Adapting communication with autistic service users: Co-produced adaptations for medical services, employers, and the third sector

Autistic people have a greater need to access services (e.g., health and social care, welfare, justice, etc.), yet face significant disadvantages when doing so, often due to poor two-way communication between service providers and service users. This study aimed to co-develop practical, evidence-based adaptations to facilitate communication between service providers and autistic people. Based on a review of current research evidence, an initial list of adaptations was developed, across four categories: (1) adapting the environment to reduce sensory stressors, (2) facilitating diagnosis disclosure, (3) adapting direct communication, and (4) modifying visual or written information. Second, we co-delivered (with autistic people) a workshop for service providers, tailoring these adaptations to their sectors. Finally, a large survey sample of autistic people and the autism community evaluated these adaptations and added their own suggestions. Workshop attendees’ autism knowledge and confidence in communicating with autistic people significantly improved post-workshop, and they went on to implement the evidence-based adaptations. The autism community endorsed the adaptations and suggested some additional adaptations that they would like. Findings demonstrate that providing evidence-based adaptations in a workshop co-delivered with autistic people improves service provider autism knowledge and confidence in communicating with autistic people, and encourages them to offer adaptations. Lay abstract: What is already known about the topic? Autistic people need access to a range of services, including health and social care, welfare, and access to justice. However, research with autistic people and their supporters has identified several barriers when trying to access these services, including a lack of autism understanding, reluctance to make accommodations, and difficulties with communication. What this paper adds? Research has shown several ways in which communication can be adapted. The current study aimed to apply these research findings to real-world practice by working with service providers, autistic people, and the autism community to create a suite of practical adaptations. We developed an initial list of adaptations, under the categories: (1) adapting the environment to reduce sensory stressors, (2) facilitating autism diagnosis disclosure (where desired), (3) adapting communication, and (4) adapting visual/written information. With autistic people, we then co-delivered a workshop for service providers, tailoring these adaptations to each sector. Service providers who attended the workshop felt more confident working and communicating with autistic people, demonstrated improved autism knowledge, and implemented several adaptations in their services. We also surveyed the autism community, who agreed that the adaptations were helpful, and also suggested additional adaptations they would like to see offered by service providers. Implications for practice, research, or policy The findings demonstrate that adaptations autistic people find helpful can be tailored to specific services. This will help autistic people and their supporters to access crucial services, and will enable service providers to offer an effective service to autistic people

Study of capsule endoscopy delivery at scale through enhanced artificial intelligence-enabled analysis (the CESCAIL study)

Funding Information: This study is funded by the National Institute for Health and Care Research (NIHR) (funder award NIHR AI_AWARD02440).Peer reviewe

Study of capsule endoscopy delivery at scale through enhanced artificial intelligence‐enabled analysis (the CESCAIL study)

Aim Lower gastrointestinal (GI) diagnostics have been facing relentless capacity constraints for many years, even before the COVID-19 era. Restrictions from the COVID pandemic have resulted in a significant backlog in lower GI diagnostics. Given recent developments in deep neural networks (DNNs) and the application of artificial intelligence (AI) in endoscopy, automating capsule video analysis is now within reach. Comparable to the efficiency and accuracy of AI applications in small bowel capsule endoscopy, AI in colon capsule analysis will also improve the efficiency of video reading and address the relentless demand on lower GI services. The aim of the CESCAIL study is to determine the feasibility, accuracy and productivity of AI-enabled analysis tools (AiSPEED) for polyp detection compared with the ‘gold standard’: a conventional care pathway with clinician analysis. Method This multi-centre, diagnostic accuracy study aims to recruit 674 participants retrospectively and prospectively from centers conducting colon capsule endoscopy (CCE) as part of their standard care pathway. After the study participants have undergone CCE, the colon capsule videos will be uploaded onto two different pathways: AI-enabled video analysis and the gold standard conventional clinician analysis pathway. The reports generated from both pathways will be compared for accuracy (sensitivity and specificity). The reading time can only be compared in the prospective cohort. In addition to validating the AI tool, this study will also provide observational data concerning its use to assess the pathway execution in real-world performance. Results The study is currently recruiting participants at multiple centers within the United Kingdom and is at the stage of collecting data. Conclusion This standard diagnostic accuracy study carries no additional risk to patients as it does not affect the standard care pathway, and hence patient care remains unaffected

Tissue tropisms opt for transmissible reassortants during avian and swine influenza A virus co-infection in swine

Genetic reassortment between influenza A viruses (IAVs) facilitate emergence of pandemic strains, and swine are proposed as a “mixing vessel” for generating reassortants of avian and mammalian IAVs that could be of risk to mammals, including humans. However, how a transmissible reassortant emerges in swine are not well understood. Genomic analyses of 571 isolates recovered from nasal wash samples and respiratory tract tissues of a group of co-housed pigs (influenza-seronegative, avian H1N1 IAV–infected, and swine H3N2 IAV– infected pigs) identified 30 distinct genotypes of reassortants. Viruses recovered from lower respiratory tract tissues had the largest genomic diversity, and those recovered from turbinates and nasal wash fluids had the least. Reassortants from lower respiratory tracts had the largest variations in growth kinetics in respiratory tract epithelial cells, and the cold temperature in swine nasal cells seemed to select the type of reassortant viruses shed by the pigs. One reassortant in nasal wash samples was consistently identified in upper, middle, and lower respiratory tract tissues, and it was confirmed to be transmitted efficiently between pigs. Study findings suggest that, during mixed infections of avian and swine IAVs, genetic reassortments are likely to occur in the lower respiratory track, and tissue tropism is an important factor selecting for a transmissible reassortant

ALBACORE OBS deployment cruise report

The primary goal of the 2010 ALBACORE (Asthenospheric and Lithospheric Broadband Architecture from the California Offshore Region Experiment) cruise was to deploy 34 ocean bottom seismometers (OBSs) in a 150 km (north-south) by 400 km (east-west) region off the coast of Southern California (Fig. 1). The cruise took place on R/V Melville, departing out of San Diego on August 14, 2010 and arriving back in San Diego on August 27, 2001 with no port stops in between

Meta-analysis of gene–environment-wide association scans accounting for education level identifies additional loci for refractive error

This work is licensed under a Creative Commons Attribution 4.0 International License. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in the credit line; if the material is not included under the Creative Commons license, users will need to obtain permission from the license holder to reproduce the material. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/Myopia is the most common human eye disorder and it results from complex genetic and environmental causes. The rapidly increasing prevalence of myopia poses a major public health challenge. Here, the CREAM consortium performs a joint meta-analysis to test single-nucleotide polymorphism (SNP) main effects and SNP × education interaction effects on refractive error in 40,036 adults from 25 studies of European ancestry and 10,315 adults from 9 studies of Asian ancestry. In European ancestry individuals, we identify six novel loci (FAM150B-ACP1, LINC00340, FBN1, DIS3L-MAP2K1, ARID2-SNAT1 and SLC14A2) associated with refractive error. In Asian populations, three genome-wide significant loci AREG, GABRR1 and PDE10A also exhibit strong interactions with education (P<8.5 × 10(-5)), whereas the interactions are less evident in Europeans. The discovery of these loci represents an important advance in understanding how gene and environment interactions contribute to the heterogeneity of myopia

A Phase 2a clinical trial of Molnupiravir in patients with COVID-19 shows accelerated SARS-CoV-2 RNA clearance and elimination of infectious virus

Molnupiravir (800 mg dose) accelerated SARS-CoV-2 RNA clearance in patients with COVID-19 compared to placebo

Effect of a Perioperative, Cardiac Output-Guided Hemodynamic Therapy Algorithm on Outcomes Following Major Gastrointestinal Surgery A Randomized Clinical Trial and Systematic Review

Importance: small trials suggest that postoperative outcomes may be improved by the use of cardiac output monitoring to guide administration of intravenous fluid and inotropic drugs as part of a hemodynamic therapy algorithm.Objective: to evaluate the clinical effectiveness of a perioperative, cardiac output–guided hemodynamic therapy algorithm.Design, setting, and participants: OPTIMISE was a pragmatic, multicenter, randomized, observer-blinded trial of 734 high-risk patients aged 50 years or older undergoing major gastrointestinal surgery at 17 acute care hospitals in the United Kingdom. An updated systematic review and meta-analysis were also conducted including randomized trials published from 1966 to February 2014.Interventions: patients were randomly assigned to a cardiac output–guided hemodynamic therapy algorithm for intravenous fluid and inotrope (dopexamine) infusion during and 6 hours following surgery (n=368) or to usual care (n=366).Main outcomes and measures: the primary outcome was a composite of predefined 30-day moderate or major complications and mortality. Secondary outcomes were morbidity on day 7; infection, critical care–free days, and all-cause mortality at 30 days; all-cause mortality at 180 days; and length of hospital stay.Results: baseline patient characteristics, clinical care, and volumes of intravenous fluid were similar between groups. Care was nonadherent to the allocated treatment for less than 10% of patients in each group. The primary outcome occurred in 36.6% of intervention and 43.4% of usual care participants (relative risk [RR], 0.84 [95% CI, 0.71-1.01]; absolute risk reduction, 6.8% [95% CI, ?0.3% to 13.9%]; P?=?.07). There was no significant difference between groups for any secondary outcomes. Five intervention patients (1.4%) experienced cardiovascular serious adverse events within 24 hours compared with none in the usual care group. Findings of the meta-analysis of 38 trials, including data from this study, suggest that the intervention is associated with fewer complications (intervention, 488/1548 [31.5%] vs control, 614/1476 [41.6%]; RR, 0.77 [95% CI, 0.71-0.83]) and a nonsignificant reduction in hospital, 28-day, or 30-day mortality (intervention, 159/3215 deaths [4.9%] vs control, 206/3160 deaths [6.5%]; RR, 0.82 [95% CI, 0.67-1.01]) and mortality at longest follow-up (intervention, 267/3215 deaths [8.3%] vs control, 327/3160 deaths [10.3%]; RR, 0.86 [95% CI, 0.74-1.00]).Conclusions and relevance: in a randomized trial of high-risk patients undergoing major gastrointestinal surgery, use of a cardiac output–guided hemodynamic therapy algorithm compared with usual care did not reduce a composite outcome of complications and 30-day mortality. However, inclusion of these data in an updated meta-analysis indicates that the intervention was associated with a reduction in complication rate