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ObjectiveTo describe the similarities and differences in the evaluation and treatment of multisystem inflammatory syndrome in children (MIS-C) at hospitals in the US.Study designWe conducted a cross-sectional survey from June 16 to July 16, 2020, of US children's hospitals regarding protocols for management of patients with MIS-C. Elements included characteristics of the hospital, clinical definition of MIS-C, evaluation, treatment, and follow-up. We summarized key findings and compared results from centers in which >5 patients had been treated vs those in which ≤5 patients had been treated.ResultsIn all, 40 centers of varying size and experience with MIS-C participated in this protocol survey. Overall, 21 of 40 centers required only 1 day of fever for MIS-C to be considered. In the evaluation of patients, there was often a tiered approach. Intravenous immunoglobulin was the most widely recommended medication to treat MIS-C (98% of centers). Corticosteroids were listed in 93% of protocols primarily for moderate or severe cases. Aspirin was commonly recommended for mild cases, whereas heparin or low molecular weight heparin were to be used primarily in severe cases. In severe cases, anakinra and vasopressors frequently were recommended; 39 of 40 centers recommended follow-up with cardiology. There were similar findings between centers in which >5 patients vs ≤5 patients had been managed. Supplemental materials containing hospital protocols are provided.ConclusionsThere are many similarities yet key differences between hospital protocols for MIS-C. These findings can help healthcare providers learn from others regarding options for managing MIS-C.

Purpose: This study aimed to evaluate a novel communication system designed to translate surface electromyographic (sEMG) signals from articulatory muscles into speech using a personalized, digital voice. The system was evaluated for word recognition, prosodic classification, and listener perception of synthesized speech. Method: sEMG signals were recorded from the face and neck as speakers with (n = 4) and without (n = 4) laryngectomy subvocally recited (silently mouthed) a speech corpus comprising 750 phrases (150 phrases with variable phrase-level stress). Corpus tokens were then translated into speech via personalized voice synthesis (n = 8 synthetic voices) and compared against phrases produced by each speaker when using their typical mode of communication (n = 4 natural voices, n = 4 electrolaryngeal [EL] voices). Naïve listeners (n = 12) evaluated synthetic, natural, and EL speech for acceptability and intelligibility in a visual sort-and-rate task, as well as phrasal stress discriminability via a classification mechanism. Results: Recorded sEMG signals were processed to translate sEMG muscle activity into lexical content and categorize variations in phrase-level stress, achieving a mean accuracy of 96.3% (SD = 3.10%) and 91.2% (SD = 4.46%), respectively. Synthetic speech was significantly higher in acceptability and intelligibility than EL speech, also leading to greater phrasal stress classification accuracy, whereas natural speech was rated as the most acceptable and intelligible, with the greatest phrasal stress classification accuracy. Conclusion: This proof-of-concept study establishes the feasibility of using subvocal sEMG-based alternative communication not only for lexical recognition but also for prosodic communication in healthy individuals, as well as those living with vocal impairments and residual articulatory function.

RET fusions are oncogenic drivers of various tumors, including non-small cell lung cancers (NSCLC). The safety and antitumor activity of the multikinase RET inhibitor RXDX-105 were explored in a phase I/Ib trial. A recommended phase II dose of 275 mg fed daily was identified. The most common treatment-related adverse events were fatigue (25%), diarrhea (24%), hypophosphatemia (18%), maculopapular rash (18%), and nonmaculopapular rash (17%). In the phase Ib cohort of RET inhibitor-naïve patients with RET fusion-positive NSCLCs, the objective response rate (ORR) was 19% (95% CI, 8%-38%, n = 6/31). Interestingly, the ORR varied significantly by the gene fusion partner (P < 0.001, Fisher exact test): 0% (95% CI, 0%-17%, n = 0/20) with KIF5B (the most common upstream partner for RET fusion-positive NSCLC), and 67% (95% CI, 30%-93%, n = 6/9) with non-KIF5B partners. The median duration of response in all RET fusion-positive NSCLCs was not reached (range, 5 to 18+ months). SIGNIFICANCE: Although KIF5B-RET is the most common RET fusion in NSCLCs, RET inhibition with RXDX-105 resulted in responses only in non-KIF5B-RET-containing cancers. Novel approaches to targeting KIF5B-RET-containing tumors are needed, along with a deeper understanding of the biology that underlies the differential responses observed.This article is highlighted in the In This Issue feature, p. 305.

Purpose: This study aimed to evaluate a novel communication system designed to translate surface electromyographic (sEMG) signals from articulatory muscles into speech using a personalized, digital voice. The system was evaluated for word recognition, prosodic classification, and listener perception of synthesized speech. Method: sEMG signals were recorded from the face and neck as speakers with (n = 4) and without (n = 4) laryngectomy subvocally recited (silently mouthed) a speech corpus comprising 750 phrases (150 phrases with variable phrase-level stress). Corpus tokens were then translated into speech via personalized voice synthesis (n = 8 synthetic voices) and compared against phrases produced by each speaker when using their typical mode of communication (n = 4 natural voices, n = 4 electrolaryngeal [EL] voices). Naive listeners (n = 12) evaluated synthetic, natural, and El speech for acceptability and intelligibility in a visual sort-and-rate task, as well as phrasal stress discriminability via a classification mechanism. Results: Recorded sEMG signals were processed to translate sEMG muscle activity into lexical content and categorize variations in phrase-level stress, achieving a mean accuracy of 96.3% (SD = 3.10%) and 91.2% (SD = 4.46%), respectively. Synthetic speech was significantly higher in acceptability and intelligibility than EL speech, also leading to greater phrasal stress classification accuracy, whereas natural speech was rated as the most acceptable and intelligible, with the greatest phrasal stress classification accuracy. Conclusion: This proof-of-concept study establishes the feasibility of using subvocal sEMG-based alternative communication not only for lexical recognition but also for prosodic communication in healthy individuals, as well as those living with vocal impairments and residual articulatory function. Supplemental Material: https://doi.org/10.23641/asha. 14558481, Augmentative and alternative communication (AAC) systems enable those with limited speech production capabilities to input physical gestures or text, which may then be visually displayed and/or acoustically synthesized to support [...]

The article presents a study which evaluated the impact of a transplant pharmacy diabetes clinic on the management of post-transplant diabetes in kidney and liver transplant recipients. Topics discussed include baseline characteristics of the patients, outcomes evaluated before and after the pharmacy consultation, and evaluation of drugs or drug classes used before and after the pharmacy consultation.

Users of augmentative and alternative communication (AAC) aids could benefit from novel methods for accelerating access to contextually relevant vocabulary. This paper describes our initial efforts toward improving access to situational vocabulary through the use of geographic context to predict vocabulary. A corpus of spoken data produced by one able-bodied male speaker across various locations was collected and used to mine location-specific vocabulary clusters. We describe the data mining algorithm and illustrate how context-driven vocabulary organization and prediction can be integrated into an iconic communication system. Correlations between user and algorithm-generated vocabulary patterns highlight discrepancies between actual versus perceived frequency statistics. Thus, device customization may be achieved through a hybrid human-algorithmic approach to vocabulary selection. Endowing the communication aid with knowledge about the user's location-specific vocabulary patterns may help to balance the burden of communication between the system and the user to yield substantial gains in accessing situationally appropriate vocabulary which may in turn accelerate communication rate. (Contains 3 figures and 4 tables.)

Research on AAC symbols has focused almost exclusively on iconicity and complexity, and thus has not established whether additional visual features are necessary for conveying meaning in graphic representations. Despite variations in individual depictions of an "apple," we understand the underlying concept due to shared consensus on the set of necessary visual elements. This initial investigation examined 25 concepts depicted in Picture Communication Symbols (PCS) in terms of a diverse set of visual features and principles. Additionally, seven artists drew the same concepts to determine whether patterns emerged across artist groups and within semantically related concepts. While visual profiles of PCS and artists' renditions differed for most concepts, they were identical for some concrete concepts. Additionally, common patterns were noted for semantically related concepts. These findings suggest that a broader set of visual features may be useful for analyzing how meaning is conveyed in existing AAC symbol sets and for developing novel symbols. (Contains 4 tables and 5 figures.)

Two prototype voice output communication aids were implemented to compare methods of graphic symbol message formulation; one emulated current devices that require syntactical ordering of icons (Default) and the other used semantic frames (iconCHAT). Message constructions of eight typically developing children (7-10 years of age) using both prototypes were compared in terms of accuracy, speed, complexity, and preference. Although there were slight differences in speed, all participants formulated equally complex and grammatically accurate sentences using both prototypes. These findings demonstrate that semantic frame-based message formulation may be a viable alternative to conventional methods based on syntax. Future research to assess whether these findings extend to children who use AAC is warranted. Outcomes and benefits of semantic composition are particularly relevant for children with emerging grammatical skills since semantic schemas provide scaffolding for constructing complete utterances that may in turn foster increased self-confidence and improved perceptions of communicative competence. (Contains 2 tables and 5 figures.)

This article presents a novel AAC communication aid based on semantic rather than syntactic schema, leading to more natural message construction. Users interact with a two-dimensional spatially organized image schema, which depicts the semantic structure and contents of the message. An overview of the interface design is presented followed by discussion of its implications and limitations. Potential benefits of the new design include more fluid, expressive and efficient face-to-face communication for individuals with severe speech and motor impairments across a broad range of ages and linguistic abilities. (Contains 5 figures.)

Purpose: To compare vowel acoustics and intelligibility in words produced with and without contrastive stress by speakers with spastic (mixed-spastic) dysarthria secondary to cerebral palsy (DYS[subscript CP]) and healthy controls (HCs). Method: Fifteen participants (9 men, 6 women; age M = 42 years) with DYS[subscript CP] and 15 HCs (9 men, 6 women; age M = 36 years) produced sentences containing target words with and without contrastive stress. Forty-five healthy listeners (age M = 25 years) completed a vowel identification task of DYS[subscript CP] productions. Vowel acoustics were compared across stress conditions and groups using 1st (F1) and 2nd (F2) formant measures. Perceptual intelligibility was compared across stress conditions and dysarthria severity. Results: F1 and F2 significantly increased in stressed words for both groups, although the degree of change differed. Mean Euclidian distance between vowels also increased with stress. The relative probability of vowels falling within the target F1 × F2 space was greater for HCs but did not differ with stress. Stress production resulted in greater listener vowel identification accuracy for speakers with mild dysarthria. Conclusions: Contrastive stress affected vowel formants for both groups. Perceptual results suggest that some speakers with dysarthria may benefit from a contrastive stress strategy to improve vowel intelligibility.

Although tongue twisters have been widely use to study speech production in healthy speakers, few studies have employed this methodology for individuals with speech impairment. The present study compared tongue twister errors produced by adults with dysarthria and age-matched healthy controls. Eight speakers (four female, four male; mean age = 54.5 years) with spastic (mixed-spastic) dysarthria of varying aetiology (cerebral palsy, multiple sclerosis, multiple system atrophy) and eight controls (four female, four male; mean age = 56.9 years) were audio-recorded producing tongue twisters. One word in each tongue twister was marked for prominence. Speakers with dysarthria produced significantly more errors and spoke slower than healthy controls. The effect of prominence was significant for both groups--words spoken with prosodic prominence were significantly less error prone compared with words without prominence. While both groups produced most errors on words in the third position (of four-word utterances), speakers with dysarthria also produced high rates of errors on the first and fourth words. This preliminary investigation demonstrated the promise of applying the tongue twister paradigm to speakers with dysarthria and contributes to the evidence base for the implementation of prosodic strategies in speech intervention.