Focus Article Research Articles

Adaptation pathways for effective responses to climate change risks

AbstractClimate related changes are already affecting every area of our world and will increasingly do so as global warming increases, resulting in compounding and cascading risks across multiple locations and sectors. Deliberative processes and anticipatory actions are required to adapt to the associated complex and uncertain systemic risks, with dynamic and long‐term planning needed even where there is limited knowledge of the effectiveness of adaptation. In this focus article, we examine the adaptation pathways developed for the Europe Chapter of the IPCC AR6. We argue that illustrative pathways built on quantitative and qualitative assessment of adaptation effectiveness can inform adaptation planning to manage the increasing severity of risks. We find that as the global warming level increases adaptation pathways can diverge, leading to radically different futures, for example, adaptation responses to sea level rise. We illustrate how adaptation measures for different risks interact resulting in trade‐offs, for example, increasing water scarcity. Although pathways offer a useful framework to address multiple adaptation challenges, other supporting conditions are needed for the successful implementation of adaptation, such as establishing legitimacy and buy‐in through collaboration of various actors and effective governance. Ultimately, adaptation will be increasingly more complex and constrained in a warmer world, increasing risks of losses and damages to people and nature.This article is categorized under: Vulnerability and Adaptation to Climate Change > Institutions for Adaptation The Social Status of Climate Change Knowledge > Climate Science and Decision Making Assessing Impacts of Climate Change > Evaluating Future Impacts of Climate Change Vulnerability and Adaptation to Climate Change > Learning from Cases and Analogies

Mapping the Role of Therapeutic Alliance in Speech and Language Therapy to the Rehabilitation Treatment Specification System

Purpose: The purpose of this clinical focus article is to highlight the significance of the therapeutic alliance (TA) and how it relates to speech and language therapy practice. We define the components of the TA through the Rehabilitation Treatment Specification System (RTSS) framework in an effort to increase clinician understanding and implementation of the components of TA. Method: With the introduction of the RTSS, there have been ongoing efforts to increase specificity in describing and outlining rehabilitation treatments to better understand, research, and translate knowledge across the field. However, the inclusion of representations and volitional ingredients is often missing from current literature or limited to certain patient populations. We map the ingredients of the TA as intentional clinician actions to provide increased specification of volition components, with the goal of shaping and enhancing the patients' mental representations and offer insights for direct application in clinical practice. Conclusions: Ongoing efforts to educate and train speech-language pathologists on the invaluable contribution of mental representations and TA are imperative. Embedding this education within the RTSS framework may serve to underscore its equal contribution to the patient experience and associated outcomes. Ongoing research and efforts to further delineate volitional ingredients into therapeutic practice is essential to maximize patient engagement and outcomes.

Through the Lens of Movement-Evoked Pain: A Theoretical Framework of the “Pain-Movement Interface” to Guide Research and Clinical Care for Musculoskeletal Pain Conditions

Over 120 million Americans report experiencing pain in the past 3 months. Among these individuals, 50 million report chronic pain and 17 million report pain that limits daily life or work activities on most days (ie, high-impact chronic pain). Musculoskeletal pain conditions in particular are a major contributor to global disability, health care costs, and poor quality of life. Movement-evoked pain (MEP) is an important and distinct component of the musculoskeletal pain experience and represents an emerging area of study in pain and rehabilitation fields. This focus article proposes the “Pain-Movement Interface” as a theoretical framework of MEP that highlights the interface between MEP, pain interference, and activity engagement. The goal of the framework is to expand knowledge about MEP by guiding scientific inquiry into MEP-specific pathways to disability, high-risk clinical phenotypes, and underlying individual influences that may serve as treatment targets. This framework reinforces the dynamic nature of MEP within the context of activity engagement, participation in life and social roles, and the broader pain experience. Recommendations for MEP evaluation, encompassing the spectrum from high standardization to high patient specificity, and MEP-targeted treatments are provided. Overall, the proposed framework and recommendations reflect the current state of science in this emerging area of study and are intended to support future efforts to optimize musculoskeletal pain management and enhance patient outcomes. PerspectiveMovement-evoked pain (MEP) is a distinct component of the musculoskeletal pain experience and emerging research area. This article introduces the “Pain-Movement Interface” as a theoretical framework of MEP, highlighting the interface between MEP, pain interference, and activity engagement. Evaluating and treating MEP could improve rehabilitation approaches and enhance patient outcomes.

Proactive Strategies for Breaking Barriers: Advancing Justice Initiatives in Speech-Language Pathology for Diverse Populations in Voice Management and Upper Airway Disorders

Purpose: This clinical focus article examines the importance of justice, equity, diversity, and inclusion (JEDI) initiatives in the field of speech-language pathology, particularly in the context of voice management and upper airway disorders. Method: We begin by acknowledging the growing focus on JEDI-related strategies, such as supporting students from diverse cultural backgrounds, measuring clinician competence in working with diverse clients, and increasing awareness of cultural and linguistic diversity in patient populations. We emphasize the need for both individual and systemic efforts to develop competence in JEDI initiatives. However, challenges exist in developing culturally responsive materials and documentation at a macro level, including the lack of research and resources in understanding the needs of diverse patient populations in voice and upper airway disorders. The clinical focus article highlights the absence of demographic data related to cultural and linguistic diversity in this field and discusses the challenges in developing language-specific materials, culturally relevant assessment tools, and therapeutic interventions aligned with cultural values and standards. Limited funding and resources further impede progress in JEDI initiatives and the development of tailored intervention models. Recognizing the impossibility of accounting for every unique intersectionality, the clinical focus article offers foundational steps toward creating an inclusive space and providing culturally responsive health care. It specifically focuses on gender-inclusive care, diagnostic considerations for socially linguistically diverse individuals, and addressing issues of clinical ableism. Conclusion: The clinical focus article aims to identify and expand upon current resources for culturally responsive practice in the American Speech-Language-Hearing Association, particularly in the context of voice and upper airway disorders.

Environmental Sustainability and AI in Radiology: A Double-Edged Sword.

According to the World Health Organization, climate change is the single biggest health threat facing humanity. The global health care system, including medical imaging, must manage the health effects of climate change while at the same time addressing the large amount of greenhouse gas (GHG) emissions generated in the delivery of care. Data centers and computational efforts are increasingly large contributors to GHG emissions in radiology. This is due to the explosive increase in big data and artificial intelligence (AI) applications that have resulted in large energy requirements for developing and deploying AI models. However, AI also has the potential to improve environmental sustainability in medical imaging. For example, use of AI can shorten MRI scan times with accelerated acquisition times, improve the scheduling efficiency of scanners, and optimize the use of decision-support tools to reduce low-value imaging. The purpose of this Radiology in Focus article is to discuss this duality at the intersection of environmental sustainability and AI in radiology. Further discussed are strategies and opportunities to decrease AI-related emissions and to leverage AI to improve sustainability in radiology, with a focus on health equity. Co-benefits of these strategies are explored, including lower cost and improved patient outcomes. Finally, knowledge gaps and areas for future research are highlighted.

The Role of Prosody in Reading Comprehension for Individuals on the Autism Spectrum

Purpose: The purposes of this clinical focus article are to describe differences in expressive prosody among autistic individuals, describe the role of prosody in reading comprehension, highlight the potential contribution of prosody to the reading comprehension difficulties experienced by many autistic individuals, discuss interventions that target prosody, and make clinical recommendations. Method: We describe differences in expressive prosody that many autistic individuals experience; review the existing body of literature surrounding reading comprehension, prosody, and autism; and discuss interventions that target prosody as it applies to reading comprehension. Conclusion: Based on the review of the literature and presentation of the challenges that currently exist, we make clinical recommendations regarding the integration of interventions addressing prosody in expressive communication and reading comprehension for autistic individuals who have strong word reading skills and poor reading comprehension.

Go Team Go! Interprofessional Practice for Pediatric Feeding in the Schools.

The purpose of this clinical focus article is to discuss processes and procedures for building school-based programs to address the feeding and swallowing needs of students in the public-school setting. Interprofessional practice (IPP) team member roles and responsibilities, screening, eligibility, considerations for developing Individualized Education Programs that address the needs of students with pediatric feeding disorder (PFD) and dysphagia, as well as billing documentation requirements, are discussed. Additionally, coordination across the continuum of service delivery for students with PFD and dysphagia is investigated. Guidance on documentation, processes, and procedures that comply with the Individuals with Disabilities Education Act mandates will be provided. This clinical focus article will demonstrate that students with PFD and dysphagia continue to present to public schools and require skilled services and supports in order to meet their individualized needs. School-based speech-language pathologists have a legal requirement to provide these supports when deemed educationally relevant. Schools must employ processes and procedures that result in the timely and effective evaluation and identification of students with PFD and dysphagia. An IPP approach to the management of PFD and dysphagia is critical to ensure optimal outcomes for students found eligible for services.

A focus on molecular representation learning for the prediction of chemical properties.

Molecular representation learning (MRL) is a specialized field in which deep-learning models condense essential molecular information into a vectorized form. Whereas recent research has predominantly emphasized drug discovery and bioactivity applications, MRL holds significant potential for diverse chemical properties beyond these contexts. The recently published study by King-Smith introduces a novel application of molecular representation training and compellingly demonstrates its value in predicting molecular properties (E. King-Smith, Chem. Sci., 2024, https://doi.org/10.1039/D3SC04928K). In this focus article, we will briefly delve into MRL in chemistry and the significance of King-Smith's work within the dynamic landscape of this evolving field.

Nanoscience and nanotechnology for water remediation: an earnest hope toward sustainability.

Water pollution and the global freshwater crisis are the most alarming concerns of the 21st century, as they threaten the sustainability and ecological balance of the environment. The growth of global population, climate change, and expansion of industrial processes are the main causes of these issues. Therefore, effective remediation of polluted water by means of detoxification and purification is of paramount importance. To this end, nanoscience and nanotechnology have emerged as viable options that hold tremendous potential toward the advancement of wastewater treatment methods to enhance treatment efficiency along with augmenting water supply via utilization of unconventional water sources. Materials at the nano level have shown great promise toward water treatment applications owing to their unique physicochemical properties. In this focus article, we highlight the role of new fundamental properties at the nano scale and material properties that are drastically increased due to the nano dimension (e.g. volume-surface ratio) and highlight their impact and potential toward water treatment. We identify and discuss how nano-properties could improve the three main domains of water remediation: the identification of pollutants, their adsorption and catalytic degradation. After discussing all the beneficial aspects we further discuss the key challenges associated with nanomaterials for water treatment. Looking at the current state-of-the-art, the potential as well as the challenges of nanomaterials, we believe that in the future we will see a significant impact of these materials on many water remediation strategies.

Dual-ion conductors: from liquid to solid.

The traditional working principle within lithium-ion batteries relies on Li+ shuttling between the cathode and anode, namely the rocking-chair mechanism. A single working ion constrains the possibilities for battery design and the selection of electrode materials, while realizing multiple working ions offers the potential to break through the fundamental principles of traditional battery construction. Accordingly, it is necessary to develop dual-ion conductors to enable the migration of multiple working ions. This focus article starts by introducing traditional dual-ion batteries based on liquid electrolytes and their pros and cons. Then, solidifying liquid dual-ion conductors is expected to overcome these drawbacks, so the development of solid dual-ion conductors is discussed in detail. Specifically, basic design principles of solid dual-ion conductors are briefly proposed, including constructing continuous ion transport channels and choosing appropriately sized ion carriers. The potential applications of solid dual-ion conductors are also summarized, such as stabilizing the electrode/electrolyte interface and activating additional redox couples. The goal of this article is to inspire researchers in the development of dual-ion conductors and to contribute to the advancement of all-solid-state batteries.

Maximizing Student Outcomes in Schools: Data-Driven Individualized Education Program Goals and Objectives Aligned to the Standards.

Federal and state laws require schools to be accountable for student performance on measures of academic achievement in literacy, mathematics, and science skills; monitor high school graduation rates; and track student growth and academic progression throughout the grade levels. Success on these measures gives students pathways to postsecondary options in the workforce, technical education, or college/university education. Speech-language pathologists (SLPs) can utilize existing data sources in the school in conjunction with their knowledge of diagnostics and treatment of cognition, language, and culture to maximize student outcomes beyond the therapy room and in the curriculum standards. This clinical focus article will review methods of data collection from existing sources in the students' grade level and academic content curriculum. Utilization of information and input from parents, teachers, paraprofessionals, and others who support the student's academic endeavors will be discussed for Individualized Education Program Present Levels of Academic Achievement and Functional Performance and goal development. Procedures for the SLP to collect independent data aligned to standards-based curriculum will be explored. Consideration will be given for utilizing data to develop future goals and objectives. The benefits of data collection for monitoring student progress and success in the grade-level or alternate standards will be highlighted through case examples. Techniques for classroom-based services, model lessons, coaching, and co-teaching will be presented. SLPs are recognized as specialized instructional support personnel who have unique knowledge and expertise for diagnosing and treating speech/language impairments (S/LI) disabilities. By understanding how they can use existing data and apply it to developing intervention plans, SLPs can ensure students with S/LI disabilities experience the maximum potential for outcomes in academic and functional success. Data-driven tools and methods aligned to the grade-level standards and curriculum are one of the most powerful tools in an SLP's toolbox. https://doi.org/10.23641/asha.24869592.

Phonemic Feature Scoring as a Tool for Progress Monitoring During Language Interventions for Children With Autism and Minimal Verbal Skills.

An increasing number of studies focus on verbal treatments for children with autism and minimal verbal skills. However, clinical tools for progress monitoring during interventions are lacking. The aim of this clinical focus article is to provide illustrations on the utility of a phonemic feature scoring system as a progress-monitoring tool, focusing on benefits and limitations as well as indications for use. Current practices for progress monitoring during language interventions with children with autism and minimal verbal skills are reviewed. A phonemic feature scoring tool is provided to aid clinicians in assessing the accuracy and consistency of expressive word productions. The authors illustrate the use of phonemic feature scoring as a progress-monitoring tool for two children with autism and minimal verbal skills, contrasting the phonemic feature scoring system to correct/incorrect, phoneme-level, and whole-word scoring. Case 1 demonstrates a scenario where the child's speech intelligibility is low and clinical use of the phonemic feature scoring system captures discrete changes in speech production progress not represented by correct/incorrect, phoneme-level, and whole-word scoring. However, Case 2 represents a situation where once a child's speech intelligibility improves, the phonemic feature scoring system is no longer needed, and correct/incorrect scoring may be sufficient. The phonemic feature scoring system allows clinicians to track phonemic feature changes in word productions and provides detailed progress monitoring information, leading to adaptations of the intervention for each individual.

Cough: An Introductory Guide for Speech-Language Pathologists

Purpose: The airway defense mechanism of cough is essential for human survival. Recognition is growing about the distinct role of speech-language pathologists in the nonpharmacological management of various cough disorders. This clinical focus article aims to deliver relevant education about normal and pathological cough to strengthen existing clinical knowledge and skills. Conclusions: The neuronal pathways underlying normal cough function are complex. Cough problems refer to either reduced or heightened cough stemming from various disease processes, and both clinical presentations have detrimental consequences. Current evidence supports that patients who suffer from cough dysfunction benefit from nonpharmacological interventions offered via speech therapy as an adjunct to medical treatments. Speech therapy strategies apply the higher cognitive components of cough by focusing on the deliberate modification and coordination of respiration. Future research priorities are positioned toward improving clinical outcomes for cough disorders.

Exploring Culturally Responsive Voice Care: Mitigating Disparities by Addressing Implicit Bias

Purpose: Access to voice care is central to improving the quality of life of patients with voice concerns. However, health care access is a dynamic, complex entity involving various factors, including the voice clinician. The purpose of this clinical focus article is to explicate the impactful role speech pathologists and voice clinicians may play in daily clinical practice to promote health equity through mitigating well-documented negative effects of personal implicit biases in health care and providing culturally responsive practices. Conclusions: Evidence indicates that implicit bias has a grave impact on daily clinical practice and dialogue. Within the complexity of health care access, a clinician either creates barriers or facilitators that determine the acceptability and approachability of the care offered. Unaddressed implicit bias and lack of culturally responsive practices may reduce the quality of care and ultimately hinder a patient from seeking behavioral voice services. However, intentional practices sought by the clinician and health care team to resolve unconscious biases and promote culturally responsive care throughout the therapeutic process are obtainable, as we collectively strive toward health equity for all patients with voice concerns.

Identifying and Treating Functional “Nonnative [Foreign] Accent Syndrome”: Perspectives From the Patient and Speech-Language Pathologist

Purpose: When nonnative speaking patterns emerge following neurologic insult or injury, it has often been referred to as foreign, or nonnative, accent syndrome (FAS). In many other cases, FAS can occur as a manifestation of a functional speech disorder (FSD). The purpose of this clinical focus article is to (a) describe the methods utilized in identifying and managing a functional communication disorder characterized by nonnative speech, language, and nonverbal communication intrusions, accompanied by a functional movement disorder and (b) describe the patient's lived experience. Method and Results: The patient is a 59-year-old monolingual English-speaking gentleman with a remote history of episodic stuttering, who later developed an abrupt onset of a nonnative speaking style that changed in quality over time. He also developed gait difficulties that, after visiting with several neurologists, were judged to reflect a functional neurological disorder. During the speech evaluation session, an “Eastern European accent” was noted, along with nonnative word use and word order. A diagnosis of FSD characterized by foreign accent was made, and intervention was undertaken as detailed in the clinical focus article and demonstrated in the accompanying video. With behavioral intervention, the patient was able to correct sound-level changes in structured tasks such as reading and repetition and then in conversation. Language dialect–like changes resolved without direct intervention. The nonspeech movement disorder was addressed with intensive occupational and physical therapy. Conclusions: The patient presented with functional FAS, which was effectively managed with symptomatic, targeted behavioral intervention. His experience demonstrates the importance of patient advocacy in acquiring an accurate diagnosis and appropriate management recommendations. Supplemental Material: https://doi.org/10.23641/asha.24653430

Adhesive ensures automotive camera modules are assembled precisely and efficiently

As consumers expect ever more sophisticated assistance systems and increasingly depend on cameras and sensors in the context of autonomous driving, the performance and reliability of these components have become critical to road users’ safety and comfort. As a follow-up to previous coverage, this focus article looks in greater detail at how the use of a single-step cure active alignment adhesive – developed by Henkel Adhesive Technologies – is helping manufacturers to produce these components not only precisely, but quickly and efficiently, whilst also reducing carbon dioxide emissions.

Campylobacter species abortion in sheep.

This focus article was prepared by Jasmine Smith of the APHA Small Ruminant Species Expert Group. Data extraction and analysis was done by Anna Brzozowska of the APHA Surveillance Intelligence Unit and Leanne Dempsey from APHA Thirsk.

What is new in the classification of peripheral Tcell lymphomas?

In this review focus article, we highlight the main modifications introduced in the latest 2022 International Consensus Classification and World Health Organization classification (ICC and WHO-HAEM5) of matureT (and NK) cell neoplasms (PTCLs) and consequent implications for diagnostic practice. The changes result from recent advances in the genomic and molecular characterization of PTCLs and enhanced understanding of their pathobiology. Specifically, consideration is given to the following groups of diseases: Epstein-Barr virus (EBV)-associated neoplasms; follicular helper Tcell lymphoma; anaplastic large cell lymphomas; primary intestinalT and NK cell lymphomas and lymphoproliferative disorders; and PTCL, not otherwise specified.

Versatile PU seal accommodates different dimensions of valves on gas cartridges

Freudenberg Sealing Technologies has developed a versatile seal for a water treatment device that not only filters tap water, but also enriches it with minerals and, if desired, carbonic acid. As this brief focus article explains the seal, made from polyurethane (PU), is capable of accommodating the different dimensions of valves used on carbon dioxide cartridges, ensuring that flow-control components are joined with a secure seal.

Applying a Developmental Model to Preliterate Aided Language Learning.

Childhood spoken language interventions and augmentative and alternative communication (AAC) interventions share a common purpose: maximizing communication and language outcomes. To ensure that interventions for children who require AAC also address expressive language acquisition, this clinical focus article focuses on how to apply a developmental model of language acquisition to guide AAC decision making for preliterate aided communicators, with a particular focus on vocabulary selection. A brief review of early expressive language development is presented, along with arguments for why relying on a developmental model to guide AAC decision making is so critical. A series of detailed examples of how to apply a developmental model to various AAC vocabulary selection approaches are provided, including analyses of how well each approach aligns with pragmatic, semantic, grammatical, and narrative development. No single AAC approach for preliterate AAC language learners adequately addresses both immediate and longer-term expressive language needs; every approach has both strengths and weaknesses. Clinical decision making requires an analysis of each approach to ensure that AAC service delivery teams clearly understand the inevitable linguistic gaps, with plans put into place to fill in those gaps with different approaches. Future efforts to improve preliterate AAC service provision should use a developmental model of language as a starting point, in combination with input from families, educators, and clinicians to ensure the feasibility of the chosen approaches.