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BackgroundPlay Kindly is a gamified animated app designed to address common behavioral problems in childhood. The interface is designed to appeal to Pacific people, a population group with a higher risk of developing clinically significant behavioral problems than most other ethnic groups in New Zealand. ObjectiveThe aim of this study is to explore the opinions of parents and professionals about the acceptability, usability, and content of Play Kindly. MethodsWe used qualitative and Pacific and Māori research methodologies. A total of five focus groups with 45 parents and 12 individual interviews with professionals were conducted. The five focus groups consisted of 2 pan-Pacific groups, 1 Māori group, 1 open group, and 1 group of young Pacific adults or prospective parents. The professionals were from a range of disciplines, and the majority had expertise in early childhood, parenting interventions, or research in this field. ResultsPlay Kindly appealed to both parents and professionals. Participants related to the scenarios, which were created in collaboration with a playwright and animator. Although most participants liked the Pacific feel, there was some disagreement about how culturally specific the app should be. A range of issues with usability and gamification techniques were highlighted, likely attributed to the low budget and lack of initial co-design with parents as well as professionals with specific expertise in parenting. A number of parents and professionals felt that the parenting strategies were overly simplified and did not take into account the context in which the behavior occurred. Professionals suggested narrowing the focus of the app to deliver two important parenting messages: playing with your child and positively reinforcing desired behaviors. ConclusionsPlay Kindly is the first culturally adapted parenting app of its kind designed for Pacific parents and other New Zealanders with children 2-5 years of age. This app has potential in Pacific communities where there are limited culturally specific parenting resources. The results of this study will guide improvements of the app prior to testing it in an open trial.

In this paper we describe the development of an online tool for assessing the foundational knowledge and competencies essential to understanding money and building financial literacy. We present findings from an initial study using the tool to (i) measure basic skills with money among secondary students with intellectual disability (N = 85) and (ii) test predictions regarding item difficulty. Item difficulty was explained using a system of 36 levels of complexity based on task type and variations in the number and combination of denominations presented. Implications of the results are discussed in terms of how sensitive assessments can inform practitioners about how they might adapt tasks to differentiate their teaching.

There has been considerable research into how children solve single-digit addition problems for more than a century now, which has brought about significant changes to the ways teachers' support children to retrieve single-digit addition facts. In this project, we examine what makes an addition problem difficult to retrieve in light of contemporary teaching approaches, based on both student performance and teacher perceptions. Australian primary school students in Years 3 and 4 (n = 166) solved 36 single-digit addition problems under two different conditions during a structured interview. These data were then used to create the Difficulty Retrieving Addition Facts (DRAF) measure, which we propose as a contemporary measure of single-digit addition problem difficulty to supersede older measures developed in a different era of instruction. We then invited Australian primary school teachers (n = 49) to complete a questionnaire asking them to estimate the percentage of students who would be able to rapidly retrieve these same 36 single-digit addition problems to facilitate comparison between student performance and teacher perceptions. We found that although teachers were generally accurate in discerning which addition problems students would find relatively easy to retrieve and which they would find more difficult, they tended to overestimate student capacity to retrieve addition facts in general, particularly when the addition fact was comparatively difficult. We suggest that this overestimation resulted from teacher responses being shaped by curriculum expectations, which states that students should be able to recall single-digit addition facts by the end of Year 3.

BackgroundSince 2014, the USA has documented three outbreaks of acute flaccid myelitis (AFM). Unique features and treatment responses of this myelitis variant have not been prospectively studied. This study prospectively measured outcomes in paediatric myelitis patients relative to treatments.MethodsThis was a prospective, multicentre, non-randomised, observational cohort study. The study duration was 5 years and the length of follow-up was 1 year. This study collected data from children and families in North America. Patients were enrolled at academic centres with expertise in myelitis or online via a web portal. Paediatric patients diagnosed with myelitis were eligible for enrolment in the study within 6 months of onset of symptoms. Patients were characterised as transverse myelitis (TM) or the AFM variant based on clinical and radiographic findings.ResultsThe cohort of 90 patients included patients with AFM and TM. Of the 51 patients with AFM there was evidence of two clinically relevant patterns. This included a grey matter restricted form of AFM and a cohort with concomitant white matter that could explain lower extremity motor deficits in patients with lesions restricted to the cervical spine. The improvement in deficits with the use of corticosteroids was similar to what was observed in the TM cohort (p=0.97).ConclusionsClinicians should consider on a case by case basis the approach to therapy for AFM patients. Prospective controlled studies of long-term outcomes would be useful in this growing patient population.

There is a growing awareness that many children are not developing fast and accurate retrieval-based strategies for solving single-digit addition problems. In this study we individually assessed 166 third and fourth grade children to identify a group of children (called accurate-min-counters) who frequently solved simple single-digit addition problems using a min-counting strategy and were accurate using it. We investigated if these children were adaptive when it came to using retrieval for simple addition and if they were disadvantaged when it came to demonstrating mental computational flexibility with multi-digit addition. We found accurate-min-counters represented over 30% of participants. These children were often incorrect when they were required to use retrieval for simple addition and were less flexible than most peers with mental computation strategies. The findings indicate that educators should be concerned about the prevalence of accurate-min-counting and call into question the widely held view that it is mostly children with a mathematics learning disability (or persistent low achievement) who display the protracted use of counting-based strategies for simple addition. Further research is needed to investigate if, and how, current teaching approaches are encouraging children to rely on counting beyond a time when it is advantageous to do so.

Acute flaccid myelitis (AFM) is a disabling, polio-like illness mainly affecting children. Outbreaks of AFM have occurred across multiple global regions since 2012, and the disease appears to be caused by non-polio enterovirus infection, posing a major public health challenge. The clinical presentation of flaccid and often profound muscle weakness (which can invoke respiratory failure and other critical complications) can mimic several other acute neurological illnesses. There is no single sensitive and specific test for AFM, and the diagnosis relies on identification of several important clinical, neuroimaging, and cerebrospinal fluid characteristics. Following the acute phase of AFM, patients typically have substantial residual disability and unique long-term rehabilitation needs. In this Review we describe the epidemiology, clinical features, course, and outcomes of AFM to help to guide diagnosis, management, and rehabilitation. Future research directions include further studies evaluating host and pathogen factors, including investigations into genetic, viral, and immunological features of affected patients, host-virus interactions, and investigations of targeted therapeutic approaches to improve the long-term outcomes in this population.

Despite reforms in mathematics education, many teachers remain reluctant to incorporate challenging (i.e., more cognitively demanding) tasks into their mathematics instruction. The current study examines how lesson structure shapes teacher perceptions of teaching with challenging tasks. Participants included three Year 1/2 classroom teachers who observed the researcher (first author) deliver two units of mathematical work. Teacher-participants were given an opportunity to observe the use of challenging tasks to both launch lessons (Task-First Approach) and extend student thinking (Teach-First Approach). It was revealed that teacher-participants perceived both the Task-First Approach and the Teach-First Approach to teaching with challenging tasks to have particular strengths. Specifically, the Task-First Approach was viewed as engaging and empowering for students, providing an opportunity to build student persistence whilst fostering student mathematical creativity. Teachers also placed value on the quality of the mathematical discussion which emerged, and the value of the Task-First Approach for supporting an authentic assessment of student mathematical knowledge. By contrast, the Teach-First Approach was viewed as highly focussed, and an efficient approach to learning. It was also perceived as providing an opportunity for lower-achieving and less confident students to be successful. Although there appear to be distinct advantages to both the Task-First and Teach-First Approaches, the study revealed that the most dramatic shift in teaching practice for some teachers may be the incorporation of more cognitively demanding tasks into their mathematics instruction in any capacity.

In this study, we investigate a program designed for young adults with intellectual disability to learn how to calculate the value of a collection of coins and notes with procedural fluency. In the first half of the paper, we establish the importance of financial literacy for people with intellectual disability and the need to address mathematical foundations using approaches that build procedural fluency. In the second half of the paper, we present findings from an analysis of pre-service teachers' weekly reflections after having just tutored a student in the program. Using educational design research, we articulate how students build procedural fluency and what supports this type of learning. This paper will be of interest to researchers and practitioners alike who are looking to apply the latest findings on effective pedagogies to the field of inclusive education.

OBJECTIVE: To determine the safety, tolerability, and efficacy of fluoxetine for proven or presumptive enterovirus (EV) D68-associated acute flaccid myelitis (AFM). METHODS: A multicenter cohort study of US patients with AFM in 2015-2016 compared serious adverse events (SAEs), adverse effects, and outcomes between fluoxetine-treated patients and untreated controls. Fluoxetine was administered at the discretion of treating providers with data gathered retrospectively. The primary outcome was change in summative limb strength score (SLSS; sum of Medical Research Council strength in all 4 limbs, ranging from 20 [normal strength] to 0 [complete quadriparesis]) between initial examination and latest follow-up, with increased SLSS reflecting improvement and decreased SLSS reflecting worsened strength. RESULTS: Fifty-six patients with AFM from 12 centers met study criteria. Among 30 patients exposed to fluoxetine, no SAEs were reported and adverse effect rates were similar to unexposed patients (47% vs 65%, p = 0.16). The 28 patients treated with >1 dose of fluoxetine were more likely to have EV-D68 identified (57.1% vs 14.3%, p < 0.001). Their SLSS was similar at initial examination (mean SLSS 12.9 vs 14.3, p = 0.31) but lower at nadir (mean SLSS 9.25 vs 12.82, p = 0.02) and latest follow-up (mean SLSS 12.5 vs 16.4, p = 0.005) compared with the 28 patients receiving 1 (n = 2) or no (n = 26) doses. In propensity-adjusted analysis, SLSS from initial examination to latest follow-up decreased by 0.2 (95% confidence interval [CI] -1.8 to +1.4) in fluoxetine-treated patients and increased by 2.5 (95% CI +0.7 to +4.4) in untreated patients (p = 0.015). CONCLUSION: Fluoxetine was well-tolerated. Fluoxetine was preferentially given to patients with AFM with EV-D68 identified and more severe paralysis at nadir, who ultimately had poorer long-term outcomes. CLASSIFICATION OF EVIDENCE: This study provides Class IV evidence that for patients with EV-D68-associated AFM, fluoxetine is well-tolerated and not associated with improved neurologic outcomes.

In Australia, student under-participation and disengagement in secondary mathematics classes are persistent problems. Academic help seeking is a unique self-regulated behaviour that is important for engagement in mathematics classes and yet many students avoid seeking help from teachers and peers as they progress through secondary school. The aim of this study was to explore the relationship between students' perceptions of the social climate of their classrooms and their avoidance of help seeking in secondary mathematics classes. Students' perceptions of classroom social climate, along with perceptions of their own academic and social self-efficacy, self-theories of intelligence, and help-seeking goals and intentions, were assessed for a sample of 551 Australian students in 47 classes from eight secondary schools and two vocational institutes. The measurement model for social climate was reduced to four factors (Task Orientation, Teacher Support, Cooperation and Investigation) and a mediated structural equation model, informed by theory and previous empirical studies, was assessed using Mplus. Bootstrap confidence intervals were used to assess the direct and indirect effects of social climate on help-seeking avoidance. Findings indicated that Task Orientation and Cooperation had a negative effect on help-seeking avoidance, while Investigation had a positive effect. Teacher Support was not associated with help-seeking avoidance. Implications for practice are discussed.

ObjectivePathogenic SLC6A1 variants were recently described in patients with myoclonic atonic epilepsy (MAE) and intellectual disability (ID). We set out to define the phenotypic spectrum in a larger cohort of SCL6A1-mutated patients.MethodsWe collected 24 SLC6A1 probands and 6 affected family members. Four previously published cases were included for further electroclinical description. In total, we reviewed the electroclinical data of 34 subjects.ResultsCognitive development was impaired in 33/34 (97%) subjects; 28/34 had mild to moderate ID, with language impairment being the most common feature. Epilepsy was diagnosed in 31/34 cases with mean onset at 3.7 years. Cognitive assessment before epilepsy onset was available in 24/31 subjects and was normal in 25% (6/24), and consistent with mild ID in 46% (11/24) or moderate ID in 17% (4/24). Two patients had speech delay only, and 1 had severe ID. After epilepsy onset, cognition deteriorated in 46% (11/24) of cases. The most common seizure types were absence, myoclonic, and atonic seizures. Sixteen cases fulfilled the diagnostic criteria for MAE. Seven further patients had different forms of generalized epilepsy and 2 had focal epilepsy. Twenty of 31 patients became seizure-free, with valproic acid being the most effective drug. There was no clear-cut correlation between seizure control and cognitive outcome. Electroencephalography (EEG) findings were available in 27/31 patients showing irregular bursts of diffuse 2.5-3.5 Hz spikes/polyspikes-and-slow waves in 25/31. Two patients developed an EEG pattern resembling electrical status epilepticus during sleep. Ataxia was observed in 7/34 cases. We describe 7 truncating and 18 missense variants, including 4 recurrent variants (Gly232Val, Ala288Val, Val342Met, and Gly362Arg).SignificanceMost patients carrying pathogenic SLC6A1 variants have an MAE phenotype with language delay and mild/moderate ID before epilepsy onset. However, ID alone or associated with focal epilepsy can also be observed.

Research suggests that teachers of mathematics are frequently reluctant to pose challenging tasks to students. Reasons for this reluctance include fears of negative student reactions, time and resource constraints, and a lack of relevant teacher content knowledge. The current study involved interviewing three early primary-grade (elementary) teachers to explore their perceptions of teaching with challenging tasks, following their observations of 2 units of mathematical work taught by the first author. Contrary to some other studies where classroom teachers were themselves observed teaching with such tasks and asked to reflect on the experience, we found that teacher-participants perceived that students responded positively to the 2 units of work. Specifically, teacher-participants described their students as autonomous, persistent and highly engaged. These positive student reactions were attributed to a variety of factors, including a classroom culture that embraced struggle, high teacher expectations, and consistent classroom routines. Despite these positive reflections, teacher-participants differed in their views of whether challenging tasks are a suitable means of differentiating instruction, with such evaluations apparently linked to how they defined student success.

Engaging students in a challenging (cognitively demanding) task and launching a mathematics lesson with a task before instruction are two characteristics of a reform-oriented approach to mathematics instruction often considered together. The authors systematically contrasted teaching with challenging tasks using a task-first lesson structure with that of a discussion-first lesson structure to three composite classes of first- and second-grade students (n = 73). Subsequent assessments of mathematical performance revealed that the discussion-first lesson structure was somewhat more efficacious in improving fluency performance but both structures similarly improved problem-solving performance. The findings suggest there is more than one way of incorporating challenging tasks into mathematics lessons to produce sizeable learning gains.

Objective:The current study longitudinally examines college student Twitter patterns throughout initial phases of the COVID-19 pandemic. This study aims to better understand psychological impact and online personal communication during the pandemic. Participants:A dataset consisting of ∼720,000 tweets posted by students from universities throughout the United States during the 2020 spring semester was analyzed according to structural and sentimental analysis. Methods:Using a data-driven approach, three time periods emerged which reflected the transition to online learning. Results:Significant changes in structure and sentiment of tweets were observed across phases. Conclusions:Changes in Twitter patterns revealed important features of this unprecedented transition to online learning for college students. [ABSTRACT FROM AUTHOR]