Study protocol for a pragmatic randomised multiple baseline trial evaluating Knowledge Insight Tools (KIT), a cognitive behavioural therapy-informed school-based counselling intervention for children and young people in UK secondary schools with low mood and anxiety.

BACKGROUND: There is a pressing need to offer more accessible, evidence-based psychological interventions to secondary school students who are increasingly reporting difficulties with anxiety and low mood. The aim of this pragmatic randomised multiple baseline trial is to evaluate the efficacy of a school-based counselling intervention called Knowledge Insight Tools (KIT) for reducing anxiety and low mood in UK secondary school students. KIT is a flexible intervention delivered individually and informed by cognitive behavioural therapy (CBT). METHODS: We will use a randomised multiple baseline design whereby young people will be randomly allocated to a baseline wait period of 3, 4, 5, 6, 7, or 8 weekly measurements, followed by receiving up to 10 weekly sessions of KIT delivered by trained, school-based practitioners. We aim to recruit 60 young people aged 11-18 who are primarily experiencing problems with low mood and/or anxiety from secondary schools across England and Scotland. We will assess child-reported anxiety, mood, and general psychological distress/coping with the Young Person's Clinical Outcomes in Routine Evaluation (YP-CORE), recorded at each session during the baseline and intervention phases. We will also assess child-reported anxiety and low mood with the Revised Children's Anxiety and Depression Scale (RCADS) at the beginning and end of treatment; practitioner-reported treatment fidelity with the KIT Fidelity Checklist; and practitioner-reported feasibility with an end-of-treatment Implementation Survey. We will analyse within-person and between-person change in YP-CORE scores across the baseline and intervention phases using visual analysis and piecewise multilevel growth curve models. We will also analyse pre-post changes in YP-CORE scores using randomisation tests, and reliable and clinically significant change using the RCADS scores. DISCUSSION: The KIT trial is a pragmatic, randomised multiple baseline trial aimed at evaluating a school-based, individual CBT counselling intervention for reducing anxiety and low mood in UK secondary school students. Results will directly inform the provision of KIT in school-based counselling services, as well as the growing evidence-base for school-based CBT interventions. TRIAL REGISTRATION: ClinicalTrials.gov NCT06188962. Retrospectively registered on 02/01/24.

One-to-one counselling and school attendance in the UK: a single group pre-post study.

OBJECTIVE: Absence rates remain high in UK schools, with negative implications for attainment, life chances and inequality. Reasons for non-attendance are complex but include psychosocial factors. Few UK-based studies have evaluated psychosocial interventions for school attendance outcomes or its moderators. This pre-post evaluation examined the potential influence of school-based one-to-one counselling on school attendance and possible moderators. DESIGN AND SETTING: Secondary analysis of routine data, collected by a national mental health provider in primary and secondary schools. PARTICIPANTS: 7405 pupils aged 4-19 years, with complete school attendance records at Time1 (pre-counselling term) and Time2 (the term when counselling ended). INTERVENTION: All participants received school-based one-to-one counselling with a trained counsellor between August 2016 and December 2019. OUTCOMES: Percentage of school sessions attended (continuous) and persistent absence (binary; attending ≤90% of sessions) in a term. Potential moderators included sociodemographics, mental health and school engagement/enjoyment. RESULTS: Median Time1 attendance was 96%. 23.6% of participants were persistently absent. The intervention was not associated with improved percentage attendance (0.028%, 95% CI -0.160-0.216%) but was associated with 18.5% reduced odds of persistent absence (OR=0.815, 95% CI 0.729-0.911). We identified five moderators of change in attendance (interaction terms p<0.05): age group (improvements for 4-9 s; worsening for 15-19 s), improvement for some ethnicities and lower parent/carer education. Mental health and school engagement/enjoyment co-varied with attendance in expected directions. CONCLUSIONS: One-to-one counselling may improve school attendance among persistently absent pupils, particularly at younger ages. Improving mental health and pupil engagement/enjoyment are potential intervention targets. Our hypotheses require confirmation with controlled designs.

Exploiting the aggregation propensity of beta-lactamases to design inhibitors that induce enzyme misfolding.

There is an arms race between beta-lactam antibiotics development and co-evolving beta-lactamases, which provide resistance by breaking down beta-lactam rings. We have observed that certain beta-lactamases tend to aggregate, which persists throughout their evolution under the selective pressure of antibiotics on their active sites. Interestingly, we find that existing beta-lactamase active site inhibitors can act as molecular chaperones, promoting the proper folding of these resistance factors. Therefore, we have created Pept-Ins, synthetic peptides designed to exploit the structural weaknesses of beta-lactamases by causing them to misfold into intracellular inclusion bodies. This approach restores sensitivity to a wide range of beta-lactam antibiotics in resistant clinical isolates, including those with Extended Spectrum variants that pose significant challenges in medical practice. Our findings suggest that targeted aggregation of resistance factors could offer a strategy for identifying molecules that aid in addressing the global antibiotic resistance crisis.

How Do Executive Functions Influence Children's Reasoning About Counterintuitive Concepts in Mathematics and Science?

Many scientific and mathematical concepts are counterintuitive because they conflict with misleading perceptual cues or incorrect naive theories that we build from our everyday experiences of the world. Executive functions (EFs) influence mathematics and science achievement, and inhibitory control (IC), in particular, might facilitate counterintuitive reasoning. Stop & Think (S&T) is a computerised learning activity that trains IC skills. It has been found effective in improving primary children's mathematics and science academic performance in a large scale RCT trial (Palak et al., 2019; Wilkinson et al., Journal of Cognitive Enhancement, 4, 296-314, 2020). The current study aimed to investigate the role of EFs and the moderating effects of S&T training on counterintuitive mathematics and science reasoning. A sample of 372 children in school Years 3 (7- to 8-year-olds) and 5 (9- to 10-year-olds) were allocated to S&T, active control or teaching as usual conditions, and completed tasks assessing verbal and visuospatial working memory (WM), IC, IQ, and counterintuitive reasoning, before and after training. Cross-sectional associations between counterintuitive reasoning and EF were found in Year 5 children, with evidence of a specific role of verbal WM. The intervention benefited counterintuitive reasoning in Year 3 children only and EF measures were not found to predict which children would most benefit from the intervention. Combined with previous research, these results suggest that individual differences in EF play a lesser role in counterintuitive reasoning in younger children, while older children show a greater association between EFs and counterintuitive reasoning and are able to apply the strategies developed during the S&T training to mathematics and science subjects. This work contributes to understanding why specifically the S&T intervention is effective. This work was preregistered with the ISRCTN registry (TRN: 54726482) on 10/10/2017. Supplementary Information: The online version contains supplementary material available at 10.1007/s41465-023-00271-0.

Manipulation of tissue factor-mediated basal PAR-2 signalling on macrophages determines sensitivity for IFNγ responsiveness and significantly modifies the phenotype of murine DTH.

Background: Tissue factor (TF) generates proteases that can signal through PAR-1 and PAR-2. We have previously demonstrated PAR-1 signalling primes innate myeloid cells to be exquisitely sensitive to interferon-gamma (IFNγ). In this work we explored how TF mediated PAR-2 signalling modulated responsiveness to IFNγ and investigated the interplay between PAR-1/-2 signalling on macrophages. Methodology: We characterised how TF through PAR-2 influenced IFNγ sensitivity in vitro using PCR and flow cytometry. and how it influenced oxazolone-induced delayed type hypersensitivity (DTH) responses in vivo. We investigated how basal signalling through PAR-2 influenced PAR-1 signalling using a combination of TF-inhibitors and PAR-1 &-2 agonists and antagonists. Finally, we investigated whether this system could be targeted therapeutically using 3-mercaptopropionyl-F-Cha-Cha-RKPNDK (3-MP), which has actions on both PAR-1 and -2. Results: TF delivered a basal signal through PAR-2 that upregulated SOCS3 expression and blunted M1 polarisation after IFNγ stimulation, opposing the priming achieved by signalling through PAR-1. PAR-1 and -2 agonists or antagonists could be used in combination to modify this basal signal in vitro and in vivo. 3-MP, by virtue of its PAR-2 agonist properties was superior to agents with only PAR-1 antagonist properties at reducing M1 polarisation induced by IFNγ and suppressing DTH. Tethering a myristoyl electrostatic switch almost completely abolished the DTH response. Conclusions: TF-mediated signalling through PARs-1 and -2 act in a homeostatic way to determine how myeloid cells respond to IFNγ. 3-MP, an agent that simultaneously inhibits PAR-1 whilst delivering a PAR-2 signal, can almost completely abolish immune responses dependent on M1 polarisation, particularly if potency is enhanced by targeting to cell membranes; this has potential therapeutic potential in multiple diseases.

Be there on time: Spatial-temporal regularities guide young children's attention in dynamic environments.

Children's ability to benefit from spatiotemporal regularities to detect goal-relevant targets was tested in a dynamic, extended context. Young adults and children (from a low-deprivation area school in the United Kingdom; N = 80; 5-6 years; 39 female; ethics approval did not permit individual-level race/ethnicity surveying) completed a dynamic visual-search task. Targets and distractors faded in and out of a display over seconds. Half of the targets appeared at predictable times and locations. Search performance in children was poorer overall. Nevertheless, they benefitted equivalently from spatiotemporal regularities, detecting more predictable than unpredictable targets. Children's benefits from predictions correlated positively with their attention. The study brings ecological validity to the study of attentional guidance in children, revealing striking behavioral benefits of dynamic experience-based predictions.

PAR-1 signaling on macrophages is required for effective in vivo delayed-type hypersensitivity responses.

Delayed-type hypersensitivity (DTH) responses underpin chronic inflammation. Using a model of oxazolone-induced dermatitis and a combination of transgenic mice, adoptive cell transfer, and selective agonists/antagonists against protease activated receptors, we show that that PAR-1 signaling on macrophages by thrombin is required for effective granuloma formation. Using BM-derived macrophages (BMMs) in vitro, we show that thrombin signaling induced (a) downregulation of cell membrane reverse cholesterol transporter ABCA1 and (b) increased expression of IFNγ receptor and enhanced co-localization within increased areas of cholesterol-rich membrane microdomains. These two key phenotypic changes combined to make thrombin-primed BMMs sensitive to M1 polarization by 1000-fold less IFNγ, compared to resting BMMs. We confirm that changes in ABCA1 expression were directly responsible for the exquisite sensitivity to IFNγ in vitro and for the impact on granuloma formation in vivo. These data indicate that PAR-1 signaling plays a hitherto unrecognized and critical role in DTH responses.

Antisocial behaviour and teacher-student relationship quality: The role of emotion-related abilities and callous-unemotional traits.

BACKGROUND: Childhood antisocial behaviour has been associated with poorer teacher-student relationship (TSR) quality. It is also well-established that youth with antisocial behaviour have a range of emotion-related deficits, yet the impact of these students' emotion-related abilities on the TSR is not understood. Furthermore, the addition of the Limited Prosocial Emotions Specifier in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) indicates that understanding the role of callous-unemotional (CU) traits for youth with antisocial behaviour problems is of particular importance. AIMS: The aim of this study was to investigate the association between antisocial behaviour difficulties and the TSR by examining the influence of emotion-related abilities and CU traits. SAMPLE: Twelve teachers from 10 primary schools provided anonymized information on 108 children aged 6-11 years. RESULTS: Antisocial behaviour was associated with higher teacher-student conflict (but not closeness) as well as higher emotion lability/negativity and lower emotion understanding/empathy. Emotion lability/negativity was associated with higher teacher-student conflict (but not closeness), and emotion understanding/empathy was associated with lower teacher-student conflict and higher closeness. CU traits were associated with higher teacher-student conflict and lower teacher-student closeness (controlling for antisocial behaviour more broadly). We found no evidence of a moderating effect of CU traits or emotion-related abilities on the association between antisocial behaviour and TSR quality. CONCLUSIONS: Interventions for behaviour difficulties should consider teacher-student relationships in the classroom. Strategies which aim to improve teacher-student closeness as well as reduce teacher-student conflict may be of particular value to students with high CU traits.

Domain-Specific Inhibitory Control Training to Improve Children's Learning of Counterintuitive Concepts in Mathematics and Science.

Evidence from cognitive neuroscience suggests that learning counterintuitive concepts in mathematics and science requires inhibitory control (IC). This prevents interference from misleading perceptual cues and naïve theories children have built from their experiences of the world. Here, we (1) investigate associations between IC, counterintuitive reasoning, and academic achievement and (2) evaluate a classroom-based computerised intervention, called Stop & Think, designed to embed IC training within the learning domain (i.e. mathematics and science content from the school curricula). Cross-sectional analyses of data from 627 children in Years 3 and 5 (7- to 10-year-olds) demonstrated that IC, measured on a Stroop-like task, was associated with counterintuitive reasoning and mathematics and science achievement. A subsample (n = 456) participated either in Stop & Think as a whole-class activity (teacher-led, STT) or using individual computers (pupil-led, STP), or had teaching as usual (TAU). For Year 3 children (but not Year 5), Stop & Think led to better counterintuitive reasoning (i.e. near transfer) in STT (p < .001, ηp 2 = .067) and STP (p < .01, ηp 2 = .041) compared to TAU. Achievement data was not available for Year 3 STP or Year 5 STT. For Year 3, STT led to better science achievement (i.e. far transfer) compared to TAU (p < .05, ηp 2 = .077). There was no transfer to the Stroop-like measure of IC. Overall, these findings support the idea that IC may contribute to counterintuitive reasoning and mathematics and science achievement. Further, we provide preliminary evidence of a domain-specific IC intervention with transferable benefits to academic achievement for Year 3 children.