Coronavirus disease 2019 infection and cerebrovascular diseases: an update on the pathophysiology and management.

PURPOSE OF REVIEW: COVID-19 is an ongoing global pandemic since it was first discovered in 2020. Cerebral vascular disease and stroke are among the most common and devastating neurological manifestations of COVID-19. This review offers an up-to-date information on the possible underlying mechanism of COVID-19-related stroke, its diagnosis, and management. RECENT FINDINGS: The thromboembolism associated with COVID-19 infection is likely related to the cytokine storm with innate immune activation, pulmonary disease leading to hypoxia-induced ischemia, thrombotic microangiopathy, endothelial damage and multifactorial activation of the coagulation cascade. Currently, there is no clear guidelines on the use of antithrombotics for the prevention and treatment of this phenomenon. SUMMARY: COVID-19 infection can directly cause a stroke or facilitate the formation of thromboembolism in the presence of other medical conditions. Physicians treating patients with COVID-19 should stay vigilant about the signs and symptoms of stroke, detect and treat early.

A systematic review and evaluation of post-stroke depression clinical practice guidelines.

OBJECTIVE: Post-stroke depression is a depressive mood disorder that follows a cerebrovascular accident and is a burden on stroke patients. Its management is included in clinical practice guidelines focused on stroke, and the recommended treatment is selective serotonin reuptake inhibitors in conjunction with psychotherapy. Clinical practice guidelines are recommendations used to standardize best medical practice, but there is no current evaluation of guidelines containing post stroke depression recommendations. Thus, the objective is to appraise the selected guidelines manner of development and quality. MATERIALS AND METHODS: A systematic literature review across three databases and a manual google search was performed to collect guidelines that included recommendations on the management of post-stroke depression. 1236 guidelines were screened, and 27 were considered for inclusion. Considered guidelines were manually reviewed by the authors, and ultimately, 7 met inclusion criteria. The appraisal of guidelines for research and evaluation was used to evaluate these guidelines' recommendations around post-stroke depression. RESULTS: Three guidelines met the threshold considered "High", with all of them having five or more quality domains eclipse the cutoff score of 70%. Across all guidelines, the highest scoring domains were "Scope and Purpose", "Clarity of Presentation", and "Editorial Independence" with scores of 76.98%, 73.81%, and 91.36% respectively. The lowest scoring domains were "Applicability", "Rigor of Development", and "Stakeholder Involvement" with respective scores of 58.73%, 54.02%, and 43.90%. CONCLUSIONS: The domains "Applicability", "Rigor of Development," and "Stakeholder Involvement" were the lowest scoring domains. These specific domains represent areas in which future guidelines could be more developed.

The impact of rapport on intelligence yield: police source handler telephone interactions with covert human intelligence sources.

Covert Human Intelligence Sources (CHIS) provide unique access to criminals and organised crime groups, and their collection of intelligence is vital to understanding England and Wales' threat picture. Rapport is essential to the establishment and maintenance of effective professional relationships between source handlers and their CHIS. Thus, rapport-based interviewing is a fundamental factor to maximising intelligence yield. The present research gained unprecedented access to 105 real-life audio recorded telephone interactions between England and Wales police source handlers and CHIS. This research quantified both the rapport component behaviours (e.g., attention, positivity, and coordination) displayed by the source handler and the intelligence yielded from the CHIS, in order to investigate the frequencies of these rapport components and their relationship to intelligence yield. Overall rapport, attention and coordination significantly correlated with intelligence yield, while positivity did not. Attention was the most frequently used component of rapport, followed by positivity, and then coordination.

Identifying challenges to critical incident decision-making through a macro-, meso-, and micro- lens: A systematic synthesis and holistic narrative analysis.

It is predicted that emergency responses to critical incidents will increase over the next few decades, as society faces unique and dynamic challenges (e.g., pandemics, migrant crises, and terrorism). As such, it is necessary to breakdown, identify, and evaluate the unique barriers associated with decision-making in the context of critical incident responses. The aim of the current study was to synthesize the bibliographic characteristics of the research on decision making and present a holistic narrative analysis of the multi-layered factors. Additionally, the systematic synthesis of evidence facilitated a critical appraisal of the quality and distribution of evidence across macro-, meso-, and micro- levels. Results suggested that research was moderately heterogeneous, as evidence captured diverse narrative factors. However, micro-centric characteristics (e.g., cognitive-related factors) were not well represented. Instead, research primarily focused toward intermediate meso-level characteristics, capturing factors such as "interoperability" and "organization policy and procedure" as critical challenges to decision-making. Six key narratives were also identified and discussed. Both the quality appraisal and narrative findings suggested that research should seek opportunities to experimentally assess, evaluate and validate decision-making. Whilst this has previously appeared ethically and practically problematic, advances in technology, research and analysis have allowed high-fidelity simulation experimentation to recreate critical incidents.

Prospects for Leveling the Playing Field for Black Children With Autism.

Among the many race-based health disparities that have persistently plagued the US population,1 the disproportionate burden of adverse neurodevelopmental outcomes to Black children affected by autism spectrum disorder (ASD) is particularly devastating given its major lifelong consequences. Recently, in 3 successive reports from the Autism and Developmental Disabilities Monitoring (ADDM) program of the US Centers for Disease Control and Prevention (CDC) (birth cohort years 2014, 2016, and 2018), we and our collaborators reported that although the prevalence of community-diagnosed ASD had equalized for Black and non-Hispanic White (NHW) children in the United States, there has persisted a pronounced racial disparity in the proportion of ASD-affected children with comorbid intellectual disability (ID), on the order of 50% for Black children with ASD vs 20% for White children with ASD.2 Here, we provide data to support the following: much earlier diagnosis is possible; early diagnosis alone is not likely to close the ID comorbidity disparity; and judicious efforts over care as usual are necessary to ensure that Black children have access to timely implementation of developmental therapy, for which we observed promising associations with improved cognitive and adaptive outcomes in our sample.

Improving Beverage Choice in Adults with Developmental Disabilities: Implementation of a Token Reinforcement System in a Community Residential Setting.

Individuals with developmental disabilities (DD) are twice as likely to have obesity than non-disabled individuals. Replacing the consumption of sugar sweetened beverages (SSBs) with water has many health benefits, including weight reduction. In this study, a token reinforcement system was implemented to increase water consumption and decrease the consumption of SSBs with 14 adult participants with DD living in a community-based independent supported living (ISL) center. Token reinforcement reduced the consumption of SSBs, with associated reductions in calorie consumption and body weight. Findings are especially important for treatment settings where resources for individualized meal planning and staffing to support comprehensive behavioral interventions may be limited.

On the Importance of Listening and Intercultural Communication for Actions against Racism.

In a period where racial inequities in the United States have garnered more attention and discussion as a result of social media (e.g., increased use of the #BlackLivesMatter hashtag; Anderson et al., 2020) and newer generations (Tatum, 2017b), it is important to ensure that communication between cultural groups is effective and produces systemic change. This article will review the failures of a "postracial" society, with emphasis on ineffective communication among Black, Indigenous People of Color and non-Black, Indigenous People of Color. The role of the listener during intercultural verbal exchanges will be examined, while highlighting the barriers and harmful results of ineffective communication. A behavioral conceptualization of effective listener behavior will be presented, which if implemented, may maintain and sustain social equity, inclusion, and justice. A call to action will be made to further investigate intercultural communication using behavior-analytic research methodologies and how such research might inform on how to functionally and precisely mediate reinforcement in the fight against racism.

Clinical practice guidelines in idiopathic facial paralysis: systematic review using the appraisal of guidelines for research and evaluation (AGREE II) instrument.

Bell's palsy, or idiopathic facial paralysis, is a peripheral facial palsy of unknown cause that presents as sudden, unilateral weakness of the muscles of the face. Prompt treatment of Bell's palsy is critical in order for patients to achieve complete recovery of facial function. Delays in diagnosis and management can result in permanent facial defects. A number of clinical practice guidelines (CPG) exist to guide clinical decision-making in patients presenting with idiopathic facial paralysis. However, to date, there has been no comprehensive review of the methodological rigor and quality of these CPGs. Thus, the objective of the authors is to appraise the existing CPGs to ensure safe and effective practices. A total of eight guidelines met the inclusion criteria and were appraised. Only two CPGs achieved an overall rating of 'High', having five or more quality domains scoring > 60%. Across the CPGs, the domains of rigor of development, stakeholder involvement, and applicability has the lowest overall scores with 48.1%, 43.9%, and 43.1%, respectively. Based on the AGREE II instrument, the methodological rigor and quality of CPGs for Bell's palsy is low to average. In particular, future guidelines for Bell's palsy should look to the quality domains of rigor of development, stakeholder involvement, and applicability as the greatest opportunities for improvement.

Implementation of a pooled surveillance testing program for asymptomatic SARS-CoV-2 infections in K-12 schools and universities.

BACKGROUND: The negative impact of continued school closures during the height of the COVID-19 pandemic warrants the establishment of cost-effective strategies for surveillance and screening to safely reopen and monitor for potential in-school transmission. Here, we present a novel approach to increase the availability of repetitive and routine COVID-19 testing that may ultimately reduce the overall viral burden in the community. METHODS: We implemented a testing program using the SalivaClear࣪ pooled surveillance method that included students, faculty and staff from K-12 schools (student age range 5-18 years) and universities (student age range >18 years) across the country (Mirimus Clinical Labs, Brooklyn, NY). The data analysis was performed using descriptive statistics, kappa agreement, and outlier detection analysis. FINDINGS: From August 27, 2020 until January 13, 2021, 253,406 saliva specimens were self-collected from students, faculty and staff from 93 K-12 schools and 18 universities. Pool sizes of up to 24 samples were tested over a 20-week period. Pooled testing did not significantly alter the sensitivity of the molecular assay in terms of both qualitative (100% detection rate on both pooled and individual samples) and quantitative (comparable cycle threshold (Ct) values between pooled and individual samples) measures. The detection of SARS-CoV-2 in saliva was comparable to the nasopharyngeal swab. Pooling samples substantially reduced the costs associated with PCR testing and allowed schools to rapidly assess transmission and adjust prevention protocols as necessary. In one instance, in-school transmission of the virus was determined within the main office and led to review and revision of heating, ventilating and air-conditioning systems. INTERPRETATION: By establishing low-cost, weekly testing of students and faculty, pooled saliva analysis for the presence of SARS-CoV-2 enabled schools to determine whether transmission had occurred, make data-driven decisions, and adjust safety protocols. We provide strong evidence that pooled testing may be a fundamental component to the reopening of schools by minimizing the risk of in-school transmission among students and faculty. FUNDING: Skoll Foundation generously provided funding to Mobilizing Foundation and Mirimus for these studies.

Increasing Exercise Intensity: Teaching High-Intensity Interval Training to Individuals with Developmental Disabilities Using a Lottery Reinforcement System.

Rates of overweight and obesity are above 70% in typically developing adults in the United States, with higher rates observed in individuals diagnosed with developmental disability (DD). Lottery reinforcement systems have been validated as effective exercise interventions for individuals with DD. Although high-intensity interval training (HIIT) has demonstrated health benefits, it has not been studied using individuals within this population. The purpose of this study was to implement a lottery reinforcement system to systematically increase heart rate (HR) during 30-min HIIT sessions with 3 adults with DD. Results demonstrated increases in HR from below to within the prescribed range in all 3 participants. For 1 participant, weight decreased by 10.8 pounds during the 9-week program. Implications include that lottery systems increase exercise intensity with adults with DD, that HR during exercise can be reliably controlled using a lottery system, and that similar programs may result in health benefits.

PEAK Pre-Assessments: Preliminary Evidence Establishing Internal Consistency and Construct Validity.

Promoting the Emergence of Advanced Knowledge (PEAK) is a behavior-analytic tool that assesses and teaches language and cognitive abilities. PEAK preassessment total scores showed statistically significant correlations with measures of intelligence (r = .703, p = .023) and adaptive behavior (r = .618, p = .018), whereas no significant correlations were found between PEAK and age, autism diagnostic instruments, or aggression scales in a sample (N = 18) receiving behavior-analytic assessment in an autism clinic. Statistically significant correlations were found between all modules within the PEAK system (p ≤ .001). Results provide preliminary evidence of the construct validity and internal consistency of the PEAK preassessments.