Special Settings Research Articles

Cardiovascular Risk Profile in Master Paralympic Athletes, a High-Risk Undertreated Population: A Cross-Sectional Longitudinal Study.

Recently, European Society of Cardiology (ESC)validated aprediction model to estimate 10-year fatal and non-fatal cardiovascular disease risk (CVDR) in individuals (aged 40-60 years) without previous cardiovascular disease or diabetes(ESC-SCORE2)and to provide indications for treatment. At present, data describing the CVDR in Paralympic athletes (PAs) are scarce and inconsistent. Therefore,we sought to assess the prevalence of risk factors in PAs to estimate their CVDR through SCORE2. Weenrolled 99 PAs aged ≥40 y.o., who participated at 2012-2022 Paralympic Games, competing in 22 different sport disciplines classified according to sport type (power, skills, endurance and mixed) and disabilities: spinal cord injuries (SCI) and non-SCI. CVDR factors,anthropometric measurements and blood samples were collected. Among the 99 PAs (78% males, mean age 45.7±4.7 y.o.), 52.5% had SCI; 54% were dyslipidemic and 23% were smokers. According to ESC-SCORE2, 29% had high and 1% very-high CVDR. Women (compared to men) and endurance (compared to other sport) exhibited better CV profile. SCI showed no differences when compared with non-SCI for CVDR, excepted for a lower HDL and lower exercise performance.None of the dyslipidemic athlete was on pharmacologically treatment, despitethe altered lipid profile had already been detected at younger age. PAs are a selected population, presenting a high CV risk profile, with 30% showing either high or very-high CVDR according to ESC-SCORE2. Dyslipidemiawas the most common risk factor, underestimated and undertreated, emphasizing the need for specific preventive strategies in this special setting of athletes.

Gender disproportionality in special education: An analysis of odd ratios and trends

AbstractIn Turkey, the special education population has steadily increased since 2006. By generating a 16‐year period of data obtained from the National Education Statistics (NES) published annually by the Presidency of Strategy Development of the Ministry of National Education, we synthesize the gender odds ratios and trends by special education categories and/or educational settings. We used odds ratios and the Mann‐Kendall test for data analysis. Gender disproportionality exists in favour of males with special needs in the majority of educational settings. In addition, we found uptrends, downtrends, and no trends for gender odds ratios. Gender disproportionality is discussed, along with implications for research and practice.

Portable spectroscopy, digital imaging colorimetry and multivariate statistical tools in contaminant identification: A case study of mint (Mentha) and basil (Ocimum basilicum)

The advent of portable Fourier-Transform Infrared (FTIR) and Raman spectrometers has revolutionized analysis capabilities, presenting the possibility of on-site contaminant identification without the need for specialized laboratory settings. Compared to laboratory instrumentation, portable spectroscopy is more prone to noise, and appropriate spectral processing procedures need to be established. This paper introduces a comprehensive methodology that integrates acquisition techniques, spectral analysis, and mathematical tools necessary for utilizing handheld spectrometers to diagnose plant contamination. It focuses on determining the efficacy of handheld FTIR, Raman spectroscopy, and digital imaging for detecting contaminants in two food plants, Basil (Ocimum basilicum) and Mint (Mentha). The study examines the impact of three pollutants: iron (II) sulphate (FeSO4), zinc (II) sulphate (ZnSO4), and copper (II) sulphate (CuSO4), on these plants, but also the necessary amount of measurements to spot the pollutants' effects. Measurements were conducted at the start, after 24 hours, and after 48 hours of exposure, on both fresh and dried plant leaves, as well as in solution. Spectral effects of each of the pollutants were identified with the use of multivariate statistical process control techniques. With the help of the developed methodologies, researchers can identify in-situ contaminant effects, exposure times and run diagnostics directly on the leaf both in alive and dried plants.

Overcoming implementation challenges through using a train-the-trainer approach to teach numeracy in a special school setting

PurposeThere is a sparsity of research that considers how to overcome implementation challenges for interventions in special school settings where specialist teaching methods are involved. Successful implementation has often relied on considerable researcher involvement, making them inaccessible and not sustainable for the majority of special schools. The purpose of this study was to implementa train-the-trainer approach to train teaching staff to use the Teaching Early Numeracy to Children with Developmental Disabilities (TEN-DD) programme in a large special school in the UK, thereby significantly reducing researcher involvement in its implementation.Design/methodology/approachOne staff member was trained to become the school lead for TEN-DD and trained other teaching staff in the school on implementation. This study recruited 13 students aged between 12 and 16 years of age with developmental disabilities to receive TEN-DD. Pre- and post-intervention tests on a standardised numeracy measure were conducted.FindingsA train-the-trainer model was developed and successfully delivered to train teaching staff in TEN-DD. A standardised outcome measure indicated that ten students made improvements to their numeracy skills after teachers trained using this approach delivered TEN-DD for between 3 and 10 months.Originality/valueVery little research has been carried out to better understand methods for overcoming implementation challenges for delivering evidence-based teaching programmes at scale to students with developmental disabilities who attend special schools. To the best of the authors’ knowledge, this study reports the results of the first evaluation of using a train-the-trainer model for the delivery of a numeracy intervention (TEN-DD), whereby there was no involvement of researchers in implementation beyond the initial training of the school lead. This model of training for interventions may be more sustainable for special schools and help improve the uptake of evidence-based interventions.

Enhancing IEP Goal Development for Preschoolers with Autism: A Preliminary Study on ChatGPT Integration.

The impact of well-crafted IEP goals on student outcomes is well-documented, but creating high-quality goals can be a challenging task for many special education teachers. This study aims to investigate potential effectiveness of using ChatGPT, an AI technology, in supporting development of high-quality, individualized IEP goals for preschool children with autism. Thirty special education teachers working with preschool children with autism were randomly assigned to either the ChatGPT or control groups. Both groups received written guidelines on how to write SMART IEP goals, but only the ChatGPT group was given handout on how to use ChatGPT during IEP goal writing process. Quality of IEP goals written by the two groups was compared using a two-sample t-test, and categorization of goals by developmental domains was reported using frequency counts. Results indicate that using ChatGPT significantly improved the quality of IEP goals developed by special education teachers compared to those who did not use the technology. Teachers in the ChatGPT group had a higher proportion of goals targeting communication, social skills, motor/sensory, and self-care skills, while teachers in the control group had a higher proportion of goals targeting preacademic skills and behaviors. The potential of ChatGPT as an effective tool for supporting special education teachers in developing high-quality IEP goals suggests promising implications for improving outcomes for preschool children with autism. Its integration may offer valuable assistance in tailoring individualized goals to meet the diverse needs of students in special education settings.

Using publicly available UK datasets to identify recruitment sites to maximise inclusion of under-served groups: three case studies.

There is strong evidence that those recruited into studies are not always representative of the population for whom the research is most relevant. Development of the study design and funding decisions are points in the research process where considerations about inclusion of under-served populations may usefully be made. Current practical guidance focuses on designing and modifying participant recruitment and retention approaches but an area that has not been addressed is recruitment site selection. We present case studies of three NIHR funded trials to demonstrate how publicly available UK population datasets can be used to facilitate the identification of under-served communities for inclusion in trials. The trials have different designs, address different needs and demonstrate recruitment planning across Trauma centres, NHS Trusts and special educational settings.We describe our use of national freely available datasets, such as those provided by NHS Digital and the Office for National Statistics, to identify potential recruitment sites with consideration of health status, socio-economic status and ethnicity as well as clinical and risk factors to support inclusivity.For all three studies, we produced lists of potential recruitment sites in excess of the number anticipated as necessary to meet the recruitment targets. We reflect on the challenges to our approach and some potential future developments. The datasets used are all free to use but each has their limitations. Agreeing search parameters, acceptable proxies and identifying the appropriate datasets, then cross referencing between datasets takes considerable time and particular expertise. The case studies are trials, but the methods are generalisable for various other study types. Through these exemplars, we aim to build on the NIHR INCLUDE project, by providing trialists with a much needed practical approach to embedding EDI into trial design at the grant application stage.

Relationship Between Directly Observed Sensory Reactivity Differences and Classroom Behaviors of Autistic Children.

Differences in sensory reactivity are a core feature of autism; however, more remains to be learned about their role in classroom learning. To use direct observational measures to investigate whether there is a link between sensory reactivity differences and classroom behaviors of autistic children. Correlational study. Two special educational needs schools. Children with a clinical diagnosis of autism, ages 5 to 18 yr (N = 53). Sensory reactivity differences were assessed with the Sensory Assessment for Neurodevelopmental Differences. Classroom behaviors were measured using the Behavior Assessment for Children-Second Edition Student Observation System. Total sensory reactivity differences were correlated positively with behaviors that impede learning (r = .31, p < .05) and negatively with behaviors that facilitate learning (r = -.38, p < .05). Hyporeactivity differences were correlated positively with behaviors that impede learning (r = .28, p < .05) and negatively with behaviors that facilitate learning (r = -.31, p < .05). Hyperreactivity and sensory-seeking differences were not significantly correlated with behavior. Results suggest a link between sensory reactivity differences and classroom behaviors, highlighting a need for further research using observational measures in special education settings. Plain-Language Summary: Differences in hyporeactivity for children with autism may play a bigger role in classroom behavior and learning than previous literature has suggested. This has implications in occupational therapy practice for how to tailor support for children with hyporeactivity differences.

Promoting Positive Self-Identity of Youths With Mental Disorders: Collaboration Between Academia and a Ministry of Education.

Inclusive schools reflect the dominant approach to education, yet many youths with mental disorders still attend special education schools. Although special education schools address educational, social, and developmental needs, they may increase students' self-stigma and hinder positive identity formation. Israel's Ministry of Education and an academic community mental health department partnered to address this challenge by developing a manual-based intervention for special education school settings. About 180 teachers were trained, and approximately 400 students participated in the self-management and positive identity group intervention. This partnership demonstrates the importance and potential of collaborations to address challenges that arise in real-world settings.

THE IMPACT OF THE USE OF DIGITAL TECHNOLOGIES IN TEACHING MATHEMATICS AT SCHOOL

The dependence of students on gadgets and digital technologies poses a significant challenge to the education system, making it imperative to find effective solutions. Interactive games offer a promising approach to addressing this issue, as they not only engage students but also enhance problem-solving skills, facilitate homework checking, and reinforce theoretical concepts. Despite these benefits, interactive games are underutilized in mathematics lessons in Kazakhstan. Therefore, this study aims to experimentally assess the effectiveness of interactive games in enhancing students' cognitive activity during mathematics lessons.The experiment involved 22 10th-grade students from a comprehensive school, divided into a research group and a control group. The research methods included analysis, comparative analysis, synthesis, and generalization of scientific literature, as well as documentary analysis of normative legal acts and educational concepts related to computerization and informatization of education.The experimental intervention lasted one month and consisted of three interactive game-based lessons and one traditional lesson as an exam. The results indicated that students in the research group demonstrated higher levels of engagement and scored approximately 50% higher on the test compared to the control group. These findings suggest that interactive games can effectively enhance cognitive activity and could be implemented in both specialized and general education settings. However, the study's scope was limited to one topic and did not include repetition or other topics, highlighting the need for further research in this area.

Commentary on “developing an evidence base for behavioural interventions: a case study of the Headsprout® Early Reading programme”

Purpose This paper aims to offer a commentary on Denne et al.’s (2024) article discussing the journey undertaken by the Sharland Foundation Developmental Disabilities Applied Behavioural Research and Impact Network to augment evidence surrounding the efficacy of the online Headsprout® Early Reading programme. Design/methodology/approach Drawing from over 15 years of professional experience as a qualified teacher in special education settings, the author reflects on the network’s approach and its alignment with their own expertise. Findings While acknowledging the commendable focus of the network on amassing additional evidence, this commentary underscores the importance of identifying barriers and fostering adaptability within the educational landscape. Central to the discussion is the imperative to prioritise students’ needs and tailor data collection methods to suit their unique contexts. Originality/value This commentary is aimed at professionals working in special education settings striving to improve their practice and student outcomes.

Will you take the opportunity to assess and manage cardiovascular risk?

Opportunistic cardiovascular risk assessment and management in specialist settings can have a major long‐term impact on patients’ health and quality of life. At its core the process is simple and feasible to deploy in all clinical settings, as the author explains.

The Impact of Steroid Responder Status on Long-Term Outcomes in Critically Ill Patients With Acute Respiratory Distress Syndrome Receiving High-Dose Glucocorticoids.

Background and objective High-dose intravenous pulsed glucocorticosteroids (GCS) are not part of the standard treatment in acute respiratory distress syndrome (ARDS), and the evidencesupporting their use is conflicting. In clinical practice, however, they are used in specialist settings when clinico-patho-radiological features suggest a potentially steroid-responsive pattern, or as a last resort in cases where patients are unable to be weaned off mechanical ventilation. This study aimed to investigate if an early objective response to high-dose GCS treatment in selected critically ill patients is predictive of survival in ARDS. Methods This study involved a case series of 63 patients treated at a tertiary specialist respiratory ICUbetween 2009 and 2017 who received high-dose GCS for ARDS following a multidisciplinary board agreement. Patients were stratified according to the change in their modified lung injury score (mLIS) between days 0 and 10 following GCS initiation. Changes in mLIS (range: 0-4)were grouped as follows - full responders: ≥2, partial responders: ≥1 and <2, and non-responders: <1. Mortality on discharge and at 6, 12, 18, and 24 months post-ICU discharge was assessed for each group. Data were analysed using logistic regression and a receiver operating curve (ROC) to determine a statistically significant association between the change in mLIS and survival. Results Of the 63 patients, there were seven full responders, 12 partial responders, and 44 non-responders to high-dose GCS. Overall mortality at ICU discharge and 6, 12, 18 and 24 months post-discharge was 29/63 (46.0%), 33/63 (52.4%), 34/63 (54.0%), 34/63 (54.0%), and 35/63 (55.6%) respectively. Mortality was significantly lower in the partial and full-response groups than in the non-response group at all time frames. Logistic regression showed a significant association between the change in mLIS and survival (p<0.001), and a ROC demonstrated that categorising the change in mLIS was a good predictive model for survival (c-statistic 0.86). Conclusions Measuring the change in mLIS by day 10 following high-dose GCS administration for ARDS may beclinically useful in prognosticating such patients. Further research using mLIS as a measure of response to GCS, and larger datasets to enable the evaluation of prognostic factors, may assist clinicians in predicting which patients with persistent ARDS are likely to respond to GCS therapy.

Implementation of an adapted Handwriting Without Tears® programme for children with developmental disabilities in a special education setting

PurposeChildren with developmental disabilities (e.g. learning disability and autism) often struggle with handwriting skills. This study aims to implement an adapted handwriting programme for children with developmental disabilities to improve their handwriting skills.Design/methodology/approachSix children with developmental disabilities aged 9–15 years received an adapted Handwriting Without Tears® (HWT) programme in small groups over eight weeks. The programme was delivered by typical teaching staff (i.e. paraprofessionals) at a special education school following a brief training session and with ongoing supervision. A range of measures assessed the children’s handwriting and related skills. Social validity interviews were conducted with school staff following the intervention to evaluate the programme’s acceptability.FindingsTypical teaching staff implemented the handwriting programme with 92.3% average fidelity and delivered a minimum of three sessions per week. Social validity interviews demonstrated the acceptability of the intervention to school staff. After eight weeks of intervention, all children improved their handwriting on various assessments. Improvements were only partially maintained at follow-up.Originality/valueThis study supports the feasibility of using an adapted HWT programme to teach handwriting to children with developmental disabilities in special education settings. Typical teaching staff can be trained to support the delivery of the programme to children in small groups.

Analysis of Patients Receiving Treatment for Inflammatory Breast Disease at Surgery Department of Tertiary Care Units

Abstract: Background: In the Surgery Department of Tertiary Care Units, an analysis of patients receiving treatment for inflammatory breast disease presents a critical assessment of disease patterns and therapeutic outcomes. This evaluation is pivotal in understanding the prevalence and efficacy of treatment modalities in addressing complex breast conditions within specialized care settings. Aims and Objectives: To assess the effectiveness of the care given to mastitis and breast abscess patients admitted to the surgical department of the Sir Gangaram Ram Hospital Lahore. Study Design: Prospective Analytical Cross-sectional Study. Place &amp; duration of study: Current study was conducted in surgical department of the Sir Gangaram Ram Hospital Lahore from March 2023 to December 2023. Methodology: The patients those visited and admitted with a diagnosis of breast abscess were included regardless of age, size of the abscess and co-morbidities. The patient was informed of the available treatment options, and their priority was taken into account for the chosen course of action. Total 100 female patients were divided in two different groups. In group-A 60 patients were operated with local anesthesia and their abscess size was larger than 2.5 cm in diameter. While in group-B, 40 patients were conservatively managed and either ultrasound guided aspiration or no intervention is used. Either the size of the abscess was less than 2.5 centimeters in these patients, or there were signs of inflammation without any fluctuation. Whereas in case of conservative treatment hot fomentation and antibiotics were recommended, some patients who received surgery or minimally invasive treatment also received prescriptions for antibiotics. The antibiotics used were a combination of a beta-lactamase inhibitor, clavulanic acid, and a broad spectrum penicillin, namely amoxicillin, which could be used as an adjuvant or sole therapy. If there was no need for surgery to treat the abscess, the treatment was considered successful. Bio- statistical program (SPSS) version 2022 were used for the raw data description. Results: Total 100 female patients were considered and their aged from 20-40 years, lactating women were 42 while 58 women non-lactating. Group A consisted of 48 surgical patients who underwent incision and drainage, while Group B consisted of 52 patients who were treated conservatively. Ischemia, skin excoriation, wound sepsis, and postoperative septicemia were among the complications that were encountered during the postoperative period. Breast deformity, sinus formation, non-healing or closure, and organized abscess were diagnosed during the follow-up. There was no any mortality. Conclusion: Surgical drainage is the only option for treating breast abscesses, both large and small, as it significantly reduces morbidity.

EO nonlinear function generator.

An electro-optical programmable nonlinear function generator (PNFG) is developed on a multimode waveguide with four parallel thermal electrodes. The current on one electrode is chosen as the input, while the rest serve as function-defining units to modulate the multimode interference. The electro-thermo-optical effects are analyzed step by step and the impact on the eigenmode properties is derived. It shows that the optical output power variation by altered interference, in response to the input current, manifests as a complex ensemble of functions in general. The PNFG aims to find the special setting under which such relation can be simplified into some basic functions. Through an optimization program, a variety of such functions are found, including Sigmoid, SiLU, and Gaussian. Furthermore, the shape of these functions can be adjusted by finetuning the defining units. This device may be integrated in a large-scale photonic computing network that can tackle complex problems with nonlinear function adaptability.

Gaussian Mixture Proposals with Pull-Push Learning Scheme to Capture Diverse Events for Weakly Supervised Temporal Video Grounding

In the weakly supervised temporal video grounding study, previous methods use predetermined single Gaussian proposals which lack the ability to express diverse events described by the sentence query. To enhance the expression ability of a proposal, we propose a Gaussian mixture proposal (GMP) that can depict arbitrary shapes by learning importance, centroid, and range of every Gaussian in the mixture. In learning GMP, each Gaussian is not trained in a feature space but is implemented over a temporal location. Thus the conventional feature-based learning for Gaussian mixture model is not valid for our case. In our special setting, to learn moderately coupled Gaussian mixture capturing diverse events, we newly propose a pull-push learning scheme using pulling and pushing losses, each of which plays an opposite role to the other. The effects of components in our scheme are verified in-depth with extensive ablation studies and the overall scheme achieves state-of-the-art performance. Our code is available at https://github.com/sunoh-kim/pps.

The Heavy Burden of Judgement: Cultivating Compassion with People Accessing Healthcare Services for Support with Weight Management

Compassion focused therapy concepts and techniques are explored in the context of weight management efforts within community, specialist and surgical settings. Living at higher weights within a culture that over-values life at low weights can induce feelings of shame, self-loathing and hypercriticism. This article examines points at which individuals engaging in weight management may experience heightened distress and describes some of the ways that the model has been applied with this population. An outline of the way that CFT could be used to inform service delivery and development is proposed, from first contact through assessment, interventions and wider aspects such as staff well-being.

A comprehensive error evaluation method for non-rigid body gantry machine tools considering quasi-static crosstalk based on optimized multilateration measurement

For large-scale machine tools, the impact of non-rigid body behavior on volumetric error accuracy cannot be ignored, which hasn't been considered in general volumetric error model. This paper presents a comprehensive error evaluation method for large-scale gantry machine tools considering non-rigid body effect, aiming to provide guidance for volumetric error calibration process. An extended kinematic model is established based on the analysis of crosstalk influence on geometric error motions. An optimized multilateration measurement with improved accuracy and robustness is carried out for volumetric error identification, verified by Monte Carlo simulations. The main novelty of the optimization is to introduce a space uniformity index to generate specialized calibration point sets for any measurement points. A new volumetric error prediction method based on classified descriptions of geometric error motions is proposed, according to their relationship with crosstalk. Experimental results show that the proposed method achieves higher prediction accuracy in crosstalk-sensitive directions.

Commentary on “Overcoming implementation challenges through using a train-the-trainer approach to teach numeracy in a special school setting”

PurposeThis commentary discusses the paper by Reardon et al. (2024; this issue) entitled, “Overcoming implementation challenges through using a train-the-trainer approach to teach numeracy in a special school setting.” This commentary outlines the necessary contribution this paper adds to the substantive area of research it is couched within while also identifying potential areas of future research to expand the understanding of this phenomenon and its impact upon practice.Design/methodology/approachWhat is fidelity of implementation, how do we measure it and how does it impact our interpretations of experimental findings? This commentary focuses specifically on the nebulous construct of fidelity in experimental studies and how this impacts experimental findings’ internal and external validity.FindingsAlthough fidelity is frequently referenced as an important aspect to consider, the measurement of the construct has been critiqued in experimental studies. To understand if an intervention was “implemented as intended,” the core dimensions of the intervention must be considered in the measurement process, as well as potential confounding variables.Originality/valueWith an increased need for experimental work to inform what works, for whom and under what conditions, there becomes a need to better investigate the implementation of the intervention in these contexts – thus, fidelity must be reconceptualized. This commentary provides an overview of this dilemma with potential ideas to investigate moving forward.

Impact of COVID‐19 lockdown in England on challenging behaviour and adaptive skills for children in a special school: A longitudinal study

AbstractLongitudinal research is crucial to fully assess the putative impact of the COVID‐19 pandemic on children with an intellectual disability in special school settings—ideally drawing on data pre‐pandemic to be able to evaluate later impact. Data on challenging behaviour and adaptive skills were collected annually for 348 students in one special school across four time points pre‐pandemic and one time point post‐pandemic. Data were analysed using multilevel models with repeated observations over the five time points. There was a decrease in aggressive and destructive behaviours and a decrease in adaptive skills at the post‐pandemic time point, after accounting for other important covariates. There was no evidence of a change in stereotyped or self‐injurious challenging behaviours. Other research using longitudinal methods is rare, but the current findings are consistent with previous research reporting on the impact of COVID‐19 on children and young people, particularly from parent reports. Future considerations for schools include adopting appropriate strategies to support learners to reintegrate back into education. Further research is needed to look at the longer‐term impact of the pandemic on challenging behaviour in children with an intellectual disability.