Mental and behavioral health (MBH) visits of children and youth to emergency departments are increasing in the United States. Reasons for these visits range from suicidal ideation, self-harm, and ...eating and substance use disorders to behavioral outbursts, aggression, and psychosis. Despite the increase in prevalence of these conditions, the capacity of the health care system to screen, diagnose, and manage these patients continues to decline. Several social determinants also contribute to great disparities in child and adolescent (youth) health, which affect MBH outcomes. In addition, resources and space for emergency physicians, physician assistants, nurse practitioners, and prehospital practitioners to manage these patients remain limited and inconsistent throughout the United States, as is financial compensation and payment for such services. This technical report discusses the role of physicians, physician assistants, and nurse practitioners, and provides guidance for the management of acute MBH emergencies in children and youth. Unintentional ingestions and substance use disorder are not within the scope of this report and are not specifically discussed.
OBJECTIVETo quantitatively measure brain glucose metabolism in treated HIV-positive individuals with F-labeled fluorodeoxyglucose (FDG) PET/CT.
METHODSWe performed a cross-sectional comparison of FDG ...uptake in 47 treated HIV+ individuals, 10 age-matched controls (HIV−) sharing many of the comorbid conditions seen in the HIV+ group, and 19 age-matched healthy controls (HCs). We compared whole-brain (WB) and regional FDG standardized uptake values (SUVs) of select subcortical/central structures among the groups and correlated the values to clinical and neuropsychological assessments. A variable selection model was used to predict SUVs in HIV+ (n = 47) and in combined HIV+ and HIV− participants (n = 57).
RESULTSWe found lower WB SUVmax in HIV+ participants compared to HCs but not to HIV− participants. Among the relative SUVmean measurements (regional SUVmean/WB SUVmean), only relative thalamic uptake values were lower in HIV+ compared to HIV− participants. When HIV+ and HIV− participants were grouped, cardiovascular disease risk scores best predicted WB SUVmean and SUVmax, while HIV status best predicted thalamic relative SUVmean.
CONCLUSIONSWe identified an important role for cardiovascular disease in neuronal loss/dysfunction, as measured by FDG-PET, in treated HIV+ patients. This underscores the need for shifting the focus of clinical intervention in this vulnerable population from HIV effects alone to a wider set of comorbid conditions, mainly cardiovascular disease. Only the thalamus showed significantly lower relative uptake in the HIV+ compared to the HC and HIV− groups. This needs to be further evaluated for underlying pathophysiology and potential association with memory, executive functioning, and attention deficits seen in the HIV+ population.
Emergency department (ED) crowding results when available resources cannot meet the demand for emergency services. ED crowding has negative impacts on patients, health care workers, and the ...community. Primary considerations for reducing ED crowding include improving the quality of care, patient safety, patient experience, and the health of populations, as well as reducing the per capita cost of health care. Evaluating causes, effects, and seeking solutions to ED crowding can be done within a conceptual framework addressing input, throughput, and output factors. ED leaders must coordinate with hospital leadership, health system planners and policy decision makers, and those who provide pediatric care to address ED crowding. Proposed solutions in this policy statement promote the medical home and timely access to emergency care for children.
Mental and behavioral health (MBH) emergencies in children and youth continue to increasingly affect not only the emergency department (ED), but the entire spectrum of emergency medical services for ...children, from prehospital services to the community. Inadequate community and institutional infrastructure to care for children and youth with MBH conditions makes the ED an essential part of the health care safety net for these patients. As a result, an increasing number of children and youth are referred to the ED for evaluation of a broad spectrum of MBH emergencies, from depression and suicidality to disruptive and aggressive behavior. However, challenges in providing optimal care to these patients include lack of personnel, capacity, and infrastructure; challenges with timely access to a mental health professional; the nature of a busy ED environment; and paucity of outpatient post-ED discharge resources. These factors contribute to prolonged ED stays and boarding, which negatively affect patient care and ED operations. Strategies to improve care for MBH emergencies, including systems-level coordination of care, are therefore essential. The goal of this policy statement and its companion technical report is to highlight strategies, resources, and recommendations for improving emergency care delivery for pediatric MBH.
The green turtle Chelonia mydas is an Endangered species that forms aggregations at neritic foraging sites where juveniles spend, in some cases, over a decade before moving to adult- or ...subadult-dominated foraging sites. Here, we used photographic identification, behavioural observations, paired-laser and stereo-photogrammetry to determine the population dynamics of a coastal aggregation of green turtles in Oslob, Philippines. We identified a total of 82 individual turtles between May 2012 and October 2018. We recorded behavioural observations during individual identification and found that turtles changed behaviour in 25% of instances. Some turtles were identified consistently throughout the study period, indicating strong site fidelity and residency. Modified maximum likelihood models suggest turtles spend the majority of their time within the study area (>92%), although some (8%) excursions outside the area do occur. Mark-recapture models suggest this foraging aggregation exhibits a pattern similar to that of a closed population. This is likely due to the extended residency periods of some individuals at the site, and the relatively low recruitment rate over time. We measured 18 turtles using paired-laser photogrammetry, with estimated straight carapace length of 55.3 cm, and mean growth rates of 3.4 cm yr-1. Stereo-photogrammetry measurements were consistent and more accurate than visual or paired-laser photogrammetry estimates. Our results highlight the use of in-water methods to understand population dynamics of green turtles, and the importance of coastal, juvenile-dominated habitats for green turtles, as well as the need for effective conservation and management strategies to safeguard them.
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