Countries globally are working towards the Sustainable Development Goals 2030. Goal 4 affirms all students’ right to a quality inclusive education. Yet achieving quality inclusive education continues to challenge education providers without reference to economic riches or location on the globe. This exploratory study examines the professional views of 20 teachers about the state of inclusive education in Pakistan with specific reference to learners with cerebral palsy. Using focus groups interviews, we systematically examined the data and identified two key themes: learning together for all and learning environment. In exploring these themes, tensions appeared between what was posed theoretically as inclusive education and the reality of implementation. Some of these tensions result from contextual factors, while others emerge through viewing inclusive education involving a transformation of culture and practice.

Several Elaeagnus species (autumn olive [Elaeagnus umbellata Thunb.], Russian olive [Elaeagnus angustifolia L.], and thorny olive [Elaeagnus pungens Thunb.]) are invasive in North America. Elaeagnus pungens is prevalent throughout much of the southeastern United States, commonly overtaking wooded and natural areas, bottomlands, and roadsides. While many management methods, including several herbicide treatments, have been evaluated, the efficacy of these methods can vary based on the size and density of the target plants. Further, personal communication with land managers revealed a lack of information that incorporated application effort, duration, and associated cost into treatment efficacy and usefulness. We evaluated three herbicide application methods using the free acid formulation of triclopyr in an E. pungens–infested forest in South Carolina, USA, to determine the effectiveness of each application method. We estimated pretreatment E. pungens biomass and destructively harvested all live material posttreatment to obtain actual biomass values. Foliar herbicide application was ineffective, but both cut stump and basal bark application nearly eliminated E. pungens in the treatment plots. The basal bark application took slightly more time to complete than cut stump treatments but was described as less physically demanding by applicators. Based on treatment efficacy and time required, the basal bark application method seems most prudent for controlling E. pungens in these areas. These results will help land managers more effectively use their resources for invasive woody plant control.

Young stellar objects (YSOs) are protostars that exhibit bipolar outflows fed by accretion disks. Theories of the transition between disk and outflow often involve a complex magnetic field structure thought to be created by the disk coiling field lines at the jet base; however, due to limited resolution, these theories cannot be confirmed with observation and thus may benefit from laboratory astrophysics studies. We create a dynamically similar laboratory system by driving a $\sim$1 MA current pulse with a 200 ns rise through a $\approx$2 mm-tall Al cylindrical wire array mounted to a three-dimensional (3-D)-printed, stainless steel scaffolding. This system creates a plasma that converges on the centre axis and ejects cm-scale bipolar outflows. Depending on the chosen 3-D-printed load path, the system may be designed to push the ablated plasma flow radially inwards or off-axis to make rotation. In this paper, we present results from the simplest iteration of the load which generates radially converging streams that launch non-rotating jets. The temperature, velocity and density of the radial inflows and axial outflows are characterized using interferometry, gated optical and ultraviolet imaging, and Thomson scattering diagnostics. We show that experimental measurements of the Reynolds number and sonic Mach number in three different stages of the experiment scale favourably to the observed properties of YSO jets with $Re\sim 10^5\unicode{x2013}10^9$ and $M\sim 1\unicode{x2013}10$, while our magnetic Reynolds number of $Re_M\sim 1\unicode{x2013}15$ indicates that the magnetic field diffuses out of our plasma over multiple hydrodynamical time scales. We compare our results with 3-D numerical simulations in the PERSEUS extended magnetohydrodynamics code.

The extent to which the oro-faecal route contributes to the transmission of SARS-CoV-2 is not established.

We systematically reviewed the evidence on the presence of infectious SARS-CoV-2 in faeces and other gastrointestinal sources by examining studies that used viral culture to investigate the presence of replication-competent virus in these samples. We conducted searches in the WHO COVID-19 Database, LitCovid, medRxiv, and Google Scholar for SARS-CoV-2 using keywords and associated synonyms, with a search date up to 28 November 2023.

We included 13 studies involving 229 COVID-19 subjects – providing 308 faecal or rectal swab SARS-CoV2 reverse transcription-polymerase chain reaction (RT-PCR)-positive samples tested with viral culture. The methods used for viral culture across the studies were heterogeneous. Three studies (two cohorts and one case series) reported observing replication-competent SARS-CoV-2 confirmed by quantitative RT-PCR (qPCR) and whole-genome sequencing, and qPCR including appropriate cycle threshold changes. Overall, six (1.9%) of 308 faecal samples subjected to cell culture showed replication-competent virus. One study found replication-competent samples from one immunocompromised patient. No studies were identified demonstrating direct evidence of oro-faecal transmission to humans.

Our review found a relatively low frequency of replication-competent SARS-CoV-2 in faecal and other gastrointestinal sources. Although it is biologically plausible, more research is needed using standardized cell culture methods, control groups, adequate follow-up, and robust epidemiologic methods, including whether secondary infections occurred, to determine the role of the oro-faecal route in the transmission of SARS-CoV-2.

Hypertension and depression are increasingly common noncommunicable diseases in Ghana and worldwide, yet both are poorly controlled. We sought to understand how healthcare workers in rural Ghana conceptualize the interaction between hypertension and depression, and how care for these two conditions might best be integrated. We conducted a qualitative descriptive study involving in-depth interviews with 34 healthcare workers in the Kassena-Nankana districts of the Upper East Region of Ghana. We used conventional content analysis to systematically review interview transcripts, code the data content and analyze codes for salient themes. Respondents detailed three discrete conceptual models. Most emphasized depression as causing hypertension: through both emotional distress and unhealthy behavior. Others posited a bidirectional relationship, where cardiovascular morbidity worsened mood, or described a single set of underlying causes for both conditions. Nearly all proposed health interventions targeted their favored root cause of these disorders. In this representative rural Ghanaian community, healthcare workers widely agreed that cardiovascular disease and mental illness are physiologically linked and warrant an integrated care response, but held diverse views regarding precisely how and why. There was widespread support for a single primary care intervention to treat both conditions through counseling and medication.

Dante Cicchetti’s earliest work, his studies of social-emotional development in infants and children with Down syndrome, set the stage for the emergence of the larger field of developmental psychopathology. By applying basic developmental principles, methodologies, and questions to the study of persons with Down syndrome, Dante took on the challenge of searching for patterns in atypical development. In doing so, he extended traditional developmental theory and introduced a more “liberal” approach that both continues to guide developmentally based research with persons with neurodevelopmental conditions (NDCs), including Down syndrome. We highlight five themes from Dante’s work: (1) appreciating the importance of developmental level; (2) prioritizing the organization of development; (3) examining whether developmental factors work similarly in those with known genetic conditions; (4) rethinking narratives about ways of being; and (5) examining the influence of multiple levels of the environment on the individual’s functioning. We highlight ways that these essential lessons anticipated present-day research with persons with a variety of NDCs, including Down syndrome, other genetic syndromes associated with intellectual disability, and autism. We conclude with visions to the future for research with these populations as well as for the field of developmental psychopathology more generally.

Background: The Clinical & Laboratory Standards Institute (CLSI) recommends use of annual antibiograms to help guide empiric antibiotic therapy. Because CLSI periodically updates minimum inhibitory concentration (MIC) breakpoints, we assessed the impact of these updates on longitudinal trends in antibiotic susceptibility rates for Escherichia coli and Klebsiella pneumoniae at a single academic medical center in Atlanta, GA. Methods: Susceptibilities for cefepime, ceftazidime, and levofloxacin in E. coli and K. pneumoniae were extracted from hospital antibiograms from 1988 to 2022. Starting in 1995, intensive care units (ICUs) and wards had separate annual antibiograms, which we combined using weighted averages to create annual overall hospital antibiograms. After summarizing the frequency of isolates tested and susceptibilities using medians and interquartile ranges (IQR), we conducted an interrupted time series analysis using linear segmented regression models, to evaluate the level changes and trends in susceptibility, before and after CLSI MIC breakpoints were updated for ceftazidime (2010 and 2017), cefepime (2014 and 2017), and levofloxacin (2013). Results: Among 21,214 E. coli, there was a median of 291 [IQR: 104, 555] isolates tested annually. Similarly, among 8,686 K. pneumoniae isolates, the median was 125 per year (IQR: 76, 178). Prior to the MIC breakpoint changes, baseline susceptibility trends of both organisms to all 3 antibiotics significantly declined at a rate between 0.2% to 2.4% per year (Table 1). For cefepime (Figure 1), susceptibility decreased annually during 1988 – 2013 for both E. coli (-0.5%) and K. pneumoniae (-1.2%). There were no significant level changes but there were trend changes after 2018, for E. coli (+2.1%) and K. pneumoniae (– 5.5%). For ceftazidime (Figure 2), significant level changes occurred after 2010 for both organisms (E. coli: -5.7%; K. pneumoniae: -5.2%). For levofloxacin (Figure 3), the breakpoint update in 2013 lead to significant level change in susceptibility (E. coli: +8.4%; K. pneumoniae: +11.4%). Conclusion: Overall, we observed a consistent decrease in antibiotic susceptibility in E. coli and K. pneumoniae over three decades, with immediate increases in the level change of susceptibility when MIC breakpoints were changed, followed by a decreasing trend. These findings highlight the importance of longitudinal surveillance and MIC breakpoint changes to inform antimicrobial stewardship strategies.

Background: An overall decrease of prescriptions for outpatient fluoroquinolones (FQs) following the FDA’s release of boxed warnings in 2016 was shown in a previous analysis1. An additional study found that this decline held true when further broken down by specialty 2. We sought to determine which different clinician specialties in Washington State (WA) continue to prescribe FQs and if these rates are congruent with previously conducted national analyses. Methods: We conducted a comprehensive analysis of Medicare Part D data from 2021. We identified specialty types contributing the highest proportions of FQ claims from the total volume of claims in 2021. Subsequently, we calculated the average FQ claims per 1,000 Medicare Part D beneficiaries for each specialty. The analysis excluded providers with missing beneficiary data. All dosage formulations were included (i.e. topical & oral). We repeated this process for each year from 2021 to 2013 to assess changes in the average FQ prescription rate for each specialty over time. Results: Our analysis encompassed 99,250 FQ prescriptions involving 976,209 Medicare Part D beneficiaries from January 1 to December 30, 2021. Among the specialties, urologists emerged as the highest prescribers of FQs to Medicare Part D beneficiaries, closely followed by ophthalmologists and family practitioners (Table 1). Notably, 72.4% of urologists prescribed FQs, while only 12.4% of family practitioners did so in 2021. Trend analysis indicated that the average FQ claims per 1,000 beneficiaries for urologists decreased from 251 claims per 1,000 beneficiaries (SD = 177.98) in 2013 to 130 claims per 1,000 beneficiaries (SD = 122.50) in 2021 (Figure 1A). In contrast, the only specialty types that had positive trends in average FQ claims per 1,000 beneficiaries from 2013 to 2021 included ophthalmologists, optometrists, and otolaryngologists (Figure 1A). Conclusion: Throughout the years leading up to 2021, most prescriber specialties contributing high volumes of FQ claims experienced a decline in FQ prescriptions. The positive trend noted amongst ophthalmologists, optometrists, and otolaryngologists could be due to the limited ability to differentiate between oral & topical FQ formulations within the dataset. These findings underscore the importance of understanding specialist prescribing behaviors and partnering with them to formulate tailored antibiotic stewardship guidance. By doing so, we can further promote patient safety and well-being in the context of FQ usage. Public health departments can promote more holistic antibiotic stewardship interventions and better patient safety outcomes with FQs. Ambulatory Fluoroquinolone Use in the United States 2015–2019 Outpatient Fluoroquinolone Prescription Fills.

Disclosure: Erica Stohs: Contracted research - Merck; Contracted research – bioMerieux

Clinical outcomes of repetitive transcranial magnetic stimulation (rTMS) for treatment of treatment-resistant depression (TRD) vary widely and there is no mood rating scale that is standard for assessing rTMS outcome. It remains unclear whether TMS is as efficacious in older adults with late-life depression (LLD) compared to younger adults with major depressive disorder (MDD). This study examined the effect of age on outcomes of rTMS treatment of adults with TRD. Self-report and observer mood ratings were measured weekly in 687 subjects ages 16–100 years undergoing rTMS treatment using the Inventory of Depressive Symptomatology 30-item Self-Report (IDS-SR), Patient Health Questionnaire 9-item (PHQ), Profile of Mood States 30-item, and Hamilton Depression Rating Scale 17-item (HDRS). All rating scales detected significant improvement with treatment; response and remission rates varied by scale but not by age (response/remission ≥ 60: 38%–57%/25%–33%; <60: 32%–49%/18%–25%). Proportional hazards models showed early improvement predicted later improvement across ages, though early improvements in PHQ and HDRS were more predictive of remission in those < 60 years (relative to those ≥ 60) and greater baseline IDS burden was more predictive of non-remission in those ≥ 60 years (relative to those < 60). These results indicate there is no significant effect of age on treatment outcomes in rTMS for TRD, though rating instruments may differ in assessment of symptom burden between younger and older adults during treatment.

This article provides an empirical overview of federal lobbying in Canada, examining lobbying contacts by field and sector from 2011 to 2022. We track shifts in lobbying representation over this period, including across Harper Conservative and Trudeau Liberal administrations. The study reveals the dominance of business interests in lobbying in Canada and a high level of lobbying concentration. By sector, export-oriented industries with high environmental and climatic impacts—namely, agriculture, fossil fuel and manufacturing industries—predominate. With the transition to Trudeau, we find a significant increase in overall rates of lobbying and a modest increase in the ratio of public interest representation. Overall, the lobbying industry is characterized by greater access but unequal voice.

The controlled chemical oxidative polymerization of metanilic anion $(m{\text{-NH}}_2{\text{C}}_6{\text{H}}_4{\text{SO}}_3^{-})$$(m{\rm{ - N}}{{\rm{H}}_2}{{\rm{C}}_6}{{\rm{H}}_4}{\rm{SO}}_3^ - )$ within the interlayer of NiAl layered double hydroxide was performed using, for the first time, ammonium persulfate as the oxidizing agent. The quantity of oxidizing agent required for control of the interlayer polymerization was investigated systematically and it was found that interleaved polyaniline sulfonic (PANIS) was present in different oxidation states and protonation levels when different quantities of external oxidizing agents were added. A mechanism for the oxidative polymerization of metanilic anion in NiAl layered double hydroxide is proposed, based on the intercalation of the oxidizing agent and the interlayer polymerization of monomer. The resulting PANIS/NiAl LDH composites were characterized by powder X-ray diffraction, ultraviolet-visible absorption spectra, Fourier transform infrared and X-ray photoelectron spectroscopy.

Reaction of a Mg-Al carbonate layered double hydroxide (LDH) with boric acid leads to a borate-pillared LDH with the stoichiometry [Mg0.65Al0.35(OH)2][B3O5]0.35.0.65H2O and an interlayer spacing of 1.07 nm. Infrared and 11B magic angle spinning nuclear magnetic resonance data are consistent with the presence of polymeric triborate anions of the type [B3O4(OH)2]nn- in the interlayer galleries so that the material can be formulated as [Mg0.65Al0.35(OH)2][B3O4(OH)2]0.35.0.30H2O. The flame-retardant properties of the borate-pillared material and the carbonate precursor in composites with ethylene vinyl acetate copolymer were compared. Introduction of the borate anion leads to a significant enhancement in smoke suppression during combustion without compromising the flammability of the material. This is related to the synergistic effect between the host layers of the LDH and the borate anions uniformly distributed in the interlayer region.