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A cancer diagnosis enlivens the question of what it means to live well with the Earth and its multidimensional beings, including the children I teach. A cancer diagnosis provides a necessary push to step out from the confines of a self and toward and into the wild fray of this life. I interpret my lived experiences through the practical philosophy of hermeneutics. Hermeneutics has helped me perform and write my lived experience, which I hope will draw in readers and listeners to a recognition of their inescapable ecological interdependence. Cultivating an ability to listen and interpret the world and the human and more-than-human kinships is important to me. Listening to words that children speak helps me learn to be open to the fullness of life, how life is lived, how life can be remembered and suffered and let go. I am gathering sense of being in the world and of understanding the offering that arrives when I nurture a commitment to care for the Earth.

Abstract The Met Office held a testbed over winter 2020/2021 where a new numerical weather prediction (NWP) sub‐km ensemble was set up on‐demand in response to interesting weather phenomena in the United Kingdom. The domain for the model was chosen in real time by a community of Met Office Research Scientists and Operational Meteorologists and over a 4‐month period the ensemble was triggered for nine events. The purpose of the testbed was to investigate whether a real‐time weather regime‐based enhancement in NWP capability was feasible, to understand what benefits a testbed environment might give, and to explore the practicalities of running such an event. Case studies from the testbed demonstrated that forecast ensembles at 2.2 km and 300 m grid spacing were able to capture observed winter weather, with greater spatial detail apparent, especially over complex orography, in the 300‐m model. Ensemble spread appeared less influenced by resolution, potentially due to the size of the domains tested or the weather regimes of the case studies. The testbed also showcased underutilized observations and additional radiosonde ascents were conducted. All the testbed meetings were conducted virtually due to COVID‐19 restrictions, and decisions were made about when to trigger the event using an online message board. The winter 2020/2021 testbed provides ideas for how on‐demand weather‐dependent testbeds might be conducted in the future. However, several recommendations are made that would enhance testbed benefits further, including more dedicated resource, stronger technology and data visualization and greater participation from both academia and weather information users.

We evaluated the effects of behavioral skills training on improving participant implementation of functional communication training with multiple schedules when working with a confederate. Behavioral skills training produced mastery-level responding for all six participants who required training, providing the first empirically supported training for this functional communication training approach. Next, we assessed durability during training challenges with (a) procedural changes to the original protocol, (b) a novel confederate with different discriminative stimuli and reinforcers, and (c) relapsed confederate destructive behavior. Training effects degraded at least once for all participants and in 62% of training challenges, although continuing to expose the participant to the challenging situations or providing postsession booster training resolved the degradation in most cases. We discuss these findings in relation to their clinical implications and directions for future research.

Long-standing shortages of well-prepared special educators, especially within rural areas, have jeopardized positive outcomes for students with disabilities. In this multiple case study of administrators and special educators, the authors examined how individuals make sense of the special education teacher shortages in relation to the challenges of working in a rural school. Local contextual factors intersected with salary and state policies, highlighting how external, political factors affected districts' ability to attract and retain special education teachers. Chief among implications for research, policy, and practice is the need to attend to multipronged approaches that have the potential to mitigate economic barriers to special educator recruitment and retention in rural school districts.

The National School Nurse Workforce Study 2.0 describes the demographic characteristics and distribution patterns, school nursing models and activities, and practice environment among self-reported public school nurses in the United States. A random sample of U.S. public schools was surveyed, stratified by region, school level, and urban/rural locale. A total of 2,827 schools responded, yielding a 38.1% response rate. Using these data, we estimate 78,869 full-time equivalents of school nurses, with 65,052 registered nurses (RN) and 13,817 licensed practical/vocational nurses (LPN/LVN). Findings indicate school nurse distribution differences by region, locale, and income. The predominant model of school nursing practice was the RN only, followed by the RN and LPN model. In general, school nurse respondents felt supported by school staff and parents. Less than half of survey respondents stated they were supervised by an RN. Research, policy, and school nursing practice implications are discussed.

Background: Quality early childhood interactions, especially quality adult--child interactions, are known to form the foundation of future skills associated with social, academic and communicative development. Speech-language therapists (SLTs) can engage with educators in professional development to improve communication environments for children. Understanding the perspectives of early childhood directors and educators in relation to the feasibility, sustainability and impact of professional development is needed. Aim(s): This study investigated the experiences of early childhood educators and directors who participated in a SLT-led professional development training program. Method: Participants were four directors and six early childhood educators. Directors participated in one focus group; educators participated in individual semi-structured interviews. All participants were female and had between 5 and 38 years of experience. They were interviewed following the completion of an eight-week training program. Verbatim transcripts of the director focus group and educator interviews were thematically analysed using NVivo12. Result(s): Three overarching themes were developed. These were the appropriateness and acceptability of the training, impact and professional engagement with eight subsequent themes also identified. Although participants reported positive experiences participating in the training, several practical and translational challenges were identified. Conclusion: The professional development training implemented by SLTs was influenced by a number of factors that assisted or hindered educator and director experience of the program. The appropriateness, acceptability and feasibility of a professional development (PD) program should carefully consider participants' learning needs and workplace environments.

In this article, we describe the exploration of the content and quality of annual goals included in the Individualized Education Programs (IEPs) of students with disabilities in one rural U.S. school district. We utilized content analysis to understand the district's service delivery model comprehensively. Findings revealed disparities between inclusive placements and special education service delivery, suggesting that, despite high rates of inclusive placements noted on IEPs, most services occurred outside general education classrooms, especially for students with intellectual and developmental disabilities (IDD). We evaluated the quality and rigor of 546 annual goals using a rubric adapted from Kurth et al. Only 37.7% of goals were rated as rigorous, highlighting a need for clearer, more specific, and applicable goals. Notably, communication goals for students with IDD were largely absent, raising concerns about support for meaningful participation in general education settings. In addition, special factors related to communication and assistive technology were not consistently addressed in IEPs. We discuss implications for improving educational experiences for students who qualify for special education services under IDD in rural schools and highlight the value of further research and actions in this area.

PURPOSE Black birthing parents and their newborns disproportionately experience newborn drug testing for prenatal substance exposure by health care professionals (HCPs), which contributes to Child Protective Services (CPS) reporting, family separation, and termination of parental rights. This qualitative study aims to interrogate dominant power structures by exploring knowledge, attitudes, and experiences of HCPs and CPS professionals regarding the influence of structural racism on inequities in newborn drug testing practices. METHODS We conducted semistructured interviews with 30 physicians, midwives, nurses, social workers, and CPS professionals guided by an explanatory framework, and conducted inductive, reflexive thematic analysis. RESULTS We identified 3 primary themes: (1) levels of racism beyond the hospital structure contributed to higher rates of drug testing for Black newborns; (2) inconsistent hospital policies led to racialized application of state law and downstream CPS reporting; and (3) health care professionals knowledge of the benefits and disproportionate harms of CPS reporting on Black families influenced their decision making. CONCLUSION Health care professionals recognized structural racism as a driver of disproportionate newborn drug testing. Lack of knowledge and skill limitations of HCPs were barriers to dismantling power structures, thus impeding systems-level change. Institutional changes should shift focus from biologic testing and reporting to supporting the mutual needs of birthing parent and child through family-centered substance use treatment. State and federal policy changes are needed to ensure health equity for Black families and eliminate reporting to CPS for prenatal substance exposure when no concern for child abuse and neglect exists. Key words: child abuse; health inequities; racism; implicit bias; qualitative research https://doi.org/10.1370/afm.3139, INTRODUCTION The United States Child Abuse and Prevention Treatment Act requires states to enact policies to identify newborns affected by substance use disorders or prenatal substance exposure (PSE) during pregnancy. [...]

Over the past two decades, a growing body of research has investigated college students' friendships and how these relationships can both enable and constrain students' success. I review this body of literature, describing the characteristics and processes of college students' friendships. First, I review work that describes characteristics of students' friendships, particularly focused on the roles of similarity and proximity in shaping the friendships students make. Second, I focus on what students do with friends that promote college success. Taking a broad view of success, I focus on how friends facilitate a sense of belonging and identity development as well as specific types of support that students provide, emotionally and academically. Third, I discuss processes related to friendships that impede students from success. I conclude by noting some implications for practice and promising areas of future research on friendships and success for post-secondary students.

Despite a long history of overrepresentation in segregated settings (Brock, 2018), students with disabilities who require extensive supports are more likely to receive inclusive placements in rural schools. In this paper, we present findings from a narrative literature analysis of inclusive education for students with disabilities in rural schools located in the United States. Our search yielded 24 articles, published between 2002 and 2019, which reveal three storylines: (a) perceptions about inclusive education in rural schools and communities, (b) inclusive placements are common for students with disabilities, and (c) access to resources is a factor for rural schools to provide inclusive education programs. The National Rural Education Association (NREA) has prioritized "building capacity to meet the needs of diverse and special populations" and so this review thoroughly examines special education practices in rural schools and describes how the diverse qualities and contexts of rural schools contribute to inclusive education practices.

Simulated learning programs are an important component of allied health education. Although the role of simulation clinical educators has been highlighted as critical for student learning within simulation, their perceptions of their role have not yet been investigated. This study aimed to explore the experiences of simulation clinical educators. Participants were ten simulation clinical educators who had supported speech-language pathology students' learning during a 5-day simulation program focussed on speech-language pathology practice with adult clients in acute hospital and rehabilitation settings. Educators participated in individual semi-structured interviews exploring their role and their perceptions of the simulation-based learning program. Data were analysed using inductive thematic analysis. Three inter-related themes emerged from participants' views. The major theme of Unique teaching and learning environment incorporated five subthemes: focus on teaching; safe learning environment; authenticity and engagement; structure and intensity of learning, and; feedback opportunities. Two additional themes were identified: Clinical educator role same but different, and Simulation bridges the gap between theory and practice. This study offers new insights into simulation clinical educators' perceptions of their role when supporting students within simulation and highlight the importance of harnessing the unique benefits of simulation as a teaching pedagogy to maximize its impacts on student learning and justify its costs.

We demonstrate an application for learning multiplication problems with an adaptive algorithm that is based on a computational cognitive model of the learner's memory. The application helps learners automatise and memorise multiplications through repeated practice over three levels of difficulty. In a naturalistic setting involving more than 500 primary school students (ages 6-10) who together recorded over 300,000 responses, we observed that performance improved as learners using the application progressed through the levels. A model-based analysis of performance revealed that learners' estimated speed of forgetting decreased from the second to the third level. This is consistent with a shift towards stronger declarative knowledge and/or more efficient computation procedures. The model also identified consistent differences in the difficulty of individual multiplication facts that persisted across levels. This study demonstrates the feasibility of using an adaptive fact learning application to help young learners master multiplication, an essential mathematical skill.

22q11.2 deletion syndrome (22q11DS) is the most frequently occurring microdeletion in humans. It is associated with a significant impact on brain structure, including prominent reductions in gray matter volume (GMV), and neuropsychiatric manifestations, including cognitive impairment and psychosis. It is unclear whether GMV alterations in 22q11DS occur according to distinct structural patterns. Then, 783 participants (470 with 22q11DS: 51% females, mean age [SD] 18.2 [9.2]; and 313 typically developing [TD] controls: 46% females, mean age 18.0 [8.6]) from 13 datasets were included in the present study. We segmented structural T1-weighted brain MRI scans and extracted GMV images, which were then utilized in a novel source-based morphometry (SBM) pipeline (SS-Detect) to generate structural brain patterns (SBPs) that capture co-varying GMV. We investigated the impact of the 22q11.2 deletion, deletion size, intelligence quotient, and psychosis on the SBPs. Seventeen GMV-SBPs were derived, which provided spatial patterns of GMV covariance associated with a quantitative metric (i.e., loading score) for analysis. Patterns of topographically widespread differences in GMV covariance, including the cerebellum, discriminated individuals with 22q11DS from healthy controls. The spatial extents of the SBPs that revealed disparities between individuals with 22q11DS and controls were consistent with the findings of the univariate voxel-based morphometry analysis. Larger deletion size was associated with significantly lower GMV in frontal and occipital SBPs; however, history of psychosis did not show a strong relationship with these covariance patterns. 22q11DS is associated with distinct structural abnormalities captured by topographical GMV covariance patterns that include the cerebellum. Findings indicate that structural anomalies in 22q11DS manifest in a nonrandom manner and in distinct covarying anatomical patterns, rather than a diffuse global process. These SBP abnormalities converge with previously reported cortical surface area abnormalities, suggesting disturbances of early neurodevelopment as the most likely underlying mechanism.

Abstract Background Advances in transcriptional profiling methods have enabled the discovery of molecular subtypes within and across traditional tissue-based cancer classifications. Such molecular subgroups hold potential for improving patient outcomes by guiding treatment decisions and revealing physiological distinctions and targetable pathways. Computational methods for stratifying transcriptomic data into molecular subgroups are increasingly abundant. However, assigning samples to these subtypes and other transcriptionally inferred predictions is time-consuming and requires significant bioinformatics expertise. To address this need, we recently reported “ClassifieR,” a flexible, interactive cloud application for the functional annotation of colorectal and breast cancer transcriptomes. Here, we report “ClassifieR 2.0” which introduces additional modules for the molecular subtyping of prostate and high-grade serous ovarian cancer (HGSOC). Results ClassifieR 2.0 introduces ClassifieRp and ClassifieRov, two specialised modules specifically designed to address the challenges of prostate and HGSOC molecular classification. ClassifieRp includes sigInfer, a method we developed to infer commercial prognostic prostate gene expression signatures from publicly available gene-lists or indeed any user-uploaded gene-list. ClassifieRov utilizes consensus molecular subtyping methods for HGSOC, including tools like consensusOV, for accurate ovarian cancer stratification. Both modules include functionalities present in the original ClassifieR framework for estimating cellular composition, predicting transcription factor (TF) activity and single sample gene set enrichment analysis (ssGSEA). Conclusions ClassifieR 2.0 combines molecular subtyping of prostate cancer and HGSOC with commonly used sample annotation tools in a single, user-friendly platform, allowing scientists without bioinformatics training to explore prostate and HGSOC transcriptional data without the need for extensive bioinformatics knowledge or manual data handling to operate various packages. Our sigInfer method within ClassifieRp enables the inference of commercially available gene signatures for prostate cancer, while ClassifieRov incorporates consensus molecular subtyping for HGSOC. Overall, ClassifieR 2.0 aims to make molecular subtyping more accessible to the wider research community. This is crucial for increased understanding of the molecular heterogeneity of these cancers and developing personalised treatment strategies.

Abstract Objective: Lennox‐Gastaut syndrome (LGS) is a severe, childhood‐onset epilepsy that is typically refractory to treatment. We surveyed the current landscape of LGS treatment, aiming to identify challenges to the development of efficacious therapies, and to articulate corresponding priorities toward clinical trials that improve outcomes. Methods: The LGS Special Interest Group of the Pediatric Epilepsy Research Consortium integrated evidence from the literature and expert opinion, into a narrative review. Results: We provide an overview of approved and emerging medical, dietary, surgical and neuromodulation approaches for LGS. We note that quality of care could be improved by standardizing LGS treatment based on expert consensus and empirical data. Whereas LGS natural history is incompletely understood, prospective studies and use of large retrospective datasets to understand LGS across the lifespan would enable clinical trials that address these dynamics. Recent discoveries related to LGS pathophysiology should enable development of disease‐modifying therapies, which are currently lacking. Finally, clinical trials have focused chiefly on seizures involving “drops,” but should incorporate additional patient‐centered outcomes, using emerging measures adapted to people with LGS. Interpretation: Clinicians and researchers should enact these priorities, with the goal of patient‐centered clinical trials that are tailored to LGS pathophysiology and natural history.

Abstract We present a nation-wide network analysis of non-fatal opioid-involved overdose journeys in the United States. Leveraging a unique proprietary dataset of Emergency Medical Services incidents, we construct a journey-to-overdose geospatial network capturing nearly half a million opioid-involved overdose events spanning 2018–2023. We analyze the structure and sociological profiles of the nodes, which are counties or their equivalents, characterize the distribution of overdose journey lengths, and investigate changes in the journey network between 2018 and 2023. Our findings include that authority and hub nodes identified by the HITS algorithm tend to be located in urban areas and involved in overdose journeys with particularly long geographical distances.

Abstract Background Mathematical models and advanced analytics play an important role in policy decision making and mobilizing action. The Imperial College Coronavirus Disease 2019 (COVID-19) Response Team (ICCRT) provided continuous, timely and robust epidemiological analyses to inform the policy responses of governments and public health agencies around the world. This study aims to quantify the policy impact of ICCRT outputs, and understand which evidence was considered policy-relevant during the COVID-19 pandemic. Methods We collated all outputs published by the ICCRT between 01-01-2020 and 24-02-2022 and conducted inductive thematic analysis. A systematic search of the Overton database identified policy document references, as an indicator of policy impact. Results We identified 620 outputs including preprints (16%), reports (29%), journal articles (37%) and news items (18%). More than half (56%) of all reports and preprints were subsequently peer-reviewed and published as a journal article after 202 days on average. Reports and preprints were crucial during the COVID-19 pandemic to the timely distribution of important research findings. One-fifth of ICCRT outputs (21%) were available to or considered by United Kingdom government meetings. Policy documents from 41 countries in 26 different languages referenced 43% of ICCRT outputs, with a mean time between publication and reference in the policy document of 256 days. We analysed a total of 1746 policy document references. Two-thirds (61%) of journal articles, 39% of preprints, 31% of reports and 16% of news items were referenced in one or more policy documents (these 217 outputs had a mean of 8 policy document references per output). The most frequent themes of the evidence produced by the ICCRT reflected the evidence-need for policy decision making, and evolved accordingly from the pre-vaccination phase [severity, healthcare demand and capacity, and non-pharmaceutical interventions (NPIs)] to the vaccination phase of the epidemic (variants and genomics). Conclusion The work produced by the ICCRT affected global and domestic policy during the COVID-19 pandemic. The focus of evidence produced by the ICCRT corresponded with changing policy needs over time. The policy impact from ICCRT news items highlights the effectiveness of this unique communication strategy in addition to traditional research outputs, ensuring research informs policy decisions more effectively.