Clinical analysis of special types of tracheobronchial foreign bodies in children.

Objectives: To explore the clinical diagnosis and treatment of special types of tracheobronchial foreign bodies in children and provide a reference for clinicians to formulate treatment plans. Methods: Clinical data of 29 children with special types of tracheobronchial foreign bodies who were treated at The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University between June 2017 and June 2022 were collected and analyzed, and their diagnosis and treatment processes were reviewed. Results: All 29 special types of foreign bodies were successfully removed using rigid bronchoscopy under general anesthesia, with no surgical complications. Conclusions and significance: For the treatment of special types of tracheobronchial foreign bodies, clinicians should make detailed surgical plans and select appropriate instruments according to different conditions to improve the surgical success rate and reduce the occurrence of complications.

The How Rather than the What: A Qualitative Analysis of Modalities and Caregiver Descriptions of Special Interests in Autistic Youth.

Nearly all autistic youth have special interests (SIs), which are associated with many benefits and challenges. Most research on SIs has focused on the subject matter of SIs, with less focus on understanding how youth engage in their SIs. We conducted a qualitative study using inductive content analysis (ICA) to examine: (1) The modalities youth use to engage in their SIs, (2) the degree to which such modalities are described by caregivers as adaptive or maladaptive, and (3) the extent to which the SIs themselves are described by caregivers positively or negatively. We coded responses from 1922 caregivers of autistic youths who completed an online version of the Special Interests Survey, a caregiver-report measure of SIs. Responses to open-ended questions on the SIS, wherein caregivers describe the specific interest within the endorsed SI category, were used as data for the ICA. Frequencies of the codes were derived from cross-tabulation data. The ICA yielded eight modalities: perseverating, creating, information-seeking, memorizing, collecting, attachment, sensory-seeking, and self-soothing. Perseverating, collecting, and attachment were described as maladaptive and negatively by caregivers, whereas creating and information-seeking were described as adaptive. SIs with the greatest proportion of positive and negative descriptions were Plants and Objects, respectively. These findings suggest that SIs - and the degree to which they are described as beneficial or problematic - may be associated with modality and the subject matter. Considering how autistic individuals engage in SIs has implications for clinical work and future research in this area.

Dynamic pathology and pathogen distribution of the yeast Metschnikowia bicuspidata in the Chinese mitten crab (Eriocheir sinensis).

In this study, the "milky disease" model of Eriocheir sinhensis was constructed via intramuscular injection with the pathogenic yeast Metschnikowia bicuspidata. The dynamic pathological changes of E. sinensis after injection were elucidated with two staining methods (haemotoxylin-eosin and alcian blue periodic acid-Schiff) and fluorescence in situ hybridization technology. Anatomical observation revealed three stages of the "milky disease": no clinical signs (1-4 days after infection), the appearance of signs of disease (5-7 days), and significant liquefaction (10 days). Histological observation also revealed three stages of the disease: yeast diffusion (1-2 days after infection), yeast slow development (3-4 days), and yeast rapid proliferation (5 days). And FISH technique was suitable for the early detection of infection with M. bicuspidata in E. sinensis. We found that M. bicuspidata spread to the whole body of the crab through the haemolymph and developed into fungal septicaemia. These results elucidate the systemic pathological characteristics of "milky disease" in E. sinensis and suggest the pathogenic mechanism of M. bicuspidata.

Experiences of patients, parents, and healthcare professionals in the process of transitioning from hospital to community after inpatient pediatric rehabilitation among children with special health care needs.

PURPOSE: Children with Special Health Care Needs (CSHCN) may experience disruptions in education due to extended hospitalizations. The purpose of this study was to describe how CSHCN experience educational supports during inpatient rehabilitation and identify the ongoing challenges when planning to return to school. MATERIALS AND METHODS: Semi-structured focus groups were conducted with parents (n = 12), former patients (n = 20), and rehabilitation professionals (n = 8). RESULTS: Through qualitative thematic analysis based on descriptive phenomenology, we developed three themes: 1) Inpatient educational support such as instruction and schoolwork helped reduce the learning loss during hospitalization. However, these supports were sometimes complicated by lags in school approvals and challenges in coordination between systems. 2) Transition planning involved establishing necessary services to support CSHCN's educational and healthcare needs at school re-entry. However, families reported limited information and guidance as key barriers. 3) Dynamic courses of school re-entry required continued support after discharge. The participants recommended that reassessment and adjustment of transition plans were often necessary to account for evolving developmental and educational needs but were not always received. CONCLUSIONS: There is an ongoing need to improve communication between clinicians and educators, information for families, and long-term follow-up on the changing educational needs for CSHCN after rehabilitation.

School re-entry after extended hospitalization is challenging for children with special health care needs (CSHCN) due to school disruption, social disconnection, and change in functional abilities.The hospital-to-school transition processes include inpatient educational programs during hospitalization, pre-discharge transition planning, and the subsequent implementation and adjustment of transition plans to facilitate individualized school re-entry.Key areas in need of improving school re-entry include coordination between the hospital and school about rehabilitation and educational goals and information provided to families about transition processes, particularly for newly acquired health conditions.A common need expressed by parents and CSHCN is to simplify and accelerate the process to establish services that support children's educational and healthcare needs.

The Role of Adverse Childhood Experience in the Relationship Between Autism Severity and Early Intervention and Special Education Plan.

The purpose of this study is to examine the association between autism spectrum disorder (ASD) severity and having a special education or early intervention plan and the impact of adverse childhood experiences (ACEs) on this association. This study used the 2020-2021 National Survey of Children's Health (NSCH) and included 2,537 children aged 3-17 years old who currently have ASD. Multivariable logistic regression, controlling for demographic and family characteristics and health status, was used to explore the association between autism severity and having an early intervention plan. The analysis was stratified by the number of ACEs to explore their role in the association. Children with moderate or severe ASD were more likely to have a special education or early intervention plan than those with mild ASD in the crude and adjusted models. This association continued to be true for children who experienced 1 ACE (aOR: 2.28, 95%CI: 1.09-4.77) but not true for those who experienced no ACEs (aOR: 1.16, 95%CI: 0.70-1.94) and 2 or more ACEs (aOR: 1.84, 95%CI: 0.92-3.69). Results demonstrate that children with moderate or severe autism were more likely to receive early intervention or special education. This association changed depending on the number of ACEs experiences.

Current and preferred services of specialized professionals in childcare settings in Quebec, Canada: A descriptive survey of childcare administrators' perspectives.

BACKGROUND: Many challenges exist in promoting inclusion in childcare settings. Adequate support from specialized professionals is necessary to create inclusive childcare settings. Understanding which services are being delivered by specialized professionals in childcare contexts is an important first step. The aim of this study was to (1) describe the services currently being delivered by specialized professionals in childcare settings in Quebec (Canada) and (2) seek childcare administrators' perspectives on their preferred services. METHODS: An online province-wide descriptive survey was conducted with childcare administrators (n = 344). Questions focused on 11 service delivery dimensions (e.g. professionals involved, children served). Descriptive statistics were calculated. RESULTS: Childcare settings received services from a median of two specialized professionals (IQR [1-4]). Most services were delivered by early childhood special educators (61.3%), speech-language pathologists (57.6%), psycho-educators (43.6%) and occupational therapists (43.3%). Childcare administrators identified these four services as being particularly supportive. Professionals delivered a median of 0.4 h of service per week in each childcare setting (IQR [0.1-3.0]). A high percentage (91.2%) of administrators reported unmet needs for professional support in at least one developmental domain, with a high percentage (57.3%) of administrators identifying needs in the socio-emotional domain. Most (63.3%) expressed a desire to prioritize services for children without an established diagnosis but identified by early childhood educators as having needs for professional support. Most administrators (71.4%) also preferred in-context services. CONCLUSIONS: Childcare administrators perceive an important role for specialized professionals in supporting inclusion in their settings. Recommendations emerging are based on the four main professional service needs identified: (1) increasing the intensity and stability of services; (2) providing services for undiagnosed children identified by early childhood educators as having unmet needs; (3) ensuring that services encompassing all developmental domains with a focus on the socio-emotional domain; and (4) prioritizing of in-context services.

The impact of an aging simulation program for dental students in two community dental clinics.

PURPOSE: Clinicians who have not experienced the difficulties that come with aging or disability may be unable to relate to the limitations and experiences of afflicted patients, which is necessary to improve patient-provider connection and treatment outcomes. The purpose of this study was to test the effectiveness of an aging-simulation experience on improving dental students' awareness of aging-related limitations, examine the students' perceptions, and assess planned patient-care modifications based on the aging-simulation experience. METHODS: A total of 78 dental students who rotated through two extramural clinic sites from August 2021 through October 2022 completed pre-simulation surveys, donned aging simulators in the dental operatory, initiated pre-defined tasks and their corresponding modifications, completed a post-simulation survey, and completed a reflection questionnaire containing structured and open-ended questions. Quantitative responses were analyzed using descriptive frequencies and paired sample t-tests, whereas thematic analyses were used to interpret free-text portion of the reflection questionnaire. RESULTS: Student awareness of the impact of the four aging-related disabilities improved after the experience. Visual impairment was identified as the most difficult symptom to experience during simulation. Students reported increased feelings of empathy and acknowledged the effectiveness of clinical practice modifications to accommodate elderly patients with limitations. Students also expressed intentions to make similar modifications in their future clinical practice and the need for exposure to longer periods of simulated experiences to further clinical practice modifications for elderly patients. CONCLUSION: The aging-simulation experience is an effective tool for raising dental students' awareness of aging-related difficulties, the need for clinical practice modifications, and increasing empathy.

A retrospective chart review to assess the impact of alpha-guided transcranial magnetic stimulation on symptoms of PTSD and depression in active-duty special operations service members.

Introduction: Special Operations Forces service members (SOF) are regularly exposed to traumatic and concussive events, increasing the prevalence of symptoms of post-traumatic stress disorder (PTSD) and depression, shortening potential years of service. Methods: This retrospective chart review presents preliminary data on a Human Performance Optimization (HPO) program that provided an average of 30 sessions of individualized alpha frequency repetitive transcranial magnetic stimulation (α-rTMS) to active-duty SOF as to reduce symptoms of PTSD and depression following traumatic brain injury. Scores from the PTSD Checklist for DSM-5, PROMIS Depression short form and Perceived Deficits Questionnaire (PDQ) were reviewed. Results: Significant reductions were noted after the HPO program in all clinical scales with an average 37% decrease in PCL-5 (p<.01), 11.3% reduction in PROMIS depression T-scores (p<.01), and 45.5% reduction in PDQ scales by session 30 (p<.01), with side effects matching those commonly reported in rTMS. Importantly, the average PCL-5 score decreased from 42.9 to 27 by end of the treatment program, which is below the clinical threshold of 33 for presence of PTSD. For those with depression symptoms scores greater than cut off clinical thresholds at baseline, 46% resolved following treatment. Conclusion: This data provides preliminary support for safe application of α-rTMS for symptom reduction in active-duty special operations military personnel.

A person-centred investigation of the associations between actual and perceived physical fitness among youth with intellectual disabilities.

The main objective of this person-centred study was to identify profiles of actual and perceived physical fitness among a sample of youth with intellectual disabilities (ID). Participants were 377 youth (60.4% boys) with mild (49.6%) to moderate (50.4%) ID recruited in Australia and Canada. Latent profile analyses revealed five profiles: (1) Underestimation of Average Physical Fitness (5.5% of the sample); (2) Moderate Overestimation of Low Physical Fitness (17.7%), (3) Moderate Underestimation of Average Physical Fitness (31.3%); (4) High Overestimation of Average Physical Fitness (28.3%); and (5) Moderate Underestimation of High Physical Fitness with an Accurate Estimation of Average Flexibility (17.2%). Profiles 1, 2, and 3 relatives to Profiles 4 and 5 included younger participants, more participants with moderate levels of ID, and participants with a higher body mass index. Additionally, profiles 1 and 3 also included a higher proportion of youth pursuing externally-driven motives and less frequently involved in sports outside of the school. In sum, our findings showed that the tendency of youth with ID to rely on upward or downward-lateral social comparisons may have resulted in a depreciation or overestimation of their low levels of physical fitness.

The use of general anesthesia for dental treatment of children with special healthcare needs in Alberta, Canada.

BACKGROUND: Children with special healthcare needs (SHCN) often require specialized interventions due to their disabilities. Dental general anesthesia (DGA) is a treatment modality, which improves their access to care but concerns about repeated DGAs persist. AIM: This study investigated DGA utilization in children with SHCN and identified factors associated with multiple DGAs in Alberta, Canada (2010-2020). DESIGN: This retrospective population-based study used administrative data encompassing all children (<18 years) undergoing DGA in publicly funded facilities. Children were identified as SHCN based on their diagnosis codes and categorized into behavioral/psychiatric disorders, mental/intellectual disabilities, physical disabilities, systemic conditions, syndromes/congenital anomalies, physical-mental disabilities, and disabilities with medical conditions. RESULTS: This study analyzed 3884 DGA visits for children with SHCN, predominantly males aged 6-11 and from low-income families. Mental/intellectual disabilities were prevalent (31.8%), and autism was the leading disease. Caries was the primary dental diagnosis across all groups, whereas pulp problems were higher in psychiatric/behavioral disorders (23.6%), and periodontal problems were more common in physical-mental disabilities (13.2%). 28.7% had multiple DGAs, with younger age, disabilities with medical conditions, mental/intellectual disabilities, and initial pulp treatments, increasing the likelihood of multiple DGAs. CONCLUSION: This study highlights the importance of individualized prevention and less conservative treatments for younger children to reduce oral health disparities.

Treatment of unresectable stage III non-small cell lung cancer for patients who are under-represented in clinical trials.

Concurrent chemoradiotherapy (cCRT) followed by one year of consolidation durvalumab is the current standard-of-care for patients with unresectable stage III non-small cell lung cancer (NSCLC), of good functional status. However, cCRT and consolidation durvalumab may be challenging to administer for selected patient populations underrepresented or even excluded in clinical trials: older and/or frail patients; those with cardiovascular or respiratory comorbidities in which treatment-related adverse events may be higher, and patients with pre-existing autoimmune disorders for whom immunotherapy use is controversial. In this narrative review, we discuss the current evidence, challenges, ongoing clinical trials and potential future treatment scenarios in relevant subgroups of patients with locally advanced NSCLC, who are underrepresented in clinical trials.

'Special issue-ization' as a growth and revenue strategy: Reproduction by the "big five" and the risks for research integrity.

The exponential growth of MDPI and Frontiers over the last decade has been powered by their extensive use of special issues. The "special issue-ization" of journal publishing has been particularly associated with new publishers and seen as potentially "questionable." Through an extended case-study analysis of three journals owned by one of the "big five" commercial publishers, this paper explores the risks that this growing use of special issues presents to research integrity. All three case-study journals show sudden and marked changes in their publication patterns. An analysis of special issue editorials and retraction notes was used to determine the specifics of special issues and reasons for retractions. Descriptive statistics were used to analyse data. Findings suggest that these commercial publishers are also promoting special issues and that article retractions are often connected to guest editor manipulation. This underlies the threat that "special issue-ization" presents to research integrity. It highlights the risks posed by the guest editor model, and the importance of extending this analysis to long-existing commercial publishers. The paper emphasizes the need for an in-depth examination of the underlying structures and political economy of science, and a discussion of the rise of gaming and manipulation within higher education systems.

Testosterone and neurobehavioral outcomes in special operations forces military with multiple mild traumatic brain injury.

BACKGROUND: U.S. Special Operations Forces (SOF) are at increased risk of multiple mild traumatic brain injury (mmTBI). Testosterone was prescribed for several participants in a VA program designed to address sequelae of mmTBI for SOF. OBJECTIVE: To determine testosterone prevalence in the Palo Alto VA Intensive Evaluation and Treatment Program (IETP) and observe for association between testosterone and neurobehavioral outcomes. METHODS: A retrospective cohort study included patients in the Palo Alto VA IETP. Sociodemographic data, testosterone blood levels, and neurobehavioral outcomes were collected from medical records. RESULTS: 55 IETP participants were included: six were testosterone users; the rest were classified as non-users. Testosterone use in this population is 11%, higher than reported national averages in the U.S. Of the 6 testosterone users, 2 (33%) had a formal diagnosis of hypogonadism prior to initiation of testosterone. Neurobehavioral outcome scores between testosterone users and non-users failed to show statistically significant differences, except for the PROMIS pain score, which was higher in the testosterone user population. CONCLUSION: The current study did not find an association between mmTBI, testosterone use, or testosterone level and neurobehavioral outcomes. This study highlights a need to further examine the relationship between hypogonadism, mmTBI, SOF culture around testosterone, and the effects of testosterone use in this population.

Social assets and the career intent of teachers serving students with extensive support needs.

Decades of research indicate social support is vital for retaining teachers. However, little is known about social support for teachers serving students with extensive support needs. The purpose of this study was to explore whether collective social assets (administrative support, colleague support, paraeducator support, school culture) were associated with retaining special education teachers (SETs) who serve students with extensive support needs (e.g., intellectual disability, autism). Stepwise regression analyses and Analysis of Variance (ANOVA) were used to analyze survey data from SETs across the United States. Results showed that positive social supports are critical, and teachers serving students with autism reported the highest levels of social support in three of the four social assets categories. Implications for future research and practice are discussed, as well as a need to promote and better understand positive school culture as this variable weighed heavily across SETs.

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Establishing enteral nutrition after the birth of preterm infants presents numerous challenges, particularly for those in special situations. Various disease factors and medical interventions impede the establishment of enteral feeding, leading to conflicts and controversies regarding feeding goals, feeding methods, and the challenges and solutions faced by these infants. A critical issue for clinical physicians is how to safely and promptly establish enteral nutrition to achieve full enteral feeding as quickly as possible. The consensus formulation working group, based on both domestic and overseas research, adopted the Grading of Recommendations Assessment, Development and Evaluation, and formed an expert consensus on enteral nutrition management for preterm infants in special situations. This consensus provides 14 recommendations for 9 common special situations, aiming to offer guidance on enteral nutrition management for preterm infants to improve their short and long-term outcomes. Citation:Chinese Journal of Contemporary Pediatrics, 2024, 26(7): 665-676.

Accommodating and Extending Various Models for Special Effects Within the Generalized Partially Confirmatory Factor Analysis Framework.

Special measurement effects including the method and testlet effects are common issues in educational and psychological measurement. They are typically covered by various bifactor models or models for the multiple traits multiple methods (MTMM) structure for continuous data and by various testlet effect models for categorical data. However, existing models have some limitations in accommodating different type of effects. With slight modification, the generalized partially confirmatory factor analysis (GPCFA) framework can flexibly accommodate special effects for continuous and categorical cases with added benefits. Various bifactor, MTMM and testlet effect models can be linked to different variants of the revised GPCFA model. Compared to existing approaches, GPCFA offers multidimensionality for both the general and effect factors (or traits) and can address local dependence, mixed-type formats, and missingness jointly. Moreover, the partially confirmatory approach allows for regularization of the loading patterns, resulting in a simpler structure in both the general and special parts. We also provide a subroutine to compute the equivalent effect size. Simulation studies and real-data examples are used to demonstrate the performance and usefulness of the proposed approach under different situations.

Stakeholder perspectives of immunisation delivery for adolescents with disability in specialist schools in Victoria, Australia: 'we need a vaccination pathway'.

BACKGROUND: Adolescents with disability have lower vaccination rates than the general population, including HPV vaccination. Understanding the multi-level influences on vaccination in specialist schools is crucial to achieve optimal vaccination coverage and vaccination experiences for adolescents living with disability. OBJECTIVE: To identify and improve understanding of the facilitators and barriers of HPV vaccination among adolescents with intellectual disabilities or autism in Victorian specialist schools to inform strategies to increase vaccination acceptance and uptake. METHODS: Qualitative interviews with key stakeholders (adolescents with disabilities, parents, school and council immunisation staff) from six specialist schools in Victoria, Australia. Data were analysed thematically. Inductively derived themes were then deductively mapped across the UNICEF 'Journey to Immunization' model. RESULTS: 32 interviews were conducted with stakeholders (2 adolescents, 7 parents, 13 school staff, 10 council staff). Trust in vaccines was high, but knowledge of the HPV vaccine was limited. Barriers included lack of accessible information for parents, the consent process, behavioural challenges and vaccine-related anxiety among students. The immunisation program in special schools was perceived as convenient, however preparing students for vaccination day and catering to individual student needs were key. Participants expressed a need for more parent information about options and additional support for vaccination outside of the school program. CONCLUSIONS: Our study identified a range of facilitators and barriers to the school immunisation program for students with disabilities in specialist schools. The next phase of this work will use co-design workshops to build on the suggestions for improvement and opportunities that could be leveraged to improve vaccination uptake.

Are secondary bacterial pneumonia mortalities increased because of insufficient pro-resolving mediators?

Respiratory viral infections, including respiratory syncytial virus (RSV), parainfluenza viruses and type A and B influenza viruses, can have severe outcomes. Bacterial infections frequently follow viral infections, and influenza or other viral epidemics periodically have higher mortalities from secondary bacterial pneumonias. Most secondary bacterial infections can cause lung immunosuppression by fatty acid mediators which activate cellular receptors to manipulate neutrophils, macrophages, natural killer cells, dendritic cells and other lung immune cells. Bacterial infections induce synthesis of inflammatory mediators including prostaglandins and leukotrienes, then eventually also special pro-resolving mediators, including lipoxins, resolvins, protectins and maresins, which normally resolve inflammation and immunosuppression. Concurrent viral and secondary bacterial infections are more dangerous, because viral infections can cause inflammation and immunosuppression before the secondary bacterial infections worsen inflammation and immunosuppression. Plausibly, the higher mortalities of secondary bacterial pneumonias are caused by the overwhelming inflammation and immunosuppression, which the special pro-resolving mediators might not resolve.

Postoperative evaluation of special needs and healthy patients with endodontic treatment under general anesthesia: a retrospective research.

BACKGROUND: This retrospective clinical study was undertaken to comparatively evaluate the number of restorative treatments, endodontic treatments, and tooth extractions performed for patients under general anesthesia due to dental anxiety or special needs between 2015 and 2022 and to examine the pain, bleeding, nausea, and vomiting data of those patients. METHODS: In total, 1165 patients underwent dental treatment under general anesthesia in the faculty hospital. Those under the age of 15 and with no endodontic procedure planned (n = 918) were excluded, followed by those with incomplete data (n = 25) and those without endodontic treatment (n = 25). Patients who underwent at least one endodontic treatment were finally included in the study (n = 184). Patients were divided into two groups: healthy and with special needs. Dental treatments were recorded as endodontic, restorative, and teeth extractions. Endodontic treatments were classified according to the tooth type (premolar, molar, and incisors). The composite restorations were classified as anterior, occlusal (O), occluso-distal (OD) or occluso-mesial (OM), and mesio-occluso-distal (MOD) restorations and patients' post-treatment pain, nausea, vomiting, and bleeding were recorded. The data were analyzed statistically. RESULTS: Among the 184 patients included in the study, 70 (38%) were healthy, and 114 (62%) had special needs. Postoperative bleeding was observed more in patients with special needs (χ2 = 4.189, p < 0.05), whereas pain was observed more in healthy patients (U = 2922.00, p < 0.05). While the number of anterior, O, and MOD restorations was higher in patients with special needs, the number of OD or OM restorations was higher in healthy patients (χ2 = 74.877, p < 0.05). CONCLUSIONS: Patients with special needs undergo a greater number of restorative treatments compared to control patients, which may be associated with the inadequate oral hygiene care of such patients. However, restorative treatment is mostly indicated for such patients in our faculty hospital, which may indicate that a conservative approach is taken. Additionally, the finding that postoperative bleeding was more severe in this group of patients compared to the control group in this study may emphasize the need to consider more possible complications after general anesthesia in these patients.