Key influences on the initiation and implementation of inclusive preschool programs

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Concurrent acute illness and comorbid conditions poorly predict antibiotic use in upper respiratory tract infections: a cross-sectional analysis

<p>Abstract</p> <p>Background</p> <p>Inappropriate antibiotic use promotes resistance. Antibiotics are generally not indicated for upper respiratory infections (URIs). Our objectives were to describe patterns of URI treatment and to identify patient and provider factors associated with antibiotic use for URIs.</p> <p>Methods</p> <p>This study was a cross-sectional analysis of medical and pharmacy claims data from the Pennsylvania Medicaid fee-for-service program database. We identified Pennsylvania Medicaid recipients with a URI office visit over a one-year period. Our outcome variable was antibiotic use within seven days after the URI visit. Study variables included URI type and presence of concurrent acute illnesses and chronic conditions. We considered the associations of each study variable with antibiotic use in a logistic regression model, stratifying by age group and adjusting for confounders.</p> <p>Results</p> <p>Among 69,936 recipients with URI, 35,786 (51.2%) received an antibiotic. In all age groups, acute sinusitis, chronic sinusitis, otitis, URI type and season were associated with antibiotic use. Except for the oldest group, physician specialty and streptococcal pharyngitis were associated with antibiotic use. History of chronic conditions was not associated with antibiotic use in any age group. In all age groups, concurrent acute illnesses and history of chronic conditions had only had fair to poor ability to distinguish patients who received an antibiotic from patients who did not.</p> <p>Conclusion</p> <p>Antibiotic prevalence for URIs was high, indicating that potentially inappropriate antibiotic utilization is occurring. Our data suggest that demographic and clinical factors are associated with antibiotic use, but additional reasons remain unexplained. Insight regarding reasons for antibiotic prescribing is needed to develop interventions to address the growing problem of antibiotic resistance.</p

Siblings, peers and adults: Differential effects of models for children with autism. Topics in Early Childhood

Employing typically developing children and adults as models of appropriate behavior for children with autism and other developmental disabilities has been a common practice for more than four decades, and peer modeling serves as one of the theoretical cornerstones of inclusion and related innovations. In addition to examining adult and peer modeling, this study extends previous modeling research by including a subset of peers-siblings. The authors employed a parallel-treatments single-subject design counterbalanced across stimulus sets and replicated across three participants to extend previous research on the effectiveness of peers, siblings, and adults as models for teaching novel language skills to children with autism spectrum disorder. Participants learned the target skills under all three modeling conditions

The Effects of Physical Activity on the On-Task Behavior of Young Children with Autism Spectrum Disorders

The purpose of this study was to examine the effects of adult-directed physical activities conducted during circle time on the on-task behavior of students during a journal-writing activity held immediately after circle. The participants of the study were three male students with Autism Spectrum Disorder (ASD) who attended a full day inclusive kindergarten program. During the last five minutes of morning circle the entire class, including the target participants, engaged in one of three activities that required different amounts of physical exertion (yoga, dance party, or book reading) that were selected randomly by the teacher. On-task behavior data was collected for each participant during the first five minutes of the subsequent journal writing activity. Results found that, in general, movement (yoga and dance party) prior to journal led to higher levels of on-task behavior during journal writing, with different activities yielding different outcomes for individual participants. Implications are that students with ASD would benefit from participating in multiple bouts of planned physical activity across the instructional day

Participatory Research: New Approaches to the Research to Practice Dilemma

The dissemination of research into practice presents an enduring challenge to the social sciences. Despite intervention research focused on individuals with disabilities and their families that reveals clear pathways to improving practice, researchers and practitioners alike express concern regarding limited and slow implementation of the results of research in typical school and community settings. This article reviews three widely disparate literatures concerned with the gap between research and practice, highlighting suggestions for narrowing the gap through the incorporation of elements of practice into the research process. For each of the steps in our research on the social relationships of children and youth, we present examples of participatory research approaches to decision making designed to increase the relevance and validity of findings for everyday practice. We conclude with criteria that might be applied to the design of effective interventions for research validation to increase the likelihood that the results of intervention research will be adopted by school and community constituencies

Developing Culturally Inclusive Services for Individuals with Severe Disabilities

In this position paper, we argue that concerns about race and culture largely have been ignored with respect to students with severe disabilities. We caution, however, that variables such as acculturation, social class, and education must be included in any consideration of cultural identity to avoid stereotyping. Second, we use the term “cultural inclusion” to indicate the need to address cultural features directly when planning for inclusion of students with severe disabilities. In this paper, we propose essentials of a culturally inclusive approach to building relationships with families and to assessment, placement, instruction, and programming for such students. Third, we call for a multicultural emphasis in personnel preparation programs, with a focus on process rather than cultural content. The paper concludes with suggestions for a research agenda

An educational intervention for contextualizing patient care and medical students' abilities to probe for contextual issues in simulated patients

Context: A contextual error occurs when a physician fails to identify elements of a patient’s environment or behavior, such as access to care, that must be addressed in order to appropriately plan care. Research has demonstrated that contextual errors can be identified using standardized patients. Objective: To evaluate an educational intervention designed to increase physicians' skills in incorporating the patient's context in assessment and management of care and to thereby decrease the rate of contextual errors. Design, Setting, and Participants: Quasi-randomized controlled trial, with assessments by blinded observers. Fourth-year medical students (n=124) in internal medicine subinternships at the University of Illinois at Chicago or Jesse Brown VA Medical Center from July 2008 – April 2009 and August 2009 – April 2010 participated and were assessed. Intervention: A 4-hour course on contextualization. Main outcome measures: Probing for contextual issues in an encounter, probing for medical issues in an encounter, and developing an appropriate treatment plan. Outcomes were assessed using 4 previously validated standardized patient encounters performed by each participant, and were adjusted for subinternship site, academic year, time of year, and case scenario. Results: Students who participated in the contextualization workshops were significantly more likely to probe for contextual issues in the standardized patient encounters than students who did not (90% [95% confidence interval {CI}, 87-94% ] vs 62% [95% CI, 54-69%]), and significantly more likely to develop appropriate treatment plans for standardized patients with contextual issues (69% [95% CI, 57-81%] vs 22% [95% CI, 12-32%]. There was no difference between the groups in the rate of probing for medical issues (80% [95% CI, 75-85%] vs 81% [95% CI, 76-86%]) or developing appropriate treatment plans for standardized patient with medical issues (54% [95% CI, 42-67%] vs 66% [95% CI, 53-79%]). Conclusion: Medical students who underwent an education intervention were more likely to contextualize care for individual standardized patients