Using intervention mapping to develop an intervention for multiparty communication with people with congenital deafblindness.

BACKGROUND: Due to their dual sensory impairment, people with congenital deafblindness (CDB) are rarely naturally involved in other people's conversations. Their communication partners find it challenging to include them in group conversations. However, overhearing others communicate is important for developing social and communication skills. Hence, we developed an intervention program to guide communication partners in offering multiparty communication to people with CDB. This article describes how the program was developed through an intervention mapping approach. METHOD: Intervention mapping is a six-step process: logic model, model of change, program design, program production, program implementation plan, and evaluation plan. These six steps were applied to systematically develop a program to foster multiparty communication in people with CDB. Representatives of the involved groups participated in the project group and the working group to ensure feasibility and acceptability. RESULTS: Following the intervention mapping steps resulted in creation of a program for communication partners that consists of an education session, practicals, and four video-feedback sessions. Information sessions for practitioners and managers were also developed. The program was implemented incrementally with program implementers in each organization. A subjective evaluation and an impact evaluation were done after each implementation phase. DISCUSSION: Intervention mapping was used to develop a program that connects theory to practice. The program appeared to meet the communication partners' needs and be feasible in terms of time investment. This article offers suggestions for broadening the scope of the program to other settings and for further investigating the effects of the program on the social and communication skills of people with CDB.

The relationship between motor performance and executive functioning in early childhood: A systematic review on motor demands embedded within executive function tasks.

This systematic review examined to what extent response demands of executive functioning (EF) tasks influence the relationship between motor performance and EF in 2- to 6-year-old typically developing (TD) children and children with motor coordination difficulties (MCD). Eighteen of the included articles focused on TD children only and three also on children with MCD. EF tasks were subdivided based on the type of responses (i.e., motor or verbal). EF tasks requiring a motor response were subdivided into two levels (i.e., complex or simple). Results showed that the relationship between motor performance and EF in 2- to 6-year-old TD children and children with MCD was inconclusive with the strength of correlation coefficients for the most part varying from very weak to moderate. The type of EF task response did not influence the relationship between motor performance and EF. The review thus implies that other task demands than the type of EF task response need to be investigated to explain the inconsistent relationship between motor performance and EF, such as the complexity of the motor response of EF tasks, the complexity of the actual motor tasks, and additional processes (e.g., memory, intelligence, language comprehension).

Development and process evaluation of a motor activity program for people with profound intellectual and multiple disabilities.

BACKGROUND: The support of people with profound intellectual and multiple disabilities (PIMD) rarely focused on motor activity, which might have negative consequences for the quality of life of these people. Evidence-based motor activity programs that present individually tailored and structural motor activity for these people are, regretfully, lacking. This study developed such a program for these people and evaluated the implementation process. METHODS: The motor activity program is developed in accordance with the theoretical premises of the educational program and consists of four methodological steps in which the content is individually filled with: motor activity structurally embedded within the activities of daily living, and 3-5 motor activities aimed at a specific goal, which is evaluated. Program delivery consisted of a manual, explanation to the teams, and coaching of one contact person per participant (n = 9). Process evaluation included the delivered fidelity, dose, reach, and adaptations made during the program. In addition, mechanisms of impact and the influence of contextual factors were evaluated. Data collection included researcher logbooks, individual program content, and staff reports. RESULTS: The intended fidelity, dose, and reach were not obtained in most participants. Content has been made explicit for seven participants, but only in one participant all critical steps in implementation were performed as intended, though later in time. In three participants, previously offered motor activities were described within the weekly program, but without all activities having a clear link with the goal set. It is showed that the core elements of the program were affected with the conceived implementation plan. The time schedule, critical elements in implementation and program content were influenced by a lack of conditions such as professionals' motivation and responsibility, methodical working, interdisciplinarity and continuity in staff. CONCLUSIONS: The results suggest that the implementation might be improved in case more attention is paid to the organizational conditions and implementation structure. The findings led to substantial changes in the implementation strategy. This study underlines the importance of process evaluation prior to testing for effectiveness. TRIAL REGISTRATION: The (overarching) study was registered at the Netherlands Trial Register (number 6627) on February 10, 2017: https://www.trialregister.nl/trial/6449 .

Construct validity of the Actiwatch-2 for assessing movement in people with profound intellectual and multiple disabilities.

BACKGROUND: Valid measures to assess either small or assisted performed movements of people with profound intellectual and multiple disabilities (PIMD) are required. We analysed the construct validity of the Actiwatch-2 to assess movement in people with PIMD. METHOD: Twenty-two persons with PIMD were video recorded while wearing an Actiwatch-2. We used 15s-partial-interval recording to record upper body movement, body position and activity situation. Multilevel analyses were used to evaluate if the Actiwatch-2, based on produced counts, could detect changes in these factors. RESULTS: The presence versus absence of upper body movement and an activity situation in which participants were involved versus not involved resulted in significantly higher counts, with a large variety in predicted counts between participants. No relationship between body position and counts was found. CONCLUSIONS: The Actiwatch-2 seems able to assess obvious upper body movement in people with PIMD, and whether there is involvement in an activity situation.

Electron Trapping Mechanism in LaAlO_{3}/SrTiO_{3} Heterostructures.

In LaAlO_{3}/SrTiO_{3} heterostructures, a still poorly understood phenomenon is that of electron trapping in back-gating experiments. Here, by combining magnetotransport measurements and self-consistent Schrödinger-Poisson calculations, we obtain an empirical relation between the amount of trapped electrons and the gate voltage. The amount of trapped electrons decays exponentially away from the interface. However, contrary to earlier observations, we find that the Fermi level remains well within the quantum well. The enhanced trapping of electrons induced by the gate voltage can therefore not be explained by a thermal escape mechanism. Further gate sweeping experiments strengthen that conclusion. We propose a new mechanism which involves the electromigration and clustering of oxygen vacancies in SrTiO_{3} and argue that such electron trapping is a universal phenomenon in SrTiO_{3}-based two-dimensional electron systems.

Rapid Naming and Phonemic Awareness in Children With or Without Reading Disabilities and/or ADHD.

Employing a large sample of children from Dutch regular elementary schools, this study assessed the contributing and discriminating values of reading disability (RD) and attention-deficit/hyperactivity disorder (ADHD) to two types of phonological processing skills, phonemic awareness (PA) and rapid automatized naming (RAN). A second objective was to investigate whether comorbidity of RD and ADHD should be considered as an additive phenomenon as to RAN and PA. A total of 1,262 children, aged 8 to 13 years, were classified as RD ( n = 121), ADHD ( n = 17), comorbid (RD+ADHD; n = 16), or control ( n = 1,108). Phonological processing was assessed by standardized tests of PA and RAN. Disability groups were compared to each other and contrasted to the control group. Although results indicate substantial effects for all three disability groups on both types of phonological processing, and the RAN/PA compound measure in particular, effect sizes were considerably larger for the RD groups, as compared to the ADHD-only group. Theoretical and practical implications are discussed.

Rapid Naming and Phonemic Awareness in Children With Reading Disabilities and/or Specific Language Impairment: Differentiating Processes?

PURPOSE: The objective of this study was to assess and compare the predictive values of group membership for rapid automatized naming (RAN) and phonemic awareness (PA) in Dutch school children with and without reading disabilities (RD) or specific language impairment (SLI). METHOD: A composite word reading index and a formal SLI diagnosis were used to classify a total of 1,267 children aged 8 to 13 years old either as RD-only (n = 126), SLI-only (n = 21), comorbid (RD+SLI; n = 30), or typically developing (n = 1,090). RAN and PA were assessed with 4 standardized subtests. The clinical subgroups were compared to each other and contrasted with the control group. RESULTS: For each subgroup, results indicate substantial effect sizes of RAN and PA. However, the RD-only group seems to be more affected by poor RAN than the SLI-only group, whereas the 2 groups perform equally poorly on PA. The comorbid group was revealed as most severely impaired on all measurements. CONCLUSIONS: In studying RD and SLI, this research indicates that it is important to distinguish between RD-only, SLI-only, and comorbid groups. The comorbid group shows additive effects of both disorders.

The attentional blink in typically developing and reading-disabled children.

This study's research question was whether selective visual attention, and specifically the attentional blink (AB) as operationalized by a dual target rapid serial visual presentation (RSVP) task, can explain individual differences in word reading (WR) and reading-related phonological performances in typically developing children and reading-disabled subgroups. A total of 407 Dutch school children (Grades 3-6) were classified either as typically developing (n = 302) or as belonging to one of three reading-disabled subgroups: reading disabilities only (RD-only, n = 69), both RD and attention problems (RD+ADHD, n = 16), or both RD and a specific language impairment (RD+SLI, n = 20). The RSVP task employed alphanumeric stimuli that were presented in two blocks. Standardized Dutch tests were used to measure WR, phonemic awareness (PA), and alphanumeric rapid naming (RAN). Results indicate that, controlling for PA and RAN performance, general RSVP task performance contributes significant unique variance to the prediction of WR. Specifically, consistent group main effects for the parameter of AB(minimum) were found, whereas there were no AB-specific effects (i.e., AB(width) and AB(amplitude)) except for the RD+SLI group. Finally, there was a group by measurement interaction, indicating that the RD-only and comorbid groups are differentially sensitive for prolonged testing sessions. These results suggest that more general factors involved in RSVP processing may explain the group differences found.

Learning capacity in adolescents with mild intellectual disabilities.

Scores on a learning potential test (the Hessels Analogical Reasoning Test) were examined to assess how to provide a better estimate of the learning capacity of students with mild intellectual disabilities compared to IQ scores. As a criterion, a dynamic test of chemistry learning was used. 46 adolescents from a special education institute participated. The results show that learning ability, as estimated with the learning potential test, did not correlate with a traditional measure of IQ (n = 23). Moreover, IQ did not predict who would profit from training in novel, school-related domains. Multiple-regression analysis confirmed the superiority of the learning potential test to predict scores on a chemistry test administered in training-posttest format. This study demonstrated that a learning potential test is able to better predict such specific future learning outcomes and may be of added value in the differentiation of the learning potential of students with mild intellectual disabilities.

Pertussis outbreak on a neonatal unit: identification of a healthcare worker as the likely source.

We describe the investigation and containment of an outbreak of pertussis on a neonatal unit. Bacterial culture, polymerase chain reaction (PCR) and serology were used to confirm suspected cases. Two infants with pertussis were identified and a nurse with prolonged cough was traced as the likely source. Control interventions included mass chemoprophylaxis of healthcare workers and patients and exclusion from work of healthcare workers with cough. The use of PCR allowed rapid assessment of the extent of the outbreak. This outbreak highlights the risk to hospitalised infants posed by circulation of Bordetella pertussis in young adults and illustrates the utility of PCR in rapidly assessing the extent of outbreaks. Prevention strategies such as universal vaccination of adolescents, or selective vaccination of healthcare workers, should be considered in the UK.

Do surgical brain lesions present as isolated dementia? A population-based study.

OBJECTIVE: To determine the incidence of clinically important subdural hematoma (SDH), hydrocephalus not associated with a recent intracranial bleed, and intracranial tumor that is not obviously metastatic, and to test the sensitivity of a promising decision rule for computerized tomography (CT) in dementia. DESIGN: Population-based, retrospective, sequential case series. SETTING: Staff model health maintenance organization (HMO). PATIENTS: Patients aged 65 years and older with one of the three lesions, diagnosed over a 4.5-year period, identified mainly through computerized databases of hospital discharge diagnoses and a registry of malignant tumors. MEASUREMENTS: Clinical data were based on chart review. The decision rule, based on one that had been previously proposed and tested, stated that CT would be required if any one of 11 clinical criteria were met by a patient with cognitive impairment. Rule sensitivity was evaluated using clinical information recorded before CT. MAIN RESULTS: One hundred forty-five clinically important lesions were identified among 137,100 person-years at risk. Average annual incidence per 100,000 was 46.7 (95% CI 36.0, 59.6) for SDH, 5.8 (95% CI 2.5, 11.5) for hydrocephalus not associated with a recent intracranial bleed, and 53.2 (95% CI 41.7, 66.9) for intracranial tumors that were not obviously metastatic. Using the 65 to 74- year age strata as a reference, the relative risk for SDH was 4.8 (95% CI 2.7, 8.5) in 75 to 84-year-olds and 13.1 (95% CI 7.7, 22.5) in the 85 and older strata. Among 59 patients who presented with cognitive impairment, without altered sensorium or physical evidence of trauma, decision rule sensitivity was 93.2% (95% CI 83.5%, 98.1%). Sensitivity was 90.7% (95% CI 77.9%, 97.4%) in the subgroup that presented to an ambulatory care clinic rather than to an emergency department. CONCLUSIONS: These three lesions, which are the most common surgical lesions that may present as dementia, are rare. Most cases have presentations that easily distinguish them from typical Alzheimer's disease. This case series indicates that it may be feasible to develop a decision rule for the selective use of CT in dementia. Disease spectrum will influence measures of decision rule performance such as sensitivity and specificity.

A review of the literature on cocaine abuse in pregnancy.

The primary research literature on cocaine abuse in pregnancy from 1982 to 1989 was reviewed. This article is a synthesis of current knowledge regarding the effects of maternal cocaine use during pregnancy on obstetrical, neonatal, and infant health and developmental outcomes. Consistencies and inconsistencies in the findings, a critique of key methodological issues, and suggestions for future research are provided.