Faculty Bibliography

In this article, Cybele Raver and Clancy Blair explore a group of cognitive processes called executive function (EF)-including the flexible control of attention, the ability to hold information through working memory, and the ability to maintain inhibitory control. EF processes are crucial for young children's learning. On the one hand, they can help students control their anxiety when they face challenging academic tasks. On the other, these same processes can be undermined when children experience chronically stressful situations-for example, poverty, homelessness, and neighborhood crime. Such adverse early experiences interfere with children's development of EF, hampering their ability to manage challenging situations. Through both behavioral examples and empirical evidence, Raver and Blair illustrate how children's cognitive development is intertwined with EF. They show how children's regulation of higher-order thinking is related to the regulation of emotion in both top down and bottom-up fashion-and they review research on early brain development, EF and emotion regulation, and children's academic performance. They also examine the efficacy of educational interventions that target EF and of integrated interventions that target both emotional and cognitive regulation. What does our understanding of EF imply for policy in pre-K-3 education? First, write Raver and Blair, to help young children learn, school districts need data not only on their academic readiness but also on key dimensions of EF. Second, we already have interventions that can at least partially close the gap in neurocognitive function and academic achievement between children who face multiple types of adversity and those who don't. In the long run, though, they argue, the best way to help these children is to invest in programs that reduce their exposure to chronic severe stress.

Teacher judgments of student competence can influence student achievement. Clothes, behavior, and physical appearance may all be used to infer student competence. We examined how fourth-grade teacher ratings of student physical appearance (e.g., appropriateness of clothing) relate to concurrent academic adjustment in terms of achievement, classroom engagement, teacher-child relations, parent-teacher partnership, and student academic self-concept and motivation, controlling for academic competence, ethnicity, and family characteristics. We followed 1,311 children from birth to grade 4. Children described by teachers more negatively in terms of their appearance had worse academic adjustment. Student physical appearance was also related to self-reported intrinsic motivation and academic self-concept, as well as to directly assessed math scores. Our results are consistent with social psychological and cognitive theories of stereotyping and classroom expectations, and suggest that school disengagement experienced by disadvantaged students may be partially rooted in elementary classroom dynamics.

BACKGROUND: Synthetic cannabinoids use has been a public health concern given association with hospitalization and death among users. While national reports estimate that reported use is declining among adolescents, differences by birth cohort may indicate subgroups who remain at higher risk, both in the overall adolescent population and among demographic subgroups. METHODS: We estimated age, period, and cohort models of self-reported past-year synthetic cannabinoid use (queried as "synthetic marijuana" ["K2," "Spice"]) among 54,865 adolescents aged 13-19 attending high school from 2011 to 2015. RESULTS: Past-year use decreased from 11.86% in 2011 to 4.75% in 2015. This decrease was best represented as a linear downward trend. When stratified by key covariates, however, results indicated evidence of a positive cohort effect for students of higher socioeconomic status (SES). For those students, use did not decrease at the same rate as the overall population; younger cohorts of high SES students remain at higher risk for synthetic cannabinoid use than older cohorts as well as lower SES peers. A similar and stronger association was found for frequent marijuana users (>/=20 occasions of past-year use). Multi-level models indicated that groups at highest risk included older adolescents, Hispanics and other/mixed race students, cigarette users, and frequent marijuana users. CONCLUSION: Synthetic cannabinoid use is associated with morbidity as well as mortality; continued attention to reducing synthetic cannabinoid use remains an important public health priority to maximizing student health.

BACKGROUND: Type 2 myocardial infarction (MI) is defined as myocardial necrosis (myonecrosis) due to an imbalance in supply and demand with clinical evidence of ischemia. Some clinical scenarios of supply-demand mismatch predispose to myonecrosis but limit the identification of symptoms and ECG changes referable to ischemia; therefore, the MI definition may not be met. Factors that predispose to type 2 MI and myonecrosis without definite MI, approaches to treatment, and outcomes remain poorly characterized. METHODS: Patients admitted to an academic medical center with an ICD-9 diagnosis of secondary myocardial ischemia or non-primary diagnosis of non-ST-elevation MI were retrospectively reviewed. Cases were classified as either MI (n=255) or myonecrosis without definite MI (n=220) based on reported symptoms, ischemic ECG changes, and new wall motion abnormalities. RESULTS: Conditions associated with type 2 MI or myonecrosis included non-cardiac surgery (38%), anemia or bleeding requiring transfusion (32%), sepsis (31%), tachyarrhythmia (23%), hypotension (22%), respiratory failure (23%), and severe hypertension (8%). Inpatient mortality was 5%, with no difference between patients with MI and those with myonecrosis (6% vs. 5%, p=0.41). At discharge, only 43% of patients received aspirin and statin therapy. CONCLUSIONS: Type 2 MI and myonecrosis occur frequently in the setting of supply-demand mismatch due to non-cardiac surgery, sepsis, or anemia. Myonecrosis without definite MI is associated with similar in-hospital mortality as type 2 MI; both groups warrant further workup for cardiovascular disease. Antiplatelet and statin prescriptions were infrequent at discharge, reflecting physician uncertainty about the role of secondary prevention in these patients.

Background. Only half of the 3.5 million individuals with chronic hepatitis C (HCV) in the US are aware of their infection. Emergency departments (ED) provide a primary point of entry to the healthcare system for marginalized populations who are traditionally at elevated risk for HCV and are becoming an important venue for screening and linkage efforts. Optimal methods for HCV screening (universal versus targeted) in ED remain undefined. We aim to ascertain the relative prevalence of HCV infection by age and other risk factors through non-targeted screening for HCV in our high-volume urban ED. Methods. In this ongoing prospective observational cohort study, consenting adult ED patients participate in a researcher-administered structured interview and are offered a rapid HCV antibody (HCV Ab) screening test. If reactive, confirmatory serologic HCV Ab and HCV RNA are sent immediately and a clinic appointment is scheduled within 4 weeks. Participants are contacted with HCV RNA PCR results; those with detectable viral load are encouraged to attend follow-up appointment and receive a reminder call one week prior to appointment. Successful linkage to care is defined as appointment attendance. Results. A total of 2018 eligible patients were approached July 2015-April 2016. Seven hundred thirty-two participated in a structured interview. Seven hundred seven accepted an HCVAb rapid test. HCV antibody prevalence in the ED was 3.8% (0.43% in non-baby boomers without injection drug use (IDU), 7.6% in baby boomers, 34% in persons endorsing IDU). Twenty-three HCVAb-reactive participants submitted blood for confirmatory testing. A total of 12 of 23 (52%) had detectable HCV RNA, corresponding to 1.7% prevalence of chronic infection. Targeted screening of the birth cohort and those with IDU would have missed 7.4% (2 of 27) of HCVAb positive patients and 8.3% (1 of 12) with chronic infection. A total of 4 of 12 (33.3%) with chronic infection were linked to care, 2 have upcoming appointments, 1 died before appointment. Conclusion. Prevalence of HCV in our ED was higher than the national estimate of 3.4% among baby boomers used to justify national birth cohort screening. Optimal ED HCV screening methods should target baby boomers and those endorsing IDU, but a modest proportion of infections will be missed without universal screening