Foundations for Self-Determination in Early Childhood: Preliminary Preschool Study

Foundations for self-determination begin in early childhood for children with disabilities with the onset of self-regulation and engagement in activities at home, school, and in the community. This article describes the development and preliminary results of an intervention model that encourages collaborative practices for parents and teachers around short-term goal setting to adjust environments for young children with special needs or at risk for delay. The Foundations Intervention was used with 48 children in authentic early childhood settings and involved parents, teachers, and a facilitator to enhance children’s self-regulation and engagement at home and school. Results showed feasibility of the intervention; positive child outcomes in goal attainment, self-regulation, and engagement measures were also evident. When parents and teachers communicated about a child’s strengths and needs within routines at home and school, this appeared to strengthen parent and teacher connections and helped children become more engaged or regulated in daily activities.U.S. Department of Education Grant R324A09026

Grading fluorescein angiograms in malarial retinopathy

This work was funded by The Wellcome Trust (IJCM, SPH, NAVB, MEM, DP, SoL: Grant No. 092668/Z/10/Z; Core Grant No. 084679/Z/08/Z).Background: Malarial retinopathy is an important finding in Plasmodium falciparum cerebral malaria, since it strengthens diagnostic accuracy, predicts clinical outcome and appears to parallel cerebral disease processes. Several angiographic features of malarial retinopathy have been described, but observations in different populations can only be reliably compared if consistent methodology is used to capture and grade retinal images. Currently no grading scheme exists for fluorescein angiographic features of malarial retinopathy. Methods: A grading scheme for fluorescein angiographic images was devised based on consensus opinion of clinicians and researchers experienced in malarial retinopathy in children and adults. Dual grading were performed with adjudication of admission fluorescein images from a large cohort of children with cerebral malaria. Results: A grading scheme is described and standard images are provided to facilitate future grading studies. Inter-grader agreement was >70 % for most variables. Intravascular filling defects are difficult to grade and tended to have lower inter-grader agreement (>57 %) compared to other features. Conclusions: This grading scheme provides a consistent way to describe retinal vascular damage in paediatric cerebral malaria, and can facilitate comparisons of angiographic features of malarial retinopathy between different patient groups, and analysis against clinical outcomes. Inter-grader agreement is reasonable for the majority of angiographic signs. Dual grading with expert adjudication should be used to maximize accuracy.Publisher PDFPeer reviewe

Global burden of 288 causes of death and life expectancy decomposition in 204 countries and territories and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

BACKGROUND Regular, detailed reporting on population health by underlying cause of death is fundamental for public health decision making. Cause-specific estimates of mortality and the subsequent effects on life expectancy worldwide are valuable metrics to gauge progress in reducing mortality rates. These estimates are particularly important following large-scale mortality spikes, such as the COVID-19 pandemic. When systematically analysed, mortality rates and life expectancy allow comparisons of the consequences of causes of death globally and over time, providing a nuanced understanding of the effect of these causes on global populations. METHODS The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 cause-of-death analysis estimated mortality and years of life lost (YLLs) from 288 causes of death by age-sex-location-year in 204 countries and territories and 811 subnational locations for each year from 1990 until 2021. The analysis used 56 604 data sources, including data from vital registration and verbal autopsy as well as surveys, censuses, surveillance systems, and cancer registries, among others. As with previous GBD rounds, cause-specific death rates for most causes were estimated using the Cause of Death Ensemble model-a modelling tool developed for GBD to assess the out-of-sample predictive validity of different statistical models and covariate permutations and combine those results to produce cause-specific mortality estimates-with alternative strategies adapted to model causes with insufficient data, substantial changes in reporting over the study period, or unusual epidemiology. YLLs were computed as the product of the number of deaths for each cause-age-sex-location-year and the standard life expectancy at each age. As part of the modelling process, uncertainty intervals (UIs) were generated using the 2·5th and 97·5th percentiles from a 1000-draw distribution for each metric. We decomposed life expectancy by cause of death, location, and year to show cause-specific effects on life expectancy from 1990 to 2021. We also used the coefficient of variation and the fraction of population affected by 90% of deaths to highlight concentrations of mortality. Findings are reported in counts and age-standardised rates. Methodological improvements for cause-of-death estimates in GBD 2021 include the expansion of under-5-years age group to include four new age groups, enhanced methods to account for stochastic variation of sparse data, and the inclusion of COVID-19 and other pandemic-related mortality-which includes excess mortality associated with the pandemic, excluding COVID-19, lower respiratory infections, measles, malaria, and pertussis. For this analysis, 199 new country-years of vital registration cause-of-death data, 5 country-years of surveillance data, 21 country-years of verbal autopsy data, and 94 country-years of other data types were added to those used in previous GBD rounds. FINDINGS The leading causes of age-standardised deaths globally were the same in 2019 as they were in 1990; in descending order, these were, ischaemic heart disease, stroke, chronic obstructive pulmonary disease, and lower respiratory infections. In 2021, however, COVID-19 replaced stroke as the second-leading age-standardised cause of death, with 94·0 deaths (95% UI 89·2-100·0) per 100 000 population. The COVID-19 pandemic shifted the rankings of the leading five causes, lowering stroke to the third-leading and chronic obstructive pulmonary disease to the fourth-leading position. In 2021, the highest age-standardised death rates from COVID-19 occurred in sub-Saharan Africa (271·0 deaths [250·1-290·7] per 100 000 population) and Latin America and the Caribbean (195·4 deaths [182·1-211·4] per 100 000 population). The lowest age-standardised death rates from COVID-19 were in the high-income super-region (48·1 deaths [47·4-48·8] per 100 000 population) and southeast Asia, east Asia, and Oceania (23·2 deaths [16·3-37·2] per 100 000 population). Globally, life expectancy steadily improved between 1990 and 2019 for 18 of the 22 investigated causes. Decomposition of global and regional life expectancy showed the positive effect that reductions in deaths from enteric infections, lower respiratory infections, stroke, and neonatal deaths, among others have contributed to improved survival over the study period. However, a net reduction of 1·6 years occurred in global life expectancy between 2019 and 2021, primarily due to increased death rates from COVID-19 and other pandemic-related mortality. Life expectancy was highly variable between super-regions over the study period, with southeast Asia, east Asia, and Oceania gaining 8·3 years (6·7-9·9) overall, while having the smallest reduction in life expectancy due to COVID-19 (0·4 years). The largest reduction in life expectancy due to COVID-19 occurred in Latin America and the Caribbean (3·6 years). Additionally, 53 of the 288 causes of death were highly concentrated in locations with less than 50% of the global population as of 2021, and these causes of death became progressively more concentrated since 1990, when only 44 causes showed this pattern. The concentration phenomenon is discussed heuristically with respect to enteric and lower respiratory infections, malaria, HIV/AIDS, neonatal disorders, tuberculosis, and measles. INTERPRETATION Long-standing gains in life expectancy and reductions in many of the leading causes of death have been disrupted by the COVID-19 pandemic, the adverse effects of which were spread unevenly among populations. Despite the pandemic, there has been continued progress in combatting several notable causes of death, leading to improved global life expectancy over the study period. Each of the seven GBD super-regions showed an overall improvement from 1990 and 2021, obscuring the negative effect in the years of the pandemic. Additionally, our findings regarding regional variation in causes of death driving increases in life expectancy hold clear policy utility. Analyses of shifting mortality trends reveal that several causes, once widespread globally, are now increasingly concentrated geographically. These changes in mortality concentration, alongside further investigation of changing risks, interventions, and relevant policy, present an important opportunity to deepen our understanding of mortality-reduction strategies. Examining patterns in mortality concentration might reveal areas where successful public health interventions have been implemented. Translating these successes to locations where certain causes of death remain entrenched can inform policies that work to improve life expectancy for people everywhere. FUNDING Bill & Melinda Gates Foundation

Foundations for Self-Determination Perceived and Promoted By Families of Young Children with Disabilities in China

Building foundational skills in the early years for the later development of self-determination in adulthood for individuals with disabilities is important in the United States, but little research has been conducted to examine whether these skills are as important in other countries. In this phenomenological study, seven family interviews were conducted to understand how foundational skills for self-determination (choice making, self-regulation, engagement) were perceived and promoted by families of young children with disabilities in China. This study indicated that these skills were also valued in China. However, Chinese families emphasized the need to develop these three skills in the context of an emphasis on dependence and obedience in accordance with its collectivist culture. They used the popular Chinese parenting practice of guan to help their children make choices, regulate themselves according to li, and engage in educational study, which is highly valued in Chinese culture. These findings have important implications for interventionists in the United States who are working with families from Chinese culture

Fostering the Foundations of Self-Determination in Early Childhood: A Process for Enhancing Child Outcomes Across Home and School

Early childhood practitioners can play a vital role in the development of early self-determination in partnership with families. Self-determination has been generally considered to be about personal agency or control that can also relate to the quality of one’s life. Young children with disabilities start to develop a range of critical skills such as engagement and self-regulation that will be needed throughout their lives. These are the early foundational skills that lead to later self-determination. This paper describes a simple four-step process and key features of foundations of self-determination in early childhood, a collaborative process focusing on home–school partnerships. The unique alliance between each dyad (i.e., family member and early childhood practitioner) support child outcomes across naturally occurring routines at home and school. Each family and practitioner dyad uses attainable short-term goals embedded in home and school routines, intentional adult cues, and environmental modifications to promote foundational skills of self-determination in young children with disabilities

Fostering the Foundations of Self-Determination in EarlyChildhood: A Process for Enhancing Child Outcomes AcrossHome and School

Early childhood practitioners can play a vital role in the development of early self-determination in partnership with families. Self-determination has been generally considered to be about personal agency or control that can also relate to the quality of one’s life. Young children with disabilities start to develop a range of critical skills such as engagement and self-regulation that will be needed throughout their lives. These are the early foundational skills that lead to later self-determination. This paper describes a simple four-step process and key features of foundations of self-determination in early childhood, a collaborative process focusing on home–school partnerships. The unique alliance between each dyad (i.e., family member and early childhood practitioner) support child outcomes across naturally occurring routines at home and school. Each family and practitioner dyad uses attainable short-term goals embedded in home and school routines, intentional adult cues, and environmental modifications to promote foundational skills of self-determination in young children with disabilities

Performance: A Strategy for Professional Development in Early Childhood Teacher Preparation

The purpose of this article is to propose performance as a creative instructional strategy to convey complex competencies related to understanding and working effectively with families in early childhood education. Performance derives from performance ethnography, which is a qualitative research methodology. Its application to professional development enables students and in-service participants not only to hear the voices of families, but to experience them through performance. This article describes the advantages and disadvantages of performance as an approach to professional development and illustrates the development and application of an example performance. Authors discuss how faculty, researchers, and those responsible for professional development can use performance to bridge the gap between research and practice and to move early childhood educators towards greater family-centered competencies when serving diverse families and children

Foundations for Self-Determination in Early Childhood: An Inclusive Model for Children with Disabilities

This article introduces the Early Childhood Foundations Model for Self-Determination and provides a rationale for the need to consider the foundations of self-determination behavior that begin early in life. This model is based on the premise that young children with disabilities benefit from a collaborative partnership between important adults in the lives of children to provide a supportive, stimulating, and coordinated environment between inclusive classrooms and home settings. Within partnership, the Foundations Model establishes the proposition that the basic foundational skills for developing self-determination in later life require young children with disabilities to gain skills in (a) choice-making and problem solving, (b) self-regulation, and (c) engagement. In this position paper, the authors review literature related to these three foundational constructs and present a rationale for use of the Foundations Model as a guide to developing systematic interventions to start young students with disabilities on the road to building a foundation for self-determination

Serum and Adipose Tissue Amino Acid Homeostasis in the Metabolically Healthy Obese

A subgroup of obese individuals, referred to as metabolically healthy obese (MHO), have preserved insulin sensitivity and a normal lipid profile despite being obese. The molecular basis for this improved cardiometabolic profile remains unclear. Our objective was to integrate metabolite and gene expression profiling to elucidate the molecular distinctions between MHO and metabolically unhealthy obese (MUO) phenotypes. A subset of individuals were selected from the Diabetes Risk Assessment study and classified into three groups using anthropometric and clinical measurements: lean healthy (LH), MHO, and MUO. Serum metabolites were profiled using gas chromatography coupled to mass spectrometry. Multivariate data analysis uncovered metabolites that differed between groups, and these were subsequently validated by capillary electrophoresis coupled to mass spectrometry. Subcutaneous adipose tissue (SAT) gene expression profiling using microarrays was performed in parallel. Amino acids were the most relevant class of metabolites distinguishing MHO from MUO individuals. Serum levels of glutamic acid, valine, and isoleucine were positively associated (i.e., LH < MHO < MUO) with homeostasis model assessment-insulin resistance (HOMA-IR) and glycated hemoglobin (HbA1c) values, while leucine was only correlated with HOMA-IR. The glutamine-to-glutamic acid ratio and glycine were inversely correlated (i.e., LH > MHO > MUO) with HbA1c values. Concomitantly, SAT gene expression profiling revealed that genes related to branched-chain amino acid catabolism and the tricarboxylic acid cycle were less down-regulated in MHO individuals compared to MUO individuals. Together, this integrated analysis revealed that MHO individuals have an intermediate amino acid homeostasis compared to LH and MUO individuals