Search

Physical restraint is an emergency procedure restricting the movement of an individual and is used in events where students pose an imminent threat of physical harm to themselves or others. Students with disabilities are subjected to these procedures seven times more than typically developing students. Over the past decade, there has been substantial policy reform on the use of restraint; however, policies still vary across the country. Additionally, research on experiences of the use of and policy on restraint in school settings is incredibly limited. The current study expands the body of literature by investigating teachers' experiences, and factors associated with experiences, of restraint events and district policy utilizing a multiple-methods survey design. One hundred eighty Prekindergarten through 12th-grade teachers working in a variety of school settings across the country completed a self-report online survey. Results revealed variability in experiences of restraint events and school district policies. While most participants reported following the district policy as written, level of education significantly impacted teachers' adhering to the policy, wherein those with higher levels of education were less likely to follow the policy. Implications for policy and practice are provided.

RNA-Puzzles is a collective endeavor dedicated to the advancement and improvement of RNA three-dimensional structure prediction. With agreement from structural biologists, RNA structures are predicted by modeling groups before publication of the experimental structures. We report a large-scale set of predictions by 18 groups for 23 RNA-Puzzles: 4 RNA elements, 2 Aptamers, 4 Viral elements, 5 Ribozymes and 8 Riboswitches. We describe automatic assessment protocols for comparisons between prediction and experiment. Our analyses reveal some critical steps to be overcome to achieve good accuracy in modeling RNA structures: identification of helix-forming pairs and of non-Watson-Crick modules, correct coaxial stacking between helices and avoidance of entanglements. Three of the top four modeling groups in this round also ranked among the top four in the CASP15 contest.

BACKGROUND AND AIMS: The role of biomarker testing in the management of obstructive hypertrophic cardiomyopathy is not well defined. This pre-specified analysis of SEQUOIA-HCM (NCT05186818) sought to define the associations between clinical characteristics and baseline concentrations of N-terminal pro-B-type natriuretic peptide (NT-proBNP) and high-sensitivity cardiac troponin I (hs-cTnI), and to evaluate the effect of treatment with aficamten on biomarker concentrations. METHODS: Cardiac biomarkers were measured at baseline and serially throughout the study. Regression analyses determined predictors of baseline NT-proBNP and hs-cTnI concentrations, and evaluated whether early changes in these biomarkers relate to later changes in left ventricular outflow tract gradient (LVOT-G), other echocardiographic measures, health status, and functional capacity. RESULTS: Baseline concentration of NT-proBNP was associated with LVOT-G and measures of diastolic function, while hs-cTnI was associated with left ventricular thickness. Within 8 weeks of treatment with aficamten, NT-proBNP was reduced by 79% (95% confidence interval 76%-83%, P < .001) and hs-cTnI by 41% (95% confidence interval 32%-49%, P < .001); both biomarkers reverted to baseline after washout. Reductions in NT-proBNP and hs-cTnI by 24 weeks were strongly associated with a lowering of LVOT-G, improvement in health status, and increased peak oxygen uptake. N-Terminal pro-B-type natriuretic peptide reduction strongly correlated with the majority of improvements in exercise capacity. Furthermore, the change in NT-proBNP by Week 2 was associated with the 24-week change in key endpoints. CONCLUSIONS: N-Terminal pro-B-type natriuretic peptide and hs-cTnI concentrations are associated with key variables in obstructive hypertrophic cardiomyopathy. Serial measurement of NT-proBNP and hs-cTnI appears to reflect clinical response to aficamten therapy.

Changes to the Welsh curriculum are becoming apparent. The Williams Report culminated in recommendations for schools and initial teacher education (ITE) on the inclusion and teaching of Black Asian and Minority Ethnic histories in Wales. The subsequent Welsh Government ITE action plan was designed to ensure the pro-active recruitment of trainee teachers from Black and racially minoritised backgrounds in Wales. As a result of this legislation, a team of ITE lecturers in a school of education in a Welsh university formed a research triad and larger research collective, the idea being that we needed to decolonise our own pedagogy and curriculum delivery and re-imagine ITE within an anti-racist paradigm. It was key to reflect on our ITE provision, ensuring that our curriculum delivery reflected the ambition of the new Curriculum for Wales, which encourages practitioners to think differently on what they teach, how they teach and what they want young people to learn. Using a patchwork methodology--which included 'deep thinking and deep listening'--we examined our current ITE delivery and work that has been done thus far and looked at the gains and areas for development. It became clear that staff within our 'ITE research collective' were becoming more knowledgeable and confident in working within a racial dynamic, and consequently felt more able to impart knowledge when engaging with other ITE colleagues and students. This paper charts our ongoing journey and makes recommendations gained from our experiences.

There is a significant variability in the prevalence of psychotropic medication use among young autistic persons worldwide and this is under-studied in Australia. Apart from risperidone, approved by the Therapeutic Goods Administration to manage challenging behaviour, the appropriateness of other psychotropic medications prescribed to young autistic persons warrants scrutiny. This retrospective study aims to gain initial insight into the magnitude, types and indications of psychotropic medication use in autistic children and adolescents in Western Australia. We analysed de-identified data from 239 autistic children and adolescents ([less than or equal to] 21 years) who participated in the Western Australian Autism Biological Registry between 2011 and 2015 and who completed a questionnaire regarding medication use. One-quarter (n = 66, 28%) of young autistic people reported using a total of 137 medications. Most (n = 46, 70%) of those medicated were under 12 years of age; half (n = 33) were 6-12 years and a fifth (n = 13) were under 6 years. The most used medications were stimulants (n = 35, 53.0%), followed by antidepressants (n = 24, 36.4%), antiepileptics (n = 21, 31.8%), sedatives (n = 15, 22.7%) and antipsychotics (n = 14, 21.2%). These medications were mainly to manage attention deficit hyperactivity disorder, challenging behaviours, seizures, insomnia, undefined anxiety, depression and mood instability. While most autistic young people in the Western Australian Autism Biological Registry did not report using psychotropic medication, over a quarter were prescribed medications, primarily stimulants, to manage symptoms of attention deficit hyperactivity disorder. Various medications, including risperidone, were used to help manage challenging behaviours. Medication use should be studied more comprehensively in a larger cohort of autistic persons to confirm our current preliminary observations. Further, future studies should monitor the effectiveness and safety outcomes of such medications due to a limited understanding of their effectiveness in managing the atypical presentation of co-occurring disorders in young autistic persons.

Play in early childhood environments is critical to the social development of all children, including those with disabilities. Children with autism often experience delays in the development of play skills and may especially struggle with social play with peers. Thus, strategies to support social play in inclusive preschool settings are needed. The purpose of this article is to provide practitioners with an overview of evidence-based strategies to increase play interactions between children with autism and their peers in inclusive preschool settings. We outline the importance of play in early childhood classrooms, provide an overview of common play and social interaction challenges experienced by young children with autism, and describe and exemplify strategies to promote play between peers. We provide recommendations for collaborations between special educators and speech language pathologists working with children with autism to support children's play in inclusive environments.

Chronic demyelination and oligodendrocyte loss deprive neurons of crucial support. It is the degeneration of neurons and their connections that drives progressive disability in demyelinating disease. However, whether chronic demyelination triggers neurodegeneration and how it may do so remain unclear. We characterize two genetic mouse models of inducible demyelination, one distinguished by effective remyelination and the other by remyelination failure and chronic demyelination. While both demyelinating lines feature axonal damage, mice with blocked remyelination have elevated neuronal apoptosis and altered microglial inflammation, whereas mice with efficient remyelination do not feature neuronal apoptosis and have improved functional recovery. Remyelination incapable mice show increased activation of kinases downstream of dual leucine zipper kinase (DLK) and phosphorylation of c-Jun in neuronal nuclei. Pharmacological inhibition or genetic disruption of DLK block c-Jun phosphorylation and the apoptosis of demyelinated neurons. Together, we demonstrate that remyelination is associated with neuroprotection and identify DLK inhibition as protective strategy for chronically demyelinated neurons.

Clinical trials in metabolic dysfunction-associated steatohepatitis (MASH, formerly known as nonalcoholic steatohepatitis) require histologic scoring for assessment of inclusion criteria and endpoints. However, variability in interpretation has impacted clinical trial outcomes. We developed an artificial intelligence-based measurement (AIM) tool for scoring MASH histology (AIM-MASH). AIM-MASH predictions for MASH Clinical Research Network necroinflammation grades and fibrosis stages were reproducible (κ = 1) and aligned with expert pathologist consensus scores (κ = 0.62-0.74). The AIM-MASH versus consensus agreements were comparable to average pathologists for MASH Clinical Research Network scores (82% versus 81%) and fibrosis (97% versus 96%). Continuous scores produced by AIM-MASH for key histological features of MASH correlated with mean pathologist scores and noninvasive biomarkers and strongly predicted progression-free survival in patients with stage 3 (P

ObjectiveTo describe how young adults use electronic cigarettes (electronic nicotine delivery systems (ENDS)) for smoking cessation and reasons why they may or may not successfully quit smoking.MethodsLongitudinal qualitative data were collected annually from 2017 to 2019 for 25 young adult tobacco users (aged 18-29 years) in California (USA) who used ENDS to quit/reduce smoking. Thematic and trajectory analyses were used to identify key within-person and between-person changes in tobacco/nicotine use over time.ResultsFive types of tobacco use transition were identified among baseline dual users of cigarettes and ENDS: sustained dual use without reduced smoking (n=8), transition to exclusive daily ENDS use (n=6), sustained dual use with reduced smoking (n=5), transition back to exclusive smoking (n=4) and transition to neither smoking nor vaping (n=2). Participants' ENDS use behaviour varied over time in terms of vaping quantity and device characteristics (eg, changing nicotine concentrations/flavours, switching between multiple devices). Three themes that related to successfully replacing cigarettes with ENDS were perceived positive physical effects, perceived satisfaction and enjoyment and context changes. Four themes for unsuccessful replacement were perceived negative physical discomforts, perceived addictiveness and harm, unsatisfactory substitution for cigarettes and device malfunction.ConclusionsYoung adults' experiences with using ENDS as a smoking cessation aid were highly variable. Adequate nicotine delivery and perceived safety and benefits contributed to successfully reducing or quitting cigarettes. Providing behavioural counselling and standardising ENDS products may enhance cessation for young adults.

The performance of superconducting qubits is degraded by a poorly characterized set of energy sources breaking the Cooper pairs responsible for superconductivity, creating a condition often called quasiparticle poisoning. Both superconducting qubits and low threshold dark matter calorimeters have observed excess bursts of quasiparticles or phonons that decrease in rate with time. Here, we show that a silicon crystal glued to its holder exhibits a rate of low-energy phonon events that is more than two orders of magnitude larger than in a functionally identical crystal suspended from its holder in a low-stress state. The excess phonon event rate in the glued crystal decreases with time since cooldown, consistent with a source of phonon bursts which contributes to quasiparticle poisoning in quantum circuits and the low-energy events observed in cryogenic calorimeters. We argue that relaxation of thermally induced stress between the glue and crystal is the source of these events.

Introduction: When used appropriately, focused limited-scope ultrasound exams could potentially provide paramedics with accurate and actionable diagnostic information to guide prehospital decision-making. In this study we aimed to investigate the impact of a 13-hour prehospital ultrasound training course on the simulated clinical decision-making of paramedics as well as their ultrasound skills, knowledge, and self-confidence.Methods: We evaluated the ultrasound competence of 31 participants using post-course written and practical assessments. Written clinical decision scenarios were administered pre- and post-training. Post-training scenarios included an uninterpreted ultrasound clip to aid decision-making. Scenarios included extended focused assessment with sonography in trauma, pulmonary exam, and focused echocardiography combined with carotid pulse check exams. Correct answers to scenarios were defined as those selected by a veteran emergency physician. Participants also indicated their confidence in each of their decisions using a Likert scale.Results: Training yielded a statistically significant increase in both mean scenario score (35.5%absolute increase) and mean participant self-confidence (15.8% relative increase), across all exam/decision types assessed (P ≤ 0.001). The focused pulmonary exam yielded the largest increase in both mean score improvement (59.7% absolute increase) and paramedic confidence in their decisions (28.6% increase).Conclusion: Trained paramedics can perform focused ultrasound exams and accurately interpret and apply actionable exam findings in the context of written scenarios. Analysis through our model characterized the theoretical clinical yield of each prehospital ultrasound exam and demonstrated how each exam may provide improved decision accuracy in several specific simulated clinical contexts. These results provide support for growing evidence that focused limited-scope ultrasound may be an effective prehospital diagnostic tool in the hands of trained paramedics.

Prenatal per- and poly-fluoroalkyl substances (PFAS) exposure may influence gestational outcomes through bioactive lipids─metabolic and inflammation pathway indicators. We estimated associations between prenatal PFAS exposure and bioactive lipids, measuring 12 serum PFAS and 50 plasma bioactive lipids in 414 pregnant women (median 17.4 weeks' gestation) from three Environmental influences on Child Health Outcomes Program cohorts. Pairwise association estimates across cohorts were obtained through linear mixed models and meta-analysis, adjusting the former for false discovery rates. Associations between the PFAS mixture and bioactive lipids were estimated using quantile g-computation. Pairwise analyses revealed bioactive lipid levels associated with PFDeA, PFNA, PFOA, and PFUdA (p < 0.05) across three enzymatic pathways (cyclooxygenase, cytochrome p450, lipoxygenase) in at least one combined cohort analysis, and PFOA and PFUdA (q < 0.2) in one linear mixed model. The strongest signature revealed doubling in PFOA corresponding with PGD2 (cyclooxygenase pathway; +24.3%, 95% CI: 7.3-43.9%) in the combined cohort. Mixture analysis revealed nine positive associations across all pathways with the PFAS mixture, the strongest signature indicating a quartile increase in the PFAS mixture associated with PGD2 (+34%, 95% CI: 8-66%), primarily driven by PFOS. Bioactive lipids emerged as prenatal PFAS exposure biomarkers, deepening insights into PFAS' influence on pregnancy outcomes.

Chronic graft-versus-host-disease (cGVHD) is divided into two subtypes: classic (absence of acute GVHD features) and overlap cGVHD (ocGVHD), in which both chronic and acute GVHD clinical features are present simultaneously. While worse outcomes with ocGVHD have been reported, there are few recent analyses. We performed a secondary analysis of data from the ABA2 trial (N = 185), in which detailed GVHD data were collected prospectively and systematically adjudicated. Analyses included cumulative incidence of classic versus ocGVHD, their specific organ manifestations, global disease severity scores, non-relapse mortality (NRM), disease-free survival (DFS) and overall survival (OS) in these two cGVHD subtypes. Of 92 patients who developed cGVHD, 35 were classified as ocGVHD. The 1-year cumulative incidence, organ involvement, and global severity of classic and ocGVHD were similar between ABA2 patients receiving CNI/MTX+placebo and CNI/MTX+abatacept; thus, cohorts were combined for ocGVHD evaluation. This analysis identified ocGVHD as having significantly higher severity at presentation and at maximum global severity compared to classic cGVHD. OS and DFS were significantly lower for ocGVHD versus classic cGVHD. OcGVHD is associated with increased cGVHD severity scores, and is associated with decreased OS and DFS compared to classic cGVHD, underscoring the high risks with this cGVHD subtype.

Hypertension affects more than one billion people worldwide. Here we identify 113 novel loci, reporting a total of 2,103 independent genetic signals (P

Educational escape rooms (ER) are an instructional activity designed to incorporate many elements of recreational ERs, which have become popular in recent years. There are many reasons to consider incorporating educational ERs into K-12 math instruction or after-school programs/camps. First, they are highly motivating for students because they engage them in game-like elements, including solving puzzles (Stohlmann, 2020). Second, education ERs foster teamwork and communication and encourage productive struggle (Borrego et al., 2017; Fotaris & Mastoras, 2019). Third, educational ERs can help students explore mathematical concepts in a fun way; however, it is important to ensure that ER puzzles are aligned with relevant learning goals and content standards (National Council of Teachers of Mathematics, 2014). Based on the literature, the main obstacles to incorporating ERs into instruction seem to be that teachers view educational ERs as too complicated, costly, and time-consuming to develop. Thus, the purpose of this article is to provide a step-by-step process teachers can follow to efficiently design high-quality educational ERs without breaking the bank. The authors use their elementary-level Treasure Hunt example to illustrate our ER design process, but this process can be applied across all grades and involve a variety of context.

This systematic review and meta-analysis examined interventions targeting play skills of children with autism spectrum disorder (ASD) involving typically developing (TD) peers. The objectives of this work are to (a) identify and describe the characteristics and components of interventions aimed at improving play skills in children with ASD and their TD peers, (b) examine the role of peers in interventions, (c) evaluate intervention effects, and (d) identify potential moderating variables that may influence intervention outcomes. Twenty single-case experimental design (SCED) studies published between 2000 and 2020 were included and summarized. The majority of interventions produced significant effects, further supporting the inclusion of TD peers in interventions targeting play skills for children with ASD. Recommendations for future research and practice are discussed.

The rise in opioid misuse coincides with increased sexually transmitted infection (STI) and HIV incidence. Transactional sex is an under-researched phenomenon among Black Americans who misuse opioids, and may increase their risk of STI or HIV transmission. Given the disproportionate impact of the opioid epidemic on Black Americans and the risks associated with opioid misuse, the current study aims to investigate sociostructural factors, history of violence, and sexual risk factors associated with transactional sex among Black men and women. A sample of n = 375 Black adult Kentuckians reporting opioid misuse completed a survey including transactional sex, sociostructural, violence history, and sexual risk measures. Results of chi-squares and independent samples t-tests revealed that compared to men who did not report engaging in transactional sex, men who engaged in transactional sex were less educated, reported being sexually assaulted or having an unwanted sexual experience in their lifetime, and were more likely to use opioids or cocaine before or during sex in the last year. Women who engaged in transactional sex had a history of violence, more structural barriers, higher psychological distress, and engaged in more sexual risk behaviors compared to women who did not engage in transactional sex. Implications for future research and interventions with this population are discussed.

Families of children with developmental disabilities in rural and underserved areas may lack access to direct service providers. Global pandemics such as COVID-19 have further affected access to service providers for most children, often shifting services online and increasing the role of technology and involvement of parents and caregivers in intervention. Thus, there is a need to examine the characteristics and effects of caregiver implemented technology-based interventions for children with developmental disabilities. The present synthesis evaluates the research on caregiver implemented technology-based interventions for children with autism spectrum disorder and other developmental disabilities aged 21 or younger. A systematic search of four electronic databases resulted in 14 single-case design studies which encompassed 58 participants with a developmental disability, along with 62 caregivers. Studies used a variety of technologies and involved strategies such as computer assisted instruction, self-management, and variations of video modeling. Interventions targeted a variety of outcomes and most incorporated behavioral strategies such as prompting or positive reinforcement. Results indicate positive outcomes without overly time intensive parent training; however, it is important to consider these findings within context of methodological strength, as only four included studies utilized strong experimental methods according to the evaluative framework provided by Reichow et al. (2008). Implications for practice and recommendations for future research are provided.

Preservice secondary science teachers often experience science learning in narrow and marginalizing ways in their science preparation. These experiences cause harm, particularly for preservice teachers of color. They also limit the disciplinary resources they can develop for later teaching science in ways that value and sustain their students' ways of knowing and being in the world. Our research explores possibilities for cultivating new spaces for preservice secondary science teachers to engage in science. In a content-focused education course, we designed for and studied preservice teachers' engagement in expansive and connective sensemaking, incorporating heterogeneity, power, and historicity in pursuits of explanatory accounts of the natural world. In this article, we examined how this course design can support preservice teachers to attune to heterogeneity in ways of knowing in science and to connect to identity and historicity in scientific sensemaking. Our analysis suggests that students' final projects reflected attunements to diverse knowing, communicating, and relating in science and deep connections with their identities and future-making, yet had fewer connections to sociohistorical narratives and structures. We developed illustrative case studies of four student projects, highlighting the personal, social, and political possibilities of creating space for future educators to imagine more expansive and connective forms of science. This study contributes a novel model for preservice science teacher education to support teacher learning to value and sustain their students' ways of knowing and being in the world.