Metacognitive Deficits in Attention Deficit Hyperactivity Disorder: Insights From Adolescents and Their Parents

ABSTRACT Objective Metacognition refers to the awareness and regulation of one's cognitive processes, including self‐monitoring, planning, and controlling thoughts. In individuals with attention deficit hyperactivity disorder (ADHD), although research is limited, deficits in metacognitive skills are commonly observed, which contribute to difficulties in attention, task completion, and self‐regulation. The aim of this study is to identify metacognitive characteristics in adolescents diagnosed with ADHD and to explore the relationship between these characteristics and the metacognitions of their parents. Methods The study included 107 adolescents, aged 12–18 years, who were newly diagnosed with ADHD, as well as 100 healthy control participants. A sociodemographic form, The Schedule for Affective Disorders and Schizophrenia for School Aged Children‐Present and Lifetime version for DSM‐5 (K‐SADS‐PL DSM‐5), Metacognitions Questionnaire for Children (MCQ‐C) were applied, while their parents completed the Metacognitions Questionnaire‐30 (MCQ‐30), Turgay DSM‐IV Disruptive Behavior Disorders Rating Scale Form (T‐DSM‐IV‐S) and the Adult ADHD Self‐Report Scale for DSM‐5 (ASRS‐5). Based on ASRS‐5 scores, parents were categorized into two groups: those at increased risk of ADHD (ASRS ≥ 14) and those at low risk of ADHD (ASRS < 14). Group differences were examined using multivariate analyses (MANCOVA/MANOVA), while associations between adolescent and parental variables were assessed using correlation analyses. Results In adolescents with ADHD, scores on the negative meta‐worry, superstitious, punishment and responsibility beliefs and cognitive monitoring subscales ‐as well as the MCQ‐C total score‐ were significantly higher compared to the control group, while no difference was found for positive meta‐worry, regardless of subtype. On the parental MCQ‐30, all subscale and total scores were significantly higher in the ADHD group. Parents categorized as being at increased risk of ADHD had significantly higher MCQ‐30 total scores compared to those at low risk. Furthermore, the severity of ADHD symptoms in adolescents, particularly inattention and hyperactivity‐impulsivity, was positively and weakly correlated with the MCQ‐C total score. In addition, a weak negative correlation was observed between adolescents' positive meta‐worry and parents' cognitive confidence. Conclusion Our study suggests that metacognitive impairment is prevalent among adolescents with ADHD and their parents. Enhancing metacognitive awareness in individuals with ADHD may facilitate their adaptation to treatment and preparedness for alternative forms of therapeutic intervention.

Efficient removal of selenite ions from coal mine waste stream using a novel O‐diaminopyridine‐based chitin composite: adsorption, equilibrium, and environmental aspects sustainability

Abstract BACKGROUND This study evaluates a newly synthesized O ‐diaminopyridine‐based chitin composite (CHI‐DIPY) for the effective elimination of selenite (Se 4+ ) ions from polluted water. The adsorbent was tested using wastewater collected from an open‐pit coal mine containing an initial selenium concentration of about 3 mg/L. Successful synthesis and structural integrity of CHI‐DIPY were confirmed using FT‐IR, XPS, BET, SEM–EDX, TGA, 1 H‐NMR, 13 C‐NMR, and MS analyses. Key operational parameters, including pH, contact time, initial selenium concentration, adsorbent dosage, co‐ion interference, temperature, and elution conditions, were systematically optimized. RESULTS Under optimal conditions (25 °C, pH 4, 25 min contact time, and 250 mg/L initial Se concentration), CHI‐DIPY achieved a maximum adsorption capacity of 110 mg/g. Equilibrium data were best described by the Langmuir isotherm model, with a theoretical capacity of 109.98 mg/g. Kinetic studies followed a pseudo‐second‐order model, predicting a capacity of 123.45 mg/g. Thermodynamic analysis indicated that adsorption was spontaneous and exothermic (Δ H  = −18.305 kJ mol −1 ; Δ G  = −3.212 to −0.446 kJ mol −1 over 298–353 K). CHI‐DIPY exhibited strong selectivity for selenite in the presence of competing ions and demonstrated excellent reusability, with 99% selenium desorption using 1 M H 2 SO 4 . CONCLUSION CHI‐DIPY is a highly efficient, selective, and regenerable adsorbent for selenite removal. Application to real coal‐mine wastewater reduced selenium concentrations below WHO and EPA limits in a single treatment cycle, highlighting its strong potential for practical environmental remediation. © 2026 Society of Chemical Industry (SCI).

Combination of Doppler US and US Elastography is Superior to Doppler US or US Elastography Alone in Detecting Delayed Kidney Graft Rejection

ABSTRACT Objectives To compare the performance of Doppler ultrasound (US) and US elastography with their combination in detecting delayed graft rejection. Methods A prospective cross‐sectional study of 60 consecutive adult kidney transplant recipients was done. Patients with creatinine > 1.5 mg/dL and a minimum interval of 3 months from renal transplant surgery were recruited. All patients underwent both Doppler US and US elastography. A direct head‐to‐head comparison was made. A glomerular filtration rate (eGFR) < 50 was regarded as delayed graft rejection. A resistive index (RI) value ≥ 0.79 was considered abnormal. Results RI was more strongly correlated to age, diabetes mellitus, and hypertension with Pearson correlation coefficients of 0.414, 0.390, and 0.386, respectively, while stiffness (kPa) exhibited a stronger correlation to the time period since surgery. Using radiological findings to estimate observed eGFR showed an adjusted R 2 of 0.135. Doppler US alone, US elastography alone, and combined Doppler US + US elastography + clinical data, respectively, showed area under curve (AUC) values of 0.668 (95% CI = 0.535 to 0.735), 0.641 (95% CI = 0.507 to 0.761), and 0.792 (95% CI = 0.667 to 0.886) in detecting delayed graft rejection. Estimating RI using clinical and US elastography findings showed AUC of 0.811 (95% CI = 0.689 to 0.901), with sensitivity of 61.5% (95% CI = 40.6 to 79.8) and specificity of 91% (95% CI = 76.3 to 98.1). Conclusion Monitoring renal allografts using a combination of Doppler US and US elastography, in conjunction with clinical data, may provide additional early diagnostic and clinical advantages.

Longitudinal Assessment Using Entrustable Professional Activities: Key Steps for Implementation in Dental Education

ABSTRACT Purpose/Objectives Curriculum evolution calls for incorporating contemporary pedagogical practice. In 2021, the UNC ASOD began the implementation of a new curriculum. One of the unique aspects was a shift from traditional single competency assessments to a longitudinal assessment system using entrustable professional activities (EPAs) for summative entrustment decisions. This paper describes the process and outcomes of determining entrustment and practice readiness for the dental Class of 2024. Methods A six‐step process leading to determination of practice readiness is outlined, with the final step culminating in summative decisions for entrustment and readiness for safe and independent practice post‐graduation. Results All 91 (100%) learners achieved Statements of Awarded Responsibility (STARs) or competence in all EPAs by graduation, meeting thresholds, and practice readiness criteria. This progression varied by EPA, with some tasks completed earlier in the curriculum and others requiring more time or being impacted by the timing of supplemental assessments. Delays in STAR designation occurred for four learners. No STARs were rescinded. Conclusion A longitudinal assessment framework with multiple assessments by multiple evaluators on cases of varying complexity in an authentic work‐based environment was successful in preparing practice‐ready graduates and ensuring the capability of learners to safely and independently perform professional tasks. Monitoring learners’ performance quality, independence, and progression over time and in varying contexts contributes to a greater ability to ascertain learners’ practice readiness. The EPA framework facilitated operationalizing longitudinal assessment by providing a comprehensive and future‐focused approach to evaluating clinical competence and ensuring public trust.

Effects of 17α‐Ethinylestradiol on Development and Gonadal Differentiation in the Estuarine Mummichog, Fundulus heteroclitus

ABSTRACT In fish, sex determination and gonadal development are controlled by various genetic and environmental factors. In this study, experiments were conducted on the estuarine mummichog ( Fundulus heteroclitus ) to investigate gonadal differentiation following exposure to the synthetic estrogen, 17α‐ethinylestradiol (EE 2 ). The period of sensitivity to EE 2 was explored by initiating the exposures at different times post fertilization. In Experiment 1, mummichog embryos were collected within 8 h of fertilization and then continually exposed to increasing concentrations of EE 2 (up to 229 ng/L) for up to 10 weeks. For controls, complete differentiation of the gonad to a testis or ovary in mummichog occurred by 3 weeks post hatch (wph) and there was an equal distribution of males and females. Exposure to all concentrations of EE 2 accelerated female gonadal differentiation as early as 1 wph and contributed to a highly female skewed sex ratio with 80% to 100% of the fish displaying ovaries. Exposure to EE 2 also resulted in a concentration‐dependent increase in skeletal abnormalities and mortalities whereas larval lengths were not affected. In Experiment 2, 24 h post‐hatch larvae were exposed for 5 weeks to three treatments with measured concentrations (ng/L) of 0.4 (Control), 2.5 ng/L, and 18.0 ng/L). The sex ratio was approximately 50/50 in controls and did not change with EE 2 treatment. EE 2 did not alter the proportion of oocyte stages (chromatin nucleolus, perinucleolar, cortical alveolar) but spermatogenesis was impeded as male fish had greater proportions of spermatogonia, and spermatids were only observed in controls. EE 2 treatment did not change the expression of genes in the ovary implicated in gonadal development including cyp19a1a , foxl2 , gdf9 , bmp15 , dmrt1 , and amh . In contrast, testis expression of dmrt1 was decreased and cyp19a1a , foxl2 , gdf9 , and amh were increased following EE 2 treatment. Overall, by the time of hatching (about 3 weeks post fertilization), sex differentiation was complete, and the sex determination mechanisms were only sensitive to EE 2 during a window of embryonic development before hatch. Early stages of testis differentiation may be more sensitive to exogenous EE 2 exposure than ovarian tissue in the mummichog.

Organoids for Metabolic Disease Modeling

ABSTRACT Inherited metabolic diseases (IMDs) are a diverse group of rare genetic disorders that disrupt metabolic pathways, leading to severe clinical manifestations. Disease models ranging from complex animal models to simple in vitro systems have provided insights into IMDs, but each has limitations. Organoids, three‐dimensional in vitro models, bridge this gap by replicating key metabolic functions that are absent in most simple 2D cell models. While organoids do not fully mimic organ complexity, they effectively model disease‐specific metabolic defects, as seen in methylmalonic acidemia, Wilson's disease, and cystic fibrosis. Recognizing that function is more critical than organ resemblance, we propose focusing on the specific function of interest rather than selecting a model solely based on its derivation from the most affected organ. Focusing on specific biological processes enables precise, disease‐relevant studies that drive novel therapeutic strategies and personalized medicine.

Drivers of Diagnostic Delay in Mitochondrial Disease: Missed Recognition of Canonical Features

ABSTRACT Diagnostic delay is common in mitochondrial disease, and its drivers remain unclear despite advances in molecular diagnostics. We retrospectively analyzed 61 individuals with molecularly confirmed mitochondrial disease at the Mount Sinai Mitochondrial Disease Clinic, diagnosed after 2016. Diagnostic delay was partitioned into intervals from symptom onset to clinical suspicion, and from suspicion to molecular diagnosis. Demographic, phenotypic, and genetic data were abstracted from health records, and Human Phenotype Ontology terms were compared before and after diagnosis using ClinPhen. Most delays occurred between symptom onset and clinical suspicion (mean 8.17 years) rather than after suspicion (mean 1.28 years), yielding a mean total delay of 8.22 years (median 3.0). Delay decreased sharply by year of birth ( r  = −0.99, p  < 49.92 × 10 −39 ) and symptom onset ( r  = −0.96, p  < 8.14 × 10 −27 ), but showed no meaningful trend with year of diagnosis. Canonical features such as seizures, hypotonia, and stroke were frequently documented years before suspicion, underscoring missed opportunities. Diagnostic delay may reflect missed recognition rather than testing limitations. Systematic capture of early phenotypes and AI/NLP‐based mining of electronic health records could proactively flag patients for reflexive sequencing, shortening diagnostic delay.

HPLC‐MS/MS Method for Monitoring of L‐Asparaginase Activity by Using Asparagine and Aspartic Acid Plasma Levels

ABSTRACT The effectiveness of L‐asparaginase and therefore the effectiveness of acute lymphoblastic leukemia treatment will be understood by determining the substrates of the enzyme, L‐asparagine and L‐glutamine. For this purpose, the high‐performance liquid chromatography–tandem mass spectrometry method was developed and validated by analyzing the L‐asparaginase substrates asparagine and glutamine and its products aspartic acid and glutamic acid from plasma. Acetonitrile and ammonium acetate were used at 0.4 mL/min in gradient mobile phase flow using a HILIC column for chromatographic separations. The linear amino acid range was found to be 500–5000 ng/mL for asparagine, aspartic acid, and glutamic acid, and 5–50 μg/mL for glutamine, respectively. Detection limit and quantitation limit were found to be 100–500 ng/mL for asparagine, aspartic acid, and glutamic acid, and 1–5 μg/mL for glutamine, respectively. The validated method has been successfully applied to plasma samples. The method was found to be selective and reproducible.

Letter to the Editor Regarding “Impact of Anisotropic Conduction and Premature Atrial Contraction on the Fractionated Atrial Potentials”

Percutaneous Left Atrial Appendage Occlusion for Atrial Fibrillation in Cardiac Amyloidosis

ABSTRACT Background Cardiac amyloidosis (CA) is frequently complicated by atrial fibrillation (AF), yet outcomes after left atrial appendage occlusion (LAAO) in this population remain poorly defined. Methods We conducted a retrospective TriNetX study of adults with AF undergoing LAAO, comparing patients with and without CA after 1:1 propensity matching. Outcomes were assessed using Kaplan–Meier analyses and Cox regression. Results Among 532 matched pairs, mortality and major adverse cardiovascular events were similar between groups, whereas major bleeding was higher in CA (HR 1.90). Conclusions LAAO yields comparable ischemic outcomes in CA, though bleeding risk is increased.