Team Approach: Osseointegration Amputation Surgery.

¼ The purpose of this article was to review the multidisciplinary, team-based approach necessary for the optimal management of patients with limb loss undergoing osseointegration surgery.¼ In this study, we describe the interdisciplinary process of screening, counseling, and surgical and rehabilitation considerations with an emphasis on principles rather than specific implants or techniques.¼ Integrated perioperative management and long-term surveillance are crucial to ensure the best possible outcomes.¼ We hope this model will service as an implant-agnostic guide to others seeking to development an osseointegration center of excellence.

Supporting data driven translational patient-centered care using network analysis to visualize symptom distress in children with serious illness.

PURPOSE: There are an increasing number of techniques and tools to improve the capacity for children to relay their perceptions of their symptom experience while undergoing blood and marrow transplant (BMT). Network analysis (NA) is a tool that can illustrate associations between symptoms and the distress they cause. We aimed to develop a biopsychosocial assessment clinical analytic tool to examine symptom relationships for children undergoing BMT to find actionable relationships for intervention to improve clinical outcomes including mood. DESIGN AND METHODS: This pilot study used an analytical mobile application tool to support a wide scope of 15 biopsychosocial symptom distress levels and five mood assessments. Children recorded their symptom distress and mood using the app. NA was used to explore relationships between symptom distress and mood. RESULTS: Four children, 11-14 years old, undergoing BMT used the app daily during hospitalization. We found a strong presence of emotional distress and its associations symptom distress and mood. Multiple symptom associations were identified including associations between the set of symptoms difficulty breathing and fever (0.557), sad and worried (0.429). Of note, pain distress had a strong capacity to bridge other symptoms and was connected directly to many symptoms. PRACTICE IMPLICATIONS: We found the significance of patient struggles with emotional and symptom distress and the importance of this relationship to other clinical outcomes. This provides valuable insights and an improved understanding of the child's symptoms. Our findings support early assessment, intervention, and improved symptom communication to enhance sense of well-being and the child's care experience.

Gut-Brain Axis Perspective on Negative Symptoms and Their Neighbors in Early Adolescence: Can We Move Care Upstream?

The current study investigated symptom network patterns in adolescents from a gut-brain-axis (GBA) biopsychosocial perspective. Our secondary analysis of data from the Adolescent Brain Cognitive Development Study assessed symptom relationships using network analysis to provide information about multivariate structural dependencies among 41 signs and symptoms. Cross-sectional EBICglasso symptom networks were evaluated to assess patterns associated with anhedonia and depressed mood. Significant differences were identified between symptom neighbors of anhedonia compared with depressed mood based on stratification by age. The GBA perspective revealed several symptom neighbors that could expand clinical assessment, diagnosing criteria, education, and interventions for adolescents at risk for, or with, anhedonia or depressed mood. Results speak to the unique impact of symptoms on health that are not interchangeable with other symptoms and do not have equal effects. Mental health nurses should consider a holistic and proactive precision health approach to improving health and well-being through evidence-based assessment of symptom associations. [Journal of Psychosocial Nursing and Mental Health Services, 61(7), 29-38.].

Minding the Gap: Adolescent and Parent/Caregiver Reporter Discrepancies on Symptom Presence, Impact of Covariates, and Clinical Implications.

INTRODUCTION: Primary care practitioners (PCPs) provide care to adolescents in the context of their families. Supporting parent/caregiver knowledge of symptoms can create opportunities for better recognition of symptoms that can then lead to early identification, intervention, and prevention of poor outcomes. METHOD: Cross-sectional comparative study of parent/caregiver reported versus adolescent reported symptom presence of anhedonia and depressed mood in the participants of ABCD Study. RESULTS: Large discrepancies exist between adolescent and parent-reported presence of symptoms. DISCUSSION: Improving understanding of the etiology, covariates, and patterns of discrepancies may improve primary care assessment, adolescent access to care, and intervention for adolescents and their families. Furthermore, providing education to families about symptom features, working to improve adolescent-caregiver communication, promoting adolescent advocacy, and connecting families to community resources are important attributes of primary care and areas of adolescent and family functioning that primary care providers can strengthen.

Model Integration: Can Understanding Biopsychosocial Gut-Brain Axis Mechanistic Pathways Improve our Clinical Reasoning in Primary Care?

INTRODUCTION: Most NPs practice in primary care settings. Cognitive tools to inform and advance NP understanding of biopsychosocial mechanisms can support early recognition, interdisciplinary collaboration, interventions, and prevention of negative outcomes. THEORY AND METHODS: We describe the development of a model to support NP consideration of gut-brain axis (GBA) evidence-based pathways, contributing variables, and related health outcomes. RESULTS: The model's outcomes are factors associated with homeostasis or disruption of biological, psychological, and social systems. DISCUSSION/CONCLUSION: This cognitive tool aims to support NP awareness of multi-domain GBA relationships to consider with differential diagnoses and clinical treatment of the "whole body system".

Conversion of Trivalent Uranium Anilido to Tetravalent Uranium Imido Species via Oxidative Deprotonation.

Two uranium(III) anilido complexes were synthesized, Tp*2U(NH-C6H4-p-terpyridine) (2-terpy) and Tp*2U(NH-C6H4-p-CH3) (2-ptol), where Tp* = hydrotris(3,5-dimethylpyrazolyl)borate, by protonation of Tp*2UBn (1-Bn; Bn = benzyl) with 4-[2,6-di(pyridin-2-yl)pyridin-4-yl]benzenamine or p-toluidine, respectively. Conversion to the respective uranium(IV) imido species was possible by oxidation and deprotonation, forming Tp*2U(N-C6H4-p-terpyridine) (3-terpy) and Tp*2U(N-C6H4-p-CH3) (3-ptol). These compounds were characterized by multinuclear NMR spectroscopy, IR spectroscopy, electronic absorption spectroscopy, and X-ray crystallography.

Gender Dysphoria in the Military.

PURPOSE OF REVIEW: With the announcement that members of the military who identify as transgender are allowed to serve openly, the need for Department of Defense behavioral health providers to be comfortable in the assessment, diagnosis, and treatment of this population becomes quickly evident. This population has been seeking care in the community and standards have been developed to help guide decision-making, but a comparable document does not exist for the military population. RECENT FINDINGS: Previously published papers were written in anticipation of the policy allowing for open service. The civilian sector has treatment guidelines and evidence supporting the same for reference. There is no similar document for the military population, likely due to the recent change and ongoing development. This paper attempts to provide an overview of the recent Department of Defense policy and walks the reader through key considerations when providing care to a transgender member of the military as it relates to those who are currently serving in the military through the use of a case example. The military transgender population faces some unique challenges due to the need to balance readiness and deployability with medically necessary health care. Also complicating patient care is that policy development is ongoing-as of this publication, the decision has not yet been made regarding how people who identify as transgender will access into the military nor is there final approval regarding coverage for surgical procedures. Unique circumstances of this population are brought up to generate more discussion and encourage further evaluation and refinement of the process.

Delays and Disabilities: NP Screening and Care Management.

Neurodevelopmental Disorders (ND) impair functioning and are associated with increased physical and psychological health risks. ND care is increasingly being provided by NPs in primary care settings. To assess NP's knowledge and care management practices for pediatric patients with potential or existing ND, practicing NPs in North Carolina were invited to complete an online survey. NC NP's provide care to ND patients in a variety of settings and have varied levels of experience with ND. Differences in knowledge, screening, and management practices are identified. Methods for improving outcomes and supporting NPs providing care for this at-risk population are discussed.