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A regulated stress response is essential for healthy child growth and development trajectories. We conducted a cluster-randomized trial in rural Bangladesh (funded by the Bill & Melinda Gates Foundation, ClinicalTrials.gov NCT01590095) to assess the effects of an integrated nutritional, water, sanitation, and handwashing intervention on child health. We previously reported on the primary outcomes of the trial, linear growth and caregiver-reported diarrhea. Here, we assessed additional prespecified outcomes: physiological stress response, oxidative stress, and DNA methylation (N = 759, ages 1-2 years). Eight neighboring pregnant women were grouped into a study cluster. Eight geographically adjacent clusters were block-randomized into the control or the combined nutrition, water, sanitation, and handwashing (N + WSH) intervention group (receiving nutritional counseling and lipid-based nutrient supplements, chlorinated drinking water, upgraded sanitation, and handwashing with soap). Participants and data collectors were not masked, but analyses were masked. There were 358 children (68 clusters) in the control group and 401 children (63 clusters) in the intervention group. We measured four F2-isoprostanes isomers (iPF(2α)-III; 2,3-dinor-iPF(2α)-III; iPF(2α)-VI; 8,12-iso-iPF(2α)-VI), salivary alpha-amylase and cortisol, and methylation of the glucocorticoid receptor (NR3C1) exon 1F promoter including the NGFI-A binding site. Compared with control, the N + WSH group had lower concentrations of F2-isoprostanes isomers (differences ranging from -0.16 to -0.19 log ng/mg of creatinine, P

Background: Understanding teachers' experiences throughout the school closures and reopenings that have characterized large periods of the COVID-19 pandemic provides us with unique insights into what it means to be a teacher during a global public health crisis. Aim and Method: To investigate teachers' narratives of their experiences, we conducted 95 semi-structured interviews with 24 teachers in England across four time points between April and November 2020. We used a longitudinal qualitative trajectory analysis of participants' stories of their high-, low- and turning-points. Results: We derived four themes that were evident at each time point and developed over time. The themes were: (1) "growing frustration at uncertainties caused by poor government leadership," (2) "expanding concern for pupil learning and well-being," (3) "an increasingly labour-intensive and exhausting job" and (4) "declining pleasure and pride in being a teacher." Conclusions: The findings shed light on the impact of COVID-19 on the professional identity of these teachers and we propose ways in which teachers can be supported now and in the future.

Background: Teaching and caring for pupils during the COVID-19 pandemic has been a challenge for many teachers, and its impact on teachers' mental health and well-being (MHWB) should be of great national and international concern. Aim and participants: This study examines 24 primary and secondary school teachers' MHWB experiences across three time points (April, July, and November 2020) using longitudinal qualitative trajectory analysis. Method: We used a mixture of inductive and deductive coding, based on the Job Demands-Resources Model, to identify the job demands (aspects of the job that can be physically or psychologically costly) and job resources (aspects of the job that can buffer the effects of job demands and promote achievement and growth) teachers reported experiencing across the three time points. Results: Generally, teachers' MHWB seemed to have declined throughout the pandemic, especially for primary school leaders. Six job demands contributed negatively to teachers' MHWB (i.e., uncertainty, workload, negative perception of the profession, concern for others' well-being, health struggles, and multiple roles) and three job resources contributed positively to their MHWB (i.e., social support, work autonomy, and coping strategies). Conclusions: Policymakers and practitioners can support teachers' MHWB by engaging in more collaborative communication and ensuring greater accessibility to sources of social support. These discussions and provisions will be crucial in supporting teachers, and thereby the educational system, both during and after the pandemic.

The rise of calcifying nannoplankton in the Late Triassic (237–201 Ma) had profound consequences for the carbonate buffering capacity of the ocean. Research on the appearance of calcification typically focuses on the reasons that made this process successful on a global scale. The underlying environmental and physiological conditions that led to its appearance, therefore, are still obscure. Here we show that the rise of intracellular calcification is intrinsically linked to cellular calcium metabolism and to the prevention of calcium accumulation in the cytoplasm. Using gene tree analysis, we present evidence that the physiological machinery for calcification was already present in non-calcifying ancestor cells. Additionally, by modelling the energy demands for calcium transport in calcifying and non-calcifying cells, we demonstrate that intracellular calcification does not require additional energy investments. Since all eukaryotic cells export calcium across the plasma membrane, our findings indicate that the onset of intracellular calcification in Earth’s history required only the activation of calcium transport proteins during their passage to the plasma membrane. Hence, intracellular calcification could have occurred at any time in the geological past because physiological preconditions were already present, but a combination of favourable environmental factors may have helped calcifying nannoplankton to spread at the beginning of the Mesozoic, a time of catastrophic climate changes and mass extinctions that reshuffled life on Earth.

Research indicates that teachers perform emotional labor daily. However, previous studies have mostly used a variable-centered approach that examines the associations of emotional labor strategies with particular outcome variables. This approach did not consider the possibility that teachers use different emotional labor strategies simultaneously. Therefore, in this study we took a person-centered approach and explored the emotional labor profiles in a large sample of Croatian teachers (N = 2,002) employed across educational levels (i.e., elementary, middle, and high school levels) by using latent profile analysis. In addition, we examined differences among profiles regarding teachers' positive affect, self-efficacy, work engagement, and job satisfaction. Results indicated the existence of six emotional labor profiles that were characterized by different combinations of deep acting, hiding feelings, and faking emotions. Profiles of teachers who dominantly rely on deep acting had the most adaptive patterns of analyzed outcomes, whereas profiles of teachers who reported higher levels of hiding feelings, regardless the level of deep acting, exhibited less desirable levels of positive affect, self-efficacy, work engagement, and job satisfaction.

Background: Many countries around the world imposed nationwide school closures to manage the spread of COVID-19. England closed its schools for most pupils in March 2020 and prepared to reopen schools to certain year groups in June 2020. Understanding teachers' lived experiences at this time of educational disruption is important, shedding light on challenges faced and support needed by schools and teachers in the event of further disruption. Purpose: The research reported here represents the second timepoint in a longitudinal study investigating what it was like being a teacher in England during the pandemic. Our aim was to better understand teachers' experiences at a time of partial reopening of schools in mid-June 2020. Method: We used the framework of Self-Determination Theory to explore challenges to teachers' basic psychological needs for autonomy, competence and relatedness. A total of 24 primary and secondary state school teachers from 20 schools across England were interviewed and asked to tell stories of a low point, a high point and a turning point. A reflexive thematic analysis, using a mix of inductive and deductive coding, was conducted. Findings: Six themes were identified in the data: "uncertainty," "practical concerns," "worry for pupils," "importance of relationships," "teacher identity," and "reflections." Challenging their basic need for autonomy and competence, teachers were anxious about current and future uncertainties while navigating school reopenings. Challenging their basic need for relatedness, teachers described the importance of connecting with pupils and their families, and with colleagues. Lastly, teachers searched for holistic meaning, evaluating what it means to be a teacher and reflecting on how these circumstances have affected their personal and professional lives. Conclusions: Our analysis of teachers' experiences provides insight into how teachers' psychological needs for autonomy, competence and relatedness have been challenged. It highlights the importance of supporting teachers to feel autonomous, competent and connected with colleagues, pupils and their families. Such support is likely to be beneficial to teachers' wellbeing and their commitment to the profession, now and in the future.

Background: The translation of genomic discoveries to the clinic is the cornerstone of precision medicine. However, incorporating next generation sequencing (NGS) of hematologic malignancies into clinical management remains limited. Methods: We describe 235 patients who underwent integrated NGS profiling (406 genes) and analyze the alterations and their potential actionability. Results: Overall, 227 patients (96.5%) had adequate tissue. Most common diagnoses included myelodysplastic syndrome (22.9%), chronic lymphocytic leukemia (17.2%), non-Hodgkin lymphoma (13.2%), acute myeloid leukemia (11%), myeloproliferative neoplasm (9.2%), acute lymphoblastic leukemia (8.8%), and multiple myeloma (7.5%). Most patients (N = 197/227 (87%)) harbored ≥1 genomic alteration(s); 170/227 (75%), ≥1 potentially actionable alteration(s) targetable by an FDA-approved (mostly off-label) or an investigational agent. Altogether, 546 distinct alterations were seen, most commonly involving TP53 (10.8%), TET2 (4.6%), and DNMT3A (4.2%). The median tumor mutational burden (TMB) was low (1.7 alterations/megabase); 12% of patients had intermediate or high TMB (higher TMB correlates with favorable response to anti-PD1/PDL1 inhibition in solid tumors). In conclusion, 96.5% of patients with hematologic malignancies have adequate tissue for comprehensive genomic profiling. Most patients had unique molecular signatures, and 75% had alterations that may be pharmacologically tractable with gene- or immune-targeted agents.

Background: The translation of genomic discoveries to the clinic is the cornerstone of precision medicine. However, incorporating next generation sequencing (NGS) of hematologic malignancies into clinical management remains limited. Methods: We describe 235 patients who underwent integrated NGS profiling (406 genes) and analyze the alterations and their potential actionability. Results: Overall, 227 patients (96.5%) had adequate tissue. Most common diagnoses included myelodysplastic syndrome (22.9%), chronic lymphocytic leukemia (17.2%), non-Hodgkin lymphoma (13.2%), acute myeloid leukemia (11%), myeloproliferative neoplasm (9.2%), acute lymphoblastic leukemia (8.8%), and multiple myeloma (7.5%). Most patients (N = 197/227 (87%)) harbored ≥1 genomic alteration(s); 170/227 (75%), ≥1 potentially actionable alteration(s) targetable by an FDA-approved (mostly off-label) or an investigational agent. Altogether, 546 distinct alterations were seen, most commonly involving TP53 (10.8%), TET2 (4.6%), and DNMT3A (4.2%). The median tumor mutational burden (TMB) was low (1.7 alterations/megabase); 12% of patients had intermediate or high TMB (higher TMB correlates with favorable response to anti-PD1/PDL1 inhibition in solid tumors). In conclusion, 96.5% of patients with hematologic malignancies have adequate tissue for comprehensive genomic profiling. Most patients had unique molecular signatures, and 75% had alterations that may be pharmacologically tractable with gene- or immune-targeted agents.

The COVID-19 pandemic has challenged many assumptions underlying education, including those related to the qualities that are most essential to being an effective teacher. We interviewed 23 state primary and secondary school teachers about what makes a great teacher during a pandemic. Two themes were identified: "caring for pupil wellbeing," and "dealing with uncertainty." Teachers reported that the need to demonstrate these qualities, while always important, has intensified during COVID-19. These findings indicate that teacher education and professional development programmes may benefit from recognising and assisting teachers to develop these qualities.

Background: On 20 March 2020, in response to COVID-19, UK schools were closed to most pupils. Teachers were required to put remote teaching and learning in place with only two days' notice from the government. Aims: The current study explores teachers' experiences of this abrupt change to their working practices, and during the 5-6 weeks that followed. Sample: Twenty-four teachers from English state schools were interviewed, representing mainstream primary and secondary schools and a range of years of experience and seniority. Methods: Participants were asked to tell stories of three key scenes during the first 5-6 weeks of lockdown: a low point, a high point, and a turning point. A reflexive thematic analysis of their narratives was conducted. Results and Conclusions: Six themes were identified: "uncertainty," "finding a way," "worry for the vulnerable," "importance of relationships," "teacher identity," and "reflections." Teachers' narratives suggest that, after an initial period of uncertainty they settled into the situation and found a way forward, supported by strong relationships. However, they remain extremely worried about the most vulnerable pupils and want more joined-up thinking from the government on how to support them effectively, along with clarity from policymakers to enable planning ahead. Teachers reflected on how to use their learning during this period to improve pupils' experiences of education post-COVID-19, and on how aspects of shared teacher identity have worked as stressors and coping mechanisms. These initial interviews form the baseline for a longitudinal interview study of teachers' experiences of COVID-19 in England.

It is often assumed that low levels of teacher self-efficacy (TSE) leads to negative outcomes, including burnout; however, the temporal order of the construct predictions has rarely been examined. We used an autoregressive cross-lagged panel design to examine whether TSE and burnout are concurrently associated with each other, whether TSE predicts future burnout levels, and/or whether burnout predicts future TSE levels. An initial sample of 3,002 Croatian teachers (82% female) from across three educational levels (i.e., elementary, middle, and secondary schools) with varying years of teaching experiences (M=15.28, SD=10.50) completed questionnaires on their levels of TSE and burnout (exhaustion and disengagement) at 3 time points (at approximately 6-month intervals). We found that burnout has a more prominent role in predicting future levels of TSE than TSE does in predicting future levels of burnout. These findings challenge the theoretical and empirical conceptualizations assuming that TSE is a predictor of burnout. Policies and interventions that focus on decreasing teacher burnout rather than increasing TSE levels may be best.

As a function of the driving strength, a degenerate parametric oscillator exhibits an instability at which spontaneous oscillations occur. Close to threshold, both the nonlinearity as well as fluctuations are vital to the accurate description of the dynamics. We study the statistics of the adiation that is emitted by the degenerate parametric oscillator at threshold. For a weak nonlinearity, we can employ a quasiclassical description. We identify a universal Liouvillian that captures the relevant long-time dynamics for large photon-numbers. We find that the cumulants obey a universal power-law scaling as a function of the nonlinearity. The Fano factor shows a maximum close, but not coinciding, with the threshold. Moreover, we predict a certain ratio of the first three cumulants to be independent of the microscopic details of the system and connect the results to experimental platforms.

BackgroundInappropriate antimicrobial use can threaten patient safety and is the focus of collaborative physician and pharmacist antimicrobial stewardship teams. However, antimicrobial stewardship is not comprehensively taught in medical or pharmacy school curricula. Addressing this deficiency can teach an important concept as well as model interprofessional healthcare.MethodsWe created an antimicrobial stewardship curriculum consisting of an online learning module and workshop session that combined medical and pharmacy students, with faculty from both professions. Learners worked through interactive, branched-logic clinical cases relating to appropriate antimicrobial use. We surveyed participants before and after the curriculum using validated questions to assess knowledge and attitudes regarding antimicrobial stewardship and interprofessional collaboration. Results were analyzed using paired χ2 and t tests and mixed-effects logistic regression.ResultsAnalysis was performed with the 745 students (425 medical students, 320 pharmacy students) who completed both pre- and postcurriculum surveys over 3 years. After completing the curriculum, significantly more students perceived that they were able to describe the role of each profession in appropriate antimicrobial use (34% vs 82%, P < .001), communicate in a manner that engaged the interprofessional team (75% vs 94%, P < .001), and describe collaborative approaches to appropriate antimicrobial use (49% vs 92%, P < .001). Student favorability ratings were high for the online learning module (85%) and small group workshop (93%).ConclusionsA curriculum on antimicrobial stewardship consisting of independent learning and an interprofessional workshop significantly increased knowledge and attitudes towards collaborative antimicrobial stewardship among preclinical medical and pharmacy students.

The question of what makes a good teacher has been asked by practitioners, policymakers, and researchers for decades. However, there is no guiding framework about which qualities are important for teachers. Thus, it is necessary to examine these qualities using a recognized framework and to summarize the previous literature on this topic. We conducted a meta-analysis on the 25 studies (total N = 6294) reporting the relationships between teacher Big Five personality domains (openness, conscientiousness, extraversion, agreeableness, and emotional stability) and two teacher job-related outcomes (i.e., teacher effectiveness and burnout). Furthermore, the influence of three moderators was assessed, namely, the type of teacher effectiveness measure (i.e., evaluations of teaching, student performance self-efficacy, classroom observation, and academic achievement), source of personality report (i.e., self-report vs other-report), and the instructed educational level (i.e., elementary, secondary, and tertiary). Overall, teacher Big Five domains (except for agreeableness) were positively associated with teacher effectiveness, especially for evaluations of teaching. Furthermore, teacher emotional stability, extraversion, and conscientiousness were negatively associated with burnout. Other-reports of teacher personality were more strongly associated with outcomes than self-reports. There were no differences in the strength of the associations between the educational levels. The need for using common descriptors in teacher research as well as practical implications of the findings for teacher personality measurement is discussed.

Background: Instructors are under pressure to produce excellent outcomes in students. Although the contribution of "student" personality on student outcomes is well established, the contribution of "instructor" personality to student outcomes is largely unknown. Aim: This study examined the influence of instructor personality (as reported by both students and instructors themselves) on student educational outcomes at university. Sample and method: Mathematics and psychology university students (N = 515) and their instructors (n = 45) reported their personality under the Big Five framework. Results: Multilevel regressions were conducted to predict each outcome from instructor personality, taking into account the effects of student gender, age, cognitive ability, and personality, as well as instructor gender and age. Student-reports of instructor personality predicted student evaluations of teaching but not performance self-efficacy or academic achievement. Instructor self-reports did not predict any of the outcomes. Stronger associations between student-reports and the outcomes than instructor self-reports could be explained by students providing information on both the predictor and the outcome variables, as well as a greater number of raters providing information on instructor personality. Different domains of the instructor Big Five were important for different element of student evaluations of teaching. Conclusions: The study highlights the importance of studying instructor personality, especially through other-reports, to understand students' educational experiences. This has implications for how tertiary institutions should use and interpret student evaluations.