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The number of children and young people admitted to children's wards with an eating disorder has increased significantly since the start of the coronavirus disease 2019 (COVID-19) pandemic. In the most extreme cases, those with severe malnutrition may need to be fed via a nasogastric tube without their consent. Children's nurses working on hospital wards may therefore care for children and young people who need to receive nasogastric tube feeding under physical restraint. This article offers an overview of eating disorders and their detrimental effects as well as practical advice for children's nurses, supporting them to provide safe, compassionate and person-centred care to their patients.

To identify factors that patients consider when choosing between future in-person, video, or telephone visits.Telemedicine has been rapidly integrated into ambulatory neurology in response to the COVID-19 pandemic.Ambulatory neurology patients at a single center were contacted via telephone to complete: (1) a survey quantifying likelihood of scheduling a future telemedicine visit, and (2) a semi-structured qualitative interview following their visit in March 2021. Data were processed using the principles of thematic analysis.Of 2493 visits, 39% assented to post-visit feedback; 74% were in-person visits and 13% video and telephone. Patients with in-person visits were less likely than those with video and telephone visits to "definitely" consider a future telemedicine visit (36 vs. 59 and 62%, respectively; p 0.001). Patients considered five key factors when scheduling future visits: "Pros of Visit Type," "Barriers to Telemedicine," "Situational Context," "Inherent Beliefs," and "Extrinsic Variables." Patients with telemedicine visits considered convenience as a pro, while those with in-person visits cited improved quality of care. Accessibility and user familiarity were considered barriers to telemedicine by patients with in-person and telephone visits, whereas system limitations were prevalent among patients with video visits. Patients agreed that stable conditions can be monitored via telemedicine, whereas physical examination warrants an in-person visit. Telemedicine was inherently considered equivalent to in-person care by patients with telephone visits. Awareness of telemedicine must be improved for patients with in-person visits.Across visit types, patients agree that telemedicine is convenient and effective in many circumstances. Future care delivery models should incorporate the patient perspective to implement hybrid models where telemedicine is an adjunct to in-person visits in ambulatory neurology.

Impairment in dopaminergic pathways has been implicated in several detrimental neuropsychiatric and neurodegenerative disorders, including schizophrenia and Parkinson’s disease. Current approved therapeutic drugs for such conditions treat the symptoms, not the underlying cause, as this requires long-term usage that often causes severe extrapyramidal side effects. A novel allosteric modulator, 3(R)-[(2(S)-pyrrolidinylcarbonyl)amino]-2-oxo-1-pyrrolidineacetamide (PAOPA), selectively attenuates the dopamine D2 receptor and effectively modulates schizophrenia-like symptoms in preclinical animal models. The pharmacokinetics and toxicological evaluation for this drug also presented its effectiveness in reaching targeted therapeutic regions without showing hematological and metabolic abnormalities in chronic treatment. Recent studies have revealed that cerebral dopamine neurotrophic factor (CDNF), an ER located protein secreted upon ER stress, has long-term neuroprotective and neuro-restorative effects on dopaminergic neurons. Given the therapeutic role of PAOPA and the restorative effect of CDNF in the dopaminergic pathway, this study examined the chronic effect of PAOPA treatment on CDNF protein expression in brain regions implicated in neurological disorders. Immunoblot results revealed a 232% striatal increase in CDNF after 7 days of daily injection. Although the mechanism is not entirely understood, this study provides more insight into the potential signalling pathways affected by PAOPA treatment. As extracellular receptor kinase (ERK1/2) is proposed to upregulate CDNF expression following an unfolded protein response and PAOPA treatment increases ERK1/2 expression, PAOPA may indirectly affect CDNF expression by modulating ERK1/2 expression. The restorative effects of CDNF implicate it in the therapeutic mechanism for the potential antipsychotic drug, PAOPA.

Background: Allosteric modulators of G-protein coupled receptors regulate receptor activity by binding to sites other than the active site and have emerged as a new and highly desirable class of drugs. PAOPA (3(R)-[(2(S)-pyrrolidinylcarbonyl)amino]-2-oxo-1-pyrrolidineacetamide), a peptidomimetic analog of L-prolyl-L-leucyl-glycinamide, is a potent dopamine D2 receptor allosteric modulator. PAOPA has shown therapeutic effects in pre-clinical models of schizophrenia and extrapyramidal dysfunction. Objective: In this study, we sought to examine the biomolecular underpinnings of PAOPA‘s therapeutic outcomes in pre-clinical models of schizophrenia. Methods: Following sub-chronic (daily for 7 days) administration of PAOPA, we assessed levels of dopamine D2 receptors, receptor kinases (GRK2 (G protein-coupled receptor kinase 2) and Arrestin- 3), and phosphorylated mitogen-activated protein kinase (MAPKs), namely, extracellular signal- regulated kinases (ERK1/2) in the hippocampus, medial pre-frontal cortex, nucleus accumbens, pre-frontal cortex, and dorsal striatum via protein quantification. Results: Following 7 days of daily PAOPA treatment, we observed decreased GRK2 and increased dopamine D2 receptor expression in the dorsal striatum. These findings potentially underscore the therapeutic mechanism of action of PAOPA for the positive-like symptoms of schizophrenia in pre-clinical animal models. Additionally, we observed a decline in GRK2 in the hippocampus and an increase in phosphorylated ERK1 in the pre-frontal cortex, suggesting a role of PAOPA in treating cognitive and/or affective dysfunction in pre-clinical models. Conclusion: While further studies are required to elucidate the mechanism of action of PAOPA, this study discusses prior investigations and develops an early framework to describe the therapeutic mechanism of action of PAOPA.

Objective: Food insecurity (FI) is a growing public health problem. Produce prescriptions are known to improve healthy eating and decrease FI; however, few studies have incorporated community voice prior to its implementation. In this study, we aimed to elicit perspectives of individuals at risk for FI and the potential impact of a fresh food prescription (FFRx) program. Methods: We conducted this qualitative descriptive study through an academic medical center in collaboration with community partners. We conducted focus groups involving Latinx (N = 16) and African-American (N = 8) adults in community settings. Data were interpreted using an inductive thematic analysis. Results: Three overarching themes emerged: (1) fresh food accessibility was limited by cost, household size, and transportation but enhanced by food pantries, budgeting, and education; (2) cooking behaviors were curbed by time constraints and unfamiliarity but propagated by passion, traditions, and communal practices; and (3) health and wellness deterrents included unhealthy diets driven by cultural and familial norms; however, weight loss and awareness of comorbidities were positive motivators. Participants shared their preference for local produce and cooking classes as components of a FFRx program while raising concerns about low participation due to the stigma of receiving aid. Conclusions: Our findings illuminated interest in engaging in a FFRx program and learning ways to prepare healthy foods. A program distributing fresh produce and healthy lifestyle education could close gaps identified in African-American and Latinx communities at risk for FI.

ObjectiveTo describe rapid implementation of telehealth during the COVID-19 pandemic and assess for disparities in video visit implementation in the Appalachian region of the United States.MethodsA retrospective cohort of consecutive patients seen in the first 4 weeks of telehealth implementation was identified from the Neurology Ambulatory Practice at a large academic medical center. Telehealth visits defaulted to video, and when unable, phone-only visits were scheduled. Patients were divided into 2 groups based on the telehealth visit type: video or phone only. Clinical variables were collected from the electronic medical record including age, sex, race, insurance status, indication for visit, and rural-urban status. Barriers to scheduling video visits were collected at the time of scheduling. Patient satisfaction was obtained by structured postvisit telephone call.ResultsOf 1,011 telehealth patient visits, 44% were video and 56% phone only. Patients who completed a video visit were younger (39.7 vs 48.4 years,p< 0.001), more likely to be female (63% vs 55%,p< 0.007), be White or Caucasian (p= 0.024), and not have Medicare or Medicaid insurance (p< 0.001). The most common barrier to scheduling video visits was technology limitations (46%). Although patients from rural and urban communities were equally likely to be scheduled for video visits, patients from rural communities were more likely to consider future telehealth visits (55% vs 42%,p= 0.05).ConclusionRapid implementation of ambulatory telemedicine defaulting to video visits successfully expanded video telehealth. Emerging disparities were revealed, as older, male, Black patients with Medicare or Medicaid insurance were less likely to complete video visits.

Objective:To assess patient experiences with rapid implementation of ambulatory telehealth during the COVID-19 pandemic.Methods:A mixed methods study was performed to characterize the patients’ experience with neurology telehealth visits during the first eight weeks of the COVID-19 response. Consecutive patients who completed a telehealth visit were contacted by telephone. Assenting patients completed a survey quantifying satisfaction with the visit followed by a semi-structured telephone interview. Qualitative data were analyzed using the principles of thematic analysis.Results:2,280 telehealth visits were performed, 753 patients (33%) were reached for post-visit feedback. Of these, 47% of visits were by video and 53% by telephone. Satisfaction was high with 77% of patients reporting that all needs were met though only 51% would consider telehealth in the future. Qualitative themes emerged suggesting that positive patient experiences were associated with elimination of commute time and associated costs as well as a positive physician interaction. Negative patient experiences were associated with the inability to complete the neurologic examination. Overall, patients tended to view telehealth as a tool that should augment, and not replace, in-person visits.Conclusion:In ambulatory telehealth, patients valued convenience, safety, and physician relationship. Barriers were observed but can be addressed.

* Abbreviations: COVID-19 — : coronavirus disease 2019 FMLA — : Family and Medical Leave Act PFL — : paid family leave PFML — : paid family and medical leave > When my daughter was born prematurely at 27 weeks, I was faced with the agonizing choice of staying with her in the neonatal intensive care unit or going back to work at my federally qualified community health center. Even as a pediatrician who is familiar with the enormous benefits of kangaroo care and singing, talking, and reading to newborns, I returned to work within two weeks of her birth because of my own economic situation. At the time, the state I lived in, Massachusetts, did not offer paid family and medical leave (PFML), and the clinic I worked at offered unpaid leave options. As a physician, I am enormously privileged with respect to job protection and income. However, the families I care for are particularly vulnerable to the adverse impacts of unpaid leave. I have come to recognize PFML as a health equity crisis that requires an urgent national policy solution. > > Dr Kimberly Montez The United States is the only developed nation that fails to guarantee any kind of paid leave to workers. We lack a national paid family and medical leave (PFML) policy that encompasses: (1) paid parental leave, which would apply to both mothers and fathers after the birth of a child, adoption of a child, or fostering a child; (2) paid family leave (PFL), which would apply to caregivers of a hospitalized child, a medically complex child, or a family member such as a declining parent; and (3) paid medical or sick leave, which would allow one to manage personal or family illness. Although the 1993 Family and Medical … Address correspondence to Kimberly Montez, MD, MPH, Department of Pediatrics, Wake Forest Baptist Medical Center, 1 Medical Center Blvd, Winston-Salem, NC 27157. E-mail: kmontez{at}wakehealth.edu

Introduction Due to the heterogeneity of psychiatric illnesses and overlapping mechanisms, patients with psychosis are differentially responsive to pharmaceutical drugs. In addition to having therapeutic effects for schizophrenia and bipolar disorder, antipsychotics and mood stabilizers have many clinical applications and are used unconventionally due to their direct and indirect effects on neurotransmitters. Synapsins, a family of neuronal phosphoproteins, play a key regulatory role in neurotransmitter release at synapses. In this study, we investigated the effects of mood stabilizers, lithium, and valproic acid on synapsin gene expression in the rat brain. Methods Intraperitoneal injections of saline, lithium, and valproic acid were administered to male Sprague Dawley rats twice daily for 14 d, corresponding to their treatment group. Following decapitation and brain tissue isolation, mRNA was extracted from various brain regions including the hippocampus, striatum, prefrontal cortex, and frontal cortex. Results Biochemical analysis revealed that lithium significantly increased gene expression of synapsin I in the striatum, synapsin IIa in the hippocampus and prefrontal cortex, and synapsin IIb in the hippocampus and striatum. Valproic acid significantly increased synapsin IIa in the hippocampus and prefrontal cortex, as well as synapsin IIb in the hippocampus and striatum. Conclusion These significant changes in synapsin I and II expression may implicate a common transcription factor, early growth response 1, in its mechanistic pathway. Overall, these results elucidate mechanisms through which lithium and valproic acid act on downstream targets compared with antipsychotics and provide deeper insight on the involvement of synaptic proteins in treating neuropsychiatric illnesses.

Schizophrenia is a mental disorder characterized by positive symptoms, negative symptoms, and cognitive dysfunction. Phencyclidine (PCP)-a N-methyl-D-aspartate (NMDA) receptor antagonist-induces symptoms indistinguishable from those of schizophrenia. A reduction of the phosphoprotein synapsin II has also been implicated in schizophrenia and has a well-known role in the maintenance of the presynaptic reserve pool and vesicle mobilization. This study assessed the behavioral and biochemical outcomes of chronic NMDA receptor antagonism in rodents and its implications for the pathophysiology of schizophrenia. Sprague Dawley rats received saline or chronic PCP (5 mg/kg/day) for 14 days via surgically implanted Alzet® osmotic mini-pumps. Following the treatment period, rats were tested with a series of behavioral paradigms, including locomotor activity, social interaction, and sensorimotor gating. Following behavioral assessment, the medial prefrontal cortex (mPFC) of all rats was isolated for synapsin II protein analysis. Chronic PCP treatment yielded a hyper-locomotive state (p = 0.0256), reduced social interaction (p = 0.0005), and reduced pre-pulse inhibition (p < 0.0001) in comparison to saline-treated controls. Synapsin IIa (p < 0.0001) and IIb (p < 0.0071) levels in the mPFC of chronically treated PCP rats were reduced in comparison to the saline group. Study results confirm that rats subject to chronic PCP treatment display behavioral phenotypes similar to established preclinical animal models of schizophrenia. Reduction of synapsin II expression in this context implicates the role of this protein in the pathophysiology of schizophrenia and sheds light on the longer-term consequences of NMDA receptor antagonism facilitated by chronic PCP treatment.

The availability of methods of irradiation and chemical agents to destroy tumor cells has stimulated research in the mechanism and in the kinetics of destruction by such modalities. Extensive experimental data that tumor cell kill follows first-order kinetics—with a given dose of cytotoxic therapy destroying a constant fraction of the tumor cell load and not an absolute number of cells—have been provided by Skipper (31). He demonstrated in the leukemia 1210 model in mice that a reduction of the number of tumor cells from 106 to 105 (1-log kill) increased the life-span by 2 days, whereas a 99.999% reduction (5-log kill) could cause a 10-day prolongation of survival. In this model, cure of the recipient infused with leukemic cells was only possible when the initial tumor cell burden was small (19,30).

Summary A patient with longstanding acute leukemia under chemotherapy developed a spiking fever of unknown origin. Chest X-rays demonstrated pulmonary involvement. Blood cultures were positive for gram negative bacteria. Specific antibiotic therapy which included Pentamidine for a surmissed pneumocystis infection did not relieve the symptoms. A routine bone marrow examination disclosed Histoplasma Capsulatum which was later confirmed by a positive bone marrow culture. Specific immunological tests were repeatedly negative. Serial bone marrow examinations and cultures are suggested as the means to search for etiologic agents in febrile patients undergoing chemotherapy.