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Objectives: The inJectable Antiretroviral feasiBility Study (JABS) aimed to evaluate the implementation of long‐acting regimens in a 'real world' Australian setting, with inclusion of participants with complex medical needs, social vulnerability and/or historical non‐adherence. Methods: JABS was a 12‐month, single‐centre, single‐arm, open‐label phase IV study of long‐acting cabotegravir 600 mg plus rilpivirine 900 mg administered intramuscularly every 2 months to adults with treated HIV‐1 infection. The primary endpoint was the proportion of attendances and administration of injections within a 14‐day dosing window over 12 months, out of the total prescribed doses. Secondary endpoints included proportions of missed appointments, use of oral bridging, discontinuations, virological failures, adverse events and participant‐reported outcomes. A multidisciplinary adherence programme embedded in the clinical service known as REACH provided support to JABS participants. Results: Of 60 participants enrolled by May 2022, 60% had one or more complexity or vulnerability factors identified, including absence of social supports (50%), mental health issues, alcohol or drug use (30%) and financial hardship or instability (13%), among others. Twenty‐seven per cent of participants had historical non‐adherence to antiretroviral therapy. Out of 395 prescribed doses, 97.2% of injections were administered within correct dosing windows at clinic visits. Two courses of short‐term oral bridging were required. The rate of injection site reactions was 29%, the majority being grade 1–2. There were no virological failures, no serious adverse events and only one injection‐related study discontinuation. High baseline treatment satisfaction and acceptability of injections increased by month 12. Those with vulnerability factors had similar adherence to injections as those without such factors. Ninety‐eight per cent of the participants who completed 12 months on the study have maintained long‐acting therapy, virological suppression and retention in care. Conclusions: Long‐acting cabotegravir plus rilpivirine was associated with very high adherence, maintenance of virological suppression, safety and treatment satisfaction in a diverse Australian clinic population, comparable to results of phase III randomized clinical trials. Individuals with vulnerability factors can achieve adherence to injections with individualized support. Long‐acting therapies in this group can increase the subsequent engagement in clinical care. [ABSTRACT FROM AUTHOR]

Galaxy clusters as gravitational lenses play a unique role in astrophysics and cosmology: they permit mapping the dark matter distribution on a range of scales; they reveal the properties of high and intermediate redshift background galaxies that would otherwise be unreachable with telescopes; they constrain the particle nature of dark matter and are a powerful probe of global cosmological parameters, like the Hubble constant. In this review we summarize the current status of cluster lensing observations and the insights they provide, and offer a glimpse into the capabilities that ongoing, and the upcoming next generation of telescopes and surveys will deliver. While many open questions remain, cluster lensing promises to remain at the forefront of discoveries in astrophysics and cosmology. [ABSTRACT FROM AUTHOR]

Background: Fetal alcohol spectrum disorders (FASD), a group of prevalent conditions resulting from prenatal alcohol exposure, affect the maturation of cerebral white matter as first identified with neuroimaging. However, traditional methods are unable to track subtle microstructural alterations to white matter. This preliminary study uses a highly sensitive and clinically translatable magnetic resonance elastography (MRE) protocol to assess brain tissue microstructure through its mechanical properties following an exercise intervention in a rat model of FASD. Methods: Female rat pups were either alcohol‐exposed (AE) via intragastric intubation of alcohol in milk substitute (5.25 g/kg/day) or sham‐intubated (SI) on postnatal days (PD) four through nine to model alcohol exposure during the brain growth spurt. On PD 30, half of AE and SI rats were randomly assigned to either a wheel‐running or standard cage for 12 days. Magnetic resonance elastography was used to measure whole brain and callosal mechanical properties at the end of the intervention (around PD 42) and at 1 month post‐intervention, and findings were validated with histological quantification of oligoglia. Results: Alcohol exposure reduced forebrain stiffness (p = 0.02) in standard‐housed rats. The adolescent exercise intervention mitigated this effect, confirming that increased aerobic activity supports proper neurodevelopmental trajectories. Forebrain damping ratio was lowest in standard‐housed AE rats (p < 0.01), but this effect was not mitigated by intervention exposure. At 1 month post‐intervention, all rats exhibited comparable forebrain stiffness and damping ratio (p > 0.05). Callosal stiffness and damping ratio increased with age. With cessation of exercise, there was a negative rebound effect on the quantity of callosal oligodendrocytes, irrespective of treatment group, which diverged from our MRE results. Conclusions: This is the first application of MRE to measure the brain's mechanical properties in a rodent model of FASD. MRE successfully captured alcohol‐related changes in forebrain stiffness and damping ratio. Additionally, MRE identified an exercise‐related increase to forebrain stiffness in AE rats. [ABSTRACT FROM AUTHOR]

OBJECTIVE: Metformin is the most common treatment for type 2 diabetes (T2D). However, there have been no pharmacogenomic studies for T2D in which a population of color was used in the discovery analysis. This study sought to identify genomic variants associated with metformin response in African American patients with diabetes. RESEARCH DESIGN AND METHODS: Patients in the discovery set were adult, African American participants from the Diabetes Multi-omic Investigation of Drug Response (DIAMOND), a cohort study of patients with T2D from a health system serving southeast Michigan. DIAMOND participants had genome-wide genotype data and longitudinal electronic records of laboratory results and medication fills. The genome-wide discovery analysis identified polymorphisms correlated to changes in glycated hemoglobin (HbA1c) levels among individuals on metformin monotherapy. Lead associations were assessed for replication in an independent cohort of African American participants from Kaiser Permanente Northern California (KPNC) and in European American participants from DIAMOND. RESULTS: The discovery set consisted of 447 African American participants, whereas the replication sets included 353 African American KPNC participants and 466 European American DIAMOND participants. The primary analysis identified a variant, rs143276236, in the gene ARFGEF3, which met the threshold for genome-wide significance, replicated in KPNC African Americans, and was still significant in the meta-analysis (P = 1.17 × 10−9). None of the significant discovery variants replicated in European Americans DIAMOND participants. CONCLUSIONS: We identified a novel and biologically plausible genetic variant associated with a change in HbA1c levels among African American patients on metformin monotherapy. These results highlight the importance of diversity in pharmacogenomic studies. [ABSTRACT FROM AUTHOR]

Background: Recent advances in multi-marker platforms offer faster data generation, but the fidelity of these methods compared to the ELISA is not established. We tested the correlation and predictive performance of SOMAscan vs. ELISA methods for NTproBNP and ST2. Methods: Patients ≥ 18 years with heart failure and ejection fraction < 50% were enrolled. We tested the correlation between SOMA and ELISA for each biomarker and their association with outcomes. Results: There was good correlation of SOMA vs. ELISA for ST2 (ρ = 0.71) and excellent correlation for NTproBNP (ρ = 0.94). The two versions of both markers were not significantly different regarding survival association. The two ST2 assays and NTproBNP assays were similarly associated with all-cause mortality and cardiovascular mortality. These associations remained statistically significant when adjusted for MAGGIC risk score (all p < 0.05). Conclusion: SOMAscan quantifications of ST2 and NTproBNP correlate to ELISA versions and carry similar prognosis. [ABSTRACT FROM AUTHOR]

Climate change is increasingly impacting marine fisheries worldwide. Concurrently, scientific interest has grown to understand how these systems can cope and adapt, with research shifting from examining vulnerability to assessing risks to focusing on determining and operationalizing resilience. As fisheries-climate-resilience researchers and practitioners navigating a sea of frameworks, toolkits, strategies, policy goals, and management desires, we take stock to ask: what does resilience mean to us? Drawing on our experiences in the northeast United States, we discuss the challenges and ambiguity we encounter in concepts of social-ecological resilience and explore implications for research and implementation. We bring together perspectives to discuss various approaches to resilience, highlighting shared and unique challenges we face. We outline three key considerations as we move forward in resilience research and practice: (1) the need for greater transparency and reflexivity among researchers regarding how they frame and approach resilience; (2) the value of increasing coordination and communication among fisheries groups working on these topics; and (3) the use of co-developed and co-produced resilience research and strategies. We urge for greater centring of communities in these discussions and to explicitly consider how resilience interacts with equity outcomes. [ABSTRACT FROM AUTHOR]

In patients with heart failure with reduced ejection fraction (HFrEF), individual responses to beta-blockers vary. Candidate gene pharmacogenetic studies yielded significant but inconsistent results, and they may have missed important associations. Our objective was to use an unbiased genome-wide association study (GWAS) to identify loci influencing beta-blocker survival benefit in HFrEF patients. Genetic variant × beta-blocker exposure interactions were tested in Cox proportional hazards models for all-cause mortality stratified by self-identified race. The models were adjusted for clinical risk factors and propensity scores. A prospective HFrEF registry (469 black and 459 white patients) was used for discovery, and linkage disequilibrium (LD) clumped variants with a beta-blocker interaction of p < 5 × 10−5, were tested for Bonferroni-corrected validation in a multicenter HFrEF clinical trial (288 black and 579 white patients). A total of 229 and 18 variants in black and white HFrEF patients, respectively, had interactions with beta-blocker exposure at p < 5 × 10−5 upon discovery. After LD-clumping, 100 variants and 4 variants in the black and white patients, respectively, remained for validation but none reached statistical significance. In conclusion, genetic variants of potential interest were identified in a discovery-based GWAS of beta-blocker survival benefit in HFrEF patients, but none were validated in an independent dataset. Larger cohorts or alternative approaches, such as polygenic scores, are needed. [ABSTRACT FROM AUTHOR]

Determining whether constituent opinion agrees or disagrees with proposed regulation is crucial to improving our understanding of standard-setting practices. However, the constituent feedback mechanisms provided by regulators to constituents results in large-scale unstructured datasets—thus establishing an obstacle in examining differences of opinion between parties. Utilizing publicly available documents of the FASB, this study trains machine-learning models to efficiently and effectively categorize the level of agreement and disagreement on proposed regulation between the regulator and its constituent base. We employ three different approaches—a lexicon-based approach using the dictionary method and two participant-based approaches leveraging human raters (AMT and AS). We find that the machine-learning models demonstrate more accuracy in correctly classifying observations as compared to human raters. Further, the analysis indicates that the machine-learning models using the participant-based approach and the lexicon-based approach achieve similar accuracy in predicting constituent agreement and disagreement with proposed regulation. Data Availability: Data available upon request. [ABSTRACT FROM AUTHOR]

Genome-wide significant loci for metformin response in type 2 diabetes reported elsewhere have not been replicated in the Diabetes Prevention Program (DPP). To assess pharmacogenetic interactions in prediabetes, we conducted a genome-wide association study (GWAS) in the DPP. Cox proportional hazards models tested associations with diabetes incidence in the metformin (MET; n = 876) and placebo (PBO; n = 887) arms. Multiple linear regression assessed association with 1-year change in metformin-related quantitative traits, adjusted for baseline trait, age, sex, and 10 ancestry principal components. We tested for gene-by-treatment interaction. No significant associations emerged for diabetes incidence. We identified four genome-wide significant variants after correcting for correlated traits (P < 9 × 10−9). In the MET arm, rs144322333 near ENOSF1 (minor allele frequency [MAF]AFR = 0.07; MAFEUR = 0.002) was associated with an increase in percentage of glycated hemoglobin (per minor allele, β = 0.39 [95% CI 0.28, 0.50]; P = 2.8 × 10−12). rs145591055 near OMSR (MAF = 0.10 in American Indians) was associated with weight loss (kilograms) (per G allele, β = −7.55 [95% CI −9.88, −5.22]; P = 3.2 × 10−10) in the MET arm. Neither variant was significant in PBO; gene-by-treatment interaction was significant for both variants [P(G×T) < 1.0 × 10−4]. Replication in individuals with diabetes did not yield significant findings. A GWAS for metformin response in prediabetes revealed novel ethnic-specific associations that require further investigation but may have implications for tailored therapy. [ABSTRACT FROM AUTHOR]

In gravitational lensing, central images in quads can serve as a powerful probe of the inner regions of lens galaxies. The presence of an offset central supermassive black hole (SMBH) has the potential to distort the time-delay surface in a way such that three central images form: a strongly demagnified image near the SMBH, and two less demagnified (and potentially observable) images at a central maximum and saddle point. Using a quad-lens macro-model, we simulate the constraints that could be placed on various lens galaxy parameters based on their central images' probability of detection or non-detection. Informed by a recent low-redshift distribution of off-nucleus active galactic nucleus, we utilize Bayesian inference to constrain the mean SMBH off-nucleus distance and galactic core radius for a sample of six quads. In general, we find that a detection of the central image in any quad would favour larger SMBH off-nucleus distances and galaxy core sizes. Assuming a linear relationship between core radii and velocity dispersion r c = b σ, these results similarly imply strong constraints on b , where the likely case of a central image non-detection in each quad constrains b to |$3.11^{+2.72}_{-2.26} \times 10^{-4}$| kpc km−1 s. Our results show that tight constraints on lens galaxy parameters can be made regardless of a detection or non-detection of a central image. Therefore, we recommend observational searches for the central image, possibly using our suggested novel detection technique in ultraviolet filters, to formalize stronger constraints on lens galaxy parameters. [ABSTRACT FROM AUTHOR]

Fraud cases used in accounting often focus on financial statement frauds affecting large businesses—while asset misappropriation frauds and those affecting governments, nonprofits, and educational organizations receive less attention. This case describes how Judith Oakes stole approximately $3.1 million of lunch money from the Rialto Unified School District. This illustrative example demonstrates how weak controls and a capable employee led to a massive fraud wherein close relationships with administrators allowed the fraudster to perpetrate the fraud for many years. The purpose of this case is to provide a detailed example of an occupational fraud, exposing students to different theories explaining why people engage in fraud beyond the fraud triangle. While analyzing the case, students evaluate the fraud using common fraud theories including the fraud triangle (including several adaptions) as well as economic, psychological, and sociological theories. Furthermore, students will assess and design internal controls to detect, prevent, and deter fraud. [ABSTRACT FROM AUTHOR]

The aim of this research was to examine predictors and characterize causes of suicide death in people with traumatic brain injury (TBI) and conduct sensitivity analyses with and without people whose first diagnosis of TBI occurred within 3 days of their suicide death. This case-control study examined suicide risk for people with TBI in eight Mental Health Research Network–affiliated healthcare systems. Sample 1 included 61 persons with TBI who died by suicide and their 75 matched controls with TBI who did not die by suicide between January 1, 2000, and December 31, 2013. Sample 2 excluded the 34 persons with TBI whose first TBI diagnosis occurred within 3 days of their suicide death and their 46 matched controls. Descriptive statistics characterized the sample stratified by cases and controls, while conditional logistic regression models estimated the adjusted odds of suicide. Over half of suicide deaths occurred within 3 days of a person's first diagnosis of TBI in the larger sample. After excluding these persons, people with TBI were 2.84 (95% confidence interval [CI]: 2.15–2.73) times more likely to die by suicide than were people without TBI. Among those with TBI, men were 16.39 times (95% CI: 1.89–142.15) more likely to die by suicide than were women. Accounting for TBI as a potential consequence of suicide attenuates the association between TBI and suicide, but a robust association persists—especially among men. Ultimately, all people with TBI should be carefully screened and monitored for suicide risk. People with traumatic brain injury (TBI) were at considerably elevated risk for suicide death Men with TBI had significantly increased risk of suicide death compared to women with TBI TBI timing suggests confusion of risk factors for and consequences of suicide [ABSTRACT FROM AUTHOR]

The purpose of this analysis was to systematically review research specific to the transition of students with Specific Learning Disabilities (SLD) and report identified key components of that process along with identifiable gaps to offer information useful for practitioners, families, and others that may be supporting students with SLD during transition. Researchers reviewed thirty years of research since the 1990 addition of transition to IDEA. Fifty-four articles met established inclusion/exclusion criteria specific to students with SLD in the United States. Articles included qualitative and quantitative studies, literature reviews, policy papers, and conceptual frameworks describing effective transition practices and services. Five themes from the literature were identified. Utilizing a historical frame, researchers analyzed the five key themes identified in the context of previously identified key components for transition planning. Recommendations and implications are suggested for future research. [ABSTRACT FROM AUTHOR]

Variability in response to short-acting β2-agonists (e.g., albuterol) among patients with asthma from diverse racial/ethnic groups may contribute to asthma disparities. We sought to identify genetic variants associated with bronchodilator response (BDR) to identify potential mechanisms of drug response and risk factors for worse asthma outcomes. Genome-wide association studies of bronchodilator response (BDR) were performed using TOPMed Whole Genome Sequencing data of the Asthma Translational Genomic Collaboration (ATGC), which corresponded to 1136 Puerto Rican, 656 Mexican and 4337 African American patients with asthma. With the population-specific GWAS results, a trans-ethnic meta-analysis was performed to identify BDR-associated variants shared across the three populations. Replication analysis was carried out in three pediatric asthma cohorts, including CAMP (Childhood Asthma Management Program; n = 560), GACRS (Genetics of Asthma in Costa Rica Study; n = 967) and HPR (Hartford-Puerto Rico; n = 417). A genome-wide significant locus (rs35661809; P = 3.61 × 10–8) in LINC02220, a non-coding RNA gene, was identified in Puerto Ricans. While this region was devoid of protein-coding genes, capture Hi-C data showed a distal interaction with the promoter of the DNAH5 gene in lung tissue. In replication analysis, the GACRS cohort yielded a nominal association (1-tailed P < 0.05). No genetic variant was associated with BDR at the genome-wide significant threshold in Mexicans and African Americans. Our findings help inform genetic underpinnings of BDR for understudied minority patients with asthma, but the limited availability of genetic data for racial/ethnic minority children with asthma remains a paramount challenge. [ABSTRACT FROM AUTHOR]

Introduction An ovarian cancer diagnosis often results in a poor prognosis, with limited effective treatment options and high rates of recurrence. Understandably significant psychosocial distress is experienced. There are few ovarian cancer specific psychosocial models of care that are evidence based and accessible to all. Objectives 1. To describe a telehealth psychosocial support service for people affected by ovarian cancer in Australia. 2. To report on the experiences of psychosocial support among people affected by ovarian cancer. Methods The telehealth psychosocial support service (PSS) at Ovarian Cancer Australia (OCA) was established to address the absence of an ovarian cancer specialised support service in Australia. A PSS questionnaire was sent to those referred to the OCA PSS in 2023 (n=115). In total 49 people completed the questionnaire (42.6% response rate). Questions pertaining to perceived satisfaction and an adapted version of the Clinical Evaluation Questionnaire (CEQ- 2) were included. Results An ovarian specific counselling service was established and implemented. For those who completed the PSS questionnaire, the average age was 65.77 years, were mostly female (96%), resided in urban/metro areas (63%), and had no active disease (53%). Main reasons for accessing support were anxiety, low mood, fear of cancer recurrence and impact of ovarian cancer on relationships. Around 80-90% of people agreed that counselling increased their coping skills and helped them better understand their experience of ovarian cancer. Overall people reported to be satisfied with OCA counselling support and would recommend it to others impacted by ovarian cancer. Conclusions OCA has successfully built an ovarian cancer specific counselling service that is free and accessible to any Australian diagnosed with ovarian cancer and their family. Those accessing the PSS report benefits and would recommend the service to others. These results may assist other oncology services who seek to develop and implement a counselling service. [ABSTRACT FROM AUTHOR]

There are both practical and ethical goals for partnering with communities in the co-production of knowledge for sustainable livelihoods. The benefits of partnering with communities include trust creation, enhanced impact, and improved sustainability of development outcomes. However, for Indigenous groups and ethnic minorities, the barriers and burdens of participation in donor-driven initiatives can be immense. We share our experiences in developing and applying an Ethical Community Engagement (ECE) framework to facilitate the inclusion of poor, marginalised women in two villages in the Bankura district of West Bengal, India. People in Hakimsinan and Chakadoba villages identify as Santhals, the largest Indigenous group in West Bengal, and are recognised as a Scheduled Tribe in the Indian constitution. The framework informed both the design of research activities and the team's interactions with tribal communities. Trialling the framework in an agriculture intensification project that aimed to increase food availability and diversity, and by extension improve nutrition outcomes, created many opportunities to explore more sustainable and culturally appropriate production options. For participating villages, improved agriculture-nutrition links were made but only after local institutions were strengthened. For the broader partnership, the ECE approach presented multiple avenues for cross-learning. We share some of the broader challenges that presented in the course of working this way, providing reflections on the shifts we observed were necessary for the framework to be applied successfully. We conclude with a discussion on navigating the tensions and barriers that transdisciplinary science presents more broadly. [ABSTRACT FROM AUTHOR]

We examined relationships between various sociodemographic factors and attendance at the Glasgow Pain Management Programme (n = 2899 from 2011 to 2019). We tested for associations between gender, age and socioeconomic deprivation of patients who were invited to attend, and uptake to a programme when invited, attendance at screening assessment, eligibility, adherence and attendance at 3- and 6-month reviews. Uptake was significantly higher for patients from more affluent areas (95% confidence interval (CI) = 0.93–0.99, p = 0.002) and for older patients (95% CI = 0.98–0.99, p = 0.006), although effect sizes were very small. Patients were significantly more likely to be assessed as suitable if they were younger (95% CI = 0.98–0.99, p = 0.013) or female (95% CI = 0.55–0.84, p < 0.001). Attendance at sessions and at 3- and 6-month reviews was higher for patients from more affluent areas (95% CI = 1–1.09, p = 0.001, and 95% CI = 1–1.1, p = 0.044 respectively). We argue that there are multiple potential explanations for these findings and that future work should attempt to determine whether these patterns replicate in other populations and to determine any modifiable causes. [ABSTRACT FROM AUTHOR]

We reviewed 140 papers to assess the ecological effectiveness of South Africa's marine protected areas (MPAs). Evidence was assessed for coverage and representivity, protection of important biodiversity areas, other recognised elements of effectiveness, connectivity, and ecological effects—from the scale of individual MPAs to the MPA network scale. We conducted complementary novel analyses to supplement the review and to objectively determine where and how the MPA network can be improved. Evidence shows that South Africa's MPAs now provide some protection to all ecoregions and 87% of ecosystem types but to less than 50% of assessed species groups. MPAs are generally well-sited, but gaps were revealed on the west coast and in estuaries, the deep sea, and two ecologically and biologically significant areas. Enforcement emerged as a key concern, and many MPAs could be improved through expansion or by increasing no-take areas. The majority of relevant papers recorded beneficial ecological effects, detectable as increases in parameters such as the abundance, biomass, sizes or reproductive output of species. Few papers examined whether ecological benefits translate into adjacent fisheries benefits, but all those that did recorded positive effects. Full protection was more effective than partial protection, with effectiveness most clearly demonstrated for vulnerable target taxa. Further research and monitoring to achieve evaluations of effectiveness are recommended, with greater focus on neglected MPAs and species. Understanding the ecological connectivity between MPAs, an important dimension for climate-change adaptation and hence for the persistence and resilience of South Africa's marine biodiversity, is identified as a key area for future research and inclusion in MPA planning. [ABSTRACT FROM AUTHOR]

Nanocomposites have become a new paradigm for thermoelectric research in recent years and have resulted in the reduction of thermal conductivity via the nano-inclusion and grain boundary scattering. In this work, we report the preparation and thermoelectric study of SiGe-yttria stabilized zirconia (YSZ) nanocomposites prepared by Spark Plasma Sintering (SPS). We experimentally investigated the reduction of lattice thermal conductivity (κL) in the temperature range (30-800 K) of n-type Si80Ge20P2 alloys with the incorporation of YSZ nanoparticles (20-40 nm diameter) into the Si-Ge matrix. These samples synthesized by using the SPS technique were found to have densities>95% of the theoretical density. The thermal conductivity, at both low and high temperatures, was measured by steady state and laser flash techniques, respectively. At room temperature, we observed approximately a 50% reduction in the lattice thermal conductivity as result of adding 10% YSZ by volume to the Si80Ge20P2 host matrix. A phenomenological model developed by Callaway was used to corroborate both the temperature dependence and reduction of κL over the measured temperature range (30-800 K) of both Si80Ge20P2 and Si80Ge20P2+YSZ samples. The observed κL is discussed and interpreted in terms of various phonon scattering mechanisms such as alloy disorder, the Umklapp phonon scattering, and boundary scattering. In addition, a contribution from the phonon scattering by YSZ nanoparticles was further included to account for the κL of Si80Ge20P2+YSZ sample. The theoretical calculations are in reasonably good agreement with the experimental results for both the Si80Ge20P2 and Si80Ge20P2+YSZ alloys. [ABSTRACT FROM AUTHOR]

In this paper we focus on a meshfree formulation for the solution of time‐harmonic acoustic scattering problems and verify the stability of the procedure. The sound waves propagate in nonhomogeneous media, giving rise to discontinuities in the gradients of the pressure field across the interfaces between regions of different material properties. Meshfree methods usually do not reproduce accurately the discontinuities in a numerical solution. We overcome this issue by introducing Lagrange multiplier fields defined at the interfaces in order to treat the discontinuities in the gradients of the pressure field. The method does not depend on any kind of adjustable parameter. We show by a numerical study of the applicable inf‐sup conditions that the resulting mixed formulation leads to well‐posed problems. The use of the proposed method is illustrated in the solution of a number of problems of wave propagation through nonhomogeneous media. [ABSTRACT FROM AUTHOR]

Properly executed hand washing by food service employees can greatly minimize the risk of transmitting foodborne pathogens to food and food contact surfaces in restaurants. However, food service employee hand washing is often not done correctly or does not occur as often as it should. The purpose of this study was to assess the relative impact of (i) the convenience and accessibility of hand washing facilities; (ii) the maintenance of hand washing supplies, (iii) multiunit status, (iv) having a certified food protection manager, and (v) having a food safety management system for compliance with proper hand washing. Results revealed marked differences in hand washing behaviors between fast-food and full-service restaurants; 45% of 425 fast-food restaurants and 57% of 396 full-service restaurants were out of compliance for washing hands correctly, and 57% of fast-food restaurants and 78% of full-service restaurants were out of compliance for employee hands being washed when required. Logistic regression results indicated the benefits of accessibility and maintenance of the hand washing sink and of a food safety management system for increasing the likelihood of employees washing hands when they are supposed to and washing them correctly when they do. [ABSTRACT FROM AUTHOR]

Summary: Whole blood cytokine release assays (CRA) assessing cellular immunity to gluten could simplify the diagnosis and monitoring of coeliac disease (CD). We aimed to determine the effectiveness of electrochemiluminescence CRA to detect responses to immunodominant gliadin peptides. HLA‐DQ2·5+ CD adults (cohort 1, n = 6; cohort 2, n = 12) and unaffected controls (cohort 3, n = 9) were enrolled. Cohort 1 had 3‐day gluten challenge (GC). Blood was collected at baseline, and for cohort 1 also at 3 h, 6 h and 6 days after commencing 3‐day GC. Gliadin peptide‐stimulated proliferation, interferon (IFN)‐γ enzyme‐linked immunospot (ELISPOT) and 14‐ and 3‐plex electrochemiluminescence CRA were performed. Poisson distribution analysis was used to estimate responding cell frequencies. In cohort 1, interleukin (IL)‐2 dominated the gliadin peptide‐stimulated cytokine release profile in whole blood. GC caused systemic IL‐2 release acutely and increased gliadin peptide‐stimulated IFN‐γ ELISPOT and whole blood CRA responses. Whole blood CRA after GC was dominated by IL‐2, but also included IFN‐γ, C‐X‐C motif chemokine ligand 10/IFN‐γ‐induced protein 10 (CXCL10/IP‐10), CXCL9/monokine induced by IFN‐γ (MIG), IL‐10, chemokine (C‐C motif) ligand 3/macrophage inflammatory protein 1‐alpha (CCL3/MIP‐1α), TNF‐α and IL‐8/CXCL8. In cohorts 2 and 3, gliadin peptide‐stimulated whole blood IL‐2 release was 100% specific and 92% sensitive for CD patients on a gluten‐free diet; the estimated frequency of cells in CD blood secreting IL‐2 to α‐gliadin peptide was 0·5 to 11 per ml. Whole blood IL‐2 release successfully mapped human leucocyte antigen (HLA)‐DQ2·5‐restricted epitopes in an α‐gliadin peptide library using CD blood before and after GC. Whole blood IL‐2 release assay using electrochemiluminescence is a sensitive test for rare gliadin‐specific T cells in CD, and could aid in monitoring and diagnosis. Larger studies and validation with tetramer‐based assays are warranted. [ABSTRACT FROM AUTHOR]

SYNOPSIS: The Public Company Accounting Oversight Board (PCAOB; Board) maintains that constituent feedback plays an essential and dynamic role in its audit standard-setting process. We examine a major source of constituent feedback, responses to standard-setting questions, using a sample drawn from the original proposals of 14 PCAOB auditing standards. We find that after receiving comment letter feedback to the standard-setting questions, the Board revises approximately half of its guidance tied to those questions. We also explore the related comment letters of eight professional auditing firms subject to the PCAOB's annual inspection program and discover varying levels of opposition to and support for the PCAOB's proposed authoritative guidance. We observe PCAOB revision to authoritative guidance highly contested by the firms in more than three-fourths of cases of standard-setting questions and PCAOB non-revision to guidance highly supported by the firms in more than 90 percent of cases. Data Availability: Publicly available. [ABSTRACT FROM AUTHOR]

Magnetostrictive materials transduce magnetic and mechanical energies and when combined with piezoelectric elements, evoke magnetoelectric transduction for high-sensitivity magnetic field sensors and energy-efficient beyond-CMOS technologies. The dearth of ductile, rare-earth-free materials with high magnetostrictive coefficients motivates the discovery of superior materials. Fe1−xGax alloys are amongst the highest performing rare-earth-free magnetostrictive materials; however, magnetostriction becomes sharply suppressed beyond x = 19% due to the formation of a parasitic ordered intermetallic phase. Here, we harness epitaxy to extend the stability of the BCC Fe1−xGax alloy to gallium compositions as high as x = 30% and in so doing dramatically boost the magnetostriction by as much as 10x relative to the bulk and 2x larger than canonical rare-earth based magnetostrictors. A Fe1−xGax − [Pb(Mg1/3Nb2/3)O3]0.7−[PbTiO3]0.3 (PMN-PT) composite magnetoelectric shows robust 90° electrical switching of magnetic anisotropy and a converse magnetoelectric coefficient of 2.0 × 10−5 s m−1. When optimally scaled, this high coefficient implies stable switching at ~80 aJ per bit. In this work, Meisenheimer et al. use careful epitaxial growth of FeGa thin films to achieve a metastable state with remarkably high magetostrictive coefficients. Materials with strong magnetostrictive properties are vital components in magnetoelectric multiferroic heterostructures, with considerable potential for use a variety of technologies. [ABSTRACT FROM AUTHOR]

Maxwellian approximations to linear general relativity are revisited in light of recent results on the degrees of freedom (DoF) in the linear gravitational field. The well-known Maxwellian formalism obtained in harmonic coordinates is compared with a Maxwellian formalism obtained under a coordinate choice where each of the metric components corresponds to each of the coordinate-invariant DoF of the linear gravitational field. The coordinate freedom of general relativity can be exploited to cast the field equations into Maxwellian form, but such forms can be mere mirages of the coordinate choice—mirages such as vector gravitational waves. A coordinate choice that yields perfectly-Maxwellian field equations, will yield a force equation that is not Lorentzian. If field definitions are chosen to obtain Lorentz-like terms in the force equation, then Maxwellian forms are compromised in the field equations. Many treatments of gravito-electromagnetism will make inconsistent ordering choices between the field equations and force equations, or else truncate terms of relevant order from the force equation. Often such mistakes reflect an attempt to force exact Maxwellian analogs simultaneously in both the field equations and the force equation, with the result that terms dropped are as large as those kept. [ABSTRACT FROM AUTHOR]

The supply of water to a plant canopy is dependent on the xylem pathway connecting roots to leaves. In some plants, sectored xylem pathways can restrict resource distribution, resulting in variable quality of organs in the shoots, yet little is known about the effects of sectoring in crop cultivars. In this study, we combined sap flow measurements and infusion of xylem-specific dyes to document functional conductive area and flow pathways from roots to shoots of 20-year-old Thompson Seedless and 8-year-old Chardonnay grapevines. Sap flow measurements and dye infusion demonstrated that water flowed predominantly in discrete xylem (visually identifiable from the trunk surface) sectors along the trunk axis, each supplying limited portions of the canopy. Functional conductive area in the trunk was proportional to that in the shoots even though sector size varied considerably between vines. Leaf area removal experiments further demonstrated sectoring in grapevines; sap flow decreased by >90 % in trunk sectors connected to excised shoots while it remained constant in trunk sectors supplying intact portions of the canopy. Despite the functional sectoring in grapevines, a high degree of interconnectivity of trunk xylem in the tangential direction was confirmed with synchrotron-based micro-computed tomography (microCT) and dye crossover infusion studies. Fruit attached to dyed canes was also similarly sectored; no clusters exhibited dye on non-dyed canes, while 97 % of clusters attached to dyed canes exhibited dye infusion. The dye travelled down the cluster rachis and appeared to accumulate at the pedicel/berry junction, but only on dyed canes. These findings suggest that xylem in grapevine trunks is integrated anatomically, but functions in a sectored manner due to high axial hydraulic conductivity. The functional sectoring of grapevine xylem documented here has important implications for management practices in vineyards and for fruit cluster uniformity within single grapevine. [ABSTRACT FROM AUTHOR]

Background: Endometriosis (where endometrial-like tissue is found outside the uterus) affects ~ 176 million women worldwide and can lead to debilitating pelvic pain. There is an unmet need for new medical treatment options for endometriosis. Pelvic peritoneal mesothelial cells of women with endometriosis exhibit detrimental metabolic reprogramming that creates an environment favouring the formation and survival of endometriosis lesions. We have generated powerful preclinical proof-of-concept data to show that it is possible to correct this metabolic phenotype using dichloroacetate (DCA), a non-hormonal compound previously used to treat rare metabolic disorders in children. We plan a single-arm, open-label, single site exploratory clinical trial to inform the design of a future randomised controlled trial (RCT) to determine the efficacy of DCA for the treatment of endometriosis-associated pain. Methods: We will recruit 30 women with endometriosis-associated pain over a 6-month period. All participants will receive approximately 6.25 mg/kg oral DCA capsules twice daily for 6 weeks, with a dose increase to approximately 12.5 mg/kg twice daily for a further 6 weeks if their pain has not been adequately controlled on this dose regime and side-effects are acceptable. If pain is adequately controlled with minimal side-effects, the lower dose will be continued for a further 6 weeks. The primary objective is to determine whether it is possible to achieve acceptable recruitment and retention rates within the defined exclusion and inclusion criteria. Secondary objectives are to determine the acceptability of the trial to participants, including the proposed methods of recruitment, treatment, follow-up frequency and number of questionnaires. The recruitment rate will be determined by the proportion of patients recruited from the pool of eligible women. The retention rate will be determined by the proportion of participants who attended the final trial visit. Discussion: This is a feasibility study to explore effectiveness and acceptability of the proposed field methodology (recruitment, retention, study processes and compliance with treatment). The results will be used to inform the design of a future RCT. Trial registration: ClinicalTrials.gov, NCT04046081 Registered 6 August 2019 [ABSTRACT FROM AUTHOR]

Complex trauma histories represent a common characteristic among incarcerated girls. Their childhoods include dysfunctional homes, emotional abuse, sexual and/or physical abuse, and witnessing of violence. Such conditions represent coercive sexual environments (CSEs), a socio-spatial phenomenon that supports continued abuse of girls. CSE studies emerge from urban studies; none has addressed such passages in rural areas. The current study takes place in a primarily rural state, exploring structural and cultural markers of CSEs in rural communities. In-depth interviews with de-identified incarcerated girls and women, as well as with community stakeholders, provide insight into these patterns in non-urban areas. Results confirm three pathways to prison based on resources, culture, and outsider status, all of which propel at-risk rural girls into an abuse-to-prison pipeline. [ABSTRACT FROM AUTHOR]

Background: Healthcare placements in dietetics education contribute significantly to student learning. Exploring students' self‐conceptualisation of placement experiences may provide insights to better support learning. Self‐determination theory (SDT) has been used to seek insight into clinical and educational settings but has not yet been applied to dietetic placement learning. The present study investigated dietetics students' reflections of key influences on placement learning experiences and their alignment with an SDT framework. Methods: A post‐placement two‐stage critical incident debrief was conducted with seven successive cohorts (168 students) of dietetic undergraduate students on final placement. In debriefs, students' anonymous themes were collected and discussed, inductively analysed, and then mapped against an SDT framework of psychological and motivational constructs. Results: Nine key themes were identified that impacted upon placement experiences. Four themes related to framework constructs: (1) Supervisor (and Peer) Autonomy Support; (2) Perceived Competence; (3) Relatedness; and (4) Autonomy and Intrinsic Motivation. Non‐SDT themes were also present, including: (5) Learning Environment and Experience; as well as themes about professional behaviours and identity: (6) Teamwork and Interactions; (7) Managing Emotions and Self‐Care; (8) Dietetic Communications and Behaviours; and (9) Developing a Professional Identity. Conclusions: Embedding a structured debrief in the curriculum and using a psychological motivational SDT framework to analyse themes arising can provide valuable information about the learning needs of students on placement with potential for wider application in dietetic learning and teaching and workforce employability. The current findings may have application in university curricula before and after professional placement. [ABSTRACT FROM AUTHOR]

Despite overall support for law and order, policing in an age of sociopolitical disruption demands community-based strategies. While most well-publicized incidents involve violence, traffic stops remain the most common interaction between police and citizens. This study provides results of a quasi-experiment based on citizens' reactions to traffic stops before and after officer training in a mid-size US town; we also include officer-level data, answering the dearth of both non-urban research and officer effects. Training followed procedural justice (PJ) principles. Findings demonstrate a positive effect of PJ training on citizens' perception of police, though outcome (citation v. warning) matters. Data suggest positive response among officers' attitudes toward PJ, but heterogeneity in behavior. Qualitative data further identified reticence regarding scripts and challenges in dealing with certain populations. Implications suggest that community input, local police culture, and everyday interactions are more important than general perceptions of policing practices. [ABSTRACT FROM AUTHOR]

We provide an analysis and statement of the source term in the classical Kaluza field equations, by considering the 5-dimensional (5D) energy-momentum tensor corresponding to the 5D geodesic hypothesis that is typically presumed in the Kaluza theory. By providing the 5D matter Lagrangian, this work completes a Lagrangian analysis of the classical Kaluza theory that began by establishing the proper form of the unique Kaluza field Lagrangian. This work considers the transformation properties necessitated by general covariance of the Kaluza source terms, to establish the correct form for the source terms in the field equations, and to establish the 5D matter Lagrangian that corresponds to the 5D geodesic hypothesis. In addition to the effects of a scalar field expected from other scalar-tensor or scalar-electromagnetic theories, a peculiar Kaluza coupling coefficient arises for charged matter which acts to vary the source strengths in ways unknown to conventional physics. We briefly evaluate the implied modifications to source terms in the field equations. We find an ADM-like neutralization of gravity at high specific charge states and a saturation in field strength at high specific charge-to-mass ratios. [ABSTRACT FROM AUTHOR]

We present new results regarding the long-range scalar field that emerges from the classical Kaluza unification of general relativity and electromagnetism. The Kaluza framework reproduces known physics exactly when the scalar field goes to one, so we studied perturbations of the scalar field around unity, as is done for gravity in the Newtonian limit of general relativity. A suite of interesting phenomena unknown to the Kaluza literature is revealed: planetary masses are clothed in scalar field, which contributes 25% of the mass-energy of the clothed mass; the scalar potential around a planet is positive, compared with the negative gravitational potential; at laboratory scales, the scalar charge which couples to the scalar field is quadratic in electric charge; a new length scale of physics is encountered for the static scalar field around an electrically-charged mass, L s = μ 0 Q 2 / M ; the scalar charge of elementary particles is proportional to the electric charge, making the scalar force indistinguishable from the atomic electric force. An unduly strong electrogravitic buoyancy force is predicted for electrically-charged objects in the planetary scalar field, and this calculation appears to be the first quantitative falsification of the Kaluza unification. Since the simplest classical field, a long-range scalar field, is expected in nature, and since the Kaluza scalar field is as weak as gravity, we suggest that if there is an error in this calculation, it is likely to be in the magnitude of the coupling to the scalar field, not in the existence or magnitude of the scalar field itself. [ABSTRACT FROM AUTHOR]

We present new results regarding the long-range scalar field that emerges from the classical Kaluza unification of general relativity and electromagnetism. The Kaluza framework reproduces known physics exactly when the scalar field goes to one, so we studied perturbations of the scalar field around unity, as is done for gravity in the Newtonian limit of general relativity. A suite of interesting phenomena unknown to the Kaluza literature is revealed: planetary masses are clothed in scalar field, which contributes 25% of the mass-energy of the clothed mass; the scalar potential around a planet is positive, compared with the negative gravitational potential; at laboratory scales, the scalar charge which couples to the scalar field is quadratic in electric charge; a new length scale of physics is encountered for the static scalar field around an electrically-charged mass, L s = μ 0 Q 2 / M ; the scalar charge of elementary particles is proportional to the electric charge, making the scalar force indistinguishable from the atomic electric force. An unduly strong electrogravitic buoyancy force is predicted for electrically-charged objects in the planetary scalar field, and this calculation appears to be the first quantitative falsification of the Kaluza unification. Since the simplest classical field, a long-range scalar field, is expected in nature, and since the Kaluza scalar field is as weak as gravity, we suggest that if there is an error in this calculation, it is likely to be in the magnitude of the coupling to the scalar field, not in the existence or magnitude of the scalar field itself. [ABSTRACT FROM AUTHOR]

The non-isothermal drying behavior and kinetics of human feces (HF) were investigated by means of thermogravimetric analysis to provide data for designing a drying unit operation. The effect of heating rate and blending with woody biomass were also evaluated on drying pattern and kinetics. At low heating rate (1 K/min), there is effective transport of moisture, but a higher heating rate would be necessary at low moisture levels to reduce drying time. Blending with wood biomass improves drying characteristics of HF. The results presented in this study are relevant for designing non-sewered sanitary systems with in-situ thermal treatment. [ABSTRACT FROM AUTHOR]

Purpose: Studies demonstrating mortality benefit of beta blockers (BB) after myocardial infarction (MI) were conducted before the era of percutaneous intervention and widespread use of statins. Recent retrospective studies show inconsistent results regarding which subgroups of coronary artery disease (CAD) patients' benefit. Most studies did not account for medication changes over time. We evaluated the association of time-varying BB exposure with death in CAD patients with or without a history of MI. Methods: This retrospective cohort study included all patients with MI and those with coronary disease but no MI at a single health care system who also had health insurance from January 1, 1997, to June 30, 2011. Pharmacy claims data were used to estimate BB exposure over 6-month rolling windows. The primary endpoint was all-cause death. The effect of BB exposure was tested using time-updated Cox proportional hazards models. Results: We identified 6220 patients with MI and 21,285 patients with CAD but no MI. Among patients who suffered MI, BB exposure was associated with a 31% relative risk reduction in all-cause death (hazard ratio [HR] 0.69, P = 0.001). Among subjects who survived 3 years after MI, BB retained a protective association (HR 0.71, P = 0.001). Among CAD-only patients, BB exposure was also associated with risk reduction (HR 0.85, P = 0.001). Conclusion: Among patients with CAD, BB exposure is associated with reduced risk of death. The association is strongest among those who have suffered MI. This favorable association appears durable beyond 3 years. [ABSTRACT FROM AUTHOR]

Australian Aboriginal populations have unacceptably high rates of bronchiectasis. This disease burden is associated with high rates of detection of pathogenic bacteria, particularly non-typeable Haemophilus influenzae (NTHi). While there is evidence to suggest that exposure to inorganic particulate matter (PM) is associated with worse respiratory infections, no studies have considered the direct effect of this PM on bacterial growth. Nine clinical isolates of pathogenic NTHi were used for this study. Isolates were exposed to two common iron oxides, haematite (Fe2O3) or magnetite (Fe3O4), or quartz (SiO2), as the main constituents of environmental inorganic PM. NTHi isolates were exposed to PM with varying levels of heme to identify whether the response to PM was altered by iron availability. The maximal rate of growth and maximum supported growth were assessed. We observed that inorganic PM was able to modify the maximal growth of selected NTHi isolates. Magnetite and quartz were able to increase maximal growth, while haematite could both increase and suppress the maximal growth. However, these effects varied depending on iron availability and on the bacterial isolate. Our data suggest that inorganic PM may directly alter the growth of pathogenic NTHi. This observation may partly explain the link between exposure to high levels of crustal PM and chronic bacterial infection in Australian Aboriginals. [ABSTRACT FROM AUTHOR]

We provide an analysis and statement of the source term in the classical Kaluza field equations, by considering the 5-dimensional (5D) energy-momentum tensor corresponding to the 5D geodesic hypothesis that is typically presumed in the Kaluza theory. By providing the 5D matter Lagrangian, this work completes a Lagrangian analysis of the classical Kaluza theory that began by establishing the proper form of the unique Kaluza field Lagrangian. This work considers the transformation properties necessitated by general covariance of the Kaluza source terms, to establish the correct form for the source terms in the field equations, and to establish the 5D matter Lagrangian that corresponds to the 5D geodesic hypothesis. In addition to the effects of a scalar field expected from other scalar-tensor or scalar-electromagnetic theories, a peculiar Kaluza coupling coefficient arises for charged matter which acts to vary the source strengths in ways unknown to conventional physics. We briefly evaluate the implied modifications to source terms in the field equations. We find an ADM-like neutralization of gravity at high specific charge states and a saturation in field strength at high specific charge-to-mass ratios. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to evaluate if a history of falls predicts future postmenopausal fractures and if this prediction variesaccording to frequency, mechanism, and severity of falls and site of fractures. Methods: This study used data from OSTPRE prospective cohort. Total study population consisted of 8744 postmenopausal women (mean age 62.2 years) who responded to postal enquiry in 1999 (baseline) and in 2004 (follow-up). Results: Women were classified by frequency (non/occasional/frequent fallers), mechanism (slip/nonslip), and severity (injurious/ non-injurious) of falls and fractures by site (major osteoporotic/other). A total of 1693 (19.4%) women reported a fall during the preceding 12 months in 1999; 812 a slip fall, 654 a nonslip, 379 an injurious fall, and 1308 a non-injurious fall. A total of 811 women (9.3%) sustained a fracture during the 5-year follow-up period (1999–2004); 431 major osteoporotic fractures and 380 other fractures. Compared with non-fallers, earlier falls predicted subsequent fractures with an OR of 1.41 (95% CI 1.19–1.67, p ≤ 0.001), 1.43 (95% CI 1.14–1.80, p = 0.002) for earlier slip falls, and 1.35 (95% CI 1.04–1.74, p = 0.02) for earlier nonslip falls. Earlier injurious falls predicted future fractures (OR = 1.64, 95% CI 1.21–2.23, p ≤ 0.01), especially other fractures (OR = 1.86, 95% CI 1.24–2.80, p ≤ 0.01), but not major osteoporotic fractures (OR = 1.37, 95% CI 0.89–2.10, p = 0.151). Fracture risk predictions for earlier non-injurious falls was OR = 1.36, 95% CI 1.12–1.64, p = 0.002. These risk patterns remain same after adjustments. Conclusion: History of falls (especially injurious falls) predicts subsequent fractures (mainly other fractures compared with major osteoporotic fractures) inpostmenopausal women. Summary: We aimed to investigate if history of falls (frequency, mechanism, and severity) is a predictor of future fractures in postmenopausal women. Our results indicate that history of falls (especially injurious falls) appeared to be an indicator for subsequent fracture overall. Earlier injurious falls were stronger predictors for future other fractures than for typical major osteoporotic fractures. [ABSTRACT FROM AUTHOR]

Background: Prior research suggests that substance use disorders (SUDs) are associated with risk of suicide mortality, but most previous work has been conducted among Veterans Health Administration patients. Few studies have examined the relationship between SUDs and suicide mortality in general populations. Our study estimates the association of SUDs with suicide mortality in a general US population of men and women who receive care across eight integrated health systems. Methods: We conducted a case–control study using electronic health records and claims data from eight integrated health systems of the Mental Health Research Network. Participants were 2674 men and women who died by suicide between 2000–2013 and 267,400 matched controls. The main outcome was suicide mortality, assessed using data from the health systems and confirmed by state death data systems. Demographic and diagnostic data on substance use disorders and other health conditions were obtained from each health system. First, we compared descriptive statistics for cases and controls, including age, gender, income, and education. Next, we compared the rate of each substance use disorder category for cases and controls. Finally, we used conditional logistic regression models to estimate unadjusted and adjusted odds of suicide associated with each substance use disorder category. Results: All categories of substance use disorders were associated with increased risk of suicide mortality. Adjusted odds ratios ranged from 2.0 (CI 1.7, 2.3) for patients with tobacco use disorder only to 11.2 (CI 8.0, 15.6) for patients with multiple alcohol, drug, and tobacco use disorders. Substance use disorders were associated with increased relative risk of suicide for both women and men across all categories, but the relative risk was more pronounced in women. Conclusions: Substance use disorders are associated with significant risk of suicide mortality, especially for women, even after controlling for other important risk factors. Experiencing multiple substance use disorders is particularly risky. These findings suggest increased suicide risk screening and prevention efforts for individuals with substance use disorders are needed. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate whether the ultrasound appearance of the deltoid muscle in diabetic patients differs from that in obese nondiabetic patients. Methods: Ultrasound images of the deltoid muscle from 137 type 2 diabetic patients (including 13 prediabetic patients) and 49 obese nondiabetic patients were blindly reviewed by 2 musculoskeletal radiologists, and by a third when arbitration was needed, to determine whether the appearance was "normal," "suspected diabetes," or "definite diabetes." Age, sex, race, body mass index (BMI), insulin use, and hemoglobin A1c were analyzed. This retrospective study included patients presenting between October 2005 and November 2017. Statistical analyses included a 2‐sided sample t test or Wilcoxon rank sum test and a χ2 or Fisher exact test. Statistical significance was defined as P <.05. Results: The type 2 diabetic patients included 98 women and 39 men aged 29 to 92 years, and the nondiabetic patients included 19 women and 30 men aged 18 to 75 years. A consensus diagnosis of definite diabetes by the musculoskeletal radiologists based on a hyperechoic deltoid was a powerful predictor of diabetes, with a positive predictive value of 89%. A hyperechoic deltoid was also a powerful predictor of prediabetes. Of the 13 prediabetic patients, all had the same hyperechoic appearance of the diabetic deltoid, regardless of BMI. Although obese diabetic patients more often had a diagnosis of definite diabetes, the BMI alone could not explain the increased echogenicity, as obese nondiabetic patients' deltoid muscles did not appear as hyperechoic and were correctly categorized as not having definite diabetes with 82% specificity. Conclusions: The characteristic hyperechoic deltoid appearance is a strong predictor of both diabetes and prediabetes and differs from that of obese nondiabetic patients. [ABSTRACT FROM AUTHOR]