With a focus on children with multiple disabilities (CMD), the purpose of this quality improvement project was to elevate educational measurement and practices involving CMD. Using the goal attainment scaling (GAS) methodology, this project was conducted within a public charter school, Pattison’s Academy for Comprehensive Education (PACE), focusing on 31 CMD and measuring student improvement and program effectiveness. For 2010–2011 and 2011–2012, improvements were demonstrated for the majority of CMD by meeting or exceeding their goals. Goal attainment scaling was able to capture improvement in educational and rehabilitation goals in the majority of CMD. Goal attainment scaling can provide an indication of a program’s effectiveness. The use of GAS in CMD has potential to maximize participation across the school setting where all children in the United States commonly develop and learn skills as well as find meaning.

Amyloid-beta (Aβ) aggregates, an Alzheimer’s disease (AD) pathological hallmark, extend beyond the brain to the heart of heart failure (HF) and AD patients. Being diseases of the elderly, increased prevalence is expected as the population ages. However, changes in the incidence and prevalence of dementia over the past decades, and the independent association of exposure to air particulate matter (PM) with poor cognitive function, adverse cardiovascular effects, and oxidative stress hint to the contribution of other factors beyond senescence. Therefore we evaluate whether, and by which mechanism(s), PM exposure affects heart and brain proteinopathy with/without genetic predisposition. AD-prone and control mice are exposed for three months to filtered air (FA) or concentrated ambient PM < 2.5μm in diameter (PM_2.5), and evaluated for Aβ pathology, cognitive and cardiac function, and markers of oxidative stress. Aβ pathology become noticeable in AD hearts and worsens with PM_2.5 in AD brains. Functionally, PM_2.5 lead to anxiety and memory deficits and worsens diastolic function. Redox homeostasis is negatively impacted by genotype and PM_2.5. This study identifies environmental pollution as a potential key contributor to early progression of heart and brain proteinopathy, delineating a crucial timepoint for early interventions to limit multiorgan damage in vulnerable patients.

Background: Quality care of individuals with sickle cell disease (SCD) is dependent upon education of the providers on their care team. Previous studies demonstrate lack of resident and provider comfort regarding care of patients with SCD, yet none have assessed these in medical students. Objective: This study aims to evaluate the adequacy of the research instrument for measuring medical students’ knowledge, confidence, and comfort regarding SCD and related complications prior to wider distribution. Methods: A self-assessment survey was distributed to medical students at two universities to evaluate their knowledge, confidence, and comfort in general SCD topics, in all clinical settings, and regarding common complications. Results: Of the 98 responses, knowledge (p < 0.001) and confidence (p = 0.02) were significantly different between topics, including epidemiology and genetics, pathophysiology, and treatment options. For “treatment options”, there were significant differences in knowledge (p = 0.02) and confidence (p = 0.02) between medical students at different levels of training. Students felt least knowledgeable and least comfortable with care of pregnant women and most knowledgeable and most comfortable with acute pain management. Caring for patients with specific SCD-related conditions increased knowledge and comfort across all domains. Conclusions: This instrument was adequate for measuring knowledge, confidence, and comfort in caring for those with SCD across all clinical settings. We identified a lack of knowledge, confidence, and comfort regarding treatment for those with SCD starting early in medical careers, which improves after caring for patients with various complications. Thus, educating and providing SCD patient experiences is crucial for medical student management confidence related to SCD.

Introduction: This trial expanded on findings from a Phase I study (Impact of Intense Physical Therapy on Mobility Outcomes in Acute Stroke) to determine whether functional outcomes after acute stroke improve more with increased therapy frequency, error augmentation training, or a combination of both. We hypothesized that patients receiving both increased frequency and error augmentation physical therapy (F-EA-PT) would demonstrate the greatest improvements in mobility and disability from hospital admission through day 3 of treatment, discharge, and 30-day follow-up. Results aim to inform optimal delivery of acute stroke physical therapy to improve length of stay, discharge planning, and long-term recovery. Methods: A total of 102 patients were randomized into 4 groups: standard-of-care physical therapy (SOC-PT, 3–5×/week); increased frequency PT (F-PT, 2×/day); error augmentation PT (EA-PT, 3–5×/week), emphasizing movement errors to challenge impairments; and combined frequency plus error augmentation (F-EA-PT). Outcomes included the Postural Assessment Scale for Stroke (PASS), Activity Measure for Post-Acute Care (AM-PAC), National Institutes of Health Stroke Scale (NIHSS), and modified Rankin Scale. Results: Ninety-two participants were analyzed. Baseline characteristics were similar across groups except for treatment exposure. PASS scores differed significantly at discharge ( P = .023), driven by better performance in the F-EA-PT group compared with SOC-PT (mean difference 6.3; 95% confidence interval, 0.75–11.87; P = .018). No other between-group differences were detected. Mixed-effects models showed significant improvement over time in PASS and AM-PAC across all groups ( P < .001), without significant time-by-group interactions. Predicted probability analysis estimated an 82.6% likelihood of detecting at least 1 significant pairwise contrast had enrollment continued to the original target of 168 participants (42 per arm), compared with the 92 participants included in the final analysis. Conclusions: Early inpatient physical therapy after acute stroke produced significant functional improvements. Although most between-group differences were not significant, combined frequent and error-augmentation therapy showed the greatest gains and superior postural outcomes at discharge. Larger multicenter trials are needed to define optimal therapy dose in acute stroke rehabilitation.

Background: The analysis of dental caries has been a major focus of recent work on modeling dental defect data. While a dental caries focus is of major importance in dental research, the examination of developmental defects which could also contribute at an early stage of dental caries formation, is also of potential interest. This paper proposes a set of methods which address the appearance of different combinations of defects across different tooth regions. In our modeling we assess the linkages between tooth region development and both the type of defect and associations with etiological predictors of the defects which could be influential at different times during the tooth crown development.Methods: We develop different hierarchical model formulations under the Bayesian paradigm to assess exposures during primary central incisor (PMCI) tooth development and PMCI defects. We evaluate the Bayesian hierarchical models under various simulation scenarios to compare their performance with both simulated dental defect data and real data from a motivating application.Results: The proposed model provides inference on identifying a subset of etiological predictors of an individual defect accounting for the correlation between tooth regions and on identifying a subset of etiological predictors for the joint effect of defects. Furthermore, the model provides inference on the correlation between the regions of the teeth as well as between the joint effect of the developmental enamel defects and dental caries. Simulation results show that the proposed model consistently yields steady inferences in identifying etiological biomarkers associated with the outcome of localized developmental enamel defects and dental caries under varying simulation scenarios as deemed by small mean square error (MSE) when comparing the simulation results to real application results.Conclusion: We evaluate the proposed model under varying simulation scenarios to develop a model for multivariate dental defects and dental caries assuming a flexible covariance structure that can handle regional and joint effects. The proposed model shed new light on methods for capturing inclusive predictors in different multivariate joint models under the same covariance structure and provides a natural extension to a nested hierarchical model.

Purpose: Heart rate variability (HRV) is a physiologic marker of autonomic nervous system (ANS) health. Because of multisystem impairments, children with medical complexity (CMC) can be challenging to evaluate and assess. They commonly display ANS dysfunction and subsequently reduced HRV. One purpose of this study was to report respiratory sinus arrhythmia (RSA) values derived from HRV, which may provide a reference and a future method to assess CMC and related treatments. Methods: Then, 36 CMC between the ages of 5–21 years were assessed within school‐based settings. All children demonstrated severe brain impairment, functional limitations, participatory restrictions in life, and high healthcare needs and utilization. A subset of 20 children with cerebral palsy (CP) was identified within the study sample. Each child was assessed by the same assessor for 5 days within a 10‐day period. Using Firstbeat Bodyguard 2 monitors, cardiac data were collected prior to and during the administration of the newly developed Pediatric Assessment of Sensory Motor Awareness. CardioEdit and CardioBatch software were used to edit cardiac data and calculate RSA values. Descriptive, repeated measures, and modeling statistics were used to analyze data. Results: Descriptive RSA values for baseline and across five sensory domains are reported for the total CMC group and its subsets of children with CP and non‐CP. Significant differences in RSA values were noted for the gustatory domain as compared to baseline and other sensory domains. Significant differences from statistical modeling were demonstrated between the CP and non‐CP groups. Conclusions and Recommendations for Clinical Practice: This study’s HRV findings provide preliminary reference RSA values in CMC. Then, 20 children considered to be CMC with primary diagnoses of CP experienced less autonomic dysfunction than other CMC diagnostic groups at baseline and across the five sensory domains. The gustatory domain significantly reduced RSA. Modeling across days indicated that CMC experience a learning effect by Day 3 or 4. The measurement of HRV may provide a method to assess health and behavioral responses in CMC and associated treatments. Replication of these study findings will be necessary.