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Many students who have Extensive Support Needs (ESN) struggle with increasing their independence in inclusive classrooms. Federal law is clear that all students—including students with ESN—should be educated alongside their peers without disabilities in regular education classrooms to the "maximum extent appropriate." Self-directed video prompting is an evidence-based practice that has been proven to fade adult support while building student independence. This article provides a practical how-to guide for how teachers can support their paraeducators in using self-directed video prompting. It introduces a framework for implementation called TAP To SKILL and describes what this approach looks like in action.

Despite decades of advocacy, most students with developmental disabilities continue to spend the majority of the school day in self-contained special education classrooms. However, there is tremendous variability of educational placement across the United States. Identification of geographic trends that explain this variability could provide opportunities for targeted advocacy. Using state-level data in Ohio, we tested the hypothesis that urbanicity predicts educational placement. Through mapping and multivariate analysis of variance, we found that students in urban districts tended to spend less time in general education classrooms, and students in rural districts tended to spend more time in general education classrooms. Furthermore, the urban districts with the largest enrollments tended to place an even lower proportion of students in general education classrooms. Given their disproportionate influence on state trends and propensity toward more self-contained and segregated placements, large urban districts offer a unique opportunity for targeted advocacy and change.

The involvement ofparaprofessionals in the education of students with intellectual and developmental disabilities (IDD) has been both complex and controversial. Many scholars and advocates have raised concerns about the roles these staff members play in schools and the degree to which there is empirical support for their direct work with students. We conducted a systematic review of the literature to address two primary questions: To what extent have paraprofessional-implemented educational practices been shown to improve outcomes for elementary and secondary students with IDD, and what professional development strategies enable paraprofessionals to implement these strategies with fidelity? These studies indicate paraprofessionals, when given adequate training, are capable of effectively implementing a number of educational practices that result in improved academic and social outcomes, specifically, teaching communication skills, reducing problem behaviors, and increasing independence for students with IDD. Follow-up training and support, modeling, and performance feedback were prominent training components across most studies in this review and are validated in the broader research literature. However, limitations leave many questions unanswered about how to best train and support paraprofessionals. We discuss recommendations for preparing paraprofessionals who work with students with IDD, as well as future directions for research.

Most paraprofessionals are not well trained to implement evidence-based practices that can improve student outcomes. In this study, we trained a paraprofessional to use evidence-based instructional practices with an elementary student with a severe disability who exhibited challenging behavior. Through functional analysis, we determined the function of the student's problem behavior was to escape instructional demands. We used a multiple probe across behavior design to test the efficacy of video modeling and performance feedback on the paraprofessional's implementation of three evidence-based instructional plans that incorporated high rates of positive reinforcement. Training strategies resulted in high rates of paraprofessional implementation fidelity, and paraprofessional implementation translated into improved student outcomes. These results provide an illustration of how effective paraprofessional training can promote learning for a student with severe disabilities and challenging behavior.

Peer networks are a promising intervention for increasing social interactions between students with severe disabilities and their peers. However, this approach has not been well studied with high school students who have complex communication needs and use augmentative and alternative communication (AAC). In this study, we used a multiple probe across participants design to evaluate the effectiveness of a lunchtime peer-network intervention for three high school students with autism and/or multiple disabilities who had complex communication needs. The intervention involved recruiting peers, sharing practical background information and modeling how to communicate with the student, and then providing support as needed. A functional relation was established between the introduction of the peer-network intervention and both social interactions and social engagement. Interactions increased substantially across communication modalities. This study builds on the peer-network literature by demonstrating how this approach can be tailored for high school students with complex communication needs.

The article of record as published may be found at http://doi.org/10.5664/jcsm.6990 ; The spectrum of sleep disorders in military personnel is varied and complicated by the presence of comorbidities and psychological disorders. Currently, little is known regarding nightmares, especially trauma-related nightmares. Study Impact: This is the first study to report on objective and subjective sleep attributes in a cohort of military personnel, determining the prevalence of nightmares and polysomnographic characteristics associated with nightmares. Clinically, this highlights the need for military and civilian health care providers to evaluate for nightmares in individuals with sleep disturbances after traumatic experiences. From a research perspective, these findings provide the basis to further address nightmares, which are associated with the pressing issues of sleep and behavioral medicine disorders and suicidality in military and veteran populations.

The article of record as published may be found at https://doi.org/10.1093/milmed/usz066 ; Excessive daytime sleepiness affects an estimated 20% of the general population. While the prevalence of sleepiness in the military is largely unknown, it is well established that short sleep duration is endemic. The reasons for this include: the demanding nature of their duties, shift work and 24-hour duty periods, deployments and exigencies of military service as well as sleep disorders. The Epworth Sleepiness Scale (ESS) is the most widely used sleep questionnaire and provides a self-assessment of daytime sleepiness. To date the clinical utility of this questionnaire in differentiating sleep disorders in military patients with sleep disorders has never been evaluated. Materials and Methods: The primary aim of this manuscript was to assess if Epworth Sleepiness Scale (ESS) scores differed between military personnel with insomnia, obstructive sleep apnea (OSA), comorbid insomnia/obstructive sleep apnea (COMISA), and a group with neither insomnia nor obstructive sleep apnea (NISA). This study assessed the clinical utility of the ESS in differentiating sleep disorders amongst a sample (N = 488) of U.S. military personnel with insomnia (n = 92), OSA (n = 142), COMISA (n = 221), and a NISA group (n = 33) which served as the control population. Results: In the present sample, 68.4% of service members reported excessive daytime sleepiness (EDS) with an ESS > 10. ESS scores differed between military personnel with COMISA (13.5 ± 4.83) and those with OSA only (11.5 ± 4.08; p < 0.001) and the NISA group (9.46 ± 4.84; p < 0.001). Also, ESS scores differed between patients with insomnia only (13.0 ± 4.84) and the NISA group (p < 0.01). Conclusions: Overall, the ESS had poor ability to differentiate sleep disorders. In military personnel, the ESS appears elevated in the most common sleep disorders, likely due to their insufficient sleep, and does not help to differentiate OSA from insomnia. Further studies are required to validate this questionnaire and determine an appropriate threshold value for abnormal sleepiness in the military population.

The article of record as published may be found at http://dx.doi.org/10.1016/j.sleep.2017.11.1121 ; Obstructive sleep apnea (OSA) is characterized by apneas and hypopneas that result in hypoxia, cerebral hypoperfusion, endothelial dysfunction, inflammation, and oxidative stress. These pathophysiologic processes likely contribute to neuronal damage. Tau is a protein that stabilizes microtubules and, along with amyloid beta (Ab), is associated with neurodegenerative processes. We sought to determine if tau and other biomarkers of inflammation were related to OSA severity. Concentrations of tau, Ab40, Ab42, c-reactive protein (CRP), TNF-a, interleukin (IL)-6, and IL-10 were measured in blood and compared between participants with moderate-severe OSA (n 1⁄4 28), those with mild OSA (n 1⁄4 22), and healthy controls (n 1⁄4 24). The cohort included relatively young, primarily male active duty military personnel without a history of traumatic brain injury or neurodegenerative disease. Total biomarker concentrations were determined from plasma samples using an ultra-sensitive detection method, SimoaTM, and CRP was assayed by ELISA. Total tau and IL-6 concentrations were elevated in participants with moderate-severe OSA, with a mean apnea-hypopnea index (AHI) of 26.1/h, compared to those with mild OSA (mean AHI 8.6/h) and healthy controls (mean AHI 2.1/h). Tau concentrations were also significantly correlated with the AHI (r 1⁄4 0.342, p 1⁄4 0.004). Our findings show that tau is elevated in the blood of young patients with moderate-severe OSA, suggesting that this degree of sleep-disordered breathing is a contributing factor in the development of neurodegenerative disorders. The finding of increased IL-6 further suggests that inflammatory biomarkers are present early in the course of this chronic disease.

STUDY OBJECTIVES: Military personnel frequently experience sleep difficulties, but little is known regarding which military or life events most impact their sleep. The Military Service Sleep Assessment (MSSA) was developed to assess the impact of initial military training, first duty assignment, permanent change of station, deployments, redeployments, and stressful life events on sleep. This study presents an initial psychometric evaluation of the MSSA and descriptive data in a cohort of service members. METHODS: The MSSA was administered to 194 service members in a military sleep disorders clinic as part of a larger study. RESULTS: Average sleep quality on the MSSA was 2.14 (on a Likert scale, with 1 indicating low and 5 indicating high sleep quality), and 72.7% (n = 140) of participants rated their sleep quality as low to low average. The events most reported to negatively impact sleep were stressful life events (41.8%), followed by deployments (40.6%). Military leadership position (24.7%) and birth/adoption of a child (9.7%) were the most frequently reported stressful life events to negatively impact sleep. There were no significant differences in current sleep quality among service members with a history of deployment compared with service members who had not deployed. CONCLUSIONS: The MSSA is the first military-specific sleep questionnaire. This instrument provides insights into the events during a service member's career, beyond deployments, which precipitate and perpetuate sleep disturbances and likely chronic sleep disorders. Further evaluation of the MSSA in nontreatment-seeking military populations and veterans is required. CITATION: Mysliwiec V, Pruiksma KE, Brock MS, et al. The Military Service Sleep Assessment: an instrument to assess factors precipitating sleep disturbances in U.S. military personnel. J Clin Sleep Med. 2021;17(7):1401–1409.

Letter to the Editor, Military Medicine, 187, 5/6:155, 2022 ; 17 USC 105 interim-entered record; under review. ; The article of record as published may be found at http://dx.doi.org/10.1177/0018720820906050 ; In their article entitled, "Engaging Stakeholders to Optimize Sleep Disorders Management in the U.S. Military: A Qualitative Analysis," Abdelwadoud and colleagues conducted focus groups of service members, primary care managers (PCMs), and administrative stakeholders about their perceptions, experiences, roles in sleep management, stated education needs, and management of sleep disorders.1 The qualitative methods are rigorous, and the findings reinforce and nuance prior results, especially regarding key requirements from PCMs. We feel compelled, however, to further nuance the authors' conclusion that "current military sleep management practices are neither satisfactory nor maximally effective" and offer specific examples of actions taken by the Department of Defense (DoD) and Defense Health Agency (DHA) in recognition of the significance of optimal sleep in combat readiness and overall health of service members. We offer here a succinct list of concrete efforts to support and implement substantial clinical, operational, research, or educational efforts by the DoD or DHA to improve sleep in service members and associated clinical challenges in this unique population. ; Identified in text as U.S. Government work.

What key issues and challenges affect the lives of people with severe disabilities todayâ€"and what should tomorrow's professionals do to address them? Aligned with the core values and agenda of TASH, this visionary text prepares professionals to strengthen supports and services for people with disabilities across the lifespan. Readers will fully examine more than a dozen critical topics in the lives of people with severe disabilities; explore necessary reforms to policy and practice; and set clear goals and priorities for improving early intervention, education, health care, behavior suppor