Preventing adverse events during paediatric cancer treatment: protocol for a multi-site hybrid randomised controlled trial of catheter lock solutions (the CLOCK trial).

INTRODUCTION: Central venous access devices (CVADs) are commonly used for the treatment of paediatric cancer patients. Catheter locking is a routine intervention that prevents CVAD-associated adverse events, such as infection, occlusion and thrombosis. While laboratory and clinical data are promising, tetra-EDTA (T-EDTA) has yet to be rigorously evaluated or introduced in cancer care as a catheter lock. METHODS AND ANALYSIS: This is a protocol for a two-arm, superiority type 1 hybrid effectiveness-implementation randomised controlled trial conducted at seven hospitals across Australia and New Zealand. Randomisation will be in a 3:2 ratio between the saline (heparinised saline and normal saline) and T-EDTA groups, with randomly varied blocks of size 10 or 20 and stratification by (1) healthcare facility; (2) CVAD type and (3) duration of dwell since insertion. Within the saline group, there will be a random allocation between normal and heparin saline. Participants can be re-recruited and randomised on insertion of a new CVAD. Primary outcome for effectiveness will be a composite of CVAD-associated bloodstream infections (CABSI), CVAD-associated thrombosis or CVAD occlusion during CVAD dwell or at removal. Secondary outcomes will include CABSI, CVAD-associated-thrombosis, CVAD failure, incidental asymptomatic CVAD-associated-thrombosis, other adverse events, health-related quality of life, healthcare costs and mortality. To achieve 90% power (alpha=0.05) for the primary outcome, data from 720 recruitments are required. A mixed-methods approach will be employed to explore implementation contexts from the perspective of clinicians and healthcare purchasers. ETHICS AND DISSEMINATION: Ethics approval has been provided by Children's Health Queensland Hospital and Health Service Human Research Ethics Committee (HREC) (HREC/22/QCHQ/81744) and the University of Queensland HREC (2022/HE000196) with subsequent governance approval at all sites. Informed consent is required from the substitute decision-maker or legal guardian prior to participation. In addition, consent may also be obtained from mature minors, depending on the legislative requirements of the study site. The primary trial and substudies will be written by the investigators and published in peer-reviewed journals. The findings will also be disseminated through local health and clinical trial networks by investigators and presented at conferences. TRIAL REGISTRATION NUMBER: ACTRN12622000499785.

No evidence for high inflexible precision of prediction errors in autism during lexical processing.

Research has shown that information processing differences associated with autism could impact on language and literacy development. This study tested an approach to autistic cognition that suggests learning occurs via prediction errors, and autistic people have very precise and inflexible predictions that result in more sensitivity to meaningless signal errors than non-autistic readers. We used this theoretical background to investigate whether differences in prediction coding influence how orthographic (Experiment 1) and semantic information (Experiment 2) is processed by autistic readers. Experiment 1 used a lexical decision task to test whether letter position information was processed less flexibly by autistic than non-autistic readers. Three types of letter strings: words, transposed letter and substituted letters nonwords were presented. Experiment 2 used a semantic relatedness task to test whether autistic readers processed words with high and low semantic diversity differently to non-autistic readers. Results showed similar transposed letter and semantic diversity effects for all readers; indicating that orthographic and semantic information are processed similarly by autistic and non-autistic readers; and therefore, differences in prediction coding were not evident for these lexical processing tasks.

'Anything but the phone!': Communication mode preferences in the autism community.

LAY ABSTRACT: What is already known about the topic?There has been a lot of research into things like how autistic people's communication styles are different to those of non-autistic people, especially among children. This has tended to focus on parent reports and experiments, rather than asking autistic people about their own experiences and preferences regarding communication.What does this article add?This article is the first to ask autistic adults how they prefer to communicate in different scenarios. We asked whether they preferred to use a range of methods, such email, phone calls, letters and live messaging, in scenarios from education to customer services to friends and family. When contacting unknown people or organisations, we found that generally email was preferred, and phone calls were very unpopular. However, for friends, family and people they felt comfortable with, they preferred both face-to-face and written forms of communication (e.g. email and text message).Implications for practice, research or policyThe findings suggest that services should move away from a reliance on phone calls for communication. They should make sure that access to support is not dependent on the phone, and instead offer written options such as email and live messaging which are more accessible. Future research should investigate the impact of COVID-19 on autistic people's communication preferences, as video calling has become much more commonly used and potentially combines benefits and challenges of other modes discussed in this article.

What Can Eye Movements Tell Us about Subtle Cognitive Processing Differences in Autism?

Autism spectrum disorder (ASD) is neurodevelopmental condition principally characterised by impairments in social interaction and communication, and repetitive behaviours and interests. This article reviews the eye movement studies designed to investigate the underlying sampling or processing differences that might account for the principal characteristics of autism. Following a brief summary of a previous review chapter by one of the authors of the current paper, a detailed review of eye movement studies investigating various aspects of processing in autism over the last decade will be presented. The literature will be organised into sections covering different cognitive components, including language and social communication and interaction studies. The aim of the review will be to show how eye movement studies provide a very useful on-line processing measure, allowing us to account for observed differences in behavioural data (accuracy and reaction times). The subtle processing differences that eye movement data reveal in both language and social processing have the potential to impact in the everyday communication domain in autism.

Processing of co-reference in autism spectrum disorder.

Accuracy for reading comprehension and inferencing tasks has previously been reported as reduced for individuals with autism spectrum disorder (ASD), relative to typically developing (TD) controls. In this study, we used an eye movements and reading paradigm to examine whether this difference in performance accuracy is underpinned by differences in the inferential work required to compute a co-referential link. Participants read two sentences that contained a category noun (e.g., bird) that was preceded by and co-referred to an exemplar that was either typical (e.g., pigeon) or atypical (e.g., penguin). Both TD and ASD participants showed an effect of typicality for gaze durations upon the category noun, with longer times being observed when the exemplar was atypical, in comparison to typical. No group differences or interactions were detected for target processing, and verbal language proficiency was found to predict general reading and inferential skill. The only difference between groups was that individuals with ASD engaged in more re-reading than TD participants. These data suggest that readers with ASD do not differ in the efficiency with which they compute anaphoric links on-line during reading. Autism Res 2017, 10: 1968-1980. © 2017 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY: Individuals with autism spectrum disorder (ASD) have previously been reported to have difficulties with reading comprehension. This study examined whether a difference in the speed with which individuals with ASD form connections between words (co-reference processing) may contribute to comprehension difficulties. No evidence was found to suggest that ASD readers differ to typically developing readers in the speed of co-reference processing. Therefore, this data would suggest that differences in co-reference processing are unlikely to account for reading comprehension difficulties in ASD.

Investigating the Use of World Knowledge During On-line Comprehension in Adults with Autism Spectrum Disorder.

The on-line use of world knowledge during reading was examined in adults with autism spectrum disorder (ASD). Both ASD and typically developed adults read sentences that included plausible, implausible and anomalous thematic relations, as their eye movements were monitored. No group differences in the speed of detection of the anomalous violations were found, but the ASD group showed a delay in detection of implausible thematic relations. These findings suggest that there are subtle differences in the speed of world knowledge processing during reading in ASD.

Benchmark eye movement effects during natural reading in autism spectrum disorder.

In 2 experiments, eye tracking methodology was used to assess on-line lexical, syntactic and semantic processing in autism spectrum disorder (ASD). In Experiment 1, lexical identification was examined by manipulating the frequency of target words. Both typically developed (TD) and ASD readers showed normal frequency effects, suggesting that the processes TD and ASD readers engage in to identify words are comparable. In Experiment 2, syntactic parsing and semantic interpretation requiring the on-line use of world knowledge were examined, by having participants read garden path sentences containing an ambiguous prepositional phrase. Both groups showed normal garden path effects when reading low-attached sentences and the time course of reading disruption was comparable between groups. This suggests that not only do ASD readers hold similar syntactic preferences to TD readers, but also that they use world knowledge on-line during reading. Together, these experiments demonstrate that the initial construction of sentence interpretation appears to be intact in ASD. However, the finding that ASD readers skip target words less often in Experiment 2, and take longer to read sentences during second pass for both experiments, suggests that they adopt a more cautious reading strategy and take longer to evaluate their sentence interpretation prior to making a manual response. (PsycINFO Database Record

Looking, seeing and believing in autism: Eye movements reveal how subtle cognitive processing differences impact in the social domain.

Adults with High Functioning Autism Spectrum Disorders (ASD) viewed scenes with people in them, while having their eye movements recorded. The task was to indicate, using a button press, whether the pictures were normal, or in some way weird or odd. Oddities in the pictures were categorized as violations of either perceptual or social norms. Compared to a Typically Developed (TD) control group, the ASD participants were equally able to categorize the scenes as odd or normal, but they took longer to respond. The eye movement patterns showed that the ASD group made more fixations and revisits to the target areas in the odd scenes compared with the TD group. Additionally, when the ASD group first fixated the target areas in the scenes, they failed to initially detect the social oddities. These two findings have clear implications for processing difficulties in ASD for the social domain, where it is important to detect social cues on-line, and where there is little opportunity to go back and recheck possible cues in fast dynamic interactions. Autism Res 2016, 9: 879-887. © 2015 International Society for Autism Research, Wiley Periodicals, Inc.