Classics in Chemical Neuroscience: Xylazine.

Xylazine (also known as "tranq") is a potent nonopioid veterinary sedative that has recently experienced a surge in use as a drug adulterant, most often combined with illicitly manufactured fentanyl. This combination may heighten the risk of fatal overdose. Xylazine has no known antidote approved for use in humans, and age-adjusted overdose deaths involving xylazine were 35 times higher in 2021 than 2018. In April 2023, the Biden Administration declared xylazine-laced fentanyl an emerging drug threat in the United States. In 2022, the Drug Enforcement Agency (DEA) reported nearly a quarter of seized fentanyl powder contained xylazine. This dramatic increase in prevalence has solidified the status of xylazine as an emerging drug of abuse and an evolving threat to public health. The following narrative review outlines the synthesis, pharmacokinetics, pharmacodynamics, and adverse effects of xylazine, as well as the role it may play in the ongoing opioid epidemic.

Digital MD: A Novel Undergraduate Medical School Elective for Social Media and Digital Scholarship.

An outcomes-based novel curriculum integrating digital literacy, social media, and digital scholarship was implemented into an undergraduate medical education elective for first- and second-year medical students. Learners engaged in asynchronous discussion boards, live didactics and seminars, and a capstone project with peer feedback throughout the 7-week course.

Narrative Review of Clinical Productivity and Teaching in Emergency Medicine.

Emergency medicine educators are subject to external pressures to increase clinical productivity while maintaining quality teaching. Strategies to mitigate this perceived conflict include alterations in staffing and incentive compensation with educational value units. There is a paucity of information describing the effect of clinical demands on teaching metrics in emergency medicine. We performed a narrative review of the literature describing the relationship between clinical productivity and teaching evaluations of emergency medicine faculty and residents. We searched PubMed and Google Scholar for peer-reviewed articles describing emergency medicine clinical productivity metrics, teaching metrics, and the relationship between them. Seven articles met inclusion criteria. While most articles utilized relative value units (RVUs) per hour, other outcomes metrics were heterogeneous. Almost all studies utilized retrospective data and took place at academic teaching hospitals. Despite variability in statistical analysis, no studies found a relationship between clinical productivity and teaching metrics. Multiple articles identified characteristics of faculty that were associated with improved teaching metrics independent of clinical demands. The available literature does not support the concept that increased clinical productivity conflicts with quality teaching. A subset of faculty was identified who excelled at both. Next research steps should include developing shared standards for assessment of clinical productivity and educational quality that can be used to collect data at multiple sites at academic and community clinical settings; a secondary outcome includes measuring the effects of additional teaching attendings and educational value units.

HIV and club drugs in emerging adulthood.

PURPOSE OF REVIEW: To evaluate the incidence of club drug use in pediatric patients, especially those aged 13-25, and how it relates to the spread of HIV. RECENT FINDINGS: Transmission of HIV among younger patients has become largely associated with risky sexual behaviors, as the rate of transmission from vertical infection and intravenous drug use has decreased. Use of club drugs in emerging adult populations contributes to the HIV epidemic through a combination of decreased inhibitions as well as physiological effects that increase high-risk sexual practices. Robust data exists linking the use of club drugs by the men who have sex with men population with spread of HIV, but this data in other at-risk populations (e.g. African Americans) is not as robust. Additional research is needed to identify the rates of transmission among adolescents and emerging adults, as well as knowledge, attitudes, beliefs, and practices that affect HIV transmission in this population. SUMMARY: Use of club drugs by adolescents and emerging adults contributes to the current rate of HIV transmission among this age group.

First-Onset Seizure After Use of an Energy Drink [corrected].

The health consequences of energy drink use in adolescents are unknown. We discuss an adverse event in an adolescent who presented to the emergency department with his first-ever seizure after consumption of 5-Hour Energy. We review the typical presentation of caffeine toxicity, as well as the importance of screening for energy drink use in adolescents with appropriate clinical findings. We pay particular attention to the identification of energy drink-related adverse events in the emergency department and the need for subsequent reporting to the Food and Drug Administration. To our knowledge, this is the first reported case of an adolescent presenting with a new-onset seizure associated with energy drink use.

The association between flavor labeling and flavor recall ability in children.

This study sought to determine if the ability to label a flavor is associated with an improved ability to recall having tasted the flavor in preschool-aged children. A total of 120 3- to 6-year-old English-speaking children tasted and labeled 20 different flavors, blinded to color. Children's labels for the flavors were scored for consistency and accuracy. Recall for having tasted the flavor was tested. Both labeling ability and recall ability improved rapidly between the ages of 3 and 6 years in this cohort. Regression analysis indicated that independent of the child's age, consistent accurate labeling was positively associated with recall ability. Higher maternal education was an independent and marginal contributor to greater recall ability. The combination of consistent and accurate labeling, age, and maternal education accounted for 28% of the variance in flavor recall ability. Consistent but inaccurate labeling alone contributed little to the variance in flavor recall ability. We conclude from these findings that children's ability to recall having tasted a flavor develops rapidly during the preschool age range and that improved recall ability is associated with the ability to consistently and accurately label the flavor. We conclude that language mediates memory for flavors in young children.