Positive attitude is thought to impact academic achievement and learning in children, but little is known about its underlying neurocognitive mechanisms. Using a large behavioral sample of 240 children, we found that positive attitude toward math uniquely predicted math achievement, even after we accounted for multiple other cognitive-affective factors. We then investigated the neural mechanisms underlying the link between positive attitude and academic achievement in two independent cohorts of children (discovery cohort: n = 47; replication cohort: n = 28) and tested competing hypotheses regarding the differential roles of affective-motivational and learning-memory systems. In both cohorts, we found that positive attitude was associated with increased engagement of the hippocampal learning-memory system. Structural equation modeling further revealed that, in both cohorts, increased hippocampal activity and more frequent use of efficient memory-based strategies mediated the relation between positive attitude and higher math achievement. Our study is the first to elucidate the neurocognitive mechanisms by which positive attitude influences learning and academic achievement.

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Background Obtaining 24‐hour ambulatory blood pressure ( BP ) is recommended for the detection of masked or white‐coat hypertension. Our objective was to determine whether the magnitude of the difference between ambulatory and clinic BP s has prognostic implications. Methods and Results We included 610 participants of the AASK (African American Study of Kidney Disease and Hypertension) Cohort Study who had clinic and ambulatory BPs performed in close proximity in time. We used Cox models to determine the association between the absolute systolic BP ( SBP ) difference between clinic and awake ambulatory BPs (primary predictor) and death and end‐stage renal disease. Of 610 AASK Cohort Study participants, 200 (32.8%) died during a median follow‐up of 9.9 years; 178 (29.2%) developed end‐stage renal disease. There was a U‐shaped association between the clinic and ambulatory SBP difference with risk of death, but not end‐stage renal disease. A 5– to <10–mm Hg higher clinic versus awake SBP (white‐coat effect) was associated with a trend toward higher (adjusted) mortality risk (adjusted hazard ratio, 1.84; 95% CI, 0.94–3.56) compared with a 0– to <5–mm Hg clinic‐awake SBP difference (reference group). A ≥10–mm Hg clinic‐awake SBP difference was associated with even higher mortality risk (adjusted hazard ratio, 2.31; 95% CI, 1.27–4.22). A ≥−5–mm Hg clinic‐awake SBP difference was also associated with higher mortality (adjusted hazard ratio, 1.82; 95% CI, 1.05–3.15) compared with the reference group. Conclusions A U‐shaped association exists between the magnitude of the difference between clinic and ambulatory SBP and mortality. Higher clinic versus ambulatory BPs (as in white‐coat effect) may be associated with higher risk of death in black patients with chronic kidney disease.

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Background: Suboptimal blood pressure (BP) control is known to be common in patients with advanced chronic kidney disease (CKD) and may contribute to elevated risk of cardiovascular (CV) morbidity and mortality. Most trials have tested alternative clinicbased BP targets, even though home and ambulatory BPs have been shown to be more strongly associated with outcomes of interest. We designed a pilot randomized controlled trial to examine whether intensive lowering of systolic blood pressure (SBP) to a target <120 mmHg with remote home BP monitoring is safe and feasible for patients with advanced CKD as they transition to end-stage kidney disease (ESKD). Methods: Patients with stage 4 or 5 CKD (estimated glomerular filtration rate ≤30 mL/min/ 1.73 m 2 ) with hypertension, defined as receipt of at least one antihypertensive agent or a clinic SBP>140 mmHg, will be randomly assigned to either a home SBP target of <120 mmHg (intervention group) or 130-140 mmHg (control group). Antihypertensive medications are titrated as needed to achieve target SBP levels over the first 4 months of the trial, and target SBPs are maintained thereafter. After month 12, biannual visits are conducted until study closeout. Participants are followed closely for safety and feasibility outcomes including screening:enrollment ratio, rates of hyperkalemia, hospitalizations or emergency room visits, and achieved separation in home BP readings between the two groups at month 8. Discussion: This protocol outlines the design of a pilot trial to examine the safety and feasibility of an intensive home BP lowering intervention in patients with advanced CKD through remote home BP monitoring. This pilot study will provide the necessary data to inform the planning of a full-scale trial comparing strict versus usual BP control in patients with advanced CKD, including those with diabetes. Knowledge of the optimal BP targets in advanced CKD will better inform the approach to CV and kidney risk reduction as patients transition to ESKD. Trial Registration: ClinicalTrials.gov identifier NCT02975505. Registered November 29, 2016. https://clinicaltrials.gov/ct2/show/NCT02975505?term=NCT02975505&draw=2&rank=1.