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Feeding challenges are a significant concern for autistic children. Literature has yet to comprehensively characterize feeding challenges for autistic children. Further research is needed to understand predictors of feeding severity and identify opportunities for screening and intervention. The purpose of this study was to characterize the presentation of feeding challenges in autistic children and identify predictors of feeding challenge classification and severity. Data from a national cross-sectional survey of caregivers (n = 427) of autistic children with feeding challenges was used. Feeding challenges were characterized using descriptive statistics. Autism diagnosis age and age of onset of feeding challenges was compared using non-parametric testing. Bi-directional stepwise multivariate linear regression was used to identify significant predictors of feeding challenge scores. Sensory-based feeding challenges were the most common. Age of onset of feeding challenges was significantly lower than the age of autism diagnosis. Early feeding challenges differentially predicted feeding challenge severity and classification scores. The results of this study identify the relationships among early feeding challenges and the severity and classification of feeding challenges in later childhood. Results demonstrate the importance of early monitoring of feeding challenges. These findings can be used to inform the identification of critical timepoints for intervention.

Background: The COVID-19 pandemic has brought about disruptions in healthcare for adults with intellectual and developmental disabilities. There is a need to explore ways to promote proactive healthcare and better prepare individuals for healthcare encounters. Methods: A co-designed tool, the COVID Check-in Tool, was introduced as part of a virtual health education programme to encourage proactive healthcare. Implementation of this Health Check-in was evaluated with 36 adults with intellectual and developmental disabilities and 96 family caregivers who completed the programme using surveys, structured interviews and focus groups. Findings: Forty-four percent of participants engaged in the Health Check-in process, resulting in many reported benefits for those who participated. However, there were also barriers to initiating the Check-in, along with challenges using the COVID Check-in Tool, according to both the adults with disabilities who were interviewed and the family caregivers. Conclusions: The study underscores the importance of considering ways to integrate tools into routine healthcare practices, to facilitate improved healthcare delivery for people with intellectual and developmental disabilities during pandemic recovery efforts. As well, involving people with lived experience in the development and implementation of healthcare resources is critical.

The normative role of the World Health Organization (WHO) involves creating evidence-based, principled guidelines to guide its Member States in making well-informed public health decisions. While these guidelines often need to be adapted to ensure contextual relevance, foster better implementation and adherence, adapting existing guidelines is more efficient than creating new ones. Here we describe the adaptation of the WHO coronavirus disease 2019 (COVID-19) living guideline on pharmacological interventions for the Caribbean using the grading of recommendations, assessment, development and evaluation (GRADE)-ADOLOPMENT method. The Caribbean Public Health Agency and the Pan American Health Organization led the effort, assembling a diverse panel of 16 experts from seven Caribbean countries and territories. The adaptation process, involving 15 steps, was guided by an experienced methodologist and included selecting relevant clinical questions and prioritizing them based on regional needs. The panel evaluated the latest WHO guidelines and integrated additional local data. They adjusted the direction and strength of several recommendations to better fit the Caribbean context, considering local values and preferences, resources, accessibility, feasibility and impact on health equity. Ultimately, we changed the direction of two recommendations and the strength of five, tailoring them to regional realities. This effort highlights the importance of adapting global guidelines to local settings, improving their applicability and effectiveness. The adaptation process also serves as a valuable opportunity for skill transfer and capacity-building in guideline development. Continued research is needed to assess the impact of these adaptations on health-care outcomes in the Caribbean. [phrase omitted] Le role normatif de l'Organisation mondiale de la sante (OMS) consiste a elaborer des lignes directrices fondees sur des donnees scientifiques et sur des principes afin d'aider ses Etats membres a prendre des decisions eclairees en matiere de sante publique. Bien qu'elles necessitent souvent des adaptations pour garantir leur pertinence par rapport a des contextes precis et pour favoriser une meilleure mise en oeuvre et adhesion, il est plus efficace d'adapter les lignes directrices existantes que d'en creer de nouvelles. La presente publication decrit l'adaptation de la ligne directrice evolutive de l'OMS sur les interventions pharmacologiques dans le cadre de la maladie a coronavirus (COVID-19) pour les Caraibes en appliquant la methodologie GRADE (classement des recommandations, de l'appreciation, du developpement et de l'evaluation)-ADOLOPMENT. LAgence de sante publique des Caraibes et l'Organisation panamericaine de la Sante ont dirige les travaux en reunissant un groupe diversifie de 16 experts issus de sept pays et territoires des Caraibes. Le processus d'adaptation, comptant 15 etapes et encadre par un methodologiste experimente, a consiste a selectionner des questions cliniques pertinentes et a les classer par ordre de priorite selon les besoins regionaux. Ce groupe a evalue les dernieres lignes directrices de l'OMS et a integre des donnees locales supplementaires. Il a ensuite ajuste l'orientation et le poids de plusieurs recommandations afin de mieux les adapter au contexte des Caraibes, en tenant compte des valeurs et des preferences locales, des ressources, de l'accessibilite, de la faisabilite et de l'impact sur l'equite en matiere de sante. En fin de compte, l'orientation de deux recommandations et le poids de cinq autres ont ete modifies, en les adaptant aux realites regionales. Cet effort souligne l'importance d'adapter des lignes directrices mondiales aux contextes locaux, afin d'en ameliorer l'applicabilite et l'efficacite. Le processus d'adaptation represente egalement une occasion precieuse de transfert de competences et de renforcement des capacites en matiere d'elaboration de lignes directrices. Des recherches continues s'imposent pour evaluer l'impact de ces adaptations sur les resultats des soins de sante dans les Caraibes. [phrase omitted] La funcion normativa de la Organizacion Mundial de la Salud (OMS) consiste en elaborar directrices basadas en pruebas y principios para orientar a sus Estados Miembros en la toma de decisiones de salud publica bien fundamentadas. Aunque con frecuencia es necesario adaptar estas directrices para garantizar su pertinencia contextual y fomentar una mejor implementacion y observancia, la adaptacion de directrices existentes es mas eficiente que la creacion de otras nuevas. Aqui describimos la adaptacion de la directriz vigente de la OMS sobre la enfermedad por coronavirus (COVID-19) relativa a las intervenciones farmacologicas para el Caribe utilizando el metodo de clasificacion de valoracion, elaboracion y evaluacion de las recomendaciones (GRADE)ADOLOPMENT. La Agencia de Salud Publica del Caribe y la Organizacion Panamericana de la Salud lideraron la iniciativa, que reunio a un variado grupo de 16 expertos de siete paises y territorios caribenos. El proceso de adaptacion, que comprendio 15 pasos y fue guiado por un metodologo experimentado, Incluyo la seleccion de preguntas clinicas pertinentes y su priorizacion en funcion de las necesidades regionales. El grupo evaluo las ultimas directrices de la OMS e integro datos locales adicionales. Ajustaron la orientacion y la fuerza de varias recomendaciones para adaptarlas mejor al contexto caribeno, teniendo en cuenta los valores y preferencias locales, los recursos, la accesibilidad, la viabilidad y el impacto en la equidad sanitaria. Finalmente, cambiamos la orientacion de dos recomendaciones y la fuerza de cinco para adaptarlas a las realidades regionales. Esta iniciativa destaca la importancia de adaptar las directrices mundiales a los contextos locales, lo que mejora su aplicabilidad y eficacia. El proceso de adaptacion tambien constituye una valiosa oportunidad para la transferencia de conocimientos y el desarrollo de capacidades en la elaboracion de directrices. Es necesario seguir investigando para evaluar el impacto de estas adaptaciones en los resultados de la atencion sanitaria en el Caribe., Introduction Although the coronavirus disease 2019 (COVID-19) pandemic was a global catastrophe, its impact was not felt equally around the world. Despite being home to only 8% of the world's [...]

This study provides an overview of efforts to improve experiential learning outcomes by integrating the curriculum of an upper-level Project Management (PM) course with an Introductory Programming (IP) course using a game-making project. Students in the PM course applied PM methods and techniques while supervising teams of students in the IP course in making a gaming app. Paradoxically, it was found that transitioning from complex, real-world client projects to more structured and guided student projects increased realism and enhanced experiential learning. Positive results were not automatically derived by employing experiential learning tools. More important was a focus on the process through which student experiences resulted in knowledge acquisition and creation. The findings of this study encourage educators to pay special attention to the implementation and integration of learning tools to create synergy in the learning process.

Abstract A significant challenge in measurements of neutrino oscillations is reconstructing the incoming neutrino energies. While modern fully-active tracking calorimeters such as liquid argon time projection chambers in principle allow the measurement of all final state particles above some detection threshold, undetected neutrons remain a considerable source of missing energy with little to no data constraining their production rates and kinematics. We present the first demonstration of tagging neutrino-induced neutrons in liquid argon time projection chambers using secondary protons emitted from neutron-argon interactions in the MicroBooNE detector. We describe the method developed to identify neutrino-induced neutrons and demonstrate its performance using neutrons produced in muon-neutrino charged current interactions. The method is validated using a small subset of MicroBooNE’s total dataset. The selection yields a sample with $$60\%$$ 60 % of selected tracks corresponding to neutron-induced secondary protons. At this purity, the integrated efficiency is 8.4% for neutrons that produce a detectable proton.

Clasina Leslie Smith,1,2,* Bill Reddy,3,* Charis M Wolf,4,5,* Rosa N Schnyer,6,7,* Korina St John,8,* Lisa Conboy,4,7,9– 14,* Jen Stone,15 Lixing Lao16– 18 1Chicago Healing Center, Chicago, IL, USA; 2School of Medicine, Southern Illinois University, Springfield, IL, USA; 3Vital Point Acupuncture, Annandale, VA, USA; 4Seattle Institute of East Asian Medicine, Seattle, WA, USA; 5Middle Way Acupuncture Institute, Seattle, WA, USA; 6School of Nursing, University of Texas, Austin, TX, USA; 7Oregon College of Oriental Medicine, Portland, OR, USA; 8Modern Medicine Woman, LLC, Palmer, AK, USA; 9Beth Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; 10California Institute of Integral Studies, San Francisco, CA, USA; 11Pacific College of Oriental Medicine, San Diego, CA, USA; 12YoSan University, Los Angeles, CA, USA; 13Five Branches University, Santa Cruz, CA, USA; 14American Academy of Health and Wellness, Roseville, MN, USA; 15CTSI, Indiana University School of Medicine, Indianapolis, IN, USA; 16Virginia University of Integrative Medicine, Vienna, VA, USA; 17School of Medicine, University of Maryland, Baltimore, MD, USA; 18School of Chinese Medicine, University of Hong Kong, Pokfulam, Hong Kong*These authors contributed equally to this workCorrespondence: Clasina Leslie Smith, Chicago Healing Center, 1560 N Sandburg Ter, Unit 3215, Chicago, IL, 60610, USA, Tel +1-773-217-0567, Email LeslieTCM@gmail.comAbstract: The term “acupuncture” commonly refers to a non-pharmacologic therapy that is increasingly employed by diverse segments of the population for a wide variety of complaints including pain, insomnia, anxiety, depression, frozen shoulder, and other issues. The term is also used as a short-hand for the wider medical system from which the placement of needles into the skin for therapeutic benefit and related techniques evolved. Thus “acupuncture” refers both to the therapeutic technique and the therapeutic system of Acupuncture and Herbal Medicine (AHM). The other modalities included within AHM include a wide variety of physical and mechanical manipulations, herbal medicines, dietary recommendations, and lifestyle modifications. Clinically, acupuncture is increasingly offered in a variety of conventional medical settings such as hospitals, medical school clinics, veterans’ healthcare centers, oncology facilities, and rehabilitation centers, and its safety profile is excellent overall. Barriers to further incorporation of acupuncture into biomedical sites include insurance coverage of acupuncture, education of conventional medical practitioners and other stakeholders about the utility, efficacy, and evidence base of acupuncture. Acupuncturists in the United States are skilled practitioners who are highly educated in the complex therapeutic system from which acupuncture arose and in the technical aspects of its utility as a treatment modality. The training, certification, licensure, and regulation of acupuncturists is similar to that of conventional providers such has physician’s assistants, advanced practice nurses, and medical and osteopathic doctors. While clinical use and acceptance of acupuncture continues to grow, there is to date no definitive composite document explaining the utility of acupuncture in various healthcare settings, the current understanding of how acupuncture works, and the training, professional regulation, and certification of acupuncture practitioners. This article will address these topics and strive to create a reference for practitioners, administrators, legislators, insurance providers, patients and their families, and other stakeholders.Plain Language Summary: Acupuncture refers to the placement of thin, sterile needles into the skin to stimulate healing effects, and, in the United States, it also refers to the medical system from which the technique of acupuncture evolved. That system, Acupuncture and Herbal Medicine (AHM), uses acupuncture, dietary and lifestyle advice, herbal medicines, and other therapies to facilitate health and healing. Acupuncture is increasingly being used for a wide variety of medical problems including pain, difficulty sleeping, mental health concerns, and other issues in a wide variety of settings and is supported by a growing scientific basis for understanding why and how it works. Training and licensure of acupuncturists are similar to many conventional practitioners, and the process is accredited and overseen by various governmental and regulatory bodies. This paper aims to provide an overview of the use of acupuncture in the United States, the scientific basis for acupuncture, the training and licensure of acupuncturists, and the ways in which acupuncture is and might be incorporated into conventional medical settings.Keywords: acupuncture, herbal medicine, traditional Chinese medicine, integrative medicine, integrative health, medical policy

There is a growing interest in understanding the connection between Indigenous art, nature, and art therapy, however information on the health implications of Indian Indigenous art practices is scarce. This case study highlights the application of nature-based Indian Indigenous art form "Gond" and explores its therapeutic potential in art therapy. A workshop was organized, combining nature-based guided imagery visualization with "Gond" folktale narration, followed by "Gond"-inspired artmaking using natural pigments and repetitive patterns. Workshop participants' responses indicated that this approach fostered engagement, intense concentration, present moment awareness, a relaxed meditative state, and personal expression. Sensitively adapting Indigenous knowledge, like "Gond" practices, can promote awareness about interconnectedness with nature, artmaking, and storytelling, offering therapeutic benefits for self-care in art therapy.

Placement tests are used to support a particular need in a local context--to determine the best starting place for a student entering a specific programme of language study. This brief report will focus on the development of an innovative placement test with self-directed elements for our local needs at a university in Canada for students studying English or French as a second language. Our goals are to produce a more efficient assessment instrument while allowing students more agency through the process. We hope that sharing these details will encourage others to consider the potential of incorporating self-directed elements in low-stakes placement decision-making.

Design education in Australia is still largely dominated by Westphalian perspectives, values, histories and ways of learning. The focus on Euro-western aesthetics, technologies, timelines and processes marginalises other identities, cultures and places. This signals to students that they should internalise, value and master dominant narratives, knowledges and ways of designing. Responding to this legacy, this article details the development of an intersectional and transformative framework to guide pedagogy for design education futures. Drawing from intersectional, student-centred and transformative learning theories, we argue that students can develop self-awareness and critical evaluation skills through understanding and designing within their own histories and cultures. In applying our framework, we reflect on how we developed a communication design history curriculum that centres on previously marginalised designers and prioritises pluralistic work that comes out of diverse cosmologies, perspectives and points of view. Early results demonstrate that offering spaces for students to connect design to their own intersectional identities increases self-reflection and belonging, while engaging students to contribute new knowledges and perspectives to design history than we have had in the past. We hope this framework contributes to design education moving towards and respecting expanded ways of thinking, seeing and teaching design.

Did anyone believe one life mattered More than any other or that lives In a sketchbook held anything Beyond a few gestures caught out of time Always more by accident [...]

Abstract Objective New characterized carbohydrate-active enzymes are needed for use as tools to discriminate complex carbohydrate structural features. Fungal glycoside hydrolase family 3 (GH3) β-xylosidases have been shown to be useful for the structural elucidation of glucuronic acid (GlcA) and arabinofuranose (Araf) substituted oligoxylosides. A homolog of these GH3 fungal enzymes from the bacterium Segatella baroniae (basonym Prevotella bryantii), Xyl3C, has been previously characterized, but those studies did not address important functional specificity features. In an interest to utilize this enzyme for laboratory methods intended to discriminate the structure of the non-reducing terminus of substituted xylooligosaccharides, we have further characterized this GH3 xylosidase. Results In addition to verification of basic functional characteristics of this xylosidase we have determined its mode of action as it relates to non-reducing end xylose release from GlcA and Araf substituted oligoxylosides. Xyl3C cleaves xylose from the non-reducing terminus of β-1,4-xylan until occurrence of a penultimate substituted xylose. If this substitution is O2 linked, then Xyl3C removes the non-reducing xylose to leave the substituted xylose as the new non-reducing terminus. However, if the substitution is O3 linked, Xyl3C does not hydrolyze, thus leaving the substitution one-xylose (penultimate) from the non-reducing terminus. Hence, Xyl3C enables discrimination between O2 and O3 linked substitutions on the xylose penultimate to the non-reducing end. These findings are contrasted using a homologous enzyme also from S. baroniae, Xyl3B, which is found to yield a penultimate substituted nonreducing terminus regardless of which GlcA or Araf substitution exists.

Background Internationally, stresses related to the COVID-19 pandemic negatively affected the mental health of family caregivers of adults with intellectual and developmental disabilities (IDDs). Aims This cross-sectional study investigated demographic, situational and psychological variables associated with mental wellbeing among family caregivers of adults with IDDs during the COVID-19 pandemic. Method Baseline data from 202 family caregivers participating in virtual courses to support caregiver mental well-being were collected from October 2020 to June 2022 via online survey. Mental well-being was assessed using total scores from the Warwick-Edinburgh Mental Wellbeing Scale. Demographic, situational and psychological contributors to mental well-being were identified using hierarchical regression analysis. Results Variables associated with lower levels of mental well-being were gender (women); age (

This manuscript presents a proof-of-concept for a generalizable strategy, the full algorithm, designed to estimate disease risk using real-world clinical tabular data systems, such as electronic health records (EHR) or claims databases. By integrating classic statistical methods and modern artificial intelligence techniques, this strategy automates the production of a disease prediction model that comprehensively reflects the dynamics contained within the underlying data system. Specifically, the full algorithm parses through every facet of the data (e.g., encounters, diagnoses, procedures, medications, labs, chief complaints, flowsheets, vital signs, demographics, etc.), selects which factors to retain as predictor variables by evaluating the data empirically against statistical criteria, structures and formats the retained data into time-series, trains a neural network-based prediction model, then subsequently applies this model to current patients to generate risk estimates. A distinguishing feature of the proposed strategy is that it produces a self-adaptive prediction system, capable of evolving the prediction mechanism in response to changes within the data: as newly collected data expand/modify the dataset organically, the prediction mechanism automatically evolves to reflect these changes. Moreover, the full algorithm operates without the need for a-priori data curation and aims to harness all informative risk and protective factors within the real-world data. This stands in contrast to traditional approaches, which often rely on highly curated datasets and domain expertise to build static prediction models based solely on well-known risk factors. As a proof-of-concept, we codified the full algorithm and tasked it with estimating 12-month risk of initial stroke or myocardial infarction using our hospital's real-world EHR. A 66-month pseudo-prospective validation was conducted using records from 558,105 patients spanning April 2015 to September 2023, totalling 3,424,060 patient-months. Area under the receiver operating characteristic curve (AUROC) values ranged from .830 to .909, with an improving trend over time. Odds ratios describing model precision for patients 1-100 and 101-200 (when ranked by estimated risk) ranged from 15.3 to 48.1 and 7.2 to 45.0, respectively, with both groups showing improving trends over time. Findings suggest the feasibility of developing high-performing disease risk calculators in the proposed manner.