Culturally Appropriate Stimuli for Cognitive Neuropsychology-Based Treatment "Intensive Language Action Therapy (ILAT)".

CONTEXT: A standardized set of picture stimuli for neuro-language disorder has been long overdue. AIMS: To develop a standardized set of 303 pictures for use in experiments of Intensive Language Action Therapy (ILAT). METHODS AND MATERIAL: Several sources with standardized picture stimuli having culturally unbiased features were studied. Among those studies two prime sources (1) Snodgrass & Vanderwart (1980), 127 (89+37) items and (2) Neininger & Pulvermuller (2002), 147 (89+56) items were used extensively. Out of 303 stimuli, 89 items were common to both principle sources. An Indian study by George & Mathuranath (2007) has also been taken as an additional source. Line drawing stimuli were standardized on four variables of central relevance to memory and cognitive processing: name agreement, image agreement, familiarity, and visual complexity. STATISTICAL ANALYSIS USED: All measures related to 303 concepts i.e. % correct, H statistics, familiarity, image agreement and visual complexity were analysed descriptively. RESULTS: Low mean and positive skew on H statistics and visual complexity show that many concepts had a high name agreement (13 concepts have H values of .0, and 55 have H values of 0.68 or below, where 0.68 represents consensus among all but few of the subjects on a picture's name) and were visually simple line drawings. The intercorrelations among the four measures were low, suggesting that they are indices of different attributes of the pictures. CONCLUSIONS: Usage of appropriate items/stimuli has immense potential to influence aphasia therapy outcome. This set of pictures and its normative variable has enhanced the ILAT outcome. It could be generalised for other aphasia therapy too to understand its efficacy.

Aphasia in Neurology Practice: A Survey about Perceptions and Practices.

BACKGROUND: Aphasia is one of those clinical conditions, where the role of affiliated professionals, mainly speech language pathologists (SLPs) is substantial in diagnostic assessments, therapy, and rehabilitation. There is no study to focus on neurologists, with respect to their perceptions and practices about aphasia, the disease, as well as the profession of SLP. OBJECTIVE: To reach out to the neurologist community in India and learn about their perceptions and practices about the nature of the ailment and role of speech language therapy (SLT). Our premise was that observations and inferences from a questionnaire-based survey will be subsequently helpful in planning educational activities targeted to neurologists with more focus on specific gaps in perceptions and practices. MATERIAL AND METHODS: Three neurologists and two SLPs collaboratively developed the questionnaire. The aim was to probe the issues which were likely to have a bearing upon optimum service delivery to persons with aphasia by a dyad of neurologist and SLP. The survey was set in "Google Forms" and sent by "WhatsApp" and email to approximately 500 practicing neurologists in India. We employed a nonprobability sampling design for ease of administration with a combination of "chunk sampling" and "snowball sampling." Telephonic reminders were made to almost all. RESULTS AND DISCUSSION: We received 100 responses. The mean age of respondents was 50.64 (SD +/- 12.60) with a range of 28-78 years. The mean number of years of experience as a neurophysician was 19.88 (SD. +/- 12.72) with range of 1-47 years. Females were only 8%. Apparently, the proportion of neurologists working in large corporate and large public sector institutions from tier one and tier two cities was higher, who are more likely to have SLP and related rehabilitation facilities in their institutions and hence harbor more conducive attitudes to SLT in aphasia. The ground reality from tier three cities and small private and public sector hospital and solo practitioners may be somewhat worse than this. Many responses were in conformity with facts and in tune with desirable attitudes as per guidelines like aphasia being a detrimental factor in stroke recovery, doing assessment of handedness, paying attention to neuroimaging correlations and associated cognitive functions, not resorting to unnecessary pharmacotherapy, being aware about efficacy of SLT, and fairly good chances of recovery. However, many more answers highlighted a need for emphasis in Continuing Medical Education like not being aware about community burden of aphasia in comparison to a few better known neurological diseases, not paying attention to psychosocial aspects apart from biological ones in assessment and rehabilitation, not using a standardized and validated battery, not confidant about role of SLT in chronic stable aphasia and need for longer and intensive therapy, and being unconcerned for the value of advocacy for aphasia, like the role of Self-Help Groups. CONCLUSION: The thrust areas, pertaining to gaps in perception and practices identified through this study, can be viewed as "an in-time input." We hope that changes in some of the perceptions and practices can be attained through an emphasis on education and training at multiple levels right from the undergraduate to the practicing physicians. A few more themes and domains will need advocacy actions targeted to different stakeholders.

Signatures of consolidated superparamagnetic and spin-glass behavior in magnetite-silver core-shell nanoparticles.

A detailed investigation of magnetization relaxation for silver-coated magnetite nanostructures with three different types of magnetic behavior in a single particle is presented. Magnetite nanoparticles of diameter ∼6.5 nm synthesized via single-phase emulsion were further coated with a silver shell of thickness ∼2 nm. The synthesized nanoparticles are found to be efficiently photoluminescent. The coating of silver generates a magnetically disordered spin layer at the interface of the magnetic core and the non-magnetic shell. This intermediate layer plays a significant role in the dynamical magnetic response of nanoparticles under an external magnetic field. We present detailed magnetic measurements such as field- and temperature-dependent dc magnetization with zero-field-cooled and field-cooled protocols, ac susceptibility and time decay of magnetization relaxation along with their analysis using various formalisms viz. Néel-Arrhenius, Vogel-Fulcher and power law models. The relaxation analysis suggests the consolidated presence of two characteristic relaxation times corresponding to the superparamagnetic and spin-glass behavior of silver-coated magnetite nanoparticles.

The structural basis for the function of two anti-VEGF receptor 2 antibodies.

The anti-VEGF receptor 2 antibody IMC-1121B is a promising antiangiogenic drug being tested for treatment of breast and gastric cancer. We have determined the structure of the 1121B Fab fragment in complex with domain 3 of VEGFR2, as well as the structure of a different neutralizing anti-VEGFR2 antibody, 6.64, also in complex with VEGFR2 domain 3. The two Fab fragments bind at opposite ends of VEGFR2 domain 3; 1121B directly blocks VEGF binding, whereas 6.64 may prevent receptor dimerization by perturbing the domain 3:domain 4 interface. Mutagenesis reveals that residues essential for VEGF, 1121B, and 6.64 binding are nonoverlapping among the three contact patches.

Two routes of transobturator tape procedures in stress urinary incontinence: a meta-analysis with direct and indirect comparison of randomized trials.

STUDY TYPE: Therapy (meta-analysis) Level of Evidence 1a. OBJECTIVES: To assess the effectiveness and complications of transobturator tape (inside-out and outside-in, TOT) by means of a systematic review of direct and indirect randomized controlled trials (RCTs). METHOD: MEDLINE, EMBASE, CINAHL, LILIACS (up to December 2008), CENTRAL (The Cochrane Library, Issue 1, 2009), MetaRegister of Controlled Trials, The National Library for Health, the National Research Register and Google Scholar were searched using various relevant search terms. The citation lists of review articles and included trials were searched and contact with the Correspondence of each included trials was attempted. RCTs which compared the effectiveness of synthetic transobturator (inside-out tape TVTO, or outside-in TOT) with TVT by the retropubic route (Gynecare, Ethicon, Inc., or similar tape by a different company) or with each other for the treatment of stress urinary incontinence (SUI), and in all languages, were included. Two reviewers extracted data on participants' characteristics, study quality, intervention, cure and adverse effects independently. The data were analysed using Review Manager 5 software. RESULTS: There were 12 RCTs that compared TOT with TVT, and 15 that compared TVTO vs TVT for treating SUI. There were four direct comparison RCTs of TVTO vs TOT. When compared at 1-44 months, the subjective (odds ratio 1.16; 95% confidence interval 0.83-1.6) and objective (0.94; 0.66-1.32) cure of TOT was similar to TVT. For TVTO, the subjective (1.06, 0.85-1.33) and objective cure (1.03, 0.77-1.39) was also similar to TVT. Adverse events such as bladder injuries (TOT, odds ratio 0.11, 0.05-0.25; TVTO, 0.15, 0.06-0.35) and haematomas (0.06, 0.01-0.30) were less in the TOT than TVT. Voiding difficulties (TOT, odds ratio 0.61, 0.35-1.07); TVTO, 0.81, 0.48-1.31) were slightly lower in TOT but this was not statistically significant. Groin/thigh pain (TVTO, odds ratio 8.05, 3.78-17.16) and vaginal injuries (TOT, 5.82, 1.85-18.3; TVTO, 1.69, 0.73-3.91) were more common in the transobturator tapes. Mesh erosion in TVTO (0.77, 0.22-2.72) and TOT (1.11, 0.54-2.28) was similar to TVT. The effectiveness data over 6 months available from four direct comparison studies of TVTO vs TOT suggested equivalent results for objective cure (1.06, 0.65-1.73) and subjective cure (1.37, 0.93-2.00). When compared indirectly, TVTO has similar subjective (1.23, 0.83-1.82) and objective cure (0.97, 0.62-1.52) to TOT. On indirect comparison, the de novo risk of urgency was similar in the two groups but voiding difficulties seemed to be less in the inside-out group. CONCLUSION: The evidence for the equivalent effectiveness of TOT and TVTO when compared with each other is established over the short-term. Bladder injuries and voiding difficulties seem to be less with inside-out tapes on indirect comparison. An adequate long-term follow-up of the RCTs is desirable to establish the long-term continued effectiveness of transobturator tapes.