Association of back pain with all-cause and cause-specific mortality among older men: a cohort study.

OBJECTIVE: We evaluated whether more severe back pain phenotypes-persistent, frequent or disabling back pain-are associated with higher mortality among older men. METHODS: In this secondary analysis of a prospective cohort, the Osteoporotic Fractures in Men (MrOS) study, we evaluated mortality rates by back pain phenotype among 5215 older community-dwelling men (mean age, 73 years, SD = 5.6) from six U.S. sites. The primary back pain measure used baseline and year five back pain questionnaire data to characterize participants as having: no back pain; non-persistent back pain; infrequent persistent back pain; or frequent persistent back pain. Secondary measures of back pain from year five questionnaire included disabling back pain phenotypes. The main outcomes measured were all-cause and cause-specific mortality. RESULTS: After the year five exam, during up to 18 years of follow-up (mean follow-up=10.3 years), there were 3513 deaths (1218 cardiovascular, 764 cancer, 1531 other). A higher proportion of men with frequent persistent back pain versus no back pain died (78% versus 69%; sociodemographic-adjusted HR = 1.27, 95%CI=1.11-1.45). No association was evident after further adjusting for health-related factors such as self-reported general health and comorbid chronic health conditions (fully-adjusted HR = 1.00; 95%CI=0.86-1.15). Results were similar for cardiovascular mortality and other mortality, but we observed no association of back pain with cancer mortality. Secondary back pain measures including back-related disability were associated with increased mortality risk that remained statistically significant in fully-adjusted models. CONCLUSION: While frequent persistent back pain was not independently associated with mortality in older men, additional secondary disabling back pain phenotypes were independently associated with increased mortality. Future investigations should evaluate whether improvements in disabling back pain effect general health and well-being or mortality.

Highlighting efficiency and redundancy in the Royal Australian College of General Practice standards for accreditation.

ObjectivesAccreditation to standards developed by the Royal Australian College of General Practice provides assurance to the community of the quality and safety of general practices in Australia. The objective of this study was to conduct an empirical evaluation of the 5th edition standards. Minimal empirically driven evaluation of the standards has been conducted since their publication in 2020.MethodsData encompass consecutive Australian general practice accreditation assessments between December 2020 and July 2022 recorded from a single accrediting agency. Met and not met compliance (binary) scores for 124 indicators evaluated at the site visit were recorded. A subset of indicators derived from a selection of existing and consistently non-conformant indicators within each criterion was generated. Concordance between the indicator subset and the criterion was assessed to determine the predictive ability of the indicator subset in distinguishing practices who are conformant to the entire criterion.ResultsA total of 757 general practices were included in the analysis. On average, 113.69 (s.d. = 8.16) of 124 indicators were evaluated as conformant at the site visit. In total, 52 (42%) indicators were required to obtain a true positive conformity rate above 95% for all criterions of the standards. For criterion 1 (General Practice 1) conformity to the entire criterion (nine indicators; >95% true positive rate) could be obtained by including 2/9 indicators (C1-1a and C1-2a).ConclusionOur results identified that indicator non-conformity was driven by a small proportion of indicators and identifying a subset of these consistently non-conformant indicators predicted a true positive rate above 95% at the criterion level.

The impact of self-assessment and surveyor assessment on site visit performance under the National General Practice Accreditation scheme.

ObjectiveThere is a need to undertake more proactive and in-depth analyses of general practice accreditation processes. Two areas that have been highlighted as areas of potential inconsistency are the self-assessment and surveyor assessment of indicators.MethodsThe data encompass 757 accreditation visits made between December 2020 and July 2022. A mixed-effect multilevel logistic regression model determined the association between attempt of the self-assessment and indicator conformity from the surveyor assessment. Furthermore, we present a contrast of the rate of indicator conformity between surveyors as an approximation of the inter-assessor consistency from the site visit.ResultsTwo hundred and seventy-seven (37%) practices did not attempt or accurately report conformity to any indicators at the self-assessment. Association between attempting the self-assessment and the rate of indicator non-conformity at the site visit failed to reach statistical significance (OR = 0.90 [95% CI = 1.14-0.72], P = 0.28). A small number of surveyors (N = 9/34) demonstrated statistically significant differences in the rate of indicator conformity compared to the mean of all surveyors.ConclusionsAttempt of the self-assessment did not predict indicator conformity at the site visit overall. Appropriate levels of consistency of indicator assessment between surveyors at the site visit were identified.

Stressful life events and low back pain in older men: A cross-sectional and prospective analysis using data from the MrOS study.

BACKGROUND: Stressful life events, such as loss of a partner, loss of a pet or financial problems, are more common with increasing age and may impact the experience of pain. The aim of the current study is to determine the cross-sectional and prospective association between stressful life events and low back pain reporting in the Osteoporotic Fracture in Men Study, a cohort of older men aged ≥65 years. METHODS: At a study visit (March 2005-May 2006), 5149 men reported whether they had experienced a stressful life event or low back pain in the prior 12 months. Following that visit, data on low back pain patients were gathered through triannual questionnaires every 4 months for 1 year. Multivariable logistic regression analyses estimated the association of stressful life events with recent past low back pain or future low back pain. RESULTS: N = 2930, (57%) men reported at least one stressful life event. The presence of a stressful life event was associated with greater odds of any low back pain (OR = 1.42 [1.26-1.59]) and activity-limiting low back pain (OR = 1.74 [1.50-2.01]) in the same period and of any low back pain (OR = 1.56 [1.39-1.74]) and frequent low back pain (OR = 1.80 [1.55-2.08]) in the following year. CONCLUSION: In this cohort of men, the presence of stressful life events increased the likelihood of reporting past and future low back pain. SIGNIFICANCE: Stressful life events such as accident or illness to a partner are common in later life and may impact the experience of pain. We present cross-sectional and prospective data highlighting a consistent association between stressful life events and low back pain in older men. Further, there is evidence to suggest that this relationship is upregulated by an individual's living situation. This information may be used to strengthen a biopsychosocial perspective of an individual's pain experience.

General practice accreditation - does time spent on-site matter?

Background Accreditation to the Royal Australian College of General Practitioners Standards for general practices was developed with the intent of giving assurance to the public as to the safety and quality of general practice. The standards have undergone several iterative changes but have had little empirical validation since the original entry standards. Objective To compare the rate of indicator non-conformity between a full-day survey visit conducted under the 5th edition standards against the half-day visit conducted under the 4th edition standards. Results More non-conformities were identified with the 5th edition standards (full-day visit) with a median 86% met (IQR: 14; n = 926) compared with the 4th edition standards (half-day visit) with a median 95% met (IQR: 7; n = 1687; P < 0.0001; bootstrapped t -test). Discussion The difference in conformity between editions does not appear to relate to different requirements in the two standards editions. The key variable affecting the different outcomes between the edition assessments was time spent on-site by surveyors during a survey visit.

Effects of an AAC feature on decoding and encoding skills of adults with Down syndrome.

Literacy skills can assist in the navigation and enjoyment of adult life. For individuals who have reached adulthood without strong literacy skills, opportunities for continued literacy learning are few. Redesigning AAC technologies to support literacy skill development could extend literacy learning opportunities for adults with developmental disabilities who have limited speech. The current preliminary study evaluated an AAC technology feature designed to support literacy development. The study used a multiple probe across participants design. Three adults with Down syndrome who had limited speech and only basic decoding skills participated. Results suggest the participants made modest gains in decoding accuracy after interacting using the AAC app with the literacy supportive feature, though performance was highly variable. Results also offer emerging evidence that, for two participants, some generalization to encoding performance may have also been achieved. Results showed that, for all the participants, interacting using the literacy supportive feature increased their reading confidence. Altogether, the study's results show preliminary evidence that the feature can support adults with Down syndrome in their ongoing literacy learning, though access to formal instruction is still critical. Future research is needed to continue to explore this and other AAC technology redesigns to increase learning opportunities for the people who use the technology every day to communicate.

Patient and provider characteristics associated with therapeutic intervention selection in a chiropractic clinical encounter: a cross-sectional analysis of the COAST and O-COAST study data.

BACKGROUND: Chiropractors use a variety of therapeutic interventions in clinical practice. How the selection of interventions differs across musculoskeletal regions or with different patient and provider characteristics is currently unclear. This study aimed to describe how frequently different interventions are used for patients presenting for chiropractic care, and patient and provider characteristics associated with intervention selection. METHODS: Data were obtained from the Chiropractic Observation and Analysis STudy (COAST) and Ontario (O-COAST) studies: practice-based, cross-sectional studies in Victoria, Australia (2010-2012) and Ontario, Canada (2014-2015). Chiropractors recorded data on patient diagnosis and intervention selection from up to 100 consecutive patient visits. The frequency of interventions selected overall and for each diagnostic category (e.g., different musculoskeletal regions) were descriptively analysed. Univariable multi-level logistic regression (provider and patient as grouping factors), stratified by diagnostic category, was used to assess the association between patient/provider variables and intervention selection. RESULTS: Ninety-four chiropractors, representative of chiropractors in Victoria and Ontario for age, sex, and years in practice, participated. Data were collected on 7,966 patient visits (6419 unique patients), including 10,731 individual diagnoses (mean age: 43.7 (SD: 20.7), 57.8% female). Differences in patient characteristics and intervention selection were observed between chiropractors practicing in Australia and Canada. Overall, manipulation was the most common intervention, selected in 63% (95%CI:62-63) of encounters. However, for musculoskeletal conditions presenting in the extremities only, soft tissue therapies were more commonly used (65%, 95%CI:62-68). Manipulation was less likely to be performed if the patient was female (OR:0.74, 95%CI:0.65-0.84), older (OR:0.79, 95%CI:0.77-0.82), presenting for an initial visit (OR:0.73, 95%CI:0.56-0.95) or new complaint (OR:0.82, 95%CI:0.71-0.95), had one or more comorbidities (OR:0.63, 95%CI:0.54-0.72), or was underweight (OR:0.47, 95%CI:0.35-0.63), or obese (OR:0.69, 95%CI:0.58-0.81). Chiropractors with more than five years clinical experience were less likely to provide advice/education (OR:0.37, 95%CI:0.16-0.87) and exercises (OR:0.17, 95%CI:0.06-0.44). CONCLUSION: In more than 10,000 diagnostic encounters, manipulation was the most common therapeutic intervention for spine-related problems, whereas soft tissue therapies were more common for extremity problems. Different patient and provider characteristics were associated with intervention selection. These data may be used to support further research on appropriate selection of interventions for common musculoskeletal complaints.

The effectiveness of spinal manipulative therapy procedures for spine pain: protocol for a systematic review and network meta-analysis.

BACKGROUND: Spinal manipulative therapy (SMT) is a guideline-recommended treatment option for spinal pain. The recommendation is based on multiple systematic reviews. However, these reviews fail to consider that clinical effects may depend on SMT "application procedures" (i.e., how and where SMT is applied). Using network meta-analyses, we aim to investigate which SMT "application procedures" have the greatest magnitude of clinical effectiveness for reducing pain and disability, for any spinal complaint, at short-term and long-term follow-up. We will compare application procedural parameters by classifying the thrust application technique and the application site (patient positioning, assisted, vertebral target, region target, Technique name, forces, and vectors, application site selection approach and rationale) against: 1. Waiting list/no treatment; 2. Sham interventions not resembling SMT (e.g., detuned ultrasound); 3. Sham interventions resembling SMT; 4. Other therapies not recommended in clinical practice guidelines; and 5. Other therapies recommended in clinical practice guidelines. Secondly, we will examine how contextual elements, including procedural fidelity (whether the SMT was delivered as planned) and clinical applicability (whether the SMT is similar to clinical practice) of the SMT. METHODS: We will include randomized controlled trials (RCT) found through three search strategies, (i) exploratory, (ii) systematic, and (iii) other known sources. We define SMT as a high-velocity low-amplitude thrust or grade V mobilization. Eligibility is any RCT assessing SMT against any other type of SMT, any other active or sham intervention, or no treatment control on adult patients with pain in any spinal region. The RCTs must report on continuous pain intensity and/or disability outcomes. Two authors will independently review title and abstract screening, full-text screening, and data extraction. Spinal manipulative therapy techniques will be classified according to the technique application and choice of application sites. We will conduct a network-meta analysis using a frequentist approach and multiple subgroup and sensitivity analyses. DISCUSSION: This will be the most extensive review of thrust SMT to date, and will allow us to estimate the importance of different SMT application procedures used in clinical practice and taught across educational settings. Thus, the results are applicable to clinical practice, educational settings, and research studies. PROSPERO registration: CRD42022375836.

The search for commercial sweet white lupin (Lupinus albus L.) adaptive to Ethiopian growing condition seems not successful: what should be done?

The study was conducted to find new adaptive commercial sweet white lupin (Lupinus albus L.) varieties and evaluate the effect of inoculum on herbage and seed yields of white and blue lupin varieties in Ethiopia for two growing seasons in two locations. For the experiment a factorial arrangement (seven variety * two inoculation) in a randomized complete block design with three replication was used. Three sweet blue (Bora, Sanabor and Vitabor), three sweet white (Dieta, Energy and Feodora) and one bitter white local landrace lupin varieties were tested in the experiment. Analysis of variance was done using the general linear model procedure in SAS. The effects of location and inoculum were insignificant (P ≥ 0.0761) on yield and yield parameters. The effect of variety was observed (P ≤ 0.035) only on plant height, fresh biomass yield and thousand seed weight in both seasons except for fresh biomass yield in season two. However, its effect on other parameters was not shown (P ≥ 0.134) in both growing seasons or only shown in either season. The mean dry matter yield of all varieties was 2.45 ton per ha. However, sweet blue entries performed better than white entries. The mean seed yield of blue sweet lupin entries and white local check was 2.6 ton per ha. Sweet blue and white local landrace varieties were found tolerant while, commercial sweet white lupin varieties were susceptible for anthracnose and fusarium diseases that occurred immediately after flowering. As a result imported commercial sweet white varieties failed to give seed yield. Developing adaptive, disease resistant and high yielding sweet white lupin through crossing the local and commercial varieties and looking for species specific inoculum should be the future research agendas.

Effects of an Augmentative and Alternative Communication Technology Decoding Feature on Single-Word Reading by Individuals With Down Syndrome and Limited Functional Speech.

PURPOSE: Literacy skills are foundational to participation in adolescent and adult life, and decoding skills (i.e., sounding out to read words) are critical to literacy learning. Literacy also increases communication options for individuals with developmental disabilities who use augmentative and alternative communication (AAC). Yet, current AAC technologies are limited in their support of literacy development (especially decoding skills) for the individuals with developmental disabilities who require them. The purpose of this study was to conduct a preliminary evaluation of a new AAC feature designed to support decoding skills. METHOD: Three individuals who had limited functional speech and limited literacy skills, specifically two adolescents and one young adult with Down syndrome, participated in the study. The study used a single-subject, multiple-probe, across-participants design. RESULTS: All three participants demonstrated increases in reading performance, including decoding of novel words. High variability in performance was observed, however, and no participant reached reading mastery. Still, analysis reveals that for all participants, interacting using the new app feature increased reading. CONCLUSIONS: These results offer preliminary evidence that an AAC technology feature that provides models of decoding (upon selection of AAC picture symbols) can support individuals with Down syndrome in building decoding skills. While not intended to replace instruction, this initial study offers initial evidence in its efficacy as a supplemental avenue for supporting literacy in individuals with developmental disabilities who use AAC.

Supporting Children's Communication of Choices During Inpatient Rehabilitation: Effects of a Mobile Training for Health Care Providers.

PURPOSE: Children with complex medical and communication needs often experience extensive or frequent hospital stays and rely on augmentative and alternative communication (AAC) strategies to communicate in this environment. Health care providers seldom receive training to effectively communicate with these children, which may lead to limited participation opportunities for the child during inpatient interactions. METHOD: A pretest-posttest experimental group design was completed to evaluate the effects of a brief mobile training designed to teach providers a procedure to support children with complex communication needs to communicate choices. Each provider participated in two pretest and two posttest interactions with children with complex communication needs during naturally occurring inpatient activities. Providers in the treatment group completed the video training, whereas providers in the control group did not. RESULTS: Following the training, (a) more providers offered choices to the children during hospital routines, (b) providers implemented the trained procedure with increased accuracy, and (c) the children with complex communication needs consistently communicated their choices when given the opportunity to do so. The providers rated the training as easy to use, effective, and suited to the needs of the inpatient setting. CONCLUSIONS: This is the first AAC training designed to promote child-provider interactions in inpatient settings that demonstrates results that are efficient, socially valid, and effective in a real-world context. Future work is needed to develop additional brief and focused AAC partner trainings to teach providers to support the participation of children with complex communication needs in health care interactions. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.22029008.

Effects of adapted Letter-Sound correspondence instruction with older learners with complex communication needs and autism spectrum disorder.

Individuals who use augmentative and alternative communication (AAC) are often excluded from learning literacy skills that use phonological approaches due to challenges with verbal production of speech sounds. This study was conducted to evaluate the effectiveness of systematic literacy instruction with materials modified to teach letter-sound correspondences (LSC) to pre-adolescent and adolescents with autism spectrum disorders (ASD) with minimal or no speech who use AAC. A single subject design across three letter-sound sets was used, with three individuals with ASD. A total of 12 LSC were targeted in the intervention. During the intervention, the participants were instructed using model, guided, and independent practice trials using low-tech letter tiles followed by two extension activities: letter sorting and initial letter-sound picture books. A functional relationship was established between the LSC intervention and the percent of correct responses on the LSC assessment probes. Very large and large effects sizes were calculated for all participants across the three LSC sets. The study adds to the very limited research base related to phonics instruction for older learners (ages 9 to 18) with ASD, demonstrating that LSC progress can still be made at an older age with systematic instruction.

Methodological considerations for the force-matching task.

The force-matching task integrates haptic technology and electrical engineering to determine an individual's level of sensory attenuation to somatic stimuli. The task requires a detailed methodology to facilitate reliable and replicable estimates, and there has been a distinct lack of re-evaluation of the methodological processes related to this paradigm. In this task, participants are asked to match a force delivered to their finger, either by pressing directly on their own finger with their other hand (known as the direct condition) or by controlling the device using an external potentiometer to control the force indirectly through a torque motor (known as the slider condition). We analysed 138 participants to determine 1) the optimal number of replications (2, 4, 6, or 8 replications) of the target force, 2) the optimal time window (1-1.5 s, 1.5-2 s, 2-2.5 s and 2.5-3 s) to extract the estimate of sensory attenuation, 3) if participants' performance during the task improved, worsened or was stable across the experimental period regardless of condition, and 4) if learning effects were related to psychological traits. Results showed that the number of replications of the target forces may be reduced from 8 without compromising the estimate of sensory attenuation, the optimal time window for the extraction of the matched force is 2.5-3 s, the performance is stable over the duration of the experiment and not impacted by the measured psychological traits. In conclusion, we present a number of methodological considerations which improve the efficiency and reliability of the force-matching task. HIGHLIGHTS: • The force-matching task determines an individual's level of sensory attenuation • The optimal number of replications of the target force may be reduced from 8 • The optimal time window to extract the matched force is 2.5-3.0 s • The estimate of sensory attenuation is stable across the duration of the task.

Perceptual sensory attenuation in chronic pain subjects and healthy controls.

We investigated whether sensory attenuation (or failure of) might be an explanation for heightened pain perceptions in individuals with chronic pain. N = 131 (50% chronic pain) individuals underwent a single experimental session, which included the force-matching task and several self-reported symptom and psychological measures. Individuals matched a force delivered to their finger, either by pressing directly on their own finger with their other hand (direct) or by using potentiometer to control the force through a torque motor (slider). All participants overestimated the target force in the direct condition reflecting the sensory attenuation phenomenon. No differences in the magnitude of sensory attenuation between chronic pain and control groups were observed (direct: Z = - 0.90, p = 0.37 and slider: Z = - 1.41, p = 0.16). An increased variance of sensory attenuation was observed in chronic pain individuals (direct: F(1, 129) = 7.22, p = 0.008 and slider: F(1, 129), p = 0.05). Performance in the slider condition was correlated with depressive symptoms (r = - 0.24, p = 0.05), high symptom count (r = - 0.25, p = 0.04) and positive affect (r = 0.28, p = 0.02). These were only identified in the chronic pain individuals. Overall, our findings reveal no clear differences in the magnitude of sensory attenuation between groups. Future research is needed to determine the relevance of sensory attenuation in neuro-cognitive models related to pain perception.

Limited evidence of moderation of the association between gastrointestinal symptoms and prospective healthcare utilisation by quality of life.

BACKGROUND: An individual's drive to seek medical help remains a complex behavioural process, incorporating psychological, social and symptom-specific factors. Within irritable bowel syndrome (IBS), gastrointestinal symptoms only predict a small portion of the high healthcare-seeking experienced. AIM: To examine the moderating role of quality of life (QoL) domains on this relationship to help explain the variance observed. METHODS: This is an analysis of a Swedish population-based prospective study of healthcare use over a 12-year period. At baseline, gastrointestinal symptoms were measured with the valid Gastrointestinal Symptom Rating Scale, and QoL via the SF-36. 1159 subjects (57% female; mean age 48.6 years) had their health records matched with the initial survey. 164 were classified as IBS by Rome II criteria. Negative binomial or logistic models were fit to evaluate the moderating effect of particular QoL domains on the relationship between gastrointestinal symptoms and prospective healthcare utilisation. RESULTS: Gastrointestinal symptoms were associated with prospective healthcare use, but moderation in this relationship by particular QoL domains was not supported; most models did not reach statistical significance. Furthermore, the impact of IBS status did not alter the moderation hypotheses. CONCLUSIONS: Particular QoL domains did not impact the relationship between gastrointestinal symptoms on prospective healthcare seeking. Future research should continue to examine other psychological, social and symptom variables to identify predictors of high healthcare consumers in IBS.

The effects of AAC video visual scene display technology on the communicative turns of preschoolers with autism spectrum disorder.

Over 40% of children with autism spectrum disorder (ASD) experience difficulty in using speech to meet their daily communication needs. Although augmentative and alternative communication (AAC) can be of benefit, the AAC intervention must support beginning communicators in the early social interactions that provide the foundation for more sophisticated communication skills. An AAC video visual scene display approach uses an AAC app (provided on a tablet computer), including videos based on the interests of the child and infused with AAC supports, to provide opportunities for social interaction and communication between the child and the communication partner. The purpose of this study was to investigate the impact of video visual scene display technology on the communicative turns taken by three preschoolers with ASD and complex communication needs during a high-interest, shared activity (i.e., watching videos). All three participants demonstrated a large increase in the number of communicative turns taken with their partner (Tau-U of 1.00) following the introduction of the video VSD app. The results provide evidence that a video VSD approach may be a promising intervention to increase participation in communication opportunities for young children with ASD.

"Two Friends Spending Time Together": The Impact of Video Visual Scene Displays on Peer Social Interaction for Adolescents With Autism Spectrum Disorder.

Purpose Social interaction poses many challenges for adolescents with autism spectrum disorder (ASD) and complex communication needs. The purpose of this study was to investigate the impact of video visual scene displays (video VSDs) on communication during interactions between adolescents with ASD and peer partners. Method This study used an across-participant multiple-baseline single-case experimental design. Four adolescents with ASD and complex communication needs were taught to use video VSDs, presented on a tablet-based app, during social interactions with peer partners in a high school setting. The video VSDs used during the interactions were selected (and programmed with vocabulary) based on the interests of the adolescent with ASD and their peer partner. Results Following the introduction of the video VSD intervention, all four adolescents with ASD demonstrated an increase in communicative turns compared to baseline (Tau-U= 1.0, 95% CI [0.56, 1]), and all four increased in modes of communication used. Increased use of speech also was observed for the three participants who made use of speech prior to the intervention. All participants with ASD (and their peer partners) expressed an interest in continued use of the video VSD app to support social interaction. Conclusion The use of video VSDs may be a viable option to increase the participation and communication of adolescents with ASD during social interactions with peer partners. Supplemental Material https://doi.org/10.23641/asha.16734532.

Personalized AAC Intervention to Increase Participation and Communication for a Young Adult with Down Syndrome.

Many adults with Down syndrome (DS) experience difficulty with speech production, and intelligibility challenges and communication breakdowns are common. Augmentative and alternative communication (AAC) intervention can provide important supports for persons with these complex communication needs, but must be customized to address the goals, strengths, and needs of the individual. This article provides a description of a personalized AAC intervention for a young adult with DS whose speech was frequently unintelligible. The AAC intervention made use of a video visual scene display (VSD) approach, and was investigated in two separate studies in two key community settings: An inclusive post-secondary education program (a single-case reversal ABAB design), and a community shopping activity (a non-experimental AB case study design). The participant demonstrated sharp increases in successful communication and participation in both settings following the introduction of the video VSD, and both the participant and key stakeholders viewed the intervention positively. The results provide preliminary evidence that personalized AAC intervention, including the use of a video VSD approach, can provide important supports for communication and participation in community settings for adults with DS and complex communication needs.

Effects of Online Training on Educators' Knowledge and Use of System of Least Prompts to Support Augmentative and Alternative Communication.

The present study evaluated the effects of online training on educators' knowledge and use of system of least prompts (SLP) to support the communication of individuals with autism (ASD) who use augmentative and alternative communication (AAC). A pre/posttest group design with switching replications was utilized. Three dependent variables: (a) knowledge of SLP, (b) planning for SLP, and (c) performance of SLP implementation during teleconference role-plays, were analyzed using a two-way mixed analysis of variance (ANOVA). Results indicate that training was effective in increasing educators' knowledge as well as the ability to plan for SLP. Implementation of SLP also increased over time, however, data analysis did not support the conclusion that this result was directly related to the online training. Additional results suggest that the participants viewed online instruction, with teleconference role-play assessments and case study vignettes, as a socially valid activity. Participants reported learning a valuable skill and as a result of the training were more confident working with individuals who use AAC. Implications, limitations, and directions for future research are also discussed.

Effects of a Literacy Feature in an Augmentative and Alternative Communication App on Single Word Reading of Individuals with Severe Autism Spectrum Disorders.

The purpose of this study was to investigate the effects of an augmentative and alternative communication (AAC) app with transition to literacy (T2L) software features (i.e., dynamic text and speech output upon selection of a graphic symbol within the grid display), on the acquisition of 12 personally relevant single words for individuals with severe autism spectrum disorder (ASD) who had minimal or no speech. The study implemented a single-subject, multiple-probe, across word sets design with four participants. All four participants in this study demonstrated increased accuracy reading targeted single words and results from this study provide preliminary evidence that the T2L features can positively impact the single word learning of individuals with ASD who have minimal speech and limited literacy skills.