Longitudinal changes in brain activation underlying reading fluency

Reading fluency -- the speed and accuracy of reading connected text -- is foundational to educational success. The current longitudinal study investigates the neural correlates of fluency development using a connected-text paradigm with an individualized presentation rate. Twenty-six children completed a functional MRI task in 1st/2nd grade (time 1) and again 1-2 years later (time 2). There was a longitudinal increase in activation in the ventral occipito-temporal (vOT) cortex from time 1 to time 2. This increase was also associated with improvements in reading fluency skills and modulated by individual speed demands. These findings highlight the reciprocal relationship of the vOT region with reading proficiency and its importance for supporting the transition to fluent reading. These results have implications for developing effective interventions to target increased automaticity in reading.

Validation of a Belgian Prediction Model for Patient Encounters at Belgium’s Largest Public Cultural Mass Gathering

Objective: To compare actual patient presentation rates from Belgium’s largest public open-air cultural festival with predictions provided by existing models and the Belgian Plan Risk Manifestations model. Methods: Retrospectively, actual patient presentation rates gathered from the Ghent Festivities (Belgium) during 2013–2019 were compared to predicted patient presentation rates by the Arbon, Hartman, and PRIMA models. Results: During 7 editions, 8673000 people visited the Ghent Festivities; 9146 sought medical assistance resulting in a mean patient presentation rate (PPR) of 1.05. The PRIMA model overestimated the number of patient encounters for each occasion. The other models had a high rate of underprediction. When comparing deviations in predictions between the PRIMA model to the other models, there is a significant difference in the mean deviation (Arbon: T = 0.000, P < 0.0001, r = −0.8701; Hartman: T = 0.000, P < 0.0001, r = −0.869). Conclusion: Despite the differences between the predictions of all 3 models, our results suggest that the PRIMA model is a valid tool to predict patient presentations to IEHS during public cultural MG. However, to substantiate the PRIMA model even further, more research is needed to further validate the model for a broad range of MG.

Frequency-Following Response in Newborns and Infants: A Systematic Review of Acquisition Parameters

Purpose The purpose of this study is to characterize parameters used for frequency-following response (FFR) acquisition in children up to 24 months of age through a systematic review. Method The study was registered in PROSPERO and followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses' recommendations. Search was performed in six databases (LILACS, LIVIVO, PsycINFO, PubMed, Scopus, and Web of Science) and gray literature (Google Scholar, OpenGrey, ProQuest)as well as via manual searches in bibliographic references. Observational studies using speech stimuli to elicit the FFR in infants with normal hearing on the age range from 0 until 24 months were included. No restrictions regarding language and year of publication were applied. Risk of bias was assessed with the Joanna Briggs Institute Critical Appraisal Checklist. Data on stimulus, presentation rate, time window for analysis, number of sweeps, artifact rejection, online filters, stimulated ear, and examination condition were extracted. Results Four hundred fifty-nine studies were identified. After removing duplicates and reading titles and abstracts, 15 articles were included. Seven studies were classified as low risk of bias, seven as moderate risk, and one as high risk. Conclusions There is a consensus in the use of some acquisition parameters of the FFR with speech stimulus, such as the vertical mounting, the use of alternating polarity, a sampling rate of 20000 Hz, and the /da/ synthesized syllable of 40 ms in duration as the preferred stimulus. Although these parameters show some consensus, the results disclosed lack of a single established protocol for FFR acquisition with speech stimulus in infants in the investigated age range.

Epidemiology, clinical features, and histopathology of sarcomas managed in a Haitian cancer clinic.

e23515 Background: Sarcomas are among the least described cancers diagnosed in Haiti. Suboptimal surgery and the unavailability of radiation therapy make their management challenging. The main objective of this study was to present the epidemiology, clinical features and histopathology of sarcomas in the Haitian setting. Methods: A seven-year retrospective study was conducted in the cancer program of Innovating Health International (IHI). We included all patients with clinical or histological diagnosis of sarcoma enrolled from January 1, 2014 to December 31, 2020. Date of first visit, age, gender, stage, anatomical site, histology, outcome as of December 31, 2020 and date of death were the main variables selected for this chart review. Mortality rate and overall survival were also evaluated. Results: One hundred and twenty-two (122) patients with sarcomas were diagnosed and treated during the study period. Their mean age was 43.3 years [range: 15-88] and the sample was 62.3% women and 37.7% men. 49.2% of the patients were less than 40 years of age. Among the cases of sarcomas, 86.9% were soft tissue sarcomas and 13.1% bone sarcomas. The lower limbs (36.9%), abdomen (14.8%), head and neck (13.1%), upper limbs (12.3%) and breasts (7.4%) were the most common locations of the sarcomas. 81% of abdominal/pelvic sarcoma cases (n=21) were in women. The most common histological types (n=94) were fibrosarcoma (15.2%), liposarcoma (10.9%), dermatofibrosarcoma protuberans (8.7%), malignant histiocytofibroma (6.5%), rhabdomyosarcoma (5.4%) and gastrointestinal stromal tumor (5.4%). 19.6% of the patients had metastatic disease. The mortality rate for the study period was 53.3% and 17.2% of the patients were lost to follow-up. The median overall survival was 7.2 months for the cohort and 18.4 months for the treated patients (n=70). Conclusions: The sarcomas seen in this Haitian medical clinic mainly affect the soft tissues of limbs, abdomen and head and neck. There is a strong predominance of female patients and about half of the patients are aged less than 40. Despite a low metastatic presentation rate, the prognosis is poor, likely reflecting both the aggressiveness of this group of diseases and the disparities of outcomes between high-income and low-and-middle-income countries.

Optimizing parameters for using the parallel auditory brainstem response (pABR) to quickly estimate hearing thresholds

Timely assessments are critical to providing early intervention and better hearing and spoken language outcomes for children with hearing loss. To facilitate faster diagnostic hearing assessments in infants, we developed the parallel auditory brainstem response (pABR), which presents randomly timed trains of tone pips at five frequencies to each ear simultaneously. We have shown that the pABR yields high-quality waveforms that are similar to the standard, single-frequency serial ABR but in a fraction of the recording time. While well-documented for standard ABRs, it is yet unknown how presentation rate and level interact to affect responses collected in parallel to random tone pip stimuli. Therefore, in this study we determined the optimal range of parameters for the pABR by recording responses across a range of six presentation rates, each at a low and high stimulus level. We show that a wide range of rates yields robust responses in under 15 minutes, but 40 Hz is the optimal singular presentation rate. Extending the analysis window to include later components of the response offers further time-saving advantages for the temporally broader responses to low frequency tone pips. Perceptual thresholds that subtly change across rate allow for a testing paradigm that easily transitions between rates, which may be useful for quickly estimating thresholds for different configurations of hearing loss. These optimized parameters facilitate expediency and effectiveness of the pABR to estimate hearing thresholds in a clinical setting.

O1 Admission avoidance in tonsillitis and peritonsillar abscess: a prospective national audit during the initial peak of the COVID-19 pandemic

Introduction During the COVID-19 outbreak, the collaborative network for ENT trainees in the UK (INTEGRATE), conducted a multi-centre prospective audit on the management of Tonsillitis and Quinsy. This was in response to the implementation of new COVID-19 specific guidelines released by ENT UK and to explore factors relating to unscheduled re-presentations discharges direct from the Emergency Department (ED). Methods Consecutive patients with suspected tonsillitis or quinsy, aged 18 or over, and referred to ENT in secondary care were eligible for inclusion. Data was collected, using a standardised electronic case report form, relating to patient demographics, COVID-19 status, clinicians’ grade, assessment and interventions. Each case was followed-up for 10 days to assess predictors of unscheduled re-presentation after discharge direct from the ED. Results 83 centres submitted 765 tonsillitis and 416 quinsy cases. 54.4% of tonsillitis cases and 45.3% of quinsy were discharged directly from the ED. 9.6% of tonsillitis and 10.3% of quinsy discharges re-presented within 10 days, compared to 9.7% and 10.6% for those initially admitted. IV steroids were given to 67.0% of tonsillitis patients and 73.6% of quinsy. 77.2% of quinsy patients underwent drainage during their initial presentation, but there was no significant difference in re-presentation rate in those drained vs not-drained (p = 0.85). Univariable logistic regression showed no significant predictors of re-presentation within 10 days. Conclusion Management of tonsillitis and quinsy was affected during the initial peak of the pandemic, with a shift towards outpatient care. Some patients who may previously have been admitted to hospital may be safely discharged from the ED.

P15 Admission avoidance in acute epistaxis: a prospective national audit during the initial peak of the COVID-19 pandemic

Introduction In March 2020, UK epistaxis guidelines were issued incorporating major shifts in standard practice, namely the recommended use of dissolvable products and discharge of patients with non-dissolvable packs. The aim of this audit was to assess patient outcomes following epistaxis care during the initial COVID-19 peak, exploring factors relating to unscheduled re-presentations. Methods A UK-wide prospective multicentre national audit was performed over 12-weeks from 6th April 2020 at ENT departments treating adults with epistaxis. The primary outcome was re-presentation within 10-days. Univariable binary logistic regression analysis was used to identify significant determinants of the primary outcome measure. Results 83 centres from all four UK nations submitted 2,631 cases, the majority of which were Emergency Department (ED) referrals (89.7%). ENT clinicians used a dissolvable intranasal product in 34.7% of patients overall (n = 816/2,351), and in 61.1% of those receiving an intranasal product (n = 816/1,336). 54.6% were discharged from the ED following ENT review. The overall re-presentation rate was 19.5% for ED discharges (n = 245/1,259) and 9.9% for ED admissions (n = 104/1,046). 6.8% of ED discharges and 5.7% of ED admissions were admitted following their re-presentations (n = 86 and 60 respectively). Not being packed by ED clinicians, antiplatelet medications, failed cautery and recent epistaxis treatment were predictors of re-presentation within 10-days. Discussion Re-presentation data were similar to the 2016 UK Epistaxis Audit, however, there was a notable shift towards alternative packing techniques and reduced admission. This highlights that many patients who would previously have necessitated admission may be safely discharged from ED.

Use of Medical Supplies at the Roskilde Festival 2016: A Prospective Observational Study

Introduction: Music festivals are popular events often including camping at the festival site. A mix of music, alcohol, drugs, and limited hygiene increases health risks. This study aimed to assess the use of medical supplies at a major music festival, thereby aiding planning at similar events in the future. Method: The Medical Health Care Organization (MHCO) at Roskilde Festival 2016 (Denmark) collected prospective data on disposable medical supply use and injuries and illnesses presenting to the MHCO. Results: A total of 12,830 patient presentations were registered by the MHCO and a total of 104 different types of disposable medical supplies were used by the MHCO from June 25, 2016 through July 3, 2016. Out of 12,830 cases, 594 individuals (4.6%) had a potential or manifest medical emergency, 6,670 (52.0%) presented with minor injuries, and 5,566 (43.4%) presented with minor illnesses. The overall patient presentation rate (PPR) was 99.0/1,000 attendees and the transport-to-hospital rate (TTHR) was 2.1/1,000 attendees. For medical emergencies, the most frequently used supplies were aluminum rescue blankets (n = 627), non-rebreather masks (n = 121), and suction catheters for an automatic suction unit (ASU) for airway management (n = 83). Most used diagnostic equipment were blood glucose test strips (n = 1,155), electrocardiogram electrodes (n = 960), and urinary test strips (n = 400). The most frequently used personal protection equipment were non-sterile gloves (n = 1,185 pairs) and sterile gloves (n = 189). Conclusion: This study demonstrates a substantial use of disposable medical supplies at a major music festival. The results provide aid for planning similar mass-gathering (MG) events.