The Impact of Cognitive Behavioral Therapy on Sleep Problems in Autistic Children with Co-occurring Anxiety.

PURPOSE: This study seeks to examine the relationship between anxiety-symptom severity and sleep behaviors in autistic children receiving cognitive behavioral therapy (CBT). METHODS: We conducted a secondary-data analysis from a sample of 93 autistic youth, 4 to 14 years, participating in 24 weeks of CBT. Clinicians completed the Pediatric Anxiety Rating Scale (PARS) and parents completed the Children's Sleep Habits Questionnaire, Abbreviated/Short Form (CSHQ-SF) at baseline, mid-treatment, post-treatment and 3 months post-treatment. Mediation analysis evaluated the role of anxiety symptoms in mediating the effect of time in treatment on sleep. RESULTS: There was a negative association between time in treatment and scores on the CSHQ-SF (b = - 3.23, SE = 0.493, t = - 6.553, p < 0.001). Increased time in treatment was associated with decreased anxiety (b = - 4.66, SE = 0.405, t = - 11.507, p < 0.001), and anxiety symptoms decreased with CSHQ-SF scores (b = 0.322, SE = 0.112, t = 2.869, p = 0.005). The indirect effect of time in treatment on CSHQ-SF scores through PARS reduction was negative, but not statistically significant. CONCLUSION: Increased time in CBT was associated with decreased anxiety severity and improved sleep behaviors. Reductions in anxiety symptoms may mediate improvements in sleep problems, but larger sample sizes are necessary to explore this further.

PharmaCORE: Optimizing medical pharmacology education with an innovative instructional dashboard.

WHAT WAS THE EDUCATIONAL CHALLENGE?: Diminishing emphasis on pharmacology education in medical schools has resulted in a concerning lack of prescribing knowledge among physician graduates. These concerns mirror our graduates' expressed dissatisfaction with the structure and quality of pharmacology educational experiences over the past 5 years. WHAT WAS THE SOLUTION?: PharmaCORE, a web-based instructional dashboard, was developed as an interactive faculty development tool to enhance integration and instruction of pharmacology content in pre-clinical curriculum at a US medical school. HOW WAS THE SOLUTION IMPLEMENTED?: PharmaCORE was introduced in Spring 2022 for instructors teaching pharmacology in the pre-clinical curriculum. Instructors used the dashboard to assess coverage of specific drug topics throughout the curriculum and to apply tailored, learner-centered teaching strategies to optimize learner engagement and comprehension. WHAT LESSONS WERE LEARNED THAT ARE RELEVANT TO A WIDER GLOBAL AUDIENCE?: The initial assessment indicated that the dashboard was user-friendly and positively influenced instructor awareness of pharmacology content and learner-centered teaching. This faculty development approach underscores the importance of skill-based mapping and maintaining learner-centered teaching standards to address other integrated subjects and broader curricular challenges. WHAT ARE THE NEXT STEPS?: This study lays the foundation for the broader applicability of instructional dashboards in tracking and addressing curricular challenges across pharmacology and other science subjects. Future steps include more personalized feedback for instructors, creating a student-accessible version, and ongoing monitoring of maintenance measures like milestone exams.

Structural Equation Modeling Analysis on Associations of Moral Distress and Dimensions of Organizational Culture in Healthcare: A Cross-Sectional Study of Healthcare Professionals.

OBJECTIVE: Moral distress is a complex phenomenon experienced by healthcare professionals. This study examined the relationships between key dimensions of Organizational Culture in Healthcare (OCHC)-perceived psychological safety, ethical climate, patient safety-and healthcare professionals' perception of moral distress. DESIGN: Cross-sectional survey. SETTING: Pediatric and adult critical care medicine, and adult hospital medicine healthcare professionals in the United States. PARTICIPANTS: Physicians (n = 260), nurses (n = 256), and advanced practice providers (n = 110) participated in the study. MAIN OUTCOME MEASURES: Three dimensions of OCHC were measured using validated questionnaires: Olson's Hospital Ethical Climate Survey, Agency for Healthcare Research and Quality's Patient Safety Culture Survey, and Edmondson's Team Psychological Safety Survey. The perception of moral distress was measured using the Moral Distress Amidst a Pandemic Survey. The hypothesized relationships between various dimensions were tested with structural equation modeling (SEM). RESULTS: Adequate model fit was achieved in the SEM: a root-mean-square error of approximation =0.072 (90% CI 0.069 to 0.075), standardized root mean square residual = 0.056, and comparative fit index =0.926. Perceived psychological safety (ß= -0.357, p <.001) and patient safety culture (ß = -0.428, p<.001) were negatively related to moral distress experience. There was no significant association between ethical climate and moral distress (ß = 0.106, p = 0.319). Ethical Climate, however, was highly correlated with Patient Safety Culture (factor correlation= 0.82). CONCLUSIONS: We used structural equation model to test a theoretical model of multi-dimensional organizational culture and healthcare climate (OCHC) and moral distress.Significant associations were found, supporting mitigating strategies to optimize psychological safety and patient safety culture to address moral distress among healthcare professionals. Future initiatives and studies should account for key dimensions of OCHC with multi-pronged targets to preserve the moral well-being of individuals, teams, and organizations.

Longitudinal weight status and academic achievement in elementary schoolchildren in the United States.

BACKGROUND/OBJECTIVES: Childhood overweight and obesity have a well-established negative impact on children's health. Overweight and obesity might also negatively impact children's academic performance, but existing literature on this association is inconclusive. This study uses a longitudinal design in a large, diverse elementary school sample to rigorously test the association between longitudinal weight status and academic achievement. Analyses also investigate modification by sex, race/ethnicity, and cardiorespiratory fitness (CRF). SUBJECTS/METHODS: In a large suburban school district in the United States, 4936 Grade 4 students were recruited. Demographic, course grade, and standardized test data were collected from school records for Grades 3-5, and body mass index and CRF were assessed each year. Students wore accelerometers during the school day for up to 15 days across three semesters (Grade 4 Fall and Spring, Grade 5 Fall) to objectively measure physical activity. Multiple imputation addressed missing data and multilevel analyses controlled for student demographics and clustering within schools. RESULTS: Unadjusted multilevel models found small negative associations between persistent obesity and course grades and standardized test scores, but these associations largely disappeared when controlling for demographic characteristics. Residual associations for math and writing course grades were attenuated when controlling for CRF, though some marginal negative associations for math and writing remained for students who developed obesity during follow-up. There was also evidence of marginal negative associations with course grades for students who developed overweight/obesity. There was no evidence of modification by sex or race/ethnicity. CONCLUSIONS: Results suggest very small associations between weight status and academic achievement that were largely explained by sociodemographic factors and CRF. Evidence of an association between weight status and achievement was stronger among students who developed overweight/obesity. Interventions promoting healthy weight and high CRF remain critical for schools given the link between student health and achievement.

Physical activity and academic achievement: an analysis of potential student- and school-level moderators.

BACKGROUND: Many children do not engage in sufficient physical activity, and schools provide a unique venue for children to reach their recommended 60 daily minutes of moderate-to-vigorous physical activity (MVPA). Prior research examining effects of MVPA on academic achievement is inconclusive, and few studies have investigated potential moderators of this relationship. This study examined whether student-level characteristics (gender, race/ethnicity, free/reduced-price lunch status) and school-level characteristics (proportion of students qualifying for free/reduced-price lunch, physical activity environment and opportunities) moderate the relationship between MVPA and academic achievement. METHODS: In a large, diverse metropolitan public school district in Georgia, 4,936 students in Grade 4 were recruited from 40 elementary schools. Students wore accelerometers to measure school-day MVPA for a total of 15 days across three semesters (fall 2018, spring 2019, fall 2019). Academic achievement data, including course marks (grades) for math, reading, spelling, and standardized test scores in writing, math, reading, and Lexile (reading assessment), were collected at baseline (Grade 3, ages 8-9) and at follow-up in Grade 4 (ages 9-10). Standardized test scores were not measured in Grade 5 (ages 10-11) due to COVID-19-related disruptions. Multilevel modeling assessed whether student-level and/or school-level characteristics were moderators in the cross-sectional and longitudinal MVPA-academic achievement relationship. RESULTS: Cross sectional analyses indicated that the MVPA and AA relationship was moderated only by student Hispanic ethnicity for Grade 4 fall spelling marks (ß = -0.159 p < 0.001). The relationship for Grade 4 fall spelling marks was also moderated by school physical activity opportunities (ß = -0.128 (p < 0.001). Longitudinally, there was no significant moderation of the MVPA-academic achievement. A relationship by student gender, free/reduced-price lunch status, race/ethnicity; nor for school-level factors including proportion of students qualifying for free/reduced-price lunch, physical activity environment, and physical activity opportunities. CONCLUSIONS: Overall, our results did not suggest that student- or school-level characteristics moderate the MVPA-academic achievement relationship. While statistically significant results were observed for certain outcomes, practical differences were negligible. In this population, school-based MVPA does not appear to differently affect academic performance based on student gender, race/ethnicity, free/reduced-price lunch, nor school characteristics. TRIAL REGISTRATION: This study was registered with the National Institutes of Health (NIH) ClinicalTrials.gov system, with ID NCT03765047 . Registered 05 December 2018-Retrospectively registered.

The longitudinal association between objectively-measured school-day physical activity and academic achievement in US elementary school students.

BACKGROUND: It is recommended that school-aged children accrue 30 minutes of daily moderate-to-vigorous physical activity (MVPA) in school. Current literature is inconclusive about the long-term associations between school-based physical activity and academic achievement. In this study, we use a large sample and longitudinal design to rigorously evaluate whether school-day MVPA is associated with academic achievement. METHODS: In a diverse suburban public school district, 4936 Grade 4 students were recruited in 40 elementary schools. Students wore accelerometers to measure school-day MVPA for 15 days across three semesters. Academic performance data was collected across Grade 3 fall to Grade 5 spring, including teacher-assigned grades and standardized test scores. Multilevel modeling was conducted controlling for student demographics and school characteristics. RESULTS: Cross-sectional analyses found small negative associations in Grade 4. Grade 4 full-year mean daily school-day MVPA had ß = --0.066, ß = --0.063, ß = --0.066, and ß = --0.058 associations (p <  0.001) with Grade 4 math, reading, spelling, and writing grades respectively, and Grade 4 full-year mean daily school-day MVPA had ß = --0.206 and ß = --0.283 (p <  0.001) associations with Grade 4 math and English Language Arts (ELA) standardized test scores respectively out of approximately 500 points. Longitudinal analyses found no significant associations between Grade 4 full-year mean daily school-day MVPA and Grade 5 Fall course grades. Results also indicated small negative associations for students attaining 30+ minutes of daily school-day MVPA compared to those attaining less than 15 minutes, but only in Grade 4 Fall cross-sectional analyses where teacher-assigned reading, spelling, and writing grades were - 1.666, - 1.638, and - 1.993 points lower respectively (p <  0.001). CONCLUSION: The cross-sectional findings, while statistically significant in a negative direction, have a negligible association when translated practically. For example, even if students attained twice the recommended amount of school-day MVPA - which would constitute an approximately 300% increase from current levels - results suggest that grades would only decrease by 2 points on a 100-point scale. Furthermore, longitudinal analyses suggest school-day MVPA does not have a predictive association with course grades or standardized test scores. Findings suggest school-based MVPA implemented in accordance with recommendations does not meaningfully detract from academic progress. TRIAL REGISTRATION: ClinicalTrials.gov , NCT03765047. Registered 05 December 2018 - Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT03765047.

Prevalence of Evidence-Based School Meal Practices and Associations with Reported Food Waste across a National Sample of U.S. Elementary Schools.

Providing meals at school is an important part of the hunger safety net for children in the United States and worldwide; however, many children do not receive school meals even when they qualify for federally-subsidized free or reduced-priced meals. This study investigates the prevalence of several evidence-based practices that have previously been shown to increase the reach and impact of school meals. A survey was sent to a national sample of US elementary schools, with items examining practices regarding school breakfast, school lunch, recess, the promotion of meals, nutrition standards, and food waste, during the 2019-20 school year. Almost all schools that offered lunch also offered breakfast. More than 50% used a breakfast service strategy other than cafeteria service, such as grab-and-go breakfast meals. Providing at least 30 min for lunch periods and providing recess before lunch were reported by less than half of schools. About 50% of schools reported using only one or fewer meal promotional strategies (such as taste tests) throughout the school year. Use of more promotional strategies was associated with less reported food waste in a multivariable regression model accounting for school demographic characteristics. Findings show that some evidence-based practices for school meals are being implemented, but many recommendations are not being widely adopted.

Implementation of Physical Activity in US Elementary Schools: The Role of Administrative Support, Financial Resources, and Champions.

The intentional integration of physical activity in elementary school classrooms-including brief instructional breaks for activity, or integration into lessons-can benefit children's physical activity and education outcomes. Teachers are key implementation agents, but despite physical activity in the classroom being an evidence-informed practice, many teachers do not regularly implement it. The aim of this study was to obtain updated nationally representative prevalence estimates in United States public elementary schools, regarding four key outcomes: (1) school adoption of physically active lessons (PA lessons); (2) school adoption of physical-activity breaks (PA breaks); (3) penetration in the classroom, defined as ≥50% of teachers using PA breaks; and (4) dose, defined as an average of at least 50 min per week of PA breaks. We examined variations in outcomes by school demographic characteristics, and by three factors hypothesized to be implementation facilitators (administrative support, financial resources, and presence of a wellness champion at the school). In the 2019-20 school year, surveys were distributed to a nationally representative sample of 1010 public elementary schools in the US; responses were obtained from 559 (55.3%). The weighted prevalence of schools reporting adoption of PA lessons was 77.9% (95% CI = 73.9% to 81.9%), and adoption of PA breaks was nearly universal at 91.2% (95% CI = 88.4% to 94.1%). Few demographic differences emerged, although adoption of PA lessons was less prevalent at higher-poverty schools (73.9%) and medium-poverty schools (77.0%) as compared to schools with lower poverty levels (87.1%; p < 0.01). Across all four outcomes, associations emerged with facilitators in multivariable logistic regression models. The prevalence of adoption of PA lessons, adoption of PA breaks, and dose of PA breaks were all significantly higher at schools where administrative encouragement occurred more frequently. Financial support was associated with implementation outcomes, including adoption of PA lessons, and penetration and dose of PA breaks. Presence of a champion was associated with higher prevalence of reporting adoption of PA lessons. School leaders can play a crucial role in supporting teachers' implementation of PA breaks and lessons in the classroom, through providing financial resources, encouragement, and supporting champions. Effective school-leadership practices have the potential to positively impact students at a large-scale population level by supporting implementation of PA lessons and breaks.

Study protocol for testing the association between physical activity and academic outcomes utilizing a cluster-randomized trial.

The Physical Activity Guidelines for Americans recommend adolescents engaging in 60 min of physical activity (PA) every day. Students should spend at least 30 min being active while at school. However, schools rarely provide that much PA time for students. This paper describes the planned analyses for a study evaluating the relationships between PA (measured as average daily minutes of Moderate to Vigorous Physical Activity [MVPA]) and educational outcomes of standardized test scores and classroom grades cross-sectionally in 4 th grade and longitudinally from 4 th to 5 th grade. Investigations of moderators (both student- and school-level), mediators, and potential dosage of average MVPA thresholds are outlined. To ensure a high level of variability in student PA, the Health Empowers You! program is implemented in a random sample of half of the participating schools. The intervention is designed to affect students' PA behaviors and health outcomes (cardiorespiratory fitness, body mass index). Utilizing accelerometer data from students in participating schools, the relationship between PA and health and academic outcomes (academic achievement test scores, reading lexile, grades, attendance, and tardiness) is evaluated. A total of 4968 grade 4 students across 40 schools (20 receiving intervention) participated (75% participation rate), and this cohort is being tracked from grade 4 through grade 5. In addition, implementation process and fidelity data are gathered. Given that school closures in response to COVID-19 pre-maturely terminated Spring 5 th grade data collection, modifications to the original analysis plan are discussed throughout.

Evaluation of heterogeneity and heterogeneity interval estimators in random-effects meta-analysis of the standardized mean difference in education and psychology.

Meta-analyses are conducted to synthesize the quantitative results of related studies. The random-effects meta-analysis model is based on the assumption that a distribution of true effects exists in the population. This distribution is often assumed to be normal with a mean and variance. The population variance, also called heterogeneity, can be estimated numerous ways. Research exists comparing subsets of heterogeneity estimators over limited conditions. Additionally, heterogeneity is a parameter estimated with uncertainty. Various methods exist for heterogeneity interval estimation, and similar to heterogeneity estimators, these evaluations are limited. The current simulation study examined the performance of Bayesian (with 5 prior specifications) and non-Bayesian estimators over conditions found after a review of meta-analyses of the standardized mean difference in education and psychology research. Three simulation conditions were varied: (a) number of effect sizes per meta-analysis, (b) true heterogeneity, and (c) sample size per effect size within each meta-analysis. Estimators were evaluated over average bias and means square error. Methods of interval estimation were then evaluated with the estimators found to operate optimally. Interval estimators were evaluated based on coverage probability, interval width, and coverage of the estimated value. Overall, the Paule and Mandel estimator, in conjunction with the Jackson method of interval estimation, is recommended if no knowledge exists with regards to the expected value of heterogeneity when synthesizing the standardized mean difference effect size. If heterogeneity is expected to be small (e.g., < .075), then REML with the profile likelihood interval estimator is recommended. Sensitivity analysis evaluating differences in substantive conclusions with a suite of heterogeneity estimators, such as Paule and Mandel, REML, and Hedges and Olkin, is recommended. (PsycInfo Database Record (c) 2020 APA, all rights reserved).