Snellen iPad App versus Traditional Light-Box Snellen Chart in Distance Visual Acuity.

This study aimed to discover distance visual acuity (VA) assessments through the display of the Snellen chart on the iPad tablet. The findings are equivalent to those obtained using the conventional light-box Snellen chart. In this work, the Snellen iPad app and Eye Chart HD iOS app are utilized among the participants in the Ophthalmology Outpatient Department (OPD) for determining VA. A cross-sectional method was used for the examination, which included 100 new patients who were chosen by random selection. The age requirement for new patients was 8 years and up for both genders. Patients with a VA of less than 6/30 were disqualified from the experiment. Two testing modalities are used to measure VA, such as the iPad Mini 2 with the iOS software Eye Chart HD and the classic Snellen light-box chart. The observation revealed that the Snellen iPad app and the classic light-box Snellen chart produced equivalent findings. The classic Snellen chart may have been memorized by participants before their eye examination, undermining the accuracy of the conclusions of the initial testing modality used. Patient-related variables were also identified as confounders. Future studies should adjust the brightness of the iPad Mini 2 and the traditional light-box Snellen chart to make sure that neither experiment modality's brightness affects the accuracy of the findings. Future research should also investigate the use of premium apps, use both devices, and employ a bigger sample size.

Is CAA a perivascular brain clearance disease? A discussion of the evidence to date and outlook for future studies.

The brain's network of perivascular channels for clearance of excess fluids and waste plays a critical role in the pathogenesis of several neurodegenerative diseases including cerebral amyloid angiopathy (CAA). CAA is the main cause of hemorrhagic stroke in the elderly, the most common vascular comorbidity in Alzheimer's disease and also implicated in adverse events related to anti-amyloid immunotherapy. Remarkably, the mechanisms governing perivascular clearance of soluble amyloid ß-a key culprit in CAA-from the brain to draining lymphatics and systemic circulation remains poorly understood. This knowledge gap is critically important to bridge for understanding the pathophysiology of CAA and accelerate development of targeted therapeutics. The authors of this review recently converged their diverse expertise in the field of perivascular physiology to specifically address this problem within the framework of a Leducq Foundation Transatlantic Network of Excellence on Brain Clearance. This review discusses the overarching goal of the consortium and explores the evidence supporting or refuting the role of impaired perivascular clearance in the pathophysiology of CAA with a focus on translating observations from rodents to humans. We also discuss the anatomical features of perivascular channels as well as the biophysical characteristics of fluid and solute transport.

Evaluation of a self-administered iPad®-based processing speed assessment for people with multiple sclerosis in a clinical routine setting.

BACKGROUND: Limited resources often hinder regular cognitive assessment of people with multiple sclerosis (pwMS) in standard clinical care. A self-administered iPad®-based cognitive screening-tool (Processing Speed Test; PST) might mitigate this problem. OBJECTIVE: To evaluate the PST in clinical routine. METHODS: We investigated the feasibility of the PST in both a quiet and a waiting room setting. We assessed the validity of the PST in comparison with the established Symbol Digit Modalities Test (SDMT). We explored associations between processing speed assessments and the Brief International Cognitive Assessment for MS (BICAMS), magnetic resonance imaging (MRI) parameters, and psychological factors. Additionally, we explored the ability of the PST to detect impairment in processing speed compared to the SDMT. RESULTS: The PST was feasible in the waiting room setting. PST and SDMT correlated comparably with the BICAMS, MRI parameters, and psychological variables. Of 172 pwMS, 50 (30.8%) showed cognitive impairment according to the BICAMS; respective values were 47 (27.3%) for the SDMT and 9 (5.2%) for the PST. CONCLUSIONS: The PST performed in a waiting room setting correlates strongly with established cognitive tests. It thus may be used to assess processing speed in a resource-efficient manner and complement cognitive assessment in clinical routine. Despite comparable validity of the PST and SDMT, we identified more pwMS with impaired processing speed using normative data of the SDMT compared to the PST and advise caution, that the common cut-off score of - 1.5 SD from the current PST is not appropriate in Europe.

Production of egg yolk antibody (IgY) against a chimeric protein containing IpaD, StxB, and TolC antigens from Shigella: An investigation of its prophylactic effects against Shiga toxin (Stx) and Shigella dysenteriae in vitro and in vivo.

Shigella is a major problem in developing countries. Immunoglobulin Y (IgY) can be used for prophylaxis and neutralize bacteria. The aim of this study was to produce IgY against the chimeric protein containing IpaD, StxB, and TolC antigens from Shigella, investigate its prophylactic and neutralizing effects against Stx and Shigella dysenteriae. The nucleotide sequence corresponding to the chimeric protein was cloned into pET28a plasmid and expressed in E. coli BL21 (DE3). Protein expression was confirmed by SDS-PAGE and the recombinant protein was purified by Ni-NTA affinity chromatography. The 150 µg of chimeric protein was mixed with Freund's adjutant and injected into laying hens (Leghorn). IgY was purified using PEG6000 precipitation. Antibody titer in the serum and egg yolk was evaluated by ELISA. IgY challenge against 1,10 and 50 LD50 of Stx and S. dysenteriae was investigated. A 60.6 kDa recombinant protein was confirmed by SDS-PAGE. ELISA showed that the antibody titer was significantly increased. MTT assay [3-(4,5-Dimethylthiazol-2-yl)-2,5-Diphenyltetrazolium Bromide] showed that at 16 µmol/L, IgY protected HeLa cells against Stx. Treatment of mice with 1000 and 1500 µg IgY leads to complete survival of the mice against 1LD50 toxin and 4000 µg of IgY led to complete survival against 1LD50, also 70% and 30% survival against 10 and 50 LD50S. dysenteriae. This study showed that IgY produced against Stx and Shigella virulence factors could cause high protective effects against bacteria and toxins.

Accuracy and tracing time of cephalometric analyses on a tablet or desktop computer : A prospective study.

BACKGROUND: This prospective study aimed to evaluate the influence of the computer type (tablet or desktop) on accuracy and tracing time of cephalometric analyses. METHODS: Dental students used a web-based application specifically developed for this purpose to perform cephalometric analyses on tablet and desktop computers. Landmark locations and timestamps were exported to measure the accuracy, successful detection rate and tracing time. Reference landmarks were established by six experienced orthodontists. Statistical analysis included reliability assessment, descriptive statistics, and linear mixed effect models. RESULTS: Over a period of 8 semesters a total of 277 cephalometric analyses by 161 students were included. The interrater reliability of the orthodontists establishing the reference coordinates was excellent (ICC > 0.9). For the students, the mean landmark deviation was 2.05 mm and the successful detection rate for the clinically acceptable threshold of 2 mm suggested in the literature was 68.6%, with large variations among landmarks. No effect of the computer type on accuracy and tracing time of the cephalometric analyses could be found. CONCLUSION: The use of tablet computers for cephalometric analyses can be recommended.

TECH preserves global cognition of older adults with MCI compared with a control group: a randomized controlled trial.

BACKGROUND: Cognitive training using touchscreen tablet casual game applications (apps) has potential to be an effective treatment method for people with mild cognitive impairment (MCI). AIMS: This study aimed to establish the effectiveness of 'Tablet Enhancement of Cognition and Health' (TECH), a novel cognitive intervention for improving/preserving cognition in older adults with MCI. METHODS: A single-blind randomized controlled trial with assessments pre-, post-, and at 6-month follow-up was conducted. TECH entailed 5 weeks of daily self-training utilizing tablet apps, facilitated by weekly group sessions. Global cognition was assessed by the Montreal Cognitive Assessment (MoCA), and specific cognitive components were assessed using WebNeuro computerized battery. Short Form Health Survey (SF-12) assessed health-related quality of life (HRQoL). Intention-to-treat analysis was conducted and the %change was calculated between pre-post and between pre-follow-up. Cohen's d effect size was also calculated. RESULTS: Sixty-one participants aged 65-89 years were randomly allocated to TECH (N = 31, 14 women) or to standard care (N = 30, 14 women). Pre-post and pre-follow-up MoCA %change scores were significantly higher in TECH than control (U = 329.5, p < .05; U = 294.5, p < .05) with intermediate effect size values (Cohen's d = .52, Cohen's d = .66). Forty percent of TECH participants versus 6.5% of control participants achieved a minimal clinical important difference in MoCA. Pre-post between-group differences for specific cognitive components were not found and HRQoL did not change. DISCUSSION AND CONCLUSIONS: TECH encouraged daily self-training and showed to preserve global cognition of older adults with MCI. The implementation of TECH is recommended for older adults with MCI, who are at risk for further cognitive decline.

Clearance of interstitial fluid (ISF) and CSF (CLIC) group-part of Vascular Professional Interest Area (PIA), updates in 2022-2023. Cerebrovascular disease and the failure of elimination of Amyloid-ß from the brain and retina with age and Alzheimer's disease: Opportunities for therapy.

This editorial summarizes advances from the Clearance of Interstitial Fluid and Cerebrospinal Fluid (CLIC) group, within the Vascular Professional Interest Area (PIA) of the Alzheimer's Association International Society to Advance Alzheimer's Research and Treatment (ISTAART). The overarching objectives of the CLIC group are to: (1) understand the age-related physiology changes that underlie impaired clearance of interstitial fluid (ISF) and cerebrospinal fluid (CSF) (CLIC); (2) understand the cellular and molecular mechanisms underlying intramural periarterial drainage (IPAD) in the brain; (3) establish novel diagnostic tests for Alzheimer's disease (AD), cerebral amyloid angiopathy (CAA), retinal amyloid vasculopathy, amyloid-related imaging abnormalities (ARIA) of spontaneous and iatrogenic CAA-related inflammation (CAA-ri), and vasomotion; and (4) establish novel therapies that facilitate IPAD to eliminate amyloid ß (Aß) from the aging brain and retina, to prevent or reduce AD and CAA pathology and ARIA side events associated with AD immunotherapy.

How the Inflamed Skull-Box Might Ruin the Cerebello-Cerebral Social Repertoire: Imaging, Testing, Rescuing with Currents.

Nascent cerebellar neuropsychiatry is rewriting complex human relations. In daily practice this sheds light on subsets of therapy-resistant patients, who feel hampered by a lack of skills in predictively presensing the trajectories to where especially their interpersonal appropriations might end up. Humans affected by "dysmetric" social phobia often lead minimal lives, strongly dislike exposition, suffer fatiguability also from immune dysfunctions, and anhedonia. In social dysmetria especially on the cerebellar cortex`s both lateralmost Crus-II (Van Overwalle) seem damaged, the left Crus-I may add agentic failure (Guell). The cerebellum, and the basal ganglia together discipline the cortex through parallel closed circuits partly interconnected through the thalamus. "Patho-trajectories" of the cere-bellum in daily care emerge through also neurological ataxiology and MRI-imaging. A uniquely pontine axonal diffusive damage to an executive-control-loop as core of "p-factor", the prime broad risk factor, points to an immune-arterial hotspot at the root of cerebellar arterial supply, as supported by the pediatric mostly inflammatory somatic "d-factor". While localizations refer back to his "phrenology", F. G. Gall's contention, that skulls, plausibly via mycobacteria, were relevant, are rehabilitated by calvario-menigeal vessels, which added the skull to the new brain logistics. Mast cells are uniquely positioned to cause superficial and deep cortical pathologies, and, en-closed in its subtentorial posterior fossa, also the cerebellum is exposed to various, often intracellular, smoldering originally dental or ORL-infections exemplifying non-neural psychiatric etiologies.

The L-DBF vaccine cross protects mice against different Shigella serotypes after prior exposure to the pathogen.

IMPORTANCE: Shigellosis is endemic to low- and middle-income regions of the world where children are especially vulnerable. In many cases, there are pre-existing antibodies in the local population and the effect of prior exposure should be considered in the development and testing of vaccines against Shigella infection. Our study shows that L-DBF-induced immune responses are not adversely affected by prior exposure to this pathogen. Moreover, somewhat different cytokine profiles were observed in the lungs of vaccinated mice not having been exposed to Shigella, suggesting that the immune responses elicited by Shigella infection and L-DBF vaccination follow different pathways.

Pathophysiology and probable etiology of cerebral small vessel disease in vascular dementia and Alzheimer's disease.

Vascular cognitive impairment and dementia (VCID) is commonly caused by vascular injuries in cerebral large and small vessels and is a key driver of age-related cognitive decline. Severe VCID includes post-stroke dementia, subcortical ischemic vascular dementia, multi-infarct dementia, and mixed dementia. While VCID is acknowledged as the second most common form of dementia after Alzheimer's disease (AD) accounting for 20% of dementia cases, VCID and AD frequently coexist. In VCID, cerebral small vessel disease (cSVD) often affects arterioles, capillaries, and venules, where arteriolosclerosis and cerebral amyloid angiopathy (CAA) are major pathologies. White matter hyperintensities, recent small subcortical infarcts, lacunes of presumed vascular origin, enlarged perivascular space, microbleeds, and brain atrophy are neuroimaging hallmarks of cSVD. The current primary approach to cSVD treatment is to control vascular risk factors such as hypertension, dyslipidemia, diabetes, and smoking. However, causal therapeutic strategies have not been established partly due to the heterogeneous pathogenesis of cSVD. In this review, we summarize the pathophysiology of cSVD and discuss the probable etiological pathways by focusing on hypoperfusion/hypoxia, blood-brain barriers (BBB) dysregulation, brain fluid drainage disturbances, and vascular inflammation to define potential diagnostic and therapeutic targets for cSVD.

Augmented Reality-Supported Rod Bending in Multilevel Spinal Fusion Using the ADVISE Software.

BACKGROUND: One of the most common reasons for poor patient outcomes and revision surgery in spinal fusion is hardware failure. Screw loosening or pullout occurs in up to one-quarter of all cases. It is known that even small screw-rod misalignments can cause significant mechanical overloads during rod fixation, which can result in hardware failure. To address this crucial surgical step, a novel augmented reality-assisted software was developed to generate custom rod templates that are precisely adapted to the individual patient. METHODS: The novel software, which runs on a tablet, is used in spinal fusion surgery and is based on the use of a specific pedicle screw system, in which the polyaxial screw heads are connected to detachable guides. These guides can be recognized by the tablet camera and a light detection and ranging scanner. This image information is processed to determine the spatial positions of the screw heads and to calculate an ideally fitting rod template. RESULTS: The calculated rod template is displayed in a 1-to-1 scale on the tablet screen. This template is used to cut and bend the rods of the pedicle screw system. Finally, the custom bent rod can be inserted into the screw heads without tension. CONCLUSIONS: The augmented reality-assisted software is intended to give surgeons access to patient-specific intraoperative real-time data, helping them in bending rods that are more precisely adapted to the individual patient compared with the freehand technique.

Speech-language pathologists' perceptions of augmentative and alternative communication in Thailand.

Augmentative and alternative communication (AAC) systems are not well-known and broadly used in Thailand. To begin introducing AAC systems and interventions to children with complex communication needs in Thailand, understanding speech-language pathologists' (SLPs) perceptions toward various AAC systems is an important first step. This study assessed SLPs' perceptions of three AAC modalities: gestural communication, communication boards, and iPad1-based speech-output technologies. A total of 78 SLPs watched three video vignettes of a child using each mode and rated their impressions of intelligibility, ease of learnability and use, effectiveness, and preference. Then they were asked to rate factors on visual analog scales that provided additional insights into their rationales and their preferences for AAC modalities for nonverbal clients and for themselves if they were nonverbal. The results indicated that most of the SLPs rated iPad-based speech-output technologies as being the more intelligible, effective, and preferred mode of communication. Gestural communication was rated as the easiest mode to learn and use for a child with complex communication needs. Despite infrequent use of iPad-based speech-output technologies in Thailand, SLPs' ratings indicated high social acceptance of this modality for promoting communication abilities of children with complex communication needs. Results also revealed some biases and lack of knowledge about AAC systems in Thailand.

Impact of VA's video telehealth tablets on substance use disorder care during the COVID-19 pandemic.

BACKGROUND: Telehealth has the potential to improve health care access for patients but it has been underused and understudied for examining patients with substance use disorders (SUD). VA began distributing video-enabled tablets to veterans with access barriers in 2016 to facilitate participation in home-based telehealth and expanded this program in 2020 due to the coronavirus COVID-19 pandemic. OBJECTIVE: Examine the impact of VA's video-enabled telehealth tablets on mental health services for patients diagnosed with SUD. METHODS: This study included VA patients who had ≥1 mental health visit in the calendar year 2019 and a documented diagnosis of SUD. Using difference-in-differences and event study designs, we compared outcomes for SUD-diagnosed patients who received a video-enabled tablet from VA between March 15th, 2020 and December 31st, 2021 and SUD-diagnosed patients who never received VA tablets, 10 months before and after tablet-issuance. Outcomes included monthly frequency of SUD psychotherapy visits, SUD specialty group therapy visits and SUD specialty individual outpatient visits. We examined changes in video visits and changes in visits across all modalities of care (video, phone, and in-person). Regression models adjusted for several covariates such as age, sex, rurality, race, ethnicity, physical and mental health chronic conditions, and broadband coverage in patients' residential zip-code. RESULTS: The cohort included 21,684 SUD-diagnosed tablet-recipients and 267,873 SUD-diagnosed non-recipients. VA's video-enabled tablets were associated with increases in video visits for SUD psychotherapy (+3.5 visits/year), SUD group therapy (+2.1 visits/year) and SUD individual outpatient visits (+1 visit/year), translating to increases in visits across all modalities (in-person, phone and video): increase of 18 % for SUD psychotherapy (+1.9 visits/year), 10 % for SUD specialty group therapy (+0.5 visit/year), and 4 % for SUD specialty individual outpatient treatment (+0.5 visit/year). CONCLUSIONS: VA's distribution of video-enabled tablets during the COVID-19 pandemic were associated with higher engagement with video-based services for SUD care among patients diagnosed with SUD, translating to modest increases in total visits across in-person, phone and video modalities. Distribution of video-enabled devices can offer patients critical continuity of SUD therapy, particularly in scenarios where they have heightened barriers to in-person care.

Performance of a Smart Device over 12-Months for Home Monitoring of Patients with Intermediate Age-Related Macular Degeneration.

BACKGROUND: To determine the 12-month compliance with and retention of home monitoring (HM) with Melbourne Rapid Fields (MRFh) for patients with intermediate age-related macular degeneration (iAMD) and compare visual acuity (VA) and retinal sensitivity (RS) results to clinical measures. METHODS: Participants were recruited to a 12-month HM study with weekly testing of vision with MRFh. Inclusion criteria were a diagnosis of iAMD, understand English instructions, VA ≥ 20/40, and access to an iPad. Supervised in-clinic testing of high contrast VA (HVA, ETDRS), low-luminance VA (LLVA, ETDRS with ND2 filter), and RS (Macular Integrity Assessment, MAIA, and MRF in-clinic, MRFc) was conducted every 6-months. RESULTS: A total of 54 participants (67 ± 6.8 years) were enrolled. Compliance to weekly HM was 61% and study retention at 12-months was 50% of those with uptake (n = 46). No difference was observed between MRFc and MRFh across all RS and VA outcomes (p > 0.05). MRFh RS was higher than MAIA (29.1 vs. 27.1 dB, p < 0.001). MRFh HVA was not different from ETDRS (p = 0.08), but LLVA was 9 letters better (81.5 vs. 72.4 letters, p < 0.001). CONCLUSIONS: Over 12-months, MRFh yields a moderate level of compliance with (61%) and retention (50%) of weekly testing. Further studies are required to assess the ability of MRFh to detect early progression to nAMD.

Investigate the immunogenic and protective effect of trivalent chimeric protein containing IpaD-StxB-TolC antigens as a vaccine candidate against S. dysenteri and S. flexneri.

BACKGROUNDS: Shigella spp. causes bloody diarrhea and leads to death, especially in children. Chimeric proteins containing virulence factors can prevent Shigella infection. The purpose of this study is to investigate the immunogenic and protective effect of trivalent chimeric protein containing IpaD-StxB-TolC antigens against shiga toxin, S. dysenteri and S. flexneri in vitro and in vivo conditions. METHODS: Recombinant vector was transferred to E. coli BL21. The expression of the chimeric protein was confirmed by SDS PAGE and purified using the Ni-NTA column. Mice were immunized with recombinant protein and antibody titer was evaluated by ELISA. 10, 25 and 50 LD50 of Shiga toxin neutralization was evaluated in vitro (Vero cell line) and in vivo conditions. Also, the challenge of immunized mice with 10, 25 and 50 LD50 of S. dysentery and S. flexneri was done. RESULTS: The expression and purification of the recombinant protein with 60.6 kDa was done. ELISA showed increased antibody titer against the chimeric protein. MTT assay indicated that 1/8000 dilution of the sera had a 51% of cell viability against the toxin in Vero cell line. The challenge of mice immunized with toxin showed that the mice had complete protection against 10 and 25 LD50 of toxin and had 40% survival against 50 LD50. Mice receiving 10 and 25 LD50 of S. dysenteri and S. flexneri had 100% protection and in 50 LD50 the survival rate was 60 and 50%, respectively. Organ burden showed that the amount of bacterial colonization in immunized mice was 1 × 104 CFU/mL, which was significantly different from the control group. CONCLUSION: This study showed that chimeric proteins can create favorable immunogenicity in the host as vaccine candidates.

Simultaneous quantification method for eleutheroside B, eleutheroside E, chiisanoside, and sesamin using reverse-phase high-performance liquid chromatography coupled with ultraviolet detection and integrated pulsed amperometric detection.

We developed a method combining ultraviolet (UV) detection and integrated pulsed amperometric detection (IPAD) to simultaneously analyze eleutheroside B, eleutheroside E, chiisanoside, and sesamin. The gradient elution system allowed complete separation of all target components within 35 min, and showed limits of detection of 0.006-0.020 µg/mL and limits of quantification of 0.018-0.050 µg/mL. The linear regression coefficients of determination were 0.9990-0.9998. All inter- and intra-day precision values were below 4.89%, and the average recoveries were 97.79-104.40%. The developed approach exhibits excellent reproducibility, sensitivity, and selectivity without requiring any complicated pre-treatment, and is therefore expected to be helpful as a tool for establishing appropriate content criteria for Acanthopanax species.

Occupational Therapy Interventions Using New Technologies in Children and Adolescents with Autism Spectrum Disorder: A Scoping Review.

New technologies (NT) are increasingly used in Occupational Therapy (OT) interventions in people with Autism Spectrum Disorder (ASD). We conducted a scoping review to describe OT interventions investigated in scientific literature which use NT in children and adolescents with ASD. Two authors independently searched the scientific databases PubMed, EMBASE, Scopus and Web of Science, carried out a peer-review screening of articles and extracted data. Twenty studies met the inclusion criteria. OT interventions lasted between 1 week and 12 months, consisted of between 1 session per day and 5 sessions per week, were carried out exclusively by an occupational therapist, and the most used NT was the computer (n = 12). The duration of the interventions and assessment measures used varied greatly between studies.

Increasing Sight-Phrase Reading with an iPad intervention for Two Students with Intellectual Disability.

Sight-word interventions are often implemented when students show delays in word recognition. However, few studies have investigated the effects of teaching sight words using phrases. The current study investigated the effects of a tablet-based flashcard intervention on the acquisition of sight phrases. A multiple-baseline design across word sets was used for two students with intellectual disability who were included in the general education classroom for the majority of the day. For each phrase, students used an iPad flashcard program and were prompted to see the phrase, say the phrase, tap the screen to hear the phrase, and then say the phrase again before moving on to the next phrase. Results showed that both students quickly acquired the ability to read the previously unknown sight phrases across three different sets of phrases. Discussion focuses on using tablet-based interventions for students with intellectual disability, particularly those included within a general education classroom.

mLearning Versus Paper and Pencil Practice for Telling Time: Impact for Attention and Accuracy.

The purpose of this study was to investigate the impact of mLearning or mobile device practice on the attention and accuracy of student's use of math concepts, specifically, telling time. A single subject, alternating treatment design was used to compare mLearning to paper and pencil practice in four 3rd grade male students. Results were mixed; two children were observed to be more on-task during the mLearning practice, and two children were observed to perform similarly across both conditions. Additionally, two children performed similarly on correctly completed problems across both conditions, and two children performed better using paper and pencil practice. All students completed more math problems during the paper and pencil practice.

Teaching Children with Autism Spectrum Disorder to Answer Questions Using an iPad-Based Speech-Generating Device.

This study investigated whether a systematic instruction package was effective in child acquisition of question answering using an iPad-based speech generating device (SGD). The study was conducted with two children with autism using a multiple probe across behaviors design. Results demonstrated that the systematic instruction package consisting of graduated guidance, discrete trial teaching, time delay, and reinforcement resulted in acquisition of answering all questions. Follow-up data were collected one, three, and five weeks after instruction ended. For all participants, skills maintained during follow-up and generalized to novel settings and skills. Social validity data were also collected and indicated that teachers without experience using SGDs found them to be effective and feasible for teaching communication skills.