Incidence and risk factors of venous and arterial thromboembolic events among patients with ovarian cancer- data from a large Canadian database.

OBJECTIVES: To determine the incidence of thromboembolic events (TEEs) in ovarian cancer patients and to identify risk factors that are significantly associated with the development of venous thromboembolism (VTE), arterial thromboembolism (ATE), or overall TEEs in this population. METHODS: This is a retrospective cohort study of 4491 patients with epithelial ovarian cancer identified in the British Columbia cancer registry between 1996 and 2017. The presence of TEEs and risk factors were identified in administrative health records from fee-for-service provider visits and hospital data using ICD-9-CM and ICD-10-CM billing codes. Statistical analysis was performed using Chi-squared test and Fischer's exact test. RESULTS: Of 4491 patients with epithelial ovarian cancer included in this study, 1.74% experienced ATE and (9.44%) experienced VTE. There was a significant association found between the occurrence of TEEs and all-cause mortality. Sepsis was significantly associated with both venous and arterial thromboembolism. The top three risk factors for arterial thromboembolism included peripheral vascular disease (PVD), open wound, and aneurysm. CONCLUSIONS: Risk factors predictive of thrombosis in ovarian cancer patients are not consistent between ATE and VTE, thus thrombotic events should not be combined for analysis. Differential thrombosis risk assessment is needed to improve prevention strategies and guide thromboprophylaxis for these patients.

Hormonal contraception and thrombosis: Identifying the gaps in knowledge among females in post-secondary education.

Objective: To determine the current level of knowledge about hormonal contraception among young women so they may be better informed about the risks and various choices available to them regarding hormonal contraception (HC). Methods: In an online survey-based study, data was analyzed from the anonymous responses of 675 female participants aged 18-30 years in various academic programs at two post-secondary institutions in Kingston, Ontario. Surveys explored demographics, use/type/duration of hormonal contraception, and knowledge of HC and thrombosis. Kruskal Wallis test and Spearman Correlation were used to determine differences in knowledge level about contraceptives across age groups, education levels, as well as use/type/duration of HC. Results: 476 participants were users of HC (264 > 1 year) and 199 were non-HC users. 370 participants have a high school diploma. The knowledge level of HC risks was associated with duration of use and overall knowledge of thrombosis and HC. The knowledge level of thrombosis was correlated with duration of use, education level, and age. Participants with higher level of education or those that have been using HC for 5 years or longer had an increased knowledge surrounding thrombosis. Participants aged 24 and older had a higher knowledge of thrombosis than that of participants younger than 24. Overall, the data was used to generate a simple infographic to further educate women in this regard. Conclusion: Misconceptions remain among young women concerning benefits and risks of HC which can be addressed by formal education.

Testing the relationship between lateralization on sequence-based motor tasks and language laterality using an online battery.

ABSTRACTStudies have highlighted an association between motor laterality and speech production laterality. It is thought that common demands for sequential processing may underlie this association. However, most studies in this area have relied on relatively small samples and have infrequently explored the reliability of the tools used to assess lateralization. We, therefore, established the validity and reliability of an online battery measuring sequence-based motor laterality and language laterality before exploring the associations between laterality indices on language and motor tasks. The online battery was completed by 621 participants, 52 of whom returned to complete the battery a second time. The three motor tasks included in the battery showed good between-session reliability (r ≥ .78) and were lateralized in concordance with hand preference. The novel measure of speech production laterality was left lateralized at population level as predicted, but reliability was less satisfactory (r = .62). We found no evidence of an association between sequence-based motor laterality and language laterality. Those with a left-hand preference were more strongly lateralized on motor tasks requiring midline crossing; this effect was not observed in right-handers. We conclude that there is little evidence of the co-lateralization of language and sequence-based motor skill on this battery.

Inconsistent language lateralisation - Testing the dissociable language laterality hypothesis using behaviour and lateralised cerebral blood flow.

BACKGROUND: Most people have strong left-brain lateralisation for language, with a minority showing right- or bilateral language representation. On some receptive language tasks, however, lateralisation appears to be reduced or absent. This contrasting pattern raises the question of whether and how language laterality may fractionate within individuals. Building on our prior work, we postulated (a) that there can be dissociations in lateralisation of different components of language, and (b) these would be more common in left-handers. A subsidiary hypothesis was that laterality indices will cluster according to two underlying factors corresponding to whether they involve generation of words or sentences, versus receptive language. METHODS: We tested these predictions in two stages: At Step 1 an online laterality battery (Dichotic listening, Rhyme Decision and Word Comprehension) was given to 621 individuals (56% left-handers); At Step 2, functional transcranial Doppler ultrasound (fTCD) was used with 230 of these individuals (51% left-handers). 108 left-handers and 101 right-handers gave useable data on a battery of three language generation and three receptive language tasks. RESULTS: Neither the online nor fTCD measures supported the notion of a single language laterality factor. In general, for both online and fTCD measures, tests of language generation were left-lateralised. In contrast, the receptive tasks were at best weakly left-lateralised or, in the case of Word Comprehension, slightly right-lateralised. The online measures were only weakly correlated, if at all, with fTCD measures. Most of the fTCD measures had split-half reliabilities of at least .7, and showed a distinctive pattern of intercorrelation, supporting a modified two-factor model in which Phonological Decision (generation) and Sentence Decision (reception) loaded on both factors. The same factor structure fitted data from left- and right-handers, but mean scores on the two factors were lower (less left-lateralised) in left-handers. CONCLUSIONS: There are at least two factors influencing language lateralization in individuals, but they do not correspond neatly to language generation and comprehension. Future fMRI studies could help clarify how far they reflect activity in specific brain regions.

A narrative review of the late effects of paediatric cancer treatment within an educational setting: Existing evidence and where do we go from here?

OBJECTIVES: The late effects of paediatric cancer treatment within an educational context are an area that is relatively under researched within the United Kingdom. METHODS: To support this narrative review, systematic searches were conducted in key scientific databases between May and December 2020. RESULTS: Upon reviewing literature within this field, there are key considerations that should be addressed to provide clear and concise findings. These key considerations include clarification on whether the research undertaken focuses on the late or long term effects of paediatric cancer treatment, taking a consistent approach to data analysis with the aim to improve the validity of the study findings, utilising a mixed methodology to gain further depth to the findings as well as increasing the number of studies that focus on a specific tumour type rather than numerous types to allow a detailed study to be undertaken into the potential late effects a treatment for a specific tumour may elicit. DISCUSSION: If these key considerations are taken into account when conducting further research within this field, it would enable consistent findings to be utilised in providing the optimum educational provision for survivors of paediatric cancer who remain within the education system.

Evaluating cortical responses to speech in children: A functional near-infrared spectroscopy (fNIRS) study.

Functional neuroimaging of speech processing has both research and clinical potential. This work is facilitating an ever-increasing understanding of the complex neural mechanisms involved in the processing of speech. Neural correlates of speech understanding also have potential clinical value, especially for infants and children, in whom behavioural assessments can be unreliable. Such measures would not only benefit normally hearing children experiencing speech and language delay, but also hearing impaired children with and without hearing devices. In the current study, we examined cortical correlates of speech intelligibility in normally hearing paediatric listeners. Cortical responses were measured using functional near-infrared spectroscopy (fNIRS), a non-invasive neuroimaging technique that is fully compatible with hearing devices, including cochlear implants. In nineteen normally hearing children (aged 6 - 13 years) we measured activity in temporal and frontal cortex bilaterally whilst participants listened to both clear- and noise-vocoded sentences targeting four levels of speech intelligibility. Cortical activation in superior temporal and inferior frontal cortex was generally stronger in the left hemisphere than in the right. Activation in left superior temporal cortex grew monotonically with increasing speech intelligibility. In the same region, we identified a trend towards greater activation on correctly vs. incorrectly perceived trials, suggesting a possible sensitivity to speech intelligibility per se, beyond sensitivity to changing acoustic properties across stimulation conditions. Outside superior temporal cortex, we identified other regions in which fNIRS responses varied with speech intelligibility. For example, channels overlying posterior middle temporal regions in the right hemisphere exhibited relative deactivation during sentence processing (compared to a silent baseline condition), with the amplitude of that deactivation being greater in more difficult listening conditions. This finding may represent sensitivity to components of the default mode network in lateral temporal regions, and hence effortful listening in normally hearing paediatric listeners. Our results indicate that fNIRS has the potential to provide an objective marker of speech intelligibility in normally hearing children. Should these results be found to apply to individuals experiencing language delay or to those listening through a hearing device, such as a cochlear implant, fNIRS may form the basis of a clinically useful measure of speech understanding.

The relationship between lateralization patterns from sequence based motor tasks and hemispheric speech dominance.

Objective: Skilled motor praxis and speech production display marked asymmetries at the individual and the population level, favoring the right hand and the left hemisphere, respectively. Theories suggesting a common processing mechanism between praxis and speech are supported by evidence that shared neural architecture underlies both functions. Despite advances in understanding the neurobiology of this left-hemisphere specialization the cortical networks linking these 2 functions are rarely investigated on a behavioral level. Method: This study deploys functional transcranial doppler (fTCD) ultrasound to directly measure hemispheric activation during skilled manual praxis tasks shown to be correlated to hemispheric speech lateralization indices. In a new paradigm we test the hypothesis that praxis tasks are highly dependent on the left hemisphere's capacity for processing sequential information will be better correlated with direction and strength of hemispheric speech lateralization. Results: Across 2 experiments we first show that only certain praxis tasks (pegboard and coin-rotation) correlated with direct measurements of speech lateralization despite shared properties across all tasks tested. Second, through novel imaging of hemispheric activation during praxis, results showed that the pegboard differed in the lateralization pattern created and furthermore that it was significantly related to speech laterality indices, which was not the case for either of the other two tasks. Conclusion: These results are discussed in terms of a lateralized speech-praxis control mechanism and demonstrates that measurements of motor paradigms through the use of fTCD are reliable enough to provide a new insight to the behavioral relationship been speech and handedness. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Twelve tips for novice academic staff supporting medical students in distress.

The importance of having university systems to support students' wellbeing and welfare needs has been well documented, with an increasing literature on best practice for structuring student support services from an institutional perspective. Nevertheless, individual members of academic staff are often required to deal with students who are experiencing challenging circumstances, and this is especially so in the pre-clinical phases of medical training. The prospect of advising and supporting students who are in difficulty and who may be distressed, can be daunting and can also negatively impact the wellbeing of the staff involved. These tips present the practical guidelines we have developed on how academic staff can best manage meetings with students in situations of crisis or high emotion.

Disrupting the speech motor network: Exploring hemispheric specialization for verbal and manual sequencing using a dual-task approach.

OBJECTIVE: The concept of overlapping neural networks supporting both speech production and fine motor praxis is well accepted; however, few studies have explored the lateralized behavioral characteristics of both functions when performed simultaneously. METHOD: This study probes the characteristics of the dominant hemisphere by overloading cognitive processing via a novel dual-task paradigm. In 2 experiments, participants performed sets of motor and speech tasks under single-task and dual-task conditions. The sets of tasks differed as to the extent to which they relied on sequential processing, and we hypothesized that tasks more reliant on this type of processing would suffer a greater performance decrement under dual-task conditions. A reliable measure of hemispheric language dominance was obtained via functional transcranial Doppler (fTCD) ultrasound. RESULTS: Speech production scores in the experimental set (i.e., sequential processing) were consistently impaired under dual-task conditions, a distinction that was not seen in the control set. Results of Experiment 2 confirm those of Experiment 1, whereby speech scores were most strongly impaired under dual-task conditions, especially in the experimental set. Motor performance suffered less than speech performance in dual-task conditions in both the experimental and control sets across both experiments. CONCLUSION: Data suggest that the common processing capacity for speech and fine motor praxis can be disrupted through a dual-task paradigm. This novel behavioral data supports theories of a motor-based gestural origin for language and indicates that speech production is more sensitive to the effects of increased processing requirements than are motor skills. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Speech lateralization and motor control.

A relationship between motor control and speech lateralization has long been postulated by researchers and clinicians with an interest in the functional organization of the human brain. Exactly how motor control might be related to speech representation, however, is rarely examined. This chapter examines current issues relating to the organization, development, and measurement of motor control and speech representation. We further consider from neuropsychological, developmental, neurological, and genetic perspectives that speech and fine motor control involve planning and sequencing processes, which are mediated by an integrated neural network localized to the left hemisphere. Specifically, we discuss studies from our laboratory using functional transcranial Doppler ultrasonography to determine speech laterality, correlating this with hand preference and pegboard measures of motor laterality. Our findings show that handedness, as measured by a motor skill task, can be predictive of speech laterality, both in typically developing adults and children. We have also shown that individuals with developmental motor coordination impairments also show atypical speech lateralization, providing further evidence that neurological motor and speech systems are intrinsically connected. We consider these results in the context of a left-lateralized speech-praxis center model, which could account for the relationship shown between sequence-based motor and speech tasks.

Measurement reliability of atypical language lateralisation assessed using functional transcranial Doppler ultrasound.

It is well established that some individuals present with atypical, non-left hemisphere, cerebral lateralisation for language processing. However previous studies exploring the reliability of functional blood flow responses to detect lateralised activation during speech have focused only on individuals with typical left sided dominance. Here we report test-retest and between-task reliability measures obtained with functional transcranial Doppler ultrasound in 47 participants, including 9 with atypical language presentation. Results showed good test-retest reliability in atypically lateralised individuals, even after an interval of 120 days. Between-task reliability was weaker, but still within acceptable ranges.

Atypical speech lateralization in adults with developmental coordination disorder demonstrated using functional transcranial Doppler ultrasound.

Research using clinical populations to explore the relationship between hemispheric speech lateralization and handedness has focused on individuals with speech and language disorders, such as dyslexia or specific language impairment (SLI). Such work reveals atypical patterns of cerebral lateralization and handedness in these groups compared to controls. There are few studies that examine this relationship in people with motor coordination impairments but without speech or reading deficits, which is a surprising omission given the prevalence of theories suggesting a common neural network underlying both functions. We use an emerging imaging technique in cognitive neuroscience; functional transcranial Doppler (fTCD) ultrasound, to assess whether individuals with developmental coordination disorder (DCD) display reduced left-hemisphere lateralization for speech production compared to control participants. Twelve adult control participants and 12 adults with DCD, but no other developmental/cognitive impairments, performed a word-generation task whilst undergoing fTCD imaging to establish a hemispheric lateralization index for speech production. All participants also completed an electronic peg-moving task to determine hand skill. As predicted, the DCD group showed a significantly reduced left lateralization pattern for the speech production task compared to controls. Performance on the motor skill task showed a clear preference for the dominant hand across both groups; however, the DCD group mean movement times were significantly higher for the non-dominant hand. This is the first study of its kind to assess hand skill and speech lateralization in DCD. The results reveal a reduced leftwards asymmetry for speech and a slower motor performance. This fits alongside previous work showing atypical cerebral lateralization in DCD for other cognitive processes (e.g., executive function and short-term memory) and thus speaks to debates on theories of the links between motor control and language production.

Hemispheric speech lateralisation in the developing brain is related to motor praxis ability.

Commonly displayed functional asymmetries such as hand dominance and hemispheric speech lateralisation are well researched in adults. However there is debate about when such functions become lateralised in the typically developing brain. This study examined whether patterns of speech laterality and hand dominance were related and whether they varied with age in typically developing children. 148 children aged 3-10 years performed an electronic pegboard task to determine hand dominance; a subset of 38 of these children also underwent functional Transcranial Doppler (fTCD) imaging to derive a lateralisation index (LI) for hemispheric activation during speech production using an animation description paradigm. There was no main effect of age in the speech laterality scores, however, younger children showed a greater difference in performance between their hands on the motor task. Furthermore, this between-hand performance difference significantly interacted with direction of speech laterality, with a smaller between-hand difference relating to increased left hemisphere activation. This data shows that both handedness and speech lateralisation appear relatively determined by age 3, but that atypical cerebral lateralisation is linked to greater performance differences in hand skill, irrespective of age. Results are discussed in terms of the common neural systems underpinning handedness and speech lateralisation.

Is digit ratio (2D:4D) a reliable pointer to speech laterality?

The relative length of the second and fourth digits (2D:4D ratio) is sexually dimorphic and a retrospective biomarker of prenatal hormonal exposure. Low ratios indicate higher prenatal testosterone (pT) and lower estrogen exposure, whereas the reverse pattern is associated with high ratios. Elevated levels of pT exposure have long been thought to modulate hemispheric specialisation; subsequently many studies use the 2D:4D ratio as a proxy index for pT to examine the effects of prenatal hormonal exposure on lateralised cognitive abilities. Here we used Transcranial Doppler ultrasonography and digit ratio to investigate whether pT has an influence on speech laterality. We tested 34 right and 14 left handed adults. Our results indicate that speech representation is unrelated to digit characteristics and therefore purportedly pT. We discuss these findings in relation to androgen theories of lateralisation.