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The inclusion of students with autism spectrum disorder (ASD) is increasing, but there have been no longitudinal studies of included students in Australia. Interview data reported in this study concern primary school children with ASD enrolled in mainstream classes in South Australia and New South Wales, Australia. In order to examine perceived facilitators and barriers to inclusion, parents, teachers, and principals were asked to comment on the facilitators and barriers to inclusion relevant to each child. Data are reported about 60 students, comprising a total of 305 parent interviews, 208 teacher interviews, and 227 principal interviews collected at 6-monthly intervals over 3.5 years. The most commonly mentioned facilitator was teacher practices. The most commonly mentioned barrier was intrinsic student factors. Other factors not directly controllable by school staff, such as resource limitations, were also commonly identified by principals and teachers. Parents were more likely to mention school- or teacher-related barriers. Many of the current findings were consistent with previous studies but some differences were noted, including limited reporting of sensory issues and bullying as barriers. There was little change in the pattern of facilitators and barriers identified by respondents over time. A number of implications for practice and directions for future research are discussed.
For most of the twentieth century, Ireland had a system of residential institutions – known as Industrial Schools – for children. These institutions were funded and overseen by the Irish state, and run by the religious orders of the Catholic Church. Though the institutions were intended to provide children with vocational education for industrial employment and to respond to perceived problems of poverty and anti-social behaviour, in reality children were incarcerated in these residential institutions and physically, emotionally, and sexually abused. This chapter traces how Irish culture has galvanised official state responses to this history, and how contemporary narrative practices and technologies, in particular digital humanities, can facilitate greater understanding of Ireland’s difficult past.
Hypoxemic patients often desaturate further with movement and transport. While inhaled epoprostenol does not improve mortality, improving oxygenation allows for transport of severely hypoxemic patients to tertiary care centers with a related improvement in mortality rates. Extracorporeal membrane oxygenation (ECMO) use is increasing in frequency for patients with refractory hypoxemia, and with increasing regionalization of care, safe transport of hypoxemic patients only becomes more important. In this series, four cases are presented of young patients with severe hypoxemic respiratory failure from Legionnaires’ disease transported on inhaled epoprostenol to ECMO centers for consideration of cannulation. With continued climate changes, Legionella and other pathogens are likely to be a continued threat. As such, optimizing oxygenation to allow for transport should continue to be a priority for critical care transport (CCT) services.
To characterize nontuberculous mycobacteria (NTM) associated with case clusters at 3 medical facilities.
Retrospective cohort study using molecular typing of patient and water isolates.
Veterans Affairs Medical Centers (VAMCs).
Isolation and identification of NTM from clinical and water samples using culture, MALDI-TOF, and gene population sequencing to determine species and genetic relatedness. Clinical data were abstracted from electronic health records.
An identical strain of Mycobacterium conceptionense was isolated from 41 patients at VA Medical Centers (VAMCs A, B, and D), and from VAMC A’s ICU ice machine. Isolates were initially identified as other NTM species within the M. fortuitum clade. Sequencing analyses revealed that they were identical M. conceptionense strains. Overall, 7 patients (17%) met the criteria for pulmonary or nonpulmonary infection with NTM, and 13 of 41 (32%) were treated with effective antimicrobials regardless of infection or colonization status. Separately, a M. mucogenicum patient strain from VAMC A matched a strain isolated from a VAMC B ICU ice machine. VAMC C, in a different state, had a 4-patient cluster with Mycobacterium porcinum. Strains were identical to those isolated from sink-water samples at this facility.
NTM from hospital water systems are found in hospitalized patients, often during workup for other infections, making attribution of NTM infection problematic. Variable NTM identification methods and changing taxonomy create challenges for epidemiologic investigation and linkage to environmental sources.
Infective endocarditis is a microbial infection of the endothelial surface of the heart, predominantly the heart valves, that is associated with high mortality and morbidity. Few contemporary data exist regarding affected children in our context.
Aims and Objectives:
We aimed to describe the profile and treatment outcomes of infant and childhood endocarditis at our facilities.
This is a retrospective analysis of infants and children with endocarditis at two public sector hospitals in the Western Cape Province of South Africa over a 5-year period. Patients with “definite” and “possible” endocarditis according to Modified Duke Criteria were included in the review.
Forty-nine patients were identified for inclusion; 29 had congenital heart disease as a predisposing condition; 64% of patients met “definite” and 36% “possible” criteria. The in-hospital mortality rate was 20%; 53% of patients underwent surgery with a post-operative mortality rate of 7.7%. The median interval from diagnosis to surgery was 20 days (interquartile range, 9–47 days). Valve replacement occurred in 28% and valve repair in 58%. There was a significant reduction in valvular dysfunction in patients undergoing surgery and only a marginal improvement in patients treated medically. Overall, 43% of patients had some degree of residual valvular dysfunction.
Endocarditis is a serious disease with a high in-hospital mortality and presents challenges in making an accurate diagnosis. Despite a significant reduction in valvular dysfunction, a portion of patients had residual valvular dysfunction. Early surgery is associated with a lower mortality rate, but a higher rate of valve replacement compared with delayed surgery.
The 11th revision to the WHO International Classification of Diseases (ICD-11) identified complex post-traumatic stress disorder (CPTSD) as a new condition. There is a pressing need to identify effective CPTSD interventions.
We conducted a systematic review and meta-analysis of randomised controlled trials (RCTs) of psychological interventions for post-traumatic stress disorder (PTSD), where participants were likely to have clinically significant baseline levels of one or more CPTSD symptom clusters (affect dysregulation, negative self-concept and/or disturbed relationships). We searched MEDLINE, PsycINFO, EMBASE and PILOTS databases (January 2018), and examined study and outcome quality.
Fifty-one RCTs met inclusion criteria. Cognitive behavioural therapy (CBT), exposure alone (EA) and eye movement desensitisation and reprocessing (EMDR) were superior to usual care for PTSD symptoms, with effects ranging from g = −0.90 (CBT; k = 27, 95% CI −1.11 to −0.68; moderate quality) to g = −1.26 (EMDR; k = 4, 95% CI −2.01 to −0.51; low quality). CBT and EA each had moderate–large or large effects on negative self-concept, but only one trial of EMDR provided useable data. CBT, EA and EMDR each had moderate or moderate–large effects on disturbed relationships. Few RCTs reported affect dysregulation data. The benefits of all interventions were smaller when compared with non-specific interventions (e.g. befriending). Multivariate meta-regression suggested childhood-onset trauma was associated with a poorer outcome.
The development of effective interventions for CPTSD can build upon the success of PTSD interventions. Further research should assess the benefits of flexibility in intervention selection, sequencing and delivery, based on clinical need and patient preferences.
Variation in parental care by child's sex is evident across cultures. Evolutionary theory provides a functional explanation for this phenomenon, predicting that parents will favour specific children if this results in greater fitness payoffs. Here, we explore evidence for sex-biased parental care in a high-fertility, patriarchal and polygynous population in Tanzania, predicting that both mothers and fathers will favour sons in this cultural setting. Our data come from a cross-sectional study in rural northwestern Tanzania, which included surveys with mothers/guardians of 808 children under age 5. We focus on early childhood, a period with high mortality risk which is fundamental in establishing later-life physical and cognitive development. Examining multiple measures of direct/physical care provision (washing, feeding, playing with, supervising, co-sleeping and caring when sick), we demonstrate that fathers favour sons for washing, feeding and supervising, while maternal care is both more intensive and unrelated to child sex. We find no difference in parental care between girls and boys regarding the allocation of material resources and the duration of breastfeeding; or in terms of parental marital and co-residence status. This bias towards sons may result from higher returns to investment for fathers than mothers, and local gender norms about physical care provision.
Significant ethnic and socio-economic disparities exist in infectious diseases (IDs) rates in New Zealand, so accurate measures of these characteristics are required. This study compared methods of ascribing ethnicity and socio-economic status. Children in the Growing Up in New Zealand longitudinal cohort were ascribed to self-prioritised, total response and single-combined ethnic groups. Socio-economic status was measured using household income, and both census-derived and survey-derived deprivation indices. Rates of ID hospitalisation were compared using linked administrative data. Self-prioritised ethnicity was simplest to use. Total response accounted for mixed ethnicity and allowed overlap between groups. Single-combined ethnicity required aggregation of small groups to maintain power but offered greater detail. Regardless of the method used, Māori and Pacific children, and children in the most socio-economically deprived households had a greater risk of ID hospitalisation. Risk differences between self-prioritised and total response methods were not significant for Māori and Pacific children but single-combined ethnicity revealed a diversity of risk within these groups. Household income was affected by non-random missing data. The census-derived deprivation index offered a high level of completeness with some risk of multicollinearity and concerns regarding the ecological fallacy. The survey-derived index required extra questions but was acceptable to participants and provided individualised data. Based on these results, the use of single-combined ethnicity and an individualised survey-derived index of deprivation are recommended where sample size and data structure allow it.
McLeod (2004a) argued persuasively that the post-1970s renaissance in Gaelic lan-guage development had been neglecting issues related to corpus planning, with the result that codification and elaboration of the language had seriously fallen behind the status planning ambitions of the Gaelic community. He concluded that corpus planning should become a ‘key priority’ for the new statutory language body, Bòrd na Gàidhlig, created as a result of the Gaelic Language (Scotland) Act 2005, and that ‘a dedicated unit focused on corpus planning, including both the ongoing creation of new terms and specific projects such as dictionaries, thesauruses and style guidebooks, should be created without delay and made a top priority’. When the Bòrd published its first five-year National Plan for Gaelic in 2007, it included a commitment that ‘Bòrd na Gàidhlig, consulting with key partners, will investigate the most suitable structure for a Gaelic language academy in order to ensure the relevance and consistency of Gaelic, including place-names’ (BnaG 2007: 35). The need for a Gaelic language academy to deliver codification and elaboration was given further impetus by Bauer et al. (2009) in a Bòrd-commissioned survey of the prospects for Gaelic language technology.
By March 2011, Bòrd na Gàidhlig was reporting that ‘progress on [the Gaelic lan-guage academy] has been slower than expected and it is now anticipated that the public consultation will take place as part of the National Gaelic Language Plan 2012/17 consultations’ (BnaG 2011: 39). In an attempt to break the apparent deadlock, in late 2011 a group of Soillse-affiliated academics from the Universities of Glasgow and Edinburgh drafted a discussion paper for the Bòrd's Gaelic Academy Working Group, recommending ‘a twelve-month investigative survey into corpus planning for Gaelic, aimed at establishing an appropriate linguistic foundation, and surveying and evaluat-ing the work that has already been done’ (McConville et al. 2011). This recommenda-tion was largely accepted in late 2012, and in January 2013 Soillse commenced work on the Dlùth is Inneach public consultation project, commissioned by Bòrd na Gàidhlig to answer the following questions:
• What corpus planning principles, or linguistic foundations, are appropriate for the strengthening and promotion of Scottish Gaelic?
• What effective coordination, or institutional framework, would result in their implementation?
To determine whether probiotic prophylaxes reduce the odds of Clostridium difficile infection (CDI) in adults and children.
Individual participant data (IPD) meta-analysis of randomized controlled trials (RCTs), adjusting for risk factors.
We searched 6 databases and 11 grey literature sources from inception to April 2016. We identified 32 RCTs (n=8,713); among them, 18 RCTs provided IPD (n=6,851 participants) comparing probiotic prophylaxis to placebo or no treatment (standard care). One reviewer prepared the IPD, and 2 reviewers extracted data, rated study quality, and graded evidence quality.
Probiotics reduced CDI odds in the unadjusted model (n=6,645; odds ratio [OR] 0.37; 95% confidence interval [CI], 0.25–0.55) and the adjusted model (n=5,074; OR, 0.35; 95% CI, 0.23–0.55). Using 2 or more antibiotics increased the odds of CDI (OR, 2.20; 95% CI, 1.11–4.37), whereas age, sex, hospitalization status, and high-risk antibiotic exposure did not. Adjusted subgroup analyses suggested that, compared to no probiotics, multispecies probiotics were more beneficial than single-species probiotics, as was using probiotics in clinical settings where the CDI risk is ≥5%. Of 18 studies, 14 reported adverse events. In 11 of these 14 studies, the adverse events were retained in the adjusted model. Odds for serious adverse events were similar for both groups in the unadjusted analyses (n=4,990; OR, 1.06; 95% CI, 0.89–1.26) and adjusted analyses (n=4,718; OR, 1.06; 95% CI, 0.89–1.28). Missing outcome data for CDI ranged from 0% to 25.8%. Our analyses were robust to a sensitivity analysis for missingness.
Moderate quality (ie, certainty) evidence suggests that probiotic prophylaxis may be a useful and safe CDI prevention strategy, particularly among participants taking 2 or more antibiotics and in hospital settings where the risk of CDI is ≥5%.