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.

Predicting conversion to dementia in a memory clinic: A standard clinical approach compared with an empirically defined clustering method (latent profile analysis) for mild cognitive impairment subtyping

Introduction
Mild cognitive impairment (MCI) has clinical value in its ability to predict later dementia. A better understanding of cognitive profiles can further help delineate who is most at risk of conversion to dementia. We aimed to (1) examine to what extent the usual MCI subtyping using core criteria corresponds to empirically defined clusters of patients (latent profile analysis [LPA] of continuous neuropsychological data) and (2) compare the two methods of subtyping memory clinic participants in their prediction of conversion to dementia.

Methods
Memory clinic participants (MCI, n = 139) and age-matched controls (n = 98) were recruited. Participants had a full cognitive assessment, and results were grouped (1) according to traditional MCI subtypes and (2) using LPA. MCI participants were followed over approximately 2 years after their initial assessment to monitor for conversion to dementia.

Results
Groups were well matched for age and education. Controls performed significantly better than MCI participants on all cognitive measures. With the traditional analysis, most MCI participants were in the amnestic multidomain subgroup (46.8%) and this group was most at risk of conversion to dementia (63%). From the LPA, a three-profile solution fit the data best. Profile 3 was the largest group (40.3%), the most cognitively impaired, and most at risk of conversion to dementia (68% of the group).

Discussion
LPA provides a useful adjunct in delineating MCI participants most at risk of conversion to dementia and adds confidence to standard categories of clinical inference.

On the statistical memory architecture exploration and optimization

The worsening of process variations and the consequent increased spreads in circuit performance and consumed power hinder the satisfaction of the targeted budgets and lead to yield loss. Corner based design and adoption of design guardbands might limit the yield loss. However, in many cases such methods may not be able to capture the real effects which might be way better than the predicted ones leading to increasingly pessimistic designs. The situation is even more severe in memories which consist of substantially different individual building blocks, further complicating the accurate analysis of the impact of variations at the architecture level leaving many potential issues uncovered and opportunities unexploited. In this paper, we develop a framework for capturing non-trivial statistical interactions among all the components of a memory/cache. The developed tool is able to find the optimum memory/cache configuration under various constraints allowing the designers to make the right choices early in the design cycle and consequently improve performance, energy, and especially yield. Our, results indicate that the consideration of the architectural interactions between the memory components allow to relax the pessimistic access times that are predicted by existing techniques.

Evidence of syntactic working memory usage in MEG data

While reading times are often used to measure working memory load, frequency effects (such as surprisal or n-gram frequencies) also have strong confounding effects on reading times. This work uses a naturalistic audio corpus with magnetoencephalographic (MEG) annotations to measure working memory load during sentence processing. Alpha oscillations in posterior regions of the brain have been found to correlate with working memory load in non-linguistic tasks (Jensen et al., 2002), and the present study extends these findings to working memory load caused by syntactic center embeddings. Moreover, this work finds that frequency effects in naturally-occurring stimuli do not significantly contribute to neural oscillations in any frequency band, which suggests that many modeling claims could be tested on this sort of data even without controlling for frequency effects.

Historical Dialogue and Memory in Policing Change: the Case of the Police in Northern Ireland

This paper explores the complex relationship between organisational change and historical dialogue in transitional societies. Using the policing reform process in Northern Ireland as an example, the paper does three things: the first is to explore the ways in which policing changes were understood within the policing organisation and ‘community’ itself. The second is to make use of a processual approach, privileging the interactions of context, process and time within the analysis. Thirdly, it considers this perspective through the relatively new lens of ‘historical dialogue’: understood here as a conversation and an oscillation between the past, present and future through reflections on individual and collective memory. Through this analysis, we consider how members’ understandings of a difficult past (and their roles in it) facilitated and/or impeded the organisations change process. Drawing on a range of interviews with previous and current members of the organisation, this paper sheds new light on how institutions deal with and understand the past as they experience organisational change within the a wider societal transition from conflict to non-violence.

Memory-centric VDF Graph Transformations for Practical FPGA Implementation

Realising memory intensive applications such as image and video processing on FPGA requires creation of complex, multi-level memory hierarchies to achieve real-time performance; however commerical High Level Synthesis tools are unable to automatically derive such structures and hence are unable to meet the demanding bandwidth and capacity constraints of these applications. Current approaches to solving this problem can only derive either single-level memory structures or very deep, highly inefficient hierarchies, leading in either case to one or more of high implementation cost and low performance. This paper presents an enhancement to an existing MC-HLS synthesis approach which solves this problem; it exploits and eliminates data duplication at multiple levels levels of the generated hierarchy, leading to a reduction in the number of levels and ultimately higher performance, lower cost implementations. When applied to synthesis of C-based Motion Estimation, Matrix Multiplication and Sobel Edge Detection applications, this enables reductions in Block RAM and Look Up Table (LUT) cost of up to 25%, whilst simultaneously increasing throughput.

Wounded Spaces: When Planning Degraded Cairo’s Urban Memory

This paper examines the position of planning practices operated under precise guidelines for displaying modernity. Cultivating the spatial qualities of Cairo since the 1970s has unveiled centralised ideologies and systems of governance and economic incentives. I present a discussion of the wounds that result from the inadequate upgrading ventures in Cairo, which I argue, created scars as enduring evidence of unattainable planning methods and processes that undermined its locales. In this process, the paper focuses on the consequences of eviction rather than the planning methods in one of the city’s traditional districts. Empirical work is based on interdisciplinary research, public media reports and archival maps that document actions and procedures put in place to alter the visual, urban, and demographic characteristics of Cairo’s older neighbourhoods against a backdrop of decay to shift towards a global spectacular. The paper builds a conversation about the power and fate these spaces were subject to during hostile transformations that ended with their being disused. Their existence became associated with sores on the souls of its ex-inhabitants, as outward signs of inward scars showcasing a lack of equality and social justice in a context where it was much needed.

Remembering 1916: The Easter Rising, the Somme and the Politics of Memory in Ireland

The year 1916 witnessed two events that would profoundly shape both
politics and commemoration in Ireland over the course of the following
century. Although the Easter Rising and the Battle of the Somme were
important historical events in their own right, their significance also lay
in how they came to be understood as iconic moments in the emergence
of Northern Ireland and the Irish Republic. Adopting an interdisciplinary
approach drawing on history, politics, anthropology and cultural
studies, this volume explores how the memory of these two foundational
events has been constructed, mythologised and revised over the course
of the past century. The aim is not merely to understand how the Rising
and Somme came to exert a central place in how the past is viewed in
Ireland, but to explore wider questions about the relationship between
history, commemoration and memory.

Following instructions in a virtual school: Does working memory play a role?

Accumulating evidence that working memory supports the ability to follow instructions has so far been restricted to experimental paradigms that have greatly simplified the practical demands of performing actions to instructions in everyday tasks. The aim of the present study was to investigate whether working memory is involved in maintaining information over the longer periods of time that are more typical of everyday situations that require performing instructions to command. Forty-two children 7–11 years of age completed assessments of working memory, a real-world following-instructions task employing 3-D objects, and two new computerized instruction-following tasks involving navigation around a virtual school to complete a sequence of practical spoken commands. One task involved performing actions in a single classroom, and the other, performing actions in multiple locations in a virtual school building. Verbal working memory was closely linked with all three following-instructions paradigms, but with greater association to the virtual than to the real-world tasks. These results indicate that verbal working memory plays a key role in following instructions over extended periods of activity.

Language Experience Affects Grouping of Musical Instrument Sounds

Language experience clearly affects the perception of speech, but little is known about whether these differences in perception extend to non-speech sounds. In this study, we investigated rhythmic perception of non-linguistic sounds in speakers of French and German using a grouping task, in which complexity (variability in sounds, presence of pauses) was manipulated. In this task, participants grouped sequences of auditory chimeras formed from musical instruments. These chimeras mimic the complexity of speech without being speech. We found that, while showing the same overall grouping preferences, the German speakers showed stronger biases than the French speakers in grouping complex sequences. Sound variability reduced all participants' biases, resulting in the French group showing no grouping preference for the most variable sequences, though this reduction was attenuated by musical experience. In sum, this study demonstrates that linguistic experience, musical experience, and complexity affect rhythmic grouping of non-linguistic sounds and suggests that experience with acoustic cues in a meaningful context (language or music) is necessary for developing a robust grouping preference that survives acoustic variability.

Perceptual learning of acoustic noise generates memory-evoked potentials

Experience continuously imprints on the brain at all stages of life. The traces it leaves behind can produce perceptual learning [1], which drives adaptive behavior to previously encountered stimuli. Recently, it has been shown that even random noise, a type of sound devoid of acoustic structure, can trigger fast and robust perceptual learning after repeated exposure [2]. Here, by combining psychophysics, electroencephalography (EEG), and modeling, we show that the perceptual learning of noise is associated with evoked potentials, without any salient physical discontinuity or obvious acoustic landmark in the sound. Rather, the potentials appeared whenever a memory trace was observed behaviorally. Such memory-evoked potentials were characterized by early latencies and auditory topographies, consistent with a sensory origin. Furthermore, they were generated even on conditions of diverted attention. The EEG waveforms could be modeled as standard evoked responses to auditory events (N1-P2) [3], triggered by idiosyncratic perceptual features acquired through learning. Thus, we argue that the learning of noise is accompanied by the rapid formation of sharp neural selectivity to arbitrary and complex acoustic patterns, within sensory regions. Such a mechanism bridges the gap between the short-term and longer-term plasticity observed in the learning of noise [2, 4-6]. It could also be key to the processing of natural sounds within auditory cortices [7], suggesting that the neural code for sound source identification will be shaped by experience as well as by acoustics.

Heat Activated Prestressing of Shape Memory Alloys for Active Confinement of Concrete Sections

This paper presents the results from the experimental investigation on heat activated prestressing of Shape Memory Alloy (SMA) wires for active confinement of concrete sections. Active confinement of concrete is found to be much more effective than passive confinement which becomes effective only when the concrete starts to dilate. Active confinement achieved using conventional prestressing techniques often faces many obstacles due to practical limitations. A class of smart materials that has recently drawn attention in civil engineering is the super elastic SMA which has the ability to undergo reversible hysteretic shape change known as the shape memory effect. The shape memory effect of SMAs can be utilized to develop a convenient prestressing technique for active confinement of concrete sections.
In this study a series of experimental tests are conducted to study Heat Activated Prestress (HAP) in SMAs. Three different types of tests are conducted with different loading protocol to determine parameters such as HAP, residual strain after heating and range of strain that can be used for effective active confinement after HAP. Test results show a maximum HAP of about 500 MPa can be achieved after heating and approximately 450MPa is retained at 25oC in specimens pre-strained by 6%. A substantial amount of strain recovery upon unloading and after heating the SMA wires is recorded. About 2.5% elastic strain recovery upon unloading from 6% strain level is observed. In the specimen pre-strained by 6%, a total of 4% strain is recovered when unloaded after heating. A strain range of 3% is found available for effective confinement after HAP. Test results demonstrate that SMAs have unique features that can be intelligently employed in many civil engineering applications including active confinement of concrete sections.

Peace by Piece: (Re) imagining Division in Belfast’s Contested Spaces through Memory

This paper investigates processes and actions of diversifying memories of division in Northern Ireland’s political conflict known as the Troubles. Societal division is manifested in its built fabric and territories that have been adopted by predominant discourses of a fragmented society in Belfast; the unionist east and the nationalist west. The aim of the paper is to explore current approaches in planning contested spaces that have changed over time, leading to success in many cases. The argument is that divided cities, like Belfast, feature spatial images and memories of division that range from physical, clear-cut segregation to manifested actions of violence and have become influential representations in the community’s associative memory. While promoting notions of ‘re-imaging’ by current councils demonstrates a total erasure of the Troubles through cleansing its local collective memory, there yet remains an attempt to communicate a different tale of the city’s socio-economic past, to elaborate its supremacy for shaping future lived memories. Yet, planning Belfast’s contested areas is still suffering from a poor understanding of the context and its complexity against overambitious visions. 

Corrosion Fatigue Behaviour of Laser-welded Shape Memory NiTi Wires in a Simulated Body Fluid

Corrosion fatigue is a fracture process as a consequence of synergistic interactions between the material structure, corrosive environment and cyclic loads/strains. It is difficult to be detected and can cause unexpected failure of engineering components in use. This study reveals a comparison of corrosion fatigue behaviour of laser-welded and bare NiTi wires using bending rotation fatigue (BRF) test coupled with a specifically-designed corrosion cell. The testing medium was Hanks’ solution (simulated body fluid) at 37.5 oC. Electrochemical impedance spectroscopic (EIS) measurement was carried out to monitor the change of corrosion resistance of sample during the BRF test at different periods of time. Experiments indicate that the laser-welded NiTi wire would be more susceptible to the corrosion fatigue attack than the bare NiTi wire. This study can serve as a benchmark for the product designers and engineers to understand the corrosion fatigue behaviour of the NiTi laser weld joint and determine the fatigue life safety factor for NiTi medical devices/implants involving laser welding in the fabrication process.