What children on the autism spectrum have to ‘say’ about using high-tech voice output communication aids (VOCAs) in an educational setting

This paper focuses on accessing the experiences of three boys who are on the autism spectrum to identify what using a voice output communication aid (VOCA), within a classroom setting, means to them. The methods used to identify the boys' perspectives are described and evaluated. Establishing these through direct methods of engagement proved problematic but working with parents and school staff as ‘expert guides’ provided a rich insight into what using a VOCA appeared to mean to the boys. The findings suggest that using a computer-based VOCA can be viewed by children with autism as a pleasurable and motivating activity. This technology also seems to offer the potential for a much broader developmental impact for these children than that currently recognised within the research literature

“Black white zebra orange orange”: How children with autism make use of computer-based voice output communication aids in their language and communication at school.

Purpose - This naturalistic study adapted exploratory school practice in order to support empirically-informed decision making in the provision of augmentative and alternative communication (AAC) technologies for children with autism. Design - Research was conducted with three boys with autism and little speech, as part of a curricular literacy lesson. A mixed method approach, involving observational coding and staff diaries, identified how the boys used computer-based voice output communication aids (VOCAs), also called speech generating devices (SGDs) and how the technology impacted on their communication and language. The boys were observed in initial lessons (‘baseline’ sessions), without the VOCA present and in sessions in which the VOCA was available (‘intervention’ sessions). Findings - VOCAs were used for two main communicative purposes; naming and giving information; with aids being used primarily to support curricular, task-related communication. Existing modes of communication continued to be used when access to the VOCA was available. In addition, all three boys showed an increase in Mean Length of Utterance (MLU) after the VOCA was introduced. The findings suggest that computer-based VOCA technology can augment children’s communicative participation in lesson activities. Specific patterns of change were also recorded in the boys’ communication, suggesting individualised responses to this technology. Originality - This paper extends the empirical base for clinical decision making by reporting the use of high tech VOCAs by school age children with autism for additional forms of communication, beyond those described elsewhere. It adds to the evidence that interventions which include access to a computer VOCA can have a positive impact on the language complexity of children with autism. It describes the potential of VOCAs to provide an enabling and inclusive technology in a classroom setting. </p

Early life child micronutrient status, maternal reasoning, and a nurturing household environment have persistent influences on child cognitive development at age 5 years: Results from MAL-ED

Background: Child cognitive development is influenced by early-life insults and protective factors. To what extent these factors have a long-term legacy on child development and hence fulfillment of cognitive potential is unknown. Objective: The aim of this study was to examine the relation between early-life factors (birth to 2 y) and cognitive development at 5 y. Methods: Observational follow-up visits were made of children at 5 y, previously enrolled in the community-based MAL-ED longitudinal cohort. The burden of enteropathogens, prevalence of illness, complementary diet intake, micronutrient status, and household and maternal factors from birth to 2 y were extensively measured and their relation with the Wechsler Preschool Primary Scales of Intelligence at 5 y was examined through use of linear regression. Results: Cognitive T-scores from 813 of 1198 (68%) children were examined and 5 variables had significant associations in multivariable models: mean child plasma transferrin receptor concentration (β: −1.81, 95% CI: −2.75, −0.86), number of years of maternal education (β: 0.27, 95% CI: 0.08, 0.45), maternal cognitive reasoning score (β: 0.09, 95% CI: 0.03, 0.15), household assets score (β: 0.64, 95% CI: 0.24, 1.04), and HOME child cleanliness factor (β: 0.60, 95% CI: 0.05, 1.15). In multivariable models, the mean rate of enteropathogen detections, burden of illness, and complementary food intakes between birth and 2 y were not significantly related to 5-y cognition. Conclusions: A nurturing home context in terms of a healthy/clean environment and household wealth, provision of adequate micronutrients, maternal education, and cognitive reasoning have a strong and persistent influence on child cognitive development. Efforts addressing aspects of poverty around micronutrient status, nurturing caregiving, and enabling home environments are likely to have lasting positive impacts on child cognitive development.publishedVersio

Prime-boost immunization of rabbits with HIV-1 gp120 elicits potent neutralization activity against a primary viral isolate

<div><p>Development of a vaccine for HIV-1 requires a detailed understanding of the neutralizing antibody responses that can be experimentally elicited to difficult-to-neutralize primary isolates. Rabbits were immunized with the gp120 subunit of HIV-1 JR-CSF envelope (Env) using a DNA-prime protein-boost regimen. We analyzed five sera that showed potent autologous neutralizing activity (IC50s at ∼10³ to 10⁴ serum dilution) against pseudoviruses containing Env from the primary isolate JR-CSF but not from the related isolate JR-FL. Pseudoviruses were created by exchanging each variable and constant domain of JR-CSF gp120 with that of JR-FL or with mutations in putative N-glycosylation sites. The sera contained different neutralizing activities dependent on C3 and V5, C3 and V4, or V4 regions located on the glycan-rich outer domain of gp120. All sera showed enhanced neutralizing activity toward an Env variant that lacked a glycosylation site in V4. The JR-CSF gp120 epitopes recognized by the sera are generally distinct from those of several well characterized mAbs (targeting conserved sites on Env) or other type-specific responses (targeting V1, V2, or V3 variable regions). The activity of one serum requires specific glycans that are also important for 2G12 neutralization and this serum blocked the binding of 2G12 to gp120. Our findings show that different fine specificities can achieve potent neutralization of HIV-1, yet this strong activity does not result in improved breadth.</p> </div

Multiorgan MRI findings after hospitalisation with COVID-19 in the UK (C-MORE): a prospective, multicentre, observational cohort study

Introduction: The multiorgan impact of moderate to severe coronavirus infections in the post-acute phase is still poorly understood. We aimed to evaluate the excess burden of multiorgan abnormalities after hospitalisation with COVID-19, evaluate their determinants, and explore associations with patient-related outcome measures. Methods: In a prospective, UK-wide, multicentre MRI follow-up study (C-MORE), adults (aged ≥18 years) discharged from hospital following COVID-19 who were included in Tier 2 of the Post-hospitalisation COVID-19 study (PHOSP-COVID) and contemporary controls with no evidence of previous COVID-19 (SARS-CoV-2 nucleocapsid antibody negative) underwent multiorgan MRI (lungs, heart, brain, liver, and kidneys) with quantitative and qualitative assessment of images and clinical adjudication when relevant. Individuals with end-stage renal failure or contraindications to MRI were excluded. Participants also underwent detailed recording of symptoms, and physiological and biochemical tests. The primary outcome was the excess burden of multiorgan abnormalities (two or more organs) relative to controls, with further adjustments for potential confounders. The C-MORE study is ongoing and is registered with ClinicalTrials.gov, NCT04510025. Findings: Of 2710 participants in Tier 2 of PHOSP-COVID, 531 were recruited across 13 UK-wide C-MORE sites. After exclusions, 259 C-MORE patients (mean age 57 years [SD 12]; 158 [61%] male and 101 [39%] female) who were discharged from hospital with PCR-confirmed or clinically diagnosed COVID-19 between March 1, 2020, and Nov 1, 2021, and 52 non-COVID-19 controls from the community (mean age 49 years [SD 14]; 30 [58%] male and 22 [42%] female) were included in the analysis. Patients were assessed at a median of 5·0 months (IQR 4·2–6·3) after hospital discharge. Compared with non-COVID-19 controls, patients were older, living with more obesity, and had more comorbidities. Multiorgan abnormalities on MRI were more frequent in patients than in controls (157 [61%] of 259 vs 14 [27%] of 52; p&lt;0·0001) and independently associated with COVID-19 status (odds ratio [OR] 2·9 [95% CI 1·5–5·8]; padjusted=0·0023) after adjusting for relevant confounders. Compared with controls, patients were more likely to have MRI evidence of lung abnormalities (p=0·0001; parenchymal abnormalities), brain abnormalities (p&lt;0·0001; more white matter hyperintensities and regional brain volume reduction), and kidney abnormalities (p=0·014; lower medullary T1 and loss of corticomedullary differentiation), whereas cardiac and liver MRI abnormalities were similar between patients and controls. Patients with multiorgan abnormalities were older (difference in mean age 7 years [95% CI 4–10]; mean age of 59·8 years [SD 11·7] with multiorgan abnormalities vs mean age of 52·8 years [11·9] without multiorgan abnormalities; p&lt;0·0001), more likely to have three or more comorbidities (OR 2·47 [1·32–4·82]; padjusted=0·0059), and more likely to have a more severe acute infection (acute CRP &gt;5mg/L, OR 3·55 [1·23–11·88]; padjusted=0·025) than those without multiorgan abnormalities. Presence of lung MRI abnormalities was associated with a two-fold higher risk of chest tightness, and multiorgan MRI abnormalities were associated with severe and very severe persistent physical and mental health impairment (PHOSP-COVID symptom clusters) after hospitalisation. Interpretation: After hospitalisation for COVID-19, people are at risk of multiorgan abnormalities in the medium term. Our findings emphasise the need for proactive multidisciplinary care pathways, with the potential for imaging to guide surveillance frequency and therapeutic stratification

CLIMATE CHANGE LEADS TO EARLIER SEASONAL OCCURRENCE OF LARVAL FISHES IN THE SOUTHERN CALIFORNIA CURRENT

participantGlobal warming has prompted an earlier arrival of spring in numerous ecosystems. It is uncertain whether such a change is occurring in the California Current Ecosystem, because this region is subject to decadal climate oscillations and regional climate models predict seasonal delays in upwelling. We investigated changes in larval phenology of 43 fish species sampled by California Cooperative Oceanic Fisheries Investigations between 1951-2008. Trends in monthly larval abundance were analyzed by decadally averaging data from quarterly surveys conducted in different months. Phenological shifts were quantified by anomalies in the central tendency (CT) of larval abundance. 39% of species displayed increasingly early peaks in larval abundance; 18% exhibited delayed phenology; the remainder did not show a secular trend. Species with offshore distributions that spawn during spring and summer were most likely to display advancing phenology. Myctophiformes, Stomiiformes, Perciformes, and Scorpaeniformes are spawning 10-20 days earlier on average than in the 1950s, while Pleuronectiformes and Argentiniformes are spawning 9-12 days later. An inverse relationship between year and SST CT indicated earlier warming of surface waters. A significant correlation was observed between SST CT and species exhibiting phenological changes. Species with a decadal trend towards earlier phenology also spawned early during El Niño. Species with delayed phenology or no decadal trend spawned later during El Niño possibly due to delayed upwelling. Fishes that are not adjusting their phenology were less likely to shift their geographic distribution in relation to environmental variables, implying they may have a reduced capacity to adapt to climate change

Dynamic height: A key variable for identifying the spawning habitat of small pelagic fishes

a b s t r a c t Small pelagic fishes off southern California exhibit interannual variations in the regions they occupy. An enhanced understanding of these fluctuations could improve fisheries management and predictions of fish&apos;s responses to climate change. We investigated dynamic height as a variable for identifying the spawning habitat of northern anchovy (Engraulis mordax), Pacific sardine (Sardinops sagax), and jack mackerel (Trachurus symmetricus). During cruises between 1998 and 2004, dynamic height was calculated from temperature and salinity profiles, while fish egg concentration was measured with obliquely towed bongo nets and the Continuous, Underway Fish Egg Sampler. Dynamic height ranged between 68 and 108 cm, with values increasing offshore. The greatest probability of encountering anchovy, sardine, and jack mackerel eggs occurred at dynamic heights of 79-83 cm, 84-89 cm, and 89-99 cm, respectively. Four mechanisms were proposed to explain how dynamic height affects egg distribution: (1) dynamic height is a proxy for upper water column temperature and salinity, which are known to influence spawning habitat. (2) Low dynamic heights are indicative of coastal upwelling, which increases primary and secondary productivity. (3) Egg concentration is greater at dynamic heights coincident with geostrophic currents that transport larvae to favorable habitats. (4) Eddies delineated by dynamic height contours retain eggs in productive habitats. To evaluate these mechanisms, a generalized linear model was constructed using dynamic height, temperature, salinity, chlorophyll, zooplankton volume, geostrophic currents, and eddies as independent variables. Dynamic height explained more variance than any other variable in models of sardine and anchovy spawning habitat. Together temperature, salinity, and chlorophyll accounted for 80-95% of the dynamic height effect, emphasizing the importance of the first two mechanisms. However, dynamic height remained statistically significant in the models of anchovy and jack mackerel spawning habitat after considering the effects of all other variables. Dynamic height shows promise as an ecological indicator of spawning habitat, because it integrates the effects of multiple oceanic variables, can be remotely sensed, and is predicted by ocean circulation models

Seawater carbonate chemistry and biological parameters during experiments with white sea bass Atractoscion nobilis, 2009

A large fraction of the carbon dioxide added to the atmosphere by human activity enters the sea, causing ocean acidification. We show that otoliths (aragonite ear bones) of young fish grown under high CO2 (low pH) conditions are larger than normal, contrary to expectation. We hypothesize that CO2 moves freely through the epithelium around the otoliths in young fish, accelerating otolith growth while the local pH is controlled. This is the converse of the effect commonly reported for structural biominerals

Pragmatic recommendations for safety while caring for hospitalized patients with COVID-19 in low- And middle-income countries

Infection prevention and control measures to control the spread of COVID-19 are challenging to implement in many low- and middle-income countries (LMICs). This is compounded by the fact that most recommendations are based on evidence that mainly originates in high-income countries. There are often availability, affordability, and feasibility barriers to applying such recommendations in LMICs, and therefore, there is a need for developing recommendations that are achievable in LMICs. We used a modified version of the GRADE method to select important questions, searched the literature for relevant evidence, and formulated pragmatic recommendations for safety while caring for patients with COVID-19 in LMICs. We selected five questions related to safety, covering minimal requirements for personal protective equipment (PPE), recommendations for extended use and reuse of PPE, restriction on the number of times healthcare workers enter patients’ rooms, hand hygiene, and environmental ventilation. We formulated 21 recommendations that are feasible and affordable in LMICs