Health Behavior Change Following Stroke: Recommendations for Adapting the Diabetes Prevention Program-Group Lifestyle Balance Program.

Objective. History of stroke increases risk for recurrent stroke, which is a significant issue faced by survivors. The Diabetes Prevention Program-Group Lifestyle Balance (DPP-GLB) program is an effective lifestyle modification intervention for ameliorating cardiovascular risk factors but has not been adapted to account for common stroke-related deficits. The purpose of this study was to determine appropriate adaptations to the DPP-GLB for adults with stroke. Design and Methods. In this phenomenological qualitative study, a total of 15 community-dwelling adults with stroke and 10 care-partners participated in 4 focus groups to review DPP-GLB curriculum materials and provide recommendations for adaptation. Focus groups were recorded and transcribed. Inductive content analysis was used to identify key themes. Results. Three themes were identified. First, physical, cognitive, sensory, and psychosocial stroke-related deficits could affect DPP-GLB participation. Second, existing DPP-GLB characteristics could facilitate participation by adults with stroke. Third, stroke-specific adaptations were recommended, including modified session content and format, adapted physical activity and dietary recommendations, and inclusion of care-partners. Conclusion. Current DPP-GLB content and structure may be insufficient to meet the unique needs of adults with stroke. The suggested adaptations should be incorporated into a stroke-specific curriculum and tested for preliminary efficacy for reducing recurrent stroke risk.

How Adults With Stroke Conceptualize Physical Activity: An Exploratory Qualitative Study.

IMPORTANCE: Physical activity (PA) is recommended for improving physical and cardiovascular function but can be challenging because of stroke-related impairments. A better understanding of how adults with stroke conceptualize PA could assist in developing effective interventions for increasing poststroke PA. OBJECTIVE: To explore how adults with stroke conceptualize PA. DESIGN: Phenomenological qualitative design. SETTING: Participants' homes. PARTICIPANTS: Community-dwelling adults with chronic (>6 mo) stroke (N = 15). OUTCOMES AND MEASURES: Semistructured interviews were conducted with participants. Data were analyzed by means of inductive content analysis to identify key themes. RESULTS: Three key themes emerged: (1) moderate to vigorous PA, which includes exercise-related activities (going to the gym, walking, playing sports); (2) PA necessary for performing daily activities and occupations, which includes basic and instrumental activities of daily living; and (3) avoiding sedentary behavior, which includes not wanting to sit for long periods of time, avoiding boredom, and valuing PA over being sedentary. CONCLUSIONS AND RELEVANCE: Participants broadly categorized PA, encompassing multiple activity types, which is encouraging because reducing sedentary behavior and increasing PA of any intensity can improve cardiometabolic health. Interventions that complement and enhance these conceptualizations, alone or in combination with other mechanisms of action, should be explored for their efficacy in increasing PA in adults with stroke. WHAT THIS ARTICLE ADDS: After stroke, perceptions of PA encompass exercise, daily activities and occupations, and avoiding sedentary behavior; these perceptions could be harnessed to promote PA among adults after stroke.

Autistic People Do Enhance Their Selves.

We investigated whether autistic people are less prone to self-enhance (i.e., portray themselves in socially desirable ways). Autistic (N = 130) and non-autistic (N = 130) participants first responded to social desirability items using the standard instruction to endorse each item as true or false about themselves. Then, all participants read an explanation of what social desirability items measure before responding again to the social desirability items. Self-enhancement was operationalized as participants endorsing more social desirability items before learning the explanation than after. All participants endorsed significantly more social desirability items before learning the explanation than after, F subjects(1,258) = 57.73, p < .001, η2 p = .183; F items(1,34) = 43.04, p < .001, η2 p = .559). However, autistic and non-autistic participants did not significantly differ in how many items they endorsed, either before or after reading the explanation, indicating that autistic people are as susceptible to social desirability and self-enhancement as non-autistic people are. Our results challenge the claim that autistic people are immune to reputation management.

Evaluation of Students' Conceptual Organization of Neuroscience May Depend on the Expert Referent.

The Structural Assessment of Knowledge (SAK) is an implicit form of evaluation, which examines the organization of knowledge structures or networks. The current study investigates variability in expert knowledge structures of neuroscience concepts, and whether different expert referents affect undergraduate students' learning of neuronal physiology and structure and function relationships across different course levels. Experts and students made pairwise ratings of terms on their relatedness. Students completed the ratings before and after learning in the classroom. Using Pathfinder software, students' networks were compared to three expert networks: their individual professor, an average of neuroscience professors at their institution, and an average of neuroscience professors in the field across multiple institutions. Neuroscience experts had large variability in the number of links in their networks. Furthermore, an exploratory analysis suggests experts' training may differentiate knowledge structures for some concepts. For student knowledge structures, the type of expert referent interacted with the type of class for neuronal physiology, but not structure and function relationships. More specifically, for neuronal physiology, advanced students were more similar to their professor than professors at their institution or professors in the field, but introductory students' similarity did not vary by expert referent. These findings highlight the role factors such as type of class, type of expert referent, and type of knowledge may play in comparisons using SAK. These issues may be more complex in interdisciplinary fields like neuroscience.

Explicit Associations with Autism and Disability.

Objectives: Autistic people call for greater acceptance even though the general public has greater awareness of the autism spectrum. This study investigated explicit or conscious attitudes toward the autism spectrum and disability in college students and the general population. We hypothesized that both samples would associate "a person on the autism spectrum" with more negative attributes than other types of people except for "a person with a disability." Methods: In Phase 1, participants generated 10 word associations for 8 labels: a person on the autism spectrum, a person not on the autism spectrum, a person with a disability, a person without a disability, a college student, a professor, a child, and a parent. In Phase 2, participants rated the 10 most common words for each label (type of person) in Phase 1 on a 7-point Likert scale from extremely negative to extremely positive. Ninety-nine undergraduate students and 106 adults recruited through Amazon Mechanical Turk completed Phase 1. One hundred twenty-two undergraduate students and 101 adults recruited through Amazon Mechanical Turk completed Phase 2. Results: Only "a person with a disability" in the general population sample was rated as having significant negative associations. However, the associations of "a person with a disability" were rated more negatively than all other labels in both samples, and the associations of "a person on the autism spectrum" were rated as second most negative in the general population sample. Conclusion: Explicit associations toward disability and autism were somewhat mixed. Adults in the general population tended to have more negative explicit associations with disability, and to a lesser extent autism. These results underscore the need to examine attitudes in samples more representative of the general population. Furthermore, evidence of possible explicit negative associations is concerning and highlights the imperative need to confront ableism. Lay summary: Why was this study done?: The general public claims to be aware of the autism spectrum and recent research suggests that they have greater knowledge about the autism spectrum than they did in the past. However, as autistic individuals have articulated, autism awareness is not the same as autism acceptance. In order for autistic individuals to be fully included into society, we must move to autism acceptance. One way researchers examine potential discrimination is by studying attitudes.What was the purpose of this study?: This study examines people's explicit attitudes toward the autism spectrum and to disability. Explicit attitudes are attitudes that are conscious and controllable.What did the researchers do?: Two groups of adults participated in the study: a group of college students and a noncollege sample of adults designed to better represent the general population of adults. Participants completed an online study wherein they were asked to list word associations for different types of people including "a person on the autism spectrum" and "a person with a disability." In a second study, participants then rated the most common associations from extremely negative to extremely positive.What were the results of the study?: The results were somewhat mixed. Only the set of associations of "a person with a disability" were rated by participants in the noncollege group as negative. However, the associations of "a person with a disability" were rated more negatively than all other types of people in both groups, and the associations of "a person on the autism spectrum" were rated as second most negative in the noncollege sample.What do these findings add to what was already known?: The majority of research on explicit attitudes toward autism has focused on children, including how interventions may improve attitudes toward autistic children. Therefore, this research provides much needed information on the state of attitudes toward autistic individuals more generally. This research also provides a comparison of attitudes toward autism, disability, and other groups. Furthermore, research assessing attitudes toward autism in adults has largely focused on college students, whereas this research considered both college students and a noncollege sample.What are the potential weaknesses in the study?: These findings may not extend to a more diverse population as both groups had relatively high education levels, were primarily White non-Hispanic and were living in the United States. Furthermore, participants may have generated more positive associations for "a person on the autism spectrum" and "a person with a disability" because they wanted to be viewed in a favorable light. This is known as a social desirability bias.How will these findings help autistic adults now or in the future?: Unfortunately, possible explicit negative associations with the autism spectrum and with disability are concerning as they reflect people's conscious and controllable attitudes. These results highlight a need for action and also support autistic individuals' demand for actions toward autism acceptance.

Gender differences in mental rotation strategy depend on degree of autistic traits.

Participants with low, medium, and high autistic traits completed a mental rotation task while their eye movements were recorded. Men were more accurate than women (F(1, 102) = 4.36, P = 0.04, η2p = 0.04), but there were no group differences in reaction time. In terms of eye movements, all participants tended to rely on top corners of cube figures for most angles of rotation, and bottom corners of cube figures for 0 and 90 degree rotations (duration: F(8, 816) = 21.70, P < 0.001, η2p = 0.18; count: F(8, 816) = 24.42, P < 0.001, η2p = 0.19) suggesting a shift in strategy with rotation angle. Eye movements to corners of cube figures also varied by autistic traits group and gender (duration: F(4, 204) = 2.44, P = 0.05, η2p = 0.05; count: F(4, 204) = 2.47, P = 0.05, η2p = 0.05). Participants with low and medium autistic traits tended to rely more often on the top corners, whereas women with high autistic traits relied on both the top and bottom corners and men with high autistic traits relied on all corners equally. These results suggest mental rotation strategies may vary by both gender and autistic traits. Autism Res 2018, 11: 1024-1037. © 2018 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY: The current study looked at eye movements to assess adults' strategies when mentally rotating three-dimensional cube figures. Adults with varying levels of autistic traits differ in their mental rotation strategies. In addition, gender differences in strategies are observed in adults with the highest level of autistic traits.

Do puzzle pieces and autism puzzle piece logos evoke negative associations?

Puzzle pieces have become ubiquitous symbols for autism. However, puzzle-piece imagery stirs debate between those who support and those who object to its use because they believe puzzle-piece imagery evokes negative associations. Our study empirically investigated whether puzzle pieces evoke negative associations in the general public. Participants' ( N = 400) implicit negative associations were measured with an Implicit Association Task, which is a speeded categorization task, and participants' explicit associations were measured with an Explicit Association Task, which is a standard task for assessing consumers' explicit associations with brands (and images of those brands). Puzzle pieces, both those used as autism logos and those used more generically, evoked negative implicit associations ( t(399) = -5.357, p < 0.001) and negative explicit associations ( z = 4.693, p < 0.001, d = 0.491). Participants explicitly associated puzzle pieces, even generic puzzle pieces, with incompleteness, imperfection, and oddity. Our results bear public policy implications. If an organization's intention for using puzzle-piece imagery is to evoke negative associations, our results suggest the organization's use of puzzle-piece imagery is apt. However, if the organization's intention is to evoke positive associations, our results suggest that puzzle-piece imagery should probably be avoided.

Retrospectively Assessed Early Motor and Current Pragmatic Language Skills in Autistic and Neurotypical Children.

Autistic individuals often struggle developmentally, even in areas that are not explicit diagnostic criteria, such as motor skills. This study explored the relation between early motor skills, assessed retrospectively, and current pragmatic language skills. Caregivers of neurotypical and autistic children, matched on gender and age, completed assessments of their child's early motor development and current language abilities. Early motor skills were correlated with later pragmatic language skills, and autistic children exhibited fewer motor skills than neurotypical children. In fact, motor skills were a better predictor of an autism spectrum diagnosis than were scores on a measure of current pragmatic language. These results highlight the important role of motor skills in autism spectrum disorders.

Psychometric Properties of the Autism-Spectrum Quotient for Assessing Low and High Levels of Autistic Traits in College Students.

The current study systematically investigated the effects of scoring and categorization methods on the psychometric properties of the Autism-Spectrum Quotient. Four hundred and three college students completed the Autism-Spectrum Quotient at least once. Total scores on the Autism-Spectrum Quotient had acceptable internal consistency and test-retest reliability using a binary or Likert scoring method, but the results were more varied for the subscales. Overall, Likert scoring yielded higher internal consistency and test-retest reliability than binary scoring. However, agreement in categorization of low and high autistic traits was poor over time (except for a median split on Likert scores). The results support using Likert scoring and administering the Autism-Spectrum Quotient at the same time as the task of interest with neurotypical participants.

Specificity, contexts, and reference groups matter when assessing autistic traits.

Many of the personality and behavioral traits (e.g., social imperviousness, directness in conversation, lack of imagination, affinity for solitude, difficulty displaying emotions) that are known to be sensitive to context (with whom?) and reference group (according to whom?) also appear in questionnaire-based assessments of autistic traits. Therefore, two experiments investigated the effects of specifying contexts and reference groups when assessing autistic traits in autistic and non-autistic participants. Experiment 1 (124 autistic and 124 non-autistic participants) demonstrated that context matters when assessing autistic traits (F(1,244) = 267.5, p < .001, η2p = .523). When the context of the Broad Autism Phenotype Questionnaire was specified as the participants' out-group (e.g., "I like being around non-autistic people" or "I like being around autistic people"), both autistic and non-autistic participants self-reported having more autistic traits; when the context was specified as the participants' in-group, participants reported having fewer autistic traits. Experiment 2 (82 autistic and 82 non-autistic participants) demonstrated that reference group matters when assessing autistic traits (F(2,160) = 94.38, p < .001, η2p = .541). When the reference group on the Social Responsiveness Scale was specified as the participants' out-group (e.g., "According to non-autistic people, I have unusual eye contact"), autistic participants reported having more autistic traits; when the reference group was their in-group, autistic participants reported having fewer autistic traits. Non-autistic participants appeared insensitive to reference group on the Social Responsiveness Scale. Exploratory analyses suggested that when neither the context nor the reference group is specified (for assessing autistic traits on the Autism-Spectrum Quotient), both autistic and non-autistic participants use the majority ("non-autistic people") as the implied context and reference group.

The Role of Musical Experience in Hemispheric Lateralization of Global and Local Auditory Processing.

The global precedence effect is a phenomenon in which global aspects of visual and auditory stimuli are processed before local aspects. Individuals with musical experience perform better on all aspects of auditory tasks compared with individuals with less musical experience. The hemispheric lateralization of this auditory processing is less well-defined. The present study aimed to replicate the global precedence effect with auditory stimuli and to explore the lateralization of global and local auditory processing in individuals with differing levels of musical experience. A total of 38 college students completed an auditory-directed attention task while electroencephalography was recorded. Individuals with low musical experience responded significantly faster and more accurately in global trials than in local trials regardless of condition, and significantly faster and more accurately when pitches traveled in the same direction (compatible condition) than when pitches traveled in two different directions (incompatible condition) consistent with a global precedence effect. In contrast, individuals with high musical experience showed less of a global precedence effect with regards to accuracy, but not in terms of reaction time, suggesting an increased ability to overcome global bias. Further, a difference in P300 latency between hemispheres was observed. These findings provide a preliminary neurological framework for auditory processing of individuals with differing degrees of musical experience.

Use of Structural Assessment of Knowledge for Outcomes Assessment in the Neuroscience Classroom.

Outcomes assessment of undergraduate neuroscience curricula should assess the ability to think integratively about basic neuroscience concepts based on two of the core competencies established by the Faculty for Undergraduate Neuroscience. The current study investigated whether the structural assessment of knowledge (SAK) approach, which evaluates the organization of an individual's knowledge structures, is effective for demonstrating learning of basic neuroscience concepts. Students in an introductory psychology course (n = 29), an introductory neuroscience course (n = 19), or an advanced behavioral neuroscience course (n = 15) completed SAK before and after learning gross brain anatomy and neuronal physiology. All students showed improvements in their SAK after short-term dissemination for gross brain anatomy, but not for neuronal physiology, concepts. Therefore, research is needed to determine whether the effectiveness of SAK in outcomes assessment depends on the content or teaching style. Additional research using SAK should also explore effectiveness for learning over longer time frames and correlations with student performance in the course. However, the results suggest SAK is a promising technique for outcomes assessment of undergraduate neuroscience curricula.

Abstract spatial reasoning as an autistic strength.

Autistic individuals typically excel on spatial tests that measure abstract reasoning, such as the Block Design subtest on intelligence test batteries and the Raven's Progressive Matrices nonverbal test of intelligence. Such well-replicated findings suggest that abstract spatial processing is a relative and perhaps absolute strength of autistic individuals. However, previous studies have not systematically varied reasoning level--concrete vs. abstract--and test domain--spatial vs. numerical vs. verbal, which the current study did. Autistic participants (N = 72) and non-autistic participants (N = 72) completed a battery of 12 tests that varied by reasoning level (concrete vs. abstract) and domain (spatial vs. numerical vs. verbal). Autistic participants outperformed non-autistic participants on abstract spatial tests. Non-autistic participants did not outperform autistic participants on any of the three domains (spatial, numerical, and verbal) or at either of the two reasoning levels (concrete and abstract), suggesting similarity in abilities between autistic and non-autistic individuals, with abstract spatial reasoning as an autistic strength.

Infantilizing Autism.

When members of the public envision the disability of autism, they most likely envision a child, rather than an adult. In this empirically based essay, three authors, one of whom is an autistic self-advocate, analyzed the role played by parents, charitable organizations, the popular media, and the news industry in infantilizing autism. Parents portrayed the face of autism to be that of a child 95% of the time on the homepages of regional and local support organizations. Nine of the top 12 autism charitable organizations restricted descriptions of autism to child-referential discourse. Characters depicted as autistic were children in 90% of fictional books and 68% of narrative films and television programs. The news industry featured autistic children four times as often as they featured autistic adults in contemporary news articles. The cyclical interaction between parent-driven autism societies, autism fundraising charities, popular media, and contemporary news silences adult self-advocates by denying their very existence. Society's overwhelming proclivity for depicting autism as a disability of childhood poses a formidable barrier to the dignity and well-being of autistic people of all ages.

Monoclonal antibody interactions with micro- and nanoparticles: adsorption, aggregation, and accelerated stress studies.

Therapeutic proteins are exposed to various wetted surfaces that could shed subvisible particles. In this work we measured the adsorption of a monoclonal antibody (mAb) to various microparticles, characterized the adsorbed mAb secondary structure, and determined the reversibility of adsorption. We also developed and used a front-face fluorescence quenching method to determine that the mAb tertiary structure was near-native when adsorbed to glass, cellulose, and silica. Initial adsorption to each of the materials tested was rapid. During incubation studies, exposure to the air-water interface was a significant cause of aggregation but acted independently of the effects of microparticles. Incubations with glass, cellulose, stainless steel, or Fe(2)O(3) microparticles gave very different results. Cellulose preferentially adsorbed aggregates from solution. Glass and Fe(2)O(3) adsorbed the mAb but did not cause aggregation. Adsorption to stainless steel microparticles was irreversible, and caused appearance of soluble aggregates upon incubation. The secondary structure of mAb adsorbed to glass and cellulose was near-native. We suggest that the protocol described in this work could be a useful preformulation stress screening tool to determine the sensitivity of a therapeutic protein to exposure to common surfaces encountered during processing and storage.

Response of a concentrated monoclonal antibody formulation to high shear.

There is concern that shear could cause protein unfolding or aggregation during commercial biopharmaceutical production. In this work we exposed two concentrated immunoglobulin-G1 (IgG1) monoclonal antibody (mAb, at >100 mg/mL) formulations to shear rates between 20,000 and 250,000 s(-1) for between 5 min and 30 ms using a parallel-plate and capillary rheometer, respectively. The maximum shear and force exposures were far in excess of those expected during normal processing operations (20,000 s(-1) and 0.06 pN, respectively). We used multiple characterization techniques to determine if there was any detectable aggregation. We found that shear alone did not cause aggregation, but that prolonged exposure to shear in the stainless steel parallel-plate rheometer caused a very minor reversible aggregation (<0.3%). Additionally, shear did not alter aggregate populations in formulations containing 17% preformed heat-induced aggregates of a mAb. We calculate that the forces applied to a protein by production shear exposures (<0.06 pN) are small when compared with the 140 pN force expected at the air-water interface or the 20-150 pN forces required to mechanically unfold proteins described in the atomic force microscope (AFM) literature. Therefore, we suggest that in many cases, air-bubble entrainment, adsorption to solid surfaces (with possible shear synergy), contamination by particulates, or pump cavitation stresses could be much more important causes of aggregation than shear exposure during production.

The transliminal brain at rest: baseline EEG, unusual experiences, and access to unconscious mental activity.

Transliminality reflects individual differences in the threshold at which unconscious processes or external stimuli enter into consciousness. Individuals high in transliminality possess characteristics such as magical ideation, belief in the paranormal, and creative personality traits, and also report the occurrence of manic/mystic experiences. The goal of the present research was to determine if resting brain activity differs for individuals high versus low in transliminality. We compared baseline EEG recordings (eyes-closed) between individuals high versus low in transliminality, assessed using The Revised Transliminality Scale of Lange et al. (2000). Identifying reliable differences at rest between high- and low-transliminality individuals would support a predisposition for transliminality-related traits. Individuals high in transliminality exhibited lower alpha, beta, and gamma power than individuals low in transliminality over left posterior association cortex and lower high alpha, low beta, and gamma power over the right superior temporal region. In contrast, when compared to individuals low in transliminality, individuals high in transliminality exhibited greater gamma power over the frontal-midline region. These results are consistent with prior research reporting reductions in left temporal/parietal activity, as well as the desynchronization of right temporal activity in schizotypy and related schizophrenia spectrum disorders. Further, differences between high- and low-transliminality groups extend existing theories linking altered hemispheric asymmetries in brain activity to a predisposition toward schizophrenia, paranormal beliefs, and unusual experiences.

Autistics' Atypical Joint Attention: Policy Implications and Empirical Nuance.

Burack and Russo (2008) applaud our approach to understanding autistics' atypical joint attention (Gernsbacher, Stevenson, Khandakar, & Goldsmith, 2008) but express some concerns about the evidence we drew upon to support our thesis. In response, we underscore the empirical nuance of our thesis-that autistics' atypical manifestations of joint attention arise from their atypical resistance to distraction, atypical parallel perception, and atypical execution of volitional actions. We recap how our hypothesis derives from fresh interpretations, well-replicated findings, and underlying mechanisms.

Why Does Joint Attention Look Atypical in Autism?

This essay answers the question of why autistic children are less likely to initiate joint attention (e.g., use their index finger to point to indicate interest in something) and why they are less likely to respond to bids for their joint attention (e.g., turn their heads to look at something to which another person points). It reviews empirical evidence that autistic toddlers, children, adolescents, and adults can attend covertly, even to social stimuli, such as the direction in which another person's eyes are gazing. It also reviews empirical evidence that autistics of various ages understand the intentionality of other persons' actions. The essay suggests that autistics' atypical resistance to distraction, atypical skill at parallel perception, and atypical execution of volitional actions underlie their atypical manifestations of joint attention.