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Children are at high risk of exposure to potentially traumatic events (PTEs) during early childhood. This developmental period, marked by rapid growth in fundamental skills, may render children particularly vulnerable to adverse developmental effects. Embedding universal trauma-informed supports within early childhood education (ECE) settings has the potential to mitigate the negative consequences of early exposure to PTEs; yet there is a lack of early childhood trauma-informed prevention and intervention programming. To address this need, a collaborative partnership via a participatory research approach was formed between an academic partner and several early childhood education centers in a large urban public school district primarily serving youth of color. This exploratory study describes the development of the "Ready to Learn through Relationships (RLR) Program" that emerged from this partnership. The RLR program is based on the National Child Traumatic Stress Network (NCTSN) guidelines for school-based models of trauma-informed care (TIC) and the "boots on the ground" experiences of the participating school district's early childhood personnel. It utilizes implementation coaching to promote program installation and sustainability. Results demonstrate high levels of need for the program, as well as its feasibility and acceptability. Recommendations for future refinement, implementation, and evaluation efforts are discussed.

Background: Early academic achievement is critical to school readiness and later academic success. Consequently, multi-domain models are needed to identify risk factors and pathways by which they influence early academic achievement. Objective: The aim was to advance the development of a multi-domain model of risk factors associated with early academic achievement by examining the effects of contextual, parent, parenting, and child risk and protective factors assessed at age 4 years on reading and mathematics skills at age 5 years. Method: The design used structural equation modeling in half-longitudinal models to assess risk factors in a diverse community sample (N = 796) at age 4 and academic achievement at age 5. Results: Models showing the effects of socioeconomic status, conflict, stress, caretaker depression, parenting, child verbal skills, temperament, and attachment at age 4 years showed good fit for early reading and mathematics achievement. There were numerous significant indirect paths by which distal factors were associated with early academic achievement via caretaker depression, parenting, and child verbal skills for both reading and mathematics. Conclusions: In a model including the association of verbal skills and effortful control (EC), the association of EC and early academic achievement is limited. Caretaker depression is not associated with early achievement directly but is associated with achievement indirectly via parenting. Factors associated with child verbal skills were particularly important for both reading and mathematics. Findings clarify the incremental validity of direct associations of multi-domain factors with early academic achievement, and suggest possible pathways between those factors and achievement.

Despite efforts to embed mental health supports within schools, few models exist to facilitate the implementation of targeted (Tier II) evidence-based interventions in schools. To address this gap, a collaborative partnership was formed between a pediatric teaching hospital and a large urban public school district. The current exploratory study details the development and implementation of a training model (Comprehensive Implementation Training and Support--CITAS) that addresses both consultation and organizational factors known to promote the successful implementation of Tier II interventions. Additionally, the study utilizes a case example approach to highlight initial promise and areas for future development. Results demonstrated a need for CITAS to support effective implementation and provided encouraging data on the acceptability, feasibility, and initial promise of this model. Participating clinicians demonstrated engagement and satisfaction with the activities included in the CITAS model, high levels of fidelity to the intervention, and improvement in outcomes for students participating in Anger Coping groups facilitated by CITAS clinicians. Findings also indicated that the CITAS model facilitated the navigation of organizational barriers (e.g., leadership support, resources, time) that promoted implementation success.

Abstract Background Rheumatoid arthritis (RA) is characterized by increased cardiovascular (CV) mortality. CV events are particularly high in patients with RA-specific autoimmunity, including rheumatoid factor (RF) and anti-citrullinated protein antibodies (ACPA), raising the question whether RA-specific autoimmunity itself is associated with CV events. Methods New CV events (myocardial infarction, stroke or death by CV cause) were recorded in 20,625 subjects of the Electricité de France – Gaz de France (GAZEL) cohort. Self-reported RA cases in the GAZEL cohort were validated by phone interview on the basis of a specific questionnaire. In 1618 subjects, in whom plasma was available, RF and ACPA were measured. A piecewise exponential Poisson regression was used to analyze the association of CV events with presence of RA as well as RA-specific autoimmunity (without RA). Results CV events in GAZEL were associated with age, male sex, smoking, hypertension, hyperlipidemia, and diabetes mellitus (HR from 1.06 to 1.87, p

Purpose/objectives: Treating intraosseous lesions (IOLs) and interradicular bone lesions (IRLs) is an extremely technical dental procedure in periodontics. Instrumentation of these lesions is often perceived as difficult by students and inexperienced dentists before they perform a certain number of procedures on patients in the clinic. The aim of this article is to evaluate a cost‐effective three‐dimensional (3D)‐printed educational simulator for the periodontal treatment of IOLs/IRLs (including scaling, incisions and sutures). Methods: The simulators were first developed digitally, and then manufactured using printable resins and specific materials; finally, they were assembled using different bonding systems. To evaluate the simulators, assessments were gathered from two target populations: undergraduate students and periodontics experts. These individuals tested the simulator and completed a cross‐sectional questionnaire based on a Likert scale with comparative and pedagogical items scored from one to five. The purpose of the questionnaire was to compare our simulator to clinical reality (i.e., operation on human jaws) and to an animal simulator (i.e., simulation of porcine jaws). The results are expressed as the mean and standard deviation and were statistically analyzed with the Wilcoxon signed‐rank test. Results: Overall, the results were satisfactory for both groups of testers (4.70 and 4.61 out of five for students and experts, respectively, for global satisfaction). Conclusions: The overall educational relevance of the simulator designed herein highlights the fact that 3D‐printed educational simulators could enable efficient cognitive‐functional learning for clinical IOL/IRL treatment. [ABSTRACT FROM AUTHOR]

ABSTRACT Achondroplasia is the most common form of short‐limb dwarfism. In this disorder, endochondral ossification is impaired due to gain‐of‐function mutation in the Fibroblast Growth Factor Receptor 3 (FGFR3) gene. In addition to short limbs, cranial base bones are also affected leading to shortening of the skull base and to serious neurological complications associated with foramen magnum stenosis. These complications are thought to be due to the delay or premature arrest of skull base growth, caused by an accelerated ossification of the sphenooccipital (SOS) and the intraoccipital (IOS) synchondroses. Skull synchondroses consist of two opposite growth plates sharing a common reserve zone of chondrocytes. In this study, we first characterized the skull base synchondroses ossification in a mouse model of achondroplasia carrying the human G380R mutation (Fgfr3ach/+). We then addressed whether Recifercept, a soluble FGFR3, could prevent premature closure of these synchondroses. Postnatal radiological observations revealed the presence of bony bridge structures in one or more synchondroses in Fgfr3ach/+ mice as early as postnatal day 3 in the most severe cases. The presence of early ossification correlated with the severity of the disease as it was associated with an arrest of the cranial base bone growth. Histological analyses indicated changes in the synchondroses structure and matrix proteoglycan contents confirming a process of ossification. Treatment of Fgfr3ach/+ mice with Recifercept compared with vehicle prevented premature synchondrosis ossification and the transition to bone, resulting in improved skull shape and cranium ratio. Given the impact of Recifercept on synchondrosis inactivation, it is possible that it could prevent one of the most severe complication of achondroplasia if used early enough during bone development. These data support the clinical development of Recifercept for achondroplasia, and suggests that early treatment may be required to best address impaired endochondral bone growth. © 2021 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.

Hydrodynamic dispersion process in relation with the geometrical properties of the porous media are studied in two sets of 6 porous media samples of porosity θ ranging from 0.1 to 0.25. These two sets of samples display distinctly different evolutions of the microstructures with porosity but share the same permeability trend with porosity. The methodology combines three approaches. First, numerical experiments are performed to measure pre-asymptotic to asymptotic dispersion from diffusion-controlled to advection-controlled regime using Time-Domain Random Walk solute transport simulations. Second, a porosity-equivalent network of bonds is extracted in order to measure the geometrical properties of the samples. Third, the results of the direct numerical simulations are interpreted as a Continuous Time Random Walk (CTRW) process controlled by the flow speed distribution and correlation. These complementary modeling approaches allow evaluating the relation between the parameters of the conceptual transport process embedded in the CTRW model, the flow field properties and the pore-scale geometrical properties. The results of the direct numerical simulations for all the 12 samples show the same scaling properties of the mean flow distribution, the first passage time distribution and the asymptotic dispersion vs. the Péclet number than those predicted by the CTRW model. It allows predicting the asymptotic dispersion coefficient D* from Pe = 1 to the largest values of Pe expected for laminar flow in natural environments (Pe≈ 4,000). D*∝Pe2−α for Pe≥Pecrit, where α can be inferred from the Eulerian flow distribution and Pecrit depends on porosity. The Eulerian flow distribution is controlled by the distribution of fractions of fluid flowing at each of the pore network nodes and thus is determined mainly by the distribution of the throat radius and the coordination number. The later scales with the number of throats per unit volume independently on the porosity. The asymptotic dispersion coefficient D* decreases when porosity increases for all Péclet values larger than 1 due to the increase with porosity of both α and the flow speed decorrelation length.

Abstract Achondroplasia is a rare genetic disease representing the most common form of short-limb dwarfism. It is characterized by bone growth abnormalities that are well characterized and by a strong predisposition to abdominal obesity for which causes are unknown. Despite having aroused interest at the end of the 20 h century, there are still only very little data available on this aspect of the pathology. Today, interest is rising again, and some studies are now proposing mechanistic hypotheses and guidance for patient management. These data confirm that obesity is a major health problem in achondroplasia necessitating an early yet complex clinical management. Anticipatory care should be directed at identifying children who are at high risk to develop obesity and intervening to prevent the metabolic complications in adults. In this review, we are regrouping available data characterizing obesity in achondroplasia and we are identifying the current tools used to monitor obesity in these patients.

Objective To evaluate the relevance of salivary gland ultrasound (SGUS) and its place in the diagnostic algorithm in patients referred with dry syndrome (DS) for a suspicion of Sjögren’s syndrome (SS).Methods We included all patients assessed at our dedicated DS clinic from June 2015 to September 2019 for which a SGUS has been carried out. Images were read blindly and the worst salivary gland was scored according to OMERACT classification. Clinical features, disease activity and treatments were collected.Results 337 patients were seen from June 2015 to September 2019. 269 patients underwent SGUS. 77 patients were diagnosed with SS and 192 did not meet the ACR/EULAR criteria for SS: non-Sjögren’s DS (NSDS). Of these 192 patients, 60 had another possible cause of DS, and 132 patients were diagnosed with SAPS (sicca, asthenia, polyalgia syndrome).SGUS abnormalities were significantly higher in patients with SS versus NSDS: 51% vs 8% for a score ≥2 (p

Achondroplasia is a rare genetic disorder caused by mutations in the Fibroblast Growth Factor receptor 3 (FGFR3). These mutations lead to aberrant increase of inhibitory signaling in proliferating chondrocytes at the growth plate. Recifercept is a potential treatment for this disease using a decoy approach to sequester FGFR3 ligands subsequently normalizing activation of the mutated FGFR3 receptor. Recifercept binds to FGF isoforms in vitro and in cellular model systems and reduces FGFR3 signaling. In addition, in a transgenic mouse model of achondroplasia, Recifercept restores reduced body weight and long bone growth in these mice. These data suggest that Recifercept treatment could lead to clinical benefits in children treated with this molecule.

Background: Most research on the relation between parenting behaviors and child outcomes has not focused on cross-ethnic variation in these relations. Objective: This study examined if ethnicity moderates associations between parenting, child agency/persistence, and child academic achievement and social competence. Design: Participants included 608 parents and their 5-year-old children (96 African American, 117 Hispanic, and 395 European American). Parenting was assessed with the Parent Behavior Inventory (support/engagement, hostility/coercion) and a semi-structured interaction paradigm, the NICHD 3-Boxes Task (scaffolding). Child agency/persistence also was assessed with this task. The Social Skills Rating Scale was used to assess social competence (assertion, cooperation, responsibility, self-control). The Woodcock-Johnson-Achievement Test-3rd Edition was used to assess reading and math. Results: Child agency/persistence was related to academic achievement and support/engagement and hostility/coercion were related to child social competence. Only a few interaction effects between parenting and ethnicity were significant. Higher levels of scaffolding were related to higher scores in reading and mathematics in African American, but not in European American children. Hostility/coercion was associated with lower reading scores in European American, but not in Hispanic children. Support/engagement was related to higher levels of responsibility in both European American and African American children, but this relation was stronger in European American families. Conclusions: There are more similarities than differences in the effects of parenting and child variables in different ethnic groups. Higher levels of scaffolding are related to higher reading and math achievement in African American families; thus strategies to increase parental scaffolding may be effective in decreasing the "achievement gap."

Achondroplasia is a rare genetic disease is characterized by abnormal bone development and early obesity. While the bone aspect of the disease has been thoroughly studied, early obesity affecting approximately 50% of them during childhood has been somewhat neglected. It nevertheless represents a major health problem in these patients, and is associated to life-threatening complications including increasing risk of cardiovascular pathologies. We have thus decided to study obesity in patients and to use the mouse model to evaluate if soluble FGFR3 therapy, an innovative treatment approach for achondroplasia, could also impact the development of this significant complication.To achieve this, we have first fully characterized the metabolic deregulations in these patients by conducting a longitudinal retrospective study, in children with achondroplasia Anthropometric, densitometric measures as well as several blood parameters were recorded and compared between three age groups ranging from [0-3], [4-8] and [9-18] years old. Our results show unexpected results with the development of an atypical obesity with preferential fat deposition in the abdomen that is remarkably not associated with classical complications of obesity such as diabetes or hypercholosterolemia. Because it is not associated with diabetes, the atypical obesity has not been studied in the past even though it is recognized as a real problem in these patients. These results were validated in a murine model of achondroplasia (Fgfr3ach/+) where similar visceral adiposity was observed. Unexpected alterations in glucose metabolism were highlighted during high-fat diet. Glucose, insulin or lipid levels remained low, without the development of diabetes. Very interestingly, in achondroplasia mice treated with soluble FGFR3 during the growth period (from D3 to D22), the development of these metabolic deregulations was prevented in adult animals (between 4 and 14 weeks of age). The lean-over-fat tissues ratio was restored and glucose metabolism showed normal levels. Treating Fgfr3ach/+ mice with soluble FGFR3 during the growth period, prevented the development of these metabolic deregulations in adult animals and restored lean-over-fat tissues ratio as well as glucose metabolism in adult animals.This study demonstrate that achondroplasia patients develop an atypical obesity with preferential abdominal obesity not associated with classical complications. These results suggest that achondroplasia induces an uncommon metabolism of energy, directly linked to the FGFR3 mutation. These data strongly suggest that this common complication of achondroplasia should be included in the clinical management of patients. In this context, sFGFR3 proved to be a promising treatment for achondroplasia by normalizing the biology at different levels, not only restoring bone growth but also preventing the atypical visceral obesity and some metabolic deregulations.

Few studies have been designed to assess the pathways by which risk factors are associated with symptoms of psychopathology across multiple domains, including contextual factors, parental depression, parenting, and child characteristics. The present study examines a cross-sectional model of risk factors for symptoms of Oppositional Defiant Disorder (ODD) in a diverse community sample of 796 four-year-old children. In the best-fitting model: (a) SES had indirect effects on contextual factors of stress and conflict, parental depression, and parenting factors including hostility, support, and scaffolding; (b) stress and conflict had both direct effects on ODD symptoms, and indirect effects via parental depression and parenting; (c) parenting had direct effects on ODD symptoms and indirect effects via child effortful control (EC), negative affect (NA) and sensory regulation (SR); (c) NA, EC, and SR had direct effects on symptom frequency, and attachment had indirect effects via EC, and SR. These results highlight the importance of using a multi-domain model to examine risk factors for symptoms of ODD, and also provide information about areas to target in treatment.

Background: National policy statements increasingly espouse the delivery of comprehensive mental health services in schools. In response to the limited evidence supporting this recommendation, the purpose of this study was to assess the need for, and feasibility, desirability, and outcomes of a full model of comprehensive mental health services in 2 public elementary schools in inner-city neighborhoods. Methods: The program, based upon a national model for comprehensive school mental health services, comprised universal and indicated preventive as well as clinical interventions designed to target needs identified in a baseline screening survey. The program was implemented over 1 school year by mental health professionals in collaboration with school teachers. Mental health outcomes comparing baseline to follow-up data were assessed in multiple domains among students and teachers. Results: After 1 year of intervention, students had significantly fewer mental health difficulties, less functional impairment, and improved behavior, and reported improved mental health knowledge, attitudes, beliefs, and behavioral intentions. Teachers reported significantly greater proficiency in managing mental health problems in their classrooms. School staff overwhelmingly endorsed satisfaction with the program. Conclusion: If the observed favorable findings from this pilot demonstration can be replicated in methodologically rigorous studies, additional support would be garnered for national policy recommendations about comprehensive school mental health services. (Contains 4 tables and 1 figure.)

This study examined the role of pretreatment demographic and clinical predictors of attendance as well as barriers to treatment and consumer satisfaction on attendance at therapist-led parent training with 86 families of children ages 3 to 6 years conducted in pediatric primary care settings. Only socioeconomic status (SES) and minority group membership were significantly associated with not completing treatment. Using optimal data analysis procedures, high SES correctly predicted treatment completion 83.6% of the time. Being from a low SES, minority group family correctly predicted noncompletion of treatment 72.7% of the time, but being from a low SES, white family predicted treatment completion 80% of the time. Since barriers to treatment, such as stressors, obstacles to treatment, and treatment demands were unrelated to attendance in the present study, other factors related to social class and minority status that could contribute to better consumer satisfaction and treatment attendance must be investigated. (Contains 2 tables and 1 figure.)

The risk of CO2 leakage from damaged wellbore is identified as a critical issue for the feasibility and environmental acceptance of CO2 underground storage. For instance, Portland cement can be altered if flow of CO2-rich water occurs in hydraulic discontinuities such as cement-tubing or cement-caprock interfaces. In this case, the raw cement matrix is altered by diffusion of the solutes. This fact leads to the formation of distinctive alteration fronts indicating the dissolution of portlandite, the formation of a carbonate-rich layer and the decalcification of the calcium silicate hydrate, controlled by the interplay between the reaction kinetics, the diffusion-controlled renewing of the reactants and products, and the changes in the diffusion properties caused by the changes in porosity induced by the dissolution and precipitation mechanisms. In principle, these mass transfers can be easily simulated using diffusion-reaction numerical models. However, the large uncertainties of the parameters characterizing the reaction rates (mainly the kinetic and thermodynamic coefficients and the evolving reactive surface area) and of the porosity-dependent diffusion properties prevent making reliable predictions required for risk assessment. In this paper, we present the results of a set of experiments consisting in the alteration of a holed disk of class-G cement in contact with a CO2-rich brine at reservoir conditions (P = 12 MPa and T = 60 °C) for various durations. This new experimental protocol allows producing time-resolved data for both the spatially distributed mass transfers inside the cement body and the total mass transfers inferred from the boundary conditions mass balance. The experimental results are used to study the effect of the fluid salinity and the pCO2 on the overall reaction efficiency. Experiments at high salinity triggers more portlandite dissolution, thinner carbonate layers, and larger alteration areas than those at low salinity. These features are accompanied with different spatial distribution of the alteration layers resulting from a complex interplay between salinity-controlled dissolution and precipitation mechanisms. Conversely, the effect of the pCO2 is more intuitive: Increasing pCO2 results in increasing the overall alteration rate without modifying the relative distribution of the reaction fronts.

The aims of this study were threefold: (1) to compare prevalence of sensory regulation dysfunction based on previously established criteria to rates established with a more representative community sample of 796 4-year-olds; (2) to examine ethnic/racial and gender differences in prevalence according to the different criteria; and (3) to examine the co-occurrence of sensory regulation dysfunction and preschool psychiatric disorders. Prevalence rates ranged from 3.4% (current criteria) to 15.6% (previous criteria). In contrast to previous studies with less representative samples, there were no significant ethnic or racial differences using the current criteria. Boys were more likely to have sensory regulation dysfunction than girls according to all criteria. Depending upon impairment criteria used, 33-63% of children meeting criteria for sensory dysregulation also had a psychiatric disorder; 37-67% had only a sensory dysregulation disorder, indicating that sensory regulation dysfunction exists independent of psychiatric disorder, and is also a significant risk factor for disorder.

Few studies have examined the epidemiology of preschoolers' psychopathology. This study included 796 4-year-old children recruited from schools and pediatric practices in a diverse, urban area. Psychiatric disorder was assessed by a structured interview adapted for preschool children and by questionnaire. The most common disorders were oppositional defiant disorder (ODD) and attention deficit hyperactivity disorder (ADHD). Generalized anxiety disorder (GAD) and depressive disorders were reported in less than 1% of the sample. Race/ethnicity differences were not significant. Gender differences showed ADHD-inattentive type more common among boys, with no gender differences for GAD, major depressive disorder, dysthymia, separation anxiety disorder, or ODD at any level of impairment. The overall comorbidity rate was 6.4%. Approximately 3% of individuals receiving a diagnosis had received mental health services. (Contains 3 tables.)

Objective: To survey teachers' beliefs about mental health service needs in inner city elementary schools. Method: A total of 119 teachers from six elementary schools in a major city in the midwestern United States were surveyed to assess their beliefs about the major mental health problems facing their schools, the major barriers to surmounting those problems, their preferences for mental health topics for in-service education, and their education, experience, knowledge, attitudes, and self-efficacy pertaining to mental health issues. Results: Disruptive behavior was endorsed by approximately 50% of teachers as the largest mental health problem facing their schools, and lack of information/training was endorsed as the greatest barrier to surmounting mental health problems. The highest-rated topics for in-service education were disruptive behavior disorders and implementing behavior plans. Although most teachers had taught students with mental health problems, most had had little education in mental health and little consultation with mental health professionals. Correspondingly, teachers' knowledge about mental health issues was limited, and they did not feel confident about their ability to manage mental health problems in their classrooms. Conclusions: Teachers would benefit from education, training, and consultation from mental health professionals if they serve as effective gatekeepers to mental health services. (Contains 3 tables and 2 figures.)

Thirty years ago, leaders in psychiatry expressed hope for more interdisciplinary collaboration with family therapy. Since then marriage and family therapy (MFT) has entered the mainstream of clinical practice in psychiatry and psychology. It is mandated for training in psychiatry and psychology. We propose a model for collaboration, training, and treatment in interdisciplinary mental health settings that strives to integrate empirical bodies of knowledge in MFT, psychiatry, and psychology and to provide a usable and testable clinical approach to treatment. It can be taught to trainees with various or limited training in MFT. This model delineates nine critical domains that guide treatment. Flexibility is central to this model, focusing on techniques and clinical methods based on empirically supported treatments, when available, and best-practice standards.