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Medical school curriculum integrates pre-clinical coursework with clinical experiences to impart understanding of pathophysiologic processes and requisite skills for future physicians. Evaluation through examinations measures students' knowledge and skills acquisition, while practice exam questions remain underexplored in studies on student study habits and exam performance. This study addresses the study habits, perceptions, and utilization of practice questions among first-year medical students (M1s). A survey conducted in 2023 revealed that a substantial proportion of students dedicate extensive time to independent study, with a majority expressing a strong preference for utilizing practice questions in their exam preparation. Notably, the survey findings underscored the perceived effectiveness of practice questions in assessing comprehension and identifying crucial content areas. Furthermore, students emphasized the value of practice questions that integrate and synthesize information across different curriculum blocks. The majority of students reported improved perceived performance on content accompanied by practice questions, highlighting the potential benefits of integrating these resources into medical school curricula. By understanding and supporting effective study strategies, educators can potentially mitigate student stress and enhance overall academic performance.

Artificial Intelligence (AI) has threatened higher education (HE). In doing so it has granted a portal that makes visible the dominant paradigm that has long defined what "intelligence" is and the narrow set of knowledges and literacies sanctioned for its pursuit. In this paper, we orient our thinking from this clarifying moment, asking: beyond these limits, what intelligences should educators value and nurture for sustainable and anti-colonial futures, and how might we support these through educational practices in HE? We also pause to reflect on the ways in which AI might move learners' pursuits of intelligence in more expansive directions. This orientation, we argue, provides a means to unsettle the hierarchies of intelligence that we live with/out, and a pathway to (re)direct AI's potential toward just and hopeful ends.

Background: Parents' conceptualizations of adulthood for their emerging adults with Down syndrome have the potential to impact the transition planning process as families prepare for life after graduation. Aims: This study aimed to explore parent perceptions of the meaning of adulthood for their emerging adults with Down syndrome. Methods: In this qualitative study, we interviewed 11 parents of emerging adults with Down syndrome using phenomenological methodology and analysed these data using thematic analysis. Results: Three topics emerged: (1) Parents' constructions of the meaning of adulthood; (2) Parents' perceptions about the transition to adulthood; and (3) Parents' perceptions of current adult life skills. Ten themes arose out of these topics. Conclusions: Parents expressed ambivalence about the meaning of adulthood for their emerging adults with Down syndrome, sharing that in some ways they were adults and in others they were not. The meaning of adulthood was closely tied to obtained skills, particularly those related to personal safety.

Abstract Background Though social determinants are the primary drivers of health, few studies of people living with HIV focus on non-clinical correlates of insecure and/or fragmented connections with the care system. Our team uses linked clinical and multisector non‐clinical data to study how residential mobility and connection to social services influence the HIV care continuum. We engage a diverse group of individuals living with HIV and other invested community members to guide and inform this research. Our objective is to generate consultant-informed, research-based interventions that are relevant to the community, and to share our engagement approach and findings so that other researchers can do the same. Methods Our research team partnered with the Indiana Clinical and Translational Sciences Institute’s Research Jam to develop and implement a human-centered design research plan to engage individuals with experience relevant to our research. We recruited a panel of consultants composed of people living with HIV and/or clinicians and individuals from agencies that provide medical and non-medical services to people living with HIV in Marion County, Indiana. To date, we have used a variety of human-centered design tools and activities to engage individuals during six sessions, with results informing our future engagement and research activities. Results Since the inception of the project, 48 consultants have joined the panel. Thirty-five continue to be actively engaged and have participated in one or more of the six sessions conducted to date. Consultants have helped guide and prioritize analyses, aided in identification of data missing from our ecosystem, helped interpret results, provided feedback on future interventions, and co-presented with us at a local health equity conference. Conclusions We utilize community engagement to expand the scope of our research and find that the process provides value to both consultants and the research team. Human-centered design enhances this partnership by keeping it person-centered, developing empathy and trust between consultants and researchers, increasing consultant retention, and empowering consultants to collaborate meaningfully with the research team. The use of these methods is essential to conduct relevant, impactful, and sustainable research. We anticipate that these methods will be important for academic and public health researchers wishing to engage with and integrate the ideas of community consultants.

IntroductionSocial prescribing (SP) is a holistic and collaborative approach to help individuals access community-based supports and services for their nonmedical social needs. The aim of this study was to assess the needs and priorities of Canadian older adults (aged 55 years and older), with a focus on optimizing SP programs for those who are systemically disadvantaged and socially marginalized. MethodsSemistructured focus groups (N = 10 groups, 43 participants) were conducted online via Zoom with participants from across Canada. Data transcription and thematic analysis were completed in NVivo. Analyses were informed by self-determination theory. ResultsOur results suggest that older adults desire SP programs that respect their ability to maintain their autonomy and independence, aid and facilitate the development of connectedness and belonging, are built on a foundation of trust and relationship-building in interactions with providers and link workers, and prioritize the person and thus personalize SP to the unique needs of each individual. ConclusionSP programs should be informed by the values of older adults. As work is currently underway to formalize and scale SP in Canada, personalizing these programs to the unique circumstances, needs and priorities of participants should be a top priority.

IntroductionLa prescription sociale est une approche holistique et collaborative qui vise à aider les individus à avoir accès aux mesures de soutien et aux services communautaires nécessaires pour combler leurs besoins sociaux non médicaux. Cette étude visait à évaluer les besoins et les priorités des aînés canadiens (55 ans et plus), en portant une attention particulière à l’optimisation des programmes de prescription sociale à l’intention des personnes qui sont systémiquement défavorisées et socialement marginalisées. MéthodologieDes groupes de discussion semi-structurés (N = 10 groupes, 43 participants) ont été organisés en ligne sur Zoom avec des participants de l’ensemble du Canada. La transcription des données et l’analyse thématique ont été réalisées à l’aide du logiciel NVivo. Les analyses s’appuient sur la théorie de l’autodétermination. RésultatsD’après nos résultats, les aînés souhaitent avoir accès à des programmes de prescription sociale qui respectent leur capacité à maintenir leur autonomie et leur indépendance; qui favorisent le développement de liens et d’un sentiment d’appartenance; qui sont fondés sur la confiance et l’établissement de relations solides dans les interactions avec les fournisseurs et les agents de liaison communautaires et qui donnent la priorité à la personne, personnalisant ainsi la prescription sociale en fonction des besoins spécifiques de chacun. ConclusionLes programmes de prescription sociale doivent être fondés sur les valeurs des aînés. Alors que des travaux sont actuellement en cours pour formaliser et étendre la prescription sociale au Canada, la personnalisation de ces programmes en fonction de la situation, des besoins et des priorités spécifiques des participants devrait être une priorité majeure.

Hemodynamic support in critically ill children with septic shock is a pervasive challenge in the intensive care settings. Cardiovascular involvement in sepsis entails both macro- and microcirculation abnormalities, with the main treatment objectives seeking to increase cardiac output and improve tissue perfusion, respectively. Fluid therapy and vasoactive drugs are cornerstone therapies for circulatory problems in sepsis. Fluid boluses are a common first-line treatment for actual and relative hypovolemia. However, their use has been linked to adverse events due to factors such as their composition, high volumes and rapid infusion rates, and the variable response of individual patients. Furthermore, they often have transient efficacy or lack of response in many patients. Vasoactive drugs are also often used late, which favors repetitive fluid boluses, leading to hypervolemia, tissue edema and worse outcomes. After the resuscitation phase, active fluid removal through diuresis or dialysis is increasingly being used in patients who receive fluid therapy, but it has not yet been standardized, and the safest and most effective strategies in children are still not known. We believe that these interventions for hemodynamic problems in sepsis offer an opportunity to personalize treatment and apply precision medicine strategies. Using a phased approach adapted to each patient's context and clinical condition can potentially improve outcomes. The proposed Resuscitation, Equilibrium and De-escalation (RED) strategy is a simplified phased hemodynamic management approach for patients with sepsis and septic shock. Our goal with the introduction of this concept is to organize and underscore the fact that the cardiovascular support of sepsis is dynamic and should be adapted to each individual and context.

From September 2023 to March 2024 a field trial on a live manual demining site was conducted to test a new and innovative approach for the collection and analysis of operational data. The approach, titled the Clearance Data Model, involved the collection of sixty-six data attributes for each mine found. For the first time the mine itself would become the accountable unit of demining data, against which an expanded range of relevant attributes particular to that specific mine would be recorded. This novel approach represented a considerable expansion to the operational data collected concerning Victim Operated Explosive Devices such as mines, booby-traps and victim operated Improvised Explosive Devices from the field. Previously few if any details about individual accountable mines were collected. The trial proved that is it entirely practical to collect such levels of data without impeding operational efficiency. It also showed that such data has significant benefits for quantitative operational risk management, as well as overall operations and quality management. For example, the recording of mine depth alongside excavation times enables oversight of individual excavation speed and management of any risk identified.

Abstract Background In recent years, covalent modifications on RNA nucleotides have emerged as pivotal moieties influencing the structure, function, and regulatory processes of RNA Polymerase II transcripts such as mRNAs and lncRNAs. However, our understanding of their biological roles and whether these roles are conserved across eukaryotes remains limited. Results In this study, we leveraged standard polyadenylation-enriched RNA-sequencing data to identify and characterize RNA modifications that introduce base-pairing errors into cDNA reads. Our investigation incorporated data from three Poaceae (Zea mays, Sorghum bicolor, and Setaria italica), as well as publicly available data from a range of stress and genetic contexts in Sorghum and Arabidopsis thaliana. We uncovered a strong enrichment of RNA covalent modifications (RCMs) deposited on a conserved core set of nuclear mRNAs involved in photosynthesis and translation across these species. However, the cohort of modified transcripts changed based on environmental context and developmental program, a pattern that was also conserved across flowering plants. We determined that RCMs can partly explain accession-level differences in drought tolerance in Sorghum, with stress-associated genes receiving a higher level of RCMs in a drought tolerant accession. To address function, we determined that RCMs are significantly enriched near exon junctions within coding regions, suggesting an association with splicing. Intriguingly, we found that these base-pair disrupting RCMs are associated with stable mRNAs, are highly correlated with protein abundance, and thus likely associated with facilitating translation. Conclusions Our data point to a conserved role for RCMs in mRNA stability and translation across the flowering plant lineage.

Abstract Resistance to pod shattering is a key domestication-related trait selected for seed production in many crops. Here, we show that the transition from shattering in wild soybeans to shattering resistance in cultivated soybeans resulted from selection of mutations within the coding sequences of two nearby genes - Sh1 and Pdh1. Sh1 encodes a C2H2-like zinc finger transcription factor that promotes shattering by repressing SHAT1-5 expression, thereby reducing the secondary wall thickness of fiber cap cells in the abscission layers of pod sutures, while Pdh1 encodes a dirigent protein that orchestrates asymmetric lignin distribution in inner sclerenchyma, creating torsion in pod walls that facilitates shattering. Integration analyses of quantitative trait locus mapping, genome-wide association studies, and allele distribution in representative soybean germplasm suggest that these two genes are primary modulators underlying this domestication trait. Our study thus provides comprehensive understanding regarding the genetic, molecular, and cellular bases of shattering resistance in soybeans.

Introduction:. The orthopaedic surgery physician workforce is predominately White and male and has been identified as the least diverse medical specialty. Increasing efforts toward diversification within orthopaedic surgery are underway. Evaluating the effectiveness of these programs requires a thorough understanding of the current demographic profile of the profession. Methods:. The American Board of Orthopaedic Surgery (ABOS) is the leading board certification organization for orthopaedic surgeons in the United States. The ABOS began collecting self-reported race/ethnicity and sex/gender data of its examinees and diplomates in 2017. This new data set of ABOS was analyzed to describe both the current demographic profile of orthopaedic surgery and trends over time. Underrepresented minority (URM) was defined as a group that is less well represented in orthopaedic surgery than in US census data and includes female, American Indian or Alaska Native, Black or African American, Hispanic/Latino, and Native Hawaiian or Other Pacific Islander categories. Results:. Of the 21,025 currently practicing ABOS diplomates with time-limited ABOS certificates (issued since 1986), 19,912 (94.7%) provided sex/gender data, and 19,876 (94.5%) provided race/ethnicity data. Approximately 84.78% selected male and 8.43% female. The majority identified as White (73.67%), whereas 16.35% selected a URM race/ethnicity category. There have been significant increases in the proportions of female (odds ratio [OR] = 4.72, 95% confidence interval [CI] = 3.64-6.11, p < 0.001) and URM (OR = 2.31, 95% CI = 1.80-2.96, p < 0.0001). Diplomates among orthopaedic surgeons attaining ABOS board Diplomates from 1989 to present. Among the subspecialties, pediatric orthopaedics reported the highest percentage of females (30.4%). Spine had both the lowest percentage of females (2.63%) and the highest percentage of URMs (8.97%). Sports had the lowest percentage of URMs at 5.63%. Conclusion:. Orthopaedic surgery in 2023 remains largely White and male. However, there have been promising trends toward diversification of orthopaedic surgery both in terms of gender and race/ethnicity. Specialties within orthopaedics have a wide variety of demographic profiles. Level of Evidence:. Level IV Retrospective Cohort Study. See Instructions for Authors for a complete description of levels of evidence.

The methodology and mathematical treatment of several classic multivariate methods for the analysis of spectroscopic data is demonstrated in a straightforward way that can be used as a basis for teaching an undergraduate introductory course on chemometric analysis. The multivariate techniques of classical least-squares (CLS), principal component regression (PCR), and partial least-squares (PLS), as well as the univariate Beer's law method have been described and compared, building students' understanding by starting with the univariate method and progressing step by step into the multivariate methods. Equations for the production of regression vectors from training set spectral data are described and their use demonstrated for the prediction of constituent concentrations on a separate validation set of spectra. Extreme care is taken to ensure consistency in variable formatting of data matrices. This provides a key foundation to understand how spectral data are manipulated using these different mathematical approaches for building quantitative regression models. Each method is applied to a real-world data set, and the results are discussed to show students the types of information that can be gleaned from each method. A training set comprising 20 infrared absorbance spectra containing 3 constituents (benzene, polystyrene, and gasoline) of known composition are used to demonstrate the matrix operations for each regression method. A separate set of 12 real-world napalm samples (containing benzene, polystyrene, and gasoline) are used as a validation set to demonstrate the ability to utilize the regression models on an unknown data set. A toolbox (PNNL Chemometric Toolbox) written in MATLAB language is supplied in the Supporting Information and can be used as a companion for understanding the development and deployment of the chemometric algorithms described in this paper. The data sets of the infrared spectra are also supplied, allowing users to build and inspect the chemometric models on their own. Finally, the Toolbox includes scripts to assist users in loading their own data sets into MATLAB and performing CLS, PCR, and PLS on their data.

Alzheimer’s disease (AD) is a progressive neurodegenerative disease and the most common form of dementia globally. Although the direct cause of AD remains under debate, neuroinflammation and oxidative stress are critical components in its pathogenesis and progression. As a result, compounds like cannabidiol (CBD) are being increasingly investigated for their ability to provide antioxidant and anti-inflammatory neuroprotection. CBD is the primary non-psychotropic phytocannabinoid derived from Cannabis sativa. It has been found to provide beneficial outcomes in a variety of medical conditions and is gaining increasing attention for its potential therapeutic application in AD. CBD is not psychoactive and its lipophilic nature allows its rapid distribution throughout the body, including across the blood–brain barrier (BBB). CBD also possesses anti-inflammatory, antioxidant, and neuroprotective properties, making it a viable candidate for AD treatment. This review outlines CBD’s mechanism of action, the role of oxidative stress and neuroinflammation in AD, and the effectiveness and limitations of CBD in preclinical models of AD.

Abstract Understanding causal relationships between evolution and ocean oxygenation hinges on reliable reconstructions of marine oxygen levels, typically from redox-sensitive geochemical proxies. Here, we develop a proxy, using dolomite U–Pb geochronology, to reconstruct seawater U/Pb ratios. Dolomite samples consistently give U–Pb dates and initial 207Pb/206Pb ratios lower than expected from their stratigraphic ages. These observations are explained by resetting of the U–Pb system long after deposition; the magnitude of deviations from expected initial 207Pb/206Pb are a function of the redox-sensitive U/Pb ratios during deposition. Reconstructed initial U/Pb ratios increased notably in the late-Paleozoic, reflecting an increase in oxygenation of marine environments at that time. This timeline is consistent with documented shifts in some other redox proxies and supports evolution-driven mechanisms for the oxygenation of late-Paleozoic marine environments, as well as suggestions that early animals thrived in oceans that on long time scales were oxygen-limited compared to today.

Translocation of captive-bred animals is a widely used conservation strategy to support the recovery of imperiled wild populations. Identifying which factors enhance or limit survival after release can be important in adapting translocation strategies, particularly for species with low survival rates after release from captivity. Many translocation programs track post-translocation survival, but few complete spatial-statistical assessments of mortality risk associated with release environments. Typically, few animals are released from captive breeding programs, limiting the sample size available for analyses. We aimed to create a workflow that used limited datasets to evaluate the influence of spatial conditions and other factors on mortality risk. Greater sage-grouse (Centrocercus urophasianus) are endangered in Canada and of conservation concern throughout their range in the United States. After the species declined precipitously in Canada, a captive breeding program was initiated with subsequent releases in Alberta and Saskatchewan. Despite success in captive breeding, mortality rates of released sage-grouse were high. We used GPS- and VHF-based locations of released sage-grouse to determine how spatial features influence mortality risk of sage-grouse after release from captivity. We implemented a multistep approach to quantify and map risk relative to the environmental features associated with mortality. We also assessed whether the movement behaviors of sage-grouse correspond with environmental risk factors by using a combination of survival models and integrated step-selection functions. Mortality of sage-grouse in Alberta was hastened in areas close to anthropogenic disturbance. Although birds in Alberta avoided areas of higher mortality risk, those in Saskatchewan did not, perhaps due to environmental and selection constraints. This multistep approach allowed us to utilize small sample sizes to assess key risk factors in the landscape. This process supports the adaptive modification of translocation plans and can similarly support other data-limited scientists and managers in assessing environmental mortality risk and defining conservation actions for endangered species.

The CRISPR-Cas13 system has been proposed as an alternative treatment of viral infections. However, for this approach to be adopted as an antiviral, it must be optimized until levels of efficacy rival or exceed the performance of conventional approaches. To take steps toward this goal, we evaluated the influenza viral RNA degradation patterns resulting from the binding and enzymatic activity of mRNA-encoded LbuCas13a and two crRNAs from a prior study, targeting PB2 genomic and messenger RNA. We found that the genome targeting guide has the potential for significantly higher potency than originally detected, because degradation of the genomic RNA is not uniform across the PB2 segment, but it is augmented in proximity to the Cas13 binding site. The PB2 genome targeting guide exhibited high levels (>1 log) of RNA degradation when delivered 24 hours post-infection in vitro and maintained that level of degradation over time, with increasing multiplicity of infection (MOI), and across modern influenza H1N1 and H3N2 strains. Chemical modifications to guides with potent LbuCas13a function, resulted in nebulizer delivered efficacy (>1-2 log reduction in viral titer) in a hamster model of influenza (Influenza A/H1N1/California/04/09) infection given prophylactically or as a treatment (post-infection). Maximum efficacy was achieved with two doses, when administered both pre- and post-infection. This work provides evidence that mRNA-encoded Cas13a can effectively mitigate Influenza A infections opening the door to the development of a programmable approach to treating multiple respiratory infections.

Abstract The t(X,17) chromosomal translocation, generating the ASPSCR1::TFE3 fusion oncoprotein, is the singular genetic driver of alveolar soft part sarcoma (ASPS) and some Xp11-rearranged renal cell carcinomas (RCCs), frustrating efforts to identify therapeutic targets for these rare cancers. Here, proteomic analysis identifies VCP/p97, an AAA+ ATPase with known segregase function, as strongly enriched in co-immunoprecipitated nuclear complexes with ASPSCR1::TFE3. We demonstrate that VCP is a likely obligate co-factor of ASPSCR1::TFE3, one of the only such fusion oncoprotein co-factors identified in cancer biology. Specifically, VCP co-distributes with ASPSCR1::TFE3 across chromatin in association with enhancers genome-wide. VCP presence, its hexameric assembly, and its enzymatic function orchestrate the oncogenic transcriptional signature of ASPSCR1::TFE3, by facilitating assembly of higher-order chromatin conformation structures demonstrated by HiChIP. Finally, ASPSCR1::TFE3 and VCP demonstrate co-dependence for cancer cell proliferation and tumorigenesis in vitro and in ASPS and RCC mouse models, underscoring VCP’s potential as a novel therapeutic target.

Abstract Reductions in nonresidential water demand during the COVID-19 pandemic highlighted the importance of understanding how water age impacts drinking water quality and microbiota in piped distribution systems. Using benchtop model distribution systems, we aimed to characterize the impacts of elevated water age on microbiota in bulk water and pipe wall biofilms. Five replicate constant-flow reactors were fed with municipal chloraminated tap water for 6 months prior to building closures and 7 months after. After building closures, chloramine levels entering the reactors dropped; in the reactor bulk water and biofilms the mean cell counts and ATP concentrations increased over an order of magnitude while the detection of opportunistic pathogens remained low. Water age, and the corresponding physicochemical changes, strongly influenced microbial abundance and community composition. Differential initial microbial colonization also had a lasting influence on microbial communities in each reactor (i.e., historical contingency).

Public trust in journalism has fallen disconcertingly low. This study sets out to understand the news industry’s credibility crisis by comparing public perceptions of journalism with public perceptions of another institution facing similar trust challenges: healthcare. Drawing on in-depth interviews with 31 US adults, we find that although both healthcare and journalism face public distrust, members of the public generally tend to feel more trusting of individual doctors than they do of individual journalists. This is because people (a) perceive doctors to be experts in their field and (b) engage more frequently with doctors than they do with journalists. Consequently, our interviewees described treating their doctors as “fact-checkers” when it comes to health information they find online, demonstrating trust in their physicians despite their lack of trust in healthcare more broadly. Meanwhile, the opposite unfolds in journalism: Instead of using legitimate news sources to fact-check potential misinformation, people feel compelled to “fact-check” legitimate news by seeking alternative sources of corroboration. We conclude that, to improve their credibility among the public, journalists must strike the right balance between persuading the public to perceive them as experts while also pursuing opportunities to engage with the public as peers.

Trust in news is declining globally and has been for some time a phenomenon that has been amplified in the context of a global pandemic, the rise in anti-media populism, and social and political unrest. Overall, public trust in journalism remains low (44% globally), according to the Reuters Institute Digital News Report 2021. Building on a growing body of research on predictors of (dis)trust among news audiences, this study examines survey data from the Reuters Institute Digital News Report 2021 to explore distrust profiles—comparative profiles of users based on their relative distrust in news in general, news they consume, and news accessed through digital intermediaries like social and search—across distinct news environments: India, South Korea, and the US. We conclude that, across all three countries, there are large segments who either trust everything or distrust everything, suggesting a trust polarization phenomenon. Moreover, the results identify segments of swing trusters, users who trust some news and distrust other types but do not indicate a blanket tendency to trust or distrust everything. Normative expectations about the institution of journalism (i.e., folk theories) seem to be the most powerful factors in explaining the relative likelihood of membership in all profiles, where expectations regarding impartiality, concern about fake news, and fair coverage were important indicators of (dis)trust, with varying degrees depending on the media, political, and technological contexts in which they are situated. These findings suggest that to regain trust, journalists should consider how they can change people’s folk theories when it comes to news by comprehensively taking into account the unique trajectory of a given country’s media system.

Myocardial infarction and reperfusion constitute a complex injury consisting of many distinct molecular stress patterns that influence cardiomyocyte survival and adaptation. Cell signalling, which is essential to cardiac development, also presents potential disease-modifying opportunities to recover and limit myocardial injury or maladaptive remodelling. Here, we hypothesized that Yap signalling could be sensitive to one or more molecular stress patterns associated with early acute ischemia. We found that Yap, and not Taz, expression patterns differed in a post-myocardial infarct compared to a peri-infarct region of rat hearts post-myocardial infarction, suggesting cell specificity that would be challenging to resolve for causation in vivo. Using H9c2 ventricular myotubes in vitro as a model, Yap levels were determined to be more sensitive to nutrient deprivation than other stress patterns typified by ischemia within the first hour of stress. Moreover, this is mediated by amino acid availability, predominantly L-isoleucine, and influences the expression of connective tissue growth factor (Ctgf)—a major determinant of myocardial adaptation after injury. These findings present novel opportunities for future therapeutic development and risk assessment for myocardial injury and adaptation.

To identify the state-level policies and policy domains that state policymakers and advocates perceive as most important for positively impacting the use of children's mental health services (CMHS). We used a modified Delphi technique (i.e., two rounds of questionnaires and an interview) during Spring 2021 to elicit perceptions among state mental health agency officials and advocates (n = 28) from twelve states on state policies that impact the use of CMHS. Participants rated a list of pre-specified policies on a 7-point Likert scale (1 = not important, 7 = extremely important) in the following policy domains: insurance coverage and limits, mental health services, school and social. Participants added nine policies to the initial list of 24 policies. The "school" policy domain was perceived as the most important, while the "social" policy domain was perceived as the least important after the first questionnaire and the second most important policy domain after the second questionnaire. The individual policies perceived as most important were school-based mental health services, state mental health parity, and Medicaid reimbursement rates. Key stakeholders in CMHS should leverage this group of policies to understand the current policy landscape in their state and to identify gaps in policy domains and potential policy opportunities to create a more comprehensive system to address children's mental health from a holistic, evidence-based policymaking perspective.