The Utah psychotropic oversight program: collaboratively addressing antipsychotic use within youth in foster care without prior authorization

ObjectivesFostered youth have increased risk of exposure to trauma. Antipsychotic medications are often utilized within the foster care system, potentially to address problematic behaviors that may be associated with trauma. The Utah Psychotropic Oversight Program (UPOP) was formed to support prescribers and encourage evidence-based treatment approaches for fostered youth. However, it is unclear what impact an oversight program can have on a high turnover population and without tools such as prior authorization. This study evaluates 4 years of collected data from the UPOP program for efficacy and to identify future intervention targets.MethodsDeidentified data were collected as a routine function of the oversight program over 4 years (01/2019-12/2022), from individuals aged 0–18 years old (total N = 8,523, 48.3% female). UPOP oversight criteria: ≤6yo + any psychotropic medication, ≥7yo + 2 or more psychotropic medications. For this analysis, youth were divided by UPOP individuals ever receiving an antipsychotic (AP) prescription (UPOP_AP; N = 755, 42.3% female) or not (UPOP_NAP, N = 1,006, 48.3% female) and non-UPOP fostered (N = 6,762, 48.9% female). Comparisons were made across demographic and clinical variables via ANOVA, Chi-square, unpaired t-test, and logistic regression.ResultsUPOP_AP more likely to be older males with behavioral diagnoses, increased polypharmacy, longer duration of fostering, and higher care level. AP prescription rates dropped from 52.8 to 39.1% for males and 43.3 to 38.2% in females with unchanged number of psychotropic prescriptions and care level across 2019-2022. UPOP_AP that discontinued AP treatment had fewer average psychotropic medications, but increased antidepressant and sleep prescriptions, as compared with individuals that remained on AP.ConclusionYouth within the foster care system receive antipsychotics at high rates and in an uneven distribution. Prescribing practices can change in the context of supportive oversight programs without components such as prior authorization, and without increasing the need for higher levels of care. Specific emphasis on the treatment of mood, anxiety, and sleep issues may also lead to greater success in discontinuing AP treatment. Oversight may support treatment providers while reducing exposure to medications with considerable side effect burden that could cause future comorbidity

Elevated Salivary Alpha Amylase in Adolescent Sexual Abuse Survivors with Posttraumatic Stress Disorder Symptoms

Objective: Little is known regarding neuroendocrine responses in adolescent girls with posttraumatic stress disorder (PTSD) who have experienced sexual abuse. Therefore, we collected saliva samples three times daily for 3 days to assess concentrations of salivary alpha amylase (sAA) – a surrogate marker for autonomic nervous system (ANS) activity and, in particular, sympathetic activity – in sexually abused adolescent girls

Severe Facial Herpes Vegetans and Viremia in NFKB2-Deficient Common Variable Immunodeficiency

With the accessibility of next-generation sequencing modalities, an increasing number of primary immunodeficiency disorders (PIDDs) such as common variable immunodeficiency (CVID) have gained improved understanding of molecular pathogenesis and disease phenotype with the identification of a genetic etiology. We report a patient with early-onset CVID due to an autosomal dominant loss-of-function mutation in NFKB2 who developed a severe herpes vegetans cutaneous infection as well as concurrent herpes simplex virus viremia. The case highlights features of CVID, unique aspects of NF-κB2 deficiency including susceptibility to herpesvirus infections, the detection of neutralizing anticytokine antibodies, and the complexity of medical management of patients with a PIDD that can be aided by a known genetic diagnosis

Endocarditis as a Marker for New Epidemics of Injection Drug Use

Background—We examined discharges for infective endocarditis (IE) at an academic teaching hospital for over 10 years to evaluate if an increase in hospitalizations for IE and increase in hepatitis C virus (HCV) in patients with IE could predict a new epidemic of injection drug use (IDU). Materials and Methods—Retrospective medical record review of discharged patients with the diagnosis of IE as defined by the modified Duke criteria. Student’s t test, chi-squared test and Fisher’s exact test were used to calculate P values. Results—There were 542 discharges among 392 unique patients with IE and 104 patients were readmitted 2–7 times. Of the total discharges, 367 (67.7%) were not screened for HCV, and of those tested, 86 (49.1%) were HCV+; 404 (74.5%) were not screened for HIV and of those tested, 28 (20.3%) were HIV+. Patients who self-identify as a person who injects drugs were more likely to be tested for HCV, 75 (69.4%) versus 12 (31.5%, P \u3c 0.0001), and for HIV, 72 (66.6%) versus 13 (34.2%, P \u3c 0.0001) compared with those who self-report no IDU. Those with a positive result for opiate or heroin toxicology test were more likely to be screened for HCV, 70 (66%) versus 22 (44.8%, P \u3c 0.0001), and for HIV, 66 (62.2%) versus 25 (51%, P \u3c 0.0001) than those with negative result for toxicology test. Over this period, there was a 2-fold increase in IE cases, a 3- fold increase in HCV antibody prevalence and a 6-fold increase in opiate toxicology screens showing positive result, but no increase in HIV. Conclusions—Although IDU is a known risk factor for IE, the observation of a sharp increase in IE cases may signal a new epidemic of IDU and HCV

Text Message Reminder-Recall to Increase HPV Immunization in Young HIV-1-Infected Patients

HIV infected patients have higher rates of HPV infection, worse disease progression, increase severity of disease, and are at higher risk for intraepithelial neoplasia and cancer than their HIV negative counterparts. We conducted a yearlong pilot project to evaluate the impact of text message HPV immunization reminder-recall in young HIV-1 positive patients in a large urban academic HIV clinic. We found that text message reminder-recall improved HPV immunization uptake in a young, primarily black and un- or underinsured HIV-1 infected patients. As communication by texting is characteristic of teens and young adults in the general population, text message reminder-recalls should be considered a viable option to improve vaccination rates among young HIV patients

Hispanic Mothers’ Comfort about Domestic Violence Screening Compared with Other Routine Screening Questions

Introduction One fourth of all women experience domestic violence at some point during their lives. Preliminary studies show that Latina women in the United States are less likely to report abuse, have a greater tolerance of severe abuse and are more likely to stay in an abusive relationship than their Anglo counterparts. Many organizations, including the American Medical Association and the American Academy of Pediatrics recommend that physicians screen routinely without children or partner present. Because mothers accompany their children 85 percent of the time to pediatric visits, screening the mother alone is logistically difficult in a busy practice. Furthermore, many doctors report that they don\u27t want to offend the patient by asking about domestic violence (DV). Research has shown that it may be acceptable to screen mothers for DV using general questions in front of their children. Rational/Hypothesis The purpose of our study is to evaluate the acceptability of general DV screening questions for women in Spanish compared with other routine sensitive screening questions when their children (3-12 yrs.) are with them in the primary care setting. Methods 46 Spanish-speaking mothers with children ages 3-12 were interviewed at community centers, churches and in their homes without children present. The survey composed of validated questions for drug/alcohol use, sexual activity, depression and general DV questions. The mother was asked to indicate her comfort level in answering each question alone and if her child were present using a 5-point Likert scale. The participants were then asked to rank the five general DV questions from most comfortable to answer in front of their children to the least comfortable in front of their children. Results Latina mothers were most comfortable answering sensitive issue screening questions alone. They indicated greater comfort with the DV screening questions: Do you feel safe in your current relationship and how is your partner treating you and the kids, than with questions about sex, depression and with the DV questions that talked about tension in the relationship and arguments, significance(\u3c 0.005) When subjects were examined by income, higher income (\u3e20,000 per year, N=11) reported no significant differences in any of the DV questions whereas those in the lower income cohort (\u3c20,000, N=35) reported significant differences with the two DV questions (tension and arguments). When asked to rank questions based on most comfort in front of the children, the questions with safe and treat were preferred. Conclusions and Significance Helping doctors understand that Latina mothers are more comfortable about general screening questions for DV than they are about screening for sexual activity and depression in front of their children may make physicians more willing to do routine DV screening. However, Latina mothers are uncomfortable with DV screening questions that include tension and argument. More research is needed to appreciate differences concerning DV screening among Latina women living in the United States

Hispanic Mothers’ Comfort about Domestic Violence Screening Compared with Other Routine Screening Questions

Introduction One fourth of all women experience domestic violence at some point during their lives. Preliminary studies show that Latina women in the United States are less likely to report abuse, have a greater tolerance of severe abuse and are more likely to stay in an abusive relationship than their Anglo counterparts. Many organizations, including the American Medical Association and the American Academy of Pediatrics recommend that physicians screen routinely without children or partner present. Because mothers accompany their children 85 percent of the time to pediatric visits, screening the mother alone is logistically difficult in a busy practice. Furthermore, many doctors report that they don\u27t want to offend the patient by asking about domestic violence (DV). Research has shown that it may be acceptable to screen mothers for DV using general questions in front of their children. Rational/Hypothesis The purpose of our study is to evaluate the acceptability of general DV screening questions for women in Spanish compared with other routine sensitive screening questions when their children (3-12 yrs.) are with them in the primary care setting. Methods 46 Spanish-speaking mothers with children ages 3-12 were interviewed at community centers, churches and in their homes without children present. The survey composed of validated questions for drug/alcohol use, sexual activity, depression and general DV questions. The mother was asked to indicate her comfort level in answering each question alone and if her child were present using a 5-point Likert scale. The participants were then asked to rank the five general DV questions from most comfortable to answer in front of their children to the least comfortable in front of their children. Results Latina mothers were most comfortable answering sensitive issue screening questions alone. They indicated greater comfort with the DV screening questions: Do you feel safe in your current relationship and how is your partner treating you and the kids, than with questions about sex, depression and with the DV questions that talked about tension in the relationship and arguments, significance(\u3c 0.005) When subjects were examined by income, higher income (\u3e20,000 per year, N=11) reported no significant differences in any of the DV questions whereas those in the lower income cohort (\u3c20,000, N=35) reported significant differences with the two DV questions (tension and arguments). When asked to rank questions based on most comfort in front of the children, the questions with safe and treat were preferred. Conclusions and Significance Helping doctors understand that Latina mothers are more comfortable about general screening questions for DV than they are about screening for sexual activity and depression in front of their children may make physicians more willing to do routine DV screening. However, Latina mothers are uncomfortable with DV screening questions that include tension and argument. More research is needed to appreciate differences concerning DV screening among Latina women living in the United States

含主族第十五族(銻、鉍)之混合過渡金屬(鉬、錳、鐵)團簇化合物之合成與系統性研究

[[abstract]][1] 鉍(Bi)-鐵(Fe)系統的研究 使用 [Et4N][BiFe3(CO)10] 與有機鹵化物CH3C(O)Cl，反應生成加成性產物 BiFe3(CO)9(m3-COC(O)CH3)。[Et4N][BiFe3(CO)10]與BrCH2C(O)OCH3在CH2Cl2中加熱生成氧化性產物Bi2Fe3(CO)9。 BiFe3(CO)9(m3-COC(O)CH3) 以Na/Ph2CO的THF溶液進行還原反應，欲合成含有carbide片段產物，卻得到 [BiFe3(CO)10]-、[Bi2Fe4(CO)13]2Ó，若使用PPNCl作為陽離子來源，可以得到一個特殊產物 [PPN][Bi2Fe2(CO)6Cl2(m-Cl)]。以 [BiFe3(CO)10]- 進行還原反應，同樣得到 [Bi2Fe4(CO)13]2Ó。並探討之間的關係。 [Et4N][BiFe3(CO)10] 與 Mn(CO)5Br及AgNO3得到已知的混合錳鐵團簇化合物 [Et4N][Bi4Fe3Mn(CO)14]。也可利用NaBiO3混合Fe(CO)5及Mn2(CO)10於甲醇溶液加熱反應一步合成此產物。提供更方便的合成方法，而可研究其反應性。 [2] 第十五族(As、Sb、Bi)-Mn-Fe系統的研究 NaBiO3混合Fe(CO)5及Mn2(CO)10於甲醇溶液加熱反應，可以生成已知的產物 [Et4N][Bi4Fe3Mn(CO)14] 及 [Et4N][BiFe3(CO)10]，並經由控制Fe(CO)5在反應中的比例，改變產物的比例。以不同主族氧化物NaSbO3混合Fe(CO)5及Mn2(CO)10於甲醇溶液加熱反應，得到結構為spirocyclic的 [PPh4][SbMn2Fe2(CO)16] 及三角平面結構的 [PPh4][MnFe2(CO)12]。成功地合成出含第十五族之混合錳鐵團簇化合物。 [3] 銻(Sb)-第六族(Cr、Mo、W)-Fe系統研究 以NaSbO3混合Mo(CO)6及Fe(CO)5在甲醇溶液中的加熱迴流反應，得到釘狀(Spiked)結構的 [Et4N][H2Fe3(CO)9{m3-SbMo(CO)5}]。Sb原子罩在Fe3三角平面上，並提供一對孤對電子與外來Mo(CO)5鍵結。在1H NMR的光譜顯示二組橋接H原子訊號 d -18.61 (m-H)、d -20.06 (m-H) ppm。 [4] 第十五族(As、Sb、Bi)-第六族(Cr、Mo、W)系統研究 使用NaSbO3與Mo(CO)6於甲醇溶液中加熱迴流反應，反應生成[Et4N]2[(CO)5MoSbMo4(CO)12(m3-OMe)3]。此一陰離子產物是建構在一個四面體結構SbMo3中心。一個Mo(CO)3片段經由三個三橋接的甲醇基與Mo3平面鍵結。Sb原子上的孤對電子與Mo(CO)5片段鍵結。此化合物不遵守電子計算規則。