The purpose of this study was to investigate teachers' beliefs about the participation of students with severe disabilities (SD) in school clubs. Participants were special education teachers (N = 60) of middle and junior high school students with SD from one state. Data were collected using a survey. Results indicate that teachers value including students in school clubs and believe that students benefit from engaging in club activities, yet they did not view this setting as a place to address curricula. Issues with supports, transportation, and planning were identified as barriers to participation. Prior experience sponsoring a school club positively affected teachers' perceptions of benefits gained from participation.

Background Hepatic encephalopathy (HE) is a complication of cirrhosis. Rifaximin, added to lactulose, effectively maintains remission and reduces hospitalizations from HE compared with lactulose alone. Although the clinical evidence supports the use of rifaximin, concerns remain regarding the financial implications and subsequent impact on medication access and outcomes. Objective The goal of this study was to determine whether medication access to rifaximin at hospital discharge reduces readmission and office visits related to HE. Methods A retrospective study was conducted in compliance with local institutional review board including cirrhotic patients discharged with a rifaximin prescription for HE. Patients were stratified into 2 groups: those able to obtain rifaximin and those unable to obtain rifaximin upon discharge. The primary outcome was to evaluate the rate of HE recurrence in each group as defined as a composite of readmission or office visit for acute HE within 12 months of discharge. Results Access to rifaximin significantly reduced the risk of hospital admission and office visit for acute HE over 12 months. A hospitalization or office visit occurred in 24.5% of patients in the medication access group compared with 50% in the group without medication access. Only 58% of patients had access to rifaximin at discharge. Conclusion and Relevance Rifaximin use was associated with significantly reduced risk of hospitalization and office visits for HE. At discharge, 42% of patients did not have access to rifaximin regardless of being prescribed the medication, identifying that copay is a significant barrier in allowing patients to have access to rifaximin.

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The purpose of this study was to examine how secondary students with severe disabilities (i.e., severe intellectual disability or autism, multiple disabilities) participate in extracurricular school clubs. Using a qualitative multiple case design, the experiences of three high school students were examined. Data were collected through interviews, observations, and document reviews. A single-case inductive open-coding strategy was utilized across all data sources in which codes and categories emerged, and a final cross-case thematic evaluation was conducted. The cross-case thematic analysis resulted in the following four overarching themes: (a) going with the flow; (b) social obstacles: on the outside looking in; (c) supports provided: too much, too little, just right; and (d) safety in numbers.