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Layla is a 6.7-year-old girl diagnosed with attention-deficit/hyperactivity disorder (ADHD)-predominantly hyperactive/impulsive type-delayed adaptive skills, enuresis, unspecified malnutrition, and feeding difficulties. She presented to developmental-behavioral pediatrics (DBP) in January 2022 due to caregiver concerns for autism spectrum disorder (ASD).Layla lives in a polyamorous family with her biological mother and father, mother's partner whom Layla refers to as her uncle, and her 2 half-siblings. There is a maternal history of special education services, schizoaffective disorder, bipolar disorder, multiple sclerosis, Wolff-Parkinson-White syndrome, and ADHD. Layla's father is a veteran diagnosed with post-traumatic stress disorder. Layla's siblings, aged 5 and 9 years, have established diagnoses of ADHD, ASD, global developmental delays, behavioral concerns, and poor sleep. There is a history of adverse childhood experiences, including parental mental health, poverty, and involvement with child protective services. Acknowledgement and inclusion of all members of this diverse family structure, as well as consistent validation from the DBP and social worker, allowed a strong treatment alliance to form and the mother continued to contact the DBP clinic, even for those questions related to other specialties. A social worker received weekly calls from the mother sharing grievances related to feeling misunderstood and spoke about the assumptions she felt external providers made about her family, culture, and parenting styles. For example, she recalls the pediatrician commenting about their family structure being "confusing for the children" and describing their home as "chaotic," assumptions that may not have been made of nuclear family structures. Behavioral therapies were a repeated recommendation, but the mother verbalized not being interested in these options as she had participated in parent management training several years earlier and felt that the strategies taught were not applicable to her unique family structure, to which the clinician replied, "this is the standard recommendation for all children this age with disruptive behaviors." Although the mother was initially hesitant to trial medications, she eventually agreed that Layla's symptoms were negatively affecting her school performance, and the DBP initiated a stimulant medication.Layla's initial evaluation included a developmental history, behavioral observations, and standardized testing. The results from developmental testing demonstrated age equivalents between 4 and 6 years across gross motor, adaptive, visual motor, and speech-language domains.On observation, Layla was extremely active. During the visit, she walked over to her mother, made eye contact, and showed her the picture that she had drawn. She engaged in imaginary play, reciprocal conversation, and responded to social bids. The mother felt strongly that Layla had ASD and reported symptoms such as motor stereotypies (hand flapping), covering ears with certain noises/sounds, and rigidity when it came to things being a certain way or a certain color. These behaviors did not occur in the initial or subsequent clinic visits with DBP, her general pediatrician, or during other outside evaluations the mother pursued. The DBP felt strongly that Layla was mimicking her siblings' symptoms and provided ongoing education regarding ADHD symptomology.In terms of behavior management, the mother did not attempt to redirect Layla's behaviors during the initial clinic visit and in subsequent visits, and both adult men yelled loudly, clapped, and hit their hands on the table as a form of redirection. The mother continued to voice her diagnostic disagreement with the DBP and the pediatrician and insisted that Layla met the criteria for ASD. When the mother reviewed the report, a statement insinuating that Layla's behaviors were "understandable given parental inconsistency and complicated family structure" upset her.What factors would you consider when thinking about caregiver disagreement with the diagnosis and treatment plan? Does diagnostic overshadowing apply here?

We report gastroretentive (GR) tablets optimized via a data-driven regression-based predictive modeling strategy to determine the optimal hydroxypropyl methylcellulose (HPMC)-to-croscarmellose sodium (CCS) ratio. A botanical extract (BE, Layla® soft extract), composed of 12 medicinal herbs, was selected as the model drug and was first solidified into granules using Neusilin via fluid bed granulation. To optimize the formulation of GR tablets, a four-parameter sigmoid-based regression model was constructed in MATLAB and compared with a quadratic response surface model (RSM) and an artificial neural network (ANN, 2-8-1 structure). Although the ANN exhibited the best fit to the training data (highest R2), the regression model provided more accurate predictions under extrapolated conditions, outperforming both ANN and RSM. Cross-validation, residual diagnostics, and bootstrap-based prediction interval analysis collectively confirmed the statistical robustness of the regression model. The optimized composition of BE, HPMC, and CCS was determined as 600:160:140 (w/w/w), followed by compression into tablet form. The GR tablet successfully incorporated BE without evidence of physicochemical interactions among BE, HPMC, and CCS. Upon contact with simulated gastric acid, the GR tablet floated within 10 s, remained buoyant for over 18 h in an expanded state, and sustained the release of BE. In vivo X-ray imaging in beagle dogs confirmed that the GR tablets remained in the stomach for up to 6 h. Altogether, this study presents a formulation strategy that systematically optimizes the complementary functions of HPMC and CCS through predictive modeling, leading to prolonged gastric retention and sustained drug release.

Neurobrucellosis (NB) and Neurotuberculosis (NT) are rare central nervous system infections, but pose significant diagnostic and therapeutic challenges. If not diagnosed and treated early, they can have high mortality. Clinical presentations for both are nonspecific, mimicking diverse pathologies. Therefore, it is crucial to identify distinguishing features to ensure timely treatment. We conducted a retrospective review of cases of NB and NT admitted to the American University of Beirut Medical Center (AUBMC) between January 1982 and December 2022, identifying 20 patients with NT, and five cases of NB. Their presentation and diagnostic work-up were compared. NT patients were mostly male and presented earlier than NB patients (median symptom duration 150 days). Patients with NT had higher rates of systemic and neurologic symptoms compared to NB. Both groups had hyponatremia. NB patients had higher cerebrospinal fluid lymphocyte counts. Imaging in NT revealed diverse brain abnormalities such as hydrocephalus and small nodules whereas mostly meningeal enhancement in NB. Despite severe presentations no 30-day mortality occurred in either group. Neurological complications were more frequent in NT. Finally, NT patients generally present earlier with more severe symptoms than NB. Due to overlapping features but differing treatments, larger scale studies are crucial to better understand and manage these infections.

Sports injuries are linked to negative impacts on mental health and well-being, including depression, anxiety, stress and lower quality of life. Conversely, poor mental health and well-being have been found to increase the risk of sports injury, injury severity and time taken to recover. Although existing research indicates these associations in athletes broadly, the nature and directionality of these relationships among adolescents are not well characterised. A related limitation is that much of the existing evidence, in both children and adult athletes, is cross-sectional in design, limiting our understanding of causal directionality. Given the high rates of sports participation and the specific risk factors for injury in this demographic, as well as the growing concern about adolescents' mental health and well-being worldwide, this complex relationship warrants greater attention. We aimed to examine the bidirectional relationship between sports injuries and mental health and well-being in adolescents aged 10-24 years, and potential mechanisms of this relationship. This systematic review and meta-analysis was registered on PROSPERO (ID: CRD42023374807). Literature searches were performed according to PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guidelines by searching PsycINFO, Web of Science, ERIC, CINAHL, MEDLINE, Embase, Cochrane Library, SPORTDiscus, PEDro, Elicit and Google Scholar. Articles were included if they were quantitative, published in English between 1990 and 2023, focused on young athletes aged 10-24 years, measured mental health/well-being and were an all-complaints sports injury that ranged across all levels of sport. Of 397 studies screened, 84 studies were included. The final sample included 221,095 adolescents and young people. A narrative synthesis indicated that sports injuries were associated with worse mental health and well-being in the majority of studies, and vice versa. Meta-analyses revealed that sports injury incidence was significantly associated with worse mental health/well-being (Zr = 0.34, 95% confidence interval 0.17, 0.50), and concussion incidence was significantly associated with worse mental health/well-being (Zr = 0.19, 95% confidence interval 0.08, 0.30), with no evidence of publication bias. Conversely, worse mental health/well-being was associated with a significantly increased risk of sports injury incidence (odds ratio = 1.54, 95% confidence interval 1.13, 2.10). However, after accounting for potential publication bias, the pooled association between mental health/well-being and sports injury risk was no longer statistically significant, highlighting the need for caution in interpreting this relationship. Regarding mechanisms, a small number of studies revealed psychosocial factors (e.g. athletic identity, social support) that could influence this reciprocal relationship. We found evidence for a bidirectional relationship between sports injuries and mental health in adolescent athletes. Further research is needed to elucidate the mechanisms underlying this relationship. Early interventions focusing on supporting mental health after sports injury, and addressing pre-existing mental health issues to reduce the risk of subsequent injury, should be tailored towards psychosocial mechanisms that particularly impact adolescent athletes.

Inflammatory bowel disease (IBD), including ulcerative colitis (UC) and Crohn’s disease (CD), affects approximately 4.9 million individuals globally. Advanced therapies have significantly improved IBD management; however, maintenance doses commonly exceed labeled recommendations for optimal efficacy. This study aimed to estimate the financial impact of introducing Risankizumab (RISA) for CD and Upadacitinib (UPA) for UC treatment in Saudi Arabia (KSA), incorporating adjusted dosing practices rather than label doses alone. Cost-calculation model (CCM) was developed to estimate average monthly costs per patient, capturing complexities like induction, maintenance adjustments, discontinuation, switching, re-induction, and death. Data on adjusted dosing were collected via two expert interviews. The CCM compared scenarios “with” and “without” UPA for UC, and “with” and “without” RISA for CD, analyzing financial impacts over a 5-year horizon, from the payer’s perspective. Adjusted UC treatment doses increased five-year costs by 22% compared to label doses. Introducing UPA with adjusted dosing resulted in a 6.7% higher cost versus scenarios without UPA, based on tender prices. For CD, adjusted dosing increased treatment costs by 24.5% compared to label doses. However, adding RISA with adjusted dosing slightly reduced the total drug cost by 0.35%. Expert interviews and detailed patient pathway modeling indicated substantial cost increases for UC and CD treatments in KSA when adjusted doses were considered. The introduction of UPA and RISA under adjusted dosing yielded minor financial differences, with potential implications for economic evaluations in other regions.

There is a scarcity of information regarding the distribution of the diseases leading to kidney failure (KF) in children living in the emerging world. We used registry data to provide a global overview of the underlying disease spectrum in children commencing kidney replacement therapy (KRT). We analyzed KF causes among 23,620 children and adolescents commencing maintenance KRT in 80 countries, using data from the IPNA Global KRT Registry (including ESPN/ERA Registry), the International Pediatric Dialysis Network (IPDN), the United States Renal Data System (USRDS), and the Australia and New Zealand Dialysis and Transplant Registry (ANZDATA). The analysis considered geographic region, country-level gross national income (GNI), average annual temperature, and patient age. Marked regional differences were observed in the distribution of KF causes. Immune-mediated glomerulopathies (GP) were most common in Southeast Asia, hereditary nephropathies in the Middle East, Africa, and Europe, and systemic GP in Northeast Asia and Latin America. In 14% of cases the cause of KF was unknown, with the highest proportion in Northeast Asia. Disease patterns were also influenced by countries' GNI and average yearly temperature; immune-mediated GP accounted for 43% of diagnoses in low-income countries and were more frequent in warmer climates. Among younger children, congenital anomalies of the kidney and urinary tract (CAKUT) and hereditary nephropathies were the predominant cause of KF, whereas adolescents more commonly presented with immune-mediated GP. There is significant global variability in the spectrum of diseases leading to pediatric KF, partially attributable to genetic, environmental, and macroeconomic factors.

Refugee and asylum-seeking parents face distinct challenges in supporting their children's mental health during resettlement. Although elevated child mental health risks and barriers to service access are well documented, less is known about how parents could best be supported to help their children. This study explored parent and stakeholder perspectives to inform family-centred support. Semi-structured interviews were conducted with 23 refugee parents (ENRICH) and 30 stakeholders across health, education, local authority and voluntary sectors (ESTEEM) in the UK. Data were analysed using Reflexive Template Analysis. Four levels of support were identified: basic stability; belonging through community, language and play; understanding and trust; and specialist psychological support. Three overarching system conditions shaped whether families could access and use support: coordination, communication and competence; responsiveness; and the right setting. Parents also identified specific specialist supports, including practical guidance, family-centred and joint parent-child approaches, and culturally responsive therapeutic spaces. Services were often described as reactive, fragmented and culturally mismatched, limiting engagement and reducing support effectiveness. Effective support for refugee parents to help their children requires attention not only to what is provided but how it is delivered. Coordinated systems, culturally and linguistically responsive practices, timely support, and delivery through trusted community settings are central to enabling parents to support their children's mental health. Together, these findings provide a practical framework to inform the development of family-centred approaches during resettlement.

Dextroamphetamine is a psychostimulant widely used in the treatment of attention-deficit/hyperactivity disorder and as a model compound in clinical toxicology and pharmacokinetic studies, and some studies report its use in cocaine dependence treatment. The present work describes the development and validation of a capillary electrophoresis (CE) method coupled with diode array (DAD) and capacitively coupled contactless conductivity (C4D) detectors for the simultaneous analysis of dextroamphetamine and its main urinary metabolites. Although phenylacetone is a key intermediate in the oxidative deamination pathway, this study focuses on the determination of 4-hydroxyamphetamine, norephedrine, hippuric acid, and benzoic acid in synthetic urine and spiked human samples. The method was optimized for background electrolyte composition, pH, and separation voltage, allowing efficient resolution and dual detection. Rapid separations were obtained, with migration times under 8 min. Linear responses were observed for all compounds within 1-200 μM (R2 ≥ 0.955), with LOD/LOQ ranging 0.32-32.2 μM and 1.07-97.6 μM, respectively. For dextroamphetamine, migration occurred at 3.64 min (DAD) and 3.41 min (C4D), with LOD/LOQ of 2.16/7.19 μM (DAD) and 8.58/28.60 μM (C4D). Intra- and inter-day repeatability tests demonstrated analytical precision with acceptable limits. The method was applied to spiked human urine samples using the standard addition technique for endogenous metabolites (hippuric acid and benzoic acid). This study demonstrates the feasibility of clinical and toxicological monitoring involving psychostimulant determination.

This study aimed to apply cardiometabolic genetic testing in a community setting with a predominantly Hispanic population and assess feasibility and perspectives toward genetic testing. A genome-sequencing-based genetic panel for cardiometabolic disorders (177 genes related to monogenic conditions, 2 LPA risk alleles, 2 pharmacogenomic loci, and ancestry-adjusted polygenic risk scores for type 2 diabetes and coronary artery disease) was deployed in community cardiology and endocrinology clinics in South Texas. A survey on perceptions toward genetic testing was administered after return of results. Testing was completed for 776 patients (18-92 years old, 92% Hispanic). 26 patients (3.4%) were identified with a pathogenic or likely pathogenic variant in a monogenic disease gene, including 17 diagnostic and 9 secondary findings. Additionally, 291 (37.5%), 181 (23.3%), and 298 (38.4%) patients were identified with at least 1 LPA risk allele, pharmacogenomic finding, or elevated polygenic risk scores, respectively. Patients perceived the testing to be beneficial with few concerns. This study expanded cardiometabolic genetic testing to a predominantly Hispanic population in a community setting, providing actionable guidance for disease diagnosis, intervention, and preventive care with a favorable patient perception.

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X-linked hypophosphataemia (XLH) represents the most prevalent genetic cause of phosphate wasting and is associated with skeletal deformities, muscular pain, and dental hypomineralisation. Dental complications, particularly spontaneous abscesses, may be the earliest clinical sign. Despite this, guidance on optimal dental care remains limited and there is a need for improved understanding of oral manifestations and management. This project aimed to review existing literature and evaluate the dental disease burden and management strategies in children with XLH. Medline, Embase, and the Cochrane Register of Controlled Trials were searched on 7th December 2025 for English language publications describing the dental diagnosis and management of children with XLH. A service evaluation was conducted to explore the management of patients with XLH under the care of Charles Clifford Dental Hospital (CCDH) and Sheffield Children's Hospital (SCH). Of the 37 articles identified, 21 met the inclusion criteria, with 6 relevant publications added. Findings revealed a high prevalence of spontaneous dental abscesses affecting both the primary and permanent dentition, alongside additional dental anomalies. Ten patients were included in the service evaluation; eight experienced abscesses associated with non-carious teeth, mainly affecting the primary dentition. Treatment approaches varied, and barriers to accessing specialist dental care were evident amongst patients. Due to the rarity of XLH, both patients and clinicians face challenges in ensuring appropriate dental management. Without timely intervention, oral complications can result in premature tooth loss and reduced quality of life. Early specialist involvement and a multidisciplinary approach are essential to improve patient outcomes and reduce the burden of disease.

Infancy marks a critical period of developing brain-behavior relationships that might influence the emergence of emotional and behavioral problems and psychopathology later in childhood and adolescence. In this review, we describe infant MRI studies that examined the development of neural networks, their associations with emerging emotional reactivity and regulation, and the relationships of caregiver factors, such as psychopathology, parenting behaviors and socioeconomic status (SES), with these developmental trajectories. We highlight the potential of utilizing infant MRI methodologies to identify key neural network structural and functional substrates of current and future emotional reactivity and regulation. Such an approach could identify early objective neural markers of dysregulation problems that are precursors of emotional and behavioral disorders, help monitor the effectiveness of existing interventions, and ultimately guide the development of new interventions for at-risk infants.

This study investigated the potential impact of fifth-generation (5 G) radiofrequency (RF) on the autonomic nervous system (ANS). Electrocardiograms (n = 43) and salivary samples (n = 33) were collected from healthy young volunteers before, during, and after exposure to a 3.5 GHz frequency (electrical field intensity ~1-2 V/m) emitted by an antenna while participants were seated at rest. Heart-rate (HR) and heart rate variability (HRV) indices, including time and frequency domain measures, were analyzed from short-term epochs during both "real" and "sham" exposure sessions, under eyes-open (EO) and eyes-closed (EC) conditions. Initial variations in RR intervals and HR were observed during 5 G exposure; however, these effects were not confirmed by post-hoc analyses after correction for multiple comparisons, suggesting the absence of consistent exposure-related modulation. The only statistically significant result was a time-by-exposure interaction for the RMSSD parameter during the final exposure period. This effect was small in magnitude, limited to a single time point, and not supported by other parasympathetic indices, and should therefore be interpreted cautiously as it may reflect normal physiological variability or a statistical artifact. No consistent exposure-related effects were detected in salivary stress biomarkers, including cortisol, alpha-amylase, and chromogranin A. Although minor variations were observed in some measures, all values remained within normal physiological ranges, and their clinical relevance remains uncertain. These findings are restricted to the specific experimental conditions examined, namely short-term far-field exposure (25.5 min) at low specific absorption rate (SAR) levels (0.008 mW/kg in the brain). Overall, the results provide preliminary baseline human data at 3.5 GHz rather than confirmatory evidence of biological effects. Further studies involving larger cohorts and longer exposure durations are required to determine whether subtle or cumulative autonomic effects of 5 G exposure can be reliably detected. Bioelectromagnetics. 00:00-00, 2026. © 2026 Bioelectromagnetics Society.

Missed nursing care is a key indicator of compromised care quality, often attributed to workload and staffing. Yet it may also be influenced by accountability focus-whether nurses are evaluated on outcomes or on processes. Evidence suggests that its effect on performance, and thus on missed care, may depend on task complexity, but this has not been tested in clinical practice. To investigate whether task complexity (simple vs. complex) moderates the association between nurses' felt accountability focus (outcome vs. process) and missed nursing care. A prospective repeated-measures field study with nurses nested within wards. The study was conducted in one medium-sized public hospital, encompassing 10 internal medicine and surgical wards. A total of 105 registered nurses providing direct patient care participated in the study. Data were collected between November 2023 and April 2024. Each nurse completed anonymous mobile survey at the end of three different shifts, yielding 315 repeated observations nested within 105 nurses. Nurses completed questionnaires assessing missed nursing care, task complexity, felt accountability focus, and sociodemographic characteristics. Mixed linear modeling accounted for the repeated-measures design and nested data structure. No direct effects of task complexity and felt accountability focus were found. However, both interaction effects were statistically significant: task complexity × felt process accountability focus (β = -0.04, p = 0.012) and task complexity × felt outcome accountability focus (β = 0.04, p = 0.006). Probing revealed a crossover pattern: under simple tasks, higher outcome accountability was associated with less missed care, whereas under complex tasks, higher process accountability was associated with less missed care. Accountability should be adapted to task complexity rather than applied uniformly. Outcome accountability enhances consistency in routine care, whereas process accountability safeguards thoroughness in complex situations. These findings extend accountability research into real-world nursing practice and offer actionable guidance for designing systems that promote safe, high-quality care. Accountability focus impacts missed nursing care differently by task complexity. This field study bridges lab findings & clinical practice, offering a framework to design smarter accountability systems that protect patients & support nurses. #NursingResearch #PatientSafety #HealthcareQuality #NurseLeadership.

Some people experience mood changes when hungry. However, the relevance of this phenomenon to clinical conditions, such as depression, anxiety and eating disorders, is understudied. Therefore, we devised a questionnaire to measure hunger-related mood dysregulation. We developed and validated the Mood, Emotions and Appetite List (MEAL) using exploratory and confirmatory factor analysis in adults and adolescents in the community, and adults with a history of mental health disorder (N = 1119). We examined the association of MEAL scores with happiness, frustration and boredom during the frustration-inducing mood drift task, in which participants wait for six minutes and rate their mood every 30 s. The MEAL showed good psychometric properties, capturing three factors for hunger-related 'irritability', 'low mood' and 'somatic feelings' (RMSEA = 0.03 in community adults, 0.05 in community adolescents, 0.08 in adults with mental health disorder history). Quantitative and qualitative responses evidenced that hunger-related mood dysregulation impacts relationships, work and hobbies. MEAL scores were associated with irritability, depression, anxiety and menstrual symptoms. In the mood drift task, the irritability subscale (MEAL-i) demonstrated a significant interaction with time, such that individuals with higher MEAL-i scores reported steeper decreases in happiness (B = -0.11; 95 % CI: -0.16--0.06) and steeper increases in boredom (B = 0.06; 95 % CI: 0.00-0.12) and frustration (B = 0.12; 95 % CI: 0.05-0.19). The MEAL measures individual differences in hunger-related mood dysregulation, is associated with mental health, self-reported functioning, and predicts faster worsening of mood during experimentally induced frustration.

To investigate predictors of headache resolution following surgical intervention for superior semicircular canal dehiscence (SSCD) syndrome. We conducted a retrospective chart review on 344 surgical repairs of SSCD via the middle cranial fossa (MCF) approach conducted at an institution. The primary outcome measure was the resolution of headaches after SSCD repair. Analyses explored the predictive potential of several comorbidities and lifestyle factors pre-operatively. Among a total of 344 repairs, 193 (56 %) reported headaches preoperatively. Among which, 114 (59 %) experienced headache resolution following surgery. Compared to patients without a history of general anxiety disorder (GAD), patients with GAD reported a 65 % lower odds of headache resolution following surgery (aOR 0.35, 95 % CI [0.14, 0.91]). Compared to patients without hypertension (HTN), patients with HTN were significantly more likely to experience headache resolution following surgery (aOR 4.65, [1.19, 18.22]). A substantial portion of patients with headaches experienced resolution following SSCD repair (∼60 %). Patients with GAD were less likely to experience headache resolution following SSCD repair, whereas patients with HTN were more likely to experience headache resolution. Level IV.

This article begins as a review of the French-Moroccan film, Carved by the Wind (2024), directed by Layla Triqui. The film offers an opportunity to use a 'case history' approach in considering classical and recent psychoanalytic theories of forgiveness, a theme embedded in the storyline. A contemporary model of forgiveness proposed by the Italian psychoanalyst Carla Mucci is applied to the principal character, a woman suffering from the overpowering guilt of infanticide. Here, forgiveness is characterised as a potent exchange between the forgiver and the forgiven, involving truthful witnessing of fact, emotional expression and the emergence of shared empathy. The adaptation of Professor Mucci's psychoanalytic model to the non-clinical setting of the film suggests how forgiveness might foster healing in ordinary life.