Aligning Individual Education Program (IEP) goals of students with severe disabilities with the general education curriculum is required by the Individuals with Disabilities Education Improvement Act of 2004 (IDEIA). This study sought to determine the perspectives of special educators regarding this requirement. Special educators from three school districts participated in focus groups to offer their perspectives in aligning IEP goals with the general education curriculum. The researchers also sought the special educators' perspectives with regards to providing access to the general education curriculum. The study found that special educators are striving to align IEP goals through the use of general education classes, the extended core, and portfolios. The main approaches to providing access to the core curriculum were general education classes, peer tutors, and adapted curriculum.

The primary purpose of this study was to determine if and how the perceptions of general education students toward their peers with severe disabilities changes when they participate in a peer tutoring program. The study was conducted in a suburban/rural district in Utah and included 102 participants in treatment and control groups over three junior high schools. The data found mixed results. One of the three schools had a significant difference in the attitudes of the treatment group after being part of a peer tutoring program. The study shows that being part of a peer tutoring program can have a positive impact on the attitudes and perceptions of students in general education.

Renal hypoperfusion from renal artery stenosis (RAS) activates the renin-angiotensin system, which in turn causes volume overload and hypertension. Atherosclerosis and fibromuscular dysplasia are the most common causes of renal artery stenosis. Recurrent flash pulmonary edema, also known as Pickering syndrome, is commonly associated with bilateral renal artery stenosis. There should be a high index of clinical suspicion for renal artery stenosis in the setting of recurrent flash pulmonary edema and severe hypertension in patients with atherosclerotic disease. Duplex ultrasonography is commonly recommended as the best initial test for the detection of renal artery stenosis. Computed tomography (CT) angiography (CTA) or magnetic resonance (MR) angiography (MRA) are useful diagnostic imaging studies for the detection of renal artery stenosis in patients where duplex ultrasonography is difficult. If duplex ultrasound, CTA, and MRA are indeterminate or pose a risk of significant renal impairment, renal angiography is useful for a definitive diagnosis of RAS. The focus of medical management for RAS relies on controlling renovascular hypertension and aggressive lifestyle modification with control of atherosclerotic disease risk factors. The restoration of renal artery patency by revascularization in the setting of RAS due to atherosclerosis may help in the management of hypertension and minimize renal dysfunction.

“Linking Functional Skills to Educational Goals for Students with Significant Disabilities: A Professional Development Series” is an occupational therapist-developed multi-disciplinary professional development and mentorship series that helps special educators link educational standards to functional life skills to support improved post-school outcomes. The evidence-based and theoretically-grounded professional development series addresses the need for ongoing professional development for educators working with students with significant disabilities and in so doing also attempts to improve the long-standing poor post-school outcomes of this student population. A review of the literature indicated that overall, post-school outcomes continue to be poor for students with significant disabilities as they remain dependent upon their caregivers for daily living activities and are consistently under-employed, if employed at all. Content of the program will help educational staff integrate functional life skills into academic curriculum thereby supporting functional as well as academic outcomes using Alwell and Cobb’s (2009) five domains of life skills. Structure of the program will entail collaborative sessions using matrices that guide goal and curriculum development based on assessment protocols. Monthly job-embedded coaching and mentorship opportunities will align with recommendations in the literature. Local and national grant opportunities will fund the project and dissemination of program results will occur via local, state, and national conference opportunities. Such an occupation- and performance-based curriculum serves to develop young adults whose education truly results in participating and active members of their community, with decreased caregiver burden, as well as increased student self-concept and established and continuously emerging identities and roles.

INTRODUCTION: Abnormal ventilation is the functional consequence of airway obstruction. In patients with severe asthma, ventilation patterns visualized by magnetic resonance imaging (MRI) exhibit significant inter-patient heterogeneity. Therefore, our objectives were to identify MRI ventilation phenotypes of severe asthma using an unsupervised clustering approach and examine their associated demographic, clinical, physiologic, and inflammatory characteristics. METHODS: This retrospective analysis included 58 adults with severe asthma who underwent hyperpolarized 129Xe ventilation MRI. Nineteen quantitative variables were extracted from ventilation MRI (including ventilation defect percent (VDP), ventilation defect size, and ventilation texture features) and transformed to principal components for hierarchical clustering. Differences in demographics, clinical characteristics, spirometry, inflammatory biomarkers, and computed tomography (CT) measurements between phenotypes were evaluated using one-way ANOVA or Kruskal-Wallis tests. RESULTS: Three ventilation phenotypes of severe asthma were identified. They were significantly different with respect to their age, prevalence of obesity, spirometry, sputum neutrophil percent, sputum cytokines (interleukin-4, interleukin-6, interleukin-15, B-cell activating factor), total lung capacity, CT air-trapping, and CT mucus score (all p<0.05). They were not different with respect to their asthma control or medication requirement, and ~75% of each phenotype reported uncontrolled asthma (ACQ-5≥1.5). Phenotype 1 had normal ventilation (VDP=1.7±0.9%) and predominantly consisted of young, obese females (88% female, 41±11 years old, 63% obese). They had normal-to-moderately reduced FEV1 (80±15%pred), normal post-bronchodilator FEV1/FVC, and reduced total lung capacity (85%pred [57-108]). 25% had intraluminal inflammation (all eosinophilic) and their sputum interleukin-4 levels were elevated. Phenotype 2 had markedly abnormal ventilation (VDP=6.2±3.8%) and was older than Phenotype 1, but also predominantly consisted of obese females (63% female, 54±13 years old, 59% obese). They had mildly-to-severely reduced FEV1 (61±17%pred) and partially reversible obstructive spirometry (72%, post-bronchodilator FEV1/FVC<0.70). 50% had intraluminal inflammation (28% eosinophilic/13% neutrophilic/9% mixed-granulocytic) and their sputum interleukin-6 levels were elevated. Phenotype 3 had severely abnormal ventilation (VDP=24.8±10.2%) and was also older than Phenotype 1 but was gender-balanced and not obese (50% female, 56±12 years old, 11% obese). They had moderately-to-very severely reduced FEV1 (41±12%pred) and partially reversible obstructive spirometry (89%, post-bronchodilator FEV1/FVC<0.70). 73% had intraluminal inflammation (39% eosinophilic/17% neutrophilic/17% mixed-granulocytic) and their sputum interleukin-15 and B-cell activating factor levels were elevated. They had the highest burden of gas-trapping and mucus on CT. CONCLUSION: Three distinct MRI ventilation phenotypes of severe asthma were identified through unbiased analysis, all of which reported uncontrolled asthma. The discordance in ventilation between phenotypes, and their characteristics, suggest different mechanisms that may be driving severe asthma. / Thesis / Master of Science (MSc) / Severe asthma is an airways disease that is characterized by inflamed, twitchy and obstructed airways. There is remarkable clinical heterogeneity between asthma patients due to the various mechanisms of disease. Abnormal ventilation is the functional consequence of abnormal airway pathology in asthma, which can be directly visualized by hyperpolarized 129Xe magnetic resonance imaging (MRI). Each ventilation pattern is unique and there is significant inter-patient variability. Thus, the goal of the thesis was to extract quantitative information from the 129Xe MRI ventilation patterns of patients with severe asthma, identify novel ventilation phenotypes, and determine their clinical relevance. An unsupervised machine learning approach using quantitative ventilation MRI features identified three unique, clinically relevant ventilation phenotypes of severe asthma with distinct clinical, physiological, and biological characteristics. The discordance in ventilation between phenotypes, and their characteristics, suggest different mechanisms that may be driving severe asthma.

Since ancient times, mankind has faced a constant battle against natural hazards. From the earlieststages of human communication, when human beings communicate by some sort of harsh gruntsand unintelligible words, people were struck by the awe-inspiring power of nature as floods, storms,earthquakes, and other events which reshaped their environment and way of living. However,among these events, droughts have been particularly devastating, and have left a profound mark onhuman history. Throughout centuries, droughts have forced communities to adapt and evolve in response tochanging environmental conditions. In California, the frequency and severity of droughts haveincreased in recent decades, leading to significant changes in land use patterns. These changes haveimpacted the economy, social structure, and ecology of the region, making the study of land usechanges after drought periods a crucial area of research. In this master thesis, the effects of droughts on land use in California will be deeply explored,analysing the outcome and impacts resulting from extreme dry events in the state, and identifyingpotential climate adaptation actions that can be implemented based on an enhanced understandingof the consequences of droughts on land use. By understanding the complex relationship betweendroughts and land use, mankind may better prepare and adapt to the challenges posed by futureclimate change and other environmental stressors. / Sedan urminnes tider har mänskligheten stått inför en ständig kamp mot naturliga faror. Ända frånde tidigaste stadierna av mänsklig kommunikation, när människor kommunicerade genom någonform av hårda grymtningar och obegripliga ord, har människor imponerats av naturens mäktigakraft i form av översvämningar, stormar, jordbävningar och andra händelser som omformat derasmiljö och levnadssätt. Bland dessa händelser har torka varit särskilt förödande och har satt djupaspår i mänsklighetens historia. Under århundraden har torkor tvingat samhällen att anpassa sig och utvecklas som svar påförändrade miljöförhållanden. I Kalifornien har frekvensen och allvaret av torkor ökat under desenaste decennierna, vilket har lett till betydande förändringar i markanvändningsmönster. Dessaförändringar har påverkat ekonomin, den sociala strukturen och ekologin i regionen, vilket görstudiet av markanvändningsförändringar efter torkperioder till ett avgörande forskningsområde. I denna masteruppsats kommer effekterna av torkor på markanvändningen i Kalifornien attutforskas ingående. Resultat och påverkan av extrema torkhändelser i delstaten kommer attanalyseras, och potentiella åtgärder för klimatanpassning kommer att identifieras baserat på en ökadförståelse för konsekvenserna av torkor för markanvändningen. Genom att förstå det komplexaförhållandet mellan torkor och markanvändning kan mänskligheten bättre förbereda sig ochanpassa sig till utmaningarna som framtidens klimatförändringar och andra miljömässigapåfrestningar medför.

Mindfulness utövas av sjuksköterskor i en ökad omfattning både i öppenvården och slutenvården och ges till allt sjukare patienter. Omvårdnadsåtgärder inom psykiatrisk vård syftar till att stärka patientens förmåga till återhämtning, vilket väcker frågan kring vilka verktyg psykiatrisjuksköterskan bör använda, då självkänsla, empowerment och livskvalitet står för en stor del av hälsoupplevelsen hos patienter. Syftet var därför att sammanställa kunskap om mindfulness och dess betydelse för återhämtning i psykiatrisk vård. Då ämnet var lite beforskat inom omvårdnadsforskningen utfördes en systematisk integrerad litteraturstudie. Tjugofyra artiklar utgjorde grunden för vårt resultat, som visar att det finns oenighet i synen på återhämtning och vilka mätmetoder som ska användas för att mäta återhämtning. Återhämtning kan främjas eller motverkas av Mindfulness, vilket i första hand beror på huruvida fokus på återhämtning ligger inom den biomedicinska eller den psykosociala modellen. Om sjuksköterskor tolkar återhämtning utifrån den psykosociala modellen, gör en helhetsbedömning av patientens somatiska och psykiska hälsa och härefter planerar åtgärder utifrån patientens individuella behov, kan mindfulness bli en omvårdnadsåtgärd som bidrar till återhämtning. Studien kan då utgöra ett underlag för hur sjuksköterskor inom psykiatrin kan använda mindfulness som omvårdnadsåtgärd för att uppnå återhämtning för patienterna.

Asthma is an inflammatory airways disease affecting over 339 million people of all ages worldwide. More than 10% of asthmatics have uncontrolled severe disease which is insensitive to high doses of oral corticosteroid treatment. Type 2 innate lymphoid cells (ILC2) are pro-inflammatory lymphomononuclear cells proposed as critical drivers of eosinophilic inflammatory disease of the upper and lower airways. Controlling this activity may provide novel therapies for asthma. This thesis aimed to investigate factors that affect the local activation and expansion of ILC2 in the airways including anti-inflammatory medications such as (i) corticosteroids, (ii) neuro-immune regulation of ILC2, and (iii) effect of locally generated cytokines on ILC phenotypes and the relationship to the ongoing airway inflammatory profile. We firstly investigated the effect of intranasal corticosteroids on activation levels of ILC2 in the upper airway of allergic rhinitics with mild asthma following controlled nasal allergen challenge (Chapter 2). Following pre-treatment with intranasal corticosteroid there was an attenuation in the allergen-induced increase in total ILC2 and IL-5/13+ ILC2 in the nasal mucosa. In addition, HLA-DR expression on ILC2 in the nasal mucosa was down-regulated. Overnight culture with IL-2, TSLP or IFN-γ up-regulated HLA-DR expression on ILC2, in vitro; an effect that is inhibited in the presence of corticosteroids. Attenuation of HLA-DR expression by ILC2 may be an additional mechanism by which corticosteroids modulate adaptive immune responses in the airways. We have previously reported that lung ILC2 are activated within 7h following allergen-inhalation challenge. Since airway mucosal tissue is highly innervated, we investigated whether neuroimmune interactions may trigger early and rapid host immune responses (Chapter 3). In a diluent-controlled allergen-inhalation challenge cross-over study, where mild asthmatics developed early and late bronchoconstrictor responses with sputum eosinophilia (>3%), NMUR1, a receptor for the neuropeptide, neuromedin-U, was up-regulated on sputum ILC2 in 7h post allergen challenge. This was associated with increased expression of IL-5/IL-13 by sputum ILC2 post-allergen and following in vitro culture. ILC2 activation was mediated through a MAPK/PI3 kinase dependent-signaling pathway that was attenuated in the presence of dexamethasone. Co-culture with IL-33 and TSLP, in vitro up-regulated NMUR1 expression on ILC2 at the protein and transcriptomic level which was attenuated by dexamethasone. The close interplay between neuropeptide signalling and tissue-derived alarmin cytokines may be important interactions for rapid ILC2 activation in airway inflammatory responses in asthma. We have reported increased ILC2 with the highest level of IL-5/13+ ILC2 in the airways of severe asthma with uncontrolled eosinophilia (>3%). The prevalence and phenotypic analyses of innate lymphoid cells subsets in severe asthma with neutrophilic or mixed granulocytic airway inflammatory endotypes remains unclear and was investigated in Chapter 4. Sputum ILC3 were most abundant in severe asthma with neutrophilic airway inflammation where IL-17A+ ILC3 correlated with airway neutrophilia. ILC2 were predominant in severe asthma with airway eosinophilia. Importantly, we identified an intermediate ILC2 phenotype displaying ILC3-like markers (c-kit and IL-17A) in severe asthma with neutrophilic and mixed granulocytic airway inflammation. Inflammasome related cytokines, IL-1β and IL-18 were significantly increased in the airways of these patients. At both proteomic and transcriptomic levels, flow sort-purified ILC2 trans-differentiated to the intermediate phenotype when co-cultured with IL-1β+IL-18. Blocking inflammasome-related cytokines may control T2-low severe asthma exacerbations. Collectively, the findings of this thesis highlight the role of corticosteroids, neuropeptides and airway inflammasome related cytokines as modulators of ILC fate and activity in asthma. / Thesis / Doctor of Philosophy (PhD) / Asthma is a disease of the airways that makes breathing difficult. About 10% of asthma patients have uncontrolled severe symptoms despite treatment with high doses of corticosteroids which imposes many unwanted side effects. Investigating processes that worsen the disease will help to discover new treatments for asthma. Type 2 innate lymphoid cells (ILC2) are novel cells that produce large quantities of factors which attract and activate effector cells to the lungs which in turn make breathing difficult. This thesis investigated whether controlling ILC2 activity reduces asthma symptoms by studying i) responsiveness of ILC2 to corticosteroids using a controlled allergen exposure through the nose in people with allergic rhinitis and mild asthma, ii) the role of airway nerves and mediators on ILC2 activation, and iii) the ability of signals produced by the lungs to impact factors released by ILC2 and the relationship to effector cells found in the airways of severe asthma. Overall, ILC2 activation can be modulated by corticosteroids, nerve derived factors and lung tissue derived cytokines, and this is associated with changes in the number and type of effector cells in the lungs.

Alabama, also known as the Dixie state, is no stranger to severe weather. Severe weather can occur during much of the year. Experienced local forecasters have long suspected that North and Central Alabama has its own tornado alley. Many of these forecasters have noticed storm tracks as well as tornado tracks to be similar to past historic events. Many questions have risen about the exact influential factors that cause convective initiation and tornadic development. For example the effects of terrain, water, and population on tornado climatology will be discussed in this study. The sometimes unreliable climatology of tornadoes will be addressed as well as the history of storm reporting. Tornado clusters were found and further explained regarding relationships with terrain, water, and population. Through this research, it is concluded that there are two distinct tornado regions that exist in North and Central Alabama.

No description available.