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Training key stakeholders in the design of reasonable adjustments for students with disabilities could promote collaboration and inclusion. We tested the feasibility of a randomized controlled trial to evaluate the effectiveness of online education (intervention) in designing reasonable adjustments by Victorian (Australian) parents and professionals (n = 31). Participants suggested reasonable adjustments for contrived students with varied needs to support their participation in described classroom activities. Data collected pre- and post-intervention, and, at follow-up, were rated across five dimensions: Authenticity, Agency, Real Learning, Strengths Based, and Inclusion. Analyses from 15 intervention and 14 control participants (10 parents, 10 teaching staff, and 9 allied health professionals) showed higher scores for Inclusion post-intervention for the intervention group. This difference was maintained at follow-up, generalized to a new contrived student scenario, and mostly attributable to parents. Online education may improve parents' contribution in the design of reasonable adjustments that promote inclusion. A larger study is warranted.

The study aim was to scope research into student outcomes of co-teaching models to promote inclusive school education for students with disability. A systematized search was conducted of studies addressing models of co-teaching involving two teachers and student outcomes published from January 2008 to June 2019. Each study was appraised for quality. Most of 21 studies that met inclusion criteria were conducted in the United States (n = 17). Fourteen studies followed quantitative approaches, six followed qualitative and one included both. Although the benefits of co-teaching for students were demonstrated, it was difficult to determine comparative effectiveness across models, with only one study providing a systematic comparison. There was some evidence of differential effects across factors such as disability type, grade level, and outcome types, but heterogeneity across study aims, participants characteristics, extent to which co-teaching models were described or implemented, and outcomes targeted precluded meaningful comparisons. Limitations were found in study designs, with appraisal scores ranging from 0.6% to 89%. Hence, the research into student outcomes for various models of co-teaching was found to be limited both in number and quality. Findings point to the need for greater attention to what occurs in classrooms to support positive student outcomes of inclusive education through co-teaching.

Background: We investigated the context for translating evidence-based early intervention for autism spectrum disorders (ASD) into real world settings through a case study of a regional town characterised as disadvantaged. Methods: Data were from interview surveys of five managers reporting on 15 services, and surveys from 19 practitioners and 15 mothers of young children with ASD. Results: The 15 services were multidisciplinary, offering diagnostic assessments (n = 2) and interventions delivered in the home and centres. Children were diagnosed at a mean age of 3 years; access to intervention was delayed and mostly limited to one session every two weeks. Some families travelled substantial distances to services, driving on average 50 minutes each way. Practitioners described intervention strategies in broad terms, rather than name interventions. Conclusions: Services available to young children with ASD in this town were far removed from good practice in terms of early diagnosis, and intervention frequency and intensity.

School inclusion of students with disabilities relies on reasonable adjustments to curriculum and class activities. The Reasonable Adjustments for Inclusive Education (RAIE) was designed to elicit reasonable adjustments from stakeholders in mainstream school inclusion for three contrived students with varied learning needs. We evaluated a scale for rating the quality of elicited reasonable adjustments across five dimensions: Agency, Authenticity, Real Learning, Strengths Based, and Inclusion. A trial (n = 5 participants) led to refinement of the scale, which was tested for inter-rater reliability with data from a randomized controlled trial (RCT) of an intervention to improve the quality of reasonable adjustments. RCT participants (10 parents, 10 educators, nine allied health professionals) provided 596 reasonable adjustments, rated for each dimension by two independent raters (n = 2980 ratings). Overall agreement was 75.3%; intraclass correlation (ICC) was.778. ICCs were moderate-good (.612–.816). Further refinement and testing with multiple raters are recommended. [ABSTRACT FROM AUTHOR]

Ambulatory polysomnography (PSG) does not commonly include an objective measure of light to determine the time of lights off (Loff), and thus cannot be used to calculate important indices such as sleep onset latency and sleep efficiency. This study examined the technical specifications and appropriateness of a prototype light sensor (LS) for use in ambulatory Compumedics Somte PSG.Two studies were conducted. The first examined the light measurement characteristics of the LS when used with a portable PSG device, specifically recording trace range, linearity, sensitivity, and stability. This involved the LS being exposed to varying incandescent and fluorescent light levels in a light controlled room. Secondly, the LS was trialled in 24 home and 12 hospital ambulatory PSGs to investigate whether light levels in home and hospital settings were within the recording range of the LS, and to quantify the typical light intensity reduction at the time of Loff. A preliminary exploration of clinical utility was also conducted. Linearity between LS voltage and lux was demonstrated, and the LS trace was stable over 14 hours of recording. The observed maximum voltage output of the LS/PSG device was 250 mV, corresponding to a maximum recording range of 350 lux and 523 lux for incandescent and fluorescent light respectively. At the time of Loff, light levels were within the recording range of the LS, and on average dropped by 72 lux (9–245) in the home and 76 lux (4–348) in the hospital setting. Results suggest that clinical utility was greatest in hospital settings where patients are less mobile. The LS was a simple and effective objective marker of light level in portable PSG, which can be used to identify Loff in ambulatory PSG. This allows measurement of additional sleep indices and support with clinical decisions. [ABSTRACT FROM AUTHOR]

Telehealth offers the potential to address inequalities in autism service access for young children living in regional and rural areas with limited access to autism specialists. Our aim was to explore parent and practitioner uses of technology, and views about telehealth, including perceived barriers, for autism early intervention service delivery in a regional town in Australia. Fifteen mothers and 19 front-line autism practitioners completed surveys distributed by local autism service and support providers in the regional town; eight front-line practitioners from one service participated in interviews. Mothers and practitioners had access to technology that could be used for video-communication, but had little or no experience with telehealth. Mothers appeared more willing to try telehealth for receiving autism services than practitioners appeared to believe, and practitioners preferred to use it for consulting with other professionals and professional development. Barriers to telehealth included limited experience and practitioners not knowing what a telehealth service would look like, poor access to reliable and high speed internet, lack of skill and technical supports, and practitioners believing families preferred face-to-face services. The success of telehealth in this regional town will rely on better infrastructure, and upskilling practitioners in evidence-based autism interventions so they can provide the required support remotely. Use of telehealth to upskill practitioners in evidence-based practice could provide a first step in ensuring equitable access to expert autism services to regional and rural families. [ABSTRACT FROM AUTHOR]

BACKGROUND: When polysomnography is indicated in a patient with a presumed sleep disorder, continuous monitoring of arterial carbon dioxide tension (PaCO2 ) is desirable, especially if nocturnal hypoventilation is suspected. Transcutaneous CO2 monitors (PtcCO2 ) provide a noninvasive correlate of PaCO2 , but their accuracy and stability over extended monitoring have been considered inadequate for the diagnosis of hypoventilation. We examined the stability and accuracy of PtcCO2 measurements and the performance of a previously described linear interpolation technique designed to correct for calibration drift. METHODS: We compared the PtcCO2 values from 2 TINA TCM-3 monitors to PaCO2 values from arterial blood samples obtained at the beginning, every 15 min of the first hour, and then hourly over 8 hours of monitoring in 6 hemodynamically stable, male, intensive care patients (mean age 46 17 y). RESULTS: Time had a significant (P .002) linear effect on the PtcCO2 -PaCO2 difference, suggesting calibration drift over the monitoring period. We found no differences between monitor type or interaction between time and monitor type. For the 2 monitors the uncorrected bias was 3.6 mm Hg and the limits of agreement were 5.1 to 12.3 mm Hg. Our linear interpolation algorithm improved the bias and limits of agreement to 0.4 and 5.5 to 6.4 mm Hg, respectively. CONCLUSIONS: Following stabilization and correction for both offset and drift, PtcCO2 tracks PaCO2 with minimal residual bias over 8 hours of monitoring. Should future research confirm these findings, then interpolated PtcCO2 may have an increased role in detecting sleep hypoventilation and assessing the efficacy of treatment. [ABSTRACT FROM AUTHOR]

Objectives: To explore if there are differences in shift patterns and work-related factors between metropolitan and regional/rural healthcare shift workers and their risk of poor sleep and mental health. Furthermore, explore whether these factors impact on medical errors, workplace and car/near car accidents., Design: A cross-sectional study., Setting: An anonymous online survey of healthcare shift workers in Australia., Participants: A total of 403 nurses, midwives and paramedics completed the survey., Main Outcome Measures: Sample characteristics, employment location, shift work-related features, sleep and mental health measurements, workplace accidents, medical errors and car/near car accident post shift., Results: Regional/rural healthcare shift workers were significantly older, had more years' experience, worked more nights, on-call and hours per week. Those in metropolitan areas took significantly longer (minutes) to travel to work, had higher levels of anxiety, increased risk of shift work disorder, reported significantly more workplace accidents and were more likely to have a car/near car accident when commuting home post shift. Both groups reported ~25% having a medical error in the past year. Workplace accidents were related to more on-call shifts and poor sleep quality. Medical errors were associated with fewer years' experience, more evening shifts and increased stress. Car accidents were associated with metropolitan location and increased depression., Conclusion: Differences in work-related factors between metropolitan and regional/rural healthcare shift workers were observed. Some of these factors contributed to occupational health and safety risks. Further exploration is needed to understand how to reduce occupational health and safety risks, and improve employee and patient safety both in both regional/rural and metropolitan areas., (© 2023 The Authors. Australian Journal of Rural Health published by John Wiley & Sons Australia, Ltd on behalf of National Rural Health Alliance Ltd.)

Background and Objective: Melatonin in breast milk exhibits a 24-hour circadian rhythm, present in nighttime breast milk but nearly undetectable in daytime breast milk. Shift work can disrupt the circadian timing of individuals, evident in changes in melatonin in saliva and urine samples. However, it is unknown whether these changes are also reflected in breast milk from a shift working mother. The aim of this study was to investigate whether maternal circadian rhythm disturbance from shift work impacts the melatonin concentration in breast milk. Materials and Methods: Breast milk and saliva samples were collected from 11 shift working mothers at four timepoints across five consecutive days. This included during their day shift or nonworkdays to act as a control, night shift, subsequent night shifts and postnight shift. Where possible, pre- and postfeed collections were also undertaken. Samples were grouped into four-time intervals: 12-6:30 am, 7-11:30 am, 12-6:30 pm, 7-11:30 pm, and melatonin levels (picogram per milliliter) in the breast milk and saliva samples were analyzed. Results: There was a significant decrease in breast milk melatonin ( p  = 0.026) at the 12-6:30 am time interval on subsequent night shifts, compared with control days. However, there was no overall time and shift type interaction effect ( p  = 0.70). In addition, no observed difference in melatonin levels was found in saliva samples, or when comparing pre- and postfeed breast milk. Breast milk melatonin however was found to be significantly higher compared with saliva ( p  > 0.001), at all but one time interval. Conclusion: The findings suggest that there is a potential effect of maternal circadian rhythm disruption from shift work on breast milk melatonin levels. This is an important step in exploring the role of maternal circadian timing and the effect on breast milk composition. Expansion of this research and exploration of other circadian rhythm misalignment sleep disorders on breast milk is highly recommended.

Background and Objective: There is a question as to whether melatonin levels in breast milk are impacted by the cooling rate postpasteurization. Past research that has used in the Australian donor bank's breast milk Holder Pasteurization technique has reported varying findings regarding melatonin levels postpasteurization. Where breast milk was cooled slowly, a significant reduction in breast milk melatonin levels was observed. Conversely, where a rapid cooling method was used, there was no significant reduction in melatonin levels. The aim of this study was to investigate whether the cooling process between the different pasteurization techniques impact on melatonin levels in breast milk postpasteurization. Materials and Methods: Twenty-seven nighttime breast milk samples were collected, with each sample divided into three; one remained unpasteurized, one was pasteurized and rapidly cooled to 4°C, and the other was pasteurized and cooled slowly to 4°C. Results: Melatonin levels were significantly reduced in both the rapidly cooled and slow cooled breast milk samples when compared to their unpasteurized counterpart ( p  < 0.001). There was no significant difference in melatonin levels between the two cooling methods ( p  = 0.91). Conclusion: This study showed that both the rapid and cooling pasteurization processes had a similar reduction in melatonin levels in breast milk. However, even after pasteurization melatonin was still present. Therefore, it is recommended that donor banks still take into consideration circadian timing hormones such as melatonin and the time of day breast milk is expressed.