Headaches cause high disease burden, and are often under-treated. Adequate treatment requires time and expertise, which can be limited in general practices. With the aim to improve the quality and accessibility of care, an unique nurse-led, digital transmural care pathway has been developed in which treatment is provided by nurse practitioners specialized in headache care. It is essential to understand patients' perspectives on the novice care pathway to uncover opportunities for enhancement. To explore patients' experiences with the nurse-led transmural headache care pathway, including experienced headache burden, improved headache control, and experiences with communication, person-centeredness, and accessibility within the care pathway. This descriptive qualitative study consisted of fourteen semi-structured interviews with patients included in the care pathway. The population consisted of patients with tension-type headache, migraine, and medication overuse headache. Data were analysed using thematic analysis by Braun and Clark. Five main themes emerged: (1) expectations related to the care pathway, where patients expressed a desire for reduced headache burden, support in understanding and managing their condition; (2) effectiveness of treatment on everyday functioning, with many participants experiencing fewer headaches and improved daily functioning; (3) digital communication contributing to more accessible care, where participants recognized digital care as accessible and time-saving. However in-person visits were preferred for initial contact, because digital care can feel more impersonal; (4) more insight into headaches due to the use of the digital diary app, where participants talked about gaining more insight into their headaches and mentioned opportunities to improve the app's usability; and (5) patient-centered care provided by the nurse practitioner, because of their expertise, listening abilities, and personalized approach to treatment. This care pathway was valued for its accessible, person-centered care and the nurse practitioner's expertise and personalized approach. However, improvements in digital headache app and holistic assessment (e.g., help identify triggers) could further increase its contribution to patient care. After treatment within the care pathway, many participants experienced reduced headache symptoms. Therefore, the care pathway has potential for wider implementation, enabling nurse practitioners to extend this care pathway to other headache patient groups.
Estimating vocal-tract length (VTL) from vowel formants can aid speaker normalization, but few methods have been benchmarked against an anatomical reference in the same speakers. We combined acoustic pharyngometry (APh) and speech data from 42 adults to benchmark eight widely used formant-based VTL estimators against incisors-to-glottis length and to test an interpretable two-stage bias-corrected linear estimator. Across more than 400 000 central frames with valid F1-F4, traditional quarter-wave, odd-harmonic, and dispersion-type estimators correlated with VTLAPh but showed poor out-of-sample anatomical recovery and strong calibration compression. Re-estimated one-stage linear models reduced mean absolute error (MAE; median ≈1.0 cm) but still overestimated shorter tracts and underestimated longer tracts. A two-stage model markedly improved calibration and agreement, outperforming one-stage linear and nonlinear alternatives (median per-vowel MAE 0.39 cm, median out-of-sample R2=0.83). Front and front-rounded vowels were the most informative. Speaker-level 95% limits of agreement were about ±0.9 cm, indicating that the method is better suited to aggregated tract-scale estimation than to direct anatomical measurement. These results identify calibration bias as a central limitation of standard formant-based VTL estimators and provide a practical, interpretable route to tract-scale estimation from similarly processed labeled-vowel data under matched conditions.
Documenting change is fundamental to understanding the process of intervention among individuals with communication disorders. This technical report demonstrates the clinical applicability of wearable fNIRS systems and the NeuroDOT processing pipelines for examining within-person cortical dynamics of learning. Using a microgenetic research design and a dense sampling approach, we examined changes in the prefrontal cortical hemodynamic response in an adult female participant who completed the same spoken sentence repetition and auditory fixation tasks across eight sessions. In addition to behavioral accuracy, hemodynamic data were collected with a continuous-wave, multi-channel fNIRS system (NIRSport2) using a prefrontal 20-channel optode montage. Data were processed using NeuroDOT ( https://www.nitrc.org/projects/neurodot ) (Eggebrecht & Culver, 2019) to: (i) standardize signal quality across the sessions to quantify motion levels and to ensure standardized brain map specificity, (ii) to examine both channel space fluctuations in the hemodynamic response and map changes in cortical activation patterns over the sessions. The signal quality met the predefined criteria for only the first five sessions. Participant's repetition accuracy did not improve over the five sessions. Channel-wise analysis revealed that HbO concentration differs significantly over right and left hemisphere channels over the course of the five sessions for the Sentence Repetition task, but not for the Auditory Fixation condition. Brain maps revealed qualitative differences in the pattern of prefrontal cortical activation across the five sessions. Behavioral assessments do not fully capture what occurs during speech repetition tasks, and leveraging neuroimaging can help identify and discriminate between disordered and neurotypical populations.
DSM 5 indicates social communication deficit as one of the necessary criteria for the diagnosis of autism spectrum disorder. However, the pragmatic assessment of language is not as commonly considered as the formal aspects of language. The presented guide aims to consider communicative elements that include nonverbal aspects of language and the intentionality of communicative acts to identify the first signs of pragmatic alteration. The ROLPP (Observation Script of Language from a Pragmatic Perspective) is an observation script for socio-cognitive and pre-verbal language skills and communication necessary for language development preceding speech and part of the pragmatic language construct. The protocol was applied to children aged 18 to 36 months, consisting of 11 children with suspected ASD and discarded diagnosis, and 11 children with confirmed ASD diagnosis. A descriptive level of 5% (p <0.05) was considered statistically significant. The results indicate that Participants with a confirmed diagnosis of ASD had higher scores than those in whom the diagnosis was discarded. Children with a confirmed diagnosis tended to score higher on the ROLPP overall (p <0.001), highlighting the impact of pragmatic language disorders in children with ASD, even at preschool age. These preliminary results indicate the possibility of identifying signs of disorders or pragmatic difficulties even before 36 months of age, with low application costs, including for use by professionals with little experience or contact with developmental disorders such as ASD. O DSM 5 indica o déficit de comunicação social como um dos critérios necessários para o diagnóstico do transtorno do espectro autista. No entanto, a avaliação pragmática da linguagem não é tão comumente considerada quanto os aspectos formais da linguagem. O roteiro apresentado visa considerar elementos comunicativos que incluem aspectos não verbais da linguagem e a intencionalidade dos atos comunicativos para identificar os primeiros sinais de alteração pragmática. O Roteiro de Observação da Linguagem na Perspectiva Pragmática (ROLPP) é um roteiro de observação de habilidades sociocognitivas e pré-verbais necessárias para o desenvolvimento da linguagem que precedem a fala. Tais habilidades fazem parte do construto da linguagem pragmática. O protocolo foi aplicado em crianças de 18 a 36 meses, sendo composto por 11 crianças com suspeita de TEA e diagnóstico descartado, e 11 crianças com diagnóstico confirmado de TEA. Um nível descritivo de 5% (p < 0,05) foi considerado estatisticamente significativo. Os resultados indicam que os participantes com diagnóstico confirmado de TEA apresentaram pontuações mais altas do que aqueles em que o diagnóstico foi descartado. Crianças com diagnóstico confirmado tenderam a pontuar mais alto no ROLPP geral (p < 0,001), destacando o impacto dos transtornos pragmáticos de linguagem em crianças com TEA, mesmo em idade pré-escolar. Esses resultados preliminares indicam a possibilidade de identificar sinais de transtornos ou dificuldades pragmáticas mesmo antes dos 36 meses de idade, com baixos custos de aplicação, inclusive para uso por profissionais com pouca experiência ou contato com transtornos do neurodesenvolvimento como o TEA.
Flexible endoscopic evaluation of swallowing (FEES) is internationally recognised as an important instrumental assessment for paediatric dysphagia. Evidence supports its feasibility and safety in infants and children, but UK specific data remain limited. No published UK report describes a jointly delivered speech and language therapist (SLT) and paediatric otolaryngologist (ENT) FEES model applied across both neonatal and paediatric cohorts. To describe the implementation of a neonatal and paediatric FEES service delivered jointly by SLTs and ENT surgeons, and to evaluate clinical characteristics, FEES findings and subsequent changes to management. A retrospective audit included all children undergoing FEES between January 2024 and January 2025. Extracted data included demographics, comorbidities, referral indications, secretion management, penetration and aspiration events, swallow physiology, procedural tolerance and pre and post FEES feeding plans. Descriptive statistics were used to describe results. Governance approval was obtained through the hospital's information governance office. (IG 2024-890). Thirty-three children aged 4 days to 8 years underwent FEES. Comorbidities associated with dysphagia were present in 31/33 participants. Penetration or aspiration occurred in 21/33 participants, and secretion management difficulties occurred in 14/33 participants. Following FEES, 30/33 participants had a change to their feeding management plan compared with the plan developed based on a clinical feeding evaluation. No major adverse events occurred. One brief episode of mild epistaxis resolved spontaneously. The joint SLT and ENT model supported efficient scope passage and likely contributed to high procedural tolerance. A neonatal and paediatric FEES service can be safely implemented in a UK tertiary hospital using a joint SLT and ENT model. Simultaneous upper airway examination alongside FEES provided clinically meaningful information that frequently changed management. Findings support further multicentre work to establish national paediatric FEES pathways. What is already known on this subject FEES is a well-established instrumental assessment for paediatric dysphagia, providing objective insights into swallow function and airway protection. While widely used in countries like the U.S., Australia, and Canada, there is limited research describing paediatric or neonatal FEES in the United Kingdom or broader European context. Existing literature focuses primarily on feasibility and diagnostic accuracy, but does not address its implementation in UK public health systems or its integration with ENT services. What this study adds to the existing knowledge This is the first known study to describe the implementation of a joint ENT-SLT led paediatric FEES service within an NHS hospital. It identifies a high incidence of laryngomalacia during FEES, suggesting a potential association with oropharyngeal dysphagia even in the absence of classic airway symptoms. The study also demonstrates substantial variation in oral feeding plans post-FEES compared to bedside assessment, raising concerns about the standalone reliability of non-instrumental evaluations in neonates and infants. What are the potential or actual clinical implications of this work? The study supports routine inclusion of ENT in paediatric FEES, particularly for neonates, due to the frequency of structural airway anomalies such as mild laryngomalacia. It highlights critical limitations of bedside swallow evaluations as sole diagnostic tools and underscores the need for expanded access to FEES within the NHS. These findings reinforce the urgency for standardized UK-specific protocols and training pathways for neonatal and paediatric FEES to ensure accurate diagnosis and safe feeding management.
Background The widespread adoption of electronic health records (EHRs) has imposed substantial documentation burdens on healthcare workers and is internationally recognized as a major contributor to clinician burnout. Rehabilitation therapists also experience documentation burdens comparable to those of physicians and nurses. However, integrated evaluations of the efficiency, usability, and safety of generative artificial intelligence (AI)-assisted creation of rehabilitation discharge summaries remain limited. Objective This study aimed to evaluate the impact of an AI-assisted rehabilitation discharge summary creation workflow - combining a commercial generative AI service with an in-house Excel/Visual Basic for Applications (VBA) macro-based transcription system (Microsoft Corp., Redmond, Washington) - on documentation efficiency, usability, and safety in the rehabilitation department of a general hospital in Japan. Methods This single-center, before-after implementation study was conducted in the rehabilitation department of a 290-bed general hospital in Kyoto, Japan. Documentation time for rehabilitation discharge summary creation (pre-implementation, n=16; post-implementation, n=22; therapists, n=21) was analyzed using a linear mixed-effects model with random intercepts for therapist ID, supplemented by the Wilcoxon signed-rank test. Usability was assessed using the System Usability Scale (SUS) administered to 18 cooperating therapists (physical, occupational, and speech-language therapists) following implementation, with results interpreted according to the established criteria. Hallucination and omission evaluation was performed on 11 randomly sampled AI-generated rehabilitation discharge summaries by two independent raters using a published clinical safety framework; disagreements were resolved through consensus discussion. Results The median documentation time decreased from 23.0 minutes pre-implementation to 10.0 minutes post-implementation. The adjusted linear mixed-effects model revealed a significant reduction of 12.26 minutes (95% CI: -15.71 to -8.81; p<0.001). The Wilcoxon signed-rank test in the nine therapists who contributed to both periods also confirmed a large effect size (r=0.87, p=0.014). No difference in documentation time was observed based on previous lecture attendance (β=0.05, p=0.98). The median SUS score was 83.75 (IQR: 72.5-90.0), corresponding to Letter Grade B (80-89), with 15 of 18 respondents (83.3%) classified as "Acceptable" (≥70). In the hallucination and omission evaluation, 9 of 11 rehabilitation discharge summaries (81.8%) contained at least one error, yielding a total of 19 hallucinations and 1 omission. Major errors accounted for 52.6% (10/19), and the major rate of fabrication-type hallucinations was 83.3% (5/6). Conclusions This exploratory, single-center implementation study found that an AI-assisted rehabilitation discharge summary workflow was associated with reduced documentation time and favorable usability ratings. However, hallucinations occurred at a level requiring therapist verification and correction, with clinically relevant errors in high-risk content segments. These findings provide preliminary evidence that a low-cost, low-technical-barrier AI-assisted documentation workflow may improve documentation efficiency and usability within the studied institutional context. Safe implementation requires final human verification and risk-stratified review of high-risk content segments.
This article details the community-based participatory research development of the CARE Model Assessment instrument, which measures the Blank Center CARE Model's four primary components: Communication, Advocacy, Resiliency, and Education (CARE). The CARE Assessment instrument is not designed to diagnose stuttering; rather, it assumes an a priori diagnosis and provides a strengths-based evaluation of the four CARE Model components. It is intended for use in individuals diagnosed with stuttering who may receive stuttering-affirming treatment. The CARE Assessment instrument provides an evaluation framework clinicians can use to inform and construct a strengths-based treatment plan. To develop this instrument, the authors conducted two related studies. Study 1 established and refined the initial Assessment tool, resulting in the Revised CARE Assessment instrument (the current version). Subsequently, Study 2 objectively examined the psychometric properties of this revised instrument using a sample of school-age children (N = 107; 8-17 years of age) and their caregivers (N = 107). This study examined participants' responses to establish test-retest reliability, divergent validity, and redundancy across the model's four components. Together, the findings of Studies 1 and 2 provide empirical evidence that the CARE Assessment instrument yields meaningful qualitative and quantitative insights into communication, advocacy, resilience, and knowledge relative to stuttering from the responses of school-age children, their caregivers, and clinicians.
Hearing loss is a major global health issue with potentially severe consequences for speech development, social integration, and cognitive health. A significant proportion of this burden is preventable through targeted strategies applied across the human lifespan. This narrative review synthesizes key evidence-based preventive measures in otology and provides practical recommendations for clinicians. A selective review of the current literature was conducted, including national clinical guidelines, systematic reviews, epidemiological studies, and pivotal clinical trials. Key preventive measures begin before birth with maternal vaccinations and hygiene counseling as well as screening for syndromes or congenital cytomegalovirus infection. Universal newborn hearing screening is a cornerstone of early diagnosis and intervention, enabling superior outcomes with cochlear implantation or emerging gene therapies. Recommended childhood immunizations, noise protection, cautious use of ototoxic medications, and managing lifestyle-related risk factors are effective strategies for preventing acquired hearing loss. Furthermore, auditory rehabilitation with hearing aids or implants is crucial for tertiary prevention, mitigating secondary consequences such as social isolation and cognitive decline. A multifaceted, proactive, life-course approach to hearing health is essential to reduce the burden of hearing loss. Otolaryngologists play a central role in implementing these preventive strategies, from counseling expectant parents to ensuring timely rehabilitation in older adults. HINTERGRUND: Hörverlust ist ein weltweites Gesundheitsproblem mit potenziell schwerwiegenden Folgen für Sprachentwicklung, soziale Integration und kognitive Fähigkeiten. Ein erheblicher Teil dieser Belastung lässt sich durch gezielte Strategien verhindern. Die vorliegende Literaturübersicht fasst wichtige evidenzbasierte Präventionsmaßnahmen in der Otologie zusammen und gibt Empfehlungen für die Praxis. Es erfolgte eine kritische Bewertung und Zusammenfassung aktueller nationaler klinischer Leitlinien, systematischer Übersichtsarbeiten sowie relevanter epidemiologischer und klinischer Studien. Wichtige Präventionsmaßnahmen beginnen bereits vor der Geburt mit Impfungen und Hygieneberatung für Schwangere sowie Vorsorgeuntersuchungen wie Screening auf Syndrome oder kongenitale Zytomegalievirus(CMV)-Infektion. Das universelle Neugeborenen-Hörscreening ist ein Eckpfeiler für frühzeitige Diagnose und Intervention und ermöglicht optimierte Ergebnisse mit Cochleaimplantaten oder neuartigen Gentherapien. Impfungen für Kinder, Lärmschutz, limitierter Einsatz ototoxischer Medikamente und Optimierung lebensstilbezogener Faktoren sind wirksame Strategien zur Prävention von erworbenem Hörverlust. Darüber hinaus ist die auditive Rehabilitation mit Hörgeräten oder Implantaten entscheidend für die Tertiärprävention, um Folgen wie soziale Isolation und kognitiven Verfall zu mildern. Von der Beratung werdender Eltern bis hin zur Sicherstellung einer rechtzeitigen Rehabilitation bei älteren Erwachsenen spielen HNO-Ärzte eine zentrale Rolle bei der Umsetzung vielschichtiger, proaktiver Präventionsstrategien zur Förderung der Hörgesundheit und zur Verminderung der Belastung durch Schwerhörigkeit.
Verbal fluency tasks are ubiquitous in mild cognitive impairment (MCI) screenings. Yet, their assessment is traditionally limited to valid response counts. This subjective approach constrains analysis to univariate methods and overlooks which semantic memory dimensions are affected, introducing human bias while limiting informativeness. We tackled these gaps with a novel automated framework. Ninety-six participants (53 with MCI, 43 cognitively unimpaired individuals) performed phonemic and semantic fluency tasks alongside standard cognitive tests. Word properties (e.g., frequency, granularity, length) and timing features (e.g., number of pauses) were (i) automatically extracted to discriminate between groups via machine learning classification, (ii) benchmarked against standard cognitive measures (Trail Making Test-A, Trail Making Test-B, episodic memory subscore from the Addenbrooke's Cognitive Examination, digit span, and Mini-mental State Examination), and (iii) used to predict brain patterns and plasma phosphorylated tau 217 (pTau217) concentration. Our approach yielded moderate classification performance when using word properties and speech timing features combined (Area under the receiver operating characteristic curve [AUC] = .81, 95% confidence interval [CI] = [0.71, 0.89]), outperforming cognitive measures (AUC = .77, CI = [.68, .85]). Frequency, granularity, and semantic distance correlated with the gray matter volume of semantic-related regions commonly atrophied in MCI. No fluency feature was associated with functional connectivity patterns. Granularity was moderately associated with pTau217 levels. In sum, automated fluency analyses facilitate MCI detection, capturing fine-grained neurocognitive and biomarker patterns in the condition.
Among US teenagers, 79% of HIV infections are attributable to male-to-male sexual contact; yet, few interventions have been shown to effectively reduce sexual risk among gay and bisexual adolescents (GBA). Parent communication about sex is associated with adolescent sexual risk, and interventions to improve parent communication have been shown to successfully reduce sexual risk among heterosexual samples. However, no interventions designed specifically for parents of GBA have been tested in clinical trials. Parents and Adolescent Talking About Healthy Sexuality (PATHS) is a web-based intervention we created for parents of GBA that aims to improve parent communication about sexuality and HIV and increase parent behaviors supportive of GBA sexual health. This trial aims to test whether delivering PATHS to parents of GBA ages 14-19 years will improve GBA sexual health outcomes in the 6 months following intervention delivery. Secondary aims are to test whether the intervention's effects are sustained at 12 months after the intervention and to examine whether effects are mediated through specific parent behaviors. In total, 350 parents of GBA will be recruited online via social media advertising and randomized to receive either PATHS or an active control. PATHS is fully automated, self-paced, and can be completed in a single session lasting under an hour. The active control is an education entertainment film created to provide general support and guidance to parents of GBA. Both parents and their GBA sons will complete online assessments every 3 months over a 1-year period. Primary outcomes will be evaluated at 6 months after the intervention, and then, the control arm will crossover and receive PATHS, and dyads will be followed for another 6 months. Primary outcomes include both adolescent sexual preparedness (eg, condom skills) as well as HIV-related sexual risk behavior (ie, condomless anal or vaginal sex that is not protected by pre-exposure prophylaxis). The study was funded in March 2022, and we completed enrollment of 393 parent-GBA dyads in September 2025. We project that all participants will have completed study activities by November 2026, with data analysis and results of the trial forthcoming in the first quarter of 2027. If proven efficacious, PATHS will be among the first HIV prevention interventions shown to reduce sexual risk for GBA. Moreover, as other adolescent-focused interventions emerge, PATHS' unique focus on parents will offer a complementary, additional means for reaching GBA who do not engage with other intervention options. ClinicalTrials.gov NCT05852600; https://clinicaltrials.gov/study/NCT05852600. PRR1-10.2196/81316.
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Using communication aids in everyday interaction is often challenging, despite evidence showing that their use can facilitate linguistic development and social participation. Previous research has identified that a key factor in promoting the use of communication aids is teaching communication partners skills that facilitate aided interaction. This paper outlines, step by step, the design process of a new evidence-based intervention model called Reco (relaxed communication), which was developed according to the Intervention Mapping Protocol. Reco was designed for children and young people for whom communication aids are recommended as well as for their communication partners. The aim of Reco is to facilitate the use of communication aids in everyday interaction. The development process began by identifying the problem and objectives for intervention and continued by selecting evidence-based methods. In the pilot phase, participants comprised two school-aged children who use AAC and their parents, school instructors, and speech and language therapists, and in the implementation phase six children and their communication partners. The implementation phase is currently under review. This protocol article is valuable for demonstrating how to use participatory research design and evaluate evidence-based interventions in the AAC field.
Many autistic children have spoken vocabulary delays that impact communication abilities during critical developmental periods. Behavioral and brain predictors of spoken language development in autism have been independently identified but rarely evaluated simultaneously. Here, we examined how fine motor skills, joint attention, and white matter microstructure of speech-related tracts are associated with spoken vocabulary development in autistic children with a broad range of speech abilities. Spoken vocabulary was assessed longitudinally in 122 autistic children (38% female) first between 2-4 years (Time 1) and again approximately two years later. Children were divided into groups based on their Time 1 spoken vocabularies: larger, average, or smaller. Fifty-eight autistic children (47% of the sample) were in the smaller vocabulary group, which represented both emergent speakers and non-speaking individuals. Within this smaller vocabulary group, faster rates of spoken vocabulary development were associated with better Time 1 fine motor and joint attention skills, and lower Time 1 fractional anisotropy (FA) in the occipital inferior longitudinal fasciculus, central arcuate fasciculus, and inferior corticospinal tract. Rates of spoken vocabulary development were best predicted by models that included both brain and behavior metrics, which each individually explained significant variance and together accounted for roughly half of the model variability. Results suggest that together early childhood fine motor skills, joint attention skills, and white matter microstructure contribute to a developmental cascade supporting spoken language. Findings demonstrate the potential clinical utility of early brain scanning, indicating that microstructure is predictive of language development above and beyond salient behavioral predictors.
Stroke during pregnancy is uncommon but poses a significant threat to both mother and fetus, requiring rapid, carefully balanced interventions. We describe a 46-year-old woman at 24 weeks' gestation who presented with sudden speech difficulties, facial droop, and weakness on one side of her body. Imaging revealed an acute right middle cerebral artery occlusion, and extensive evaluation ruled out cardioembolic, thrombophilia, and vascular causes. She underwent urgent mechanical thrombectomy under monitored anesthesia care, achieving partial revascularization without complications. Her neurological function improved progressively, and both maternal and fetal outcomes were favorable. This case highlights the complexity of managing acute stroke in pregnancy, where timely decision-making must integrate standard stroke protocols with pregnancy-specific considerations, including imaging, anesthesia, and multidisciplinary care. Sharing such experiences is essential to expand knowledge on the safety and effectiveness of endovascular interventions in this rare but critical setting.
Angelman syndrome is a neurodevelopmental disorder caused by loss of maternal UBE3A expression. With promising therapies now in clinical trials, there is a pressing need for reliable and translatable biomarkers. Elevated delta power in electroencephalography (EEG) recordings is a hallmark of Angelman syndrome and a promising biomarker, but traditional measures of delta power conflate true delta oscillations with broadband spectral shifts, limiting interpretability and utility. We sought to investigate whether separating out periodic and aperiodic contributions to delta power would yield more interpretable biomarkers. We applied spectral parameterization to EEG recordings from children with Angelman syndrome (n = 95) and typically developing children (n = 185), and to cortical local field potential recordings from Ube3a mutant mice (n = 39) and littermate controls (n = 47) across postnatal development. We related periodic and aperiodic features to Bayley developmental scores in children, and to performance on a motor-based behavioral battery in mice. Here we show that elevated delta power reflects a combination of increased periodic delta oscillations as well as elevated aperiodic slope and offset in both humans and mice. Periodic delta power predicts cognitive ability in children, while aperiodic features predict motor deficits in mice. These features also follow divergent developmental trajectories in both species, suggesting distinct underlying mechanisms. Aperiodic spectral features represent a translatable biomarker for Angelman syndrome. Periodic and aperiodic components of the delta phenotype show separable behavioral and developmental signatures, and their complementary use offers improved precision for biomarker-based evaluation in preclinical and clinical research. Angelman syndrome is a rare genetic disorder affecting movement, speech, cognition, and sleep. As new therapies enter clinical trials, reliable measures of brain function are needed to determine whether treatments are effective. Children with Angelman syndrome show elevated slow brain waves in EEG recordings, but this commonly used measure actually reflects two distinct signals: rhythmic slow oscillations and a broader shift in background brain activity. We separated these two signals in EEG recordings from children with Angelman syndrome and in a mouse model of the disorder. Each component was linked to different behavioral features and followed different developmental trajectories. Together, these findings provide more precise tools for tracking Angelman syndrome and evaluating emerging treatments in both patients and preclinical models.
Head and neck cancers (HNCs) represent a heterogeneous group of malignancies with high morbidity and complex functional impairment. Despite advances in multimodal therapy, many patients present with advanced or incurable disease, demanding early integration of palliative care. To review the epidemiology, symptom burden, and best practices in palliative care for patients with advanced HNC, highlighting strategies for symptom management, communication, and end-of-life decision-making. A narrative review of current literature, clinical guidelines (National Comprehensive Cancer Network (NCCN), American Society of Clinical Oncology (ASCO), UK National Multidisciplinary Guidelines), and key studies on palliative interventions in HNC was conducted. Emphasis was placed on early integration of palliative care, multidisciplinary management, and evidence-based approaches to symptom control. HNC patients experience high symptom burden, including pain, dysphagia, airway compromise, hemorrhage, and psychological distress. Early palliative care integration improves symptom control, quality of life, and alignment of treatment with patient goals. Multidisciplinary approaches involving surgeons, oncologists, palliative specialists, speech therapists, dietitians, and psychosocial support are essential. Sentinel clinical events should trigger structured discussions on prognosis, treatment objectives, and end-of-life preferences. Advance care planning, including documentation of "do not resuscitate" (DNR) orders and preferred location of death, is critical in the terminal phase. Effective palliative care in HNC requires early, proactive, and multidisciplinary strategies that balance disease-directed therapy with patient-centered goals. Standardization of care pathways and ongoing evaluation of emerging evidence are essential to optimize symptom management, facilitate informed decision-making, and enhance quality of life for patients with advanced diseases.
The Brief Version of the Unhelpful Thoughts and Beliefs About Stuttering Scales (UTBAS-6) is an efficient and reliable way to screen for unhelpful and negative thoughts, as well as negative beliefs and anxiety among people who stutter. It makes it easier to provide information about people who stutter by saving time for SLPs in clinics. The aim of this study was to construct an Arabic version of the Brief Version of the Unhelpful Thoughts and Beliefs About Stuttering Scales (A-UTBAS-6) and to evaluate its clinical validity, reliability, and internal consistency. The developed A-UTBAS-6 was administered to 53 adults who stuttered (AWS) and 112 adults who did not stutter (ANS). Both test-retest reliability and internal consistency were tested. The results for both groups were compared. The internal consistency of the A-UTBAS-6 total score was excellent (Cronbach's α = 0.957), and test-retest reliability was statistically significant (p < 0.001). The scores for the two groups in the A-UTBAS-6 were significantly different (p < 0.001). A-UTBAS-6 is a valid tool for the early detection of thoughts and beliefs that are unhelpful and which may accompany speech disorders among Arabic patients who stutter.
To compare quality-of-life (QoL) outcomes between flap reconstruction and primary closure following intermediate-volume (partial to hemi-) glossectomy in patients with oral tongue carcinoma. Retro-prospective cross-sectional study. Department of Otolaryngology-Head and Neck Surgery, King Chulalongkorn Memorial Hospital, Bangkok, Thailand. Seventy patients undergoing partial to hemi-glossectomy were included and grouped by reconstruction method (flap reconstruction vs primary closure). QoL was assessed at 6 to 12 months posttreatment using the EORTC QLQ-H&N35 questionnaire. Multivariable linear regression was performed adjusting for age, stage group, neck dissection, and adjuvant therapy. Effect sizes were calculated to evaluate clinical relevance. Baseline demographic and clinicopathologic characteristics were comparable between groups. Operative time was significantly longer in the flap group. Flap reconstruction was associated with significantly better QoL, including lower overall HN35 scores (40.89 ± 3.39 vs 44.74 ± 5.26; P < .01), and improved swallowing and speech domains (both P < .01). In multivariable analysis, flap reconstruction remained independently associated with better overall QoL (adjusted β, -5.23; 95% CI, -7.09 to -3.37; P < .001), swallowing (adjusted β, -2.18; P < .001), and speech (adjusted β, -1.65; P < .001). Effect size analysis demonstrated large to very large effects. Wound complications were more frequent in the flap group (14.3% vs 0%; P = .02). Flap reconstruction was associated with improved QoL at 6 to 12 months, particularly in swallowing and speech, but with longer operative time and higher wound complication rates. Prospective studies are warranted to confirm these findings.
Humic substances (HS) are important parts of soil organic matter and are very important for the health of the soil, the growth of plants, and the soil's ability to withstand both biotic and abiotic pressures. HS are used a lot in sustainable farming because they have several different physicochemical qualities that make them useful for things such as soil conditioning, nitrogen management, and biostimulation. This review compiles existing information regarding the structure, origin, and methods of action of HS, focusing specifically on its impact on soil characteristics, nutrient availability, plant growth, and resilience to stress. Recent advancements in extraction, characterization, and application methodologies are examined, alongside novel notions that regard HS as supramolecular assemblies rather than distinct macromolecules. The paper talks about the main problems with HS heterogeneity, extraction artifacts, and standardization. It also points out the most important research areas that might help make HS safer and more effective in agriculture and related fields.
To explore mechanisms that lead mothers with perinatal mental health difficulties to take up an offer of face-to-face peer support from trained volunteers, and contextual factors triggering those mechanisms. Realist evaluation methods were used to identify context-mechanism-outcome configurations for take-up in a community-based, third sector programme offering one-to-one and group peer support in the UK. Data were from semi-structured interviews with mothers (n = 20), peer support volunteers (n = 27), and staff (n = 9), and baseline quantitative and open-text data about mothers at referral (n = 260). 182/260 mothers (70%) took up peer support, varying between sites with different populations. Twenty context-mechanism-outcome configurations explained take-up, which depended on complex contextual factors. Mechanisms clustered around mothers' expectations of psychological safety; desire for a meaningful reference group for social comparison; beliefs about what they may gain; expectations about how it might compare to professional mental health support; and practical issues such as mode of delivery. The purpose of peer support can be misunderstood. Not all communities see value in talking about emotional distress with peers, and not all mothers trust peers to be non-judgemental. One-to-one and group support may feel safe to different mothers. Programmes should work with mothers, third sector organisations, and community leaders, to identify how perinatal mental health peer support can be locally offered most appealingly. Accessibility may be increased by offering a choice of group or one-to-one support, and a blend of face-to-face, telephone, and video-conferencing. Publicity material should clearly explain what peer support is and how it can help.