Treatment for Stuttering in Preschool-Age Children: A Qualitative Document Analysis of Treatment Programs

PURPOSE

The purpose of this study was to identify commonalities and differences between content components in stuttering treatment programs for preschool-age children.

METHOD

In this document analysis, a thematic analysis of the content was conducted of handbooks and manuals describing Early Childhood Stuttering Therapy, the Lidcombe Program, Mini-KIDS, Palin Parent-Child Interaction Therapy, RESTART Demands and Capacities Model Method, and the Westmead Program. First, a theoretical framework defining a content component in treatment was developed. Second, we coded and categorized the data following the procedure of reflexive thematic analysis. In addition, the first authors of the treatment documents have reviewed the findings in this study, and their feedback has been analyzed and taken into consideration.

RESULTS

Sixty-one content components within the seven themes-interaction, coping, reactions, everyday life, information, language, and speech-were identified across the treatment programs. The content component SLP providing information about the child's stuttering was identified across all treatment programs. All programs are multithematic, and no treatment program has a single focus on speech, language, or parent-child interaction. A comparison of the programs with equal treatment goals highlighted more commonalities in content components across the programs. The differences between the treatment programs were evident in both the number of content components that varied from seven to 39 and the content included in each treatment program.

CONCLUSIONS

Only one common content component was identified across programs, and the number and types of components vary widely. The role that the common content component plays in treatment effects is discussed, alongside implications for research and clinical practice.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.25457929.

Stuttering Behavior in a National Age Cohort of Norwegian First-Graders With Down Syndrome

PURPOSE

The aims of this study were to investigate the occurrence of stuttering behavior across time and to evaluate the relationship between stuttering behavior and language ability in children with Down syndrome.

METHOD

A national age cohort of Norwegian first graders with Down syndrome (N = 75) participated in the study. Speech samples from a story-retelling task and a picture book dialogue as well as standardized measures of vocabulary, grammar, and nonverbal mental ability were collected at two time points approximately 5 months apart. Stuttering behavior was evaluated through counting stuttering-like disfluencies and stuttering severity ratings. The relationship between stuttering behavior and language ability was investigated through hierarchical regression analysis.

RESULTS

The participants had stuttering severity ratings ranging from no stuttering behavior to severe and displayed all types of stuttering-like disfluencies. There were significant relationships between stuttering behavior and language ability at the first time point, whereas the relationships were not significant at the second time point. The stuttering severity ratings were significantly predicted by language ability across time, whereas the frequency of stuttering-like disfluencies was not.

CONCLUSIONS

The occurrence of stuttering behavior was high across the measures and time points; however, the relationship between stuttering behavior and language ability varied across these variables. Thus, the nature of the relationship does not seem to follow a strict pattern that can be generalized to all children across time.

Abstract P5-04-20: Targeting CDK4/6 and IGF1R or insulin receptor synergistically inhibits growth of endocrine sensitive and endocrine resistant breast cancers

Estrogen receptor positive (ER+) breast cancers are treated with hormonal therapies such as tamoxifen or aromatase inhibitors. More than 30% of patients with early-stage ER+ breast cancer treated with endocrine therapy will relapse and all patients with metastatic breast cancer expressing ER eventually acquire resistance to hormonal therapy. Endocrine therapy resistant patients therefore require novel therapeutic options. Insulin-like growth factors (IGFs) and insulin signaling via the type I IGF receptor (IGF1R) and insulin receptor (IR) respectively regulate breast cancer biology. Unfortunately, IGF1R targeted therapies failed to show a benefit in prolonging either disease-free or overall survival in clinical trials. In pre-clinical models acquired resistance to tamoxifen results in loss of IGF1R and enhanced sensitivity to IR signaling. Inhibition of mTOR alone relieves the negative feedback loop regulating levels of the adaptor protein IRS-1, which mediates proliferative effects of IGFs and insulin and enhanced phosphorylation of Akt. The ribosomal protein S6 kinase (S6K) phosphorylates IRS-1 on serine residues targeting it for proteasomal degradation, and this negative feedback regulation is important in attenuating IGF and insulin signaling. Cyclin dependent kinases (CDKs) 4 and 6 are required for cell cycle progression. CDK4/6 inhibitors have recently been approved for treatment of ER+, Her2- advanced breast cancers and these such as palbociclib and abemaciclib block phosphorylation of retinoblastoma. IGFs and insulin stimulate cell cycle progression and increase cyclin D1 levels in breast cancers. Therefore, we hypothesized that CDK4/6 inhibition combined with IGF1R or IR targeting, to block mitogenic functions of IGF or insulin signaling, could be a viable therapeutic option in endocrine sensitive and endocrine resistant breast cancer, respectively. Parental MCF-7 and T47D were more sensitive to palbociclib compared to matched cells with acquired resistance to tamoxifen, MCF-7/TamR and T47D/TamR. Palbociclib also blocked IGF-I and insulin stimulated entry into cell cycle leading to G0/G1 arrest in ER+ breast cancer cells. Unlike mTOR inhibitors that upregulated IRS-1 levels leading to increased phosphorylation of Akt through IGF1R/IR, palbociclib did not affect IRS-1 levels and did not enhance phosphorylation of Akt in ER+ breast cancer cells. Combination of palbociclib with an IGF1R inhibitory antibody (huEM164), but not IR antibody (83-7), was better at inhibiting growth of endocrine sensitive MCF-7 and T-47D cells than either drug alone. Further, in a formal synergy study using the method of Chou-Talalay, the combination index of palbociclib and the IGF1R antibody was <1 for MCF-7 parent cells, indicating the two drugs synergistically inhibit growth. Combination of palbociclib with an IR antibody synergistically inhibited the growth of endocrine resistant MCF-7/TamR cells. Our data show that cotrageting CDK4/6 and IGF1R is more effective in endocrine sensitive but cotargeting CDK4/6 and IR is more effective in tamoxifen resistant breast cancer cells. These data indicate that targeting CDK4/6 and IR could be a therapeutic option for patients with endocrine resistant disease.

Citation Format: Hoff K, Sachdev D. Targeting CDK4/6 and IGF1R or insulin receptor synergistically inhibits growth of endocrine sensitive and endocrine resistant breast cancers [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P5-04-20.

Abstract PD4-03: CDK4/6 inhibition blocks effects of IGFs and insulin in estrogen receptor positive and triple negative breast cancers: Implications for cotargeting IGF1R/IR and CDKs

IGF and insulin signaling via the type I insulin-like growth factor receptor (IGF1R) and insulin receptor (IR) respectively, are potent activators of PI3K/Akt/mTOR. Drugs targeting IGF1R and the related IR were tested clinically including in combination with mTOR inhibitors. Inhibition of mTOR was not effective as inhibition of mTOR relieved the negative feedback loop regulating levels of the adaptor protein, insulin receptor substrate 1 (IRS-1), that mediates proliferative effects of IGFs and insulin and rapamycin enhanced phosphorylation of Akt. The ribosomal protein S6 kinase (S6K) phosphorylates IRS-1 on serine residues and targets it for proteasomal degradation and this negative feedback regulation is important in attenuating IGF and insulin signaling. Cyclin dependent kinases (CDKs) 4 and 6 are required for cell cycle progression. CDK4/6 inhibitors have recently been approved for treatment of estrogen receptor positive (ER+), Her2- advanced breast cancers and these CDK4/6 inhibitors such as palbociclib block phosphorylation of retinoblastoma (Rb). IGFs and insulin stimulate cell cycle progression and increase cyclin D1 levels in breast cancers. Therefore, we hypothesized that CDK4/6 inhibition can be combined with IGF1R/IR targeting to block mitogenic functions of IGF/insulin signaling in breast cancer as this would not relieve the negative feedback regulation of IGF and insulin signaling. Herein, we analyzed the effect of palbociclib on IGF-I/insulin signaling, Rb phosphorylation and growth of various subtypes of breast cancer cells. Palbociclib blocked growth of both endocrine sensitive and resistant ER+ breast cancers. Further, ER+ parental MCF-7 and T47D cells that respond to hormonal therapy including tamoxifen, a selective estrogen receptor modulator, were more sensitive to palbociclib compared to matched cells with acquired resistance to tamoxifen. Palbociclib blocked IGF-I and insulin stimulated entry into cell cycle leading to G0/G1 arrest in ER+ breast cancer cells. Further, palbociclib also blocked growth and cell cycle progression of triple negative breast cancer (TNBC) cells. Unlike mTOR inhibitors that upregulated IRS-1 levels leading to increased phosphorylation of Akt through IGF1R/IR, palbociclib did not affect IRS-1 levels and did not enhance phosphorylation of Akt in ER+ and TNBC cells. Further, combination of palbociclib with IGF1R inhibitory antibody was more effective in inhiibiting growth of ER+ breast cancer cells. Our data show that palbociclib can be a potential therapeutic strategy for TNBC and that combining IGF1R/IR inhibitors with palbociclib may be superior to combining them with mTOR inhibitors for ER+ breast cancer.

Citation Format: Sachdev D, Hoff K. CDK4/6 inhibition blocks effects of IGFs and insulin in estrogen receptor positive and triple negative breast cancers: Implications for cotargeting IGF1R/IR and CDKs [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr PD4-03.

Abstract P1-01-16: Performance evaluation of two ready-to-use antibodies under development for the Dako Omnis automated staining platform on breast carcinoma specimens: Anti-estrogen receptor α clone EP1 and anti-progesterone receptor clone PgR 1294

Background: The expression of estrogen receptor alpha (ERα) and progesterone receptor (PR) in breast carcinomas is a strong predictor of the efficacy of hormonal therapy for breast cancer patients as well as providing a degree of prognostic information. Anti-ERα (clone EP1) and anti-PR (clone PgR 1294) configured as FLEX ready-to-use antibodies have been tested on the Dako Omnis automated staining platform. These products are in performance evaluation and are not commercially available. A series of concordance studies were performed to evaluate the performance characteristics of these monoclonal antibodies on breast cancer tissue specimens: anti-ERα clone EP1/Dako Omnis was compared to (a) anti-ERα clone EP1/Autostainer Link 48 (238 specimens) and to (b) anti-ERα clone SP1/Autostainer (116 specimens), and anti-PR clone PgR 1294/Dako Omnis was compared to (a) anti-PR clone PgR 636/Autostainer Link 48 (289 specimens) and to (b) anti-PR clone 16 (Leica Biosystems, Newcastle, UK) (144 specimens). In addition, the specificity of the ER and PR antibodies for Dako Omnis was evaluated on a set of normal tissue specimens.

Methods: Formalin-fixed, paraffin-embedded (FFPE) human breast carcinoma specimens and normal tissues were obtained from commercial providers or local hospitals. The specimens had no associated personal information and were not traceable back to the tissue donors. Tissue pretreatment and immunohistochemical staining were performed using the recommended protocol for each antibody and staining platform. The stained slides were evaluated for nuclear ER or PR expression according to ASCO/CAP guidelines (≥1% cut-off for positive) by pathologists who were blinded from the staining method and specimen ID. The concordance studies included breast cancer specimens covering the clinical range of ER or PR expression with approximately half the specimens in the negative (<1%) category, and at least 10% of the specimens in the weakly positive (≥1 ≤10%) category in each study. Two-sided Wilson Score 95% Confidence Intervals were calculated using JMP software (SAS Institute, USA). For the analytical specificity studies the presence or absence of specific staining in the various normal tissue types was recorded.

Results: High concordance rates were observed with both anti-ERα clone EP1/Dako Omnis and anti-PR clone PgR 1294/Dako Omnis compared to the other ER/PR antibodies, with overall agreement rates exceeding 95% in all of the comparative studies. On a set of normal tissues, specific positive nuclear staining was observed only in tissue types known to express ERα or PR.

Conclusions: Monoclonal antibodies anti-ERα clone EP1 and anti-PR clone PgR 1294 configured as FLEX ready-to-use on Dako Omnis are sensitive and specific assays for detecting estrogen receptor and progesterone receptor in FFPE tissues. In comparison testing for assessment of hormonal receptor status on breast carcinoma specimens, anti-ERα clone EP1/Dako Omnis and anti-PR clone PgR 1294/Dako Omnis were highly concordant with commercially-available ER or PR antibodies.

Citation Format: Viale G, Dell'Orto P, Falzon M, Fält A, Hicks D, Hoff K, Jakobsen K, Jensen LB, Levy YY, McMahon L, Miller K, Russo L. Performance evaluation of two ready-to-use antibodies under development for the Dako Omnis automated staining platform on breast carcinoma specimens: Anti-estrogen receptor α clone EP1 and anti-progesterone receptor clone PgR 1294. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P1-01-16.

SPAG7 is a candidate gene for the periodic fever, aphthous stomatitis, pharyngitis and adenopathy (PFAPA) syndrome

Periodic fever, aphthous stomatitis, pharyngitis and adenopathy (PFAPA) syndrome is an auto-inflammatory disease for which a genetic basis has been postulated. Nevertheless, in contrast to the other periodic fever syndromes, no candidate genes have yet been identified. By cloning, following long insert size paired-end sequencing, of a de novo chromosomal translocation t(10;17)(q11.2;p13) in a patient with typical PFAPA syndrome lacking mutations in genes associated with other periodic fever syndromes we identified SPAG7 as a candidate gene for PFAPA. SPAG7 protein is expressed in tissues affected by PFAPA and has been functionally linked to antiviral and inflammatory responses. Haploinsufficiency of SPAG7 due to a microdeletion at the translocation breakpoint leading to loss of exons 2-7 from one allele was associated with PFAPA in the index. Sequence analyses of SPAG7 in additional patients with PFAPA point to genetic heterogeneity or alternative mechanisms of SPAG7 deregulation, such as somatic or epigenetic changes.

The prevalence of pseudoexfoliation in three separate municipalities of Middle-Norway. A preliminary report

An epidemiological eye study has been performed in three separate municipalities in the county of South-Trøndelag, Norway. The prevalence of pseudoexfoliation syndrome turned out to be 10.2%, 21.0%, and 19.6% in the respective areas, stating beyond doubt that there are considerable geographic variations in the distribution of this syndrome.

Jac1, a mitochondrial J-type chaperone, is involved in the biogenesis of Fe/S clusters in Saccharomyces cerevisiae

A minor Hsp70 chaperone of the mitochondrial matrix of Saccharomyces cerevisiae, Ssq1, is involved in the formation or repair of Fe/S clusters and/or mitochondrial iron metabolism. Here, we report evidence that Jac1, a J-type chaperone of the mitochondrial matrix, is the partner of Ssq1 in this process. Reduced activity of Jac1 results in a decrease in activity of Fe/S containing mitochondrial proteins and an accumulation of iron in mitochondria. Fe/S enzyme activities remain low in both jac1 and ssq1 mutant mitochondria even if normal mitochondrial iron levels are maintained. Therefore, the low activities observed are not solely due to oxidative damage caused by excess iron. Rather, these molecular chaperones likely play a direct role in the normal assembly process of Fe/S clusters.

Saccharomyces cerevisiae ISU1 and ISU2: members of a well-conserved gene family for iron-sulfur cluster assembly

Recent studies in bacteria and eukaryotes have led to the identification of several new genes implicated in the biogenesis of iron-sulfur (Fe/S) cluster-containing proteins. This report focuses on two genes of bakers yeast Saccharomyces cerevisiae, ISU1 and ISU2, which encode homologues to bacterial IscU and NifU, potential iron-binding or cluster-assembly proteins. As with other yeast genes implicated in Fe/S protein assembly, deletion of either ISU1 or ISU2 results in increased accumulation of iron within the mitochondria, loss of activity of the [4Fe-4S] aconitase enzyme, and suppression of oxidative damage in cells lacking cytosolic copper/zinc superoxide dismutase. Both genes are induced in strains expressing an activated allele of Aft1p, the iron-sensing transcription factor, suggesting that they are regulated by the iron status of the cell. Immunoblotting studies using an antibody directed against Escherichia coli IscU reveal that both Isu1p and Isu2p are localized primarily in the mitochondria and that Isu1p is the predominant form expressed under all growth conditions tested. The possible role of the Isu proteins in the assembly and/or repair of Fe/S clusters is discussed.

The effects of schema-based instruction on the mathematical word-problem-solving performance of students with learning disabilities

This study examined the effects of a schema-based direct instruction strategy on the word-problem-solving performance of three third- and fourth-grade students (2 girls, 1 boy) with learning disabilities. An adapted multiple-probe-across-students design was used. Results indicated that the intervention was successful in increasing the percentage of correct solutions to word problems for all 3 students. In addition, maintenance of word-problem solving was seen 2 to 3 weeks after the study. Student interviews indicated that the strategy was beneficial. Further research with different students and problem types (e.g., multistep) and an investigation of the long-term effects of the strategy and its use in novel settings appear warranted.

The middle-Norway eye-screening study. III. The prevalence of capsular glaucoma is influenced by blood-group antigens

The association between blood groups (ABO, Rh, Kell, Duffy) and pseudo-exfoliation syndrome, simple, and capsular glaucoma have been evaluated. The findings were: 1). No statistically significant abnormalities regarding blood group distribution in persons with pseudo-exfoliation syndrome. 2). In contrast to simple glaucoma, capsular glaucoma showed an abnormal distribution in the ABO- and the Kell-system. There was less glaucoma prevalence in the capsular A1-group compared to the O-group (p = 0.013), and less in the K1 negative group compared to the K1 positive one (p = 0.005). This trend was even escalated when combining the two systems: Among the K1 negative persons the glaucoma prevalence was lower in the A1-group compared to the O-group (p = 0.003). In the K1 negative group only 9 of 61 A1-persons developed glaucoma, in contrast to the K1 positive group where 4 of 4 A1-persons had glaucoma. This difference gave p < or = 0.00038, whereas the corresponding difference for the O-groups showed p = 0.65. It is concluded that once a person with blood group A1 has developed pseudo-exfoliation syndrome, the risk that capsular glaucoma will occur is about 7 times higher when that person is K1 positive compared to K1 negative. Perhaps this observation may be used as a prognostic factor for non-glaucomatous PE positive persons.

The middle-Norway eye-screening study. II. Prevalence of simple and capsular glaucoma

In this population-based screening study, dealing with 1941 persons above 64 years of age from three different municipalities, the overall open-angle glaucoma prevalence was found to be 8.3%. The prevalence in the separate areas (7.0%, 8.6%, and 9.5%) were not statistically different. Roughly 30% of the population with pseudo-exfoliation syndrome had glaucoma, and 4.2% had ocular hypertension, whereas the corresponding figures for those without pseudo-exfoliation were 4% and 0.8%, respectively. The high glaucoma rates are partly due to the high pseudo-exfoliation prevalence in the area. The prevalence of the capsular glaucoma increased towards a maximum between 75 and 79 years of age, whereafter the curve declined. This may indicate reduced survival time of glaucomatous patients.

The Middle-Norway eye-screening study. I. Epidemiology of the pseudo-exfoliation syndrome

This is the first population-based PE prevalence study allowing comparison of observations from different geographical areas. The prevalence of the PE syndrome for persons above 64 years of age was found to be 10.2, 21.0 and 19.6% in three municipalities lying distinctly apart. Of 343 married couples the man was PE-positive in 36, the woman in 34, and both in 12 cases. One of the 12 couples was excluded because the spouses were cousins. The observed number of 11 couples is significantly higher (P = 0.022) than expected assuming independent occurrence of PE syndrome. Two homozygote pairs of twins were found in this material, both of them discordant for the presence of PE syndrome. This fact along with the discrepancy between observed and expected numbers of PE positivity in both spouses may indicate environmental influence on the distribution of the syndrome.