Involvement and Participation of Students with Severe Disabilities in SWPBIS

With more schools implementing Schoolwide Positive Behavioral Interventions and Supports (SWPBIS) and achieving valued student outcomes associated with these efforts, the inclusion of students with extensive and pervasive support needs (i.e., ‘severe’ disabilities) in this tiered system must be considered. These students remain programmatically and physically separated from general education instruction and activities. Given that SWPBIS is implemented in general education settings and it is designed to support all students, the purpose of this study was to investigate SWPBIS coaches’ perceptions of the involvement of students with extensive support needs in SWPBIS processes and procedures within one state. Findings suggest the coaches believe that students with extensive support needs are physically and programmatically separated from tier one SWPBIS instruction and activities, with few general educators expressing participation in facilitating their involvement. Implications and recommendations for these findings are provided

Vibration and its effect on the respiratory system

Vibration is a manual technique used widely to assist with the removal of pulmonary secretions. Little is known about how vibration is applied or its effect on the respiratory system. The purpose of this study was to describe mechanical consequences of vibration on the chest wall of a normal subject and the effects of vibration on expiratory flow rates and volumes. The effects of vibration were compared to other interventions of chest wall compression, chest wall oscillation, cough, huff from high lung volume, inspiration to total lung capacity with relaxed expiration, tidal breathing, and sham. Sixteen physiotherapists applied vibration and other interventions in a randomised order to the chest wall of a healthy adult female subject. The magnitude and direction of the force and the frequency of vibration were measured by an instrumented bed with seven load cells. Inductive plethsysmography measured the change in chest wall circumference with vibration. A heated pneumotachometer measured inspiratory and expiratory flow rates, which were integrated to provide volumes. Vibration was applied with a mean resultant force of 74.4 N (SD 47.1). The mean (SD) change in chest wall circumference and frequency of vibration were 0.8 cm (SD 0.4) and 5.5 Hz (SD 0.8) respectively. The mean peak expiratory flow rate was 0.97 l/s (SD 0.27). Peak expiratory flow rates with vibration were less than 20% of those achieved with cough or huff from high lung volume but greater than with chest wall compression, chest wall oscillation, relaxed expiration from total lung capacity, sham treatment or tidal breathing

Sugar intake and dental decay : results from a national survey of children in Scotland

Peer reviewedPreprin

Teachers’ Views of their Preparation for Inclusive Education and Collaboration

There is a need to advance inclusive education for students with significant disabilities, and one way to support this effort is to ensure educators have expertise in, and are prepared to implement, inclusive practices. We surveyed and interviewed general and special education teachers to understand their experiences and preparation to demonstrate skills associated with inclusive education and collaboration and identify the factors that may contribute to their preparation. There was a relationship between educators’ preparedness for inclusive education and whether they have taken university courses or had special training on inclusive education. Analysis of interviews with a subset of participants supported this finding and provided a deeper understanding of the educators’ preparation and experiences in implementing inclusive practices for students with significant disabilities

Inclusion of Students with Significant Disabilities in SWPBS Evaluation Tools

Students with significant disabilities (intellectual and developmental disabilities) are predominantly educated in separate settings, and tend to have little access to schoolwide positive behavior supports (SWPBS). In this study, we first identified the most commonly cited SWPBS evaluation tools in the literature between 2010 and 2016. The SET, TIC, and BoQ were identified as the most commonly cited. Next, these evaluation tools were analyzed for their purposeful inclusion of students with significant disabilities. Findings revealed the tools emphasize all staff and all students when describing systems and data aspects of SWPBS which have limited direct impact on students, but make allowances, such as “most students” when describing the implementation SWPBS that directly impact students, thus creating loopholes that may inadvertently permit the exclusion of learners with the most significant disabilities from fully participating in, and benefitting from, SWPBS efforts. Implications and recommendations for practitioners and researchers are provided

Provider Insight on Surmounting Specialty Practice Challenges to Improve Tdap Immunization Rates among Pregnant Women

Background Pertussis, or “whooping cough,” is an acute, contagious pulmonary disease that, despite being vaccine-preventable, has become an increasingly widespread problem in the United States. As a result, the Advisory Committee on Immunization Practices and American College of Obstetricians and Gynecologists updated recommendations stating clinicians should give a Tdap dose during every pregnancy, preferably at 27–36 weeks. Despite this recommendation, reported Tdap vaccine receipt rates during pregnancy vary from 16–61%, and previous studies have shown that clinician recommendation and vaccine administration are strongly associated with vaccine uptake among pregnant women. Methods Our aim was to inform new strategies to increase uptake of the Tdap vaccine among pregnant women and, ultimately, reduce pertussis-related morbidityand mortality in infants. We conducted interviewswith a sample of 24 ob-gyns. We subsequently performed grounded theory analyses of transcripts using deductive and inductive coding strategies followed by intercoder reliability assessment. Results All physicians interviewed were familiar with the most recent recommendation of giving the Tdap vaccine during the third trimester of every pregnancy, and the majority of physicians stated that they felt that the vaccine was important and effective due to the transfer of pertussis antibodies from the mother to the fetus. Most physicians indicated that they recommended the vaccine to patients during pregnancy, but not all reported administering it on site because it was not stocked at their practice. Implementation challenges for physicians included insurance reimbursement and other challenges (i.e., patient refusal). Tdap vaccinationduring pregnancy was a lower clinical priority for some physicians. Physicians recognized the benefits associated with Tdap vaccination during pregnancy. Conclusions Findings indicate while most ob-gyns recognize the benefits of Tdap and recommend vaccination during pregnancy, barriers such as insurance reimbursement and financial concerns for the practice can outweigh the perceived benefits. This resulted in some ob-gyns reporting choosing not to stock and administer the vaccine in their practice. Recommendations to address these concerns include 1) structural support for Tdap vaccine administration in ob-gyns practices; 2) Continuing medical education-equivalent educational interventions that address management techniques, vaccine coding, and other relevant information; and 3) interventions to assist physicians in communicating the importance of Tdap vaccination during pregnancy

Risk management for drinking water safety in low and middle income countries - cultural influences on water safety plan (WSP) implementation in urban water utilities

AbstractWe investigated cultural influences on the implementation of water safety plans (WSPs) using case studies from WSP pilots in India, Uganda and Jamaica. A comprehensive thematic analysis of semi-structured interviews (n=150 utility customers, n=32 WSP ‘implementers’ and n=9 WSP ‘promoters’), field observations and related documents revealed 12 cultural themes, offered as ‘enabling’, ‘limiting’, or ‘neutral’, that influence WSP implementation in urban water utilities to varying extents. Aspects such as a ‘deliver first, safety later’ mind set; supply system knowledge management and storage practices; and non-compliance are deemed influential. Emergent themes of cultural influence (ET1 to ET12) are discussed by reference to the risk management, development studies and institutional culture literatures; by reference to their positive, negative or neutral influence on WSP implementation. The results have implications for the utility endorsement of WSPs, for the impact of organisational cultures on WSP implementation; for the scale-up of pilot studies; and they support repeated calls from practitioner communities for cultural attentiveness during WSP design. Findings on organisational cultures mirror those from utilities in higher income nations implementing WSPs – leadership, advocacy among promoters and customers (not just implementers) and purposeful knowledge management are critical to WSP success

Parent Perspectives on Special Education Services: How Do Schools Implement Team Decisions?

The purpose of this qualitative study was to examine parents’ perspectives and experiences of special education, including the degree to which decisions about their child’s education were implemented as they had agreed upon with the school personnel. Additionally, a secondary purpose of this study was to understand how parents explain why school personnel do or do not implement elements of their child’s Individualized Education Program (IEP). In this study, parents of children with intellectual and developmental disabilities described their experiences attempting to reach agreement with school personnel on decisions involving their child’s educational placement and special education services. Parents expressed a desire to be involved in decisions, and they described a desire to obtain inclusive educational placements for their children. Parents described varied experiences with the implementation of special education services. They also described both successes and concerns related to the special education services their child was receiving at school. Implications for special education policy, practice, and research are discussed from the perspective of supporting family involvement in the special education process

Telomere length and common disease: study design and analytical challenges.

Telomeres, the repetitive sequences that protect the ends of chromosomes, help to maintain genomic integrity and are of key importance to human health. The aim here is to give an overview of the evidence for the importance of telomere length (TL) to the risk of common disease, considering the strengths and weaknesses of different epidemiological study designs. Methods for measuring TL are described, all of which are subject to considerable measurement error. TL declines with age and varies in relation to factors such as smoking and obesity. It is also highly heritable (estimated heritability of ~40 to 50%), and genome-wide studies have identified a number of associated genetic variants. Epidemiological studies have shown shorter TL to be associated with risk of a number of common diseases, including cardiovascular disease and some cancers. The relationship with cancer appears complex, in that longer telomeres are associated with higher risk of some cancers. Prospective studies of the relationship between TL and disease, where TL is measured before diagnosis, have numerous advantages over retrospective studies, since they avoid the problems of reverse causality and differences in sample handling, but they are still subject to potential confounding. Studies of the genetic predictors of TL in relation to disease risk avoid these drawbacks, although they are not without limitations. Telomere biology is of major importance to the risk of common disease, but the complexities of the relationship are only now beginning to be understood.This research was supported by Cancer Research UK Programme Awards C588/A10589 and C588/A19167 (MMI and JHB) and C8197/A16565 (AMD and KAP) and the Isaac Newton Trust.This is the final version of the article. It first appeared from Springer via http://dx.doi.org/10.1007/s00439-015-1563-

Integrating Community-Based Interventions to Reverse the Convergent TB/HIV Epidemics in Rural South Africa.

The WHO recommends integrating interventions to address the devastating TB/HIV co-epidemics in South Africa, yet integration has been poorly implemented and TB/HIV control efforts need strengthening. Identifying infected individuals is particularly difficult in rural settings. We used mathematical modeling to predict the impact of community-based, integrated TB/HIV case finding and additional control strategies on South Africa's TB/HIV epidemics. We developed a model incorporating TB and HIV transmission to evaluate the effectiveness of integrating TB and HIV interventions in rural South Africa over 10 years. We modeled the impact of a novel screening program that integrates case finding for TB and HIV in the community, comparing it to status quo and recommended TB/HIV control strategies, including GeneXpert, MDR-TB treatment decentralization, improved first-line TB treatment cure rate, isoniazid preventive therapy, and expanded ART. Combining recommended interventions averted 27% of expected TB cases (95% CI 18-40%) 18% HIV (95% CI 13-24%), 60% MDR-TB (95% CI 34-83%), 69% XDR-TB (95% CI 34-90%), and 16% TB/HIV deaths (95% CI 12-29). Supplementing these interventions with annual community-based TB/HIV case finding averted a further 17% of TB cases (44% total; 95% CI 31-56%), 5% HIV (23% total; 95% CI 17-29%), 8% MDR-TB (68% total; 95% CI 40-88%), 4% XDR-TB (73% total; 95% CI 38-91%), and 8% TB/HIV deaths (24% total; 95% CI 16-39%). In addition to increasing screening frequency, we found that improving TB symptom questionnaire sensitivity, second-line TB treatment delays, default before initiating TB treatment or ART, and second-line TB drug efficacy were significantly associated with even greater reductions in TB and HIV cases. TB/HIV epidemics in South Africa were most effectively curtailed by simultaneously implementing interventions that integrated community-based TB/HIV control strategies and targeted drug-resistant TB. Strengthening existing TB and HIV treatment programs is needed to further reduce disease incidence