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Students who require intensive individualized intervention often demonstrate needs in both academic and behavioral domains. However, practices around assessment and development of interventions are often siloed and separate, which can be a barrier to implementing intensive individualized support in an integrated manner to maximize efficiency. In this article, we provide a blueprint for educators to work collaboratively to complete an integrated assessment that can lead to developing a truly integrated individualized intervention. We also share a vignette demonstrating how team members might create a team to complete an integrated assessment and create a corresponding intervention plan.

Students' behavioral and academic needs are interrelated, and educators may maximize the efficiency and effectiveness of their classroom practice by intentionally integrating academic instruction and positive behavior support practices within an integrated multi-tiered system of support (I-MTSS) framework. Integrated classroom practices are particularly important for students with disabilities and those with intensive learning and behavior needs. In this article, we describe a simple four-step plan to support the integrated implementation of foundational reading skills and share a lesson plan designed to support integrated implementation.

Abstract Background eHealth has potential for supporting interdisciplinary care in contemporary traumatic brain injury (TBI) rehabilitation practice, yet little is known about whether this potential is being realised, or what needs to be done to further support its implementation. The purpose of this study was to explore health professionals’ experiences of, and attitudes towards eHealth technologies to support interdisciplinary practice within rehabilitation for people after TBI. Methods A qualitative study using narrative analysis was conducted. One individual interview and three focus groups were conducted with health professionals (n = 17) working in TBI rehabilitation in public and private healthcare settings across regional and metropolitan New South Wales, Australia. Results Narrative analysis revealed that participants held largely favourable views about eHealth and its potential to support interdisciplinary practice in TBI rehabilitation. However, participants encountered various issues related to (a) the design of, and access to electronic medical records, (b) technology, (c) eHealth implementation, and (d) information and communication technology processes that disconnected them from the work they needed to accomplish. In response, health professionals attempted to make the most of unsatisfactory eHealth systems and processes, but were still mostly unsuccessful in optimising the quality, efficiency, and client-centredness of their work. Conclusions Attention to sources of disconnection experienced by health professionals, specifically design of, and access to electronic health records, eHealth resourcing, and policies and procedures related to eHealth and interdisciplinary practice are required if the potential of eHealth for supporting interdisciplinary practice is to be realised.

Students of color, especially Black males identified as having emotional behavior disorders (EBD), are overrepresented in exclusionary practices. Exclusionary practices, such as in-school suspension, out-of-school suspension, and expulsion, negatively impact academic and social-emotional-behavioral outcomes for all students, especially students with EBD. This article identifies the overlapping principles of culturally responsive teaching and culturally responsive pedagogy as theorized by Gay and Ladson-Billings so that teachers of students of color identified with EBD can better support the specific learning needs of their students. These principles are explicitly applied to behavior-specific praise and error corrections, two evidence-based classroom behavioral management practices.

The continual use of suspension and expulsion remains an unsettling concern for many educational stakeholders. With some guidance from the federal government, states have begun to address the issue of discipline disproportionality through policy reform that restrict the use of suspension and expulsion for certain student groups (e.g., Pre-Kindergarten through 2nd grade) and particular behaviors (e.g., dress code, tardiness, willful disobedience). This study is novel as it extends the research base by providing a preliminary assessment of restrictive discipline policies, or non-suspension and non-expulsion policies. Findings from this study found that 0 states had non-in-school-suspension policies, 20 states had non-OSS policies, and 18 states had non-expulsion policies. Further, descriptive statistics demonstrated that White, Hispanic, and Black students saw increases in academic achievement after non-out-of-school-suspension and non-expulsion policies were implemented with Black students experiencing lower rates of OSS but higher expulsions and Hispanic students experiencing both higher rates of OSS and expulsions compared to White students. Implications for policy, research, and practice are discussed.

Abstract BackgroundGrowing evidence suggests that severe acute COVID-19 illness increases the risk of long COVID (also known as post–COVID-19 condition ObjectiveThis study aimed to examine associations between acute COVID-19 symptom profiles and long COVID prevalence using a population-based sample. MethodsWe used a dual mode (phone and web-based) population-based probability survey of adults with polymerase chain reaction–confirmed SARS-CoV-2 between June 2020 and May 2022 in the Michigan Disease Surveillance System to examine (1) how acute COVID-19 symptoms cluster together using latent class analysis, (2) sociodemographic and clinical predictors of symptom clusters using multinomial logistic regression accounting for classification uncertainties, and (3) associations between symptom clusters and long COVID prevalence using modified Poisson regression. ResultsIn our sample (n=4169), 15.9% (n=693) had long COVID, defined as new or worsening symptoms at least 90 days post SARS-CoV-2 infection. We identified 6 acute COVID-19 symptom clusters resulting from the latent class analysis, with flu-like symptoms (24.7%) and fever (23.6%) being the most prevalent in our sample, followed by nasal congestion (16.4%), multi-symptomatic (14.5%), predominance of fatigue (10.8%), and predominance of shortness of breath (10%) clusters. Long COVID prevalence was highest in the multi-symptomatic (39.7%) and predominance of shortness of breath (22.4%) clusters, followed by the flu-like symptom (15.8%), predominance of fatigue (14.5%), fever (6.4%), and nasal congestion (5.6%) clusters. After adjustment, females (vs males) had greater odds of membership in the multi-symptomatic, flu-like symptom, and predominance of fatigue clusters, while adults who were Hispanic or another race or ethnicity (vs non-Hispanic White) had greater odds of membership in the multi-symptomatic cluster. Compared with the nasal congestion cluster, the multi-symptomatic cluster had the highest prevalence of long COVID (adjusted prevalence ratio [aPR] 6.1, 95% CI 4.3‐8.7), followed by the predominance of shortness of breath (aPR 3.7, 95% CI 2.5‐5.5), flu-like symptom (aPR 2.8, 95% CI 1.9‐4.0), and predominance of fatigue (aPR 2.2, 95% CI 1.5‐3.3) clusters. ConclusionsResearchers and clinicians should consider acute COVID-19 symptom profiles when evaluating subsequent risk of long COVID, including potential mechanistic pathways in a research context, and proactively screen high-risk patients during the provision of clinical care.

Sea ice is crucial in regulating the heat balance between the ocean and atmosphere and quintessential for supporting the prevailing Arctic food web. Due to limited and often local data availability back in time, the sensitivity of sea-ice proxies to long-term climate changes is not well constrained, which renders any comparison with palaeoclimate model simulations difficult. Here we compiled a set of marine sea-ice proxy records with a relatively high temporal resolution of at least 100 years, covering the Common Era (past 2k years) in the Greenland–North Atlantic sector of the Arctic to explore the presence of coherent long-term trends and common low-frequency variability, and we compared those data with transient climate model simulations. We used cluster analysis and empirical orthogonal functions to extract leading modes of sea-ice variability, which efficiently filtered out local variations and improved comparison between proxy records and model simulations. We find that a compilation of multiple proxy-based sea-ice reconstructions accurately reflects general long-term changes in sea-ice history, consistent with simulations from two transient climate models. Although sea-ice proxies have varying mechanistic relationships to sea-ice cover, typically differing in habitat or seasonal representation, the long-term trend recorded by proxy-based reconstructions showed a good agreement with summer minimum sea-ice area from the model simulations. The short-term variability was not as coherent between proxy-based reconstructions and model simulations. The leading mode of simulated sea ice associated with the multidecadal to centennial timescale presented a relatively low explained variance and might be explained by changes in solar radiation and/or inflow of warm Atlantic waters to the Arctic Ocean. Short variations in proxy-based reconstructions, however, are mainly associated with local factors and the ecological nature of the proxies. Therefore, a regional or large-scale view of sea-ice trends necessitates multiple spatially spread sea-ice proxy-based reconstructions, avoiding confusion between long-term regional trends and short-term local variability. Local-scale sea-ice studies, in turn, benefit from reconstructions from well-understood individual research sites.

Abstract Background At the beginning of the COVID-19 pandemic in the United States in the spring of 2020, many Americans avoided the healthcare system, while those with COVID-19 symptoms were faced with decisions about seeking healthcare services for this novel virus. Methods Using a probability sample (n = 1088) from the Michigan adult population of PCR-confirmed COVID-19 cases who were diagnosed prior to July 31, 2020, we used logistic regression to examine sociodemographic and symptom severity predictors of care-seeking behaviors. The analyses examined three different outcomes: (1) whether respondents sought care and, among those who sought care, whether they sought care from (2) a primary care provider or (3) an emergency room. Final models were adjusted for sex, age, race and ethnicity, income, education, marital status, living arrangement, health insurance, and self-reported symptom severity. Results We found that participants ages 65 and older had 4.00 times higher odds of seeking care than 18-34-year-olds (95% CI: 2.21, 7.24), while adults reporting very severe symptoms had roughly 15 times higher odds of seeking care than those with mild symptoms (95% CI: 7.73, 27.01). Adults who were non-Hispanic Black or were uninsured had lower odds of seeking care from a primary care physician versus seeking care from other locations in comparison to adults who were non-Hispanic White or were privately insured, respectively (non-Hispanic Black: aOR = 0.27, 95% CI: 0.16, 0.44; Uninsured: aOR = 0.19, 95% CI: 0.09, 0.42). Conversely, adults who were older or reported more severe symptoms had higher odds of seeking care from an emergency room versus other locations in comparison to adults who were younger or reported less severe symptoms (Age 65+: aOR = 2.96, 95% CI: 1.40, 6.28; Very Severe Symptoms: aOR = 6.63, 95% CI: 3.33, 13.20). Conclusions Our results suggest differential utilization of healthcare services early in the COVID-19 pandemic. Further analyses are needed to examine the reasons for these differences.

Abstract Water in rivers is delivered via the critical zone (CZ)—the living skin of the Earth, extending from the top of the vegetation canopy through the soil and down to fresh bedrock and the bottom of significantly active groundwater. Consequently, the success of stream‐rearing salmonids depends on the structure and resulting water storage and release processes of this zone. Physical processes below the land surface (the subsurface component of the CZ) ultimately determine how landscapes “filter” climate to manifest ecologically significant streamflow and temperature regimes. Subsurface water storage capacity of the CZ has emerged as a key hydrologic variable that integrates many of these subsurface processes, helping to explain flow regimes and terrestrial plant community composition. Here, we investigate how subsurface storage controls flow, temperature, and energetic regimes that matter for salmonids. We illustrate the explanatory power of broadly applicable, storage‐based frameworks across a lithological gradient that spans the Eel River watershed of California. Study sites are climatically similar but differ in their geologies and consequent subsurface CZ structure that dictates water storage dynamics, leading to dramatically different hydrographs, temperature, and riparian regimes—with consequences for every aspect of salmonid life history. Lithological controls on the development of key subsurface CZ properties like storage capacity suggest a heretofore unexplored link between salmonids and geology, adding to a rich literature that highlights various fluvial and geomorphic influences on salmonid diversity and distribution. Rapidly advancing methods for estimating and observing subsurface water storage dynamics at large scales present new opportunities for more clearly identifying landscape features that constrain the distributions and abundances of organisms, including salmonids, at watershed scales.

Background The goal of this study was to determine if 10-min of anodal transcranial direct current stimulation (a-tDCS) to the motor cortex (M1) is capable of modulating quadriceps isometric maximal voluntary contraction (MVC) force or fatigue endurance contralateral or ipsilateral to the stimulation site. Methods In a randomized, cross-over design, 16 (8 females) individuals underwent two sessions of a-tDCS and two sham tDCS (s-tDCS) sessions targeting the left M1 (all participants were right limb dominant), with testing of either the left (ipsilateral) or right (contralateral) quadriceps. Knee extensor (KE) MVC force was recorded prior to and following the a-tDCS and s-tDCS protocols. Additionally, a repetitive MVC fatiguing protocol (12 MVCs with work-rest ratio of 5:10-s) was completed following each tDCS protocol. Results There was a significant interaction effect for stimulation condition x leg tested x time [F(1,60) = 7.156, p = 0.010, ηp2 = 0.11], which revealed a significant absolute KE MVC force reduction in the contralateral leg following s-tDCS (p < 0.001, d = 1.2) and in the ipsilateral leg following a-tDCS (p < 0.001, d = 1.09). A significant interaction effect for condition x leg tested [F(1,56) = 8.12, p = 0.006, ηp2 = 0.13], showed a significantly lower ipsilateral quadriceps (to tDCS) relative MVC force with a-tDCS, versus s-tDCS [t(15) = -3.07, p = 0.016, d = -0.77]. There was no significant difference between the relative contralateral quadriceps (to tDCS) MVC force for a-tDCS and s-tDCS. Although there was an overall significant [F(1,56) = 8.36, p < 0.001] 12.1% force decrease between the first and twelfth MVC repetitions, there were no significant main or interaction effects for fatigue index force. Conclusion a-tDCS may be ineffective at increasing maximal force or endurance and instead may be detrimental to quadriceps force production.

Women face disproportionate challenges while undertaking coastal fieldwork. We draw on 18 responses that specifically raise fieldwork issues from an international survey about perceptions and experiences of gender inequality for those working in coastal sciences to discuss two common themes. These themes are barriers to fieldwork participation and challenges for women working in coastal field settings such as boats or working on beaches, including discrimination and sexual harassment. We suggest five priority behavioural and policy changes to improve the fieldwork experience for women in coastal sciences: (i) publicise field role models and trail blazers, (ii) improve opportunities and capacity for women to undertake fieldwork, (iii) establish field codes of conduct, (iv) acknowledge the challenges women face in the field and provide support where possible, and (v) foster an enjoyable and supportive fieldwork culture.

Abstract The growth of any organism depends on habitat conditions, food availability, and their seasonal interactions. Yet in the vast literature on Pacific salmon (Oncorhynchus), the seasonal interaction between habitat conditions and food availability has received relatively little attention. We examined juvenile Oncorhynchus mykiss rearing, physical habitat, and resource phenologies in two Mediterranean coastal streams—one perennial, cool, and shaded and the other intermittent, seasonally warm, and sunny. We used a bioenergetic model to investigate the timing and magnitude of growth potential for drift‐foraging O. mykiss during the spring and summer in both systems. Growth potential peaked at least 2 months earlier in the intermittent stream than in the perennial stream. By early summer (June), growth potential had declined in the intermittent stream, whereas growth rates were peaking in the perennial stream. However, the mid‐July lipid content of juvenile O. mykiss in the intermittent stream was nearly twice that of fish in the perennial stream. By late summer (August), foraging profitability declined in both streams, as abiotic conditions in the intermittent stream approached lethal. In contrast, the perennial stream maintained suitable abiotic conditions even though the growth rate was low. We suggest that the divergent resource phenologies and seasonal mortality risks experienced by anadromous O. mykiss rearing in these streams could drive diversification of traits governing size, age, and timing of outmigration.

Extragonadal germ cell tumors account for 2–5.7% of germ cell tumors (GCTs). Of these, primary mediastinal GCTs (PMGCTs) are responsible for 16–36% of cases. Given the rarity of these tumors, specific treatment strategies have not been well defined. We report our experience in treating these complex patients. In total, 318 men treated at our institution with chemotherapy for GCTs between 1980 and 2016 were reviewed. PMGCT was defined as clinically diagnosed mediastinal GCT with no evidence of testicular GCT (physical exam/ultrasound). We identified nine patients diagnosed with PMGCT. All patients presented with an anterior mediastinal mass and no gonadal lesion; four patients also had metastatic disease. Median age at diagnosis was 30 years (range, 14–56) and median mass size at diagnosis was 9 cm (range, 3.4–19). Eight patients had non-seminoma and one had pure seminoma. All patients received cisplatin-based chemotherapy initially. Surgical resection was performed in four patients; three patients had a complete resection and one patient was found to have an unresectable tumor. At a median follow-up of 2 years (range, 3 months–28 years) six patients had progressed. Progression-free survival was short with a median of 4.1 months from diagnosis (range 1.5–122.2 months). Five patients died at a median of 4.4 months from diagnosis. One and 5-year overall survivals were 50% and 38%, respectively. PMGCT are rare and aggressive. Our real-life Canadian experience is consistent with current literature suggesting that non-seminoma PMGCT has a poor prognosis despite prompt cisplatin-based chemotherapy followed by aggressive thoracic surgery.

Background: The prevalence of intraductal carcinoma of the prostate (IDC-P) is poorly studied in the Irish population. This study investigated the incidence and clinicopathologic characteristics of IDC-P in an Irish prostate cancer (PCa) patient cohort. The study also discusses the rationale for genetic counseling and screening in Irish patients with familial risk factors for IDC-P. Materials and methods: This study investigated patients diagnosed with IDC-P on prostate biopsy from 2012 to 2016. Primary outcome measurements were incidence, management, and clinical outcomes after follow-up in patients with IDC-P. The secondary outcome measurement was to identify a familial link for IDC-P. Results: A total of 1,143 patients were diagnosed with PCa on needle biopsy, of which 30 (2.3%) had concomitant IDC-P. Mean age and prostate-specific antigen at diagnosis were 68.6 ± 10.5 years (range 53–85 years) and 9.15 ± 8.65 ng/mL (range 2.1–166 ng/mL), respectively. In total, 17 of 30 patients (57%) were diagnosed with concomitant high-grade (i.e., ≥Gleason score 8) PCa. Eight patients (27%) were treated with radical prostatectomy; of which five had biochemical recurrence (BCR) after 10.55 ± 25.9 months. Eleven patients (37%) received radical radiotherapy; of which one had BCR after 36 months. Eleven patients (37%) presented with advanced PCa and were managed with androgen deprivation therapy ± chemotherapy. A family history for PCa in first-degree relatives was found in eight patients (27%). Conclusions: IDC-P is associated with more aggressive clinicopathologic features and an increased risk of BCR after treatment. In Ireland, clinical guidelines and a genetic screening pathway are required to provide early detection and appropriate multimodal management of patients with IDC-P.

We present the result of a collaborative priority setting exercise to identify emerging issues and priorities in coastal geoscience and engineering (CGE). We use a ranking process to quantify the criticality of each priority from the perspective of Australian CGE researchers and practitioners. 74 activities were identified across seven categories: Data Collection and Collation, Coastal Dynamics and Processes, Modelling, Engineering Solutions, Coastal Hazards and Climate Change, Communication and Collaboration, and Infrastructure, Innovation, and Funding. We found consistent and unanimous support for the vast majority of priorities identified by the CGE community, with 91% of priorities being allocated a score of ≥ 3 out of 5 (i.e., above average levels of support) by ≥ 75% of respondents. Data Collection and Collation priorities received the highest average score, significantly higher than four of the other six categories, with Coastal Hazards and Climate Change the second ranked category and Engineering Solutions the lowest scoring category. Of the 74 priorities identified, 11 received unified and strong support across the CGE community and indicate a critical need for: additional coastal data collection including topographic and bathymetric, hydrodynamic, oceanographic, and remotely sensed data; improved data compilation and access; improved understanding of extreme events and the quantification of future impacts of climate change on nearshore dynamics and coastal development; enhanced quantification of shoreline change and coastal inundation processes; and, additional funding to support CGE research and applications to mitigate and manage coastal hazards. The outcomes of this priority setting exercise can be applied to guide policy development and decision-making in Australia and jurisdictions elsewhere. Further, the research and application needs identified here will contribute to addressing key practical challenges identified at a national level. CGE research plays a critical role in identifying and enabling social, environmental, and economic benefits through the proactive management of coastal hazard impacts and informed planning to mitigate the potential impacts of growing coastal risk, particularly in a changing climate. The prevalence and commonalities of the challenges faced by coastal communities globally due to increasing pressures from coastal hazards in a changing climate suggest that our findings will be applicable to other settings.

Arm cycling is commonly used in rehabilitation settings for individuals with motor impairments in an attempt to facilitate neural plasticity, potentially leading to enhanced motor function in the affected limb(s). Studies examining the neural control of arm cycling, however, typically cycle using a set cadence and power output. Given the importance of motor output intensity, typically represented by the amplitude of electromyographic (EMG) activity, on neural excitability, surprisingly little is known about how arm muscle activity is modulated using relative workloads. Thus, the objective of this study was to characterize arm muscle activity during arm cycling at different relative workloads. Participants (n = 11) first completed a 10-second maximal arm ergometry sprint to determine peak power output (PPO) followed by 11 randomized trials of 20-second arm cycling bouts ranging from 5–50% of PPO (5% increments) and a standard 25 W workload. All submaximal trials were completed at 60 rpm. Integrated EMG amplitude (iEMG) was assessed from the biceps brachii, brachioradialis, triceps brachii, flexor carpi radialis, extensor carpi radialis and anterior deltoid of the dominant arm. Arm cycling was separated into two phases, flexion and extension, relative to the elbow joint for all comparisons. As expected, iEMG amplitude increased during both phases of cycling for all muscles examined. With the exception of the triceps brachii and extensor carpi radialis, iEMG amplitudes differed between the flexion and extension phases. Finally, there was a linear relationship between iEMG amplitude and the %PPO for all muscles during both elbow flexion and extension.

Continuous water level records are required to detect long-term trends and analyse the climatological mechanisms responsible for extreme events. This paper compiles nine ocean water level records from gauges located along the New South Wales (NSW) coast of Australia. These gauges represent the longest and most complete records of hourly—and in five cases 15-min—water level data for this region. The datasets were adjusted to the vertical Australian Height Datum (AHD) and had the rainfall-related peaks removed from the records. The Unified Tidal Analysis and Prediction (Utide) model was subsequently used to predict tides for datasets with at least 25 years of records to obtain the associated tidal residuals. Finally, we provide a series of examples of how this dataset can be used to analyse trends in tidal anomalies as well as extreme events and their causal processes.

The common hippopotamus, Hippopotamus amphibius, transports millions of tons of organic matter annually from its terrestrial feeding grounds into aquatic habitats. We evaluated whether carbon stable isotopes (δ13C) can be used as tracers for determining whether H. amphibius‐vectored allochthonous material is utilized by aquatic consumers. Two approaches were employed to make this determination: (1) lab‐based feeding trials where omnivorous river fish were fed a H. amphibius dung diet and (2) field sampling of fish and aquatic insects in pools with and without H. amphibius. Lab trials revealed that fish fed exclusively H. amphibius dung exhibited significantly more positive δ13C values than fish not fed dung. Fish and aquatic insects sampled in a river pool used for decades by H. amphibius also exhibited more positive δ13C values at the end of the dry season than fish and insects sampled from an upstream H. amphibius‐free reference pool. Fish sampled in these same pools at the end of the wet season (high flow) showed no significant differences in δ13C values, suggesting that higher flows reduced retention and use of H. amphibius subsidies. These data provide preliminary evidence that δ13C values may be useful, in certain contexts, for quantifying the importance H. amphibius organic matter.

BACKGROUND:Severe Acute Respiratory Infection (SARI) causes substantial mortality and morbidity worldwide. The country of Georgia conducts sentinel surveillance to monitor SARI activity and changes in its infectious etiology. This study characterizes the epidemiology of SARI in Georgia over the 2015/16 and 2016/17 influenza seasons, compares clinical presentations by etiology, and estimates influenza vaccine effectiveness using a test-negative design. METHODS:SARI cases were selected through alternate day systematic sampling between September 2015 and March 2017 at five sentinel surveillance inpatient sites. Nasopharyngeal swabs were tested for respiratory viruses and Mycoplasma pneumoniae using a multiplex diagnostic system. We present SARI case frequencies by demographic characteristics, co-morbidities, and clinical presentation, and used logistic regression to estimate influenza A vaccine effectiveness. RESULTS:1,624 patients with SARI were identified. More cases occurred in February (28.7%; 466/1624) than other months. Influenza was the dominant pathogen in December-February, respiratory syncytial virus in March-May, and rhinovirus in June-November. Serious clinical symptoms including breathing difficulties, ICU hospitalization, and artificial ventilation were common among influenza A and human metapneumovirus cases. For influenza A/H3, a protective association between vaccination and disease status was observed when cases with unknown vaccination status were combined with those who were unvaccinated (OR: 0.53, 95% CI: 0.30, 0.97). CONCLUSIONS:Multi-pathogen diagnostic testing through Georgia's sentinel surveillance provides useful information on etiology, seasonality, and demographic associations. Influenza A and B were associated with more severe outcomes, although the majority of the population studied was unvaccinated. Findings from sentinel surveillance can assist in prevention planning.