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Black youth and rural adolescents are two groups who experience asthma disparities. Racism and discrimination in health care likely lead to group-based (systems-level) medical mistrust for some adolescents. Group-based medical mistrust, one pathway by which racism drives health inequities, is associated with poorer outcomes for patients with chronic conditions. Despite its potential importance in adolescent asthma, previous research has not considered group-based medical mistrust in this population. To fill this gap, we characterize group-based medical mistrust among rural adolescents with poorly controlled asthma, examining demographic differences. We analyzed baseline data from a school-based clinical trial in which 164 adolescents (mean age = 16.3; 76.2% Black) completed the Group-Based Medical Mistrust Scale (GBMMS). Using linear regression, we tested associations with race, gender, and age, controlling for recent medical visits and insurance status. The total GBMMS mean score was 2.3 (SD = 1.22); subscale scores ranged from 2.3 to 2.4. Black adolescents reported significantly higher total GBMMS scores (β =.45, p =.003) and significantly higher scores on two GBMMS subscales: suspicion of health care providers (β =.56, p =.007) and lack of support from health care providers (β =.36, p =.007). Gender and age were not associated with GBMMS scores. Health care providers need to consider medical mistrust and its role in their clinical care. Together with their institutions, health care providers and researchers should work toward changing systems that perpetuate racism to build trust as a means of reducing asthma disparities among adolescents. [ABSTRACT FROM AUTHOR]

This article discusses the negative impacts of raptor collisions with human-made structures and vehicles. It highlights the need for further research and conservation efforts to address these collision risks. The article specifically discusses the impacts of vehicle collisions, wind turbine collisions, and window collisions on raptors. It suggests various solutions to mitigate raptor collisions, such as using flight diverters, fencing, and bird-friendly glass. The article also mentions other strategies for mitigating raptor collisions, such as planning power line routes and communication tower placement to avoid migratory corridors. The Raptor Research Foundation is dedicated to resolving raptor conservation concerns and promoting the coexistence of raptor populations with human populations. The given text consists of a list of references to various articles and reports related to raptor mortality in urban landscapes. These sources cover topics such as the impact of wind turbines on raptors, bird-window collisions, road mortality, and the use of citizen science to study raptors. The articles provide insights into the causes of raptor mortality and offer potential mitigation strategies. They highlight the need for further research and conservation efforts to protect raptors in urban environments. [Extracted from the article]

Understanding how human activities affect wildlife is fundamental for global biodiversity conservation. Ongoing land use change and human‐induced climate change, compel species to adapt their behaviour in response to shifts in their natural environments. Such responses include changes to a species' diet or trophic ecology, with implications for the wider ecosystem. This is particularly the case for predatory species or those that occupy high positions within trophic webs, such as raptors. Between 2002 and 2019, we observed 1578 feeding events of the globally near threatened and understudied, Red‐necked Falcon (Falco chicquera) in Bangladesh. We explored the effects of mean monthly temperature, precipitation, temperature differences, and urban land cover on (a) mean prey weights and (b) dietary composition of 15 falcon pairs. Falcons hunted smaller prey items during months with increased temperatures and precipitation, and in more urban areas. However, during months with increased temperature differences, falcons tended to prey on larger prey items. Being specialist aerial hunters, these dietary patterns were largely driven by the probabilities of bats and birds in the diet. Falcons were more likely to prey on bats during warmer and wetter months. Furthermore, urban pairs tended to prey on bats, whereas more rural pairs tended to prey on birds. Mean monthly temperature difference, i.e., a proxy for climate change, was better at explaining the probability of bats in the falcon diet than mean monthly temperature alone. Anthropogenic dietary shifts can have deleterious effects on species with declining populations or those of conservation concern. The effects of urbanisation and human‐induced climate change are expected to continue into the foreseeable future. Therefore, our findings represent a cornerstone in our understanding of how falcons respond to an increasingly human‐dominated world. [ABSTRACT FROM AUTHOR]

Background: Sickle cell disease is the most common human monogenetic disease, and its risks are amplified during pregnancy. Methods: This report describes a 35-year-old woman with HgbSS sickle cell disease who developed hyperhemolysis syndrome after undergoing an exchange transfusion during pregnancy. Results: In addition to conventional medical treatment, the patient received prepartum hyperbaric oxygen therapy (HBOT), totaling 17 treatments for the indication of severe anemia. She experienced significant clinical improvement while undergoing HBOT and ultimately delivered a healthy preterm infant by cesarean section. Conclusions: The risks, benefits, and challenges of using HBOT in this unique context are discussed. [ABSTRACT FROM AUTHOR]

Dietary studies are essential to better understand raptor ecology and resource requirements through time and space, informing species habitat use, interspecific interactions and demographic rates. Methods used to collect data on raptor diets can constrain how dietary analyses can be interpreted. Traditional approaches to study raptor diets, such as analysis of pellets or prey remains, often provide dietary data at the local population level and tend to be restricted to pairs during the breeding season. The increasing use of citizen science data has the potential to provide dietary inferences at larger spatial, demographic and temporal scales. Using web-sourced photography, we explore continental-scale demographic and latitudinal dietary patterns between adult and non-adult Crested Caracaras (Caracara plancus), throughout the species' range across the Americas. We analysed 1,555 photographs of caracaras feeding and found no age effects on the probabilities of different food groups being included in photographs. The probability of reptiles being included in photographs of caracaras from the northern population was significantly higher than those from the southern population, with the opposite pattern for birds. There were significant latitudinal effects with the probabilities of fishes and invertebrates in the diet of northern caracaras increasing towards the equator. Contrastingly, the probability of mammals in the diet increased away from the equator for both populations. Assuming the focal species is well-sampled, web-sourced photography can improve our understanding of raptor diets at large-scales and complements more traditional approaches. This approach is more accessible to raptor researchers without access to the field or expertise in physical prey identification techniques. [ABSTRACT FROM AUTHOR]

Shape transformations of active composites (ACs) depend on the spatial distribution of constituent materials. Voxel-level complex material distributions can be encoded by 3D printing, offering enormous freedom for possible shape-change 4D-printed ACs. However, efficiently designing the material distribution to achieve desired 3D shape changes is significantly challenging yet greatly needed. Here, we present an approach that combines machine learning (ML) with both gradient-descent (GD) and evolutionary algorithm (EA) to design AC plates with 3D shape changes. A residual network ML model is developed for the forward shape prediction. A global-subdomain design strategy with ML-GD and ML-EA is then used for the inverse material-distribution design. For a variety of numerically generated target shapes, both ML-GD and ML-EA demonstrate high efficiency. By further combining ML-EA with a normal distance-based loss function, optimized designs are achieved for multiple irregular target shapes. Our approach thus provides a highly efficient tool for the design of 4D-printed active composites. Researchers have developed a machine learning-empowered voxel-level inverse design approach for complicated shape changes of 4D-printed plates, which paves the way for intelligent design and fabrication for 4D printing and shape-morphing structures [ABSTRACT FROM AUTHOR]

Cardiac complications are a rare but potentially serious consequence of hyperbaric oxygen treatment (HBOT), resulting from increased blood pressure and decreased heart rate and cardiac output associated with treatment. These physiologic changes are generally well-tolerated by patients without preexisting cardiac conditions, although those with known or undetected cardiac disease may be more vulnerable to treatment complications. Currently, there are no universally accepted guidelines for pre-HBOT cardiac screening to identify these patients at heightened risk, leading to variability in practice patterns. In the absence of HBOT-specific evidence, screening protocols might be adapted from the diving medicine community; however, given the important differences in physiological stressors, these may not be entirely applicable to patients undergoing HBOT. Traditional cardiac investigations such as electro- and echo-cardiograms are limited in their ability to detect relevant risk modifying states in the pre-HBOT patient, stymieing their cost-effectiveness as routine tests. In the absence of strong evidence to support routine cardiac investigation, we argue that a comprehensive history and physical exam - tailored to identify high-risk patients based on clinical parameters - may serve as a more practical screening tool. While certain unique patient groups such as those undergoing dialysis or with implanted cardiac devices may warrant specialised assessment, thorough evaluation may be sufficient to identify many patients unlikely to benefit from cardiac investigation in the pre- HBOT setting. A clinical decision-making tool based on suggested low-risk and high-risk features is offered to guide the use of targeted cardiac investigation prior to HBOT. [ABSTRACT FROM AUTHOR]

How well do governments represent the societies they serve? A key aspect of this question concerns the extent to which leaders reflect the demographic features of the population they represent. To address this important issue in a systematic manner, we propose a unified approach for measuring descriptive representation. We apply this approach to newly collected data describing the ethnic, linguistic, religious, and gender identities of over fifty thousand leaders serving in 1,552 political bodies across 156 countries. Strikingly, no country represents social groups in rough proportion to their share of the population. To explain this shortfall, we focus on compositional factors—the size of political bodies as well as the number and relative size of social groups. We investigate these factors using a simple model based on random sampling and the original data described above. Our analyses demonstrate that roughly half of the variability in descriptive representation is attributable to compositional factors. [ABSTRACT FROM AUTHOR]

Introduction: The administration of opioids can be followed by enduring neuroplastic changes in the peripheral and central nervous systems. This remodeling can lead to opioid-induced hyperalgesia, causing an increased sensitivity to painful stimuli. The description of opioid-induced changes in the somatosensory system has seldom been described in the setting of opioid agonist therapy in the treatment of opioid use disorders, and the few existing reports provide no guidance with respect to the effect of varied doses or substances. Objective: The aim of the present study was to assess alterations of pain pathways among patients receiving opioid agonist therapy and to elucidate the dose-response relationship. Methods: This study was planned as cross-sectional in an outpatient clinic in Graz, Austria. Patients receiving opioid agonist therapy for opioid use disorders (including methadone, levomethadone, buprenorphine, and extended-release morphine) were asked to fill out a questionnaire, including the central sensitization inventory. A battery of somatosensory system assessments was then performed. Results: A total of 120 patients participated (85 men/35 women). The mean oral morphine milligram equivalent (MME) was 694 ± 249 mg/day. Our study found significant alterations in pain perception, conditioned pain modulation, and wind-up. We demonstrated a moderate dose-response relationship between high-dose opioids and markers of central sensitization. Conclusion: The present trial demonstrates the clear effects of opioid agonist therapy on the somatosensory system. Both central sensitization and descending pain modulation are negatively affected by high doses of opioids and our data elucidate a moderate dose-response relationship for these phenomena. [ABSTRACT FROM AUTHOR]

A commentary on the 2024 article "Affect, Values and Problems Assessing Decision-Making Capacity," by J. Hawkins is presented. Topics covered include how models, including Hawkins,' tend to fall short, a proposed model of capacity assessment and the possible scenarios following a patient decision. It also discusses the issue of testing bias in capacity assessment.

Background: Hyperbaric oxygen therapy (HBOT) has several hemodynamic effects including increases in afterload (due to vasoconstriction) and decreases in cardiac output. This, along with rare reports of pulmonary edema during emergency treatment, has led providers to consider HBOT relatively contraindicated in patients with reduced left ventricular ejection fraction (LVEF). However, there is limited evidence regarding the safety of elective HBOT in patients with heart failure (HF), and no existing reports of complications among patients with HF and preserved LVEF. We aimed to retrospectively review patients with preexisting diagnoses of HF who underwent elective HBOT, to analyze HBOT-related acute HF complications. Methods: Research Ethics Board approvals were received to retrospectively review patient charts. Patients with a history of HF with either preserved ejection fraction (HFpEF), mid-range ejection fraction (HFmEF), or reduced ejection fraction (HFrEF) who underwent elective HBOT at two Hyperbaric Centers (Toronto General Hospital, Rouge Valley Hyperbaric Medical Centre) between June 2018 and December 2020 were reviewed. Results: Twenty-three patients with a history of HF underwent HBOT, completing an average of 39 (range 6–62) consecutive sessions at 2.0 atmospheres absolute (ATA) (n = 11) or at 2.4 ATA (n = 12); only two patients received fewer than 10 sessions. Thirteen patients had HFpEF (mean LVEF 55 ± 7%), and seven patients had HFrEF (mean LVEF 35 ± 8%) as well as concomitantly decreased right ventricle function (n = 5), moderate/severe tricuspid regurgitation (n = 3), or pulmonary hypertension (n = 5). The remaining three patients had HFmEF (mean LVEF 44 ± 4%). All but one patient was receiving fluid balance therapy either with loop diuretics or dialysis. Twenty-one patients completed HBOT without complications. We observed symptoms consistent with HBOT-related HF exacerbation in two patients. One patient with HFrEF (LVEF 24%) developed dyspnea attributed to pulmonary edema after the fourth treatment, and later admitted to voluntarily holding his diuretics before the session. He was managed with increased oral diuretics as an outpatient, and ultimately completed a course of 33 HBOT sessions uneventfully. Another patient with HFpEF (LVEF 64%) developed dyspnea and desaturation after six sessions, requiring hospital admission. Acute coronary ischemia and pulmonary embolism were ruled out, and an elevated BNP and normal LVEF on echocardiogram confirmed a diagnosis of pulmonary edema in the context of HFpEF. Symptoms subsided after diuretic treatment and the patient was discharged home in stable condition, but elected not to resume HBOT. Conclusions: Patients with HF, including HFpEF, may develop HF symptoms during HBOT and warrant ongoing surveillance. However, these patients can receive HBOT safely after optimization of HF therapy and fluid restriction. [ABSTRACT FROM AUTHOR]

Red-necked Falcons Falco chicquera shift their trophic niche, from eating birds to bats, during the rainy monsoon season. To explore seasonal changes in prey weight, diet composition, and mobbing interactions of the globally Near Threatened Red-necked Falcon in Bangladesh. We analysed long-term direct observations of 19 adult pairs feeding on prey between 2002 and 2019, exploring changes in mean prey weight, prey group, and mobbing interactions throughout the cool dry winter, hot pre-monsoon, and rainy monsoon seasons. The probability of bats being present within the diet increased over time, from 16% in the cool dry winter and 11% in the pre-monsoon hot season, to 48% in the rainy monsoon season. This coincided with a significant decline in mean prey weight and biomass consumed during the rainy monsoon season. Probabilities of falcons being mobbed during feeding varied throughout the seasons, depending on mobbing species. Red-necked Falcons appeared to track changing environments by shifting their trophic niche during the rainy monsoon season. This may be due to: (a) an optimal foraging response to bat population fluxes, itself a response to weather-induced increases in flying insect abundances, (b) opportunistic hunting of bats during periods of crepuscular activity peaks, and/or (c) the energetic demands of fledglings during the rainy monsoon season. [ABSTRACT FROM AUTHOR]

Purpose: Shear-mediated thrombosis is a clinically relevant phenomenon that underlies excessive arterial thrombosis and device-induced thrombosis. Red blood cells are known to mechanically contribute to physiological hemostasis through margination of platelets and vWF, facilitating the unfurling of vWF multimers, and increasing the fraction of thrombus-contacting platelets. Shear also plays a role in this phenomenon, increasing both the degree of margination and the near-wall forces experienced by vWF and platelets leading to unfurling and activation. Despite this, the contribution of red blood cells in shear-induced platelet aggregation has not been fully investigated—specifically the effect of elevated hematocrit has not yet been demonstrated. Methods: Here, a microfluidic model of a sudden expansion is presented as a platform for investigating platelet adhesion at hematocrits ranging from 0 to 60% and shear rates ranging from 1000 to 10,000 s−1. The sudden expansion geometry models nonphysiological flow separation characteristic to mechanical circulatory support devices, and the validatory framework of the FDA benchmark nozzle. PDMS microchannels were fabricated and coated with human collagen. Platelets were fluorescently tagged, and blood was reconstituted at variable hematocrit prior to perfusion experiments. Integrin function of selected blood samples was inhibited by a blocking antibody, and platelet adhesion and aggregation over the course of perfusion was monitored. Results: Increasing shear rates at physiological and elevated hematocrit levels facilitate robust platelet adhesion and formation of large aggregates. Shear-induced platelet aggregation is demonstrated to be dependent on both αIIbβIII function and the presence of red blood cells. Inhibition of αIIbβIII results in an 86.4% reduction in overall platelet adhesion and an 85.7% reduction in thrombus size at 20-60% hematocrit. Hematocrit levels of 20% are inadequate for effective platelet margination and subsequent vWF tethering, resulting in notable decreases in platelet adhesion at 5000 and 10,000 s-1 compared to 40% and 60%. Inhibition of αIIbβIII triggered dramatic reductions in overall thrombus coverage and large aggregate formation. Stability of platelets tethered by vWF are demonstrated to be αIIbβIII-dependent, as adhesion of single platelets treated with A2A9, an anti-αIIbβIII blocking antibody, is transient and did not lead to sustained thrombus formation. Conclusions: This study highlights driving factors in vWF-mediated platelet adhesion that are relevant to clinical suppression of shear-induced thrombosis and in vitro assays of platelet adhesion. Primarily, increasing hematocrit promotes platelet margination, permitting shear-induced platelet aggregation through αIIbβIII-mediated adhesion at supraphysiological shear rates. [ABSTRACT FROM AUTHOR]

During endochondral ossification, chondrocytes secrete a proteoglycan (PG)-rich extracellular matrix that can inhibit the process of cartilage maturation, including expression of Ihh and Col10a1. Because bone morphogenetic proteins (BMPs) can promote cartilage maturation, we hypothesized that cartilage PGs normally inhibit BMP signalling. Accordingly, BMP signalling was evaluated in chondrocytes of wild-type and PG mutant (fam20b-/-) zebrafish and inhibited with temporal control using the drug DMH1 or an inducible dominant-negative BMP receptor transgene (dnBMPR). Compared with wild type, phospho-Smad1/5/9, but not phospho-p38, was increased in fam20b-/- chondrocytes, but only after they secreted PGs. Phospho-Smad1/5/9 was decreased in DMH1-treated or dnBMPR-activated wild-type chondrocytes, and DMH1 also decreased phospho-p38 levels. ihha and col10a1a were decreased in DMH1-treated or dnBMPR-activated chondrocytes, and less perichondral bone formed. Finally, early ihha and col10a1a expression and early perichondral bone formation of fam20b mutants were rescued with DMH1 treatment or dnBMPR activation. Therefore, PG inhibition of canonical BMP-dependent cartilage maturation delays endochondral ossification, and these results offer hope for the development of growth factor therapies for skeletal defects of PG diseases. [ABSTRACT FROM AUTHOR]

Concomitant depression negatively impacts outcomes following total knee arthroplasty (TKA). Patient-Reported Outcomes Measurement Information System (PROMIS) surveys are validated measures that quantify depression, pain, and physical function. We hypothesized that higher preoperative PROMIS-depression scores would be associated with inferior outcomes following TKA. A total of 258 patients underwent primary TKA at a tertiary academic center between June 2018 and August 2020. PROMIS scores were collected preoperatively and at 6 weeks, 3 months, 1 year, and 2 years postoperatively. Patients with preoperative PROMIS depression scores of 55 or greater were considered PROMIS depressed (PD) and patients with scores less than 55 were considered not PROMIS depressed (ND). The primary outcomes were changes in PROMIS scores. Secondary outcomes included total and daily mean morphine milligram equivalents (MME) received during admission as well as 90-day hospital readmission and 2-year all-cause revision rates. There were 66 (25.58%) patients in the PD group and 192 (74.42%) in the ND group. Patients in the PD group had improved depression scores at all follow-up intervals (P<.001) and decreased pain scores at 1 year (P=.016). Both groups experienced similar changes in function scores at each follow-up interval. Patients in the PD group had higher total (P=.176) and daily (P=.433) mean MME use while admitted. Ninety-day hospital readmissions were higher in the PD group (P=.002). There were no differences in 2-year revision rates (P=.648). Preoperative PROMIS-depression scores of 55 or greater do not negatively impact postoperative function, depression, or pain, and patients with these scores have greater improvement in depression and pain at certain intervals. Patients in the PD group had higher readmission rates. [Orthopedics. 2024;47(1):40–45.] [ABSTRACT FROM AUTHOR]

Case: A 12-year-old adolescent boy presented with a proximal fibula fracture and lateral ankle dislocation consistent with a Maisonneuve fracture (MF) associated with a transsyndesmotic ankle dislocation. The dislocation was reduced under conscious sedation in the emergency department. Postreduction imaging studies demonstrated a Tillaux fracture. The patient underwent surgical stabilization of the Tillaux fragment and of the distal tibiofibular syndesmosis. At the 26-month follow-up, the patient remained active without restrictions. Conclusion: Operative treatment of a concurrent MF, Tillaux fracture with lateral ankle dislocation, or a pediatric "logsplitter" injury resulted in satisfactory alignment and function of the ankle joint. [ABSTRACT FROM AUTHOR]

In many jurisdictions, legal frameworks afford patients the opportunity to make prospective medical decisions or to create directives that contain a special provision forfeiting their own ability to object to those decisions at a future time point, should they lose decision‐making capacity. These agreements have been described with widely varying nomenclatures, including Ulysses Contracts, Odysseus Transfers, Psychiatric Advance Directives with Ulysses Clauses, and Powers of Attorney with Special Provisions. As a consequence of this terminological heterogeneity, it is challenging for healthcare providers to understand the terms and uses of these agreements and for ethicists to engage with the nuances of clinical decision‐making with such unique provisions surrounding patient autonomy. In theory, prospective self‐binding agreements may safeguard patient's "authentic" wishes from future "inauthentic" changes of mind. In practice, it is unclear what may be comprised within these agreements or how—and to what effect—they are used. The primary focus of this integrative review is to curate the existing literature describing Ulysses Contracts (and analogous decisions) used in the clinical arena, in order to empirically synthesize their shared essence and provide insights into the traditional components of these agreements when used in practice, the requirements of their consent processes, and the outcomes of their utilization. [ABSTRACT FROM AUTHOR]

Congenital melanocytic nevi (CMN) are rare, pigmented birthmarks that can predispose patients to melanoma of the central nervous system and skin. Data from non‐CMN melanoma cohorts suggest that vitamin D levels may be connected to outcome, prompting this study of 25‐hydroxyvitamin D levels in plasma samples from 40 children with CMN. While 27% were insufficient and 13% deficient, this was representative of European populations, and UK supplementation guidelines are already in place. Our data support routine vitamin D supplementation for all CMN patients during winter months, without routine serum measurement. [ABSTRACT FROM AUTHOR]

To date, studies have not yet established the mechanisms underpinning differences in autistic and non-autistic emotion recognition. The current study first investigated whether autistic and non-autistic adults differed in terms of the precision and/or differentiation of their visual emotion representations and their general matching abilities, and second, explored whether differences therein were related to challenges in accurately recognizing emotional expressions. To fulfil these aims, 45 autistic and 45 non-autistic individuals completed three tasks employing dynamic point light displays of emotional facial expressions. We identified that autistic individuals had more precise visual emotion representations than their non-autistic counterparts, however, this did not confer any benefit for their emotion recognition. Whilst for non-autistic people, non-verbal reasoning and the interaction between precision of emotion representations and matching ability predicted emotion recognition, no variables contributed to autistic emotion recognition. These findings raise the possibility that autistic individuals are less guided by their emotion representations, thus lending support to Bayesian accounts of autism. [ABSTRACT FROM AUTHOR]

Introduction: Phantom limb pain (PLP) refers to pain perceived in a part of the body removed by amputation or trauma. Despite the high prevalence of PLP following amputation and the significant morbidity associated with it, robust therapeutic approaches are currently lacking. Calcitonin, a polypeptide hormone, has recently emerged as a novel analgesic with documented benefits in the treatment of several pain-related conditions. Methods: We present a systematic review that comprehensively evaluates the analgesic effects of calcitonin for patients with PLP. We searched MEDLINE, OLDMEDLINE, and PubMed Central databases with the key words "calcitonin" "phantom limb pain" and "phantom pain" to identify clinical studies evaluating the efficacy or effectiveness of calcitonin administration, in any form and dose, for the treatment of PLP. Additionally, Google Scholar was searched manually with the search term "calcitonin phantom limb pain". All four databases were searched from inception until 1 December 2022. The methodological quality of each included study was assessed using the Downs and Black checklist and the GRADE criteria were used to assess effect certainty and risk of bias. Results: Our search identified 4108 citations, of which six ultimately met the criteria for inclusion in the synthesis. The included articles described a mix of open-label (n = 2), prospective observational cohort (n = 1), and randomized clinical trials (n = 3). The most common treatment regimen in the current literature is a single intravenous infusion of 200 IU salmon-derived calcitonin. Conclusion: The available evidence supported the use of calcitonin as either monotherapy or adjuvant therapy in the treatment of PLP during the acute phase, while the evidence surrounding calcitonin treatment in chronic PLP is heterogeneous. Given the limited treatment options for the management of PLP and calcitonin's relatively wide therapeutic index, further research is warranted to determine the role that calcitonin may play in the treatment of PLP and other pain disorders. [ABSTRACT FROM AUTHOR]

Hyperbaric oxygen therapy (HBOT) is known to be associated with pulmonary oxygen toxicity. However, the effect of modern HBOT protocols on pulmonary function is not completely understood. The present study evaluates pulmonary function test changes in patients undergoing serial HBOT. We prospectively collected data on patients undergoing HBOT from 2016–2021 at a tertiary referral center (protocol registration NCT05088772). Patients underwent pulmonary function testing with a bedside spirometer/pneumotachometer prior to HBOT and after every 20 treatments. HBOT was performed using 100% oxygen at a pressure of 2.0–2.4 atmospheres absolute (203–243 kPa) for 90 minutes, five times per week. Patients' charts were retrospectively reviewed for demographics, comorbidities, medications, HBOT specifications, treatment complications, and spirometry performance. Primary outcomes were defined as change in percent predicted forced expiratory volume in one second (FEV1), forced vital capacity (FVC), and forced mid-expiratory flow (FEF25-75), after 20, 40, and 60 HBOT sessions. Data was analyzed with descriptive statistics and mixed-model linear regression. A total of 86 patients were enrolled with baseline testing, and the analysis included data for 81 patients after 20 treatments, 52 after 40 treatments, and 12 after 60 treatments. There were no significant differences in pulmonary function tests after 20, 40, or 60 HBOT sessions. Similarly, a subgroup analysis stratifying the cohort based on pre-existing respiratory disease, smoking history, and the applied treatment pressure did not identify any significant changes in pulmonary function tests during HBOT. There were no significant longitudinal changes in FEV1, FVC, or FEF25-75 after serial HBOT sessions in patients regardless of pre-existing respiratory disease. Our results suggest that the theoretical risk of pulmonary oxygen toxicity following HBOT is unsubstantiated with modern treatment protocols, and that pulmonary function is preserved even in patients with pre-existing asthma, chronic obstructive lung disease, and interstitial lung disease. [ABSTRACT FROM AUTHOR]

Purpose: Arthrofibrosis after primary total knee arthroplasty (TKA) is a significant contributor to patient dissatisfaction. While treatment algorithms involve early physical therapy and manipulation under anaesthesia (MUA), some patients ultimately require revision TKA. It is unclear whether revision TKA can consistently improve these patient's range of motion (ROM). The purpose of this study was to evaluate ROM when revision TKA was performed for arthrofibrosis. Methods: A retrospective study of 42 TKA's diagnosed with arthrofibrosis from 2013 to 2019 at a single institution with a minimum 2-year follow-up was performed. The primary outcome was ROM (flexion, extension, and total arc of motion) before and after revision TKA, and secondary outcomes included patient reported outcomes information system (PROMIS) scores. Categorical data were compared using chi-squared analysis, and paired samples t tests were performed to compare ROM at three different times: pre-primary TKA, pre-revision TKA, and post-revision TKA. A multivariable linear regression analysis was performed to assess for effect modification on total ROM. Results: The patient's pre-revision mean flexion was 85.6 degrees, and mean extension was 10.1 degrees. At the time of the revision, the mean age of the cohort was 64.7 years, the average body mass index (BMI) was 29.8, and 62% were female. At a mean follow-up of 4.5 years, revision TKA significantly improved terminal flexion by 18.4 degrees (p < 0.001), terminal extension by 6.8 degrees (p = 0.007), and total arc of motion by 25.2 degrees (p < 0.001). The final ROM after revision TKA was not significantly different from the patient's pre-primary TKA ROM (p = 0.759). PROMIS physical function, depression, and pain interference scores were 39 (SD = 7.72), 49 (SD = 8.39), and 62 (SD = 7.25), respectively. Conclusion: Revision TKA for arthrofibrosis significantly improved ROM at a mean follow-up of 4.5 years with over 25 degrees of improvement in the total arc of motion, resulting in final ROM similar to pre-primary TKA ROM. PROMIS physical function and pain scores showed moderate dysfunction, while depression scores were within normal limits. While physical therapy and MUA remain the gold standard for the early treatment of stiffness after TKA, revision TKA can improve ROM. Level of evidence: IV. [ABSTRACT FROM AUTHOR]

Chronic pain is a major source of morbidity for which there are limited effective treatments. Palmitoylethanolamide (PEA), a naturally occurring fatty acid amide, has demonstrated utility in the treatment of neuropathic and inflammatory pain. Emerging reports have supported a possible role for its use in the treatment of chronic pain, although this remains controversial. We undertook a systematic review and meta-analysis to examine the efficacy of PEA as an analgesic agent for chronic pain. A systematic literature search was performed, using the databases MEDLINE and Web of Science, to identify double-blind randomized controlled trials comparing PEA to placebo or active comparators in the treatment of chronic pain. All articles were independently screened by two reviewers. The primary outcome was pain intensity scores, for which a meta-analysis was undertaken using a random effects statistical model. Secondary outcomes including quality of life, functional status, and side effects are represented in a narrative synthesis. Our literature search identified 253 unique articles, of which 11 were ultimately included in the narrative synthesis and meta-analysis. Collectively, these articles described a combined sample size of 774 patients. PEA was found to reduce pain scores relative to comparators in a pooled estimate, with a standard mean difference of 1.68 (95% CI 1.05 to 2.31, p = 0.00001). Several studies reported additional benefits of PEA for quality of life and functional status, and no major side effects were attributed to PEA in any study. The results of this systematic review and meta-analysis suggest that PEA is an effective and well-tolerated treatment for chronic pain. Further study is warranted to determine the optimal dosing and administration parameters of PEA for analgesic effects in the context of chronic pain. [ABSTRACT FROM AUTHOR]

The authors comment on an article by L. Shavelson and colleagues which identifies a key ethical concern associated with medical aid-in-dying (MAiD) laws in the U.S. jurisdictions where the practice is legal. Topics discussed include implications of neuroscience for volition and consent, challenges faced by physicians caring for patients undergoing MAiD, and enabling equity in expressions of volition.

Some scholars build models to classify documents into chosen categories. Others, especially social scientists who tend to focus on population characteristics, instead usually estimate the proportion of documents in each category—using either parametric "classify-and-count" methods or "direct" nonparametric estimation of proportions without individual classification. Unfortunately, classify-and-count methods can be highly model-dependent or generate more bias in the proportions even as the percent of documents correctly classified increases. Direct estimation avoids these problems, but can suffer when the meaning of language changes between training and test sets or is too similar across categories. We develop an improved direct estimation approach without these issues by including and optimizing continuous text features, along with a form of matching adapted from the causal inference literature. Our approach substantially improves performance in a diverse collection of 73 datasets. We also offer easy-to-use software that implements all ideas discussed herein. [ABSTRACT FROM AUTHOR]

This article explores the concept of ecosystem restoration and its significance in addressing the degradation of ecosystems caused by human activities. It emphasizes the benefits provided by ecosystems, such as clean air and water, carbon storage, and biodiversity. The article provides examples of successful restoration projects, including the reintroduction of beavers in England and Scotland and the Great Green Wall project in Africa. It highlights the importance of collaboration with local communities, including Indigenous peoples, in achieving successful restoration efforts. The article also discusses the role of urban ecosystems in cities, presenting examples of restoration projects in Shanghai and Nottingham. It emphasizes the need for swift action and involvement of diverse stakeholders, including young people, in restoration efforts. The article concludes by discussing the Decade on Ecosystem Restoration and its aim to implement restoration projects globally. [Extracted from the article]

Praying mantids (class Insecta, order Mantodea) are a group of predatory insects comprising approximately 2500 described species, that occur across all continents except Antarctica, with the greatest species diversity in tropical and subtropical regions. Mantids predominantly prey on other invertebrates but are known to feed on small vertebrates. During April and May 2021, we observed mantid feeding events in Manujan County, Kerman Province in southern Iran. Two distinct feeding events were observed where female European Mantids (Mantis religiosa) preyed on Purple Sunbird (Cinnyris asiaticus) and Crested Lark (Galerida cristata) nestlings. In addition, we collated information from online searches of mantids feeding on nestlings elsewhere in the world, revealing two more observations. In Taiwan, a Giant Asian Mantid (Hierodula patellifera) was recorded preying on a nestling Warbling White‐eye (Zosterops japonicus) and in Brazil, a mantid (Stagmatoptera sp.) was recorded feeding on a nestling White‐throated Seedeater (Sporophila albogularis). To date, the only existing scientific evidence of praying mantids feeding on passerine nestlings was recorded in 1922. We propose two potential explanations for the observed trophic interactions between mantids and passerine nestlings: (1) during egg production female mantids, especially those in poor physical condition, may opportunistically feed on nestlings in order to increase fecundity via nutrient gain and (2) mantids may initially be attracted toward the nest by parasitic or coprophagous insects, as a result of poor nest sanitation, and subsequently prey on nestlings after detecting movements. Our unusual observations represent the first records of praying mantids feeding on nestling passerines in nearly 100 years. [ABSTRACT FROM AUTHOR]

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Respiratory injury during or following hyperbaric oxygen treatment (HBOT) is rare, but associated pressure changes can cause iatrogenic pulmonary barotrauma with potentially severe sequelae such as pneumothoraces. Pulmonary blebs, bullae, and other emphysematous airspace abnormalities increase the risk of respiratory complications and are prevalent in otherwise healthy adults. HBOT providers may elect to use chest X-ray routinely as a pre-treatment screening tool to identify these anomalies, particularly if a history of preceding pulmonary disease is identified, but this approach has a low sensitivity and frequently provides false negative results. Computed tomography scans offer greater sensitivity for airspace lesions, but given the high prevalence of incidental and insignificant pulmonary findings among healthy individuals, would lead to a high false positive rate because most lesions are unlikely to pose a hazard during HBOT. Post-mortem and imaging studies of airspace lesion prevalence show that a significant proportion of patients who undergo HBOT likely have pulmonary abnormalities such as blebs and bullae. Nevertheless, pulmonary barotrauma is rare, and occurs mainly in those with known underlying lung pathology. Consequently, routinely using chest X-ray or computed tomography scans as screening tools prior to HBOT for low-risk patients without a pertinent medical history or lack of clinical symptoms of cardiorespiratory disease is of low value. This review outlines published cases of patients experiencing pulmonary barotrauma while undergoing pressurised treatment/testing in a hyperbaric chamber and analyses the relationship between barotrauma and pulmonary findings on imaging prior to or following exposure. A checklist and clinical decision-making tool based on suggested low-risk and high-risk features are offered to guide the use of targeted baseline thoracic imaging prior to HBOT. [ABSTRACT FROM AUTHOR]

Among-individual variation in performance on cognitive tasks is ubiquitous across species that have been examined, and understanding the evolution of cognitive abilities requires investigating among-individual variation because natural selection acts on individual differences. However, relatively little is known about the extent to which individual differences in cognition are determined by domain-specific compared with domain-general cognitive abilities. We examined individual differences in learning speed of zebra finches across seven different tasks to determine the extent of domain-specific versus domain-general learning abilities, as well as the relationship between learning speed and learning generalization. Thirty-two zebra finches completed a foraging board experiment that included visual and structural discriminations, and then these same birds went through an acoustic operant discrimination experiment that required discriminating between different natural categories of acoustic stimuli. We found evidence of domain-general learning abilities as birds' relative performance on the seven learning tasks was weakly repeatable and a principal components analysis found a first principal component that explained 36% of the variance in performance across tasks with all tasks loading unidirectionally on this component. However, the few significant correlations between tasks and high repeatability within each experiment suggest the potential for domain-specific abilities. Learning speed did not influence an individual's ability to generalize learning. These results suggest that zebra finch performance across visual, structural, and auditory learning relies upon some common mechanism; some might call this evidence of "general intelligence"(g), but it is also possible that this finding is due to other noncognitive mechanisms such as motivation. [ABSTRACT FROM AUTHOR]

Recycling of waste plastics has become vital due to the threat to the environment the huge piles of those wastes represent, with research revealing High-Density Polyethylene (HDPEs) as the most dominant waste plastics. Because of their dominance and significant environmental impact, this paper reports the economic potential of recycling HDPE waste plastic into liquid fuels via pyrolysis. A risk and benefit assessment are presented to highlight whether the process has reasonable potential prior to the analysis of its corresponding finances. Aspen HYSYS simulation models were used as the basis for the analysis. From this, preliminary cost estimations for the net present value (NPV) of the process, its economic viability, were determined. It is shown that 100 kg/h of waste is not financially sustainable. Retailing the fuel product at a competitive price of £60/barrel would ultimately bankrupt the business. This is a consequence of the extremely high production cost of £198.40/barrel inducing the complete absence of profitability. Furthermore, the operating expenditure is found to be the root cause of the consequential financial decline, totalling £1.46 million per annum. The two most detrimental expenditures for the production cost of the pyrolysis oils were the wages of the skilled operating labour and higher utility fees incurred by the extreme temperature conditions. In addition, an unrealistically optimistic sale price of £300/barrel was also applied to ascertain a positive economic incentive. Even with the increased retail price, the process' profits are negligible and further highlight the detrimental effect of the undesirably high operational expenditures, once more signifying that the process should not commence in its current state. However, executing such a project in developing countries such as Sierra Leone, Senegal, or Kenya where utilities and manpower, among other operational components, are cheaper, is believed to complement the immense opportunity underlying pyrolysis oil production regarding production quantity and quality. [ABSTRACT FROM AUTHOR]

Nest-building behaviour in birds may be particularly relevant to investigating the evolution of physical cognition, as nest building engages cognitive mechanisms for the use and manipulation of materials. We hypothesized that nest-building ecology may be related to physical cognitive abilities. To test our hypothesis, we used zebra finches, which have sex-differentiated roles in nest building. We tested 16 male and 16 female zebra finches on three discrimination tasks in the following order: length discrimination, flexibility discrimination, and color discrimination, using different types of string. We predicted that male zebra finches, which select and deposit the majority of nesting material and are the primary nest builders in this species, would learn to discriminate string length and flexibility-structural traits relevant to nest building-in fewer trials compared to females, but that the sexes would learn color discrimination (not structurally relevant to nest building) in a similar number of trials. Contrary to these predictions, male and female zebra finches did not differ in their speed to learn any of the three tasks. There was, however, consistent among-individual variation in performance: learning speed was positively correlated across the tasks. Our findings suggest that male and female zebra finches either (1) do not differ in their physical cognitive abilities, or (2) any cognitive sex differences in zebra finches are more specific to tasks more closely associated with nest building. Our experiment is the first to examine the potential evolutionary relationship between nest building and physical cognitive abilities. [ABSTRACT FROM AUTHOR]

Alexithymia concerns a difficulty identifying and communicating one's own emotions, and a tendency towards externally-oriented thinking. Recent work argues that such alexithymic traits are due to altered arousal response and poor subjective awareness of "objective" arousal responses. Although there are individual differences within the general population in identifying and describing emotions, extant research has focused on highly alexithymic individuals. Here we investigated whether mean arousal and concordance between subjective and objective arousal underpin individual differences in alexithymic traits in a general population sample. Participants rated subjective arousal responses to 60 images from the International Affective Picture System whilst their skin conductance was recorded. The Autism Quotient was employed to control for autistic traits in the general population. Analysis using linear models demonstrated that mean arousal significantly predicted Toronto Alexithymia Scale scores above and beyond autistic traits, but concordance scores did not. This indicates that, whilst objective arousal is a useful predictor in populations that are both above and below the cut-off values for alexithymia, concordance scores between objective and subjective arousal do not predict variation in alexithymic traits in the general population. [ABSTRACT FROM AUTHOR]

Background: Mild internal jugular vein (IJV) compression, aimed at increasing intracranial fluid volume to prevent motion of the brain relative to the skull, has reduced brain injury markers in athletes suffering repeated traumatic brain injuries. However, an increase in intracranial volume with IJV compression has not been well demonstrated. This study used transorbital ultrasound to identify changes in optic nerve sheath diameter (ONSD) as a direct marker of accompanying changes in intracranial volume.Methods: Nineteen young, healthy adult volunteers (13 males and 6 females) underwent IJV compression of 20 cm H2O low in the neck, while in upright posture. IJV cross-sectional area at the level of the cricoid cartilage, and the change in right ONSD 3 mm behind the papillary segment of the optic nerve, were measured by ultrasound. Statistical analysis was performed using a paired t-test with Bonferroni correction.Results: Mean (SD) cross-sectional area for the right IJV before and after IJV compression was 0.10 (0.05) cm2 and 0.57 (0.37) cm2, respectively (p=0.001). ONSD before and after IJV compression was 4.6 (0.5) mm and 4.9 (0.5) mm, respectively (p=0.001).Conclusions: These data verify increased cerebral volume following IJV compression, supporting the potential for reduced brain 'slosh' as a mechanism connecting IJV compression to possibly reducing traumatic brain injury following head trauma. [ABSTRACT FROM AUTHOR]

Data from wildlife rehabilitation centers (WRCs) can provide on‐the‐ground records of causes of raptor morbidity and mortality, allowing threat patterns to be explored throughout time and space. We provide an overview of native raptor admissions to four WRCs in England and Wales, quantifying the main causes of morbidity and mortality, trends over time, and associations between threats and urbanization between 2001 and 2019. Throughout the study period, 14 raptor species were admitted totalling 3305 admission records. The Common Buzzard (Buteo buteo; 31%) and Tawny Owl (Strix aluco; 29%) were most numerous. Relative to the proportion of breeding individuals in Britain and Ireland, Peregrine Falcons (Falco peregrinus), Little Owls (Athene noctua), and Western Barn Owls (Tyto alba) were over‐represented in the admissions data by 103%, 73%, and 69%, respectively. Contrastingly Northern Long‐eared Owls (Asio otus), Western Marsh Harriers (Circus aeruginosus), and Merlin (Falco columbarius) were under‐represented by 187%, 163%, and 126%, respectively. Across all species, vehicle collisions were the most frequent anthropogenic admission cause (22%), and orphaned young birds (10%) were most frequent natural cause. Mortality rate was highest for infection/parasite admissions (90%), whereas orphaned birds experienced lowest mortality rates (16%). For one WRC, there was a decline in admissions over the study period. Red Kite (Milvus milvus) admissions increased over time, whereas Common Buzzard and Common Kestrel admissions declined. There were significant declines in the relative proportion of persecution and metabolic admissions and an increase in orphaned birds. Urban areas were positively associated with persecution, building collisions, and unknown trauma admissions, whereas vehicle collisions were associated with more rural areas. Many threats persist for raptors in England and Wales, however, have not changed substantially over the past two decades. Threats associated with urban areas, such as building collisions, may increase over time in line with human population growth and subsequent urban expansion. [ABSTRACT FROM AUTHOR]

To date, studies have not established whether autistic and non-autistic individuals differ in emotion recognition from facial motion cues when matched in terms of alexithymia. Here, autistic and non-autistic adults (N = 60) matched on age, gender, non-verbal reasoning ability and alexithymia, completed an emotion recognition task, which employed dynamic point light displays of emotional facial expressions manipulated in terms of speed and spatial exaggeration. Autistic participants exhibited significantly lower accuracy for angry, but not happy or sad, facial motion with unmanipulated speed and spatial exaggeration. Autistic, and not alexithymic, traits were predictive of accuracy for angry facial motion with unmanipulated speed and spatial exaggeration. Alexithymic traits, in contrast, were predictive of the magnitude of both correct and incorrect emotion ratings. [ABSTRACT FROM AUTHOR]

Recent developments suggest that autistic individuals require dynamic angry expressions to have a higher speed in order for them to be successfully identified. Therefore, it is plausible that autistic individuals do not have a 'deficit' in angry expression recognition, but rather their internal representation of these expressions is characterised by very high‐speed movement. In this study, matched groups of autistic and non‐autistic adults completed a novel emotion‐based task which employed dynamic displays of happy, angry and sad point light facial (PLF) expressions. On each trial, participants moved a slider to manipulate the speed of a PLF stimulus until it moved at a speed that, in their 'mind's eye', was typical of happy, angry or sad expressions. Participants were shown three different types of PLFs—those showing the full‐face, only the eye region, and only the mouth region, wherein the latter two were included to test whether differences in facial information sampling underpinned any dissimilarities in speed attributions. Across both groups, participants attributed the highest speeds to angry, then happy, then sad, facial motion. Participants increased the speed of angry and happy expressions by 41% and 27% respectively and decreased the speed of sad expressions by 18%. This suggests that participants have 'caricatured' internal representations of emotion, wherein emotion‐related kinematic cues are over‐emphasised. There were no differences between autistic and non‐autistic individuals in the speeds attributed to full‐face and partial‐face angry, happy and sad expressions respectively. Consequently, we find no evidence that autistic adults possess atypically fast internal representations of anger. Lay Summary: This study shows that autistic and non‐autistic individuals do not differ in the speeds they assign to angry, happy and sad facial expressions. This is important because it means that we know that autistic and non‐autistic individuals picture angry, happy and sad expressions in a similar way in terms of speed. Therefore, autistic individuals' difficulties recognising 'normal speed' angry expressions are not due to differences in the speeds they expect the expressions to be. [ABSTRACT FROM AUTHOR]

Introduction: Hereditary hemorrhagic telangiectasia is an autosomal dominant condition with an estimated prevalence of 1 in 5000. It is characterized by the presence of abnormalities of vascular structures, and may affect many organ systems, including the lungs, brain, spinal cord, gastrointestinal tract, and liver. A causative mutation is identified in approximately 97% of patients with definite hereditary hemorrhagic telangiectasia in one of three genes including a mutation in endoglin, a mutation in a locus mapped to chromosome 5, and an activin receptor-like kinase-1 (ACVRL1) mutation that is associated with an increased incidence of primary pulmonary hypertension. Pulmonary arterial hypertension is a rare (15–25 cases per million people) but severe vascular disorder. Heritable pulmonary arterial hypertension is associated with several gene mutations, with 75% having a mutation in the bone morphogenetic protein receptor 2 (BMPR2). However, the remaining 25% of patients have other associated genetic mutations including ACVLR1, which is also associated with hereditary hemorrhagic telangiectasia. Pulmonary arterial hypertension is a rare complication in patients with hereditary hemorrhagic telangiectasia (< 1% of the hereditary hemorrhagic telangiectasia population). We describe a case report with this rare occurrence. Case presentation: A 70-year-old white/caucasian Irish male presented for screening for hereditary hemorrhagic telangiectasia due to a history of recurrent epistaxis (once/week) and a family history suggestive of pulmonary hypertension. Genetic testing confirmed an ACVRL1 mutation, while an echocardiogram and right heart catheterization confirmed pulmonary arterial hypertension. On examination, he had several mucocutaneous telangiectasia across his face. He was commenced on tadalafil and macitentan. However, this led to increased iron deficiency anemia and pedal edema. Selexipag was also added to his drug regime. He continues to require intermittent admissions for diuresis and blood transfusions. Conclusion: The association of hereditary hemorrhagic telangiectasia and pulmonary arterial hypertension is rare (< 1%). Here we describe a case of hereditary hemorrhagic telangiectasia complicated with pulmonary arterial hypertension as a result of an ACVRL1 mutation. We also describe the clinical challenges of treating these two conditions together, as treatment options for pulmonary arterial hypertension tend to worsen hereditary hemorrhagic telangiectasia symptoms. [ABSTRACT FROM AUTHOR]

Background: The expectation of pandemic-induced severe resource shortages has prompted authorities to draft and update frameworks to guide clinical decision-making and patient triage. While these documents differ in scope, they share a utilitarian focus on the maximization of benefit. This utilitarian view necessarily marginalizes certain groups, in particular individuals with increased medical needs.Main Body: Here, we posit that engagement with the disability critique demands that we broaden our understandings of justice and fairness in clinical decision-making and patient triage. We propose the capabilities theory, which recognizes that justice requires a range of positive capabilities/freedoms conducive to the achievement of meaningful life goals, as a means to do so. Informed by a disability rights critique of the clinical response to the pandemic, we offer direction for the construction of future clinical triage protocols which will avoid ableist biases by incorporating a broader apprehension of what it means to be human.Conclusion: The clinical pandemic response, codified across triage protocols, should embrace a form of justice which incorporates a vision of pluralistic human capabilities and a valuing of positive freedoms. [ABSTRACT FROM AUTHOR]

Background: An increasing body of evidence implicates the resident gut microbiota as playing a critical role in type 2 diabetes (T2D) pathogenesis. We previously reported significant improvement in postprandial glucose control in human participants with T2D following 12-week administration of a 5-strain novel probiotic formulation ('WBF-011') in a double-blind, randomized, placebo controlled setting (NCT03893422). While the clinical endpoints were encouraging, additional exploratory measurements were needed in order to link the motivating mechanistic hypothesis - increased short-chain fatty acids - with markers of disease. Results: Here we report targeted and untargeted metabolomic measurements on fasting plasma (n = 104) collected at baseline and end of intervention. Butyrate and ursodeoxycholate increased among participants randomized to WBF-011, along with compelling trends between butyrate and glycated haemoglobin (HbA1c). In vitro monoculture experiments demonstrated that the formulation's C. butyricum strain efficiently synthesizes ursodeoxycholate from the primary bile acid chenodeoxycholate during butyrogenic growth. Untargeted metabolomics also revealed coordinated decreases in intermediates of fatty acid oxidation and bilirubin, potential secondary signatures for metabolic improvement. Finally, improvement in HbA1c was limited almost entirely to participants not using sulfonylurea drugs. We show that these drugs can inhibit growth of formulation strains in vitro. Conclusion: To our knowledge, this is the first description of an increase in circulating butyrate or ursodeoxycholate following a probiotic intervention in humans with T2D, adding support for the possibility of a targeted microbiome-based approach to assist in the management of T2D. The efficient synthesis of UDCA by C. butyricum is also likely of interest to investigators of its use as a probiotic in other disease settings. The potential for inhibitory interaction between sulfonylurea drugs and gut microbiota should be considered carefully in the design of future studies. [ABSTRACT FROM AUTHOR]