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Introduction Communication impairment during mechanical ventilation and prolonged critical illness is extremely frustrating and frightening for patients and increases the risk for miscommunication, misinterpretation, and poor outcomes. The COVID-19 pandemic amplified patient communication impairment in intensive care units. This article presents 3 case examples from the experience of a team of hospital-based speech-language pathologists providing augmentative and alternative communication support resources and services to intensive care unit patients treated for COVID-19 during the first wave of the pandemic. Cases were selected to illustrate the protracted and complex in-hospital and rehabilitative recovery of critically ill patients with COVID-19, necessitating creative problem-solving and nursing collaborations with speech-language pathologists to support patient-provider communication. Clinical Findings The cases demonstrate (1) increased need for bilingual communication resources, (2) impaired cognitive and motor function associated with a variety of post–COVID-19 sequelae including severe critical illness myopathy, and (3) delayed transition to a speaking valve due to the secretion burden. Diagnoses COVID-19 and acute respiratory distress syndrome (all), cerebral microhemorrhage, multi-system organ failure, hypoxic brain injury, altered mental status, seizure, stroke. Interventions Multimodal and progressive augmentative and alternative communication interventions included low-technology strategies and simple communication boards, video language interpretation, tracheostomy speaking strategies, and a video intercom system. Outcomes All patients made progressive gains in communication ability. Conclusion Evaluation by augmentative and alternative communication specialists and progressive intervention from speech-language pathologists in collaboration with intensive care unit nurses can greatly improve patient-provider communication during treatment for and recovery from COVID-19 and other prolonged critical illnesses.

Magnetars are a special subset of the isolated neutron star family, with X-ray and radio emission mainly powered by the decay of their immense magnetic fields. Many attributes of magnetars remain poorly understood: spin-down glitches or the sudden reductions in the star's angular momentum, radio bursts reminiscent of extra-galactic Fast Radio Bursts (FRBs), and transient pulsed radio emission lasting months to years. Here we unveil the detection of a large spin-down glitch event ($|\Delta\nu/\nu| = 5.8_{-1.6}^{+2.6}\times10^{-6}$) from the magnetar SGR~1935+2154 on 2020 October 5 (+/- 1 day). We find no change to the source persistent surface thermal or magnetospheric X-ray behavior, nor is there evidence of strong X-ray bursting activity. Yet, in the subsequent days, the magnetar emitted three FRB-like radio bursts followed by a month long episode of pulsed radio emission. Given the rarity of spin-down glitches and radio signals from magnetars, their approximate synchronicity suggests an association, providing pivotal clues to their origin and triggering mechanisms, with ramifications to the broader magnetar and FRB populations. We postulate that impulsive crustal plasma shedding close to the magnetic pole generates a wind that combs out magnetic field lines, rapidly reducing the star's angular momentum, while temporarily altering the magnetospheric field geometry to permit the pair creation needed to precipitate radio emission., Comment: 51 pages, 3 tables, 8 figures. Accepted for publication in Nature Astronomy

We monitored four supersoft sources - two persistent ones, CAL 83 and MR Vel, and the recent novae YZ Ret (Nova Ret 2020) and V1674 Her (Nova Her 2021) - with NICER. The two persistent SSS were observed with unvaried X-ray flux level and spectrum, respectively, 13 and 20 years after the last observations. Short period modulations of the supersoft X-ray source (SSS) appear where the spectrum of the luminous central source was fully visibl (in CAL 83 and V1674 Her) and were absent in YZ Ret and MR Vel, in which the flux originated in photoionized or shocked plasma, while the white dwarf (WD) was not observable. We thus suggest that the pulsations occur on, or very close to, the WD surface. The pulsations of CAL 83 were almost unvaried after 15 years, including an irregular drift of the $\simeq$67 s period by 2.1 s. Simulations, including previous XMM-Newton data, indicate actual variations in period length within hours, rather than an artifact of the variable amplitude of the pulsations. Large amplitude pulsations with a period of 501.53$\pm$0.30 s were always detected in V1674 Her, as long as the SSS was observable. This period seems to be due to rotation of a highly magnetized WD.We cannot confirm the maximum effective temperature of ($\simeq$145,000 K) previously inferred for this nova, and discuss the difficulty in interpreting its spectrum. The WD appears to present two surface zones, one of which does not emit SSS flux., in press in the Astrophysical Journal