BAT Score Research Articles

Predicting Intracerebral Hemorrhage Expansion With Noncontrast Computed Tomography: The BAT Score.

Although the computed tomographic angiography spot sign performs well as a biomarker for hematoma expansion (HE), computed tomographic angiography is not routinely performed in the emergency setting. We developed and validated a score to predict HE-based on noncontrast computed tomography (NCCT) findings in spontaneous acute intracerebral hemorrhage. After developing the score in a single-center cohort of patients with intracerebral hemorrhage (n=344), we validated it in a large clinical trial population (n=954) and in a multicenter intracerebral hemorrhage cohort (n=241). The following NCCT markers of HE were analyzed: hypodensities, blend sign, hematoma shape and density, and fluid level. HE was defined as hematoma growth >6 mL or >33%. The score was created using the estimates from multivariable logistic regression after final predictors were selected from bootstrap samples. Presence of blend sign (odds ratio, 3.09; 95% confidence interval [CI],1.49-6.40; P=0.002), any intrahematoma hypodensity (odds ratio, 4.54; 95% CI, 2.44-8.43; P<0.0001), and time from onset to NCCT <2.5 hours (odds ratio, 3.73; 95% CI, 1.86-7.51; P=0.0002) were predictors of HE. A 5-point score was created (BAT score: 1 point for blend sign, 2 points for any hypodensity, and 2 points for timing of NCCT <2.5 hours). The c statistic was 0.77 (95% CI, 0.70-0.83) in the development population, 0.65 (95% CI 0.61-0.68) and 0.70 (95% CI, 0.64-0.77) in the 2 validation cohorts. A dichotomized score (BAT score ≥3) predicted HE with 0.50 sensitivity and 0.89 specificity. An easy to use 5-point prediction score can identify subjects at high risk of HE with good specificity and accuracy. This tool requires just a baseline NCCT scan and may help select patients with intracerebral hemorrhage for antiexpansion clinical trials.

Are Bleeding Scores Predicting Severity and Outcome in Hemophilia and Rare Bleeding Disorders?

▪Background: Hemophilia is an inherited severe bleeding disorder, Factors VIII and IX deficiencies have X linked inheritance. Most rare bleeding disorders (RBD) have autosomal recessive inheritance. The ISTH-BAT is a valuable research tool that is applicable to clinical practice and scores patients' bleeding symptoms from 0 to 4. ISTH-BAT has the potential to avoid unwanted laboratory testing, predict the risk of bleeding, describe symptom severity and inform treatment.Aims: To assess the utility of ISTH-BAT in our bleeding disorder population, compare the bleeding score (BS) in adult and pediatric groups and investigate its association with plasma factor levels.Von Wilebrand disease and thrombasthenia was excluded from this study. One hundred cases of epistaxis whose coagulation workups were within normal limits were enrolled in the control group.Methods: This is an observational analytical study. The ISTH-BAT was used to calculate bleeding scores (BS) in a group of hemophilic patients and healthy controls. Ethics approval and informed consents were secured prior to the study.Results: A total of 100 patients, (38 hemophilia A; FVIII deficiency,22hemophilia B; FIX deficiency, 10 hemophilia C; factor XI deficiency, 10 factor VII deficiency, 8 factor X deficiency, 6 factor V deficiency, 5 Afibrinogenemia, Factor I deficiency) and 100 controls were analyzed using the ISTH BAT. Mean BAT score in hemophilia A, B and C were 12.8±8.2; 11.6±8.6; and 7.5 ±5.52respectively.While in RBD were and 7.97±5.56. BAT score in 30 controls was 5.35±4.48. Bleeding Scores were significantly higher in hemophilia A and B patients as compared to controls (P < 0.05) but it was not significant when BAT Scores of hemophilia C patients compared with controls (P=0.35). ANOVA test revealed BAT Score were significantly different among the mild, moderate and severe hemophilia A and B in both adult and pediatric patients but there was no difference in Hemophilia C patients. BAT scores were linked to hematomas; minor wound bleeding in hemophilia A, B patients in the pediatric group while more linked with epistaxis bleeding after dental extraction and surgical interventions in the adult group. Mean BAT Scores of rare bleeding disorders was significantly higher than control group (10.97± 5.65; compared with 5.35±4.48; P<0.05). BAT Score of 10 cases of factor VII deficiency and 5 cases of Afibrinogenemia were higher than other case of RBD, and control group (14.35 ± 7.87; and 13.54±5.56 compared with 5.35±4.48; P< 0.001 and P<0.05respectively).Conclusions: Our data revealed that the ISTH-BAT can help diagnose the bleeding condition in hemophilia and RBD patients and can be considered a predictor for the bleeding risk or severity. This will decrease need of subspecialty coagulation tests; it ultimately improvesdecision making and the clinical management of patients. DisclosuresNo relevant conflicts of interest to declare.

Identification of Qualitative Platelet Disorders in Adolescent Women with Heavy Menstrual Bleeding

Introduction: Nearly 40% of adolescent women experience heavy menstrual bleeding (HMB), and identifiable bleeding disorders are diagnosed in only 20-60% of these patients. We suspect that qualitative platelet disorders contribute to HMB, but are under-diagnosed. A pilot study was conducted to evaluate platelet function in adolescent women with HMB employing four novel, small-volume, whole blood platelet function assays. In addition, primary and secondary hemostasis, bleeding phenotype, and quality of life were assessed.Methods: Patients referred to the Young Women’s Hematology Clinic at Oregon Health & Science University for evaluation of HMB were offered participation in the study. Participants underwent standard review of their medical and family history and physical exam. Standard lab evaluation included CBC, PT, PTT, fibrinogen, thrombin time, Von Willebrand Panel, PFA-100, and iron studies with platelet aggregation or phenotyping performed if clinically indicated. Using less than 0.5 mL of whole blood, platelet function was assessed with four novel platelet function assays: assessment of platelet activation, secretion, and aggregation was assessed by flow cytometry analysis, while platelet adhesion and aggregation was assessed under shear in a capillary tube. Quality of life (QOL) was assessed using the PedsQL tool. Bleeding phenotype was assessed with the ISTH Bleeding Assessment Tool (ISTH BAT). Menorrhagia was assessed with the Pictorial Bleeding Assessment Chart (PBAC), the Philipp Tool and the clinical history.Results: Nine participants have enrolled on study to date, with 2 completing the 3-month visit. The median age of the cohort was 16 years (14-18 years). Eight out of nine categorized their period as heavy, 6 also had epistaxis, and 7 reported excessive bruising. The median ISTH BAT score was 4 (3-7). Of the 7 patients who had a Philipp Score obtained, 5 were positive. Median PBAC score was 161 (64-196). Median ferritin was 13 ng/mL (4-65 ng/mL). Median QOL psychosocial score was 70 (68.36-88.25), comparable to that of pediatric patients with cancer. Of the 9 participants, 6 had platelet aggregation and phenotyping. Four participants did not receive a bleeding disorder diagnosis, 1 was diagnosed with Type 1 VWD, 1 was diagnosed with bleeding disorder, NOS, and 1 was diagnosed with Ehlers Danlos Syndrome. Two participants were diagnosed with a qualitative platelet disorder (QPD): one based on platelet aggregation and one based on thromboelastography. The four novel platelet function assays confirmed platelet function abnormalities in the participants diagnosed with QPD’s (Figure 1&2). Impaired platelet response to agonist stimulation was also observed in participants with non-platelet disorder bleeding disorder diagnoses and in participants without a bleeding disorder diagnosis.Conclusions: In this pilot study, the etiology of HMB in adolescent women was evaluated with four novel platelet assays in addition to standard assays of hemostasis. A bleeding disorder diagnosis was not made with standard evaluations in 4 out of 9 participants. The novel assays detected platelet abnormalities not observed using currently available clinical labs, and confirmed the presence of abnormal platelet function in participants with abnormal platelet function testing. These assays require significantly less blood volume than currently available assays and expand investigation of platelet function to platelet adhesion and platelet interactions in whole and flowing blood. Further work is needed to determine the sensitivity and specificity of the novel assays in detecting platelet dysfunction. Continued investigation into the impact of HMB on the adolescent female population is needed. [Display omitted] [Display omitted] DisclosuresHaley:CSL Behring: Honoraria; Baxalta: Membership on an entity's Board of Directors or advisory committees. Recht:Biogen: Membership on an entity's Board of Directors or advisory committees; CSL Behring: Membership on an entity's Board of Directors or advisory committees; Biogen: Research Funding; Genentech: Research Funding; Novo Nordisk: Research Funding; Baxalta: Research Funding; Novo Nordisk: Membership on an entity's Board of Directors or advisory committees; Pfizer: Membership on an entity's Board of Directors or advisory committees.

Comprehensive Evaluation of Bleeding Disorders in Adolescents with Heavy Menstrual Bleeding

Introduction: Unpredictable, prolonged or heavy menstrual bleeding (HMB) is not unusual in many adolescents soon after menarche. Anovulation, owing to immaturity of the hypothalamic-pituitary-ovarian axis, is often the cause of HMB; however, it may coexist and mask an underlying bleeding disorder (BD). Retrospective data in adolescents with HMB suggest a prevalence of BDs from 10 to 62%. Prospective studies with uniform hemostatic evaluation and concurrent quality of life (QoL) assessments have not been performed. The incidence of BDs in adolescents, especially those with anovulatory bleeding, remains unknown. Methods: In this ongoing prospective cohort study (targeted n=200), 130 adolescents referred for HMB to multidisciplinary Young Women's Blood Disorders Clinics were enrolled. An assessment of menstrual loss using pictorial blood assessment chart (PBAC) and bleeding symptoms using ISTH-bleeding assessment tool (BAT) was undertaken. Participants underwent a comprehensive evaluation determined a priori, including assessment of hypermobility, standardized laboratory evaluation (prothrombin time, activated partial thromboplastin time, fibrinogen, thrombin time, von Willebrand disease (VWD) panel, whole blood platelet aggregation with ATP secretion, factor assays (FIX and FXIII), global hemostasis and hyperfibrinolysis using ROTEM, and a pelvic ultrasound (US). Patient reported outcomes for health related QoL(HR-QoL) was completed. Results: The mean age of participants was 14 (range 11-18) and mean age at menarche was 11.7 yrs. (range: 9-16). The mean PBAC score, before contraceptive initiation, was 504 (range: 100- 1200) and the mean ISTH BAT score was 3.8 (range: 1-8) in all participants. 62% had anovulatory menstrual bleeding. An inherited BD and/or bleeding risk was diagnosed in 24.6% (n=32); 9% (n=12) were diagnosed with VWD, 5% (n=6) with qualitative platelet dysfunction and 2 subjects were found to be hemophilia A (HA) carriers. Low VWF levels (VWF:Rco 30-50%) were detected in 9% (n=12). 15% had evidence of mild systemic hyperfibrinolysis (lysis 3-8% on ROTEM) but none met the criteria for further investigation for an inherited disorder of hyperfibrinolysis . Of those without BD, 2 were diagnosed to have VWF exon 28 polymorphism, and 3 were referred and ultimately diagnosed with hypermobility syndrome by Genetics. One was found to have endometriosis by laparoscopy and 3 were diagnosed with PCOS. Of those with BDs (all with low VWF), 3 were diagnosed with hypermobility syndrome (total 6) and 4 with PCOS (total 7). US was normal in all subjects. The PBAC scores were higher in BDs (634 vs. 410; SD ± 275 p=0.002), irrespective of the pattern of bleeding. No differences were found in the ISTH BAT scores (after excluding HA carriers) (3.6 vs. 4.8; SD ± 1.19, p=0.06), initial hbg or ferritin levels between the two groups. Only 6% (n=8) with BDs required ED visit and/or hospitalization for HMB vs. 14% (n=18) without a BD, of which majority had anovulatory bleeding. On multivariate logistic regression, no predictors of BDs were found. Adolescents with BDs had a decreased HR-QoL compared to those without a BD (QoL score 58 vs.87; SD± 12.5, p=&lt;0.001) even after control of HMB and correction of anemia. Conclusions: Inherited BDs are common in adolescents with HMB, confer a decreased HR-QoL and can be associated with anovulatory bleeding. A comprehensive evaluation is required to unravel disorders causing HMB. In this ongoing study, at this time, no predictor of an inherited BD was found in adolescents with HMB. Data accrual from the fully powered, ongoing, prospective study may offer further data to develop an ideal tool with a scoring system to take into account all prevalent causes of HMB to accurately predict a BD in adolescents. Disclosures Zia: NHLBI K23: Research Funding. Journeycake:CSL: Consultancy; Biogen: Consultancy; Baxalta/Shire: Consultancy. Jain:Novo Nordisk: Honoraria; Bayer: Membership on an entity's Board of Directors or advisory committees; Biogen: Speakers Bureau. Sarode:CSL Behring: Consultancy, Honoraria.

Impact of limited hamstring flexibility on vertical jump, kicking speed, sprint, and agility in young football players

This study aims to analyse the impact of limited hamstring flexibility (HF) on specific football skills, such as sprinting and jumping ability, agility, and kicking speed in young football players. Forty-three male football players (aged 14–18) from a semi-professional football academy participated voluntarily in this study. Data about anthropometric measurements, HF (unilateral passive straight-leg raise test: PSLR), vertical jumping ability (countermovement jump: CMJ), sprinting ability (5, 10, 20 m: S5 m, S10 m, S20 m), agility (Balsom agility test: BAT), and kicking speed in terms of ball speed (dominant and non-dominant leg: KSdom and KSnon-dom) were collected. Cluster analysis grouped according to HF, dividing participants into a flexible group (FG, n = 24) and a non-flexible group (NFG, n = 19) in relation to performances on the PSLR test. Despite finding no significant differences between groups in body composition and age, the FG performed better in terms of sprint scores (S5 m: 6.12%, S10 m: 4.09%, S20 m: 3.29%), BAT score (4.11%), CMJ score (10.49%), and scores for KSdom (6.86%) and KSnon-dom (8%) than the NFG. The results suggest that HF is a key factor for performing football-specific skills, such as sprinting, jumping, agility, and kicking in young football players. These results support the rationale that muscle flexibility must be specifically trained in football players beginning at early ages.

Analysis of Bleeding Phenotype of Severe Hemophilia a Carriers and Comparation with a Working Population Group. Impact on Quality of Life

INTRODUCTIONWe have little information about if there is a particular bleeding phenotype of severe haemophilia A female carriers. In the literature, an increased bleeding tendency is described in this group, justified even by levels of factor VIII (FVIII) very close to normal values, in absens of primary hemostasis evaluation in many cases. There is no published evidence about quality of life (QoL) of these women and the relationship between QoL and this bleeding tendency. OBJECTIVES• To evalute the hemorrhagic phenotype of severe haemophilia A carrier and to compare them with the general population.• To identify symptomatic carriers and to study from laboratory point of view the reasons for that bleeding tendency.• To define the bleeding profile of symptomatic carriers.• To analyze the quality of life and state of anxiety/depression in carriers and to compare them with the general population. PATIENTS AND METHODSThis is a descriptive cross-sectional, non-interventional, single center study. Ethics Committee evaluation and written informed consent are requested to be included for carriers and controls. The target population are severe Haemophilia A carriers from our area aged between 18 and 70 years old. The control group are women from regular health laboral checkings. We will evaluate family bleeding, ischemic and thrombotic personal and familiar antecedents, bleeding profile (ISTH/SSC bleeding assessment tool, ISTH BAT, and pictorial blood assessment chart, PBAC), carrier genetic study, complete blood count, basic biochemistry, haemostasis (aPTT, PT, fibrinogen, platelet function tests, FVIIIc, FvWAg and FvWRCo, FXIII). QoL has been studied trough SF-36 (Spanish version 1,4 1999) and anxiety and depression states using Goldberg questionary (1998, Spanish version Gzempp, 1993).The controls have been studied in the same way except for laboratory studies of hemostasis. Only in controls with pathological ISTH BAT (greater than 3) basic and primary hemostasis have been studied. RESULTSOut of a total of 81 carriers identified between August 2012 to December 2013. We have evaluated 69 carriers. To achieve a confidence level of 95% with 50% heterogeneity we have recruited 138 controls. The mean and standard deviation (SD) age of the carrier and controls was 43.7+/-15 and 41.5+/-11.7 years old (p 0.308). In the population of carriers, the mean and SD of FVIII levels are 87.2+/-35.7%. We found no relationship between levels of FVIII:c and haemophilia genetic defect (34.8% substitutions, 34.8% intron 22, 27.5% mutations). 20.3% of carriers and 2.2% of controls present a pathologic ISTH BAT score (p 0.001). There are 14 carriers with a pathologic ISTH BAT score (median 5.5, range 4-11). In this group we found FVIII levels less than 40% in 4 carriers, 1 thrombopathy and levels of VWF:RCo and VWF:Ag compatible with von Willebrand disease in other 4 carriers. The remaining 5 present ISTH BAT score between 4 and 6 (low), FVIII levels above 60% and no other laboratory abnormal results to justify bleeding tendency. In the 3 controls with pathologic ISTH BAT score (4-5), we have not found any hemostatic disorder from laboratory point of view. The carrier group has a higher incidence of abnormal bleeding at wounds (1.5% vs. 14.5% p 0.000), tooth extraction (3.6% vs. 11.6%, p 0.028), surgery (0% vs. 11.6 %, p 0.028) and methrorragia (13.8% vs 43.5%, p 0.000). However when methrorrragia is analysed with an objective scale of menstrual bleeding as PBAC, methrorragia incidence in carriers is similar to controls (23.2% carriers vs 31.5% controls, p 0.071). Regarding quality of life, the population of carriers presented worse scores in the domains of social activity (p 0.01) and mental health (p 0.014). In the group of symptomatic carriers there are no differences in quality of life with the control group. The control population has a higher incidence of anxiety (42.3% vs 21.7%, p 0.002), with no differences in the presence of depression. CONCLUSIONSIn our series, women with symptomatic severe hemophilia A are those with FVIII lower than 40% or another disorder of hemostasis associated to carrier condition. The hemorrhagic symtoms able to define a severe haemophilia A carrier could be abnormal bleedings from wounds (surgical or traumatic) and in dental extractions. Quality of life in women with hemophilia is worse in the mental health and social activity fields, but for reasons other than their own bleeding phenotype. DisclosuresNo relevant conflicts of interest to declare.

Analysis of Hemorrhagic Phenotype and Cardiovascular Risk of Severe Hemophilia a Carriers and Difference with Female Working Population Control Group

INTRODUCTIONRecent studies in male subjects with haemophilia have described a prevalence of cardiovascular risk factors (CVRF) and cardiovascular events (CVE) similar to the general population. This finding has not been tested in severe haemophilia A carriers so far. We have little information about whether there is a particular bleeding profile in this group and if this tendency is able to modify cardiovascular risk in these women. OBJECTIVESTo evaluate bleeding profile from laboratory and clinical point of view in haemophilia A carriers and working population controls; to define and to calculate CVRF, CVE and cardiovascular risk scores in severe haemophilia A carriers and controls; to analyse if there is any difference in cardiovascular risk between symptomatic severe haemophilia A carriers and general population. PATIENTS AND METHODSThis is a descriptive, cross-sectional, non interventional, single center study. Ethics Committee evaluation and written informed consent are requested to be included for carriers and controls. The target population are severe haemophilia A carriers from our area aged between 18 and 70 years old. The control group are women from regular health laboral checkings. We evaluate bleeding, ischemic and thrombotic personal and familiar history, bleeding profile (ISTH/SSC bleeding assessment tool, ISTH BAT), factor VIII (FVIII) genetic study, complete blood count, basic biochemistry, haemostasis (aPTT, PT, fibrinogen, platelet function tests, FVIIIc, FvWAg and FvWRCo, FXIII, homocysteine, resistence to APC, antithrombin, protein C and S, 20210A prothrombin mutation), cardiovascular risk (Framingham score and Systematic Coronary Risk Evaluation Project, SCORE). The controls have been studied in the same way with the exception of laboratory studies of hemostasis. Only in controls with pathologic ISTH BAT (greater than 3), basic and primary hemostasis have been studied. To describe continuous variables we will use mean, median, standard deviation, maximum and minimum. For categorical variables will be used the percentage of every category. RESULTSOut of a total of 81 carriers have been identified between August 2012 to December 2013. We have evaluated 69 carriers. To achieve a confidence level of 95% with 50% heterogeneity we have recruited 138 controls. The mean age of carriers and controls was 43.7+/-15 and 41.5 +/-11.7 years old (p 0.308). In the group of carriers, the mean and standard deviation (SD) of FVIII levels were 87.2+/-35.7%, FvW:RCo 75.6 +/-30% and vWF:Ag 75.6 +/-30, 1%. We found no relationship between levels of FVIII:c and haemophilia genetic defect (34.8% substitutions, 34.8% intron 22, 27.5% mutations). 20.3% of carriers and 2.2% of controls present a pathologic ISTH BAT score (p 0.001). The table describes CVRF and cardiovascular risk scores of carriers and controls. TableCARRIERSCONTROLSHigh Blood Pressure(HBP)17,4%5%0,001Smoking29%32,6%0,596Sedentariness55,1%37,7%0,025Diabetes8,7%2,9%0,069Metabolic Syndrome(ATPIII)14,5%8%0,143Dyslipemia14,5%12,8%0,474Overweight and Obesity50,7%34,8%0,027Framingham(median, IQR)2 (0,47-7,41)0,4 (0-3,75)0,001SCORE (median, IQR)1 (0,73-1,58)0 (0-0,71)0,001Family history ischemia66,7%28,3%0,001No personal CVE in carriers group. We found two cases of thrombophilia. They are two women from the same family with high homocysteine levels and family history of heart attack and stroke in haemophiliacs men. Most of family history of ischemia in carriers group comes from haemophiliac male relatives. Among controls only one patient has experienced heart attack and other a deep vein thrombosis. They both were older controls with CVRF. We have analysed separately the 14 symptomatic carriers (pathological ISTH BAT). This particular group has a similar Framingham score to general population but remains in a higher risk of death from vascular event (SCORE) compared to general population. CONCLUSIONSLow levels of FVIII do not prevent from developing vascular risk factors in syntomatic carriers of severe haemophilia A. In our media, we describe a higher prevalence of HBP, sedentariness, obesity and overweight in the group of carriers than in controls. The risk of suffering a cardiovascular event and the risk of death because of a cardiovascular events is higher in the group of severe hemophilia A carriers than in the working control population, even in symptomatic carriers. DisclosuresNo relevant conflicts of interest to declare.

Individual differences in rhythmic ability: Behavioral and neuroimaging investigations.

Rhythmic abilities vary widely in the general population, but little is known about the factors that give rise to this variability. One factor may be musical training. Another may be differences in auditory short-term memory (STM) capacity (the amount of auditory information that can be remembered over a few seconds). Finally, as rhythms with temporal regularity (e.g., a beat) are more easily remembered and reproduced, individual differences in sensitivity to regularity may contribute to rhythmic ability differences. To investigate the contribution of each of these factors to rhythm reproduction ability, we assessed auditory STM capacity (using digit and pseudoword span tasks), sensitivity (using the Beat Alignment Test [BAT]), and levels of musical training. Rhythmic ability was measured using a rhythm reproduction test. We found that STM capacity, sensitivity, and musical training predicted unique variance in rhythm reproduction performance. Using functional magnetic resonance imaging (MRI), we assessed individual differences in brain activity related to the previously measured auditory STM capacity, BAT score, musical training, and rhythmic ability, while participants performed a rhythm discrimination task. Activity in posterior superior temporal gyrus and middle temporal gyrus negatively correlated with auditory STM capacity. Positive correlations with BAT score were found in leftangular gyrus, supplementary motor area, and premotor cortex. Positive correlations with musical training were observed in leftposterior middle temporal gyrus, and negative correlations were observed in leftsupplementary motor area. The findings implicate both auditory and motor areas in factors that underlie individual differences in rhythmic ability.Keywords: music, timing, auditory perceptionSupplemental materials: http://dx.doi.org/10.1037/a0031188.suppAnecdotally, rhythmic ability is thought to vary widely across healthy individuals. Several individuals report having no sense of rhythm, and previous work has investigated individuals with specific rhythmic impairments or beat deafness (Foxton, Nandy, & Griffiths, 2006; Phillips-Silver et al., 2011). However, little work has specifically investigated and reported on the range of rhythmic ability in the general population, and the underlying causes of individual differences in rhythmic ability have yet to be fully elucidated. Three factors seem like promising candidates and form the focus of the current study. The first is auditory short-term memory (STM) capacity, as this has been shown to relate to rhythm reproduction, discrimination, and synchronization ability in previous work (Bailey & Penhune, 2010; Saito, 2001; Wallentin, Nielsen, Friis-Olivarius, Vuust, & Vuust, 2010). The second is sensitivity to the presence of regular temporal structure (e.g., structure). Rhythms that have a regular temporal structure are discriminated and reproduced better than irregular rhythms (Grahn & Brett, 2007; Patel, Iversen, Chen, & Repp, 2005); therefore, it is likely that individuals with better ability to detect this regularity (when it exists) should do better on rhythm tasks. The third factor is musical training. However, musical training may exert an indirect effect by influencing the aforementioned factors: musical training is associated with better auditory STM span (Bailey & Penhune, 2010; Saito, 2001; Wallentin et al., 2010), and seems likely to improve detection, although this has not been tested directly. Music also may have direct effects on rhythmic ability, such as providing a range of strategies for accurate rhythmic encoding and reproduction. The potential role of each of these factors will now be described and considered in more detail.Auditory STMMost models of auditory STM posit two components: one involved in representing the to-be-remembered items and the other involved in maintaining those representations (Baddeley & Hitch, 1974; Cowan, 1999). …