Do Schools Promote Executive Functions? Differential Working Memory Growth Across School-Year and Summer Months

Children’s working memory (WM) skills, which support both academic and social success, continue to improve significantly through the school years. This study leverages the first nationally representative data set with direct assessments of elementary school students’ WM skills to examine whether WM grows more during the school year or summer months and whether WM growth rates differ by household income. Results demonstrate that WM skills grow more during the school-year months compared to the summer months, suggesting that school environments provide children with unique opportunities to improve and practice their WM skills. Further, lower-income children have significantly faster WM growth rates in the first 2 years of school and the intervening summer, compared to their peers from higher-income families, leading to an overall narrowing in WM disparities by household income during the early school years. However, there was no evidence that schools equalize or exacerbate differences in WM skills between children from lower-income and higher-income households

Measuring and understanding social-emotional behaviors in preschoolers from rural Pakistan

The Strengths and Difficulties Questionnaire (SDQ) is widely-used to measure symptoms of common childhood behavioral problems that may lead to mental health difficulties. In a sample of 1,302 highly-disadvantaged mothers and their preschoolers, we evaluated the factor structure and reliability of the parent-report version of the SDQ in rural Pakistan. Confirmatory factor analyses suggested that the original structure of the SDQ was not appropriate for our data. We created conceptually- and empirically-coherent measures of children’s externalizing behavior problems and prosocial skills. Child and family correlates of social-emotional behaviors were similar to those found in other countries, supporting the validity of our new composites. Girls and children with more siblings had fewer externalizing behavior problems and more prosocial behaviors at four years. Further, maternal depressive symptoms and food insecurity were uniquely linked to more externalizing behavior problems at four years. In contrast, maternal education, home environment quality, and social-emotional skills at two years were associated with more prosocial behaviors at four year

PANC Study (Pancreatitis: A National Cohort Study): national cohort study examining the first 30 days from presentation of acute pancreatitis in the UK

Abstract Background Acute pancreatitis is a common, yet complex, emergency surgical presentation. Multiple guidelines exist and management can vary significantly. The aim of this first UK, multicentre, prospective cohort study was to assess the variation in management of acute pancreatitis to guide resource planning and optimize treatment. Methods All patients aged greater than or equal to 18 years presenting with acute pancreatitis, as per the Atlanta criteria, from March to April 2021 were eligible for inclusion and followed up for 30 days. Anonymized data were uploaded to a secure electronic database in line with local governance approvals. Results A total of 113 hospitals contributed data on 2580 patients, with an equal sex distribution and a mean age of 57 years. The aetiology was gallstones in 50.6 per cent, with idiopathic the next most common (22.4 per cent). In addition to the 7.6 per cent with a diagnosis of chronic pancreatitis, 20.1 per cent of patients had a previous episode of acute pancreatitis. One in 20 patients were classed as having severe pancreatitis, as per the Atlanta criteria. The overall mortality rate was 2.3 per cent at 30 days, but rose to one in three in the severe group. Predictors of death included male sex, increased age, and frailty; previous acute pancreatitis and gallstones as aetiologies were protective. Smoking status and body mass index did not affect death. Conclusion Most patients presenting with acute pancreatitis have a mild, self-limiting disease. Rates of patients with idiopathic pancreatitis are high. Recurrent attacks of pancreatitis are common, but are likely to have reduced risk of death on subsequent admissions. </jats:sec

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

Do Schools Promote Executive Functions? Differential Working Memory Growth Across School-Year and Summer Months

Children’s working memory (WM) skills, which support both academic and social success, continue to improve significantly through the school years. This study leverages the first nationally representative data set with direct assessments of elementary school students’ WM skills to examine whether WM grows more during the school year or summer months and whether WM growth rates differ by household income. Results demonstrate that WM skills grow more during the school-year months compared to the summer months, suggesting that school environments provide children with unique opportunities to improve and practice their WM skills. Further, lower-income children have significantly faster WM growth rates in the first 2 years of school and the intervening summer, compared to their peers from higher-income families, leading to an overall narrowing in WM disparities by household income during the early school years. However, there was no evidence that schools equalize or exacerbate differences in WM skills between children from lower-income and higher-income households

Do Schools Promote Executive Functions? Differential Working Memory Growth Across School-Year and Summer Months

Children’s working memory (WM) skills, which support both academic and social success, continue to improve significantly through the school years. This study leverages the first nationally representative data set with direct assessments of elementary school students’ WM skills to examine whether WM grows more during the school year or summer months and whether WM growth rates differ by household income. Results demonstrate that WM skills grow more during the school-year months compared to the summer months, suggesting that school environments provide children with unique opportunities to improve and practice their WM skills. Further, lower-income children have significantly faster WM growth rates in the first 2 years of school and the intervening summer, compared to their peers from higher-income families, leading to an overall narrowing in WM disparities by household income during the early school years. However, there was no evidence that schools equalize or exacerbate differences in WM skills between children from lower-income and higher-income households

Moving beyond executive functions: Challenge preference as a predictor of academic achievement in elementary school

Intrinsic motivation and executive functions (EFs) have been independently studied as predictors of academic achievement in elementary school. The goal of this investigation was to understand how students’ challenge preference (CP), an aspect of intrinsic motivation, is related to academic achievement while accounting for EFs as a confounding variable. Using data from a longitudinal study of 569 third-, fourth-, and fifth-graders (50% female), we tested students’ self-reported CP as a predictor of mathematics and English language arts (ELA) achievement in multilevel models that controlled for school fixed effects and student demographic characteristics. CP was positively associated with mathematics and ELA over and above the set of covariates and EFs. While also controlling for prior achievement, CP continued to explain a small amount of unique variance in mathematics, but not in ELA. These results underscore the importance of including measures of students’ intrinsic motivation, in addition to EFs, to obtain a comprehensive understanding of academic success

Peers Matter: Links Between Classmates’ and Individual Students’ Executive Functions in Elementary School

Students’ executive functions (EFs) are linked to school success. Although school-age children spend much of their time interacting with peers, few studies have explored how children’s classmates may promote EF development in elementary school. In this study, we test whether mean levels and variability in classmates’ EF skills are associated with growth in individual students’ accuracy and speed on EF tasks among third, fourth, and fifth graders (N = 806). We find that classmates’ speed, but not accuracy, on EF tasks is linked to significant improvements in individual students’ EFs over the school year. Classmates’ average EFs, as indexed by faster accurate responses on EF tasks, are associated with improvements in individual students’ speed on EF tasks. These results were robust to the inclusion of individual students’ general processing speed. In contrast, variability in classmates’ accuracy and speed on EF tasks was not associated with individual students’ EF growth. Our results highlight the role of peers and the school context for EF development in middle childhood