Teaching rejecting response using wrong-item format embedding into missing-item format for children with developmental disabilities

textMands, of which requesting and rejecting responses are considered subclasses, are the first emerging communication functions that allow children to express their wants and needs. While typically developing children develop speech without specifically designed intervention, many children with autism and developmental disabilities are likely to rely on prelinguistic communication forms that are socially and developmentally inappropriate or unacceptable until symbolic forms of functional communication are taught. A review of the literature on teaching mands indicates that although there is an abundance of research addressing teaching communicative requesting behaviors, rarely have studies attempted to teach communicative rejecting. The purpose of this study was to create rejecting opportunities using the wrong-item format embedded into the missing item format, and to teach socially appropriate rejecting response using AAC for four children with autism and developmental disabilities. This study employed a multiple probe design across four participants to examine the effectiveness of the procedure. Results indicated that the wrong-item format embedded into the missing-item format was effective in teaching symbolic forms of rejecting responses using VOCAs and PECS. The results were generalized across two untrained activities and were maintained up to four weeks following the termination of generalization probes for three participants. The implications and limitations of this study, as well as potential topics for future research are also discussed.Special Educatio

Bronchiectasis exacerbation:a narrative review of causes, risk factors, management and prevention

Background and Objective: Bronchiectasis exacerbations are significant events in the natural course of the disease and determine long-term clinical outcomes. This review aims to discuss the definition, causes, risk factors, management and prevention of bronchiectasis exacerbations.Methods: The PubMed database was searched for relevant articles published in English between January 1990 and March 2022 using keywords "bronchiectasis" and "exacerbation".Key Content and Findings: Causes of bronchiectasis exacerbation are multifactorial; it can be associated with bacterial and viral pathogens, host inflammatory responses, and external environmental effects. In addition, recent advances in bronchiectasis research highlight the phenotype of patients who are more prone to exacerbations, including those with chronic Pseudomonas aeruginosa infection, worse symptoms, greater lung inflammation and comorbid airway diseases. Once bronchiectasis exacerbations occur, antibiotics are the mainstay treatment. Preventing exacerbations is of paramount importance because frequent exacerbations are linked to a detrimental disease course and higher mortality. To prevent frequent exacerbations, clinicians should attempt to understand the risk factors for exacerbation that are amenable to therapeutic intervention: so called "treatable traits". Treatments are personalised but include improving mucociliary clearance by physiotherapy and mucoactive therapy, reducing airway infection by inhaled antibiotics, and inflammation by long-term macrolide or in specific subpopulations, inhaled corticosteroids (ICS). Novel approaches to prevent exacerbations including direct anti-inflammatory therapies are in development for bronchiectasis.Conclusions: Future research is needed to better manage and prevent exacerbations in patients with bronchiectasis, although recent studies have characterised frequent exacerbator phenotype and enhanced our understanding of various aspects of exacerbations.</p