Risk of COVID-19 infection and severe disease in MS patients on different disease-modifying therapies.

BACKGROUND: The risk of SARS-CoV-2 infection and severity with disease modifying therapies (DMTs) in multiple sclerosis (MS) remains unclear, with some studies demonstrating increased risks of infection with B-cell-depleting (anti-CD20) therapies and severity, while others fail to observe an association. Most existing studies are limited by a reliance on 'numerator' data (i.e., COVID-19 cases) only. OBJECTIVE: To assess the risks of COVID-19 by DMT, this study aimed to assess both 'numerator' (patients with SARS-CoV-2 infection) and 'denominator' data (all patients treated with DMTs of interest) to determine if any DMTs impart an increased risk of SARS-CoV-2 infection or disease severity. METHODS: We systematically reviewed charts and queried patients during clinic encounters in the NYU MS Comprehensive Care Center (MSCCC) for evidence of COVID-19 in all patients who were on the most commonly used DMTs in our clinic (sphingosine-1-phosphate receptor (S1P) modulators (fingolimod/siponimod), rituximab, ocrelizumab, fumarates (dimethyl fumarate/diroximel fumarate), and natalizumab). COVID-19 status was determined by clinical symptoms (CDC case definition) and laboratory testing where available (SARS-CoV-2 PCR, SARS-CoV-2 IgG). Multivariable analyses were conducted to determine predictors of infection and severe disease (hospitalization or death) using SARS-CoV-2 infected individuals per DMT group and all individuals on a given DMT as denominator. RESULTS: We identified 1,439 MS patients on DMTs of interest, of which 230 had lab-confirmed (n = 173; 75.2%) or suspected (n = 57; 24.8%) COVID-19. Infection was most frequent in those on rituximab (35/138; 25.4%), followed by fumarates (39/217; 18.0%), S1P modulators (43/250; 17.2%), natalizumab (36/245; 14.7%), and ocrelizumab (77/589; 13.1%). There were 14 hospitalizations and 2 deaths. No DMT was found to be significantly associated with increased risk of SARS-CoV-2 infection. Rituximab was a predictor of severe SARS-CoV-2 infection among patients with SARS-CoV-2 infection (OR 6.7; 95% CI 1.1-41.7) but did not reach statistical significance when the entire patient population on DMT was used (OR 2.8; 95% CI 0.6-12.2). No other DMT was associated with an increased risk of severe COVID-19. CONCLUSIONS: Analysis of COVID-19 risk among all patients on the commonly used DMTs did not demonstrate increased risk of infection with any DMT. Rituximab was associated with increased risk for severe disease.

Self-management interventions for reducing challenging behaviors among school-age students: A systematic review.

Background: Challenging classroom behaviors can interfere with student social and academic functioning and may be harmful to everyone in schools. Self-management interventions within schools can address these concerns by helping students develop necessary social, emotional, and behavioral skills. Thus, the current systematic review synthesized and analyzed school-based self-management interventions used to address challenging classroom behaviors. Objectives: The current study aimed to inform practice and policy by (a) evaluating the effectiveness of self-management interventions at improving classroom behaviors and academic outcomes and (b) examining the state of research for self-management interventions based on existing literature. Search Methods: Comprehensive search procedures included electronically searching online databases (e.g., EBSCO Academic Search Premier, MEDLINE, ERIC, PsycINFO), hand-searching 19 relevant journals (e.g., School Mental Health, Journal of School Psychology), reference-list searching 21 relevant reviews, and searching gray literature (e.g., contacting authors, searching online dissertation/theses databases and national government clearinghouses/websites). Searches were completed through December of 2020. Selection Criteria: Included studies employed either a multiple group-design (i.e., experimental or quasi-experimental) or single-case experimental research design and met the following criteria: (a) utilized a self-management intervention, (b) conducted in a school setting, (c) included school-aged students, and (d) assessed classroom behaviors. Data Collection and Analysis: Standard data collection procedures expected by the Campbell Collaboration were used in the current study. Analyses for single-case design studies incorporated three-level hierarchical models to synthesize main effects, and meta-regression for moderation. Further, robust variance estimation was applied to both single-case design and group-design studies to account for dependency issues. Main Results: Our final single-case design sample included 75 studies, 236 participants, and 456 effects (i.e., 351 behavioral outcomes and 105 academic outcomes). Our final group-design sample included 4 studies, 422 participants, and 11 total behavioral effects. Most studies occurred in the United States, in urban communities, in public schools, and in elementary settings. Single-case design results indicated that self-management interventions significantly and positively impacted both student classroom behaviors (LRRi = 0.69, 95% confidence interval [CI] [0.59, 0.78]) and academic outcomes (LRRi = 0.58, 95% CI [0.41, 0.76]). Single-case results were found to be moderated by student race and special education status, whereas intervention effects were more pronounced for African American students (F = 5.56, p = 0.02) and students receiving special education services (F = 6.87, p = 0.01). Single-case results were not found to be moderated by intervention characteristics (i.e., intervention duration, fidelity assessment, fidelity method, or training). Despite positive findings for single-case design studies, risk of bias assessment indicated methodological shortcomings that should be considered when interpreting findings. A significant main effect of self-management interventions for improving classroom behaviors was also revealed for group-design studies (g = 0.63, 95% CI [0.08, 1.17]). However, these results should be interpreted with caution given the small number of included group-design studies. Implications for Policy Practice and Research: The current study, conducted using comprehensive search/screening procedures and advanced meta-analytic techniques, adds to the large amount of evidence indicating that self-management interventions can be successfully used to address student behaviors and academic outcomes. In particular, the use specific self-management elements (i.e., self-determining a performance goal, self-observing and recording progress, reflecting on a target behavior, and administering primary reinforcers) should be considered within current interventions as well as in the development of future interventions. Future research should aim to assess the implementation and effects of self-management at the group or classroom-level within randomized controlled trials.

Exploring the link between principal leadership and family engagement across elementary and middle school.

As leaders in the school, principals play an important role in fostering family engagement. Unfortunately, little is known about specific aspects of leadership that promote family engagement. Collegial leadership, an aspect of principal leadership that promotes organizational health via trusting relationships and a sense of community, may be particularly useful to understanding how principals influence family engagement. Drawing on data from two randomized controlled trials evaluating the effects of teacher training in universal classroom management practices, the current study explores the relationship between teacher reports of family engagement and principal collegial leadership. Participants included 3208 students and 207 teachers across 18 elementary and middle schools in the Midwest United States. Utilizing hierarchical linear modeling, results revealed a significant positive relationship between family engagement and overall collegial leadership in addition to specific collegial leadership practices/characteristics. Further, baseline collegial leadership predicted increased end-of-year family engagement when controlling for baseline family engagement, developmental context, intervention status, and student-level characteristics. Overall, results provide empirical evidence for an important link between principal leadership practices and family engagement. Albeit promising, more research is needed to identify and explain the particular mechanisms by which principal collegial leadership may promote family engagement.

Family-school engagement across child and adolescent development.

Family school engagement practices (e.g., family school partnerships and parental involvement) are empirically supported across academic and social-behavioral domains. Despite family school engagement and parent involvement being deemed important across elementary and secondary schooling, much of the research has focused on early childhood and elementary students. Understanding family school engagement across all stages of development is important, as aspects of family school engagement practices often become more challenging as children grow into middle- and high-school students. This special series works to build our knowledge of family school engagement across development. The series presents a set of studies which confer current knowledge on the association between family school engagement and child outcomes in elementary, middle, and high school while offering important implications for school personnel. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Understanding family-school engagement across and within elementary- and middle-school contexts.

Although family-school engagement is important across child and adolescent development, most research, programs, and policies have focused primarily on elementary students and contexts. The current study extends beyond elementary settings by exploring the unique and shared contributions of developmental context on family-school engagement (i.e., across and within elementary- and middle-school settings). Data were drawn from two randomized controlled trials that evaluated the efficacy of teacher training in universal classroom-management practices. Participants included 3,174 students and 207 teachers across 21 elementary and middle schools in the Midwest. Using hierarchical linear modeling, results revealed that family-school engagement was significantly higher in elementary than in middle schools. Student-level characteristics (i.e., identifying as White, participation in the free/reduced-price lunch program, and having lower levels of disruptive behavior) were also associated with higher levels of family-school engagement. In addition, student characteristics (i.e., race/ethnicity and level of disruptive behavior) moderated the relations between family-school engagement and developmental context. Regardless of developmental context, family-school engagement predicted positive end-of-year behavioral outcomes (i.e., increases in youth prosocial skills and decreases in youth concentration problems, disruptive behaviors, and emotional dysregulation). Last, moderation analyses revealed that these effects of family-school engagement were especially pronounced in middle school for concentration problems and emotional dysregulation. Overall, findings provide further support for the value of family-school engagement across development in fostering positive youth outcomes. However, it is evident that more steps must be taken to ensure family-school engagement practices are developed to support the unique needs of middle-school students and contexts. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Gadolinium Deposition in Neurology Clinical Practice.

Background: Magnetic resonance imaging (MRI) enhanced with gadolinium-based contrast agents (GBCAs) is an essential tool in the diagnosis and management of many neurologic diseases, including multiple sclerosis, brain tumors, and infections. The clinical utility of GBCAs is evidenced by their widespread use. GBCAs are produced in macrocyclic and linear forms. Since 2014, evidence has suggested that repeated administration of GBCAs can lead to gadolinium deposition in the brain. Methods: We review the literature on gadolinium deposition, including both animal and human studies, as well as the literature on GBCA-associated health outcomes. Additionally, we summarize and discuss the updated medical society recommendations and perspectives on GBCA use in clinical practice. Results: The first publication reporting gadolinium deposition in the human brain was published in 2014. Since that seminal report, multiple studies have demonstrated that exposure to linear GBCAs is associated with gadolinium deposition in the dentate nucleus and globus pallidus as seen on brain MRI. Macrocyclic GBCA exposure has not convincingly been associated with gadolinium deposition evident on brain MRI. Conclusion: Clear evidence demonstrates that GBCAs lead to gadolinium deposition in the brain in a dose-dependent manner; however, only linear GBCAs have been associated with gadolinium deposition visualized on MRI. To date, no evidence links gadolinium deposition with any adverse health outcome. Updated medical society guidelines emphasize the importance of an individualized risk-benefit analysis with each administration of GBCAs.