Common Practice for Behavioral Health Screening in Pediatric Primary Care Settings

Mental health disorders in the United States are highly prevalent, affecting 14-20% of children yearly. Only 25-35% receive treatment after on average a six-plus year delay from symptom onset. Current recommendations suggest primary care physicians/providers (PCP) manage mental health conditions, however, PCPs are wary, citing lack of time, training and resources.This study evaluated pediatric/adolescent PCPs using a self-report questionnaire assessing knowledge/skill, clinical practice (e.g. screening tool) and perceived barriers when managing attention deficit hyperactivity disorder (ADHD), anxiety and depression (N = 11). Self-reported knowledge/skill diagnosing, treating and referring each disorder were recorded on a 5-point Likert scale and evaluated using repeated-measures ANOVA with post-hoc Bonferroni tests. Percentages of providers screening for each disorder were calculated (91% for depression, 55% for ADHD and 9% for anxiety). Results showed significant differences in self-reported skill diagnosing the conditions assessed, and in self-reported skill treating the conditions assessed, F (2, 20) = 13.671, p F (2, 20) = 14.933, p p = 0.01), and the significant differences in skill treating were between ADHD (M=3.45, SD=0.688) and anxiety (M=2.36, SD=0.5, p \u3c 0.001), and between ADHD and depression (M=2.73, SD=0.9, p = 0.036). Providers were unlikely to screen for anxiety indicating an area where PCPs could improve their management of mental health disorders. Further study may reveal differences in clinical practice and perceived barriers to increased PCP screening and management

Interactions between the oomycete Pythium arrhenomanes and the rice root-knot nematode Meloidogyne graminicola in aerobic Asian rice varieties

Background: Aerobic rice fields are frequently infested by pathogenic oomycetes (Pythium spp.) and the rice root-knot nematode Meloidogyne graminicola. Here, the interaction between Pythium arrhenomanes and Meloidogyne graminicola was studied in rice roots of two aerobic rice varieties. In different experimental set-ups and infection regimes, plant growth, rice yield, Pythium colonization, as well as establishment, development and reproduction of M. graminicola were studied. Results: In this study, it is shown that the presence of P. arrhenomanes delays the establishment, development and reproduction of M. graminicola compared to single nematode infected plants. The delay in establishment and development of M. graminicola becomes stronger with higher P. arrhenomanes infection pressure. Conclusions: Our data indicate that P. arrhenomanes antagonizes M. graminicola in the rice root and that the plant benefits from this antagonism as shown by the yield data, especially when either of the pathogens is present in high levels

El estudio de las miasis en España durante los últimos cien años

Las miasis son un parasitismo producido por larvas de dípteros que, de forma obligatoria o accidental, necesitanalimentarse, para crecer y mudar, de tejidos vivos o muertos. El presente trabajo aporta una lista de las 47 especiescitadas en España como responsables de miasis en animales domésticos y en el hombre. Del mismo modo, se incluyenlas principales localizaciones en el hospedador. Así mismo, la bibliografía recopila fundamentalmente los trabajosde autores españoles sobre el tema durante este siglo

COVID-19 infection outcome in African American Renal Transplant recipients: Detroit Medical Center

Background: Transplant recipients are more vulnerable to infections including COVID-19, given their comorbidities and chronic immunosuppression. Most preliminary care series report rapid clinical progression and higher mortality compared to the general population. Methods: Retrospective study at Harper University Hospital - Detroit Medical Center. Twenty-five renal transplant recipients (RTR) presenting consecutively with COVID-19 symptoms and positive NP swab PCR for SARS-CoV2 between 03/01/2020 - 05/01/2020 were included. Data on demographics, clinical presentation, laboratory findings, management and outcomes were collected. Results: Patients had a median age of 56, all African American and deceased donor transplant recipients. Most had hypertension (96%), about half (52%) had diabetes, 64% had pulmonary disease including obstructive sleep apnea, COPD and pulmonary hypertension. Most common presenting symptom was dyspnea (64%), followed by fever and cough (56%) and diarrhea (56%). Half of patients had multifocal opacities on initial chest x-ray (52%). Immunosuppression with tacrolimus and low dose prednisone was continued, while mycophenolate mofetil was held on admission. Following institution guidelines, hydroxychloroquine was given to 32% who met criteria for risk of severe disease, while 48% received both hydroxychloroquine and steroids. Prophylactic anticoagulation was given to 80% of patients, while therapeutic coagulation to 8%. Oxygen supplementation given to 60% of patients and one patient required intubation. Three patients (12%) were admitted to intensive care, of which one expired. Treatment with mycophenolate was reintroduced based on resolution of symptoms and laboratory parameters. Conclusion: COVID-19 infected RTR in this cohort had lower mortality of 4% (n=1) compared to State-wide mortality of 10%. Clinical presentation was similar to non-immunocompromised hosts, but diarrhea was common. Despite multiple co-morbidities and chronic immunosuppression, our patient cohort had favorable outcome and lower mortality compared to other series. Exact reasons for this optimal outcome are unclear

Lyme Disease Prophylaxis: IDSA guidelines

Clinical Question: When should patients be given antibiotics for lyme prophylaxis after a tick bite? Bottom Line Answer: To provide antibiotic prophylaxis for Lyme disease ALL of these criteria should be met: Tick identified as an adult or nymphal deer tick Attached for \u3e or = 36 hours (by engorgement or time of exposure) Treatment started within 72 hours of tick removal Local rate of infection of ticks with B. Bourgdorferi \u3e=20% (assumed in Vermont) Doxyclycline is not contraindicate

Jefferson Postpartum Oxytocin Protocol Standardization

Aims for Improvement We aimed to reduce the variation and subsequent waste of postpartum oxytocin by standardizing the concentration available across the three maternity hospitals within the hospital enterprise system

Providing Comprehensive Care to Underserved Communities

This panel shares the history, vision and programs of Philadelphia FIGHT Community Health Centers, charting their growth from 1990 to today. Originally formed as a clinical research organization committed to ending the AIDS epidemic, FIGHT expanded into an AIDS Service Organization (ASO) and has since become a large Federally Qualified Health Center (FQHC) incorporating dental care, behavioral health and recovery programs, and pediatric, adolescent, and adult primary care, with a special focus on treating HIV and curing Hep C. FIGHT is unique because the health services are embedded in an organization that prioritizes digital access and digital literacy while addressing the needs of formerly incarcerated persons, homeless and unstably housed individuals, and anyone at risk of HIV. In addition, the panel discusses the relationship between the Jefferson College of Population Health and Philadelphia FIGHT, particularly with the JCPH MPH students. Learning Objectives: Describe FIGHT’s history in community research and how the type of programs they offer positively affect underserved communities. Explain various successes and challenges of building a multi-disciplinary practice servicing some of Philadelphia\u27s most vulnerable citizens. List ways Federally Qualified Health Centers impact populations and how they play an important role in population health. Presentation: 56:4

Core Topic: Anemia

Agenda Diagnosis and evaluation Approach to anemia Hypoproliferative Hyperproliferative Management of common anemias Cases Q & A Objectives Become familiar with signs and symptoms of anemia Use laboratory findings to differentiate anemias Review pathophysiology of anemia and recognize anemia as a symptom of other conditions Understand management of common anemias seen in primary car

COMFormer: classification of maternal-fetal and brain anatomy using a residual cross-covariance attention guided transformer in ultrasound

Monitoring the healthy development of a fetus requires accurate and timely identification of different maternal-fetal structures as they grow. To facilitate this objective in an automated fashion, we propose a deep-learning-based image classification architecture called the COMFormer to classify maternal-fetal and brain anatomical structures present in two-dimensional fetal ultrasound images. The proposed architecture classifies the two subcategories separately: maternal-fetal (abdomen, brain, femur, thorax, mother's cervix, and others) and brain anatomical structures (trans-thalamic, trans-cerebellum, trans-ventricular, and non-brain). Our proposed architecture relies on a transformer-based approach that leverages spatial and global features by using a newly designed residual cross-variance attention (R-XCA) block. This block introduces an advanced cross-covariance attention mechanism to capture a long-range representation from the input using spatial (e.g., shape, texture, intensity) and global features. To build COMFormer, we used a large publicly available dataset (BCNatal) consisting of 12, 400 images from 1,792 subjects. Experimental results prove that COMFormer outperforms the recent CNN and transformer-based models by achieving 95.64% and 96.33% classification accuracy on maternal-fetal and brain anatomy, respectively