Classroom Variables and Access to the General Curriculum for Students With Disabilities

This is the published version, also found here: http://cec.metapress.com/content/g60x7rn128875233/?p=278b5ff7212a461facb598da9f5d0cff&pi=5This study investigated the degree to which students with intellectual and developmental disabilities have access to the general education curriculum and the degree to which such access is related to and predicted by classroom setting and ecological variables. We observed 19 students during science or social studies instruction and collected data with Access CISSAR, a computer-based observation system that uses time sampling observation. The results of the study indicated that accommodations and modifications were provided depending on the amount of time students were educated with their nondisabled peers. Further, one-on-one or independent instructional groupings were better predictors of access than whole-group instruction, as were entire or divided group physical arrangements

Impact of curriculum modifications on access to the general education curriculum for students with disabilities

This is the publisher's version, also found here: http://cec.metapress.com/content/4r15312203720k10/?p=894108fe09e449b9a6b0c2c7538086b1&pi=4This study investigated whether curriculum modifications predicted student and teacher behaviors related to the general education curriculum and if there were differences in ecological, student, and teacher variables depending on the presence of such curriculum modifications. The study observed 45 high school students with disabilities during instruction in core content areas. Findings indicated that there were significant differences in student and teacher variables depending on the presence of curriculum modifications. When curriculum modifications were provided, students were engaged in more academic-related responses and fewer competing behaviors and teachers were engaged in fewer classroom management activities. Implications and recommendations from these findings are provided pertaining to the importance and implementation of curriculum modifications for students with disabilities in general education settings

Examining individual and ecological predictors of the self-determination of students with disabilities

This is the publisher's version, also found here: http://cec.metapress.com/content/x680x4m0826t85k0/?p=20877da369544f8d9cbd0284aee95022&pi=5This article examines the impact of multiple individual and ecological factors on the self-determination of students with learning disabilities, mild and moderate mental retardation, and other health impairments. Baseline data from a multistate, longitudinal research project evaluating interventions to promote self determination were examined using structural equation modeling. The findings suggest that teachers viewed students' capacity for self-determination differently based on level of cognitive impairment, but not students' opportunities for self-determination. Capacity, opportunity, and transition empowerment predicted students' self-reported level of self-determination, but the degree to which students were included in general education did not. Significant differences emerged in the pattern of predictive relationships, however, depending on the measure of self-determination utilized. Also discussed are implications for research and practice

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

The Effect of Erythromycin on Resolution of Symptoms Among Adults with Pharyngitis Not Caused by Group A Streptococcus

OBJECTIVE: To determine the effect of treatment with erythromycin on the resolution of symptoms among adults with pharyngitis not caused by group A streptococcus (GAS). DESIGN: Randomized, double-blind, placebo-controlled trial. SETTING: Ambulatory setting (hospital-based general internal medicine practices, walk-in clinic, employee health service, and university health service). PATIENTS: One hundred and eighty-six adults who met eligibility criteria and whose chief complaint included sore throat. Patients with positive cultures for GAS were excluded. INTERVENTION: Ninety-three patients received erythromycin (333 mg three times daily for 10 days) and 93 control patients received placebo. MEASUREMENTS AND MAIN RESULTS: Major outcome measurements included time to improvement in sore throat, time to improvement in cough, time to improvement in activity level, and subjective sense of well-being. The average age of the patients studied was 26.6 years; 35% were men. Patients given erythromycin had more rapid resolution of sore throat symptoms (hazard ratio 1.43; 95% confidence interval [CI] 1.00, 2.03; p = .049). Cough also resolved more rapidly in patients receiving erythromycin (hazard ratio 2.22; 95% CI 1.01, 4.88; p = .05). There were no differences between the two treatment groups in improvement of activity level or how sick patients felt in general. Most of the benefit in resolution of sore throat was conferred on patients who sought medical care within 2 days of onset. CONCLUSIONS: Our results suggest that the benefit of erythromycin treatment for patients with non–GAS pharyngitis is small and of borderline statistical significance. Because of the small size of the effect and because widespread use of erythromycin could promote drug resistance, we do not recommend routine use of erythromycin in adult patients with this type of pharyngitis