ADHD in Children: Common Questions and Answers.

Attention-deficit/hyperactivity disorder (ADHD) is a multidimensional chronic neurodevelopmental condition that affects 8.4% of U.S. children between two and 17 years of age and may pose long-term morbidity if untreated. The evaluation for ADHD begins when parents or caregivers present to primary care physicians with concerns about behavior problems or poor school or social function. A comprehensive history and physical examination should assess for comorbid or other conditions that can mimic ADHD. The combination of Diagnostic and Statistical Manual of Mental Disorders, 5th ed., criteria and validated screening tools completed by parents, teachers, or other adults can aid in establishing the diagnosis. The goals of treatment include symptom reduction and improved social and cognitive function. Psychosocial interventions are the recommended first-line treatment for preschool children (four to five years) and can improve overall function when used as an adjunct therapy in elementary school children (six to 11 years of age) and adolescents (12 to 17 years of age). Stimulant medications are well-established as an effective treatment for reducing symptoms of ADHD in elementary school children and adolescents. Nonstimulant medications are less effective but reasonable as adjunct or alternative therapy when stimulants are ineffective or not tolerated. Regular follow-up is key in the management of ADHD and should assess symptoms, overall function, presence of comorbidities, adverse effects of treatment, and medication use.

Primary Care of the Solid Organ Transplant Recipient.

The advancing science of transplantation has led to more transplants and longer survival. As a result, primary care physicians are more involved in the care of transplant recipients. Immunosuppressive therapy has significantly decreased rates of transplant rejection but accounts for more than 50% of transplant-related deaths, often due to infections and other risks related to long-term use. Cardiovascular disease is the leading cause of non-transplant-related mortality. Aggressive risk factor management is recommended for transplant recipients, including a blood pressure goal of less than 130/80 mm Hg and statin therapy in kidney, liver, and heart recipients. Fertility typically increases posttransplant, and female transplant recipients should avoid pregnancy for one year after surgery. The best contraceptive choice is usually an intrauterine device. Because of the increased risk of infection, patients should be tested for graft dysfunction or infection if suspicion arises. Testing should be coordinated with the transplant center. Malignancies are a common cause of death in transplant recipients, requiring careful attention to screening recommendations and informed discussions with patients. Family physicians should maintain an ongoing relationship with the transplant team to discuss medication changes and the risk of infection or graft rejection.

Cross-Cultural Mentorship in Military Family Medicine: Defining the Problem.

BACKGROUND AND OBJECTIVES: Mentorship is critical to physician recruitment, career development, and retention. Many underrepresented in medicine (URiM) physicians experience minority taxes that can undermine their professional objectives. Use of cross-cultural mentoring skills to navigate differences between non-URiM and URiM physicians can make mentorship relationships with URiM physicians more effective. This survey examined military family physician demographics and mentorship practices. METHODS: Design and Setting: Cross-sectional study using voluntary, anonymous data from the 2021 Uniformed Services Academy of Family Physicians (USAFP) Annual Meeting Omnibus Survey. STUDY POPULATION: USAFP Members attending 2021 Virtual Annual Meeting. INTERVENTION: None. STATISTICAL ANALYSIS: Descriptive statistics and χ2 tests. RESULTS: The response rate to the omnibus survey was 52.9%, n=258. More than half of respondents did not have a URiM mentee and had not collaborated with a URiM colleague on a scholarly activity within the last 3 years. Only 54.7% of respondents could recognize and address minority taxes. URiM physicians were more likely to have a URiM mentee (65.4% vs 44.4%, P=.042) and to recognize and address minority taxes (84.6% vs 51.3%, P=.001). They also were more confident (84.6% vs 60.3%, P=.015) and more skilled in discussing racism (80.8% vs 58.2%, P=.026). CONCLUSIONS: Structured programs are needed to improve knowledge and skills to support cross-cultural mentorship. Additional studies are needed to further evaluate and identify implementation strategies.

Effect of the deposition process on the stability of Ti3C2Tx MXene films for bioelectronics.

Ti3C2Tx MXene is emerging as the enabling material in a broad range of wearable and implantable medical technologies, thanks to its outstanding electrical, electrochemical, and optoelectronic properties, and its compatibility with high-throughput solution-based processing. While the prevalence of Ti3C2Tx MXene in biomedical research, and in particular bioelectronics, has steadily increased, the long-term stability and degradation of Ti3C2Tx MXene films have not yet been thoroughly investigated, limiting its use for chronic applications. Here, we investigate the stability of Ti3C2Tx films and electrodes under environmental conditions that are relevant to medical and bioelectronic technologies: storage in ambient atmosphere (shelf-life), submersion in saline (akin to the in vivo environment), and storage in a desiccator (low-humidity). Furthermore, to evaluate the effect of the MXene deposition method and thickness on the film stability in the different conditions, we compare thin (25 nm), and thick (1.0 µm) films and electrodes fabricated via spray-coating and blade-coating. Our findings indicate that film processing method and thickness play a significant role in determining the long-term performance of Ti3C2Tx films and electrodes, with highly aligned, thick films from blade coating remarkably retaining their conductivity, electrochemical impedance, and morphological integrity even after 30 days in saline. Our extensive spectroscopic analysis reveals that the degradation of Ti3C2Tx films in high-humidity environments is primarily driven by moisture intercalation, ingress, and film delamination, with evidence of only minimal to moderate oxidation.

Effect of Dietary Organic Acids and Botanicals on Metabolic Status and Milk Parameters in Mid-Late Lactating Goats.

The microencapsulated mixture of organic acids and pure botanicals (OA/PB) has never been evaluated in goats. The aim of this study was to extend the analysis to mid-late lactating dairy goats, evaluating the effects of OA/PB supplementation on the metabolic status, milk bacteriological and composition characteristics, and milk yield. Eighty mid-late lactating Saanen goats were randomly assigned to two groups: one group was fed the basal total balanced ration (TMR) (CRT; n = 40) and the other was fed a diet that was TMR supplemented with 10 g/head of OA/PB (TRT; n = 40) for 54 days during the summer period. The temperature-humidity index (THI) was recorded hourly. On days T0, T27, and T54, the milk yield was recorded, and blood and milk samples were collected during the morning milking. A linear mixed model was used, considering the fixed effects: diet, time, and their interaction. The THI data (mean ± SD: 73.5 ± 3.83) show that the goats did not endure heat stress. The blood parameters fell within the normal range, confirming that their metabolic status was not negatively influenced by OA/PB supplementation. OA/PB increased the milk fat content (p = 0.04) and milk coagulation index (p = 0.03), which are effects that are looked on as favorable by the dairy industry in relation to cheese production.

Virtual teaching kitchen classes and cardiovascular disease prevention counselling among medical trainees.

Background: Hands-on culinary medicine education for medical trainees has emerged as a promising tool for cardiovascular health promotion. Purpose: To determine whether virtual culinary medicine programming associates with Mediterranean diet (MedDiet) adherence and lifestyle medicine competencies among medical trainees across the USA. Method: A total of 1433 medical trainees across 19 sites over a 12-month period were included. The Cooking for Health Optimisation with Patients-Medical Trainees survey composed of 61 questions regarding demographics, nutritional attitudes, dietary habits including MedDiet score and lifestyle medicine counselling competencies. Multivariable logistic regression assessed the association of virtual culinary medicine education with MedDiet intake and nutritional attitudes. Results: There were 519 medical trainees who participated in virtual culinary medicine education and 914 medical trainees who participated in their standard nutrition curricula. More than one-half of participants were women (n=759) and the mean age was 27 years old. Compared with students enrolled in traditional nutrition curricula, participants in virtual culinary medicine education were 37% more likely to adhere to MedDiet guidelines for fruit intake (OR 1.37, 95% CI 1.03 to 1.83, p=0.03). Virtual culinary medicine education was associated with higher proficiency in lifestyle medicine counselling categories, notably recommendations involving fibre (OR 4.03; 95% CI 3.05 to 5.34), type 2 diabetes prevention (OR 4.69; 95% CI 3.51 to 6.27) and omega fatty acids (OR 5.21; 95% CI 3.87 to 7.02). Virtual culinary medicine education had a similar, although higher magnitude association with MedDiet counselling competency (OR 5.73, 95% CI 4.26 to 7.70) when compared with historical data previously reported using hands-on, in-person culinary medicine courseware (OR 4.97, 95% CI 3.89 to 6.36). Conclusions: Compared with traditional nutritional educational curricula, virtual culinary medicine education is associated with higher MedDiet adherence and lifestyle medicine counselling competencies among medical trainees. Both virtual and hands-on culinary medicine education may be useful for cardiovascular health promotion.

Can We Realize Our Collaborative Potential? A Critical Review of Faculty Roles and Experiences in Interprofessional Education.

PURPOSE: Faculty within interprofessional education (IPE) are essential contributors to IPE implementation efforts. Although the majority of existing IPE literature consists of reports on IPE innovations, few insights are available into the experiences of the faculty members who deliver IPE. This critical narrative review was designed to synthesize the knowledge available about (1) roles assigned to IPE educators and (2) IPE faculty members' experiences of fulfilling these roles. METHOD: Six databases for English-language studies published between 2000 and March 2021 were searched: PubMed, Embase, Web of Science, MEDLINE, CINAHL, PsycINFO, ERIC, and MedEdPortal. A total of 1,717 manuscripts were identified for possible inclusion. After applying inclusion/exclusion criteria, 214 articles constituted the final literature corpus. Harden and Crosby's original framework of 6 roles of medical educators augmented with the manager role introduced in Harden and Lilley's 2018 framework informed the analysis. RESULTS: IPE faculty take on all 6 roles identified by Harden and Crosby: facilitator, planner, information provider, examiner, role model, and resource developer, as well as the manager role. Faculty were most commonly identified as facilitator and planner, and rarely as role models. The authors identified 3 main struggles experienced by IPE faculty: personal (e.g., confidence as a cross-professions educator), interpersonal (e.g., co-teaching IPE), and institutional (e.g., supporting IPE logistics). CONCLUSIONS: This review highlights the complexity of the roles taken on by IPE faculty and the struggles they experience in the process. The results suggest that attention to the different roles that IPE faculty play in educational interventions and to equipping faculty with the necessary competencies, tools, and support, is fundamental to the success of IPE. Future research should harness the explanatory power of theories to help explain dynamics at play between personal, interpersonal, and institutional barriers to identify interventions that can aid IPE faculty in delivering collaboration-ready professionals.

Vitamin C-reduced graphene oxide improves the performance and stability of multimodal neural microelectrodes.

Nanocarbons are often employed as coatings for neural electrodes to enhance surface area. However, processing and integrating them into microfabrication flows requires complex and harmful chemical and heating conditions. This article presents a safe, scalable, cost-effective method to produce reduced graphene oxide (rGO) coatings using vitamin C (VC) as the reducing agent. We spray coat GO + VC mixtures onto target substrates, and then heat samples for 15 min at 150°C. The resulting rGO films have conductivities of ∼44 S cm-1, and are easily integrated into an ad hoc microfabrication flow. The rGO/Au microelectrodes show ∼8x lower impedance and ∼400x higher capacitance than bare Au, resulting in significantly enhanced charge storage and injection capacity. We subsequently use rGO/Au arrays to detect dopamine in vitro, and to map cortical activity intraoperatively over rat whisker barrel cortex, demonstrating that conductive VC-rGO coatings improve the performance and stability of multimodal microelectrodes for different applications.

Surveys on Exposure to Reptile-Associated Salmonellosis (RAS) in the Piedmont Region-Italy.

Reptile-associated salmonellosis (RAS), Salmonella infection in humans, is acquired through contact with reptiles. Reptiles have become popular pet animals, and RAS is likely to be an underestimated but growing problem. No epidemiological data about RAS are routinely collected in Italy. In order to estimate the occurrence of RAS in the Italian human population and to investigate the exposure, two epidemiological studies on patients with sporadic salmonellosis were carried out in the Piedmont region, along with an evaluation of human exposure in public places displaying reptiles and with a survey on people awareness. RAS appeared make up 7% of sporadic salmonellosis in the first study and 3% in the second, more extensive study. A prevalence of 11.7% and 5.7%, respectively, were calculated for the age range of 0-21 years. It was observed that in public places displaying reptiles, it was possible to easily come into contact with the animals and their environment. Some knowledge about RAS emerged from the interviews with the general population, but preventive measures are not completely applied by reptile owners. In conclusion, RAS in Italy is present and constitutes a proportion of the human salmonellosis cases in line with the percentages reported in other countries. Exposure to reptiles should always be considered as a risk factor, and people should be more informed about RAS and the related preventive measures.

Thermal and Quasi-Static Mechanical Characterization of Polyamide 6-Graphene Nanoplatelets Composites.

The growing demand for lightweight and multifunctional products in numerous industrial fields has recently fuelled a growing interest in the development of materials based on polymer matrices including graphene-like particles, intrinsically characterized by outstanding mechanical, thermal, and electrical properties. Specifically, with regard to one of the main mass sectors, which is the automotive, there has been a significant increase in the use of reinforced polyamides for underhood applications and fuel systems thanks to their thermal and chemical resistance. In this frame, polyamide 6 (PA6) composites filled with graphene nanoplatelets (GNPs) were obtained by melt-compounding and compared in terms of thermal and mechanical properties with the neat matrix processed under the same condition. The results of the experimental tests have shown that the formulations studied so far offer slight improvements in terms of thermal stability but much more appreciable benefits regarding both tensile and flexural parameters with respect to the reference material. Among these effects, the influence of the filler content on the strength parameter is noteworthy. However, the predictable worsening of the graphene sheet dispersion for GNPs contents greater than 3%, as witnessed by scanning electron images of the tensile fractured sections of specimens, affected the ultimate performance of the more concentrated formulation.

Anterior cruciate ligament injury: diagnosis, management, and prevention.

There are an estimated 80,000 to 100,000 anterior cruciate ligament (ACL) repairs in the United States each year. Most ACL tears occur from noncontact injuries. Women experience ACL tears up to nine times more often than men. Evaluation of the ACL should be performed immediately after an injury if possible, but is often limited by swelling and pain. When performed properly, a complete knee examination is more than 80 percent sensitive for an ACL injury. The Lachman test is the most accurate test for detecting an ACL tear. Magnetic resonance imaging is the primary study used to diagnose ACL injury in the United States. It can also identify concomitant meniscal injury, collateral ligament tear, and bone contusions. Treatment consists of conservative management or surgical intervention, with the latter being the better option for patients who want to return to a high level of activity. Patients who undergo surgery must commit to appropriate rehabilitation for the best outcome. Long-term sequelae of ACL injury include knee osteoarthritis in up to 90 percent of patients. Primary prevention of ACL injury includes specific proprioceptive and neuromuscular training exercises to improve knee stability.

An Interdisciplinary, Multi-Institution Telehealth Course for Third-Year Medical Students.

PROBLEM: The American Medical Association has called for telehealth to become a core competency of medical students. Studies indicate that a principal reason physicians do not practice telehealth is lack of training, yet patient interest in and satisfaction with telehealth are high. No comprehensive U.S. undergraduate medical education curriculum teaching telehealth principles has been published. APPROACH: In February 2018, the Uniformed Services University of the Health Sciences (USU) provided an innovative telehealth training experience for third-year medical students. USU led an interinstitutional, interprofessional learner-centered course including six segments: (1) multiple-choice pretest; (2) asynchronous lectures covering telehealth history, applications, ethics, safety, military uses, etiquette, and patient considerations; (3) in-person interactive telehealth instruction including patient selection, current uses, and risk management; (4) faculty-supervised mock patient telehealth encounters; (5) hands-on diagnosis and advanced surgical procedures using telehealth equipment; and (6) multiple-choice posttest. OUTCOMES: This course was piloted with 149 third-year medical students. Students' improvement in telehealth knowledge was demonstrated through (1) 10.1% average improvement between pre- and posttest scores, (2) completion of competency-based checklists, and (3) postcourse preceptor and student feedback. Faculty feedback indicated that technology use was novel and effective based on student input. Faculty noted that students enjoyed engaging via videoconference. Of participating medical students, 119 (80%) indicated future plans to practice telehealth; several requested to be part of future telehealth courses. NEXT STEPS: Telehealth will be integrated into clinical rotations in collaboration with other institutions. As the telehealth curriculum is taught at other institutions, lessons learned will inform enhancements at USU.

Morphology, molecular interactions and H2O diffusion in a poly(lactic-acid)/graphene composite: A vibrational spectroscopy study.

A composite system made of poly(l-lactic acid) (PLLA) and graphene nanoplatelets (GNP) was investigated by Raman and FTIR spectroscopy. Two compositions were prepared and characterized in comparison to the pristine polymer: they contained, respectively, 0.25 and 0.75 wt% of the nanofiller. The study was focused on the morphological properties of the system, and, in particular, on the level of dispersion and the homogeneity obtainable with the adopted preparation protocol. Furthermore, the possible molecular interactions taking place between the nanofiller and the polymer matrix were considered. Both the above issues were investigated by confocal Raman spectroscopy, with the aid of first-principle calculations to strengthen the spectral interpretation. Finally, the effect of the nanofiller on water diffusion was investigated by time-resolved FTIR spectroscopy, which provided accurate equilibrium and kinetic data, as well as molecular level information on the penetrant-to-substrate interactions. It was found that, for a 0.25 wt% composition, the adopted preparation protocol allowed us to achieve a dispersion at the level of single nanoplatelets, while for a 0.75 wt% composition, the GNP's aggregate into a co-continuous phase. PLLA/GNP interactions were detected by Raman spectroscopy, producing a detectable perturbation of the PLLA conformational equilibrium. Both the diffusivities and the equilibrium water uptake were found to decrease significantly by increasing the filler content.

Eumelanin Coated PLA Electrospun Micro Fibers as Bioinspired Cradle for SH-SY5Y Neuroblastoma Cells Growth and Maturation.

Within the framework of neurodegenerative disorder therapies, the fabrication of 3D eumelanin architectures represents a novel strategy to realize tissue-engineering scaffolds for neuronal cell growth and control by providing both mechanical support and biological signals. Here, an appropriate procedure combining electrospinning, spin coating and solid-state polymerization process is established to realize the scaffolds. For biological analysis, a human derived cell line SH-SY5Y from neuroblastoma is used. Cell maturation on eumelanin microfibers, random and aligned, is evaluated by using confocal analysis and specific markers of differentiating neurons (ßIII tubulin and GAP-43 expression). Cell morphology is tested by SEM analysis and immunofluorescence techniques. As results, eumelanin coated microfibers prove capable to support biological response in terms of cell survival, adhesion and spreading and to promote cell differentiation toward a more mature neuronal phenotype as confirmed by GAP-43 expression over the culture.

Prevalence and risk factors for pelvic floor symptoms in women in rural El Salvador.

Our aim was to assess the frequency of pelvic floor symptoms among women in rural El Salvador. After written informed consent was obtained, we administered the short form of the urodynamic distress inventory (UDI-6) plus four other pelvic floor questions to 236 women aged 30 to 75 in rural El Salvador attending a general medicine or gynecology clinic. Average (SD) age, parity, and body mass index were 48.0 (8.4) years, 5.9 (3.4), and 26.9 (4.9) kg/m(2), respectively. Ten (4.2%) women had a prior hysterectomy, 16 (6.8%) women were smokers, and 108 (45.8%) women were postmenopausal. Seventy-one percent of women reported urinary incontinence (UI); 49.3 and 61.1% of women reported urge UI and stress UI, respectively. Forty-one percent of women reported fecal incontinence (FI) of solid or liquid stool. Women with UI were significantly more likely to have had a hysterectomy compared to women without UI. Women with FI had significantly fewer years of education when compared to women without FI. In conclusion, pelvic floor symptoms are highly prevalent among women in rural El Salvador.