Early Start Research Articles

Long-Term Outcome of Infantile Onset Pompe Disease Patients Treated with Enzyme Replacement Therapy - Data from a German-Austrian Cohort.

Enzyme replacement therapy (ERT) with recombinant human alglucosidase alfa (rhGAA) was approved in Europe in 2006. Nevertheless, data on the long-term outcome of infantile onset Pompe disease (IOPD) patients at school age is still limited. We analyzed in detail cardiac, respiratory, motor, and cognitive function of 15 German-speaking patients aged 7 and older who started ERT at a median age of 5 months. Starting dose was 20 mg/kg biweekly in 12 patients, 20 mg/kg weekly in 2, and 40 mg/kg weekly in one patient. CRIM-status was positive in 13 patients (86.7%) and negative or unknown in one patient each (6.7%). Three patients (20%) received immunomodulation. Median age at last assessment was 9.1 (7.0-19.5) years. At last follow-up 1 patient (6.7%) had mild cardiac hypertrophy, 6 (42.9%) had cardiac arrhythmias, and 7 (46.7%) required assisted ventilation. Seven patients (46.7%) achieved the ability to walk independently and 5 (33.3%) were still ambulatory at last follow-up. Six patients (40%) were able to sit without support, while the remaining 4 (26.7%) were tetraplegic. Eleven patients underwent cognitive testing (Culture Fair Intelligence Test), while 4 were unable to meet the requirements for cognitive testing. Intelligence quotients (IQs) ranged from normal (IQ 117, 102, 96, 94) in 4 patients (36.4%) to mild developmental delay (IQ 81) in one patient (9.1%) to intellectual disability (IQ 69, 63, 61, 3x <55) in 6 patients (54.5%). White matter abnormalities were present in 10 out of 12 cerebral MRIs from 7 patients. Substantial motor, cardiac, respiratory, and cognitive deficits are frequent in IOPD long-term survivors who started ERT before 2016. The findings of this study can be valuable as comparative data when evaluating the impact of newer treatment strategies including higher enzyme dosage, immunomodulation, modified enzymes, or early start of treatment following newborn screening.

Effects of Hormone Replacement Therapy on Bone Mineral Density in Korean Adults With Turner Syndrome.

Turner syndrome (TS) is a common chromosomal abnormality, which is caused by loss of all or part of one X chromosome. Hormone replacement therapy in TS is important in terms of puberty, growth and prevention of osteoporosis however, such a study has never been conducted in Korea. Therefore, the purpose of our study was to determine relationship between the starting age, duration of estrogen replacement therapy (ERT) in TS and develop a hormone replacement protocol suitable for the situation in Korea. This is retrospective study analyzed the medical records in TS patients treated at the Severance hospital, Yonsei University College of Medicine, Seoul, Korea from 1997 to 2019. Total of 188 subjects who had received a bone density test at least once were included in the study. Korean National Health and Nutrition Examination Survey (KNHANES) was used for achieving bone mineral density (BMD) of normal control group. Student's t-test, Mann-Whitney U test, ANOVA and correlation analysis were performed using SPSS 18.0. Each BMD measurement was significantly lower in women with TS than in healthy Korean women. Early start and longer duration of ERT is associated with higher lumbar spine BMD but not femur neck BMD. Femur neck BMD, but not lumbar spine BMD was significantly higher in women with mosaicism than 45XO group. Early onset and appropriate duration of hormone replacement therapy is important for increasing bone mineral density in patients with Turner syndrome. Also, ERT affects differently to TS patients according to mosaicism.

Venous thromboembolism prophylaxis in operative traumatic brain injury.

Venous thromboembolism (VTE) is a significant complication in patients with traumatic brain injury (TBI), but the optimal timing of pharmacological prophylaxis in operative cases remains controversial. This retrospective study aimed to describe the timing of pharmacological prophylaxis initiation in operative TBI cases, stratified by surgery type, and to report the frequency of worsening postoperative intracranial pathology. Data from 90 surgical TBI patients were analyzed, revealing that 87.8% received VTE pharmacological prophylaxis at a mean of 85 hours postsurgery. The timing of initiation varied by procedure, with burr holes having the earliest start at a mean of 66 h. Craniotomy and decompressive craniectomy had the longest delay, with means of 116 and 109 h, respectively. Worsening intracranial pathology occurred in 5.6% of patients, with only one case occurring after VTE pharmacological prophylaxis initiation. The overall VTE rate was 3.3%. These findings suggest that initiating VTE pharmacological prophylaxis between 3 and 5 days postsurgery may be safe in operative TBI patients, with the timing dependent on the procedure's invasiveness. The low frequencies of worsening intracranial pathology and VTE support the safety of these proposed timeframes. However, the study's limitations, including its single-center retrospective nature and lack of a standardized protocol, necessitate further research to confirm these findings and establish evidence-based guidelines for VTE pharmacological prophylaxis in operative TBI patients.

Barriers to health care and pregnancy experiences in relation to Black, low-income mothers' perinatal attachment and depression.

The goal of this study was to examine whether barriers to accessing health care and negative pregnancy experiences would predict depressive symptomatology and attachment to their neonates among Black mothers from low-income backgrounds across the perinatal period. We were also interested in examining whether these mothers' engagement in prenatal health practices would buffer against their pregnancy experiences to promote positive postnatal maternal functioning. Participants were 118 Black pregnant women from low-income backgrounds, recruited from WIC and Early Head Start programs. A prenatal assessment between 28 and 40 weeks gestation measured pregnancy experiences and prenatal health practices, and a postnatal assessment about 4 weeks postpartum measured maternal functioning in the form of depressive symptoms and attachment to their neonates. Linear regressions with prenatal health practices included as a moderator suggested that while engaging in positive health practices during pregnancy could potentially buffer against negative pregnancy experiences and prenatal depressive symptoms, it is unlikely to buffer against barriers to accessing health care. These results imply the need to provide support for accessing health care among pregnant women to address disparities in the United States. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

ВОЗРАСТНЫЕ ПРЕОБРАЗОВАНИЯ УПРАВЛЯЮЩИХ ФУНКЦИЙ В ДОШКОЛЬНОМ ВОЗРАСТЕ (ОТ 3-Х ДО 7-МИ ЛЕТ). НЕЙРОПСИХОЛОГИЧЕСКИЙ АНАЛИЗ

To identify age-related transformations of various components of voluntary regulation and organization of goal-directed behavior (executive functions – EF), qualitative and quantitative neuropsychological assessment of 472 preschool children of 4 age groups (3-4, 4-5, 5-6 and 6-7 years) was performed. The results of the study indicate the heterochronic development of various components of EF. Statistically significant progressive changes were observed in: (1) mastering instructions, (2) following programs of activity, (3) action switching, (4) cognitive planning. At the same time, children of all age groups, including children of preschool age, demonstrate age-related immaturity of the following components of EF: (1) creation of their own activity strategy, (2) task switching, (3) self-monitoring of activity results, (4) working memory. The data obtained show the importance of developmental education based on the joint activities of a child and an adult in early preschool age. On the other hand, they testify to the inappropriateness of an early (before 5 years) start of targeted training in mastering writing and reading skills.

Predicting Communication Skills Outcomes for Preschool Children with Autism Spectrum Disorder Following Early Intervention.

This study aims to assess changes in the receptive and expressive language skills and to determine if the baseline characteristics such as communication, cognitive and motor skills, predict outcomes in preschool children with Autism Spectrum Disorder (ASD) following early intervention. We recruited 64 children participating in the Early Start Denver Model (ESDM) early intervention program at an Autism Specific Early Learning and Care Center (ASELCC) in Australia. Baseline characteristics across various developmental domains was measured using the Mullen Scales of Early Learning (MSEL), Vineland Adaptive Behaviour Scales, 2nd Edition (VABS-II), and the ESDM Curriculum Checklist. Linear mixed-effects models were used to examine the effects of the intervention on outcomes. Fixed-effects such as time, groups (verbal and minimally verbal), and time-by-group interactions were assessed whilst adjusting for covariates. Further, multiple linear regression models were used to determine if the baseline characteristics were significant predictors of the outcomes following the early intervention. Among the 64 children who participated in this study, 38 children were verbal, whereas 26 were deemed to have minimal verbal skills. The mean age of the sample was 4.1 years with a significant male predilection (83%) and from a culturally and linguistically diverse (CALD) background (64%). Findings of the linear mixed effects model showed significant within and between group differences in the ESDM subscales, indicating higher magnitude of changes in the verbal group compared to the minimally verbal group. Finally, the multiple linear regression models suggested that baseline MSEL visual reception and expressive language scores were predictive of changes in the ESDM receptive and expressive communication scores. Understanding a child's baseline skill levels may provide valuable clues regarding what interventions would work best, or which interventions may be less suitable for individual preschool-aged children with ASD.

Impact of posterior wall gastrojejunostomy versus anterior wall gastrojejunostomy in pancreaticoduodenectomy on delayed gastric emptying and enhanced recovery: a prospective study

Background Pancreaticoduodenectomy (Whipple operation) is considered the main surgical management for duodenal, pancreatic head, and lower end common bile duct neoplasm. Gastrojejunostomy orientation has a direct impact on enteral feeding and delayed gastric emptying (DGE). Aim The primary outcomes were reviewing the effect of changing the orientation of gastrojejunostomy either anterior wall vertical gastrojejunostomy versus posterior wall vertical gastrojejunostomy on DGE, early enteral feeding, leakage, and overall enhanced recovery with early start of chemotherapy. Patients and methods A prospective randomized trial 55 patients total number of patients after substraction of lost follow up was 50 patients and were divided into two group; group A: 27 patients underwent posterior wall gastrojejunostomy and group B: 23 patients underwent anterior wall gastrojejunostomy both techniques done in antecolic vertical manner. Results Operative time, postoperative bleeding, and leakage was not significantly different between the two groups. The total incidence of DGE was significantly lower in group A (posterior wall vertical) than group B (anterior wall vertical), regarding grades of DGE grade a was significantly lower in group A while the incidence in grades B and C was not significantly different regarding the number of patients. Ryle removal and starting oral intake was earlier and statistically significant in posterior wall vertical gastrojejunostomy when compared to anterior wall vertical gastrojejunostomy. Readmission, the actual use of prokinetics and need for nutritional support was higher in group B (anterior wall vertical gastrojejunostomy) than group A (posterior wall vertical gastrojejunostomy) but was not statistically significant. Conclusions Posterior wall vertical gastrojejunostomy has a better overall significant better outcome regarding early enteral feeding and DGE over anterior wall vertical gastrojejunostomy group also has better enhanced recovery and earlier time of starting chemotherapy. This topic should be evaluated in depth in a large-volume studies.

Early start of anticoagulation in stroke-timing is essential!

Early start of anticoagulation in stroke-timing is essential!

Cognitive, behavioral and socio-communication skills as predictors of response to Early Start Denver Model: a prospective study in 32 young children with Autism Spectrum Disorder.

The effectiveness of early interventions in young autistic children is well established, but there is great interindividual variability in treatment response. Predictors of response to naturalistic developmental behavioral interventions (NDBI), like the Early Start Denver Model (ESDM), are needed. We conducted an exploratory study to prospectively seek predictors of response in 32 young children treated with ESDM after receiving an ASD diagnosis. All children were less than 39 months old (mean age: 29.7 mo), and received individualized ESDM for nine months. Tests were administered at the beginning, after 4 months, and at the end of treatment. Four children (12.5%) were "strong responders", 8 children (25.0%) were "moderate responders", and 20 children (62.5%) were "poor responders". A more favorable response to ESDM was significantly predicted by higher PEP-3 Expressive Language, Receptive Language, Cognitive Verbal/Preverbal, Visuo-Motor Imitation scores, higher GMDS-ER Personal/Social, and VABS-II Communication scores, by lower ADI-R C restricted/stereotypic behaviors, and by joint attention level. Most predictors showed a linear association with increasing response to ESDM, but GMDS-ER Personal-Social and joint attention level predicted strong response, while PEP-3 receptive language equally predicted moderate or strong response. Although larger samples will be necessary to reach definitive conclusions, in conjunction with prior reports our findings begin providing information able to assist clinicians in choosing the most appropriate treatment program for young autistic children.

Diagnostic Utility of NT-Pro BNP in Elderly Patients Presenting With Acute Dyspnea in Emergency Department

ABSTRACT&#x0D; BACKGROUND: Acute dyspnea may be related to lungs pathology or cardiac pathology or due to involvement of both. Rapid diagnosis of the cause of dyspnea in emergency can help in early start of treatment preventing further progress of the symptoms, prolong hospital stay, need of more invasive medical procedures like intubation and ventilation thereby decrease the morbidity and mortality of the patients.&#x0D; METHODOLOGY: The study was conducted for three months i.e, from 16th May 2023 till 17th August 2023. 150 patients fulfilling inclusion criteria were taken. Clinical diagnosis in these patients was established based on medical history as well as echo and chest X-ray. Based on their clinical diagnosis, the patients were divided into three groups: group A diagnosed with pulmonary dyspnea (PD), group B diagnosed with congestive heart failure (CHF), and group C diagnosed with combined dyspnea (CHF+PD). NT-proBNP level in these patients was measured and compared.&#x0D; RESULTS: The study population constituted 60% males and 40% female with mean age of 68.9±10.99. Out of 150 patients presenting with acute dyspnea in emergency department, 65 patients were diagnosed with congestive heart failure, 55 patients were diagnosed with pulmonary dyspnea and 30 patients diagnosed with combined dyspnea. Average NT-proBNP among group A patients was (1300±175) ng/l, among group B patients was (275±70) ng/l and among group C patients was (1276±165) ng/l.&#x0D; CONCLUSION: NT-proBNP is the reliable marker to differentiate the cardiac and pulmonary causes of acute dyspnea among elderly patients presenting to emergency.&#x0D; &#x0D; KEY WORDS: N-terminal pro-B-type natriuretic peptide (NT-proBNP), emergency, elderly patients, dyspnea, biomarker

Клинические случаи повреждений глаз физическими факторами

INTRODUCTION: Injuries of the organ of vision are the most severe cases of ophthalmopathy. This report describes clinical cases of eye damage by different physical factors (light emission of the Sun, light emission of a laser pointer, explosion of a firecracker) in everyday life. An eye damage by the light emission of the Sun may occur in observing a solar eclipse without means of eye protection. Clinical cases of solar retinopathy in three children aged 12–13 years who referred to an ophthalmologist in different periods after observation of a solar eclipse (2 days, a month, three months) are presented. The outcomes of the process: in early start of treatment, the function of the eye restored; in later stages, the visual acuity remained reduced, retinal edema and hyperemia of fovea persisted. A laser pointer widely used in everyday life, may cause damage to the macular zone of the retina in case a laser beam gets into an eye. We followed up two patients aged 12 and 30 years with retinal burn caused by direct looking into a laser beam. After the treatment, visual acuity remained impaired in both cases, the residual edema, redistribution of pigment, pigment epithelium destruction foci were observed in the retina. Incorrect use of safe pyrotechnics may result in a severe eye damage. We observed two cases of a severe contusion trauma of eyes caused by explosion of a firecracker. In one case (patient aged 45 years), a severe contusion with crush injury of the eyeball resulted in nucleation of eye; in another case (a child aged 15 years), there were a persistent impairment of visual acuity and hemorrhages into the retina. CONCLUSION: The possibility of eye damage by the described physical factors indicates the need for sanitary and educational work aimed at preventing these injuries, especially in children.

Feasible Adaptation of ESDM for Statewide Implementation: A Look at Potential Effects, Implementation Conditions, and Cost

This article describes the development and use of a first of its kind statewide implementation of an adapted Early Start Denver Model (ESDM). Supported by a collaborative partnership between stakeholders that included families, state agencies, and a state university, the intervention was implemented within the existing framework of a northeastern state’s relationship-based Individuals with Disabilities Education Act (IDEA) Part C early intervention program. Participants were 194 families. The study examined the effectiveness and implementation costs of an adaptation of the ESDM using a coaching model to inform statewide implementation to improve outcomes for young children with autism spectrum disorder (ASD) in rural and low-resource states. Results indicated 194 children who received a monthly average of 10.90 hr of adapted ESDM for an average of 12 months demonstrated an improvement in the frequency of ASD symptomology for a total cost of US$2,511/child. Intervention intensity and child factors demonstrated varying influence on outcomes. This study contributes to the literature by demonstrating the potential for positive impact of an evidence-based practice scaled to a statewide model of early intervention for young children with ASD.

Immunoglobulin-G4 Related Disease with Multiple Organ Involvement

Dear Editor, Immunoglobulin G4-related disease (IgG4-RD) is an immune-mediated fibroinflammatory disease affecting multiple organ systems. The clinical findings may range due to the affected organ. The main distinguishing histopathological features of IgG4-RD are lymphoplasmacytic infiltration, storiform fibrosis, obliterative phlebitis, and mild or moderate tissue eosinophilia. Rarely, it may affect the lungs, hearts, pituitary, meninges, skin, prostate, breast, and thyroid gland [1–3]. In this article, we present a case diagnosed with IgG4-related disease involving multiple organs, including the pituitary, lymphatic system, kidney, and heart, and the patient responded well to immunosuppressive treatment. A fifty-five-year-old female patient applied with complaints of fatigue, polydipsia, polyuria, widespread body pain, and 20 kg weight loss in the last year. After excluding other possibilities, with a prediagnosis of diabetes insipidus (DI) pituitary MRI was performed which showed an increase in size and heterogeneous patchy contrast enhancement in the adenohypophysis (Fig. 1a). Based on the current clinical and imaging findings, the patient's laboratory results were evaluated, and central DI was diagnosed. In computerized thorax tomography, multiple lymph nodes in the mediastinum were detected, the largest of which was 21x17 mm. Tissue sampling was performed with the guidance of EBUS, pathological examination showed no diagnostic findings. Transesophageal Echocardiography (TEE) revealed an appearance consistent with a 10-15 mm thick thrombus surrounding the left atrium wall and narrowing the cavity. Increased thickness narrowing the left atrial lumen was reported in thorax computed tomography (CT) (Fig. 2). Further, a cardiac MRI was performed and reported to be consistent with lymphoproliferative-inflammatory involvement rather than thrombus. Abdominopelvic CT was performed and a lesion of 54x28 mm in size, less contrast enhancing than the surrounding parenchyma, in the middle part posterior of the left kidney was detected (Fig. 3). Histopathological findings were consistent with inflammatory processes, and no findings in favor of a neoplastic lymphoproliferative process were detected in the samples. Since the patient was presented with pituitary involvement, mediastinal lymphadenopathy, renal and cardiac mass, the IgG4 level was ordered and resulted as 299 mg/dl (3-201). IgG4 staining could not be performed in the current biopsy specimen; for confirming the diagnosis of IgG4-related disease, a re-biopsy was performed on the kidney mass. Histopathological findings were consistent with IGG4-RD (Fig. 4). Due to multisystemic involvement, the patient received 0.6 mg/kg/day oral corticosteroid and mycophenolate mofetil 3x1000 mg/day. The pituitary MRI that was performed in the first month of treatment was normal (Fig. 1b). Desmopressin treatment was stopped. Also, control TEE in the first-month follow-up visit showed a significant reduction in the mass image in the left atrium. After three months of follow-up, there was a significant improvement in the patient's symptoms and acute phase response. The corticosteroid was tapered and maintenance treatment with mycophenolate mofetil was continued. IgG4-related disease is rare and difficult to diagnose, though its presentation may be in a wide variety of clinical features. It is crucial to make an early diagnosis and start treatment early in these patients to prevent morbidity and mortality. In cases with mass lesions and especially with multiple organ involvement, as in our case, IgG4-related disease should be kept in mind, and IgG4 staining should always be kept in mind. Kind Regards

Reaction of the endogenous regulatory mechanisms to early weekday wakeups: a review of its popular explanations in light of model-based simulations.

Introduction: Several widely held explanations of the mechanisms underlying the responses of endogenous sleep-wake-regulating processes to early weekday wakeups have been proposed. Here, they were briefly reviewed and validated against simulations based on the rhythmostatic version of a two-process model of sleep-wake regulation. Methods: Simulated sleep times on weekdays and weekends were compared with the times averaged over 1,048 samples with either earlier or later weekday risetimes. In total, 74 paired samples were collected before and during lockdown, and 93 paired samples were collected during early and later school start times. Results: The counterintuitive predictions of the simulations included the following: 1) only one night of ad lib sleep is sufficient to restore the endogenously determined sleep times after 1day/5 days of larger/smaller reduction/extension of the sleep/wake phase of the circadian sleep-wake cycle; 2) sleep loss on weekdays is irrecoverable; 3) irrespective of the amount of such deadweight loss, sleep on weekends is not prolonged; and 4) the control of the circadian clocks over the sleep-wake cyclicity is not disrupted throughout the week. Discussion: The following popular explanations of the gaps between weekends and weekdays in sleep timing and duration were not supported by these simulations: 1) early weekday wakeups cause "social jetlag," viewed as the weekend and weekday (back and forth) shifts of the sleep phase relative to the unchanged phase of the circadian clocks, and 2) early weekday wakeups cause an accumulation of "sleep debt paid back" on weekends, or, in other terms, people can "catch-up" or "compensate" sleep on weekends.

Parenting and family self-sufficiency services contribute to impacts of Early Head Start for children and families.

There is evidence that two-generation early childhood programs, those that strive to support not only child development, but also optimal parenting and family wellbeing, help to foster resilience for young children and their families in the face of adversity. Using data from a large experimental evaluation, the Early Head Start Research and Evaluation Project, this paper explores how parenting and family self-sufficiency services embedded in Early Head Start (EHS), a federally funded, nationally implemented two-generation early childhood program for low-income families lasting from pregnancy and until children are three, contribute to the impacts of the program for both the children and their families. Parenting support in any modality (home visiting, case management or parent education) contributed to program impacts on important child and family outcomes, but not parent employment. Somewhat surprisingly, family receipt of employment services did not lead to any of the impacts of the program, while education and job training services did. When EHS parents received education or job training services, it led to impacts not only on mother employment, but also on other important family and child outcomes. These findings validate and reinforce the two-generation approach of EHS, specifically supporting the focus on parenting and parent education and job training.

An Overview Pharmacological Approaches and Herbal Intervention for Alzheimer Disease

The most prevalent kind of dementia, Alzheimer’s disease (AD), is a progressive neurodegenerative illness that has a major impact on memory and cognitive function. As the condition advances to more advanced stages, it results in behavioral issues like aggression, depression, and verbal and visuospatial impairments. Alzheimer’s has no known cure, however symptomatic treatment helps with memory loss and other symptoms. Natural goods provide a therapeutic alternative for many ailments, effectively halting their progression, and alleviating the symptoms of many different types of diseases. Traditionally, memory diseases including dementia and amnesia have been treated with medicinal plants and plant derivatives. Although there is little scientific backing for the claims made in numerous research regarding the effectiveness of plants in treating Alzheimer's disease. However, reports indicate that an early start to usage

Green Recovery and Regenerative Tourism: The Success Story of Miso Walai Homestay in Building a Resilient Rural Tourism Destination

Summary Although green recovery and regenerative tourism are well-documented in the literature, case studies at the destination level are lacking, and this is because the application of these concepts is still in its early stages. Therefore, this case study examines a rural tourism community in Lower Kinabatangan, Sabah (Malaysia). The authors used longitudinal analysis from 2007 to 2019, semi-structured interviews, and participant observations to illustrate how the area has managed to successfully recover from intense deforestation following years of exploitation by timber companies and also cushion the impact of COVID-19. The community pushed for a recovery agenda based on community-based ecotourism and green recovery, which resulted in the growth of regenerative tourism. This study examines how the community has seized new opportunities through ecotourism at Miso Walai Homestay, linked to a community forest-restoration programme, and how these opportunities were intensified during the COVID-19 pandemic to compensate for the lack of tourists. Consequently, this case study shows how Miso Walai Homestay has become a model of a regenerative approach that promotes a resilient rural tourism destination. Key success factors have been the agile community leadership, an early start in community forest restoration, partnerships with volunteer organizations, the establishment of trust and reputation, the promotion of citizen science, and the embrace of green recovery initiatives. This case highlights the success of Miso Walai Homestay in leveraging green recovery initiatives to cushion the financial impact of two situations. First, after the withdrawal of the timber companies from the Kinabatangan region (Malaysia), a new model of community-based tourism was established through a community forest restoration programme. Second, during the lockdown period of the COVID-19 pandemic, income streams were consolidated from green recovery. The Miso Walai Homestay enjoyed a subsequent recovery stage in tandem with the gradual return of international tourists. Information © The Authors 2023

Parent Perceptions of Participating in a Parent-Mediated Program for Young Autistic Children

Parents may be well placed to deliver therapeutic support to their own autistic preschool children. Parent-implemented Early Start Denver Model (P-ESDM) is one well-researched program for coaching parents to use strategies in daily routines to support child development. This qualitative study examined the perceptions of parents of autistic preschool children who participated in a two-tiered 20-week P-ESDM program. This program was novel in that it involved group delivery of P-ESDM as well as a two-tiered approach to support provision. Semi-structured interviews were conducted with the nine parents of seven autistic preschool boys who participated in the program. Data were analyzed using reflexive thematic analysis. Four key themes and 13 subthemes were developed. The themes centered on (a) program accessibility and participation, (b) experience of the two-tiered coaching process, (c) commitment and perseverance, and (d) outcomes. Parents perceived the program to be feasible, acceptable, and effective and gave recommendations for improving future tiered P-ESDM supports. The mixed perceptions from parents suggest the need for flexible, individualized support. Understanding the reported strengths and barriers of this program could allow future programs to better meet the needs of diverse families.

Teacher–researcher collaborative development of critical (trans)languaging awareness through leveraging linguistic strengths

Abstract This study explores the collaborative process that two Korean–English and one Spanish–English bilingual Early Head Start family childcare educators, two instructional coaches, and the author engaged in as they co-created intentional bilingual pedagogical approaches to support young emergent bilinguals and co-develop critical (trans)languaging awareness. Data included participant and non-participant observations; field notes; debriefing sessions between the teachers and the author, and instructional coaches and the author; informal interviews with teachers; and two Saturday meet-ups with all participants and the author. Data were analyzed using thematic analysis to identify salient themes in the creation and implementation of practices and pedagogies that leveraged both teachers’ and children’s languaging practices as we deepened our critical language awareness. The design-based collaborative approach that involved co-learning, co-planning, and co-shifting supported our focus on critical language use, trial of different (trans)languaging practices that transgressed English hegemony, and decision-making around how to best leverage everyone’s linguistic strengths in support of children’s developing bilingualism.

Navigating the Challenges of Gluten Enteropathy and Infertility: The Role of Celiac-Related Antibodies and Dietary Changes.

Celiac disease (CD) is an autoimmune condition that is initiated in genetically susceptible individuals by the exposure of the intestines to gluten, and the early start of symptoms is related to malabsorption. Atypical variants of the illness are often identified in adulthood and are frequently associated with manifestations outside of the intestines, including metabolic osteopathy, anemia, and dermatitis herpetiformis. But also, empirical data suggest a correlation between CD and reproductive abnormalities, including repeated abortions. Infertility and repeated miscarriages frequently manifest in women diagnosed with CD and may serve as the initial clinical indication of a subclinical form. Furthermore, the condition may manifest as amenorrhea, infertility, and the delivery of infants with a low birth weight. Regarding the mechanisms of CD in infertility, along with the anti-tTG action to hinder the invasiveness of trophoblast, these antibodies could damage endometrial angiogenesis, which has been shown in in vitro models with human endometrial cells and in vivo in murine models. Another important aspect is the role of nutrient deficiencies, such as zinc deficiency (connected to impaired hormone production, secondary amenorrhea, and pre-eclampsia) and folic acid, etc. Therefore, our objective was to conduct a comprehensive review of the existing literature pertaining to this specific topic and to elucidate the role of the autoantibodies in its pathogenesis.