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Abstract The release of Ca2+ ions from endoplasmic reticulum calcium stores is a key event in a variety of cellular processes, including gene transcription, migration and proliferation. This release of Ca2+ often occurs through inositol 1,4,5-triphosphate receptors and the activity of these channels and the levels of stored Ca2+ in the endoplasmic reticulum are important regulators of cell death in cancer cells. A recently identified Ca2+ channel of the endoplasmic reticulum is transmembrane and coiled-coil domains 1 (TMCO1). In this study, we link the overexpression of TMCO1 with prognosis in node-positive basal breast cancer patients. We also identify interacting proteins of TMCO1, which include endoplasmic reticulum-resident proteins involved in Ca2+ regulation and proteins directly involved in nucleocytoplasmic transport. Interacting proteins included nuclear transport proteins and TMCO1 was shown to have both nuclear and endoplasmic reticulum localisation in MDA-MB-231 basal breast cancer cells. These studies also define a role for TMCO1 in the regulation of breast cancer cells in their sensitivity to BCL-2/MCL-1 inhibitors, analogous to the role of inositol 1,4,5-triphosphate receptors in the regulation of cell death pathways activated by these agents.

Abstract At the intersection of drug policy, the opioid crisis, and fragmented care systems, persons with opioid use disorder (OUD) in the United States are significantly vulnerable to contact with the criminal legal system (CLS). In CLS settings, provision of evidence-based treatment for OUD is variable and often secondary to punitive approaches. Linkage facilitation at every touch point along the CLS Sequential Intercept Model has potential to redirect persons with OUD into recovery-oriented systems of care, increase evidence-based OUD treatment connections, and therefore reduce CLS re-exposure risk. Research in this area is still nascent. Thus, this narrative review explores the state of the science on linkage facilitation across the varied CLS contexts, including general barriers, facilitators, and opportunities for using linkage facilitation for OUD treatment and related services. Following the CLS Sequential Intercept Model, the specific CLS contexts examined include community services, police encounters, the courts (pre- and post-disposition), incarceration (pre-trial detention, jail, and prison), reentry (from jails, prisons, and unified systems), and community supervision (probation and parole). Examples of innovative linkage facilitation interventions are drawn from the Justice Community Opioid Innovation Network (JCOIN). Areas for future research and policy change are highlighted to advance the science of linkage facilitation for OUD services in the CLS.

Background: For students with traumatic brain injury (TBI), the COVID-19 pandemic exacerbated challenges they were already experiencing at school. Methods: This qualitative study employed focus groups and interviews with students, parents, school, and medical personnel to explore the school experiences of students with TBI. Thematic qualitative analyses were used. Results: Key themes from the analysis include (a) incidence of brain injuries decreased; (b) screen time for students with TBI exacerbated symptoms; (c) COVID protocols at school made it difficult for educators to identify and provide accommodations for students with TBI; (d) COVID protocols at school could inadvertently exacerbate mental health difficulties after a TBI; and (e) COVID-related logistics increased the time between an injury and return to school or return to play. Implications for School Health Policy, Practice, and Equity: The results from this study suggest that professional development for teachers supporting students with TBI is needed, especially for online learning environments. Additionally, because mental/behavioral health concerns may arise for students with TBI in online learning environments, school health care providers can work with families to assess a student's mental health, making referrals to appropriate supports. Conclusions: There is a significant need for professional development and school-wide infrastructure supportive of students with TBI.

BackgroundEmerging adults (aged 18-26 years) are the most at-risk yet underserved age group among people with substance use disorder, especially rural emerging adults, and polysubstance use is common. Recovery capital is lower among emerging adults than older adults, and evidence-based treatments are typically unavailable or not developmentally tailored, especially in rural areas. Both supportive parents (or parental figures) and peer recovery support services (PRSS) can be leveraged to better support these emerging adults. Previous research indicates parents can be engaged to deliver contingency management (CM), an extensively researched evidence-based intervention for substance use. ObjectiveThis protocol describes a funded pilot of Launch, a novel, scalable service package that pairs web-based coaching for parents to deliver CM for emerging adults (CM-EA) at home and in-person PRSS with educational and vocational goal setting. Specifically, this protocol describes feasibility, acceptability, and appropriateness testing (implementation-related outcomes) and steps taken to prepare for a future large-scale trial of Launch. MethodsUpon the recruitment of 48 emerging adult and parent pairs from sites serving primarily rural clients, participants will be randomized into 1 of 3 conditions for this randomized controlled trial: virtual parent coaching to deliver CM-EA, in-person PRSS for emerging adults, or both sets of services. Emerging adult eligibility includes polysubstance use, a substance use disorder, and availability of a consenting parent. Emerging adults will be interviewed at baseline and 6 months about substance use, quality of life, recovery capital, parental relationship, and Launch implementation-related outcomes (6-month follow-up only). Parents, peer workers delivering PRSS, and parent CM-EA coaches will be interviewed about implementation-related outcomes at the end of the study period. Peer workers and CM-EA coaches will be asked to complete checklists of services delivered after each session. Finally, payers and providers will be interviewed for additional insights into Launch implementation and to identify key outcomes of Launch. Data analysis for emerging adult outcomes will be primarily descriptive, but parent CM-EA training adherence will be assessed using nested mixed-effects regression models of repeated measures. ResultsLaunch is currently ongoing, with funding received in August 2023, and is expected to end in September 2025, with data analysis and results in December 2026. Participants are expected to begin enrolling in June 2024. ConclusionsWhile this pilot is limited by the small sample size and restriction to emerging adults with an involved parent, this is mitigated by the study’s strengths and is appropriate for the pilot stage. Launch uses an innovative combination of existing strategies to generate better outcomes for emerging adults while remaining scalable. This pilot will provide insights into the feasibility and acceptability of Launch from the perspectives of service recipients, providers, and payers to inform a larger-scale effectiveness trial. Trial RegistrationClinicalTrials.gov NCT06414993; https://clinicaltrials.gov/study/NCT06414993 International Registered Report Identifier (IRRID)PRR1-10.2196/60671

BackgroundThere are no clear dosing recommendations when using apixaban for venous thromboembolism (VTE) treatment in patients with severe or end-stage renal disease; clinical trials excluded patients with a creatinine clearance (CrCl) 2.5 mg/dL, CKD stage 4 or 5, or on dialysis. The primary endpoint was rate of clinically relevant bleeding within six months of starting apixaban. Secondary endpoints were VTE recurrence within six months of starting apixaban, time to clinically relevant bleed, and time to VTE recurrence.ResultsA total of 203 patients were included in the final analysis (n = 125 on 5 mg; n = 78 on 2.5 mg). Clinically relevant bleeding rate was significantly higher in the standard dose group (14.4 % vs 3.8 %, p = 0.02). Rates of VTE recurrence appear similar (6.4 % vs 7.7 %, p = 0.21).ConclusionsA reduced dose of apixaban may be considered when treating VTE in patients with severe or end-stage renal disease.

Unintentional injuries are a leading cause of child death. The present study evaluated the effectiveness of a behavioral injury prevention program for children aged 3-18 years and their caregivers. To accommodate families during the Coronavirus-19 pandemic, training was modified to be delivered virtually. Forty-one children aged 3-18 years and 14 parents/caregivers of children aged 3-5 years attended one of several 4-hour online injury prevention training sessions directed toward residents of Washington state. Training was targeted to three different developmental stages (ages 3-5, 6-12 and 13-18 years). Study outcomes included knowledge about injury prevention strategies, perceived vulnerability for injury, self-efficacy to engage in safety behaviors and behavioral intentions to be safe. Following training, participants showed improved self-efficacy to stay safe, excellent knowledge about the learned material and increased behavioral intention to engage safely. There was minimal change in perceived vulnerability to injury among children; caregivers of young children felt their children were somewhat less vulnerable to injury following the training. Almost all participants said they would recommend the program to others. Results suggest that a virtual behavioral training program delivered remotely is feasible and may be effective to create behavior change and reduce child injury risk. Given its scalability and reach, such programs are recommended for further study, refinement and, if demonstrated effective in larger-scale controlled trials, dissemination to address the leading cause of child mortality in the United States, unintentional injury.

Inclusive educational practices are rooted in a body of research indicating that when students in need of support through special education are meaningfully included in schools, academic and social outcomes improve for all students. To realize this promise of better outcomes, traditional schools with separate classrooms and even schools designated to exclusively serve various learner subgroups (e.g., students identified for special education) will require reorganized systems, structures, and resources. A school with a fully integrated educational framework is better positioned to meet the needs of all students, including those who live in poverty, who experience high mobility, who benefit from an accelerated curriculum, or who struggle to learn for other reasons. This paper describes an example of a transformational framework and technical assistance provided to a whole interlocking education systems (i.e., state, district, school) to reshape and increase school capacity to implement and sustain an equity-based, inclusive multi-tiered system of support. Statistical analyses that compared academic achievements of students with Individualized Education Programs (IEPs, i.e., disability) in schools reflecting early stages of transformation with that of students with IEPs in schools reflecting advanced transformation. The extent of school transformation to the framework significantly predicted improved outcomes for students with IEPs.

Tiered instructional supports are on a steep growth trajectory in the US and getting underway internationally as a means to providing equitable education to all student groups. In the US, the Department of Education funded the expansion of multi-tiered system of support (MTSS) through school and personnel improvement grants to states. This retrospective article examines the history of MTSS and California's significant investment to scale up the practice statewide, with an eye to identifying key issues that are likely to surface in other such ambitious state efforts. We examine the infrastructure support methodology to develop local capacity to support school-level implementation with measured fidelity. We present some preliminary results from a small sample comparison study that demonstrate students' academic achievement increased when the California MTSS efforts resulted in implementation with adequate fidelity. These findings suggest long-term replication of this initiative will mirror other student-level impact studies showing positive gains on measures of academic progress, in this case, English Language Arts and Math.

The present study investigated relationships among technical assistance, school leadership quality, and multitiered system of support (MTSS) implementation. The findings indicated technical assistance improved school leadership quality, and improved leadership significantly mediated the relationship between technical assistance and MTSS implementation for both behavior and academic systems. These results provide support for the foundational role of school leadership in MTSS implementation. Implications for providers of technical assistance are discussed.

Traumatic brain injury (TBI) has historically been considered a low-incidence disability in public education, and yet estimates indicate that nearly 145,000 children in the United States aged 0-19 are currently living with long-lasting, significant alterations in social, behavioral, physical, and cognitive functioning from a TBI. Comparing this number with the total number of students receiving special education services under the TBI eligibility category found only 26,371 students across all grades. Thus, it appears that a large number of students with significant disability following TBI are not being served under the TBI category, and raises the possibility that many students are not being identified and/or effectively served by educational practitioners in the public-school system. This paper examined the discrepancy between the number of students expected to experience disability using hospitalization data for moderate-severe TBI and the number of students who receive special education services under the TBI eligibility category. On average, the number of students actually identified nationally under the Special Education TBI category is only 32% of the students who have moderate-severe TBI across the country. Possible reasons for this discrepancy are explored, including lack of awareness about TBI as a disability, lack of communication between hospital and school, under-reporting of injuries by parents, a narrow definition of TBI that excludes other forms of acquired brain injury, and students with TBI receiving services under alternate disability categories. Recommendations are offered for providing staff training on brain injury, increasing parent awareness of TBI, increasing identification of brain injury in students through screening, and program evaluation of school brain injury protocols.

Abstract Background Many families and individuals do not meet criteria for a known hereditary cancer syndrome but display unusual clusters of cancers. These families may carry pathogenic variants in cancer predisposition genes and be at higher risk for developing cancer. Methods This multi-centre prospective study recruited 195 cancer-affected participants suspected to have a hereditary cancer syndrome for whom previous clinical targeted genetic testing was either not informative or not available. To identify pathogenic disease-causing variants explaining participant presentation, germline whole-genome sequencing (WGS) and a comprehensive cancer virtual gene panel analysis were undertaken. Results Pathogenic variants consistent with the presenting cancer(s) were identified in 5.1% (10/195) of participants and pathogenic variants considered secondary findings with potential risk management implications were identified in another 9.7% (19/195) of participants. Health economic analysis estimated the marginal cost per case with an actionable variant was significantly lower for upfront WGS with virtual panel ($8744AUD) compared to standard testing followed by WGS ($24,894AUD). Financial analysis suggests that national adoption of diagnostic WGS testing would require a ninefold increase in government annual expenditure compared to conventional testing. Conclusions These findings make a case for replacing conventional testing with WGS to deliver clinically important benefits for cancer patients and families. The uptake of such an approach will depend on the perspectives of different payers on affordability.

Abstract Obesity is associated with an increased risk of developing breast cancer (BC) and worse prognosis in BC patients, yet its impact on BC biology remains understudied in humans. This study investigates how the biology of untreated primary BC differs according to patients’ body mass index (BMI) using data from >2,000 patients. We identify several genomic alterations that are differentially prevalent in overweight or obese patients compared to lean patients. We report evidence supporting an ageing accelerating effect of obesity at the genetic level. We show that BMI-associated differences in bulk transcriptomic profile are subtle, while single cell profiling allows detection of more pronounced changes in different cell compartments. These analyses further reveal an elevated and unresolved inflammation of the BC tumor microenvironment associated with obesity, with distinct characteristics contingent on the estrogen receptor status. Collectively, our analyses imply that obesity is associated with an inflammaging-like phenotype. We conclude that patient adiposity may play a significant role in the heterogeneity of BC and should be considered for BC treatment tailoring.

Abstract Brain metastases are secondary brain tumours characterised by their aggressive nature and poor prognosis. Breast cancer is one of the most common primary tumours in women to spread to the brain. A lack of biomarkers predicting likely spread to the brain and limited therapeutic interventions represents major areas of clinical unmet need. We investigated N‐myc downregulated gene‐1 (NDRG1) as a clinically relevant biomarker in breast cancer brain metastasis patients. NDRG1 expression was investigated using immunohistochemistry on tissue microarrays of two clinical cohorts: (i) brain metastatic breast cancers (n = 48) and brain metastases (n = 64; including a subset of 39 patient‐matched breast and brain metastasis cases) and (ii) unselected primary breast cancers (n = 336). NDRG1 was highly expressed in breast‐to‐brain metastases, as well as in high‐grade primary breast cancers. High NDRG1 expression and also an absence of expression were associated with worse survival outcomes in both breast cancer and breast cancer brain metastasis patients. This establishes NDRG1 as a ‘Goldilocks’ protein, where too much or too little has a negative effect on survival. We pose that this accounts for its previous categorisation as both tumour suppressor and oncoprotein. Additionally, a shift in NDRG1 localisation with a gain of nuclear expression was seen at the brain metastasis stage. Significant survival benefit in cases expressing cytoplasmic NDRG1 was observed, whereas NDRG1 localisation in the nucleus showed a clear association with poorer survival. In vitro analyses revealed that hypoxic stress significantly elevated NDRG1 expression and resulted in its nuclear localisation. Our findings suggest NDRG1 expression and subcellular localisation are clinically relevant biomarkers for poor prognosis in breast cancer and breast cancer brain metastasis.

Understanding the gut microbiome of polar bears can shed light on the effects of climate change-induced prolonged ice-free seasons on their health and nutritional status as a sentinel species. The fecal microbiome of habitat-housed captive polar bears who had consumed a high protein diet long-term was compared with that of the wild population. Individual differences, season, year and dietary inclusion of a brown seaweed (Fucus spiralis; part of the natural diet of wild polar bears), as a representation for nutritional change, were investigated for their effects on the fecal microbiome of captive polar bears. Microbial variations among fecal samples from wild and captive polar bears were investigated using 16s rRNA gene based metataxonomic profiling. The captive bears exhibited more diverse fecal microbiota than wild bears (p

Tumor-specific overexpression of receptors enables a variety of targeted cancer therapies, exemplified by peptide-receptor radiotherapy (PRRT) for somatostatin receptor (SSTR)-positive neuroendocrine tumors. While effective, PRRT is restricted to tumors with SSTR overexpression. To overcome this limitation, we propose using oncolytic vaccinia virus (vvDD)-mediated receptor gene transfer to permit molecular imaging and PRRT in tumors without endogenous SSTR overexpression, a strategy termed radiovirotherapy. We hypothesized that vvDD-SSTR combined with a radiolabeled somatostatin analog could be deployed as radiovirotherapy in a colorectal cancer peritoneal carcinomatosis model, producing tumor-specific radiopeptide accumulation. Following vvDD-SSTR and 177Lu-DOTATOC treatment, viral replication and cytotoxicity, as well as biodistribution, tumor uptake, and survival, were evaluated. Radiovirotherapy did not alter virus replication or biodistribution, but synergistically improved vvDD-SSTR-induced cell killing in a receptor-dependent manner and significantly increased the tumor-specific accumulation and tumor-to-blood ratio of 177Lu-DOTATOC, making tumors imageable by microSPECT/CT and causing no significant toxicity. 177Lu-DOTATOC significantly improved survival over virus alone when combined with vvDD-SSTR but not control virus. We have therefore demonstrated that vvDD-SSTR can convert receptor-negative tumors into receptor-positive tumors and facilitate molecular imaging and PRRT using radiolabeled somatostatin analogs. Radiovirotherapy represents a promising treatment strategy with potential applications in a wide range of cancers.

Abstract Background Post-secondary students frequently experience high rates of mental health challenges. However, they present meagre rates of treatment-seeking behaviours. This elevated prevalence of mental health problems, particularly after the COVID-19 pandemic, can lead to distress, poor academic performance, and lower job prospects following the completion of education. To address the needs of this population, it is important to understand students' perceptions of mental health and the barriers preventing or limiting their access to care. Methods A broad-scoping online survey was publicly distributed to post-secondary students, collecting demographic, sociocultural, economic, and educational information while assessing various components of mental health. Results In total, 448 students across post-secondary institutions in Ontario, Canada, responded to the survey. Over a third (n = 170; 38.6%) of respondents reported a formal mental health diagnosis. Depression and generalized anxiety disorder were the most commonly reported diagnoses. Most respondents felt that post-secondary students did not have good mental health (n = 253; 60.5%) and had inadequate coping strategies (n = 261; 62.4%). The most frequently reported barriers to care were financial (n = 214; 50.5%), long wait times (n = 202; 47.6%), insufficient resources (n = 165; 38.9%), time constraints (n = 148; 34.9%), stigma (n = 133; 31.4%), cultural barriers (n = 108; 25.5%), and past negative experiences with mental health care (n = 86; 20.3%). The majority of students felt their post-secondary institution needed to increase awareness (n = 231; 56.5%) and mental health resources (n = 306; 73.2%). Most viewed in-person therapy and online care with a therapist as more helpful than self-guided online care. However, there was uncertainty about the helpfulness and accessibility of different forms of treatment, including online interventions. The qualitative findings highlighted the need for personal strategies, mental health education and awareness, and institutional support and services. Conclusions Various barriers to care, perceived lack of resources, and low knowledge of available interventions may contribute to compromised mental health in post-secondary students. The survey findings indicate that upstream approaches such as integrating mental health education for students may address the varying needs of this critical population. Therapist-involved online mental health interventions may be a promising solution to address accessibility issues.

For many autistic students, to experience more successful outcomes, school processes must be restructured and given necessary resources. The probability of success can be increased by implementing a school system that integrates research-based academic and behavioral instructional support, along with collaborative data-informed decision-making routines. This paper presents an example of a transformational framework and technical assistance that were provided to six schools to reshape and increase the schools’ capacity to implement and sustain an equity-based multi-tiered system of support (MTSS) with intensified instructional decision making. Statistical analyses were used to examine the outcomes of autistic students (n = 23) who participated in a state assessment over three consecutive years in the same state. The results demonstrated an increase in academic scores, and many students transitioned to less-restrictive educational environments.

U.S. public education systems are required to provide free appropriate public education to students with disabilities in least restrictive environments that are appropriate to meet their individual needs. The practice of educating students with disabilities in neighborhood schools in age-appropriate general education classrooms and other school settings to meet this requirement has come to be known as "inclusive education." The long-standing interest in keeping students with disabilities in the same classrooms with their neighbors and peers has created a need for reform to establish equity in America's schools. Schoolwide Integrated Framework for Transformation (SWIFT) is a whole-system school reform model provided through a national technical assistance center that addresses core features of inclusive education support for elementary and middle schools, particularly those that are chronically low performing and those serving students with the most extensive needs. We describe the development and preliminary technical adequacy of SWIFT Fidelity of Implementation Tool (SWIFT-FIT) as a means to document the extent to which schools are implementing inclusive education. Findings provide preliminary support for trained assessors using SWIFT-FIT as a valid and reliable instrument to produce evidence that describes the extent to which schools install, implement, and sustain these evidence-based practices. Researchers and other school personnel can use these data to evaluate the impact of implementation on progress as well as important student and other outcomes.

The present investigation examines the schoolwide applications model (SAM) as a potentially effective school reform model for increasing equity-based inclusive education practices while enhancing student reading and math achievement for all students. A 3-year quasi-experimental comparison group analysis using latent growth modeling (LGM) was used with seven urban elementary or elementary/middle schools and seven matched comparison schools in the same district. Results suggest significantly larger growth for experimental school students in math and no statistically significant difference in reading score growth between experimental and comparison schools. However, reading score growth for experimental schools was statistically significant in a post hoc analysis of selected schools. Additional descriptive analysis is presented for three schools that implemented the model with the highest measured fidelity; these schools made improvements on both reading and math scores while those of matching comparison schools decreased.

Abstract Intratumoral heterogeneity is caused by genomic instability and phenotypic plasticity, but how these features co-evolve remains unclear. SOX10 is a neural crest stem cell (NCSC) specifier and candidate mediator of phenotypic plasticity in cancer. We investigated its relevance in breast cancer by immunophenotyping 21 normal breast and 1860 tumour samples. Nuclear SOX10 was detected in normal mammary luminal progenitor cells, the histogenic origin of most TNBCs. In tumours, nuclear SOX10 was almost exclusive to TNBC, and predicted poorer outcome amongst cross-sectional (p = 0.0015, hazard ratio 2.02, n = 224) and metaplastic (p = 0.04, n = 66) cases. To understand SOX10’s influence over the transcriptome during the transition from normal to malignant states, we performed a systems-level analysis of co-expression data, de-noising the networks with an eigen-decomposition method. This identified a core module in SOX10’s normal mammary epithelial network that becomes rewired to NCSC genes in TNBC. Crucially, this reprogramming was proportional to genome-wide promoter methylation loss, particularly at lineage-specifying CpG-island shores. We propose that the progressive, genome-wide methylation loss in TNBC simulates more primitive epigenome architecture, making cells vulnerable to SOX10-driven reprogramming. This study demonstrates potential utility for SOX10 as a prognostic biomarker in TNBC and provides new insights about developmental phenotypic mimicry—a major contributor to intratumoral heterogeneity.

Understanding the gut microbiome of polar bears can shed light on the effects of climate change-induced prolonged ice-free seasons on their health and nutritional status as a sentinel species. The fecal microbiome of habitat-housed captive polar bears who had consumed a high protein diet long-term was compared with that of the wild population. Individual differences, season, year and dietary inclusion of a brown seaweed (Fucus spiralis; part of the natural diet of wild polar bears), as a representation for nutritional change, were investigated for their effects on the fecal microbiome of captive polar bears. Microbial variations among fecal samples from wild and captive polar bears were investigated using 16s rRNA gene based metataxonomic profiling. The captive bears exhibited more diverse fecal microbiota than wild bears (p<0.05). The difference was due to significantly increased Firmicutes, Campilobacterota and Fusobacteriota, decreased Actinobacteriota (p<0.05), and absent Bdellovibrionota and Verrucomicrobiota in the captive bears. Compared with other factors, individual variation was the main driver of differences in fecal microbial composition in the captive bears. Seaweed consumption did not alter microbial diversity or composition, but this did not rule out dietary influences on the hosts. This is the first study, to the best of our knowledge, comparing the fecal microbiota of captive and wild polar bears and it reveals distinct differences between the two groups, which could result from many factors, including available food sources and the ratio of dietary macronutrients. Our findings provide preliminary insights into climate-change induced dietary shifts in polar bears related to climate-associated habitat change. [ABSTRACT FROM AUTHOR]

Cooperation and conflict are common in plant–pollinator interactions. Flowering plants often entice pollinators to visit by offering floral food rewards, thereby facilitating pollination. However, pollinators such as bees can learn to improve their collection of floral rewards (such as pollen), changing how they interact with the flower's reproductive organs, which together could reduce pollination success. Consequently, complex flowers that slow pollinator learning might benefit the plant. Yet how pollinator learning and flower complexity interact to affect pollination success is unknown. We therefore asked how differences in complexity of 4 flower types (Phacelia campanularia, Exacum affine , Solanum elaeagnifolium , and Erythranthe guttata) affected learning by pollen-foraging generalist bumble bees (Bombus impatiens) and how learning affected pollen collection and pollen deposition on these flowers. We found that bees generally learned how to efficiently handle more complex flower types more slowly. Bees that required more visits to become efficient foragers collected less pollen, with no effect on pollen deposition. Except for the simplest flower type, learning also involved development of motor routines unique to each flower type. Experienced bees overall collected more pollen, but individual differences in motor routines did not affect pollen collection. Conversely, individual differences in motor routines affected pollen deposition, but there was no overall effect of experience. Thus, even though learning overall benefits the bee, it does not alter female (and potentially male) fitness benefits for the plant. We discuss potential reasons for these patterns and consequences for bee behavior and flower evolution. [ABSTRACT FROM AUTHOR]

The present study investigated the effectiveness of an equity-based inclusive school reform model nested within a multitiered system of support (MTSS) framework on the improvement of math and reading performance of students with Individualized Education Programs (IEPs). Descriptive statistics revealed that math state assessment scores of students with IEPs increased over the implementation period. Results of multilevel modeling demonstrated that the model's fidelity of implementation scores positively and significantly predicted state assessment math scores. A further analysis examining the effectiveness of the model in three schools that implemented with adequate fidelity compared with nonimplementing schools indicated students with IEPs in implementing schools increased their math scores at a greater rate than their peers in comparison schools; however, effects on reading scores were equivocal. Findings are discussed in the context of inclusion and efforts to support high fidelity implementation of MTSS.

Background: Returning to learn following a concussion is the process of managing a student's recovery during the school day by implementation of academic supports with varying intensity. Due to a lack of consensus or even guidance on Return to Learn, this paper set out to establish cross discipline consensus on some essential elements of Return to Learn using a Delphi method. Methods: Sixteen national organizations participated in a Delphi process to reach consensus on overarching themes of Return to Learn focused on: returning a student to school, composition of the school-based concussion management team, progress-monitoring, educational safeguards, neuropsychological testing, and legislation. Two rounds of questionnaires were disseminated via email using a Delphi process. Consensus was established during round 2. Results: Twelve national organizations were able to reach consensus and endorse 13 essential elements of Return to Learn following a concussion. Conclusions: There continues to be limited research on concussion Return to Learn leading to confusion in the field. In this paper, we demonstrate consensus on a number of essential elements, from a wide variety of professional disciplines who participate in the care of students following a concussion, as a starting place for some guidance on Return to Learn.

Purpose: This retrospective case series utilized clinical data mining (CDM) to understand the potential key components in an integrated treatment approach delivered by speech-language pathologists (SLPs) treating adolescents experiencing persistent cognitive effects postconcussion. The first purpose was to describe the profiles of students treated in our clinic, how they were treated, and the nature of multidisciplinary communication. The second purpose was to generate testable hypotheses about effective intervention options for this population. Methods: Fifteen students aged 13-18 years experiencing prolonged concussion symptoms (PCS) were referred to our SLP graduate training clinic by a local pediatric neuropsychologist for cognitive rehabilitation services. Clinical data mining extracted clinical data in 4 main categories: (a) student characteristics, (b) SLP treatment parameters, (c) clinical outcomes following SLP treatment, and (d) the nature of multidisciplinary communication between practitioners. Results: Aligned with risk factors for PCS as reported in the literature, data on student characteristics revealed that the majority of students had sustained multiple previous concussions and reported a history of depression/anxiety. Data on SLP treatment parameters identified metacognitive strategy instruction and the training of assistive technology for cognition as the most frequent interventions selected to address academic goals. Data showing the frequency and type of multidisciplinary communication revealed that SLPs communicated most often with the pediatric neuropsychologist and educational liaison. Clinical outcome data revealed that 12 of the 15 students achieved their academic goals at the time of discharge. Conclusions: Overall, CDM results suggested that when working in a multidisciplinary team, SLPs can provide cognitive rehabilitation, support symptom reduction, and deliver psychoeducation potentially effective for students experiencing PCS. Key treatment and outcome measurement issues important for developing testable interventions are discussed.