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Universal design for learning (UDL) is a pedagogical framework that utilizes the principles of equal access, flexibility, simplicity, perceptibility, and efficiency in the process of teaching and learning. This multi-institutional cross-sectional study examined instructional methods and designs that occupational therapy students identified to be useful or not useful for their diverse learning needs based on principles of UDL. The study also sought to determine if select methods or designs were perceived to enhance learning for those who are neurodivergent in contrast to other students. An online survey was distributed to students across four occupational therapy programs. The survey consisted of demographic questions, lists of instructional methods and designs framed by the Center for Applied Technology (CAST) domains, and two general questions about overall learning and self-efficacy. Data were analyzed using descriptive statistics and non-parametric comparison. Of the 81 participants, results indicated that nearly all perceived an instructor who is approachable, learning through real world activities, and practicing hands-on skills in the classroom to be useful for their learning. Students with neurodivergence identified six learning methods significantly less useful than not neurodivergent students including doing first with discussion to follow, being preassigned group membership by the instructor, flexible seating and classroom arrangement, and course requirements with flexible due dates. The CAST domain of engagement had the strongest impact on student preferences. This indicates that attention to engaging students and methods that draw students into the why of learning may meet all student needs in graduate occupational therapy education.

Imaging studies have implicated altered functional connectivity in adults with major depressive disorder (MDD). Whether similar dysfunction is present in adolescent patients is unclear. The degree of resting-state functional connectivity (rsFC) may reflect abnormalities within emotional (‘hot’) and cognitive control (‘cold’) neural systems. Here, we investigate rsFC of these systems in adolescent patients and changes following cognitive behavioral therapy (CBT). Functional Magnetic Resonance Imaging (fMRI) was acquired from adolescent patients before CBT, and 24-weeks later following completed therapy. Similar data were obtained from control participants. Cross-sectional Cohort: From 82 patients and 34 controls at baseline, rsFC of the amygdala, anterior cingulate cortex (ACC), and pre-frontal cortex (PFC) was calculated for comparison. Longitudinal Cohort: From 17 patients and 30 controls with longitudinal data, treatment effects were tested on rsFC. Patients demonstrated significantly greater rsFC to left amygdala, bilateral supragenual ACC, but not with PFC. Treatment effects were observed in right insula connected to left supragenual ACC, with baseline case-control differences reduced. rsFC changes were significantly correlated with changes in depression severity. Depressed adolescents exhibited heightened connectivity in regions of ‘hot’ emotional processing, known to be associated with depression, where treatment exposure exerted positive effects, without concomitant differences in areas of ‘cold’ cognition.

IntroductionThe human functional connectome is a graphical representation, consisting of nodes connected by edges, of the inter-relationships of blood oxygenation-level dependent (BOLD) time-series measured by MRI from regions encompassing the cerebral cortices and, often, the cerebellum. Semi-metric analysis of the weighted, undirected connectome distinguishes an edge as either direct (metric), such that there is no alternative path that is accumulatively stronger, or indirect (semi-metric), where one or more alternative paths exist that have greater strength than the direct edge. The sensitivity and specificity of this method of analysis is illustrated by two case-control analyses with independent, matched groups of adolescents with autism spectrum conditions (ASC) and major depressive disorder (MDD).ResultsSignificance differences in the global percentage of semi-metric edges was observed in both groups, with increases in ASC and decreases in MDD relative to controls. Furthermore, MDD was associated with regional differences in left frontal and temporal lobes, the right limbic system and cerebellum. In contrast, ASC had a broadly increased percentage of semi-metric edges with a more generalised distribution of effects and some areas of reduction. In summary, MDD was characterised by localised, large reductions in the percentage of semi-metric edges, whilst ASC is characterised by more generalised, subtle increases. These differences were corroborated in greater detail by inspection of the semi-metric backbone for each group; that is, the sub-graph of semi-metric edges present in >90% of participants, and by nodal degree differences in the semi-metric connectome.ConclusionThese encouraging results, in what we believe is the first application of semi-metric analysis to neuroimaging data, raise confidence in the methodology as potentially capable of detection and characterisation of a range of neurodevelopmental and psychiatric disorders.

Many animals are marked with conspicuous circular features often called ‘eyespots’, which intimidate predators, preventing or halting an attack. It has long been assumed that eyespots work by mimicking the eyes of larger animals, but recent experiments have indicated that conspicuousness and contrast is important in eyespot function, and not eye mimicry. We undertake two further experiments to distinguish between the conspicuousness and mimicry hypotheses, by using artificial prey presented to wild avian predators in the field. In experiment 1, we test if eyespot effectiveness depends on the marking shape (bar or circle) and arrangement (eye-like and non-eye-like positions). We find no difference between shapes or arrangement; all spots were equally effective in scaring birds. In experiment 2, we test if the often yellow and black colors of eyespots mimic the eyes of birds of prey. We find no effect of shape, and no advantage to yellow and black spots over non-eye-like but equally conspicuous colors. The consistent finding is that eyespot function lies in being a conspicuous signal to predators, and not necessarily due to eye mimicry [Current Zoology 55 (5): –2009].

In 1981 the Robert Wood Johnson Foundation provided funds to 20 teaching hospitals to support health services to high-risk adolescents (young people living in communities with high rates of pregnancy, drug abuse, alcohol abuse, accidents, homicide, suicide, and depression). The experiences of these institutions are described. (Author/MLW)

BackgroundConcussion is a common condition that can lead to a constellation of symptoms that affect quality of life, social integration, and return to work. There are several evidence-based behavioral and psychological interventions that have been found to improve postconcussion symptom burden. However, these are not routinely delivered, and individuals receive limited support during their concussion recovery. ObjectiveThis study aimed to develop and test the feasibility of a digital health intervention using a systematic evidence-, theory-, and person-based approach. MethodsThis was a mixed methodology study involving a scoping review (n=21), behavioral analysis, and logic model to inform the intervention design and content. During development, the intervention was optimized with feedback from individuals who had experienced concussions (n=12) and health care professionals (n=11). The intervention was then offered to patients presenting to the emergency department with a concussion (n=50). Participants used the intervention freely and input symptom data as part of the program. A number of outcome measures were obtained, including participant engagement with the intervention, postconcussion symptom burden, and attitudes toward the intervention. A selection of participants (n=15) took part in in-depth qualitative interviews to understand their attitudes toward the intervention and how to improve it. ResultsEngagement with the intervention functionality was 90% (45/50) for the symptom diary, 62% (31/50) for sleep time setting, 56% (28/50) for the alcohol tracker, 48% (24/50) for exercise day setting, 34% (17/50) for the thought diary, and 32% (16/50) for the goal setter. Metrics indicated high levels of early engagement that trailed off throughout the course of the intervention, with an average daily completion rate of the symptom diary of 28.23% (494/1750). A quarter of the study participants (13/50, 26%) were classified as high engagers who interacted with all the functionalities within the intervention. Quantitative and qualitative feedback indicated a high level of usability and positive perception of the intervention. Daily symptom diaries (n=494) demonstrated a wide variation in individual participant symptom burden but a decline in average burden over time. For participants with Rivermead scores on completion of HeadOn, there was a strong positive correlation (r=0.86; P

Background: The POP Trial was a phase 1, open-label, rising-dose, randomised study that explored the safety and tolerability of calmangafodipir (superoxide dismutase mimetic) co-treatment with n-acetylcysteine (NAC) for paracetamol overdose. Methods: Patients were recruited at the Royal Infirmary of Edinburgh (8th June 2017-10th May 2018). Inclusion criterion: adults within 24 h of a paracetamol overdose that required NAC. Within each of 3 sequential cohorts, participants were randomly assigned, with concealed allocation, to NAC and a single intravenous calmangafodipir dose (n = 6) or NAC alone (n = 2). Calmangafodipir doses were 2, 5, or 10 μmol/kg. Participants, study and clinical teams were not blinded. The primary outcome was safety and tolerability. Secondary outcomes were alanine transaminase (ALT), international normalised ratio (INR), keratin-18, caspase-cleaved keratin-18 (ccK18), microRNA-122, and glutamate dehydrogenase (GLDH). (Clinicaltrials.gov:NCT03177395). Findings: All 24 participants received their allocated drug doses and were analysed. Primary endpoints: all participants experienced ≥1 adverse event (AE), most commonly gastrointestinal. Patients experiencing ≥1 serious adverse event (SAE): NAC alone, 2/6; NAC + calmangafodipir (2 μmol/kg), 4/6; NAC + calmangafodipir (5 μmol/kg), 2/6; NAC + calmangafodipir (10 μmol/kg), 3/6. No AEs or SAEs were probably or definitely calmangafodipir-related. Secondary safety outcomes demonstrated no differences between groups. With NAC alone, 2/6 had ALT > 100 U/L; with NAC + calmangafodipir, 0/18. No INR difference. Keratin-18 and ccK18 increased in the NAC alone group more than with calmangafodipir (baseline to 20 h fold change, NAC + calmangafodipir (5 μmol/kg) compared to NAC alone: 0.48 (95%CI 0.28–0.83)). microRNA-122 changes were similar to K18, GLDH was frequently undetected. Interpretation: Calmangafodipir was tolerated when combined with NAC and may reduce biomarkers of paracetamol toxicity.

Low-income children and adolescents continue to bear a heavy burden of untreated pain and complications from dental disease. To explore why proposals to remediate this problem have not gained traction, the authors interviewed experts involved in efforts to improve the oral health status of low-income and minority children during the past decade. Key informants believe that success requires addressing both consumer demand and provider supply factors. They especially cite the lack of public outcry for more accessible oral health care and the undervaluing of oral health, relative to medical care. Informants were cautiously optimistic that strategies such as health literacy and outreach campaigns, which have helped increase children's physical activity and improve their diets, offer unexplored opportunities for progress. [ABSTRACT FROM AUTHOR]

Camouflage is an important strategy in animals to prevent predation. This includes disruptive coloration, where high-contrast markings placed at an animal's edge break up the true body shape. Successful disruption may also involve non-marginal markings found away from the body outline that create ‘false edges’ more salient than the true body form (‘surface disruption’). However, previous work has focused on breaking up the true body outline, not on surface disruption. Furthermore, while high contrast may enhance disruption, it is untested where on the body different contrasts should be placed for maximum effect. We used artificial prey presented to wild avian predators in the field, to determine the effectiveness of surface disruption, and of different luminance contrast placed in different prey locations. Disruptive coloration was no more effective when comprising high luminance contrast per se, but its effectiveness was dramatically increased with high-contrast markings placed away from the body outline, creating effective surface disruption. A model of avian visual edge processing showed that surface disruption does not make object detection more difficult simply by creating false edges away from the true body outline, but its effect may also be based on a different visual mechanism. Our study has implications for whether animals can combine disruptive coloration with other ‘conspicuous’ signalling strategies. [ABSTRACT FROM AUTHOR]

A vast array of child health professionals—99,000 counselors; 56,000 nurses; 30,000 school psychologists; 15,000 social workers; and smaller numbers of dental hygienists, dentists, physicians, and substance abuse counselors—provide care to children and adolescents at school. However, most thought leaders in child health know little about this ‘hidden’ system of care or are skeptical about its capacity to contribute to children's well-being. Increased interest in prevention and chronic disease management, powered by escalating concern about childhood overweight, might end the isolation of school health programs and link them more effectively to community-based prevention programs and health care services. [ABSTRACT FROM AUTHOR]