Daniela Plesa Skwerer | Boston University (original) (raw)
Papers by Daniela Plesa Skwerer
People with Williams syndrome (WS) are known to use prosodic devices extensively in conversation ... more People with Williams syndrome (WS) are known to use prosodic devices extensively in conversation and narratives, but their ability to interpret prosody to comprehend speakers' communicative intentions and emotional states has not been investigated systematically. We present findings from three experiments probing sensitivity to lexical stress and to affective prosodic cues
Autism & Developmental Language Impairments, 2019
Background and aims When children hear a novel word, they tend to associate it with a novel rathe... more Background and aims When children hear a novel word, they tend to associate it with a novel rather than a familiar object. The ability to map a novel word to its corresponding referent is thought to depend, at least in part, on language-learning strategies, such as mutual exclusivity and lexical contrast. Although the importance of word learning strategies has been broadly investigated in typically developing children as well as younger children with autism spectrum disorder, who are usually language delayed, there is a paucity of research on such strategies and their role in language learning in school-age children and adolescents with autism spectrum disorder who have failed to develop fluent speech. In this study, we examined the ability of minimally verbal children and adolescents with autism spectrum disorder to learn and retain novel words in an experimental task, as well as the cognitive, language, and social correlates of these abilities. We were primarily interested in the ...
Journal of Intellectual Disability Research, 2016
BackgroundAnecdotal and caregiver reports often highlight the sociability and empathy of children... more BackgroundAnecdotal and caregiver reports often highlight the sociability and empathy of children with Williams syndrome (WS), a genetically based neurodevelopmental disorder characterised by a distinctive, cognitive and social phenotype. Despite these characteristics, people with WS have many difficulties navigating the social world. In this study, we investigated whether the heightened social motivation and empathy demonstrated by children with WS lead to prosocial behaviours such as instrumental helping.MethodsWe compared 2;8 to 5;8 year olds with WS to an age‐matched and developmental quotient‐matched group of children with Down syndrome (DS) and an age‐matched group of typically developing children, in their responses to semi‐structured naturalistic situations designed to elicit empathic and helping behaviours.ResultsChildren with WS showed more empathic concern than both comparison groups towards a person in distress but did not differ from controls in their level of helping b...
Frontiers Research Topics, 2014
Human-animal interactions, Feb 14, 2024
Through the years, the range of services involving animals benefiting people, often described as ... more Through the years, the range of services involving animals benefiting people, often described as "animal-assisted interventions" (AAIs), has been plagued with confusing and inconsistent taxonomy, terminology, and definitions. This has caused difficulties for the delineation of roles of service providers, for the recipients of services, as well as for the preparation, training, and expectations of the animals that work in different roles. It can be argued that these difficulties have compromised the development of the field in terms of establishing agreed standards of practice, qualifications, and competencies and adopting good animal welfare practices. It has also likely limited the base of evidence, as search terms used to access studies are not consistent, and study protocols are difficult to compare, lacking uniformity in terminology. Additionally, the current terminology cannot accommodate the expansion and diversification of programs in recent years, which is likely to continue as the field evolves. Establishing internationally agreed upon uniform taxonomy, terminology, and definitions is crucial to more accurately reflect the key features of different approaches, to define the scope and competencies for different service providers and their animals, to provide transparency about services for recipients, and to ensure the appropriate preparation, training, and support of the animals that work with them. The recommendations in this article are the result of an international work group that convened over the course of two years. The umbrella term animal-assisted services (AAS) is proposed, defined as services that are facilitated, guided or mediated by a health or human service provider or educator, who works with and maintains the welfare of a specially alongside a specially qualifying animal to provide therapeutic, educational, supportive and/or ameliorative processes aimed at enhancing the well-being of humans. AAS are further categorized into three main areas: treatment, education, and support programs. A recommendation for provider-specific terminology is also suggested. The aim of these proposals is to set clear expectations and boundaries for each specialty of practice, without compromising the richness and diversity of each approach. The adoption of this new umbrella term and its categories is intended to improve clarity for all involved in the receipt and delivery of services, as well as for those who study their effects.
Williams syndrome (WS) is a neurodevelopmental condition that occurs as a result of a contiguous ... more Williams syndrome (WS) is a neurodevelopmental condition that occurs as a result of a contiguous deletion of ∼26-28 genes on chromosome 7q11.23. WS is often associated with a distinctive social phenotype characterized by an increased affinity toward processing faces, reduced sensitivity to fear related social stimuli and a reduced ability to form concrete social relationships. Understanding the biological mechanisms that underlie the social phenotype in WS may elucidate genetic and neural factors influencing the typical development of the social brain. In this article, we review available studies investigating the social phenotype of WS throughout development and neuroimaging studies investigating brain structure and function as related to social and emotional functioning in this condition. This review makes an important contribution by highlighting several neuro-behavioral mechanisms that may be a cause or a consequence of atypical social development in WS. In particular, we discuss how distinctive social behaviors in WS may be associated with alterations or delays in the cortical representation of faces, connectivity within the ventral stream, structure and function of the amygdala and how long-and short-range connections develop within the brain. We integrate research on typical brain development and from existing behavioral and neuroimaging research on WS. We conclude with a discussion of how genetic and environmental factors might interact to influence social brain development in WS and how future neuroimaging and behavioral research can further elucidate social brain development in WS. Lastly, we describe how ongoing studies may translate to improved social developmental outcomes for individuals with WS.
doi: 10.3389/fpsyg.2012.00266
Handbook of Pragmatic Language Disorders, 2021
Psychiatry Investigation, 2011
The number of defecting North Koreans has increased considerably since 1995, and by 2009 more tha... more The number of defecting North Koreans has increased considerably since 1995, and by 2009 more than 15,000 defectors had entered South Korea. 1 With the ever-increasing number of North Korean Defectors (NKDs) entering South Korea, helping their successful adaptation to South Korean society has become a major undertaking for the government of South Korea. 2 The mental health of refugees or immigrants has been re
Supplemental material, AUT845563_Lay_Abstract for Do minimally verbal and verbally fluent individ... more Supplemental material, AUT845563_Lay_Abstract for Do minimally verbal and verbally fluent individuals with autism spectrum disorder differ in their viewing patterns of dynamic social scenes? by Daniela Plesa Skwerer, Briana Brukilacchio, Andrea Chu, Brady Eggleston, Steven Meyer and Helen Tager-Flusberg in Autism
aut.sagepub.com It is now well recognized that there is enormous heteroge-neity within the autism... more aut.sagepub.com It is now well recognized that there is enormous heteroge-neity within the autism spectrum disorder (ASD) popula-tion not only in core symptoms but also in co-morbid characteristics (American Psychiatric Association (APA), 2013). The most widely varying co-morbidities include IQ, which can range from profoundly disabled to superior levels of intelligence, and language, which varies from the complete absence of language to intact linguistic functions including vocabulary level and grammatical abilities (Tager-Flusberg et al., 2005). Co-morbid characteristics sometimes travel together, for example, low IQ is associ-ated with limited or absent language, more frequent atypi-cal behaviors, and some medical conditions; however, they are recognized as independent features each of which impact diagnosis, classification, treatment approaches, and long-term prognosis (Doshi-Velez et al., 2014). Recent reports have highlighted the fact that research over the past several decade...
Journal of Autism and Developmental Disorders, 2020
Although pragmatic speech impairments have been found across the autism spectrum, how these manif... more Although pragmatic speech impairments have been found across the autism spectrum, how these manifest in minimally verbal (MV) individuals with autism spectrum disorder (ASD) has not been studied. We compared the pragmatic speech profiles of MV (n=50) and verbally fluent (VF) individuals with ASD (n=50; 6-21 years-old) based on natural language sampling during the Autism Diagnostic Observation Schedule-2. MV individuals with ASD primarily used their speech to agree/acknowledge/disagree, respond to a question, and request. In contrast, the primary pragmatic function used by VF individuals was commenting. Out of the total non-echolalic speech, groups did not differ proportionally in labeling and response to questions. Findings highlight the importance of investigating multiple aspects of pragmatic communication across different conversational partners and contexts.
Journal of Autism and Developmental Disorders, 2019
Numerous studies have investigated the predictors of language in pre-verbal toddlers and verbally... more Numerous studies have investigated the predictors of language in pre-verbal toddlers and verbally fluent children with autism spectrum disorder (ASD). The present study investigated the concurrent relations among expressive language and a set of empirically-selected social communication variables-joint attention, imitation, and play-in a unique sample of 37 minimally verbal (MV) children and adolescents with ASD. Results revealed that imitation and play were significantly correlated with expressive language, even when controlling for non-verbal IQ, but joint attention was not. Imitation was the only predictor variable to reach significance within the regression model. Findings demonstrate that predictors of expressive language vary for subpopulations of the autism spectrum, and have broader implications for intervention design for older, MV individuals with ASD.
Autism, 2019
Attending preferentially to social information in the environment is important in developing soci... more Attending preferentially to social information in the environment is important in developing socio-communicative skills and language. Research using eye tracking to explore how individuals with autism spectrum disorder deploy visual attention has increased exponentially in the past decade; however, studies have typically not included minimally verbal participants. In this study, we compared 37 minimally verbal children and adolescents with autism spectrum disorder with 34 age-matched verbally fluent individuals with autism spectrum disorder in how they viewed a brief video in which a young woman, surrounded by interesting objects, engages the viewer, and later reacts with expected or unexpected gaze-shifts toward the objects. While both groups spent comparable amounts of time looking at different parts of the scene and looked longer at the person than at the objects, the minimally verbal autism spectrum disorder group spent significantly less time looking at the person’s face during...
Autism Research, 2019
The LENA system was designed and validated to provide information about the language environment ... more The LENA system was designed and validated to provide information about the language environment in children 0 to 4 years of age and its use has been expanded to populations with a number of communication profiles. Its utility in children 5 years of age and older is not yet known. The present study used acoustic data from two samples of children with autism spectrum disorders (ASD) to evaluate the reliability of LENA automated analyses for detecting speech utterances in older, school age children, and adolescents with ASD, in clinic and home environments. Participants between 5 and 18 years old who were minimally verbal (study 1) or had a range of verbal abilities (study 2) completed standardized assessments in the clinic (study 1 and 2) and in the home (study 2) while speech was recorded from a LENA device. We compared LENA segment labels with manual ground truth coding by human transcribers using two different methods. We found that the automated LENA algorithms were not successful (<50% reliable) in detecting vocalizations from older children and adolescents with ASD, and that the proportion of speaker misclassifications by the automated system increased significantly with the target-child's age. The findings in children and adolescents with ASD suggest possibly misleading results when expanding the use of LENA beyond the age ranges for which it was developed and highlight the need to develop novel automated methods that are more appropriate for older children.
Human Development, 1998
... Paper. Children's Theory of Mind: An Experiential Interpretation Katherine Nelson,, Dani... more ... Paper. Children's Theory of Mind: An Experiential Interpretation Katherine Nelson,, Daniela Plesa,, Sarah Henseler City University of New York Graduate Center, New York, NY, USA. Address of Corresponding Author. ... 12. Chandler, M., & Hala, S. (1994). ...
Applied Psycholinguistics, 2008
ABSTRACTLanguage samples elicited through a picture description task were recorded from 38 adoles... more ABSTRACTLanguage samples elicited through a picture description task were recorded from 38 adolescents and adults with Williams syndrome (WS) and one control group matched on age, and another matched on age, IQ, and vocabulary knowledge. The samples were coded for use of various types of inferences, dramatic devices, and verbal fillers; acoustic analyses of prosodic features were carried out, and an independent group of judges provided global ratings of the overall expressiveness of the language. In addition, a standardized measure of social adaptive functioning was administered to the parents of the participants with WS. The findings revealed distinctive developmental trends in the use of expressive content and prosodic patterns by adolescents and adults with WS that were not evident among the controls. Ratings of expressiveness by naive judges of the speech samples produced by the participants with WS were related to parent evaluations of adaptive social communication skills; howe...
Toward a feminist developmental …, 2000
For almost two decades, researchers in cognitive development have focused extraordinary attention... more For almost two decades, researchers in cognitive development have focused extraordinary attention on the problem identified as children's developing" theory of mind." Central to this area of research are questions regarding children's understanding of self and others as" ...
International Review of Research in Developmental Disabilities
This book and the individual contributions contained in it are protected under copyright by the P... more This book and the individual contributions contained in it are protected under copyright by the Publisher (other than as may be noted herein). Notices Knowledge and best practice in this field are constantly changing. As new research and experience broaden our understanding, changes in research methods, professional practices, or medical treatment may become necessary. Practitioners and researchers must always rely on their own experience and knowledge in evaluating and using any information, methods, compounds, or experiments described herein. In using such information or methods they should be mindful of their own safety and the safety of others, including parties for whom they have a professional responsibility.
People with Williams syndrome (WS) are known to use prosodic devices extensively in conversation ... more People with Williams syndrome (WS) are known to use prosodic devices extensively in conversation and narratives, but their ability to interpret prosody to comprehend speakers' communicative intentions and emotional states has not been investigated systematically. We present findings from three experiments probing sensitivity to lexical stress and to affective prosodic cues
Autism & Developmental Language Impairments, 2019
Background and aims When children hear a novel word, they tend to associate it with a novel rathe... more Background and aims When children hear a novel word, they tend to associate it with a novel rather than a familiar object. The ability to map a novel word to its corresponding referent is thought to depend, at least in part, on language-learning strategies, such as mutual exclusivity and lexical contrast. Although the importance of word learning strategies has been broadly investigated in typically developing children as well as younger children with autism spectrum disorder, who are usually language delayed, there is a paucity of research on such strategies and their role in language learning in school-age children and adolescents with autism spectrum disorder who have failed to develop fluent speech. In this study, we examined the ability of minimally verbal children and adolescents with autism spectrum disorder to learn and retain novel words in an experimental task, as well as the cognitive, language, and social correlates of these abilities. We were primarily interested in the ...
Journal of Intellectual Disability Research, 2016
BackgroundAnecdotal and caregiver reports often highlight the sociability and empathy of children... more BackgroundAnecdotal and caregiver reports often highlight the sociability and empathy of children with Williams syndrome (WS), a genetically based neurodevelopmental disorder characterised by a distinctive, cognitive and social phenotype. Despite these characteristics, people with WS have many difficulties navigating the social world. In this study, we investigated whether the heightened social motivation and empathy demonstrated by children with WS lead to prosocial behaviours such as instrumental helping.MethodsWe compared 2;8 to 5;8 year olds with WS to an age‐matched and developmental quotient‐matched group of children with Down syndrome (DS) and an age‐matched group of typically developing children, in their responses to semi‐structured naturalistic situations designed to elicit empathic and helping behaviours.ResultsChildren with WS showed more empathic concern than both comparison groups towards a person in distress but did not differ from controls in their level of helping b...
Frontiers Research Topics, 2014
Human-animal interactions, Feb 14, 2024
Through the years, the range of services involving animals benefiting people, often described as ... more Through the years, the range of services involving animals benefiting people, often described as "animal-assisted interventions" (AAIs), has been plagued with confusing and inconsistent taxonomy, terminology, and definitions. This has caused difficulties for the delineation of roles of service providers, for the recipients of services, as well as for the preparation, training, and expectations of the animals that work in different roles. It can be argued that these difficulties have compromised the development of the field in terms of establishing agreed standards of practice, qualifications, and competencies and adopting good animal welfare practices. It has also likely limited the base of evidence, as search terms used to access studies are not consistent, and study protocols are difficult to compare, lacking uniformity in terminology. Additionally, the current terminology cannot accommodate the expansion and diversification of programs in recent years, which is likely to continue as the field evolves. Establishing internationally agreed upon uniform taxonomy, terminology, and definitions is crucial to more accurately reflect the key features of different approaches, to define the scope and competencies for different service providers and their animals, to provide transparency about services for recipients, and to ensure the appropriate preparation, training, and support of the animals that work with them. The recommendations in this article are the result of an international work group that convened over the course of two years. The umbrella term animal-assisted services (AAS) is proposed, defined as services that are facilitated, guided or mediated by a health or human service provider or educator, who works with and maintains the welfare of a specially alongside a specially qualifying animal to provide therapeutic, educational, supportive and/or ameliorative processes aimed at enhancing the well-being of humans. AAS are further categorized into three main areas: treatment, education, and support programs. A recommendation for provider-specific terminology is also suggested. The aim of these proposals is to set clear expectations and boundaries for each specialty of practice, without compromising the richness and diversity of each approach. The adoption of this new umbrella term and its categories is intended to improve clarity for all involved in the receipt and delivery of services, as well as for those who study their effects.
Williams syndrome (WS) is a neurodevelopmental condition that occurs as a result of a contiguous ... more Williams syndrome (WS) is a neurodevelopmental condition that occurs as a result of a contiguous deletion of ∼26-28 genes on chromosome 7q11.23. WS is often associated with a distinctive social phenotype characterized by an increased affinity toward processing faces, reduced sensitivity to fear related social stimuli and a reduced ability to form concrete social relationships. Understanding the biological mechanisms that underlie the social phenotype in WS may elucidate genetic and neural factors influencing the typical development of the social brain. In this article, we review available studies investigating the social phenotype of WS throughout development and neuroimaging studies investigating brain structure and function as related to social and emotional functioning in this condition. This review makes an important contribution by highlighting several neuro-behavioral mechanisms that may be a cause or a consequence of atypical social development in WS. In particular, we discuss how distinctive social behaviors in WS may be associated with alterations or delays in the cortical representation of faces, connectivity within the ventral stream, structure and function of the amygdala and how long-and short-range connections develop within the brain. We integrate research on typical brain development and from existing behavioral and neuroimaging research on WS. We conclude with a discussion of how genetic and environmental factors might interact to influence social brain development in WS and how future neuroimaging and behavioral research can further elucidate social brain development in WS. Lastly, we describe how ongoing studies may translate to improved social developmental outcomes for individuals with WS.
doi: 10.3389/fpsyg.2012.00266
Handbook of Pragmatic Language Disorders, 2021
Psychiatry Investigation, 2011
The number of defecting North Koreans has increased considerably since 1995, and by 2009 more tha... more The number of defecting North Koreans has increased considerably since 1995, and by 2009 more than 15,000 defectors had entered South Korea. 1 With the ever-increasing number of North Korean Defectors (NKDs) entering South Korea, helping their successful adaptation to South Korean society has become a major undertaking for the government of South Korea. 2 The mental health of refugees or immigrants has been re
Supplemental material, AUT845563_Lay_Abstract for Do minimally verbal and verbally fluent individ... more Supplemental material, AUT845563_Lay_Abstract for Do minimally verbal and verbally fluent individuals with autism spectrum disorder differ in their viewing patterns of dynamic social scenes? by Daniela Plesa Skwerer, Briana Brukilacchio, Andrea Chu, Brady Eggleston, Steven Meyer and Helen Tager-Flusberg in Autism
aut.sagepub.com It is now well recognized that there is enormous heteroge-neity within the autism... more aut.sagepub.com It is now well recognized that there is enormous heteroge-neity within the autism spectrum disorder (ASD) popula-tion not only in core symptoms but also in co-morbid characteristics (American Psychiatric Association (APA), 2013). The most widely varying co-morbidities include IQ, which can range from profoundly disabled to superior levels of intelligence, and language, which varies from the complete absence of language to intact linguistic functions including vocabulary level and grammatical abilities (Tager-Flusberg et al., 2005). Co-morbid characteristics sometimes travel together, for example, low IQ is associ-ated with limited or absent language, more frequent atypi-cal behaviors, and some medical conditions; however, they are recognized as independent features each of which impact diagnosis, classification, treatment approaches, and long-term prognosis (Doshi-Velez et al., 2014). Recent reports have highlighted the fact that research over the past several decade...
Journal of Autism and Developmental Disorders, 2020
Although pragmatic speech impairments have been found across the autism spectrum, how these manif... more Although pragmatic speech impairments have been found across the autism spectrum, how these manifest in minimally verbal (MV) individuals with autism spectrum disorder (ASD) has not been studied. We compared the pragmatic speech profiles of MV (n=50) and verbally fluent (VF) individuals with ASD (n=50; 6-21 years-old) based on natural language sampling during the Autism Diagnostic Observation Schedule-2. MV individuals with ASD primarily used their speech to agree/acknowledge/disagree, respond to a question, and request. In contrast, the primary pragmatic function used by VF individuals was commenting. Out of the total non-echolalic speech, groups did not differ proportionally in labeling and response to questions. Findings highlight the importance of investigating multiple aspects of pragmatic communication across different conversational partners and contexts.
Journal of Autism and Developmental Disorders, 2019
Numerous studies have investigated the predictors of language in pre-verbal toddlers and verbally... more Numerous studies have investigated the predictors of language in pre-verbal toddlers and verbally fluent children with autism spectrum disorder (ASD). The present study investigated the concurrent relations among expressive language and a set of empirically-selected social communication variables-joint attention, imitation, and play-in a unique sample of 37 minimally verbal (MV) children and adolescents with ASD. Results revealed that imitation and play were significantly correlated with expressive language, even when controlling for non-verbal IQ, but joint attention was not. Imitation was the only predictor variable to reach significance within the regression model. Findings demonstrate that predictors of expressive language vary for subpopulations of the autism spectrum, and have broader implications for intervention design for older, MV individuals with ASD.
Autism, 2019
Attending preferentially to social information in the environment is important in developing soci... more Attending preferentially to social information in the environment is important in developing socio-communicative skills and language. Research using eye tracking to explore how individuals with autism spectrum disorder deploy visual attention has increased exponentially in the past decade; however, studies have typically not included minimally verbal participants. In this study, we compared 37 minimally verbal children and adolescents with autism spectrum disorder with 34 age-matched verbally fluent individuals with autism spectrum disorder in how they viewed a brief video in which a young woman, surrounded by interesting objects, engages the viewer, and later reacts with expected or unexpected gaze-shifts toward the objects. While both groups spent comparable amounts of time looking at different parts of the scene and looked longer at the person than at the objects, the minimally verbal autism spectrum disorder group spent significantly less time looking at the person’s face during...
Autism Research, 2019
The LENA system was designed and validated to provide information about the language environment ... more The LENA system was designed and validated to provide information about the language environment in children 0 to 4 years of age and its use has been expanded to populations with a number of communication profiles. Its utility in children 5 years of age and older is not yet known. The present study used acoustic data from two samples of children with autism spectrum disorders (ASD) to evaluate the reliability of LENA automated analyses for detecting speech utterances in older, school age children, and adolescents with ASD, in clinic and home environments. Participants between 5 and 18 years old who were minimally verbal (study 1) or had a range of verbal abilities (study 2) completed standardized assessments in the clinic (study 1 and 2) and in the home (study 2) while speech was recorded from a LENA device. We compared LENA segment labels with manual ground truth coding by human transcribers using two different methods. We found that the automated LENA algorithms were not successful (<50% reliable) in detecting vocalizations from older children and adolescents with ASD, and that the proportion of speaker misclassifications by the automated system increased significantly with the target-child's age. The findings in children and adolescents with ASD suggest possibly misleading results when expanding the use of LENA beyond the age ranges for which it was developed and highlight the need to develop novel automated methods that are more appropriate for older children.
Human Development, 1998
... Paper. Children's Theory of Mind: An Experiential Interpretation Katherine Nelson,, Dani... more ... Paper. Children's Theory of Mind: An Experiential Interpretation Katherine Nelson,, Daniela Plesa,, Sarah Henseler City University of New York Graduate Center, New York, NY, USA. Address of Corresponding Author. ... 12. Chandler, M., & Hala, S. (1994). ...
Applied Psycholinguistics, 2008
ABSTRACTLanguage samples elicited through a picture description task were recorded from 38 adoles... more ABSTRACTLanguage samples elicited through a picture description task were recorded from 38 adolescents and adults with Williams syndrome (WS) and one control group matched on age, and another matched on age, IQ, and vocabulary knowledge. The samples were coded for use of various types of inferences, dramatic devices, and verbal fillers; acoustic analyses of prosodic features were carried out, and an independent group of judges provided global ratings of the overall expressiveness of the language. In addition, a standardized measure of social adaptive functioning was administered to the parents of the participants with WS. The findings revealed distinctive developmental trends in the use of expressive content and prosodic patterns by adolescents and adults with WS that were not evident among the controls. Ratings of expressiveness by naive judges of the speech samples produced by the participants with WS were related to parent evaluations of adaptive social communication skills; howe...
Toward a feminist developmental …, 2000
For almost two decades, researchers in cognitive development have focused extraordinary attention... more For almost two decades, researchers in cognitive development have focused extraordinary attention on the problem identified as children's developing" theory of mind." Central to this area of research are questions regarding children's understanding of self and others as" ...
International Review of Research in Developmental Disabilities
This book and the individual contributions contained in it are protected under copyright by the P... more This book and the individual contributions contained in it are protected under copyright by the Publisher (other than as may be noted herein). Notices Knowledge and best practice in this field are constantly changing. As new research and experience broaden our understanding, changes in research methods, professional practices, or medical treatment may become necessary. Practitioners and researchers must always rely on their own experience and knowledge in evaluating and using any information, methods, compounds, or experiments described herein. In using such information or methods they should be mindful of their own safety and the safety of others, including parties for whom they have a professional responsibility.