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Rwanda started teaching English to support sustainable development and deliver the five key pillars that would help Rwandans transition from their existing way of life to the society they all desire and are happy to be a part of. As a follow-up to the Sustainable Development Goals and the Berlin Declaration on Education for Sustainable Development, the government ensured the standardisation and teaching of English. In order to assist the implementation of English teaching nationally, the theoretical paper explains how the 4Rs Framework--relationship-building, recognition, responsibilities, and reciprocity--combine to generate synergy among many stakeholders and cross-sectoral collaboration. The study presents literature on Rwanda's Vision 2050, education for sustainable development, and teaching using English as a medium of communication. It is founded on a critical literature review. The article discusses options for national transformation while emphasising the importance of locally rooted collaboration. The 4Rs technique is intended to foster discussion among important players about the issues and problems facing the area of education in emergencies rather than serving as a rigid theoretical framework. The study shows the connections between and tensions among the various "Rs," as well as the efficiency of the 4R dimensions in encouraging the teaching of English. The study considered ways to get beyond the approach's drawbacks and difficulties to support sustainable schooling in Rwanda. This framework encourages the creation of a synergistic educational ecosystem that equips students with the information, skills, and attitudes required to actively participate in Rwanda's path to sustainable development.

There has been a call to amplify the scholarship of teaching and learning (SoTL) and expand its reach by engaging with audiences outside the academy. In this paper, we share our journey in crossing disciplinary boundaries and creating a SoTL-informed infographic for public consumption. As the field of SoTL continues to evolve, infographics hold tremendous potential to communicate SoTL to various stakeholders, including educators, students, administrators, policymakers, and the public. We outline best practices in infographic development and the potential of infographics as a tool for taking SoTL public, emphasizing their visual appeal and effectiveness in conveying complex information. We conclude by discussing the implications of using infographics to advance SoTL communication. The efforts of our group serve as a valuable example of how infographics can be used to bring SoTL knowledge out of academia and into the public domain.

The prevalence of "long COVID" is just one of the conundrums highlighting how little we know about the lung's response to viral infection, particularly to syndromecoronavirus-2 (SARS-CoV-2), for which the lung is the point of entry. We used an in vitro human lung system to enable a prospective, unbiased, sequential single-cell level analysis of pulmonary cell responses to infection by multiple SARS-CoV-2 strains. Starting with human induced pluripotent stem cells and emulating lung organogenesis, we generated and infected three-dimensional, multi-cell-type-containing lung organoids (LOs) and gained several unexpected insights. First, SARS-CoV-2 tropism is much broader than previously believed: Many lung cell types are infectable, if not through a canonical receptor-mediated route (e.g., via Angiotensin-converting encyme 2(ACE2)) then via a noncanonical "backdoor" route (via macropinocytosis, a form of endocytosis). Food and Drug Administration (FDA)-approved endocytosis blockers can abrogate such entry, suggesting adjunctive therapies. Regardless of the route of entry, the virus triggers a lung-autonomous, pulmonary epithelial cell-intrinsic, innate immune response involving interferons and cytokine/chemokine production in the absence of hematopoietic derivatives. The virus can spread rapidly throughout human LOs resulting in mitochondrial apoptosis mediated by the prosurvival protein Bcl-xL. This host cytopathic response to the virus may help explain persistent inflammatory signatures in a dysfunctional pulmonary environment of long COVID. The host response to the virus is, in significant part, dependent on pulmonary Surfactant Protein-B, which plays an unanticipated role in signal transduction, viral resistance, dampening of systemic inflammatory cytokine production, and minimizing apoptosis. Exogenous surfactant, in fact, can be broadly therapeutic.

As Social Studies teachers with decades of combined experience and as teacher educators at a predominantly white midwestern university, the authors center their curriculum around teaching challenging and whole histories, analyzing primary sources, and creating classroom community spaces where difficult dialogues can safely happen. While the authors primarily work with preservice and early career teachers in their 16-week Social Studies in the Elementary Curriculum and Teaching and Learning Social Studies in the Secondary School Methods courses, the authors feel all Social Studies educators should use strategies that get students to think deeply about historical events and their effect on present-day social issues.

The article investigates four vulnerable learners and their histories of drug misuse in rural schools. The purpose of this study was to conduct a situational analysis with a view to understanding the current drug abuse situation in Zimbabwean rural schools and giving some recommendations on what needs to be done to lessen its effects. The study's mode of investigation was qualitative. As means of gathering data, focus groups and participatory research were used. The participatory research design employed by the study unearthed evidence that indicates that drug abuse has an adverse effect on a learner's cognitive optimal functioning both in the community and school contexts. The study's findings point to the necessity of teaching parents how to prioritise their responsibilities and liberate them from the mental poverty they currently experience, which is a societal construct that keeps them from finishing their work with their learners. The study further found out that the absence of guidance and counselling exposes learners to more drug abuse cases and culture, thus having a two-pronged impact on the optimal functioning of rural learners. The study makes some recommendations for how the school and the community should work together and coordinate their efforts to manage the experiences of vulnerable students in order to achieve cognitive optimal functioning for rural learners in Zimbabwe. [Note: The page range (155-175) shown on the PDF is incorrect. The correct page range is 155-174.]

As the number of international students in higher education continues to grow, so do concerns regarding systemic obstacles, discrimination, and social isolation that can impede students' academic success. Peer mentorship has been shown to support graduate students through academic socialization and achievement in higher education (Lorenzetti et al., 2019). The purpose of this study was to explore the transitional experiences of international graduate students, and the extent to which peer-mentoring relationships can support academic and emotional wellbeing. Researchers interviewed 13 international graduate students from 3 professional faculties at a research-intensive Canadian university. International students described academic and intersectional challenges experienced while navigating and adapting to new environments and how these impacted both academic outcomes and students' well-being. Relationships with peers were viewed as an essential means by which students could access academic and psychosocial supports necessary to adjust to and thrive in their new educational and cultural environments.

Abstract Background Diabetic heart disease may eventually lead to heart failure, a leading cause of mortality in diabetic individuals. The lack of effective treatments for diabetes-induced heart failure may result from a failure to address the underlying pathological processes, including chronic, low-grade inflammation. Previous studies have reported that lipoxin A4 (LXA4), known to promote resolution of inflammation, attenuates diabetes-induced atherosclerosis, but its impact on diabetic hearts has not been sought. Thus, we aimed to determine whether LXA4 therapeutic treatment attenuates diabetes-induced cardiac pathology. Methods Six-week-old male apolipoprotein E-deficient (ApoE−/−) mice were followed for 16 weeks after injection of streptozotocin (STZ, 55 mg/kg/day, i.p. for 5 days) to induce type-1 diabetes (T1DM). Treatment with LXA4 (5 μg/kg, i.p.) or vehicle (0.02% ethanol, i.p.) was administered twice weekly for the final 6 weeks. One week before endpoint, echocardiography was performed within a subset of mice from each group. At the end of the study, mice were euthanized with sodium pentobarbital (100 mg/kg i.p.) and hearts were collected for ex vivo analysis, including histological assessment, gene expression profiling by real-time PCR and protein level measurement by western blot. Results As expected diabetic mice showed a significant elevation in plasma glycated hemoglobin (HbA1c) and glucose levels, along with reduced body weight. Vehicle-treated diabetic mice exhibited increased cardiac inflammation, macrophage content, and an elevated ratio of M1-like to M2-like macrophage markers. In addition, myocardial fibrosis, cardiomyocytes apoptosis and hypertrophy (at the genetic level) were evident, with echocardiography revealing early signs of left ventricular (LV) diastolic dysfunction. Treatment with LXA4 ameliorated diabetes-induced cardiac inflammation, pro-inflammatory macrophage polarization and cardiac remodeling (especially myocardial fibrosis and cardiomyocytes apoptosis), with ultimate improvement in cardiac function. Of note, this improvement was independent of glucose control. Conclusions These findings demonstrated that LXA4 treatment attenuated the extent of cardiac inflammation in diabetic hearts, resulting in limited cardiac remodeling and improved LV diastolic function. This supports further exploration of LXA4-based therapy for the management of diabetic heart disease. The recent development of stable LXA4 mimetics holds potential as a novel strategy to treat cardiac dysfunction in diabetes, paving the way for innovative and more effective therapeutic strategies. Graphical Abstract

There are marked racial and ethnic disparities in diagnosis and services for individuals on the autism spectrum, yet race and ethnicity are underreported and underexamined in autism research. The current study examines the reporting of race and ethnicity and the inclusion of participants across racial and ethnic groups in studies included in a large-scale systematic review of autism intervention research (1990-2017). Trained research assistants reviewed 1013 articles and extracted data on the reporting of race and ethnicity data and the inclusion of participants from different racial and ethnic categories from each article. Only 25% of the articles reported any data on race and ethnicity and reporting over time has slowly increased across the 28 years of the review. Descriptive statistics suggest that race and ethnicity reporting varied by study design, intervention, and outcomes. In studies with reported data, White participants had the highest rate of participation (64.8%), with a large gap between the next highest rates of participation, which were among Hispanic/Latino (9.4%), Black (7.7%), and Asian (6.4%) participants. The lack of reporting and the limited inclusion of participants across minoritized racial and ethnic groups are concerning and suggest a need to examine practices in autism research from planning to dissemination. [For the corresponding grantee submission, see ED618543.]

Paraprofessionals are critical members of instructional teams for students with autism; however, little is known about their job preparation and professional development needs. This study addressed the gap in the literature by surveying 325 paraprofessionals in public school settings in the United States and Guam who reported working with students with autism. Data were gathered on paraprofessionals' (a) roles and responsibilities, (b) applied knowledge from different types of professional development, (c) perceived barriers to professional development, and (d) types and timing of communication with their supervising teachers. The results of this study have direct implications for individuals interested in developing a model of professional development that will meet the unique needs of paraprofessionals who work with students with autism.

Background: Pre-clinical and retrospective data suggest that doxycycline added to treatment regimens has benefit in AL amyloidosis. However, a recent multicenter, open-label, randomized controlled trial in AL amyloidosis patients treated with CyBorD did not demonstrate a progression-free survival (PFS) or cardiac PFS benefit with added doxycycline. Objective: The main objective of this study was to explore the role of doxycycline combined with bortezomib-containing regimens (BCRs) for newly diagnosed AL amyloidosis patients with cardiac involvement and to compare them with a cohort of concurrent patients treated with BCR only. Material and Methods: AL amyloidosis patients, newly diagnosed between January 2012 and March 2022, who were treated with BCR at the Amyloidosis Program of Calgary (APC) were evaluated. Results: Sixty-four concurrent patients were identified. Thirty-nine patients received doxycycline in addition to BCR (BCR-D) for a median of 8 months. The overall response rate was similar among the groups. No significant differences in VGPR/CR, dFLC at 1 month, time to first response, time to best response, or organ responses were noted between the BCR alone and BCR-D groups. Summary and Conclusions: Our retrospective study demonstrated that doxycycline combined with BCR failed to prolong OS, PFS, or cardiac responses compared with BCR alone in patients with cardiac AL amyloidosis.

Abstract Coevolutionary antagonism generates relentless selection that can favour genetic exchange, including transfer of antibiotic synthesis and resistance genes among bacteria, and sexual recombination of disease resistance alleles in eukaryotes. We report an unusual link between biological conflict and DNA transfer in bdelloid rotifers, microscopic animals whose genomes show elevated levels of horizontal gene transfer from non-metazoan taxa. When rotifers were challenged with a fungal pathogen, horizontally acquired genes were over twice as likely to be upregulated as other genes — a stronger enrichment than observed for abiotic stressors. Among hundreds of upregulated genes, the most markedly overrepresented were clusters resembling bacterial polyketide and nonribosomal peptide synthetases that produce antibiotics. Upregulation of these clusters in a pathogen-resistant rotifer species was nearly ten times stronger than in a susceptible species. By acquiring, domesticating, and expressing non-metazoan biosynthetic pathways, bdelloids may have evolved to resist natural enemies using antimicrobial mechanisms absent from other animals.

As higher education institutions and the people who learn, work, and live within them, continue to face challenges, it is critical to foster safe, inclusive, and respectful cultures of learning and growth. Numerous mentorship models can be meaningfully integrated into campus culture to support professional and personal learning and development across various disciplines and career stages. In this paper, I introduce several mentorship models, present some of the challenges experienced across various career stages, and discuss a variety of evidence-based mentorship models that may be introduced and strengthened in different stages and personal contexts across higher education. [Articles in this journal were presented at the University of Calgary Conference on Postsecondary Learning and Teaching.]

Outbreaks of fungal diseases have devastated plants and animals throughout history. Over the past century, the repeated emergence of coffee wilt disease caused by the fungal pathogen Fusarium xylarioides severely impacted coffee production across sub-Saharan Africa. To improve the disease management of such pathogens, it is crucial to understand their genetic structure and evolutionary potential. We compared the genomes of 13 historic strains spanning 6 decades and multiple disease outbreaks to investigate population structure and host specialisation. We found that F. xylarioides comprised at least 4 distinct lineages: 1 host-specific to Coffea arabica, 1 to C. canephora var. robusta, and 2 historic lineages isolated from various Coffea species. The presence/absence of large genomic regions across populations, the higher genetic similarities of these regions between species than expected based on genome-wide divergence and their locations in different loci in genomes across populations showed that horizontal transfers of effector genes from members of the F. oxysporum species complex contributed to host specificity. Multiple transfers into F. xylarioides populations matched different parts of the F. oxysporum mobile pathogenicity chromosome and were enriched in effector genes and transposons. Effector genes in this region and other carbohydrate-active enzymes important in the breakdown of plant cell walls were shown by transcriptomics to be highly expressed during infection of C. arabica by the fungal arabica strains. Widespread sharing of specific transposons between F. xylarioides and F. oxysporum, and the correspondence of a putative horizontally transferred regions to a Starship (large mobile element involved in horizontal gene transfers in fungi), reinforce the inference of horizontal transfers and suggest that mobile elements were involved. Our results support the hypothesis that horizontal gene transfers contributed to the repeated emergence of coffee wilt disease.

Hypocretin (Hcrtr, HCRTR) / orexin (OX) receptors modulate a range of neurobiological functions and are drug targets for several disorders. Mapping the distribution of receptors in the brain can inform their function and guide targeting of specific disorders. Although studied in rodents, orexin receptor distribution has remained relatively unexplored in humans, and thus there is also a paucity of comparative anatomy. The aim of this study was therefore to map the distribution of hypocretin/orexin receptor mRNA in selected regions of the mouse and human brain by non-radioactive in situ hybridization (ISH) using digoxigenin (DIG)-labelled cRNA anti-sense probes. Data revealed both distinct and overlapping patterns of distributions of Hcrtr1/HCRTR1 and Hcrtr2/HCRTR2 mRNA suggesting that the functions of the orexin system are mediated differently by each receptor. In the mouse brain, the highest expression of Hcrtr1 mRNA was in the locus coeruleus (LC) whereas Hcrtr2 mRNA was most abundant in the lateral hypothalamus (LH). The human caudate nuclei showed significant expression of both HCRTR1 and HCRTR2 mRNA, whereas the mouse predominantly expressed Hcrtr2 mRNA. The noradrenergic neurons of the human LC showed high signals for both HCRTR1 (71.7%) and HCRTR2 (81.5%) mRNA. Expression of HCRTR2 mRNA in non-noradrenergic human LC cells was also notable. The distribution pattern in mouse and human brains is consistent with the involvement of the orexin system in arousal and the sleep/wake cycle in both species, however, variations in receptor subtype expression profiles suggests that species differences in responses to orexin receptor ligands may be expected.

AimsPatients visiting the emergency department (ED) or hospitalized for heart failure (HF) are at increased risk for subsequent adverse outcomes, however effective risk stratification remains challenging. We utilized a machine-learning (ML)-based approach to identify HF patients at risk of adverse outcomes after an ED visit or hospitalization using a large regional administrative healthcare data system.Methods and resultsPatients visiting the ED or hospitalized with HF between 2002-2016 in Alberta, Canada were included. Outcomes of interest were 30-day and 1-year HF-related ED visits, HF hospital readmission or all-cause mortality. We applied a feature extraction method using deep feature synthesis from multiple sources of health data and compared performance of a gradient boosting algorithm (CatBoost) with logistic regression modelling. The area under receiver operating characteristic curve (AUC-ROC) was used to assess model performance. We included 50,630 patients with 93,552 HF ED visits/hospitalizations. At 30-day follow-up in the holdout validation cohort, the AUC-ROC for the combined endpoint of HF ED visit, HF hospital readmission or death for the Catboost and logistic regression models was 74.16 (73.18-75.11) versus 62.25 (61.25-63.18), respectively. At 1-year follow-up corresponding values were 76.80 (76.1-77.47) versus 69.52 (68.77-70.26), respectively. AUC-ROC values for the endpoint of all-cause death alone at 30-days and 1-year follow-up were 83.21 (81.83-84.41) versus 69.53 (67.98-71.18), and 85.73 (85.14-86.29) versus 69.40 (68.57-70.26), for the CatBoost and logistic regression models, respectively.ConclusionsML-based modelling with deep feature synthesis provided superior risk stratification for HF patients at 30-days and 1-year follow-up after an ED visit or hospitalization using data from a large administrative regional healthcare system.

Significant volumes of wastewater, particularly from the textile industry, pose environmental concerns due to the presence of hazardous substances such as ortho-toluidine (OT). The photo-Fenton process can be used to break down and remove this hazardous organic compound. Previous studies on the photo-Fenton process have focused on local optimization of operating variables without considering cost factors. The photo-Fenton process is studied in this paper with UVA irradiation, Fe2+ dosage, and H2O2 concentration considered as variables. The study uses fuzzy optimization in a multi-objective framework for making decisions to determine the optimal values of OT degradation with its corresponding cumulative uncertainty error (YA), and the total operating cost (CT), both of which are essential for assessing the techno-economic feasibility of the process. The Pareto front was generated from the objective functions to establish the boundary limits for YA and CT. The results show an overall satisfaction level of 71.81% for the objective functions, indicating a partially satisficing solution for maximizing OT degradation while minimizing operating cost. The optimum conditions of the variables require 85.70 W m−3 UVA irradiation, 0.5177 mM for Fe2+ dosage, and 7.85 mM for the H2O2 concentration. These conditions yielded an OT degradation value of 83.22% and a total operating cost of 768.61 USD·m−3. Comparison with previous literature showed an OT degradation efficiency that was 16.78% lower. However, this tradeoff in the process efficiency is offset by a total operating cost that is 2.28 times cheaper, emphasizing the cost-effectiveness of the fuzzy optimized solution.

Older adults are the least physically active group with specific barriers to regular exercise, and online exercise programs could overcome some of those barriers. This scoping review aimed to describe the characteristics of supervised group-based synchronous online exercise programs for older adults living in the community, their feasibility, acceptability, and potential benefits. MEDLINE (Ovid), Embase, SPORTDiscus, and the Cumulative Index to Nursing and Allied Health Literature were searched until November 2022. The included studies met the following criteria: participants aged 50 years and above, a minimum of a 6-week group-based supervised and synchronous intervention, and original articles available in English. Eighteen articles were included, with 1,178 participants (67% female, average age of 71 [57–93] years), most (83%) published in the past 3 years. From the limited reported studies, delivering supervised, synchronous online exercise programs (one to three times/week, between 8 and 32 weeks) for older adults living in the community seems feasible, accepted, and can improve physical function. [ABSTRACT FROM AUTHOR]

BACKGROUND: The increasing use of activity trackers in mobile health studies to passively collect physical data has shown promise in lessening participation burden to provide actively contributed patient-reported outcome (PRO) information. OBJECTIVE: The aim of this study was to develop machine learning models to classify and predict PRO scores using Fitbit data from a cohort of patients with rheumatoid arthritis. METHODS: Two different models were built to classify PRO scores: a random forest classifier model that treated each week of observations independently when making weekly predictions of PRO scores, and a hidden Markov model that additionally took correlations between successive weeks into account. Analyses compared model evaluation metrics for (1) a binary task of distinguishing a normal PRO score from a severe PRO score and (2) a multiclass task of classifying a PRO score state for a given week. RESULTS: For both the binary and multiclass tasks, the hidden Markov model significantly (P

Comprehensive evaluations include data from multiple informants, but discrepancies occur on adaptive skill measures of youth with autism spectrum disorder (ASD) and intellectual disabilities (ID). This study investigated discrepancies between parent-teacher ratings on a measure of adaptive behavior ["Adaptive Behavior Assessment System, Third Edition" (ABAS-3)] in a clinical sample of 115 youth. Agreement between informants was determined and then discrepancies were identified using paired-sample "t"-tests for the whole sample and subsamples. Factors associated with parent-teacher discrepancies were investigated including age, diagnoses, IQ, autism symptomology, and parent education. Parent-teacher scores were moderately correlated for the ABAS-3 composite and domains. Teachers rated youth with ASD and ID as having higher adaptive skills. Autism symptomology significantly predicted discrepancies between informants on the ABAS-3.

Objective We performed a scoping review of the relevant literature on home‐based telehealth in rheumatology to understand its appropriate application in rheumatology practice. Methods We searched the Cochrane Library, PubMed, Web of Science, and scientific meeting abstracts to identify articles that specifically addressed telehealth suitability, barriers to telehealth, patient‐reported outcomes (PROs) collected in telehealth settings, and telehealth satisfaction. From the initial search of 4,882 studies, 23 reports were included. In addition, 10 abstracts were also eligible for analysis, resulting in a total of 33 articles: 2 randomized clinical trials, 9 prospective cohort studies, and 22 retrospective studies. Results We found that triage appointments or predictive models could be helpful in selecting patients for telehealth and that telehealth interventions were appropriate for follow‐up of patients with systemic lupus erythematosus and inflammatory arthritis, but that conducting new patient visits over telehealth was not ideal. Barriers to telehealth include patient factors (age, technology access) and need for physician/process factors (eg, physical examinations). PROs collected in regular practice can be incorporated into telehealth. Several small, single‐center studies suggest that telehealth does not lead to negative outcomes compared with in‐person visits, and overall, patients report high patient satisfaction with telehealth. In several scenarios, home‐based telehealth was equivalent to in‐person visits with regard to patient outcomes and satisfaction. Conclusion The widespread potential of telehealth to manage and deliver care for people with rheumatic disease is significant. As such, further research in the form of randomized controlled trials can help contribute to growing evidence that shapes telehealth implementation for patients with rheumatic diseases.

Orphans and vulnerable children (OVC) in mainstream rural schools encounter unique challenges stemming from loss, economic instability, and disrupted familial structures. Addressing their needs demands a comprehensive and culturally sensitive approach. This paper thus explored the use of an ethnopsychology framework to understand and address the diverse needs of rural children, emphasizing the importance of culturally sensitive interventions in mainstream schools. It also evaluated the effectiveness of ethnopsychological interventions and the role of community collaboration. This article used secondary data sources to understand how the ethnopsychology approach can be utilized as a potential sustainable intervention strategy for the needs of OVC in mainstream rural schools. The results show that OVC are well-served by the cultural resources that rural schools have in abundance from a cultural perspective. The study also emphasized the significance of cultural practices and beliefs in influencing community responses and developing resilience in assisting OVC. The study supported the care, protection, and psychosocial support to OVC as significantly influenced by family and relationship networks, community-based organizations, and traditional support systems. The paper made recommendations for improving rural schools’ response to OVC needs in light of cultural sensitivity. These include boosting collaboration between formal and informal support systems, creating community networks, fostering cultural adaptation and preservation, and giving community members more agency through programs that increase their knowledge and skills. This study underscored the significance of ethnopsychology principles of community and social connection in leveraging cultural resources, context-based and responsive interventions, and appreciating and sustaining existing indigenous knowledge systems in understanding and addressing the needs of OVC in mainstream rural schools. Understanding and supporting OVC contributes towards cultivating meaningful collaborations and transformative care of OVC in the Global South.

Neuronal intranuclear inclusion disease (NIID), a neurodegenerative disease previously thought to be rare, is increasingly recognized despite heterogeneous clinical presentations. NIID is pathologically characterized by ubiquitin and p-62 positive intranuclear eosinophilic inclusions that affect multiple organ systems, including the brain, skin, and other tissues. Although the diagnosis of NIID is challenging due to phenotypic heterogeneity, a greater understanding of the clinical and imaging presentations can improve accurate and early diagnosis. Here, we present three cases of pathologically proven adult-onset NIID, all presenting with episodes of acute encephalopathy with protracted workups and lengthy time between symptom onset and diagnosis. Case 1 highlights challenges in the diagnosis of NIID when MRI does not reveal classic abnormalities and provides a striking example of hyperperfusion in the setting of acute encephalopathy, as well as unique pathology with neuronal central chromatolysis, which has not been previously described. Case 2 highlights the progression of MRI findings associated with multiple NIID-related encephalopathic episodes over an extended time period, as well as the utility of skin biopsy for antemortem diagnosis.

BackgroundHeterogeneous mental health outcomes during the COVID-19 pandemic are documented in the general population. Such heterogeneity has not been systematically assessed in youth with autism spectrum disorder (ASD) and related neurodevelopmental disorders (NDD). To identify distinct patterns of the pandemic impact and their predictors in ASD/NDD youth, we focused on pandemic-related changes in symptoms and access to services.MethodsUsing a naturalistic observational design, we assessed parent responses on the Coronavirus Health and Impact Survey Initiative (CRISIS) Adapted For Autism and Related neurodevelopmental conditions (AFAR). Cross-sectional AFAR data were aggregated across 14 European and North American sites yielding a clinically well-characterized sample of N = 1275 individuals with ASD/NDD (age = 11.0 ± 3.6 years; n females = 277). To identify subgroups with differential outcomes, we applied hierarchical clustering across eleven variables measuring changes in symptoms and access to services. Then, random forest classification assessed the importance of socio-demographics, pre-pandemic service rates, clinical severity of ASD-associated symptoms, and COVID-19 pandemic experiences/environments in predicting the outcome subgroups.ResultsClustering revealed four subgroups. One subgroup-broad symptom worsening only (20%)-included youth with worsening across a range of symptoms but with service disruptions similar to the average of the aggregate sample. The other three subgroups were, relatively, clinically stable but differed in service access: primarily modified services (23%), primarily lost services (6%), and average services/symptom changes (53%). Distinct combinations of a set of pre-pandemic services, pandemic environment (e.g., COVID-19 new cases, restrictions), experiences (e.g., COVID-19 Worries), and age predicted each outcome subgroup.LimitationsNotable limitations of the study are its cross-sectional nature and focus on the first six months of the pandemic.ConclusionsConcomitantly assessing variation in changes of symptoms and service access during the first phase of the pandemic revealed differential outcome profiles in ASD/NDD youth. Subgroups were characterized by distinct prediction patterns across a set of pre- and pandemic-related experiences/contexts. Results may inform recovery efforts and preparedness in future crises; they also underscore the critical value of international data-sharing and collaborations to address the needs of those most vulnerable in times of crisis.

Feeding problems are common among autistic children and are linked to negative health consequences. Therefore, understanding feeding problems and factors that influence these behaviors is important for developing supports for children and families. While certain sensory processing patterns are commonly associated with feeding problems, less is known about the link between sensory processing and feeding behaviors in autism, as well as how parent behaviors and feelings during mealtime differ based on child sensory preferences. This research examined two groups of young autistic children who were reported to be picky eaters by their parents: those with and those without oral hypersensitivity. Children with oral hypersensitivity had more difficulty with food acceptance, and their parents reported more negative feelings around feeding their child. However, the two groups of children (oral hypersensitive and not) did not differ in their medical/oral motor symptoms, mealtime behavior, or parent use of strategies at mealtimes. This research supports the need for personalized treatment strategies based on the child's sensory preferences to support both the child and parent in managing mealtimes.

The purpose of this study was to examine the efficacy of a teacher-implemented professional development program to increase the fidelity with which paraeducators use evidence-based practices (EBPs) in instruction for children with autism. Employing a modified multiple-probe design, investigators implemented the Autism Focused Intervention Resources and Modules for Paraprofessionals (AFP) program in four special education and four inclusive classrooms enrolling students with autism. As the teacher initiated features of the AFP program focusing on individual EBPs, level changes in paraeducators' EBP fidelity increased markedly, with replications across paraeducators demonstrating experimental control. Statistical analyses produced large effect sizes, Goal Attainment Scale scores indicated student progress, and participants' ratings reflected strong social validity. School closure due to the COVID-19 pandemic prevented the completion of the study, but the pattern of effects suggests the efficacy of the AFP program as a program of professional development for paraeducators providing instruction for children with autism.

Background: Wild-type transthyretin amyloidosis (ATTRwt amyloidosis) is primarily diagnosed in elderly men but diagnoses in younger patients and women have recently increased. Objectives: The purpose of this study was to examine age- and sex-related differences in patients with ATTRwt amyloidosis enrolled in the THAOS (Transthyretin Amyloidosis Outcomes Survey). Methods: THAOS was a global, longitudinal, observational survey of patients with transthyretin amyloidosis, including both hereditary and wild-type disease, and asymptomatic carriers of pathogenic transthyretin gene variants. Patient characteristics at enrollment were analyzed by age at enrollment and sex (data cutoff date: August 1, 2022). Results: Of 1,251 patients with ATTRwt amyloidosis, 13.7%, 49.1%, 34.5%, and 2.8% were aged