PEERS® Curriculum for Children with Autism Spectrum Disorder: A Scoping Review.

AIMS: The Program for the Education and Enrichment of Relational Skills (PEERS®), designed to enhance social skills and relationships for individuals with autism spectrum disorder (ASD) and their caregivers, has primarily been implemented with older children and adolescents ages 11-19, leaving a gap in research on its effectiveness in young children. This scoping review assesses evidence of the effectiveness of the PEERS® program for children with ASD. METHODS: A literature search was conducted, resulting in 97 articles. Following the implementation of inclusion and exclusion criteria, four articles of Level III and IV evidence based on CEBM guidelines were included in this review. RESULTS: All studies demonstrated positive findings regarding social skills development with one study revealing statistically significant results in increasing social skills and decreasing problem behaviors after participation in the PEERS® program. CONCLUSIONS: This scoping review found improvements in the PEERS® programs for social skills in young children (ages 4-7) with ASD. However, further research is warranted, emphasizing larger sample sizes, consideration of external factors, and implementation of randomization and blinding in future studies.

The Adolescent Patient Perspective on Activity Limitations Following Sport-Related Concussion.

CONTEXT: Assessment of sport-related concussion (SRC) has begun to include patient- reported outcome measures (PROMs). However, there is a limited understanding of which health limitations are most meaningful to adolescents following SRC. OBJECTIVE: To explore patient-perceived activity limitations following SRC and throughout recovery to return-to-play (RTP) and mapped according to the International Classification of Functioning, Disability, and Health (ICF) model. DESIGN: Longitudinal. SETTING: Secondary school athletic training facilities. PATIENTS OR OTHER PARTICIPANTS: Fifty patients (41 males, 5 females, 4 sex not reported, age=14.9±3.5 years, grade=10.2±0.93 level) with a medically diagnosed SRC. INTERVENTIONS: The Patient Specific Functional Scale (PSFS) was used to assess changes in the patient's condition and the impact the injury posed on their ability to perform activities. The PSFS is a self-reported assessment of health used to identify activity limitations and rate the difficulty of performing those tasks. The PSFS was administered to patients on days 3 (D3) and 10 (D10) following SRC and at RTP. MAIN OUTCOME MEASURES: Activities impacted by injury were coded into common categories and themes by a three-person research team for subsequent analysis. The coded themes were also mapped to the ICF domains, chapters, and categories. The dependent variables were the PSFS themes, number of activities endorsed, PSFS scores, ICF domains, chapters, and categories. Descriptive analyses and frequencies were reported for the dependent variables. RESULTS: A total of 157 different activities were identified at D3 and coded into 28 categories that fit into six themes: activities of daily living (ADLs), cognitive and school (COG), sports and physical activity (SPA), screen time (SCR), sleep (SLP) and social (SOC). On D3, all patients (50/50) identified at least one activity limitation. The majority related to SPA (37.6%) and COG (31.2%). Sixty percent of patients endorsed activity limitations at D10, primarily in COG (38.6%) and SPA (36.6%). All (100%) response categories were mapped to the ICF, with most (75%) fitting the activities and participation (AP) domain. CONCLUSION: Our primary findings suggest that sport-related concussion influences many facets of the lives of adolescent athletes. Specifically, adolescent athletes identified activity restrictions primarily related to physical activity and sports participation.

Nanoarchitectonics of Bimetallic MOF@Lab-Grade Flexible Filter Papers: An Approach Towards Real-Time Water Decontamination and Circular Economy.

This study presents a novel approach to decontaminate ferrocyanide-contaminated wastewater. The work effectively demonstrates the use of bimetallic Mo/Zr-UiO-66 as a super-adsorbent for rapid sequestration of Prussian blue, a frequently found iron complex in cyanide-contaminated soils/groundwater. The exceptional performance of Mo/Zr-UiO-66 is attributed to the insertion of secondary metallic sites, which deliver synergistic effects, benefiting the inherent qualities of the framework. Moreover, to extend the industrial applications of metal-organic frameworks (MOFs) in real-world scenarios, an approach is delivered to structure the nanocrystalline powders into MOF-based macrostructures. The work demonstrates an interfacial process to develop continuous MOF nanostructures on ordinary laboratory-grade filter papers. The novelty of the work lies in the development of robust free-standing filtration materials to purify PB dye-contaminated water. Additionally, the work embraces a circular economy concept to address problems related to resource scarcity, excessive waste production, and maintenance of economic benefits. Consequently, the PB dye-loaded adsorbent waste is re-employed for the adsorption of heavy metals (Pb2+ and Cd2+ ). Simultaneously, the study aims to address the problems related to the real-time handling of powdered adsorbents, and the generation of ecologically harmful secondary waste, thereby, progressing toward a more sustainable system.

Impact of Teaching Social Determinants of Health on PIF in the Health Professions.

OBJECTIVE: To address the lack of methods for assessing learning on social determinants of health, particularly from a health systems perspective. Using a conceptual framework of professional identity formation applied across 3 professions (athletic training, occupational therapy, and pharmacy), the study aimed to describe students' level of professional identity when applying knowledge of structural factors' impact on health. METHODS: This study was a deductive content analysis of students' written reflections. Identified themes explored how students explained sociopolitical influences on health as well as their assessed level of professional identity. RESULTS: Students were inclined to author narratives focused on the ways in which structural factors influence individual outcomes and aspects within the health care system. Most students were assessed to be at the initial levels of professional identity formation, but those with a comparatively higher level of professional identity expressed a commitment to professional behaviors that address social determinants of health. CONCLUSION: This analysis created a foundation for future pedagogical work in health care system-related structural learning outcomes within and between different health professions. Findings suggest that across professions, most first-year students demonstrated the ability to reconcile different perspectives and were in the early stages of aligning personal values with professional values. The use of reflection has the potential to assess professional identity formation among a range of health professional students.

A Customized Triggers Program: A Children's Hospital's Experience in Improving Trigger Usability.

BACKGROUND: Despite the growth of patient safety programs across the United States, errors and adverse events remain a source of patient harm. Many hospitals rely on retrospective voluntary reporting systems; however, there are opportunities to improve patient safety using novel tools like trigger programs. METHODS: Children's National Hospital developed a unique pediatric triggers program that offers customized, near real-time reports of potential safety events. Our team defined a measure to quantify clinical utility of triggers, termed "trigger signal," as the percentage of cases that represent true adverse or near-miss events (numerator) per total triggers activated (denominator). Our key driver diagram focused on unifying the program structure, increasing data analytics, promoting organizational awareness, and supporting multidisciplinary end user engagement. Using the model for improvement, we aimed to double overall trigger signal from 8% to 16% and sustain for 12 months. RESULTS: The trigger signal increased from 8% to 41% and sustained during the coronavirus disease 2019 pandemic. A balancing measure of time to implement a new trigger decreased. Key interventions to increase trigger signal were change in the program structure, increasing stakeholder engagement, and development of self-service reports for end users. CONCLUSIONS: Children's National Hospital's triggers program highlights successful evolution of an iterative, customized approach to increase clinical utility that hospitals can implement to impact real-time patient care. This triggers program requires an iterative, customized approach rather than a "1-size-fits-all," static paradigm to add a new dimension to current patient safety programs.

A comprehensive review on water remediation using UiO-66 MOFs and their derivatives.

Metal-organic frameworks (MOFs) are a versatile class of porous materials offering unprecedented scope for chemical and structural tunability. On account of their synthetic versatility, tunable and exceptional host-guest chemistry they are widely utilized in many prominent water remediation techniques. However, some of the MOFs present low structural stabilities specifically in aqueous and harsh chemical conditions which impedes their potential application in the field. Among the currently explored MOFs, UiO-66 exhibits structural robustness and has gained immense scientific popularity. Built with a zirconium-terephthalate framework, the strong Zr-O bond coordination contributes to its stability in aqueous, chemical, and thermal conditions. Moreover, other exceptional features such as high surface area and uniform pore size add to the grand arena of porous nanomaterials. As a result of its stable nature, UiO-66 offers relaxed admittance towards various functionalization, including synthetic and post-synthetic modifications. Consequently, the adsorptive properties of these highly stable frameworks have been modulated by the addition of various functionalities. Moreover, due to the presence of catalytically active sites, the use of UiO-66 has also been extended towards the degradation of pollutants. Furthermore, to solve the practical handling issues of the crystalline powdered forms, UiO-66 has been incorporated into various membrane supports. The incorporation of UiO-66 in various matrices has enhanced the rejection, permeate flux, and anti-fouling properties of membranes. The combination of such exceptional characteristics of UiO-66 MOF has expanded its scope in targeted purification techniques. Subsequently, this review highlights the role of UiO-66 in major water purification techniques such as adsorption, photocatalytic degradation, and membrane separation. This comprehensive review is expected to shed light on the existing developments and guide the inexhaustible futuristic scope of UiO-66 MOF.

Engagement and Bundle Compliance during COVID-19: A Virtual Strategy.

COVID-19 forced industries to change work processes; this was no different for those working to improve patient outcomes in healthcare. Due to competing priorities, many hospitals struggled with the upkeep of hospital-acquired condition (HAC) auditing and engagement. Children's National hospital developed a three-pronged approach for virtual engagement and sustainment of the processes necessary to achieve and maintain goal auditing and bundle compliance in three HACs: unplanned extubation, central line-associated bloodstream infections, and employee staff safety overexertion injuries. Methods: The overall goal was to create a flexible approach to maintaining engagement while relying on virtual communication. Aim: To maintain, without a decrease of more than 20%, the baseline bundle compliance per month for each HAC (unplanned extubation, central line-associated bloodstream infections, and employee staff safety) from March 2020 to March 2021. Our approach to increasing bundle compliance (primary outcome measure) and audits (process measure) included: regular leadership meetings using multiple virtual modalities, improving the audit process, and ensuring fidelity to bundle elements. Results: Qualitatively, we have found that microsystem leaders regularly engage with quality improvement staff and their teams using virtual touchpoints and ongoing communication. We exceeded the goal of maintaining our monthly bundle compliance, and we saw a significant positive change in the rate of audits after COVID-19. Conclusions: In a time of change during a pandemic, increased engagement in HAC work can adapt structure and processes. Our results are generalizable by increasing touchpoints using multiple virtual modalities.

Non-Time-Loss and Time-Loss Injuries in Secondary School Girls' Volleyball Athletes: A Report From the National Athletic Treatment, Injury, and Outcomes Network Surveillance Program.

CONTEXT: Volleyball is a popular sport with a risk of injury to the entire body. Insight into non-time-loss (NTL) and time-loss (TL) injuries is needed to inform seasonal injury trends that may lead to appropriate prevention and management strategies. This study provides a descriptive analysis of volleyball injuries among secondary school athletes. STUDY DESIGN: Descriptive epidemiology study. METHODS: Data were collected from 72 secondary schools, representing 135 team seasons of data from the National Athletic Treatment, Injury, and Outcomes Network Surveillance Program (2014-2015 to 2018-2019 academic years). Injury counts, injury rates (IR) per 1000 athlete exposures (AEs), and incidence rate ratios (IRR) were reported with 95% confidence intervals (CIs). RESULTS: In total, 529 injuries over 193,858 AEs for girls' volleyball were captured, producing an IR of 2.73/1000AEs (95% CI = 2.50-2.96). The overall IR was highest during the preseason compared with regular season (IRR = 1.31, 95% CI = 1.09-1.59). Overall IRs were higher in competition (IR: 3.56, 95% CI = 3.07-4.05) compared with practice (IR: 2.38, 95% CI = 2.12-2.64; IRR = 1.49, 95% CI = 1.25-1.79). Common body locations injured were ankle (n = 141, 26.7%; NTL: n = 56, 21.7%; TL: n = 85, 31.7%), knee (n = 61, 11.5%; NTL: n = 33, 12.8%, TL: n = 28, 10.5%), hand/wrist (n = 59, 11.2%; NTL: n = 32, 12.4%, TL: n = 27, 10.1%), and head/face (n = 62, 11.7%; NTL: n = 14, 5.4%; TL: n = 47, 17.5%). CONCLUSIONS: Volleyball IRs were highest in preseason and during competition. Most injuries affected the lower-extremity which is notable considering the high upper-extremity load in volleyball. Consideration of strategies to reduce injuries prior to the start of the formal sports season may be needed to help reduce the incidence of preseason injuries.

Improving Follow-Up of Tests Pending at Discharge.

BACKGROUND AND OBJECTIVES: Follow-up on results of inpatient tests pending at discharge (TPAD) must occur to ensure patient safety and high-quality care continue after discharge. We identified a need to improve follow-up of TPAD and began a quality improvement initiative with an aim of reducing the rate of missed follow-up of TPAD to ≤20% within 12 months. METHODS: The team used the Plan-Do-Study-Act method of quality improvement and implemented a process using reminder messages in the electronic health record. We collected data via retrospective chart review for the 6 months before the intervention and monthly thereafter. The primary outcome measure was the percentage of patients with missed follow-up of TPAD, defined as no documented follow-up within 72 hours of a result being available. The use of a reminder message was monitored as a process measure. RESULTS: We reviewed charts of 764 discharged patients, and 216 (28%) were noted to have TPAD. At baseline, the average percentage of patients with missed follow-up was 80%. The use of reminder messages was quickly adopted. The average percentage of patients with missed follow-up of TPAD after beginning the quality improvement interventions was 35%. CONCLUSIONS: We had significant improvement in follow-up after our interventions. Additional work is needed to ensure continued and sustained improvement, focused on reducing variability in performance between providers and investing in technology to allow for automation of the follow-up process.

Athletic Administrators' Reporting of Emergency Preparedness Regarding Policies and Procedures in Iowa Secondary Schools.

CONTEXT: Secondary schools that offer school-sponsored athletic events should follow best-practice guidelines to provide policies that promote student health and safety. OBJECTIVE: To assess emergency preparedness from the perspective of athletic administrators (AAs) in Iowa secondary schools. DESIGN: Cross-sectional study. SETTING: Online survey. PATIENTS OR OTHER PARTICIPANTS: Ninety-eight AAs from Iowa completed the survey (age = 45.33 ± 10.22 years, years as an AA = 9.37 ± 8.14, years in current role = 7.72 ± 7.09). MAIN OUTCOME MEASURES(S): The 6-section survey contained with questions about access to athletic trainers (ATs), emergency action plans (EAPs), cardiopulmonary resuscitation (CPR), automated external defibrillators (AEDs), concussions, heat illness, and other general policies. Descriptive statistics (percentages and frequencies) were reported. Relative risk was calculated to compare schools with and those without access to ATs (P < .05). RESULTS: Most respondents (76.5%, n = 75/98) reported their school had access to a licensed AT. The majority had a written EAP (83.3%, n = 70/84), but fewer than half (39.2%, n = 31/79) reviewed it annually and fewer than 10% (n = 6/85) reported practicing it each year. All respondents (100%, N = 78/78) stated they had an AED on campus. All respondents (N = 77/77) indicated that they were familiar with the Iowa High School Athletic Association's (IHSAA's) concussion policy and had a concussion guideline in place. Many respondents (95.9%, n = 71/74) described being familiar with the IHSAA's heat illness policy, but more than half (62.1%, n = 41/66) noted they did not have a heat illness policy in place at their school. CONCLUSIONS: Most respondents indicated their school had access to ATs, followed the state-mandated concussion guidelines, and had an AED. Although participants reported having written EAPs in place, levels of annual EAP review and practice were low. These results suggest that schools would benefit from educational opportunities to improve safety policies.

Cerium based UiO-66 MOF as a multipollutant adsorbent for universal water purification.

Herein, we demonstrate the use of cerium (Ce)-UiO-66 metal organic framework (MOF) for the removal of a variety of potentially toxic pollutants. The Ce-UiO-66 MOF, with similar framework topologies to Zr-UiO-66, has not been explored for its adsorptive properties in water remediation. The replacement of Zr metal center with Ce yields a MOF that can be synthesized in shorter durations with lesser energy consumptions and with excellent multipollutant adsorption properties. Further, the Ce-UiO-66 MOF was also studied for its adsorption abilities in the binary component system. Interestingly, the adsorbent showed higher adsorption capacities in the presence of other pollutants. Removal studies for other potentially toxic anionic and cationic dyes showed that the Ce-UiO-66 MOF has a wide range of contaminant removal abilities. Investigations of individual adsorption capacities revealed that the Ce-UiO-66 MOF has a maximum adsorption capacity of 793.7 mg/g for congo red (CR), 110 mg/g for methylene blue (MB), 66.1 mg/g for fluoride (F-), 30 mg/g for Cr6+ and 485.4 mg/g for the pharmaceutical waste diclofenac sodium (DCF). To imply the practical applications of the Ce-UiO-66 MOF we have also demonstrated an adaptable filter that could separate all the potentially toxic pollutants.

MOF based engineered materials in water remediation: Recent trends.

The significant upsurge in the demand for freshwater has prompted various developments towards water sustainability. In this context, several materials have gained remarkable interest for the removal of emerging contaminants from various freshwater sources. Among the currently investigated materials for water treatment, metal organic frameworks (MOFs), a developing class of porous materials, have provided excellent platforms for the separation of several pollutants from water. The structural modularity and the striking chemical/physical properties of MOFs have provided more room for target-specific environmental applications. However, MOFs limit their practical applications in water treatment due to poor processability issues of the intrinsically fragile and powdered crystalline forms. Nevertheless, growing efforts are recognized to impart macroscopic shapability to render easy handling shapes for real-time industrial applications. Furthermore, efforts have been devoted to improve the stabilities of MOFs that are subjected to fragile collapse in aqueous environments expanding their use in water treatment. Advances made in MOF based material design have headed towards the use of MOF based aerogels/hydrogels, MOF derived carbons (MDCs), hydrophobic MOFs and magnetic framework composites (MFCs) to remediate water from contaminants and for the separation of oils from water. This review is intended to highlight some of the recent trends followed in MOF based material engineering towards effective water regeneration.

Evaluating Multiple Domains of Health in High School Athletes With Sport-Related Concussion.

CONTEXT: Concussions are shown to hinder multiple health dimensions, including health-related quality of life (HRQOL), suggesting a need for a whole-person approach to assessment and treatment. Patient-reported outcome measures are one method to gather the patient's perspective regarding their HRQOL. OBJECTIVE: To evaluate perceived HRQOL using the Patient-Reported Outcomes Measurement Information System Pediatric-25 subscale in patients throughout concussion recovery. DESIGN: Prospective cohort, descriptive survey. SETTING: There were 9 high school athletic training facilities. PARTICIPANTS: A total of 70 patients with diagnosed concussions (51 males, 7 females, 12 unreported; age = 15.7 [0.9] y, height = 174.6 [8.4] cm, mass = 72.8 [14.8] kg, grade = 10.0 [0.9] level). INTERVENTIONS: Patient-Reported Outcomes Measurement Information System Pediatric-25 was administered at 3 days, 10 days postconcussion, and return to play (RTP). MAIN OUTCOME MEASURES: Patient-Reported Outcomes Measurement Information System Pediatric-25 subscale T scores and self-reported concussion history (yes/no). RESULTS: A total of 70 patients completed the study. For the Pediatric-25 subscales, the severity of problems associated with Physical Function Mobility, Anxiety, Depression, Fatigue, and Pain Interference were highest 3 days postconcussion, decreasing at 10 days and RTP (all p < .05). No differences were found between days 3 and 10 for Peer Relationship scores, but improvements were identified at RTP (p < .05). Pediatric-25 subscale scores at the 3 measurements were not statistically associated with concussion history (all p > .05). Ceiling and floor effects were present in all subscales throughout each timepoint, except for Physical Function Mobility (14.7%), and pain interference (11.8%) at day 3 postinjury. CONCLUSIONS: Patients who had suffered a concussion improved from day 3 through RTP on multiple health domains as demonstrated through the Pediatric-25 subscales. These findings highlight the need for health care professionals to serially monitor HRQOL and social factors that may affect the patient postconcussion as part of a multifactorial assessment. Ceiling effects in high functioning adolescent athletes were present; thus, efforts should be made to identify appropriate scales for use in managing recovery in athletic populations.

Reducing Antacid Use in a Level IV NICU: A QI Project to Reduce Morbidity.

INTRODUCTION: Gastroesophageal reflux is a physiologic occurrence in infants. Clinicians caring for neonates use histamine-2 receptor antagonists (H2As) or proton pump inhibitors (PPIs) for symptomatic reflux, apnea/bradycardia/desaturations, or irritability. Recent studies have shown that there is an increased incidence of infection, fracture, and mortality in neonates who receive antacids. METHODS: A multidisciplinary team aimed to decrease nonindicated antacid use in the NICU by 50% by April 2019. Outcome measures include the median number of inappropriate antacid prescriptions and patient-days on acid-suppressants. Interventions include education regarding use and risks of antacids, development of a list of indications deemed "appropriate" for starting an H2A or PPI, mandatory discussion on rounds when considering antacids, documentation of treatment goal, and indication, and an automatic drop-off in the electronic medical record. RESULTS: Baseline data (June-December 2017) showed 19 prescriptions of H2As or PPIs. Of those, 10 orders were deemed "inappropriate," according to our indicated uses. There were 407 total patient-days of medication-use (median: 51 patient-days). After the implementation of the interventions (October 2018-May 2019), there were 11 prescriptions of antacid medications, 3 of which were deemed "inappropriate." There were 206 total days of medication-use (median: 18.5 patient-days). CONCLUSIONS: A multidisciplinary agreement on indications for antacid use in neonates stimulates discussion and creates more purposeful use. Overall, we successfully decreased nonindicated antacid prescriptions in the NICU. For the next steps, we hope to educate physicians on the risks of antacid use and reduce prescriptions in other areas of the hospital and the outpatient setting.

Naturally available diatomite and their surface modification for the removal of hazardous dye and metal ions: A review.

The presence of toxic pollutants such as dyes and metal ions at higher concentrations in water is very harmful to the environment. Removal of these pollutants using diatomaceous earth or diatomite (DE) and surface-modified DE has been extensively explored due to their excellent physio-chemical properties and low cost. Therefore, naturally available DE being inexpensive, their surface modified adsorbents could be one of the potential candidates for the wastewater treatment in the future. In this context, the current review has been summarized for the removal of both pollutants i.e., dyes and metal ions by surface-modified DE using the facile adsorption process. In addition, this review is prominently focused on the various modification process of DE, their cost-effectiveness; the physio-chemical characteristics and their maximum adsorption capacity. Further, real-time scenarios of reported adsorbents were tabulated based on the cost of the process along with the adsorption capacity of these adsorbents.

Acute Dilation of Venous Sinuses in Animal Models of Mild Traumatic Brain Injury Detected Using 9.4T MRI.

Mild traumatic brain injury (mTBI) is a debilitating but extremely common form of brain injury that affects a substantial number of people each year. mTBI is especially common in children and adolescents. Our understanding of mTBI pathophysiology is limited, and there is currently no accepted marker for disease severity. A potential marker for disease severity may be cerebrovascular dysfunction. Recent findings have implicated cerebrovascular alteration as an important component of mTBI and suggest it contributes to the development of persistent, long-term symptoms. In this paper, we conducted two studies to investigate whether mTBI affects venous drainage patterns in the central nervous system using alterations in the size of venous sinuses as a marker of changes in drainage. Using a closed head vertical weight-drop model and a lateral impact injury model of mTBI, we imaged and quantified the size of three major draining vessels in the adolescent rat brain using 9.4T MRI. Areas and volumes were quantified in the superior sagittal sinus and left and right transverse sinuses using images acquired from T2w MRI in one study and post-gadolinium T1w MRI in another. Our results indicated that the three venous sinuses were significantly larger in mTBI rats as compared to sham rats 1-day post injury but recovered to normal size 2 weeks after. Acutely enlarged sinuses post-mTBI may indicate abnormal venous drainage, and this could be suggestive of a cerebrovascular response to trauma.

Bio-inspired materials for defluoridation of water: A review.

The polluted water sources pose a serious issue concerning the various health hazards they bring along. Due to various uncontrolled anthropogenic and industrial activities, a great number of pollutants have gained entry into the water systems. Among all the emerging contaminants, anionic species such as fluoride cause a major role in polluting the water bodies because of its high reactivity with other elements. The need for water remediation has led the research community to come up with several physicochemical and electrochemical methods to remove fluoride contamination. Among the existing methods, biosorption using bio and modified biomaterials has been extensively studied for defluoridation, as they are cheap, easily available and effectively recyclable when compared to other methods for defluoridation. Adding on, these materials are non-toxic and are safe to use compared to many other synthetic materials that are toxic and require high-cost design requirements. This review focuses on the recent developments made in the defluoridation techniques by biosorption using bio and modified biomaterials and defines the current perspectives of fluoride removal specifically using biomaterials.