Leveraging Comprehensive Sexuality Education as a Tool for Knowledge, Equity, and Inclusion.

BACKGROUND: Sexual education programs in the United States are rooted in inequitable structures and are often inadequate at educating marginalized student groups such as students of color, Lesbian, Gay, Bisexual, Transgender, Queer (LGBTQ+), women, and disabled students. CONTRIBUTIONS TO THEORY: Current sexual education is irregularly implemented and often excludes or misrepresents the experiences of students with marginalized identities. This theoretical paper specifically discusses ways that sexual education has been harmful or exclusionary for marginalized student groups and how a shift toward making sexual education inclusive and equitable will improve outcomes for students of all identities. IMPLICATIONS FOR SCHOOL HEALTH POLICY, PRACTICE, AND EQUITY: This paper discusses several recommendations on improving access to equitable sexual health education for all students including reviewing and improving sexual education curriculum and delivery, as well as the need for additional research focused on this topic. CONCLUSIONS: This article provides an overview on the current sexual education system, its inadequacies, and how comprehensive sexuality education programs can be leveraged as a tool for equity for students of all backgrounds, but particularly those who are underrepresented in sexual education curricula.

Teachers, Stress, and the COVID-19 Pandemic: A Qualitative Analysis.

The 2020-2021 academic year brought numerous challenges to teachers across the country as they worked to educate students amidst the COVID-19 pandemic. The current study is a secondary data analysis of qualitative responses collected as part of a teacher survey to evaluate a social emotional learning curriculum implemented during the 2020-2021 academic year. The lived experiences of teachers (N = 52) across 11 elementary schools in the Great Plains region were captured through open-ended questions as the teachers transitioned from in-person to remote learning. A phenomenological approach was utilized to analyze the challenges expressed by teachers as they faced instability and additional professional demands. Given that stress and other factors that strain mental health exist within multiple layers of an individual's social ecology, a modified social-ecological framework was used to organize the results and themes. Findings suggest that during the academic year, teachers experienced stressors related to their personal and professional roles, concerns for students' well-being which extended beyond academics, and frustrations with administration and other institutional entities around COVID safety measures. Without adequate support and inclusion of teacher perspectives, job-related stress may lead to teacher shortages, deterioration of teacher mental health, and ultimately worse outcomes for students. Implications for policy, research, and practice are discussed. Supplementary Information: The online version contains supplementary material available at 10.1007/s12310-022-09533-2.

Developing a Multi-Tiered System of Support-Based Plan for Bullying Prevention Among Students with Disabilities: Perspectives from General and Special Education Teachers During Professional Development.

Students with disabilities or at risk for disability identification (SWD) are disproportionately affected by the bullying dynamic; however, professional development and educator-focused training on preventing bullying for this population is lacking. To address this gap, this study presents an analysis of qualitative data collected from general and special education teachers (n = 33) participating in an online professional development training using Multi-Tiered System of Supports (MTSS) to prevent bullying among students with disabilities. Braun and Clarke's six-step process was used to identify key themes and exemplar quotes from qualitative reflections collected as knowledge check responses embedded within two training modules. Three themes were identified and examined based on MTSS tiers: (1) teacher perceptions of SWD and their inclusion in a MTSS-based bullying prevention plan; (2) identifying key stakeholders for preventing bullying within a MTSS-based bullying prevention plan; and (3) potential challenges and solutions of implementing a MTSS-based bullying prevention plan within the individual, classroom, and school contexts. Findings highlight the need to educate teachers on how to use MTSS, especially for bullying prevention and interventions that are inclusive of SWD. Implications from this work extend to all students including those with mental health considerations, regardless of disability status. Supplementary Information: The online version contains supplementary material available at 10.1007/s12310-023-09589-8.

Pilot Evaluation of the Elementary Social-Emotional Learning Program Sources of Strength.

Schools and students have faced a variety of challenges during the 2020-2021 academic year as the COVID-19 pandemic continues. These issues have drawn attention to the increased need for robust social-emotional learning skills at the elementary level to address the deficits exacerbated by the pandemic. Sources of Strength is an evidence-based suicide prevention program for middle and high school students. In 2020, Sources of Strength launched an elementary school curriculum focused on promoting protective factors and resilience. Data were collected across 11 elementary schools (N = 1022; 3-5th graders) in the Great Plains region of the USA at two time points during the COVID-19 pandemic (T1: Fall of 2020, T2: Spring of 2021). We examine the effectiveness of the program using a pre- and post-test design measuring various student social-emotional outcomes including positive classroom climate, emotional problems, school belonging, help-seeking attitudes, bullying perpetration, peer victimization, student and teacher intervention, student well-being, and student resilience. The program was evaluated using multilevel regression models to examine the associations between self-reported student program exposure and student outcomes. Although comparisons between T1 and T2 indicated a worsening of several student outcomes, positive associations were found when accounting for the degree of student exposure to the program. Greater student exposure was associated with improved positive classroom climate, school belonging, help-seeking attitudes, student well-being, resiliency, and lower reports of emotional problems. Implications for research and practice are discussed. Supplementary Information: The online version contains supplementary material available at 10.1007/s12310-023-09567-0.

Administration of reduced glutathione in FOLFOX4 adjuvant treatment for colorectal cancer: effect on oxaliplatin pharmacokinetics, Pt-DNA adduct formation, and neurotoxicity.

Oxaliplatin is a promising drug for cancer therapy and the oxaliplatin/5-fluorouracil/leucovorin (FOLFOX) regimen has become the standard adjuvant treatment for colorectal cancer. However, the oxaliplatin-induced neurotoxicity still represents a clinical problem leading to a discontinuation of the therapy. Many strategies have been proposed in order to manage the neurotoxicity, but their effect on antitumoral efficacy is still unclear. In this study, we investigated the effect of reduced glutathione administration on neurotoxicity, oxaliplatin pharmacokinetics, and platinum-DNA (Pt-DNA) adduct formation in patients affected by colorectal cancer treated with FOLFOX4 adjuvant regimen. Twenty-seven patients were randomized to receive GSH 1500 mg/m or saline solution before oxaliplatin infusion. Evaluation of neurotoxicity, pharmacokinetics of plasmatic total and ultrafiltered Pt, and determination of Pt-DNA adduct formation on white blood cells was performed during the 5th, 9th, and 12th cycles. At the end of all cycles of therapy, the patients in the GSH arm showed a statistically significant reduction of neurotoxicity (P=0.0037) compared with the placebo arm. There were no significant differences in the main pharmacokinetic parameters between the two arms except a lower area under the plasma concentration-time curve and a smaller apparent steady-state volume of distribution (Vss) when GSH was coadministered. This difference can be explained by the natural function of GSH in the detoxification of oxaliplatin and by its ability to remove the Pt bound to plasma proteins. The determination of Pt-DNA adduct formation shows no statistically significant differences between the two arms. In conclusion, this study indicates that coadministration of GSH is an effective strategy to reduce the oxaliplatin-induced neurotoxicity without impairing neither the pharmacokinetics of oxaliplatin, nor the Pt-DNA adduct formation.

Pharmacokinetics of a novel anticancer ruthenium complex (KP1019, FFC14A) in a phase I dose-escalation study.

A phase I and pharmacokinetic study was carried out with the new ruthenium complex indazolium trans-[tetrachlorobis(1H-indazole)ruthenate(III)] (KP1019, FFC14A). Seven patients with various types of solid tumours refractory to standard therapy were treated with escalating doses of KP1019 (25-600 mg) twice weekly for 3 weeks. No dose-limiting toxicity occurred. Ruthenium plasma concentration-time profiles after the first dose and under multiple-dose conditions were analysed using a compartmental approach. The pharmacokinetic disposition was characterised by a small volume of distribution, low clearance and long half-life. Only a small fraction of ruthenium was excreted renally. The area under the curve values increased proportionally with dose indicating linear pharmacokinetics.

Pharmacokinetics of oxaliplatin in patients with severe hepatic dysfunction.

PURPOSE: Data are lacking on the pharmacokinetics of oxaliplatin in patients with severe hepatic dysfunction. The aim of this study was to determine the pharmacokinetic parameters of platinum after administration of oxaliplatin in cancer patients with severe hepatic impairment due to extended metastases into the liver. PATIENTS AND METHODS: Two female breast cancer patients and one male colon cancer patient were treated with oxaliplatin monotherapy at 130 mg/m(2) given as a 3-h intravenous infusion. The patients exhibited bilirubin concentrations of 9.6, 22.5 and 41.1 mg/dl indicating severe hepatic dysfunction. Serial blood samples were collected immediately before treatment, and at fixed intervals up to 27 h after start of therapy. Platinum concentrations in plasma, ultrafilterable plasma, and whole blood were determined using a validated flameless atomic absorption spectrometry (FAAS) method. Pharmacokinetic data analysis was performed assuming a two-compartment model. Individual pharmacokinetic parameters were compared with a reference population with normal hepatic function. RESULTS: The area under the curve (AUC from 0 to infinity) as well as the elimination half-life of platinum in ultrafilterable plasma were substantially increased and clearance accordingly decreased in the three patients with severe hepatic dysfunction. In plasma and whole blood, the deviations from the reference population were less pronounced. However, partial AUC from 0 up to 2 h after end of infusion reflecting better the exposure with cytotoxic platinum species was not different or only slightly altered. Moreover, no acute oxaliplatin-associated neurotoxicity was observed. CONCLUSIONS: The comparable platinum exposure early after administration in conjunction with the lack of acute toxicity do not support a dose reduction of oxaliplatin in patients with markedly elevated bilirubin concentrations. However, a larger number of patients must be examined before valid dose recommendations can be derived.

Population PK/PD model of homocysteine concentrations after high-dose methotrexate treatment in patients with acute lymphoblastic leukemia.

Elevated homocysteine concentrations have been associated with methotrexate-induced neurotoxicity. Based on methotrexate and homocysteine plasma concentrations of 494 children with acute lymphoblastic leukemia treated with high-dose methotrexate in the TOTAL XV study, a pharmacokinetic/pharmacodynamic (PK/PD) model was built with NONMEM. Several compartment and indirect response models were investigated. The pharmacokinetic disposition of methotrexate was best described by a two-compartment model. Homocysteine concentrations were included by an indirect response model where methotrexate inhibition of the homocysteine elimination rate was described by an E(max) model. The homocysteine baseline level was found to be age-dependent. Simulations revealed that folinate rescue therapy does not affect peak concentrations of homocysteine but leads to a modestly reduced homocysteine exposure. In conclusion, our PK/PD model describes the increase of methotrexate-induced HCY concentrations with satisfactory precision and can be applied to assess the effect of folinate regimens on the HCY concentration-time course.

[Observed, pursued, disintegrated--mental disorders among victims of non-criminal repressions in the former GDR]. / Beobachtet, verfolgt, zersetzt--psychische Erkrankungen bei Betroffenen nichtstrafrechtlicher Repressionen in der ehemaligen DDR.

OBJECTIVE: While there are numerous studies on the mental sequelae of political imprisonment in the former German Democratic Republic (GDR), there is little knowledge about the prevalence of mental disorders in victims of other forms of political persecution. METHODS: 74 individuals, who were subject to non-criminal repressions in the GDR, were investigated by means of a standardized psychiatric interview. RESULTS: They had been exposed to a variety of reprisals such as observations, purposeful indiscretions, arranged professional failure and other forms of social marginalization. At least one mental disorder was found in 60 % of the participants. Affective disorders were the most common ones with a lifetime prevalence of 38 %, followed by anxiety (23 %) and somatoform disorders (28 %). CONCLUSIONS: The frequency of mental disorders in our sample of politically persecuted people was higher than in the general population and similar to that of political prisoners, who only show higher rates of anxiety and posttraumatic stress disorders.