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BACKGROUND: Sodium–glucose co-transporter 2 inhibitors (SGLT2i) have emerged as a paramount treatment for patients with heart failure (HF), irrespective of underlying reduced or preserved ejection fraction. However, a definite cardiac mechanism of action remains elusive. Derangements in myocardial energy metabolism are detectable in all HF phenotypes, and it was proposed that SGLT2i may improve energy production. The authors aimed to investigate whether treatment with empagliflozin leads to changes in myocardial energetics, serum metabolomics, and cardiorespiratory fitness. METHODS: EMPA-VISION is a prospective, randomized, double-blind, placebo-controlled, mechanistic trial that enrolled 72 symptomatic patients with chronic HF with reduced ejection fraction (HFrEF; n=36; left ventricular ejection fraction ≤40%; New York Heart Association class ≥II; NT-proBNP [N-terminal pro-B-type natriuretic peptide] ≥125 pg/mL) and HF with preserved ejection fraction (HFpEF; n=36; left ventricular ejection fraction ≥50%; New York Heart Association class ≥II; NT-proBNP ≥125 pg/mL). Patients were stratified into respective cohorts (HFrEF versus HFpEF) and randomly assigned to empagliflozin (10 mg; n=35: 17 HFrEF and 18 HFpEF) or placebo (n=37: 19 HFrEF and 18 HFpEF) once daily for 12 weeks. The primary end point was a change in the cardiac phosphocreatine:ATP ratio (PCr:ATP) from baseline to week 12, determined by phosphorus magnetic resonance spectroscopy at rest and during peak dobutamine stress (65% of age-maximum heart rate). Mass spectrometry on a targeted set of 19 metabolites was performed at baseline and after treatment. Other exploratory end points were investigated. RESULTS: Empagliflozin treatment did not change cardiac energetics (ie, PCr:ATP) at rest in HFrEF (adjusted mean treatment difference [empagliflozin – placebo], –0.25 [95% CI, –0.58 to 0.09]; P =0.14) or HFpEF (adjusted mean treatment difference, –0.16 [95% CI, –0.60 to 0.29]; P =0.47]. Likewise, there were no changes in PCr:ATP during dobutamine stress in HFrEF (adjusted mean treatment difference, –0.13 [95% CI, –0.35 to 0.09]; P =0.23) or HFpEF (adjusted mean treatment difference, –0.22 [95% CI, –0.66 to 0.23]; P =0.32). No changes in serum metabolomics or levels of circulating ketone bodies were observed. CONCLUSIONS: In patients with either HFrEF or HFpEF, treatment with 10 mg of empagliflozin once daily for 12 weeks did not improve cardiac energetics or change circulating serum metabolites associated with energy metabolism when compared with placebo. Based on our results, it is unlikely that enhancing cardiac energy metabolism mediates the beneficial effects of SGLT2i in HF. REGISTRATION: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT03332212.

In this article, we highlight Bronfenbrenner’s bioecological approach to explore identity formation and the impact of dynamic interactions between the student and their environment in the development of self-concept, self-esteem, and self-efficacy. We examine the complex interactions between student identity and the systems of support that are meant to help students achieve academic success; looking specifically at how the intersections between race, ethnicity, learning exceptionalities, and socioeconomic standing affect students who are identified as gifted and as emotionally/behaviorally challenged. Our call to rethink the services offered to students in special and gifted education leads to a proposed culturally responsive and enhanced multi-tiered system of supports (CR-MTSS). We believe the CR-MTSS approach can better address the strength of students with or a risk for developing emotional and behavioral challenges, supporting each student’s success.

Structured abstractObjectivesWe aimed to design and produce a low-cost, ergonomic, hood-integrated Powered Air-Purifying Respirator (Bubble-PAPR) for pandemic healthcare use, offering optimal and equitable protection to all staff. We hypothesised that participants would rate Bubble-PAPR more highly than current FFP3 face mask respiratory protective equipment (RPE).DesignRapid design and evaluation cycles occurred based on the identified user needs. We conducted diary card and focus group exercises to identify relevant tasks requiring RPE. Lab-based safety standards established against British Standard BS-EN-12941 and EU2016/425. Questionnaire-based usability data from participating frontline healthcare staff before (usual RPE) and after using Bubble-PAPR.SettingOverseen by a trial safety committee, evaluation progressed sequentially through laboratory, simulated, low-risk, then high-risk clinical environments of a single tertiary NHS hospital.Participants15 staff completed diary cards and focus groups. 91 staff from a range of clinical and non-clinical roles completed the study, wearing Bubble-PAPR for a median of 45 minutes (IQR 30-80 [15-120]). Participants self-reported a range of heights (mean 1.7m [SD 0.1, range 1.5-2.0]), weights (72.4kg [16.0, 47-127]) and body mass indices (25.3 [4.7,16.7-42.9]).Outcome measuresPrimary: “How comfortable do you feel in your PPE?” (Likert scale bounded by 1 [very uncomfortable] to 7 [very comfortable]). Secondary outcomes: perceived safety, communication, anxiety, discomfort, and performance.ResultsBubble-PAPR mean comfort score was 5.64(SD 1.55) versus usual FFP3 2.96(1.44) (mean difference 2.68 (95% CI 2.23-3.14, pConclusionsBubble-PAPR achieved its primary purpose of keeping staff safe from airborne particulate material whilst improving comfort and the user experience. The design and development of Bubble-PAPR were conducted using a careful evaluation strategy addressing key regulatory and safety steps, in contrast to many devices rapidly developed and deployed during the pandemic.Trial registrationIRAS ID:288493, REC Ref:21/WA/0018. ClinicalTrials.gov (NCT04681365).Strengths and limitations of this studyWe employed user-centred design, engineering optimisation and staged feasibility testing to develop a novel Powered Air-Purifying Respirator (Bubble-PAPR) for use specifically in frontline healthcare settings.Diverse, frontline healthcare staff compared Bubble-PAPR with usual FFP3 face masks.The design and development of Bubble-PAPR were conducted using a careful strategy addressing key regulatory and safety steps, in contrast to many devices rapidly developed and deployed during the pandemic.Bubble-PAPR is an excellent example of developing a cosmopolitan network that could become a key feature of future system resilience.

The following is a list of websites that have resources for implementing Response to Intervention.

The Response to Intervention (RtI) model is sweeping the country, changing the way children’s educational needs are recognized and met. The standard protocol model requires the use of scientifically based classroom instruction for all students using the same curriculum, the same program, and/or the same management strategies; regular administration of curriculum-based assessments; and frequent comparisons of students to expect or normal growth. The problem-solving approach relies on a system of increasingly intensive interventions that are planned and implemented by school personnel to provide an effective program for a particular student. The tiered approach within RtI extends this thinking to the supports and services provided. To implement RtI with gifted students, universal screening needs to include all students who are achieving at a high level. The Higher Education Opportunity Act requires all teacher preparation programs to contain information about teaching gifted learners.

Every student comes to us as a unique individual with a set of strengths, interests, quirks, and challenges. Teachers do not get to select who their students are, but as educators, people do have the profound responsibility of helping each student become, as fully as possible, the best that he or she can be. Science is ideal because it has rich content that is of high interest to children, stimulating their natural curiosity and problem solving. The importance of family and school partnerships to support the success of the child has been well documented. The importance of family and school partnerships to support the success of the child has been well documented. Response to Intervention (RtI) uses a tiered approach to arrange supports and services. Tiered services scaffold support as needed to meet the increasing intensity or complexity of student needs. The tiered supports and services are activated, as needed, to help students meet with success in school.

Diversity and Developing Gifts and Talents: A National Call to Action (The Association for the Gifted [TAG], 2009) calls on educators to address issues of race, culture, ethnicity, language, class, gender, and sexual orientation as they work to provide equity and excellence for all students. This call to action, setting diversity as a key agenda for the field of gifted education, is critical to ensure that all children have access to the highest quality learning opportunities to nurture and respond to their potential (Baldwin, 2007; Ford, 2007; Hertzog, 2005). In spite of years of awareness of the disproportionately low representation of children of cultural and ethnic diversity and poverty receiving gifted education services, this underrepresentation continues in many schools (Ford & Grantham, 2003; Henfield, Washington, & Owens, 2010; National Research Council, 2002). Children who do not have access to these services are educationally vulnerable and will struggle to reach their potential (Coleman & Shah-Coltrane, 2010a). Gaining access to high-quality, challenging, and enriching learning environments depends on the school the student attended, which is largely dependent on where the student 44lives. In other words, address drives access (Coleman, Shah-Coltrane, Harradine, & Timmons, 2007).

Gifted education today faces a significant challenge in reaching equity as well as excellence. This is reflected in the disproportionate underrepresentation of children from Black, Hispanic, Native, and low-income families. This pattern of underrepresentation within programs for students with gifts and talents is pervasive and pernicious and impacts gifted education programming across all 50 states in the United States of America. This article describes the efforts of Milwaukee Public Schools, a large urban school district in Wisconsin, to address the need for both equity and excellence within their gifted education programming. The U~STRARS~PLUS model formed the foundation for changing the culture of the schools from “at risk” to “at potential”. Dedicated leadership and the combination of securing external support, developing internal trust, and building capacity across the district were critical to creating a strength-based focus within the schools. While the journey is not over, the authors hope that others can learn from Milwaukee’s experiences.

Hands-on science is the ideal platform for observing young children's ability to solve problems, think deeply, and use their creative ingenuity to explore the world around them. Science is naturally interesting and offers authentic reasons to read for information and use math skills to collect, compile, and analyze data. This chapter will share one approach to nurturing and recognizing young children with high-potential: U-STARS∼PLUS (Using Science, Talents, and Abilities to Recognize Students∼Promoting Learning for Underrepresented Students). Each of the five components (high-end learning environments; teacher's observations of potential; engaging science activities; partnerships with parents; and capacity building for system change) will be explained. Concrete examples will be given for each area showing how it works and why it is important. Special attention will be paid to the needs of educationally vulnerable gifted children who remain underserved: racially, ethnically, and linguistically different; economically disadvantaged, and children who are twice exceptional (2e).

Until recently, reading instruction for early grades has focused on fiction. However, the Common Core State Standards and the Next Generation Science Standards both emphasize the reading of nonfiction texts to gain specific skill sets for analyzing information. Research has shown that gifted students and children with culturally/linguistically diverse backgrounds may find nonfiction texts more engaging to their interests than fiction. Nonfiction can activate prior learning and encourage students to learn to categorize and synthesize information, especially when combined with scientific inquiry. In this article, the authors explore the new standards-based emphasis on reading nonfiction, the skills built by students’ reading nonfiction with a focus on gifted students from culturally/linguistically different and economically disadvantaged families, and we share one approach to including nonfiction in elementary classrooms through the U-STARS~PLUS Science & Nonfiction Connections, a program for recognizing and supporting underrepresented gifted populations.

One of the most challenging decisions made by school system administrators each year is how to assign students to teachers. This decision, usually guided by the administrator’s beliefs and values, has major implications for the teacher and the student. Collins and Gan undertook a complex study to examine the impact of grouping practices on student achievement within 135 schools in the Dallas independent school district. Their study addressed three issues: (a) how schools sort students into classes, (b) the effect of these sorting practices on student performance, and (c) differences in effects for different groups of students. They looked at the “tracking effect” on high- and low-achieving students, students who had been identified for special (SPED) and gifted (GT) education, and for students with limited English proficiency (LEP). This commentary explores the implications of this study for students with gifts and talents.

Anders Gustavsson, Anna Kittelsaa and Jan Tossebro describe an important dilemma: most published research shows positive outcomes for the intervention being studied, thus making it difficult to determine which of the interventions would be best suited for any given situation. The author’s discuss this within the context of the Dodo Bird effect, that “all are winners and all should get prizes” and call for a new research paradigm; challenging us to go beyond a surface look at interventions to identify the common factors across interventions that may act as the deeper anchors of success. This response, to the paper, explores why publications tend to focus on positive outcomes, briefly addresses a broader conceptualization of an evidence base, and discusses the possible use of a “root causes” approach to identify common factors that lead to success across interventions.

Meeting the needs of students who are twice exceptional (2e), those with gifts and talents as well as areas of disabilities, can feel daunting. Responding to the complexities of strengths and challenges of 2e students requires flexibility, innovation, and most especially teamwork. This chapter explores how the needs of 2e students change across the lifespan, sharing the role of the problem-solving team from early childhood through postsecondary planning. The chapter includes (a) problem-solving guidelines that foster collaboration to address academic, social, and emotional success; (b) examples of instructional strategies using universal design for learning and differentiated instruction for pre-K though postsecondary; and (c) family partnership approaches to support the students’ success.

You can see them, you can hear them, and sometimes you can “feel” them—these young gifted children. The ways they differ from their chronological peers are observable to those who know how to look. Yet, one or two years later they become invisible. What is it that happens between the time they enter kindergarten and leave first grade? What is it that turns enthusiasm to apathy, and apathy to hostility by the fifth and sixth grades?

The provision of flexible, multidimensional, customized supports and services for a twice-exceptional (2e) child requires a system of education that is capable of dynamic and personalized interventions that respond to a 2e student’s learning strengths and challenges. We believe that this kind of educational response entails more than an excellent individual teacher . . . it takes a team.

Students of color are often underrepresented in academic programs for gifted and talented students. This study explored the impact of The Teacher’s Observation of Potential in Students (TOPS) tool on teachers’ ability to systematically observe and document the academic strengths of 5- to 9-year-old students across nine domains. Teachers indicated that without the TOPS, they would have overlooked the academic potential of 22% (1,741) of their children of color and 53% of African American boys, in particular. After using the TOPS, a majority of the teachers (74%) felt they could more readily recognize high-potential students from culturally or linguistically different and economically disadvantaged families. Barriers that might have kept teachers from seeing students’ strengths were also examined. Results indicate two statistically significant relationships between teacher race and perceptions of student behavior. This study has implications for supporting teachers’ more effective identification of strengths in all children.

This article calls for a new paradigm of professionalism in the field of gifted education. The definition of professionalism varies, and yet the need for a common vision of professionalism in the field is necessary to strengthen gifted education in the future. The authors delineate a framework for sustaining professionalism within the field and ask for commitment from the field’s stakeholders to long-range planning, fidelity with flexibility, and a collaborative infrastructure.

Response to intervention is a school reform movement embracing the academic and behavioral needs of all students, including those with gifts and talents. With the implementation of response to intervention in schools across the country, education is in the midst of a significant systems change that is affecting the roles of the school psychologist. In this article, the authors (a) describe the changing roles of the school psychologist in relation to gifted education and response to intervention; (b) examine a specific issue (students who are twice-exceptional) where these role changes can be clearly illustrated; (c) share remaining opportunities and challenges in implementing response to intervention to address the strengths and needs of all children; and (d) review the process in Colorado for exploring and redefining these roles.

develop competence in an area of inquiry; they must understand facts and ideas in the context of a conceptual framework, and they must organize knowledge in ways that facilitate retrieval and application.  A metacognitive approach to instruction can help students learn to take control of their own learning by defining learning goals and monitoring their progress in achieving them. (pp. 1-2) These three principles are essential

As the role of distance learning within the educational setting expands, it is imperative that potential producers and receivers of these courses examine the prospects and problems of a distance learning initiative prior to embarking on this new educational journey. The authors provide guidance from their own distance learning experiences at the North Carolina School of Science and Mathematics. The article focuses on the importance of instructor and facilitator training, student selection, physical arrangements for the studio/classroom, and an evaluation plan.

Eight hundred seventy‐one academically gifted students from nine school districts in North Carolina were asked whether the classes they were taking challenged them and whether their schools’ climate and programs were appropriate and meeting their needs. The students generally agreed that special Academically Gifted and mathematics classes challenged them, but only about half of the students reported a similar satisfaction with their Science, Language Arts, and Social Studies classes. Consistent themes stated by the students about the curriculum's lack of challenge included a slow pace, too much repetition of already mastered information, inability to move on after mastering the regular curriculum, few opportunities to study topics of personal interest, and an emphasis on the mastery of facts rather than the use of thinking skills. Current policies of exclusive heterogeneous grouping at the Middle School level may have impacted the particular dissatisfaction of students from this group. Recommendations inc...

A bad year, without bad people really, no one exactly to blame, just a sequence of events a class that didn't belong to me, and I not belonging to it the round peg in the square whole [sic] ... as words sprang and papers vanished, I became more and more confused and most of all sad and so the round peg, found a round whole and so the story ends, at least it was without villains— Shane Wilder (2E Student), 2004; first appeared in Kirk, Gallagher, and Coleman (2015, p. 126)