Determinants of living well With aphasia in the first year poststroke: a prospective cohort study

Objective: To determine factors that contribute to living well with aphasia in the first 12 months poststroke

31st Annual Meeting and Associated Programs of the Society for Immunotherapy of Cancer (SITC 2016) : part two

Background The immunological escape of tumors represents one of the main ob- stacles to the treatment of malignancies. The blockade of PD-1 or CTLA-4 receptors represented a milestone in the history of immunotherapy. However, immune checkpoint inhibitors seem to be effective in specific cohorts of patients. It has been proposed that their efficacy relies on the presence of an immunological response. Thus, we hypothesized that disruption of the PD-L1/PD-1 axis would synergize with our oncolytic vaccine platform PeptiCRAd. Methods We used murine B16OVA in vivo tumor models and flow cytometry analysis to investigate the immunological background. Results First, we found that high-burden B16OVA tumors were refractory to combination immunotherapy. However, with a more aggressive schedule, tumors with a lower burden were more susceptible to the combination of PeptiCRAd and PD-L1 blockade. The therapy signifi- cantly increased the median survival of mice (Fig. 7). Interestingly, the reduced growth of contralaterally injected B16F10 cells sug- gested the presence of a long lasting immunological memory also against non-targeted antigens. Concerning the functional state of tumor infiltrating lymphocytes (TILs), we found that all the immune therapies would enhance the percentage of activated (PD-1pos TIM- 3neg) T lymphocytes and reduce the amount of exhausted (PD-1pos TIM-3pos) cells compared to placebo. As expected, we found that PeptiCRAd monotherapy could increase the number of antigen spe- cific CD8+ T cells compared to other treatments. However, only the combination with PD-L1 blockade could significantly increase the ra- tio between activated and exhausted pentamer positive cells (p= 0.0058), suggesting that by disrupting the PD-1/PD-L1 axis we could decrease the amount of dysfunctional antigen specific T cells. We ob- served that the anatomical location deeply influenced the state of CD4+ and CD8+ T lymphocytes. In fact, TIM-3 expression was in- creased by 2 fold on TILs compared to splenic and lymphoid T cells. In the CD8+ compartment, the expression of PD-1 on the surface seemed to be restricted to the tumor micro-environment, while CD4 + T cells had a high expression of PD-1 also in lymphoid organs. Interestingly, we found that the levels of PD-1 were significantly higher on CD8+ T cells than on CD4+ T cells into the tumor micro- environment (p < 0.0001). Conclusions In conclusion, we demonstrated that the efficacy of immune check- point inhibitors might be strongly enhanced by their combination with cancer vaccines. PeptiCRAd was able to increase the number of antigen-specific T cells and PD-L1 blockade prevented their exhaus- tion, resulting in long-lasting immunological memory and increased median survival

Evidence for reduced neuronal somal size within the insular cortex in schizophrenia, but not in affective disorders

The insular cortex is a paralimbic area of the brain thought to have important roles in sensory integration, auditory hallucinations and language. Both structural and functional MRI studies have revealed that this brain area is abnormal in both size and activity in schizophrenia. Further investigation of this region at the cellular level in schizophrenia has not been carried out. In the current study, we conducted a stereological examination of neuronal and glial size and density in layers 2 and 3 of the dorso-caudal region of the insular cortex in 15 schizophrenic, 15 bipolar, 15 unipolar and 15 control patients. These cortical layers are candidate layers based on previous cytoarchitectual investigations. Statistical analysis (ANCOVA, correcting for pH, post-mortem interval and age) showed decreased neuronal volume in layer 2 in schizophrenia (p=0.0008, 16.2% mean reduction). No other signi!cant changes were observed. This study thus provides the !rst evidence of cytoarchitectural abnormality of the insular cortex in the pathophysiology of schizophrenia but not mood disorders. Further work is needed to investigate the molecular basis for this neuronal abnormality in schizophrenia in order to elucidate its role in the pathophysiology of schizophrenia

Living successfully with aphasia during the first year post-stroke: a longitudinal qualitative study

Background: Studies exploring the concept of living successfully with aphasia have advanced the understanding of positive adaptive factors, which may inform clinical interventions provided to people with aphasia. Adaptation over time has been identified as a critical component of living successfully with aphasia. Yet, the experiences of individuals with aphasia and factors they perceive to influence living successfully over time remain ill-described. Longitudinal research might add an important perspective to existing literature in the area of living successfully with aphasia and provide clarification regarding the needs of people with aphasia over time

Audiovisual Integration Varies With Target and Environment Richness in Immersive Virtual Reality

We are continually bombarded by information arriving to each of our senses; however, the brain seems to effortlessly integrate this separate information into a unified percept. Although multisensory integration has been researched extensively using simple computer tasks and stimuli, much less is known about how multisensory integration functions in real-world contexts. Additionally, several recent studies have demonstrated that multisensory integration varies tremendously across naturalistic stimuli. Virtual reality can be used to study multisensory integration in realistic settings because it combines realism with precise control over the environment and stimulus presentation. In the current study, we investigated whether multisensory integration as measured by the redundant signals effects (RSE) is observable in naturalistic environments using virtual reality and whether it differs as a function of target and/ or environment cue-richness. Participants detected auditory, visual, and audiovisual targets which varied in cue-richness within three distinct virtual worlds that also varied in cue-richness. We demonstrated integrative effects in each environment-by-target pairing and further showed a modest effect on multisensory integration as a function of target cue-richness but only in the cue-rich environment. Our study is the first to definitively show that minimal and more naturalistic tasks elicit comparable redundant signals effects. Our results also suggest that multisensory integration may function differently depending on the features of the environment. The results of this study have important implications in the design of virtual multisensory environments that are currently being used for training, educational, and entertainment purposes

Increasing the confidence and knowledge of occupational therapy and physiotherapy students when communicating with people with aphasia: A pre-post intervention study

This study investigated occupational therapy and physiotherapy students' level of confidence and knowledge of strategies for communicating with people with aphasia (PWA) before and after a communication partner-training (CPT) program. Twenty-eight physiotherapy and occupational therapy students participated in a pre–post CPT program. Students completed a customized mixed-methods questionnaire before and after the intervention. The CPT program involved a lecture about effective communication strategies followed by a conversation with PWA to practice strategies learnt. Before CPT, students were not confident with the possibility of communicating with PWA. Students demonstrated rudimentary knowledge of supported conversation, identifying a maximum of five strategies for communicating effectively with PWA. Following intervention, students demonstrated increased confidence. Students' knowledge of effective communication strategies improved, with students identifying a maximum of 16 suitable strategies post-training. The results suggest that occupational therapy and physiotherapy students have potential to benefit from practical training in supported communication with PWA, which may assist them during placements in clinical settings with neurological patients or subsequent employment

Telepractice communication partner training for health professionals: A randomised trial

Communication partner training can be beneficial in reducing accessibility barriers for people with aphasia The aim of the present study was to determine whether face-to-face or telepractice (real time video-teleconference system) delivery of a communication partner training program was associated with greater improvements in confidence and knowledge of effective communication strategies among allied health professionals.55 health professionals were randomly allocated to receive face-to-face (n = 27) or telepractice (n = 28) communication partner training. All participants completed their allocated training. A customised mixed-methods self-completed questionnaire was used before and after receiving communication partner training for participants to rate their confidence when communicating with people with aphasia using a 100mm visual analogue scale and answer an open-ended question about knowledge of communication strategies.At baseline, there was no significant differences between groups in confidence ratings (median (IQR), face-to-face 48mm (32mm, 54mm), telepractice 43mm (29mm, 56mm)) or number of strategies identified (face-to-face median=4, IQR 3-5; telepractice median=3, IQR 2-4). At the post-intervention assessment, confidence was significantly higher (

A pre-post intervention study investigating the confidence and knowledge of health professionals communicating with people with aphasia in a metropolitan hospital

Background Communication partner training (CPT) is a social intervention approach that can be used to educate and train volunteers, family members, significant others and professionals, in addition to providing skills and strategies for people with aphasia (PWA). This body of CPT research extends the current research in the area by implementing CPT with health professionals (HPs) in using PWA as trainers in a sub-acute care setting, but some previous research in acute care setting has primarily focused on caregivers and volunteers in a community setting. Aims The aim of this study was to investigate implementing a CPT programme in an Australian metropolitan hospital by training professionals and utilising PWA as a key component of the training to facilitate “real-time” practical skill acquisition. Method &amp; Procedures Fifty-two HPs from multidisciplinary teams (allied health assistants, audiology, dietetics, occupational therapy, pharmacy, physiotherapy, social work and nursing staff in a rehabilitation unit) participated in a pre–post intervention study. HPs completed a questionnaire to collect demographic information, identify current knowledge of aphasia-related communication strategies and ascertain their confidence levels (using a 100-mm visual analogue scale) related to interacting with people with communication impairments and list any strategies/resources that could be used as an adjunct to facilitate exchanges with PWA. These open-ended responses were categorised into four main groups using content analysis. The CPT component, adapted from two programmes run by “Connect—Communication Disability Network” in the United Kingdom, consisted of an educational lecture on communicating with PWA given by a speech-language pathologist and a practical conversation with a person with aphasia. The PWA provided “expert” practical feedback to the professionals participating in the training. Outcomes &amp; Results HPs reported mean confidence levels of 46.56 mm (SD = 15.71) prior to training and 75.81 mm (SD = 12.16) post-training, t(51) = 12.479 (p Conclusions The results provide preliminary evidence to suggest that a CPT programme may be an effective method to increase the confidence and knowledge of communication strategies of HPs, in an acute care setting, when interacting with PWA