Degree of explanation

Partial explanations are everywhere. That is, explanations citing causes that explain some but not all of an effect are ubiquitous across science, and these in turn rely on the notion of degree of explanation. I argue that current accounts are seriously deficient. In particular, they do not incorporate adequately the way in which a cause’s explanatory importance varies with choice of explanandum. Using influential recent contrastive theories, I develop quantitative definitions that remedy this lacuna, and relate it to existing measures of degree of causation. Among other things, this reveals the precise role here of chance, as well as bearing on the relation between causal explanation and causation itself

SOlution Focused brief therapy In post-stroke Aphasia (SOFIA Trial): protocol for a feasibility randomised controlled trial

Background: Around a quarter of people post stroke will experience aphasia, a language disability. Having aphasia places someone at risk of becoming depressed and isolated. There is limited evidence for effective interventions to enhance psychological well-being for this client group. A potential intervention is Solution Focused Brief Therapy (SFBT), which supports a person to build meaningful, achievable change through focusing on a person’s skills and resources rather than their deficits. The SOFIA Trial aims to explore the acceptability of SFBT to people with varying presentations of aphasia, including severe aphasia, and to assess the feasibility of conducting a future definitive trial investigating clinical and cost effectiveness. Methods: The trial is a single-blind, randomised, wait-list controlled feasibility trial with nested qualitative research and pilot economic evaluation comparing SFBT plus usual care to usual care alone. The study will recruit 32 participants with aphasia who are ≥6 months post stroke. All participants will be assessed on psychosocial outcome measures at baseline, then at three and six months post randomisation by assessors blinded to treatment allocation. Participants will be randomly assigned to intervention group (start intervention immediately post randomisation) or wait-list group (start intervention six months post randomisation). Wait-list group will additionally be assessed nine months post randomisation. The intervention consists of up to six SFBT sessions delivered over three months by speech and language therapists. Participants and therapists will also take part in in-depth interviews exploring their experiences of the study. The pilot economic evaluation will use the EQ-5D-5L measure and an adapted Client Service Receipt Inventory. People with aphasia have been involved in designing and monitoring the trial. Discussion: Given the high levels of depression and isolation, there is a need to investigate effective interventions that enhance the psychological wellbeing of people with aphasia. Trial registration: ClinicalTrials.gov NCT03245060. 10/08/2017

Does mode of administration affect health-related quality-of-life outcomes after stroke?

Telephone interviews and postal surveys may be a resource-efficient way of assessing health-related quality-of-life post-stroke, if they produce data equivalent to face-to-face interviews. This study explored whether telephone interviews and postal surveys of the Stroke and Aphasia Quality of Life Scale (SAQOL-39g) yielded similar results to face-to-face interviews. Participants included people with aphasia and comprised two groups: group one (n =22) were 3-6 months post-stroke; group two (n =26) were ≥1 year post-stroke. They completed either a face-to-face and a telephone interview or a face-to-face interview and a postal survey of the SAQOL-39g. Response rates were higher for group two (87%) than for group one (72-77%). There were no significant differences between respondents and non-respondents on demographics, co-morbidities, stroke severity, or communication impairment. Concordance between face-to-face and telephone administrations (.90-.98) was excellent; and very good-excellent between face-to-face and postal administrations (.84-.96), although scores in postal administrations were lower (significant for psychosocial domain and overall SAQOL-39g in group two). These findings suggest that the SAQOL-39g yields similar results in different modes of administration. Researchers and clinicians may employ alternative modes, particularly in the longer term post-stroke, in order to reduce costs or facilitate clients with access difficulties

Solution Focused brief therapy In post-stroke Aphasia (SOFIA): feasibility and acceptability results of a feasibility randomised wait-list controlled trial

Objectives: the SOlution Focused brief therapy In post-stroke Aphasia (SOFIA) feasibility trial had four primary aims: to assess (1) acceptability of the intervention to people with aphasia, including severe aphasia; (2) feasibility of recruitment and retention; (3) acceptability of research procedures and outcome measures; and (4) feasibility of delivering the intervention by Speech and Language Therapists. Design: two-group randomised controlled feasibility trial with wait-list design; blinded outcome assessors; nested qualitative research. Setting: participants identified via two community NHS Speech and Language Therapy London services and through community routes (e.g. voluntary-sector stroke groups). Participants: people with aphasia at least six months post stroke. Intervention: Solution Focused Brief Therapy, a psychological intervention, adapted to be linguistically accessible. Participants offered up to six sessions over three months, either immediately post randomisation or after a delay of six months. Outcome measures: primary endpoints related to feasibility and acceptability. Clinical outcomes were collected at baseline, three- and six-months post randomisation, and at nine months (wait-list group only). The candidate primary outcome measure was the Warwick Edinburgh Mental Wellbeing Scale. Participants and therapists also took part in in-depth interviews. Results: Thirty-two participants were recruited, including 44% with severe aphasia. Acceptability endpoints: therapy was perceived as valuable and acceptable by both participants (n=30 interviews) and therapists (n=3 interviews); 93.8% of participants received ≥2 therapy sessions (90.6% received 6/6 sessions). Feasibility endpoints: recruitment target was reached within the pre-specified 13-month recruitment window; 82.1% of eligible participants consented; 96.9% were followed up at six months; missing data <0.01%. All five pre-specified feasibility progression criteria were met. Conclusion: the high retention and adherence rates, alongside the qualitative data, suggest the study design was feasible and therapy approach acceptable even to people with severe aphasia. These results indicate a definitive RCT of the intervention would be feasible. Trial registration: ClinicalTrials.gov NCT03245060

Molecular subgroups of medulloblastoma: the current consensus

Medulloblastoma, a small blue cell malignancy of the cerebellum, is a major cause of morbidity and mortality in pediatric oncology. Current mechanisms for clinical prognostication and stratification include clinical factors (age, presence of metastases, and extent of resection) as well as histological subgrouping (classic, desmoplastic, and large cell/anaplastic histology). Transcriptional profiling studies of medulloblastoma cohorts from several research groups around the globe have suggested the existence of multiple distinct molecular subgroups that differ in their demographics, transcriptomes, somatic genetic events, and clinical outcomes. Variations in the number, composition, and nature of the subgroups between studies brought about a consensus conference in Boston in the fall of 2010. Discussants at the conference came to a consensus that the evidence supported the existence of four main subgroups of medulloblastoma (Wnt, Shh, Group 3, and Group 4). Participants outlined the demographic, transcriptional, genetic, and clinical differences between the four subgroups. While it is anticipated that the molecular classification of medulloblastoma will continue to evolve and diversify in the future as larger cohorts are studied at greater depth, herein we outline the current consensus nomenclature, and the differences between the medulloblastoma subgroups

What factors predict who will have a strong social network following a stroke?

Purpose: Measures of social networks assess the number and nature of a person's social contacts, and strongly predict health outcomes. We explored how social networks change following a stroke and analysed concurrent and baseline predictors of social networks six months post stroke. Method: Prospective longitudinal observational study. Participants were assessed two weeks (baseline), three months and six months post stroke. Measures included: Stroke Social Network Scale; MOS Social Support Survey; NIH Stroke Scale; Frenchay Aphasia Screening Test; Frenchay Activities Index; and the Barthel Index. ANOVA and standard multiple regression were used to analyse change and identify predictors. Results: 87 participants (37% with aphasia) were recruited; 71 (16% with aphasia) were followed up at six months. Social network scores declined post stroke (p = .001). While the Children and Relatives factors remained stable, the Friends factor significantly weakened (p <.001). Concurrent predictors of social network at six months were: perceived social support, ethnicity, aphasia and extended ADL (adjusted R 2 = .42). There were two baseline predictors: pre-morbid social network and aphasia (adjusted R 2 = .60). Conclusions: Social networks declined post stroke. Aphasia was the only stroke-related factor measured at the time of the stroke that predicted social network six months later

'A habitual disposition to the good': on reason, virtue and realism

Amidst the crisis of instrumental reason, a number of contemporary political philosophers including Jürgen Habermas have sought to rescue the project of a reasonable humanism from the twin threats of religious fundamentalism and secular naturalism. In his recent work, Habermas defends a post-metaphysical politics that aims to protect rationality against encroachment while also accommodating religious faith within the public sphere. This paper contends that Habermas’ post-metaphysical project fails to provide a robust alternative either to the double challenge of secular naturalism and religious fundamentalism or to the ruthless instrumentalism that underpins capitalism. By contrast with Habermas and also with the ‘new realism’ of contemporary political philosophers such as Raymond Geuss or Bernard Williams, realism in the tradition of Plato and Aristotle can defend reason against instrumental rationality and blind belief by integrating it with habit, feeling and even faith. Such metaphysical–political realism can help develop a politics of virtue that goes beyond communitarian thinking by emphasising plural modes of association (not merely ‘community’), substantive ties of sympathy and the importance of pursuing goodness and mutual flourishing