Search

Schools are mandated to provide transition planning support for individuals with autism spectrum disorder (ASD) who receive special education services in the transition from high school to adulthood. Current research suggests critical gaps in this process that can lead to a number of negative outcomes for youth. It is imperative to better understand the factors that shape the transition planning process for families of individuals with ASD. This qualitative study examined postsecondary expectations among 11 parents of youth with ASD and how family functioning was implicated in parents' formation of and efforts to assist youth in achieving these expectations. Findings suggest parents had similar expectations to those reported in previous studies of families of youth with ASD, and that youth characteristics, family background, and access to support services all shaped those expectations. The study adds to this literature by highlighting the emotional and physical toll parents described in making efforts to help youth achieve these expectations, and the influence of these processes on parent and family life. Together, study findings underscore the need for a family-focused approach to supporting successful postsecondary planning and transition among youth with ASD.

Educators are charged with the task of providing specialized programming to meet individual needs while also ensuring this occurs in the least restrictive environment, with as much inclusion as possible. Research has demonstrated the importance of access to evidence-based practices (EBP) to ensuring positive outcomes on targeted skills for students with autism; however, it is less clear what evidence exists supporting the implementation of these EBPs in a variety of inclusive settings. Thus, the purpose of this literature review was to evaluate the quality and strength of evidence for the implementation of EBPs to improve targeted skills in a variety of inclusive settings for students with autism. The 79 studies that met the inclusion criteria and quality standards included 120 experiments that met the quality standards. The strength of effect varied with 33% demonstrating non-effects, of which 77% demonstrated moderate to strong effects. EBPs have most frequently been evaluated in inclusive whole group settings and less frequently in small group settings. Females, secondary-age participants, and participants with high support needs are rarely included. Social communication is targeted most frequently, whereas academic skills are rarely targeted for improvement in the inclusive literature. Implications for practice and direction for future research are discussed.

Research has established that implementing evidence-based practices with a high procedural fidelity is integral in promoting positive outcomes for students with moderate-to-severe disabilities and more significant support needs. However, special education teachers who teach students with moderate-to-severe developmental disabilities often lack training in adopting and implementing evidence-based practices. This study used a multiple-baseline single-case experimental design to investigate the effects of job-embedded, individualized coaching on a special education teacher's implementation fidelity of systematic instruction for students with disabilities within natural teaching routines. Immediate and maintained increases in the implementation fidelity were found across all systematic instruction components, demonstrating the effectiveness of the individualized coaching intervention. Additionally, a brief social validity assessment at the completion of the study suggested that the coaching procedures were highly acceptable and useful for enhancing the implementation of an evidence-based practice in a natural setting.

Abstract Background Sodium-Glucose Cotransporter-2 inhibitors (SGLT2i) represent a deep revolution of the therapeutic approach to heart failure (HF), preventing its insurgence but also improving the management of the disease and slowing its natural progression. To date, few studies have explored the effectiveness of SGLT2i and, in particular, Dapagliflozin in a real-world population. Therefore, in this observational prospective study, we evaluated Dapagliflozin's effectiveness in a real-world HF population categorized in the different hemodynamic profiles. Methods From January 2022 to June 2023, we enrolled 240 patients with chronic HF and reduced ejection fraction (HFrEF) on optimal medical therapy, according to 2021 ESC guidelines, that added treatment with Dapagliflozin from the HF Clinics of 6 Italian University Hospitals. Clinical, biochemical, and echocardiographic parameters were collected before and after 6 months of Dapagliflozin introduction. Moreover, the HFrEF population was classified according to hemodynamic profiles (A: SV ≥ 35 ml/m2; E/e′

Abstract Aims We report the results of a real‐world study based on heart failure (HF) patients' continuous remote monitoring strategy using the CardioMEMS system to assess the impact of this device on healthcare outcomes, costs, and patients' management and quality of life. Methods and results We enrolled seven patients (69.00 ± 4.88 years; 71.43% men) with HF, implanted with CardioMEMS, and daily remote monitored to optimize both tailored adjustments of home therapy and/or hospital infusions of levosimendan. We recorded clinical, pharmacological, biochemical, and echocardiographic parameters and data on hospitalizations, emergency room access, visits, and costs. Following the implantation of CardioMEMS, we observed a 50% reduction in the total number of hospitalizations and a 68.7% reduction in the number of days in the hospital. Accordingly, improved patient quality of life was recorded with EQ‐5D (pre 58.57 ± 10.29 vs. 1 year post 84.29 ± 19.02, P = 0.008). Echocardiographic data show a statistically significant improvement in both systolic pulmonary artery pressure (47.86 ± 8.67 vs. 35.14 ± 9.34, P = 0.022) and E/e′ (19.33 ± 5.04 vs. 12.58 ± 3.53, P = 0.023). The Quantikine® HS High‐Sensitivity Kit determined elevated interleukin‐6 values at enrolment in all patients, with a statistically significant reduction after 6 months (P = 0.0211). From an economic point of view, the net savings, including the cost of CardioMEMS, were on average €1580 per patient during the entire period of observation, while the analysis performed 12 months after the implant vs. 12 months before showed a net saving of €860 per patient. The ad hoc analysis performed on the levosimendan infusions resulted in 315 days of hospital avoidance and a saving of €205 158 for the seven patients enrolled during the observation period. Conclusions This innovative strategy prevents unplanned access to the hospital and contributes to the efficient use of healthcare facilities, human resources, and costs.

Abstract During the Roman age, the southern promontory of the gulf of Baia was the perfect location for the construction of villae maritimae for the Roman élite that decided to spend their summer residences by the sea. One of these residences is now located in the military fortress of the Castello Aragonese di Baia, built in 1495 CE during the Aragonese period (15th century). Here, during restoration works, the ruins of the residential sector of the villa, which historical sources ascribe to Caesar, were unearthed. The most representative evidence of this is the outstanding in situ remain of mosaics, decorated plasters and finely frescoed surfaces decorated according to the repertoire of the II style. This research aims to investigate the polychromy of a wall decoration representing a perspective depiction of architectural scenes en trompe l'oeil analysed by means of a multi-analytical, non-destructive approach performed in situ. The combined use of spectroscopic techniques (portable X-ray fluorescence, Raman and Fourier Transform Infrared Spectroscopy) points out the use of a characteristic Roman palette, quantitatively assessed by colorimetric measurements. It consists of red and yellow ochre, calcite, hematite, organic black pigments, precious materials such as cinnabar and Egyptian blue, green copper compounds. Fourier Transform Infrared Spectroscopy also revealed the presence of synthetic resins, likely used for the conservation of mural paintings. These are, however, damaged by atmospheric humidity, as detected by Infrared Thermography. Gypsum has been identified as the main weathering product.

The aim of these evidence-based guidelines is to present a consensus position from members of the Italian Unitary Society of Colon-Proctology (Società Italiana Unitaria di Colon-Proctologia, SIUCP) on the diagnosis and management of hemorrhoidal disease, with the goal of guiding physicians in the choice of the best treatment option. A panel of experts was charged by the Board of the SIUCP to develop key questions on the main topics related to the management of hemorrhoidal disease and to perform an accurate and comprehensive literature search on each topic, in order to provide evidence-based answers to the questions and to summarize them in statements. All the clinical questions were discussed by the expert panel in multiple rounds through the Delphi approach and, for each statement, a consensus among the experts was reached. The questions were created according to PICO (patients, intervention, comparison, and outcomes) criteria, and the statements were developed adopting the GRADE (Grading of Recommendations, Assessment, Development, and Evaluations) methodology. In cases of grade 1 hemorrhoidal prolapse, outpatient procedures including hemorrhoidal laser procedure and sclerotherapy may be considered the preferred surgical options. For grade 2 prolapse, nonexcisional procedures including outpatient treatments, hemorrhoidal artery ligation and mucopexy, laser hemorrhoidoplasty, the Rafaelo procedure, and stapled hemorrhoidopexy may represent the first-line treatment options, whereas excisional surgery may be considered in selected cases. In cases of grades 3 and 4, stapled hemorrhoidopexy and hemorrhoidectomy may represent the most effective procedures, even if, in the expert panel opinion, stapled hemorrhoidopexy represents the gold-standard treatment for grade 3 hemorrhoidal prolapse.

Many children with developmental delays need early intervention services but do not receive them. Developmental screening provides the impetus for identification of delays and service referrals but is not used consistently across all early childhood education settings. We used an implementation science framework to examine attitudes and engagement in a developmental screening program across three U.S. early childcare centers. Teachers demonstrated adequate knowledge of screening following training in the screener and were highly engaged in the screening process. Teachers' positive attitudes toward screening increased yet perceived barriers to regular use of screening in their practice remained unchanged. Family participation in the screening process varied across centers and suggested a trend between family income and participation. Future research is needed to target pervasive barriers to teachers' use of screening, such as perceived difficulties in engaging parents in the screening process.

The proportion of older adults using medical cannabis is rising. Most of the cannabinoid research has focused on a healthy, younger population free from frailty and major comorbidity. In this case report, we describe an 82-year-old woman who was autonomous in basic and instrumental activities of daily living and who came to our geriatric department for marked weight loss over the past 2 months (about 10 kg) and anemia. After appropriate clinical and endoscopic checks, it was concluded that the weight loss was induced by the initiation of therapy with oral cannabis for the control of rheumatic pain.

Ieramilimab, a humanized anti-LAG-3 monoclonal antibody, was well tolerated in combination with the anti-PD-1 antibody spartalizumab in a phase 1 study. This phase 2 study aimed to further investigate the efficacy and safety of combination treatment in patients with selected advanced (locally advanced or metastatic) solid malignancies. Eligible patients with non-small cell lung cancer (NSCLC), melanoma, renal cell carcinoma (RCC), mesothelioma, and triple-negative breast cancer (TNBC) were grouped depending on prior anti-PD-1/L1 therapy (anti-PD-1/L1 naive or anti-PD-1/L1 pretreated). Patients received ieramilimab (400 mg) followed by spartalizumab (300 mg) every 3 weeks. The primary endpoint was objective response rate (ORR), along with safety, pharmacokinetics, and biomarker assessments. Of 235 patients, 142 were naive to anti-PD-1/L1 and 93 were pretreated with anti-PD-1/L1 antibodies. Durable responses (>24 months) were seen across all indications for patients naive to anti-PD-1/L1 and in melanoma and RCC patients pretreated with anti-PD1/L1. The most frequent study drug-related AEs were pruritus (15.5%), fatigue (10.6%), and rash (10.6%) in patients naive to anti-PD-1/L1 and fatigue (18.3%), rash (14.0%), and nausea (10.8%) in anti-PD-1/L1 pretreated patients. Biomarker assessment indicated higher expression of T-cell-inflamed gene signature at baseline among responding patients. Response to treatment was durable (>24 months) in some patients across all enrolled indications, and safety findings were in accordance with previous and current studies exploring LAG-3/PD-1 blockade.

Spreadsheet simulation models provide a powerful method for estimating many different types of probabilities. Here we focus on estimating probabilities involving order statistics. We look at what happens to the distributions for a complete range of order statistics and consider applications using both uniform and exponential distributions as the base distribution. We also demonstrate how simulation and order statistics can be used to estimate binomial and hypergeometric probabilities.

Early childhood special education teachers require training and support in implementing function-based intervention for challenging behavior. Yet, teacher professional development practices are not universally effective, and teachers may benefit from differentiated supports. The purpose of this study was to pilot and evaluate a multilevel approach to teacher professional development for function-based intervention. The multilevel approach included behavioral skills training, practice-based coaching, and teacher self-monitoring and was evaluated using a multiple baseline across participants single-case research design. Results demonstrated that while all teachers benefited from the professional development, teachers required different levels of support within the multilevel approach. These findings support a growing body of work suggesting that teachers may require varying levels of support to implement evidence-based practices.

Abstract Poaching is again driving rhinos to the brink of extinction due to the demand for rhino horn products consumed for cultural, medicinal, and social purposes. Paradoxically, the same horn for which rhinos are killed may contain valuable clues about the species’ health. Analyses of horn composition could reveal such useful bioindicators while elucidating what people actually ingest when they consume horn derivatives. Our goals were to quantify minerals (including metals) in rhino horn and investigate sampling factors potentially impacting results. Horns (n = 22) obtained during necropsies of white (n = 3) and black (n = 13) zoo rhinos were sampled in several locations yielding 182 specimens for analysis. Initial data exposed environmental (soil) contamination in the horn’s exterior layer, but also confirmed that deep (≥ 1 cm), contaminant-free samples contained measurable concentrations of numerous minerals (n = 18). Of the factors examined in deep samples, color-associated mineral differences were the most profound with dark samples higher in zinc, copper, lead, and barium (p

Abstract The Global Navigation Satellite System (GNSS) is widely used for air traffic management—more than 150,000 aircraft and 5000 airports worldwide are equipped with SBAS (Satellite-based augmentation system) technology, which contributes to safer and more efficient air operations. The next challenge is to extend GNSS positioning to maritime, autonomous cars and railway control systems preserving their safety requirements. The main parameter is the integrity of the GNSS positioning, although the time for which the integrity is guaranteed, defined by continuity, the most demanding requirement for aviation applications, has not been sufficiently investigated for land transportation. The aim of this paper is to close this gap by clarifying: (1) where the requirement for GNSS continuity comes from, (2) why GNSS continuity is needed in land transport, and (3) how GNSS-based applications can be made more reliable when needed. Using a comparative analysis, the continuity requirements in aviation, rail, maritime, and road transport have been investigated showing their importance for railways and automotive control, paving the way to eventually update the current EN 50126 (RAMS) and ISO/TR 4804 standards respectively for railways and automated cars. One of the main findings, through Markov modeling, is the improvement of the Mean Time to System Failure (MTTFsys) that for the railway safety-of-life applications can be significantly increased from about 521 h up to 5 × 105 h. These results can contribute to accelerating the adoption of GNSS positioning for automated land transportation, by exploiting the extensive experience brought by the aviation sector where GNSS was introduced 20 years ago.

Apresentamos neste trabalho uma abordagem pedagógica da descrição do núcleo atômico a partir do modelo de camadas. A análise proposta está alicerçada na equação de Schrödinger. Neste sentido, analisamos dois sistemas, ambos baseadas na teoria de campo médio, em que as interações nucleares e eletromagnéticas são modeladas por osciladores harmônicos, mas que em um deles a interação entre os spins dos núcleons é considerada. Como resultado, alguns aspectos do núcleo foram explicados, onde merece destaque a obtenção dos números mágicos nucleares. Assim, a abordagem proposta pode ser utilizada em cursos de mecânica quântica, como aplicação da equação de Schrödinger, bem como em disciplinas de física e engenharia nuclear.

Between 2018 and 2023, the Department of Environmental, Land and Infrastructure Engineering (DIATI) at the Polytechnic University of Turin (PoliTo) implemented a project to advance research and education on climate change monitoring, adaptation and mitigation solutions. As part of their communication efforts, DIATI partnered with Faber Teater to create the play “Cambiare il clima” (in Italian, this means “Change the Climate”).This involved a collaboration between DIATI researchers, communication officers, and Faber Teater. The documentary theater that resulted was premiered at Biennale Tecnologia in 2020 and performed at various venues in Northern Italy, targeting both the general public and students.

Despite substantial empirical support, correlates of retention and success in community-based parent-child interaction therapy (PCIT) implementation are not well defined. Widespread application of PCIT necessitates improved understanding of intervention components relating to family outcomes beyond highly controlled research trials. Using data collected as part of routine care, this study examined homework completion, time in intervention, and parent perceptions of pre-intervention behavioral issues as predictors of PCIT completion in a community-based sample. Subjects included 78 parents (49 women and 29 men) of 45 children (20 girls, 25 boys; mean age = 5.53 years) participating in PCIT in an outpatient behavioral health clinic in a small Midwestern U.S. city. Unlike previous controlled trials, homework completion did not predict child behavior growth or intervention completion. Reasons for early termination were examined thematically, and parent stress emerged as a possible avenue for future intervention in helping parents successfully complete PCIT. The issue of intervention dosage was also explored to see if families who prematurely terminated from PCIT still evidenced gains in child behavior.

Acute colonic pseudo-obstruction (ACPO), also known as Ogilvie’s syndrome, is an uncommon postoperative complication of major orthopedic surgery that is characterized by massive colonic dilatation and the potential for substantial morbidity and mortality. Most patients who had Ogilvie’s syndrome had risk factors that could be identified preoperatively, such as immobility, elevated comorbidity, and polypharmacy, prefiguring the frail elderly patient. In modern terms, it is considered a typical orthogeriatric syndrome. In these kinds of patients, we need to be vigilant for its development and judicious in the use of epidural anesthesia. We present an ACPO case in an elderly frail patient with a hip fracture, and we review the available literature to outline clinical characteristics and outcomes. Our patient presented numerous risk factors for developing the syndrome in the preoperative period: nonautonomy in basic and daily living activities, polypharmacotherapy, spinal trauma, and hyposodiemia. In this patient, epidural anesthesia was an additional risk factor. The purpose of this case report is to emphasize the presence of this rare syndrome (1.5% of orthogeriatric patients) in orthogeriatric departments and to identify not only pharmacological, traumatic, and electrolytic risk factors but also those that can be identified even through geriatric evaluation to avoid the use of anesthesiologic techniques and drugs that may have an impact on the prognosis of these patients.

The practice of including students with disabilities in art education has existed longer than efforts to increase access to general academic instruction. However, most teacher education programs do not offer sufficient coursework or field experiences in training pre-service art teachers to teach students with disabilities. To examine how pre-service art teachers are trained to provide inclusive art instruction, semi-structured interviews were conducted with art education faculty and instructors across six institutions in the Midwest of United States and interview data were systematically analyzed at three levels, including within case, cross case, and conversation. Results indicate that while all programs offer a required course related to special education, exposure to students with disabilities in field experiences is limited and collaboration between art teachers and special education teachers or paraprofessionals is not emphasized. Recommendations for strengthening teacher education programs in teaching art to students with disabilities are offered based on study findings.

Objective: We propose a modular stretchable coil design using conductive threads and commercially available embroidery machines. The coil design increases customizability of coil arrays for individual patients and each body part. Methods: Eight rectangular coils were constructed with custom-fabricated stretchable tinsel copper threads incorporated onto textile. Tune, match, and detune circuits were incorporated on the coil. A hook-and-loop mechanism was used to attach and decouple the modular coils. Phantom and in vivo scans at various anatomical flexion angles were acquired to highlight performance, and a temperature test was performed to verify safety. Results: In vivo MRI experiments demonstrate high sensitivity and coverage of each anatomy. As the coils are stretched, the sensitive volume increases at a rate of 10.93 mL/cm2. The SNR reduction of a single coil was greater during compression than when stretched, but this did not affect image quality for the array. The modularity of the array allows for adaptability for any anatomy with simple on-demand adjustment to the number and position of coil elements. Conclusion: The images demonstrated high sensitivity and coverage of the stretchable array for various anatomies and flexion angles. Stretching the coils increases the sensitive volume, allowing for a larger region to be effectively imaged. The resonance shift and SNR decrease during stretch and compression support further investigation of methods to reduce frequency shift in stretchable coils. Significance: The proposed array design allows for highly stretchable, flexible, modular, and conformal patient-centered coils that allow for increased imaging quality, greater comfort, and rapid production.

Technology has been widely used to teach reading skills to students with autism spectrum disorder (ASD), but the quality of research backing up this practice has not yet been fully investigated. The purpose of this review was to examine the quality of research on technology-aided reading interventions for students with ASD and summarize study characteristics of research studies with meeting the What Works Clearinghouse (WWC) design standards. A total of 31 studies using group design (n = 4) or single-case design (n = 27) were systematically aggregated, and 16 studies (52%) met the WWC design standards. Study features related to participants, intervention, technology usage, and outcome variables were synthesized for these 16 studies. Results indicated that two types of technology (i.e., computer, iPad) were used to deliver reading instruction through software programs or support interventionist-directed reading instruction. Finally, implications for research and practice are discussed.

Abstract Alteration of basaltic glass and in situ mineral growth are fundamental processes that influence the chemical and material properties of Earth’s oceanic crust. These processes have evolved at the basaltic island of Surtsey (SW Iceland) since eruptions terminated in 1967. Here, subaerial and submarine lapilli tuff samples from a 192 m-deep borehole drilled in 2017 (SE-02b) are characterized through petrographic studies, X-ray powder diffraction analyses, and SEM–EDS imaging and chemical analyses. The integrated results reveal (i) multi-stage palagonitization processes in basaltic glass and precipitation of secondary minerals from matrix pore fluids, (ii) multi-stage crystallization of secondary phillipsite, analcime and Al-tobermorite in the vesicles of basaltic pyroclasts and (iii) variations in palagonitization processes as a function of thermal and hydrological domains. Although temperature appears to be an important factor in controlling rates of secondary mineralization, the chemistry of original basaltic components and interstitial fluids also influences reaction pathways in the young pyroclastic deposits. The integration of systematic mineralogical analyses of the 50-year-old tuff from one of the most carefully monitored volcanic sites on Earth, together with temperature monitoring in boreholes since 1980, provide a reference framework for evaluating mineralogical evolution in other Surtseyan-type volcanoes worldwide.

Severe non-infectious or non-haemorrhagic brain edema surrounding the electrode represents a rare complication of subthalamic nucleus deep brain stimulation (STN-DBS) surgery. The aim of this study is to report three patients with advanced Parkinson’s Disease (PD) who developed symptomatic brain edema after STN-DBS surgery treated with intravenous steroids with a specific profile of reversible cognitive alterations. Patients were both assessed with a comprehensive neuropsychological battery including attention, memory, visuo-spatial and executive tasks. They were also briefly assessed for emotional and behavioural alterations, and for possible limitations in the activities of daily living. Normative data for an Italian population were available for all neuropsychological tests. The patients were firstly assessed before the surgery (baseline) as soon as they became symptomatic for the post-surgery edema and a few more times in follow-up up to ten months. In all patients we observed the resolution of cognitive deficits within six months after surgery with the corresponding reabsorption of edema at brain CT scans. The appearance of post-DBS edema is a fairly frequent and clinically benign event. However, in some rare cases it can be very marked and lead to important clinical—albeit transient—disturbances. These events can compromise, at least from a psychological point of view, the delicate path of patients who undergo DBS and can prolong the post-operative hospital stay. In this setting it could be helpful to perform a brain CT scan in 2–3 days with the aim of detecting the early appearance of edema and treating it before it can constitute a relevant clinical problem.