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Background: The Pediatric Interagency Registry for Mechanical Circulatory Support (Pedimacs), supported by The Society of Thoracic Surgeons, provides detailed information on pediatric patients supported with ventricular assist devices (VADs)., Methods: From September 19, 2012, to December 31, 2021, there were 1355 devices in 1109 patients (<19 years) from 42 North American Hospitals., Results: Cardiomyopathy was the most common underlying cause (59%), followed by congenital heart disease (25%) and myocarditis (9%). Regarding device type, implantable continuous (IC) VADs were most common at 40%, followed by paracorporeal pulsatile (PP; 28%) and paracorporeal continuous (PC; 26%). Baseline demographics differed, with the PC cohort being younger, smaller, more complex (ie, congenital heart disease), and sicker at implantation (P < .0001). At 6 months after VAD implantation, a favorable outcome (transplantation, recovery, or alive on device) was achieved in 84% of patients, which was greatest among those on IC VADs (92%) and least for PC VADs (69%). Adverse events were not uncommon, with nongastrointestinal bleeding (incidence of 14%) and neurologic dysfunction (11% [stroke, 4%]), within 2 weeks after implantation being the most prevalent. Stroke and bleeding had negative impacts on overall survival (P = .002 and P < .001, respectively)., Conclusions: This Sixth Pedimacs Report demonstrates the continued evolution of the pediatric field. The complexity of cardiac physiologies and anatomic constraint mandates the need for multiple types of devices used (PC, PP, IC). Detailed analyses of each device type in this report provide valuable information to further advance the care of this challenging and vulnerable population., (Copyright © 2023 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)

Ventricular assist device (VAD) options vary for children in different weight groups. This study evaluates contemporary device usage and outcomes for children based on weight. Data from the Advanced Cardiac Therapies Improving Outcomes Network (ACTION) registry were examined for patients with dilated cardiomyopathy (DCM) in 4 weight cohorts: <8 kg, 8-20 kg, 21-40 kg, and >40 kg, for devices implanted 3/2013-10/2020. Adverse event rates and ultimate outcome (deceased, alive on device, transplanted, or ventricular recovery) were analyzed. 222 DCM patients were identified with 24% in cohort 1, 23% in cohort 2, 15% in cohort 3, and 38% in cohort 4. Of 272 total implants, paracorporeal pulsatile devices were most common (95%) in cohorts 1 and 2 and intracorporeal continuous devices (81%) in cohorts 3 and 4. Stroke was noted in 17%, 12%, 6%, and 4% of cohorts, respectively (Cohort 1 vs. 4 and 2 vs. 4 - p = 0.01; other comparisons - not significant). Incidences of major bleeding, device malfunction, and infection was not different. All cohorts had >90% positive outcomes. Stroke incidence was higher in smaller cohorts, but other outcomes were similar. Positive outcomes were attained in over 90% across all weight groups, demonstrating excellent outcomes using current VADs in this DCM population., Competing Interests: The authors have no conflicts of interest., (Copyright © ASAIO 2023.)

Purpose: Cardiac disease results in significant morbidity and mortality in patients with muscular dystrophy (MD). Single centers have reported their ventricular assist device (VAD) experience in specific MDs and in limited numbers. This study sought to describe the outcomes associated with VAD therapy in an unselected population across multiple centers., Methods: We examined outcomes of patients with MD and dilated cardiomyopathy implanted with a VAD at Advanced Cardiac Therapies Improving Outcomes Network (ACTION) centers from 9/2012 to 9/2020., Results: A total of 19 VADs were implanted in 18 patients across 12 sites. The majority of patients had dystrophinopathy (66%) and the median age at implant was 17.2 years (range 11.7-29.5). Eleven patients were non-ambulatory (61%) and 6 (33%) were on respiratory support pre-VAD. Five (28%) patients were implanted as a bridge to transplant, 4 of whom survived to transplant. Of 13 patients implanted as bridge to decision or destination therapy, 77% were alive at 1 year and 69% at 2 years. The overall frequencies of positive outcome (transplanted or alive on device) at 1 year and 2 years were 84% and 78%, respectively. Two patients suffered a stroke, 2 developed sepsis, 1 required tracheostomy, and 1 experienced severe right heart failure requiring right-sided VAD., Conclusions: This study demonstrates the potential utility of VAD therapies in patients with muscular dystrophy. Further research is needed to further improve outcomes and better determine which patients may benefit most from VAD therapy in terms of survival and quality of life., (Copyright © 2022 International Society for Heart and Lung Transplantation. Published by Elsevier Inc. All rights reserved.)

Aims: Agar art bridges the gap between science and art using microbes instead of paint. Afterwards, the art can change in response to microbial fluctuation, meaning preservation of the original art is essential. Here, formaldehyde and glutaraldehyde were investigated as preservatives, involving techniques used in healthcare settings to preserve samples., Methods and Results: Formaldehyde was tested at 1.0%, 2.0% and 3.7%, w/v, whereas glutaraldehyde was tested at 1% and 2.5%, w/v. Both compounds and respective concentrations were tested for different time periods. Escherichia coli, Serratia marcescens, Staphlococcus aureus and Micrococcus luteus were used as bacteria for "drawing" the works of art. The effectiveness of fixation was determined using integrated densities and visual assessment. Initially, both compounds showed potential promise, albeit with a loss of bacteria. Ser. marcescens was prone to colour changes and glutaraldehyde caused discolouration of agar and bacteria. These could be caused by a pH decrease in the agar, due to residual free aldehyde groups. Reduction of this was tested using 300 mM sodium metabisulfite to neutralize excess aldehydes. This initially led to reduced bacterial loss and avoided colour changes, however measurements 24 h post-fixation showed colour loss to some bacterial clusters., Conclusions: Here, at least 2% formaldehyde for a short fixation period, typically 1 min, depending on the species, was most promising for the preservation of art. Given the success of this with different bacteria, it would make a good starting combination for anyone trying to fix agar art, although methodology refinement may be needed for optimisation depending on the bacterial species used., Significance and Impact of Study: This study shows, for the first time, successful fixation and preservation of different bacterial species on agar. The impact of this is to preserve agar art while making it safe and non-infective to those in contact with the microbial art., (© 2022 The Authors. Journal of Applied Microbiology published by John Wiley & Sons Ltd on behalf of Society for Applied Microbiology.)

Abnormal dystrophin production due to mutations in the dystrophin gene causes Duchenne Muscular Dystrophy (DMD). Cases demonstrate considerable genetic and disease progression variability. It is unclear if specific gene mutations are prognostic of outcomes in this population. We conducted a retrospective cohort study of DMD patients followed at 17 centers across the USA and Canada from 2005 to 2015 with goal of understanding the genetic variability of DMD and its impact on clinical outcomes. Cumulative incidence of clinically relevant outcomes was stratified by genetic mutation type, exon mutation location, and extent of exon deletion. Of 436 males with DMD, 324 (74.3%) underwent genetic testing. Deletions were the most common mutation type (256, 79%), followed by point mutations (45, 13.9%) and duplications (23, 7.1%). There were 131 combinations of mutations with most mutations located along exons 45 to 52. The number of exons deleted varied between 1 and 52 with a median of 3 exons deleted (IQR 1-6). Subjects with mutations starting at exon positions 40-54 had a later onset of arrhythmias occurring at median age 25 years (95% CI 18-∞), p = 0.01. Loss of ambulation occurred later at median age of 13 years (95% CI 12-15) in subjects with mutations that started between exons 55-79, p = 0.01. There was no association between mutation type or location and onset of cardiac dysfunction. We report the genetic variability in DMD and its association with timing of clinical outcomes. Genetic modifiers may explain some phenotypic variability., (© 2021. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Purpose: This study aims to investigate the relationship between nonverbal cognitive functions and language processing of people with aphasia (PWA) by taking a data-driven approach, as well as multiple cognitive components and multilevel linguistic perspectives. It is hypothesized that language performance is differentially associated with cognitive processing of PWA, with executive functions (EFs) playing a stronger role in language tasks with increasing linguistic complexity., Method: A language battery assessing word comprehension/production, sentence comprehension, and discourse production, together with a series of nonlinguistic cognitive tasks targeting simple/complex attention, short-term/working memory, or EFs, was administered to 53 Cantonese-speaking PWA. Cognitive factors extracted from principal component analysis applied to the cognitive battery served as predictors in four multiple regression analyses to predict PWA's performance at various linguistic levels., Results: Two cognitive factors, representing (a) simple attention and memory and (b) EF, were extracted. The former predicted performance in word processing tasks, whereas EF significantly predicted performance in all language tasks with increasing contribution as a function of linguistic complexity., Conclusion: The results based on Chinese PWA provide comprehensive evidence for the view that language performance is the end product of interaction between linguistic and nonlinguistic functions and have clear implications for clinical management of PWA.

Background: The Pediatric Interagency Registry for Mechanical Circulatory Support (Pedimacs) provides detailed information on pediatric patients supported with ventricular assist devices (VADs)., Methods: From September 19, 2012, to December 31, 2020, 1229 devices in 1011 patients were reported to the registry from 47 North American Hospitals in patients aged younger than 19 years., Results: Cardiomyopathy was the most common underlying etiology (58%), followed by congenital heart disease (CHD; 25%) and myocarditis (10%). The most common devices implanted were implantable continuous (IC; 419 [41%]), followed by paracorporeal pulsatile (PP; 269 [27%]), paracorporeal continuous (PC; 263 [26%]), and percutaneous (53 [5%]). Overall, at 6 months after VAD implantation, 83% had a positive outcome (transplant, explant, or alive on device). The freedom from stroke at 3 months was highest in IC VADs (93%), compared with PP VADs (84%) and with PC VADs (75%). There were differences in survival by device type, with patients on IC VADs having the best overall survival and those on PC having the lowest overall survival, though the patient populations being supported by each VAD type differed significantly from each other., Conclusions: This Fifth Pedimacs Report demonstrates the continued robust growth of VADs in the pediatric community, now with more than 1000 patients reported to the registry. The multiple available device types (PC, PP, IC) serve different populations with different pre-VAD risk profiles, which may account for differences in survival and adverse events between device types., (Copyright © 2021 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)

While the issue of individual variation has been widely studied in second language learning or processing, it is less well understood how perceptual and musical aptitude differences can explain individual variation in native speech processing. In the current study, we make use of tone merger in Hong Kong Cantonese, an ongoing sound change that concerns the merging of tones in perception, production or both in a portion of native speakers, to examine the possible relationship between tone merger and musical and pitch abilities. Although a previous study has reported the occurrence of tone merger independently of musical training, it has not been investigated before whether tone-merging individuals, especially those merging tones in perception, would have inferior musical perception and fine-grained pitch sensitivities, given the close relationship of speech and music. To this end, we tested three groups of tone-merging individuals with various tone perception and production profiles on musical perception and pitch threshold tasks, in comparison to a group of Cantonese speakers with congenital amusia, and another group of controls without tone merger or amusia. Additionally, the amusics were compared with tone-merging individuals on the details of their tone discrimination and production profiles. The results showed a clear dissociation of tone merger and amusia, with the tone-merging individuals exhibiting intact musical and pitch abilities; on the other hand, the amusics demonstrated widespread difficulties in tone discrimination yet intact tone production, in contrast to the highly selective confusion of a specific tone pair in production or discrimination in tone-merging individuals. These findings provide the first evidence that tone merger and amusia are distinct from each other, and further suggest that the cause of tone merger may lie elsewhere rather than being driven by musical or pitch deficits. We also discussed issues arising from the current findings regarding the neural mechanisms of tone merger and amusia., Competing Interests: The authors have declared that no competing interests exist.

Right heart failure (RHF) is a vexing problem in children after left ventricular assist device (LVAD) implantation that can negatively impact transplant candidacy and survival. Anticipation, prevention, early identification and appropriate medical and device management of RHF are important to successful LVAD outcomes. However, there is limited pediatric evidence to guide practice. This pediatric-focused review summarizes the relevant literature and describes the harmonized approach to RHF from the Advanced Cardiac Therapies Improving Outcomes Network (ACTION). This review seeks to improve RHF outcomes through the sharing of best practices and experience across the pediatric VAD community., (© 2021 Wiley Periodicals LLC.)

Previous research has shown that the components of Chinese characters (e.g., semantic components, phonetic components, and radicals) serve as processing units in reading. One outstanding question concerns the existence of amodal orthographic representations that unify multiple, form-specific character components, similar to the abstract letter identities (ALIs) that unify case-specific letter forms (A/a) in Roman script. Although Chinese does not have case, a subset of semantic radicals have multiple forms (e.g., - are both "water" radicals), allowing for a test of the existence of Abstract Radical Identities (ARIs) that unify the multiple forms. In Experiment 1, a visual same-different judgement task was used to detect the presence of ARI representations. Evidence for ARIs was provided by the finding that radical pairs with different forms but the same radical identity were judged to be visually different more slowly than matched pairs of different forms with different radical identities. In Experiment 2, we evaluated ARI effects in real character reading. A lexical decision priming task compared prime-target character pairs containing radicals with the same identity but different forms (e.g., -) with matched prime-target character pairs with unrelated radicals (e.g., -). Inhibitory priming was observed only in the same-identity radical condition compared with the unrelated condition. These combined results provide, for the first time, evidence of format-free representations of orthographic units in Chinese characters-abstract radical identities (ARIs).

Orthographic uniqueness point (OUP) refers to the letter position of a word at which it is distinguishable from other lexical items in the language. Previous findings of OUP effects have been mixed and mainly demonstrated in native readers of alphabetic languages. The current study investigated whether OUP effects could be shown among non-native readers in a visual repetition detection task. The experiment tested three OUP conditions (early, mid, late) in native English readers and proficient non-native English readers whose native scripts were Japanese or Korean. Results revealed main effects of OUP on N170 amplitude, where early OUP words elicited more negative N170 and late OUP words elicited marginally less negative N170 than mean activation for both native and non-native readers. There was no indication that non-linearity or non-alphabetic nature of one's native script influenced OUP effects. Results were consistent with a parallel letter processing account in single word reading., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Background: Immunosuppression is considered a risk factor for more severe clinical presentation of COVID-19. Limited data regarding clinical outcome exist in adults, whereas very little is known about the spectrum of the disease in pediatric heart transplant recipients., Methods: We retrospectively reviewed the charts of young heart transplant patients from our tertiary care center during the coronavirus pandemic in New York City and identified patients infected with SARS-CoV-2., Results: We present four cases with COVID-19 disease and elaborate on their presentation and clinical course., Conclusions: Although far from conclusive and limited by the small sample size and selection bias, these cases demonstrate mild and self-limited disease despite immunosuppressive therapy and various comorbidities that are expected to increase the severity of the clinical picture based on extrapolation from the adult experience with this novel disease., (© 2020 Wiley Periodicals LLC.)

Duchenne muscular dystrophy (DMD) is characterized by myocardial fibrosis and left ventricular (LV) dysfunction. Implantable cardioverter defibrillator (ICD) use has not been characterized in this population but is considered for symptomatic patients with severe LV dysfunction (SLVD) receiving guideline-directed medical therapy (GDMT). We evaluated ICD utilization and efficacy in patients with DMD. Retrospective cohort study of DMD patients from 17 centers across North America between January 2, 2005 and December 31, 2015. ICD use and its effect on survival were evaluated in patients with SLVD defined as ejection fraction (EF) < 35% and/ or shortening fraction (SF) < 16% on final echocardiogram. SLVD was present in 57/436 (13.1%) patients, of which 12 (21.1%) died during the study period. Of these 12, (mean EF 20.9 ± 6.2% and SF 13.7 ± 7.2%), 8 received GDMT, 5 received steroids, and none received an ICD. ICDs were placed in 9/57 (15.8%) patients with SLVD (mean EF 31.2 ± 8.5% and SF 10.3 ± 4.9%) at a mean age of 20.4 ± 6.3 years; 8/9 received GDMT, 7 received steroids, and all were alive at study end; mean ICD duration was 36.1 ± 26.2 months. Nine ICDs were implanted at six different institutions, associated with two appropriate shocks for ventricular tachycardia in two patients, no inappropriate shocks, and one lead fracture. ICD use may be associated with improved survival and minimal complications in DMD cardiomyopathy with SLVD. However, inconsistent GDMT utilization may be a significant confounder. Future studies should define optimal indications for ICD implantation in patients with DMD cardiomyopathy.

As survival and neuromuscular function in Duchenne muscular dystrophy (DMD) have improved with glucocorticoid (GC) therapy and ventilatory support, cardiac deaths are increasing. Little is known about risk factors for cardiac and non-cardiac causes of death in DMD. A multi-center retrospective cohort study of 408 males with DMD, followed from January 1, 2005 to December 31, 2015, was conducted to identify risk factors for death. Those dying of cardiac causes were compared to those dying of non-cardiac causes and to those alive at study end. There were 29 (7.1%) deaths at a median age of 19.5 (IQR: 16.9-24.6) years; 8 (27.6%) cardiac, and 21 non-cardiac. Those living were younger [14.9 (IQR: 11.0-19.1) years] than those dying of cardiac [18 (IQR 15.5-24) years, p = 0.03] and non-cardiac [19 (IQR: 16.5-23) years, p = 0.002] causes. GC use was lower for those dying of cardiac causes compared to those living [2/8 (25%) vs. 304/378 (80.4%), p = 0.001]. Last ejection fraction prior to death/study end was lower for those dying of cardiac causes compared to those living (37.5% ± 12.8 vs. 54.5% ± 10.8, p = 0.01) but not compared to those dying of non-cardiac causes (37.5% ± 12.8 vs. 41.2% ± 19.3, p = 0.58). In a large DMD cohort, approximately 30% of deaths were cardiac. Lack of GC use was associated with cardiac causes of death, while systolic dysfunction was associated with death from any cause. Further work is needed to ensure guideline adherence and to define optimal management of systolic dysfunction in males with DMD with hopes of extending survival.

Rejection with severe hemodynamic compromise is a significant source of morbidity and mortality for pediatric heart transplant patients. Traditionally, treatment for these patients includes inotropes and escalation to extracorporeal membrane oxygenation (ECMO) when necessary. There is increasing interest in using percutaneous ventricular assistive devices in the pediatric population as a less invasive alternative to ECMO. We report the largest case series to date of biventricular support using percutaneous Impella devices. Retrospective case series was performed by chart review. Hemodynamics, left ventricular ejection fraction (LVEF), and indices of end organ function were collected before and after Impella placement. A 14-year-old male, 18-year-old male, and 19-year-old female, all status post heart transplant, presented with severely decreased biventricular function due to presumed clinical rejection, requiring maximal inotropic support without improvement. In all the three cases, simultaneous Impella CP and RP devices were placed percutaneously. Prior to implantation, LVEFs were 40%, 23%, and 25%, respectively. Hemodynamics measured invasively prior to device placement showed elevated filling pressures. Adverse events while on support included bleeding, hemolysis, and right femoral arterial dissection during implantation. All patients were successfully weaned from the devices and survived to discharge. The average time of right-sided support and total support was 11 days and 13 days, respectively. After device removal, right-sided pressures and echocardiographic measurements showed improvement in all patients. Bilateral Impella configuration (BiPella) is a viable option for temporary mechanical circulatory support in pediatric patients with significant graft dysfunction., (© 2019 International Center for Artificial Organs and Transplantation and Wiley Periodicals, Inc.)

Recent neurophysiological studies have proposed distinct roles of β and γ oscillations in implementing top-down and bottom-up processes. The present study aims to test this hypothesis in the domain of speech perception. We examined β and γ oscillations elicited to a tone contrast in a passive oddball paradigm, and their relationships with discrimination sensitivity d' and RT from two groups of healthy adults who showed high and low discrimination sensitivity to the contrast. The low-sensitivity group showed a significant reduction in β, which was further related to d'. Individual differences in RT were related to different frequency bands in the two groups, with a RT-β correlation in the low-sensitivity group, and a RT-γ relation in the high-sensitivity group. Based on these findings, we suggest that β, implicated in top-down processing, reflects individual differences in phonological representations, and that γ, involved in bottom-up processing, reflects individual differences in acoustic encoding., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Across languages, lexical frequency and age of acquisition (AoA) are important predictors of word reading that are naturally correlated, and both variables have been shown to interact with phonological regularity. Previous behavioral findings in Chinese have shown stronger regularity effects in low frequency relative to high frequency characters. Meanwhile, the arbitrary mapping hypothesis predicts stronger interference effects in late-acquired irregular words. This study examined the neural bases of these phenomena in Chinese using a delayed naming task with 480 single characters. Single-trial ERP analyses were conducted to contrast the interactions of frequency or AoA effects with phonological regularity, while controlling for the other factor. Results showed differential and significant effects of AoA and frequency at the N400 and late positive component (LPC), respectively, indicating their independence. ERP interaction patterns of frequency and regularity in Chinese were observed for the first time in the LPC time window and suggested semantic interference from sublexical units during character reading. Interaction of AoA and regularity at the N400 could be explained by the semantic hypothesis but appeared inconsistent with the arbitrary mapping hypothesis., (© 2019 Society for Psychophysiological Research.)

This article reports the construction of a multimodal annotated database of spoken discourse and co-verbal gestures by native healthy speakers of Cantonese and individuals with language impairment: the Cantonese AphasiaBank. This corpus was established as a foundation for aphasiologists and clinicians to use in designing and conducting research investigations into theoretical and clinical issues related to acquired language disorders in Chinese. Details in terms of the purpose, structure, and levels of annotation of the database (containing part-of-speech-annotated orthographic transcripts with Romanization and the corresponding videos) are described. The discussion presents the challenges of building a spoken database of a language that is not linguistically well-researched and that does not have a standardized written form for many of its lexical items, as well as presenting how these issues were addressed. Most importantly, the article highlights the potential of Cantonese AphasiaBank as a powerful research tool for linguists and psycholinguists.

Background: As survival and neuromuscular function in Duchenne Muscular Dystrophy (DMD) improve with glucocorticoid therapy and respiratory advances, the proportion of cardiac deaths is increasing. Little is known about the use and outcomes of advanced heart failure (HF) therapies in this population., Methods: A retrospective cohort study of 436 males with DMD was performed, from January 1, 2005-January 1, 2018, with the primary outcome being use of advanced HF therapies including: implantable cardioverter defibrillator (ICD), left ventricular assist device (LVAD), and heart transplantation (HTX)., Results: Nine subjects had an ICD placed, 2 of whom (22.2%) had appropriate shocks for ventricular tachycardia; 1 and 968 days after implant, and all of whom were alive at last follow-up; median 18 (IQR: 12.5-25.5) months from implant. Four subjects had a LVAD implanted with post-LVAD survival of 75% at 1 year; 2 remaining on support and 1 undergoing HTX. One subject was bridged to HTX with ICD and LVAD and was alive at last follow-up, 53 months after HTX., Conclusion: Advanced HF therapies may be used effectively in select subjects with DMD. Further studies are needed to better understand risk stratification for ICD use and optimal candidacy for LVAD implantation and HTX, with hopes of improving cardiac outcomes., Competing Interests: Declaration of interest Carol A. Wittlieb-Weber, MD: None. Chet R. Villa, MD: None. Matthew J. Bock, MD: None. Katheryn E. Gambetta, MD: None. Jonathan N. Johnson, MD: None. Ashwin K. Lal, MD: None. Kurt R. Schumacher, MD: None. Sabrina P. Law, MD: None. Shriprasad R. Deshpande, MD, MS: None. Shawn C. West, MD, MSc: None. Joshua M. Friedland-Little, MD: None. Irene D. Lytrivi, MD: None. Michael A. McCulloch, MD: None. Ryan J. Butts, MD: None. David R. Weber, MD, MSCE: Consulted for Marathon Pharmaceuticals. Kenneth R. Knecht, MD: None.

Previous studies involving ex-illiterate and young readers of alphabetic scripts have shown that processing of non-verbal visual stimuli may be affected by literacy, which is attributable to intensive perceptual training during reading acquisition. This study examined whether the characteristics of one's native writing system, with respect to visual complexity and overall shape of orthographic unit, would influence the processing of pictured objects using event-related potential (ERP) with linear mixed-effects modeling. Kanji and Hangul constitute an interesting contrast as they differ in visual complexity but are similar in orthographic shape. Neural responses to pictures were analyzed in N170 and N400 reflecting ease of recognition and access to semantic representation, respectively. Trilingual speakers with Japanese or Korean as L1, who learned to read Chinese and English as non-native languages, as well as native Chinese and native English readers participated in a repetition detection task in which mixed blocks of pictures and words (Chinese or English) were presented. The overall results showed bilaterally distributed N170 and N400, and group differences in the N400 were confined to the anterior region. More importantly, Japanese readers exhibited more negative N170 and less negative N400 than Korean participants regardless of language context. The present findings have provided insights into the possible impact of reading acquisition on non-linguistic visual processing, and suggest that one's early experience of a visually complex orthography has positive transfer to processing of line drawings in terms of more efficient visual recognition and semantic access., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Background: Co-verbal gestures refer to hand or arm movements made during speaking. Spoken language and gestures have been shown to be tightly integrated in human communication., Aims: The present study investigated whether co-verbal gesture use was associated with lexical retrieval in connected speech in unimpaired speakers and persons with aphasia (PWA)., Methods & Procedures: Narrative samples of 58 fluent PWA and 58 control speakers were extracted from Cantonese AphasiaBank. Based on the indicators of word-finding difficulty (WFD) in connected speech adapted from previous research, and a gesture annotation system with independent coding of gesture forms and functions, all WFD instances were identified. The presence and type of gestures accompanying each incident of WFD were then annotated. Finally, whether the use of gesture was accompanied by resolution of WFD, i.e., the corresponding target word could be retrieved, was examined., Outcomes & Results: Employment of co-verbal gesture did not seem to be related to the success of word retrieval. PWA's naming ability at single-word level and their overall language ability (as reflected by the aphasia quotient of the Cantonese version of the Western Aphasia Battery) were found to be the two strongest predictors of success rate of resolving WFD., Conclusions: The Lexical Retrieval Hypothesis highlighting the facilitative functions of iconic and metaphoric gestures in lexical retrieval was not supported. Challenges in conducting research related to WFD, and the clinical implications in gesture-based language intervention for PWA were discussed., Competing Interests: Declaration of interest The authors report no conflicts of interest and are responsible for the content of the paper.

Auditory neuroscience has provided strong evidence that neural oscillations synchronize to the rhythm of speech stimuli, and oscillations at different frequencies have been linked to processing of different language structures. The present study aims to examine how these ubiquitous neurophysiological attributes may inform us about the brain processes that underpin individual differences in speech perception and production, which in turn elucidate the specific functions of neural oscillations in the domain of speech processing. To this end, we recorded electrophysiological responses to a lexical tone contrast in a passive auditory oddball paradigm from two groups of healthy tone-language speakers who were equal in perceptual discriminability but differed in response latency and production distinctiveness of the tone contrast. Time-frequency analysis was applied to the EEG data, and decomposed into theta (4-7 Hz), beta (12-30 Hz), and gamma (30-50 Hz) frequency bands. Results show that listeners with longer discrimination RT and less distinctive production showed significantly higher induced (non-phase-locked) gamma during tone processing. Moreover, among speakers with less distinctive production, individual differences in induced gamma were significantly correlated with discrimination latency and production distinction. Based on the present findings, we propose that differences in gamma oscillations reflect differential sensory/perceptual computations during acoustic encoding, impacting the quality of perceptual representations, which further mediates individual differences in speech perception and production., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Influenza is a cause of significant morbidity and mortality worldwide. Myocarditis is a rare complication of the virus and can vary widely in severity. The published cases of influenza B myocarditis in children tend to be severe with a high mortality rate. Current standard treatment of viral myocarditis is supportive care, although immunomodulatory therapies, such as steroids and intravenous immunoglobulin, are often used. T cells have been implicated in causing significant myocyte damage in myocarditis by leading to the downstream production of antibodies against viral and myocyte antigens; this has created a theoretical basis for the use of antithymocyte globulin to target T cells in these patients. We present a case of acute fulminant influenza B myocarditis in a pediatric patient that required mechanical circulatory support and improved only after treatment with antithymocyte globulin., Competing Interests: POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose., (Copyright © 2018 by the American Academy of Pediatrics.)

Purpose: The existing body of work regarding discourse coherence in aphasia has provided mixed results, leaving the question of coherence being impaired or intact as a result of brain injury unanswered. In this study, discourse coherence in non-brain-damaged (NBD) speakers and speakers with anomic aphasia was investigated quantitatively and qualitatively., Method: Fifteen native speakers of Cantonese with anomic aphasia and 15 NBD participants produced 60 language samples. Elicitation tasks included story-telling induced by a picture series and a procedural description. The samples were annotated for discourse structure in the framework of Rhetorical Structure Theory (RST) in order to analyse a number of structural parameters. After that 20 naïve listeners rated coherence of each sample., Result: Disordered discourse was rated as significantly less coherent. The NBD group demonstrated a higher production fluency than the participants with aphasia and used a richer set of semantic relations to create discourse, particularly in the description of settings, expression of causality, and extent of elaboration. People with aphasia also tended to omit essential information content., Conclusion: Reduced essential information content, lower degree of elaboration, and a larger amount of structural disruptions may have contributed to the reduced overall discourse coherence in speakers with anomic aphasia.

Background: Pediatric ventricular assist device (VAD) support as bridge to transplant has improved waitlist survival, but the effects of pre-implant status and VAD-related events on post-transplant outcomes have not been assessed. This study is a linkage analysis between the PediMACS and Pediatric Heart Transplant Study databases to determine the effects of VAD course on post-transplant outcomes., Methods: Database linkage between October 1, 2012 and December 31, 2015 identified 147 transplanted VAD patients, the primary study group. The comparison cohort was composed of 630 PHTS patients without pre-transplant VAD support. The primary outcome was post-transplant survival, with secondary outcomes of post-transplant length of stay, freedom from infection and freedom from rejection., Results: At implant, the VAD cohort was INTERMACS Profile 1 in 33 (23%), Profile 2 in 89 (63%) and Profile 3 in 14 (10%) patients. The VAD cohort was older, larger, and less likely to have congenital heart disease (p < 0.0001). However, they had greater requirements for inotrope and ventilator support and increased liver and renal dysfunction (p < 0.0001), both of which normalized at transplant after device support. Importantly, there were no differences in 1-year post-transplant survival (96% vs 93%, p = 0.3), freedom from infection (81% vs 79%, p = 0.9) or freedom from rejection (71% vs 74%, p = 0.87) between cohorts., Conclusions: Pediatric VAD patients have post-transplant outcomes equal to that of medically supported patients, despite greater pre-implant illness severity. Post-transplant survival, hospital length of stay, infection and rejection were not affected by patient acuity at VAD implantation or VAD-related complications. Therefore, VAD as bridge to transplant mitigates severity of illness in children., (Copyright © 2017 International Society for the Heart and Lung Transplantation. Published by Elsevier Inc. All rights reserved.)

Objectives: Ventricular assist devices have gained popularity in the management of refractory heart failure in children listed for heart transplantation. Our primary aim was to compare the composite endpoint of all-cause pretransplant mortality and loss of transplant eligibility in children who were treated with a ventricular assist device versus a medically managed cohort., Design: This was a retrospective cohort analysis., Settings: Data were obtained from the Scientific Registry of Transplant Recipients., Patients: The at-risk population (n = 1,380) was less than 18 years old, either on a ventricular assist device (605 cases) or an equivalent-severity, intensively medically treated group (referred to as MED, 775 cases)., Interventions: None., Measurements and Main Results: The impact of ventricular assist devices was estimated via Cox proportional hazards regression (hazard ratio), dichotomizing 1-year outcomes to "poor" (22%: 193 deaths, 114 too sick) versus all others (940 successful transplants, 41 too healthy, 90 censored), while adjusting for conventional risk factors. Among children 0-12 months old, ventricular assist device was associated with a higher risk of poor outcomes (hazard ratio, 2.1; 95% CI, 1.5-3.0; p < 0.001). By contrast, ventricular assist device was associated with improved outcomes for ages 12-18 (hazard ratio, 0.3; 95% CI, 0.1-0.7; p = 0.003). For candidates 1-5 and 6-11 years old, there were no differences in outcomes between the ventricular assist device and MED groups (hazard ratio, 0.8 and 1.0, p = 0.43 and 0.9). The interaction between ventricular assist devices and age group was strongly significant (p < 0.001)., Conclusions: This is a comparative study of ventricular assist devices versus medical therapy in children. Age is a significant modulator of waitlist outcomes for children with end-stage heart failure supported by ventricular assist device, with the impact of ventricular assist devices being more beneficial in adolescents.

This study analysed the topic and vocabulary of Chinese speakers based on language samples of personal recounts in a large spoken Chinese database recently made available in the public domain, i.e. Cantonese AphasiaBank ( http://www.speech.hku.hk/caphbank/search/ ). The goal of the analysis is to offer clinicians a rich source for selecting ecologically valid training materials for rehabilitating Chinese-speaking people with aphasia (PWA) in the design and planning of culturally and linguistically appropriate treatments. Discourse production of 65 Chinese-speaking PWA of fluent types (henceforth, PWFA) and their non-aphasic controls narrating an important event in their life were extracted from Cantonese AphasiaBank. Analyses of topics and vocabularies in terms of part-of-speech, word frequency, lexical semantics, and diversity were conducted. There was significant overlap in topics between the two groups. While the vocabulary was larger for controls than that of PWFA as expected, they were similar in distribution across parts-of-speech, frequency of occurrence, and the ratio of concrete to abstract items in major open word classes. Moreover, proportionately more different verbs than nouns were employed at the individual level for both speaker groups. The findings provide important implications for guiding directions of aphasia rehabilitation not only of fluent but also non-fluent Chinese aphasic speakers.

Right Dislocation (RD) has been suggested to be a focus marking device carrying an affective function motivated by limited planning time in conversation. The current study investigated the effects of genre type, planning load and affective function on the use of RD in Cantonese monologues. Discourse data were extracted from a recently developed corpus of oral narratives in Cantonese Chinese containing language samples from 144 native Cantonese speakers evenly distributed in age, education levels and gender. Three genre types representing different structures, styles and degrees of topic familiarity were chosen for an RD analysis: procedural description, story-telling and recount of personal event. The results revealed that genre types and planning load influenced the rate of RD occurrence. (1) Specifically, the lowest proportion of RD occurred in procedural description, assumed to be the most structured genre; whereas the highest rate was found in personal event recount, considered to be the most stylized and less structured genre. (2) The highest proportion of RD appeared near the end of a narrative, where heavier cognitive load is demanded compared with the beginning of a narrative; moreover, RD also tended to co-occur with disfluency. (3) There was a high percentage of RD tokens in the personal event recount for expressing explicit emotions; and (4) a lower rate of occurrence of RD was found in monologues than previous studies based on conversations. The overall findings suggest that the use of RD is sensitive to genre structure and style, as well as planning load effects.

Purpose: Coverbal gesture use, which is affected by the presence and degree of aphasia, can be culturally specific. The purpose of this study was to compare gesture use among Cantonese-speaking individuals: 23 neurologically healthy speakers, 23 speakers with fluent aphasia, and 21 speakers with nonfluent aphasia., Method: Multimedia data of discourse samples from these speakers were extracted from the Cantonese AphasiaBank. Gestures were independently annotated on their forms and functions to determine how gesturing rate and distribution of gestures differed across speaker groups. A multiple regression was conducted to determine the most predictive variable(s) for gesture-to-word ratio., Results: Although speakers with nonfluent aphasia gestured most frequently, the rate of gesture use in counterparts with fluent aphasia did not differ significantly from controls. Different patterns of gesture functions in the 3 speaker groups revealed that gesture plays a minor role in lexical retrieval whereas its role in enhancing communication dominates among the speakers with aphasia. The percentages of complete sentences and dysfluency strongly predicted the gesturing rate in aphasia., Conclusions: The current results supported the sketch model of language-gesture association. The relationship between gesture production and linguistic abilities and clinical implications for gesture-based language intervention for speakers with aphasia are also discussed.

This study investigated whether individual differences in cognitive functions, attentional abilities in particular, were associated with individual differences in the quality of phonological representations, resulting in variability in speech perception and production. To do so, we took advantage of a tone merging phenomenon in Cantonese, and identified three groups of typically developed speakers who could differentiate the two rising tones (high and low rising) in both perception and production [+Per+Pro], only in perception [+Per-Pro], or in neither modalities [-Per-Pro]. Perception and production were reflected, respectively, by discrimination sensitivity d' and acoustic measures of pitch offset and rise time differences. Components of event-related potential (ERP)-the mismatch negativity (MMN) and the ERPs to amplitude rise time-were taken to reflect the representations of the acoustic cues of tones. Components of attention and working memory in the auditory and visual modalities were assessed with published test batteries. The results show that individual differences in both perception and production are linked to how listeners encode and represent the acoustic cues (pitch contour and rise time) as reflected by ERPs. The present study has advanced our knowledge from previous work by integrating measures of perception, production, attention, and those reflecting quality of representation, to offer a comprehensive account for the underlying cognitive factors of individual differences in speech processing. Particularly, it is proposed that domain-general attentional switching affects the quality of perceptual representations of the acoustic cues, giving rise to individual differences in perception and production.

One way to understand the relationship between speech perception and production is to examine cases where the two dissociate. This study investigates the hypothesis that perceptual acuity reflected in event-related potentials (ERPs) to rise time of sound amplitude envelope and pitch contour [reflected in the mismatch negativity (MMN)] may associate with individual differences in production among speakers with otherwise comparable perceptual abilities. To test this hypothesis, advantage was taken of an on-going sound change-tone merging in Cantonese, and compared the ERPs between two groups of typically developed native speakers who could discriminate the high rising and low rising tones with equivalent accuracy but differed in the distinctiveness of their production of these tones. Using a passive oddball paradigm, early positive-going EEG components to rise time and MMN to pitch contour were elicited during perception of the two tones. Significant group differences were found in neural responses to rise time rather than pitch contour. More importantly, individual differences in efficiency of tone discrimination in response latency and magnitude of neural responses to rise time were correlated with acoustic measures of F0 offset and rise time differences in productions of the two rising tones.

While Chinese character reading relies more on addressed phonology relative to alphabetic scripts, skilled Chinese readers also access sublexical phonological units during recognition of phonograms. However, sublexical orthography-to-phonology mapping has not been found among beginning second language (L2) Chinese learners. This study investigated character reading in more advanced Chinese learners whose native writing system is alphabetic. Phonological regularity and consistency were examined in behavioral responses and event-related potentials (ERPs) in lexical decision and delayed naming tasks. Participants were 18 native English speakers who acquired written Chinese after age 5 years and reached grade 4 Chinese reading level. Behaviorally, regular characters were named more accurately than irregular characters, but consistency had no effect. Similar to native Chinese readers, regularity effects emerged early with regular characters eliciting a greater N170 than irregular characters. Regular characters also elicited greater frontal P200 and smaller N400 than irregular characters in phonograms of low consistency. Additionally, regular-consistent characters and irregular-inconsistent characters had more negative amplitudes than irregular-consistent characters in the N400 and LPC time windows. The overall pattern of brain activities revealed distinct regularity and consistency effects in both tasks. Although orthographic neighbors are activated in character processing of L2 Chinese readers, the timing of their impact seems delayed compared with native Chinese readers. The time courses of regularity and consistency effects across ERP components suggest both assimilation and accommodation of the reading network in learning to read a typologically distinct second orthographic system.

A growing body of research has suggested that cognitive abilities may play a role in individual differences in speech processing. The present study took advantage of a widespread linguistic phenomenon of sound change to systematically assess the relationships between speech processing and various components of attention and working memory in the auditory and visual modalities among typically developed Cantonese-speaking individuals. The individual variations in speech processing are captured in an ongoing sound change-tone merging in Hong Kong Cantonese, in which typically developed native speakers are reported to lose the distinctions between some tonal contrasts in perception and/or production. Three groups of participants were recruited, with a first group of good perception and production, a second group of good perception but poor production, and a third group of good production but poor perception. Our findings revealed that modality-independent abilities of attentional switching/control and working memory might contribute to individual differences in patterns of speech perception and production as well as discrimination latencies among typically developed speakers. The findings not only have the potential to generalize to speech processing in other languages, but also broaden our understanding of the omnipresent phenomenon of language change in all languages.

This paper presents a study on intonation patterns in Cantonese aphasia speech. The speech materials were spontaneous discourse recorded from seven pairs of aphasic and unimpaired speakers. Hidden Markov model based forced alignment was applied to obtain syllable-level time alignments. The pitch level of each syllable was determined and normalized according to the given tone identity of the syllable. Linear regression of the normalized pitch levels was performed to describe the intonation patterns of sentences. It was found that aphasic speech has a higher percentage of sentences with increasing pitch. This trend was found to be more prominent in story-telling than descriptive discourses.

Background: Although evidence links HLA allele mismatching to worse outcomes in pediatric heart transplantation, no studies to our knowledge have applied the quantification of structural HLA differences between donor and recipient to risk evaluation. We examine the association between molecular-level HLA mismatching and long-term graft loss in pediatric recipients of heart transplants., Methods: HLA Matchmaker was used to quantify the number of mismatched class-specific HLA eplets among 4,851 heart transplant recipients ≤18 years of age in the Scientific Registry of Transplant Recipients (1987-2012). Survival analysis was used to compare long-term probabilities of graft loss by number of eplet mismatches and allele mismatches stratified by eplet mismatches., Results: Recipients with 10 to 20 or >20 class I (HLA-A and HLA-B) eplet mismatches experienced increased long-term graft loss compared with recipients with <10 class I eplet mismatches (adjusted hazard ratio = 1.23 [95% confidence interval = 1.06-1.42], adjusted hazard ratio = 1.27 [95% confidence interval = 1.08-1.50], respectively). Recipients with 2 to 4 class I allele mismatches had increased long-term graft loss compared with recipients with 0 to 1 class I allele mismatches. Neither class II (HLA-DR) eplet mismatching nor class II allele mismatching was associated with graft loss. On stratification by allele and structural eplet mismatching, only recipients with 2 to 4 class I allele mismatches and ≥10 class I eplet mismatches had an increased probability of graft loss compared with recipients with 0 to 1 class I allele mismatches (adjusted hazard ratio = 1.42 [95% confidence interval = 1.09-1.57])., Conclusions: Molecular-level HLA mismatching may aid in identifying recipients at increased risk of long-term graft loss who could benefit from intensified post-transplant surveillance and management., (Copyright © 2015 International Society for Heart and Lung Transplantation. Published by Elsevier Inc. All rights reserved.)

Unlabelled: The use of co-verbal gestures is common in human communication and has been reported to assist word retrieval and to facilitate verbal interactions. This study systematically investigated the impact of aphasia severity, integrity of semantic processing, and hemiplegia on the use of co-verbal gestures, with reference to gesture forms and functions, by 131 normal speakers, 48 individuals with aphasia and their controls. All participants were native Cantonese speakers. It was found that the severity of aphasia and verbal-semantic impairment was associated with significantly more co-verbal gestures. However, there was no relationship between right-sided hemiplegia and gesture employment. Moreover, significantly more gestures were employed by the speakers with aphasia, but about 10% of them did not gesture. Among those who used gestures, content-carrying gestures, including iconic, metaphoric, deictic gestures, and emblems, served the function of enhancing language content and providing information additional to the language content. As for the non-content carrying gestures, beats were used primarily for reinforcing speech prosody or guiding speech flow, while non-identifiable gestures were associated with assisting lexical retrieval or with no specific functions. The above findings would enhance our understanding of the use of various forms of co-verbal gestures in aphasic discourse production and their functions. Speech-language pathologists may also refer to the current annotation system and the results to guide clinical evaluation and remediation of gestures in aphasia., Learning Outcomes: None., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Gestures are commonly used together with spoken language in human communication. One major limitation of gesture investigations in the existing literature lies in the fact that the coding of forms and functions of gestures has not been clearly differentiated. This paper first described a recently developed Database of Speech and GEsture (DoSaGE) based on independent annotation of gesture forms and functions among 119 neurologically unimpaired right-handed native speakers of Cantonese (divided into three age and two education levels), and presented findings of an investigation examining how gesture use was related to age and linguistic performance. Consideration of these two factors, for which normative data are currently very limited or lacking in the literature, is relevant and necessary when one evaluates gesture employment among individuals with and without language impairment. Three speech tasks, including monologue of a personally important event, sequential description, and story-telling, were used for elicitation. The EUDICO Linguistic ANnotator (ELAN) software was used to independently annotate each participant's linguistic information of the transcript, forms of gestures used, and the function for each gesture. About one-third of the subjects did not use any co-verbal gestures. While the majority of gestures were non-content-carrying, which functioned mainly for reinforcing speech intonation or controlling speech flow, the content-carrying ones were used to enhance speech content. Furthermore, individuals who are younger or linguistically more proficient tended to use fewer gestures, suggesting that normal speakers gesture differently as a function of age and linguistic performance.

Background: Differences in processing nouns and verbs have been investigated intensely in psycholinguistics and neuropsychology in past decades. However, the majority of studies examining retrieval of these word classes have involved tasks of single word stimuli or responses. While the results have provided rich information for addressing issues about grammatical class distinctions, it is unclear whether they have adequate ecological validity for understanding lexical retrieval in connected speech which characterizes daily verbal communication. Previous investigations comparing retrieval of nouns and verbs in single word production and connected speech have reported either discrepant performance between the two contexts with presence of word class dissociation in picture naming but absence in connected speech, or null effects of word class. In addition, word finding difficulties have been found to be less severe in connected speech than picture naming. However, these studies have failed to match target stimuli of the two word classes and between tasks on psycholinguistic variables known to affect performance in response latency and/or accuracy., Aims: The present study compared lexical retrieval of nouns and verbs in picture naming and connected speech from picture description, procedural description, and story-telling among 19 Chinese speakers with anomic aphasia and their age, gender, and education matched healthy controls, to understand the influence of grammatical class on word production across speech contexts when target items were balanced for confounding variables between word classes and tasks., Methods & Procedures: Elicitation of responses followed the protocol of the AphasiaBank consortium (http://talkbank.org/AphasiaBank/). Target words for confrontation naming were based on well-established naming tests, while those for narrative were drawn from a large database of normal speakers. Selected nouns and verbs in the two contexts were matched for age-of-acquisition (AoA) and familiarity. Influence of imageability was removed through statistical control., Outcomes & Results: When AoA and familiarity were balanced, nouns were retrieved better than verbs, and performance was higher in picture naming than connected speech. When imageability was further controlled for, only the effect of task remained significant., Conclusions: The absence of word class effects when confounding variables are controlled for is similar to many previous reports; however, the pattern of better word retrieval in naming is rare but compatible with the account that processing demands are higher in narrative than naming. The overall findings have strongly suggested the importance of including connected speech tasks in any language assessment and evaluation of language rehabilitation of individuals with aphasia.

Phonological access is an important component in theories and models of word reading. However, phonological regularity and consistency effects are not clearly separable in alphabetic writing systems. We investigated these effects in Chinese, where the two variables are operationally distinct. In this orthographic system, regularity is defined as the congruence between the pronunciation of a complex character (or phonogram), and that of its phonetic radical, while phonological consistency indexes the proportion of orthographic neighbors that share the same pronunciation as the phonogram. In the current investigation, regularity and consistency were contrasted in an event-related potential (ERP) study using a lexical decision (LD) task and a delayed naming (DN) task with native Chinese readers. ERP results showed that effects of regularity occurred early after stimulus onset and were long-lasting. Regular characters elicited larger N170, smaller P200, and larger N400 compared to irregular characters. In contrast, significant effects of consistency were only seen at the P200 and consistent characters showed a greater P200 than inconsistent characters. Thus, both the time course and the direction of the effects indicated that regularity and consistency operated under different mechanisms and were distinct constructs. Additionally, both of these phonological effects were only found in the DN task and absent in LD, suggesting that phonological access was non-obligatory for LD. The study demonstrated cross-language variability in how phonological information was accessed from print and how task demands could influence this process.

Problem-based learning (PBL) has been shown to be effective for promoting student competencies in self-directed and collaborative learning, critical thinking, self-reflection and tackling novel situations. However, the need for face-to-face interactions at the same place and time severely limits the potential of traditional PBL. The requirements of space and for meeting at a specific location at the same time create timetabling difficulties. Such limitations need to be tackled before all potentials of PBL learning can be realized. The present study aimed at designing and implementing an online PBL environment for undergraduate speech/language pathology students, and assessing the associated pedagogical effectiveness. A group of eight PBL students were randomly selected to participate in the study. They underwent 4 weeks of online PBL using Adobe Connect. Upon completion of the experiment, they were assessed via a self-reported questionnaire and quantitative comparison with traditional PBL students based on the same written assignment. The questionnaire revealed that all participating students enjoyed online PBL, without any perceived negative effects on learning. Online PBL unanimously saved the students travel time to and from school. Statistical analysis indicated no significant difference in assignment grades between the online and traditional PBL groups, indicating that online PBL learning appears to be similarly effective as traditional face-to-face PBL learning.

This study examined whether the degree of complexity of a grammatical component in a language would impact on its representation in the brain through identifying the neural correlates of grammatical morpheme processing associated with nouns and verbs in Chinese. In particular, the processing of Chinese nominal classifiers and verbal aspect markers were investigated in a sentence completion task and a grammaticality judgment task to look for converging evidence. The Chinese language constitutes a special case because it has no inflectional morphology per se and a larger classifier than aspect marker inventory, contrary to the pattern of greater verbal than nominal paradigmatic complexity in most European languages. The functional imaging results showed BA47 and left supplementary motor area and superior medial frontal gyrus more strongly activated for classifier processing, and the left posterior middle temporal gyrus more responsive to aspect marker processing. We attributed the activation in the left prefrontal cortex to greater processing complexity during classifier selection, analogous to the accounts put forth for European languages, and the left posterior middle temporal gyrus to more demanding verb semantic processing. The overall findings significantly contribute to cross-linguistic observations of neural substrates underlying processing of grammatical morphemes from an analytic and a classifier language, and thereby deepen our understanding of neurobiology of human language.

This study investigated a theoretically challenging dissociation between good production and poor perception of tones among neurologically unimpaired native speakers of Cantonese. The dissociation is referred to as the near-merger phenomenon in sociolinguistic studies of sound change. In a passive oddball paradigm, lexical and nonlexical syllables of the T1/T6 and T4/T6 contrasts were presented to elicit the mismatch negativity (MMN) and P3a from two groups of participants, those who could produce and distinguish all tones in the language (Control) and those who could produce all tones but specifically failed to distinguish between T4 and T6 in perception (Dissociation). The presence of MMN to T1/T6 and null response to T4/T6 of lexical syllables in the dissociation group confirmed the near-merger phenomenon. The observation that the control participants exhibited a statistically reliable MMN to lexical syllables of T1/T6, weaker responses to nonlexical syllables of T1/T6 and lexical syllables of T4/T6, and finally null response to nonlexical syllables of T4/T6, suggests the involvement of top-down processing in speech perception. Furthermore, the stronger P3a response of the control group, compared with the dissociation group in the same experimental conditions, may be taken to indicate higher cognitive capability in attention switching, auditory attention or memory in the control participants. This cognitive difference, together with our speculation that constant top-down predictions without complete bottom-up analysis of acoustic signals in speech recognition may reduce one's sensitivity to small acoustic contrasts, account for the occurrence of dissociation in some individuals but not others.

In the investigation of orthographic representation of Chinese characters, one question that has stimulated much research is whether radicals (character components) are specified for spatial position in a character (e.g., Ding et al., 2004; Tsang and Chen, 2009). Differing from previous work, component or radical position information in this study is conceived in terms of relative frequency across different positions of characters containing it. A lexical decision task in a masked priming paradigm focusing on radicals with preferred position of occurrence was conducted. A radical position that encompasses more characters than other positions was identified to be the preferred position of a particular radical. The prime that was exposed for 96 ms might share a radical with the target in the same or different positions. Moreover, the shared radical appeared either in its preferred or non-preferred position in the target. While response latencies only revealed the effect of graphical similarity, both effects of graphical similarity and radical position preference were found in the event-related potential (ERP) results. The former effect was reflected in greater positivity in occipital P1 and greater negativity in N400 for radicals in different positions in prime and target characters. The latter effect manifested as greater negativity in occipital N170 and greater positivity in frontal P200 in the same time window elicited by radicals in their non-preferred position. Equally interesting was the reversal of the effect of radical position preference in N400 with greater negativity associated with radicals in preferred position. These findings identify the early ERP components associated with activation of position-specific radical representations in the orthographic lexicon, and reveal the change in the nature of competition from processing at the radical level to the lexical level.

This paper reports a conjunction analysis between semantic relatedness judgment and semantic associate generation of Chinese nouns and verbs with concrete or abstract meanings. The results revealed a verb-specific task-independent region in LpSTG&MTG, and task-dependent activation in a left frontal region in semantic judgment and the left SMG in semantic associate production. The observation of word class effects converged on Yu, Law, Han, Zhu, and Bi (2011), but contrasted with null findings in previous reports using a lexical decision task. While word class effects in the left posterior temporal cortices have been described in previous studies of languages with rich inflectional morphology, the significance of this study lies in its demonstration of the effects in these regions in a language known to have little inflectional morphology. In other words, differential neural responses to nouns and verbs can be observed without confounding from morphosyntactic operations or contrasts between actions and objects., (Copyright © 2012 Elsevier Inc. All rights reserved.)

Background: Heart transplantation remains a resource-intensive therapy for children. However, data regarding change in costs over time are scarce. We tested the hypothesis that hospital charges for pediatric heart transplant hospitalizations would increase from 1997 to 2006 and assessed factors associated with hospital charges., Methods: A retrospective analysis of the Healthcare Cost and Utilization Project Kids' Inpatient Database was performed on admissions surrounding heart transplantation for the years 1997, 2000, 2003, and 2006. The database is a nationwide sampling of pediatric hospital discharges and is weighted to provide national estimates., Results: There were 353 (95% confidence interval, 201-505) pediatric heart transplants in 1997 and 355 (95% confidence interval, 226-485) in 2006. Mean hospital charges increased from $279,399 in 1997 to $451,738 in 2006 (p < 0.001). This increase was similar to that observed for other pediatric surgical diseases. Increases also occurred in morbidities, including pulmonary hypertension (p = 0.04) and sepsis (p = 0.04), and in the use of extracorporeal membrane oxygenation (p = 0.03). On multivariable analysis, greater hospital charges were associated with later calendar year (p = 0.001), stroke (p = 0.03), sepsis (p = 0.001), renal failure (p = 0.008), arrhythmia (p = 0.03), and use of extracorporeal membrane oxygenation (p < 0.001) and ventricular assist device (p < 0.001)., Conclusions: From 1997 to 2006, mean charges for pediatric heart transplant hospitalizations increased by > $170,000 (160%). Although greater morbidities in the later years of the study potentially contributed to increased charges, later calendar year was independently associated with increased charges. The changes in charges for heart transplant are similar to the increases seen in other surgical procedures. Ongoing study of management strategies is needed to determine cost-effective therapies for this complex group of patients., (Copyright © 2012 International Society for Heart and Lung Transplantation. Published by Elsevier Inc. All rights reserved.)