Decreasing Social Media Use Through Motivational Interviewing: A Pediatric Primary Care Quality Improvement Project.

Background: Social media use has been correlated to worsening anxiety and depression in teenagers.

Local Problem: In the United Staes, social media is frequently used amongst adolescents, and rates of anxiety and depression in this population have increased over time.

Methods: A convenience sample of adolescents aged 12 to 18 years old were evaluated using a pre-post design.

Implementing an Adverse Childhood Experiences Screening Tool With Migrant Children: A Quality Improvement Project Using the PEARLS Screening Tool.

Background: Immigrants, asylum seekers, and refugees live with extreme stress, consistent vulnerability, and life-long health consequences. Children in these populations face an increased risk of poor mental health because of adverse childhood experiences (ACEs).

Aim: To implement an ACE screening questionnaire for all migrant children aged < 19 years in a community shelter.

Incorporating a Patient Education Video With Provider Consultation to Improve Patient Satisfaction and Reduce Consultation Time Among New Patients Seeking Cosmetic Injections.

The field of aesthetics is expanding more rapidly than ever before, bringing with it an influx of new-to-aesthetics patients who lack industry knowledge. We investigated ways to bridge this gap in knowledge and provide patients with important procedural information and also increase their satisfaction and confidence. We implemented this project to improve the delivery of preprocedural patient education via the implementation of an educational video.

Evaluation of the Impact of Optical Coherence Tomography on Pediatrician Otologic Examination Judgment.

Accurate diagnosis of otitis media is imperative to judicious antibiotic prescription. Visualization of the tympanic membrane and accurate identification of middle ear effusion with standard otoscopy is inherently challenging in pediatrics, especially in the youngest children who are most at risk for otitis media. With the average diagnostic accuracy among primary care physicians of 50% and accurate identification of normal tympanic membrane versus acute otitis media versus otitis media with effusion ranging from 30% to 84% among pediatricians, there is great opportunity for diagnostic improvement and decreasing unnecessary antibiotic use.

Use and Interchange of Incretin Mimetics in the Treatment of Metabolic Diseases: A Narrative Review.

Purpose: Glucagon-like peptide 1 receptor agonists (GLP-1 RAs) and now tirzepatide, a dual GLP-1 RA/glucose-dependent insulinotropic polypeptide agonist, have numerous advantages in the treatment of type 2 diabetes and obesity, yet only 11% of patients with type 2 diabetes are prescribed a GLP-1 RA. This narrative review addresses the complexity and cost issues surrounding incretin mimetics to support clinicians.

Methods: This narrative review summarizes key trials on the differing effects of incretin mimetics on glycosylated hemoglobin and weight, provides a table with rationale for how to interchange among agents, and summarizes the key factors that guide drug selection beyond guidance from the American Diabetes Association.

An Evaluation of Websites Offering Caregiver Education for Tracheostomy and Home Mechanical Ventilation.

Background: Parental and familial caregivers of a child with a tracheostomy, and possibly home mechanical ventilation (HMV), face the overwhelming task of learning to medically care for their child prior to discharge. Caregivers may cope by seeking health information on the Internet. This is concerning because information found during an Internet search may not be accurate, comprehensive, or up to date.

Nanoscale strain engineering of giant pseudo-magnetic fields, valley polarization, and topological channels in graphene.

The existence of nontrivial Berry phases associated with two inequivalent valleys in graphene provides interesting opportunities for investigating the valley-projected topological states. Examples of such studies include observation of anomalous quantum Hall effect in monolayer graphene, demonstration of topological zero modes in "molecular graphene" assembled by scanning tunneling microscopy, and detection of topological valley transport either in graphene superlattices or at bilayer graphene domain walls. However, all aforementioned experiments involved nonscalable approaches of either mechanically exfoliated flakes or atom-by-atom constructions.

Nearly 90% Circularly Polarized Emission in Monolayer WS Single Crystals by Chemical Vapor Deposition.

Monolayer transition-metal dichalcogenides (TMDCs) in the 2H-phase are promising semiconductors for opto-valleytronic and opto-spintronic applications because of their strong spin-valley coupling. Here, we report detailed studies of opto-valleytronic properties of heterogeneous domains in CVD-grown monolayer WS single crystals. By illuminating WS with off-resonance circularly polarized light and measuring the resulting spatially resolved circularly polarized emission (), we find significantly large circular polarization ( up to 60% and 45% for α- and β-domains, respectively) already at 300 K, which increases to nearly 90% in the α-domains at 80 K.

Sleep Evaluation in the Assessment of Pediatric Attention Deficit Disorders.

Introduction: Examining the impact of appropriate sleep evaluation on diagnosis of attention deficit disorders can improve the standard of care in pediatrics. This quality improvement project examined current practice and subsequent implementation of a validated standardized sleep evaluation tool in the assessment of children with symptoms of attention deficit.

Methods: Retrospective chart review and implementation of the Children's Sleep Habits Questionnaire (CSHQ) for children 6 to 14years old with attention deficit symptoms.

Pediatric rheumatologic diseases: A review for primary care NPs.

Rheumatologic diseases are uncommon in children but have the potential for significant morbidity, mortality, and disability. This article reviews the most common rheumatologic diseases in children, their diagnostic evaluations, and the NP's role in the management and coordination of these conditions.

Single-step deposition of high-mobility graphene at reduced temperatures.

Current methods of chemical vapour deposition (CVD) of graphene on copper are complicated by multiple processing steps and by high temperatures required in both preparing the copper and inducing subsequent film growth. Here we demonstrate a plasma-enhanced CVD chemistry that enables the entire process to take place in a single step, at reduced temperatures (<420 °C), and in a matter of minutes. Growth on copper foils is found to nucleate from arrays of well-aligned domains, and the ensuing films possess sub-nanometre smoothness, excellent crystalline quality, low strain, few defects and room-temperature electrical mobility up to (6.

A systematic review of the emotional, behavioural and cognitive features exhibited by school-aged children experiencing neglect or emotional abuse.

Background: Interventions to minimize the long-term consequences of neglect or emotional abuse rely on prompt identification of these children. This systematic review of world literature (1947-2012) identifies features that children aged 5-14 years experiencing neglect or emotional abuse, as opposed to physical or sexual abuse, may exhibit.

Methods: Searching 18 databases, utilizing over 100 keywords, supplemented by hand searching, 13,210 articles were identified and 111 underwent full critical appraisal by two independent trained reviewers.

Surface-dominated conduction in a 6 nm thick Bi2Se3 thin film.

We report a direct observation of surface dominated conduction in an intrinsic Bi(2)Se(3) thin film with a thickness of six quintuple layers grown on lattice-matched CdS (0001) substrates by molecular beam epitaxy. Shubnikov-de Haas oscillations from the topological surface states suggest that the Fermi level falls inside the bulk band gap and is 53 ± 5 meV above the Dirac point, which is in agreement with 70 ± 20 meV obtained from scanning tunneling spectroscopies. Our results demonstrate a great potential of producing genuine topological insulator devices using Dirac Fermions of the surface states, when the film thickness is pushed to nanometer range.

Measurement of a sign-changing two-gap superconducting phase in electron-doped Ba(Fe(1-x)Co(x))2As2 single crystals using scanning tunneling spectroscopy.

Scanning tunneling spectroscopic studies of Ba(Fe(1-x)Co(x))(2)As(2) (x=0.06, 0.12) single crystals reveal direct evidence for predominantly two-gap superconductivity.

Accuracy of temporal artery thermometry in neonatal intensive care infants.

Purpose: To determine the accuracy of temporal artery and axillary temperatures and the discomfort level of stable neonates during temperature measurement.

Subjects: Convenience sample of neonates between the ages of 32 and 40 weeks' gestation cared for in an isolette or crib.

Design: A method-comparison design was used to compare different methods for noninvasive temperature monitoring (infra-red temporal artery; axillary electronic) to core body temperatures (indwelling rectal probe).

Evidence for strain-induced local conductance modulations in single-layer graphene on SiO2.

Graphene has emerged as an electronic material that is promising for device applications and for studying two-dimensional electron gases with relativistic dispersion near two Dirac points. Nonetheless, deviations from Dirac-like spectroscopy have been widely reported with varying interpretations. Here we show evidence for strain-induced spatial modulations in the local conductance of single-layer graphene on SiO(2) substrates from scanning tunneling microscopic (STM) studies.

Tunneling Dynamics in a Double-Well Model of an H Transfer Reaction.

We study the role that tunneling can play in the reaction dynamics of H atom transfer. The small mass of the H atom offers it another, nonclassical route, from reactants to products, tunneling through an activation barrier. In this work, we carefully define the portion of a reaction rate constant that is caused by tunneling in such reactions.

Ab initio calculation of through-space magnetic shielding of linear polycyclic aromatic hydrocarbons (acenes): extent of aromaticity.

GIAO-HF within Gaussian 03 was employed to compute the NMR isotropic shielding values of a diatomic hydrogen probe above a series of acenes (linear polycyclic aromatic hydrocarbons). Subtraction of the isotropic shielding of diatomic hydrogen by itself allowed the determination of computed through-space proton NMR shielding increment surfaces for these systems. Shielding was observed above the center of each aromatic ring, but the magnitude of calculated shielding above each ring center depends on the number of fused benzenoid rings.

The use of gamma-irradiation and ultraviolet-irradiation in the preparation of human melanoma cells for use in autologous whole-cell vaccines.

Background: Human cancer vaccines incorporating autologous tumor cells carry a risk of implantation and subsequent metastasis of viable tumor cells into the patient who is being treated. Despite the fact that the melanoma cell preparations used in a recent vaccine trial (Mel37) were gamma-irradiated (200 Gy), approximately 25% of the preparations failed quality control release criteria which required that the irradiated cells incorporate 3H-thymidine at no more than 5% the level seen in the non-irradiated cells. We have, therefore, investigated ultraviolet (UV)-irradiation as a possible adjunct to, or replacement for gamma-irradiation.

A viral epitope that mimics a self antigen can accelerate but not initiate autoimmune diabetes.

We document here that infection of prediabetic mice with a virus expressing an H-2Kb-restricted mimic ligand to a self epitope present on beta cells accelerates the development of autoimmune diabetes. Immunization with the mimic ligand expanded autoreactive T cell populations, which was followed by their trafficking to the islets, as visualized in situ by tetramer staining. In contrast, the mimic ligand did not generate sufficient autoreactive T cells in naive mice to initiate disease.

Copper-induced changes in locomotor behaviors and neuronal physiology of the freshwater oligochaete, Lumbriculus variegatus.

The behavioral and neurotoxic effects of copper exposure were examined in the freshwater oligochaete, Lumbriculus variegatus. The 24 h LC50 for worms exposed to copper sulfate in an artificial pond water was 0.45 microM.

Calciphylaxis and metastatic calcification associated with nephrogenic fibrosing dermopathy.

Background: Calciphylaxis and metastatic calcification are known complications of chronic renal failure. Recently, a sclerosing condition of the skin termed nephrogenic fibrosing dermopathy (NFD) has been described in patients with renal disease, many of whom have undergone hemodialysis and/or renal transplantation. To our knowledge, the simultaneous occurrence of both conditions in the same patient, in the same lesion, has not been previously reported.