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Many schools face barriers that hinder access to services, including limited funding and staff trained in evidence-based interventions. In particular, rural schools must provide targeted intervention to promote academic growth and narrow achievement gaps despite these barriers. One seldom-considered solution to ease the resource costs in the provision of intervention services is to provide high school students with the training and supervision necessary to carry them out. Thirty elementary students participated in an explicit timing intervention administered by either a high school student or graduate student in school psychology. A 2 × 2 mixed factorial ANOVA found significant growth from pre- to post-test with no effects of interventionist education level. These findings imply that school-based interventionists may be able to expand the reach of their practice by recruiting and training older students to carry out interventions.

Hypoxia-ischaemia (HI) can result in structural brain abnormalities, which in turn can lead to behavioural deficits in various cognitive and motor domains, in both adult and paediatric populations. Cardiorespiratory arrest (CA) is a major cause of hypoxia-ischaemia in adults, but it is relatively rare in infants and children. While the effects of adult CA on brain and cognition have been widely studied, to date, there are no studies examining the neurodevelopmental outcome of children who suffered CA early in life. Here, we studied the long-term outcome of 28 children who suffered early CA (i.e., before age 16). They were compared to a group of control participants (n = 28) matched for age, sex and socio-economic status. The patient group had impairments in the domains of memory, language and academic attainment (measured using standardised tests). Individual scores within the impaired range were most commonly found within the memory domain (79%), followed by academic attainment (50%), and language (36%). The patient group also had reduced whole brain grey matter volume, and reduced volume and fractional anisotropy of the white matter. In addition, lower performance on memory tests was correlated with bilaterally reduced volume of the hippocampi, thalami, and striatum, while lower attainment scores were correlated with bilateral reduction of fractional anisotropy in the superior cerebellar peduncle, the main output tract of the cerebellum. We conclude that patients who suffered early CA are at risk of developing specific cognitive deficits associated with structural brain abnormalities.

Policy makers in California intend to provide free preschool to all 4-year-olds solely within public schools by 2026, becoming the nation's second largest single pre-K program in the United States after Head Start. This initiative builds on the state's existing Transitional Kindergarten (TK) option that has served a modest share of 4-year-olds since 2010. Tracing the historical growth in TK enrollments, we find that just 30, mostly urban school districts, enrolled two-fifths of all children served by 2020, responding to funding incentives and displaying stronger organizational capacity. Meanwhile, one-third of California's nearly one thousand districts enrolled fewer than 12 TK children. Black, white, and Asian children remained disproportionally under-enrolled as a share of their respective populations, as enrollments climbed past 90,000 children prior to the COVID-19 pandemic. Identifying factors that may explain widely differing gains in TK enrollment, merging education and local census data, we find the suburbs began to catch-up with cities in serving additional 4-year-olds, as well as districts offering school choice (e.g., charter schools). We discuss implications for other nations attempting to rapidly expand preschool, including the inequities that may inadvertently arise.

Background: Despite the growing diversity among students in higher education, nonprogression to postsecondary education persists for many students with intellectual disabilities with low completion rates for those who do progress. Research suggests that occupational therapy (OT) support can be extremely beneficial in assisting students. Less is known however about the impact of OT in higher education. This study aims to examine the use of OT embedded in a postsecondary programme for students with intellectual disabilities. Methods: This study uses a scoping review of relevant literature and a qualitative analysis of OT working in a higher education programme specifically designed for students with intellectual disabilities in Ireland. Findings: This paper highlights how the OT support within this programme uses a four-fold collaborative approach supporting students, staff, business partners and wider organisational structures in the university. Conclusion: The analysis highlights the opportunities for collaboration between OT and curriculum developers, teaching and ancillary staff and students in higher education along with the significant OT input into work placements and internships with business partner mentors. Challenges in educating stakeholders to understand OT in the higher education environment would suggest a substantial need for further research.

BACKGROUND AND OBJECTIVE: Radiation therapy has increasingly been used in the management of pelvic malignancies. However, the use of radiation continues to pose a risk of a secondary malignancy to its recipients. This study investigates the risk of secondary malignancy development following radiation for primary pelvic malignancies. METHODS: A retrospective cohort review of the Surveillance, Epidemiology, and End Results database from 1975 to 2016 was performed. Primary pelvic malignancies were subdivided based on the receipt of radiation, and secondary malignancies were stratified as pelvic or nonpelvic to investigate the local effect of radiation. KEY FINDINGS AND LIMITATIONS: A total of 2 102 192 patients were analyzed (1 189 108 with prostate, 315 026 with bladder, 88 809 with cervical, 249 535 with uterine, and 259 714 with rectal/anal cancer). The incidence rate (defined as cases per 1000 person years) of any secondary malignancies (including but not limited to secondary pelvic malignancies) was higher in radiation patients than in nonradiation patients (incidence rate ratio [IRR] 1.04, confidence interval [CI] 1.03-1.05), with significantly greater rates noted in radiation patients with prostate (IRR 1.22, CI 1.21-1.24), uterine (IRR 1.34), and cervical (IRR 1.80, CI 1.72-1.88) cancer. While the overall incidence rate of any secondary pelvic malignancy was lower in radiation patients (IRR 0.79, CI 0.78-0.81), a greater incidence was still noted in the same cohorts including radiation patients with prostate (IRR 1.42, CI 1.39-1.45), uterine (IRR 1.15, CI 1.08-1.21), and cervical (IRR 1.72, CI 1.59-1.86) cancer. CONCLUSIONS AND CLINICAL IMPLICATIONS: Except for localized cervical cancer, when put in the context of median overall survival, the impact of radiation likely does not carry enough weight to change practice patterns. Radiation for pelvic malignancies increases the risk for several secondary malignancies, and more specifically, secondary pelvic malignancies, but with a relatively low absolute risk of secondary malignancies, the benefits of radiation warrant continued use for most pelvic malignancies. Practice changes should be considered for radiation utilization in malignancies with excellent cancer-specific survival such as cervical cancer. PATIENT SUMMARY: The use of radiation for the management of pelvic malignancies induces a risk of secondary malignancies to its recipients. However, the absolute risk being low, the benefits of radiation warrant its continued use, and a change in practice patterns is unlikely.

INTRODUCTION: Procalcitonin (PCT) is a useful biomarker in the initial evaluation of febrile infants for serious bacterial infections (SBIs). However, PCT is not always available locally and must at times be frozen and shipped to a reference laboratory for research studies. We sought to compare PCT measured locally versus centrally at a reference laboratory during a research study. MATERIALS AND METHODS: This was a secondary analysis of a multicenter study of febrile infants ≤60 days evaluated for SBIs from June 2016 to April 2019. A PCT cutoff value of 0.5 ng/mL was used to stratify infants at low-versus high-risk of SBIs. Statistical analyses consisted of Spearmans correlation, Bland-Altman difference plotting, Passing-Bablok regression, Deming regression, and Fishers exact testing at the 0.5 ng/mL threshold. RESULTS: 241 febrile infants had PCT levels measured both locally and at the reference laboratory. PCT levels measured locally on 5 different platforms and from the frozen research samples demonstrated strong Spearmans correlation (ρ = 0.83) and had similar mean PCT values with an average relative difference of 0.02%. Eleven infants with SBIs had PCT values

IntroductionReproductive health history may contribute to cognitive aging and risk for Alzheimer's disease, but this is understudied among Hispanic/Latina women.MethodsParticipants included 2126 Hispanic/Latina postmenopausal women (44 to 75 years) from the Study of Latinos-Investigation of Neurocognitive Aging. Survey linear regressions separately modeled the associations between reproductive health measures (age at menarche, history of oral contraceptive use, number of pregnancies, number of live births, age at menopause, female hormone use at Visit 1, and reproductive span) with cognitive outcomes at Visit 2 (performance, 7-year change, and mild cognitive impairment [MCI] prevalence).ResultsYounger age at menarche, oral contraceptive use, lower pregnancies, lower live births, and older age at menopause were associated with better cognitive performance. Older age at menarche was protective against cognitive change. Hormone use was linked to lower MCI prevalence.DiscussionSeveral aspects of reproductive health appear to impact cognitive aging among Hispanic/Latina women.

INTRODUCTION: Tau is a key pathology in chronic traumatic encephalopathy (CTE). Here, we report our findings in tau positron emission tomography (PET) measurements from the DIAGNOSE CTE Research Project. METHOD: We compare flortaucipir PET measures from 104 former professional players (PRO), 58 former college football players (COL), and 56 same-age men without exposure to repetitive head impacts (RHI) or traumatic brain injury (unexposed [UE]); characterize their associations with RHI exposure; and compare players who did or did not meet diagnostic criteria for traumatic encephalopathy syndrome (TES). RESULTS: Significantly elevated flortaucipir uptake was observed in former football players (PRO+COL) in prespecified regions (p

Ribonucleoprotein complexes are composed of RNA, RNA-dependent proteins (RDPs) and RNA-binding proteins (RBPs), and play fundamental roles in RNA regulation. However, in the human malaria parasite, Plasmodium falciparum, identification and characterization of these proteins are particularly limited. In this study, we use an unbiased proteome-wide approach, called R-DeeP, a method based on sucrose density gradient ultracentrifugation, to identify RDPs. Quantitative analysis by mass spectrometry identifies 898 RDPs, including 545 proteins not yet associated with RNA. Results are further validated using a combination of computational and molecular approaches. Overall, this method provides the first snapshot of the Plasmodium protein-protein interaction network in the presence and absence of RNA. R-DeeP also helps to reconstruct Plasmodium multiprotein complexes based on co-segregation and deciphers their RNA-dependence. One RDP candidate, PF3D7_0823200, is functionally characterized and validated as a true RBP. Using enhanced crosslinking and immunoprecipitation followed by high-throughput sequencing (eCLIP-seq), we demonstrate that this protein interacts with various Plasmodium non-coding transcripts, including the var genes and ap2 transcription factors.

Educational travel, and in particular study abroad programs, are generally beneficial to students, but less is known about impacts on the communities in which they are located. This study explores such impacts for a small rural community in Costa Rica that has hosted dozens of ecotourism and study abroad programs. Sixteen interviews were conducted in the community to explore the social and cultural rewards and costs of these programs, including cultural changes such as increases in community members speaking English, availability of drugs and alcohol, appreciation of nature, and adoption of sustainable living practices. We analyze these impacts by examining common programmatic assumptions about study abroad and borrowing biological constructs of symbiosis to diagram the potential trade-offs and costs for the local community -- as the basis for developing more mutualistic, decolonized programs in the future.

We describe the design and performance of a high-fidelity wearable head-, body-, and eye-tracking system that offers significant improvement over previous such devices. This devices sensors include a binocular eye tracker, an RGB-D scene camera, a high-frame-rate scene camera, and two visual odometry sensors, for a total of ten cameras, which we synchronize and record from with a data rate of over 700 MB/s. The sensors are operated by a mini-PC optimized for fast data collection, and powered by a small battery pack. The device records a subjects eye, head, and body positions, simultaneously with RGB and depth data from the subjects visual environment, measured with high spatial and temporal resolution. The headset weighs only 1.4 kg, and the backpack with batteries 3.9 kg. The device can be comfortably worn by the subject, allowing a high degree of mobility. Together, this system overcomes many limitations of previous such systems, allowing high-fidelity characterization of the dynamics of natural vision.

We investigated whether inner language enhances memory for events in a naturalistic, non-verbal task where participants constructed simple models from memory after watching an instructional video. Across three experiments, we used linguistic suppression to manipulate access to language and tested its effect on overall memory performance. Results showed that access to inner language consistently affected event memory: when inner language was disrupted at encoding, participants were poorer at recalling the models and remembered fewer events. Critically, the effect of linguistic suppression on memory performance was greater than a control secondary task that did not affect access to language (i.e., poorer performance was not solely due to dual-task effects). These findings support the proposal that inner language enhances event memory via a mechanism of linguistic bootstrapping, which in turn extends theories of event memory and adds to a growing body of evidence that inner language is a highly valuable cognitive tool.

IntroductionWith Alzheimer's disease and related dementias (ADRD) representing an enormous public health challenge, there is a need to support individuals in learning about and addressing their modifiable risk factors (e.g., diet, sleep, and physical activity) to prevent or delay dementia onset. However, there is limited availability for evidence-informed tools that deliver both quality education and support for positive behavior change such as by increasing self-efficacy and personalizing goal setting. Tools that address the needs of Latino/a, at higher risk for ADRD, are even more scarce.MethodsWe established a multidisciplinary team to develop the Healthy Actions and Lifestyles to Avoid Dementia or Hispanos y el ALTo a la Demencia (HALT-AD) program, a bilingual online personalized platform to educate and motivate participants to modify their risk factors for dementia. Grounded in social cognitive theory and following a cultural adaptation framework with guidance from a community advisory board, we developed HALT-AD iteratively through several cycles of rapid prototype development, user-centered evaluation through pilot testing and community feedback, and refinement.ResultsUsing this iterative approach allowed for more than 100 improvements in the content, features, and design of HALT-AD to improve the program's usability and alignment with the interests and educational/behavior change support needs of its target audience. Illustrative examples of how pilot data and community feedback informed improvements are provided.DiscussionDeveloping HALT-AD iteratively required learning through trial and error and flexibility in workflows, contrary to traditional program development methods that rely on rigid, pre-set requirements. In addition to efficacy trials, studies are needed to identify mechanisms for effective behavior change, which might be culturally specific. Flexible and personalized educational offerings are likely to be important in modifying risk trajectories in ADRD.

This study assessed whether the effect of vascular risk on cerebral blood flow (CBF) varies by gene dose of apolipoprotein (APOE) ε4 alleles. 144 older adults without dementia from the Alzheimers Disease Neuroimaging Initiative underwent arterial spin labeling and T1-weighted MRI, APOE genotyping, fluorodeoxyglucose positron emission tomography (FDG-PET), lumbar puncture, and blood pressure (BP) assessment. Vascular risk was assessed using pulse pressure (systolic BP - diastolic BP). CBF was examined in six AD-vulnerable regions: entorhinal cortex, hippocampus, inferior temporal cortex, inferior parietal cortex, rostral middle frontal gyrus, and medial orbitofrontal cortex. Linear regressions tested the interaction between APOE ε4 dose and pulse pressure on CBF in each region, adjusting for age, sex, cognitive classification, antihypertensive medication use, FDG-PET, reference CBF region, and AD biomarker positivity. There was a significant interaction between pulse pressure and APOE ɛ4 dose on CBF in the entorhinal cortex, hippocampus, and inferior parietal cortex, such that higher pulse pressure was associated with lower CBF only among ε4 homozygous participants. These findings demonstrate that the association between pulse pressure and regional CBF differs by APOE ε4 dose, suggesting that targeting modifiable vascular risk factors may be particularly important for those genetically at risk for AD.

BackgroundAPOE4 is the strongest genetic risk factor for sporadic Alzheimer's disease (AD), whereas APOE2 confers protection. However, effects of APOE on neurodegeneration in cognitively intact individuals, and how these associations evolve with cognitive decline, are unclear. Furthermore, few studies have evaluated whether effects of APOE on neurodegenerative changes are modified by other AD key risk factors including age and sex.MethodsParticipants included older adults (57% women; 77 ± 7 years) from the Rancho Bernardo Study of Health Aging and the University of California San Diego Alzheimer's Disease Research Center, including 192 cognitively normal (CN) individuals and 33 with mild cognitive impairment. Participants underwent diffusion MRI, and multicompartment restriction spectrum imaging (RSI) metrics were computed in white matter, gray matter, and subcortical regions of interest. Participants were classified as APOE4 carriers, APOE2 carriers, and APOE3 homozygotes. Analysis of covariance among CN (adjusting for age, sex, and scanner) assessed differences in brain microstructure by APOE, as well as interactions between APOE and sex. Analyses across all participants examined interactions between APOE4 and cognitive status. Linear regressions assessed APOE by age interactions.ResultsAmong CN, APOE4 carriers showed lower entorhinal cortex neurite density than non-carriers, whereas APOE2 carriers showed lower cingulum neurite density than non-carriers. Differences in entorhinal microstructure by APOE4 and in entorhinal and cingulum microstructure by APOE2 were present for women only. Age correlated with lower entorhinal restricted isotropic diffusion among APOE4 non-carriers, whereas age correlated with lower putamen restricted isotropic diffusion among APOE4 carriers. Differences in microstructure between cognitively normal and impaired participants were stronger for APOE4-carriers in medial temporal regions, thalamus, and global gray matter, but stronger for non-carriers in caudate.ConclusionsThe entorhinal cortex may be an early target of neurodegenerative changes associated with APOE4 in presymptomatic individuals, whereas APOE2 may support beneficial white matter and entorhinal microstructure, with potential sex differences that warrant further investigation. APOE modifies microstructural patterns associated with aging and cognitive impairment, which may advance the development of biomarkers to distinguish microstructural changes characteristic of normal brain aging, APOE-dependent pathways, and non-AD etiologies.

Skeletal muscle has recently arisen as a regulator of central nervous system (CNS) function and aging, secreting bioactive molecules known as myokines with metabolism-modifying functions in targeted tissues, including the CNS. Here, we report the generation of a transgenic mouse with enhanced skeletal muscle lysosomal and mitochondrial function via targeted overexpression of transcription factor E-B (TFEB). We discovered that the resulting geroprotective effects in skeletal muscle reduce neuroinflammation and the accumulation of tau-associated pathological hallmarks in a mouse model of tauopathy. Muscle-specific TFEB overexpression significantly ameliorates proteotoxicity, reduces neuroinflammation, and promotes transcriptional remodeling of the aged CNS, preserving cognition and memory in aged mice. Our results implicate the maintenance of skeletal muscle function throughout aging in direct regulation of CNS health and disease and suggest that skeletal muscle originating factors may act as therapeutic targets against age-associated neurodegenerative disorders.

The Aralkum is a new desert created by the desiccation of the Aral Sea and is an efficient source of dust aerosol which perturbs the regional Central Asian radiation balance. COSMO–MUSCAT model simulations are used to quantify the direct radiative effects (DREs) of Aralkum dust, and investigate the associated perturbations to the atmospheric environment. Considering scenarios of “Past” (end of 20th century) and “Present” (beginning of 21st century) defined by differences in surface water coverage, it is found that in the Present scenario the simulated yearly mean net surface DRE across the Aralkum is −1.34 W m−2 with a standard deviation (±) of 6.19 W m−2, of which −0.15 ± 1.19 W m−2 comes from dust emitted by the Aralkum. In the atmosphere the yearly mean DRE is −0.62 ± 2.91 W m−2, of which −0.05 ± 0.51 W m−2 is from Aralkum dust: on the yearly timescale, Aralkum dust is cooling both at the surface and in the atmosphere, due to its optically scattering properties. The daytime surface cooling effect (solar zenith angle ≲ 70–80°) outweighs the nighttime heating effect and the atmospheric daytime (solar zenith angle ≲ 60–70°) heating and nighttime cooling effects. Instantaneous Aralkum dust DREs contribute up to −116 W m−2 of surface cooling and +54 W m−2 of atmospheric heating. Aralkum dust perturbs the surface pressure in the vicinity of the Aralkum by up to +0.76 Pa on the monthly timescale, implying a strengthening of the Siberian High in winter and a weakening of the Central Asian heat low in summer. These results highlight the impacts of anthropogenic lakebed dust on regional atmospheric environments.

Abstract Intracranial pressure (ICP) is a physiological parameter that conventionally requires invasive monitoring for accurate measurement. Utilising multivariate predictive models, we sought to evaluate the utility of non-invasive, widely accessible MRI biomarkers in predicting ICP and their reversibility following cerebrospinal fluid (CSF) diversion. The retrospective study included 325 adult patients with suspected CSF dynamic disorders who underwent brain MRI scans within three months of elective 24-h ICP monitoring. Five MRI biomarkers were assessed: Yuh sella grade, optic nerve vertical tortuosity (VT), optic nerve sheath distension, posterior globe flattening and optic disc protrusion (ODP). The association between individual biomarkers and 24-h ICP was examined and reversibility of each following CSF diversion was assessed. Multivariate models incorporating these radiological biomarkers were utilised to predict 24-h median intracranial pressure. All five biomarkers were significantly associated with median 24-h ICP (p

Abstract Background Fibroids are non-cancerous uterine growths that can cause symptoms impacting quality of life. The breadth of treatment options allows for patient-centered preference. While conversation aids are known to facilitate shared decision making, the implementation of these aids for uterine fibroids treatments is limited. We aimed to develop two end-user-acceptable uterine fibroids conversation aids for an implementation project. Our second aim was to outline the adaptations that were made to the conversation aids as implementation occurred. Methods We used a multi-phase user-centered participatory approach to develop a text-based and picture-enhanced conversation aid for uterine fibroids. We conducted a focus group with project stakeholders and user-testing interviews with eligible individuals with symptomatic uterine fibroids. We analyzed the results of the user-testing interviews using Morville’s Honeycomb framework. Spanish translations of the conversation aids occurred in parallel with the English iterations. We documented the continuous adaptations of the conversation aids that occurred during the project using an expanded framework for reporting adaptations and modifications to evidence-based interventions (FRAME). Results The first iteration of the conversation aids was developed in December 2018. Focus group participants (n = 6) appreciated the brevity of the tools and suggested changes to the bar graphs and illustrations used in the picture-enhanced version. User-testing with interview participants (n = 9) found that both conversation aids were satisfactory, with minor changes suggested. However, during implementation, significant changes were suggested by patients, other stakeholders, and participating clinicians when they reviewed the content. The most significant changes required the addition or deletion of information about treatment options as newer research was published or as novel interventions were introduced into clinical practice. Conclusions This multi-year project revealed the necessity of continuously adapting the uterine fibroids conversation aids so they remain acceptable in an implementation and sustainability context. Therefore, it is important to seek regular user feedback and plan for the need to undertake updates and revisions to conversation aids if they are going to be acceptable for clinical use.

Federal funds for human trafficking victim programmes and services in the United States have increased from approximately USD 10 million in 2002 to more than USD 90 million in 2022. This increase in fund availability, however, has not necessarily translated into meaningful or accessible services for trafficking survivors. This paper examines the distribution of Department of Justice anti-trafficking funds through the Office for Victims of Crime (OVC), particularly looking at OVC recipients in Alaska. It highlights certain trends in OVC funding in the state, including changes in funding distribution, the emphasis on task force creation and collaboration between service providers and law enforcement, and discussions of equity and inclusion. The paper further explores institutional mechanisms of exclusion and harm of some victims, complexities in collaborating with law enforcement, criminalisation of trafficking survivors, and criteria to qualify for services. As the reality faced by trafficking survivors does not always align with OVC narratives, these mechanisms are illustrated through the experiences of a sex trafficking survivor who has been turned away as not qualifying for services by many of the OVC funded providers in Alaska. The paper concludes by exploring the implications of this research for policymakers and service providers.