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A publicly available online webcam hosted by Reid Park Zoo (Tucson, AZ, USA) was utilized to study the 'visitor effect' in Chilean flamingos (Phoenicopterus chilensis) to eliminate any potential influence that the presence of a researcher may have had on the behavior of the birds. Flamingos were found to be closer to one another in the webcam image on days when more humans were observed in the vicinity of the exhibit, successfully evidencing a 'visitor effect.' Higher temperatures, lower barometric pressures, and lower wind speeds were all found to be associated with increased flamingo activity. Higher temperatures and UV index, and lower humidity and wind speed were all associated with increased numbers of visitors seen near the flamingo exhibit. [ABSTRACT FROM AUTHOR]

Objective: This study delineated the unmet mental health needs of peripartum mothers with symptoms of depression, ascertained their willingness to engage in psychotherapy via text message, and identified potential determinants of that willingness (e.g., demographics, preferred communication methods) to inform improvement to service delivery. Method: This was a cross-sectional national survey of 897 adults who had given birth in the previous 24 months, had at least one lifetime symptom of depression, had internet access, and could read English. Univariate analysis was followed by multivariable Firth's logistic regression. Results: Peripartum participants with at least one symptom of depression wanted mental health care the most within 2 years of giving birth (64.4%) and had less access to mental health care during pregnancy and postpartum (35.1% and 38.1%, compared with 23.9%). Fifty-three percent of participants were willing to engage in psychotherapy via text message. Determinants of willingness to engage in text message therapy for all periods (pregnancy, postpartum, and not peripartum) included wanting mental health treatment but not having access and previous experience with psychotherapy via text message. During pregnancy and not peripartum, more depressive symptoms were associated with willingness to engage in psychotherapy via text message. Conclusion: The peripartum period is an especially high-risk time for mothers to experience depressive symptoms. In general, most wanted therapy but were unable to access it. Most participants were willing to engage in text message therapy. [ABSTRACT FROM AUTHOR]

Purpose: LGBTQ + community connectedness is generally a protective health factor for sexual and gender minorities. However, existing scales have not been validated among Black sexual minority men living with HIV (SMMLWH), who face unique marginalized experiences that disproportionately impact several health outcomes compared to the general LGBT + community. We validated the Connectedness to the LGBT Community Scale among Black SMMLWH. Methods: We validated the 9-item Connectedness to the LGBT Community Scale from Frost and Meyer using preliminary data from a cohort of Mid-Atlantic Black SMMLWH (n = 650). Factor analysis and intercorrelations were conducted to assess unidimensionality, and Cronbach's alpha was measured for reliability. Correlations and cumulative ordinal regression models were generated using internalized homophobia, hopelessness, depression, HIV stigma, social support, and resilience as criterion constructs. Models were adjusted for sociodemographic and behavioral characteristics. Results: The Connectedness to the LGBT Community Scale demonstrated high internal consistency (alpha = 0.948) and strong item intercorrelation with a single factor structure. The scale was associated with all criterion measures before and after adjustment, including lower internalized homophobia (aCOR = 0.19, 95% CI 0.15–0.25), lower hopelessness (aCOR = 0.53, 95% CI 0.41–0.68), lower HIV stigma (aCOR = 0.58, 95% CI 0.47–0.72), and lower depression (aCOR = 0.61, 95% CI 0.50–0.75). The scale was also associated with greater social support (aCOR = 2.38, 95% CI 1.91–2.97) and resilience (aCOR = 2.53, 95% CI 2.03–3.15). Conclusion: The Connectedness to the LGBT Community Scale is a valid measure for use among Black SMMLWH. Future studies should explore relationships between community connectedness and HIV care outcomes and quality of life among Black SMMLWH. [ABSTRACT FROM AUTHOR]

Background: Hand, foot, and mouth disease (HFMD) is an infectious disease that often affects children under 5 years of age. Over the past 20 years, enterovirus 71 (EV71) has become a major concern among children, especially in the Asia-Pacific region. Currently, there are no data showing the seroprevalence of HMFDs in Indonesia. This study aimed to determine the seroprevalence of antibodies to EV71 infection in rural and urban areas. Methods: This study was an observational analysis and cross-sectional seroprevalence survey of HFMD in children aged 6 to 71 months. The sampling locations were the Padalarang health centre, which is rural, and the Garuda health centre, which is urban. The total sample included 600 children aged 6–71 months from these two locations. Blood sample testing uses enzyme-linked immunosorbent assays (ELISAs) to identify subjects who are positive for IgG EV71 and the risk factors that may influence it. Results: In total, 596 subjects (99.3%) were positive for the seroprevalence of EV71 IgG in rural and urban areas. Child age, sex, nutritional status, height/age, immunisation status, parental income, and father's and mother's educations were not statistically related in rural and urban areas (p > 0.05) because the rate of IgG EV71 seropositivity was very high. Conclusion: This study revealed that the rate of IgG EV71 HFMD seropositivity in Indonesia, especially in the Padalarang health centre and Garuda health centre, was very high. Further research is needed to investigate HFMD cases because of the lack of attention given to this disease and the need to consider whether immunisation is necessary to prevent HFMD. Trial registration: This study is registered at clinicaltrials.gov, National Clinical Trial (NCT) No. NCT05637229. [ABSTRACT FROM AUTHOR]

Background: There has been a shift in postgraduate medical education towards digital educational resources—podcasts, videos, social media and other formats consumed asynchronously and apart from formal curricula. It is unclear what drives residents to select and use these resources. Understanding how and why residents choose digital resources can aid programme directors, faculty and residents in optimising residents' informal learning time. Method: This focus group study was conducted with residents at two US internal medicine residency programmes. The authors used the framework approach to content analysis using self‐determination theory as guide for deductive coding and iteratively assessing connections among codes and identifying themes. Trustworthiness was addressed through use of analytic memos, reflexive practice and member checking. Results: The authors conducted eight virtual focus groups (n = 23) from 5/27/20 to 6/11/20. Residents described that a feeling of 'should know' drove initial choices towards self‐directed learning outside of work. Regular use of a resource was influenced by how the resource fit into a resident's lifestyle, the personal cognitive energy and the perceived 'activation energy' of using a particular resource. Familiarity, increased confidence and in‐person social networks gained from digital resources served to reinforce and further guide resource choice. Conclusions: The selection of digital resources for self‐directed learning is driven by multiple factors, suggesting an interdependent relationship between the learning environment and a residents' cognitive capacity. Understanding these interconnections can help residents and clinical educators explicitly choose resources that fit their lifestyle and learning needs. [ABSTRACT FROM AUTHOR]

The Northern Triangle countries, including El Salvador, Guatemala, and Honduras, are sources of a significant number of asylum seekers in the United States today. This article examines the underlying societal dynamics in these countries and considers the typical profile of transgender immigrant women seeking asylum in the U.S. on the legal grounds of having faced gender-based violence in their countries of origin. It analyzes the relevant international conventions as well as the social determinants of the health and mental health of transgender asylum seekers. It draws from 35 cases of transgender immigrant women subjected to child sexual abuse; sexual assault, including assault by police; and forced sex work; it reviews examples from the academic and gray literature, including a precedent-setting case heard before the Inter-American Court on Human Rights. It discusses the implications for social science professionals, including the role of experts of country conditions. It provides guidance for immigrant service providers and advocates, particularly the importance of gender-affirming policies and healthcare to this population deserving of protection. [ABSTRACT FROM AUTHOR]

The author discusses a study by Manning and colleagues, published in the issue on health care stereotype threat which is a measure of anticipated stigma and discrimination in health care settings. Topics include extant research about sexual and gender minority people, finding by Manning and colleagues on health care stereotype threat among non-Hispanic Black participants, and approaches that explore interlocking systems of power that minoritize individuals along multiple axes of identity.

Political theory as a discipline has long been skeptical of computational methods. In this paper, I argue that it is time for theory to make a perspectival shift on these methods. Specifically, we should consider integrating recently developed generative large language models like GPT-4 as tools to support our creative work as theorists. Ultimately, I suggest that political theorists should embrace this technology as a method of supporting our capacity for creativity—but that we should do so in a way that is mindful of the content and value of theorizing, the technical constraints of the models, and the ethical questions that the technology raises. [ABSTRACT FROM AUTHOR]

Hypothesis: Elder abuse and neglect occurs as a result of lack of relevant personnel training, poor remuneration, and depression among caregivers. To test the hypothesis, overall findings analyzed confirm if they were in agreement or not. Background: Reported cases of elder abuse and neglect have been on the rise. To add on to that, not enough studies exist that can be of help in guiding policy-makers to formulate solutions and offer answers as to why this problem is on the increase. Method: These researchers conducted a review of existing literature about elder abuse in order to better understand the risk factors and causes of elder abuse and neglect. Information was mined from various databases that contained information relevant to this review. Results: Results of findings showed that reports of abuse cases were on the rise, especially among elder patients; worse still for those with a secondary chronic illness like dementia and Parkinson's disease. Women reported more cases of abuse compared to those reported by men. By demographics, abuse was found to be much higher among minority groups like African Americans and Asians Americans. Some elder patients in the studies experienced concurrent types or forms of abuse. Those with severe forms of cognitive impairments reported the highest cases of abuse and self-neglect. Conclusion: Better remuneration, continuous training to caregivers about aging and better healthcare skills are necessary to help to end this scourge. This study concludes that despite great efforts made by some institutions to end abuse and neglect, more publicity, more studies or research and more funds are required in order to build a sufficient body of knowledge that can be relied upon by the relevant policy-makers. [ABSTRACT FROM AUTHOR]

This Article uses civil-military relations theory, an interdisciplinary academic theory, to inform a critique of the Supreme Court's military deference doctrine. National security leaders noted in late 2022 that we are in a moment where civil-military relations are backsliding. Civil-military relations theory requires robust civilian oversight of the military in a functioning democracy. The Article discusses the language and arguments that underpin the military deference doctrine and argues that using national security deference or congressional deference while focusing on civilian decision-making and the exercise of oversight of the military, rather than deference to military decision-making itself, would be a more responsible approach. [ABSTRACT FROM AUTHOR]

The article focuses on the implications of the 2024 GOLD report for chronic obstructive pulmonary disease (COPD) care, emphasizing the importance of adhering to current guidelines and providing effective management strategies. Topics include the definition of COPD, screening methods, and the diagnosis and initial assessment process, highlighting the importance of spirometry and categorization of symptoms for treatment decisions.

The early stages of the COVID-19 pandemic and associated stay-at-home orders resulted in a stark reduction in daily social interactions for children and adolescents. Given that peer relationships are especially important during this developmental stage, it is crucial to understand the impact of the COVID-19 pandemic on social behavior and risk for psychopathology in children and adolescents. In a longitudinal sample (N=224) of children (7-10y) and adolescents (13-15y) assessed at three strategic time points (before the pandemic, during the initial stay-at-home order period, and six months later after the initial stay-at-home order period was lifted), we examine whether certain social factors protect against increases in stress-related psychopathology during the pandemic, controlling for pre-pandemic symptoms. Youth who reported less in-person and digital socialization, greater social isolation, and less social support had worsened psychopathology during the pandemic. Greater social isolation and decreased digital socialization during the pandemic were associated with greater risk for psychopathology after experiencing pandemic-related stressors. In addition, children, but not adolescents, who maintained some in-person socialization were less likely to develop internalizing symptoms following exposure to pandemic-related stressors. We identify social factors that promote well-being and resilience in youth during this societal event. [ABSTRACT FROM AUTHOR]

We present the results from a pair of high-resolution, long-timescale (∼105 GM / c 3), global, three-dimensional magnetohydrodynamical accretion disk simulations with differing initial magnetic plasma β in order to study the effects of the initial toroidal field strength on the production of a large-scale poloidal field. We initialize our disks in approximate equilibrium with purely toroidal magnetic fields of strength β 0 = 5 and 200. We also perform a limited resolution study. We find that simulations of differing field strengths diverge early in their evolution and remain distinct over the time studied, indicating that the initial magnetic conditions leave a persistent imprint in our simulations. Neither simulation enters the magnetically arrested disk regime. Both simulations are able to produce poloidal fields from initially toroidal fields, with the β 0 = 5 simulation evolving clear signs of a large-scale poloidal field. We make a cautionary note that computational artifacts in the form of large-scale vortices may be introduced in the combination of initially weak field and disk-internal mesh refinement boundaries, as evidenced by the production of an m = 1 mode overdensity in the weak field simulation. Our results demonstrate that the initial toroidal field strength plays a vital role in the simulated disk evolution for the models studied. [ABSTRACT FROM AUTHOR]

Climate warming, land use change, and altered fire regimes are driving ecological transformations that can have critical effects on Earth's biota. Fire refugia—locations that are burned less frequently or severely than their surroundings—may act as sites of relative stability during this period of rapid change by being resistant to fire and supporting post‐fire recovery in adjacent areas. Because of their value to forest ecosystem persistence, there is an urgent need to anticipate where refugia are most likely to be found and where they align with environmental conditions that support post‐fire tree recruitment. Using biophysical predictors and patterns of burn severity from 1180 recent fire events, we mapped the locations of potential fire refugia across upland conifer forests in the southwestern United States (US) (99,428 km2 of forest area), a region that is highly vulnerable to fire‐driven transformation. We found that low pre‐fire forest cover, flat slopes or topographic concavities, moderate weather conditions, spring‐season burning, and areas affected by low‐ to moderate‐severity fire within the previous 15 years were most commonly associated with refugia. Based on current (i.e., 2021) conditions, we predicted that 67.6% and 18.1% of conifer forests in our study area would contain refugia under moderate and extreme fire weather, respectively. However, potential refugia were 36.4% (moderate weather) and 31.2% (extreme weather) more common across forests that experienced recent fires, supporting the increased use of prescribed and resource objective fires during moderate weather conditions to promote fire‐resistant landscapes. When overlaid with models of tree recruitment, 23.2% (moderate weather) and 6.4% (extreme weather) of forests were classified as refugia with a high potential to support post‐fire recruitment in the surrounding landscape. These locations may be disproportionately valuable for ecosystem sustainability, providing habitat for fire‐sensitive species and maintaining forest persistence in an increasingly fire‐prone world. [ABSTRACT FROM AUTHOR]

Background: The COVID-19 pandemic has created substantial and profound barriers to several forms of health care engagement. For Black sexual minority men, this may include engagement with pre-exposure prophylaxis (PrEP) to prevent HIV infection, with significant implications for HIV disparities. Our study explored how the COVID-19 pandemic affected Black sexual minority men, with a focus on relationships between COVID-19 and PrEP engagement. Setting: We sampled 24 Black sexual minority men attending HIV prevention-related events in the greater D.C. Metropolitan area (D.C., Maryland, Virginia). Methods: We conducted qualitative phone interviews among our sample. Questions were primarily focused on the COVID-19 pandemic and how it affected engagement and considerations of PrEP use. Interviews were transcribed and qualitatively analyzed using the 6 stages of thematic analysis. Results: We identified 3 major themes from our thematic analysis: Changes in the health care system, changes in sexual and relationship contexts, and COVID-19 vaccine hesitancy and misinformation. Relationships between COVID-19 vaccine hesitancy and PrEP hesitancy were especially prevalent, with participants describing that COVID-19 hesitancy can directly deter PrEP use through eroding medical trust further. Conclusions: We identified changes in the health care system, sexual and relationship contexts, and COVID-19 vaccine hesitancy as important issues driven by COVID-19 with significant implications for PrEP use. The COVID-19 pandemic has changed the health care and social landscape in profound ways that affect PrEP access, sexual networks, and associated HIV vulnerability. Future research further exploring relationships between specific pandemic stressors and HIV prevention among Black sexual minority men is recommended. [ABSTRACT FROM AUTHOR]

Factors associated with COVID-19 presentation in children with asthma are poorly defined. Our study aimed to assess the clinical course of COVID-19 in children with asthma, with particular attention to possible risk factors for severe disease and long-term sequelae in this group of patients. We assessed the occurrence of SARS-CoV-2 infection in children with asthma six months before their regular outpatient visit to the asthma clinic. Characteristics of patients presenting with signs of SARS-CoV-2 upper (URTI) or lower respiratory tract infection (LRTI) were compared. We focused on factors previously associated with COVID-19 severity. Twenty-seven percent of patients (57/210) reported exposure to SARS-CoV-2 infection. In the symptomatic group, 36% (15/42) reported symptoms of LRTI and 64% (27/42) of URTI. Poorer asthma control was observed in patients with LRTI compared to URTI (80% vs. 7%, p < 0.001). In addition, children with poorer asthma control had a higher risk of presenting with SARS-CoV-2 LRTI in a multiple logistic regression analysis. COVID-19 disease course was not associated with regular ICS use and asthma severity. However, patients on regular ICS had better asthma control (p = 0.026). We found no PFT deterioration post-COVID-19 in either group of patients. Our results suggest good asthma control and treatment adherence prior to infection are associated with better COVID-19 outcomes in children with asthma. [ABSTRACT FROM AUTHOR]

Key Points: Question: Among patients with uncontrolled hypertension, does the aldosterone synthase inhibitor lorundrostat safely lower blood pressure? Findings: In this randomized clinical trial that included 200 participants, lorundrostat decreased blood pressure significantly more than placebo with 50-mg and 100-mg once-daily doses, and adverse events, including hyperkalemia, were uncommon. Meaning: Aldosterone synthase inhibition with lorundrostat showed potential for blood pressure lowering in patients with hypertension that was inadequately controlled despite background antihypertensive treatment. Importance: Excess aldosterone production contributes to hypertension in both classical hyperaldosteronism and obesity-associated hypertension. Therapies that reduce aldosterone synthesis may lower blood pressure. Objective: To compare the safety and efficacy of lorundrostat, an aldosterone synthase inhibitor, with placebo, and characterize dose-dependent safety and efficacy to inform dose selection in future trials. Design, Setting, and Participants: Randomized, placebo-controlled, dose-ranging trial among adults with uncontrolled hypertension taking 2 or more antihypertensive medications. An initial cohort of 163 participants with suppressed plasma renin (plasma renin activity [PRA] ≤1.0 ng/mL/h) and elevated plasma aldosterone (≥1.0 ng/dL) were enrolled, with subsequent enrollment of 37 participants with PRA greater than 1.0 ng/mL/h. Interventions: Participants were randomized to placebo or 1 of 5 dosages of lorundrostat in the initial cohort (12.5 mg, 50 mg, or 100 mg once daily or 12.5 mg or 25 mg twice daily). In the second cohort, participants were randomized in a 1:6 ratio to placebo or lorundrostat, 100 mg once daily. Main Outcomes and Measures: The primary end point was change in automated office systolic blood pressure from baseline to study week 8. Results: Between July 2021 and June 2022, 200 participants were randomized, with final follow-up in September 2022. Following 8 weeks of treatment in participants with suppressed PRA, changes in office systolic blood pressure of −14.1, −13.2, −6.9, and −4.1 mm Hg were observed with 100 mg, 50 mg, and 12.5 mg once daily of lorundrostat and placebo, respectively. Observed reductions in systolic blood pressure in individuals receiving twice-daily doses of 25 mg and 12.5 mg of lorundrostat were −10.1 and −13.8 mm Hg, respectively. The least-squares mean difference between placebo and treatment in systolic blood pressure was −9.6 mm Hg (90% CI, −15.8 to −3.4 mm Hg; P =.01) for the 50-mg once-daily dose and −7.8 mm Hg (90% CI, −14.1 to −1.5 mm Hg; P =.04) for 100 mg daily. Among participants without suppressed PRA, 100 mg once daily of lorundrostat decreased systolic blood pressure by 11.4 mm Hg (SD, 2.5 mm Hg), which was similar to blood pressure reduction among participants with suppressed PRA receiving the same dose. Six participants had increases in serum potassium above 6.0 mmol/L that corrected with dose reduction or drug discontinuation. No instances of cortisol insufficiency occurred. Conclusions and Relevance: Among individuals with uncontrolled hypertension, use of lorundrostat was effective at lowering blood pressure compared with placebo, which will require further confirmatory studies. Trial Registration: ClinicalTrials.gov Identifier: NCT05001945 This randomized clinical trial assesses the effect of 5 dosages of lorundrostat treatment vs placebo on 8-week systolic blood pressure change among adults with uncontrolled hypertension. [ABSTRACT FROM AUTHOR]

The article focuses on the importance of preparing physicians for the use of clinical decision support (CDS) algorithms in patient care. Topics discussed include the changing scope of CDS applications, the potential impact of physicians' interpretation of algorithmic predictions on patient care, and the need for medical education to explicitly cover probabilistic reasoning tailored to CDS.

Sexual and gender minority (SGM) college students experience compounding psychological effects as a result of the COVID-19 pandemic. Using latent profile analysis of cross-sectional data from a sample of SGM students (n = 565) we tested for a syndemic of victimization, internalized LGBTQ + stigma, racism, racialized heterosexism/cisgenderism, family rejection, and isolation associated with psychological distress. We also tested if increases in these factors since the start of the COVID-19 pandemic were associated with greater psychological distress among syndemic profiles. We identified four profiles: 'Lowest syndemic factors' (reference), 'High isolation only', 'High isolation and rejection only', and 'High syndemic'. The greatest distress was observed among the 'High syndemic' profile (aPR = 2.99, 95% CI 2.20, 4.06), followed by the 'High isolation and rejection only' profile (aPR = 2.11, 95% CI 1.61, 2.76), and the 'High isolation only' profile (aPR = 1.32, 95% CI 1.03, 1.70). Among the 'High syndemic profile', increases in every factor since the start of the COVID-19 pandemic were associated with greater psychological distress. The strongest associations were seen among increased victimization (aPR = 5.85, 95% CI 1.33, 25.71). Victimization, internalized LGBTQ + stigma, racism, family rejection, and isolation form a syndemic among SGM students, which has magnified since the start of the COVID-19 pandemic. [ABSTRACT FROM AUTHOR]

Colorectal cancer (CRC) disparities continue to persist in the four corners region (states of New Mexico, Arizona, Utah, and Colorado) of the United States. The Comprehensive Cancer Control (CCC) state plans provide a policy and practice snapshot on how a state identifies and addresses its cancer burden. This study critically examines the four state plans to identify gaps and opportunities for cancer prevention and control. Using a conventional content analysis approach, we reviewed the CCC plans for CRC screening-related information, culminating in a conceptual framework that highlights three themes. First, states reported their cancer burden using national data from American Cancer Society, Centers for Disease Control and Prevention, or the NCI's Surveillance, Epidemiology, and End Results. Although these data informed specific goals and objectives, not all plans reported state-level data on CRC differences by specific social determinants of health and other characteristics. Second, it was not clear whether the interventions chosen to address state plan objectives were evidence-based and whether or not clearly described criteria were used for the selection of the interventions. Third, very limited information was provided in terms of state-specific contextual challenges and practical implementation of interventions. Study findings highlight opportunities to improve state-level cancer prevention and control efforts: first, by promoting the selection and adaptation of contextually relevant evidence-based interventions for this unique region; and second, through multidirectional engagement with communities, researchers, and policy and practice stakeholders. Such synergies in research and policies are vital for a coordinated and integrated approach to cancer prevention and control. [ABSTRACT FROM AUTHOR]

This study presents a novel layered spatial beam model with discrete connections between layers, developed to accurately capture large displacements and rotations as well as finite strains. The formulation is characterized by simplicity, robustness and compatibility with automatic code generation, making it suitable for various applications. Key features of the model include the use of a piecewise constant strain field, the inclusion of discrete unknowns such as strains and stress resultants, and the efficient numerical implementation using the automatic code generation. The discrete connections between the layers of the model enable an efficient description of the interlaminar behaviour and the consideration of nonlinear constitutive properties. Numerical examples demonstrate the effectiveness and accuracy of the proposed approach and illustrate its potential for practical engineering applications. [ABSTRACT FROM AUTHOR]

Background: Diabetes Mellitus (DM) and its associated immune dysfunction are well-studied risk factors for adverse surgical outcomes. The literature regarding endoscopic sinus surgery (ESS) is less robust and there have been conflicting reports on post-operative complications and surgical results in this patient population. The purpose of this study was to analyze the impact of diabetes mellitus on outcomes after ESS via rates of post-operative medical intervention in the first 6 months after surgery. Methods: This was a retrospective cohort study of 176 subjects who underwent ESS from 2015 to 2019 at a single institution by 2 fellowship-trained rhinologists. Subjects were divided into 2 groups, those with a documented Hemoglobin A1c (HbA1c) >6.5 or diagnosis of DM and those with HbA1C < 6.5. Patient age, demographics, 6-month preoperative HbA1c, surgical status and extent, and 6-monthpostoperative need for steroids and/or antibiotics were collected. Results: Out of n = 176 total patients, n = 39 (22.2%) were categorized into the DM group, which were older (46.4 vs 53.8 years, P =.004) and higher proportion of white patients (89.7% vs 68.6%, P =.008). There were no significant differences between the 2 groups in proportion of revision surgery, surgical extent, and post-operative use of antibiotics or steroids. When including all variables in binary logistic regression for use of postoperative antibiotics or steroids, the only significant variable predicting these outcomes was the extent of surgical resection including sphenoid sinus (P =.001, OR [95% CI] = 4.02 [1.73-9.34]) or frontal sinus (P <.001, OR [95% CI = 9.86 [4.00-24.33]). Conclusions: Patients with DM do not appear to have worse post-operative outcomes outside of the initial 6-month postoperative period. [ABSTRACT FROM AUTHOR]

Nat Turner's Revolt and the Renaming ofJerusalem, Virginia [I]t cannot be that a prophet perish out of Jerusalem.O Jerusalem, Jerusalem, which killest the prophets, andstonest them that are sent unto thee - Luke 13:33b-1 3:34a Names are the turning point of who will be master. Taken to the countycourthouse in Jerusalem, Nat Turner was jailed, put ontrial, and executed by hanging.19 During the brief windowof time between Turner's capture at the end of October,his incarceration, trial, and finally his execution on 11November, an enterprising lawyer named Thomas R. Grayjumped at the chance to interview and write about NatTurner's version of events, probably because Gray was indire straits and "needed to make some money." It is at this late point that Turnerdevelops a "great desire to get there [Jerusalem]", andhe switches to a different route in order to do so.27 Turner, remember, is talking to Gray after he has beenhiding for two months, and as he is about to be executedby the state in Jerusalem; Turner's favorite and mostoft-cited text is Luke, which centralizes Jerusalem asthe necessary scene for the death of Jesus, and Turnerclearly understand himself to be "a successor to or'double' of Christ." For Eric Sundquist, for example, "It is beyondquestion that Turner himself understood the symbolicsignificance of his attempted destruction of the city of'abominations' and 'perverseness.'" Nowhere does Turner,in Gray's text, say that, although he does state,repeatedly, that he wanted to reach Jerusalem. [Extracted from the article]

Peer relationships and social belonging are particularly important during adolescence. Using a willingness-to-work paradigm to quantify incentive motivation, we examined whether evaluative information holds unique value for adolescents. Participants (N = 102; 12–23 years old) rated peers, predicted how peers rated them, and exerted physical effort to view each peer's rating. We measured grip force, speed, and opt-out behavior to examine the motivational value of peer feedback, relative to money in a control condition, and to assess how peer desirability and participants' expectations modulated motivated effort across age. Overall, when compared with adolescents, adults were relatively less motivated for feedback than money. Whereas adults exerted less force and speed for feedback when expecting rejection, adolescents exerted greater force and speed when expecting to be more strongly liked or disliked. These findings suggest that the transition into adulthood is accompanied by a self-protective focus, whereas adolescents are motivated to consume highly informative feedback, even if negative. [ABSTRACT FROM AUTHOR]

Amplified by warming temperatures and drought, recent outbreaks of native bark beetles (Curculionidae: Scolytinae) have caused extensive tree mortality throughout Europe and North America. Despite their ubiquitous nature and important effects on ecosystems, forest recovery following such disturbances is poorly understood, particularly across regions with varying abiotic conditions and outbreak effects.To better understand post‐outbreak recovery across a topographically complex region, we synthesized data from 16 field studies spanning subalpine forests in the Southern Rocky Mountains, USA. From 1997 to 2019, these forests were heavily affected by outbreaks of three native bark beetle species (Dendroctonus ponderosae, Dendroctonus rufipennis and Dryocoetes confusus). We compared pre‐ and post‐outbreak forest conditions and developed region‐wide predictive maps of post‐outbreak (1) live basal areas, (2) juvenile densities and (3) height growth rates for the most abundant tree species – aspen (Populus tremuloides), Engelmann spruce (Picea engelmannii), lodgepole pine (Pinus contorta) and subalpine fir (Abies lasiocarpa).Beetle‐caused tree mortality reduced the average diameter of live trees by 28.4% (5.6 cm), and species dominance was altered on 27.8% of field plots with shifts away from pine and spruce. However, most plots (82.1%) were likely to recover towards pre‐outbreak tree densities without additional regeneration. Region‐wide maps indicated that fir and aspen, non‐host species for bark beetle species with the most severe effects (i.e. Dendroctonus spp.), will benefit from outbreaks through increased compositional dominance. After accounting for individual size, height growth for all conifer species was more rapid in sites with low winter precipitation, high winter temperatures and severe outbreaks.Synthesis. In subalpine forests of the US Rocky Mountains, recent bark beetle outbreaks have reduced tree size and altered species composition. While eventual recovery of the pre‐outbreak forest structure is likely in most places, changes in species composition may persist for decades. Still, forest communities following bark beetle outbreaks are widely variable due to differences in pre‐outbreak conditions, outbreak severity and abiotic gradients. This regional variability has critical implications for ecosystem services and susceptibility to future disturbances. [ABSTRACT FROM AUTHOR]

As cancer survivorship increases, so does the number of patients that suffer from the late effects of radiation therapy. This includes arthrofibrosis, the development of stiff joints near the field of radiation. Previous reports have concentrated on skin fibrosis around the joint but largely ignored the deeper tissues of the joint. We hypothesized that fat, muscle, and the joint tissues themselves would play a more significant role in joint contracture after radiation than the skin surrounding the joint. To address this hypothesis, we irradiated the right hind flanks of mice with fractionated and unfractionated dose schedules, then monitored the mice for 3 months postradiotherapy. Mice were euthanized and physiological indications of arthrofibrosis including limb contracture and joint resting position were assessed. Stifle (knee) joints demonstrated significant arthrofibrosis, but none was observed in the hock (ankle) joints. During these studies, we were surprised to find that male and female mice showed a significantly different response to radiation injury. Female mice developed more injuries, had significantly worse contracture, and showed a greater difference in the expression of all markers studied. These results suggest that women undergoing radiation therapy might be at significantly greater risk for developing arthrofibrosis and may require specific adjustments to their care. [ABSTRACT FROM AUTHOR]

Understanding the impact of the COVID-19 virus on the retinochoroidal vasculature can provide valuable information regarding potential multi-organ ischaemic sequelae in COVID-19 patients, and can thus be a useful tool for optometrists, ophthalmologists, pulmonologists, infectious disease specialists and others. Assessment of retinochoroidal vasculature alterations in recovered mild COVID-19 patients using optical coherence tomography angiography (OCTA) when compared to age and ethnic matched controls. Multimodal imaging was performed using OCTA, spectral domain (SD)-OCT (Optovue RTVue XR Avanti; Optovue, Inc, Fremont, CA), and colour fundus photography (Compass; iCare Inc, Raleigh, NC). Vessel flow density, foveal avascular zone, foveal perimeter circumference and retinal thickness were calculated automatically by the OCTA software on 6 × 6mm angiograms. Morphologic changes in the retinochoroidal vasculature on OCTA were assessed and compared with the findings on fundoscopy, SD-OCT and fundus photography and were evaluated by two trained graders. Mean vessel parafoveal density, superior and inferior hemispheric vessel density and perifoveal temporal vessel density on 6 × 6 angiograms of the superficial capillary plexus were lower among the COVID-19 patients when compared to their age and ethnic matched controls. Vessel flow density of the deep capillary plexus, foveal avascular zone size and circumference and retinal thickness did not illustrate statistical significance between the groups. OCTA provides non-invasive high-resolution imaging of the retinochoroidal vascular network. Compared with conventional imaging, OCTA can demonstrate precise microvascular structural alterations in the retinal vessels before visible on SD-OCT or fundus examination. When matched for age and ethnicity, patients with a history of mild COVID illness manifested alterations in vessel density. [ABSTRACT FROM AUTHOR]

The article discusses how the integration of AI, particularly large language models like GPT, into medical education and practice has the potential to reshape clinical reasoning, diagnostic patterns, and physician training. It explores the challenges and opportunities posed by AI, including concerns about biases, ethical implications, and the changing dynamics of the patient-doctor relationship.

The objective of this study was to identify factors that predict for sperm granuloma formation and the impact of sperm granuloma presence and quantity on vasectomy reversal (VR) outcomes. A cross sectional retrospective review of prospectively collected data, on the impact of granuloma on VR outcomes from a single academic center was performed. The impact of age, obstructive interval, intraoperative vasal fluid findings, anastomosis type, body mass index, tobacco use and total motile count (TMC) was determined. A total of 1550 men underwent VR between January 2000 and August 2019. Granulomas were present unilaterally in 23.3% (n = 361) and bilaterally in 14.2% (n = 220). On univariate analysis, increasing patient age negatively correlated with a larger number of granulomas (p =.011). Granuloma presence was associated with finding intact and motile sperm from the vasal stump intraoperatively (p =.001), and vasoepididymostomy anastomosis (p <.001). However, granuloma presence (and quantity) did not correlate with obstructive interval or maximum TMC. Tobacco use and body mass index (BMI) were not associated with granuloma presence. On multivariate analysis, granuloma quantity was not associated with TMC. Obstructive interval and vasovasostomy anastomosis were associated with higher TMC, while BMI was negatively associated with TMC. In conclusion, increasing age was negatively correlated with granuloma formation. Granuloma presence was associated with more favourable intraoperative fluid findings and anastomosis type, but not post‐VR TMC, suggesting men with and without granulomas undergoing skilled microsurgery will have similar patency rates. Heavier men should be encouraged for weight loss prior to vasectomy reversal as increasing BMI was associated with lower TMC. [ABSTRACT FROM AUTHOR]

The multilocus variable-number tandem-repeat analysis (MLVA) typing method is commonly used in Mycoplasma pneumoniae (M. pneumoniae) epidemiology. It remains unknown if clinical manifestations of lower respiratory tract infections (LRTI) in children differ between different MLVA genotypes. We aimed to determine if specific M. pneumoniae MLVA genotypes indicate the severity of LRTI in children. We performed a retrospective study of children younger than 18 years with signs of acute M. pneumoniae LRTI from January 1, 2009, to December 31, 2014. All patients who were PCR-positive for M. pneumoniae from pharyngeal swabs and had MLVA genotype successfully defined were included in the study. We compared the epidemiological and clinical data of children infected with different MLVA genotypes. In total, 429 patients (mean age 7.4 years, SD 3.4 years; 54% boys) met the study inclusion criteria. We compared the data of patients infected with the three most common MLVA types: MLVA-3,5,6,2 (86/429), MLVA-3,6,6,2 (71/429) and MLVA-4,5,7,2 (256/429). MLVA-3,5,6,2-infected patients over 5 years of age presented with a significantly higher median C-reactive protein level (34 vs 23 vs 19 mg/L, p =.008) and a higher median white blood cell count (9.4 vs 7.9 vs 8.5 × 109/L, p =.040) compared to MLVA-3,6,6,2- and MLVA-4,5,7,2-infected patients. No such difference was observed in the group of younger than 5 years. The results from our large cohort indicate that different MLVA genotypes may have different pathogenic potential and that children with MLVA-3,5,6,2 LRTI may present with higher inflammatory marker levels in comparison with other MLVA types. [ABSTRACT FROM AUTHOR]

Background: Sexually transmitted infections (STIs) are important public health concerns among black men who have sex with men only (BMSMO), as well as those who have sex with both men and women (BMSMW). Sexually transmitted infections also increase risk of acquiring and HIV, which is also a critical concern. Compared with BMSMO, research shows that BMSMW experience elevated levels of HIV/STI vulnerability factors occurring at the intrapersonal, interpersonal, and social/structural levels. These factors may work independently, increasing one's risk of engaging in high-risk sexual behaviors, but often work in a synergistic and reinforcing manner. The synergism and reinforcement of any combination of these factors are known as a syndemic, which increases HIV/STI risk.Methods: Data from the HIV Prevention Trials Network (HPTN) 061 study (n = 799) was used to conduct a latent profile analysis to identify unique combinations of risk factors that may form a syndemic and that may vary between BMSMO and BMSMW. We hypothesized that the convergence of syndemic factors would differ between groups and predict sexual risk and subsequent incident STI.Results: For BMSMO who had a high sexual risk profile, the syndemic factors characterizing this group included perceived racism, incarceration, intimate partner violence, depression, and binge drinking. For BMSMW with a high sexual risk profile, the syndemic factors that characterized this group were incarceration, depression, and binge drinking.Conclusions: The current analysis highlights syndemic profiles that differentiated BMSMO and BMSMW from one another and supports the need for tailored interventions that address specific syndemic factors for both subpopulations of black men who have sex with men. [ABSTRACT FROM AUTHOR]

Part one of this series tracked the evolution of the death examination, noting its stability over the last century despite changing diagnostic and therapeutic technologies and social contexts. In part two, we discuss the practical and ethical debates surrounding the exact timing of death. Although the irreversible cessation of cardiopulmonary systems remains the most common criteria used for the determination of death, identification of the moment of irreversibility is imprecise. In most cases, this imprecision is not problematic, but, when the cessation of circulation is used to identify the time of organ procurement for transplantation, it becomes critical. The phenomenon of autoresuscitation highlights these issues because patients who meet all the criteria for circulatory death (sometimes for periods of observation well beyond the norm) apparently return to life. Were these patients resurrected (like Lazarus) or did we simply not wait long enough? [ABSTRACT FROM AUTHOR]

Cardiopulmonary determination of death is a mainstay of the practice of internal medicine and pulmonary physicians. Despite this, there is considerable variability in death examinations. This article tracks the evolution of the tripartite death examination, initially developed in the middle of the 19th century to protect against premature burial. Although the societal context for controversies about death determination has shifted to discussions about end-of-life care in ICUs and organ transplantation, the cardiopulmonary death examination has largely remained unchanged from its original formulation. The recognition of coma dépassé and brain death has further pushed the focus of the death examination onto the neurological system. Despite advancing diagnostics and legislative attempts to standardize the definition of death, cardiopulmonary death determination largely remains an ad hoc process. [ABSTRACT FROM AUTHOR]

The massive Israeli–Egyptian tank battle in the Sinai on 14 October 1973 constituted a turning point on the southern front during the Yom Kippur War. The crushing Israeli victory set the stage for another turning point on this front, the Israeli counter-crossing of the Suez Canal. Yet, the battle of 14 October has received rather scant attention from military historians. This article, therefore, attempts to fill a gap in the literature about the Yom Kippur War by describing and analysing the battle itself, as well as by highlighting its broader impact on the course of hostilities in the Sinai. [ABSTRACT FROM AUTHOR]

Vaginal microbiota provide the first line of defense against urogenital infections primarily through protective actions of Lactobacillus species Perceived stress increases susceptibility to infection through several mechanisms, including suppression of immune function. We investigated whether stress was associated with deleterious changes to vaginal bacterial composition in a subsample of 572 women in the Longitudinal Study of Vaginal Flora, sampled from 1999 through 2002. Using Cox proportional hazards models, both unadjusted and adjusted for sociodemographic factors and sexual behaviors, we found that participants who exhibited a 5-unit-increase in Cohen's Perceived Stress Scale had greater risk (adjusted hazard ratio (HR) = 1.40, 95% confidence interval (CI): 1.13, 1.74) of developing molecular bacterial vaginosis (BV), a state with low Lactobacillus abundance and diverse anaerobic bacteria. A 5-unit increase in stress score was also associated with greater risks of transitioning from the L. iners -dominated community state type (26% higher) to molecular-BV (adjusted HR = 1.26, 95% CI: 1.01, 1.56) or maintaining molecular-BV from baseline (adjusted HR = 1.23, 95% CI: 1.01, 1.47). Inversely, women with baseline molecular-BV reporting a 5-unit stress increase were less likely to transition to microbiota dominated by L. crispatus , L. gasseri , or L. jensenii (adjusted HR = 0.81, 95% CI: 0.68, 0.99). These findings suggest that psychosocial stress is associated with vaginal microbiota composition, inviting a more mechanistic exploration of the relationship between psychosocial stress and molecular-BV. [ABSTRACT FROM AUTHOR]

Stressful life events (SLEs) are tightly coupled with the emergence of anxiety and depression symptoms among adolescents, but the mechanisms underlying this relationship remain poorly understood. We investigated within-person fluctuations in emotion regulation as a mechanism linking SLEs and internalizing psychopathology in an intensive longitudinal study. We examined how monthly fluctuations in SLEs were related to engagement in three emotion regulation strategies—acceptance, reappraisal, and rumination—and whether these strategies were associated with changes in internalizing symptoms in adolescents followed for one year (N = 30; n = 355 monthly observations). Bayesian hierarchical models revealed that on months when adolescents experienced more SLEs than was typical for them, they also engaged in more rumination, which, in turn, was associated with higher anxiety and depression symptoms and mediated the prospective relationship between SLEs and internalizing symptoms. In contrast, greater use of acceptance and reappraisal selectively moderated the association between stressors and internalizing symptoms, resulting in stronger links between SLEs and symptoms. These results suggest that emotion regulation strategies play different roles in the stress-psychopathology relationship. Understanding how changes in emotion regulation contribute to increases in internalizing symptoms following experiences of stress may provide novel targets for interventions aimed at reducing stress-related psychopathology. • Heightened internalizing symptoms follow exposure to more stress for an individual. • Rumination links stress with anxiety and depression at the within-person level. • Adolescents have increased anxiety following more reported engagement in acceptance. • More reappraisal results in higher depression symptoms in the following month. [ABSTRACT FROM AUTHOR]

The article focuses on the Considerations related to the use of molecular diagnostic tests in veterinary clinical and regulatory practice . Topics discussed include technological advances are creating an ever widening array of options for detecting pathogens and diagnosing diseases of concern in clinical and regulatory veterinary medicine; and new technology can facilitate timelier responses and, in some instances, move assays from laboratory-based to patient-side.

Background: Pelvic inflammatory disease (PID) leads to long-term reproductive consequences for cisgender women. Bacterial vaginosis (BV) and behavioral factors may play a role in PID pathogenesis. We assessed associations between BV, behavioral factors, and incident PID.Methods: We analyzed participants (N = 2956) enrolled in the National Institutes of Health Longitudinal Study of Vaginal Flora, a cohort of nonpregnant cisgender women followed quarterly for 12 months. PID was defined by at least 1 of the following: cervical motion tenderness, uterine tenderness, or adnexal tenderness (160 cases). We tested associations between BV (measured using Nugent and Amsel criteria) and PID at the subsequent visit. Sociodemographic factors, sexual behaviors, and Chlamydia trachomatis (CT), untreated at baseline and concurrent with BV, were covariates in Cox proportional hazards models. Adjusting for the few Neisseria gonorrhoeae and Trichomonas vaginalis cases did not alter results.Results: In multivariable modeling, Nugent-BV (adjusted hazard ratio [aHR], 1.53 [95% confidence interval {CI}, 1.05-2.21]), symptomatic Amsel-BV (aHR, 2.15 [95% CI, 1.23-3.75]), and vaginal douching (aHR, 1.47 [95% CI, 1.03-2.09]) were associated with incident PID.Conclusions: BV was associated with incident PID in a large prospective cohort, controlling for behavioral factors and sexually transmitted infections (STIs). Larger studies on how BV, STIs, behaviors, and host responses interactively affect PID risk are needed. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic has introduced novel stressors into the lives of youth. Identifying factors that protect against the onset of psychopathology in the face of these stressors is critical. We examine a wide range of factors that may protect youth from developing psychopathology during the pandemic. We assessed pandemic-related stressors, internalizing and externalizing psychopathology, and potential protective factors by combining two longitudinal samples of children and adolescents (N = 224, 7–10 and 13–15 years) assessed prior to the pandemic, during the stay-at-home orders, and six months later. We evaluated how family behaviors during the stay-at-home orders were related to changes in psychopathology during the pandemic, identified factors that moderate the association of pandemic-related stressors with psychopathology, and determined whether associations varied by age. Internalizing and externalizing psychopathology increased substantially during the pandemic. Higher exposure to pandemic-related stressors was associated with increases in internalizing and externalizing symptoms early in the pandemic and six months later. Having a structured routine, less passive screen time, lower exposure to news media about the pandemic, and to a lesser extent more time in nature and getting adequate sleep were associated with reduced psychopathology. The association between pandemic-related stressors and psychopathology was reduced for youths with limited passive screen time and was absent for children, but not adolescents, with lower news media consumption related to the pandemic. We provide insight into simple, practical steps families can take to promote resilience against mental health problems in youth during the COVID-19 pandemic and protect against psychopathology following pandemic-related stressors. [ABSTRACT FROM AUTHOR]

Phenomenon: Physician shortages in low- and middle-income countries (LMIC) have led to increased interest in using e-learning tools for training. Organic digital education (ODE)—digital scholarship largely created outside of formal medical curricula—has increased in popularity over the past decade. Medical podcasting has become one of the most prominent asynchronous ODE sources for learners in high-income (HI) countries; there have been no previous attempts to characterize their use in LMIC. Approach: Listener data from a 2-year period from three major internal medicine podcasts—Bedside Rounds, Core IM, and The Curbsiders—were aggregated, 188 episodes in total. These data were subdivided into country by top-level domain, normalized by population, and grouped together by World Bank income levels and English-speaking status. This methodology was also repeated to compare individual episodes on topics more versus less relevant to learners in LMIC. Findings: Over a 2-year period, the three podcasts had a total of 2.3 million unique downloads and were listened to in 192 of 207 countries worldwide. Overall, 91.5% of downloads were in HI countries, with 8.2% in LMIC. A total of 86.1% of listens were in countries with English as an official or unofficial listed language, whereas 13.8% were in countries without. Normalized for population, listeners in HI countries represented 970.5 listens per million population compared with 12.4 per million in LMIC. An analysis of individual episodes by topic showed that material more relevant to learners in LMIC had significantly more listeners from these countries. Insights: Compared with other forms of ODE, medical podcasting has much lower uptake in LMIC. However, there are considerable opportunities for growth. Medical podcasters in HI countries should be aware of a potential global audience and should take concrete steps to ensure a diversity of content and to periodically audit their data. Medical educators in LMIC should consider podcasting as a potentially powerful form of teaching. International medical educational organizations as well as podcasting organizations should provide resources for educators in these countries. [ABSTRACT FROM AUTHOR]

Identification of barriers to adequate health care for sexual minority populations remains elusive given that they are complex and variable across sexual orientation subgroups (e.g. gay, lesbian, bisexual). To address these complexities, we used data from a US nationally representative sample of health-care consumers to assess sexual identity differences in health-care access and satisfaction. We conducted a secondary data analysis of 12 waves (2012–2018) of the biannual Consumer Survey of Health Care Access (n  = 30,548) to assess sexual identity differences in 6 health-care access and 3 health-care satisfaction indicators. Despite parity in health insurance coverage, sexual minorities—with some variation across sexual minority subgroups and sex—reported more chronic health conditions alongside restricted health-care access and unmet health-care needs. Gay/lesbian women had the lowest prevalence of health-care utilization and higher prevalence rates of delaying needed health care and medical tests relative to heterosexual women. Gay/lesbian women and bisexual men were less likely than their heterosexual counterparts to be able to pay for needed health-care services. Sexual minorities also reported less satisfactory experiences with medical providers. Examining barriers to health care among sexual minorities is critical to eliminating health disparities that disproportionately burden this population. [ABSTRACT FROM AUTHOR]

Homophobia is associated with sexual risk among sexual minorities, including Black sexual minority men, though experienced homophobia may differ across sexual identities. We conducted latent class analysis of sexual identities and experienced homophobia associated with sexual risk, and tested mediators of this association. We used longitudinal data from the HIV Prevention Trials Network Study 061 (n = 1,553). We generated rate ratios between baseline latent classes of experienced homophobia and sexual identity and 12-month outcomes: Condomless receptive anal intercourse (CRAI), number of partners, and transactional sex. Mediators included 6-month internalized homophobia, depression, social support, and substance use. We selected the following 7-class model: "Bisexual, rare homophobia" (reference), "Mixed identities, mixed homophobia", "Bisexual, frequent homophobia", "Heterosexual/Same-gender loving, frequent homophobia", "Gay, frequent homophobia", " Gay/Same-gender loving, frequent homophobia," and "Gay, rare homophobia." All other classes had greater CRAI than the reference. For bisexual/mixed/heterosexual classes, approximately 20% of this association was positively mediated through our mediators (p <.05). The Heterosexual/Same-gender loving class had the largest proportion mediated through internalized homophobia. For gay-identifying classes, mediation was marginally significant (.05 < p <.10). Classes of sexual identity and experienced homophobia were associated with CRAI among Black sexual minority men, partially mediated through internalized homophobia, depression, social support, and substance use. [ABSTRACT FROM AUTHOR]

On the Fourth of July, 1860, the New York Times introduced readers to a new persona treading the minstrel boards: Matinées are the order of the day, two at both the Bowerys, at George Christy's, at Bryant's, and at the Palace Gardens. Here "versatile performers" and "talented danseuses" will diversify the hours of patriotic emotion with comic pantomime and grand "Japanese ballets," led by "Little Tommy." Japan has dropped a little into the sere and yellow leaf, perhaps, for the natives, but for the "strangers from the provinces" the land of blacking may still have charms, and we desire that "all such" may understand that the Japan of their dreams will be on exhibition to-night at Miss Laura Keene's Theatre. [ABSTRACT FROM AUTHOR]

Adolescent males who have sex with males (AMSM) are at increased risk of HIV/STI acquisition compared to other adolescents, making sexual risk behaviors in this population a priority public health focus. AMSM experience more victimization (including sexual/partner violence), depression, and substance abuse than their heterosexual counterparts; these may form a syndemic associated with risky sexual behavior. We pooled data from the 2015 and 2017 Youth Risk Behavior Survey, restricted to male students who reported a previous male sexual partner (n = 448). Latent profile analysis was used to identify syndemic profiles, with log-binomial and cumulative complementary log-log models used to test associations with substance use at last intercourse, condomless sex at last intercourse, and the number of sexual partners. Nearly all measures of victimization, depression, and substance use had bivariate associations with greater substance use during sex and more sexual partners. We identified three profiles of AMSM: The profile (n = 55) with the greatest risk factors (evident of a syndemic) had substantially higher prevalence of substance use during sex (aPR = 4.74, 95% CI 3.02, 7.43) and more sexual partners (aPR = 2.45, 95% CI 1.39, 4.31) than the profile with the lowest risk factors (n = 326) after adjusting for confounders. This profile was not associated with condomless sex. We identified a syndemic characterized by victimization, depression, and substance use associated with risky sexual behaviors in a nationally representative sample of AMSM. Comprehensive sexual risk reduction interventions incorporating mental health and substance use are critically important in this population. [ABSTRACT FROM AUTHOR]