Digital Media-related Problems Contributing to Psychiatric Hospitalizations Among Children and Adolescents Before and After the Onset of the COVID-19 Pandemic.

The role of digital media in crises leading to youth psychiatric admissions is understudied and digital media use increased during the COVID-19 pandemic. In this cross-sectional study, demographics, clinical characteristics, and digital media-related problems (DMRPs; sub-coded as cyberbullying, online communication problems, triggering content, and limit-setting problems) were extracted from hospital records of youth (n = 1,101) admitted to a pediatric psychiatric unit from May 2018 to November 2021. DMRPs were identified in 127 admissions (11.5%), led by the online communication problems and limit-setting subtypes (both 4-5%). Significantly more overall problems were identified following the pandemic onset (13.9% of admissions vs. 9.1% before, p < 0.05). The limit-setting subtype specifically increased post-COVID-19 (6.0% vs. 2.7%, p < 0.01), and was associated with prior admissions, suicide attempts, and impulse control/behavioral disorders. Online communication problems were significantly more common among girls and youth with a history of trauma. Interventions in acute settings to mitigate consequences of DMRPs are needed.

Transmission Blocking Activity of Low-dose Tafenoquine in Healthy Volunteers Experimentally Infected With Plasmodium falciparum.

BACKGROUND: Blocking the transmission of parasites from humans to mosquitoes is a key component of malaria control. Tafenoquine exhibits activity against all stages of the malaria parasite and may have utility as a transmission blocking agent. We aimed to characterize the transmission blocking activity of low-dose tafenoquine. METHODS: Healthy adults were inoculated with Plasmodium falciparum 3D7-infected erythrocytes on day 0. Piperaquine was administered on days 9 and 11 to clear asexual parasitemia while allowing gametocyte development. A single 50-mg oral dose of tafenoquine was administered on day 25. Transmission was determined by enriched membrane feeding assays predose and at 1, 4, and 7 days postdose. Artemether-lumefantrine was administered following the final assay. Outcomes were the reduction in mosquito infection and gametocytemia after tafenoquine and safety parameters. RESULTS: Six participants were enrolled, and all were infective to mosquitoes before tafenoquine, with a median 86% (range, 22-98) of mosquitoes positive for oocysts and 57% (range, 4-92) positive for sporozoites. By day 4 after tafenoquine, the oocyst and sporozoite positivity rate had reduced by a median 35% (interquartile range [IQR]: 16-46) and 52% (IQR: 40-62), respectively, and by day 7, 81% (IQR 36-92) and 77% (IQR 52-98), respectively. The decline in gametocyte density after tafenoquine was not significant. No significant participant safety concerns were identified. CONCLUSIONS: Low-dose tafenoquine (50 mg) reduces P. falciparum transmission to mosquitoes, with a delay in effect.

Difference in Psychiatric Hospital Admissions Between Cisgender and Transgender and Gender Nonconforming Youth, Before and During the Start of the COVID-19 Pandemic.

This retrospective study of 1101 children and adolescents examines differences in psychiatric admissions between cisgender and transgender/gender nonconforming (TGNC) youth between June 2018 and November 2021. Sociodemographic and clinical characteristics for each admission were extracted from medical records. We compared proportion of total admissions and clinical characteristics between cisgender and TGNC youth, during specified time frames of pre-COVID-19, during quarantine, and post-quarantine. During quarantine, 294 (89.9%) youth identified as cisgender and 33 (10.1%) youth identified as TGNC. Post-quarantine, 205 (88.4%) youth identified as cisgender and 27 (11.6%) identified as TGNC. TGNC patients had more history of mood disorders (p < 0.001), self-injurious behavior (p < 0.001), and suicide attempt (p = 0.007), whereas cisgender patients had more history of Attention-deficit/Hyperactivity Disorder (ADHD) (p = 0.011) and violence (p < 0.001) across each time frame of the study. TGNC patients were more likely to be admitted due to suicidal ideation (p = 0.003), whereas cisgender patients were more often admitted for aggression (p < 0.001). There was no change across COVID-19 time periods in terms of any psychiatric history variable among patients identifying as TGNC. The proportion of admitted youth identifying as TGNC increased by 8.1% from pre-COVID-19 to post-quarantine (p < 0.001). These findings suggest that TGNC youth might be particularly vulnerable to mental health crises when faced with pandemic-related stressors. Further research on the vulnerabilities of TGNC youth during sudden and extreme social changes and how this can impact their mental health is necessary, as global pandemics could and are anticipated to repeat.

Impact of dual tasking on gaze behaviour and locomotor strategies adopted while circumventing virtual pedestrians during a collision avoidance task.

We investigated gaze behaviour and collision avoidance strategies in 16 healthy young individuals walking towards a goal while exposed to virtual pedestrians (VRPs) approaching from different directions (left, middle, right). This locomotor task and an auditory-based cognitive task were performed under single and dual-task conditions. Longer gaze fixation durations were observed on the approaching vs. other VRPs, with longer fixations devoted to the upper trunk and head compared to other body segments. Compared to other pedestrian approaches, the middle pedestrian received longer fixations and elicited faster walking speeds, larger onset distances of trajectory devitation and smaller obstacle clearances. Gaze and locomotor behaviours were similar between single and dual-task conditions but dual-task costs were observed for the cognitive task. The longer gaze fixations on approaching vs. other pedestrians suggest that enhanced visual attention is devoted to pedestrians posing a greater risk of collision. Likewise, longer gaze fixations for the middle pedestrians may be due to the greater collision risk entailed by this condition, and/or to the fact that this pedestrian was positioned in front of the end goal. Longer fixations on approaching VRPs' trunk and head may serve the purpose of anticipating their walking trajectory. Finally, the dual-task effects that were limited to the cognitive task suggest that healthy young adults prioritize the locomotor task and associated acquisition of visual information. The healthy patterns of visuomotor behaviour characterized in this study will serve as a basis for comparison to further understand defective collision avoidance strategies in patient populations.

Engineering improved ethylene production: Leveraging systems biology and adaptive laboratory evolution.

Ethylene is a small hydrocarbon gas widely used in the chemical industry. Annual worldwide production currently exceeds 150 million tons, producing considerable amounts of CO2 contributing to climate change. The need for a sustainable alternative is therefore imperative. Ethylene is natively produced by several different microorganisms, including Pseudomonas syringae pv. phaseolicola via a process catalyzed by the ethylene-forming enzyme (EFE), subsequent heterologous expression of EFE has led to ethylene production in non-native bacterial hosts including Escherichia coli and cyanobacteria. However, solubility of EFE and substrate availability remain rate-limiting steps in biological ethylene production. We employed a combination of genome-scale metabolic modelling, continuous fermentation, and protein evolution to enable the accelerated development of a high efficiency ethylene producing E. coli strain, yielding a 49-fold increase in production, the most significant improvement reported to date. Furthermore, we have clearly demonstrated that this increased yield resulted from metabolic adaptations that were uniquely linked to EFE (wild type versus mutant). Our findings provide a novel solution to deregulate metabolic bottlenecks in key pathways, which can be readily applied to address other engineering challenges.

Safety and feasibility of apheresis to harvest and concentrate parasites from subjects with induced blood stage Plasmodium vivax infection.

BACKGROUND: In the absence of a method to culture Plasmodium vivax, the only way to source parasites is ex vivo. This hampers many aspects of P. vivax research. This study aimed to assess the safety of apheresis, a method for selective removal of specific components of blood as a means of extracting and concentrating P. vivax parasites. METHODS: An iterative approach was employed across four non-immune healthy human subjects in single subject cohorts. All four subjects were inoculated with ~ 564 blood stage P. vivax (HMP013-Pv) and subjected to apheresis 10 to 11 days later. Blood samples collected during apheresis (haematocrit layers 0.5% to 11%) were tested for the presence and concentration of P. vivax by microscopy, flow cytometry, 18S rDNA qPCR for total parasites, and pvs25 qRT-PCR for female gametocyte transcripts. Safety was determined by monitoring adverse events. Malaria transmission to mosquitoes was assessed by membrane feeding assays. RESULTS: There were no serious adverse events and no significant safety concerns. Apheresis concentrated asexual parasites by up to 4.9-fold (range: 0.9-4.9-fold) and gametocytes by up to 1.45-fold (range: 0.38-1.45-fold) compared to pre-apheresis densities. No single haematocrit layer contained > 40% of all the recovered P. vivax asexual parasites. Ex vivo concentration of parasites by Percoll gradient centrifugation of whole blood achieved greater concentration of gametocytes than apheresis. Mosquito transmission was enhanced by up to fivefold in a single apheresis sample compared to pre-apheresis. CONCLUSION: The modest level of parasite concentration suggests that the use of apheresis may not be an ideal method for harvesting P. vivax. Trial Registration Australia New Zealand Clinical Trials Registry (ANZCTR) Trial ID: ACTRN12617001502325 registered on 19th October 2017. https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=373812.

Influence of path curvature on collision avoidance behaviour between two walkers.

Navigating crowded community spaces requires interactions with pedestrians that follow rectilinear and curvilinear trajectories. In the case of rectilinear trajectories, it has been shown that the perceived action opportunities of the walkers might be afforded based on a future distance of closest approach. However, little is known about collision avoidance behaviours when avoiding walkers that follow curvilinear trajectories. Twenty-two participants were immersed in a virtual environment and avoided a virtual human (VH) that followed either a rectilinear path or a curvilinear path with a 5 m or 10 m radius curve at various distances of closest approach. Compared to a rectilinear path (control condition), the curvilinear path with a 5 m radius yielded more collisions when the VH approached from behind the participant and more inversions when the VH approached from in-front. During each trial, the evolution of the future distance of closest approach showed similarities between rectilinear paths and curvilinear paths with a 10 m radius curve. Overall, with few collisions and few inversions of crossing order, we can conclude that participants were capable of predicting future distance of closest approach of virtual walkers that followed curvilinear trajectories. The task was solved with similar avoidance adaptations to those observed for rectilinear interactions. These findings should inform future endeavors to further understand collision avoidance strategies and the role of-for example-non-constant velocities.

Case Report: Buprenorphine-A Treatment for Psychological Pain and Suicidal Ideation?

BACKGROUND AND OBJECTIVES: Buprenorphine is commonly used to manage opioid use disorder; however, the literature describes its potential role in treating treatment-resistant depression. METHODS: We present a patient with bipolar disorder and opioid use disorder, who presented status post-suicide attempt. RESULTS: After initiating buprenorphine-naloxone, the patient reported rapid improvement in depressive symptoms, pain, and suicidal ideation. DISCUSSION AND CONCLUSIONS: This case demonstrates buprenorphine's antisuicidal and mood-stabilizing capabilities, potentially via antagonizing κ-opioid receptors as well as reinstating the balance between reward and antireward circuitry. SCIENTIFIC SIGNIFICANCE: This case highlights buprenorphine-naloxone as a treatment for both treatment-resistant depression and opioid use disorder, as well as buprenorphine's rapid antidepressant, analgesic, and antisuicidal effects. (Am J Addict 2021;30:80-82).

Care Coordination in Emergency Departments for Children and Adolescents With Behavioral Health Conditions: Assessing the Degree of Regular Follow-up After Psychiatric Emergency Department Visits.

BACKGROUND: Increasing numbers of children are receiving care for behavioral health conditions in emergency departments (EDs). However, studies of mental health-related care coordination between EDs and primary and/or specialty care settings are limited. Such coordination is important because ED care alone may be insufficient for patients' behavioral health needs. METHODS: We analyzed claims during the year 2014 from Truven Health Analytics MarketScan Medicaid and Commercial databases for outpatient services and prescription drugs for youth 2 to 18 years old with continuous enrollment. We applied a standard care coordination measure to insurance claims data in order to examine whether youth received a primary care or specialty follow-up visit within 7 days following an ED visit with a psychiatric diagnosis. We calculated descriptive statistics to evaluate differences in care coordination by enrollees' demographic, insurance, and health-related characteristics. In addition, we constructed a multivariate logistic regression model to detect the factors associated with the receipt of care coordination. RESULTS: The total percentages of children who received care coordination were 45.8% (Medicaid) and 46.6% (private insurance). Regardless of insurance coverage type, children aged 10 to 14 years had increased odds of care coordination compared with youth aged 15 to 18 years. Children aged 2 to 5 years and males had decreased odds of care coordination. CONCLUSIONS: It is of concern that fewer than half of patients received care coordination following an ED visit. Factors such as behavioral health workforce shortages, wait times for an appointment with a provider, and lack of reimbursement for care coordination may help explain these results.

Characteristics of Calls to a COVID-19 Mental Health Hotline in the First Wave of the Pandemic in New York.

This report describes the development, implementation and outcomes of a "COVID-19 Anxiety Hotline," designed to address the community's mental health crisis provoked by the coronavirus pandemic. The service was specifically designed using survey data regarding the effects of the COVID-19 pandemic on its staff and community members. Callers had around-the-clock direct access to mental healthcare providers at no cost. Quantitative analysis showed that nearly three out of four callers experienced new onset anxiety and insomnia driven by fear of exposure, and had difficulty accessing mental health care. In addition to immediate support, referral to tele-mental health care was provided to 86% of callers. Qualitative analysis indicates the effectiveness of immediate support and appropriate referrals using a tele-health platform. Our report indicates that the service was utilized by the general population, by health care workers, and rapidly provided referrals to individuals with limited access to mental health care during the pandemic.

Follow-Up Care After Behavioral Health-Related Hospitalization for Children and Adolescents.

Although the coordination of follow-up behavioral health-related care between hospitals and outpatient behavioral health care settings is important, studies on this topic are few. Claims were selected from Truven Health Analytics' Marketscan databases during 2014 for youth aged 2-18 years who had an inpatient stay with a behavioral health diagnosis. Analyses identified whether youth received a behavioral health follow-up visit within 30 days following a hospitalization. The percentage of children who received post-hospitalization follow-up care was 59.1% (Medicaid) and 59.4% (private insurance). While children less than 15 years old (Medicaid) had increased odds of follow-up care compared with youth aged 15-18 years, children 2-9 years old with commercial insurance had decreased odds of follow-up care. Variations in follow-up care by patient characteristics provide an opportunity to target efforts to increase coordinated care to those who are least likely to receive it.

Prevalence and Treatment of Depression, Anxiety, and Conduct Problems in US Children.

OBJECTIVES: To use the latest data to estimate the prevalence and correlates of currently diagnosed depression, anxiety problems, and behavioral or conduct problems among children, and the receipt of related mental health treatment. STUDY DESIGN: We analyzed data from the 2016 National Survey of Children's Health (NSCH) to report nationally representative prevalence estimates of each condition among children aged 3-17 years and receipt of treatment by a mental health professional. Parents/caregivers reported whether their children had ever been diagnosed with each of the 3 conditions and whether they currently have the condition. Bivariate analyses were used to examine the prevalence of conditions and treatment according to sociodemographic and health-related characteristics. The independent associations of these characteristics with both the current disorder and utilization of treatment were assessed using multivariable logistic regression. RESULTS: Among children aged 3-17 years, 7.1% had current anxiety problems, 7.4% had a current behavioral/conduct problem, and 3.2% had current depression. The prevalence of each disorder was higher with older age and poorer child health or parent/caregiver mental/emotional health; condition-specific variations were observed in the association between other characteristics and the likelihood of disorder. Nearly 80% of those with depression received treatment in the previous year, compared with 59.3% of those with anxiety problems and 53.5% of those with behavioral/conduct problems. Model-adjusted effects indicated that condition severity and presence of a comorbid mental disorder were associated with treatment receipt. CONCLUSIONS: The latest nationally representative data from the NSCH show that depression, anxiety, and behavioral/conduct problems are prevalent among US children and adolescents. Treatment gaps remain, particularly for anxiety and behavioral/conduct problems.

Pediatric Behavioral Health-Related EMS Encounters: A Statewide Analysis.

Objectives: Pediatric behavioral health disorders and related emergency department visits are increasing, but effects on emergency medical services (EMS) are unknown. This study's objective was to describe the statewide epidemiology of pediatric behavioral health-related EMS encounters in Florida, including mental health and substance use. Methods: This analysis is a retrospective study of pediatric behavioral health-related EMS encounters from Florida's statewide EMS Tracking and Reporting Systems Database from 2011 to 2016. Demographic, clinical, EMS, and geographic characteristics are described. We also compared characteristics between patients who did and did not receive an acute EMS behavioral/psychiatric intervention. Results: There were 22,254 pediatric behavioral health-related EMS encounters during the study period, one-quarter of which were noted to have suspected or confirmed ingestion/substance use. The median age was 16 and the majority of patients were female and white. A total of 946 patients (4%) had an acute EMS behavioral/psychiatric intervention. EMS scene, ED turnaround, and total EMS time were significantly longer for intervention patients. Of the 14 counties in the top quartile of percentages of intervention patients, 7 were rural, 10 did not have any hospitals with child/adolescent psychiatric services, and 7 did not have any child psychiatrists. Conclusions: Pediatric behavioral-health related EMS encounters had a significant proportion of suspected ingestions/substance use, and we found disproportionate effects on rural agencies. Increases in EMS resource utilization (including longer EMS times) occurred in certain settings with limited behavioral health infrastructure. Those findings suggest an opportunity for community paramedicine to alleviate EMS utilization and decrease the frequency of pediatric behavioral health emergencies.

Characterizing behavioral health-related emergency department utilization among children with Medicaid: Comparing high and low frequency utilizers.

While the frequency of children's behavioral health (BH)-related visits to the emergency department (ED) is rising nationwide, few studies have examined predictors of high rates of ED use. This study examines Florida Medicaid claims (2011-2012) for children age 0-18 who were seen in an emergency department (ED) for behavioral health (BH) conditions. A logistic regression model was used to explore factors associated with frequent ED use and patterns of psychotropic medication utilization. The majority (95%) of patients with at least one BH-related ED visit had three or fewer of these visits, but 5% had four or more. Seventy-four percent of ED visits were not associated with psychotropic medication, including over half (54%) of visits for attention deficit hyperactivity disorder (ADHD). Frequent ED use was higher among older children and those with substance use disorders. The implementation of interventions that reduce non-emergent ED visits through the provision of care coordination, social work services, and/or the use of community health workers as care navigators may address these findings.

Pediatric integrated behavioral health service delivery models: Using a federal framework to assess levels of integration.

OBJECTIVE: To assess the level of integration of pediatric integrated behavioral health service delivery models (IBHSDM) since it has not been well established. DATA SOURCES: A systematic review of journal databases (e.g., PubMed) and Google searches was used to identify publications. STUDY SELECTION: Studies were included if they examined children who were treated in an IBHSDM. DATA EXTRACTION: The authors extracted data from studies and assessed them for level of integration using a federal conceptual framework. DATA SYNTHESIS: Guided by PRISMA standards, the authors identified 40 journal articles that described 32 integrated delivery models. Five models (15.6%) were rated at integration level 1 or 2 (coordinated care), eight models (25%) were rated level 3 and five models (15.6%) were rated level 4 (co-located care), and fourteen models (43.8%) were rated level 5 or 6 (integrated care). CONCLUSIONS: In general, it is assumed that more completely integrated care will result in higher quality care and reduced costs. Thirteen of the models described (40.6%) had levels of integration of 3 or lower that may be too low to produce desired effects on quality and cost. Future research should address potential barriers that impede the development of models with higher degrees of integration.

Screening for Behavioral Health Conditions in Primary Care Settings: A Systematic Review of the Literature.

BACKGROUND: Mounting evidence indicates that early recognition and treatment of behavioral health disorders can prevent complications, improve quality of life, and help reduce health care costs. The aim of this systematic literature review was to identify and evaluate publicly available, psychometrically tested tools that primary care physicians (PCPs) can use to screen adult patients for common mental and substance use disorders such as depression, anxiety, and alcohol use disorders. METHODS: We followed the Institute of Medicine (IOM) systematic review guidelines and searched PubMed, PsycINFO, Applied Social Sciences Index and Abstracts, Cumulative Index to Nursing and Allied Health Literature, and Health and Psychosocial Instruments databases to identify literature addressing tools for screening of behavioral health conditions. We gathered information on each tool's psychometrics, applicability in primary care, and characteristics such as number of items and mode of administration. We included tools focused on adults and the most common behavioral health conditions; we excluded tools designed for children, youth, or older adults; holistic health scales; and tools screening for serious but less frequently encountered disorders, such as bipolar disorder. RESULTS: We identified 24 screening tools that met the inclusion criteria. Fifteen tools were subscales stemming from multiple-disorder assessments or tools that assessed more than one mental disorder or more than one substance use disorder in a single instrument. Nine were ultra-short, single-disorder tools. The tools varied in psychometrics and the extent to which they had been administered and studied in primary care settings. DISCUSSION: Tools stemming from the Patient Health Questionnaire had the most testing and application in primary care settings. However, numerous other tools could meet the needs of primary care practices. This review provides information that PCPs can use to select appropriate tools to incorporate into a screening protocol.

Biomarkers of Nutrition for Development (BOND)-Iron Review.

This is the fifth in the series of reviews developed as part of the Biomarkers of Nutrition for Development (BOND) program. The BOND Iron Expert Panel (I-EP) reviewed the extant knowledge regarding iron biology, public health implications, and the relative usefulness of currently available biomarkers of iron status from deficiency to overload. Approaches to assessing intake, including bioavailability, are also covered. The report also covers technical and laboratory considerations for the use of available biomarkers of iron status, and concludes with a description of research priorities along with a brief discussion of new biomarkers with potential for use across the spectrum of activities related to the study of iron in human health.The I-EP concluded that current iron biomarkers are reliable for accurately assessing many aspects of iron nutrition. However, a clear distinction is made between the relative strengths of biomarkers to assess hematological consequences of iron deficiency versus other putative functional outcomes, particularly the relationship between maternal and fetal iron status during pregnancy, birth outcomes, and infant cognitive, motor and emotional development. The I-EP also highlighted the importance of considering the confounding effects of inflammation and infection on the interpretation of iron biomarker results, as well as the impact of life stage. Finally, alternative approaches to the evaluation of the risk for nutritional iron overload at the population level are presented, because the currently designated upper limits for the biomarker generally employed (serum ferritin) may not differentiate between true iron overload and the effects of subclinical inflammation.

Utilization of Mental Health Services by Preschool-Aged Children with Private Insurance Coverage.

There is increasing recognition that some preschool-aged children suffer from mental health conditions, but little is known about the treatment they receive. Using the 2014 MarketScan Commercial Claims and Encounters database (N = 1,987,759) the study finds that only a small proportion of preschool-aged children receive any behavioral interventions, including psychotherapy, in conjunction with having a filled psychiatric prescription. Nearly all of the preschool-aged children who had psychotropic prescriptions filled had no other claims for treatment, and among those children who had prescriptions for psychotropic medication filled, the vast majority did not have a mental health diagnosis on a claim.

Helical Axis Data Visualization and Analysis of the Knee Joint Articulation.

We present processing methods and visualization techniques for accurately characterizing and interpreting kinematical data of flexion-extension motion of the knee joint based on helical axes. We make use of the Lie group of rigid body motions and particularly its Lie algebra for a natural representation of motion sequences. This allows to analyze and compute the finite helical axis (FHA) and instantaneous helical axis (IHA) in a unified way without redundant degrees of freedom or singularities. A polynomial fitting based on Legendre polynomials within the Lie algebra is applied to provide a smooth description of a given discrete knee motion sequence which is essential for obtaining stable instantaneous helical axes for further analysis. Moreover, this allows for an efficient overall similarity comparison across several motion sequences in order to differentiate among several cases. Our approach combines a specifically designed patient-specific three-dimensional visualization basing on the processed helical axes information and incorporating computed tomography (CT) scans for an intuitive interpretation of the axes and their geometrical relation with respect to the knee joint anatomy. In addition, in the context of the study of diseases affecting the musculoskeletal articulation, we propose to integrate the above tools into a multiscale framework for exploring related data sets distributed across multiple spatial scales. We demonstrate the utility of our methods, exemplarily processing a collection of motion sequences acquired from experimental data involving several surgery techniques. Our approach enables an accurate analysis, visualization and comparison of knee joint articulation, contributing to the evaluation and diagnosis in medical applications.