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The COVID-19 pandemic impacted school-based delivery of special educational supports and therapeutic services. This study describes student receipt of school-based supports/services and parent satisfaction by instruction modalities during the 2020-2021 academic year in the United States. Data were collected through the COVID Experiences Survey from parents of children ages 5-12 years, administered using NORC's AmeriSpeak panel. Most parents reported satisfaction with supports (88.4%) and services (93.2%). Dissatisfaction with special education supports and therapeutic services was more common among parents whose children received supports/ services virtually than in person (special educational supports: aOR=12.00, 95% CI [1.49-96.89], p=0.020; therapeutic services: aOR=15.76, 95% CI [1.01-245.40], p=0.049). These findings suggest opportunities to improve design and delivery of online special education supports and therapeutic services as well as emergency preparedness by considering the needs of students with disabilities and their families.

Authorship and dissemination policies vary across NIH research consortia. We aimed to describe elements of real-life policies in use by eligible U01 clinical research consortia. Principal investigators of eligible, active U01 clinical research projects identified in the NIH Research Portfolio Online Reporting Tools database shared relevant policies. The characteristics of key policy elements, determined a priori, were reviewed and quantified, when appropriate. Twenty one of 81 research projects met search criteria and provided policies. K elements (e.g., in quotations): manuscript proposals reviewed and approved by committee (90%); guidelines for acknowledgements (86%); writing team formation (71%); process for final manuscript review and approval (71%), responsibilities for lead author (67%), guidelines for other types of publications (67%); draft manuscript review and approval (62%); recommendation for number of members per consortium site (57%); and requirement to identify individual contributions in the manuscript (19%). Authorship/dissemination policies for large team science research projects are highly variable. Creation of an NIH policies repository and accompanying toolkit with model language and recommended key elements could improve comprehensiveness, ethical integrity, and efficiency in team science work while reducing burden and cost on newly funded consortia and directing time and resources to scientific endeavors.

In the Maximize Project, we are engaging in a research-practice partnership to co-create implementation strategies to facilitate elementary school teachers' use of equity-focused positive behavior supports (EF-PBS). In this paper, we describe the processes used to build an interactive, technology-based platform to enhance teachers' use of EF-PBS via self-reflection, self-assessment, goal setting, and goal review. We describe how we established a multi-disciplinary, multi-state community advisory board to collaborate on Version 1 of platform (Phase 1). We explain how we obtained quantitative and qualitative feedback about the platform from educators in three partnering schools, and how we used those data to produce Version 2 of the platform (Phase 2). Platform use data suggested high utilization in Quarter 1 (August-October) of the school year, when there was protected time to complete activities. However, platform use was moderate in Quarter 2 (October-December) and low in Quarters 3 and 4 (January-May). Educator feedback revealed moderate acceptability, feasibility, and appropriateness of the platform and highlighted ways to improve the user experience (e.g., streamlining steps in goal setting, making resources about strategy implementation easier to find). We discuss lessons learned to inform school mental health co-creation endeavors, including strategies for supporting diverse perspectives, for enhancing advisory board members' voices and confidence, and for creating practical and feasible methods for teachers to benefit from co-created technology-based implementation strategies. Our processes offer guidance for others engaging in research-practice partnerships, developing education technologies and/or supporting teachers' use of equity-focused practices to improve daily school experiences for all students.

Although neurobiologic and genetic factors figure prominently in the development of attention deficit/hyperactivity disorder (ADHD), adverse physical health experiences and conditions encountered during childhood may also play a role. Poor health is known to impact the developing brain with potential lifelong implications for behavioral issues. In attempt to better understand the relationship between childhood physical health and the onset and presence of ADHD symptoms, we summarized international peer-reviewed articles documenting relationships between a select group of childhood diseases or health events (e.g., illnesses, injuries, syndromes) and subsequent ADHD outcomes among children ages 0-17 years. Drawing on a larger two-phase systematic review, 57 longitudinal or retrospective observational studies (1978-2021) of childhood allergies, asthma, eczema, head injury, infection, or sleep problems and later ADHD diagnosis or symptomatology were identified and subjected to meta-analysis. Significant associations were documented between childhood head injuries, infections, and sleep problems with both dichotomous and continuous measures of ADHD, and between allergies with dichotomous measures of ADHD. We did not observe significant associations between asthma or eczema with ADHD outcomes. Heterogeneity detected for multiple associations, primarily among continuously measured outcomes, underscores the potential value of future subgroup analyses and individual studies. Collectively, these findings shed light on the importance of physical health in understanding childhood ADHD. Possible etiologic links between physical health factors and ADHD are discussed, as are implications for prevention efforts by providers, systems, and communities.

Parenting and family environment have significant impact on child development, including development of executive function, attention, and self-regulation, and may affect the risk of developmental disorders including attention-deficit/hyperactivity disorder (ADHD). This paper examines the relationship of parenting and family environment factors with ADHD. A systematic review of the literature was conducted in 2014 and identified 52 longitudinal studies. A follow-up search in 2021 identified 7 additional articles, for a total of 59 studies that examined the association of parenting factors with ADHD outcomes: ADHD overall (diagnosis or symptoms), ADHD diagnosis specifically, or presence of the specific ADHD symptoms of inattention and hyperactivity/impulsivity. For parenting factors that were present in three or more studies, pooled effect sizes were calculated separately for dichotomous or continuous ADHD outcomes, accounting for each study's conditional variance. Factors with sufficient information for analysis were parenting interaction quality (sensitivity/warmth, intrusiveness/reactivity, and negativity/harsh discipline), maltreatment (general maltreatment and physical abuse), parental relationship status (divorce, single parenting), parental incarceration, and child media exposure. All factors showed a significant direct association with ADHD outcomes, except sensitivity/warmth which had an inverse association. Parenting factors predicted diagnosis and overall symptoms as well as inattentive and hyperactive symptoms when measured, but multiple factors showed significant heterogeneity across studies. These findings support the possibility that parenting and family environment influences ADHD symptoms and may affect a child's likelihood of being diagnosed with ADHD. Prevention strategies that support parents, such as decreasing parenting challenges and increasing access to parent training in behavior management, may improve children's long-term developmental health.

Attention-deficit/hyperactivity disorder (ADHD) is characterized by persistent patterns of inattention, hyperactivity, and impulsiveness. Among US children and adolescents aged 3-17 years, 9.4% have a diagnosis of ADHD. Previous research suggests possible links between parental substance use and ADHD among children. We conducted a systematic review and meta-analysis of 86 longitudinal or retrospective studies of prenatal or postnatal alcohol, tobacco, or other parental substance use and substance use disorders and childhood ADHD and its related behavioral dimensions of inattention and hyperactivity-impulsivity. Meta-analyses were grouped by drug class and pre- and postnatal periods with combined sample sizes ranging from 789 to 135,732. Prenatal exposure to alcohol or tobacco and parent substance use disorders were consistently and significantly associated with ADHD among children. Other parental drug use exposures resulted in inconsistent or non-significant findings. Prevention and treatment of parental substance use may have potential for impacts on childhood ADHD.

Abstract Participant management in a lung cancer screening (LCS) depends on the assigned Lung Imaging Reporting and Data System (Lung-RADS) category, which is based on reliable detection and measurement of pulmonary nodules. The aim of this study was to compare the agreement of two AI-based software tools for detection, quantification and categorization of pulmonary nodules in an LCS program in Northern Germany (HANSE-trial). 946 low-dose baseline CT-examinations were analyzed by two AI software tools regarding lung nodule detection, quantification and categorization and compared to the final radiologist read. The relationship between detected nodule volumes by both software tools was assessed by Pearson correlation (r) and tested for significance using Wilcoxon signed-rank test. The consistency of Lung-RADS classifications between Software tool 1 (S1, Aview v2.5, Coreline Soft, Seoul, Korea) and Software tool 2 (S2, Prototype ‘’ChestCTExplore’’, software version ToDo, Siemens Healthineers, Forchheim, Germany) was evaluated by Cohen’s kappa (κ) and percentual agreement (PA).The derived volumes of true positive nodules were strongly correlated (r > 0.95), the volume derived by S2 was significantly higher than by S1 (P

Abstract: Introduction: Physical activity (PA) shows beneficial effects for various mental illnesses, but exercise-prescription has not yet become routine practice in psychiatry. Therefore, this survey addresses attitudes and barriers towards exercise-prescription in health professionals. Methods: We conducted an anonymous online survey among health professionals on the importance of PA in prevention and treatment of mental illness and perceived barriers as part of a larger survey on sports psychiatry. The survey was promoted by societies for sports psychiatry. Results: N = 310 health professionals from Switzerland (86.5%) and other countries responded to the online survey. Sixty percent were physicians (51.1% psychiatrists). Most respondents strongly agreed that PA plays an important role in prevention and treatment of mental (80.2%, 69.8%) and physical (84.5%, 72.0%) illness. Forty-six percent use PA in prevention and 59.4% in treatment of mental illness with lower proportions for physical illness (39.5%, 36.2%). Most mentioned barriers to the use of PA were “insufficient possibilities” in psychiatric institutions (34.8%) and “no reimbursement” (41.9%) in private practice. Participants working in private practice rated barriers in practice significantly higher than those from other workplaces. “No motivation” was found to be the most common barrier for patients (56.5%). PA was used most often for depression (39.5%) followed by substance use disorders (32.1%) and anxiety disorders (30.9%). Conclusions: Health professionals in Switzerland and some extent other European countries show a positive attitude towards the use of PA in mental illness. Current barriers, especially reimbursement in private practice should be addressed to improve prescription-rates of PA.

This mixed-methods study examined how WiseGuyz, a gender-transformative healthy relationships program, can support positive sexual health self-efficacy (SHSE) among adolescents. 570 adolescent boys provided data on SHSE from before to after the program, and 20 adolescent boys participated in interviews and focus groups to discuss their sexual health education needs. Results showed that boys who participated in WiseGuyz reported a significant increase in SHSE from pretest to post-test and that WiseGuyz was different from typical school-based sexual health education in terms of content and facilitation and increasing program engagement. These findings indicate the potential for gender-transformative interventions in supporting positive SHSE.

INTRODUCTION 1956 I. THE DELEGATIONS AND THEIR ELABORATIONS 1959 A. Early Statutes and Institutional Foundations 1960 B. The Statutory Free-Trade and Security Dichotomy 1964 II. CONSTITUTIONALIZING PRESIDENTIAL CONTROL OF 1968 [...], The U.S. Constitution grants Congress the power "[t]o regulate Commerce with foreign Nations," but today the exercise of the foreign commerce power resides primarily with the executive branch. That transfer of control is partly the result of significant delegations of responsibility for managingforeign commerce from Congress to the executive. It is also, however, the result of the securitization of foreign commerce. The executive branch asserts that foreign commerce issues fall under its constitutional powers over foreign affairs, and, thus, that it enjoys authority over foreign commerce that exceeds the scope of congressional delegations. This Article makes three contributions. First, we analyze the development of a trade administrative state charged with managing two sets of broad delegations: to liberalize trade, on the one hand, and to restrict it in the name of "economic security" when the executive deems necessary. Second, we document the way in which the executive branch in recent presidential administrations of both parties has defended those administrations' trade policies in court by arguing that the president's independent constitutional powers over (noncommercial) foreign affairs give him license to exercise power over commerce beyond that delegated by Congress, or that congressional delegations should be construed in his favor. The courts, for their part, have often accepted these claims either directly or indirectly. Third, we propose three statutory reforms that Congress could pass to restore balance to the branches' regulation of foreign commerce: (1) Congress should sunset the president's imposition of tariffs or other trade restrictions pursuant to economic security statutes after 90 or 180 days without the possibility of renewal unless Congress acts; (2) Congress should prohibit the executive branch from relying on any international agreement as the legal basis under which any good or service is imported into the United States, exported from the United States, or regulated while in the United States, unless Congress has either explicitly authorized the agreement in advance or approved it after its conclusion; and (3) Congress should eliminate the Federal Circuit's exclusive jurisdiction over appeals in most trade cases.

Abstract WingAnalogy is a computer tool for automated insect wing morphology and asymmetry analysis. It facilitates project management, enabling users to import pairs of wing images obtained from individual insects, such as left and right, fore- and hindwings. WingAnalogy employs image processing and computer vision to segment wing structures and extract cell boundaries, and junctions. It quantifies essential metrics encompassing cell and wing characteristics, including area, length, width, circularity, and centroid positions. It enables users to scale and superimpose wing images utilizing Particle Swarm Optimization (PSO). WingAnalogy computes regression, Normalized Root Mean Square Error (NRMSE), various cell-based parameters, and distances between cell centroids and junctions. The software generates informative visualizations, aiding researchers in comprehending and interpreting asymmetry patterns. WingAnalogy allows for dividing wings into up to five distinct wing cell sets, facilitating localized comparisons. The software excels in report generation, providing detailed asymmetry measurements in PDF, CSV, and TXT formats.

Claus F Vogelmeier,1 Kai-Michael Beeh,2 Michael Schultze,3 Nils Kossack,4 Lena M Richter,4 Jing Claussen,5 Chris Compton,6 Stephen G Noorduyn,7,8 Afisi S Ismaila,8,9 Gema Requena10 1Department of Medicine, Pulmonary and Critical Care Medicine, University Medical Centre Giessen and Marburg, Philipps-University Marburg, German Center for Lung Research (DZL), Marburg, Germany; 2Insaf Respiratory Research Institute, Wiesbaden, Germany; 3ZEG – Berlin Center for Epidemiology and Health Research GmbH, Berlin, Germany; 4WIG2 GmbH (Wissenschaftliches Institut für Gesundheitsökonomie und Gesundheitssystemforschung) - Scientific Institute for Health Economics and Health System Research, Leipzig, Germany; 5Global Medical Affairs, GSK, Munich, Germany; 6Global Medical, GSK, Brentford, UK; 7Value Evidence and Outcomes, R&D Global Medical, GSK, Mississauga, ON, Canada; 8Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada; 9Value Evidence and Outcomes, R&D Global Medical, GSK, Collegeville, PA, USA; 10Value Evidence and Outcomes, R&D Global Medical, GSK, Brentford, UKCorrespondence: Gema Requena, GSK, 980 Great West Road, Brentford, Middlesex, TW8 9GS, UK, Tel +44 20 80476893, Email gema.x.requena@gsk.comPurpose: Triple therapy (long-acting muscarinic antagonist/long-acting β2-agonist/inhaled corticosteroid) is recommended for patients with chronic obstructive pulmonary disease (COPD) who experience recurrent exacerbations. Multiple-inhaler triple therapy (MITT) is associated with poor adherence and persistence. This study assessed comparative adherence and persistence to single-inhaler triple therapy (SITT) versus MITT among patients with COPD in a real-world setting in Germany.Patients and Methods: This retrospective analysis using the WIG2 benchmark database identified patients with COPD newly initiating triple therapy with MITT or SITT (fluticasone furoate/umeclidinium/vilanterol [FF/UMEC/VI] or formoterol/beclomethasone/glycopyrronium bromide [FOR/BDP/GLY]) November 2017–June 2019. Eligible patients were ≥ 35 years with 1 year’s continual insurance prior to triple therapy initiation and no previous record of triple therapy. Inverse probability of treatment weighting was used to balance baseline characteristics. Adherence was measured using proportion of days covered (PDC) at 6, 12, and 18 months post-treatment initiation; persistence (time until treatment discontinuation) was measured at 6, 12, and 18 months, with a gap of > 30 days used to define non-persistence.Results: Of 5710 patients included in the analysis (mean age 66 years), 71.4% initiated MITT and 28.6% initiated SITT (FF/UMEC/VI: 41.4%; FOR/BDP/GLY: 58.6%). Mean PDC was higher among SITT versus MITT users at all time points; at each time point, mean PDC was highest among FF/UMEC/VI users. During the first 6 months following treatment initiation, higher adherence was exhibited by FF/UMEC/VI (29%) and FOR/BDP/GLY (19%) users versus MITT users. Over the entire observation period, FF/UMEC/VI users had the highest proportion of persistent patients; at 18 months, 16.5% of FF/UMEC/VI users were persistent versus 2.3% of MITT users.Conclusion: Patients initiating SITT in Germany had significantly higher adherence and persistence compared with patients initiating MITT over 6 to 18 months following treatment initiation. Among SITT, FF/UMEC/VI users had the highest proportion of adherence and persistence.Keywords: comparative, multiple- or single-inhaler triple therapy, new-user, proportion of days covered, real-world analysis, treatment discontinuation

During the early Holocene to mid-Holocene, about 11 500 to 5500 years ago, lakes expanded across the Sahel and Sahara in response to enhanced summer monsoon precipitation. To investigate the effect of these lakes on the West African summer monsoon, previous simulation studies prescribed mid-Holocene lakes from reconstructions. By prescribing mid-Holocene lakes, however, the terrestrial water balance is inconsistent with the size of the lakes. In order to close the terrestrial water cycle, we construct a dynamic endorheic lake (DEL) model and implement it into the atmosphere–land model ICON-JSBACH4. For the first time, this allows us to investigate the dynamic interaction between climate, lakes, and vegetation across northern Africa. Additionally, we investigate the effect of lake depth changes on mid-Holocene precipitation, a neglected aspect in previous simulation studies. A pre-industrial control simulation shows that the DEL model realistically simulates the lake extent across northern Africa. Only in the Ahnet and Chotts basins is the lake area slightly overestimated, which is likely related to the coarse resolution of the simulations. The mid-Holocene simulations reveal that both the lake expansion and the vegetation expansion cause a precipitation increase over northern Africa. The sum of these individual contributions to the precipitation is, however, larger than the combined effect that is generated when lake and vegetation dynamics interact. Thus, the lake–vegetation interaction causes a relative drying response across the entire Sahel. The main reason for this drying response is that the simulated vegetation expansion cools the land surface more strongly than the lake expansion, which is dominated by the expansion of Lake Chad. Accordingly, the surface temperature increases over the region of Lake Chad and causes local changes in the meridional surface-temperature gradient. These changes in the meridional surface-temperature gradient are associated with reduced inland moisture transport from the tropical Atlantic into the Sahel, which causes a drying response in the Sahel. An idealized mid-Holocene experiment shows that a similar drying response is induced when the depth of Lake Chad is decreased by about 1–5 m, without changing the horizontal lake area. By reducing the depth of Lake Chad, the heat storage capacity of the lake decreases, and the lake warms faster during the summer months. Thus, in the ICON-JSBACH4 model, the lake depth significantly influences the simulated surface temperature and the simulated meridional surface-temperature gradient between the simulated lakes and vegetation, thereby affecting mid-Holocene precipitation over northern Africa.

Summary:. Modern approaches to autogenous auricular reconstruction involve a multistage approach where ear elevation is an independent procedure. The goal is to project the reconstructed ear at an anatomically accurate and symmetric auriculocephalic angle, but postoperative scar contraction may adversely affect the long-term outcomes. An ear elevation splint was developed to provide rigid support for the auricle during the acute healing period to promote lasting elevation. The splint is low cost, made from commonly used orthotic materials, and can be conveniently customized for each patient in less than 15 minutes.

Background: Evidence on how decisions regarding escalation to triple therapy and de- or re-escalation are taken and the rationale on which these decisions are based is currently limited in Germany. Objectives: The TETRIS study aims to elucidate influences on treatment decisions surrounding triple therapy in a real-world practice setting in Germany. Design: TETRIS is an ongoing, multicenter, prospective, observational cohort study recruiting patients with chronic obstructive pulmonary disease (COPD) with or without asthma who have already been treated with triple therapy for 2–48 weeks. Methods: For better representation of the treatment reality in Germany, patients are recruited from general practitioners and pulmonologists. Data are collected in two parts. Part 1 involves cross-sectional phenotyping of patients at enrollment. Part 2 involves a 2-year longitudinal follow-up period to monitor/document all visits by the patients during the 24-month observation period per routine clinical practice. Here, we report the demographic and baseline characteristics of 1213 eligible patients recruited to part 1 of the study. Results: The mean patient age was 66.4 years overall, and 29.3% (356/1213) of patients had no comorbidities. The mean CAT score was 19.4; the number of exacerbations and hospitalizations due to exacerbations in the past 3 years before starting triple therapy was 0.6 and 0.1, respectively. Dual bronchodilation with a long-acting muscarinic antagonist (LAMA) plus a long-acting β-2 agonist (LABA) was the most common therapy for COPD before initiation of triple therapy in 58.3% of patients. Conclusion: In this real-world setting in Germany, patients with COPD have a relatively low reported exacerbation rate but high symptom burden, and over 70% are multimorbid. Triple therapy is initiated in patients who are primarily highly symptomatic despite being on LAMA + LABA. Future prospective studies in patients with multimorbidity are warranted to better understand the treatment landscape across the disease spectrum. Trial registration: https://clinicaltrials.gov/study/NCT04657211