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Anxiety disorders are common and negatively impact students' social, behavioral, and academic functioning. However, most students with anxiety do not receive needed assistance. The current study evaluated the feasibility and preliminary impact of a brief school-home elementary teacher-administered intervention for reducing student anxiety. Seventy-eight elementary teachers in New England were randomly assigned to be trained and deliver the Teacher Anxiety Program for Elementary Students (TAPES; a five-meeting school-home intervention) or a control condition (Teacher Anxiety Training, TAT). Students (N = 54) were ages 5-11 (mean age 8.0; 78% White; 46% female). Feasibility results indicated that 72% of trained teachers enrolled a student and teachers assigned to TAPES completed a modal number of 5/5 school-home meetings. Teacher fidelity ratings across the five TAPES meetings were adequate. Students in TAPES versus TAT demonstrated greater improvements in anxiety at post-intervention (but not follow-up) based on independent evaluator ratings. On student, teacher, and parent-report measures, students in both groups showed significant improvement over time. Findings suggest that training teachers to identify and assist students with anxiety using a brief intervention appears feasible and shows promise for reducing anxiety and related impairment. Addressing barriers to teacher training and intervention implementation are paramount.

Post-training consultation support is linked to improvements in evidence-based treatment fidelity following initial training, but little is known about what makes it work, and how clinician-level factors may moderate its effects. This study examined the adherence and competence of N = 33 school-based clinicians trained to provide modular Cognitive Behavioral Therapy to youth, while receiving ongoing consultation. We examined two aspects of consultation as predictors of growth in adherence and competence, consultation dosage and use of session audio review. We also examined several clinician-level predictors of fidelity growth, including education, years of experience, burnout, and self-efficacy. Fidelity was rated by both independent observers and consultants, with differing findings. Independent observer ratings of adherence and competence did not change during consultation, and were not associated with any predictors. Consultant ratings of competence showed a trend toward growth during consultation. Greater clinician self-efficacy and years of experience were associated with lower initial consultant-rated competence, but more rapid growth over time. Higher consultation dosage and use of session audio review were negatively associated with growth in consultant-rated competence. These findings reinforce the need for further study of the active ingredients of consultation (i.e. consultation practices that help clinicians improve their treatment implementation), and the factors associated with perceptions of consultant fidelity raters.

The purpose of this study was to compare the impact of two teacher trainings, both focused on identifying student anxiety and implementing empirically supported anxiety reduction strategies in the classroom. A comparison of teachers' satisfaction with their training was examined along with pre-post training changes on measures of teachers' knowledge and use of evidence-based anxiety reduction strategies, perceived confidence in assisting students with anxiety, and teaching self-efficacy. Volunteer elementary teachers in New England USA were randomized to receive either a six-hour interactive training (Teacher Anxiety Program for Elementary Students; TAPES; n = 41) or a three-hour didactic (Teacher Anxiety Training; TAT; n = 37). Fifty-four teachers completed their respective training (mean age 40.9; SD = 10.2; 98% female; 96% White). Results from t-tests indicated that levels of training satisfaction were high and similar across trainings. Mixed-design ANOVA analyses found that teachers receiving both trainings showed significant improvements in teacher knowledge and use of anxiety reduction strategies, confidence, and self-efficacy. Teachers receiving TAPES, compared to TAT, showed greater improvements in their knowledge of anxiety reduction strategies. Findings highlight the need and perceived value of training teachers on topics related to identifying and managing student anxiety.

Sexual assault is a pervasive problem that has devastating consequences for college students. California's legislation stipulates that public colleges and universities must define sexual misconduct and sexual consent as well as provide ongoing sexual assault prevention education on campus. Despite these efforts, little is known about how well students understand consent or whether their knowledge differs by gender identity and sexual orientation. To address this gap, we collected data from 291 students attending a public university in Northern California and found that most (presumably well-informed) students had only cursory understandings of consent. We argue that colleges and universities need to do more to provide gender and sexual-orientation informed, creative, interactive and context-based approaches to consent education. Additionally, consent education should be tailored to the unique needs of specific subgroups, including cisgender heterosexual men and asexual students who had the lowest level of consent understanding in this study. Such an approach is needed to support college students to enjoy mutually respectful, fulfilling, and fun sexual and romantic relationships.

Abstract Recently, in Hepatocellular carcinoma (HCC) setting, the use of metformin has been associated to a trend toward worse response rate, overall survival and progression free survival in patients who received immunotherapy. The study population included individuals from both Eastern and Western regions with a confirmed diagnosis of HCC and receiving first line treatment with Atezolizumab plus bevacizumab or Lenvatinib. Univariate and multivariate analyses were performed by Cox proportional. For the analysis, patients were stratified based on their use of concomitant medication or not. At the time of database lock, 319 deaths were observed: 209 in the Lenvatinib cohort, 110 in the Atezolizumab plus bevacizumab cohort. In the Atezolizumab plus Bevacizumab arm, 50 (16.5%) patients were on chronic metformin use. At the univariate analysis for OS, patients who used metformin showed significantly shorter OS compared to patients who did not use metformin (HR 1.9, 95% CI 1.1–3.2). Multivariate analysis confirmed that patients in metformin group had significantly shorter OS compared to patients in no-metformin group (HR 1.9; 95% CI 1.1–3.1). At the univariate analysis for PFS, patients in metformin group had significantly shorter PFS compared to patients in no-metformin group (HR 1.6, 95% CI 1.0–2.6). Multivariate analysis confirmed that patients in metformin group had significantly shorter PFS compared to patients in no-metformin group (HR 1.7; 95% CI 1.1–2.7; p = 0.0147). No differences were reported in terms of ORR and DCR between patients in metformin group and those in no-metformin group. In the Lenvatinib cohort, 65 (15%) patients were recorded to chronically use metformin. No statistically significant differences in terms of both OS and PFS were found between patients in metformin group and patients in no-metformin group. This analysis unveils a negative prognostic role associated with metformin use specifically within the Atezolizumab plus Bevacizumab group.

Background: School-based treatments for anxiety disorders are needed to address barriers to accessing community-based services. A key question for school administers are the costs related to these treatments. Aims of the Study: This study examined the cost-effectiveness of a school-based modular cognitive behavioral therapy (M-CBT) for pediatric anxiety disorders compared to school-based treatment as usual (TAU). Methods: Sixty-two school-based clinicians in Maryland and Connecticut were randomized (37 in CBT; 25 in TAU), trained, and enrolled at least one anxious student (148 students in CBT; 68 in TAU). Students (N = 216) were ages 6-18 (mean age 10.9); 63.9% were non-Hispanic White race-ethnicity; and 48.6% were female. Independent evaluators (IEs) assessed outcomes at post treatment and at a one-year follow up. Anxiety related costs included mental health care expenses and the opportunity costs of added caregiver time and missed school days. Results: The overall M-CBT ICER value of $6917/QALY reflected both lower costs for days absent from school (mean difference: $-117 per youth; p = 0.045) but also lower QALY ratings (mean difference: -0.024; p = 0.900) compared with usual school counseling. Among youth with more severe anxiety at baseline, MCBT had a more favorable ICER ($-22,846/QALY). Other mental health care costs were similar between groups (mean difference: $-90 per youth; p = 0.328). Discussion: Although training school clinicians in M-CBT resulted in lower costs for school absences, evidence for the cost effectiveness of a modular CBT relative to existing school treatment for pediatric anxiety disorders was not robustly supported. Findings suggest school-based M-CBT is most cost effective for youth with the highest levels of anxiety severity and that M-CBT could help reduce the costs of missed school. Interpretations are limited due to use of retrospective recall, lack of data on medication use, and small sample size. Implications for Health Care Provision and Use: Schools may benefit from providing specialized school-based services such as MCBT for students with the highest levels of anxiety. Implications for Health Policies: Investment decisions by schools should take into account lower costs (related to school absences), the costs of training clinicians, and student access to CBT in the community. Implications for Further Research: Replication with a larger sample, service use diaries, and objective school and medical records over a longer period of time is warranted.

RESUMO A Estratégia Saúde da Família é reconhecida como capaz de minimizar os efeitos das iniquidades em saúde. Este estudo descritivo buscou apresentar a distribuição das equipes de Saúde da Família (eSF) e Unidades Básicas de Saúde (UBS) no Distrito Federal (DF), usando como parâmetros o Índice de Vulnerabilidade da Saúde (IVSaúde) e a densidade demográfica categorizadas por setores censitários. Foram utilizados dados do último censo demográfico publicado e dados oficiais do Cadastro Nacional de Estabelecimentos de Saúde e da Secretaria de Estado de Saúde do DF. Os resultados mostraram que o DF tem uma população heterogênea, quando se trata de vulnerabilidade, e que a maioria dos setores censitários de alto risco está nas zonas periféricas. O DF possui 165 UBS e 615 eSF (média: 3,7 equipes/ UBS). Cerca de 35% dos setores censitários apresentam IVSaúde de baixo risco, e 19,8%, de elevado e muito elevado risco. O estudo mostrou que a maior parte das UBS e equipes está localizada em lugares de alta densidade demográfica e de maior vulnerabilidade, embora ainda seja necessário aumentar o número de equipes e de UBS para uma adequada cobertura do modelo adotado na capital federal, bem como reduzir a razão de equipes por estabelecimento de saúde.

Despite the high prevalence of and documented impairment associated with pediatric anxiety disorders, less than half of youth access mental health services. This study examined (a) the utilization of eight school services and supports (e.g., seen a school counselor for a mental health reason, placement in a special class for a behavior or emotional difficulty) and (b) demographic (gender, age) child clinical (anxiety severity and impairment) and family (parent psychopathology, caregiver strain) predictors of service utilization. Participants included 208 anxious youth between ages 6 to 18 years (M = 10.92, SD = 3.29, 51% male, 64% White) who were enrolled in a school-based randomized controlled trial for anxiety treatment; only baseline data were used for this study. Parents, children, teachers and independent evaluators completed measures of the above predictors. Results indicated that less than half (48%) of youth received school services for anxiety. Several predictors of higher total service utilization were identified. Youth with comorbid externalizing behaviors were more likely to be referred for and receive school-based services. Consistent with published data in community samples, less than half of anxious youth received needed services. Results suggest a need for improvements in school assessments and service referral mechanisms for students with anxiety. [For the corresponding grantee submission, see ED608019.]

This study examined: (1) school-based avoidance among students with problematic anxiety, (2) teachers' levels of accommodation of avoidant behaviour, and (3) the relation between teacher accommodation and student avoidance and anxiety. Participants included 31 elementary school students with problematic anxiety (mean age = 7.7 years; range 5-11; 58% female; 71% White) and their teachers (mean age = 41.1 years; 100% female; 100% White). Children completed interviews about their anxiety, and teachers reported on students' avoided situations and completed a questionnaire about their own use of accommodation. Results indicated that the most commonly avoided situations involved individual and group academic performance (e.g., reading aloud in front of class). All teachers engaged in some form of accommodating behaviour more than one day a week (e.g., assisted a student in avoiding things that might make him/her more anxious), and teachers who reported engaging in more accommodating behaviours had students with higher avoidance and anxiety. Findings suggest that additional training and research on teachers' behaviours that maintain and/or reduce anxiety via reducing accommodating behaviours appears warranted. [For the corresponding grantee submission, see ED620190.]

Blood-derived products, such as citrate platelet-rich plasma (CPRP) and hyperacute serum (HAS), are recognized for their rich growth factor content. When human dermal fibroblast (HDF) cells are exposed to combined mitogenic and DNA-damaging stimuli, it can lead to an increased burden of senescent cells and a modified senescence-associated secretory phenotype. In this study, the senescent state was comprehensively assessed through various methods, including phosphorylated histone H2AX (γH2AX) staining, p21 and p16 q-PCR, p21-western blot, growth curves, and senescence-associated ß-galactosidase staining. Two primary treatments with blood products were administered, one early (immediately after etoposide) and the other late (11 days after etoposide treatment). The effects of the blood product treatment were evaluated by measuring interleukin 6 and 8 (IL-6 and IL-8) levels, as well as collagen 1 (COL1) and p21 mRNA expression. Additionally, 2,3-bis-(2-methoxy-4-nitro-5-sulfophenyl)-2H-tetrazolium-5-carboxanilide (XTT) assays, cell size measurements, viability assays, and cell number calculations were conducted. The results revealed that cells treated with hyperacute serum in the early treatment phase exhibited the lowest observed IL-6 and IL-8 levels. In contrast, a clear inflammatory response for IL-8 was observed in cells treated with hyperacute serum and citrate platelet-rich plasma during the late treatment. Furthermore, an upregulation of COL1 expression was observed in the early treatment, while cells in the late treatment group remained unaffected. Notably, citrate platelet-rich plasma-treated cells showed a decrease in COL1 expression. Overall, the treatment with blood products appears to have slightly positive effects on skin rejuvenation.

Image-guided treatment adaptation is a game changer in oncological particle therapy (PT), especially for younger patients. The purpose of this study is to present a cycle generative adversarial network (CycleGAN)-based method for synthetic computed tomography (sCT) generation from cone beam CT (CBCT) towards adaptive PT (APT) of paediatric patients. Firstly, 44 CBCTs of 15 young pelvic patients were pre-processed to reduce ring artefacts and rigidly registered on same-day CT scans (i.e., verification CT scans, vCT scans) and then inputted to the CycleGAN network (employing either Res-Net and U-Net generators) to synthesise sCT. In particular, 36 and 8 volumes were used for training and testing, respectively. Image quality was evaluated qualitatively and quantitatively using the structural similarity index metric (SSIM) and the peak signal-to-noise ratio (PSNR) between registered CBCT (rCBCT) and vCT and between sCT and vCT to evaluate the improvements brought by CycleGAN. Despite limitations due to the sub-optimal input image quality and the small field of view (FOV), the quality of sCT was found to be overall satisfactory from a quantitative and qualitative perspective. Our findings indicate that CycleGAN is promising to produce sCT scans with acceptable CT-like image texture in paediatric settings, even when CBCT with narrow fields of view (FOV) are employed.

AimsStatin intolerance (SI) represents a significant public health problem for which precise estimates of prevalence are needed. Statin intolerance remains an important clinical challenge, and it is associated with an increased risk of cardiovascular events. This meta-analysis estimates the overall prevalence of SI, the prevalence according to different diagnostic criteria and in different disease settings, and identifies possible risk factors/conditions that might increase the risk of SI.Methods and resultsWe searched several databases up to 31 May 2021, for studies that reported the prevalence of SI. The primary endpoint was overall prevalence and prevalence according to a range of diagnostic criteria [National Lipid Association (NLA), International Lipid Expert Panel (ILEP), and European Atherosclerosis Society (EAS)] and in different disease settings. The secondary endpoint was to identify possible risk factors for SI. A random-effects model was applied to estimate the overall pooled prevalence. A total of 176 studies [112 randomized controlled trials (RCTs); 64 cohort studies] with 4 143 517 patients were ultimately included in the analysis. The overall prevalence of SI was 9.1% (95% confidence interval 8.0-10%). The prevalence was similar when defined using NLA, ILEP, and EAS criteria [7.0% (6.0-8.0%), 6.7% (5.0-8.0%), 5.9% (4.0-7.0%), respectively]. The prevalence of SI in RCTs was significantly lower compared with cohort studies [4.9% (4.0-6.0%) vs. 17% (14-19%)]. The prevalence of SI in studies including both primary and secondary prevention patients was much higher than when primary or secondary prevention patients were analysed separately [18% (14-21%), 8.2% (6.0-10%), 9.1% (6.0-11%), respectively]. Statin lipid solubility did not affect the prevalence of SI [4.0% (2.0-5.0%) vs. 5.0% (4.0-6.0%)]. Age [odds ratio (OR) 1.33, P = 0.04], female gender (OR 1.47, P = 0.007), Asian and Black race (P 4 million patients, the prevalence of SI is low when diagnosed according to international definitions. These results support the concept that the prevalence of complete SI might often be overestimated and highlight the need for the careful assessment of patients with potential symptoms related to SI.

Non-invasive possibilities of predicting cardiovascular risk and monitoring the treatment and progression of coronary artery disease (CAD) are important subjects of cardiovascular research. Various inflammatory markers have been identified as potential biomarkers of CAD, including interleukin-6 (IL-6), lipocalin-2 (LCN-2), growth differentiation factor 15 (GDF-15), and T cell immunoglobulin and mucin domain-3 (TIM-3). This research aims to identify their utility in the investigation of CAD severity and progression. The basic anthropometric parameters, as well as the levels of urea, creatinine, CRP, leukocytes, fibrinogen, and biomarkers of inflammation, were measured in 130 patients who underwent coronary angiography. In male patients, divided according to findings on coronary angiography, we observed an increasing expression of GDF-15 with increasing stenosis (with worsening findings). In females, we observed increasing fibrinogen expression with increasing stenosis, i.e., findings on coronary angiography. Correlation analysis did not confirm the relationship between TIM-3, LCN and 2, IL-6 and the severity of findings obtained by coronary angiography; however, the correlation of TIM-3 and LCN-2 expression was positive with the finding, and the correlation of IL-6 with the finding was surprisingly negative. Understanding the role of these inflammatory markers in CAD can be helpful in risk stratification, guiding therapeutic strategies, and monitoring treatment responses in patients with CAD.

Few studies provide information about the clinical correlates of economic costs in pediatric anxiety disorders. This study uses baseline data from a randomized trial involving 209 children and adolescents with clinical anxiety to examine clinical and demographic correlates of direct and indirect costs. Measured costs included the direct costs of mental health services and the indirect costs resulting from children's missed school and parents' missed work. Validated measures of anxiety and depression severity and of internalizing and externalizing behaviors were reported by youth, their parents, and independent evaluators. Seventy-two percent of youth (n=150) had positive costs. Among these youth, the mean annual total cost was $6405 ("sd"-=$11,674), of which $5890 represented direct cost and $4658 represented indirect cost. Higher average costs were correlated with greater child anxiety and depression severity (p<0.001). Most pediatric anxiety disorders result in substantial individual and family costs, and costs may increase rapidly with elevated anxiety severity and depressed mood.

The current study compared the effectiveness of a school-clinician administered cognitive behavioral treatment (CBT) to treatment as usual (TAU) at post-treatment (i.e., after 12 weeks) and at a 1 year follow-up. Sixty-two school-based clinicians (37 in CBT; 25 in TAU) and 216 students (148 students in CBT; 68 in TAU) participated. Students were ages 6-18 (mean age 10.87; 64% Caucasian & 29% African American; 48.6% female) and all met DSM-IV diagnostic criteria for a primary anxiety disorder. Independent evaluators (IEs) assessed clinical improvement, global functioning, and loss of anxiety diagnoses; children and parents completed measures of anxiety symptoms. At post-treatment, no significant treatment main effects emerged on the primary outcome; 42% and 37% of youth were classified as treatment responders in CBT and TAU respectively. However, parent-report of child anxiety showed greater improvements in CBT relative to TAU (d = 0.29). Moderation analyses at post-treatment indicated that older youth, those with social phobia and more severe anxiety at baseline were more likely to be treatment responders in CBT compared to TAU. At the 1 year follow-up, treatment gains were maintained but no treatment group differences or moderators emerged. CBT and TAU for pediatric anxiety disorders, when delivered by school clinicians were generally similar in effectiveness for lowering anxiety and improving functioning at both post-treatment (on all but the parent measure and for specific subgroups) and 1 year follow-up. Implications for disseminating CBT in the school setting are discussed.

Statin intolerance is a clinical syndrome whereby adverse effects (AEs) associated with statin therapy [most commonly statin-associated muscle symptoms (SAMS)] result in the discontinuation of therapy and consequently increase the risk of adverse cardiovascular outcomes. However, complete statin intolerance occurs in only a small minority of treated patients (estimated prevalence of only 3-5%). Many perceived AEs are misattributed (e.g. physical musculoskeletal injury and inflammatory myopathies), and subjective symptoms occur as a result of the fact that patients expect them to do so when taking medicines (the nocebo/drucebo effect)-what might be truth even for over 50% of all patients with muscle weakness/pain. Clear guidance is necessary to enable the optimal management of plasma in real-world clinical practice in patients who experience subjective AEs. In this Position Paper of the International Lipid Expert Panel (ILEP), we present a step-by-step patient-centred approach to the identification and management of SAMS with a particular focus on strategies to prevent and manage the nocebo/drucebo effect and to improve long-term compliance with lipid-lowering therapy.

Abstract Background Brodalumab, a fully human anti‐interleukin (IL)‐17 monoclonal antibody that blocks IL‐17RA, is approved in Europe for the treatment of adult patients with moderate‐to‐severe plaque psoriasis who are candidates for systemic treatment. Objectives This study evaluated the achievement and maintenance of therapeutic response for 1 year in psoriasis patients treated with brodalumab in the Italian clinical practice. Methods Real‐world, multicenter, observational, retrospective and prospective study. The retrospective phase ranged from enrolment visit to initiation of brodalumab (12 ± 4 weeks before). The prospective phase ranged from enrolment to a routine follow‐up visit set after 52 ± 4 weeks. Results One hundred eighty‐four patients were eligible and 164 completed the observation period (median 11.9 months; Q1–Q3: 11.4–12.3). At enrolment, the mean duration of disease was 13.9 years (standard deviation; 13.3), 94% of patients (N = 172) had ≥1 clinical manifestation of psoriasis, mainly erythema and itching, and 95.6% had received ≥1 antipsoriatic treatment before brodalumab. Patients who reached an absolute Psoriasis Area and Severity Index (PASI) score ≤3 at week 12 and maintained it ≤3 through week 52 were 97 (64.7%). At week 12, 72.7% of patients achieved PASI 75, 54.5% PASI 90 and 42.0% PASI 100. At Week 52, 92.9% of patients achieved PASI 75, 84.4% PASI 90 and 61.7% PASI 100. A static Physician's Global Assessment (sPGA) score = 0 was obtained by 55.0% of patients after 12 weeks of brodalumab and by 77.0% after 52 weeks. A Dermatology Life Quality Index ≤1 was reported by 71.9% of patients after 12 weeks and by 89.9% after 52 weeks of treatment. No significant outcome differences were shown among patient subgroups defined by previous antipsoriatic treatments (none, systemic other than biologics or biologic) at either brodalumab initiation or any of the subsequent study visits. Conclusions In this real‐world setting, brodalumab was rapidly effective on skin lesions and quality of life both in biologic‐naïve and biologic‐experienced moderate‐to‐severe psoriasis patients, with a favourable safety profile.

The focus of this study, and the subject of this article, resides in the conceptually funded usability evaluation of an application of descriptive models to a specific dataset obtained from the East Slovak Institute of Heart and Vascular Diseases targeting cardiovascular patients. Delving into the current state-of-the-art practices, we examine the extent of cardiovascular diseases, descriptive data analysis models, and their practical applications. Most importantly, our inquiry focuses on exploration of usability, encompassing its application and evaluation methodologies, including Van Welie’s layered model of usability and its inherent advantages and limitations. The primary objective of our research was to conceptualize, develop, and validate the usability of an application tailored to supporting cardiologists’ research through descriptive modeling. Using the R programming language, we engineered a Shiny dashboard application named DESSFOCA (Decision Support System For Cardiologists) that is structured around three core functionalities: discovering association rules, applying clustering methods, and identifying association rules within predefined clusters. To assess the usability of DESSFOCA, we employed the System Usability Scale (SUS) and conducted a comprehensive evaluation. Additionally, we proposed an extension to Van Welie’s layered model of usability, incorporating several crucial aspects deemed essential. Subsequently, we rigorously evaluated the proposed extension within the DESSFOCA application with respect to the extended usability model, drawing insightful conclusions from our findings.

Background: Excessive student anxiety is a common problem that severely impairs short- and long-term academic functioning and increases teacher burden. Reducing student anxiety has been associated with improvement in educational functioning. Because anxiety manifests daily in the classroom, teachers are in an ideal position to identify and help students manage their anxiety. Unfortunately, teachers lack the knowledge and skills to support the learning of students with excessive anxiety. The Teacher Anxiety Program for Elementary Students (TAPES), a novel teacher-administered school-home collaborative intervention, was designed to address this gap. Methods: This manuscript describes the protocol for developing and evaluating TAPES. Specifically, we present a description of: (1) the intervention and theoretical model; and (2) methods for the proposed randomized controlled trial comparing TAPES to a standard professional development seminar focused on reducing student anxiety. Discussion: Primary aims examine the impact of the TAPES training on teacher knowledge and skill. Secondary aims examine the impact of TAPES on student outcomes. Exploratory aims will examine mediators based on our proposed theory of change. If effective, TAPES has the potential to directly benefit teachers (improving skills) and students (reducing anxiety and improving functioning).

While the root-associated microbiome is typically less diverse than the surrounding soil due to both plant selection and microbial competition for plant derived resources, it typically retains considerable complexity, harboring many hundreds of distinct bacterial species. Here, we report a time-dependent deviation from this trend in the rhizospheres of field grown sorghum. In this study, 16S rRNA amplicon sequencing was used to determine the impact of nitrogen fertilization on the development of the root-associated microbiomes of 10 sorghum genotypes grown in eastern Nebraska. We observed that early rhizosphere samples exhibit a significant reduction in overall diversity due to a high abundance of the bacterial genus Pseudomonas that occurred independent of host genotype in both high and low nitrogen fields and was not observed in the surrounding soil or associated root endosphere samples. When clustered at 97% identity, nearly all the Pseudomonas reads in this dataset were assigned to a single operational taxonomic unit (OTU); however, exact sequence variant (ESV)-level resolution demonstrated that this population comprised a large number of distinct Pseudomonas lineages. Furthermore, single-molecule long-read sequencing enabled high-resolution taxonomic profiling revealing further heterogeneity in the Pseudomonas lineages that was further confirmed using shotgun metagenomic sequencing. Finally, field soil enriched with specific carbon compounds recapitulated the increase in Pseudomonas, suggesting a possible connection between the enrichment of these Pseudomonas species and a plant-driven exudate profile.

Problematic anxiety in students impairs academic functioning. Teachers are often the first among school personnel to interact with these students, but they rarely receive training in evidence-based anxiety reduction strategies. This study assessed the feasibility of a brief teacher-administered school-home intervention (TAPES; Teacher Anxiety Program for Elementary Students) to reduce student anxiety symptoms. Eight elementary teachers completed a 1-day training and administered TAPES to 10 students with elevated symptoms of anxiety (M age: 8 years old; 50% female; 90% Caucasian). Feasibility of the intervention was assessed using several indicators, including training and intervention satisfaction as well as fidelity of implementation. Pre-post intervention student outcomes were collected from parents, students, and teachers. Results indicated that the majority of teachers were satisfied with the training and reported the intervention was feasible. Paired t-tests on pre-post outcome measures revealed significant reductions in student anxiety symptoms according to teachers and parents. Preliminary results suggest TAPES is feasible and helpful in reducing anxiety symptoms. Additional evaluation using a randomized controlled design is warranted.

The current study examined elementary (or primary) school teachers' knowledge of student anxiety and evidence-based anxiety reduction strategies, whether this knowledge was associated with their use of evidence-based anxiety reduction strategies in the classroom, and correlates of teacher knowledge and use of anxiety reduction strategies in the classroom. Fifty-one volunteer elementary teachers (98% female; 98% White) participated and completed questionnaires about: themselves and work-related factors (e.g., years of teaching experience, self-efficacy), knowledge of student anxiety and anxiety treatment (e.g., core manifestations of anxiety such as physiological arousal, behavioural avoidance, and anxious thoughts), and use of anxiety reduction strategies in the classroom (e.g., relaxation strategies, encouraging the use of coping self-talk, and gradual exposure to feared situations). Results indicated that the average score on the knowledge assessment was 57% and knowledge levels were unrelated to self-reported use of anxiety reduction strategies. The most robust correlate of knowledge of anxiety and use of anxiety reduction strategies was teachers' perceived personal accomplishment. Findings suggest additional teacher training to increase knowledge about student anxiety and use of evidence-based anxiety reduction strategies in the classroom is warranted. [For the corresponding grantee submission, see ED620191.]

The purpose of this retrospective study was to simulate a daily pre-alignment strategy to mitigate systematic positioning errors in image-guided pediatric hadron therapy. All pediatric patients (32 patients, 853 fractions) treated from December 2021 and September 2022 at our Institution were retrospectively considered. For all fractions, daily correction vectors (CVs) resulting from image registration for patient positioning were retrieved in the form of txt files from the hospital database. For each fraction, an adjusted correction vector (V′) was then computed as the difference between the actual one (V) and the algebraic average of the previous ones, as to simulate patient pre-alignment before imaging. The Euclidean norm of each V′ was computed and normalized with respect to that of the corresponding V to derive N. Pre-correcting all the coordinate values led to a 46% average reduction (min 20%, max 60%) in CVs, considering the first 27 fractions (average value in this cohort of patients). Such a potential improvement (N < 1) was observed for the most patients’ fractions (781/853, 91.6%). For the remaining 72/853 cases (8.4%), a remarkable worsening (N > 2) involved only 7/853 (0.82%) fractions. The presented strategy shows promising outcomes in order to ameliorate pediatric patient setup before imaging. However, further investigations to identify patients most likely to benefit from this approach are warranted.

This study examined children's perceived barriers to attending school-based anxiety treatment. One hundred and twenty-two anxious youth ("mean" age = 11.03 years; 51.6% female; 46.7% non-white) were randomized to receive either a modular cognitive behavioral anxiety treatment or usual care. The frequencies of 13 child-reported perceived barriers were examined following randomization and during one of the first three treatment sessions. Correlates of perceived barriers were also examined using a multi-informant assessment including: (1) child/family demographics, (2) child clinical characteristics, and (3) parental/family factors. Results indicated that 87.7% of children reported at least one perceived barrier to attending treatment. The most common barriers were worries about missing classroom work (45.3%) and the stigma associated with receiving mental health services (37.7%). Several factors were correlated with greater perceived barriers including minority racial/ethnic background, low parental education, higher child anxiety, and higher teacher-reported child externalizing behavior in the classroom. A multiple regression model showed that the strongest association was between teacher-rated externalizing behavior and children's perceived barriers. Although school-based treatment removes logistical problems, children's perceived barriers are still common. Assessing and reducing these perceived barriers, particularly among racial minority families and families with parents who did not attend college, may be beneficial. [This article was published in "School Mental Health" (EJ1229487).]

Purpose Blood pressure variability (BPV) is an independent cardiovascular risk factor in CKD. Kidney transplantation (KTx) is associated with improved BP levels for kidney transplant recipient (KTRs), without evoking significant changes in donors. The aim of this study was to assess the short- and mid-time effects of KTx and donation on short-term BPV in KTRs and their respective living kidney donors. Materials and Methods Forty KTRs and their respective donors were evaluated with 24-h ABPM (Mobil-O-Graph-NG) at baseline (1 month before), 3-months and 12-months after KTx. Standard-deviation (SD), weighted-SD (wSD), coefficient-of-variation (CV), average-real-variability (ARV) and variability independent of mean (VIM) for SBP/DBP were calculated with validated formulas Results All 24-h systolic and diastolic BPV indexes studied did not change significantly from baseline to 3-month (SBP-wSD: 12.8 ± 3.0 vs 13.2 ± 3.4 mmHg, p = 0.608; SBP-ARV: 10.3 ± 2.4 vs 10.8 ± 2.6 mmHg, p = 0.463) and 12-month evaluation (SBP-wSD 12.8 ± 3.0 vs 12.1 ± 2.8; p = 0.424 and SBP-ARV: 10.3 ± 2.4 vs 10.2 ± 2.5; p = 0.615) after kidney transplantation in the KTRs.In kidney donors, all 24-h systolic BPV indices displayed a trend towards higher values at 3 months compared to baseline, but without reaching statistical significance (SBP-wSD: 12.2 ± 2.8 vs 13.6 ± 4.2 mmHg, p = 0.107 and SBP-ARV: 10.1 ± 2.1 vs 11.2 ± 3.1 mmHg, p = 0.099), the levels of 24-h systolic SBP indices at 12-months were almost identical to baseline values. 24-h diastolic BPV indices at 3-month and 12-month evaluation were similar to baseline. Conclusion Short-term BPV did not change significantly 3 and 12 months after kidney transplantation/donation neither in KTRs nor in living kidney donors. Longitudinal studies examining associations of BPV with adverse outcomes in these individuals are needed.