Technological aids for the rehabilitation of memory and executive functioning in children and adolescents with acquired brain injury (Review).

Background The use of technology in healthcare settings is on the increase and may represent a cost-effective means of delivering rehabilitation. Reductions in treatment time, and delivery in the home, are also thought to be benefits of this approach. Children and adolescents with brain injury often experience deficits in memory and executive functioning that can negatively affect their school work, social lives, and future occupations. Effective interventions that can be delivered at home, without the need for high-cost clinical involvement, could provide a means to address a current lack of provision. We have systematically reviewed studies examining the effects of technology-based interventions for the rehabilitation of deficits in memory and executive functioning in children and adolescents with acquired brain injury. Objectives To assess the effects of technology-based interventions compared to placebo intervention, no treatment, or other types of intervention, on the executive functioning and memory of children and adolescents with acquired brain injury. Search methods We ran the search on the 30 September 2015. We searched the Cochrane Injuries Group Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL), Ovid MEDLINE(R), Ovid MEDLINE(R) In-Process & Other Non-Indexed Citations, Ovid MEDLINE(R) Daily and Ovid OLDMEDLINE(R), EMBASE Classic + EMBASE (OvidSP), ISI Web of Science (SCI-EXPANDED, SSCI, CPCI-S, and CPSI-SSH), CINAHL Plus (EBSCO), two other databases, and clinical trials registers. We also searched the internet, screened reference lists, and contacted authors of included studies. Selection criteria Randomised controlled trials comparing the use of a technological aid for the rehabilitation of children and adolescents with memory or executive-functioning deficits with placebo, no treatment, or another intervention. Data collection and analysis Two review authors independently reviewed titles and abstracts identified by the search strategy. Following retrieval of full-text manuscripts, two review authors independently performed data extraction and assessed the risk of bias. Main results Four studies (involving 206 participants) met the inclusion criteria for this review. Three studies, involving 194 participants, assessed the effects of online interventions to target executive functioning (that is monitoring and changing behaviour, problem solving, planning, etc.). These studies, which were all conducted by the same research team, compared online interventions against a 'placebo' (participants were given internet resources on brain injury). The interventions were delivered in the family home with additional support or training, or both, from a psychologist or doctoral student. The fourth study investigated the use of a computer program to target memory in addition to components of executive functioning (that is attention, organisation, and problem solving). No information on the study setting was provided, however a speech-language pathologist, teacher, or occupational therapist accompanied participants. Two studies assessed adolescents and young adults with mild to severe traumatic brain injury (TBI), while the remaining two studies assessed children and adolescents with moderate to severe TBI. Risk of bias We assessed the risk of selection bias as low for three studies and unclear for one study. Allocation bias was high in two studies, unclear in one study, and low in one study. Only one study (n = 120) was able to conceal allocation from participants, therefore overall selection bias was assessed as high. One study took steps to conceal assessors from allocation (low risk of detection bias), while the other three did not do so (high risk of detection bias). Primary outcome 1: Executive functioning: Technology-based intervention versus placebo Results from meta-analysis of three studies (n = 194) comparing online interventions with a placebo for children and adolescents with TBI, favoured the intervention immediately post-treatment (standardised mean difference (SMD) -0.37, 95% confidence interval (CI) -0.66 to -0.09; P = 0.62; I2 = 0%). (As there is no 'gold standard' measure in the field, we have not translated the SMD back to any particular scale.) This result is thought to represent only a small to medium effect size (using Cohen’s rule of thumb, where 0.2 is a small effect, 0.5 a medium one, and 0.8 or above is a large effect); this is unlikely to have a clinically important effect on the participant. The fourth study (n = 12) reported differences between the intervention and control groups on problem solving (an important component of executive functioning). No means or standard deviations were presented for this outcome, therefore an effect size could not be calculated. The quality of evidence for this outcome according to GRADE was very low. This means future research is highly likely to change the estimate of effect. Primary outcome 2: Memory One small study (n = 12) reported a statistically significant difference in improvement in sentence recall between the intervention and control group following an eight-week remediation programme. No means or standard deviations were presented for this outcome, therefore an effect size could not be calculated. Secondary outcomes Two studies (n = 158) reported on anxiety/depression as measured by the Child Behavior Checklist (CBCL) and were included in a meta-analysis. We found no evidence of an effect with the intervention (mean difference -5.59, 95% CI -11.46 to 0.28; I2 = 53%). The GRADE quality of evidence for this outcome was very low, meaning future research is likely to change the estimate of effect. A single study sought to record adverse events and reported none. Two studies reported on use of the intervention (range 0 to 13 and 1 to 24 sessions). One study reported on social functioning/social competence and found no effect. The included studies reported no data for other secondary outcomes (that is quality of life and academic achievement). Authors' conclusions This review provides low-quality evidence for the use of technology-based interventions in the rehabilitation of executive functions and memory for children and adolescents with TBI. As all of the included studies contained relatively small numbers of participants (12 to 120), our findings should be interpreted with caution. The involvement of a clinician or therapist, rather than use of the technology, may have led to the success of these interventions. Future research should seek to replicate these findings with larger samples, in other regions, using ecologically valid outcome measures, and reduced clinician involvement.

Development and Evaluation of a Computer-Based, Self-Management Tool for People Recently Diagnosed with Type 2 Diabetes

Aim. The purpose of this study was to develop and evaluate a computer-based, dietary, and physical activity self-management program for people recently diagnosed with type 2 diabetes. 
Methods. The computer-based program was developed in conjunction with the target group and evaluated in a 12-week randomised controlled trial (RCT). Participants were randomised to the intervention (computer-program) or control group (usual care). Primary outcomes were diabetes knowledge and goal setting (ADKnowl questionnaire, Diabetes Obstacles Questionnaire (DOQ)) measured at baseline and week 12. User feedback on the program was obtained via a questionnaire and focus groups. Results. Seventy participants completed the 12-week RCT (32 intervention, 38 control, mean age 59 (SD) years). After completion there was a significant between-group difference in the “knowledge and beliefs scale” of the DOQ. Two-thirds of the intervention group rated the program as either good or very good, 92% would recommend the program to others, and 96% agreed that the information within the program was clear and easy to understand. 
Conclusions. The computer-program resulted in a small but statistically significant improvement in diet-related knowledge and user satisfaction was high. With some further development, this computer-based educational tool may be a useful adjunct to diabetes self-management.

The Development of a Two-Dimensional Transient Catalyst Model for Direct Injection Two-Stroke Applications.

This paper describes the development of a two-dimensional transient catalyst model. Although designed primarily for two-stroke direct injection engines, the model is also applicable to four-stroke lean burn and diesel applications. The first section describes the geometries, properties and chemical processes simulated by the model and discusses the limitations and assumptions applied. A review of the modeling techniques adopted by other researchers is also included. The mathematical relationships which are used to represent the system are then described, together with the finite volume method used in the computer program. The need for a two-dimensional approach is explained and the methods used to model effects such as flow and temperature distribution are presented. The problems associated with developing surface reaction rates are discussed in detail and compared with published research. Validation and calibration of the model is achieved by comparing predictions with measurements from a flow reactor. While an extensive validation process, involving detailed measurements of gas composition and thermal gradients, has been completed, the analysis is too detailed for publication here and is the subject of a separate technical paper.

Three-Dimensional Analysis of Seepage below and around Hydraulic Structures

This paper investigates the problem of seepage under the floor of hydraulic structures considering the compartment of flow that seeps through the surrounding banks of the canal. A computer program, utilizing a finite-element method and capable of handling three-dimensional (3D) saturated–unsaturated flow problems, was used. Different ratios of canal width/differential head applied on the structure were studied. The results produced from the two-dimensional (2D) analysis were observed to deviate largely from that obtained from 3D analysis of the same problem, despite the fact that the porous medium was isotropic and homogeneous. For example, the exit gradient obtained from 3D analysis was as high as 2.5 times its value obtained from 2D analysis. Uplift force acting upwards on the structure has also increased by about 46% compared with its value obtained from the 2D solution. When the canal width/ differential head ratio was 10 or higher, the 3D results were comparable to the 2D results. It is recommended to construct a core of low permeability soil in the banks of canal to reduce the seepage losses, uplift force, and exit gradient.

Probabilistic program analysis for parallelizing compilers

Parallelizing compilers have difficulty analysing and optimising complex code. To address this, some analysis may be delayed until run-time, and techniques such as speculative execution used. Furthermore, to enhance performance, a feedback loop may be setup between the compile time and run-time analysis systems, as in iterative compilation. To extend this, it is proposed that the run-time analysis collects information about the values of variables not already determined, and estimates a probability measure for the sampled values. These measures may be used to guide optimisations in further analyses of the program. To address the problem of variables with measures as values, this paper also presents an outline of a novel combination of previous probabilistic denotational semantics models, applied to a simple imperative language.

International on-line reciprocal peer tutoring to promote modern language development in primary schools

The paper reports data from an on-line peer tutoring project. In the project 78, 9–12-year-old students from Scotland and Catalonia peer tutored each other in English and Spanish via a managed on-line envi- ronment. Significant gains in first language (Catalonian pupils) modern language (Scottish pupils) and attitudes towards modern languages (both Catalonian and Scottish pupils) were reported for the exper- imental group as compared to the control group. Results indicated that pupils tutored each other in using Piagetian techniques of error correction during the project. Error correction provided by tutors to tutees focussed on morph syntaxys, more specifically the correction of verbs. Peer support provided via the on- line environment was predominantly based on the tutor giving the right answer to the tutee. High rates of impact on tutee corrected messages were observed. The implications for peer tutoring initiative taking place via on-line environments are discussed. Implications for policy and practice are explored

Relational architecture description language for software families

Software Product-Line Engineering has emerged in recent years, as an important strategy for maximising reuse within the context of a family of related products. In current approaches to software product-lines, there is general agreement that the definition of a reference-architecture for the product-line is an important step in the software engineering process. In this paper we introduce ADLARS, a new form of architecture Description language that places emphasis on the capture of architectural relationships. ADLARS is designed for use within a product-line engineering process. The language supports both the definition of architectural structure, and of important architectural relationships. In particular it supports capture of the relationships between product features, component and task architectures, interfaces and parameter requirements.

A SPECIFICATION OF A COMPLEX PROGRAMMING LANGUAGE STATEMENT

A formal specification of a complex programming language statement is presented. The subject matter was selected as being typical of the kind confronting a small software house. It is shown that formal specification notations may be applied, with benefit, to 'messy' problems. Emphasis is placed upon producing a specification which is readable by, and useful to a reader not familiar with formal notations.

English Language Education at University: Trends and Challenges in Teaching and Learning Academic Discourse in the UK

This chapter discusses English Language Education at university and highlights a number of trends and their associated challenges in teaching and learning academic discourse. Academic discourse refers to the ways in which language is used by participants in academia. It encompasses written discourse, from article and book publishing, PhD theses to course assignments; spoken discourse, from study groups, tutorials, conference presentations to inaugural lectures; and more recently, computer-mediated discourse, from asynchronous text-based conferencing to academic blogs. The role of English language educators in preparing students and academics for successful participation in these academic events, or the academy, in English is not to be underestimated. Academic communication is not only vital to an individual’s success at university, but to the maintenance and creation of academic communities and to scientific progress itself (Hyland, 2009). This chapter presents an overview of academic discourse and discusses recent issues which have an impact on teaching and learning English at university and discusses their associated challenges: first, the increasing internationalisation of universities. Second, the emergence of a mobile academe in its broadest sense, in which students and academics move across traditional geopolitical, institutional and disciplinary boundaries, is discussed. Third, the growth of UK transnational higher education is examined as a trend which sees academics and students vicariously or otherwise involved in English language teaching and learning. Fourth, the chapter delves into the rapid and ongoing development in technology assisted and online learning. While responding to trends can be difficult, they can also inspire ingenuity. Furthermore, such trends and challenges will not emerge in the same manner in different contexts. The discussion in this chapter is illustrated with examples from a UK context but the implications of the trends and challenges are such that they reach beyond borders.