The Speech & Language Society No Voice (AAC) Challenge

No Voice (AAC) Challenge

On the week of the 6th November 2017 Speech and Language Therapy students took part in a No Voice Challenge. For one day of the week they used a range of Alternative and Augmentative Communication aids instead of speaking with the aim of raising awareness of the importance of Speech and Language Therapy as part of the Giving Voice Campaign. The Regional Communication Aid Service kindly lent us high tech tablets with symbol programmes installed, e trans frames and communication charts. Other AAC approaches adopted included VOCA apps on our phones, symbol apps, signing, writing, alphabet boards and drawing.

Below are some comments from those who took part:

What AAC/ strategies did you use the most?

  • Typing on a laptop/ phone was the easiest by far- hard to imagine how tough it must be for our clients who can’t type if they don’t have the language/literacy/ motor skills.
  • Signing and gestures came naturally to me as I gesture a lot when I speak anyway. When gestures or signing failed, I tended to write. My hands were essential for my ‘voice’. I couldn’t reply anytime someone spoke to me when I had my hands full such as walking down a corridor.
  • The E Trans frame was so difficult! It took such a long time to use. If it was my only means of communication I would say very little and be quite depressed.

 How did you feel?

  • Really frustrated! I feel like that is a word we use a lot but it is TRUE!! Also felt rude when I couldn’t say excuse me/ thank you and people didn’t see me signing. Isolated from conversations.
  • Makes you feel like not bothering because it is so much effort to get your message across.
  • Sometimes I just gave up when communicating because it was so hard. I felt isolated, frustrated and self-conscious. By the end of the day I was emotionally and mentally drained. At 5pm I went home and accidentally fell asleep!
  • When you have nothing and all your contributions are minutes after the original point was made in conversation- frustration builds.

 

How did others react to you?

  • I got bad vibes from some people who I couldn’t say “excuse me” to. Speech therapy students were quite good at waiting for you to finish what you wanted to say but some non-SLTs really weren’t.
  • I was appreciative of people adapting their communication for me e.g. being patient and waiting to respond via my VOCA app.
  • I went to Subway with my order on a whiteboard and they thought I was crazy. They may my order though. It was so time pressured as there was a huge queue behind me.
  • As there was nothing visible about not being able to speak people are surprised when they realise you’re not talking.

 

How did it impact your participation?

  • Conversations often moved so quickly that by the time I had written what I wanted to say the conversation had already moved on. It was so hard trying to convey something complex in a limited time span. I couldn’t do it- I struggled.
  • I couldn’t really contribute in class. A lecturer asked me for an answer and I couldn’t reply.
  • People walked off when I was trying to communicate, I couldn’t get people’s attention without tapping them on the shoulder. It was very hard to participate in group conversations because the conversation would change before I could input. I didn’t realise how quickly people give up trying to have a conversation when you can’t talk back.
  • Anything more than a basic yes/no or good/bad response required writing, gesturing, typing to using an app which takes much longer.
  • People spoke to me less.
  • I couldn’t sing in the shower and small things like that have a big impact!

 

How will this experience influence how you work with clients?

  • When they say they’re tired I can understand why. Giving adequate time means more than you think. Communication difficulties would be a nightmare- lots of strategies were needed.
  • I will give them loads of time to reply and not sit over them like I’m being inpatient. I understand why my non-verbal client didn’t want to use the iPad app- it was so frustrating.
  • I will certainly make sure I am aware of my own body language, pitch etc.
  • I think it’s help me grow in empathy and compassion towards them, experiencing in a really small way just something of how difficult it must be. I’ve grown in respect for how they keep going after understanding a little more of what a challenge having a communication difficulty must be.
  • I can understand more deeply the importance of groups such as NETA where service users can meet others experiencing similar communication difficulties. For me, it really helped being around others who were taking part in the challenge and who could understand the difficulties.

 

We learnt a lot through the No Voice Challenge and would recommend it to anyone working with people with communication difficulties. It has helped us gain a small insight into what life is like for some of our service users. We’d like to thank everyone who sponsored us and helped us raise £532.13 (including Gift Aid at time of writing) for the Percy Hedley Foundation.

Demographics, short-term memory, and aphasia: Insights from the Aphasia Bank

A task that is routinely used by different clinicians (speech & language therapists, psychologists, neurologists) to evaluate the ability of adults with aphasia (the language deficit often associated with stroke) to remember spoken information for a brief period of time is the so-called word-span task. Lists of words that become progressively longer from one list to another are read out to a person. The person has to repeat each list immediately in the same order. Word-span provides clinicians with an insight as to whether short-term memory for language is compromised. Healthy people who do not have aphasia show variable performance in word-span. Demographic factors (age, gender and level of education) have been reported to influence performance on word-span, either favourably or unfavourably. For example, younger adults perform better on word-span than older adults. Also, older adults who are more educated perform better than their less educated peers.

When using word-span clinically to assess individuals, based on knowledge drawn from healthy individuals, some authors suggest that it is advisable to adjust word-span scores for age and/or education. However, very little is known whether the demographic characteristics of people with aphasia (such as age, gender, education) influence performance on word-span in relation to the language abilities they have as a result of their aphasia.

The present retrospective analyses of data from the Aphasia Bank (a shared database of interactions for the study of aphasia), had two aims:

  1. To understand the effects of demographics and language ability (as measured by a standard aphasia test) on word-span.
  2. To understand in more detail whether demographics, and word-span influence particular language abilities such as naming, repetition, spontaneous speech, spoken understanding.

Demographics, language ability (the Western Aphasia Battery, a standard aphasia test) and word-span data from the Aphasia Bank (212 participants) were analysed using regressions. Demographic characteristics were age, education, gender, time-post onset. Time post-onset refers to the length of time since the person had a stroke and has lived with aphasia.

The findings showed that only age and language ability (i.e., performance on the Western Aphasia Battery) predicted performance. Education, gender and time post-onset did not. Older participants performed worse, and participants with less severe aphasia performed better. Importantly, language ability exerted a much greater effect than age. These findings suggest that the effect of brain damage (reflected in language ability) attenuates the role of demographic variables on word-span. Age did not influence scores in naming, repetition and spontaneous speech but did exert a small influence on spoken understanding.

In summary, overall, in chronic aphasia age does not influence language ability, except for a small effect on spoken understanding of language. Education and time post-onset did not affect any of the language measures. There were small effects of gender on spontaneous speech and spoken understanding. Word-span had a prominent influence in all linguistic abilities (but most notably in naming and repetition). This might partially reflect the fact that word-span requires verbal production, but it is in line with previous studies that did not take into account demographic factors. Clinically, the findings suggest that it is more important to adjust for age than education when using word-span.

The present study was carried out in collaboration with Gayle DeDe (Temple University, USA). It was presented at the 54th Academy of Aphasia meeting in Llandudno. We would like to thank ECLS for the financial support to present this study. The authors are greatful for the support of Prof Brian MacWhinney for giving us permission to use Aphasia Bank for this project.

Written by Dr Christos Salis, Lecturer in Speech and Language Sciences

International Aphasia Rehabilitation Conference

City University, London – 14-16 December 2016

Thanks to ECLS postgraduate conference fund for approving my trip to IARC in December 2016. The conference was an excellent opportunity to immerse myself for three days in the world of aphasia research and to network with colleagues from around the world.

I had the opportunity to present my poster on interventions to support internet use for a person with aphasia. Poster sessions were organised so that delegates rotated around posters in small groups, giving me the chance to give a short talk to small groups. Thirty delegates took a copy of the poster and many more took photographs or requested copies by email. Interest was very positive, with many reporting they felt a need for research in the area.

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Anna Caute, Linsey Thiel, Becky Moss, Fiona Menger, and Katie Monelley. A group of early career researchers with an interest in technology to support writing for aphasia.

The conference provided me with the opportunity to discuss my work with people with similar research interests. This included a group of early career researchers working on email writing and technology to support written expression (see picture below), and a Swedish OT with an interest in skills needed for successful Internet use and use of everyday technologies. I also had some interesting discussions with colleagues around measuring informativeness and interest of written narratives which has led to finding and reading recently published papers of great relevance to my PhD. Workshops and talks on the final day were extremely useful for considering some of the issues around designing technology for and with people with aphasia.

Outside of my own work, the conference explored a breadth of issues in aphasia research increasing my knowledge and awareness in many areas. Talks I found most interesting were on the published systematic review on SLT for aphasia after stroke, outcome measurement, group therapy, telerehabilitation, Big Data driven approaches to decision making, predicting recovery using fMRI data, and treatment of depression. There was also a hugely varied and interesting display of posters on each day of the conference.

Finally, the conference dinner was a glittering affair in the St. Pancras Renaissance hotel. This provided the unforgettable experience of a group of aphasia researchers recreating the famous Spice Girls video filmed in the same location. No picture attached to preserve professional dignity.

Written by Fiona Menger, Research Assistant, School of Education, Communication and Language Sciences.

23rd Annual Meeting of Society for Scientific Studies of Reading (SSSR)

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I was given the excellent opportunity to present a poster at the 23rd Annual Meeting of Society for Scientific Studies of Reading (SSSR), which was held in the University of Porto (Faculty of Psychology and Educational Sciences), Portugal, from the 13th to 16th of July. The title of my poster was “Morphology without semantics? The roles of vocabulary knowledge and language exposure in influencing the nature of lexical representations in a rote learning context”.

During the conference, I enjoyed catching up with former schoolmates, and more importantly, making new connections with potential collaborators in Hong Kong and Kuwait. Not only that, attending talks, seminars, and posters related to my work have further inspired me in terms of my current work as well as future research directions. Last, presenting my work to other researchers not only gave me an opportunity to practise communicating my findings to an audience, but it also allowed me to learn from other researchers who were so helpful in giving suggestions about how to analyse my data, specifically certain R codes for data cleaning as well as further pairwise comparisions. I am excited to implement these suggestions in my work!

Overall, it was a very productive and beneficial time for me at the conference. The conference was very well-organised with student volunteers who were always ready to help conference attendees. The lovely sunny weather in Porto certainly helped a lot! I strongly encourage graduate students who are interested in research on literacy, language acquisition, reading, writing, spelling, etc. to attend this conference in the future.

Written by Siti Syuhada Binte Faizal, who is a 3rd-year PhD student in Speech and Language Sciences.

My experiences in Short Term Scientific Mission within the ISCH COST Action IS1406 Enhancing children’s oral language skills across Europe and beyond – a collaboration focusing on interventions for children with difficulties learning their first language

My name is Ana Matic and I am from Zagreb, Croatia. I have a Master’s in Speech and Language Pathology and I currently work in the Laboratory for Psycholinguistic Research at the Department of Speech and Language Pathology at the University of Zagreb. As my wonderful Professor Jelena Kuvac Kraljevic is passionately involved in this COST Action which includes over 30 countries across Europe and three international partner countries, she encouraged me to come and visit Professor James Law here at Newcastle University in order to share experiences and broaden my knowledge.

I must admit at first I was slightly worried about how I will represent our Laboratory and all the work we do. Words scientific and mission in the 4-word title of my visit did not help; you can probably imagine why. Nevertheless, my worries did not last long as I immediately fell in love with the University and all the academic staff which was more than welcoming and pleased to help in every way.

As this COST Action has an aim of enhancing the science in the field, improving the effectiveness of services for children with language impairment (LI) and developing a sustainable network of researchers, I was motivated to present the Croatian contribution on the matter. We all know that there are many services that are being delivered to children with LI out of which some do not meet the preferred criteria of being proven effective and cost-effective. Having that in mind, within the EU project Prerequisites for academic equality: early recognition of language disorders awarded to the Department of Speech and Language Pathology, University of Zagreb (head: Jelena Kuvac Kraljevic, PhD) we developed a Group and Indirect Language Therapy Programme aimed at fostering early literacy in preschool children with LI. It was a carefully designed programme based on the latest empirical findings in the area which involved two groups of four children and also their parents. The programme lasted for 30 sessions, each 45 minutes in duration and covered all the early literacy abilities that form a basis for later development of reading and writing. The programme was indirect in the sense that parents were also actively involved: they watched the group sessions through the one-way mirror, they were educated on the importance of early literacy and given advices on how to help fostering the targeted abilities in the home environment. The pre- and post- comparison of the children’s results achieved on tests measuring literacy and language, as well as the parental responses on the questionnaire given to them in order to gain insight on their thoughts on the therapy provided, led us to the assumption that this programme might indeed be effective. Of course, we should not rush and make final conclusions as there are some obvious disadvantages of the study (e.g., lack of the control group and a rather small cohort), but this is definitely something to be investigated further.

I have to say I am very thankful for being given the opportunity which does not happen that often – to present these findings to the lovely academic audience of Newcastle University. They all gave me stunning ideas and motivated me to explore this further. My one week experience here was informative and enlightening in every way and I will most certainly come back.

I want to seize this opportunity to thank my Professor Jelena Kuvac Kraljevic for always having brilliant and clear visions and pushing me forward, Professor James Law for welcoming me, giving me numerous useful advices and making me a part of the COST Action, and also Frances Hardcastle for so patiently answering all my questions and making this experience run incredibly smoothly.

 

Best to all,

Ana

Newcastle University Speech Therapy Society’s Giving Voice Campaign (13th-15th April 2016)

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In 2010, the Royal College of Speech and Language Therapists started a campaign, Giving Voice, to raise awareness of the importance of Speech and Language Therapy (SLT). 2.5 million people in the UK have Speech, Language and Communication Needs, yet it is still a little-known about profession amongst the general public. This year, Newcastle University’s Speech Therapy Society organised a 3 day Giving Voice Campaign. Students from all stages in the Speech and Language Sciences department got involved and it was a huge success.

Challenging Perceptions on Campus – 250 responses to a survey were analysed and posters were created showing what the general public think about SLT. Comments ranged from “teach people to talk” to “changing lives” and even “I will never forget their gift to my life”.

Pub Quiz and Silent Auction in aid of the Stroke Association – Nearly 100 people descended on a local pub to take part in our pub quiz. We had 14 ‘lots’ up for silent auction throughout the evening. An amazing £255 was raised for the Stroke Association – thank you to everyone who came!

Awareness of Alternative Communication Methods on Campus – a range of alternative communication methods, including Makaton, symbol exchange and pen and paper were provided and members of the public were encouraged to use these methods to ask for a freebie. Many people found it difficult to imagine using these methods as opposed to their voice as their main method of communication, but unfortunately, this is the reality for many people.

Awareness of Swallowing Disorders on Campus – People were drawn to our table for a ‘free drink with a twist’. 1/3 of people experience difficulties swallowing post-stroke and use thickener to increase the consistency of their drinks to ensure swallowing does not threaten life. There were various reactions but a consensus that quality of life would be significantly reduced.

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Silent Flash Mob – Newcastle University’s city campus and Northumberland Street are both bustling main areas in Newcastle and, at 11am, were filled with a range of people going about their daily business. However, attention was diverted to the student wandering around trying to shout, but without any sound. The public changed direction to avoid the student, which struck a chord with many students as this reaction is experienced by a vast number of people with disabilities. With the blow of a whistle, 20 students appeared with large speech bubbles containing facts, quotes and statistics about SLT. Members of the public were seen to bump into each other as they read the bubbles and murmurs of ‘I know someone who had SLT were heard all around. The society then shouted, ‘Speech and Language Therapy transforms lives’, the Giving Voice tagline, and, with another whistle blow, the students disappeared. This demonstration, which lasted less than 2 minutes, drew the attention of the public to SLT and its importance for so many people.

“Without Speech and Language Therapists, I wouldn’t be here” – Service User

“I have learnt a lot about Speech and Language Therapy” – Member of the Public

“Speech and Language Therapy gave me a voice” – Service User

Osborne’s study of speech after stroke, 1833. An early case of evidence based practice?

I was recently doing some reading around to see how long people have been reporting on foreign accent syndrome (FAS) and related matters. I came across a case reported by Jonathan Osborne (1794-1864). He was a Dublin physician, professor of materia medica and surgical pioneer. He reported a case of speech after stroke in the Dublin Journal of Medical and Chemical Science, November 1833. The case was interesting from the point of view of my FAS searches, and wider studies in aphasia, but also had an added angle from the point of view of evidence based practice (EBP). We smugly sit here in 2016 thinking EBP is a recent ‘invention’, forgetting that we wouldn’t be where we are today if people in the past had not been practising it already. So, first a bit on Osborne’s case, then a little light on his therapy practices.

His description is of a 26 year old male, proficient in French, German, Italian, Latin and English and planning to take up medical training. A year prior to Osborne meeting him he had been staying up in the country. He was taking his breakfast after his usual morning swim in the local lake. During breakfast he suffered a stroke (the term then was apoplectic fit). A doctor was summoned. He was bled; and after being ‘subjected to the appropriate treatment’ became ‘restored to his intellects’ after about two weeks. Unfortunately he ‘had the mortification of finding himself deprived of the gift of speech’. He had no paralysis and spoke a variety of syllables fluently, with apparent ease. His speech though was incomprehensible.

To those unaware that he had suffered a stroke, it sounded as if he were talking in a foreign tongue. When he arrived back in Dublin his jargon caused him to be taken as a foreigner in the hotel where he signed in. When he went to Trinity College to visit his friend he was unable to convey whom he wanted to visit to the gatekeeper. He was only able to point to the flat where his friend had lived.

When he came under the care of Osborne he is reported to have been able to understand everything said to him. His written language comprehension was fine – he continued to read the newspaper daily and indicated correctly when tested on the content. His written output was fluent, ‘the words being orthographically correct, but sometimes not in their proper places’. He wrote correct answers to historical question and translated Latin sentences accurately and reported on medical tracts in French.

Arithmetic was accurate too and he could still play a good game of draughts. As Osborne had no knowledge of his pre-stroke musical abilities he was unable to test this in informed detail. The gent could nevertheless remember the tune of ‘God save the king’ (the whole of Ireland at the time was an English colony) and pointed to the ships on the river when played ‘Rule Britannia’.

Alas, despite all this, his spoken output was severely impaired, even though it appeared from efforts to self-correct that he knew his output was errorful. His repetition was confined to uttering certain monosyllables. A range of consonants in isolation were beyond him, even though on trying to utter one he would produce another he had not been able to speak a moment ago.

Osborne gave him some sentences to read aloud – not what today would be a standard aphasia passage – he used an excerpt from the Bylaws of the College of Physicians. Osborne transcribed what he heard — an early endeavour to phonetically transcribe disordered speech after stroke. His rendition of the sentence ‘It shall be in the power of the College to examine or not examine any Licentiate, previously to his admission to a Fellowship as they see fit’ was transcribed by Osborne as ‘And the be what in the tomother of the trothertodoo to majorum or that emidrate ein einkrastrai mestreit to ketra totombreidei to ra fromtreido asthat kekritest’. A repeat reading a few days afterwards elicited: ‘Be mather be in the kondreit of the compestret to samtreis amtreit entreido of deid daf drit des trest’.

Osborne speculated that a principal factor associated with the man’s jargon was his polyglot status – pointing out that several of the syllables here have a distinct German flavour. His speech output apparatus was unable to stably focus on one language, but ranged amongst them all.

This of course is a possible ingredient, but is unlikely to have been the prime factor. It is more likely that he presented either with what nowadays we might term apraxia of speech, conduction aphasia or phonological jargon. These do not require that someone speaks more than one language for them to arise. Certainly in the case in FAS the diagnostic marker is that the accent arises de novo and is not associated with another language which the person speaks, or has spoken. Osborne’s account of how this man was mistaken for a foreigner does, though, illustrate the power of the perceptual impression of the listener to read into a situation a dimension which is, in objective terms, not there.

C.S. Breathnach claimed in an article on the Irish Journal of Medical Science in 2011 that this was definitely conduction aphasia (principally focusing on the poor performance to repetition). Osborne does not offer sufficient detail to clinch a definitive diagnosis or differential diagnosis, so Breathnach’s conclusions are not that strongly supported.

The patient was given the interventions of the day for apoplectic seizures: repeated applications of leeches, a succession of blisters to the nape and occiput, mercurial purgatives and shower baths every morning. But to no avail. Based on his systematic, longitudinal investigation of what the man was, and was not able to accomplish by way of speech, Osborne was able to show that these interventions were unlikely to and did not affect the underlying speech problem.

Instead he prescribed actual speech therapy, basing it on revolutionary thinking for the time, that speech and language were separate processes, that the man did not have ‘loss of memories’ for words because he could not speak them (how could one speculate he had lost the memories of Latin words if he could correctly understand and translate them, Osborne argued). Accordingly therapy focused on actions and capability of ‘performing by means of his voluntary muscles’. He prescribed systematically built up drills (largely following the presumed order of acquisition in childhood) to re-establish basic movements for speech sounds, aiming to make them once more automatic, fluent, ‘with a rapidity almost equal to that of thought’. He also explained how his therapy focused on utterance initial recall and accuracy and what we might nowadays term using alternative routes to activation. He drew the analogy of a musician who cannot access a tune, but having been aided with the first notes his retained learning takes over. Thus his therapy aimed for the ‘faculty of setting the machinery of speech to the beginning of the sentence, trusting to the peculiar memory depending on associate objects for its continuance, and releasing him from the care of pronouncing the individual syllables of which it is composed’.

Given the later clearer transcriptions of the College regulation sentence in Osborne’s report, the therapy appeared to afford great strides forward. ‘It may be in the power of the College to evhavine or not, ariatin any Licentiate seviously to his amission to a spolowship, as they shall think fit’. No doubt cessation of the other treatments may have had a hand in progress too!

A fascinating case from many points of view – but made interesting by the level of detail Osborne was able to proffer on several levels. There is, for the age, a serious attempt to describe the strengths and weakness of the man’s impairments. There is the discussion of his therapeutic reasoning in why the purgatives and so forth would not affect language and a reasoned argument for his alternative methods (supported additionally with data from reports of cases from head injury in the battle of Waterloo). His advocacy of separation of speech and language, of circumscribed lesions associated with specific impairments anticipates by several decades the studies that today are celebrated as establishing these facts. It was a long time before writers reported data from their assessments and conducted longitudinal follow up. Finally, this may be a first report of systematic, explicit, theory based treatment for speech output problems after stroke.

 

Nick Miller

BAAP Conference 2016 (Yiling Chen)

Yiling Chen is an IPhD Phonetics and Phonology student who has kindly written a short account about her recent visit to BAAP.

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It has been a wonderful experience presenting a paper at the 2016 BAAP Colloquium (British Association of Academic Phoneticians) which took place on 30 March — 1 April.

I fully enjoyed this 3-day event where many interesting talks were delivered by active phoneticians from a wide range of areas such as speech and language therapy, speech acquisition, speech technology and forensic science, etc. I have benefited a lot not just from a lively discussion following my presentation, but also from the socialization with other members in which we exchanged our ideas and shared our experience of researching.

I personally think the conference was well organized and very successful. The next colloquium will be held by the University of Kent in 2018. It is worth being a part of it for anyone who endeavors to pursue an academic career in phonetics and speech sciences, particularly graduate students. I believe you will be amazed and inspired by this informative and insightful conference as it has always been. 

Experiences of BAAP Conference 2016 (Dan McCarthy)

My name is Dan McCarthy and I am a second year PhD student in Speech Sciences.

From 30 March to 1 April 2016 I attended in Lancaster the biannual BAAP Conference (BAAP standing for the British Association for Academic Phoneticians). I found this experience to be beneficial in a number of ways:

  1. I had the opportunity of presenting the results of my pilot study to a broad academic audience. The members of BAAP number several hundred and work in a variety of topics related to phonetics (e.g. the production and perception of speech, acoustic analysis, forensic voice profiling, sociolinguistic variation). Presenting my results to such an audience of experts boosted my confidence in my research abilities and in my ability to communicate ideas clearly.
  2. Attending the conference dinner helped me make new contacts in the academic world. In particular, I was able to get advice on what programming languages and statistical packages work best for my area.
  3. My attention was drawn to research publications relevant to my research that I had been unaware of. (This was during my poster presentation.)
  4. I had a number of interesting conversations with researchers engaged in similar areas of interest to my own, which was an enjoyable experience in my own right.
  5. The other presentations at the conference gave me a feel for what research areas are currently being most extensively pursued. This included learning that there appears to be no one in the UK currently researching how to acoustically distinguish the places of articulation of plosive consonants (my own topic), although there are some researchers in the UK investigating the acoustics of somewhat similar consonants (e.g. /s/).
  6. I learnt new information on topics not related to my own, by attending the above-mentioned talks and poster presentations.