Focus Article Research Articles

European brown hare syndrome virus and other lagoviruses of interest.

This focus article was prepared by Paul Duff of the APHA Wildlife Expert Group, with support from David Everest (APHA Pathology Department), Lucy Martindale (APHA Surveillance Intelligence Unit), Alex Barlow (Wildlife Network for Disease Surveillance), Mara Rocchi (Moredun Research Institute) and Antonio Lavazza (Istituto Zooprofilattico Sperimentale della Lombardia e dell'Emilia Romagna, Italy).

Revitalizing the heart: cutting-edge nucleic acid therapies in cardiac regeneration

Heart failure (HF) arises from cardiac injury and subsequent loss of contractile cells. While some organisms can regenerate cardiac tissue through cardiomyocyte proliferation, the adult mammalian heart has limited regenerative capacity due to cardiomyocyte replication ceasing shortly after birth. To enhance proliferation in the adult heart, we aim to identify master regulators of proliferation. In Professor Mauro Giacca’s laboratory, human-specific microRNAs (miRNAs) like miR199a-3p or miR-1825 have been identified as potential enhancers of cardiomyocyte proliferation. My PhD will evaluate these miRNAs using different delivery methods, comparing viral vectors with lipid nanoparticle (SNALP) technology. Additionally, I will adapt CycleTrack, a tool for labelling mitotic cells, to study cardiomyocyte replication accurately in response to these miRNAs. By assessing these approaches in human myocardial slices, this work seeks to uncover the molecular mechanisms of pro-proliferative miRNAs and pave the way for future clinical interventions targeting heart regeneration. In this Student Focus article, I also highlight another aspect: the framework used to address complex biological questions is crucial in shaping the answers we seek. What intrigues me most about my research is the interplay between elucidating discrete molecular pathways and employing holistic approaches to understand cardiac proliferation.

A First-Person Account of Caring for a Parent With Dysphagia.

Research has shown that caregiver burden is compounded by dysphagia experienced by the care recipient. However, little is known about the caregiver perception of the caregiving experience, highlighting both the positive and negative experiences. As such, the purpose of this clinical focus article was to provide a first-person account of an adult caregiver of an aging parent with dysphagia and relate their experiences to current literature to inform clinical practice. The caregiver provided a detailed account of her experiences caring for her father with dysphagia. Her account was analyzed to identify recurring themes in the literature regarding the caregiving experience and to identify gaps in dysphagia-related caregiver support. The caregiver's story is organized into seven main sections: (a) life before dysphagia, (b) dysphagia onset and diagnosis, (c) dysphagia management and support, (d) community support, (e) impact on family relationships, (f) social and emotional health, and (g) current perspectives on the caregiving experience. The challenges associated with caregiving clearly impact the caregiver's overall well-being, but she received abundant support from her family, community-based speech-language pathologist, and caregiver support groups. The caregiver's experiences, while not applicable to every caregiver caring for a loved one with dysphagia, can offer valuable insights to clinicians and other caregivers facing similar situations.

Nodular skin disease in cattle.

This focus article was prepared by Caroline Fenemore and Vanessa Swinson of the APHA Cattle Species Expert Group, with Aiden Foster of the University of Bristol (Farm Animal Pathology Services).

A conceptual model for assessing the risk of unidentified pain

Untreated or undertreated pain is well established as a significant problem, but unidentified pain is a distinct construct that still needs to be clearly modeled or fully described. This paper aims to develop a conceptual model of unidentified pain in humans with the goal of future development of an unidentified pain risk tool. A multi-phase process was employed consisting sequentially of 1) brainstorming followed by consensus building, 2) peer-review and publication of an integrative theoretical review protocol for “unidentified pain,” 3) conduct of the integrative review, and 4) a repeated brainstorming session to identify areas of risk for unidentified pain to produce a conceptual model. Brainstorming led to a consensus on “unidentified pain” as the concept of interest, followed by developing a review protocol. Twenty-four abstracts were reviewed after database searches, and four articles were included for full-text review. Three pain risk areas (hazards) were identified: cognition/communication problems, being alone or in the absence of a surrogate/proxy report, and the presence of known painful conditions or treatments and a conceptual model was developed. The hazards are posited to have the potential to both interact and be cumulative, increasing the risk for unidentified pain. There is currently no risk tool for assessing unidentified pain. The development of this conceptual model will be used for future development and psychometric testing of a tool to recognize the risk for unidentified pain in humans. PerspectiveThis focus article describes the development a conceptual model for the concept of unidentified pain in humans. This pain may occur in individuals who experience one or more interactive and cumulative hazards: cognition/communication problems, being alone, absence of a surrogate/proxy report, or presence of known painful conditions or treatments.

How Well Can We Measure Chronic Pain Impact in Existing Longitudinal Cohort Studies? Lessons Learned

Multiple large longitudinal cohorts provide opportunities to address questions about predictors of pain and pain trajectories, even when not anticipated in the design of the historical databases. This focus article uses 2 empirical examples to illustrate the processes of assessing the measurement properties of data from large cohort studies to answer questions about pain. In both examples, data were screened to select candidate variables that captured the impact of chronic pain on self-care activities, productivity, and social activities. We describe a series of steps to select candidate items and evaluate their psychometric characteristics in relation to the measurement of pain impact proposed. In the UK Biobank, a general lack of internal consistency of variables selected prevented the identification of a satisfactory measurement model, with lessons for the measurement of chronic pain impact. In the English Longitudinal Study of Ageing, a measurement model for chronic pain impact was identified, albeit limited to capturing the impact of pain on self-care and productivity but lacking coverage related to social participation. In conjunction with its Supplementary Material, this focus article aims to encourage exploration of these valuable prospectively collected data to support researchers to make explicit the relationships between items in the databases and constructs of interest in pain research and to use empirical methods to estimate the possible biases in these variables. PerspectiveThis focus article outlines a theory-driven approach for fitting new measurement models to data from large cohort studies and evaluating their psychometric properties. This aims to help researchers develop an empirical understanding of the gains and limitations connected with the process of repurposing the data stored in these datasets.

Cattle and sheep anthelmintics: reporting suspected lack of expected efficacy.

This focus article was adapted by Vanessa Swinson and Natalie Jewell of the APHA from one written collaboratively by the Veterinary Medicines Directorate, APHA, British Cattle Veterinary Association, Sheep Veterinary Society and National Office of Animal Health.

Best Practices for Supporting Social–Emotional Development in Children With Developmental Language Disorder and Attention-Deficit/Hyperactivity Disorder

Purpose: Children with developmental language disorder (DLD) and/or attention-deficit/hyperactivity disorder (ADHD) are at an elevated risk of social–emotional difficulties, including low self-esteem and anxiety, related to school achievement and peer interactions. This clinical focus article provides best practice guidelines, shaped by a neurodiversity-affirming lens, to support children's social–emotional development. Method: The guidelines were developed through interprofessional discussions among the authors, which included three communication specialists and two mental health specialists, and supported by review of the scholarly literature on neurodiversity, DLD, and ADHD, with a focus on first-person perspectives of children and adults with these conditions and their parents and teachers. Results: The practice guidelines include recommendations for the interprofessional assessment of DLD and/or ADHD and suggestions for neurodiversity-affirming supports to promote acceptance of students with DLD and/or ADHD by teachers and peers. Intervention recommendations for social communication skills, self-regulation supports, and self-advocacy are described. A hypothetical case study is provided to illustrate implementation of the recommended practices. Conclusions: First-person and family perspectives studies provide compelling evidence that having DLD and/or ADHD, coupled with the negative reactions of others to children's differences related to these conditions, have adverse effects on children's social–emotional development. Speech-language pathologists and their interprofessional team members have an important role to play in preventing these effects by providing social–emotional supports for children with DLD and/or ADHD.

Scale‐sensitive marine law and policy design: Towards ecosystem‐based management across spatial and temporal scales

AbstractEcosystem‐based management (EBM) is promoted in scholarly literature and international policy as a way to improve marine ecosystem outcomes, through the integration of marine law and policies across sectors, communities, and scales. A legal and policy framework that supports EBM at appropriate temporal and spatial scales is fundamental to the successful deployment of EBM. However, marine management is typically fragmented and misaligned, with a range of laws, policies, governance institutions, and sectoral frameworks applying to different marine spaces and working on varying timescales. In this focus article, we draw on our comprehensive study of Aotearoa New Zealand's marine law and policy to analyze the challenges scale mismatches present for marine law and policy implementation, focusing on key policy areas across fisheries, environment, conservation, and Indigenous rights and interests. We identify key opportunities to better align marine law and policy to ecosystem scale dynamics, revealing critical lessons for the imperative of scale‐sensitive marine law and policy design, globally.This article is categorized under: Policy and Economics > Research and Development Policy and Economics > Governance and Regulation Climate and Environment > Ecosystem Services

Navigating the Role of Mobile Audiology in Public Health: Overcoming Hearing Health Care Barriers That Impact the Underserved

Purpose: The purpose of this clinical focus article is to convey the significant role that mobile audiology could have in the public health space and discuss how mobile audiology can overcome obstacles that hinder access to traditional audiological care. This article also introduces strategies for delivering innovative audiological care. Method: The article is drawn from the authors' personal research, business, and clinical experiences. It describes the variations in mobile audiology that could aid in improving health care outcomes, identifying underserved areas, identifying barriers, implementing innovative solutions to overcome barriers, limitations of mobile audiology, and implications for optimized hearing health care. Conclusions: Mobile audiology services may play a vital role in public health programs and initiatives by bringing hearing health care to underserved communities, promoting accessibility, and addressing hearing health care concerns that disproportionately impact vulnerable populations. Mobile audiology services extend beyond the conventional concept of service delivery and can reduce barriers that prevent access to hearing health care, such as lack of transportation, geographical conditions/distance, time, lack of insurance coverage for evaluation/treatment, lack of qualified hearing health professionals, and financial constraints. Various services can be offered through mobile audiology, such as comprehensive screenings, diagnostic evaluations, and rehabilitation services/interventions. Mobile audiology services provide patients with the intervention necessary to improve communication abilities, quality of life, and overall health care outcomes.

Reconsidering the Role of Weight Loss in Treatment for Chronic Pain: Knee Osteoarthritis as an Exemplar

Chronic pain is prevalent among individuals with higher body weight and associated with greater impairment. As a result, weight loss is a common recommendation for pain management among those with higher body weight. Body weight is an appealing target because it is modifiable and evidence-based treatments to produce weight loss are well-established. In the last 2 decades, there has been a growing line of scientific work investigating the application of weight loss to individuals with chronic pain. This represents an important step to integrate the conceptualization of pain and body weight and there is preliminary work suggesting treatment effects are enhanced when weight loss treatment is combined with pain coping skills. However, weight loss outcomes are variable and difficult to sustain, and access to evidence-based treatment is limited. These concerns are set against the backdrop of growing public and academic concern about the weight-centric approach to health care that dominates western medicine. This is a timely moment to reconsider the conceptualization of weight and pain, and the role of weight loss in chronic pain treatment. Using osteoarthritis as an exemplar, we review the evidence for and clinical uptake of weight loss as a chronic pain management strategy and conclude with key areas for consideration to advance the scientific understanding of these comorbid conditions and how to optimize pain management for individuals of higher body weight. PerspectiveThis focus article critically considers the role of weight loss in management of chronic pain among individuals of higher body. Using knee osteoarthritis as an exemplar, the evidence and clinical uptake of weight loss for pain management is reviewed. Limitations are considered to guide future research and clinical care.

Contextualized, Multicomponent Language Instruction: From Theory to Randomized Controlled Trial.

Clinicians address a wide range of oral language skills when working with school-age students with language and literacy difficulties (LLDs). Therefore, there is a critical need for carefully designed, rigorously tested, multicomponent contextualized language interventions (CLIs) that have a high likelihood of successful implementation and measurable academic impacts. This clinical focus article summarizes the development and testing of a CLI entitled Supporting Knowledge in Language and Literacy (SKILL), which is a supplementary narrative intervention program for elementary school-age children. Our aims are to (a) to review the foundational theoretical models that are the foundation of SKILL; (b) describe the iterative process used to develop the phases, lessons, procedures, materials, and progress monitoring tool; (c) summarize recent findings of the randomized controlled trial that was conducted to test its efficacy; and (d) discuss factors that may contribute to successful implementation of multicomponent language interventions. A total of 357 students in Grades 1-4 with LLDs were randomized to a treatment group or to a business-as-usual control group. The treatment group received the SKILL curriculum in small groups during 30-min lessons by trained speech-language pathologists, teachers, and special educators. Students who received SKILL significantly outperformed those who did not on oral and written measures of storytelling and comprehension immediately after treatment and after 5-months at follow-up. Gains were similar among students with different levels of language ability (at-risk, language impaired) and language status (monolingual, bilingual) at pretest. There is growing support for the use of multicomponent CLIs to bring about educationally relevant outcomes for students with LLDs. The authors present this review of how SKILL was designed, manualized, and rigorously tested by a team of researchers and practitioners with the hope that this approach will serve as a springboard for the development of future multicomponent CLIs that may meaningfully improve communicative and educational outcomes for students with LLDs.

Caregiver Progress in Early Intervention: A Collaborative Approach to Goal Writing and Data Collection

Purpose: Effective early intervention (EI) services hinge on a partnership between speech-language pathologists (SLPs) and caregivers. Caregivers play a pivotal role in this partnership, as they must learn language facilitation strategies from SLPs and then implement these strategies with their children. Unfortunately, caregiver progress has often been overlooked, in both research and practice. The purpose of this clinical focus article is to underscore the importance of monitoring caregiver progress in EI and highlight practical data collection methods to do so. Method: This clinical focus article reviews the value of collecting caregiver data at baseline, during EI sessions, and over the course of a caregiver-implemented intervention. A fictional clinical scenario is used to illustrate how these methods can be applied. In this scenario, an EI SLP works with a caregiver to set goals, teaches the caregiver language facilitation strategies using the See and Say Sequence, and measures progress using various types of caregiver data. Conclusions: Collecting caregiver data can be a feasible and useful practice in EI. Caregiver data can guide SLPs in setting caregiver and child goals, in promoting caregiver practice during EI sessions, and in monitoring progress over time. Furthermore, it has the potential to increase caregiver engagement and build caregiver confidence in the EI process.

Targeting and Manipulating Tryptophan Interactions on Proteins.

Tryptophan, commonly regarded as buried within the interior cores of proteins to maintain secondary structures, is now being recognized for its significant contributions to protein functionality. However, investigating functional tryptophan-involved interactions across the proteome and manipulating these interactions in live cells are considerable challenges. In this In Focus article, we summarize emerging advances in the field, describing innovative chemistries that leverage distinctive biochemical properties of the indole moiety for targeting and functionally manipulating tryptophan interactions.

Toward global net zero: The voluntary carbon market on its quest to find its place in the post‐Paris climate regime

AbstractThis focus article traces the evolution of the voluntary carbon market (VCM), putting emphasis on the more recent developments following the adoption of the Paris Agreement in 2015. It focuses on the interplay between the privately governed VCM and the global climate regime under the United Nations (UN). For years, the VCM and the UN carbon market operated in parallel and mutually influenced each other. The adoption of the Paris Agreement, however, marked a turning point for the VCM. It triggered the proliferation of net zero targets, sparking the interest in the VCM as a supplier of carbon credits to offset companies' remaining emissions. At the same time, the global scope and ambitious targets set by the agreement have put the future of the VCM in limbo, raising concerns about double claiming and more generally, questioning the adequacy of offsetting. Considering these challenges, numerous stakeholders have started a process to redefine the rules of the market to ensure its credibility and legitimacy. While some areas of convergence were identified, the VCM's private governance has long been unable to address the question of how to deal with double claiming and the claims companies should be allowed to make. In this situation, signals from international policy and regulation under national policy point the way forward for the VCM. By moving from offsetting toward a contribution claim model, the VCM may overcome its “identity crisis” and find a new place within the broader climate change regime.This article is categorized under: The Carbon Economy and Climate Mitigation > Policies, Instruments, Lifestyles, Behavior Policy and Governance > Multilevel and Transnational Climate Change Governance Policy and Governance > Private Governance of Climate Change

A Clinical Focus on Shared Decision Making in Clinical Practice When Providing Dysarthria and Dysphagia Services to Individuals With Amyotrophic Lateral Sclerosis

Purpose: Traditional health care decision-making models center on clinicians making decisions for patients/caregivers based on the best available research evidence. However, this diminishes patient/caregiver involvement in their care and hinders the ability to align care plans with patient values and preferences. Shared decision making is a potentially beneficial process to implement with individuals with amyotrophic lateral sclerosis (ALS) to provide more holistic, patient-centered dysarthria and dysphagia treatment. Shared decision making promotes active involvement by patients/caregivers by informing them of potential treatment options, understanding their values and preferences, and aligning their desires with treatment options to determine the most optimal individualized care plan. Conclusions: The benefits and barriers to incorporating shared decision making within ALS multidisciplinary clinics are discussed in this clinical focus article. Furthermore, a fictional case study example of how to apply shared decision making to dysarthria and dysphagia management of individuals with ALS is provided.

Counseling Protocol for a Transitional Intervention for Debilitating Hyperacusis.

This clinical focus article describes a structured counseling protocol for use with protected sound management and therapeutic sound in a transitional intervention for debilitating hyperacusis. The counseling protocol and its associated visual aids are crafted as a teaching tool to educate affected individuals about hyperacusis and encourage their acceptance of a transitional intervention. The counseling protocol includes five components. First, the patient's audiometric results are reviewed with the patient, and the transitional intervention is introduced. An overview of peripheral auditory structures and central neural pathways and the concept of central gain are covered in the second and third components. Maladaptive hyper-gain processes within the auditory neural pathways, which underlie the hyperacusis condition, and associated connections with nonauditory processes responsible for negative reactions to hyperacusis are covered in the fourth component. Detrimental effects from misused hearing protection devices (HPDs) and the necessity to wean the patient from overuse of HPDs are also discussed. In the fifth component, the importance of therapeutic sound is introduced as a tool to downregulate hyper-gain activity within the auditory pathways; its implementation in uncontrolled and controlled sound environments is described. It is explained that, over the course of the transitional intervention, recalibration of the hyper-gain processes will be ongoing, leading to restoration of normal homeostasis within the auditory pathways. In turn, associated activation of reactive nonauditory processes, which contribute to hyperacusis-related distress, will be reduced or eliminated. As recalibration progresses, there will be less need for protected sound management and sound therapy. Sound tolerance will improve, hyperacusis will subside, and daily activities in typical healthy sound environments will again become routine. The combination of counseling with protected sound management and therapeutic sound is highlighted in companion reports, including a summary of the outcomes of a successful trial of the transitional intervention.

We Have to Talk About Something: Why NOT Talk About the Curriculum? A Guide to Embedding Language Interventions in Curricular Content.

Children with developmental language disorder frequently have difficulty with both academic success and language learning and use. This clinical focus article describes core principles derived from a larger program of research (National Science Foundation 1748298) on language intervention combined with science instruction for preschoolers. It serves as an illustration of a model for integrating language intervention with curricular content delivery. We present a five-step model for a speech-language pathologist and other school professionals to follow to (a) understand the grade-level core curriculum objectives; (b) align intervention targets with the curriculum; (c) select a therapy approach that aligns with both goals and curricular content, and (d) methods for implementing the intervention; and (e) verify that both the intervention and the curriculum have been provided in accordance with best practices. We apply this model to the Next Generation Science Standards, a science curriculum popular in the United States, and to grammar and vocabulary interventions, two areas of difficulty for children with developmental language disorders, though it would be possible to extend the steps to other curricular areas and intervention targets. We conclude by discussing the barriers and benefits to adopting this model. We recognize that both speech-language pathologists and teachers may have limited time to implement language intervention within a general education curriculum, but we suggest that the long-term benefits outweigh the barriers.

Person-Centered Stories on the Main Stage in Intervention: Case Examples From the My Story Project, Aphasia! This Is Our World, and Aphasia-Friendly Reading

Purpose: Researchers working in the Life Participation Approach to Aphasia (LPAA) framework are beginning to recognize the value of supportive co-constructed storytelling for people with aphasia. Supported storytelling facilitates identity reconstruction that is part of rehabilitation as defined in the LPAA and the Living with Aphasia: Framework for Outcome Measurement. This clinical focus article reviews the therapeutic value of using co-constructed storytelling in clinical practice and describes how this was done in the My Story Project, Aphasia! This Is Our World, and Aphasia-Friendly Reading. These projects used co-constructed storytelling in intervention with people with aphasia in university and support group settings. Three case examples are presented, including sample therapy goals and documentation. Co-constructed person-centered storytelling has been used in clinical projects and has been shown to have immense value in rehabilitation for improving quality of life for people with aphasia. Conclusions: Co-constructed stories can provide a powerful opportunity for targeting life participation, identity, and environmental factors, while simultaneously targeting language. Clinicians are encouraged to consider incorporating the use of co-constructed person-centered storytelling in clinical practice. Guidance is offered for preparing for storytelling intervention sessions and documenting these sessions as billable, skilled services.

Prefrontal-Amygdala Pathways for Object and Social Value Representation.

This special focus article was prepared to honor the memory of our National Institutes of Health colleague, friend, and mentor Leslie G. Ungerleider, who passed away in December 2020, and is based on a presentation given at a symposium held in her honor at the National Institutes of Health in September 2022. In this article, we describe an extension of Leslie Ungerleider's influential work on the object analyzer pathway in which the inferior temporal visual cortex interacts with the amygdala, and then discuss a broader role for the amygdala in stimulus-outcome associative learning in humans and nonhuman primates. We summarize extant data from our and others' laboratories regarding two distinct frontal-amygdala circuits that subserve nonsocial and social valuation processes. Both neuropsychological and neurophysiological data suggest a role for the OFC in nonsocial valuation and the ACC in social valuation. More recent evidence supports the possibility that the amygdala functions in conjunction with these frontal regions to subserve these distinct, complex valuation processes. We emphasize the dynamic nature of valuation processes and advocate for additional research on amygdala-frontal interactions in these domains.