Exploring training, involvement and confidence: a study of healthcare professionals in decision-making capacity assessments

AIM

To explore the training, involvement and confidence of healthcare professionals involved in decision-making capacity (DMC) assessments, and to compare any differences between those conducting and those involved in, but not conducting DMC assessments.

METHOD

A 10-minute anonymous, online survey was conducted with both closed and open questions. A total of 78 participants completed the survey.

RESULTS

Training was lacking in quantity and adequacy. Only 14.1% received formal training during and post their qualification and only 38.5% reported the right amount of training. Just over 55% reported having the right amount of involvement, with 18% having too much and 27% having not enough involvement. A significantly higher response was given for having too much involvement by those conducting DMC assessments (p=0.006), while those not conducting felt they do not have enough involvement (p<0.001). Only 25.6% (n=20) were very confident in being able to explain DMC to a patient.

CONCLUSIONS

Healthcare professionals working in this area urgently require support in the form of formal training and defined roles. Given what can be at stake for an individual undergoing a DMC assessment, it is imperative that improvements are made to upskill the workforce and utilise expertise of all healthcare professionals.

The treatment journey of attention-related communication difficulties following traumatic brain injury: Perspectives of international health professionals

Traumatic brain injuries (TBI) can result in long-lasting changes in cognition, communication, behavior, and physical abilities that require specialized rehabilitation by health professionals. Communication difficulties following TBI are driven by difficulties in all aspects of cognition and linguistic skills. This study focuses specifically on attention-related communication difficulties and how international health professionals are treating this frequently occurring difficulty following TBI. One hundred and sixty-four international health professionals (e.g., speech language therapists, occupational therapists, neuropsychologists, clinical psychologists, and medical doctors) from seven countries completed an online survey. A small portion from New Zealand then participated in a focus group reviewing the topic of attention-related communication difficulties following TBI. This mixed-methods study used reflexive thematic analysis to analyse the qualitative data from both survey and focus groups alongside quantitative survey results. Fourmain themes were identified that relate to how attention-related communication difficulties should be treated and a roadmap for this important area following TBI was outlined. The four themes include: (1) signposts for attention and communication recovery; (2) change agents of attention and communication; (3) core therapy components; and (4) collaborative teams allow for better and more efficient treatment related to the client's goals. Clinical implications are discussed.

Correction: Viral burden is associated with age, vaccination, and viral variant in a population-representative study of SARS-CoV-2 that accounts for time-since-infection-related sampling bias

[This corrects the article DOI: 10.1371/journal.ppat.1011461.].

Viral burden is associated with age, vaccination, and viral variant in a population-representative study of SARS-CoV-2 that accounts for time-since-infection-related sampling bias

In this study, we evaluated the impact of viral variant, in addition to other variables, on within-host viral burden, by analysing cycle threshold (Ct) values derived from nose and throat swabs, collected as part of the UK COVID-19 Infection Survey. Because viral burden distributions determined from community survey data can be biased due to the impact of variant epidemiology on the time-since-infection of samples, we developed a method to explicitly adjust observed Ct value distributions to account for the expected bias. By analysing the adjusted Ct values using partial least squares regression, we found that among unvaccinated individuals with no known prior exposure, viral burden was 44% lower among Alpha variant infections, compared to those with the predecessor strain, B.1.177. Vaccination reduced viral burden by 67%, and among vaccinated individuals, viral burden was 286% higher among Delta variant, compared to Alpha variant, infections. In addition, viral burden increased by 17% for every 10-year age increment of the infected individual. In summary, within-host viral burden increases with age, is reduced by vaccination, and is influenced by the interplay of vaccination status and viral variant.

Investigating Variability in Microbial Fuel Cells

In scientific studies, replicas should replicate, and identical conditions should produce very similar results which enable parameters to be tested. However, in microbial experiments which use real world mixed inocula to generate a new "adapted" community, this replication is very hard to achieve. The diversity within real-world microbial systems is huge, and when a subsample of this diversity is placed into a reactor vessel or onto a surface to create a biofilm, stochastic processes occur, meaning there is heterogeneity within these new communities. The smaller the subsample, the greater this heterogeneity is likely to be. Microbial fuel cells are typically operated at a very small laboratory scale and rely on specific communities which must include electrogenic bacteria, known to be of low abundance in most natural inocula. Microbial fuel cells (MFCs) offer a unique opportunity to investigate and quantify variability as they produce current when they metabolize, which can be measured in real time as the community develops. In this research, we built and tested 28 replica MFCs and ran them under identical conditions. The results showed high variability in terms of the rate and amount of current production. This variability perpetuated into subsequent feeding rounds, both with and without the presence of new inoculate. In an attempt to control this variability, reactors were reseeded using established "good" and "bad" reactors. However, this did not result in replica biofilms, suggesting there is a spatial as well as a compositional control over biofilm formation. IMPORTANCE The research presented, although carried out in the area of microbial fuel cells, reaches an important and broadly impacting conclusion that when using mixed inoculate in replica reactors under replicated conditions, different communities emerge capable of different levels of metabolism. To date there has been very little research focusing on this, or even reporting it, with most studies using duplicate or triplicate reactors, in which this phenomenon is not fully observed. Publishing data in which replicas do not replicate will be an important and brave first step in the research into understanding this fundamental microbial process.

Rethinking the Place of Qualitative Methods in Behavior Analysis

Single-case design research is pervasive and dominant in the field of behavior analysis (BA). It allows for effective application of behavior change technologies in a wide variety of real-world settings. However, as the field has grown, behavioral scholars have suggested incorporating other methods into the investigator’s toolbox to supplement single-case design. To date, the call to expand beyond using only variations of single-case design as the standard for behavior analytic research has gone largely unheard. Given the need for behavior analytic work to be more closely aligned with consumer and stakeholder needs and priorities, along with a proliferation of practitioners and researchers in the field, now is the time to consider the benefits of qualitative research methods for behavior analysts. In particular, in areas of social validity and in exploring diverse applied topics, qualitative methods may help the field of behavior analysis to achieve greater success with documenting the outcomes from behavior change interventions. The present article explores areas where behavior analysis may benefit from utilizing qualitative methods, namely social validity and breadth of topics for study, and provides examples of the value of qualitative research from other fields. A brief outline of qualitative research is provided alongside consideration of the seven dimensions of applied behavior analysis. In situations where single-case design does not offer behavior analysts sufficient methodological opportunity, qualitative research methods could form a powerful addition to the field of behavior analysis.

Bioavailability of potentially toxic elements influences antibiotic resistance gene and mobile genetic element abundances in urban and rural soils

Antibiotic resistance genes (ARGs) that can encode resistance traits in bacteria are found across the environment. While it is often difficult to discern their origin, their prevalence and diversity depends on many factors, one of which is their exposure to potentially toxic elements (PTE, i.e., metals and metalloids) in soils. Here, we investigated how ambient ARGs and mobile genetic elements (MGEs) relate to the relative bioavailability of different PTEs (total versus exchangeable and carbonate-bound PTE) in rural and urban soils in northeast England. The average relative abundances of ARGs in rural sites varied over a 3-log range (7.24 × 10^-7 to 1.0 × 10^-4 genes/16S rRNA), and relative ARG abundances in urban sites varied by four orders of magnitude (1.75 × 10^-6 to 2.85 × 10^-2 genes/16S rRNA). While beta-lactam and aminoglycoside resistance genes dominated rural and urban sites, respectively, non-specific ARGs, also called multidrug-resistance genes, were significantly more abundant in urban sites (p < 0.05). Urban sites also had higher concentrations of total and exchangeable forms of PTE than rural sites, whereas rural sites were higher in carbonate-bound forms. Significant positive Spearman correlations between PTEs, ARGs and MGEs were apparent, especially with bioavailable PTE fractions and at urban sites. This study found significant positive correlations between ARGs and beryllium (Be), which has not previously been reported. Overall, our results show that PTE bioavailability is important in explaining the relative selection of ARGs in soil settings and must be considered in future co-selection and ARG exposure studies.

Outcomes of attention-related communication deficits following traumatic brain injury: perspectives of international health professionals

PRIMARY OBJECTIVE

Attention and communication difficulties are common yet often invisible following Traumatic Brain Injury (TBI). The focus of this paper is to use practice-based evidence from health professionals working with individuals following TBI to gain a deep and relevant understanding of the impact that attention and communication can have in the lives of individuals following TBI.

RESEARCH DESIGN

This dataset comes from a larger mixed-methods study that includes a survey with both open and closed questions and focus group data sources.

METHODS AND PROCEDURES

Thematic analysis was completed on a single open-ended question from the survey of health professionals. It asked health professionals about the outcomes they believe are directly related to attention difficulties that result in specific communication difficulties.

MAIN OUTCOMES AND RESULTS

Responses from 73 health professionals who work in neurorehabilitation generated five themes: behavior, connections, self, purpose, and empowerment. The themes were pervasive across all aspects of the recovery journey for individuals post-TBI.

CONCLUSIONS

The implications for clinical practice and future research indicate a need to focus on attention-related strategies for language deficits; treating communication difficulties related to relationships and friendships; and redefining a sense of self following TBI.

Linguistic analysis in public speaking: evidence from a Gavel Club for people with aphasia

Public speaking has been described as one of the most daunting tasks one can engage in, even more so for people with aphasia (PWA). Gavel Clubs (affiliated with Toastmasters International) were established over 20 years ago for those who want to engage in public speaking but do not meet the eligibility criteria for Toastmasters membership. This study is the first of its kind to systematically evaluate changes in the speeches of PWA attending a weekly Gavel Club. The aims were to compare Table Topics (TT) and Prepared Speeches (PS) which are two different tasks regularly performed in a Gavel Club; to measure linguistic change over time in the two speech types; and to determine the feasibility of a discourse measure for analysing public speeches. Thirty-six speeches (four each from nine PWA) were audio-recorded, transcribed and analysed using the Linguistic Communication Measure (LCM). The nine participants represented a wide range of aphasia severity. Analysis revealed that engaging in weekly speaking activities in the GC was associated with an improvement in conveying content and in grammaticality through an increase in total number of words and number of correct words produced. The LCM is a comprehensive analysis tool but proved to be challenging in its speed and utility when measuring linguistic change in public speeches of PWA. Regular GC participation appears to facilitate improved language abilities, but we have yet to find the best tool to demonstrate this.

Organic complexation of U(VI) in reducing soils at a natural analogue site: Implications for uranium transport

Understanding the long-term fate, stability, and bioavailability of uranium (U) in the environment is important for the management of nuclear legacy sites and radioactive wastes. Analysis of U behavior at natural analogue sites permits evaluation of U biogeochemistry under conditions more representative of long-term equilibrium. Here, we have used bulk geochemical and microbial community analysis of soils, coupled with X-ray absorption spectroscopy and μ-focus X-ray fluorescence mapping, to gain a mechanistic understanding of the fate of U transported into an organic-rich soil from a pitchblende vein at the UK Needle's Eye Natural Analogue site. U is highly enriched in the Needle's Eye soils (∼1600 mg kg^-1). We show that this enrichment is largely controlled by U(VI) complexation with soil organic matter and not U(VI) bioreduction. Instead, organic-associated U(VI) seems to remain stable under microbially-mediated Fe(III)-reducing conditions. U(IV) (as non-crystalline U(IV)) was only observed at greater depths at the site (>25 cm); the soil here was comparatively mineral-rich, organic-poor, and sulfate-reducing/methanogenic. Furthermore, nanocrystalline UO₂, an alternative product of U(VI) reduction in soils, was not observed at the site, and U did not appear to be associated with Fe-bearing minerals. Organic-rich soils appear to have the potential to impede U groundwater transport, irrespective of ambient redox conditions.

Beyond N and P: The impact of Ni on crude oil biodegradation

N and P are the key limiting nutrients considered most important for the stimulation of crude oil degradation but other trace nutrients may also be important. Experimental soil microcosms were setup to investigate crude oil degradation in the context of Ni amendments. Amended Nickel as NiO, NiCl₂, or, a porphyrin complex either inhibited, had no effect, or, enhanced aerobic hydrocarbon degradation in an oil-contaminated soil. Biodegradation was significantly (95% confidence) enhanced (70%) with low levels of Ni-Porph (12 mg/kg) relative to an oil-only control; whereas, NiO (200 and 350 mg/kg) significantly inhibited (36 and 87%) biodegradation consistent with oxide particle induced reactive oxygen stress. Microbial community compositions were also significantly affected by Ni. In 16S rRNA sequence libraries, the enriched hydrocarbon degrading genus, Rhodococcus, was partially replaced by a Nocardia sp. in the presence of low levels of NiO (12 and 50 mg/kg). In contrast, the highest relative and absolute Rhodococcus abundances were coincident with the maximal rates of oil degradation observed in the Ni-Porph-amended soils. Growth dependent constitutive requirements for Ni-dependent urease or perhaps Ni-dependent superoxide dismutase enzymes (found in Rhodococcus genomes) provided a mechanistic explanation for stimulation. These results suggest biostimulation technologies, in addition to N and P, should also consider trace nutrients such as Ni tacitly considered adequately supplied and available in a typical soil.

Recalibrating hope: A longitudinal study of the experiences of people with aphasia after stroke

Background

Hope is a critical resource for people with aphasia after stroke, sustaining people though times of distress and uncertainty and providing motivation. In the first months after stroke, hope is vulnerable to different influences, and people can struggle to identify and work towards hopes for the future. We have little knowledge about how people with aphasia experience hope in the longer term after stroke.

Objectives

To identify how people with aphasia experience hope 1 year after stroke and how hope may change in the year after stroke.

Methods

The study used an Interpretive Description methodology. Interviews were conducted with four people with aphasia who had been interviewed 1 year previously. These were analysed using content analysis.

Results

All people reported a broad sense of hope for the future. They described an active process of recalibrating their early poststroke hopes through a process of reflecting on past progress, current function and what they considered might be possible and desirable in the future. People were able to develop ‘new’ hopes that were meaningful and seemingly achievable when they had a sense of a possible, desirable future. Those who struggled to see a possible future maintained a hope that things will be good. Social supports, a sense of progress, engagement in meaningful activities and interactions appeared crucial in helping people (re)develop hopes for their future.

Conclusions

Hope and hopes for the future gradually changed after stroke. Hope, identity and social connectedness were closely entwined and could enable people to both dwell in the present and move towards desired futures. This research suggests clinicians should prioritise creating hope‐fostering environments which support people to develop hope for their future.

Understanding drivers of antibiotic resistance genes in High Arctic soil ecosystems

Soils in tropical and temperate locations are known to be a sink for the genetic potential of anthropogenic-driven acquired antibiotic resistance (AR). In contrast, accumulation of acquired AR is less probable in most Polar soils, providing a platform for characterizing background resistance and establishing a benchmark for assessing AR spread. Here, high-throughput qPCR and geochemistry were used to quantify the abundance and diversity of both antibiotic resistance genes (ARGs) and selected mobile genetic elements (MGEs) across eight soil clusters in the Kongsfjorden region of Svalbard in the High Arctic. Relative ARG levels ranged by over two orders of magnitude (10^-6 to 10^-4 copies/16S rRNA gene copy), and showed a gradient of potential human and wildlife impacts across clusters as evidenced by altered geochemical conditions and increased "foreign" ARG abundances (i.e., allochthonous), including bla_NDM-1. Impacted clusters exhibited 100× higher total ARGs and MGEs in tandem with elevated secondary nutrients, especially available P that is typically low and limiting in Arctic soils. In contrast, ARGs in less-impacted clusters correlated strongly to local soil lithology. The most plausible source of exogenous P and allochthonous ARGs in this region is bird and other wildlife guano, disseminated either by local human wastes or via direct carriage and deposition. Regardless of pathway, accumulation of apparent allochthonous ARGs and MGEs in High Arctic soils is concerning, highlighting the importance of characterizing Arctic sites now to establish benchmarks for tracking AR spread around the world.

Dissolved Mn(III) in water treatment works: Prevalence and significance

Dissolved Mn(III) has been identified at all stages throughout a Water Treatment Works (WTW) receiving inflow from a peaty upland catchment in NE England. Ninety percent of the influent total manganese into the WTW is particulate Mn, in the form of Mn oxide (>0.2 μm). Approximately 9% (mean value, n = 22, range of 0-100%) of the dissolved (<0.2 μm) influent Mn is present as dissolved Mn(III). Mn(III) concentrations are highest (mean of 49% of total dissolved Mn; n = 26, range of 17-89%) within the WTW where water comes into contact with the organic-rich sludges which are produced as waste products in the WTW. These Mn(III)-containing wastewaters are recirculated to the head of the works and constitute a large input of Mn(III) into the WTW. This is the first report of Mn(III) being identified in a WTW. The ability of Mn(III) to act as both an oxidant and a reductant is of interest to the water industry. Understanding the formation and removal of Mn(III) within may help reduce Mn oxide deposits in pipe networks. Further understanding how the ratio of Mn(III) to Mn(II) can be used to optimise dissolved Mn removal would save the water industry significant money in reducing discoloration 'events' at the customers' tap.

In situ arsenic oxidation and sorption by a Fe-Mn binary oxide waste in soil

The ability of a Fe-Mn binary oxide waste to adsorb arsenic (As) in a historically contaminated soil was investigated. Initial laboratory sorption experiments indicated that arsenite [As(III)] was oxidized to arsenate [As(V)] by the Mn oxide component, with concurrent As(V) sorption to the Fe oxide. The binary oxide waste had As(III) and As(V) adsorption capacities of 70mgg^-1 and 32mgg^-1 respectively. X-ray Absorption Near-Edge Structure and Extended X-ray Absorption Fine Structure at the As K-edge confirmed that all binary oxide waste surface complexes were As(V) sorbed by mononuclear bidentate corner-sharing, with 2 Fe at ∼3.27Ǻ. The ability of the waste to perform this coupled oxidation-sorption reaction in real soils was investigated with a 10% by weight addition of the waste to an industrially As contaminated soil. Electron probe microanalysis showed As accumulation onto the Fe oxide component of the binary oxide waste, which had no As innately. The bioaccessibility of As was also significantly reduced by 7.80% (p<0.01) with binary oxide waste addition. The results indicate that Fe-Mn binary oxide wastes could provide a potential in situ remediation strategy for As and Pb immobilization in contaminated soils.

Aphasia and Auditory Processing after Stroke through an International Classification of Functioning, Disability and Health Lens

Aphasia is an acquired language impairment affecting speaking, listening, reading, and writing. Aphasia occurs in about a third of patients who have ischemic stroke and significantly affects functional recovery and return to work. Stroke is more common in older individuals but also occurs in young adults and children. Because people experiencing a stroke are typically aged between 65 and 84 years, hearing loss is common and can potentially interfere with rehabilitation. There is some evidence for increased risk and greater severity of sensorineural hearing loss in the stroke population and hence it has been recommended that all people surviving a stroke should have a hearing test. Auditory processing difficulties have also been reported poststroke. The International Classification of Functioning, Disability and Health (ICF) can be used as a basis for describing the effect of aphasia, hearing loss, and auditory processing difficulties on activities and participation. Effects include reduced participation in activities outside the home such as work and recreation and difficulty engaging in social interaction and communicating needs. A case example of a young man (M) in his 30s who experienced a left-hemisphere ischemic stroke is presented. M has normal hearing sensitivity but has aphasia and auditory processing difficulties based on behavioral and cortical evoked potential measures. His principal goal is to return to work. Although auditory processing difficulties (and hearing loss) are acknowledged in the literature, clinical protocols typically do not specify routine assessment. The literature and the case example presented here suggest a need for further research in this area and a possible change in practice toward more routine assessment of auditory function post-stroke.

Parent-rated measures of bilingual children's speech accuracy: Implications for a universal speech screen

PURPOSE

This study investigated whether parents were reliable in judging their bilingual children's speech and whether parent-rated measure of children's speech could be used as a tool for a universal speech screen to identify children with speech sound disorder (SSD).

METHOD

Single word samples from 33 Korean-English bilingual (KEB) pre-school children were analysed for percentage of consonants correct (PCC). Their parents completed the Intelligibility in Context Scale and a similarly constructed scale devised by Stertzbach and Gildersleeve-Neumann. Spearman rank correlations were used to examine the association between the PCC scores and the parent-rated measures.

RESULT

A number of factors influenced parents' reliability in judging their bilingual children's speech, including language dominance and the nature of the questions that were asked. The perception of strangers on a child's speech problems, as judged by the parents, could be significant in identifying children with SSD. When the cut-off ICS mean score derived from a previous monolingual research was applied to KEB children, over 40% of the sample was identified as requiring a comprehensive clinical assessment.

CONCLUSION

Implementation of a universal speech screen utilising parent-rated measures of children's speech cannot be introduced without further research.

Microbial Communities in a High Arctic Polar Desert Landscape

The High Arctic is dominated by polar desert habitats whose microbial communities are poorly understood. In this study, we used next generation sequencing to describe the α- and β-diversity of microbial communities in polar desert soils from the Kongsfjorden region of Svalbard. Ten phyla dominated the soils and accounted for 95% of all sequences, with the Proteobacteria, Actinobacteria, and Chloroflexi being the major lineages. In contrast to previous investigations of Arctic soils, relative Acidobacterial abundances were found to be very low as were the Archaea throughout the Kongsfjorden polar desert landscape. Lower Acidobacterial abundances were attributed to characteristic circumneutral soil pHs in this region, which has resulted from the weathering of underlying carbonate bedrock. In addition, we compared previously measured geochemical conditions as possible controls on soil microbial communities. Phosphorus, pH, nitrogen, and calcium levels all significantly correlated with β-diversity, indicating landscape-scale lithological control of available nutrients, which in turn, significantly influenced soil community composition. In addition, soil phosphorus and pH significantly correlated with α-diversity, particularly with the Shannon diversity and Chao 1 richness indices.

Remediation of a historically Pb contaminated soil using a model natural Mn oxide waste

A natural Mn oxide (NMO) waste was assessed as an in situ remediation amendment for Pb contaminated sites. The viability of this was investigated using a 10 month lysimeter trial, wherein a historically Pb contaminated soil was amended with a 10% by weight model NMO. The model NMO was found to have a large Pb adsorption capacity (qmax 346±14 mg g(-1)). However, due to the heterogeneous nature of the Pb contamination in the soils (3650.54-9299.79 mg kg(-1)), no treatment related difference in Pb via geochemistry could be detected. To overcome difficulties in traditional geochemical techniques due to pollutant heterogeneity we present a new method for unequivocally proving metal sorption to in situ remediation amendments. The method combines two spectroscopic techniques; namely electron probe microanalysis (EPMA) and X-ray photoelectron spectroscopy (XPS). Using this we showed Pb immobilisation on NMO, which were Pb free prior to their addition to the soils. Amendment of the soil with exogenous Mn oxide had no effect on microbial functioning, nor did it perturb the composition of the dominant phyla. We conclude that NMOs show excellent potential as remediation amendments.

Choral singing therapy following stroke or Parkinson's disease: an exploration of participants' experiences

PURPOSE

People with stroke or Parkinson's disease (PD) live with reduced mood, social participation and quality of life (QOL). Communication difficulties affect 90% of people with PD (dysarthria) and over 33% of people with stroke (aphasia). These consequences are disabling in many ways. However, as singing is typically still possible, its therapeutic use is of increasing interest. This article explores the experiences of and factors influencing participation in choral singing therapy (CST) by people with stroke or PD and their significant others.

METHOD

Participants (eight people with stroke, six with PD) were recruited from a community music therapy choir running CST. Significant others (seven for stroke, two for PD) were also recruited. Supported communication methods were used as needed to undertake semi-structured interviews (total N = 23).

RESULTS

Thematic analysis indicated participants had many unmet needs associated with their condition, which motivated them to explore self-management options. CST participation was described as an enjoyable social activity, and participation was perceived as improving mood, language, breathing and voice.

CONCLUSIONS

Choral singing was perceived by people with stroke and PD to help them self-manage some of the consequences of their condition, including social isolation, low mood and communication difficulties.

IMPLICATIONS FOR REHABILITATION

Choral singing therapy (CST) is sought out by people with stroke and PD to help self-manage symptoms of their condition. Participation is perceived as an enjoyable activity which improves mood, voice and language symptoms. CST may enable access to specialist music therapy and speech language therapy protocols within community frameworks.

Communication impairments in people with progressive supranuclear palsy: A tutorial

Progressive supranuclear palsy (PSP) is a progressive neurological condition, whose main features include supranuclear gaze palsy, frequent falls, bradykinesia, axial rigidity, cognitive decline and communication impairments. Even though communication impairments are early and prominent manifestations, there is a significant lack of research on the nature of these impairments in PSP and the role of speech-language pathologists (SLPs). This tutorial article aims to describe the communication impairments observed in people with PSP; provide clinical guidelines for SLPs when assessing motor speech, language and other communication impairments; and to present facilitation and compensation approaches to treatment for people with PSP. The predominant motor speech impairment is mixed dysarthria, but there is a lack of consensus about the classification of language impairments. The involvement of SLPs in the assessment and treatment of people with PSP should be early, on-going and in collaboration with other health professionals, with the primary focus of maintaining quality of life for these patients and their family members.

Stroke awareness and knowledge in an urban New Zealand population

BACKGROUND

Stroke is the third most common cause of death and a major cause of chronic disability in New Zealand. Linked to risk factors that develop across the life-course, stroke is considered to be largely preventable. This study assessed the awareness of stroke risk, symptoms, detection, and prevention behaviors in an urban New Zealand population.

METHODS

Demographics, stroke risk factors awareness, symptoms, responsiveness, and prevention behaviors were evaluated using a structured oral questionnaire. Binomial logistic regression analyses were used to identify predictors of stroke literacy.

RESULTS

Although personal experience of stroke increased awareness of symptoms and their likeliness to indicate the need for urgent medical attention, only 42.7% of the respondents (n = 850) identified stroke as involving both blood and the brain. Educational attainment at or above a trade certificate, apprenticeship, or diploma increased the awareness of stroke symptoms compared with those with no formal educational attainment. Pacific Island respondents were less likely than New Zealand Europeans to identify a number of stroke risk factors. Māori, Pacific Island, and Asian respondents were less likely to identify symptoms of stroke and indicate the need for urgent medical attention.

CONCLUSIONS

The variability in stroke awareness and knowledge may suggest the need to enhance stroke-related health literacy that facilitates understanding of risk and of factors that reduce morbidity and mortality after stroke in people of Māori and Pacific Island descent and in those with lower educational attainment or socioeconomic status. It is therefore important that stroke awareness campaigns include tailored components for target audiences.

Māori experiences of aphasia therapy: "But I'm from Hauiti and we've got shags"

This study explored Māori experiences of aphasia therapy, with a view to ascertaining what makes a service culturally safe as well as "accessible to and culturally appropriate for" Māori with aphasia and their whānau (extended family). Māori are the indigenous peoples of New Zealand. This study incorporated interpretive description (a qualitative methodology) within kaupapa Māori research (a Māori approach to research). In-depth semi-structured interviews were undertaken with 11 Māori with aphasia and 23 of their nominated whānau members. They reported a wide variety of experiences of aphasia therapy, in six themes: We're happy to do the work, but we can't do it alone; Relationship; Our worldview; The speech-language therapy setting; Aphasia resources; and Is this as good as it gets? While some Māori with aphasia reportedly received an accessible and culturally appropriate service, others did not. It is concluded that, for Māori with aphasia, a strong therapeutic relationship is central. The success of this relationship is shaped by the SLP's appreciation of the worldview of the person with aphasia and whānau, the setting of the therapy, and the resources used. Successful therapy will involve collaboration between clinician and whānau, and therapy resources that affirm the identity of the person with aphasia.

The use of interpretive description within Kaupapa Māori research

Kaupapa Māori research (KMR) is an Indigenous research approach that is decolonizing and transformative. Interpretive description (ID) is a qualitative methodology used to generate knowledge relevant to the applied health disciplines. In this article, we discuss how we combined KMR and ID to investigate the experiences of Māori (the Indigenous peoples of New Zealand) with aphasia and their whānau (extended family). This is novel because it is the first time these two approaches have been combined. In the context of aphasia research, we discuss how they work together in theory, and the synergies that became apparent in practice. We conclude that the combination of KMR and ID enables clinicians and Māori with aphasia to learn from each other and work together, thereby generating knowledge that makes a difference for Māori with aphasia and their whānau.

Neospora caninum in cattle: experimental infection with oocysts can result in exogenous transplacental infection, but not endogenous transplacental infection in the subsequent pregnancy

Whilst it is presumed that infection of pregnant cattle with Neospora caninum oocysts can provoke abortion and is the likely cause of epidemic abortion outbreaks, only two previous experiments have involved inoculation of pregnant cows with oocysts (and only one abortion was provoked in 22 pregnancies). Here, we describe the oral oocyst challenge of 18 cows synchronously bred and inoculated precisely at 70 (n=6), 120 (n=6) and 210 (n=6) days in pregnancy with a nominal dose of 40,000 oocysts. Only one abortion occurred (at the 120 days challenge) which could be definitively ascribed to N. caninum and no transplacental infection (TPI) was detected in any of the other 11 calves born in the 70 and 120 day challenge groups. In contrast, 4/5 live calves born to cattle challenged at 210 days were transplacentally infected. When cows which had transplacentally infected their calves in the first pregnancy were rebred, no TPI occurred. The results show that the timing of challenge influences clinical and parasitological outcomes and that cattle in late pregnancy are exquisitely sensitive to oocyst challenge leading to exogenous TPI and congenitally infected calves. However, cattle which were indisputably systemically infected in their first pregnancy did not induce endogenous TPI in their subsequent pregnancy. This confirms previous results with experimental tachyzoite challenge and suggests that post-natal infection does not lead to persisting infections which can recrudesce in pregnancy.

Molecularly cloned SHIV-1157ipd3N4: a highly replication- competent, mucosally transmissible R5 simian-human immunodeficiency virus encoding HIV clade C Env

Human immunodeficiency virus type 1 (HIV-1) clade C causes >50% of all HIV infections worldwide, and an estimated 90% of all transmissions occur mucosally with R5 strains. A pathogenic R5 simian-human immunodeficiency virus (SHIV) encoding HIV clade C env is highly desirable to evaluate candidate AIDS vaccines in nonhuman primates. To this end, we generated SHIV-1157i, a molecular clone from a Zambian infant isolate that carries HIV clade C env. SHIV-1157i was adapted by serial passage in five monkeys, three of which developed peripheral CD4(+) T-cell depletion. After the first inoculated monkey developed AIDS at week 137 postinoculation, transfer of its infected blood to a naïve animal induced memory T-cell depletion and thrombocytopenia within 3 months in the recipient. In parallel, genomic DNA from the blood donor was amplified to generate the late proviral clone SHIV-1157ipd3. To increase the replicative capacity of SHIV-1157ipd3, an extra NF-kappaB binding site was engineered into its 3' long terminal repeat, giving rise to SHIV-1157ipd3N4. This virus was exclusively R5 tropic and replicated more potently in rhesus peripheral blood mononuclear cells than SHIV-1157ipd3 in the presence of tumor necrosis factor alpha. Rhesus macaques of Indian and Chinese origin were next inoculated intrarectally with SHIV-1157ipd3N4; this virus replicated vigorously in both sets of monkeys. We conclude that SHIV-1157ipd3N4 is a highly replication-competent, mucosally transmissible R5 SHIV that represents a valuable tool to test candidate AIDS vaccines targeting HIV-1 clade C Env.

Psychophysiological characteristics of narcissism during active and passive coping

This study provides the first psychophysiological analysis of narcissism by measuring autonomic responses during active and passive anticipatory coping in 40 undergraduate men who scored high or low on the Narcissistic Personality Inventory (NPI). Compared to the low NPI group, the high NPI group showed greater preejection period (PEP) shortening, cardiac deceleration, and skin conductance response (SCR) habituation during anticipation of an aversive stimulus (p < .02). As expected, SCR and PEP reactivity were greater during active than passive coping. In the case of PEP, this effect emerged only in the low NPI group; the high NPI group showed the greatest PEP reactivity during the first task, regardless of coping demands. These data support hypothesized relationships among narcissism, psychopathy, and psychological predictors of cardiovascular disease, and suggest that a psychobiological dimension may underlie important features of narcissism.