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BACKGROUND Despite the growing prevalence of depression and anxiety among adolescents, fewer than half access appropriate mental health care. Single-session interventions for depression and anxiety offered in primary care are a promising approach to bridging the treatment gap. OBJECTIVE We aimed to implement a clinical workflow for primary care and behavioral health providers to refer 13–17-year-old patients with mild to moderate depression and anxiety symptoms to Project YES, an open-access single-session intervention platform, in a large group medical practice. METHODS Pediatric primary care and behavioral health providers will be educated on the benefits of Project YES for adolescent anxiety and depression and trained in a workflow integrated within the Electronic Health Record System, Epic, to refer patients during well child visits and pediatric behavioral health visits. Patients with mild-moderate internalizing symptoms based on the 17-item Pediatric Symptom Checklist or youth Pediatric Symptom Checklist will be invited to try an SSI through Project YES. We will examine provider uptake and perceptions of acceptability, feasibility, and appropriateness over time. We will also assess patient uptake, and satisfaction, as well as pre-post outcomes including the Mood and Feelings Questionnaire-Short, State Hope, Beck Hopelessness, Self-Hate, Perceived Control, and Perceived Change in Hopelessness and Problem Solving scales. RESULTS Rollout will take place between November 2022 and May 2023 when outcomes will be evaluated. Data analysis and manuscript writing are anticipated to be completed during the summer of 2023. CONCLUSIONS SSIs such as those available through Project YES have the potential to provide low-cost, evidence based mental health treatment to adolescents with mild-moderate depression and anxiety. If deemed feasible and acceptable, providing SSIs in primary care settings could significantly improve access to mental health care without taxing pediatric primary care and behavioral health providers.

The purpose of this study was to identify the population of pediatric patients who arrive without signs of life and describe outcomes using a national database. Patients eighteen and younger with no signs of life were pulled from the National Trauma Database (NTDB) from the years 2007-2016. A total of N = 7503 patients were separated into two cohorts for comparison. Subset analysis was also conducted for patients undergoing a thoracotomy. Statistical analysis was performed on the collected data. Over the 9-year period most patients died in the ED or hospital (95.7%), very few patients were discharged home (1.3%), and ED thoracotomies were performed rarely (9%) with most patients dying (97%). Arrival to the trauma bay without signs of life is associated with a dismal prognosis. Clinical judgment must be carefully applied to choose the small number of patients who would benefit from an aggressive approach.

From 2009 to 2019 there were 77 youth and 1046 adults injured in tree stand-related emergency department visits. There was no statistically significant different in sex or gender. Injury types were similar among groups and were categorized by body part. Despite the above-mentioned insignificant differences between the groups, we did identify several statistically significant findings. Adults that were not Caucasian or African-American were more likely to sustain injuries related to tree stands when compared to their youth counterparts (P-value 0.029). Adult patients were also more likely to sustain trauma to their torso (P-value 0.017). Lastly, adult patients were found to be more likely to require hospitalization in comparison to the youth population (P-value 0.018). Improved education and safety guidelines in the use of tree stands, particularly in individuals in ages 18 and up, would likely lessen the discrepancies between age groups identified in this study.

Amino acids can be converted to peptides by the process of heating if the mixture is dry and if the appropriate proportion of glutamic acid as the dominant monomer is present. Three thermal peptide fractions of the diffusible fraction were isolated in this study. Trifluoracetic acid (TFA) hydrolysis was utilized to open the blocked N-terminal group before performing the dansylation reaction. When the molecular weight of the thermal peptide increased, the proportion of neutral amino acids increased slightly, with a decrease in the concentration of glutamic acid. Quantitative analysis of amino acid composition is also reported.