Extensive Support Research Articles

ВИКОРИСТАННЯ ЦИФРОВИХ ІНСТРУМЕНТІВ ПРИ ПРОВЕДЕННІ ІНВЕНТАРИЗАЦІЇ ОБ’ЄКТІВ ОБЛІКУ

Introduction. The development of the digital economy has left its mark on all areas of activity, including accounting processes. The theoretical and practical foundations of accounting are also undergoing significant changes. Accounting tools must be in line with modern realities. Enterprises automate the collection and registration of primary information using modern measuring instruments, which ensures the documentation of business transactions exclusively in electronic form. The article discusses the need to ensure the reliability of accounting indicators and prevent possible deviations by means of inventory, one of the main methods of accounting and control. The purpose of the article. To study and improve the digital tools used in the inventory of accounting objects at business entities of various types of activities. Methods. The methods of abstraction, analysis, logical, theoretical, generalization and comparison were used in the study. The research is based on the dialectical method. Results. The transformation of accounting in accordance with the new needs of society is a necessary stage in its development. Changes and improvements in the accounting methodology will help not to lose its relevance in the era of universal digitalization. The complexity of the inventory and its labor intensity is explained by the need for a set of preparatory and organizational actions, extensive documentary support, involvement of significant human resources in control procedures, and the multidimensional scope of application. With the ever-increasing range and assortment of inventory items on the market, the number of accounting items is growing, which in turn requires significant time spent on control procedures. Inventory at the vast majority of enterprises is characterized by a statutory procedure and frequency. Conclusions. The use of digital identification technologies in inventory procedures will reduce labor and working time costs, increase the efficiency of such procedures, ensure timeliness and efficiency of inventory, and reduce the likelihood of abuse.

To Identify and Discuss the Enablers or Facilitators and Barriers to International Medical Graduates Adapting to the United Kingdom National Health Service in a Defined Surgical Trainee Population: A Qualitative Study

Background International medical graduates (IMGs) play a crucial role in the United Kingdom National Health Service (NHS), yet they encounter significant challenges adapting to the NHS environment. This study aims to identify the enablers and barriers affecting the adaptation of IMGs, specifically focusing on surgical trainees in the Master of Surgery (MCh) program at Edge Hill University. Methods A qualitative approach was employed, utilizing an interpretivist philosophy and descriptive design. Data were collected through focus group discussions with first-year MCh surgical trainees. Thematic analysis was conducted to extract key themes related to adaptation. Results Three focus groups with a total of seven participants revealed several enablers and barriers. Enablers included robust administrative support, effective communication courses, comprehensive mentorship programs, and supportive hospital staff. Barriers identified were limited access to formal teaching, a fast-paced academic environment, language and cultural differences, and variations in medical practice. Conclusions The successful integration of IMGs into the NHS hinges on strong support systems, including administrative assistance, mentorship, and cultural and communication training. Addressing these barriers can facilitate smoother adaptation, enhance retention, and improve patient care. Recommendations To enhance IMG adaptation, the study recommends extensive induction programs, improved mentorship and support networks, cultural competence training, and better access to formal teaching with feedback.

The Dilemma of Urban Heritage Conservation in Post-Conflict Bamiyan: A Critical Analysis of Causes, Failures, Consequences and Prospects

ABSTRACT This study presents a detailed analysis of the challenges and opportunities in heritage conservation within the conflict-affected Bamiyan Valley, Afghanistan. Renowned for its rich cultural history and the iconic Buddhas carved into its cliffs, the valley has endured decades of conflict and devastation. Despite the constructive intentions and extensive support of international organisations, the absence of effective management policies and precise monitoring systems has led to significant budget misallocation. To highlight the critical aspects and hurdles of heritage conservation, this research employs a qualitative and descriptive methodology, the study examines 15 conservation projects (2001–2021) through rigorous document analysis and data collection. Project failures are categorised into five primary groups: security, technical, socio-cultural, environmental, and administrative-financial issues. Through a robust analytical framework, significant patterns and themes are distilled, revealing the intricacies of conservation efforts. Findings highlight the impact of political instability, inadequate technical expertise, socio-cultural barriers, and more on heritage conservation. Conclusions highlight five key strategies: comprehensive assessments, inclusive stakeholder engagement, context-sensitive integration, sustained support, and adaptive monitoring. This research contributes to the existing literature and provides valuable insights for policymakers and practitioners, guiding future research and conservation efforts in similar contexts.

Design of Neko—A Scalable High‐Fidelity Simulation Framework With Extensive Accelerator Support

ABSTRACTRecent trends and advancements in including more diverse and heterogeneous hardware in High‐Performance Computing (HPC) are challenging scientific software developers in their pursuit of efficient numerical methods with sustained performance across a diverse set of platforms. As a result, researchers are today forced to re‐factor their codes to leverage these powerful new heterogeneous systems. We present our design considerations of Neko—a portable framework for high‐fidelity spectral element flow simulations. Unlike prior works, Neko adopts a modern object‐oriented Fortran 2008 approach, allowing multi‐tier abstractions of the solver stack and facilitating various hardware backends ranging from general‐purpose processors, accelerators down to exotic vector processors and Field‐Programmable Gate Arrays (FPGAs). Focusing on the performance and portability of Neko, we describe the framework's device abstraction layer managing device memory, data transfer and kernel launches from Fortran, allowing for a solver written in a hardware‐neutral yet performant way. Accelerator‐specific optimizations are also discussed, with auto‐tuning of key kernels and various communication strategies using device‐aware MPI. Finally, we present performance measurements on a wide range of computing platforms, including the EuroHPC pre‐exascale system LUMI, where Neko achieves excellent parallel efficiency for a large direct numerical simulation (DNS) of turbulent fluid flow using up to 80% of the entire LUMI supercomputer.

The Poor Performance of Students with Hearing Impairments in Tanzania: A Case Study of Iringa Girls' Secondary School

This study aimed to identify factors contributing to the poor performance of students with hearing impairments in Tanzania's secondary schools."Specifically, the study examined the challenges the teachers, school administrators and students face in supporting academic achievement. The study involved 23 participants including DQAOs, DEOs, the head of school, teachers and students with hearing impairments. Data were collected using document review, observation, and interviews with District Quality Assurance Officers and the head of school. Additionally, the study gathered primary data from teachers and students with hearing impairments, who participated focus group discussions. The study identified significant barriers to include a shortage of specialised teachers, inadequate teaching and learning facilities and limited support from school leadership. Furthermore, the study suggests that supporting inclusive education and improving academic performance for students with hearing impairments required initiatives such as more training for school administrators, more funding, and extensive support networks.

Facilitators and Barriers to Increasing Equity in Cystic Fibrosis Newborn Screening Algorithms.

Newborn screening (NBS) for cystic fibrosis (CF) was universally implemented in the United States in 2010 to improve disease outcomes. Despite universal screening, disparities in outcomes currently exist between people with CF (PwCF) with Black/African, Asian, Indigenous, and Latino/Hispanic ancestry in comparison to PwCF of European ancestry. This is in part because CFTR panels used for newborn screening are often based on variants common in European ancestries leading to higher rates of false negatives for PwCF from minoritized racial and ethnic groups. This study investigated how states evaluate and update their CFNBS algorithms through semi-structured interviews with professionals from four states with ethnically diverse populations and one national consultant. Interviews were transcribed verbatim and analyzed through inductive thematic analysis. Five themes were identified encompassing facilitators, barriers, and motivations for evaluating and updating CF NBS algorithms. Facilitators of effective evaluation and updating of algorithms included effective communication with CF clinical centers and extensive support for CF as compared to other conditions. Although participants stated that their respective NBS programs were aware of the disparate impact of their CF panels on PwCF from minoritized racial and ethnic groups, motivations to decrease this disparity were hampered by a range of funding and logistical barriers, such as limited information about false negative cases and difficulties incorporating next generation sequencing technology. This study shed light on the experiences of states considering alterations to their CFNBS panels, revealing several key barriers and facilitators to implementing equitable CFNBS algorithms.

Black Fathers' Views on Breastfeeding Facilitators, Barriers, and Support Services: Insights From a Qualitative Community-Based Participatory Research Study.

Despite the persistence of breastfeeding racial and ethnic disparities in the United States, little is known about Black fathers' perceptions of breastfeeding and breastfeeding support services (e.g., maternity hospital-based care and lactation management care). This qualitative, community-based participatory research study reports Black fathers' perceptions of barriers and facilitators to breastfeeding, including the provision of breastfeeding support services in Connecticut. A focus group guide was co-developed with community partners and adapted from the Barrier Analysis Tool to identify breastfeeding facilitators, barriers, and service improvement areas. Four focus groups were conducted with 30 Black fathers who were Connecticut residents with a child under 3 years old. Qualitative data were analyzed using rapid template analysis involving deductive and inductive coding. We identified factors influencing breastfeeding and fathers' ability to support breastfeeding across all levels of the Socio-Ecological Model. Facilitators included high paternal breastfeeding knowledge, paternal breastfeeding involvement, parents' shared decision-making, extensive maternity hospital discharge support, ongoing breastfeeding support into the postnatal period, availability of community breastfeeding resources, and designated spaces for public breastfeeding. Barriers included low paternal breastfeeding knowledge, familial discouragement, insufficient prenatal breastfeeding education, exclusion of the father from breastfeeding support services, and stigma against breastfeeding in public. Understanding breastfeeding perceptions among members of a mother's support network, including their partners, is key for developing effective person- and family-centered breastfeeding education and counseling services that are well coordinated from the prenatal to postnatal periods with strong direct engagement from fathers.

How does the Chinese Communist Party manage a pluralised society?: issue politics and political strategy in China, 1921–2020

ABSTRACT This study analyzes political issues based on structural topic modelling (STM) for the party documents and news articles from the Chinese Communist Party (CCP)‘s archive on 19 National Congresses of the CCP and 82 plenary sessions of the central committee. This article discusses how the CCP has emphasised development issues as common goals to mobilise different social groups since 1989, when critical social cleavages emerged in China. Evidence from text mining analysis shows that the CCP emphasised the issues of economic development and consistent development as social conflicts and inequality increased after economic reform took place. The focus on economic development and consistent development was a political strategy to elicit extensive support from powerful groups within society and the mass public. This finding helps to understand how political parties in non-democratic countries utilise political issues to strengthen their regimes.

The Bridge to Somewhere How Practitioners Can UNITE to Support Adults With Extensive Support Needs in Inclusive Employment Opportunities

The Bridge to Somewhere How Practitioners Can UNITE to Support Adults With Extensive Support Needs in Inclusive Employment Opportunities

Extending Fraud Detection in Students Exams Using AI

The objective of the research is to enhance the functionality of the FraudDetector software agent within the Distributed eLearning Center (DeLC), a platform providing extensive support for e-learning activities. DeLC assists students and teachers in organizing learning materials, addressing knowledge gaps, conducting exams, and fostering personalized elearning environments. The project scope encompasses various extensions, including an agent-oriented environment that enriches functionalities with reactive and proactive intelligent components, referred to as agents or assistants. This paper focuses on the latest evolution of the FraudDetector software agent, transitioning from its base functionality for fraud detection to leveraging artificial intelligence (AI) capabilities. The goal is to integrate AI, specifically the knowledgebase provided by ChatGPT, to enhance FraudDetector's effectiveness. This integration is the primary contribution of the research, aimed at improving fraud detection precision. Experimentation reveals promising results, suggesting that involving ChatGPT enriches FraudDetector's functionality and enhances the agent's precision. Moving forward, the agent's architecture should remain open for collaboration with external AI providers, with efforts to decouple components responsible for integration. The real-world implementation of these findings is pending, warranting further validation through production environment testing.

Therapeutic effects of powered exoskeletal robot-assisted gait training in inpatients in the early stage after stroke: a pilot case-controlled study

BackgroundRobot-assisted rehabilitation is considered beneficial for functional recovery in patients with stroke, but the therapeutic effect remains inconclusive. The present study investigated the therapeutic effects of gait training assisted by a user-initiated powered exoskeletal robot (UIPER) in patients in the early stage after stroke. We also characterized patients’ improvement by analyzing chronological changes in clinical measurements together with gait parameters obtained from internal sensors in the exoskeletal robot.MethodsIn this pilot case-controlled study, 17 and 81 patients with stroke onset durations of < 3 months were included in the robot-assisted combined with conventional treatment (RT + CT) group and conventional treatment only (CT) group, respectively. The UIPER, which provides knee flexion and extension support and has hip and knee sensors, was applied to guide gait performance in the RT + CT group. The patients in the RT + CT group received robot-assisted gait training for 40 min/ session, 1 session a day, and 2–3 sessions a week (6 sessions in total). The primary outcome was the proportion of patients reaching the minimum clinically important difference (MCID) in the 5-meter walking speed (5MWS) assessment, and the secondary outcomes were the MCID for the six-minute walking test, the Berg Balance Scale, the Barthel Index, the Fugl-Meyer assessment, and the timed up and go test before, during, and after the interventions. Gait parameters of the hip and knee were evaluated at baseline, midterm, and final sessions.ResultsGait function improved in both groups after the intervention (both P < 0.05). The primary outcome showed that a greater proportion of patients reached the MCID for the 5MWS in the RT + CT group than in the CT group (70.6 vs. 43.2%, P = 0.040; \\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$${r_\\phi }$$\\end{document} = 0.208). Similarly, in terms of the secondary outcomes, more patients in the RT + CT group reached the MCID for the Barthel index as compared with the CT group (41.2 vs. 17.3%, P = 0.047, \\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$${r_\\phi }$$\\end{document} = 0.220). Gait analysis revealed improvements in gait in the RT + CT group, as indicated by increases in the perimeter and area of the hip–knee cyclogram, as well as the range of motion in the hip joint.ConclusionsGait training assisted by UIPER facilitates the recovery of walking speed and activities of daily living in patients with stroke, and these improvements may be related to improvements in gait parameters. Randomized controlled studies with larger sample sizes are needed to confirm these findings.Trial registrationThis trial was approved by the Institutional Review Board of Chang Gung Medical Foundation (No. 202200822B0).

Associations Between State Policies Facilitating Telehealth and Buprenorphine Episode Initiation and Duration Early in the COVID Pandemic : State Telehealth Policies and Buprenorphine.

State policies facilitating telehealth implemented early in COVID may support buprenorphine treatment of opioid use disorder. However, little empirical information is available about those policies' effects. Examine association between state policies that may facilitate telehealth use and buprenorphine treatment. Retrospective cohort study using 2019-2020 national pharmacy data on dispensed buprenorphine prescriptions. State policies implemented after March 3, 2020, public health emergency declaration requiring private insurers' telehealth reimbursement to be commensurate with in-person service reimbursement, authorizing Medicaid reimbursement for audio-only telehealth, allowing physicians to provide cross-state telehealth services, and allowing psychologists to provide cross-state telehealth services. (a) Duration of treatment episodes started between March 1 and March 13 in both 2019 and 2020, and (b) daily numbers of new buprenorphine treatment episodes from March 13 through December 31 in each year. We found little change in the number of new buprenorphine treatment episodes started in 2020 compared to 2019 and an increase in treatment duration of 10.3days (95%CI 8.3 to 12.2days) for episodes started in March 2020 before the public health emergency declaration compared to the comparable 2019 period. States implementing a telehealth parity policy in 2020 had 7.3% (95%CI - 13.3% to - 0.4%) fewer new buprenorphine treatment episodes. States joining the psychologist interstate compact in 2020 after the public health emergency declaration had treatment episodes 7.97days longer (95%CI 0.78 to 15.16) than other states. None of the other policies examined was associated with changes in new treatment episodes or treatment duration. Policies undertaken during the pandemic we examined were associated with few significant changes in buprenorphine treatment initiation and duration. Findings suggest realizing the benefits of telehealth and other policy changes for buprenorphine may require more extensive implementation and infrastructure support.

AHP SO06 - A case report of the nutritional and multi-disciplinary team (MDT) management of an emergency oesophageal perforation associated with Eosinophilic Oesophagitis (EOE)

Abstract Background EOE once considered rare, is a chronic inflammatory condition of the oesophagus presenting as dysphagia and food impaction in children and adults. Awareness and management of EOE is variable despite an increasing prevalence and the condition deemed the most common cause of oesophageal perforation in adults and children by the British Society of Gastroenterology (BSG). This case review aims to increase the awareness of EOE, highlight the clinical presentation of EOE, discuss considerations for the nutritional management and the importance of an MDT approach to the care of this condition in relation to the BSG consensus guidelines. Method The patient was admitted to a specialist oesophago-gastric surgical centre in the Northwest of England. A retrospective review of the patient’s case notes was completed. This included exploration of all inpatient and outpatient contacts stored in the electronic patient records system. Results 18-year-old underweight male with IgE-mediated nut allergy and odynophagia, developed complex multi-site oesophageal perforations following OGD. Management included 40-day endoluminal vacuum therapy and extensive nutritional support. Although initial biopsies lacked diagnostic quality and conclusive results, EOE was subsequently confirmed. Dietetic evaluation included nutritional status, atopic history, symptoms, and dietary intolerances. MDT discussions influenced care continuity and patient compliance. Feeding delays attributable to frequent theatre visits impacted continued weight loss; addressed with allergen-free enteral and parenteral feeding, and dietary reintroduction, following six-food elimination once perforations had healed. Healthy BMI was achieved through patient’s preferred long-term management of normal diet and Budesonide. Conclusion Increased awareness of EOE is paramount for patients presenting with unexplained oesophageal perforation. Obtaining biopsy samples as per BSG guidance supports earlier diagnosis and management plan. A thorough clinical history including childhood eating behaviours, atopic history, dietary intolerances and symptom presentation from the patient and relatives gathers collateral information to support diagnosis and treatment planning. Joint discussions regarding pharmaceutical management, dietary elimination and reintroduction are important to achieve remission. The case highlights the importance of collaborative MDT working with the surgical, medical and dietetics whilst empowering the patient to make informed decisions regarding the nutritional and medical management of condition.

Unpacking the COVID-19 roadway fatality paradox: an analysis of motor vehicle crashes in Michigan 2019-2022

Objectives Motor vehicle travel shifts during the COVID-19 pandemic resulted in fewer vehicle miles traveled yet paradoxically higher fatality rates. Anecdotally, the paradox was blamed on increases in risky behavior in the absence of regular traffic and enforcement. We examined three hypotheses to explain the fatality paradox using Michigan crash data: (1) lack of congestion led to higher-speed impacts; (2) increased risky driver/driving; and (3) low-risk driving miles decreased. Methods We examined changes in hypotheses-related crash factors and injury outcomes for the years 2019–2022; restricted to the duration of Michigan’s stay-at-home order in 2020 (March 23 and June 1). First, we used logistic regression to evaluate the prevalence of the crash factors in all crashes and in severe/fatal crashes only in 2020, 2021; and 2022 compared to 2019. Second, to identify whether those crash factors differentially resulted in worse injury outcomes, we used logistic regression to evaluate whether odds of a severe/fatal crash occurring in March 23–June 1 across the years 2019–2022. Results All three hypotheses tested to explain Michigan’s traffic safety paradox had moderate to extensive support. Risky driving/driver factors were more prevalent during the 2020 stay-at-home order in all crashes; however, the risky driving factors were largely not more prevalent in severe and fatal injury crashes in 2020. In contrast, although less prevalent, many factors associated with the low-risk mileage and congestion hypotheses were more likely to result in severe and fatal outcomes during the stay-at-home orders in 2020. The prevalence of most congestion and low-risk miles factors remained less prevalent in 2020–2022 compared to 2019; while the prevalence of risky driving and driver factors in crashes had largely returned to 2019 levels or lower in 2022. Conclusions The overlapping contributions of the three different hypotheses explaining Michigan’s pandemic traffic safety paradox underscore the complexity of roadway safety and the need for simultaneous investments in driving education, environmental infrastructure, and technology-based mechanisms of enforcement. In the post-pandemic new normal, system-wide changes from investments like these can encourage safer driving even in the absence of social pressure or physical law enforcement presence.

Characterizing the impact of emergent technologies on earth communications reliance for crewed deep space missions

Future human expeditions into deep space will encounter unique design challenges posed by the increasing distance from Earth, one of which is the inability to maintain near-continuous communication with ground support teams. As a result, the habitat and crew will require a higher level of operational self-sufficiency informed by onboard self-awareness and decision-making capabilities to accomplish functions that have historically involved extensive support from mission control personnel. These include, for example, task planning and anomaly detection, diagnosis and correction, as well as monitoring of consumable usage rates and system performance. Novel emergent technologies in the domain of ‘smart’ systems and digital twins can be employed to enable the onboard capabilities needed to function with minimal Earth communication. However, these technologies are generally low-TRL and difficult to incorporate through traditional systems engineering methods.This work proposes an extension of utility theory to assess the potential reduction in Earth communication reliance between baseline and emergent technologies, scored through a summation of weighted attributes and evaluated against future deep space mission needs and constraints. Case studies are defined from technology under development in the NASA Habitats Optimized for Missions of Exploration (HOME) Space Technology Research Institute (STRI), a project charged with developing and evaluating technologies to enable highly autonomous deep space habitats, and compared to the current baseline technologies used onboard the International Space Station. Notional deep space mission needs and constraints are informed from current NASA plans for the Moon and Mars. These in turn are broken out into higher resolution attributes that are used to assess the operational capabilities of each emergent technology and whether it offers a potentially viable solution for deep space. These technology attributes are scored through a series of semi-structured subject-matter interviews and compared to notional deep space mission constraints. Additional considerations for technology maturation and integration are also discussed. The design analysis paradigm described and demonstrated here can be adapted to assess the degree to which other emergent technologies rely on Earth-based communication, and is intended to provide trade space considerations for future research and development towards deep space habitat self-sufficiency.

Individuals With Extensive Support Needs and Mixed Methods Research: A Systematic Literature Review Across Education Subfields

Mixed methods research (MMR) can support enhanced understanding of complex educational issues, like the inclusion and support of individuals with disabilities in community and school settings. In this systematic review, we explored the extent to which MMR has been used in research exclusively focused on disability across special education (SPED), general education (GE), and disability studies in education (DSE; n = 115 studies). We examined research explicitly considering individuals with extensive support needs (ESNs) in this literature. We highlight the prevalence of MMR exploring topics relevant to individuals with ESN and features of this body of work, including (a) participants in these studies, (b) the presence of theoretical and/or conceptual framing for the research, (c) the goals/aims of the research studies, (d) the purposes for mixing, and (e) the data-generation methods used by the authors. We discuss patterns in the data that reflect differences across subfields, presumptions of competence, and ways ableism shapes research studies. Implications for research and practice to improve inclusive experiences for individuals with ESN are discussed.

"More Than Just Holding the iPad": Family Members' Perspectives on the Work of Video Calling in Aged Care

Video calls are increasingly being adopted to enable older adults living in long-term residential care (aged care homes) to remain socially connected with friends and family. However, care home residents often require extensive support to participate effectively in video calls. Despite growing interest in examining the work involved in facilitating technology use in care homes, the role of caregivers---comprising family members and staff---in facilitating video calls has received limited attention. Drawing on data from a study of family members' experiences in Australia, we analysed the essential work activities required to make video calls function in residential aged care. We show how video calling is underpinned by the development of relationships between families and staff, and how video calling requires considerable work in preparation, facilitation, and troubleshooting. We discuss how video calling systems for care homes might be designed to alleviate unwanted work, lowering the burden of call participation for residents, families, and care staff.

A Mixed-Methods Quality Analysis of Behavior Intervention Plans for Students With Extensive Support Needs

Students with extensive support needs are at risk of demonstrating challenging behavior due to inadequate support of their individual needs or class-wide factors such as low quality of instruction. Students with extensive support needs are also among the students who are most likely to experience aversive interventions and be placed in segregated educational placements. The purpose of this mixed-methods study was to investigate behavior intervention plans (BIPs) written for students with extensive support needs to understand their structural features and technical adequacy, trends across components of plans, and the alignment of the BIP with the student’s individualized education program (IEP). We analyzed BIPs that were developed by IEP teams including a teacher candidate enrolled in a master’s program, a mentor teacher, or a colleague. We found BIPs were of low technical adequacy with patterns of errors reflecting harmful assumptions about students, lack of operational definitions, and intervention procedures that were not aligned with other components of the plan. BIPs and IEPs were not well-aligned, a finding that reflected overall poor planning for students with extensive support needs. Implications for research and practice are presented with a focus on the critically important nature of effective behavior supports for students with extensive support needs.

Le Carnavalesque: La Passion Par Rapport à la Theorie de Mikhail Bakhtin

According to the theory of Mikhail Bakhtin, the carnival of the Middle Ages and Renaissance played a significant role in medieval culture because it permitted the expression of the carnival spirit, a fundamental tendency of humanity that was hidden from public view in daily activities. In contrast with the ordinary life of mankind, the carnival world was a “second world” and “upside-down world” where laws, social structure, and religious authority ceased to exist. It was a place for unadulterated passion where free and familiar contact between individuals and exceptional creativity promoted the formation of new modes of communication and personal relationships. The expression of carnival spirit was necessary for the survival of humanity such that, upon the demise of the carnival, the same passionate desires of the carnival were transferred to the domain of literature and art. Through an examination of menippean literature, as well as the collective works of Francois Rabelais and Fyodor Dostoevsky, this article provides extensive support in favor of the carnival’s influence on literary works that surrounded the demise of the carnival in popular culture.

Widespread Adoption of Precision Anticancer Therapies After Implementation of Pathologist-Directed Comprehensive Genomic Profiling Across a Large US Health System.

Precision therapies and immunotherapies have revolutionized cancer care, with novel genomic biomarker-associated therapies being introduced into clinical practice rapidly, resulting in notable gains in patient survival. Despite this, there is significant variability in the utilization of tumor molecular profiling that spans the timing of test ordering, comprehensiveness of gene panels, and clinical decision support through therapy and trial recommendations. To standardize testing, we designed a pathologist-directed test ordering system at the time of diagnosis using a 523-gene DNA/RNA hybrid comprehensive genomic profiling (CGP) panel and extensive clinical decision support tools. To comprehensively characterize the clinical impact of this protocol, we developed a novel natural language processing (NLP)-based approach to extract clinical features from physician chart notes. We assessed test actionability rates, therapy choice, and outcomes across a set of 3,216 patients with advanced cancer. We observed 49% of patients had at least one actionable genomic biomarker-driven-approved and/or guideline-recommended targeted or immunotherapy (IO) and 53% of patients would have been eligible for a precision therapy clinical trial from three large basket trials. When assessing CGP versus an in silico 50-gene panel, 67% of tumors compared with 33% harbored actionable alterations including clinical trials. Among patients with 6 months or more of follow-up, over 52% received a targeted therapy (TT) or IO, versus 32% who received conventional chemotherapy alone. Furthermore, patients receiving TT had significantly improved overall survival compared with patients receiving chemotherapy alone (P < .001). Overall, these data represent a major shift in standard clinical practice toward molecularly guided treatments (targeted and immunotherapies) over conventional systemic chemotherapy. As guidelines continue to evolve and more precision therapeutics gain approval, we expect this gap to continue to widen.