Increasing the intensity and comprehensiveness of aphasia services: identification of key factors influencing implementation across six countries

Background: Aphasia services are currently faced by increasing evidence for therapy of greater intensity and comprehensiveness. Intensive Comprehensive Aphasia Programs (ICAPs) combine these elements in an evidence-based, time-limited group program. The incorporation of new service delivery models in routine clinical practice is, however, likely to pose challenges for both the service provider and administering clinicians. This program of research aims to identify these challenges from the perspective of aphasia clinicians from six countries and will seek to trial potential solutions. Continual advancements in global communication technologies suggest that solutions will be easily shared and accessed across multiple countries. Aims: To identify the perceived and experienced barriers and facilitators to the implementation of 1) intensive aphasia services, 2) comprehensive aphasia services, and 3) ICAPs, from aphasia clinicians across six countries. Methods and procedures: A qualitative enquiry approach included data from six focus groups (n = 34 participants) in Australia, New Zealand, Canada, United States of America (USA), United Kingdom (UK), and Ireland. A thematic analysis of focus group data was informed by the Theoretical Domains Framework (TDF). Outcomes and results: Five prominent theoretical domains from the TDF influenced the implementation of all three aphasia service types across participating countries: environmental context and resources, beliefs about consequences, social/professional role and identity, skills, and knowledge. Four overarching themes assisted the identification and explanation of the key barriers and facilitators: 1. Collaboration, joint initiatives and partnerships, 2. Advocacy, the promotion of aphasia services and evidence-based practice, 3. Innovation, the ability to problem solve challenges, and 4. Culture, the influence of underlying values. Conclusions: The results of this study will inform the development of a theoretically informed intervention to improve health services’ adherence to aphasia best practice recommendations

Fluctuation force exerted by a planar self-avoiding polymer

Using results from Schramm Loewner evolution (SLE), we give the expression of the fluctuation-induced force exerted by a polymer on a small impenetrable disk, in various 2-dimensional domain geometries. We generalize to two polymers and examine whether the fluctuation force can trap the object into a stable equilibrium. We compute the force exerted on objects at the domain boundary, and the force mediated by the polymer between such objects. The results can straightforwardly be extended to any SLE interface, including Ising, percolation, and loop-erased random walks. Some are relevant for extremal value statistics.Comment: 7 pages, 22 figure

Enhancement of vaccinia virus based oncolysis with histone deacetylase inhibitors

Histone deacetylase inhibitors (HDI) dampen cellular innate immune response by decreasing interferon production and have been shown to increase the growth of vesicular stomatitis virus and HSV. As attenuated tumour-selective oncolytic vaccinia viruses (VV) are already undergoing clinical evaluation, the goal of this study is to determine whether HDI can also enhance the potency of these poxviruses in infection-resistant cancer cell lines. Multiple HDIs were tested and Trichostatin A (TSA) was found to potently enhance the spread and replication of a tumour selective vaccinia virus in several infection-resistant cancer cell lines. TSA significantly decreased the number of lung metastases in a syngeneic B16F10LacZ lung metastasis model yet did not increase the replication of vaccinia in normal tissues. The combination of TSA and VV increased survival of mice harbouring human HCT116 colon tumour xenografts as compared to mice treated with either agent alone. We conclude that TSA can selectively and effectively enhance the replication and spread of oncolytic vaccinia virus in cancer cells. © 2010 MacTavish et al

Age-related synaptic loss of the medial olivocochlear efferent innervation

Age-related functional decline of the nervous system is consistently observed, though cellular and molecular events responsible for this decline remain largely unknown. One of the most prevalent age-related functional declines is age-related hearing loss (presbycusis), a major cause of which is the loss of outer hair cells (OHCs) and spiral ganglion neurons. Previous studies have also identified an age-related functional decline in the medial olivocochlear (MOC) efferent system prior to age-related loss of OHCs. The present study evaluated the hypothesis that this functional decline of the MOC efferent system is due to age-related synaptic loss of the efferent innervation of the OHCs. To this end, we used a recently-identified transgenic mouse line in which the expression of yellow fluorescent protein (YFP), under the control of neuron-specific elements from the thy1 gene, permits the visualization of the synaptic connections between MOC efferent fibers and OHCs. In this model, there was a dramatic synaptic loss between the MOC efferent fibers and the OHCs in older mice. However, age-related loss of efferent synapses was independent of OHC status. These data demonstrate for the first time that age-related loss of efferent synapses may contribute to the functional decline of the MOC efferent system and that this synaptic loss is not necessary for age-related loss of OHCs

V.I. Vernadsky and the noosphere concept: Russian understandings of society-nature interaction

Recent Russian legislative and policy documentation concerning national progress towards sustainable development has suggested that the attainment of such a state would represent the first stage in the development of the noosphere as outlined by the Russian scientist Vladimir Ivanovich Vernadsky (1863–1945). This paper explores Vernadsky’s model of evolutionary change through a focus on his work on the biosphere and noosphere in an attempt to further understanding of the way in which Russia is approaching the concept of sustainable development in the contemporary period. It is argued that the official Russian interpretation of the noosphere idea tends to obscure the evolutionary and materialist foundations of Vernadsky’s biosphere–noosphere conceptualisation. At the same time, the concluding section of the paper suggests that the scope of Vernadsky’s work can be used to stimulate the search for a more coherent approach to work in areas of sustainable development and sustainability across the span of the social and physical sciences

Food after deprivation rewards the earlier eating

Food intake can be increased by learning to anticipate the omission of subsequent meals. We present here a new theory that such anticipatory eating depends on an associative process of instrumental reinforcement by the nutritional repletion that occurs when access to food is restored. Our evidence over the last decade from a smooth-brained omnivore has been that food after deprivation rewards intake even when those reinforced ingestive responses occur long before the physiological signals from renewed assimilation. Effects of food consumed after self-deprivation might therefore reward extra eating in human beings, through brain mechanisms that could operate outside awareness. That would have implications for efforts to reduce body weight. This food reward mechanism could be contributing to the failure of the dietary component of interventions on obesity within controlled trials of the management or prevention of disorders such as hypertension, atherosclerosis and type 2 diabetes

Health-related quality of life in people with aphasia: Implications for fluency disorders quality of life research

Abstract It is increasingly important that clinicians address the health-related quality of life (HRQOL) of adults with communication disorders in clinical practice. The overall aim of this paper is to draw conclusion about the suitability of the Short Form 36 Health Survey for the communication disorders of aphasia and stuttering. This study reports on the impact of post-stroke aphasia on 30 Australian older adults’ HRQOL. It also comments on the capacity of the SF-36 to measure HRQOL in this population, specifically whether it is sensitive to the three known determinants of post-stroke HRQOL – emotional, physical and social functioning. Comparisons with other data are made to assist interpretation of the SF-36 subscale scores: with 75 older adults with no history of neurological conditions; and with data from the 1995 National Health Survey data. The main findings are: (1) adults with post-stroke aphasia have similar HRQOL to their peers on six subscales, but significantly lower Role emotional and Mental health HRQOL; (2) a substantial number of aphasic adults reported depressive mood; and (3) aphasic adults with depressive mood have significantly worse HRQOL on six subscales than aphasic adults without depressive mood, but similar Role emotional and Body pain HRQOL. In conclusion, stroke and aphasia have minimal impact on older adults’ HRQOL as measured by the SF-36, which conflicts with an established evidence base of the negative consequences of aphasia on life. Thus, the SF-36 is not advisable for use with aphasic adults. Implications of these findings for aphasia and stuttering are discussed. Educational objectives: The reader will be able to: (a) describe the impact of aphasia and depressive mood on quality of life; (b) compare the impact of aphasia on the quality of life of adults to adults who do not have aphasia; (c) describe the similarities and differences between quality of life of adults with aphasia and adults who stutter; and (d) describe the strengths and limitations of the SF-36 as a measure of quality of life in adults who stutter versus adults with aphasia

The Relationship between ECOG-PS, mGPS, BMI/WL Grade and Body Composition and Physical Function in Patients with Advanced Cancer

Cancer remains one of the leading causes of mortality worldwide and the associated reduction in physical function has a marked impact on both quality of life and survival. The aim of the present study was to examine the relationship between Eastern Cooperative Oncology Group-Performance status (ECOG-PS), modified Glasgow Prognostic Score (mGPS), Body Mass Index/Weight Loss grade (BMI/WL grade), and Computerised Tomography (CT)-derived body composition measurement and physical function in patients with advanced cancer. Nine sites contributed prospective data on patient demographics, ECOG-PS, mGPS, physical function tests, and CT-derived body composition. Categorical variables were analysed using χ2 test for linear-by-linear association, or χ2 test for 2-by-2 tables. Associations were analysed using binary logistic regression. A total of 523 cancer patients (266 males, 257 females) were included in the final analysis and most had metastatic disease (83.2%). The median overall survival was 5.6 months. On multivariate binary logistic regression analysis, a high ECOG-PS remained independently associated with a low skeletal muscle index (p < 0.001), low skeletal muscle density (p < 0.05), and timed up and go test failure (p < 0.001). A high mGPS remained independently associated with a low skeletal muscle density (p < 0.05) and hand grip strength test failure (p < 0.01). A high BMI/WL grade remained independently associated with a low subcutaneous fat index (p < 0.05), low visceral obesity (p < 0.01), and low skeletal muscle density (p < 0.05). In conclusion, a high ECOG-PS and a high mGPS as outlined in the ECOG-PS/mGPS framework were consistently associated with poorer body composition and physical function in patients with advanced cancer

Liver Involvement Associated with Dengue Infection in Adults in Vietnam

Globally, the number of adults hospitalized with dengue has increased markedly in recent years. It has been suggested that hepatic dysfunction is more significant in this group than among children. We describe the spectrum and evolution of disease manifestations among 644 adults with dengue who were prospectively recruited on admission to a major infectious disease hospital in southern Vietnam and compare them with a group of patients with similar illnesses not caused by dengue. Transaminase levels increased in virtually all dengue patients and correlated with other markers of disease severity. However, peak enzyme values usually occurred later than other complications. Clinically severe liver involvement was infrequent and idiosyncratic, but usually resulted in severe bleeding. Chronic co-infection with hepatitis B was associated with modestly but significantly increased levels of alanine aminotransferase, but did not otherwise impact the clinical picture