Filling the Gap: Development of Best Practice Guidelines to Support Speech-Language Pathologists Working with Autistic Clients

Speech-language pathologists (SLPs) are among the most important clinicians involved in providing assessment and therapy services for autistic children. Yet, a study found that 60% of graduate students in speech-language pathology only had one week of coursework that focused on autism. Our project aims to address this gap, by working with SLPs working in the community to create a best-practice-guidelines web-based tool SLPs can use to supplement their learning and inform their decision-making when assessing and providing support for autistic individuals. We used three phases to incorporate research and expert opinions to answer the question “What are considered best-practices when providing SLP services to autistic clients?”. In Phase 1, 48 documents were reviewed and main themes were extracted to create a policy-informed framework. In Phase 2, a targeted literature review of 134 documents was conducted for the main themes extracted in Phase 2. In Phase 3, 5 interviews were conducted with community SLPs from the Ontario Association of Speech-Language Pathologists and Audiologists’ Autism Interest Group. An additional 53 documents were reviewed based on feedback from the clinicians. The multi-phase review yielded four major themes. SLPs’ assessment and intervention practices should be inclusive, diversified, collaborative and individualized. Clinical recommendations aligned with each theme are provided within the best-practice guidelines document. Next steps for the web-based tool include the development of a knowledge hub and tools to support dissemination and implementation and the examination of impact on client outcomes

Evaluating The Effectiveness of Speech-Language Pathology Interventions for Autistic Children and Youth

Speech-language pathologists (SLPs) play a crucial role in the delivery of support services for autistic children and youth by improving outcomes such as language, communication and social interaction. However, a recent systematic review of assessment and intervention practices found a paucity of clinical guideline documents aiding SLPs in the provision of services to autistic individuals (Choi, Cardy & Binns, submitted). Our project aims to support the development of a guidance document that uses a co-production model approach to best meet the needs of autistic persons. We are using a three-pronged approach incorporating research, community input and partnerships with autistic self-advocates and parents. This project narrows in on the research aspect of the project, by conducting an umbrella review of existing interventions delivered by SLPs to explore the efficacy of SLP delivered Autism interventions. A total of 3138 articles were screened by two reviewers (L.D., L.C.), 271 articles underwent full-text review and 38 studies met inclusion criteria. Data extraction and quality appraisal are still being conducted at this time. Results of the review will be integrated with community input to inform the development of evidence-based intervention recommendations within the guidance document

Bullous dermatoses secondary to anti-PD-L1 agents: a case report and review of the literature

Immune checkpoint inhibitors are used to treat numerous malignancies but may be associated with severe adverse events. Bullous dermatoses, chiefly bullous pemphigoid (BP), are potentially progressive adverse events that cause blistering skin lesions and may involve a significant body surface area. Herein, we report an 87-year-old man with urothelial cell carcinoma undergoing atezolizumab treatment who presented with an acute-onset blistering eruption. Biopsy revealed a subepidermal bulla, direct immunofluorescence revealed linear IgG and C3 deposits at the dermal-epidermal junction, and serum studies revealed elevated levels of antibodies to BP180 and BP230. Anti-PD-L1-induced BP was diagnosed, immunotherapy was withheld, and he was treated with oral doxycycline with niacinamide and clobetasol ointment. He restarted atezolizumab and has successfully received four cycles (every 3 weeks) while continuing this BP treatment regimen. A literature review revealed eight other cases of anti-PD-L1-induced bullous disorders. The incidence of bullous dermatoses with anti-PD-1/anti-PD-L1 agents combined is 1%, whereas the reported incidence for anti-PD-L1 agents alone ranges from 1.3-5%, raising concerns for a higher overall risk. In addition to our case, only one other case reported successful resumption of immunotherapy. Early control and management of immunotherapy-induced BP may reduce complications and prevent treatment discontinuation

Regionalization of Hydrologic Response in the Great Lakes Basin: Considerations of Temporal Scales of Analysis

Methods for predicting streamflow in areas with limited or nonexistent measures of hydrologic response commonly rely on regionalization techniques, where knowledge pertaining to gauged watersheds is transferred to ungauged watersheds. Hydrologic response indices have frequently been employed in contemporary regionalization research related to predictions in ungauged basins. In this study, we developed regionalization models using multiple linear regression and regression tree analysis to derive relationships between hydrologic response and watershed physical characteristics for 163 watersheds in the Great Lakes basin. These models provide an empirical means for simulating runoff in ungauged basins at a monthly time step without implementation of a rainfall-runoff model. For the dependent variable in these regression models, we used monthly runoff ratio as the indicator of hydrologic response and defined it at two temporal scales: (1) treating all monthly runoff ratios as individual observations and (2) using the mean of these monthly runoff ratios for each watershed as a representative observation. Application of the models to 62 validation watersheds throughout the Great Lakes basin indicated that model simulations were far more sensitive to the temporal characterization of hydrologic response than to the type of regression technique employed, and that models conditioned on individual monthly runoff ratios (rather than long term mean values) performed better. This finding is important in light of the increased usage of hydrologic response indices in recent regionalization studies. Models using individual observations for the dependent variable generally simulated monthly runoff with reasonable skill in the validation watersheds (median Nash-Sutcliffe efficiency = 0.53, median R2 = 0.66, median absolute value of deviation of runoff volume = 13%). These results suggest the viability of empirical 3 approaches to simulate runoff in ungauged basins. This finding is significant given the many regions of the world with sparse gaging networks and limited resources for gathering the field data required to calibrate rainfall-runoff models

Atypical Teratoid/Rhabdoid Tumors in Adults: A Case Report and Treatment-Focused Review

Atypical teratoid/rhabdoid tumor is predominantly a childhood tumor and has only been rarely reported in adults; therefore, treatment regimens are often extrapolated from the pediatric experience. Typically, children are treated with craniospinal radiation therapy which is often followed by systemic chemotherapy. Employing pediatric regimens to treat this tumor in adult patients poses a particular risk for myelosuppression, as the prescribed doses in pediatric protocols exceed those tolerated by adults, and conventional craniospinal radiation can be associated with prolonged myelotoxicity and a depletion of the bone marrow reserve in vertebrae of adults. Here we present a case of a woman with a pineal region atypical teratoid/rhabdoid tumor, an unusual adult cancer presenting in an atypical location. This is followed by a review of the disease in adult patients with an emphasis on treatment and suggestions to minimize myelotoxicity

Walking in multiple sclerosis improves with tDCS: a randomized, double‐blind, sham‐controlled study

Objective: To evaluate whether multiple sessions of transcranial direct current stimulation (tDCS) applied to the primary motor (M1) cortex paired with aer- obic exercise can improve walking functions in multiple sclerosis (MS). Meth- ods: MS participants were recruited for a double-blind, parallel-arm, randomized, sham-controlled trial and assigned to 10 sessions (5 d/wk for 2 weeks) of either active or sham tDCS paired with unloaded cycling for 20 minutes. Stimulation was administered over the left M1 cortex (2.5 mA; anode over C3/cathode over FP2). Gait spatiotemporal parameters were assessed using a wearable inertial sensor (10-meter and 2-minute walking tests). Mea- surements were collected at baseline, end of tDCS intervention, and 4-week postintervention to test for duration of any benefits. Results: A total of 15 par- ticipants completed the study, nine in the active and six in the sham condition. The active and sham groups were matched according to gender (50% vs. 40% female), neurologic disability (median EDSS 5.5 vs. 5), and age (mean 52.1 ! 12.9 vs. 53.7 ! 9.8 years). The active group had a significantly greater increase in gait speed (0.87 vs. 1.20 m/s, p < 0.001) and distance covered dur- ing the 2-minute walking test (118.53 vs. 133.06 m, p < 0.001) at intervention end compared to baseline. At 4-week follow-up, these improvements were maintained (baseline vs. follow-up: gait speed 0.87 vs. 1.18 m/s, p < 0.001; dis- tance traveled 118.53 vs. 143.82 m, p < 0.001). Interpretation: Multiple ses- sions of tDCS paired with aerobic exercise lead to cumulative and persisting mprovements in walking and endurance in patients with MS

Effectiveness of the Relaxation Response-Based Group Intervention for Treating Depressed Chinese American Immigrants: A Pilot Study

Background:: This study examined the feasibility, safety and efficacy of an 8-week Relaxation Response (RR)-based group. Methods:: Twenty-two depressed Chinese American immigrants were recruited. Outcomes measures were response and remission rates, the Hamilton Rating Scale for Depression, Clinical Global Impressions Scale, Quality of Life Enjoyment and Satisfaction Questionnaire, and the Multidimensional Scale of Perceived Social Support Scale. Results: Participants (N = 22) were 82% female, mean age was 53 (±12). After intervention, completers (N = 15) showed a 40% response rate and a 27% remission rate, and statistically significant improvement in most outcome measures. Discussion: The RR-based group is feasible and safe in treating Chinese American immigrants with depression

Metacognition Is Necessary for the Emergence of Motivation in People With Schizophrenia Spectrum Disorders: A Necessary Condition Analysis

Metacognition deficits are a putative cause of reduced motivation in people with schizophrenia spectrum disorders. However, it is unclear whether certain levels of metacognition are necessary for motivation to emerge. This study used a Necessary Condition Analysis (NCA) to test whether metacognition was necessary for the presence of motivation and to identify the minimum level of metacognition necessary for high motivation to be possible in people with schizophrenia spectrum disorders (N=175). Participants completed clinician-rated measures of metacognition and motivation. NCA revealed that metacognition is a necessary condition for motivation and that high levels of motivation were only possible, although not guaranteed, when at least a basic level of metacognition was present. Findings suggest that metacognition is a necessary building block for the development of motivation. Results suggest that targeting metacognition may be essential for improving motivation among people with schizophrenia spectrum disorders who do not meet this metacognition threshold

AbGRI4, a novel antibiotic resistance island in multiply antibiotic-resistant Acinetobacter baumannii clinical isolates.

OBJECTIVES: To investigate the genomic context of a novel resistance island (RI) in multiply antibiotic-resistant Acinetobacter baumannii clinical isolates and global isolates. METHODS: Using a combination of long and short reads generated from the Oxford Nanopore and Illumina platforms, contiguous chromosomes and plasmid sequences were determined. BLAST-based analysis was used to identify the RI insertion target. RESULTS: Genomes of four multiply antibiotic-resistant A. baumannii clinical strains, from a US hospital system, belonging to prevalent MLST ST2 (Pasteur scheme) and ST281 (Oxford scheme) clade F isolates were sequenced to completion. A class 1 integron carrying aadB (tobramycin resistance) and aadA2 (streptomycin/spectinomycin resistance) was identified. The class 1 integron was 6.8 kb, bounded by IS26 at both ends, and embedded in a new target location between an α/β-hydrolase and a reductase. Due to its novel insertion site and unique RI composition, we suggest naming this novel RI AbGRI4. Molecular analysis of global A. baumannii isolates identified multiple AbGRI4 RI variants in non-ST2 clonal lineages, including variations in the resistance gene cassettes, integron backbone and insertion breakpoints at the hydrolase gene. CONCLUSIONS: A novel RI insertion target harbouring a class 1 integron was identified in a subgroup of ST2/ST281 clinical isolates. Variants of the RI suggested evolution and horizontal transfer of the RI across clonal lineages. Long- and short-read hybrid assembly technology completely resolved the genomic context of IS-bounded RIs, which was not possible using short reads alone