the composite pain score was ≥5 [maximal value 15; median (interquartile range)]. Significance was defined as p ≤ 0.05.

Results: Groups SF and E required less total intraoperative and early postoperative opioid doses compared with groups S and F (p = 0.031). No dogs in group SF had a block failure or required postoperative methadone. A reduced methadone requirement was found in group SF compared with all the other groups up to 150 minutes after recovery (p = 0.041).

Conclusions And Clinical Relevance: Combined sciatic and femoral nerve block and epidural anaesthesia lead to less cumulative consumption of perioperative opioids than single nerve blockade. Sciatic or femoral nerve block alone might be insufficient to control nociception and early postoperative pain in dogs undergoing TPLO.
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http://dx.doi.org/10.1016/j.vaa.2020.10.010DOI Listing
May 2021

Safety Monitoring of Gene Therapy for Spinal Muscular Atrophy with Onasemnogene Abeparvovec -A Single Centre Experience.

J Neuromuscul Dis 2021 ;8(2):209-216

Department of Neuropediatrics, University Hospital Bonn, Bonn, Germany.

Background: Recently gene therapy with onasemnogene abeparvovec has been approved for the treatment of spinal muscular atrophy (SMA). As the experience from clinical trials is limited, there are still uncertainties for which patient population the treatment can be considered safe and effective.

Methods: We report our experience with eight consecutive patients with SMA who were treated with the standard dose of onasemnogene abeparvovec (1.1×1014 vg/kg) at the University Hospital Bonn, Germany. All patients received prophylactic immunosuppression with 1 mg/kg/d prednisolone for four weeks starting on the day before gene therapy.

Results: We treated eight patients (4 male, 4 female, age range 10-37 months) with a body weight between 7.1 and 11.9 kg. All patients had 2 or 3 copies of the SMN2-gene and were previously treated with nusinersen. Following treatment with onasemnogene abeparvovec all patients showed a temporary increase of the body temperature and an increase of transaminase levels. In all but one patient it was necessary to increase or prolong the standard steroid dose to control the immune response. In one severe case, liver damage was associated with impaired liver function. This patient received a steroid pulse therapy for five days. Blood counts revealed asymptomatic thrombocytopenia (<150×109/L) in 6/8 patients and a significant increase of monocytes following gene therapy. Liver values and blood counts returned to almost normal levels during the post-treatment observation period. Troponin I increased above normal limit in 4/8 patients but was not associated with any abnormalities on cardiac evaluation.

Conclusions: In a broader spectrum of patients, treatment with onasemnogene abeparvovec was associated with a higher rate of adverse events. In our cases it was possible to control the immune response by close monitoring and adaptation of the immunosuppressive regimen. Further research is needed to better understand the immune response following gene therapy and ideally to identify patients at risk for a more severe reaction.
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http://dx.doi.org/10.3233/JND-200593DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8075402PMC
January 2021

Experiencing dementia: How does assessment of cognition and language relate to daily life?

Dementia (London) 2021 May 5;20(4):1408-1424. Epub 2020 Aug 5.

Department of Speech and Hearing Sciences, 8795University College Cork, Ireland; Department of Biomedical and Clinical Sciences, 4566Linköping University, Sweden.

This Swedish study investigates how persons living with dementia report their experiences of cognitive and linguistic testing, as well as their perspectives on the communicative resources and barriers they experience in daily interactions. Eight dyads were included in this qualitative exploratory study; eight persons with dementia and eight family members with whom they interact with daily. Semi-structured interviews, with questions focusing on experiences of diagnostic pathways as well as communicative and cognitive function in daily life, were carried out together with standard clinical testing. The data were analysed using qualitative content analysis. The results shed light on the experiences of uncertainty during the dementia assessment process related to the assessment tasks, the consequences of the assessment and receiving a diagnosis. We interpret this as a result of the unfamiliar clinical focus on function as measured in decontextualised tasks, compared to the participants' view based on their abilities in everyday life. The study also reveals that adjustments in daily life that are necessitated by the consequences of neurological change are often developed in collaboration between the person with dementia and their conversation partners. There are, however, reports of conflicting feelings by the persons diagnosed with dementia, and by their families, as well as their views on how to best handle change, while maintaining a sense of being a competent person through the progression of disease.
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http://dx.doi.org/10.1177/1471301220945832DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8132008PMC
May 2021

Building capacity: getting evidence-based practice into healthcare professional curricula.

BMJ Evid Based Med 2020 Jul 27. Epub 2020 Jul 27.

Catherine McAuley School of Nursing & Midwifery, University College Cork National University of Ireland, Cork, Ireland.

Fostering a culture of clinical effectiveness in healthcare is crucial to achieving optimum outcomes for patients. Evidence-based practice (EBP) is a cornerstone of clinical effectiveness. An EBP capacity-building project commenced in Ireland in 2016, in collaboration with the Centre of Evidence-Based Medicine in Oxford. A key part of this project, reported here, was the development of a competency framework for education in EBP and clinical effectiveness to ensure responsiveness of education standards and curricula of healthcare professionals in this area.

Methods: Following a review of national and international reports, professional guidance documents and empirical literature pertaining to clinical effectiveness education (CEE), a preliminary competency framework was developed. Stakeholder consultations were conducted over a 6-month period, which consisted of 13 focus groups (n=45) and included representatives from clinical practice, higher education and professional training sectors, regulator/accrediting bodies, the Department of Health (Ireland) and patient/service user groups.

Results: An overarching interprofessional competency framework for CEE was proposed and included the following domains: EBP, quality improvement processes, implementation strategies and collaborative practice: a total of 16 competencies and 60 indicators.

Conclusion: A competency framework for CEE for health and social care professionals is presented. It is intended that this framework will provide guidance to healthcare educators and regulators in the construction and revision of curricula, learning outcomes, teaching and assessment strategies, and graduate/clinician attributes.
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http://dx.doi.org/10.1136/bmjebm-2020-111385DOI Listing
July 2020

Urinary values of NT-proBNP in children with congenital heart disease - Is it feasible?

Clin Chim Acta 2020 Oct 9;509:224-227. Epub 2020 Jun 9.

Department for Pediatric Cardiology, Children's Hospital, University of Bonn, Germany.

Plasma NT-proBNP (N-terminal prohormone of brain natriuretic peptide) is an established clinical biomarker for children with congenital heart disease. In adult studies the relation between plasma and urinary NT-proBNP has been investigated with a good correlation. Considering the age dependence of NT-proBNP in healthy children and the age dependence of kidney function, an investigation of the correlation between NT-proBNP plasma and urinary values in children of different ages is necessary. We analyzed plasma and urine samples of 33 children (mean age 7 months) with congenital heart disease before surgery. Plasma and urinary creatinine were also measured to evaluate the influence of kidney function. A Pearson correlation between Lg10-plasma and Lg10-urine values of NT-proBNP corrected for urine creatinie showed a correlation coefficient of r = 0,902 (P < 0,000) without discriminating for age. This study demonstrates that urinary NT-proBNP values correlate well with plasma NT-proBNP values in infants and toddlers and that single random urine sample corrected to urine-creatinine can be used as an alternative to plasma samples. The use of urinary biomarkers could help reduce the need of stressful blood sampling in infants and children.
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http://dx.doi.org/10.1016/j.cca.2020.06.015DOI Listing
October 2020

Age-related hearing loss and provider-patient communication across primary and secondary care settings: a cross-sectional study.

Age Ageing 2020 08;49(5):873-877

Medical Education Unit, School of Medicine, University College Cork, Cork, Ireland.

Background: The prevalence of age-related hearing loss (ARHL) increases with age. Older adults are amongst the most dependent users of healthcare and most vulnerable to medical error. This study examined health professionals' strategies, as well as level of formal training completed, for communication with older adults with ARHL, and their views on the contribution of ARHL to suboptimal quality of patient care.

Methods: A 17-item questionnaire was distributed to a sample of Irish primary care physicians, as well as hospital-based clinicians providing inpatient palliative care and geriatric services.

Results: A total of 172 primary care physicians and 100 secondary care providers completed the questionnaire. A total of 154 (90%) primary and 97 (97%) secondary care providers agreed that ARHL had a negative impact on quality of care. Across both settings, 10% of respondents reported that communication issues contributed to multiple medication error events each year. Although only 3.5% of secondary care providers and 13% of primary care physicians attended formal training on communication with hearing-impaired patients, 66.5% of respondents were confident in their capacity to communicate with these patients. Primary care physicians reported that they either never used assistive hearing technology (44%) or were unfamiliar with this technology (49%).

Conclusions: Primary and secondary care health providers reported that ARHL reduces patient care quality and may initiate errors leading to patient harm. Formal training addressing the communication needs of ARHL patients appears to be underdeveloped, and there is a limited familiarity with assistive hearing technology. This is both an error in health professional training and healthcare services.
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http://dx.doi.org/10.1093/ageing/afaa041DOI Listing
August 2020

Physical activity and heart rate monitoring in Fontan patients - Should we recommend activities in higher intensities?

PLoS One 2020 30;15(1):e0228255. Epub 2020 Jan 30.

Department for Paediatric Cardiology, University Hospital Bonn, Bonn, Germany.

Objective: Exercise capacity is impaired in Fontan palliated patients. The change in daily activity behaviour with an increase in sedentary lifestyle results in low physical activity levels. This might have a greater impact on patients with chronic heart disease in contrast to healthy controls. For a better understanding, we compared data from cardiopulmonary exercise testing (CPET) with heart rates and physical activity in daily life.

Methods: 21 Fontan patients and 20 age, sex and BMI matched controls underwent CPET and 5 days of daily life activity tracking with a triaxial accelerometer (wGT3x-BT, Actigraph) including heart rate monitoring with an optical heart rate sensor.

Results: 27% of our Fontan teenagers and 71% of the Fontan adults reached the specific WHO recommendations for moderate to vigorous physical activity (MVPA) during everyday life (EDL), without differences to controls. There was a strong correlation between MVPA and [Formula: see text] for all Fontan patients (p = 0.0035, Pearson r = 0.788). Daily MVPA correlated to peak oxygen uptake and lactate production. Up to workloads of 2 W/kg and in daily life heart rates in Fontan patients were similar to controls.

Conclusions: Daily MVPA is alarmingly low without any differences between Fontan patients and controls. Heart rate behaviour was similar and does not seem to be a limiting factor for physical activity in daily life. Higher intensity activities should be implemented regularly in EDL for Fontan patients. Proof is needed as to whether sports in moderate or possibly even in vigorous activity (e.g. high-intensity interval training) improve exercise capacity the most.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0228255PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6992185PMC
May 2020

Swedish Clinical Professionals' Perspectives on Evaluating Cognitive and Communicative Function in Dementia.

Clin Gerontol 2019 Dec 12:1-15. Epub 2019 Dec 12.

Division of Speech and Language Pathology, Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, Sweden.

: This study investigated Swedish clinical professionals' experiences of diagnostic pathways in dementia, focusing on the assessment of cognitive and communicative abilities.: Interdisciplinary teams in Memory Clinics, General Practitioners in Primary Health Care, and Speech Language Pathologists were interviewed. The transcripts were analyzed using qualitative Content Analysis.: The study sheds light upon the perceived barriers and facilitators of good practice, e.g. time and clinical collaborations. Perspectives among professionals vary as to how informal and formal information and procedures are to be integrated and weighted. External factors (e.g. physical proximity of professions) have considerable influence on information availability, transmission, and diagnostic processes. Communication impairment does not emerge as a clinical priority.: Published clinical guidelines notwithstanding, there is in practice no "gold standard" regarding diagnostic processes. Reorganization of services that impact feasibility of cross-disciplinary contact may negatively impact diagnostics.: Interprofessional collaboration is impacted by many factors, e.g. physical proximity and availability of specific professions. In order to optimize collaboration in dementia diagnosis, communication channels between professions need to be optimized. Additionally, making clinical impressions and "gut-feelings" explicit could contribute valuable information to the diagnostic process.
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http://dx.doi.org/10.1080/07317115.2019.1701168DOI Listing
December 2019

Altered Hemorheology in Fontan Patients in Normoxia and After Acute Hypoxic Exercise.

Front Physiol 2019 22;10:1443. Epub 2019 Nov 22.

Department of Molecular and Cellular Sports Medicine, German Sport University Cologne, Cologne, Germany.

Background: The Fontan circulation is a unique palliation procedure for several congenital heart defects. Impaired exercise capacity has previously been demonstrated in these patients and also a higher risk for cardiopulmonary mortality. Hemorheology was shown to affect cardiopulmonary capacity and in turn to be affected by regular exercise and hypoxia but none of these have been investigated in Fontan patients so far. The aim of this study was to detect general differences in hemorheology in normoxia as well as possible altered hemorheological responses to hypoxia exposure and hypoxic exercise between Fontan patients and healthy controls.

Methods And Findings: 26 Fontan patients and 20 healthy controls performed an acute exercise test (AET) on a bicycle ergometer under hypoxia with ambient 15.2% oxygen saturation (sO). Blood samples were taken at rest in normoxia (T0), at rest in hypoxia (T1), after maximum exhaustion in hypoxia (T2), and after 50 min recovery in normoxia (T3). Hemorheological and blood parameters were investigated. Additionally, arterial stiffness was tested at T0. Red blood cell (RBC) deformability, NOx, erythropoietin (EPO) concentration, RBC count, hemoglobin (Hb) concentration and hematocrit (hct) were significantly increased in Fontan patients compared to controls. Same was observed for arterial stiffness. No changes were observed for RBC aggregation, fibrinogen concentration, free radical levels and vascular endothelial growth factor (VEGF). Hypoxia exposure did not change parameters, whereas exercise in hypoxia increased aggregation and hct significantly in both groups. Fontan patients showed significantly increased aggregation-disaggregation balance compared to controls.

Conclusion: Acute hypoxia exposure and exercise under hypoxia might have similar impact on hemorheology in Fontan patients and controls and was clinically well tolerated. Nevertheless, exercise alters aggregation and possibly hemodynamics which requires special attention in Fontan patients.
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http://dx.doi.org/10.3389/fphys.2019.01443DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6883377PMC
November 2019

The role of consistency in use of morphosyntactic forms in child-directed speech in the acquisition of Irish, a minority language undergoing rapid language change.

J Child Lang 2020 03 3;47(2):267-288. Epub 2019 Dec 3.

University College Cork, Ireland.

Irish is a rapidly changing minority language spoken as the main community language in some areas of the officially Irish-speaking Gaeltacht regions in Ireland. We analyse narratives from 17 parent-child dyads, living in one such area. All children, aged 3-6;4, had high exposure to the local variety of Irish. The input quality was measured by specifying consistency and accuracy of use of morphosyntactic forms in parental narratives directed to their children. The same morphosyntactic forms were analysed in narrative retell by the children. The children produced with high accuracy those forms that the parents used consistently and accurately. For the forms where parents' usage was inconsistent, large variation in the children's usage was observed. The findings suggest that consistency and accuracy in the use of morphosyntactic forms in the parental language is an important factor in language acquisition; however, its influence might be confounded by other factors.
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http://dx.doi.org/10.1017/S0305000919000734DOI Listing
March 2020

Laborabklärung der Medikamentenallergie: Grenzen und Möglichkeiten.

Ther Umsch 2019 Jul;75(1):33-37

1 ADR-AC GmbH, Bern.

The diagnosis of drug allergy is essentially based on a detailed anamnesis, involving the doctors who first treated the patient, and skin testing (prick, intradermal and epicutaneous / patch tests). In the allergological practice / clinic, provocation tests with the presumed trigger are only carried out if the indication is very clear (see articles in this issue on drug allergy children, allergies to betalactam and other antibiotics as well as analgesic intolerance). The provocation with a probably tolerable alternative is in the foreground. Unfortunately, the skin tests of certain drug groups have a low sensitivity even under optimal conditions, but very good specificity. Accordingly, positive skin tests are mostly relevant, but negative skin tests cannot rule out an allergy. In recent years, it has therefore proved successful to carry out supplementary laboratory tests in the clarification of drug allergies. The serological tests (IgE) are of little help. In contrast, the test forms based on the analysis of leukocytes (basophil activation test, BAT, and lymphocyte transformation test, LTT) have gained in importance and complement the diagnostic repertoire. In the combination of all test methods (skin test, LTT, BAT, sometimes provocation test) the trigger of a drug allergy can be defined in a good 70 % of cases and in most cases a safe therapeutic alternative can be found. In the following, we will discuss the importance of laboratory diagnostics in drug allergy.
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http://dx.doi.org/10.1024/0040-5930/a001056DOI Listing
July 2019

Association Between Glycaemic Control and the Intake of Thiazide Diuretics, Beta Blockers and Levothyroxine in People Without Diabetes.

Exp Clin Endocrinol Diabetes 2021 Jun 1;129(6):443-448. Epub 2019 Jul 1.

Jena University Hospital, Department of Internal Medicine III, Division of Endocrinology and Metabolic Diseases, Jena, Germany.

Objective: The pharmacological additional information for many medications includes warnings stating that the blood sugar control may be worsened by the intake of certain drugs. However a quantification of the effects is missing. This may result in confusion for patients as well as for their physicians. The aim of this study was to assess a potential association between medication (beta blockers, thiazides, levothyroxine) and HbA in people without diabetes.

Methods: In this cross-sectional study we analysed data from 2 921 people (7 699 visits) without diabetes (age 46.6 y; 69.1% women; BMI 27.6±6.4 kg/m²; HbA 5.2%) who had at least one HbA determination and a complete documentation of their drug intake. An oral glucose tolerance test was not performed. The participants were divided in 8 groups (no regular drug intake, levothyroxine alone, beta blockers alone, thiazides alone, combination 2 of 3, combination of all 3). Patients with known distorting influences of the HbA were excluded.

Results: People with no regular drug intake had an HbA of 5.4% [35.8 mmol/mol]. The HbA of the group that took all 3 drugs in combination was 5.6% [38.2 mmol/mol]. A multiple linear mixed model showed an increase in HbA for thiazides (β=0.0558, p=0.025) and a decrease for combination of levothyroxine and thiazide (β=-0.0765, p=0.010).

Conclusion: Thiazides and the combination of levothyroxine and thiazides were associated with slight changes in HbA. In this study there was no association between the intake of beta blockers and HbA At least for people without diabetes these effects seem to be of minor importance.
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http://dx.doi.org/10.1055/a-0919-4525DOI Listing
June 2021

Effect Sizes in Single-Case Aphasia Studies: A Comparative, Autocorrelation-Oriented Analysis.

J Speech Lang Hear Res 2019 Jul 1:1-10. Epub 2019 Jul 1.

Department of Communication Sciences and Disorders, Bowling Green State University, OH.

Purpose In single-case treatment studies, researchers may compare client performance during a baseline, nontreatment phase(s) to client performance during intervention phases. Autocorrelation in the data series gathered during such studies increases the likelihood that analysts will detect or fail to detect meaningful differences between baseline and treatment phase data. We examined the impact that autocorrelation has on 4 effect size calculation methods when these methods are applied to data generated by people with aphasia during anomia treatment studies. The effect sizes we selected were Busk and Serlin's d, Young's C, nonoverlap of all pairs, and Tau- U. We hypothesized that d and C would be influenced by autocorrelation, whereas nonoverlap of all pairs and Tau- U would not. Method We extracted 173 highly autocorrelated data series from published investigations of treatments for anomia. These data series were then "cleansed" of autocorrelation through the use of an autoregressive integrated moving average (ARIMA) process. The 4 effect size calculation methods were used to derive an effect size for each published and each corresponding ARIMA-tized data series. The published and ARIMA-tized effect sizes associated with each calculation method were then compared. Results For all of the 4 effect sizes, statistically significant differences existed between the published effect sizes and the ARIMA-tized effect sizes. Conclusions All 4 of the methods were influenced by autocorrelation. Further research that develops effect size calculation methods that are not influenced by autocorrelation will help to improve the quality of single-case studies. Supplemental Material https://doi.org/10.23641/asha.8298530.
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http://dx.doi.org/10.1044/2019_JSLHR-L-18-0186DOI Listing
July 2019

Does eHealth Literacy Impact Patients' Opinion on the EHR?

Stud Health Technol Inform 2019 ;259:95-98

Bern University of Applied Sciences, Biel, Switzerland.

An electronic health record (EHR) will be established nationwide in Switzerland in 2020. Patients can decide on their own whether they open an EHR. It is still unclear what might influence the patient decision. For this reason, we performed an online survey among the Swiss population to study whether there is a lack of knowledge on the EHR which impacts the willingness to open a personal health record and agree to health data sharing. A questionnaire with 13 question was distributed in a period of 4 weeks. More than 1200 participants replied to the survey. The results were analyzed with statistical methods. There are correlations between some of the questions in our survey. We conclude that the willingness to open a personal health record directly depends on the trust into the enabling technology.
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August 2019

Metabolization of the Advanced Glycation End Product N-ε-Carboxymethyllysine (CML) by Different Probiotic E. coli Strains.

J Agric Food Chem 2019 Feb 12;67(7):1963-1972. Epub 2019 Feb 12.

Chair of Food Chemistry , Technische Universität Dresden , D-01062 Dresden , Germany.

N-ε-Carboxymethyllysine (CML) is formed during glycation reactions (synonym, Maillard reaction). CML is degraded by the human colonic microbiota, but nothing is known about the formation of particular metabolites. In the present study, six probiotic E. coli strains were incubated with CML in the presence or absence of oxygen in either minimal or nutrient-rich medium. CML was degraded by all strains only in the presence of oxygen. HPLC-MS/MS was applied for identification of metabolites of CML. For the first time, three bacterial metabolites of CML have been identified, namely N-carboxymethylcadaverine (CM-CAD), N-carboxymethylaminopentanoic acid (CM-APA), and the N-carboxymethyl-Δ-piperideinium ion. During 48 h of incubation of CML with five different E. coli strains in minimal medium in the presence of oxygen, 37-66% of CML was degraded, while CM-CAD (1.5-8.4% of the initial CML dose) and CM-APA (0.04-0.11% of the initial CML dose) were formed linearly. Formation of the metabolites is enhanced when dipeptide-bound CML is applied, indicating that transport phenomena may play an important role in the "handling" of the compound by microorganisms.
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http://dx.doi.org/10.1021/acs.jafc.8b06748DOI Listing
February 2019

Patients' and communication partners' experiences of communicative changes in Parkinson's disease.

Disabil Rehabil 2020 06 23;42(13):1835-1843. Epub 2019 Jan 23.

Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.

The aim of the present study was to investigate the experiences of people with Parkinson's disease and their close communication partners regarding disease-related communicative changes and participation in everyday conversations. Semi-structured qualitative interviews were conducted with six dyads consisting of a person with Parkinson's disease and a close communication partner. The interview material was analysed through thematic analysis. The main theme was the experiences of barriers and facilitators for participation in conversations. Subthemes were experiences related to changes in voice and articulation, language and cognition, body language and facial expressions, fatigue, self-image, communicative initiative, and familiarity with conversation partner. The results show individual variation. A change observed in almost all dyads was the person with Parkinson's disease participating less in conversations. Assessment and interventions should be based on a broad perspective on communication, and individuals' priorities should be foregrounded in intervention planning. Both the person with Parkinson's disease and communication partners need to make adjustments for communication to work. Therefore, close communication partners should be included in assessment and intervention of communication in Parkinson's disease from an early stage.Implications for rehabilitationInterventions targeting communication in Parkinson's disease should be individually tailored and be based on a holistic perspective on communication.Communicative functions and participation should be assessed already at an early stage of the disease in order to minimize and slow down adverse effects, and to enable the development of effective, personalized strategies.Since changes in communicative abilities might affect self-perception and self-confidence, these aspects need to be taken into account when assessing and planning interventions targeting communication.Close communication partners should be included early in both assessment and intervention.
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http://dx.doi.org/10.1080/09638288.2018.1539875DOI Listing
June 2020

Study protocol of a randomized controlled trial on two new dissemination strategies for a brief, shared-decision-making (SDM) training for oncologists: web-based interactive SDM online-training versus individualized context-based SDM face-to-face training.

Trials 2019 Jan 7;20(1):18. Epub 2019 Jan 7.

Department of General Internal Medicine and Psychosomatics, Center for Psychosocial Medicine, Heidelberg University Hospital, Thibautstraße 4, 69115, Heidelberg, Germany.

Background: Oncological patients often feel left out of important treatment decisions. However, when physicians engage them in shared decision-making (SDM), patients benefit in many ways and the situation is improved. SDM can effectively be taught to physicians, but participation barriers for SDM physician group trainings are high, making it hard to convince physicians to participate. With this in mind, we aim to develop and evaluate two new dissemination strategies for a brief, SDM training program based upon a proven SDM group-training concept: an individualized context-based SDM face-to-face training (IG I) and a web-based interactive SDM online training (IG II). We aim to analyze which improvements can be achieved by IG I and II compared to a control group (CG) in physician SDM competence and performance as well as the impact on the physician-patient relationship. Furthermore, we analyze differences in satisfaction concerning the two dissemination strategies by means of a training evaluation.

Methods/design: We examine - based on a three-armed randomized controlled trial (IG I, IG II, CG) - the effectiveness of two new dissemination strategies for a SDM training program compared to a CG receiving no SDM training (voluntary access to SDM training as an incentive for participation after completion of the study). We aim to include 162 physicians randomized to one of the three arms. There will be two assessment points in time (before intervention: T and post-training: T). The main outcome is the SDM competence of physicians as measured by an established observational assessment rating system (OPTION-12) by means of consultations with Standardized Patients. Standardized Patients are individuals trained to act as "real" patients. Secondary outcome measures are the SDM performance (SDM-Q-9) and the Questionnaire on the Quality of Physician-Patient-Interaction (QQPPI) both rated by Standardized Patients as well as the physicians' training evaluation.

Discussion: This trial will assess the effectiveness and acceptability of two new dissemination strategies for a brief, SDM training program for physicians. Opportunities and challenges regarding implementation in daily routines will be discussed.

Trial Registration: ClinicalTrials.gov, Identifier: NCT02674360 . Prospectively registered on 4 February 2016.
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http://dx.doi.org/10.1186/s13063-018-3112-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6323749PMC
January 2019

XIAP deficiency in hematopoietic recipient cells drives donor T-cell activation and GvHD in mice.

Eur J Immunol 2019 03 3;49(3):504-507. Epub 2019 Jan 3.

Medizinische Klinik III, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.

Patients with X-linked lymphoproliferative syndrome type 2 (XLP-2) (BIRC4 deficiency) suffer from hyperinflammation often observed during the conditioning regimen prior to allogeneic bone marrow transplant. This article shows that in mice hematopoietic recipient cells contribute to graft-versus-host disease by the secretion of elevated levels of proinflammatory cytokines during engraftment when BIRC4 is absent.
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http://dx.doi.org/10.1002/eji.201847818DOI Listing
March 2019

Where phonology meets morphology in the context of rapid language change and universal bilingualism: Irish initial mutations in child language.

Clin Linguist Phon 2019 16;33(1-2):3-19. Epub 2018 Nov 16.

c Speech and Language Therapy , National University of Ireland Galway , Galway , Ireland.

As one of the Celtic languages, Irish is among the few languages in the world that employ word initial mutations (IMs) in order to express grammatical functions. IMs express grammatical information by a way of systematic alternation of minimal phonological contrasts, which closely links segmental phonology to grammatical morphology (Irish also employs final consonant palatalization as a grammatical marker, but this will not be the focus of our paper). The overwhelming majority of Irish speakers are bilingual (with English), and virtually all Irish-speaking children grow up with varying degrees of exposure to and use of English in the home. Irish is undergoing rapid language change at present, and the system of IM is affected by this process of shift such that many fluent Irish speakers show inconsistent use of IM in their spoken language. Given inconsistency in the use of a grammatical system in the adult language, the question arises whether it will be possible to identify developmental norms for the use of IM in child language. This in turn has clinical implications, in terms of the presence (or absence) of clinical markers of language delay or disorder. The data we report on consist of narrative samples from typically developing children (aged between 3 and 6) and a group of parents, who completed the same task (telling a story from a wordless picture book). We plot consistency and accuracy IM use in the language of children and parents. A key finding is that inconsistent IM use by parents is mirrored by inconsistent use by children. We discuss clinical implications for language sampling for diagnostic purposes, and the importance of individualized assessment.
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http://dx.doi.org/10.1080/02699206.2018.1542742DOI Listing
April 2020

Cinnamyl Isobutyrate Decreases Plasma Glucose Levels and Total Energy Intake from a Standardized Breakfast: A Randomized, Crossover Intervention.

Mol Nutr Food Res 2018 09 21;62(17):e1701038. Epub 2018 Aug 21.

Christian Doppler Laboratory for Bioactive Aroma Compounds, Faculty of Chemistry, University of Vienna, Althanstraße 14, 1090, Vienna, Austria.

Scope: Cinnamon is associated with anti-obesity effects, regulating food intake, improving plasma glucose levels and lipid profiles in vivo. In the present study, the impact of cinnamyl isobutyrate (CIB), one constituent of cinnamon, on ad libitum food intake from a standardized breakfast and outcome measures of hormonal regulation of appetite were investigated.

Methods And Results: In this randomized, short-term crossover intervention study, a 75 g per 300 mL glucose solution solely (control) or supplemented with 0.45 mg CIB was administered to 26 healthy volunteers. Prior to and 2 h after receiving control or CIB treatment, subjective hunger perceptions were rated using a visual analog scale. Food intake from a standardized breakfast was assessed 2 h after treatments. Plasma peptide YY , glucagon-like-peptide1, ghrelin, and serotonin as well as plasma glucose and insulin were measured in blood samples drawn at fasting and 15, 30, 60, 90, and 120 min after treatment. CIB administration decreased total energy intake and delta area under curve plasma glucose by 4.64 ± 3.51% and 49.3 ± 18.5% compared to control treatment, respectively.

Conclusions: CIB, administered at a 0.45 mg bolus in 75 g glucose-water solution, decreased ad libitum energy intake from a standardized breakfast and postprandial plasma glucose levels.
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http://dx.doi.org/10.1002/mnfr.201701038DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6175204PMC
September 2018

Culturally Anchoring an Intervention for Gender-Based Violence.

Int J Health Promot Educ 2018 19;56(2):85-94. Epub 2017 Dec 19.

Caribbean Exploratory (National Institute of Minority Health Disparities) Research Center, School of Nursing, University of the Virgin Islands, #2 John Brewer's Bay, St. Thomas, Virgin Islands, USA, (340) 693-1178,

Haitians continue to rebuild following the devastating earthquake in 2010, as many also strive to recover and heal from associated horrific events. Immediately following the earthquake, domestic and international agencies reported dramatic increases in violence against women and girls in this small Caribbean nation that shares the island of Hispaniola with the Dominican Republic. In this article we highlight one segment of a situational analysis used as groundwork for developing an intervention to address gender-based violence (GBV). We sought to rapidly identify existing and needed resources and services for internally displaced women and girls in Haiti and to facilitate an immediate and sustainable response. During an eight-day period, we convened focus groups in Port au Prince. Displaced women and older girls, directors of nongovernmental organizations (NGOs), healthcare providers and administrators, and community youth leaders participated in the focus groups. Findings from these focus groups illuminate the multiple influences of GBV on displaced women and girls. Gaps, strengths, and limitations of existing resources, capacities, systems, and services for internally displaced Haitian women and girls were identified. In addition, factors that could potentially support or hinder effective implementation of preventive and response interventions were revealed. Our findings provided a foundation and structure for developing a culturally- specific educational and safety plan which was used in Haiti following the earthquake and continues to have relevance for use, today.
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http://dx.doi.org/10.1080/14635240.2017.1415766DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6426333PMC
December 2017

To change or not to change - That is the question: A qualitative study of lifestyle changes following acute myocardial infarction.

Chronic Illn 2018 03 21;14(1):25-41. Epub 2017 Feb 21.

2 Department of General Internal Medicine and Psychosomatics, Center for Psychosocial Medicine, University of Heidelberg, Germany.

Objective The purpose of this study was to investigate key factors related to lifestyle changes following acute myocardial infarction (AMI) by eliciting survivors' subjective needs for, attitudes towards and experiences with behaviour changes in their everyday life to improve future interventions promoting lifestyle changes. Methods Semi-structured interviews were conducted with 21 individuals who had recently experienced an AMI. The interviews were audio-recorded and transcribed verbatim. The data were analysed using qualitative content analysis. Results The data analysis revealed that lifestyle changes following AMI are influenced by a combination of individual (physical and psychological) and social factors that can be grouped into facilitators and barriers. The interviews indicated the need for more personalised information regarding the causes and risk factors of illness, the benefits of lifestyle changes and the importance of including significant others in lifestyle advice and education and of individualising support. Discussion Lifestyle change is a continuous process that is not completed within a few months after a cardiac event. Considering the identified themes when developing interventions to promote lifestyle changes following AMI may enhance the effectiveness and sustainability of such interventions.
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http://dx.doi.org/10.1177/1742395317694700DOI Listing
March 2018

Functional Laterality of Task-Evoked Activation in Sensorimotor Cortex of Preterm Infants: An Optimized 3 T fMRI Study Employing a Customized Neonatal Head Coil.

PLoS One 2017 11;12(1):e0169392. Epub 2017 Jan 11.

Department of Radiology, University of Bonn, Bonn, Germany.

Background: Functional magnetic resonance imaging (fMRI) in neonates has been introduced as a non-invasive method for studying sensorimotor processing in the developing brain. However, previous neonatal studies have delivered conflicting results regarding localization, lateralization, and directionality of blood oxygenation level dependent (BOLD) responses in sensorimotor cortex (SMC). Amongst the confounding factors in interpreting neonatal fMRI studies include the use of standard adult MR-coils providing insufficient signal to noise, and liberal statistical thresholds, compromising clinical interpretation at the single subject level.

Patients / Methods: Here, we employed a custom-designed neonatal MR-coil adapted and optimized to the head size of a newborn in order to improve robustness, reliability and validity of neonatal sensorimotor fMRI. Thirteen preterm infants with a median gestational age of 26 weeks were scanned at term-corrected age using a prototype 8-channel neonatal head coil at 3T (Achieva, Philips, Best, NL). Sensorimotor stimulation was elicited by passive extension/flexion of the elbow at 1 Hz in a block design. Analysis of temporal signal to noise ratio (tSNR) was performed on the whole brain and the SMC, and was compared to data acquired with an 'adult' 8 channel head coil published previously. Task-evoked activation was determined by single-subject SPM8 analyses, thresholded at p < 0.05, whole-brain FWE-corrected.

Results: Using a custom-designed neonatal MR-coil, we found significant positive BOLD responses in contralateral SMC after unilateral passive sensorimotor stimulation in all neonates (analyses restricted to artifact-free data sets = 8/13). Improved imaging characteristics of the neonatal MR-coil were evidenced by additional phantom and in vivo tSNR measurements: phantom studies revealed a 240% global increase in tSNR; in vivo studies revealed a 73% global and a 55% local (SMC) increase in tSNR, as compared to the 'adult' MR-coil.

Conclusions: Our findings strengthen the importance of using optimized coil settings for neonatal fMRI, yielding robust and reproducible SMC activation at the single subject level. We conclude that functional lateralization of SMC activation, as found in children and adults, is already present in the newborn period.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0169392PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5226735PMC
August 2017

How Does a Shared Decision-Making (SDM) Intervention for Oncologists Affect Participation Style and Preference Matching in Patients with Breast and Colon Cancer?

J Cancer Educ 2018 06;33(3):708-715

Department of General Internal Medicine and Psychosomatics, Center for Psychosocial Medicine, Heidelberg University Hospital, Thibautstraße 4, 69115, Heidelberg, Germany.

The aims of this study are to assess patients' preferred and perceived decision-making roles and preference matching in a sample of German breast and colon cancer patients and to investigate how a shared decision-making (SDM) intervention for oncologists influences patients' preferred and perceived decision-making roles and the attainment of preference matches. This study is a post hoc analysis of a randomised controlled trial (RCT) on the effects of an SDM intervention. The SDM intervention was a 12-h SDM training program for physicians in combination with decision board use. For this study, we analysed a subgroup of 107 breast and colon cancer patients faced with serious treatment decisions who provided data on specific questionnaires with regard to their preferred and perceived decision-making roles (passive, SDM or active). Patients filled in questionnaires immediately following a decision-relevant consultation (t1) with their oncologist. Eleven of these patients' 27 treating oncologists had received the SDM intervention within the RCT. A majority of cancer patients (60%) preferred SDM. A match between preferred and perceived decision-making roles was reached for 72% of patients. The patients treated by SDM-trained physicians perceived greater autonomy in their decision making (p < 0.05) with more patients perceiving SDM or an active role, but their preference matching was not influenced. A SDM intervention for oncologists boosted patient autonomy but did not improve preference matching. This highlights the already well-known reluctance of physicians to engage in explicit role clarification.

Trial Registration: German Clinical Trials Register DRKS00000539; Funding Source: German Cancer Aid.
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http://dx.doi.org/10.1007/s13187-016-1146-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5949132PMC
June 2018

Problem solving, impulse control and planning in patients with early- and late-stage Huntington's disease.

Eur Arch Psychiatry Clin Neurosci 2016 Oct 2;266(7):663-71. Epub 2016 Jul 2.

Department of Psychiatry, Medical University of Graz, Auenbruggerplatz 31/1, 8036, Graz, Austria.

Sub-domains of executive functions, including problems with planning, accuracy, impulsivity, and inhibition, are core features of Huntington's disease. It is known that the decline of cognitive function in Huntington's disease is related to the anatomical progression of pathology in the basal ganglia. However, it remains to be determined whether the severity of executive dysfunction depends on the stage of the disease. To examine the severity of sub-domains of executive dysfunction in early- and late-stage Huntington's disease, we studied performance in the Tower of London task of two groups of Huntington's disease patients (Group 1: early, n = 23, and Group 2: late stage, n = 29), as well as a third group of age, education, and IQ matched healthy controls (n = 34). During the task, we measured the total number of problems solved, total planning time, and total number of breaks taken. One aspect of executive function indexed by the number of solved problems seems to progress in the course of the disease. Late-stage Huntington's disease patients scored significantly worse than early-stage patients and controls, and early-stage patients scored significantly worse than controls on this measure of accuracy. In contrast, late- and early-stage HD patients did not differ in terms of planning time and number of breaks. Early- and late-stage HD pathology has a different impact on executive sub-domains. While accuracy differs between early- and late-stage HD patients, other domains like planning time and number of breaks do not. Striatal degeneration, which is a characteristic feature of the disease, might not affect all aspects of executive function in HD.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5037143PMC
http://dx.doi.org/10.1007/s00406-016-0707-4DOI Listing
October 2016

[Shared Decision Making (SDM) - Patient and Physician as a Team].

Psychother Psychosom Med Psychol 2016 May 27;66(5):195-207. Epub 2016 Apr 27.

Klinik für Allgemeine Innere Medizin und Psychosomatik, Zentrum für Psychosoziale Medizin, Universitätsklinikum Heidelberg.

The article provides an overview on Shared Decision Making (SDM), which is considered as the ideal form of physician-patient-interaction by many stakeholders of the health care system. SDM is distinguished from other models of physician-patient-interaction such as the paternalistic model and the information model. Besides the degree of acceptance of SDM in the general population and among physicians, barriers for its implementation will be reported. Indications for SDM as well as strategies and support material for its use in individual consultations will be discussed and illustrated by an oncological case study. Effects of SDM for patients as well as for clinicians will be highlighted. After background information on origins of SDM, its significance with regard to health policy in Germany is discussed.
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http://dx.doi.org/10.1055/s-0042-105277DOI Listing
May 2016