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OBJECTIVE Many infants with neonatal opioid withdrawal syndrome (NOWS) from prenatal exposure to opioids require transfer to a pediatric inpatient unit for medication weaning. The purpose of this study is to assess the difference in the duration of medication weaning between infants transferred by day of life (DOL) 14 versus later (DOL 15 and after) to a tertiary care setting for pharmacological and nonpharmacological management of NOWS. METHODS This single-site retrospective cohort study uses medical chart data from infants with NOWS transferred to specialized care between May 2016 and June 2021 (n = 87). The primary outcome is length of medication weaning, calculated as the number of days between transfer from the NICU to a tertiary care setting and the cessation of pharmacotherapy. RESULTS The majority of the infants in this sample are transferred from acute to tertiary care after DOL 15 (62% versus 38% by DOL 14). The predicted number of days to wean is 14.2 among those infants transferred by DOL 14, whereas the duration of weaning is 6.6 days longer among the later transfer group (20.8 days), adjusting for key covariates. The duration of weaning is also prolonged among infants with greater NOWS symptom severity and with prenatal exposure to psychotropic medications. CONCLUSIONS Delayed treatment prolongs NOWS symptoms and increases the burden on the health care system. Earlier referral from NICUs to pediatric inpatient units with environmental supports could reduce prolonged medication exposure and length of hospitalization for infants diagnosed with NOWS.

Secondary students’ identity development is multidimensional, informed by distinct sociohistorical, cultural, structural, and individual forces and factors. For students who receive both special education and English learner services, identity development may also be connected to being categorized as needing both types of support services. Understanding how students receiving both services perceive themselves, and how they leverage identity while planning their futures could inform the field of transition, yet this is an infrequent subject of inquiry in special education transition research. We interviewed 26 students, all of whom received both services in a high school in a large school district in the northeastern United States. The development of language and learner dimensions of identity emerged from the data as a key factor informing participants’ perceptions and experiences as they prepared for the transition into adulthood. Implications and recommendations for researchers and practitioners supporting students’ language and learner dimensions of identity during postschool transition are shared.

Importance: Existing autism assessments, interventions, and research focus primarily on deficits rather than strengths, which affects autistic people’s well-being and their physical and mental health. Objective: To develop an operational definition for strengths-based practice, develop a taxonomy to classify studies that characterize and provide strengths-based assessments and interventions, and present the impact on the mental health and well-being of autistic people of using strengths and interests in practice. Data Sources: Literature was searched from 2000 to 2021 in the CINAHL, PsycINFO, EBSCOhost, MEDLINE, Web of Science, JSTOR, and ERIC databases. Study Selection and Data Collection: A five-stage scoping review framework was merged with Joanna Briggs Institute enhancements to scrutinize peer-reviewed studies written in English that characterized and provided strengths-based assessments and interventions. Findings: We sorted the 38 studies into four categories: strengths-based interventions, descriptive studies, exploratory studies, and commentaries. We found three fundamental themes: mental health outcomes, increased knowledge in interest areas, and supportive environments. Strengths-based interventions were related to positive social engagement, learning, self-advocacy, and anxiety reduction. Descriptive studies used strength assessments and examined stakeholder perceptions of strengths. Exploratory studies explored ways to incorporate strengths in practice. Finally, commentaries discussed the need to presume autistic competence and involve autistic people in research and practice. Conclusions and Relevance: Despite the small body of literature, these findings have implications for pushing the boundaries of support to center the needs of autistic people and form genuine client collaborations. What This Article Adds: This article adds to the understanding of using the strengths and interests of autistic people by incorporating their voices into occupational therapy research and practice in meaningful and purposeful ways. Positionality Statement: This article uses the identity-first language autistic people. This nonableist language describes their strengths and abilities and is a conscious decision. This language is favored by autistic communities and self-advocates and has been adopted by health care professionals and researchers (Bottema-Beutel et al., 2021; Kenny et al., 2016).

Background: Adolescents on the autism spectrum often experience challenges participating socially in inclusive education. The majority of school-based social supports focuses on social skills train...

Many youth on the autism spectrum possess interests and strengths for STEM-related postsecondary pathways, yet there are few research-based programs to support those interests and competencies including complex problem solving and social communication. This qualitative study explored the experiences and perceived outcomes of students, teachers, and parents participating in an inclusive, strength-based, extracurricular engineering design program entitled the IDEAS Maker Club. Twenty-six students, 13 parents, and nine teachers in the program completed interviews and program logs while researchers conducted classroom observations over 2 years. Thematic analysis identified five common themes: (1) positive student experience and engagement, (2) skills acquisition, (3) development of interest in STEM and related careers, (4) social relationships and community, and (5) safe spaces that supported self-determination.

Social interaction is inherently bidirectional, but research on autistic peer interactions often frames communication as unidirectional and in isolation from the peer context. This study investigated natural peer interactions among six autistic and six non-autistic adolescents in an inclusive school club over 5 months (14 45-min sessions in total) to examine the students’ peer preferences in real-world social interactions and how the preferences changed over time. We further examined whether social behavior characteristics differ between student and peer neurotype combinations. Findings showed that autistic students were more likely to interact with autistic peers then non-autistic peers. In both autistic and non-autistic students, the likelihood of interacting with a same-neurotype peer increased over time. Autistic and non-autistic students’ within-neurotype social interactions were more likely to reflect relational than functional purposes, be characterized as sharing thoughts and experiences rather than requesting help or objects, and be highly reciprocal, as compared with cross-neurotype interactions. These peer preferences and patterns of social interactions were not found among student-peer dyads with the same genders. These findings suggest that peer interaction is determined by more than just a student’s autism diagnosis, but by a combination of student and peer neurotypes. Lay abstract Autistic students often experience challenges in peer interactions, especially for young adolescents who are navigating the increased social expectations in secondary education. Previous research on the peer interactions of autistic adolescents mainly compared the social behaviors of autistic and non-autistic students and overlooked the peers in the social context. However, recent research has shown that the social challenges faced by autistic may not be solely contributed by their social differences, but a mismatch in the social communication styles between autistic and non-autistic people. As such, this study aimed to investigate the student-and-peer match in real-world peer interactions between six autistic and six non-autistic adolescents in an inclusive school club. We examined the odds of autistic and non-autistic students interacting with either an autistic peer, a non-autistic peer, or multiple peers, and the results showed that autistic students were more likely to interact with autistic peers then non-autistic peers. This preference for same-group peer interactions strengthened over the 5-month school club in both autistic and non-autistic students. We further found that same-group peer interactions, in both autistic and non-autistic students, were more likely to convey a social interest rather than a functional purpose or need, be sharing thoughts, experiences, or items rather than requesting help or objects, and be highly reciprocal than cross-group social behaviors. Collectively, our findings support that peer interaction outcomes may be determined by the match between the group memberships of the student and their peers, either autistic or non-autistic, rather than the student’s autism diagnosis.

Rich in protein and adjacent to pancreatic cancer cells, pancreatic juice has been considered an attractive source to discover biomarkers for pancreatic ductal adenocarcinoma (PDAC). Here, we identified a novel biomarker, TBC1D23 in pancreatic juice of PDAC patients. High TBC1D23 expression was also observed in tumor tissues and sera, associated with lymphatic metastasis and shorter survival. TBC1D23 was strongly expressed in PDAC cell lines, and knocking down TBC1D23 reduced cell proliferation and migration in vitro and suppressed xenograft tumor growth and peritoneal metastasis in vivo. DNA microarray analysis identified the down-regulation of VEGF-C in TBC1D23 knockdown cells compared to control. Indeed, depletion of TBC1D23 decreased VEGF-C expression and secretion. Treatment with conditioned medium from PANC-1 cells promoted lymphangiogenesis in lymphatic endothelial cells, while this effect was counteracted by the VEGFR3 inhibitor MAZ51 or knockdown of TBC1D23, indicating that VEGF-C is a target gene of TBC1D23. Mechanistically, TBC1D23 could increase EGFR membrane distribution, enhance EGFR recycling, but inhibit EGFR endocytic degradation, suggesting that TBC1D23 up-regulates VEGF-C by maintaining EGFR capacity to transduce signals. This study clearly demonstrates the oncogenic role of TBC1D23 and EGFR/VEGF-C as its downstream signaling pathway for lymphatic metastasis.

We investigate the dynamic changes in trader positions of market participants in the VIX futures markets. We find that in a low-VIX period, below the 23.81 threshold determined by our model, changes in VIX futures affect the trading decisions of dealers and leveraged fund managers, but in an opposite direction. During a high-VIX period, dealers and leveraged fund managers would then alter their trading strategies. We highlight the important role of exchange-traded products trading in hedging demand of dealers and show the impact on VIX futures. Trader positions are determinants of VIX futures prices, basis, and VIX premium.

We investigate the contributions of the Taiwan regular and mini index futures to price discovery. We find that the regular futures provide more price discovery, which is inconsistent with the findings for the US futures markets. This dominance of regular futures became relatively weaker after the introduction of the standard portfolio analysis of the risk margin system because of more arbitrage trades mainly executed by institutional investors. We show the effect of the introduction of an integrated margin system on the price‐discovery processes and efficiencies for futures with the same underlying asset but different contract sizes.

Constraint-induced therapy (CIT) is highly effective yet not accessible to many families. Integrating commercial exergaming in home-based CIT may support the availability and attainability of the intervention. The study compared the effects of supplementary use of Nintendo Wii in home-based CIT with dose-equivalent conventional CIT. Eighteen children with cerebral palsy were randomly assigned to 8 weeks of CIT (CIT) or 4 weeks of CIT, followed by 4 weeks of Wii-augmented CIT (CIT-Wii). Outcome measures included the Bruininks–Oseretsky Test of Motor Proficiency (Manual Dexterity), the ABILHAND-Kids, the WeeFIM (Self-Care), the Test of Playfulness, the Engagement Questionnaire, and the Parenting Stress Index–Short Form. Both groups significantly improved motor outcomes and playfulness. The CIT group demonstrated greater improvement in self-care skills, whereas parental stress decreased only in the CIT-Wii group. CIT-Wii yields no significant difference in treatment effects from conventional CIT and may provide psychosocial benefits.

Unfavorable prognoses are often accompanied for hyperglycemic stroke patients. This study aimed to construct a hyperglycemia/diabetes-derived polygenic risk score (PRS) to improve the predictive performance for poor outcome risks after a stroke and to evaluate its potential clinical application.A hospital-based cohort study was conducted including 1320 first-ever acute ischemic stroke (AIS) patients and 1210 patients who completed the follow-up at 3 months. PRSs were calculated for hyperglycemia/diabetes mellitus using results from genome-wide association studies in Asians. An unfavorable functional outcome was defined as a modified Rankin Scale score of ≥3 at 3, 6, and 12 months of follow-up. The prediction of a poor prognosis was evaluated using measures of model discrimination, calibration, and net reclassification improvement (NRI).The second to fourth PRS quartiles (≥Q2) were significantly associated with higher risks of unfavorable outcomes at 3 months compared with the first quartile as the reference group after adjusting for age, baseline stroke severity, hypertension, diabetes, dyslipidemia, smoking, heart disease, and ischemic stroke subtype (p for trend0.0001). The addition of the PRS to traditional risk predictors of poor outcomes after an AIS significantly improved the model fit (likelihood ratio test p0.0001) and enhanced measures of reclassification (NRI, 0.245; 95% confidence interval [CI], 0.195-0.596). The corrected C-index for the PRS combining traditional risk factors at 3 months after a stroke was 0.899 (95% CI, 0.878-0.980). Among hyperglycemic AIS patients, those who did not take an antidiabetic drug and whose PRS was ≥Q2 had higher risks of an unfavorable outcome at 3 months compared with patients who took the medicine.The hyperglycemia/diabetes-derived PRS was associated with poor outcomes after an AIS, but further studies are needed to validate its use for clinical applications.

Autistic students often struggle to engage with peers in integrated education; however, research has largely focused on individual characteristics rather than the interpersonal and environmental factors affecting peer engagement. This mixed-methods study examined longitudinal peer interactions over a school year among 17 adolescents (seven were autistic) in an inclusive school club. The quantitative phase investigated participants’ social behavior rates to identify sessions where each student demonstrated high and low peer engagement compared with their average participation levels. The qualitative phase compared social interactions and contexts between sessions of high and low peer engagement, revealing four themes regarding contextual supports and barriers to autistic peer engagement: (1) peer engagement is a participatory process where a student and their peer(s) navigate mutual understanding, shaped by both student and peer social characteristics, openness, and involvement; (2) student–peer synchronicity, such as shared interests or compatibility of social styles, was essential to autistic peer engagement; (3) peer engagement can be supported by activities facilitating joint engagement and exploration of mutual interests; (4) classroom interventions emphasizing strengths can support peer engagement, while normative behavioral standards without peer education on individual differences and diversity can perpetuate peers’ negative perceptions of autistic difficulties. Lay abstract Peer engagement is essential but often challenging for autistic students in integrated education, especially for adolescents. Although peer engagement is bidirectional and context-dependent, research has largely focused on individual characteristics rather than the interpersonal and environmental factors affecting peer engagement. This mixed-methods study examined peer interactions over a school year among 17 adolescents (seven were autistic) in an inclusive school club at a public middle school in the Northeastern United States. The study began with a quantitative phase identifying sessions in which each student was socially engaged with peers more or less often than usual for them. We then qualitatively compared the social interactions and contexts between sessions where each participant experienced high and low peer engagement. Thematic analysis revealed four themes regarding contextual supports and barriers to autistic peer engagement: (1) peer engagement is a participatory process where a student and their peer(s) navigate mutual understanding, shaped by both student and peer social characteristics, openness, and involvement; (2) student–peer synchronicity, such as shared interests or compatibility of social styles, was essential to autistic peer engagement; (3) peer engagement can be supported by activities facilitating joint engagement and exploration of mutual interests; (4) classroom interventions emphasizing strengths can support peer engagement, while normative behavioral standards without peer education on individual differences and diversity can perpetuate peers’ negative perceptions of autistic difficulties. The findings have implications for better inclusive practice to support autistic social participation by modifying the peer environments, activities, and classroom interventions.

Predictive metabolic biomarkers for the recurrent luminal breast cancer (BC) with hormone receptor (HR)-positive and human epidermal growth factor receptor type 2 (HER2)-negative are lacking. High levels of O-GlcNAcylation (O-GlcNAc) and pyruvate kinase isoenzyme M2 (PKM2) are associated with malignancy in BC, however, the association with the recurrence risk remains unclear. We first conduct survival analysis by using the METABRIC dataset to assess the correlation of PKM2 expression with BC clinical outcomes. Next, patients with HR+/HER2- luminal BC were recruited for PKM2/O-GlcNAc testing. Logistic regression and receiver operating characteristic curve analysis were performed to evaluate the 10-year DFS predicted outcome. Survival analysis of the METABRIC dataset revealed that high expression of PKM2 was significantly associated with worse overall survival in luminal BC. The high expression of O-GlcNAc or PKM2 was a significant independent marker for poor 10-year DFS using immunohistochemical analysis. The PKM2 or O-GlcNAc status was a significant predictor of DFS, with the combination of PKM2–O-GlcNAc status and T stage greatly enhancing the predictive outcome potential. In summary, O-GlcNAc, PKM2, and T stage serve as good prognostic discriminators in HR+/HER2− luminal BC.

This study investigates the impact of improved central parity quotations in the Chinese Renminbi on price discovery in onshore (USD/CNY) and offshore (USD/CNH) markets. Chinese news releases refer to the gross domestic product, trade balances, and foreign exchange reserves; U.S. news features information on the meetings, statements, and minutes of the Federal Open Market Committee. They all have positive impacts on price discovery in the USD/CNH market. The greater contribution by the USD/CNH market to price discovery can be attributed to an improved quotation policy, which has enabled central parity to incorporate and transmit more USD/CNH information to the USD/CNY market.

Social participation in schools is critical to student academic and psychosocial outcomes. Neurodivergent students, however, often experience environmental barriers to social participation, such as lack of awareness and negative attitudes among peers and school staff, including teachers. Although authentic social participation is composed of dynamic interactions between a person and the external environments, occupational therapy’s role in addressing student social participation primarily focuses on internal social characteristics. Barriers within school environments often remain unaddressed, with no clear role for occupational therapy practitioners. We advocate an expansion of occupational therapy’s role to address school environments, especially the social, physical, and policy aspects, to promote social participation and inclusion. We also discuss the need for change and present a framework guiding intervention in school environments.

Research Objectives Medical rehabilitation for neonatal abstinence syndrome (NAS) combines medically supervised opiate weaning with intensive, individualized therapeutic supports. The purpose of this study is to investigate differences in length of stay in an NAS treatment program by: 1) early admission (by day 14 of life versus after); and 2) infant characteristics including prenatal narcotic exposure, prenatal care, birth complications, and demographics. Design Secondary analysis of data abstracted from electronic medical records. Setting An acute inpatient pediatric rehabilitation facility in the Northeast with a dedicated NAS program. Participants 62 infants were admitted for NAS treatment between July 2016 and April 2020. One case was excluded because of an atypical length of stay. The final analytic sample was N=61. Interventions Not applicable. Main Outcome Measures Inpatient rehabilitation length of stay in days. Results Infants with NAS in this sample spent an average of 17.9 days in the NICU, with a range of 5 to 39 days. 38% were admitted for NAS rehabilitation within two weeks of birth. These infants spent significantly less time in acute rehabilitation compared to infants admitted for NAS treatment after day 14 of life. Based on the results of a Poisson regression model, the predicted length of stay was 15.2 days (95% CI: 13.6-16.8) for infants in the early admission group and 19.9 days (95% CI: 18.5-21.4) for the later admission group, adjusting for differences in prenatal narcotic exposures, delivery type, birth complications, sex, and race. Conclusions Early admission for NAS reduces the length of time required to wean infants from opiates. We discuss the benefits of improving the referral process between NICU and NAS medical rehabilitation programs for this vulnerable population. Author(s) Disclosures None.

Helicobacter pylori colonizes human stomach mucosa and its infection causes gastrointestinal diseases with variable severity. Bacterial infection stimulates autophagy, which is a part of innate immunity used to eliminate intracellular pathogens. Several intracellular bacteria have evolved multipronged strategies to circumvent this conserved system and thereby enhance their chance of intracellular survival. Nonetheless, studies on H. pylori have produced inconsistent results, showing either elevated or reduced clearance efficiency of intracellular bacteria through autophagy. In this review, we summarize recent studies on the mechanisms involved in autophagy induced by H. pylori and the fate of intracellular bacteria.

Date Presented Accepted for AOTA INSPIRE 2021 but unable to be presented due to online event limitations. This study evaluated an inclusive extracurricular science, technology, engineering, and mathematics (STEM) program for middle-school students on the spectrum cocreated by OTs, educators, and program developers. The program demonstrated positive outcomes on student engagement, executive functioning, social participation, and interests in STEM. The presentation will discuss the collaboration model for the program and strategies used to support the engagement of students on the spectrum. Primary Author and Speaker: Yu-Lun Chen Additional Authors and Speakers: Kavitha Murthi, Kristie Patten Contributing Authors: Wendy Martin, Regan Vidiksis, and Ariana Riccio

We utilize the respective information share and common factor component weight approaches of Hasbrouck (1995) and Gonzalo and Granger (1995) to examine price discovery competition between the VIX and VIX futures. Our results show that VIX futures prices play a dominant role in the overall process of price discovery. An increase in the price difference between the VIX and VIX futures, commonly referred to as the futures basis, causes a corresponding increase in the contribution to price discovery made by VIX futures. Our empirical results also show that news announcements on macro-economic issues in the United States increase the dominant role of VIX futures in the overall process of price discovery. This dominant role remains unchanged when compared to VIX exchange-traded products and the volatility indices on non-US equity exchange-traded funds.

During the manufacture and installation of power transformers, or after long-term operation, there may be various partial discharge (PD) sources inside the power transformer. In order to accurately assess the insulation state, it requires accurate measurement and diagnostics of type and location of PD source. Therefore, it is necessary to find an accurate method to extract effective features from phase-resolved partial discharge (PRPD) patterns, which can effectively characterize the PD type. In this paper, four keypoint extraction algorithms (the scale invariant feature transform (SIFT), the speeded up robust features (SURF), oriented fast and rotated brief (ORB) and BRISK methods) are introduced. For different types of PDs, different methods were used to extract a fixed number of key points. Then, the key points of the PRPD pattern of same defect type were matched. Thus, keypoint extraction methods were compared according to the degree of matching. According to the matching results, the ORB algorithm and the SURF algorithm have better performance, and the SIFT has the worst result.

Introduction The purpose of this study was to describe the demographic characteristics and prognosis of children admitted to the intensive care unit (ICU) after a pediatric emergency department (PED) return visit within 72 h. Method We conducted this retrospective study from 2010 to 2016 in the PED of a tertiary medical center in Taiwan and included patients under the age of 18 years old admitted to the ICU after a PED return visit within 72 h. Clinical characteristics were collected to perform demographic analysis. Pediatric patients who were admitted to the ICU on an initial visit were also enrolled as a comparison group for outcome analysis, including mortality, ventilator use, and length of hospital stay. Results We included a total of 136 patients in this study. Their mean age was 3.3 years old, 65.4% were male, and 36.0% had Chronic Health Condition (CHC). Disease-related return (73.5%) was by far the most common reason for return. Compared to those admitted on an initial PED visit, clinical characteristics, including vital signs at triage and laboratory tests on return visit with ICU admission, demonstrated no significant differences. Regarding prognosis, ICU admission on return visit has a higher likelihood of ventilator use (aOR:2.117, 95%CI 1.021~4.387), but was not associated with increased mortality (aOR:0.658, 95%CI 0.150~2.882) or LOHS (OR:-1.853, 95%CI -4.045~0.339). Conclusion Patients who were admitted to the ICU on return PED visits were associated with an increased risk of ventilator use but not mortality or LOHS compared to those admitted on an initial visit.