Knowledge and barriers to inclusion of ASC pupils in Scottish mainstream schools:A mixed methods approach

Inclusion of autistic pupils into mainstream schools is common practice and staff should have adequate knowledge on teaching and managing classroom behaviour. However, autism knowledge among teaching staff may be inconsistent. A mixed-methods design examined differences between school staff in autism knowledge, perceived barriers to inclusion and required support. 138 early years staff, school teachers and pupil support assistants took part. Knowledge and experience were assessed using Knowledge about Childhood Autism among Health Workers questionnaire (KCAHW; [Bakare, M. O., P. O. Ebigbo, A. O. Agomoh, and N. C. Menkiti. 2008. Knowledge about childhood autism among health workers (KCAHW) questionnaire: description, reliability and internal consistency. Clinical Practice and Epidemiology in Mental Health 4 (1): 17]). Qualitative measures addressed perceived barriers to inclusion and recommended supports. Significant differences in the knowledge of autism scores were shown. Similar themes were identified across all staff, with five themes reflecting barriers to inclusion (Knowledge, Support, Training, Management of ASC features and Parent involvement) and four themes relating to required support (Individualising educational experience, Changes to learning spaces, Opportunities to learn about ASC and Communication). Government inclusion policy should take a whole school approach and consider staffs’ actual and perceived barriers to inclusion of autistic children

"I try and smile, I try and be cheery, I try not to be pushy. I try to say ‘I’m here for help’ but I leave feeling… worried’’: A qualitative study of perceptions of interactions with health professionals by community-based older adults with chronic pain

Background: Over 50% of community-dwelling older adults experience chronic pain, which threatens their quality of life. Of importance to their pain management is older people’s interaction with health professionals that, if unsatisfactory, may impair the outcome. Aims: To add to the limited research specific to older people living with chronic pain in the community, we explored how they perceive their experiences of interacting with health professionals, seeking factors that might optimise these interactions. Methods: Purposive sampling was used to recruit men and women .65 years with self-reported musculoskeletal chronic pain. Qualitative individual interviews and one group interview were undertaken with 23 participants. Data were transcribed verbatim and underwent Framework Analysis. Results: Three themes were identified. Seeking help illustrates issues around why older people in the community may or may not seek help for chronic pain, and highlights the potential involvement of social comparison. Importance of diagnosis illustrates the desire for professional validation of their condition and an aversion to vague explanations based on the person’s age. Being listened to and being heard illustrates the importance of empathic communication and understanding expectations, with due respect for the person’s age. Conclusions: In common with people of all ages, an effective partnership between an older person in pain and health professionals is essential if pain is to be reported, appropriately assessed and managed, because of the subjective nature of pain and its treatment responses. For older people with pain, perception about their age, by both parties in the partnership, is an additional factor that can unnecessarily interfere with the effectiveness of this partnership. Health professionals should engage with older adults to clarify their expectations about pain and its management, which may be influenced by perceptions about age; and to encourage expression of their concerns, which may also be affected by perceptions about age

Strengthening and stretching for rheumatoid arthritis of the hand (SARAH):Design of a randomised controlled trial of a hand and upper limb exercise intervention-ISRCTN89936343

Background: Rheumatoid Arthritis (RA) commonly affects the hands and wrists with inflammation, deformity, pain, weakness and restricted mobility leading to reduced function. The effectiveness of exercise for RA hands is uncertain, although evidence from small scale studies is promising. The Strengthening And Stretching for Rheumatoid Arthritis of the Hand (SARAH) trial is a pragmatic, multi-centre randomised controlled trial evaluating the clinical and cost effectiveness of adding an optimised exercise programme for hands and upper limbs to best practice usual care for patients with RA.Methods/design: 480 participants with problematic RA hands will be recruited through 17 NHS trusts. Treatments will be provided by physiotherapists and occupational therapists. Participants will be individually randomised to receive either best practice usual care (joint protection advice, general exercise advice, functional splinting and assistive devices) or best practice usual care supplemented with an individualised exercise programme of strengthening and stretching exercises. The study assessors will be blinded to treatment allocation and will follow participants up at four and 12 months. The primary outcome measure is the Hand function subscale of the Michigan Hand Outcome Questionnaire, and secondary outcomes include hand and wrist impairment measures, quality of life, and resource use. Economic and qualitative studies will also be carried out in parallel.Discussion: This paper describes the design and development of a trial protocol of a complex intervention study based in therapy out-patient departments. The findings will provide evidence to support or refute the use of an optimised exercise programme for RA of the hand in addition to best practice usual care.Trial registration: Current Controlled Trials ISRCTN89936343Keywords: Randomised controlled trial, Rheumatoid arthritis, Exercise, Hand, Rehabilitatio

Functional annotations of diabetes nephropathy susceptibility loci through analysis of genome-wide renal gene expression in rat models of diabetes mellitus

<p>Abstract</p> <p>Background</p> <p>Hyperglycaemia in diabetes mellitus (DM) alters gene expression regulation in various organs and contributes to long term vascular and renal complications. We aimed to generate novel renal genome-wide gene transcription data in rat models of diabetes in order to test the responsiveness to hyperglycaemia and renal structural changes of positional candidate genes at selected diabetic nephropathy (DN) susceptibility loci.</p> <p>Methods</p> <p>Both Affymetrix and Illumina technologies were used to identify significant quantitative changes in the abundance of over 15,000 transcripts in kidney of models of spontaneous (genetically determined) mild hyperglycaemia and insulin resistance (Goto-Kakizaki-GK) and experimentally induced severe hyperglycaemia (Wistar-Kyoto-WKY rats injected with streptozotocin [STZ]).</p> <p>Results</p> <p>Different patterns of transcription regulation in the two rat models of diabetes likely underlie the roles of genetic variants and hyperglycaemia severity. The impact of prolonged hyperglycaemia on gene expression changes was more profound in STZ-WKY rats than in GK rats and involved largely different sets of genes. These included genes already tested in genetic studies of DN and a large number of protein coding sequences of unknown function which can be considered as functional and, when they map to DN loci, positional candidates for DN. Further expression analysis of rat orthologs of human DN positional candidate genes provided functional annotations of known and novel genes that are responsive to hyperglycaemia and may contribute to renal functional and/or structural alterations.</p> <p>Conclusion</p> <p>Combining transcriptomics in animal models and comparative genomics provides important information to improve functional annotations of disease susceptibility loci in humans and experimental support for testing candidate genes in human genetics.</p

Continent-wide genomic analysis of the African buffalo (<i>Syncerus caffer</i>)

AbstractThe African buffalo (Syncerus caffer) is a wild bovid with a historical distribution across much of sub-Saharan Africa. Genomic analysis can provide insights into the evolutionary history of the species, and the key selective pressures shaping populations, including assessment of population level differentiation, population fragmentation, and population genetic structure. In this study we generated the highest qualityde novogenome assembly (2.65 Gb, scaffold N50 69.17 Mb) of African buffalo to date, and sequenced a further 195 genomes from across the species distribution. Principal component and admixture analyses provided surprisingly little support for the currently described four subspecies, but indicated three main lineages, in Western/Central, Eastern and Southern Africa, respectively. Estimating Effective Migration Surfaces analysis suggested that geographical barriers have played a significant role in shaping gene flow and the population structure. Estimated effective population sizes indicated a substantial drop occurring in all populations 5-10,000 years ago, coinciding with the increase in human populations. Finally, signatures of selection were enriched for key genes associated with the immune response, suggesting infectious disease exert a substantial selective pressure upon the African buffalo. These findings have important implications for understanding bovid evolution, buffalo conservation and population management

Neuropsychological functions and pedestrian behaviour in children with and without ADHD

This thesis examines the development of pedestrian skill level and the extent to which cognitive functioning underpins this amongst children with and without Attention Deficit Hyperactivity Disorder (ADHD). Three studies are reported, the first of which is an examination of the development of three pedestrian skills (safe place finding, visual gap timing and predicting road user intentions) and four aspects of cognitive function amongst typically developing children aged 5 to 12 years. Results from the first study revealed clear age related improvement in both pedestrian skill level and cognitive function. Inhibitory control, spatial working memory as well as non-executive delayed short term memory (but not risk taking) predicted children's pedestrian skill level. The second study examined developmental differences in pedestrian skill level and cognitive function by comparing the abilities of medication naive children with ADHD and matched controls aged 5-12 years on the same three tasks assessing pedestrian skill level and three aspects of cognitive function. Findings from the second study revealed significant between group differences in both cognitive function and pedestrian skill level such that children with ADHD performed markedly less well than controls. Whilst inhibitory control, spatial working memory and delayed short term memory predicted pedestrian skill level for control children, these relationships were for the most part, absent amongst children with ADHD. The final study was a longitudinal follow up study of a subset of the children with and without ADHD who took part in study 2. In study 3 the same tasks were administered to children at a mean time of 14 months following their participation in study 2, by which point all of the children with ADHD were being treated with stimulant medication. The findings of study 3 revealed medication had normalised the performance of children with ADHD on tasks assessing inhibitory control and non-executive delayed short term memory but had no impact on spatial working memory. Medication had also normalised performance on two of the three tasks assessing pedestrian skill level and improved most measures of performance on a third. These results have implications for clinicians and educators working with children with ADHD and highlight scope for future research to develop and trial interventions which take account of the relationship between cognitive function and pedestrian skill level amongst both typically developing children and the more vulnerable group of children with ADHD.This thesis examines the development of pedestrian skill level and the extent to which cognitive functioning underpins this amongst children with and without Attention Deficit Hyperactivity Disorder (ADHD). Three studies are reported, the first of which is an examination of the development of three pedestrian skills (safe place finding, visual gap timing and predicting road user intentions) and four aspects of cognitive function amongst typically developing children aged 5 to 12 years. Results from the first study revealed clear age related improvement in both pedestrian skill level and cognitive function. Inhibitory control, spatial working memory as well as non-executive delayed short term memory (but not risk taking) predicted children's pedestrian skill level. The second study examined developmental differences in pedestrian skill level and cognitive function by comparing the abilities of medication naive children with ADHD and matched controls aged 5-12 years on the same three tasks assessing pedestrian skill level and three aspects of cognitive function. Findings from the second study revealed significant between group differences in both cognitive function and pedestrian skill level such that children with ADHD performed markedly less well than controls. Whilst inhibitory control, spatial working memory and delayed short term memory predicted pedestrian skill level for control children, these relationships were for the most part, absent amongst children with ADHD. The final study was a longitudinal follow up study of a subset of the children with and without ADHD who took part in study 2. In study 3 the same tasks were administered to children at a mean time of 14 months following their participation in study 2, by which point all of the children with ADHD were being treated with stimulant medication. The findings of study 3 revealed medication had normalised the performance of children with ADHD on tasks assessing inhibitory control and non-executive delayed short term memory but had no impact on spatial working memory. Medication had also normalised performance on two of the three tasks assessing pedestrian skill level and improved most measures of performance on a third. These results have implications for clinicians and educators working with children with ADHD and highlight scope for future research to develop and trial interventions which take account of the relationship between cognitive function and pedestrian skill level amongst both typically developing children and the more vulnerable group of children with ADHD

Parental beliefs towards the inclusion of autistic children in mainstream schools

Research has examined teacher attitudes, knowledge, and stigma towards inclusion of autistic children in mainstream schools. Less focus has been given to these beliefs among parents. This is problematic as parents are important in the implementation of inclusion and fostering a positive school environment. The current study examined differences in autism attitudes, knowledge, stigma, and inclusive education attitudes (core perspective; expected outcomes; classroom practices) among parents with and without an autistic child; The study also investigated whether autism knowledge, attitudes and stigma predicted inclusion attitudes. 185 parents in the UK (52% had an autistic child) completed questionnaires measuring these variables. Parents of an autistic child had significantly higher core perspective inclusive attitudes than parents without an autistic child. However, this group also reported more beliefs that parents of autistic children are stigmatised. For all parents, core perspective inclusive attitudes were predicted by autism attitudes and stigma towards parents of autistic children. Predictors of expected outcomes and classroom practices inclusive attitudes differed between groups. Findings highlight the need for parental attitude research to be disability-specific and consider different aspects of inclusive attitudes. Parent education to enhance inclusive attitudes should be tailored for distinct parent groups and contact interventions should be considered

Parental beliefs towards the inclusion of autistic children in mainstream schools

Research has examined teacher attitudes, knowledge, and stigma towards inclusion of autistic children in mainstream schools. Less focus has been given to these beliefs among parents. This is problematic as parents are important in the implementation of inclusion and fostering a positive school environment. The current study examined differences in autism attitudes, knowledge, stigma, and inclusive education attitudes (core perspective; expected outcomes; classroom practices) among parents with and without an autistic child; The study also investigated whether autism knowledge, attitudes and stigma predicted inclusion attitudes. 185 parents (52% had an autistic child) completed questionnaires measuring these variables. Parents of an autistic child had significantly higher core perspective inclusive attitudes than parents without an autistic child. However, this group also reported more beliefs that parents of autistic children are stigmatised. For all parents, core perspective inclusive attitudes were predicted by autism attitudes and stigma towards parents of autistic children. Predictors of expected outcomes and classroom practices inclusive attitudes differed between groups. Findings highlight the need for parental attitudes research to be disability specific and consider different aspects of inclusive attitudes. Parent education to enhance inclusive attitudes should be tailored for distinct parent groups and contact interventions should be considered