Collaborative team approaches to supporting inclusion of children with disability in mainstream schools: A co-design study.

BACKGROUND: Collaborative consultation involving educational staff, allied health professionals and parents working towards goals for children with disability is considered best practice in inclusive education. However, challenges can hinder effective collaboration, thereby potentially limiting child outcomes. AIMS: The study aims were to (a) explore the experiences of teachers, teacher assistants, allied health professionals, and parents engaging in collaborative teamwork to support inclusion of children with disability in mainstream primary schools, and (b) identify key factors influencing effective teamwork and the design of support strategies. METHODS AND PROCEDURES: A co-design research method emulated collaborative consultation and authentic stakeholder teamwork. Data were from a series of six co-design workshops (15 h); discussions were audio-recorded and transcribed verbatim. An interpretive descriptive method of thematic analysis resulted in four key themes. OUTCOMES AND RESULTS: Critical factors that influenced collaborative teamwork were access to diagnosis and funding, mechanisms for team communications, practical ways of working together, and shared understandings of inclusion. CONCLUSIONS AND IMPLICATIONS: Stakeholder teams require effective communication mechanisms and practical ways of working together within and outside of classrooms. Shared understandings of inclusion provide a foundation for collaboration, requiring access to professional development to ensure teamwork is informed by best inclusive education practice.

A scoping review of AAC research conducted in segregated school settings.

BACKGROUND: School education for children with severe disabilities tends to occur in restricted or segregated settings, especially for students who require augmentative and alternative communication (AAC). AIM: We sought to understand the role played by AAC, especially in supporting students' academic learning and social participation in studies conducted in segregated school settings. METHODS: We conducted a scoping review, searching five databases, supplemented by hand, ancestral and forward citation searches of studies published from 2000 to 2020 involving compulsory school-aged students and featuring AAC. Data were extracted and summarized regarding study and participant characteristics, and key findings. RESULT: Our search yielded 141 studies conducted in a segregated setting (n = 129) or mixed settings (n = 12). Most studies focused on communication skills (n = 69); academic skills (n = 27) and social participation (n = 17) were addressed to a far lesser extent. CONCLUSIONS: Research into students requiring or using AAC has focused on teaching communication skills and far less on academic learning and social activities of classrooms and schools. There is a need for research that extends beyond functional communication into how AAC can promote access to these key aspects of school education.

Protective effect of suppressor of cytokine signalling 1-based therapy in experimental abdominal aortic aneurysm.

BACKGROUND AND PURPOSE: Abdominal aortic aneurysm (AAA) is a multifactorial disease characterized by chronic inflammation, oxidative stress and proteolytic activity in the aortic wall. Targeting JAK/signal transducer and activator of transcription (JAK/STAT) pathway is a promising strategy for chronic inflammatory diseases. We investigated the vasculo-protective role of suppressor of cytokine signalling-1 (SOCS1), the negative JAK/STAT regulator, in experimental AAA. EXPERIMENTAL APPROACH: A synthetic, cell permeable peptide (S1) mimic of SOCS1 kinase inhibitory domain to suppress STAT activation was evaluated in the well-established mouse model of elastase-induced AAA by monitoring changes in aortic diameter, cellular composition and gene expression in abdominal aorta. S1 function was further evaluated in cultured vascular smooth muscle cells (VSMC) and macrophages exposed to elastase or elastin-derived peptides. KEY RESULTS: S1 peptide prevented AAA development, evidenced by reduced incidence of AAA, aortic dilation and elastin degradation, partial restoration of medial VSMC and decreased inflammatory cells and oxidative stress in AAA tissue. Mechanistically, S1 suppressed STAT1/3 activation in aorta, down-regulated cytokines, metalloproteinases and altered the expression of cell differentiation markers by favouring anti-inflammatory M2 macrophage and contractile VSMC phenotypes. In vitro, S1 suppressed the expression of inflammatory and oxidative genes, reduced cell migration and reversed the phenotypic switch of macrophages and VSMC. By contrast, SOCS1 silencing promoted inflammatory response. CONCLUSION AND IMPLICATIONS: This preclinical study demonstrates the therapeutic potential of SOCS1-derived peptide to halt AAA progression by suppressing JAK/STAT-mediated inflammation and aortic dilation. S1 peptide may therefore be a valuable option for the treatment of AAA.

Staphylococcus epidermidis in feedings and feces of preterm neonates.

Staphylococcus epidermidis has emerged as the leading agent causing neonatal late-onset sepsis in preterm neonates; although the severity of the episodes caused by this species is often underestimated, it might exert relevant short- and long-term detrimental effects on neonatal outcomes. In this context, the objective of this study was to characterize a collection of S. epidermidis strains obtained from meconium and feces of preterm infants, and to assess the potential role of the enteral feeding tubes as potential reservoirs for this microorganism. A total of 26 preterm infants were enrolled in the study. Meconium and fecal samples were collected weekly during their first month of life (n = 92). Feeding samples were collected after their pass through the enteral feeding tubes (n = 84). S. epidermidis was present in the fecal samples of all the infants in, at least, one sampling time at concentrations ranging from 6.5 to 7.8 log10 CFU/g. Initially, 344 isolates were obtained and pulsed-field gel electrophoresis (PFGE) profiling allowed the reduction of the collection to 101 strains. Among them, multilocus sequence typing (MLST) profiling showed the presence of 32 different sequence types (ST). Globally, most of the STs to hospital-adapted high-risk clones and belonged to clonal complexes (CC) associated to the hospital environment, such as CC2. The virulence gene most commonly detected among the strains was altE. High resistance rates to macrolides and aminoglycosides were detected and 64% of the strains harboured the mecA gene, which was codified in SCCmec types. Our results indicates the existence of a complex and genetically diverse S. epidermidis population in the NICU environment. A better knowledge of S. epidermidis strains may help to devise strategies to avoid their conversion from symbiont to pathobiont microorganisms in the NICUs.

Serratia marcescens colonization in preterm neonates during their neonatal intensive care unit stay.

Background: Nosocomial sepsis is the main problem that preterms have to face during their stay at neonatal intensive care units (NICU). Serratia marcescens is an emerging cause of preterm sepsis but its epidemiology is still largely unknown. Consequently, the aims of this study were to know the rate of preterms colonized by S. marcescens during their stay at the NICU and the characteristics and evolution of the S. marcescens population, including the susceptibility to clinically relevant antibiotics. Methods: Twenty-six preterm infants born with a gestational age ≤ 32 weeks and/or weigh ≤1500 g were included in the study. Samples of meconium and feces (n = 92) were collected during their first month of life of the infants, together with feeding samples after their pass through enteral feeding tubes (n = 37). Samples were inoculated on MacConkey agar plates. The isolates identified as S. marcescens were genotyped using RAPD and PFGE; and antibiotics susceptibility was performed in a Vitek 2 system. Results: A total of 179 S. marcescens isolates were obtained from the samples. PFGE profiling and cluster analysis allowed the classification of the isolates into 7 different S. marcescens clones. PFGE patterns 1 and 3 were the dominant strains in the fecal samples colonizing 31 and 35% of the infants, respectively. Those isolates causing bacteremia in two infants clustered in PFGE pattern 3. Conclusion: S. marcescens is a bacterial species closely associated to the NICU environment. It can be frequently isolated from preterm's feces although only some genetic lineages seem to be associated to sepsis. Enteral feeding tubes act as important reservoirs to keep the S. marcescens population in the NICU. Trial registration: The local ethic committee approved this trial with the reference 09/157.

Nrf2 Activation Provides Atheroprotection in Diabetic Mice Through Concerted Upregulation of Antioxidant, Anti-inflammatory, and Autophagy Mechanisms.

Interactive relationships between metabolism, inflammation, oxidative stress, and autophagy in the vascular system play a key role in the pathogenesis of diabetic cardiovascular disease. Nuclear factor (erythroid-derived 2)-like 2 (Nrf2) is a stress-sensitive guarantor of cellular homeostasis, which cytoprotective contributions extend beyond the antioxidant defense. We investigated the beneficial effects and underlying mechanisms of the Nrf2 inducer tert-butyl hydroquinone (tBHQ) on diabetes-driven atherosclerosis. In the experimental model of streptozotocin-induced diabetes in apolipoprotein E-deficient mice, treatment with tBHQ increased Nrf2 activity in macrophages and vascular smooth muscle cells within atherosclerotic lesions. Moreover, tBHQ significantly decreased the size, extension and lipid content of atheroma plaques, and attenuated inflammation by reducing lesional macrophages (total number and M1/M2 phenotype balance), foam cell size and chemokine expression. Atheroprotection was accompanied by both systemic and local antioxidant effects, characterized by lower levels of superoxide anion and oxidative DNA marker 8-hydroxy-2'-deoxyguanosine, reduced expression of NADPH oxidase subunits, and increased antioxidant capacity. Interestingly, tBHQ treatment upregulated the gene and protein expression of autophagy-related molecules and also enhanced autophagic flux in diabetic mouse aorta. In vitro, Nrf2 activation by tBHQ suppressed cytokine-induced expression of pro-inflammatory and oxidative stress genes, altered macrophage phenotypes, and promoted autophagic activity. Our results reinforce pharmacological Nrf2 activation as a promising atheroprotective approach in diabetes, according to the plethora of cytoprotective mechanisms involved in the resolution of inflammation and oxidative stress, and restoring autophagy.

SOCS1-targeted therapy ameliorates renal and vascular oxidative stress in diabetes via STAT1 and PI3K inhibition.

Oxidative stress resulting from excessive production of reactive oxygen species (ROS) or impaired antioxidant defenses is closely related to the development of diabetic vascular complications, including nephropathy and atherosclerosis. Chronic activation of Janus kinase/Signal transducer and activator of transcription (JAK/STAT) signaling pathway contributes to diabetic complications by inducing expression of genes involved in cell proliferation, fibrosis, inflammation, and oxidative stress. Suppressors of cytokine signaling (SOCS) family of endogenous JAK/STAT regulators is an attractive target for therapeutic intervention. We investigated the beneficial effect of two different SOCS1-targeted therapies (adenovirus-mediated gene transfer and kinase-inhibitory region peptidomimetic) to combat oxidative stress injury in an experimental diabetes model of concomitant renal and macrovascular disease (streptozotocin-induced diabetic apolipoprotein E-deficient mouse). Diabetes resulted in progressive alteration of redox balance in mice, as demonstrated by increased ROS levels and decreased antioxidant activity, which ultimately led to renal dysfunction and vascular injury. The molecular and pathological alterations in early diabetes were partially reversed by preventive intervention with SOCS1-targeted therapies. Importantly, SOCS1 peptidomimetic provided reno- and atheroprotection in diabetic mice even in a setting of established disease. Compared with untreated controls, kidney and aorta from SOCS1-treated mice exhibited significantly lower levels of superoxide anion, DNA oxidation marker and NADPH oxidase (Nox) subunits, along with higher expression of antioxidant enzymes. These trends correlated with a reduction in parameters of renal damage (albuminuria, creatinine and tubular injury), atherosclerosis (lesion size) and inflammation (leukocytes and chemokines). Mechanistic studies in renal, vascular and phagocytic cells exposed to cytokines and high-glucose showed that SOCS1 blocked ROS generation by inhibiting both Nox complex assembly and Nox subunit expression, an effect mediated by inactivation of JAK2, STAT1, and PI3K signaling pathways. This study provides evidence for SOCS1-targeted therapies, especially SOCS1 peptidomimetic, as an alternative antioxidant strategy to limit the progression of diabetic micro- and macrovascular complications.

Supervivencia de cáncer gástrico en el occidente de Honduras, estudio piloto: 2002-2012 / Survival of Gastric Cancer in Western Honduras Pilot study: 2002-2012

Antecedentes: El cáncer gástrico es la segunda causa de muerte por cáncer globalmente. En Honduras la incidencia en la década pasada fue de 39 y 21 por 100,000 habitantes para hombres y mujeres, respectivamente. En 2008 IARC (GLOBOCAN) colocó a Honduras como el país con más alta incidencia de cáncer gástrico en Latinoamérica. Objetivo: Determinar la supervivencia en pacientes diagnosticados con cáncer gástrico en el occidente de Honduras entre los años 2002-2012. Métodos: Se diseñó un es- tudio de cohorte retrospectivo de pacientes diagnosticados con cáncer gástrico en el Hospital de Occidente (2002-2012). Una muestra de 144 pacientes fue seleccionada de un total de 490 para obtener un nivel de confianza de 95%. La recolección de datos se obtuvo mediante autopsia verbal. Se analizaron los factores pronósticos de supervivencia mediante modelos de razón de riesgos proporcio - nales de Cox (CI:95%) Resultados: La relación hombre/mujer fue 2.8:1. La media de edad fue 63.29 años. La supervivencia global a cinco años fue 9.39%. Entre los pacientes que recibieron terapia dual (cirugía y quimioterapia), se encontró un aumento estadísti- camente significativo de la supervivencia (10.42%,p=0.048). Entre la localizaci ón proximal (28.95%) y distal (56.58%) se observó diferencia estadísticamente significativa (p=0.03). No hubo diferencia estadísticamente significativa entre hallazgos macroscópicos (Borrmann) y microscópicos (Lauren). Discusión: Este estudio representa el primer esfuerzo para estimar la supervivencia de cáncer gástrico en Honduras. La supervivencia podría estar ligada a la localización de la lesión primaria y al tipo de tratamiento. Se espera desarrollar estudios con mayor cobertura, para responder a estas preguntas...(AU)

Bacterial Diversity of the Gastric Content of Preterm Infants during Their First Month of Life at the Hospital.

Studies focused on the stomach microbiota are relatively scarce, and most of them are focused on the adult population. The aim of this work is to describe the bacterial communities inhabiting the gastric content (GC) of preterm neonates. For that purpose, GC samples were collected weekly from a total of 13 preterm neonates during their first month of life within their hospital stay. Samples were analyzed by using both culture-dependent and -independent techniques. The former allowed the isolation of bacteria belonging mainly to the genera Enterococcus, Staphylococcus, Streptococcus, Serratia, Klebsiella, and Escherichia. The cultured dominant species in the GC samples during all the hospitalization period were Enterococcus faecalis and Staphylococcus epidermidis. Multilocus sequence typing (MLST) analysis revealed the presence of high-risk clonal complexes associated with the hospital environment, which may colonize enteral feeding tubes. Similarly, the 16S rRNA sequencing showed that Streptococcus, Staphylococcus, Lactobacillus, Enterococcus, Corynebacterium, and Propionibacterium were the dominant genera present at 75% of the gastric samples. However, the genera Serratia, Klebsiella, and Streptococcus were the most abundant. Own mother's milk (OMM) and donor milk (DM) were collected after their pass through the external feeding tubes to assess their bacterial content. OMM and DM had a similar bacterial pattern to GC. Based on these data, the GC of preterm neonates is dominated by Proteobacteria and Firmicutes and harbors high-risk bacterial clones, which may colonize enteral feeding tubes, and therefore the feeds that pass through them.

[Survival of Gastric Cancer in Western Honduras Pilot study: 2002-2012]. / SUPERVIVENCIA DE CÁNCER GÁSTRICO EN EL OCCIDENTE DE HONDURAS ESTUDIO PILOTO: 2002­2012.

Background: Gastric cancer is the second leading cause of cancer death globally. In Honduras the incidence in the last decade was 39 and 21 per 100,000 inhabitants for men and women, respectively. In 2008 IARC (GLOBOCAN) placed Honduras as the country with the highest incidence of gastric cancer in Latin America. Methods: A retrospective cohort study of patients diagnosed with gastric cancer at the Hospital de Occidente between 2002-2012 was designed. A sample of 144 patients was selected from a total of 490 to obtain a confidence level of 95%. The data collection was obtained by verbal autopsy. Prognostic factors of survival were analyzed using Cox proportional hazards ratio models (CI: 95%). Outcomes: The male/female ratio was 2.8:1. The mean age was 63.29 years. Overall five-year survival was 9.39%. Among patients receiving dual therapy (surgery and chemotherapy), a statistically significant increase in survival was found (10.42%, p=0.048). Between the proximal (28.95%) and distal (56.58%) locations also a statistically significant difference was observed (p=0.03). There was no statistically significant difference in the macroscopic (Borrmann) and microscopic findings (Lauren). Disscusion: This study represents the first effort to estimate survival of gastric cancer in Honduras. Survival may be linked to the location of the primary lesion and the type of treatment. It is expected to develop studies with greater coverage, to answer these questions.

Early Gut Colonization of Preterm Infants: Effect of Enteral Feeding Tubes.

OBJECTIVE: The aim of the study was to evaluate the potential colonization of nosocomial bacteria in enteral feeding systems and its effect on early gut colonization of preterm neonates. METHODS: Mother's own milk, donor milk, and preterm formula samples obtained after passing through the external part of the enteral feeding tubes were cultured. In addition, meconium and fecal samples from 26 preterm infants collected at different time points until discharge were cultured. Random amplification polymorphism DNA and pulse field gel electrophoresis were performed to confirm the presence of specific bacterial strains in milk and infant fecal samples. RESULTS: Approximately 4000 bacterial isolates were identified at the species level. The dominant species in both feces from preterm infants and milk samples were Staphylococcus epidermidis, S aureus, Enterococcus faecalis, E faecium, Serratia marcescens, Klebsiella pneumoniae, and Escherichia coli. All of them were present at high concentrations independently of the feeding mode. Random amplification polymorphism DNA and pulse field gel electrophoresis techniques showed that several bacteria strains were found in both type of samples. Furthermore, scanning electron microscopy revealed the presence of a dense bacterial biofilm in several parts of the feeding tubes and the tube connectors. CONCLUSIONS: There is a sharing of bacterial strains between the neonates' gastrointestinal microbiota and the feeding tubes used to feed them.

Post-authorization safety surveillance of a liquid pentavalent vaccine in Guatemalan children.

OBJECTIVE: Combination vaccines have improved the efficiency of delivery of new vaccines in low and middle-income countries. Post-authorization monitoring of adverse events (AEs) after vaccination with a liquid pentavalent DTwP-HepB-Hib combination vaccine was conducted in Guatemalan infants. METHODS: A prospective observational safety study of the incidence of medical attended events (MAEs) and serious adverse events (SAEs) in children who received pentavalent and oral polio vaccines at 2, 4 and 6 months of age was conducted in two clinics at the Institute of Guatemala. Parents were contacted by telephone after each dose. All outpatient, emergency department visits, and hospitalizations were monitored. A self-controlled analysis was conducted to determine if there was evidence of increased risk of MAEs or SAEs following vaccines as compared to control time windows. RESULTS: Of 3000 recruited infants, 2812 (93.7%) completed the third dose and 2805 (93.5%) completed follow-up. Ten AEs in eight infants, of which four SAEs in four infants, were classified as related to the vaccine. Thirteen deaths were reported due to common illnesses of infancy, and none were judged to be related to the vaccine. The mortality rate (4.4 per 1000) was lower than expected for the population. The incidence-rate-ratio for healthcare visits was lower in post-vaccination time windows than for control windows; after the first vaccine dose, the rate ratios for the risk periods of 0-1, 2-6, and 7-30 days post-vaccination were 0.3, 0.5, and 0.7, respectively (all statistically significantly different from the reference value of 1.0 for the 31-60 day control period). CONCLUSION: The liquid pentavalent vaccine was associated with lower rates of health care visits and not associated with increases in SAEs or hospitalizations. Systems can be set up in low to middle income countries to capture all health care visits to monitor the safety of new vaccines.

Eficacia de un programa educativo sobre el nivel de conocimiento de salud sexual y reproductiva en estudiantes del tercer año de secundaria de la Institución Educativa José Carlos Mariategui, Manchay - Pachacámac / Effectiveness of an educational program about the level of knowledge of sexual and reproductive health in students of the third year of high school at the Educational Institution Jose Carlos Mariategui, Manchay-Pachacamac

Objetivos: Determinar la eficacia de un Programa Educativo en el nivel de conocimiento sobre Salud Sexual y Reproductiva en estudiantes del tercer año de secundaria de la Institución Educativa "José Carlos Mariátegui" Manchay- Pachacamac. Diseño: Pre experimental, cuya intervención fue un programa educativo en salud sexual y reproductiva, realizándose una medición de los conocimientos antes y después de la intervención. Lugar: Una institución educativa estatal de nivel secundario, distrito Manchay-Pachacamac, Lima, Perú. Participantes: 54 alumnos del tercer año de secundaria. Intervención: Un cuestionario y test de Salud sexual y reproductiva validada en estudios previos aplicada a 54 alumnos, constó de preguntas sobre los datos generales de los estudiantes y 34 preguntas cerradas de alternativas múltiples, respectivamente. Para la medición de la variable se procedió a clasificar al nivel de conocimiento en alto, medio y bajo, según los indicadores de percentiles. Después de recolectar los datos, estos fueron ingresados a los paquetes estadísticos de Excel y SPSS versión 19 para ser analizados. Resultados: Se observó que el nivel de conocimiento sobre Salud Sexual y Reproductiva antes de la intervención fue bajo en la mayoría de los estudiantes, y después de la intervención fue alto para el 90 por ciento de los estudiantes; asimismo el nivel de conocimiento sobre sexualidad, roles y género antes de la intervención del programa educativo fue bajo en un 68 por ciento de los estudiantes, luego de la intervención educativa el 66 por ciento de los estudiantes tuvieron un nivel medio; con respecto al nivel de conocimiento sobre cambios anatómicos y fisiológicos durante la adolescencia antes de la intervención del programa educativo fue medio en el 68 por ciento de estudiantes, luego de la intervención educativa un 92 por ciento de estudiantes tienen un nivel alto; acerca del nivel de conocimientos de infecciones de transmisión sexual en el pre test un 75 por ciento...

Uso de exanguinotransfusión parcial con solución salina en neonatos policitémicos

La policitemia neonatal se define como hematocrito central igual o mayor a 65% durante las primeras 24 horas de vida extrauterina, pudiendo presentarse con síntomas o sin ellos. Cincuenta y nueve neonatos policitérmicos a quienes se les practicó exanguinotransfusión parcial con solución salina normal a través de un catéter venoso umbilical fueron estudiados. El 100% presentó uno o más sítomas y sólo el 6.7% tuvo factores de riesgo. El 96.6% de los casos son hematocrito inicial 66-75% y el 11% requirió segunda exanguinotransfusión cuatro horas después de la primera. El 28.8% eran hijos de madres primigestas y el 30.8% correspondían a hijos de madres con 5 ó más embarazos. No se observaron complicaciones, por lo que se recomienda como un método adecuado y con bajo costo para el tratamiento de policitemia neonatal