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Background: State-level leadership and conditions are instrumental to local and regional comprehensive school mental health system (CSMHS) quality, sustainability, and growth. However, systematic documentation of state-level school mental health (SMH) policy, infrastructure, funding, and practice is limited. Methods: Using a multi-phase, multi-method process, we developed the State School Mental Health Profile (State Profile) to offer a comprehensive landscape of state SMH efforts. State leaders in 25 states completed the State Profile once over a 3-year data collection period. Mixed methods results are reported in 8 domains. Results: State education agencies were reportedly most involved in SMH technical assistance, advocacy, leadership, funding, and service provision, with mental health agencies reported as second most involved. Nearly half of state respondents reported having a state-level SMH director or coordinator. Policies with the greatest perceived impact require implementation of and funding for SMH services and supports. Despite leveraging multiple sources of funding, most states emphasized lack of funding as a primary barrier to establishing CSMHSs. All states reported staffing shortages. Conclusion: The State Profile can assist multi-agency state leadership teams to self-assess policy, infrastructure, and resources to support CSMHSs statewide. Findings point to areas of opportunity to advance equity across resource allocation, service provision, and policy development.

Abstract Mitochondrial respiration is essential for the survival and function of T cells used in adoptive cellular therapies. However, strategies that specifically enhance mitochondrial respiration to promote T cell function remain limited. Here, we investigate methylation-controlled J protein (MCJ), an endogenous negative regulator of mitochondrial complex I expressed in CD8 cells, as a target for improving the efficacy of adoptive T cell therapies. We demonstrate that MCJ inhibits mitochondrial respiration in murine CD8+ CAR-T cells and that deletion of MCJ increases their in vitro and in vivo efficacy against murine B cell leukaemia. Similarly, MCJ deletion in ovalbumin (OVA)-specific CD8+ T cells also increases their efficacy against established OVA-expressing melanoma tumors in vivo. Furthermore, we show for the first time that MCJ is expressed in human CD8 cells and that the level of MCJ expression correlates with the functional activity of CD8+ CAR-T cells. Silencing MCJ expression in human CD8 CAR-T cells increases their mitochondrial metabolism and enhances their anti-tumor activity. Thus, targeting MCJ may represent a potential therapeutic strategy to increase mitochondrial metabolism and improve the efficacy of adoptive T cell therapies.

Abstract A substantial body of social scientific research considers the negative mental health consequences of social media use on TikTok. Fewer, however, consider the potentially positive impact that mental health content creators (“influencers”) on TikTok can have to improve health outcomes; including the degree to which the platform exposes users to evidence-based mental health communication. Our novel, influencer-led approach remedies this shortcoming by attempting to change TikTok creator content-producing behavior via a large, within-subject field experiment (N = 105 creators with a reach of over 16.9 million viewers; N = 3465 unique videos). Our randomly-assigned field intervention exposed influencers on the platform to either (a) asynchronous digital (.pdf) toolkits, or (b) both toolkits and synchronous virtual training sessions that aimed to promote effective evidence-based mental health communication (relative to a control condition, exposed to neither intervention). We find that creators treated with our asynchronous toolkits—and, in some cases, those also attending synchronous training sessions—were significantly more likely to (i) feature evidence-based mental health content in their videos and (ii) generate video content related to mental health issues. Moderation analyses further reveal that these effects are not limited to only those creators with followings under 2 million users. Importantly, we also document large system-level effects of exposure to our interventions; such that TikTok videos featuring evidence-based content received over half a million additional views in the post-intervention period in the study’s treatment groups, while treatment group mental health content (in general) received over three million additional views. We conclude by discussing how simple, cost-effective, and influencer-led interventions like ours can be deployed at scale to influence mental health content on TikTok.

In the United States of America, democratic education has evolved philosophically over 200 years from Jeffersonian ideas of educated citizenry to Deweyan principles of democracy as a "mode of associated living." In contemporary society, Dianna Hess has written about democratic education as a process of deliberative democracy. Yet the idea of democratic education remains challenging to implement in actual classrooms. In this article, we focus on one teacher's practice of introducing the topic of Confederate monuments in a Georgia history classroom. Then, we explore how philosophical theories of democratic education help teachers guide students as they encounter controversial issues. Although democracy is viewed by contemporary philosophers of education as a social construct that must be cared for primarily by educators, placing the responsibility for democracy solely on teachers through democratic classroom practices is unrealistic. However, by implementing democratic pedagogies to foster active student decision-making and deliberative skills in a respectful environment that values diversity, students and teachers can embark on a mode of associated living that values democracy. We conclude with recommendations to assist teachers who want to practice democratic education.

OBJECTIVES:. To estimate the expected value of undertaking a future randomized controlled trial of thresholds used to initiate invasive ventilation compared with usual care in hypoxemic respiratory failure. PERSPECTIVE:. Publicly funded healthcare payer. SETTING:. Critical care units capable of providing invasive ventilation and unconstrained by resource limitations during usual (nonpandemic) practice. METHODS:. We performed a model-based cost-utility estimation with individual-level simulation and value-of-information analysis focused on adults, admitted to critical care, receiving noninvasive oxygen. In the primary scenario, we compared hypothetical threshold A to usual care, where threshold A resulted in increased use of invasive ventilation and improved survival compared with usual care. In the secondary scenario, we compared hypothetical threshold B to usual care, where threshold B resulted in decreased use of invasive ventilation and similar survival compared with usual care. We assumed a willingness-to-pay of 100,000 Canadian dollars (CADs) per quality-adjusted life year. RESULTS:. In the primary scenario, threshold A was cost-effective compared with usual care due to improved hospital survival (78.1% vs. 75.1%), despite more use of invasive ventilation (62% vs. 30%) and higher lifetime costs (86,900 vs. 75,500 CAD). In the secondary scenario, threshold B was cost-effective compared with usual care due to similar survival (74.5% vs. 74.6%) with less use of invasive ventilation (20.2% vs. 27.6%) and lower lifetime costs (71,700 vs. 74,700 CAD). Value-of-information analysis showed that the expected value to Canadian society over 10 years of a 400-person randomized trial comparing a threshold for invasive ventilation to usual care in hypoxemic respiratory failure was 1.35 billion CAD or more in both scenarios. CONCLUSIONS:. It would be highly valuable to society to identify thresholds that, in comparison to usual care, either increase survival or reduce invasive ventilation without reducing survival.

The availability of employment opportunities in sport psychology (SP) has been subject of much discussion, with anecdotal observations of increased opportunities within military and professional/collegiate athletics in the US (Mugford, 2017). The last review of the employment trends conducted by Meyers and colleagues (2001) indicated bleak prospects for stable careers in applied SP. Consequently, some argued that applied SP careers are an illusion (Martin, 2020). The purpose of the present study was to update employment and income data by surveying 333 primarily US-based, SP professionals (female n =174, 52.9%; male n = 155, 47.1%; median age = 36-40 years) via an online questionnaire. Three of four participants were certified (CMPC). The gross median income ranged between US$75,000-90,000. While, possession of a PhD was the most financially favorable vocational route, 31.7% practiced with a master's degree. Licensed mental health SP professionals reported significantly higher median income and were more likely to have PhDs compared to sport science trained SP professionals. Findings indicate promising trends for sport science trained individuals' pursuit of applied SP practice employment opportunities. Keywords: Employment; Hiring; Certification; Licensure; Professional Practice, The prevailing wisdom within the sport psychology (SP) community is that the field is growing and careers in applied practice are available. Little empirical data exists to support this perspective. [...]

Abstract Background The optimal thresholds for the initiation of invasive ventilation in patients with hypoxemic respiratory failure are unknown. Using the saturation-to-inspired oxygen ratio (SF), we compared lower versus higher hypoxemia severity thresholds for initiating invasive ventilation. Methods This target trial emulation included patients from the Medical Information Mart for Intensive Care (MIMIC-IV, 2008–2019) and the Amsterdam University Medical Centers (AmsterdamUMCdb, 2003–2016) databases admitted to intensive care and receiving inspired oxygen fraction ≥ 0.4 via non-rebreather mask, noninvasive ventilation, or high-flow nasal cannula. We compared the effect of using invasive ventilation initiation thresholds of SF

Emerging research suggests an association between exposure to violence, specifically indirect forms, and substance use among youth involved in the child welfare (CW) system. However, this has only been recently and tentatively explored. This study examined the associations among various forms of indirect violence exposure and substance use among subgroups of youth involved in the CW system. The analytic sample consisted of participants (aged 11 years or older) in the baseline year of the second National Survey of Child and Adolescent Well-Being (2008-2012), including youth and their caregivers. Latent class analysis was used to examine associations among distinct forms of indirect violence exposure and substance use and the potential identification of unique at-risk groups. Models for the overall sample suggested two classes of at-risk youth, with the higher-risk class having higher probabilities of alcohol, marijuana, and hard drug use, which coincided with higher probabilities of exposure to arrests, stealing, drug deals, and weapon use. However, stratified models suggested unique results for youth aged 13-14 and 15-17, suggesting that the confluence of these risks appears to differ developmentally. Prevention and intervention services for CW-involved youth should assess and address violence exposure types among youth as a potential opportunity to mitigate substance use and subsequent high-risk behavior., Author(s): Amy S. He [sup.1] , Lisa M. Yarnell [sup.2] , Sheree M. Schrager [sup.3] , Dorian E. Traube [sup.4] Author Affiliations: (1) grid.266239.a, 0000 0001 2165 7675, Graduate School [...]

Accurately quantifying species' area requirements is a prerequisite for effective area-based conservation. This typically involves collecting tracking data on species of interest and then conducting home-range analyses. Problematically, autocorrelation in tracking data can result in space needs being severely underestimated. Based on the previous work, we hypothesized the magnitude of underestimation varies with body mass, a relationship that could have serious conservation implications. To evaluate this hypothesis for terrestrial mammals, we estimated home-range areas with global positioning system (GPS) locations from 757 individuals across 61 globally distributed mammalian species with body masses ranging from 0.4 to 4000 kg. We then applied block cross-validation to quantify bias in empirical home-range estimates. Area requirements of mammals 1, meaning the scaling of the relationship changed substantially at the upper end of the mass spectrum.

© 2020 Elsevier B.V. Seasonal flow transitions between wet and dry conditions are a primary control on river conditions, including biogeochemical processes and aquatic life-history strategies. In regions like California with highly seasonal flow patterns and immense interannual variability, a rigorous approach is needed to accurately identify and quantify seasonal flow transitions from the annual flow regime. Drawing on signal processing theory, this study develops a transferable approach to detect the timing of seasonal flow transitions from daily streamflow time series using an iterative smoothing, feature detection, and windowing methodology. The approach is shown to accurately identify and characterize seasonal flows across highly variable natural flow regimes in California. A quantitative error assessment validated the accuracy of the approach, finding that inaccuracies in seasonal timing identification did not exceed 10%, with infrequent exceptions. Results for seasonal timing were also used to highlight the statistically distinct timing found across streams with varying climatic drivers in California. The proposed approach improves understanding of spatial and temporal trends in hydrologic processes and climate conditions across complex landscapes and informs environmental water management efforts by delineating timing of seasonal flows.