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Background and objectivesChildren with autism spectrum disorder (ASD) present with distinctive clinical features. No objective laboratory assay has been developed to establish a diagnosis of ASD. Considering the known immunological associations with ASD, immunological biomarkers might enable ASD diagnosis and intervention at an early age when the immature brain has the highest degree of plasticity. This work aimed to identify diagnostic biomarkers discriminating between children with ASD and typically developing (TD) children.MethodsA multicenter, diagnostic case-control study trial was conducted in Israel and Canada between 2014 and 2021. In this trial, a single blood sample was collected from 102 children with ASD as defined in Diagnostic Statistical Manual of Mental Disorders [DSM)-IV (299.00) or DSM-V (299.00)], and from 97 typically developing control children aged 3–12 years. Samples were analyzed using a high-throughput, multiplexed ELISA array which quantifies 1,000 human immune/inflammatory-related proteins. Multiple logistic regression analysis was used to obtain a predictor from these results using 10-fold cross validation.ResultsTwelve biomarkers were identified that provided an overall accuracy of 0.82 ± 0.09 (sensitivity: 0.87 ± 0.08; specificity: 0.77 ± 0.14) in diagnosing ASD with a threshold of 0.5. The resulting model had an area under the curve of 0.86 ± 0.06 (95% CI: 0.811–0.889). Of the 102 ASD children included in the study, 13% were negative for this signature. Most of the markers included in all models have been reported to be associated with ASD and/or autoimmune diseases.ConclusionThe identified biomarkers may serve as the basis of an objective assay for early and accurate diagnosis of ASD. In addition, the markers may shed light on ASD etiology and pathogenesis. It should be noted that this was only a pilot, case-control diagnostic study, with a high risk of bias. The findings should be validated in larger prospective cohorts of consecutive children suspected of ASD.

BackgroundRespiratory syncytial virus (RSV) is a major cause of respiratory infection in children. Despite usually following a consistent seasonal pattern, the 2020-2021 RSV season in many countries was delayed and changed in magnitude. ObjectiveThis study aimed to test if these changes can be attributed to nonpharmaceutical interventions (NPIs) instituted around the world to combat SARS-CoV-2. MethodsWe used the internet search volume for RSV, as obtained from Google Trends, as a proxy to investigate these abnormalities. ResultsOur analysis shows a breakdown of the usual correlation between peak latency and magnitude during the year of the pandemic. Analyzing latency and magnitude separately, we found that the changes therein are associated with implemented NPIs. Among several important interventions, NPIs affecting population mobility are shown to be particularly relevant to RSV incidence. ConclusionsThe 2020-2021 RSV season served as a natural experiment to test NPIs that are likely to restrict RSV spread, and our findings can be used to guide health authorities to possible interventions.

Abstract Background Compared to the many uses of DNA-level testing in clinical oncology, development of RNA-based diagnostics has been more limited. An exception to this trend is the growing use of mRNA-based methods in early-stage breast cancer. Although DNA and mRNA are used together in breast cancer research, the distinct contribution of mRNA beyond that of DNA in clinical challenges has not yet been directly assessed. We hypothesize that mRNA harbors prognostically useful information independently of genomic variation. To validate this, we use both genomic mutations and gene expression to predict five-year breast cancer recurrence in an integrated test model. This is accomplished first by comparing the feature importance of DNA and mRNA features in a model trained on both, and second, by evaluating the difference in performance of models trained on DNA and mRNA data separately. Results We find that models trained on DNA and mRNA data give more weight to mRNA features than to DNA features, and models trained only on mRNA outperform models trained on DNA alone. Conclusions The evaluation process presented here may serve as a framework for the interpretation of the relative contribution of individual molecular markers. It also suggests that mRNA has a distinct contribution in a diagnostic setting, beyond and independently of DNA mutation data.

Primary progressive aphasia (PPA) is a language-led dementia associated with Alzheimer's pathology and fronto-temporal lobar degeneration. Multiple tailored speech and language interventions have been developed for people with PPA. Speech and language therapists/speech-language pathologists (SLT/Ps) report lacking confidence in identifying the most pertinent interventions options relevant to their clients living with PPA during their illness trajectory. The aim of this study was to establish a consensus amongst 15 clinical-academic SLT/Ps on best practice in selection and delivery of speech and language therapy interventions for people with PPA. An online nominal group technique (NGT) and consequent focus group session were held. NGT rankings were aggregated and focus groups video recorded, transcribed, and reflexive thematic analysis undertaken. The results of the NGT identified 17 items. Two main themes and seven further subthemes were identified in the focus groups. The main themes comprised (1) philosophy of person-centredness and (2) complexity. The seven subthemes were knowing people deeply, preventing disasters, practical issues, professional development, connectedness, barriers and limitations, and peer support and mentoring towards a shared understanding. This study describes the philosophy of expert practice and outlines a set of best practice principles when working with people with PPA. Primary progressive aphasia (PPA) describes a group of language led dementias which deteriorate inexorably over time. Providing speech and language therapy for people with PPA is complex and must be person centred and bespoke. This study describes the philosophy of expert practice and outlines a set of best practice principles for speech and language therapists/pathologists working with people with people with PPA. [ABSTRACT FROM AUTHOR]

Although spoken discourse is an outcome prioritised by all stakeholders in aphasia rehabilitation, assessment and treatment of discourse are not routine clinical practice. The small evidence base, varied clinical expertise, multiple barriers in the workplace, and challenges for clients in understanding their altered language abilities all contribute to this situation. These factors need serious consideration when developing a new treatment. Involving intended stakeholders as partners in the development process is recommended. This assists with future implementation by ensuring assessment and treatment are practical, feasible, and acceptable to those who will deliver and undertake it. This paper reports on the coproduction phase of the Linguistic Underpinnings of Narrative in Aphasia (LUNA) research project and describes the levels of partners' involvement, the outcomes and impact of coproduction, and the factors that influenced it. Four partners with aphasia and four speech and language therapists (SLTs) worked with academic team members across a 6-month period to create the LUNA assessment and treatment. Separate sessions were held with partners with aphasia (monthly) and SLTs (fortnightly). Coproduction methods included open discussion, the Someone Who Isn't Me (SWIM) technique (thinking from others' perspectives), low and high fidelity prototypes, flexible brainstorming, card sort, and active experimentation with assessment and treatment tasks. Verbal and written information was presented, shared and documented during each session in supportive formats, and each session summarised as accessible minutes. Partners contributed at consultation, cooperation, and co-learning levels during the coproduction phase. Outcomes included joined-up thinking across assessment-goal setting-treatment-desired outcomes; agreed decisions and content for assessment protocol and treatment manual; clarity on personalised, meaningful, and relevant treatment; therapeutic alliance operationalised in treatment manual; and more. Impacts included increased confidence, self-knowledge, pride, validation, peer support, networking, and benefits to SLTs' services. Coproduction was positively influenced by consistent session structure and conduct, group dynamics, accessible communication methods, active task experimentation, and SWIM technique. Although the process was time and labour intensive, all partners considered this worthwhile. LUNA has exemplified how an inclusive coproduction process can work well despite the language challenges of aphasia. Authors also believe that coproduction with intended users has resulted in products (assessment protocol, treatment manual) that are more practical, feasible, and acceptable to clinicians and clients than if designed by academics alone. This latter claim now needs testing on a wide scale. [ABSTRACT FROM AUTHOR]

Background: Limited data exist on the extent of specific functional sequelae, including acquired communication disorder, among Aboriginal stroke survivors, making planning of multidisciplinary services difficult. Aims: To obtain estimates of the extent and profile of acquired communication disorder in Aboriginal and non- Aboriginal adult stroke survivors in Western Australia and investigate potential disparities in receiving in-hospital speech pathology services among survivors with acquired communication disorder. Methods: Stroke cases surviving their first stroke episode during 2002-2011 were identified using Western Australia-wide person-based linked hospital and mortality data, and their five-year comorbidity profiles determined. The mid-year prevalence of stroke cases with acquired communication disorder was estimated for 2011. Regression methods were used to investigate determinants of receiving speech pathology services among acquired communication disorder cases. Results: Of 14,757 stroke survivors aged 15-79 years admitted in 2002-2011, 33% had acquired communication disorder (22% aphasia/dysphasia) and 777 (5.3%) were Aboriginal. Aboriginal patients were more likely to be younger, live remotely, and have comorbidities. A diagnosis of aphasia was more common in Aboriginal than non-Aboriginal patients 15-44 years (p=0.003). A minimum of 107 Aboriginal and 2324 non-Aboriginal stroke patients with acquired communication disorder lived in Western Australia in 2011. Aboriginal status was not associated with receiving in-hospital speech services among acquired communication disorder patients in unadjusted or adjusted models. Conclusions: The relative youth, geographical distribution, high comorbidity prevalence, and cultural needs of Aboriginal stroke patients with acquired communication disorder should inform appropriate service design for speech pathology and rehabilitation. Innovative models are required to address workforce issues, given low patient volumes. [ABSTRACT FROM AUTHOR]

Background: The goals of people with aphasia should guide service delivery. Services are increasingly influenced by the International Classification of Functioning, Disability and Health (ICF) (WHO, 2001), but little is yet known about whether the goals of people with aphasia span the full spectrum of the ICF. Aims: The purpose of this study was to describe the goals of people with aphasia and to code the goals according to the ICF. Methods & Procedures: A qualitative descriptive research approach was used involving semi-structured in-depth interviews with 50 participants with aphasia post-stroke. Interviews were videotaped and transcribed verbatim and then analysed using qualitative content analysis. The goals of a 30% consecutive subsample were then coded using the ICF. Outcomes & Results: Nine broad categories of goals were identified. Participants with aphasia wanted to return to their pre-stroke life and to communicate not only their basic needs but also their opinions. They also wanted information about aphasia, stroke, and available services; more speech therapy; greater autonomy; and dignity and respect. They identified the importance of engagement in social, leisure, and work activities as well as regaining their physical health. Interestingly, their goals included wanting to help others. Goals could be linked to all ICF components within the ICF, with the majority linked to Activities and Participation, followed by Environmental Factors, Body Functions and Structures, and Personal Factors. Conclusions: People with aphasia in this study were able to articulate a wide range of goals post-stroke that encompassed all of the ICF components but had a particular focus on the Activity and Participation components. [ABSTRACT FROM AUTHOR]

Background: Previous research into metaphoric expression has suggested that metaphor offers a window into intra-individual conceptions as well as into socio-cultural understandings of illness and recovery. This study explored how people with aphasia, their family members, and their speech-language pathologists described their experiences of rehabilitation through the linguistic resource of metaphor. Aims: This study aimed to compare the perspectives of five people with aphasia, five of their family members, and their eight treating speech-language pathologists by analysing the way they used the linguistic resource of metaphor to describe their experience of aphasia therapy. Methods & Procedures: Interviews with five people with aphasia, five of their family members, and their eight speech-language pathologists were recorded, transcribed, and coded for metaphoric expressions and concepts. Outcomes & Results: Quantitatively across all participants, the metaphorical concepts of JOURNEY, BATTLE, and PRODUCT were the most frequently used metaphoric concepts expressed by the participants. Qualitatively within sets of participants, differences in the patterns of use of metaphoric concepts indicated important contrasts in the way they viewed their experiences. Conclusions: The frequent use of JOURNEY metaphor accorded with previous research into recovery, while the identification of BATTLE and PRODUCT metaphor was suggested to point to critical sites reflecting social disempowerment. Attention to the use of metaphoric expression may offer clinicians a window into how others involved in the collaborative therapy process are constructing their experience. [ABSTRACT FROM AUTHOR]

Background: A life-coaching and positive psychology approach to aphasia has recently been advocated by Audrey Holland, to whom this issue is dedicated. Aims: This paper reviews our recent research which informs the three basic assumptions behind a life-coaching approach to aphasia: (1) learning to live successfully with aphasia takes time; (2) aphasia is a family problem; and (3) the goal is to help people with aphasia fit it into their lives. Methods & Procedures: We assimilate results from three independent qualitative data sets: (1) a project that sought the perspective of 50 people with aphasia, their families, and their treating speech-language pathologist about their goals over time; (2) a project that seeks the views of 25 people with aphasia, their family, and speech-language pathologists about what it means to live successfully with aphasia; and (3) a qualitative structured interview on quality of life with 30 people with aphasia. Outcomes & Results: The three basic assumptions of the life-coaching approach to aphasia are supported and extended by the data. Participants with aphasia in our studies report how their goals change over time to reflect how they are learning to live with aphasia, but the journey is different for each person. The stories from families elucidate how aphasia is indeed a family concern and requires family involvement. Finally, not only did participants in our studies fit aphasia into their lives, but they also fitted it into a new lifestyle after their stroke. Conclusions: The assumptions behind the life-coaching approach are well supported by the narratives of people living with aphasia. Even if the life-coaching approach is not adopted wholeheartedly by the profession, the principles of positive psychology and the life goal perspective appear highly relevant to living successfully with aphasia. [ABSTRACT FROM AUTHOR]

This article uses the medium of clinicians' comments and stories to explore their perceptions of therapeutic relationships and how these relationships come to a close at discharge from aphasia therapy. These narratives are drawn from a qualitative, grounded theory study carried out in South Australia and Northern Territory involving semi-structured interviews with 30 speech pathologists. The stories reported here shed light on the complexities of negotiating boundaries and endings to therapeutic relationships. Interviewees discussed the special nature of their relationships with their clients with aphasia, professional distance, and dependence. Exploration of these narratives is timely because of the increasing emphasis on person-centeredness in rehabilitation, shared decision making, and authentic relationships. This work is important to encourage reflective practice and greater insight into both speech pathologists' professional identities and their therapeutic relationships. [ABSTRACT FROM AUTHOR]

Background: The aphasiology literature contains very little on how therapy ends. However, the events surrounding discharge are complex and are an integral part of therapy as a whole. Aims: This article focuses on how people with aphasia view their discharge from therapy in order to shed some light on this rarely explored issue. Methods & Procedures: This research is based on the results of a larger qualitative study that explored the experiences of treatment termination for both clients and speech pathologists. This paper draws on in-depth interviews with 21 people with aphasia and 16 family members. Data collection and analysis were carried out using principles and techniques of grounded theory. Outcomes & Results: Interviewees' narratives of discharge reflected three broad influences: their biographies, their notions of recovery, and their feelings about their aphasia therapy. This paper summarises interviewees' perceptions on why they were discharged, how it happened, and how they felt about it. Conclusions: Despite the individual circumstances of each person's account, a common finding was uncertainty and confusion surrounding discharge. Clients were not always sure why therapy ended. They rarely discussed it with their therapists in much depth and often felt unable to question their therapists' decisions. This paper argues that such findings reflect the disempowered position of our clients with aphasia and that a more open, shared process of decision making would not only be more satisfactory for all parties but also demonstrate better outcomes of therapy itself. [ABSTRACT FROM AUTHOR]

Despite a considerable literature on assessment and treatment issues in aphasiology, little has been written about how therapy ends. We lack detail about how clinicians decide to terminate treatment and about how patients and carers view leaving therapy. This paper explores experiences and perceptions of aphasia treatment termination. It uses in-depth interview data gathered in South Australia as part of a doctoral study with a speech pathologist, three ex-patients with aphasia and one spouse. This case study allows comparison of client and professional narratives to each other and also to the official discharge documentation in the medical file. The discharge process arising from this analysis is discussed. [ABSTRACT FROM AUTHOR]

Hurricane Bob, a category 3 storm, made landfall on Cape Cod in August 1991, and its effects on watersheds and adjoining estuaries were detected in the ongoing studies being carried out as part of the Waquoit Bay Land Margin Ecosystems Research project. On land, Bob had onlyminor overall effects on forests; localized wind bursts did snap andbreak trees in small and widely scattered forest parcels. Wind stripped up to half the leaves of deciduous trees and many herbaceous plants on the watershed, and most remaining leaves were damaged by salt, so that by the end of Aug, Cape Cod forests were defoliated. Damaged growing tips of exposed trees were evident for several growing seasons. The salt exposure was followed by a burst of growth and bloom in some plants during Sep--Oct. Forest invertebrates were disturbed by the storm. Nests of hornets and wasps, for example, were apparently destroyed and the survivors became a serious pest problem: hospital records show a ten-fold increase in cases of wasp stings just after Bob. Populations of these insects did not return to earlier abundance for several years. Birds and mammals did not appear to have suffered muchdamage. Leaching of salt to soils released previously-adsorbed soil ammonium. Such loss of critical nitrogen may be in part responsible for the characteristically dwarfed near-shore coastal forests, as wellas adds nitrogen to groundwater that in turn transports the nitrogento receiving waters. On the Bay, Bob thoroughly mixed the water column, but the stratification was restored within 1--2 days after passage of the storm. Short recovery times might be characteristic of shallow bays with short (2--3 d) water residence times. Bob opened a new inlet to Waquoit Bay, which remains open. The new inlet exerts only minor effects on circulation within the Bay, but did create localized damage to dune and eelgrass habitats near the new inlet. The mixing ofthe water column released major amounts of nutrients that were held within [ABSTRACT FROM AUTHOR]