‘What was required above all else was collaboration’: keeping the momentum for SEND partnership working in the wake of Covid‐19.

Introduction In March 2020 and January 2021, schools in England were closed to help control the spread of Covid-19 (Gov.UK, 2020). Children and young people whose parents/carers were key workers and those with education, health and care plans (EHCPs) were allowed and later encouraged to attend schools (DfE & Williamson, 2020). The parents/carers of these children and young people did, however, have the right to keep their children at home should they so choose (Gov.UK, 2020). Local authorities and school leaders, including SENCos, were ‘left with responsibility for maintaining the systems of special educational “offers” … developed for their schools’ (Wedell, 2020) in a constantly evolving and unpredictable policy environment as the Department for Education (DfE) responded to the situation. Concerns about meeting deadlines led to the Government’s relaxation of the legislation about timescales for statutory assessments and for annual reviews, much to the concern of parents and others (Children’s Commissioner, 2020). Previously published findings from an online questionnaire (n = 100) undertaken by the Special Educational Needs Policy Research Forum (SENPRF, 2021) provided insight into how school staff were supported in the teaching of pupils with special educational needs and/or disabilities (SEND) during school closures, what lessons had been learned, and the conditions required to enable these lessons to be harnessed in schools. This present article aims to ask, ‘What else?’ (Singh et al., 2014) and offers a thematic analysis of the optional narrative responses provided within the survey, which focus on partnership working across the local SEND system and the role occupied by policy actors (Ball et al., 2011) within this system. The contributing authors share a common interest in SEND. As members of the lead group for the SENPRF, we were part of the team involved in developing the questionnaire. One of us has worked as SENCo and SEND inspector in a local authority and is a university course leader for the National Award for SEN Coordination; another works as SEND advisor, and as a teacher and lecturer has previously interrogated the SEND Code of Practice (DfE & DoH, 2015) and its implications for professionalism, partnership working and ethical concerns; the third contributor has a disabled daughter and is undertaking doctoral research approaching the subjectivity of parents of disabled children and how it relates to inclusion. Accordingly, we each handled the analysis of the survey findings from different personal and professional perspectives. In the spirit of partnership, we have respected each other’s expertise and lived experience, and worked together with an open © 2022 NASEN British Journal of Special Education � Volume 0 � Number 0 � 2022 3 mind, engaging in the nuances and tensions that exist within partnership working, to embrace divergent understandings. In what follows, we will briefly review the literature on multi-agency working and inter-professional collaboration and how this is conceptualized within SEND literature, before considering the role of parents/carers in these partnerships. A methodology section then leads into a discussion of six key statements that can be understood as some of the lessons learned from the pandemic, drawing on our data and reflecting the experiences of parents/carers, school staff and advising professionals working in local authorities

‘What was required above all else was collaboration’: keeping the momentum for SEND partnership working in the wake of Covid‐19

Introduction In March 2020 and January 2021, schools in England were closed to help control the spread of Covid-19 (Gov.UK, 2020). Children and young people whose parents/carers were key workers and those with education, health and care plans (EHCPs) were allowed and later encouraged to attend schools (DfE & Williamson, 2020). The parents/carers of these children and young people did, however, have the right to keep their children at home should they so choose (Gov.UK, 2020). Local authorities and school leaders, including SENCos, were ‘left with responsibility for maintaining the systems of special educational “offers” … developed for their schools’ (Wedell, 2020) in a constantly evolving and unpredictable policy environment as the Department for Education (DfE) responded to the situation. Concerns about meeting deadlines led to the Government’s relaxation of the legislation about timescales for statutory assessments and for annual reviews, much to the concern of parents and others (Children’s Commissioner, 2020). Previously published findings from an online questionnaire (n = 100) undertaken by the Special Educational Needs Policy Research Forum (SENPRF, 2021) provided insight into how school staff were supported in the teaching of pupils with special educational needs and/or disabilities (SEND) during school closures, what lessons had been learned, and the conditions required to enable these lessons to be harnessed in schools. This present article aims to ask, ‘What else?’ (Singh et al., 2014) and offers a thematic analysis of the optional narrative responses provided within the survey, which focus on partnership working across the local SEND system and the role occupied by policy actors (Ball et al., 2011) within this system. The contributing authors share a common interest in SEND. As members of the lead group for the SENPRF, we were part of the team involved in developing the questionnaire. One of us has worked as SENCo and SEND inspector in a local authority and is a university course leader for the National Award for SEN Coordination; another works as SEND advisor, and as a teacher and lecturer has previously interrogated the SEND Code of Practice (DfE & DoH, 2015) and its implications for professionalism, partnership working and ethical concerns; the third contributor has a disabled daughter and is undertaking doctoral research approaching the subjectivity of parents of disabled children and how it relates to inclusion. Accordingly, we each handled the analysis of the survey findings from different personal and professional perspectives. In the spirit of partnership, we have respected each other’s expertise and lived experience, and worked together with an open © 2022 NASEN British Journal of Special Education � Volume 0 � Number 0 � 2022 3 mind, engaging in the nuances and tensions that exist within partnership working, to embrace divergent understandings. In what follows, we will briefly review the literature on multi-agency working and inter-professional collaboration and how this is conceptualized within SEND literature, before considering the role of parents/carers in these partnerships. A methodology section then leads into a discussion of six key statements that can be understood as some of the lessons learned from the pandemic, drawing on our data and reflecting the experiences of parents/carers, school staff and advising professionals working in local authorities

Association of combination statin and antihypertensive therapy with reduced Alzheimer’s disease and related dementia risk

Background Hyperlipidemia and hypertension are modifiable risk factors for Alzheimer's disease and related dementias (ADRD). Approximately 25% of adults over age 65 use both antihypertensives (AHTs) and statins for these conditions. While a growing body of evidence found statins and AHTs are independently associated with lower ADRD risk, no evidence exists on simultaneous use for different drug class combinations and ADRD risk. Our primary objective was to compare ADRD risk associated with concurrent use of different combinations of statins and antihypertensives. Methods In a retrospective cohort study (2007-2014), we analyzed 694,672 Medicare beneficiaries in the United States (2,017,786 person-years) who concurrently used both statins and AHTs. Using logistic regression adjusting for age, socioeconomic status and comorbidities, we quantified incident ADRD diagnosis associated with concurrent use of different statin molecules (atorvastatin, pravastatin, rosuvastatin, and simvastatin) and AHT drug classes (two renin-angiotensin system (RAS)-acting AHTs, angiotensin converting enzyme inhibitors (ACEIs) or angiotensin-II receptor blockers (ARBs), vs non-RAS-acting AHTs). Findings Pravastatin or rosuvastatin combined with RAS-acting AHTs reduce risk of ADRD relative to any statin combined with non-RAS-acting AHTs: ACEI+pravastatin odds ratio (OR) = 0.942 (CI: 0.899-0.986, p = 0.011), ACEI+rosuvastatin OR = 0.841 (CI: 0.794-0.892, p< 0.001), ARB+pravastatin OR = 0.794 (CI: 0.748-0.843, p< 0.001), ARB+rosuvastatin OR = 0.818 (CI: 0.765-0.874, p< 0.001). ARBs combined with atorvastatin and simvastatin are associated with smaller reductions in risk, and ACEI with no risk reduction, compared to when combined with pravastatin or rosuvastatin. Among Hispanics, no combination of statins and RAS-acting AHTs reduces risk relative to combinations of statins and non-RAS-acting AHTs. Among blacks using ACEI+rosuvastatin, ADRD odds were 33% lower compared to blacks using other statins combined with non-RAS-acting AHTs (OR = 0.672 (CI: 0.5480.825, p<0.001)). Conclusion Among older Americans, use of pravastatin and rosuvastatin to treat hyperlipidemia is less common than use of simvastatin and atorvastatin, however, in combination with RAS-acting AHTs, particularly ARBs, they may be more effective at reducing risk of ADRD. The number of Americans with ADRD may be reduced with drug treatments for vascular health that also confer effects on ADRD.Open access journalThis item from the UA Faculty Publications collection is made available by the University of Arizona with support from the University of Arizona Libraries. If you have questions, please contact us at [email protected]

Insights into the pathological basis of dementia from population-based neuropathology studies

The epidemiological neuropathology perspective of population and community-based studies allows unbiased assessment of the prevalence of various pathologies and their relationships to late-life dementia. In addition, this approach provides complementary insights to conventional case–control studies, which tend to be more representative of a younger clinical cohort. The Cognitive Function and Ageing Study (CFAS) is a longitudinal study of cognitive impairment and frailty in the general United Kingdom population. In this review, we provide an overview of the major findings from CFAS, alongside other studies, which have demonstrated a high prevalence of pathology in the ageing brain, particularly Alzheimer's disease neuropathological change and vascular pathology. Increasing burdens of these pathologies are the major correlates of dementia, especially neurofibrillary tangles, but there is substantial overlap in pathology between those with and without dementia, particularly at intermediate burdens of pathology and also at the oldest ages. Furthermore, additional pathologies such as limbic-predominant age-related TDP-43 encephalopathy, ageing-related tau astrogliopathy and primary age-related tauopathies contribute to late-life dementia. Findings from ageing population-representative studies have implications for the understanding of dementia pathology in the community. The high prevalence of pathology and variable relationship to dementia status has implications for disease definition and indicate a role for modulating factors on cognitive outcome. The complexity of late-life dementia, with mixed pathologies, indicates a need for a better understanding of these processes across the life-course to direct the best research for reducing risk in later life of avoidable clinical dementia syndromes

The association of multiple anti-hypertensive medication classes with Alzheimer’s disease incidence across sex, race, and ethnicity

<div><p>Background</p><p>Antihypertensive treatments have been shown to reduce the risk of Alzheimer’s disease (AD). The renin-angiotensin system (RAS) has been implicated in AD, and thus RAS-acting AHTs (angiotensin converting enzyme inhibitors (ACEIs), and angiotensin-II receptor blockers (ARBs)) may offer differential and additional protective benefits against AD compared with other AHTs, in addition to hypertension management.</p><p>Methods</p><p>In a retrospective cohort design, we examined the medical and pharmacy claims of a 20% sample of Medicare beneficiaries from 2007 to 2013, and compared rates of AD diagnosis for 1,343,334 users of six different AHT drug treatments, 65 years of age or older (4,215,338 person-years). We compared AD risk between RAS and non-RAS AHT drug users, and between ACEI users and ARB users, by sex and race/ethnicity. Models adjusted for age, socioeconomic status, underlying health, and comorbidities.</p><p>Findings</p><p>RAS-acting AHTs were slightly more protective against onset of AD than non-RAS-acting AHTs for males, (male OR = 0.931 (CI: 0.895–0.969)), but not so for females (female OR = 0.985 (CI: 0.963–1.007)). Relative to other AHTs, ARBs were superior to ACEIs for both men (male ARB OR = 0.834 (CI: 0.788–0.884); male ACEI OR = 0.978 (CI: 0.939–1.019)) and women (female ARB OR = 0.941 (CI: 0.913–0.969); female ACEI OR = 1.022 (CI: 0.997–1.048)), but only in white men and white and black women. No association was shown for Hispanic men and women.</p><p>Conclusion</p><p>Hypertension management treatments that include RAS-acting ARBs may, in addition to lowering blood pressure, reduce AD risk, particularly for white and black women and white men. Additional studies and clinical trials that include men and women from different racial and ethnic groups are needed to confirm these findings. Understanding the potentially beneficial effects of certain RAS-acting AHTs in high-risk populations is of great importance.</p></div