Comparison Of Treatment Strategies Research Articles

Management of urachal anomalies in pediatric patients: A comparison of treatment strategies between pediatric urology and general surgery

Persistence of embryonic urachal structures due to a failure of the urachus to involute into the median umbilical ligament is known as a urachal anomaly (UA). UAs may remain asymptomatic or lead to abdominal pain and recurrent infections. Management of UAs in pediatric patients has historically lacked a clear consensus between conservative and surgical management. While both urologists and general surgeons manage this pathology, a comparison of management style and outcomes between these specialties has not been published to our knowledge. To (1) evaluate trends in management of UAs among pediatric urologists and general surgeons across three tertiary care children's hospitals and (2) identify factors that place patients at higher risk for requiring surgery. All patients diagnosed with a UA from 2016 to 2020at our multi-site institution were identified by ICD-10 code Q64.4 "malformation of the urachus" and retrospectively reviewed. Patient demographics, treatment specialty, remnant subtype, and management strategy were recorded. Data was dichotomized between both urology and general surgery as well as between surgical and nonsurgical intervention to identify and compare management strategies. Overall, 143 patients diagnosed with UAs were identified. Of these patients, 74 were treated by urology and 69 were treated by general surgery. Patients who were treated by urology were significantly more likely to receive conservative treatment (66.2% treated conservatively vs. 33.8% treated surgically), while patients treated by general surgery were significantly more likely to undergo surgery (84.1% treated surgically vs. 15.9% treated conservatively, p<.0001). Though, urology was more likely to treat patients who presented incidentally (p<.01), and general surgery was more likely to treat patients who presented with an infected remnant (p<.01). Patients of male sex were more likely overall to receive surgery compared to female patients (p<.01). Management of UAs by urologists was more conservative than general surgeons. However, both specialties treat distinctly different patient presentations, with urology managing more incidental remnants and general surgery operating on more emergent, infected urachi. Limitations of the study included its retrospective nature and the insufficient reporting of urachal remnant subtypes and presence of infection among patients. Management strategies of UAs differ among urology and general surgery, but surgical and conservative treatments are necessary to appropriately treat their distinct patient populations. This study provides valuable insight into current practices of UA management and may help to inform future treatment.

A core outcome domain set for clinical research on capillary malformations (the COSCAM project): an e-Delphi process and consensus meeting.

There is limited evidence on the best available treatment options for capillary malformations (CMs), mainly due to the absence of uniform outcome measures in trials on therapies. A core outcome set (COS) enables standard reporting of trial outcomes, which facilitates comparison of treatment results. To develop a core outcome domain set (CDS), as part of a core outcome set (COS), for clinical research on CMs. Sixty-seven potentially relevant outcome subdomains were recognized based on the literature, focus group sessions, and input from the COSCAM working group. These outcome subdomains were presented in an online Delphi study to CM experts (medical specialists and authors of relevant literature) and (parents of) patients with CM (international patient associations). During three e-Delphi study rounds, the participants repeatedly scored the importance of these outcome subdomains on a seven-point Likert scale. Participants could also propose other relevant outcome subdomains. Consensus was defined as ≥ 80% agreement as to the importance of an outcome subdomain among both stakeholder groups. The CDS was finalized during an online consensus meeting. In total 269 participants from 45 countries participated in the first e-Delphi study round. Of these, 106 were CM experts from 32 countries, made up predominantly of dermatologists (59%) and plastic surgeons (18%). Moreover, 163 (parents of) patients with CM from 28 countries participated, of whom 58% had Sturge-Weber syndrome. During the two subsequent e-Delphi study rounds, 189 and 148 participants participated, respectively. After the entire consensus process, consensus was reached on 11 outcome subdomains: colour/redness, thickness, noticeability, distortion of anatomical structures, glaucoma, overall health-related quality of life, emotional functioning, social functioning, tolerability of intervention, patient satisfaction with treatment results, and recurrence. We recommend the CDS to be used as a minimum reporting standard in all future trials of CM therapy. Our next step will be to select suitable outcome measurement instruments to score the core outcome subdomains. What is already known about this topic? Besides physical and functional sequelae, capillary malformations (CMs) often cause emotional and social burden. The lack of uniform outcome measures obstructs proper evaluation and comparison of treatment strategies. As a result, there is limited evidence on the best available treatment options. The development of a core outcome set (COS) may improve standardized reporting of trial outcomes. What does this study add? A core outcome domain set (CDS), as part of a COS, was developed for clinical research on CMs. International consensus was reached on the recommended core outcome subdomains to be measured in CM trials: colour/redness, thickness, noticeability, distortion of anatomical structures, glaucoma, overall health-related quality of life, emotional functioning, social functioning, tolerability of intervention, patient satisfaction with treatment results, and recurrence. This CDS enables the next step in the development of a COS, namely to reach consensus on the core outcome measurement instruments to score the core outcome subdomains. What are the clinical implications of this work? The obtained CDS will facilitate standardized reporting of treatment outcomes, thereby enabling proper comparison of treatment results. This comparison is likely to provide more reliable information for patients about the best available treatment options.

Comparison of treatment strategies and survival of early-onset gastric cancer: a population-based study

Treatments for early-onset gastric cancer (EOGC) patients are rarely included in clinical trials, resulting in an unclear impact on survival. This study aimed to investigate the treatment patterns of EOGC patients and their impact on survival. Based on the Surveillance, Epidemiology, and End Results database, we conducted a retrospective analysis of 1639 EOGC patients (< 50 years) diagnosed between 2010 and 2018. Patients with larger tumours, distant metastasis, and AJCC TNM stage in IV were prone to receive nonsurgical treatment. Patients treated with surgery alone had a better prognosis than those receiving SROC or SCRT or nonsurgical treatment. However, analyses stratified by histological type, tumour size and TNM stage showed that patients did not benefit more from SROC and SCRT than from surgery alone. Similar results were observed in the stratified Cox regression risk analysis. Patients who received nonsurgical treatment had the highest risk of overall death [hazard ratio (HR) = 2.443, 95% confidence interval (CI) 1.865–3.200, P < 0.001]. This study indicated that additional radiotherapy, chemotherapy or chemoradiotherapy did not provide a coordinated survival benefit to EOGC patients.

Remission, treatment failure, and relapse in pediatric ALL: an international consensus of the Ponte-di-Legno Consortium

Comparison of treatment strategies in de novo pediatric acute lymphoblastic leukemia (ALL) requires standardized measures of efficacy. Key parameters that define disease-related events, including complete remission (CR), treatment failure (TF; not achieving CR), and relapse (loss of CR) require an updated consensus incorporating modern diagnostics. We collected the definitions of CR, TF, and relapse from recent and current pediatric clinical trials for the treatment of ALL, including the key components of response evaluation (timing, anatomic sites, detection methods, and thresholds) and found significant heterogeneity, most notably in the definition of TF. Representatives of the major international ALL clinical trial groups convened to establish consensus definitions. CR should be defined at a time point no earlier than at the end of induction and should include the reduction of blasts below a specific threshold in bone marrow and extramedullary sites, incorporating minimal residual disease (MRD) techniques for marrow evaluations. TF should be defined as failure to achieve CR by a prespecified time point in therapy. Relapse can only be defined in patients who have achieved CR and must include a specific threshold of leukemic cells in the bone marrow confirmed by MRD, the detection of central nervous system leukemia, or documentation of extramedullary disease. Definitions of TF and relapse should harmonize with eligibility criteria for clinical trials in relapsed/refractory ALL. These consensus definitions will enhance the ability to compare outcomes across pediatric ALL trials and facilitate development of future international collaborative trials.

Abstract 15338: Comparison of Treatment Strategies for Neonates With Tetralogy of Fallot and Pulmonary Atresia: A Report From the Congenital Catheterization Research Collaborative

Introduction: Neonates with tetralogy of Fallot and pulmonary atresia (TOF/PA) with pulmonary blood flow supplied by the ductus arteriosus require early intervention. This may be accomplished by: initial palliation (IP) followed by complete repair (CR) or initial primary repair (PR). The optimal approach for patients with TOF/PA has not been established. Methods: Neonates with TOF/PA who underwent IP or PR from 2005-17 were retrospectively reviewed from the Congenital Catheterization Research Collaborative. The primary outcome was mortality. Outcomes were compared as IP vs PR and IP+CR vs PR. Secondary outcomes included hospital and procedural complications and are listed in table 1. Propensity scoring was used to adjust for baseline differences between strategies. Results: Of 282 neonates with TOF/PA, 106 underwent PR and 176 underwent IP (144 surgical, 32 transcatheter). Prior to initial intervention, IP patients had higher rates of mechanical ventilation (83.9% vs 72.2%, p=0.023) and DiGeorge syndrome (14.77% vs 4.72%, p=0.009). Mortality was greater in the IP cohort (HR 2.7, 95% CI 1.02 - 7.1, p = 0.046), with no mortality in the PR cohort after 6 months post-repair. After adjustment, differences in survival were no longer significant (HR 1.4, 95% CI 0.7 - 3.1, p=0.39). Both cohorts had similar mechanical ventilation duration and inotrope use as well as procedural and hospital complications. Intensive care and hospital length of stay, cardiac bypass (CPB) and anesthesia time favored PR when compared to IP+CR (p=&lt;0.001). Early reintervention was more common in patients undergoing IP (rate ratio 1.42, p 0.003), but post-complete repair rates were similar (p=0.837). Conclusions: In neonates with TOF/PA, the IP approach is more often utilized in higher-risk patients. Accounting for this difference, IP and PR strategies have similar adjusted survival rates. Perioperative morbidities and lower risk for reintervention generally favor PR.

Interim monitoring in a treatment strategy trial with a composite primary endpoint

When a clinical trial has a composite endpoint and a comparison of treatment strategies with multiple intervention components, interim data reviews by a data safety and monitoring board (DSMB) can be challenging as the data evolve on multiple fronts. We illustrate with a study in the treatment of Kaposi sarcoma (KS), an HIV-associated cancer with a multi-faceted disease presentation. The study, ACTG-A5264/AMC-067, was a 1:1 randomized trial to compare two strategies: immediate initiation of etoposide with antiretroviral therapy (ART), or ART with delayed etoposide upon disease progression. The outcome was a composite endpoint that included the following events, ordered from worst to best in the following three categories: (1) KS progression at 48 weeks, death, initiation of alternate KS treatment, loss to study follow-up; (2) stable KS; and (3) partial or complete KS response at 48 weeks. We present the interim results on the composite endpoint and the individual components, where components favored different study arms at an interim review. To facilitate interim data monitoring for complex trials, we recommend clear communications between the study team and the DSMB prior to the initiation of the trial on the need for a composite endpoint, the intentions behind the defined strategies, and relative importance of individual components of the composite endpoint. We also recommend flexibility in the timing of data reviews by the DSMB to interpret emerging data in multiple dimensions.Clinicaltrials.govNCT01352117

Management of infected shoulder arthroplasty: a comparison of treatment strategies

The study purpose was to determine whether 2-stage revision procedures result in superior outcomes and whether reverse shoulder arthroplasty produced superior outcomes to hemiarthroplasty or anatomic total shoulder arthroplasty at the time of reimplantation. Our prospectively collected database was retrospectively reviewed for all surgically treated infected shoulder arthroplasties between 2006 and 2014. We included 47 patients in this study: 27 underwent a 2-stage revision, and 20 were treated with an antibiotic spacer as definitive treatment. Preoperative laboratory results, intraoperative cultures and pathology findings, recurrence of infection, complications, and outcome measures were compared between treatment groups. A recurrent infection developed in 3 patients in the antibiotic spacer group and 2 patients in the 2-stage revision group (P = .25). A total of 20 procedure-related complications and 11 medical complications occurred between the 2 groups; however, there was no statistically significant difference between groups. The 2-stage group had statistically significantly better Constant scores (58.1 vs. 33.3, P = .04) and elevation (94.4° vs. 48.6°, P = .02) than the antibiotic spacer group. Subanalysis of the 2-stage revision group showed that reverse total shoulder arthroplasties had statistically superior Shoulder Pain and Disability Index, Simple Shoulder Test, American Shoulder and Elbow Surgeons, University of California at Los Angeles, and Constant scores; elevation; and abduction compared with hemiarthroplasties or anatomic total shoulder arthroplasties. Two-stage revision procedures and use of an antibiotic spacer for definitive management of periprosthetic shoulder infections appear to be similar and effective in eradicating infections. Two-stage revisions using a reverse total shoulder arthroplasty at the time of reimplantation generatesuperior range of motion and functional outcome scores.

Spectrum of pathogen- and model-specific histopathologies in mouse models of acute pneumonia.

Pneumonia may be caused by a wide range of pathogens and is considered the most common infectious cause of death in humans. Murine acute lung infection models mirror human pathologies in many aspects and contribute to our understanding of the disease and the development of novel treatment strategies. Despite progress in other fields of tissue imaging, histopathology remains the most conclusive and practical read out tool for the descriptive and semiquantitative evaluation of mouse pneumonia and therapeutic interventions. Here, we systematically describe and compare the distinctive histopathological features of established models of acute pneumonia in mice induced by Streptococcus (S.) pneumoniae, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Legionella pneumophila, Escherichia coli, Middle East respiratory syndrome (MERS) coronavirus, influenza A virus (IAV) and superinfection of IAV-incuced pneumonia with S. pneumoniae. Systematic comparisons of the models revealed striking differences in the distribution of lesions, the characteristics of pneumonia induced, principal inflammatory cell types, lesions in adjacent tissues, and the detectability of the pathogens in histological sections. We therefore identified core criteria for each model suitable for practical semiquantitative scoring systems that take into account the pathogen- and model-specific patterns of pneumonia. Other critical factors that affect experimental pathologies are discussed, including infectious dose, time kinetics, and the genetic background of the mouse strain. The substantial differences between the model-specific pathologies underscore the necessity of pathogen- and model-adapted criteria for the comparative quantification of experimental outcomes. These criteria also allow for the standardized validation and comparison of treatment strategies in preclinical models.

Comparison of Treatment Strategies in Patients over 60 Years with AML: Final Analysis of a Prospective Randomized German AML Intergroup Study

Comparison of Treatment Strategies in Patients over 60 Years with AML: Final Analysis of a Prospective Randomized German AML Intergroup Study

Cost–effectiveness in colorectal cancer: challenges on quality and comparability

Costs in colorectal cancer treatment are rising, especially since the availability of expensive targeted drugs. Comparisons between cost–effectiveness evaluations are restricted to differences in applied methodology, for example, differences in model assumptions and design, healthcare systems. Cost–effectiveness analyses should be performed and reported upon in a standardized manner within a disease area and in particular in oncology to facilitate better comparisons between treatments. Ideally, to evaluate the cost–effectiveness of a treatment in daily practice, models should be based on patient cohort studies or registries with appropriate prospective data collection from a societal perspective. Randomized clinical trials remain most suitable for comparison of treatment strategies and could estimate the budget impact of a novel treatment introduction.

Kliniğimize ST Yükselmeli Miyokart İnfarktüsü Nedeniyle Başvuran Hastalarda Tercih Edilen Tedavi Stratejilerinin Karşılaştırılması (Yaşam İçin Trombolitik Tedavi)

Giriş: Bu çalışmada, kliniğimize ST-yükselmeli miyokart infarktüsü (STEMI) ile başvuran hastalara uygulanan tedavi stratejileri karşılaştırıldı. Hastalar ve Yöntem: STEMI tanısı ile başvuran 165 hastanın reperfüzyon stratejisi belirlendi. Hastaların kapı-balon ve kapı-iğne süreleri kaydedildi. Bulgular: Ortalama kapı-balon süresi sevk edilen hastalarda 240 dakika, doğrudan acil servise başvuran hastalarda 64.6 dakika bulundu (p= 0.000). Sevk edilen hastaların mekanik reperfüzyon süreleri AHA (American Heart Association) kılavuzuna göre sadece %7 hastada uygunken, ESC (European Society of Cardiology) kılavuzuna göre %26 hastada uygundu. Doğrudan acil servise başvuran hastalarda bu oranlar sırasıyla %86 ve %97 idi. Kapı-iğne ortalama süreleri, dış merkezlerde trombolitik tedavi (TT) verilen ve kliniğimize yönlendirilen hastalarda 41.3 dakika, merkezimizde TT verilen hastalarda 35 dakika idi. İkisi arasında anlamlı fark saptanmadı (p= 0.454). Sonuç: STEMI tanısı ile dış merkezlerden sevk edilen hastaların reperfüzyon süreleri kliniğimize doğrudan başvuran hastaların reperfüzyon süreleriyle karşılaştırıldığında, ikinci grupta güncel kılavuzlara düşük oranda uyulduğu gösterildi. Trombolitik tedavi kullanımında ise iki hasta grubunda da kapı-iğne zamanının kabul edilebilir sınırlar içinde olduğu görüldü. Bulgularımız, dış merkezlerden sevk edilen hastalarda, güncel kılavuzlara göre hareket edildiği taktirde, trombolitik tedavinin etkili bir reperfüzyon stratejisi olarak öne çıktığını göstermektedir.

Parental preferences for treatment: Preliminary report from a randomised comparison of treatment strategies in (early) juvenile idiopathic arthritis (BeSt for Kids trial)

Methods A questionnaire is taken at the start in all parents of the participants of the BeSt for Kids trial, treated with either initial sequential monotherapy (group 1) with either methotrexate or sulfasalazine, initial combination therapy with methotrexate and tapered prednisone (group 2), or initial combination therapy with methotrexate and etanercept (group 3). ACRp50 is the primary goal, treatment adjustments are made every 3 months to aim at clinical remission on medication from 6 months and onwards. The questionnaire explores parental preferences or dislikes for the initial therapy.

Comparison of radiographical imaging modalities for measuring the diameter of renal masses: is there a sizeable difference?

•To determine which imaging modality (magnetic resonance imaging, MRI; computed tomography, CT; ultrasonography, US) best predicted pathological tumour size before radical or partial nephrectomy. •The clinicopathological data of 776 patients who underwent radical or partial nephrectomy were retrospectively reviewed in the context of the radiological modality used for preoperative diagnosis. •The maximum reported diameter of the tumour was compared with the maximum diameter of the tumour after resection. Data were analyzed by a paired Student's t-test, correlation and logistic regression analysis. •In total, 717 patients had available data for analysis, including 414 CT scans, 121 ultrasonographs and 455 MRIs. When tumour size was compared with preoperative tumour size on ultrasonography, CT and MRI, there was no significant differences between the estimated preoperative tumour size and pathological tumour size (CT: P= 0.56, MRI: P= 0.62, ultrasonography: P= 0.55). Tumour size was also well correlated with all three modalities. •All three standard renal imaging modalities appear to accurately predict pathological tumour size. •These data are relevant to the interpretation and comparison of treatment strategies, such as active surveillance protocols and ablative therapy, where pathological size is not available. •Furthermore, lack of inferiority of ultrasonography in predicting pathological tumour size affords opportunities for the reduction of patient radiation exposure and for cost containment.

Meta‐analysis of Survival of Patients with Stage 4 Colorectal Cancer Managed with Resection versus Chemotherapy Alone: Letter to the Editor

In their article Stillwell et al. conclude that, to avoid tumorrelated complications, asymptomatic patients presenting with metastatic colorectal cancer should undergo resection of the primary tumor [1]. While this observation may once have been correct, we believe that recent advances in medical oncology warrant re-examination of this assertion. In the last decade five new chemotherapeutic agents (irinotecan, capecitabine, oxaliplatin, bevacizumab, and cetuximab) have been approved, and a number of effective regimens have been developed, broadening the armamentarium against metastatic colorectal cancer. Clinical trials have demonstrated an increase in median survival in patients with metastatic colorectal cancer from 6–8 months with supportive care alone to more than 20 months with the use of combination chemotherapy [2]. As a result, the view of metastatic colorectal cancer has changed from an acute condition and a certain death sentence to, potentially, a chronic condition, that patients live with but do not die from [2]. Furthermore, complications from an asymptomatic primary tumor being left in situ in a patient with unresectable synchronous metastatic disease receiving newer chemotherapy agents may not be of such concern as suggested in a recent article by Poultsides et al. [3]. In their experience, they managed 233 consecutive patients with synchronous metastatic colorectal cancer and an unresected primary tumor with up-front modern chemotherapy (oxaliplatinor irinotecan-based, triple-drug chemotherapy) between 2000 and 2006. They observed that 213 (89%) patients never required any direct symptomatic management for the intact primary tumor, and the median overall survival for the entire patient cohort was 18 months from the initiation of systemic chemotherapy. The fundamental issue is that comparisons of treatment strategies in the literature have been retrospective and uncontrolled, and they are thus subject to a significant selection bias. Therefore any evaluation is akin to comparing apples and oranges, and to paraphrase a renowned North American surgeon, this makes for an unappetizing fruit salad. Compelling arguments for both approaches can be made, but in the end they are just that ... arguments and not scientific evidence. The Halstedian principles for managing breast cancer were also convincing until welldesigned controlled trials like the National Surgical Adjuvant Breast and Bowel Project (NSABP) B-04 proved otherwise [4]. The meta-analysis of Stillwell et al. unfortunately raises more questions than it answers, foremost of which is whether the time has come for a randomized trial to determine the optimal treatment strategy for patients with asymptomatic metastatic colorectal cancer in the twentyfirst century. With an estimated 148,000 new cases of colorectal cancer diagnosed in the United States alone each year, and with nearly one-fourth of patients having metastatic disease at diagnosis [5], the numbers certainly suggest so.

Comparison of Treatment Strategies in Early Rheumatoid Arthritis

In patients with early rheumatoid arthritis, initial combination therapies provide earlier clinical improvement and less progression of joint damage after 1 year compared with initial monotherapies (as demonstrated in the BeSt study). To evaluate whether the initial clinical and radiographic efficacy of combination therapies could be maintained during the second year of follow-up in patients with early rheumatoid arthritis. Randomized, controlled clinical trial with blinded assessors. 18 peripheral and 2 university medical centers in the Netherlands. 508 patients with early active rheumatoid arthritis. Sequential monotherapy (group 1), step-up combination therapy (group 2), initial combination therapy with tapered high-dose prednisone (group 3), or initial combination therapy with infliximab (group 4). Trimonthly treatment adjustments were made to achieve low disease activity. Primary end points were functional ability (Health Assessment Questionnaire) and Sharp-van der Heijde score for radiographic joint damage. Groups 3 and 4 had more rapid clinical improvement during the first year; all groups improved further to a mean functional ability score of 0.6 (overall, P = 0.257) and 42% were in remission (overall, P = 0.690) during the second year. Progression of joint damage remained better suppressed in groups 3 and 4 (median scores of 2.0, 2.0, 1.0, and 1.0 in groups 1, 2, 3, and 4, respectively [P = 0.004]). After 2 years, 33%, 31%, 36%, and 53% of patients in groups 1 through 4, respectively, were receiving single-drug therapy for initial treatment. There were no significant differences in toxicity. Patients and physicians were aware of the allocated group, and the assessors were blinded. Currently available antirheumatic drugs can be highly effective in patients with early rheumatoid arthritis in a setting of tight disease control. Initial combination therapies seem to provide earlier clinical improvement and less progression of joint damage, but all treatment strategies eventually showed similar clinical improvements. In addition, combination therapy can be withdrawn successfully and less treatment adjustments are needed than with initial monotherapies.

The California School Psychologist Provides Valuable Information to Promote School Success Among Students with Emotional or Behavioral Disorders

This volume of The California School Psychologist provides valuable information to promote the success of students with emotional or behavioral disorders, as well as other informative articles. These articles provide valuable information for school psychologists and other professionals working in the schools, and also contribute to the literature and scholarship that aim to promote the educational success of all students. Previous articles published in The California School Psychologist, including the recent volumes addressing a) school engagement, b) strength-based assessment, c) response-to-intervention (RtI), and d) autism are available on-line at www.education.ucsb.edu/school-psychology. The first article (Re stori, Gresham, Chang, Lee, & Laija-Rodriquez, 2007) reports the results of a study using functional assessment-based interventions to support fifth-grade students at-risk for emotional and behavioral disorders. Students whose behavior was found to be functionally related to either task-avoidance or attention-seeking were randomly assigned to a treatment strategy that was primarily either antecedent or consequent-based. This study reports the results of an ABAB single-case design to examine the effects of treatment strategies. This study also conducted a comparison of treatment strategies that were primarily antecedent or consequent-based. The authors highlight that antecedent-based treatment strategies (i.e., self-monitoring and task-modification) were more effective than consequent-based treatment strategies (i.e., differential reinforcement) for increasing academic engagement and reducing disruptive behavior. They also discuss the implications for using functional assessment strategies. The second article (Muyskens, Marston, & Reschly, 2007) shares the results of a study that examines the validity of a screening instrument to identify students at risk for behavior problems. Within a Responseto-intervention framework, the authors discuss using a screening measure (a 12-item behavior screener completed by the teacher for each student in the Fall) designed to identify students at risk for behavior difficulties and targeting these students for early intervention. This study included 22,056 kindergarten through 8th grade students from the Minneapolis Public Schools. Results revealed that teacher-completed Fall scores on this measure were significantly correlated with suspensions, achievement scores, and attendance data over the course of the school year. The authors emphasize that providing teachers with a tool which in less than a minute can help them identify students likely to present significant behavioral or academic concerns over the course of the school year warrants further consideration. The third article (Fisher, Doyon, Saldaria, & Redding-Allen, 2007) discusses a comprehensive assessment of emotional disturbance, advocating cross validation procedures, and using the RIOT approach (Review, Interview, Observe, Test). The authors advocate that using all four RIOT processes together allows for comprehensive assessment for emotional disturbance. The authors also encourage school psychologists to consider a student's strengths, cultural factors, and the interaction between the student and the environment when interpreting the results of assessments. Using the multi-faceted information yielded through a comprehensive assessment, school psychologists may provide recommendations to help remediate areas of weakness and promote social and cognitive competence. The fourth article (Lambros, Culver, Angulo, & Hosmer, 2007) describes a collaborative intervention model for promoting mental health and positive social adjustment for youth with emotional or behavioral disorders (EBD). The mental health intervention team (MHIT) includes a collaborative partnership between the Mental Health Resource Center (MHRC) and the Emotional Disturbance Program (ED) and also includes research and evaluation consultation from the Child and Adolescent Services Research Center (CASRC). …