Aspergillus fumigatus is a mold that causes a spectrum of diseases, including lethal lung infections in immunocompromised humans and allergic asthma in atopic individuals. T helper 1 (Th1) CD4(+) T cells protect against invasive A. fumigatus infections whereas Th2 CD4(+) T cells exacerbate asthma upon inhalation of A. fumigatus spores. Herein, we demonstrate that A. fumigatus-specific T cells were rapidly primed in lymph nodes draining the lung and fully differentiated into interferon-gamma (IFN-gamma)-producing Th1 CD4(+) T cells upon arrival in the airways. T-bet induction in A. fumigatus-specific CD4(+) T cells was enhanced by MyD88-mediated signals in draining lymph nodes, but T cell proliferation, trafficking, and Th1 differentiation in the airways were Toll-like receptor (TLR) and MyD88 independent. Our studies demonstrate that CD4(+) T cell differentiation during respiratory fungal infection occurs incrementally, with TLR-mediated signals in the lymph node enhancing the potential for IFN-gamma production whereas MyD88-independent signals promote Th1 differentiation in the lung.

Objectives: In response to the novel coronavirus disease (COVID-19), many countries have temporarily closed educational institutions. As of June 10, 2020, more than 1.1 billion students have been affected by pandemic-related school closures. This literature review seeks to highlight key areas in which the mental health of children and adolescents worldwide are impacted by school closures. Methods: A search of Google Scholar and PubMed electronic databases was conducted using search terms including "COVID-19," "school closure," "mental health," and "anxiety" in various permutations. We selected 11 of the 79 initial search results that specifically addressed school-closure effects on the pediatric population, which included 1 longitudinal study, 1 crosssectional study, and 9 commentaries, and then we performed a narrative review.Results: Regarding broad impacts on the general school-age population, several publications identified a significant increase in both sedentary behavior and screen time. Several papers also highlighted the loss of structure afforded by school routine and its disruption of mood, organization, and motivation. Adolescents experience significant anxiety regarding academic performance associated with the disruption of standardized exams and unfamiliar online learning modalities. Increased time spent at home may also present significant risk to students with stressful, unstable, or abusive home environments. School closures also exert a significant impact on existing social disparities. Food insecurity is significantly exacerbated by the loss of scheduled school meals, further compounded by the increased financial burden of a COVID-related economic recession. Similarly, access to health care, including school nurses and mental health services, is limited. Many online learning tools require devices, internet connection, and a suitable learning environment, presenting a severe disadvantage for children of lowerincome households. Conclusions: School closure is an ongoing, unprecedented disruption in the lives of billions of children and adolescents worldwide. As the education system continues to change in response to COVID-19, it is vital to identify and address impacts on the mental health of this population of students, especially in the context of social disparities and inequalities.

Autoimmune hepatitis (AIH) is a form of liver inflammation in which immune cells target hepatocytes, inducing chronic inflammatory states. Bariatric surgery (BS) was shown to reduce inflammation in severely obese patients. We hypothesize that obese patients with AIH and BS have lower prevalence of liver-related complications and in-patient mortality compared to those without BS. The National Inpatient Sample from 2007 to 2013 was queried for hospitalizations of adults over 18 years of age with a diagnosis of AIH. Of those, hospitalizations with BS were selected as cases and those with morbid obesity as controls. Case-control 1:2 matching was done based on sex, age, race, and comorbidities. Primary outcomes were prevalence of liver-related complications and in-patient mortality. Independent risk factors of in-patient clinical outcomes were identified using multivariate regression analysis. From 137,834 hospitalizations with a diagnosis of AIH, 688 with BS were selected as cases, and 1295 were matched as controls. The prevalence of ascites was higher in the BS group compared to the control (odds ratio 1.73, 95% confidence interval (CI) 1.27–2.36). The prevalence of cirrhosis (36.8% vs 33.2%), portal hypertension (7.4% vs 10.0%), hepatic encephalopathy (10.6% vs 8.7%), and varices and variceal bleeding (3.9% vs 5.5%) was not statistically different from case controls, ( P > .05). BS was an independent risk factor for ascites (adjusted odds ratio (aOR) 1.87; 95% CI 1.36–2.56) and hepatic encephalopathy (aOR 1.42; 95% CI 1.03–1.97) but was an independent protective factor against in-patient mortality (aOR 0.21, 95% CI 0.08–0.55) once adjusted for age, sex, race, and comorbidities.

Objectives: No prior studies have examined group teleconference (TeleGroup) delivery of evidence-based treatments (EBTs) for youth mental health disorders. We evaluated the feasibility and acceptability of TeleGroups given the need to rapidly adapt multiple EBTs for telehealth during the COVID-19 pandemic. Methods: Due to local outbreak of COVID-19 in mid-March 2020, all in-person treatment groups at an academic children's hospital were canceled. We rapidly adapted 6 EBTs representing 10 distinctive curricula to TeleGroup format. We initiated 14 TeleGroups with 6 to 12 families each. Caregivers and adolescents completed anonymous digital surveys with 12 questions about their experience with group teleconferencing, acceptability of TeleGroup components, and qualitative feedback. We calculated descriptive statistics for numerical data and completed thematic analysis of open-ended feedback. Results: A total of 84 caregivers (median age range: 40-49 years; 31.5% over age 50 years; 73% female) and 10 adolescents (ages 14-18 years) completed surveys. Most caregivers surveyed in March had never used group teleconferencing, but by April, over 90% had used it for work or socializing. After technical difficulties with an initial host platform, families participating via WebEx or Zoom (n ¼ 78) reported overall high satisfaction with TeleGroups. A majority (86.7%) of caregivers endorsed satisfaction with TeleGroups compared to no treatment; a minority (5.2%) of caregivers were not satisfied due to difficulties with implementing CBT components (eg, exposure) via videoconferencing. Sixty-six percent found TeleGroups to be acceptable (moderately to highly) relative to inperson groups. Families reported the highest acceptability for lectures, group discussions, and using the chat functions. Thematic analysis indicated that participants experienced reduced logistical barriers to participation and recommended prerecording of psychoeducation lectures. Conclusions: TeleGroup delivery of EBTs is a feasible and acceptable format for youth and families with a wide range of presenting mental health concerns. Implementation strategies and implications of TeleGroups for safety, reach, and equity in the delivery of EBTs are discussed.

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