The Middle East Respiratory Syndrome-coronavirus (MERS-CoV) causes a highly lethal pneumonia. MERS was recently identified as a candidate for vaccine development but most efforts focus on antibody responses, which are often transient after CoV infections. CoV-specific T cells are generally long-lived but the virus-specific T cell response has not been addressed in MERS patients. Here, we obtained PBMCs and/or sera from 21 MERS survivors. We detected MERS-CoV-specific CD4 and CD8 T cell responses in all MERS survivors and demonstrated functionality by measuring cytokine expression after peptide stimulation. Neutralizing (PRNT50) antibody titers measured in vitro predicted serum protective ability in infected mice and correlated with CD4 but not CD8 T cell responses; patients with higher PRNT50 and CD4 T cell responses had longer ICU stays and prolonged virus shedding and required ventilation. Survivors with undetectable MERS-CoV-specific antibody responses mounted CD8 T cell responses comparable to those of the whole cohort. There were no correlations between age, disease severity, co-morbidities and virus-specific CD8 T cell responses. In conclusion, measurements of MERS-CoV-specific T cell responses may be useful for predicting prognosis, monitoring vaccine efficacy and identifying MERS patients with mild disease in epidemiological studies and will complement virus-specific antibody measurements.

Background: Coronavirus disease 2019 (COVID-19) is associated with coagulopathy but the optimal prophylactic anticoagulation therapy remains uncertain and may depend on COVID-19 severity. Objective: To compare outcomes in hospitalized adults with severe COVID-19 treated with standard prophylactic versus intermediate dose enoxaparin. Methods: We conducted a multi-center, open-label, randomized controlled trial comparing standard prophylactic dose versus intermediate dose enoxaparin in adults who were hospitalized with COVID-19 and admitted to an intensive care unit (ICU) and/ or had laboratory evidence of coagulopathy. Patients were randomly assigned in a 1:1 ratio to receive standard prophylactic dose enoxaparin or intermediate weightadjusted dose enoxaparin. The primary outcome was all-cause mortality at 30 days.Secondary outcomes included arterial or venous thromboembolism and major bleeding.Results: A total of 176 patients (99 males and 77 females) underwent randomization. In the intention-to-treat population, all-cause mortality at 30 days was 15% for intermediate dose enoxaparin and 21% for standard prophylactic dose enoxaparin (odds ratio, 0.66; 95% confidence interval, 0.30-1.45; P = .31 by Chi-square test). Unadjusted Cox proportional hazards modeling demonstrated no significant difference in mortality between intermediate and standard dose enoxaparin (hazard ratio, 0.67; 95% confidence interval, 0.33-1.37; P = .28). Arterial or venous thrombosis occurred in 13% of patients assigned to intermediate dose enoxaparin and 9% of patients assigned to standard dose enoxaparin. Major bleeding occurred in 2% of patients in each arm. Conclusion:In hospitalized adults with severe COVID-19, standard prophylactic dose and intermediate dose enoxaparin did not differ significantly in preventing death or thrombosis at 30 days.

The connection between goals and student motivation has been widely investigated in the research literature, but the relationship of goal setting and student achievement at the classroom level has remained largely unexplored. This article reports the findings of a 5‐year quasi‐experimental study examining goal setting and student achievement in the high school Spanish language classroom. The implementation of LinguaFolio, a portfolio that focuses on student self‐assessment, goal setting, and collection of evidence of language achievement, was introduced into 23 high schools with a total of 1,273 students. By using a hierarchical linear model, researchers were able to analyze the relationship between goal setting and student achievement across time at both the individual student and teacher levels. A correlational analysis of the goal‐setting process and language proficiency scores reveals a statistically significant relationship between the goal‐setting process and language achievement (p < .01).

Suicide is the second leading cause of death among Asian American youth. Few studies have examined the risk and protective factors for suicidal thoughts and behaviors (STB) for Asian American middle school students. This study used data from the Georgia Student Health Survey 2.0 to examine the relationship between individual (gender, grade level, substance use, mental health difficulties, face-to-face victimization, and cyber victimization), school (school climate, racial diversity at school, school size, student-teacher ratio, and socioeconomic status), and familial (parental involvement) predictors of STB among 12,511 Asian American middle school students from 510 schools (50.1% girls). Results showed that both face-to-face and cyber victimization predicted higher levels of STB. Positive school climate at the individual level buffered the relationship between face-to-face victimization and STB, whereas positive school climate at the school level buffered the relationship between cyber victimization and STB. Gender was also a significant moderator of these relationships. Specifically, both types of peer victimization predicted more STB for girls than for boys. Parental involvement mitigated the relationship between face-to-face victimization and STB for girls. Positive school climate at the individual level buffered the relationship between cyber victimization and STB for boys. Findings highlight the importance of school climate, parental involvement, and gender differences in STB among Asian American students. What is the public significance of this article?This study suggests that peer victimization (both face-to-face and cyber), negative school climate, and lack of parental involvement predicted more suicidal thoughts and behaviors among Asian American middle school students. Positive school climate may buffer the negative impact of victimization on suicide. Parental involvement may buffer the impact of face-to-face victimization on suicide for girls. It is important to promote positive school climate and parental involvement, reduce bullying, and consider gender differences to reduce suicide.

Background: No consensus exists in the clinical transcranial magnetic stimulation (TMS) field as to the best method for targeting the left dorsolateral prefrontal cortex (DLPFC) for depression treatment. Two common targeting methods are the Beam F3 method and the 5.5 cm rule. Objective: Evaluate the anatomical reliability of technician-identified DLPFC targets and obtain consensus average brain and scalp MNI152 coordinates. Methods: Three trained TMS technicians performed repeated targeting using both the Beam F3 method and 5.5 cm rule in ten healthy subjects (n ¼ 162). Average target locations were plotted on 7T structural MRIs to compare inter-and intra-rater reliability, respectively. Results: (1) Beam F3 inter-and intra-rater reliability was superior to 5.5 cm targeting (p ¼ 0.0005 and 0.0035). (2) The average Beam F3 location was 2.6±1.0 cm anterolateral to the 5.5 cm method. Conclusions: Beam F3 targeting demonstrates greater precision and reliability than the 5.5 cm method and identifies a different anatomical target.

The student population in American public schools has become increasingly diverse; however, the teacher workforce remains primarily White (80%). The purpose of the current paper was to examine the relationship between studentteacher racial composition and perceptions of school climate and the impact of Whiteness on the educational outcomes of minoritized students and their counterparts. Findings from the study indicate that more than 90 percent of the minoritized students in the sample are being educated by a majority White teaching staff. White students' perceptions of cultural acceptance and connectedness increased as the number of White teachers increased. However, there was no effect for minoritized students. For minoritized students, perceptions of school climate did increase as the number of minoritized students increased. Recommendations for addressing ways to create more equitable learning environments for minoritized students and address and reduce teacher bias are discussed.

Middle school is a risky period, marked by increased peer victimization, and the onset of several mental disorders, including suicidal thoughts and behaviors (STBs). Parental involvement is critical to students’ well-being; however, few studies have examined the role of parental involvement among middle school students or its effect on their mental health. This study examined the effects of perceived parental involvement and victimization on adolescents’ mental health difficulties (MHDs) and STBs. We also investigated whether these effects varied across demographic groups, and whether perceived parental involvement buffers the relationship between victimization and students’ mental health outcomes. The sample consisted of 301,628 students (50.7% female) from 615 middle schools (Grades 6 to 8) in Georgia (United States). Hierarchical linear modeling showed that higher student-level perceived parental involvement was related to fewer MHDs (b = −0.20) and STBs (b = −0.10), and higher school-level perceived parental involvement was related to fewer STBs (b = −0.11). However, higher student-level (b = 0.25, 0.08) and school-level (b = 0.37, 0.10) traditional victimization were associated with more MHDs and STBs. Student-level perceived parental involvement was also more positively related to MHDs and STBs for 6th (b = 0.06, 0.04) and 7th graders (b = 0.03, 0.02) than for 8th graders, and it was more negatively related to MHDs (b = −0.24) and STBs (b = −0.13) for girls than for boys. Perceived parental involvement also moderated the relationships among traditional victimization, cyber victimization MHDs, and STBs. Implications are discussed relating to how schools can promote parental involvement and student mental health.

Abstract Background Morbidity and mortality from candidemia remain unacceptably high. While infectious disease consultation (IDC) is known to lower the mortality from Staphylococcus aureus bacteremia, little is known on the impact of IDC in candidemia. Methods We conducted a retrospective observational cohort study of candidemia patients at a large tertiary care hospital between 2015 and 2019. The crude mortality rate was compared between those with IDC and without IDC. Then, we systematically searched five databases through February 2020 and performed a meta-analysis of the impact of IDC on mortality of patients with candidemia. Results A total of 151 patients met the inclusion criteria, 129 (85%) of whom received IDC. Thirty-day, and 90-day mortality rates were significantly lower in the IDC group (18% vs 50%, P = .002; 23% vs 50%, P = .0022, respectively). Systematic literature review returned 216 reports, of which, 13 studies including the present report fulfilled the inclusion criteria. Among the 13 studies with a total 3687 patients, IDC was performed in 49% of patients. Overall mortality was 38.2% with a significant difference in favor of the IDC group (28.4% vs. 47.6%) with a pooled relative risk of 0.41 [95% Cl 0.35-0.49]. Ophthalmology referral, echocardiogram, and central line removal were performed more frequently among patients receiving IDC. Conclusions This study is the first systematic literature review and meta-analysis to evaluate the association between IDC and candidemia mortality. IDC was associated with significantly lower mortality and should be considered in all patients with candidemia.