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BACKGROUNDEarly antiretroviral therapy initiation (ARTi) in HIV-1 restricts reservoir size and diversity while preserving immune function, potentially improving opportunities for immunotherapeutic cure strategies. For antibody-based cure approaches, the development of autologous neutralizing antibodies (anAbs) after acute/early ARTi is relevant but is poorly understood.METHODSWe characterized antibody responses in a cohort of 23 participants following ARTi in acute HIV (

This study is the first systematic examination of how school counselor multicultural counseling competence (MCC) is addressed in state licensure examinations of school counselors. Results offer preliminary support to the notion that state licensure examinations indeed address some important aspects of MCC, as identified by Holcomb-McCoy (2004). Yet, considerable variability exists across examinations in the percentage of content devoted to these commonly addressed areas. Quantitative content analysis shows there are several important aspects of school counselor MCC that are not being tested in state examinations. Discussions and implications are provided.

A national study of school counselor role and professional activities (Fan et al., 2019) was replicated using a West Virginia (WV) school counselor sample to determine if WV's unique context and state policies would reflect a difference in how counselors perceive their roles and conduct professional practices. The comparison between WV sample and its national counterparts showed that school counselors grade level is robustly related to professional practice, with high school counselors demonstrating different levels of work focus than middle and elementary counselors. The WV sample did not demonstrate any practically significant differences from the previously collected national U.S. sample (Fan et al. 2019) on any "ISSCA-US" subsamples or items. While these results add confidence to the generalizability of Fan et al.'s (2019) findings, interestingly, no differences in role or practice were identified given the significant state policy initiatives to tailor school counseling practice towards state needs, models, and approaches.

The endocannabinoid system is a highly conserved and ubiquitous signalling pathway with broad-ranging effects. Despite critical pathway functions, gene variants have not previously been conclusively linked to human disease. We identified nine children from eight families with heterozygous, de novo truncating variants in the last exon of DAGLA with a neuro-ocular phenotype characterized by developmental delay, ataxia and complex oculomotor abnormality. All children displayed paroxysms of nystagmus or eye deviation accompanied by compensatory head posture and worsened incoordination most frequently after waking. RNA sequencing showed clear expression of the truncated transcript and no differences were found between mutant and wild-type DAGLA activity. Immunofluorescence staining of patient-derived fibroblasts and HEK cells expressing the mutant protein showed distinct perinuclear aggregation not detected in control samples. This report establishes truncating variants in the last DAGLA exon as the cause of a unique paediatric syndrome. Because enzymatic activity was preserved, the observed mislocalization of the truncated protein may account for the observed phenotype. Potential mechanisms include DAGLA haploinsufficiency at the plasma membrane or dominant negative effect. To our knowledge, this is the first report directly linking an endocannabinoid system component with human genetic disease and sets the stage for potential future therapeutic avenues.

PurposeDiphthamide is a post-translationally modified histidine essential for messenger RNA translation and ribosomal protein synthesis. We present evidence for DPH5 as a novel cause of embryonic lethality and profound neurodevelopmental delays (NDDs).MethodsMolecular testing was performed using exome or genome sequencing. A targeted Dph5 knockin mouse (C57BL/6Ncrl-Dph5em1Mbp/Mmucd) was created for a DPH5 p.His260Arg homozygous variant identified in 1 family. Adenosine diphosphate-ribosylation assays in DPH5-knockout human and yeast cells and in silico modeling were performed for the identified DPH5 potential pathogenic variants.ResultsDPH5 variants p.His260Arg (homozygous), p.Asn110Ser and p.Arg207Ter (heterozygous), and p.Asn174LysfsTer10 (homozygous) were identified in 3 unrelated families with distinct overlapping craniofacial features, profound NDDs, multisystem abnormalities, and miscarriages. Dph5 p.His260Arg homozygous knockin was embryonically lethal with only 1 subviable mouse exhibiting impaired growth, craniofacial dysmorphology, and multisystem dysfunction recapitulating the human phenotype. Adenosine diphosphate-ribosylation assays showed absent to decreased function in DPH5-knockout human and yeast cells. In silico modeling of the variants showed altered DPH5 structure and disruption of its interaction with eEF2.ConclusionWe provide strong clinical, biochemical, and functional evidence for DPH5 as a novel cause of embryonic lethality or profound NDDs with multisystem involvement and expand diphthamide-deficiency syndromes and ribosomopathies.

Using qualitative content analysis (Cohen et al., 2007), we examined the expectations of states in the United States regarding program evaluation content for school counselor licensure. Results show that 43 states maintain some form of program evaluation expectations for licensure, up from the 19 identified by Trevisan (2000). Twenty-eight states require licensure tests that purportedly align with CACREP, ASCA, or maintain a state developed licensure test that measures program evaluation content. Twenty-one states mention alignment of their curriculum with CACREP, ASCA, or both. The program evaluation expectations are ambiguous and unconnected to best program evaluation practices articulated by the evaluation field. We offer recommendations to build the evaluation capacity of the school counseling profession in the United States that include refinements in graduate education of school counselors, in-service training for practicing school counselors, and revision of licensing and program expectations to include standards of best practice in program evaluation.

This article is the second of a two-part series that describes the development of the "Taxonomy of Policy Levers to Promote High Quality School-Based Counseling." Previous article (Morshed & Carey, 2020) described the development of the taxonomy using content analysis of existing published descriptions of policy levers. This article tested the utility and comprehensiveness of the taxonomy by having experts from South Korea, Nigeria, and West Virginia review policies in their regions. They analyzed the taxonomy by using it to describe the school-based counseling policy landscape in their own contexts. Overall, the taxonomy provided a useful framework for identifying policy levers that were implemented as well as the levers which were not implemented but could be used to further improve school-based counseling. A revised taxonomy adding four new levers is presented. Further research to expand the taxonomy is suggested, and its utility to guiding policy research and evaluation is explained. [For "Development of a Taxonomy of Policy Levers to Promote High Quality School-Based Counseling," see EJ1274913.]

There is a lack of an established framework or taxonomy in the academic literature to systematically analyze school counseling policies. This study was conducted to fill in this gap. Specifically, the researchers propose an initial taxonomy developed based on review of relevant school counseling policy documents and research. The proposed taxonomy has 21 policy levers grouped under seven policy foci covering school counselors' initial competence, continuing competence, effective school counseling practices, planning and evaluation of school counseling, distinct school counselor roles, hiring of school counselors, and the continual improvement of school counseling system. The Taxonomy is still in a developmental stage with a focus on improving its comprehensiveness through studies that identify additional policy levers from different countries. The authors also invite other academics and practitioners to conduct case studies using the taxonomy that will provide important knowledge to further improve the taxonomy.

This article describes a factor analytic study designed to identify the underlying dimensions of school-based counseling practice that will be useful in describing cross-national differences in school-based counseling practice and in enabling comparative research on school-based counseling policy and effectiveness. Practicing school-based counselors (N = 2913) from 10 countries (China, Costa Rica, India, Kenya, South Korea, Malta, Nigeria, Turkey, the United States, and Venezuela) used the International Survey of School-Based Counseling Activities (ISSCA) to rate the centrality of 40 activities to the role of a school-based counselor. Factor analysis determined that five dimensions adequately described the school-based counselor role: Counseling Services; Advocacy and Systemic Improvement; Prevention Programs; Administrator Role; and Educational and Career Planning. Analysis of Bartlett Factor Score averages revealed that each country demonstrates a unique profile which reflects that country's dominant mode of practice. This lead article describes these dimensions and the cross-national differences on these dimensions. Subsequent articles in this special issue describe country-specific results and explain factors that affect practice within each country.

This study used the five dimensions of practice identified by Carey, Fan, He, and Jin (2020) to describe the preferred mode of practice of US school-based counselors and compare this mode of practice with nine other countries. A total of 380 US school counselors completed the International Survey of School Counselor Activities-United States. Mean item ratings and mean BART scores were used for both descriptions and comparisons. US counselors indicated that Counseling Services; Advocacy and Systemic Improvement; Prevention Programs; and, Educational and Career Planning were all important aspects of their role. In comparison to international counterparts, US counselors placed greater emphasis on Advocacy and Systemic Improvement and Prevention Programs. Results confirmed previous scholarship suggesting that counselors in the US have a very broad role. Any reformulation of this role would benefit from comparative international research on the strengths and limitations of different modes of practice.

The Genome Empowerment Scale (GEmS), developed as a research tool, assesses perspectives of parents of children with undiagnosed disorders about to undergo exome or genome sequencing related to the process of empowerment. We defined genomic healthcare empowerment as follows: perceived ability to understand and seek new information related to the genomic sequencing, manage emotions related to the diagnostic process and outcomes, and utilize genomic sequencing information to the betterment of the individual/child and family. The GEmS consists of four scales, two are primarily emotion-focused (Meaning of a Diagnosis, and Emotional Management of the Process) and two are action-oriented (Seeking Information and Support, and Implications and Planning). The purpose of this research was to provide a strategy for interpreting results from the GEmS and present illustrative cases. These illustrations should serve to facilitate use of the GEmS in the clinical and research arena, particularly with respect to guiding genetic counseling processes for parents of children with undiagnosed conditions.

From 2005 to 2018, among 32013 adults with human immunodeficiency virus entering care, median time to antiretroviral therapy (ART) prescription declined from 69 to 6 days, CD4 count at entry into care increased from 300 to 362 cells/μL, and CD4 count at ART prescription increased from 160 to 364 cells/μL.

This study was conducted to determine: how a US sample of American Counseling Association (ACA) affiliated school-based counselors viewed their role; the extent to which various activities were practiced; and, how demographic variables (e.g., work setting and professional identity) were related to both perceptions of role and practice. Participants (N = 249) completed the International Survey of School Counselors Activities-US (ISSA-US) online, which measured both perceptions of the appropriateness of 42 activities and whether these activities are reported to be enacted. US counselors had a broad definition of their role and showed a high degree of consensus regarding the appropriateness of activities. Grade level proved to be an important determinate of the level of enactment of both group counseling and college and career counseling. The implications for of these findings for redefining the role of school counselors in the US and for international comparative research are discussed.

BackgroundTo assess the possible impact of antiretroviral therapy improvements, aging, and comorbidities, we examined trends in all-cause and cause-specific hospitalization rates among persons with HIV (PWH) from 2005 to 2015.MethodsIn 6 clinical cohorts, we followed PWH in care (≥1 outpatient CD4 count or HIV load [VL] every 12 months) and categorized ICD codes of primary discharge diagnoses using modified Clinical Classifications Software. Poisson regression estimated hospitalization rate ratios for calendar time trends, adjusted for demographics, HIV risk factor, and annually updated age, CD4, and VL.ResultsAmong 28 057 patients (125 724 person-years), from 2005 to 2015, the median CD4 increased from 389 to 580 cells/µL and virologic suppression from 55% to 85% of patients. Unadjusted all-cause hospitalization rates decreased from 22.3 per 100 person-years in 2005 (95% confidence interval [CI], 20.6-24.1) to 13.0 in 2015 (95% CI, 12.2-14.0). Unadjusted rates decreased for almost all diagnostic categories. Adjusted rates decreased for all-cause, cardiovascular, and AIDS-defining conditions, increased for non-AIDS-defining infection, and were stable for most other categories.ConclusionsAmong PWH with increasing CD4 counts and viral suppression, unadjusted hospitalization rates decreased for all-cause and most cause-specific hospitalizations, despite the potential effects of aging, comorbidities, and cumulative exposure to HIV and antiretrovirals.

The delineation of disease entities is complex, yet recent advances in the molecular characterization of diseases provide opportunities to designate diseases in a biologically valid manner. Here, we have formalized an approach to the delineation of Mendelian genetic disorders that encompasses two distinct but inter-related concepts: (1) the gene that is mutated and (2) the phenotypic descriptor, preferably a recognizably distinct phenotype. We assert that only by a combinatorial or dyadic approach taking both of these attributes into account can a unitary, distinct genetic disorder be designated. We propose that all Mendelian disorders should be designated as "GENE-related phenotype descriptor" (e.g., "CFTR-related cystic fibrosis"). This approach to delineating and naming disorders reconciles the complexity of gene-to-phenotype relationships in a simple and clear manner yet communicates the complexity and nuance of these relationships.

We describe our experiences with organizing pro bono medical genetics and neurology outreach programs on several different resource-limited islands in the West Indies. Due to geographic isolation, small population sizes, and socioeconomic disparities, most Caribbean islands lack medical services for managing, diagnosing, and counseling individuals with genetic disorders. From 2015 to 2019, we organized 2-3 clinics per year on various islands in the Caribbean. We also organized a week-long clinic to provide evaluations for children suspected of having autism spectrum disorder. Consultations for over 100 different individuals with suspected genetic disorders were performed in clinics or during home visits following referral by locally registered physicians. When possible, follow-up visits were attempted. When available and appropriate, clinical samples were shipped to collaborating laboratories for molecular analysis. Laboratory tests included karyotyping, cytogenomic microarray analysis, exome sequencing, triplet repeat expansion testing, blood amino acid level determination, biochemical assaying, and metabolomic profiling. We believe that significant contributions to healthcare by genetics professionals can be made even if availability is limited. Visiting geneticists may help by providing continuing medical education seminars. Clinical teaching rounds help to inform local physicians regarding the management of genetic disorders with the aim of generating awareness of genetic conditions. Even when only periodically available, a visiting geneticist may benefit affected individuals, their families, their local physicians, and the community at large.

This study evaluated the impact of the Student Success Skills (SSS) classroom curriculum delivered in a naturalistic setting on the metacognitive functioning of 2,725 middle and high school students in Kentucky. SSS was implemented as one intervention to fulfill an Elementary and Secondary School Counseling Grant. Results in students' self-reports indicated that those who received the intervention demonstrated increased ability to regulate their levels of emotional arousal. No additional significant differences were found. These findings differ from the results of previous outcome studies involving SSS. Implications for implementing SSS in naturalistic school settings and directions for future research are discussed.

Cadherins constitute a family of transmembrane proteins that mediate calcium-dependent cell-cell adhesion. The extracellular domain of cadherins consists of extracellular cadherin (EC) domains, separated by calcium binding sites. The EC interacts with other cadherin molecules in cis and in trans to mechanically hold apposing cell surfaces together. CDH2 encodes N-cadherin, whose essential roles in neural development include neuronal migration and axon pathfinding. However, CDH2 has not yet been linked to a Mendelian neurodevelopmental disorder. Here, we report de novo heterozygous pathogenic variants (seven missense, two frameshift) in CDH2 in nine individuals with a syndromic neurodevelopmental disorder characterized by global developmental delay and/or intellectual disability, variable axon pathfinding defects (corpus callosum agenesis or hypoplasia, mirror movements, Duane anomaly), and ocular, cardiac, and genital anomalies. All seven missense variants (c.1057G>A [p.Asp353Asn]; c.1789G>A [p.Asp597Asn]; c.1789G>T [p.Asp597Tyr]; c.1802A>C [p.Asn601Thr]; c.1839C>G [p.Cys613Trp]; c.1880A>G [p.Asp627Gly]; c.2027A>G [p.Tyr676Cys]) result in substitution of highly conserved residues, and six of seven cluster within EC domains 4 and 5. Four of the substitutions affect the calcium-binding site in the EC4-EC5 interdomain. We show that cells expressing these variants in the EC4-EC5 domains have a defect in cell-cell adhesion; this defect includes impaired binding in trans with N-cadherin-WT expressed on apposing cells. The two frameshift variants (c.2563_2564delCT [p.Leu855Valfs∗4]; c.2564_2567dupTGTT [p.Leu856Phefs∗5]) are predicted to lead to a truncated cytoplasmic domain. Our study demonstrates that de novo heterozygous variants in CDH2 impair the adhesive activity of N-cadherin, resulting in a multisystemic developmental disorder, that could be named ACOG syndrome (agenesis of corpus callosum, axon pathfinding, cardiac, ocular, and genital defects).

BackgroundThe Thymectomy Trial in Non-Thymomatous Myasthenia Gravis Patients Receiving Prednisone (MGTX) showed that thymectomy combined with prednisone was superior to prednisone alone in improving clinical status as measured by the Quantitative Myasthenia Gravis (QMG) score in patients with generalised non-thymomatous myasthenia gravis at 3 years. We investigated the long-term effects of thymectomy up to 5 years on clinical status, medication requirements, and adverse events.MethodsWe did a rater-blinded 2-year extension study at 36 centres in 15 countries for all patients who completed the randomised controlled MGTX and were willing to participate. MGTX patients were aged 18 to 65 years at enrolment, had generalised non-thymomatous myasthenia gravis of less than 5 years' duration, had acetylcholine receptor antibody titres of 1·00 nmol/L or higher (or concentrations of 0·50-0·99 nmol/L if diagnosis was confirmed by positive edrophonium or abnormal repetitive nerve stimulation, or abnormal single fibre electromyography), had Myasthenia Gravis Foundation of America Clinical Classification Class II-IV disease, and were on optimal anticholinesterase therapy with or without oral corticosteroids. In MGTX, patients were randomly assigned (1:1) to either thymectomy plus prednisone or prednisone alone. All patients in both groups received oral prednisone at doses titrated up to 100 mg on alternate days until they achieved minimal manifestation status. The primary endpoints of the extension phase were the time-weighted means of the QMG score and alternate-day prednisone dose from month 0 to month 60. Analyses were by intention to treat. The trial is registered with ClinicalTrials.gov, number NCT00294658. It is closed to new participants, with follow-up completed.FindingsOf the 111 patients who completed the 3-year MGTX, 68 (61%) entered the extension study between Sept 1, 2009, and Aug 26, 2015 (33 in the prednisone alone group and 35 in the prednisone plus thymectomy group). 50 (74%) patients completed the 60-month assessment, 24 in the prednisone alone group and 26 in the prednisone plus thymectomy group. At 5 years, patients in the thymectomy plus prednisone group had significantly lower time-weighted mean QMG scores (5·47 [SD 3·87] vs 9·34 [5·08]; p=0·0007) and mean alternate-day prednisone doses (24 mg [SD 21] vs 48 mg [29]; p=0·0002) than did those in the prednisone alone group. 14 (42%) of 33 patients in the prednisone group, and 12 (34%) of 35 in the thymectomy plus prednisone group, had at least one adverse event by month 60. No treatment-related deaths were reported during the extension phase.InterpretationAt 5 years, thymectomy plus prednisone continues to confer benefits in patients with generalised non-thymomatous myasthenia gravis compared with prednisone alone. Although caution is appropriate when generalising our findings because of the small sample size of our study, they nevertheless provide further support for the benefits of thymectomy in patients with generalised non-thymomatous myasthenia gravis.FundingNational Institutes of Health, National Institute of Neurological Disorders and Stroke.

BackgroundThe United States National HIV/AIDS Strategy established goals to reduce disparities in retention in human immunodeficiency virus (HIV) care, antiretroviral therapy (ART) use, and viral suppression. The impact of sex, age, and sexual HIV acquisition risk (ie, heterosexual vs same-sex contact) on the magnitude of HIV-related racial/ethnic disparities is not well understood.MethodsWe estimated age-stratified racial/ethnic differences in the 5-year restricted mean percentage of person-time spent in care, on ART, and virally suppressed among 19 521 women (21.4%), men who have sex with men (MSM; 59.0%), and men who have sex with women (MSW; 19.6%) entering HIV care in the North American AIDS Cohort Collaboration on Research and Design between 2004 and 2014.ResultsAmong women aged 18-29 years, whites spent 12.0% (95% confidence interval [CI], 1.1%-20.2%), 9.2% (95% CI, .4%-20.4%), and 13.5% (95% CI, 2.7%-22.5%) less person-time in care, on ART, and virally suppressed, respectively, than Hispanics. Black MSM aged ≥50 years spent 6.3% (95% CI, 1.3%-11.7%), 11.0% (95% CI, 4.6%-18.1%), and 9.7% (95% CI, 3.6%-16.8%) less person-time in these stages, respectively, than white MSM ≥50 years of age. Among MSM aged 40-49 years, blacks spent 9.8% (95% CI, 2.4%-16.5%) and 11.9% (95% CI, 3.8%-19.3%) less person-time on ART and virally suppressed, respectively, than whites.ConclusionsRacial/ethnic differences in HIV care persist in specific populations defined by sex, age, and sexual HIV acquisition risk. Clinical and public health interventions that jointly target these demographic factors are needed.

"Eccomi Pronto" (EP), an elementary school socio-emotional learning curriculum that was originally developed and evaluated in Italy was translated in Korean and implemented and evaluated in 4th grade classrooms of a primary school in South Korea. Qualitative data from teachers indicated that EP improved the self-reflection and self-direction of students, resulted in pedagogically useful insights into the psychological functioning of students, and enhanced the quality of teacher-student interaction. However, statistically significant changes in students' engaged, academic behavior (as measured by an 8-item survey) were not noted. Teachers reported that the core of the EP curriculum was appropriate for the South Korean educational context. Teachers also recommended modifications in the follow-up learning activities to make these activities more consistent with South Korean education practices.

The scale development and exploratory and confirmatory factor analyses of the Protective Factor Index (PFI) is described. The PFI is a 13-item component of elementary students' report cards that replaces typical items associated with student behavior. The PFI is based on the Construct-Based Approach (CBA) to school counseling, which proposes that primary and secondary prevention activities of school counseling programs should focus on socio-emotional, development-related psychological constructs that are associated with students' academic achievement and well-being, that have been demonstrated to be malleable, and that are within the range of expertise of school counselors. Teachers use the PFI to rate students' skills in four construct-based domains that are predictive of school success. School counselors use teachers' ratings to monitor student development and plan data-driven interventions.

BackgroundCancer remains an important cause of morbidity and mortality in people with human immunodeficiency virus (PWHIV) on effective antiretroviral therapy (ART). Estimates of cancer-attributable mortality can inform public health efforts.MethodsWe evaluated 46956 PWHIV receiving ART in North American HIV cohorts (1995-2009). Using information on incident cancers and deaths, we calculated population-attributable fractions (PAFs), estimating the proportion of deaths due to cancer. Calculations were based on proportional hazards models adjusted for age, sex, race, HIV risk group, calendar year, cohort, CD4 count, and viral load.ResultsThere were 1997 incident cancers and 8956 deaths during 267145 person-years of follow-up, and 11.9% of decedents had a prior cancer. An estimated 9.8% of deaths were attributable to cancer (cancer-attributable mortality rate 327 per 100000 person-years). PAFs were 2.6% for AIDS-defining cancers (ADCs, including non-Hodgkin lymphoma, 2.0% of deaths) and 7.1% for non-AIDS-defining cancers (NADCs: lung cancer, 2.3%; liver cancer, 0.9%). PAFs for NADCs were higher in males and increased strongly with age, reaching 12.5% in PWHIV aged 55+ years. Mortality rates attributable to ADCs and NADCs were highest for PWHIV with CD4 counts

While infrequent, cerebrospinal fluid (CSF) leaks are known to occur after surgical resection of vestibular schwannomas. Early signs of CSF leak often include headache and altered mental status. If untreated, life-threatening complications can occur, including brainstem herniation and meningitis. The appropriate surgical treatment for a CSF leak requires accurate localization of the source. While the most likely location of a CSF leak after lateral skull base surgery is through the aerated portions of the temporal bone, we present a unique case of a man with a prolonged CSF leak after an acoustic tumor removal who was ultimately found to have an occult spinal perineural (Tarlov) cyst as the source. Accurate localization was ultimately achieved with CT myelogram after empirically obliterating his mastoid failed to restore intracranial CSF volume. Tarlov cysts are the most common cause of idiopathic intracranial hypotension, and this case highlights the importance of considering this entity in the differential diagnosis of postoperative CSF leaks.

A logic model was developed based on an analysis of the 2012 American School Counselor Association (ASCA) National Model in order to provide direction for program evaluation initiatives. The logic model identified three outcomes (increased student achievement/gap reduction, increased school counseling program resources, and systemic change and school improvement), seven outputs (student change, parent involvement, teacher competence, school policies and processes, competence of the school counselors, improvements in the school counseling program, and administrator support), six major clusters of activities (direct services, indirect services, school counselor personnel evaluation, program management processes, program evaluation processes and program advocacy) and two inputs (foundational elements and program resources). The identification of these logic model components and linkages among these components was used to identify a number of necessary and important evaluation studies of the ASCA National Model.

This study examines the convergent validity and divergent validity of the Student Engagement in School Success Skills (SESSS) survey. The SESSS is easy to administer (it takes fewer than 15 minutes to complete) and is used in schools to provide educators with useful information about students' use of skills and strategies related to school success. A total of 4,342 fifth graders completed the SESSS; the Motivated Strategies for Learning Questionnaire (MSLQ) Cognitive Strategy Use, Self-Regulation, Self-Efficacy and Test Anxiety subscales; and the Self-Efficacy for Self-Regulated Learning (SESRL). The three subscales of the SESSS (Self-Direction of Learning, Support of Classmates' Learning and Self-Regulation of Arousal) correlated highly with the MSLQ Cognitive Strategy Use and Self-Regulation subscales, moderately correlated with the Self-Efficacy subscale and the SESRL, and did not correlate with the MSLQ Test Anxiety subscale. Future research is needed to use the SESSS subscales as discriminable dimensions.

This manuscript details the development and exploratory factor analysis of a United States' version of the "International Survey of School Counselors' Activities" (ISSCA-US), a 42-item instrument that identifies activities of school counselors. Responses were collected from 390 US school counselors. Separate EFAs were conducted for two distinct sections of the survey involving appropriateness of role activities and their actually being undertaken, both resulting in reliable 6-factor models.

Objective: To describe the features of antecedent head trauma in patients with superior canal dehiscence syndrome (SCDS). Study Design: Cross‐sectional survey. Setting: Tertiary referral center. Methods: An online survey was sent to 450 adult patients who underwent surgical repair for SCDS patients asking questions about the nature of internal or external traumatic events preceding symptoms. Results: One‐hundred and thirty‐six patients (avg. age, 51.9 years, 62.8% female) completed the survey, of which 61 (44.9%) described either preceding external head trauma (n = 35, 26%), preceding internal pressure event (n = 33, 25%), or both (8, 6%). Of those endorsing external trauma, 22 (63%) described a singular event (head hit by object (n = 8); head hit ground (n = 5); motor vehicle accident (n = 4); assault (n = 2); other (n = 3). One‐third experienced loss of consciousness because of the trauma. For those describing internal pressure events (n = 33), the most common events were heavy physical exertion (9, 27%); pressure changes while flying (6, 18%); coughing, nose blowing with illness (5, 15%); childbirth (5, 15%); and self contained underwater breathing apparatus diving events (3, 9%). The interval between trauma and onset of symptoms averaged 5.6 years (SD, 10.7 years). One‐third (n = 19) described onset of symptoms immediately after the external trauma or internal pressure event. Symptoms began on the side ipsilateral to the trauma in 91%. Sound‐ and pressure‐induced vertigo/oscillopsia developed more commonly after external trauma versus internal pressure events (68% and 61% vs 44% and 32%, respectively). Conclusion: Trauma or internal pressure‐related events precede SCDS symptoms in nearly half of cases, with roughly half of preceding events being external. [ABSTRACT FROM AUTHOR]