Language Areas Research Articles

Subcortical Aphasia: An Update.

This review aims to rediscuss the leading theories concerning the role of basal ganglia and the thalamus in the genesis of aphasic symptoms in the absence of gross anatomical lesions in cortical language areas as assessed by conventional neuroimaging studies. New concepts in language processing and modern neuroimaging techniques have enabled some progress in resolving the impasse between the current dominant theories: (a) direct and specific linguistic processing and (b) subcortical structures as processing relays in domain-general functions. Of particular interest are studies of connectivity based on functional magnetic resonance imaging (MRI) and tractography that highlight the impact of white matter pathway lesions on aphasia development and recovery. Connectivity studies have put into evidence the central role of the arcuate fasciculus (AF), inferior frontal occipital fasciculus (IFOF), and uncinate fasciculus (UF) in the genesis of aphasia. Regarding the thalamus, its involvement in lexical-semantic processing through modulation of the frontal cortex is becoming increasingly apparent.

Postoperative reorganization of the supplementary motor area complex: a possible latent bihemispheric network

Brain plasticity after multistep surgery in low-grade glioma is highly variable; the neurosurgical approach must be individualised and functional imaging can be used for this purpose. In supplementary motor area complex (SMAC) tumors, the early and adequate functional recovery of patients raises the possibility of a latent bihemispheric or "mirror" cortico-subcortical network, which would develop depending on the needs of each patient. Functional and DTI-MR data from 4 right-handed patients with left frontal low grade gliomas near the SMAC, who were operated at least in two occasions were collected. The time of the reintervention was variable (18 months- 8 years), related to the tumor growth. All patients were evaluated by a neuropsychologist and imaged before each surgery, in a 3 T MR, with a 24 multichanel head coil Motor and expressive language task-fMRI and DTI sequences were obtained to evidence the main cortico-subcortical components of the SMAC. Data were processed with Brainwave (GE Medical Systems) and with an Iplan Fiber Tracking tool (MEDTRONIC), respectively RESULTS: None of our patients presented permanent neurological deficits after the first or second functional surgery. Three patients with partial or complete resection of the left middle and / or inferior frontal gyrus, and the left frontal aslant tract evidenced new right hemispherical cortical activity. This right shift were not observed in the patient without left middle gyrus resection, indeed with partial absent of the left frontal aslant tract. SMAC is a latent cortico-subcortical bihemispheric network that allows it to reorganize itself in response to specific neurological deficits. We highlight the importance in the cortical reorganization of the left middle frontal gyrus in the SMAC, closely connected with the essential language areas of this region, but also we focused in the potential cortioco-subcortical changes to compensate the functionality of the FAT.

Teaching a foreign language through ICT to students with dyslexia and attention deficit hyperactivity disorder (ADHD) and the role of ICTs

Students with learning disabilities are a heterogeneous group and exhibit particularities in the areas of perception, language, memory, attention and concentration, metacognition, self-regulation, motivation, behavior, social skills and emotional development. It is therefore important to identify these difficulties as early as possible, so that students can be helped in time by adapting teaching to their own needs. New technologies, already promising in a variety of fields, seem to be able to be used for the necessary differentiation of teaching, materials and assessment of students with learning difficulties such as dyslexia and ADHD.

2.Y.1. Communication in participatory health research with refugees and migrants

Abstract Innovative approaches are needed to transform public health research and address health inequities. Participatory Health Research (PHR) is one such approach, which aims to maximize the participation of those whose life or work is the subject of the research in all stages of the research process. PHR has advantages for both research outcomes, including increased relevance, meaningfulness and impact of research, as well as for those involved, in terms of ownership and empowerment to address their health priorities. PHR with migrants has potential to reduce health inequities through the active involvement of migrants in research about their health. In a framework for refugee and migrant health in the WHO European Region, MacFarlane et al. (2022) recommend the research field of migration and health to adopt PHR as the norm, for ethical reasons and to support effective research-policy-practice translation. PHR with migrants is increasingly used but is still rare and adhoc in the field of migration health research. There are also potential practical and ethical challenges that warrant critical reflection. One persistent challenge is communication, where differences in culture, language and knowledge areas need to be considered in multiple ways, for example, in the development of participatory partnerships, in the conduct of data collection that takes place as a result of such participatory partnerships and in dissemination processes. The aim of the workshop is to share different approaches on PHR with migrants and propose solutions to common challenges in communication. The workshop will be structured in a first part where presenters will draw upon their experience in PHR with refugees and migrants covering a broad range of topics relating to communication, and a second part of open discussion with presenters and the audience. The workshop will address two key questions: what challenges have we experienced, and lessons learnt. Anne MacFarlane presents emerging evidence about music and singing as culturally attuned arts based methods that can create innovative opportunities for communication for partnership building, fieldwork and dissemination. Ana Gama presents on using idea-generation workshops with vignettes representing migrants with diverse health-literacy profiles and its potential to address communication challenges. Key messages • Participatory health research with migrants warrants critical reflection around communication, ethics and partnership-building. • In participatory health research, using innovative and creative methods can create opportunities to overcome communication barriers and build meaningful collaborations. Speakers/Panelists Anne MacFarlane University of Limerick, Limerick, Ireland Ana Gama IHMT, Universidade Nova de Lisboa, Lisbon, Portugal

On the issue of the development of adjective degree forms in the Western Lithuanian and Latvian dialects

Abstract In the Lithuanian and Latvian languages, forms of adjective degrees do not have a common etymological basis. The New Curonian (Kuresnieku) language which is a relatively new Baltic geolect has preserved a fairly distinct archaic layer of phonetics and grammar, where one can look not only for the archaisms of the western dialects of the Latvian language but also for traces of the substrate of Old Curonian. Although synthetic forms of the degrees of adjectives with the suffix -āk- are used in the current Latvian language area they are almost unknown in New Curonian. The forms of the comparative degree are made with the particle juo and an adjective of the positive degree. Analytical forms with the pronoun visu and the pronominal form of an adjective express the superlative degree. In the western Latvian and Lithuanian dialects and the Livonian language in Latvia, the relics of the analytical forms of the comparative and superlative degree are recorded in written sources and rarely in modern spoken language. Since a large part of the western dialects of the Lithuanian and Latvian languages take up the former territory of the old tribe, it may be assumed that the analytical forms of adjective degrees are possibly a sign of the substrate of Old Curonian.

Investigating the effect of rTMS over the temporoparietal cortex on the Right Ear Advantage for perceived and imagined voices

A Right Ear Advantage (REA) is well-established in perceptual tasks but it has been found also during imagery. It is ascribed to the left temporoparietal activity for language, and it can be absent/reversed in some clinical conditions including auditory hallucinations. We applied 1-Hz repetitive TMS over TP3/TP4 (left/right language areas) identified through neuronavigation in 18 healthy participants, before administering a modified white noise (WN) speech illusion paradigm: a voice was presented at one ear, at the same or lower intensities with respect to binaural WN. In some trials the voice was not presented, but participants were anyway instructed to report in which ear they believed perceiving it in all trials. Results confirmed the REA both when the voice was present (perceptual REA) and when it was absent (imaginative REA). Interestingly, results suggested that the correct localization of the voice when the stimulus was ambiguous (presented at low intensity and “masked” by WN) was better when TMS was applied over the right/left hemisphere, in male participants with a low/high proneness to unusual experiences (e.g., auditory hallucinations), respectively. This interaction must be further explored to shed light on the relationship between hemispheric asymmetries and auditory hallucinations, in healthy and clinical samples.

The utilisation of fMRI for pre-operative mapping in the paediatric population with central nervous system tumours: a systematic review.

Functional MRI (fMRI) is a well-established tool for pre-operative planning, providing neurosurgeons with a roadmap of critical functional areas to preserve during surgery. Despite its increasing use, there is a need to compare task-based (tb-fMRI) and resting-state fMRI (rs-fMRI) in the peadiatric population to comprehensively evaluate the existing literature on the use of fMRI for pre-operative mapping in pediatric patients, comparing tb-fMRI and rs-fMRI. Two databases were searched for relevant studies published before July 2024 following the PRISMA guidelines. Eleven studies were selected and comprised 431 participants: 377 patients with different types and locations of brain tumours, and 54 healthy controls (HC). Results indicate that tb-fMRI could reliably locate the eloquent cortex with more than an 80% success rate. Furthermore, results were comparable with intraoperative mapping. Two studies reported that 68-81% of patients did not develop deficits in the postoperative period. Results also found that rs-fMRI can fill the gap in the situation of paediatric patients when other techniques do not apply to younger patients. This study suggests that tb-fMRI is more effective for pre-operative mapping in pediatric patients, offering precise localisation of critical brain functions and enhancing surgical planning. Although rs-fMRI is less demanding and compatible with light sedation, it lacks the specificity needed for accurate identification of language, sensory, and motor areas, which limits its clinical relevance. rs-fMRI can aid in function-preserving treatments for brain tumour patients and reduce the need for invasive procedures. Combining tb-fMRI with intraoperative mapping optimizes precision and safety in pediatric-neurosurgery.

Lesion and lesion network localization of dysnomia after epilepsy surgery.

Temporal lobe (TL) epilepsy surgery is an effective treatment option for patients with drug-resistant epilepsy. However, neurosurgery poses a risk for cognitive deficits - up to one third of patients have a decline in naming ability following TL surgery. In this study, we aimed to better understand the neural correlates associated with reduced naming performance after TL surgery, with the goal of informing surgical planning strategies to mitigate the risk of dysnomia. We retrospectively identified 85 patients who underwent temporal lobe (TL) resective surgery (49 left TL, 36 right TL) for whom naming ability was assessed before and >3 months post-surgery using the Boston Naming Test (BNT). We used multivariate lesion-symptom mapping to identify resection sites associated with naming decline, and we used lesion-network mapping to evaluate the broader functional and structural connectivity profiles of resection sites associated with naming decline. We validated our findings in an independent cohort of 59 individuals with left temporal lobectomy, along with repeating all analyses after combining the cohorts. Lesion laterality and location were important predictors of post-surgical naming performance. Naming performance significantly improved after right temporal lobectomy (P = 0.015) while a decrement in performance was observed following left temporal lobectomy (P = 0.002). Declines in naming performance were associated with surgical resection of the left anterior middle temporal gyrus (Brodmann area 21, r =0.41, P = <.001), along with a previously implicated basal temporal language area. Resection sites linked to naming decline showed a functional connectivity profile featuring a left-lateralized network closely resembling the extended semantic \ default mode network, and a structural connectivity profile featuring major temporo-frontal association white matter tracts coursing through the temporal stem. This extends prior work by implicating the left anterior middle temporal gyrus in naming decline and provides additional support for the role of the previously identified basal temporal language area in naming decline. Importantly, the structural and functional connectivity profiles of these regions suggest they are key nodes of a broader extended semantic network. Together these regional and network findings may help in surgical planning and discussions of prognosis.

Validation of On-Head OPM MEG for Language Laterality Assessment.

Pre-surgical localization of language function in the brain is critical for patients with medically intractable epilepsy. MEG has emerged as a valuable clinical tool for localizing language areas in clinical populations, however, it is limited for widespread application due to the low availability of the system. Recent advances in optically pumped magnetometer (OPM) systems account for some of the limitations of traditional MEG and have been shown to have a similar signal-to-noise ratio. However, the novelty of these systems means that they have only been tested for limited sensory and motor applications. In this work, we aim to validate a novel on-head OPM MEG procedure for lateralizing language processes. OPM recordings, using a soft cap with flexible sensor placement, were collected from 19 healthy, right-handed controls during an auditory word recognition task. The resulting evoked fields were assessed for hemispheric laterality of the response. Principal component analysis (PCA) of the grand average language response indicated that the first two principal components were lateralized to the left hemisphere. The PCA also revealed that all participants had evoked topographies that closely resembled the average left-lateralized response. Left-lateralized responses were consistent with what is expected for a group of healthy right-handed individuals. These findings demonstrate that language-related evoked fields can be elucidated from on-head OPM MEG recordings in a group of healthy adult participants. In the future, on-head OPM MEG and the associated lateralization methods should be validated in patient populations as they may have utility in the pre-surgical mapping of language functions in patients with epilepsy.

Mapping the basal temporal language network: a SEEG functional connectivity study

The Basal Temporal Language Area (BTLA) is recognized in epilepsy surgery setting when cortical electrical stimulation (CES) of the ventral temporal cortex (VTC) trigger anomia or paraphasia during naming tasks. Despite acknowledging a ventral language stream, current cognitive language models fail to properly integrate this entity. In this SEEG study we used cortico-cortical evoked potentials in nine epileptic patients to assess and compare the effective connectivity of 73 sites in the left VTC of which 26 were deemed eloquent for naming after CES (BTLA). Eloquent sites connectivity supports the existence of a basal temporal language network (BTLN) structured around posterior projectors while the fusiform gyrus behaved as an integrator. BTLN was strongly connected to the amygdala and hippocampus unlike the non-eloquent sites, except for the anterior fusiform gyrus (FG). These observations support the FG as a multimodal functional hub and add to our understanding of ventral temporal language processing.

بولی اورزبان: اردو کے سیاق میں تجزیہ

The initial level of language is called dialect, which helps in maintaining and maintaining daily activities, business transactions, and social relations. The majority of people depend on it. Language derives its energy from local dialects. The range of language is wide and dialect is limited. There can be many dialects in a language area, but there cannot be many languages in a dialect area. Language is the queen of expressing every concept and feeling. Language covers educational, administrative, judicial, political and literary aspects. Script is necessary for language. Due to writing, language documents are preserved and the vocabulary is also increasing day by day. Dialect is mainly verbal expression. However, it is not necessary that every dialect is devoid of writing. Normally its written forms appear in private letters and folk literature.

The Accuracy and Efficiency of the Speech Language Early Literacy Screening Checklist

Objectives: This study aimed to develop the “Speech Language Early Literacy Screening Checklist” in order to identify speech, language, and early literacy difficulties in children aged 5-6 years before entering elementary school. This study examined the reliability, validity, sensitivity, specificity, positive predictive value, and negative predictive value to verify the accuracy and efficiency of the checklist as a screening tool.Methods: Out of the 2,880 children who participated in the initial screening test, 155 underwent diagnostic deep tests. A total of 110 children who exhibited difficulties in language, speech, and early literacy areas were classified as the high-risk group, while those who demonstrated appropriate development in all areas were classified as the general group.Results: The Cronbach’s α value for all checklist items was .884. The content validity index rated by six language development experts was 0.70 or higher for all 36 items, with an average content validity score of 0.91. Clinical validity was confirmed through the total score differences between the general and high-risk groups classified by the diagnostic deep tests. The receiver operating characteristic (ROC) curve results for the screening checklist showed an area under the curve (AUC) of 0.858, sensitivity of 84.4%, and specificity of 76.4%. The positive predictive value (PPV) calculated from the cut-off score was 92.3%.Conclusion: The “Speech Language Early Literacy Screening Checklist” developed to identify children at high risk of language development delays before school entry has shown appropriate reliability, validity, and classification accuracy. This study suggests that the implementation of this checklist will contribute to preventing school failure by effectively identifying at-risk children aged 5-6.

Revolucionando el aprendizaje de idiomas: el impacto transformador de las aplicaciones móviles

This study investigated the impact of mobile apps on language learning, focusing on the improvement of linguistic competencies and student motivation. Five popular applications (Duolingo, Babbel, Rosetta Stone, Memrise, and Busuu) were analyzed in an experimental group through standardized tests and qualitative evaluations, before and after a study period. The results showed that students who used these apps experienced significant improvements in their language skills compared to a control group. Interactivity, personalization and gamification were identified as the main contributions to these positive outcomes, with gamification highlighted as a crucial driver of motivation. Nonetheless, the study also emphasized the need for a more robust pedagogical design in the apps to equitably address all language areas.

Accessibility and Utility of an Electronic Self-Guided Safety Plan for Adolescents

ABSTRACT Objective Suicidal thoughts and behaviors are a leading cause of death, injury, and hospitalization among adolescents. Few evidence-based interventions exist, and these tend to be inaccessible for most youth. Electronic safety plan interventions represent a new avenue to disseminate an evidence-based suicide prevention tool. However, it is not clear whether youth find electronic, self-guided safety plans helpful, nor whether they will use the resulting safety card when experiencing suicidal thoughts or urges. This study examines adolescents’ perceptions and use of an electronic, self-guided safety plan intervention. Method We recruited 322 adolescents with a past-year history of suicidal thoughts or behaviors, ages 13–17 (55.9% white and non-Hispanic; majority reporting diverse sexual orientations and genders) online via social media to participate in this two-part longitudinal study. At baseline, participants completed the electronic safety plan interventions and reported on key aspects of its usefulness and areas of improvement. Participants reported their use and perceptions of the plan one month later. Results Results suggested that adolescents understood, liked, and believed they would use a self-guided safety plan. One month later, about ⅓ of youth who experienced suicidal thoughts or urges used their safety card. Open-ended responses highlighted several features that adolescents enjoyed, including clarity, ease of use, and privacy. Participants also highlighted key areas for improvement, including formatting and language. Conclusion This study provides initial support for adolescent use of electronic self-guided safety plans. Next steps include updating this intervention based on youth feedback and testing the effectiveness of this tool using gold standard research methods.

Multimodal training on L2 Japanese pitch accent: learning outcomes, neural correlates and subjective assessments

Abstract Japanese pitch accent is phonemic, making it crucial for second-language learners to acquire. Building on theories of multimodal learning, the present study explored how auditory, visual and gestural training of Japanese pitch accent affected behavioral, neural and meta-cognitive aspects of pitch perception across two experiments. Experiment 1 used a between-subjects pre/posttest design to train native English speakers to perceive Japanese pitch accents in one of the following three conditions: (1) baseline (audio + flat notation), (2) pitch height notation (audio + notation mimicking pitch height) and (3) pitch height notation + a left-hand gesture (L-gesture) (to engage the contralateral right hemisphere specialized for suprasegmental pitch processing). Our results indicated that (2) pitch height notation training was most robust in its benefits, as participants in this condition improved on trained and novel words alike. Experiment 2 used a within-subjects design to extend Experiment 1 in three ways: adding a right-hand gesture (R-gesture) condition (to engage more segmental language areas in the left hemisphere), introducing a neural correlate of cognitive load (measured by EEG alpha and theta power) and performing a metacognitive subjective assessment of learning (e.g., ‘Which training did you find the most helpful?’). The results showed that although there were no differences among our four training conditions on learning outcomes or EEG power, participants made the most positive subjective evaluations about pitch height notation and R-gesture training. Together, the results suggest that there may be a ‘just right’ amount of multimodal instruction to boost learning and increase engagement during foreign language pitch instruction.

TEACHING INTEGRATING PROJECT AS AN ACTIVE THEATER PRACTICE IN A RURAL SCHOOL

The application of an integrated project of language teaching in the new high school languages, led the authors of this work to develop an experience report that could combine the four components of the Language area - Portuguese Language and their literatures, English, art and Physical Education - with students of the São Felipe Annex School in the community of Cipoal in the municipality of Santarém. The work was developed in the 3 first year classes of that school in 2022, was based on the adaptation of the play of the Portuguese playwright Gil Vicente. The preparation lasted 2 and a half months from the beginning of the project, to rehearsals to the presentation. The evaluation process came from the observation of the students working in the theatrical / team of the scenario and selection of these for a night presentation to the community, with the evaluation of 1 to 40 points in each of the fields of knowledge, depending on their performance, besides Evaluation through PIE-LGG, having reference to authors such as Susan Holder, Gilian, Lazar, Domiguez, Granero, it was observed that integrating projects came to implement knowledge in contextualized practice for a development of linguistic skills, being the students the protagonists.

Musicianship and Prominence of Interhemispheric Connectivity Determine Two Different Pathways to Atypical Language Dominance.

During infancy and adolescence, language develops from a predominantly interhemispheric control-through the corpus callosum (CC)-to a predominantly intrahemispheric control, mainly subserved by the left arcuate fasciculus (AF). Using multimodal neuroimaging, we demonstrate that human left-handers (both male and female) with an atypical language lateralization show a rightward participation of language areas from the auditory cortex to the inferior frontal cortex when contrasting speech to tone perception and an enhanced interhemispheric anatomical and functional connectivity. Crucially, musicianship determines two different structural pathways to this outcome. Nonmusicians present a relation between atypical lateralization and intrahemispheric underdevelopment across the anterior AF, hinting at a dysregulation of the ontogenetic shift from an interhemispheric to an intrahemispheric brain. Musicians reveal an alternative pathway related to interhemispheric overdevelopment across the posterior CC and the auditory cortex. We discuss the heterogeneity in reaching atypical language lateralization and the relevance of early musical training in altering the normal development of language cognitive functions.

Understanding the developmental well-being of children from refugee backgrounds in British Columbia, Canada: A population-level mixed methods approach

Objectives and ApproachThis study utilized an explanatory sequential mixed methods approach to investigate the developmental well-being of children from refugee backgrounds in British Columbia (BC), Canada. Objective 1 (quantitative) leveraged population-level, government administrative data individually linked to a province-wide, routinely collected, teacher-reported measure of children’s development in kindergarten (the Early Development Instrument; EDI) to examine developmental outcomes across five domains for children identified as first-generation refugees (N=770), first-generation immigrants (N=7875), and non-migrants (N=199,186). In Objective 2 (qualitative), the population-level EDI results were brought to focus groups with BC educators and settlement workers (N=7) who work closely with children from refugee backgrounds to further corroborate, expand, and elaborate on the findings. ResultsA series of multiple linear regression models; adjusted for age, sex, and English Language Learner status showed that first-generation refugee status was significantly predictive of lower EDI scores in the areas of language &amp; cognitive development, communication &amp; generation knowledge, social competence, emotional maturity, and physical health &amp; well-being. Focus group results corroborated the quantitative findings, added critical complexity/context (e.g., impacts of trauma), and identified important policy-oriented levers (e.g., early, accessible assessments and supports). ConclusionsThe study provided an understanding of the population-level developmental well-being of children from refugee backgrounds in BC, framed by rich, contextualized, and actionable knowledge from focus groups. ImplicationsShowcasing the combined breadth and depth of using a mixed methods approach, how we can best support the developmental challenges and build upon the strengths of children from refugee backgrounds will be discussed.

Investigating Noun and Verb Naming in Behavioral Variant of Frontotemporal Dementia and Non-Patients Persian-Speaking

Introduction: Due to the prevalence of cognitive disorders, such as the behavioral variant of frontotemporal dementia (bvFTD) and the consequences that these disorders follow, early diagnosis and awareness of the deficiencies of these people in the cognitive and language areas is essential. Given that language is dependent on culture, examining the linguistic characteristics of such patients in different languages can provide valuable findings. Therefore, this study compares noun and verb naming abilities in individuals with bvFTD and non-patients Persian-speaking. Materials and Methods: In this cross-sectional study, 3 cognitive tests, including frontal assessment battery (FAB), Montreal cognitive assessment, and mini-mental state examination (MMSE), along with 2 noun naming and verb naming tests were performed on 15 patients with bvFTD and 30 homogeneous non-patient individuals. Results: The bvFTD group had significantly different scores for both noun and verb naming compared to the non-patient group (P&lt;0.05). Meanwhile, the bvFTD group was more impaired in naming verbs than nouns, with the largest difference between groups in the verb naming task. Conclusion: the results showed that bvFTD patients have poorer noun and verb naming abilities than non-patients. In particular, in verb naming, they showed more deficits than nouns. One possible explanation is that the processing of verbs is more complicated than nouns and involves a more complex neural system and cognitive processes than noun processing. Another possibility is that verbs rely more heavily on frontal and temporal regions of the brain, which are typically affected by bvFTD.

Policies on the collection, analysis, and reporting of sex and gender in Australian health and medical research: a mixed methods study.

To explore the policies of key organisations in Australian health and medical research on defining, collecting, analysing, and reporting data on sex and gender, and to identify barriers to and facilitators of developing and implementing such policies. Mixed methods study: online planning forum; survey of organisations in Australian health and medical research, and internet search for policies defining, collecting, analysing, and reporting data by sex and gender in health and medical research. Australia, 19 May 2021 (planning forum) to 12December 2022 (final internet search). Relevant webpages and documents classified as dedicated organisation-specific sex and gender policies; policies, guidelines, or statements with broader aims, but including content that met the definition of a sex and gender policy; and references to external policies. The online planning forum identified 65 relevant organisations in Australian health and medical research; twenty participated in the policy survey. Seven organisations reported at least one relevant policy, and six had plans to develop or implement such policies during the following two years. Barriers to and facilitators of policy development and implementation were identified in the areas of leadership, language and definitions, and knowledge skills and training. The internet search found that 57 of the 65 organisations had some form of sex and gender policy, including all ten peer-reviewed journals and five of ten research funders; twelve organisations, including eight peak body organisations, had published dedicated sex and gender policies on their websites. Most of the organisations included in our study had policies regarding the integration of sex and gender in health and medical research. The implementation and evaluation of these policies is necessary to ensure that consideration of sex and gender is adequate during all stages of the research process.