Functional Difficulties Research Articles

A digital intervention to support childhood cognition after the COVID-19 pandemic: a pilot trial

Difficulties in executive functioning (EF) can result in impulsivity, forgetfulness, and inattention. Children living in remote/regional communities are particularly at risk of impairment in these cognitive skills due to reduced educational engagement and poorer access to interventions. This vulnerability has been exacerbated by the COVID-19 pandemic and strategies are needed to mitigate long-term negative impacts on EF. Here we propose a pilot trial investigating the benefits, feasibility, and acceptability of a school-based EF intervention for primary school students (6–8 years) living in regional, developmentally vulnerable, and socio-economically disadvantaged communities. Students were randomised to a digital intervention or teaching as usual, for 7 weeks. Children completed measures of EF and parents/educators completed ratings of everyday EF and social/emotional wellbeing at pre-intervention, post-intervention, and 3-month follow-up. Change in EFs (primary outcome), everyday EF, and social/emotional wellbeing (secondary outcomes) from pre- to post-intervention and pre-intervention to 3-month follow-up were examined. Feasibility and acceptability of the intervention was assessed through educator feedback and intervention adherence.Protocol Registration: The stage 1 protocol for this Registered Report was accepted in principle on 20 April 2023. The protocol, as accepted by the journal, can be found at: https://doi.org/10.17605/OSF.IO/WT3S2. The approved Stage 1 protocol is available here: https://osf.io/kzfwn.

QOL-35. ANALYSIS ON THE EVOLUTIONARY PATTERN OF COGNITIVE FUNCTIONS IN CHILDREN ON FOLLOW-UP FOR BRAIN TUMORS

Abstract BACKGROUND Long-term cognitive sequelae of paediatric brain tumors are of increasing interest. The role of histology and surgery remains still unclear. Our study aimed to evaluate children cognitive functioning before and after brain tumors surgery, and at the end of additional treatments. METHODS New diagnoses of paediatric primary brain tumors were prospectively assessed. Neurocognitive evaluations were performed at diagnosis (T0), within 7-10 days from surgery (T1) and 12-18 months after the end of treatments (T2). Language, learning and memory, attention, executive functions, visuo-constructional and sensorimotor skills were evaluated at T0 and T1, Intelligent Quotient (IQ) was explored at T0 and T2. RESULTS Twenty-five patients (M:F=15:10, mean age 10.9±3.4 years) were enrolled between January 2019 and December 2022. In comparison to normal values (>7.0), at baseline patients showed major deficits in narrative memory (6.6±3.7, p<0.001) and visuo-spatial memory (copy design tasks: general 6.8±3.9, p<0.001, specific 6.2±3.3, p<0.001, motor 5.2±3.2, p<0.001). At T1 assessment, significant deficits remained in narrative memory (6.2±3.3, p<0.001) and visual-motor coordination (copy design tasks: specific 5.9±3.0, p<0.001 and motor 4.8±4.3 p<0.001); attention and visual-constructional abilities significantly improved (p=0.04 and p=0.001). On the visual construction test, children with high-grade histology scored lower than the low-grade group (Rey- Osterrieth complex figure-copy 5.1±4.4 vs 11.0±4.3; p=0.019). At T2 evaluation children showed persistent deficits in visuo-spatial processing and a possible decline in IQ scores, with lower scores compared with T0 (93 vs 100, p=0.05). CONCLUSIONS Children with brain tumors may present several neuropsychological impairments at diagnosis, particularly those with high-grade diseases. Surgery may have a positive effect on the recovery of some cognitive functions. However, cognitive decline may worsen over time. Baseline and periodic neurocognitive evaluations should be encouraged to identify functional difficulties and to develop a tailored treatment approach for the patient.

Clinical case of bone tuberculosis in the foot: involvement of the calcaneus. Diagnostic challenge and possible primary infection

Osteoarticular tuberculosis is a rare form of extrapulmonary tuberculosis, and represents a real diagnostic challenge due to its atypical presentation and similarity with other bone pathologies. The case of a 20-year-old male patient with a history of pulmonary tuberculosis treated 5 years ago, who came to the emergency room due to edema, pain and functional difficulty in the ankle and heel, is presented. The computed tomography of the left foot showed a hypodense osteolytic-type lesion that affected two thirds of the calcaneus, thinning of the cortices and involvement in the support area of the calcaneus. Surgical treatment and sample collection were performed, the anatomopathological analysis of which showed the presence of granulomatous cells inside. Tuberculostatic treatment was started, achieving the patient's improvement. The objective is to highlight the importance of early diagnosis based on clinical and radiological findings to facilitate timely intervention and minimize adverse outcomes.

Sleep and functional outcomes in children and adolescents with epilepsy: A scoping review

AimIn children and adolescents with epilepsy (CAWE), disturbed sleep and functional difficulties are frequently present, but their relationship is unclear. In this scoping review we aimed to explore associations between sleep and functional outcomes in CAWE. MethodWe registered the protocol with open science framework and conducted the review according to the PRISMA Extension for Scoping Reviews. We searched Medline, Embase, PsycINFO and PubMed for original studies reporting on relations between sleep and functional outcomes (adaptive/quality of life, behavioural/mood, cognitive & academic) in CAWE. To assess the quality of studies we used an extended version of the checklist employed by Winsor and colleagues [1]. ResultsWe identified 14 studies that included 1,785 CAWE and 1,260 control children, with a mean age of 9.94 and 10.13 years, respectively. The studies were highly heterogeneous with respect to samples, epilepsy variables, and methods used to assess sleep and functional outcomes. The quality of studies was medium. Associations between sleep and adaptive/quality of life, behavioural/mood, cognitive and academic outcomes were examined in 2, 10, 6, and 0 studies, respectively. Across studies, in CAWE, greater sleep disturbances were related to worse behavioural/mood outcomes, ranging from depression/anxiety to ADHD symptoms. Sleep disturbances did not consistently relate to cognitive outcomes, but they related to worse adaptive outcomes in both studies that examined their relationship. ConclusionsOur study provides evidence of relationship between disturbed sleep and behavioural/mood difficulties, which alerts to the need for careful evaluation and treatment of sleep disturbances in CAWE. Our study also highlights the need to examine relationships between sleep and other functional outcomes in CAWE, as studies conducted in the general population suggest that sleep disturbances may be modifiable and associated with improved functional outcomes.

Deficits in prefrontal metabotropic glutamate receptor 5 are associated with functional alterations during emotional processing in bipolar disorder

BackgroundElucidating biological mechanisms contributing to bipolar disorder (BD) is key to improved diagnosis and treatment development. With converging evidence implicating the metabotropic glutamate receptor 5 (mGlu5) in the pathology of BD, here, we therefore test the hypothesis that recently identified deficits in mGlu5 are associated with functional brain differences during emotion processing in BD. MethodsPositron emission tomography (PET) with [18F]FPEB was used to measure mGlu5 receptor availability and functional imaging (fMRI) was performed while participants completed an emotion processing task. Data were analyzed from 62 individuals (33 ± 12 years, 45 % female) who completed both PET and fMRI, including individuals with BD (n = 18), major depressive disorder (MDD: n = 20), and psychiatrically healthy comparisons (HC: n = 25). ResultsConsistent with some prior reports, the BD group displayed greater activation during fear processing relative to MDD and HC, notably in right lateralized frontal and parietal brain regions. In BD, (but not MDD or HC) lower prefrontal mGlu5 availability was associated with greater activation in bilateral pre/postcentral gyri and cuneus during fear processing. Furthermore, greater prefrontal mGlu5-related brain activity in BD was associated with difficulties in psychomotor function (r≥0.904, p≤0.005) and attention (r≥0.809, p≤0.028). LimitationsThe modest sample size is the primary limitation. ConclusionsDeficits in prefrontal mGlu5 in BD were linked to increased cortical activation during fear processing, which in turn was associated with impulsivity and attentional difficulties. These data further implicate an mGlu5-related mechanism unique to BD. More generally these data suggest integrating PET and fMRI can provide novel mechanistic insights.

Improving prospective memory in persons with multiple sclerosis via telehealth: A randomized feasibility study

BackgroundPersons with multiple sclerosis (PwMS) can experience deficits in prospective memory (PM) or “remembering to remember,” which are associated with functional difficulties. However, no cognitive rehabilitation intervention has specifically addressed improving PM in PwMS. The Telehealth PM Intervention (TPMI) provides a novel combination of two strategies—visual imagery and implementation intentions—that have each been beneficial in other populations. This study aimed to evaluate the feasibility of TPMI and its preliminary efficacy, which could be used to inform future trials. MethodsParticipants (n = 35) were PwMS who were pre-screened and endorsed experiencing problems “remembering places they have to be” and “things they have to do.” After completing a baseline evaluation, which included objective (Memory for Intentions Test; MIST) and subjective (Perceived Deficits Questionnaire; PDQ-PM) measures of PM, participants were randomized to either the active treatment (TPMI; n = 17) or active control group (Control; n = 18). TPMI was offered through remote one-on-one sessions twice a week over a four-week period. Participants were asked about treatment credibility and expectancy during the first session. The MIST and PDQ-PM were repeated at post-treatment, where treatment satisfaction was also captured. Mann-Whitney U and chi-square tests were used to examine the feasibility measures, while repeated measures ANOVAs were used to examine changes in the PM outcomes. ResultsA total of 88.2 % of the TPMI group completed all eight sessions, with moderate-to-high (≥7 out of 10) treatment credibility/expectancy and satisfaction reported by 93.3 % and 86.7 %, respectively. While there were no significant effects on overall PM, the TPMI group had an improvement in objective time-based PM after adjusting for baseline differences (F(1,29) = 4.61, p = 0.040; d = 0.80). Furthermore, the TPMI group had a significant reduction in the number of time-based loss of content errors compared to the Control group, which remained significant after covariate adjustment (F(1,25) = 4.29, p = 0.049; d = 0.83). ConclusionsTPMI is a feasible intervention, with high completion rates and moderate-to-high treatment ratings, that can be delivered remotely. Early evidence shows its potential benefit for improving time-based PM, a particular concern for PwMS, which should be further evaluated in a larger clinical trial.

Assessing adherence and clinical utility of modified goal management training for adolescents with ADHD: A pilot study

Many adolescents with attention-deficit hyperactivity disorder (ADHD) have executive functioning (EF) difficulties that contribute to academic and social-emotional challenges. This pilot explored adherence to and effectiveness of modified Goal Management Training (GMT), an EF intervention, with ADHD youth. Six adolescents with ADHD (14–17 years, 2 female) participated in a 6-session online group. Adherence was tracked via attendance and homework. Reliable change scores gaged pre-post differences on measures before and after training (primary: everyday EF and goal attainment; secondary: EF task performance, functional impairment, emotional adjustment, and self-concept). All youth attended at least 4 sessions, though homework completion was mixed. Four youth achieved their goal, some demonstrated reliable change on outcome measures, and all evidenced a reduction in impairment. Results support the feasibility of modified GMT in adolescents with ADHD and suggest that youth may benefit from this more personalized and holistic approach to EF intervention.

Combat-Genital Injury in UK Male Military Veterans: A Pilot and Feasibility Study Exploring Long-Term Psychosocial and Sexual Experiences and Support Needs

During the most recent conflicts in Iraq and Afghanistan, genital injuries were reported among male personnel at rates higher than previous conflicts. To date, research has focused predominantly on immediate medical management with limited published research exploring the long-term psychosocial and sexual impacts of combat-genital injury. This pilot study, therefore, aimed to explore the psychosocial and sexual health outcomes, experiences and support needs of military veterans who sustained combat-genital injuries and to assess the feasibility of conducting further research on this topic. A cross-sectional online survey design was used, comprising open and closed questions. Recruited through opportunity and snowball sampling, 11 eligible male UK veterans who had sustained a combat-genital injury completed the survey between March and July 2021. The results indicate that participants experienced long-term challenges related to their genital injury including low self-esteem, sexual function difficulties, and fertility concerns. The findings provide preliminary evidence of unmet long-term psychosocial, sexual, and fertility support needs among UK veterans with combat-genital injury. Further research is required to better understand the psychosexual wellbeing of combat veterans who have sustained physical injuries more broadly and to determine how best to provide psychosexual support to those who may benefit.

Social relationships in adults who were adopted following institutional deprivation

Research examining the effects of severe, prolonged early deprivation has shown elevated rates of neurodevelopmental symptoms, which frequently persist into adulthood and are associated with functional and social relationship difficulties, as well as elevated rates of mental health problems. The behavioural manifestations of these symptoms closely resemble those of ADHD and also ASD. Here, we used qualitative methods to explore and characterise the social experiences and difficulties encountered by young adults exposed to profound early deprivation, in part to highlight any apparent parallels between the experiences in this group and those identified in typically developing samples with ADHD or ASD. To do so, we interviewed young adults and their adoptive parents ( N = 18) from the English and Romanian Adoptees study, about their social lives. Participants were keen to describe not only the challenges they faced but also adaptive responses. A semantic/descriptive thematic analysis revealed that the young adults strongly desired social relationships but struggled to navigate social norms, resulting in frustration and frequent loss of relationships. This was accompanied by strong feelings of loss and rejection, all of which were perceived to have a negative impact upon self-esteem and mental health. Adaptive strategies included the fostering of casual friendships with older individuals and seeking employment with strong social components. Similarities and differences between our findings and the social difficulties experienced by typically developing groups with neurodevelopmental problems, and adopted individuals more generally, are discussed.

Occurrence of major infectious diseases and healthcare seeking among young children with disabilities in Sierra Leone using cross-sectional population-based survey data

BackgroundChildren with disabilities are at risk of worse health outcomes compared to children without functional difficulties. Sierra Leone has one of the world’s highest prevalences of functional difficulties among children,...

Challenges during implant-assisted prosthetic rehabilitation in fibula reconstructed jaws and its management: a scoping review protocol

Introduction: Oral cancer is the sixth most prevalent cancer type worldwide. Patients are placed in a crippling predicament due to the functional and psychosocial difficulties brought on by the illness and its treatments. Both surgeons and maxillofacial prosthodontists may encounter challenges with reconstruction and therapy following cancer treatment. Over 20 years, the fibula has remained the mainstay of reconstructions for head and neck cancer. Maxillary and mandibular jaws with fibula reconstructions can use fixed or removable prosthetic rehabilitation solutions. The proposed scoping review aims to ascertain the volume and nature of evidence concerning the difficulties and corrective measures in the prosthetic rehabilitation of fibula-reconstructed head and neck cancer cases. The findings will aid in improving the prosthetic treatment care for the affected population. Materials and Methods: The Joanna Briggs Institute (JBI) scoping review protocol will be followed in developing and reporting the scoping review methodology. Methods to identify the relevant literature will involve the systematic search of databases like PubMed, Scopus, Google Scholar, Cochrane Library, and gray literature sources for pertinent articles on the subject. Only papers published in English literature will be considered for the review, and the data collection period is limited to the past 20 years. The screening process will utilize defined inclusion/exclusion criteria for Title/Abstract and Full-text screening by two independent reviewers in covidence, and a third reviewer will resolve any conflicts. The data extracted will include specific details about the participants, concept, population, study methods, challenges encountered during prosthetic rehabilitation, and their management. Inductive thematic analysis and descriptive statistics will be applied where appropriate. The narrative synthesis of the evidence will be accomplished through data extraction in a tabular format, and the results will be presented as a narrative summary.

Older adults with communication disabilities and their use of communication support at doctor’s visits: a nationally representative study

Purpose Older adults with communication disabilities (CDs) experience barriers to receiving care and face a paucity of accommodations for their disability. Utilizing someone that supports communication with healthcare providers (communication support persons) may be a way that this group self-supports their disability. We examined if this utilization was independently associated with CDs among older adults. We also sought to understand if socioeconomic factors were associated with utilization. Methods We used the 2015 National Health and Aging Trends Survey (NHATS) to conduct a cross-sectional analysis of Medicare beneficiaries (n = 5954) with functional hearing, expressive, or cognitive difficulties. We calculated a weighted, population prevalence and an adjusted prevalence ratio (APR) controlling for sociodemographic, health and other disability factors. Results Among community dwelling older adults, having CDs was associated with higher utilization of a communication support person at medical visits (APR: 1.41 [CI: 1.27 − 1.57]). Among adults with CDs, Black adults and women had lower levels of utilization as compared to White adults and men, respectively. Conclusion Communication support persons may be a way that older adults with CDs self-support their disability. However, not all older adults with CDs bring someone and variation by social factors could suggest that unmet support needs exist.

Relationships between cognitive flexibility performance and adaptive behavior outcomes in survivors of pediatric brain tumor

Objective: Survivors of pediatric brain tumors are at increased risk of executive function (EF) and adaptive behavior difficulties. While previous research suggests that executive dysfunction impacts suboptimal adaptive outcomes, the specific elements of EF influencing this relationship remain unexplored. This study examines the relationship between cognitive flexibility and adaptive behavior in survivors compared to healthy controls. Methods: 86 survivors (M age(SD)=23.41(4.24), 44 females) and 86 controls (M age(SD)=23.09(4.50), 44 females) completed the Delis-Kaplan Executive Function System Trail Making Test (TMT) and Verbal Fluency Test (VFT). The Letter-Number Sequencing (LNS) and Category Switching (CS) conditions were isolated as measures of cognitive flexibility. Informants provided responses to obtain adaptive behavior ratings using the Scales of Independent Behavior-Revised (SIB-R). Linear regressions explored relationships between cognitive flexibility and SIB-R scores in survivors compared to controls. Results: For both TMT and VFT, the relationship between cognitive flexibility and adaptive behavior was significantly different between survivors and controls for SIB-R scores in Social Communication, Community Living, and Personal Living Skills (p<.0125). Survivors’ better LNS performance predicted greater SIB-R scores across the same 3 domains (all p= <.001, r 2semipartial=.08). Similarly, survivors’ better CS performance predicted greater SIB-R scores across the same 3 domains (p = 0.002 to .02, r 2semipartial =.03 to .04). No significant relationships were found in controls (all p >.05). After adjusting for working memory and inhibitory control, most relationships remained significant in survivors (p= <.001 to .046, r 2semipartial=.02 to .08). Conclusion: These findings reveal a robust, positive relationship between cognitive flexibility performance and adaptive behaviors specific to survivors.

Psychometric properties of the Five-executive Function Tests in Indonesian samples

Difficulties in executive function (EF) may be causative factors in clinical conditions, including learning disabilities, depression, and anxiety. However, defining the structure of EF is an ongoing issue, although Miyake’s three-factor structure is widely accepted. This study aims to discover the underlying factor structure of EF domains, as measured by five tests and the scores of 840 participants, to establish the domains’ validity and reliability. Five neuropsychological tests were included in the exploratory and confirmatory factor analyses (EFA and CFA): the Digit Span (DS); the Stroop Color Word Test (Stroop Test); the phonemic Verbal Fluency Test (pVFT); the Five Point Test (5PT); and the Trail Making Test (TMT). EFA could be meaningfully performed (KMO = .862, Bartlett’s test: 𝜒2 =1393.169, df 45, p .001) and yielded three factors closely mirroring the three core domains of EF. CFA of the model in which the 5PT loaded on factor 2 showed the best goodness of fit indicators, although the difference with the other three-factor models was small. Currently, these EF tests are available in Indonesia and suitable for use, although obtaining normative scores adjusted for demographic factors is necessary.

Metacognitive accuracy differences in Parkinson's disease and REM sleep behavioral disorder relative to healthy controls.

Metacognition is the ability to monitor and self-assess cognitive performance. It can be impaired in neurodegenerative diseases, with implications for daily function, and the ability of patients to reliably report their symptoms to health professionals. However, metacognition has not been systematically assessed in early-mid stage Parkinson's disease (PD) and REM sleep behavioral disorder (RBD), a prodrome of PD. This study aimed to evaluate metacognitive accuracy and self-confidence in PD and RBD patients across various cognitive tasks. We conducted detailed computerized cognitive assessments with 19 cognitive tasks within an established PD and RBD cohort. Participants self-rated their performance post-task. Metacognitive accuracy was calculated by comparing these ratings against objective performance and further analyzed against clinical and mental health factors. PD and RBD patients' metacognitive accuracy aligned with control subjects. However, they exhibited lower confidence across cognitive domains, reflecting their reduced cognitive performance. A notable inverse correlation was observed between their confidence and MDS-UPDRS I and II scales and HADS anxiety and depression scores. Our findings indicate that patients with early to mid-stage PD and RBD are generally aware of their cognitive status, differing from other neurological disorders. The inverse relationship between patient confidence and symptoms of depression, anxiety, and daily life challenges underscores the impact of emotional and functional difficulties on their self-perception of cognitive abilities. This insight could be significant for understanding how these conditions affect mental health, aiding clinicians in developing more effective patient care strategies.

Examining the Impact of Race and Poverty on the Relationship Between Purpose in Life and Functional Health: Insights from the HANDLS Study.

While research has shown a positive association between a higher sense of purpose in life and functional health, there is a gap in understanding its benefits for racially minoritized and low SES individuals. This study aimed to investigate the correlation between purpose in life and physical functional health in a diverse sample, hypothesizing that purpose in life would be negatively associated with functional difficulties, with potentially stronger associations in White and high SES groups. Data from the Healthy Aging in Neighborhoods of Diversity across the Life Span (HANDLS) study were utilized (166 participants, mean age 59.44 [SD = 8.28], 59.6% females, 65.06% Black participants, 40.36% below poverty). Purpose in life was measured by Ryff's Psychological Well-being Purpose in Life subscale. Functional health was measured by functional difficulties in mobility and daily living. Race (Black and White) and poverty status (above and below) were used as moderators to probe the purpose-functional health association using zero-inflated Poisson regression while adjusting for age, education, depressive symptomology, and previous functional difficulties in four hierarchical models. Results showed that purpose in life was negatively associated with functional difficulty, indicating fewer difficulties in mobility and daily activities among those with a high sense of purpose. While the association did not remain significant after including previous functional difficulty as a covariate in Model 4, suggesting that race may not be a consistent moderator, poverty status remained a consistent moderator. The association was stronger for individuals above the poverty level. These findings underscore the complex interplay between purpose in life, race, poverty status, and functional health, emphasizing the importance of considering socioeconomic factors in interventions aimed at eliminating functional health disparities among diverse adult populations.

Self-reported problems and functional difficulties in anxious pregnant women in Pakistan: The use of a patient-generated mental health outcome measure.

Anxiety during pregnancy affects women worldwide and is highly prevalent in Pakistan. The Psychological Outcome Profiles (PSYCHLOPS) questionnaire is an instrument used in therapy to assess patient-generated problems and the consequent functional difficulties. Using the PSYCHLOPS, we aimed to describe the type of problems and the consequent functional difficulties faced by anxious pregnant women in Pakistan. Secondarily, we sought to explore if a cognitive behavioral therapy (CBT)-based intervention brought about changes in the severity score for certain problems or functional difficulties. Anxious pregnant women were recruited from the Obstetrics/Gynecology Department of a tertiary hospital in Rawalpindi, Pakistan. Of 600 pregnant women randomized to receive a psychosocial intervention for prenatal anxiety delivered by non-specialist providers, 450 received ≥1 intervention session and were administered the PSYCHLOPS. Eight types of problems were identified; worries about the unborn baby's health and development (23%), concerns about family members (13%), and financial constraints (12%) were the most frequently reported primary problems. Severity scores between baseline and the last available therapy session indicated the largest decrease for relationship problems (mean = 2.4) and for concerns about family members (mean = 2.2). For functional difficulties, 45% of the participants reported difficulties in performing household chores, but the intervention showed the greatest decrease in severity scores for mental or emotional functional difficulties. Focus on certain types of patient-generated problems, e.g., relationship problems, could anchor therapy delivery in order to have the greatest impact. Tailored CBT-based intervention sessions have the potential to address important but neglected problems and functional difficulties in anxious pregnant women.

Development and validation of a research version of the Overall Assessment of the Speaker’s Experience of Stuttering- Adult (OASES-A-R)

BackgroundThe Overall Assessment of the Speaker’s Experience of Stuttering for Adults (OASES-A; Yaruss & Quesal, 2016) is a widely used measurement tool designed to evaluate the adverse impact associated with stuttering. Items examine general perceptions of stuttering, personal reactions to stuttering, functional communication difficulties, and consequences for quality of life. This paper presents a shortened research version of the OASES-A response form (OASES-A-R) that can be used by researchers in scientific studies involving adults who stutter that reflect the Section and Total Scores of the original OASES-A using fewer items. MethodPreviously collected OASES-A data (N = 315) were analyzed via graded response modeling to identify discrimination values of each OASES-A item in measuring each OASES-A Section Total Score. Items with the highest discrimination and items judged by expert clinicians to be more important in measuring adverse impact (N = 27) were used to create a shortened OASES-A-R. The shortened OASES-A-R response form was then validated and compared to the full OASES-A response form in an independent sample (N = 156). ResultsThe shortened 25-item OASES-A-R response form demonstrated very high and positive correlations with the full OASES-A response form. Similarly, each OASES-A-R Section demonstrated high internal reliability coefficients similar to those of the OASES-A. DiscussionThe resulting 25-item OASES-A-R response form provides a reflection of the speaker’s experience of stuttering as measured by the original 100-item OASES-A that is suitable for use in certain research studies of adults who stutter. Clinical use is not recommended, as the full OASES-A provides additional insights about a client’s experience of stuttering that are necessary for effective treatment planning and intervention.

Acute effect of complexity in basketball on cognitive capacity.

Executive functions, notably inhibition, significantly influence decision-making and behavioral regulation in team sports. However, more research must be conducted on individual player characteristics such as experience and motor skills. This study assessed how accumulated practical experience moderates inhibition in response to varying task difficulty levels. Forty-four university students (age: 20.36 ± 3.13 years) participated in this study with two sessions: one followed standard 1 × 1 basketball rules ("Regular Practice"), while the other imposed motor, temporal, and spatial restrictions ("Restriction Practice"). Functional difficulty was controlled by grouping pairs with similar skill levels. Flanker and Go-Nogo tasks were used. Increasing complexity worsened cognitive performance (inhibition). "Restriction Practice" showed a significantly slower and less accurate performance in both tests than "Regular Practice" (p < 0.001). Experience positively impacted test speed and accuracy (p < 0.001). In sports, acute cognitive impacts are intrinsically linked to the task's complexity and the athlete's cognitive resources. In this sense, it is essential to adjust individually the cognitive demands of the tasks, considering each athlete's specific cognitive abilities and capacities.

Health-related quality of life with sacituzumab govitecan in HR+/HER2- metastatic breast cancer in the phase III TROPiCS-02 trial.

The TROPiCS-02 study (NCT03901339) demonstrated that sacituzumab govitecan (SG) has superior clinical outcomes over treatment of physician's choice (TPC) chemotherapy in patients with hormone receptor-positive, human epidermal growth factor 2 receptor-negative (HR+/HER2-) metastatic breast cancer (mBC). Here, we present health-related quality of life (HRQoL) patient-reported outcome (PRO) findings from this study. Eligible adults with HR+/HER2- mBC who previously received a taxane, endocrine-based therapy, a CDK4/6 inhibitor, and 2-4 lines of chemotherapy were randomized 1:1 to receive SG or TPC until progression or unacceptable toxicity. PROs were assessed at baseline and on day 1 of each cycle, using the European Organization for Research and Treatment of Cancer Quality-of-Life Core 30 (EORTC QLQ-C30), EQ-5D-5L, and PRO Common Terminology Criteria for Adverse Events (PRO-CTCAE). Compared to TPC, overall least square mean change from baseline was significantly better for SG for physical functioning and dyspnea, but worse for diarrhea. Time to first clinically meaningful worsening or death was significantly longer for SG in global health status/quality of life, physical functioning, fatigue, emotional functioning, dyspnea, insomnia, and financial difficulties of the EORTC QLQ-C30 and the EQ-VAS, but longer for TPC in diarrhea. Few patients in both arms reported experiencing any worsening to level 3 or 4 treatment-related symptomatic events during treatment, as assessed by 16 PRO-CTCAE items, except for diarrhea frequency and amount of hair loss, which favored TPC. SG was associated with an HRQoL benefit in most symptoms and functioning, compared with TPC. This supports the favorable profile of SG as a treatment option for patients with pretreated HR+/HER2- mBC.