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Polyamines within the cell are tightly regulated by spermidine/spermine N-acetyltransferase (SSAT) enzymes. While several SSATs have been investigated in different bacterial species, there is still a significant gap in knowledge about which proteins are functional SSATs in many organisms. For example, while it is known that Pseudomonas aeruginosa synthesizes the polyamine spermidine, the SSAT that acetylates this molecule and its importance in regulating intracellular polyamines remains unknown. We previously identified a candidate Gcn5-related N-acetyltransferase (GNAT) protein from P. aeruginosa (PA2271) that could fulfill this role since it acetylates spermidine, but no further studies were conducted. Here, we explored the structure/function relationship of the PA2271 protein by determining its X-ray crystal structure and performing enzyme kinetics assays. We also identified active site residues that are essential for catalysis and substrate binding. As the study progressed, we encountered results that led us to explore the importance of four cysteine residues on enzyme activity and disulfide bond formation or modification of cysteine residues. We found these cysteine residues in PA2271 are important for protein solubility and activity, and there is an interrelationship between cysteine residues that contribute to these effects. Furthermore, we also found disulfide bonds could form between C 121 and C 165 and speculate that these residues may contribute to redox regulation of PA2271 protein activity., Competing Interests: Declaration of competing interest One of the authors (WM) notes that he has also been involved in the development of state-of-the-art software, data management, and mining tools; some of them were commercialized by HKL Research and are mentioned in the paper. WM is the co-founder of HKL Research and a member of the board. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed., (Copyright © 2025 The Authors. Published by Elsevier Inc. All rights reserved.)

Background: Inadequate airway management can contribute to preventable trauma deaths. Current machine learning tools for predicting intubation in trauma are limited to adult populations and include predictors not readily available at the time of patient arrival. We developed a Bayesian network to predict intubation in injured children and adolescents using observable data available upon or immediately after patient arrival., Methods: We obtained patient demographic, injury, resuscitation, and transportation characteristics from trauma registries from four American College of Surgeons-verified level 1 pediatric trauma centers from January 2010 through December 2021. We trained and validated a Bayesian network to predict emergent intubation after pediatric injury. We evaluated model performance using the area under the receiver operating and calibration curves., Results: The final model, TITAN (Timing of Intubation in Trauma Analysis Network), incorporated five factors: Glasgow Coma Scale, mechanism of injury, injury type (e.g., penetrating, blunt), systolic blood pressure, and age. The model achieved an area under the receiver operating characteristic curve of 0.83 (95% CI 0.80, 0.85) and had a calibration curve slope of 0.98 (95% CI 0.67, 1.29). TITAN had high specificity (98%), negative predictive value (97%), and accuracy (96%) at a binary probability threshold of 22.6%., Conclusion: The TITAN Bayesian network predicts the risk of intubation in pediatric trauma patients using five factors that are observable early in trauma resuscitation. Prospective validation of the model performance with patient outcomes is needed to assess real-life application benefits and risks., Level of Evidence: Prognostic and Epidemiological, Level III., Competing Interests: Conflicts of interest The authors have no conflict of interest to report., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Previous research suggests that psychological factors play an important role in trying to explain and predict the participation, performance, and health of player and practitioners in soccer. However, most previous works have focused on specific research questions and included samples from male populations. As part of a larger Fédération Internationale de Football Association (FIFA) project aiming to steer women's soccer research, our purpose with this scoping review was to give an overview of the current state of psychology-related research within women's soccer. We searched five electronic databases up to April 2023, from which 280 original peer-reviewed articles met the inclusion criteria. Included records were inductively coded into 75 specific research topics and nine broader research categories. Population characteristics within each topic and category, and overall publication trends, were identified. The results revealed a growth in research attention, with notable increases in publication rates around the international competitions years, over the last two decades. While a notable number of abstracts did not report sufficient details about population age and/or playing levels, senior elite players were identified as the most common population studied. Most studies examined several topics from different research categories, with research focusing on emotions, moods and/or environmental factors, and the specific the topics of anxiety, stress, and coach behavior, receiving most research attention. Our study provides an informative mapping of all psychology-related research activity within women's soccer, which will enhance researchers' understanding of the current quantity of literature within this complex, heterogeneous, and growing area of research.

Objective: Metabolic dysfunction-associated steatotic liver disease (MASLD) and vasomotor symptoms (VMS) are associated with increased cardiovascular disease risk. Although visceral adiposity has been linked to MASLD and VMS independently, this study aimed to evaluate associations between the two in midlife women., Methods: A cross-sectional study of women aged 45-60 years receiving primary care at one of four sites was conducted from March 1 through June 30, 2021. MASLD diagnosis was obtained utilizing the International Classification of Diseases , Ninth Revision and Tenth Revision codes. VMS burden was evaluated with the Menopause Rating Scale and categorized as severe/very severe versus none/mild/moderate. Logistic regression models were used to assess the association between VMS and diagnosed MASLD both univariately and after individually adjusting for several risk factors., Results: A total of 4,599 women were included in the final analysis, 304 (7%) of whom had an MASLD diagnosis. On univariate analysis, women with an MASLD diagnosis were more likely to have severe/very severe VMS (odds ratio [OR], 1.50; 95% CI, 1.08-2.08; P = 0.015). However, the association between MASLD diagnosis and severe/very severe VMS was no longer statistically significant after individually adjusting for body mass index (adjusted OR, 1.36; 95% CI, 0.97-1.92) and hypertension (adjusted OR, 1.38; 95% CI, 0.99-1.93)., Conclusions: The relationship between MASLD and VMS appears to be best explained by other variables including BMI and hypertension. Although they do not appear to be directly linked, given the prevalence of bothersome VMS in midlife women, addressing VMS may enable greater adherence to lifestyle modifications as part of MASLD management., Competing Interests: Financial disclosure/conflicts of interest: E.K. has been a consultant for Astellas Pharma Inc, Mithra Pharmaceuticals, Scynexis, Inc, and Womaness. She receives grant support from Mithra Pharmaceuticals. She has received payment for development of educational content from Med Learning Group and Academy of Continued Healthcare Learning. She has received honoraria for CME activity from CogniMed Inc, Pri-Med, AiCME, and OBG Management. M.B.W. has been a consultant for Verily, Boston Scientific, Endiatix, Fujifilm, Medtronic, and Surgical Automations. He receives grants support from Fujifilm, Boston Scientific, Olympus, Medtronic, Ninepoint Medical, and Cosmo/Aries Pharmaceuticals. He has stock/stock options in Virgo Inc and Surgical Automations. He has been consulting on behalf of Mayo Clinic for Boston Scientific, Microtek. He receives general payments/minor food and beverage from Synergy Pharmaceuticals, Boston Scientific, and Cook Medical. J.M.K. received honorarium from Everyday Health, Evolve, Medscape, and AiCME. She serves as the medical editor for Everyday Health CME and received non-CME honorarium for Medscape, Contemporary Forums, Evolve Medical Education, AiCME, Elsevier, Vindico Medical Education, EPG Health, APS, and Paradise Valley Country Club. S.S.F. received honoraria for CME activity from Pri-Med and Medscape and has been a consultant for Modern Inc. The other authors have nothing to disclose., (Copyright © 2024 by The Menopause Society.)

Background & Aims: Patients with inflammatory bowel disease (IBD) are at an increased risk for vaccine-preventable diseases, such as herpes zoster (HZ). The aim of this study was to determine whether complications of HZ are more frequent in patients with IBD than in non-IBD controls., Methods: This was a retrospective, cohort study using the Optum Research Database. Patients with IBD were matched 1:1 to non-IBD controls based on age, sex, and index year, which was defined as the diagnosis of HZ. We then identified the complications of HZ that occurred up to 90 days after the index date. We compared patients with IBD with non-IBD controls and evaluated the 90-day risk of HZ complications. We used a composite primary outcome for any HZ complication. Secondary outcomes were risk factors for complications., Results: A total of 4756 patients with IBD met the inclusion criteria and were matched to the controls. Patients with IBD were more likely to have complications of HZ than controls (738 [15.52%] vs 595 [12.51%]; P < .0001). Patients with IBD with higher comorbidity scores were more likely to develop complications (1.86 vs 1.18; P < .0001). In the logistic regression analysis of patients with IBD having a higher comorbidity score, above 50 years of age, on anti-tumor necrosis factor (TNF) or corticosteroids were all at increased risk of a complication of HZ., Conclusion: Patients with IBD are more likely to have complications of HZ than controls. Efforts are needed to increase HZ vaccine uptake to reduce the morbidity of HZ., (Copyright © 2025 AGA Institute. Published by Elsevier Inc. All rights reserved.)

Background: Deep brain stimulation (DBS) has emerged as an important therapeutic intervention for neurological and neuropsychiatric disorders. After initial programming, clinicians are tasked with fine-tuning DBS parameters through repeated in-person clinic visits. We aimed to evaluate whether DBS patients achieve clinical benefit more rapidly by incorporating remote internet-based adjustment (RIBA) of stimulation parameters into the continuum of care., Methods: We conducted a randomized controlled multicenter study (ClinicalTrails.gov NCT05269862) involving patients scheduled for de novo implantation with a DBS System to treat Parkinson's Disease. Eligibility criteria included the ability to incorporate RIBA as part of routine follow-up care. Ninety-six patients were randomly assigned in a 1:1 ratio using automated allocation, blocked into groups of 4, allocation concealed, and no stratification. After surgery and initial configuration of stimulation parameters, optimization of DBS settings occurred in the clinic alone (IC) or with additional access to RIBA. The primary outcome assessed differences in the average time to achieve a one-point improvement on the Patient Global Impression of Change score between groups. Patients, caregivers, and outcome assessors were not blinded to group assignment. Most of the data collection took place in the patient's home environment., Results: Access to RIBA reduces the time to symptom improvement, with patients reporting 15.1 days faster clinical benefit (after 39.1 (SD 3.3) days in the RIBA group (n = 48) and after 54.2 (SD 3.7) days in the IC group (n = 48)). None of the reported adverse events are related to RIBA., Conclusions: This study demonstrates safety and efficacy of internet-based adjustment of DBS therapy, while providing clinical benefit earlier than in-clinic optimization of stimulation parameters by increasing patient access to therapy adjustment., Competing Interests: Competing interests: The authors declare the following competing interests: Author AG was supported by the German Federal Ministry of Education and Research (BMBF), the European Union Joint Program – Neurodegenerative Disease Research (JPND), and by research grants from Medtronic, Abbott, Boston Scientific, all of which were unrelated to this work. Author SG reports research funding from the German Federal Ministry of Education and Research (BMBF), Deutsche Forschungsgemeinschaft (DFG), UM Mainz, Abbott, Boston Scientific, Böhringer Foundation, Magventure, Precisis, and Innovationsfond GBA. He received consulting fees from Abbott, Abbvie, Bial, BVDN, IPSEN, Stada, and UCB. Author MNG has received advisory/consulting fees from Abbott and clinical research support from Abbott. Author AS was supported by the Deutsche Forschungsgemeinschaft (TRR 295) and Brunhilde Moll Foundation unrelated to this research. He received consulting fees from Abbott, Zambon, and Abbvie, and speaker honoraria from bsh medical communication, Abbott, Kyowa Kirin, Novartis, Abbvie, and Alexion, GE Healthcare. He received an editor’s fee from Georg Thieme Verlag. Author LMD was supported by the “Río Hortega” program (CM21/00051) from the Instituto de Salud Carlos III. Author VLM has received travel grant from Bial, and speaker’s fees from Bial, Abbvie and Britannia which are unrelated to this work. Author JK received funding support from Abbott, receives honoraria for consulting services and advisory boards from Abbott and Abbvie. Author RA reports speaker fees in training courses from Abbott. Author MSF reports receiving a yearly grant from the Parkinson’s Foundation unrelated to this research. Author MJS has received advisory/consulting fees from AbbVie, Abbott, Amneal Pharmaceuticals, Merz therapeutics, Medtronic, Neurocrine, Supernus. He has received research support from AbbVie, Cerevel therapeutics, CND Lifesciences, Jazz Pharmaceuticals, Praxis Precision Medicine, Scion, and Teva. He has served on the speaking bureau for AbbVie, Amneal pharmaceuticals, and Kyowa Kiran. He has also received grant support from the HDSA. Author LL has received research grant from Beth Israel Deaconess Medical Center and served on the scientific advisory board for Mitsubishi Tanabe Pharma, all of which are unrelated to this work. Author BLW reports grant Support from Parkinson’s Foundation, Consulting/Speaking fees from Abbott, Boston Scientific, Teva, Medtronic. Author CW reports receiving consulting fees from Abbott, Medtronic, Boston Scientific. Author HL reports speaking fees for Teva Pharmaceuticals. Authors MC, YP, BB, and BC are Abbott employees. Author CL has received educational grants from Medtronic, Abbott, Boston Scientific, and Amneal and has served as consultant for Abbott and Boston Scientific and Abbvie. Author DW has received study support, speaker honoraria and travel grants from Abbott, Medtronic, Boston Scientific and has served as consultant of Abbott including remote technology. Authors LZ, SEZ, and DMH declares no competing interests. This study was funded by Abbott. Abbott provided technical support and participated in the study design and data analysis and aided in drafting the manuscript in collaboration with the academic authors., (© 2025. The Author(s).)

The balance of operational readiness and maintaining a healthy recruitment force presents increasing challenges within the DoD. Chronic preventable diseases, such as overweight and obesity, along with musculoskeletal injuries, are threats to recruitment and retention. Novel approaches are needed and leaders are in a unique position to serve a key role in influencing nutrition readiness. Leader-Inspired Nutrition (LIN) is a proposed framework that equips leaders with strategies for building a culture of health. Leader-Inspired Nutrition provides an approach leaders can leverage within units to improve health and performance. The LIN framework was developed from relevant and evidence-based information through collaboration with key nutrition subject matter experts and leaders. The 7 core pillars of LIN are to integrate nutrition basics, model top-down nutrition behaviors, promote a performance-focused food environment, integrate dietary supplements knowledge, consider economic factors that affect nutrition choices, evaluate Total Force Fitness impact, and promote utilization of DoD wellness resources. Each pillar provides leaders with a practical approach to engaging service members while encouraging nutrition readiness. As leaders engender trust and serve as role models, the adoption of the LIN framework in their units can guide and foster a culture of health within the DoD. Leader-Inspired Nutrition will assist leaders in building shared communities through healthful nutrition and mealtime experiences and serve to shape military nutrition policies that affect readiness within the DoD. This commentary describes the concept of LIN, the elements and principles of LIN, and how leaders can inspire service members to maximize performance to support nutrition readiness., (Published by Oxford University Press on behalf of the Association of Military Surgeons of the United States 2025. This work is written by (a) US Government employee(s) and is in the public domain in the US.)

Molecular breast imaging (MBI) is a functional imaging modality that utilizes technetium 99m sestamibi radiotracer uptake to evaluate the biology of breast tumors. Molecular breast imaging can be a useful tool for supplemental screening of women with dense breasts, for breast cancer diagnosis and staging, and for evaluation of treatment response in patients with breast cancer undergoing neoadjuvant systemic therapy. In addition, MBI is useful in problem-solving when mammography and US imaging are insufficient to arrive at a definite diagnosis and for patients who cannot undergo breast MRI. Based on the BI-RADS lexicon, a standardized lexicon has been developed to aid radiologists in MBI reporting. In this article, we review MBI equipment, procedures, and lexicon; clinical indications for MBI; and the radiation dose associated with MBI., (© Society of Breast Imaging 2024. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)

Background: To prevent child abuse, efforts are needed to identify potentially unhealthy parenting behaviors., Objective: To assess the proportion of parents with potentially unhealthy parenting attitudes and behaviors who receive parenting support., Participants and Setting: Parents of children ages 6 months to 10 years completed a survey in a pediatric clinic serving low-income families in Nashville Tennessee., Methods: Measures included parents' attitudes toward spanking (Attitudes Toward Spanking (ATS)) and parents' discipline practices (Quick Parenting Assessment (QPA)). Higher ATS and QPA scores indicate increased use of potentially unhealthy parenting. We assessed associations between the ATS and QPA and sociodemographic factors. We performed a blinded chart review to identify parents who received some type of parenting support, either education in clinic or referral to a parenting class., Results: 807 parents completed the survey. 59 % had a low ATS score, 35 % had a medium ATS score, and 5 % had a high ATS score. 54 % had a low QPA score, 24 % had a medium QPA score, and 22 % participants had a high QPA score. Elevated QPA scores were associated with the parent being unmarried and having other children. Overall, 13 % of parents received education about parenting and 2 % were referred to a parenting class. For parents with either elevated ATS scores or QPAs, <20 % received some type of parenting support., Conclusions: Pediatric health care providers are missing opportunities to support parents in their use of healthy discipline behaviors. The findings have implications for the prevention of child abuse and other health problems., Competing Interests: Declaration of competing interest Dr. Scholer is an author of the Quick Parenting Assessment and the Play Nicely program, both owned by Vanderbilt University., (Copyright © 2025 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Proper personal protective equipment (PPE) use is critical to prevent disease transmission to healthcare providers, especially those treating patients with a high infection risk. To address the challenge of monitoring PPE usage in healthcare, computer vision has been evaluated for tracking adherence. Existing datasets for this purpose, however, lack a diversity of PPE and nonadherence classes, represent single not multiple providers, and do not depict dynamic provider movement during patient care. We introduce the Resuscitation Room Personal Protective Equipment (R2PPE) dataset that bridges this gap by providing a realistic portrayal of diverse PPE use by multiple interacting individuals in a healthcare setting. This dataset contains 26 videos, 10,034 images and 123,751 bounding box annotations for 17 classes of PPE adherence and nonadherence for eyewear, masks, gowns, and gloves, and one additional head class. Evaluations using newly proposed metrics confirm R2PPE exhibits higher annotation density than three established general-purpose and medical PPE datasets. The R2PPE dataset provides a resource for developing computer vision algorithms for monitoring PPE use in healthcare., Competing Interests: Competing interests: The authors declare no competing interests., (© 2025. The Author(s).)

Background: Research supports the use of mobile phone apps to promote medication adherence, but the use of and satisfaction with these apps among medically underserved patients with chronic illnesses remain unclear., Objective: This study reports on the overall use of and satisfaction with a medication adherence app (Medisafe) in a medically underserved population., Methods: Medically underserved adults who received care for one or more chronic illnesses at a federally qualified health center (FQHC) were randomized to an intervention group in a larger randomized controlled trial and used the app for 1 month (n=30), after which they completed a web-based survey. Objective data on app usage were provided as secondary data by the app company., Results: The participants were very satisfied with the app, with all participants (30/30, 100%) somewhat or strongly agreeing that they would recommend the app to family and friends. Participants strongly agreed (28/30, 93%) that the reminders helped them remember to take their medications at the correct time each day, and they (28/30, 93%) found the app easy to use. Additional features accessed by some included educational features and the adherence report. Participants noted the helpfulness of having a medication list on their phones, and some used it during medication reconciliation at doctor visits. Use of the Medfriend feature, which alerts a social support person if a medication is missed, was low (n=2), but those who used it were very positive about the feature., Conclusions: A commercially available medication adherence app was found to be useful by participants, and they were satisfied with the app and the additional features provided. The use of medication adherence mobile phone apps has the potential to positively influence chronic disease management in a medically underserved population on a large scale., Trial Registration: ClinicalTrials.gov NCT05098743; https://clinicaltrials.gov/study/NCT05098743., (©Christa Hartch, Mary S Dietrich, B Jeanette Lancaster, Shelagh A Mulvaney, Deonni P Stolldorf. Originally published in JMIR Human Factors (https://humanfactors.jmir.org), 07.01.2025.)

Background: Obstructive sleep apnoea (OSA) is associated with hypertension, and OSA treatment can reduce systolic blood pressure (SBP) and diastolic blood pressure (DBP), but with a modest mean effect size and vast heterogeneity among studies. The aim of this individual patient data (IPD) meta-analysis was to understand which OSA phenotypes could benefit the most in terms of BP reduction., Methods: A systematic review of randomised controlled trials that compared continuous positive airway pressure (CPAP) with either passive or active treatment was conducted. Studies were eligible if they included adult patients with OSA diagnosed by full polysomnography or cardiorespiratory polygraphy (defined as apnoea-hypopnoea index >5 events·h -1 ) and if BP was measured both before and after CPAP treatment., Results: In total, 36 parallel studies (n=9434 patients) were included. CPAP treatment was associated with BP reduction in patients with uncontrolled office SBP only, while BP was not reduced by CPAP in patients with controlled BP (SBP -2.6 versus 0 mmHg; p<0.0001; DBP -1.7 versus -1 mmHg; p=0.091). Differences were seen also when BP changes were compared between patients aged ≤60 versus >60 years after multiple imputation only (p=0.0127 for SBP and p=0.017 for DBP). No differences were seen in terms of BP reduction when comparing patients with/without severe nocturnal hypoxia., Conclusions: This IPD meta-analysis of the BP effects of OSA treatment with CPAP shows that OSA patients with uncontrolled BP at baseline benefit the most from CPAP therapy in terms of BP reduction. These results have important implications for the decision on how to best manage arterial hypertension associated with OSA., Competing Interests: Conflict of Interest: E.I. Schwarz reports grants from Löwenstein Medical AG, Philips and LUNGE Zürich. P.A. Cistulli reports grants or contracts from ResMed, ResMed Foundation and SomnoMed for the provision of grant funds or equipment for investigator-initiated research, consulting fees from ResMed (paid to institution), and SomnoMed, Signifier Medical, Bayer and Sunrise (paid to consultant), and payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from SomnoMed (paid to speaker). L.F. Drager reports grants from FAPESP (Brazilian Funding Agency; grant 2019/23496-8) and consulting fees from ResMed (consultant for real-world data on PAP telemonitoring). C. Fava reports payment or honoraria for lectures, presentations, manuscript writing or educational events from Menarini and Novartis. M.S.M. Ip reports grants from Li Ka Shing Foundation. T. Quinnell reports grants from the UK NIHR for the PAPMAT study, with payments to their institution only, fees for an educational talk on sleep apnoea at Cambridge University Medical School, and a consultancy agreement with Jazz Pharma UK Ltd that included services in return for registration, accommodation, travel and subsistence at the World Sleep Conference in Rome; T. Quinnell is the President and then Past President of the British Sleep Society (unpaid), and the Chair of the Sleep Apnoea Specialty Advisory Group for the British Thoracic Society, and is also the Director of their own company, TNQ Medical Ltd, where they conduct private medical work. The remaining authors have no potential conflicts of interest to disclose., (Copyright ©The authors 2025. For reproduction rights and permissions contact permissions@ersnet.org.)

The Riverine Barrier Hypothesis posits that species distributions are limited by large rivers acting as geographical barriers. Accordingly, large rivers have long been thought to be a major driver of the extensive speciation and high levels of biodiversity among platyrrhine primates in South and Central America. Direct observations of river crossings provide evidence that complements studies of genetic diversity that can together shed new light on this hypothesis. Here, we discuss recent video evidence of howler monkeys successfully swimming across the Rupununi River in Guyana and the Panama Canal. The footage clearly reveals that howler monkeys can and do cross such bodies of water. These video observations help to refine questions about the species and circumstances under which rivers are barriers to gene flow. We end by joining other scientists who call for increased collaborations with local people living near river crossing sites to improve our knowledge and understanding of the frequency, contexts, and traits of the rivers and animals that characterize river crossings. Local knowledge provides new answers and helps refine questions about the river barrier hypothesis., (© 2025 The Author(s). American Journal of Primatology published by Wiley Periodicals LLC.)

The Breast Imaging Reporting and Data System (BI-RADS) category 3 assessment is used for breast imaging findings considered "probably benign," with less than a 2% likelihood of malignancy. It is used to increase specificity by decreasing the number of breast biopsies. It has been validated for mammography, breast US, and emerging indications for use in contrast-enhanced breast MRI. Despite the long-term use of category 3 and numerous published studies that evaluate characteristic imaging findings appropriate for this category, there is still misuse and confusion regarding its accurate use. Imaging findings classified as category 3 require short-term follow-up to assess stability and identify changes that may warrant a biopsy for early diagnosis of breast cancer. Category 3 should not be used in a screening study without a comprehensive diagnostic evaluation that may reveal suspicious features or downgrade a finding to benign. In mammography, category 3 findings are validated for grouped round calcifications, oval circumscribed masses, and nonpalpable asymmetries. In US, category 3 can be applied to oval circumscribed parallel solid masses and complicated cysts. Category 3 can be assigned to clustered microcysts when they are very small or deep in the breast. Recent studies have yielded characteristic findings appropriate for MRI category 3 that are expected to be included in the sixth edition of the BI-RADS atlas. These include oval circumscribed masses with associated T2-hyperintense signal, focal non-mass enhancement, and foci of enhancement with associated T 2-hyperintense signal. Surveillance with short-interval imaging enables radiologists to monitor findings and act early when a change is detected. © RSNA, 2024 Supplemental material is available for this article. See the invited commentary by Cohen and Leung.

Background: Despite local and national recommendations, health care provider adherence to personal protective equipment (PPE) varied during the COVID-19 pandemic. Previous studies have identified factors influencing initial PPE adherence but did not address factors influencing behaviors leading to correction after initial nonadherence., Methods: We conducted a retrospective video review of 18 pediatric resuscitations involving aerosol-generating procedures from March 2020 to December 2022 to identify factors associated with nonadherence correction. We quantified adherent and nonadherent providers, instances of PPE nonadherence, and time to correction. We also analyzed correction behaviors, including provider actions and correction locations., Results: Among 434 providers, 362 (83%) were nonadherent with at least 1 PPE. Only 186 of 1,832 instances of nonadherence were corrected, primarily upon room entry and during patient care. Correction time varied by PPE type and nonadherence level (incomplete vs absent). Most corrections were self-initiated, with few reminders from other providers., Discussion: Potential barriers to correction include a lack of social pressure and external reminders. Solutions include optimizing PPE availability, providing real-time feedback, and educating on double gloving., Conclusions: Most providers were nonadherent to PPE requirements during high-risk infection transmission events. The low correction rate suggests challenges in promoting collective responsibility and maintaining protective behaviors during medical emergencies., (Copyright © 2024 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.)

Objective: To evaluate the Ohio Diabetes Quality Improvement Project (QIP) equity aim to reduce the percentage of Non-Hispanic Black (NHB) and Hispanic patients with A1C >9% by ≥20% over 2 years., Research Design and Methods: The Ohio Department of Medicaid, Ohio Colleges of Medicine Government Resource Center, Ohio Medicaid managed care plans, and seven medical schools in Ohio formed the Diabetes QIP collaborative using the collective impact model to improve diabetes outcomes and equity in 20 practices across 11 health systems. The quality improvement (QI) strategies included data audit and feedback, peer-to-peer learning, QI coaching/practice facilitation, and subject matter expert consultation through coaching calls, monthly webinars, and annual virtual learning sessions. Electronic health record data were collected for preintervention (2019-2020) and intervention (2020-2022) periods. Assessments of improvements in A1C were based on prevalence of A1C >9% from preintervention, year 1, and year 2 with stratification by race and ethnicity., Results: The Diabetes QIP included 7,689 (54% female) sociodemographically diverse patients, self-identifying as non-Hispanic White (NHW) (42%), NHB (43%), Hispanic (8%), non-Hispanic Asian (4%), or other (3%). In year 2 compared with baseline, there were decreases in the proportion of patients with A1C >9% among NHW, NHB, and Hispanic patients (NHW from 19% to 12% [37% reduction], NHB 23% to 18% [22% reduction], and Hispanic 29% to 23% [20% reduction])., Conclusions: The Ohio Diabetes QIP, focused on multisector collaborative approaches, reduced the percentage of patients with A1C >9% by ≥20% among NHW, NHB, and Hispanic populations. Given the persistence of disparities, further equity-focused refinements are warranted to address disparities in diabetes control., (© 2024 by the American Diabetes Association.)

Objective: To assess the association between caregiving and menopause symptom burden in midlife women., Patients and Methods: A cross-sectional analysis was conducted among women aged 45 to 60 years receiving primary care at 1 of 4 Mayo Clinic geographic locations between March 1 and June 30, 2021, who completed a survey study. Caregiving status was self-reported, and menopause symptoms were assessed using the Menopause Rating Scale. The primary outcome was moderate or worse menopause symptoms., Results: A total of 4295 women (mean age, 54.6 years) were included, 845 (19.7%) of whom self-identified as caregivers. Among all 4295 women, 1614 (37.6%) reported moderate to very severe menopause symptoms. The proportion of women with moderate or worse menopause symptoms in at least one symptom domain increased as the number of caregiving hours increased: 92 of 270 (34.1%) in the less than 5 hours per week group, 123 of 289 (42.6%) in the 5 to 14 hours per week group, and 144 of 286 (50.4%) in the 15 or more hours per week group (P<.001). In univariate analysis, caregiving for 15 or more hours per week significantly increased the odds of having moderate or worse menopause symptoms in at least one symptom domain compared to no caregiving (odds ratio, 1.77; 95% CI, 1.39 to 2.26; P<.001). The association remained significant in multivariable analysis after adjusting for potential confounders (odds ratio, 1.37; 95% CI, 1.05 to 1.78; P=.02)., Conclusion: This study identified a positive association between caregiving hours and menopause symptom burden. Given the aging US population and likely resultant increases in caregiving burden, there is a critical need to address menopause symptoms and to provide support for midlife women in caregiving roles., (Copyright © 2024 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.)

Objectives: Human monitoring of personal protective equipment (PPE) adherence among healthcare providers has several limitations, including the need for additional personnel during staff shortages and decreased vigilance during prolonged tasks. To address these challenges, we developed an automated computer vision system for monitoring PPE adherence in healthcare settings. We assessed the system performance against human observers detecting nonadherence in a video surveillance experiment., Materials and Methods: The automated system was trained to detect 15 classes of eyewear, masks, gloves, and gowns using an object detector and tracker. To assess how the system performs compared to human observers in detecting nonadherence, we designed a video surveillance experiment under 2 conditions: variations in video durations (20, 40, and 60 seconds) and the number of individuals in the videos (3 versus 6). Twelve nurses participated as human observers. Performance was assessed based on the number of detections of nonadherence., Results: Human observers detected fewer instances of nonadherence than the system (parameter estimate -0.3, 95% CI -0.4 to -0.2, P < .001). Human observers detected more nonadherence during longer video durations (parameter estimate 0.7, 95% CI 0.4-1.0, P < .001). The system achieved a sensitivity of 0.86, specificity of 1, and Matthew's correlation coefficient of 0.82 for detecting PPE nonadherence., Discussion: An automated system simultaneously tracks multiple objects and individuals. The system performance is also independent of observation duration, an improvement over human monitoring., Conclusion: The automated system presents a potential solution for scalable monitoring of hospital-wide infection control practices and improving PPE usage in healthcare settings., (© The Author(s) 2024. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Objective: Trauma resuscitation is the initial evaluation and management of injured patients in the emergency department. This time-critical process requires the simultaneous pursuit of multiple resuscitation goals. Recognizing whether the required goal is being pursued can reduce errors in goal-related task performance and improve patient outcomes. The intention to pursue a goal can often be inferred from ongoing and completed treatment activities, but monitoring goal pursuit is cognitively demanding and prone to errors. We introduced an interpretable deep learning-based approach to aid decision making by automatically recognizing goal pursuit during trauma resuscitation., Methods: We developed a predictive model to recognize the pursuit of two resuscitation goals: airway stabilization and circulatory support. We used event logs of 381 pediatric trauma resuscitations from August 2014 to November 2022 to train a neural network model with a dual-GRU structure that learns from both time-level and activity-type-level features. Our model makes predictions based on a sequence of activities and corresponding timestamps. To enhance the model and facilitate interpretation of predictions, we used the attention weights assigned by our model to represent the importance of features. These weights identified the critical time points and contributing activities during a goal pursuit., Results: Our model achieved an average area under the receiver operating characteristic curve (AUC) score of 0.84 for recognizing airway stabilization and 0.83 for recognizing circulatory support. The most contributing activities and timestamps were aligned with domain knowledge., Conclusion: Our interpretable predictive model can recognize provider intention based on a limited number of treatment activities. The model outperformed existing predictive models for medical events in accuracy and in interpretability. Integrating our model into a decision-support system would automate the tracking of provider actions, optimizing workflow to ensure timely delivery of care., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)

With 25% of teenagers pregnant by age of 19 and about half of these married before their 18th birth day, Uganda exhibits one of the highest rates of teenage pregnancy and child marriage globally. Comprehensive data on the drivers and barriers to addressing repeat teenage pregnancies and early child marriages remains limited. Using the narrative inquiry approach, the paper explores the key socio-cultural drivers and barriers to addressing repeat teenage pregnancies and early/forced marriages among stakeholders in the districts of Mbale, Kween, Namayingo and Kalangala. Guided by purposive sampling, a total of 125 qualitative interviews (80 key informant interviews (KIIs) and 45 focus group discussions (FGDs) were conducted. Data analysis was done using deductive thematic analysis in Atlas ti software. The drives of repeat teenage pregnancy (RPT) include the distorted community understanding of repeat teenage pregnancy; poverty at the household; norms, traditions and beliefs; cultural and traditional practices; lack of comprehensive sex education, school dropout, Peer pressure and influence, and vulnerable populations. The results point to a strong relationship between teenage pregnancy, early child/forced marriage and repeat teenage pregnancy across all the four districts and to poverty as the driving force., Competing Interests: The Authors declared no conflict of interest, (African Journal of Reproductive Health © 2024.)

Broadly neutralizing antibodies (bNAbs) targeting the HIV-1 CD4-binding site (CD4bs) occur infrequently in macaques and humans and have not been reproducibly elicited in any outbred animal model. To address this challenge, we first isolated RHA10, an infection-induced rhesus bNAb with 51% breadth. The cryo-EM structure of RHA10 with HIV-1 envelope (Env) resembled prototypic human CD4bs bNAbs with CDR-H3-dominated binding. Env-antibody co-evolution revealed transient elimination of two Env CD4bs-proximal glycans near the time of RHA10-lineage initiation, and these glycan-deficient Envs bound preferentially to early RHA10 intermediates, suggesting glycan deletions in infecting SHIVs could consistently induce CD4bs bNAbs. To test this, we constructed SHIV.CH505.D3 with CD4bs-proximal glycan deletions. Infection of 10 macaques resulted in accelerated CD4bs bNAb responses in 8, compared with 1 of 115 control macaques. Glycan hole-based immunofocusing coupled to Env-Ab co-evolution can consistently induce broad CD4bs responses in macaques and thus serve as a model for HIV vaccine design., Highlights: Out of 115 wildtype HIV-1 Env bearing SHIV infected macaques, only one macaque (T681) developed CD4bs bNAbsCD4bs bNAbs in macaque T681 recognized Env similarly to previously described CDR-H3 dominated human CD4bs bNAbs and exhibited comparable breadth and potencyTransient CD4bs-proximal glycan deletions in macaque T681 preceded bNAb inductionA novel SHIV with CD4bs-proximal glycan holes and enhanced CD4bs antigenicity immunofocused B cell responses to the CD4bs and elicited cross-clade neutralizing responses in 80% of macaques.

In the present study, biopolymer (chitosan and alginate)-reinforced rhamnolipid nanoparticles were prepared and represented as 'ALG-RHLP-NPs' and 'CHI-RHLP-NPs'. The sizes of the nanoparticles ranged from 150 to 300 nm. The encapsulation efficiencies of ALG-RHLP-NPs and CHI-RHLP-NPs were found to be 81.1 % and 90.2 %, whereas the loading capacities were in the range of 42-50 %. The estimated particle size of the reinforced nanoparticle suspensions was correlated well with predicted particle size as exhibited by partial least squares regression (PLSR) model. The second derivative of the absorbance (Log 1/R) of the nanoparticle suspensions showed that the reinforcement of rhamnolipid nanoparticles (RHLP-NPs) did not alter the molecular organization of the biopolymers. The synthesized ALG-RHLP-NPs and CHI-RHLP-NPs were found to have cracked and layered fractures as revealed by surface topography. In-vitro stability and rheological flow behavior revealed that the addition of RHLP-NPs to biopolymers has reduced aggregation and facilitated the production of uniform particles, and thereby improving the stability of synthesized nanoparticles via electrostatic interactions. Furthermore, the nanoparticle-reinforced membranes were found to be non-toxic and biocompatible as revealed by cytotoxicity study of L929 fibroblast cells. The results demonstrated that biopolymer-reinforced rhamnolipid nanoparticles have good potential for use in pharmaceutical, biomedical, and tissue engineering applications., Competing Interests: Declaration of competing interest The authors claim no competing interests., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Introduction: Clinicopathologic data-based sentinel lymph node (SLN) prediction models are used to select patients with melanoma for sentinel lymph node biopsy (SLNB). However, the temporal performance of these models is unknown. Therefore, we investigated whether the performance and clinical utility of the Melanoma Institute of Australia, Memorial Sloan Kettering Cancer Center, and Friedman et al. models changed over time., Patients and Methods: Primary cutaneous melanoma cases that underwent SLNB at a single tertiary-care cancer center from 2000 to 2021 were identified from a prospectively maintained database. Calibration plots were generated. Values for estimated risks of SLN positivity and area under the receiver operator curve (AUC) were calculated. Clinical utility was assessed at thresholds between 5 and 10% using decision curve analysis., Results: In total, 2977 SLNB cases were included. The estimated risk of SLN positivity and AUCs were similar across periods for all models. However, calibration decreased over time for all models, with progressive underprediction of SLN positivity. Clinical utility also declined over time; in the most recent period investigated (2018-2021), no model offered clinical utility at risk thresholds ≤ 8%, and only the Friedman model provided clinical utility at risk thresholds of 9-10%., Conclusions: The calibration and clinical utility of three predominant models for SLN prediction declined over time. There is a need to periodically reassess the performance of SLN prognostic tools as they are applied to contemporary cohorts. Future studies are needed to determine whether findings are generalizable outside of this study cohort., Competing Interests: Disclosures: Dr. Bartlett receives institutional support from SkylineDx and Qbiotics Group. The other authors have no conflict to disclose., (© 2024. Society of Surgical Oncology.)

Background: A key driver that leads to age-associated decline and chronic disease is mitochondrial dysfunction. Our previous work revealed strong community interest in the concept of mitochondrial fitness, which led to the development of a video-based science communication intervention to prompt behavior change in adults aged 50 years and older., Objective: This study aimed to conduct formative and summative evaluations of MitoFit, an instructional, biologically based communication intervention aimed at improving physical activity in older adults aged 50 years and older., Methods: In the phase-1 formative evaluation, community-dwelling older adults (N=101) rated the acceptability, appropriateness, and helpfulness of our MitoFit video series, titled "How to Slow Down Aging Through Mitochondrial Fitness." In the phase-2 summative evaluation, a subgroup of phase-1 participants (n=19) participated in a 1-month MitoFit intervention prototype to evaluate the intervention and data collection feasibility., Results: In phase 1, participants (mean age 67.8, SD 8.9 y; 75/100, 75% female) rated the MitoFit videos as acceptable (≥4 out of 5 on a Likert-scale survey; from 97/101, 96% to 100/101, 99%), appropriate (101/101, 100%), and helpful (from 95/101, 94% to 100/101, 99%) to support adaptation and continued work on our novel approach. Previous knowledge of mitochondria ranged from 52% (50/97; What are mitochondria?) to 80% (78/97; What are the primary functions of mitochondria?). In phase 2, participants (mean age 71.4, SD 7.9 y; 13/19, 72% female) scored better than the national average (50) on the Patient-Reported Outcomes Measurement Information System-19 for physical function (57), social activities (55.5), depression (41), fatigue (48.6), and sleep disturbance (49.6) but worse for anxiety (55.3) and pain interference (52.4). Additionally, 95% (18/19) of participants demonstrated MitoFit competencies within 2 attempts (obtaining pulse: 19/19, 100%; calculating maximum and zone 2 heart rate: 18/19, 95%; and demonstration of exercises: 19/19, 100%). At 1 month after instruction, 68% (13/19) had completed a self-initiated daily walking/exercise plan and submitted a daily activity log. A walking pulse was documented by 85% (11/13) of participants. The time needed to walk 1 mile ranged from 17.4 to 27.1 minutes. The number of miles walked in 1 month was documented by 62% (8/13) of participants and ranged from 10 miles to 31 miles. The number of days of strength training ranged from 2 to 31 days/month. Intervention feasibility scores ranged from 89% (17/19; seems easy to follow) to 95% (18/19; seems implementable, possible, and doable). Overall, 79% (15/19) stated an intention to continue the MitoFit intervention. Furthermore, 4 weeks after delivery of the prototype intervention, the percentage of participants doing aerobic activity for regular moderate activity increased from 35% (6/17) to 59% (10/17; P=.03)., Conclusions: MitoFit was enthusiastically embraced and is a cost-effective, scalable, and potentially efficacious intervention to advance with community-dwelling older adults., (©Cathy A Maxwell, Brandon Grubbs, Mary S Dietrich, Jeffrey T Boon, John Dunavan, Kelly J Knickerbocker, Maulik R Patel. Originally published in JMIR Formative Research (https://formative.jmir.org), 13.12.2024.)

Iron (Fe) availability limits photosynthesis at a global scale where Fe-rich photosystem (PS) I abundance is drastically reduced in Fe-poor environments. We used single-particle cryo-electron microscopy to reveal a unique Fe starvation-dependent arrangement of light-harvesting chlorophyll (LHC) proteins where Fe starvation-induced TIDI1 is found in an additional tetramer of LHC proteins associated with PSI in Dunaliella tertiolecta and Dunaliella salina . These cosmopolitan green algae are resilient to poor Fe nutrition. TIDI1 is a distinct LHC protein that co-occurs in diverse algae with flavodoxin (an Fe-independent replacement for the Fe-containing ferredoxin). The antenna expansion in eukaryotic algae we describe here is reminiscent of the iron-starvation induced ( isiA -encoding) antenna ring in cyanobacteria, which typically co-occurs with isiB , encoding flavodoxin. Our work showcases the convergent strategies that evolved after the Great Oxidation Event to maintain PSI capacity., Competing Interests: Competing interests The author declares no competing interests.

Live vaccines are contraindicated in patients on immunosuppressive therapy. We conducted a retrospective study evaluating the administration of a live vaccine in patients with IBD on immunosuppressive therapy. The primary outcome was to determine clinical or disseminated disease episodes within three months of vaccine administration in patients who inadvertently received a live vaccine. Thirty-five patients met the inclusion criteria. Twenty-two received the measles, mumps, and varicella (MMR) vaccine, nine received the live zoster vaccine, and one received the varicella vaccine (VAR). Three patients received both the MMR and VAR. The majority of our cohort (20, 57 %) were on anti-tumor necrosis factor, followed by azathioprine (12, 34 %) and vedolizumab (3, 9 %). Although live vaccines are contraindicated in patients on immunosuppressive therapy, none of the patients in this study reported any infections after inadvertent immunization. Further studies are required to address the safety and effectiveness of live vaccine administration in this population., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Dr. Freddy Caldera has received research support from Takeda Pharmaceuticals, Janssen and Novavax. He has been a consultant for Takeda, Arena Pharmaceuticals, GSK, and Celgene. Dr. Farraye is a consultant for AbbVie, Avalo Therapeutics, BMS, Braintree Labs, Fresenius Kabi, GI Reviewers, GSK, Iterative Health, Janssen, Pfizer, Sandoz Immunology, Sebela and Viatris. He sits on a DSMB for Lilly Pharmaceuticals. Dr. Hayney is a consultant for GSK Vaccines and Seqirus, and has received research support from Novavax, Takeda Pharmaceuticals, and Dynavax., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Purpose of Review: We review the role of uromodulin, a protein exclusively expressed in the kidney, in blood pressure regulation and hypertension., Recent Findings: The last few years have seen a shift of focus from genetic association to mendelian randomisation and uromodulin-salt interaction studies, thus confirming the causal role of uromodulin in blood pressure regulation and hypertension. This work has been complemented by phenome-wide association studies in a wider range of ethnicities. Important recent molecular work elucidated uromodulin trafficking and secretion and provided more insights into the pathophysiological roles of circulating and urinary uromodulin. Uromodulin has a causal role in blood pressure regulation and hypertensin. Recent studies show utility of the uromodulin as a biomarker and a possible precision medicine application based on genetically determined differential responses to loop diuretics., (© 2024. The Author(s).)

The cumulative toxicity of volatile organic compounds (VOCs) cause many medical diseases. We analyzed the evidence of association between VOCs and risk of metabolic syndrome in the Korean population using 1771 participants from the 2023 National Health and Nutrition Examination Survey. The creatinine-corrected urinary concentrations of BMA, 2-MHA, PGA, SPMA, 3-HPMA, BPMA and DHBMA were higher in the metabolic syndrome group than in the non-metabolic syndrome group. Urine N-Acetyl-S-(phenyl)-L-cysteine (SPMA) levels were significantly associated with metabolic syndrome after adjusting for confounders (odds ratio: 1.71). 2-MHA (OR 1.29, P=0.035) and SPMA (OR 2.84, P<0.001) were associated with the risk of elevated FBG impairment and SPMA (OR 1.57) was positively connected with the high blood pressure (P=0.016). In conclusion, the findings indicated significant association between the metabolic syndrome and a number of VOCs. Among them, there was a substantial positive correlation between the urinary SPMA levels and metabolic syndrome., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Weaning foods are soft digestible baby foods introduced along with breast milk for infants of 6 to 24 months. Early nutrition is a crucial one for proper growth and wellbeing. Researchers have developed weaning food from locally available ingredients with appropriate processing methods without losing actual nutrients value. Despite this, micronutrient malnutrition irrespective of the country status is a potential threat. This is overcome by fortifying micronutrients in the formulated weaning foods. Typically, formulated weaning foods are prepared from fruits and cereal grains that are abundant in micronutrients. Different processing methods are adopted to maintain the original natural characteristics of the ingredients. Traditional homemade weaning foods always have an upper hand over industrialized ones. Additionally, fortification enhances the micronutrients in weaning food and helps in uprooting the hidden hunger thereby helping in the sustainable development goals. This review focuses and delivers insights on the various processing methods and cereal-fruit weaning foods as traditional homemade ready-to-serve food supplement. It also highlights the impact of fortification of weaning foods against micronutrient malnutrition. On the whole this work emphasizes on the importance of sustainable weaning foods and how babies can be brought up into healthy grown-ups achieving zero hunger., Competing Interests: Conflict of interestsThe authors declare no conflict of interest., (© Association of Food Scientists & Technologists (India) 2024. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.)

Purpose: Opioid medications are necessary in the treatment of critically ill infants; however. prolonged use may lead to withdrawal syndrome. The purpose of this study was to assess feasibility of delivering an acupressure protocol for the treatment of iatrogenic withdrawal in a pediatric cardiac intensive care unit as well as impact and acceptance of acupressure as an adjunct treatment., Design: Randomized pilot feasibility trial., Methods: Acupressure stickers were applied and rotated to one ear every 1-3 days until withdrawal symptoms improved., Results: There were no serious adverse events, with only one reported incident of skin irritation. Recruiting benchmarks were exceeded. Weaning phases were significantly shorter in the acupressure group (medians 6.0 vs 22.0 respectively, p = .025, d = 0.90) and the control group used skin-to-skin contact as a comfort measure significantly more than the acupressure group (42.9% vs 6.3%, p = .18). Acupressure was accepted by parents, with an overall 96.2% rating their experience as positive, as measured by the Parent Client Satisfaction Questionnaire. The majority of health care providers (n = 19) were supportive, with 71.9% agreeing or completely agreeing acupressure is an acceptable adjunct for the treatment of withdrawal symptoms; 26.8% were neutral, as measured by the Acceptability of Intervention Measure, Intervention Appropriateness Measure, and Feasibility of Intervention Measure., Conclusions: Acupressure was found to be safe, feasible, and accepted by health care providers in a pediatric cardiac intensive care setting., Clinical Implications: These findings support future research with larger sample sizes to improve clinical treatment of infants physically dependent on sedative medications., Competing Interests: Declaration of competing interest All co-authors confirmed that there is no conflict of interest among authors., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Objective: We developed an Excel-based cost calculator to assess the economic burden of university-based Neisseria meningitidis serogroup B (MenB) outbreaks. Participants: Hypothetical university with 6,354 students. Methods: Total societal costs of outbreak were estimated for three MenB pre-matriculation immunization policies-vaccination required, vaccination recommended, and no vaccine policy-under three different cost assumptions (low/mid-range/high cost). Results: Mid-range cost estimates of an outbreak under "no policy" were $2.60 and $2.70 million (of which 35% were incurred by the university) if targeting all undergraduates for mass vaccination with a two-/three-dose vaccine, respectively. The "required" and "recommended" policies lowered the burden to $2.17-$2.18 million and $2.34-$2.39 million, respectively. For a larger university with 40,000 students, costs were almost $9 million for a two-dose vaccine with "no policy" in place. Conclusions: The economic burden of a university MenB outbreak is substantial, but could be mitigated by a pre-matriculation MenB vaccination requirement or recommendation.

Purpose: The purpose of this study was to assess the overall response rate of patients receiving electronic patient-reported outcome measures (ePROMs) following hand surgery and to determine the patient characteristics associated with responding., Methods: A Health Insurance Portability and Accountability Act-compliant, web-based system was developed to automatically distribute ePROMs to patients undergoing hand surgery at five institutions with 22 surgeons. Patients who were at least 18 years old were eligible. The PROMs used were the visual analog scale (VAS) for pain and the Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH). After surgery, ePROMs along with a satisfaction questionnaire were electronically sent three, six, 12, 24, and 52 weeks after surgery., Results: A total of 6458 patients were eligible. Of these, 80% were enrolled voluntarily. Among these, 70% completed ePROMs for at least one postoperative time point, whereas 30% did not complete any. Among responders, 28% completed all five time points, whereas 72% completed four or fewer time points. Incomplete responders were more likely to be insured by workers' compensation when compared to complete responders. Incomplete responders exhibited higher baseline QuickDASH scores and similar baseline VAS compared to complete responders. During the follow-up, incomplete responders demonstrated worse VAS and QuickDASH scores at all time points. Finally, in comparison with complete responders, incomplete responders were less likely to be satisfied with their surgery at all time points., Conclusions: This study demonstrates that automated email-based ePROM systems may be an effective method for survey distribution. Particularly for simple, outpatient surgeries, this study illustrates the potential for clinical use of the data obtained from these systems., Clinical Relevance: Patient-reported outcome measures continue to have an expanding role in health care with the rise of valued-based systems. Electronic PROMs are a relatively unexplored medium that may offer a viable alternative to more effectively collecting these valuable patient metrics., (Copyright © 2024 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.)

Objective: This study examined the associations of anxiety and drinking motives with hazardous and binge alcohol use among young adults., Participants: We recruited young adults (N = 182, mean age 25) between November 2020 and December 2020., Methods: Linear regressions were used to evaluate relationships among hazardous alcohol use (US Alcohol Use Disorders Identification Test-C [USAUDIT-C]), binge drinking (Alcohol Intake Questionnaire [AIQ]), PROMIS-Anxiety, COVID-19 related anxiety (CAS), and the drinking to cope with depression and anxiety subscales of the Modified Drinking Motives Questionnaire., Results: Sixty-two percent of participants reported hazardous drinking (USAUDIT-C score > 4). PROMIS Anxiety and CAS scores were 63.7 and 1.0, respectively. Scores were positively associated with drinking patterns. However, the drinking to cope with depression motive significantly mediated these associations., Conclusions: After the onset of the pandemic, hazardous and binge drinking patterns among young adults were associated with drinking to cope with depression rather than anxiety.

The complex pathology of mild traumatic brain injury (mTBI) is a main contributor to the difficulties in achieving a successful therapeutic regimen. Thyroxine (T4) administration has been shown to prevent the cognitive impairments induced by mTBI in mice but the mechanism is poorly understood. To understand the underlying mechanism, we carried out a single cell transcriptomic study to investigate the spatiotemporal effects of T4 on individual cell types in the hippocampus and frontal cortex at three post-injury stages in a mouse model of mTBI. We found that T4 treatment altered the proportions and transcriptomes of numerous cell types across tissues and timepoints, particularly oligodendrocytes, astrocytes, and microglia, which are crucial for injury repair. T4 also reversed the expression of mTBI-affected genes such as Ttr, mt-Rnr2, Ggn12, Malat1, Gnaq, and Myo3a, as well as numerous pathways such as cell/energy/iron metabolism, immune response, nervous system, and cytoskeleton-related pathways. Cell-type specific network modeling revealed that T4 mitigated select mTBI-perturbed dynamic shifts in subnetworks related to cell cycle, stress response, and RNA processing in oligodendrocytes. Cross cell-type ligand-receptor networks revealed the roles of App, Hmgb1, Fn1, and Tnf in mTBI, with the latter two ligands having been previously identified as TBI network hubs. mTBI and/or T4 signature genes were enriched for human genome-wide association study (GWAS) candidate genes for cognitive, psychiatric and neurodegenerative disorders related to mTBI. Our systems-level single cell analysis elucidated the temporal and spatial dynamic reprogramming of cell-type specific genes, pathways, and networks, as well as cell-cell communications as the mechanisms through which T4 mitigates cognitive dysfunction induced by mTBI., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier B.V. All rights reserved.)

Background: While some literature on clinical outcomes in persons with dementia-related psychosis exists, little is known regarding Alzheimer's disease-related psychosis (ADP)., Objective: Describe demographic/clinical characteristics of adults with ADP and estimate incidence of clinical events by antipsychotic treatment status., Methods: This cohort study identified adults ≥65 years with Alzheimer's disease and incident psychosis (US Medicare database [2013-2018]) and no prior exposure to antipsychotics. Two nonmutually exclusive ADP subcohorts included: patients who initiated treatment with antipsychotic medications (antipsychotic users) and those who remained untreated (antipsychotic nonusers). Baseline characteristics were evaluated before psychosis diagnosis in untreated patients and before antipsychotic initiation in treated patients. Incidence rates were estimated for falls and fractures (composite and separately), seizure/epilepsy (new onset and any), and mortality., Results: 145,333 ADP antipsychotic nonusers and 49,452 antipsychotic users were identified. Both cohorts had similar baseline demographics; however, antipsychotic users versus nonusers had higher baseline skilled nursing facility use (40.3% and 27.8%), mood (72.7% and 62.1%) and anxiety (70.9% and 57.3%) disorders, falls/fractures (39.5% and 33.8%), urinary tract infections (55.1% and 47.0%), and frailty index scores (76.0% and 69.7%). Crude incidence rates (95% confidence interval)/100 person-years in antipsychotic users and nonusers were 70.0 (68.9-71.2) and 55.8 (55.4-56.1) (falls/fractures composite), 69.0 (67.9-70.1) and 54.9 (54.5-55.2) (falls), 38.6 (38.1-39.0) and 33.0 (32.7-33.2) (mortality), and 45.8 (44.9-46.7) and 54.2 (53.9-54.6) (any seizure/epilepsy)., Conclusions: Antipsychotic initiators with ADP had a higher burden of some baseline comorbidities; experienced higher incidence of falls, fractures, and mortality; and had lower incidence of seizure/epilepsy than antipsychotic nonusers.

Hydraulic fracturing has unlocked vast amounts of hydrocarbons trapped within unconventional shale formations. This large-scale engineering approach inadvertently introduces microorganisms into the hydrocarbon reservoir, allowing them to inhabit a new physical space and thrive in the unique biogeochemical resources present in the environment. Advancing our fundamental understanding of microbial growth and physiology in this extreme subsurface environment is critical to improving biofouling control efficacy and maximizing opportunities for beneficial natural resource exploitation. Here, we used metaproteomics and exometabolomics to investigate the biochemical mechanisms underpinning the adaptation of model bacterium Halanaerobium congolense WG10 and mixed microbial consortia enriched from shale-produced fluids to hypersalinity and very low reservoir flow rates (metabolic stress). We also queried the metabolic foundation for biofilm formation in this system, a major impediment to subsurface energy exploration. For the first time, we report that H. congolense WG10 accumulates tyrosine for osmoprotection, an indication of the flexible robustness of stress tolerance that enables its long-term persistence in fractured shale environments. We also identified aromatic amino acid synthesis and cell wall maintenance as critical to biofilm formation. Finally, regulation of transmembrane transport is key to metabolic stress adaptation in shale bacteria under very low well flow rates. These results provide unique insights that enable better management of hydraulically fractured shale systems, for more efficient and sustainable energy extraction., Competing Interests: Chika Jude Ugwuodo is currently employed by Geosyntec Consultants, Kennesaw, GA, United States. Fabrizio Colosimo is currently employed by New England Biolabs, Ipswich, MA, United States. Jishnu Adhikari is currently employed by Tetra Tech Inc., King of Prussia, PA, United States. The remaining authors declare no conflict of interest., (© The Author(s) 2024. Published by Oxford University Press on behalf of the International Society for Microbial Ecology.)

Background: Weight stigma (devaluation due to body weight) in healthcare is common and influences one's engagement in healthcare, health behaviors, and relationship with providers. Positive patient-provider relationships (PPR) are important for one's healthcare engagement and long-term health., Purpose: To date, no research has yet investigated whether weight bias internalization (self-stigma due to weight; WBI) moderates the effect of weight stigma on the PPR. We predict that weight stigma in healthcare is negatively associated with (i) trust in physicians, (ii) physician empathy, (iii) autonomy and competence when interacting with physicians, and (iv) perceived physician expertise. We also predict that those with high levels of WBI would have the strongest relationship between experiences of weight stigma and PPR outcomes., Methods: We recruited women (N = 1,114) to complete a survey about weight stigma in healthcare, WBI and the previously cited PPR outcomes., Results: Weight stigma in healthcare and WBI were associated with each of the PPR outcomes when controlling for age, BMI, education, income, race, and ethnicity. The only exception was that WBI was not associated with trust in physicians. The hypothesis that WBI would moderate the effect of weight stigma in healthcare on PPR outcomes was generally not supported., Conclusions: Overall, this research highlights how weight stigma in healthcare as well as one's own internalization negatively impact PPRs, especially how autonomous and competent one feels with their provider which are essential for one to take an active role in their health and healthcare., (© Society of Behavioral Medicine 2024. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)

Benthic macrofauna are important and widely used biological indicators of marine ecosystems as they have limited mobility and therefore integrate the effects of local environmental stressors over time. Recently, environmental DNA (eDNA) analysis has provided a potentially more resource-efficient approach for benthic biomonitoring than traditional morphology-based methods. Several studies have compared eDNA with morphology-based monitoring, but few have compared the two approaches using the exact same sediment cores. In addition, the meiofauna and pelagic organisms obtained as 'bycatch' using eDNA have largely been disregarded from comparisons. Here, we address these shortcomings through comparative invertebrate analyses of six sediment sample replicates from each of four stations in Denmark, using eDNA metabarcoding and morphological identification. Our results revealed large variation between the six replicates for both methods and little overlap in taxon compositions between methods. While the morphological dataset was dominated by molluscs and annelids, the eDNA dataset was dominated by arthropods and annelids. Using community composition data, we found that sampling stations could be distinguished both with eDNA and morphology. Finally, we inferred expected total richness from extrapolated accumulation curves of detected taxa from each method. This indicated that eDNA metabarcoding requires less replication than morphology for maximum coverage of diversity to be reached. However, both methods required high levels of replication, and our results on taxonomic composition add to the evidence that morphological and eDNA-based methods should preferably be used as complimentary tools for marine bioassessment., Competing Interests: The authors declare no conflicts of interest., (© 2024 The Author(s). Ecology and Evolution published by John Wiley & Sons Ltd.)

Drying and rewetting of soil stimulates soil carbon emission. The Birch effect, driven by these cycles, leads to CO 2 efflux, which can be monitored using real-time mass spectrometry (RTMS). Although soil fungi retain water during droughts, their contribution to CO 2 release during drying-rewetting cycles remains unclear. In this study, we present the first demonstration of integrating micromodels with RTMS to monitor the Birch effect by simulating drought and rewetting. Micromodels were inoculated with axenic fungal culture and dried to assess moisture retention. After drying, RTMS quantified CO 2 release upon rewetting with H 2 18 O mixtures. Our results showed that soil fungi released CO 2 upon rehydration and immediately utilized the external water source at the pore scale by generating subsequent 46 CO 2 . This work is the first to integrate RTMS with microsystems to investigate pore-scale biogeochemistry and the involvement of fungi in the Birch effect.

Background: Patient transitions in critical care require coordination across provider roles and rely on the quality of providers' actions to ensure safety. Studying the behavior of providers who transition patients in critical care may guide future interventions that ultimately improve patient safety in this setting., Objective: To establish the feasibility of using the Theory of Planned Behavior in a trauma environment and to describe provider behavior elements during trauma patient transfers (de-escalations) to non-critical care units., Methods: This cross-sectional study surveyed a convenience sample of 103 multidisciplinary providers who do the cognitive and physical work of transitioning trauma patients from critical care to another non-critical care unit at a U.S. Level I trauma center. Descriptive methods for survey development, analysis, and administration were evaluated., Results: A total of 72 respondents completed the survey; they included registered nurses, nurse practitioners, and medical doctors, demonstrating a 70% response rate. Statistically significant differences among ICU roles were observed in perceived control (Eta-squared = 0.09, p = .001) and in several anchors in the attitude, subjective norms, and behavioral intent theoretical domains (Cohen's d ranging from 0.36 to 2.03, p < .05)., Conclusions: This study demonstrated variability in theory domains, signaling an opportunity to study a representative sample. It can serve as a blueprint for future behavioral studies designed to examine the Theory of Planned Behavior elements in trauma critical care providers., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2024 Society of Trauma Nurses.)

Mesopelagic fishes are a vital component of the biological carbon pump and are, to date, largely unexploited. In recent years, there has been an increased interest in harvesting the mesopelagic zone to produce fish feed for aquaculture. However, great uncertainties exist in how the mesopelagic zone interacts with the climate and food webs, presenting a dilemma for policy. Here, we investigate the consequences of potential policies relating to mesopelagic harvest quotas with a dynamic social-ecological modeling approach, combining system dynamics and global sensitivity analyses informed by participatory modeling. Our analyses reveal that, in simulations of mesopelagic fishing scenarios, uncertainties about mesopelagic fish population dynamics have the most pronounced influence on potential outcomes. The analysis also shows that prioritizing the development of the fishing industry over environmental protection would lead to a significantly higher social cost of climate change to society. Given the large uncertainties and the potential large impacts on oceanic carbon sequestration, a precautionary approach to developing mesopelagic fisheries is warranted., (© 2024. The Author(s).)

Objective: Existing binge drinking reduction interventions such as brief intervention and personalized normative feedback have shown modest impact. The purpose of this study was to evaluate the feasibility (recruitment and retention rates), acceptability, and preliminary efficacy testing of a short-term "Know Your Numbers" (KYN) intervention on motivating young adults to reduce their engagement in binge drinking., Method: Young adults ( N = 94, mean age = 21 years) with a history of binge drinking received a 4-week KYN intervention that included information about their U.S. Alcohol Use Disorders Identification Test (USAUDIT) scores and the alcohol biomarker phosphatidylethanol (PEth) level in relationship to different risk levels of alcohol use. At baseline and 4 weeks, measures included USAUDIT scores, PEth levels, motivation (Alcohol Contemplation Ladder), and other drinking measures. Focus groups were conducted at 4 weeks for feedback on the KYN approach., Results: The recruitment rate was 82.26% (retention rate = 76.9%). At 4 weeks, there was a 62% increase in contemplation scores (indicating higher motivation), a decrease in USAUDIT scores, and an increase in the percentage of participants classified as low-risk drinkers. No differences were found between baseline and 4-week PEth levels or number of binge episodes. Focus group results revealed satisfaction with the KYN approach but the need to understand how PEth levels and USAUDIT scores corresponded to health consequences and alcohol use levels., Conclusions: Results from this pilot study support the acceptability and potential use of a KYN approach in helping young adults understand their drinking levels., Competing Interests: The authors have no conflicts of interest to declare.

Background: The University of California, San Diego Brief Assessment of Capacity to Consent (UBACC) is a tool to assess the capacity of participants to consent in psychiatric research. However, little is known about the psychometric properties in low and middle-income countries. This study aimed to examine the psychometric properties of the UBACC., Methods: We examined the reliability, latent factor structure, and item response of the first attempt of the UBACC items in a sample of 32,208 adults (16,467 individuals with psychosis and 15,741 controls) in Ethiopia, Kenya, South Africa, and Uganda; exploring these properties in the full sample and stratified by country, diagnostic status, sex, and ethnolinguistic language groups., Results: Exploratory factor analysis (EFA) suggested a two-factor model for the overall sample. However, a three-factor model was more appropriate when examining the latent structure across country, language, and sex. Confirmatory factor analyses (CFA) revealed an adequately fitting three-factor model for the full sample and across country, sex, and language. A two-factor model, however, was more appropriate for English and Amharic languages. Across all groups, the internal consistency of the UBACC was low, indicating below-threshold reliability (Cronbach's α (95 % CI = 0.58 (0.57-0.59). Using a multidimensional item-response theory framework for the full sample revealed that UBACC item 8, measuring understanding of the benefits of study participation, was the most discriminating item. Many of the other items had below-threshold discriminating characteristics., Conclusion: EFA and CFA converged towards a two and three-dimensional structure for the UBACC, in line with the developers of the original scale. The differences in properties between populations and language groups, low internal consistency, and below-threshold item functioning suggest that investigations into the cultural and linguistic nuances are still warranted. Understanding the utility of consent tools, such as the UBACC, in underrepresented populations will be a part of the larger process which ensures that research participants are adequately protected., Competing Interests: Declaration of competing interest None., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Limb-loss is a significant medical event with lifelong consequences, impacting various aspects of a patient's well-being. Care for these often-complex patients involves providers from many different specialties working toward a set of patient-centered goals. This article aims to highlight the important role of physiatrists in directing the interdisciplinary care for these patients. Through evidence-based concepts, the authors aim to lay a roadmap for comprehensive, longitudinal management of these patients from pre-amputation assessment through lifelong care., Competing Interests: Disclosures None of the authors have any commercial or financial conflicts of interest and any funding sources., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Purpose: To develop an exploratory survey measuring family caregiver use of elements of pain assessment in people living with dementia (PLWD)., Method: A survey development process was conducted: Phase 1 (item development), Phase 2 (content validity), and Phase 3 (face validity)., Results: A set of survey questions was developed, and their wording modified after review by experts in survey question writing. Content experts rated the exploratory questions as having item content validity indices (I-CVI) from 0.25 to 1. Questions were further tested with a sample of family caregivers ( N = 10) who supported face validity and content validity for questions with a low I-CVI. The final survey has eight quantitative and two free-text questions., Conclusion: This survey can be used for exploratory purposes to describe pain assessment by family caregivers of PLWD; however, further validation is needed for uses beyond exploratory work. [ Research in Gerontological Nursing, 17 (6), 308-316.].

Systolic and diastolic functions are coordinated in the heart by myofilament proteins that influence force of contraction and calcium sensitivity. Fine control of these processes is afforded by a variety of post-translation modifications that occur on specific proteins at different times during each heartbeat. Cardiac myosin binding protein-C is a sarcomeric accessory protein whose function is to interact transiently with actin, tropomyosin and myosin. Previously many different types of post-translational modification have been shown to influence the action of myosin binding protein-C and we present the first report that the protein can be modified covalently by the small ubiquitin like modifier protein tag. Analysis by mass spectrometry suggests that there are multiple modification sites on myosin binding protein-C for this tag and single point mutations did not serve to abolish the covalent addition of the small ubiquitin like modifier protein. Functionally, our data from both model human embryonic kidney cells and transfected neonatal cardiac myocytes suggests that the modification reduces phosphorylation of the filament protein on serine 282. In cardiac myocytes, the hypo-phosphorylation coincided with a significantly slower relaxation response following isoprenaline induced contraction. We hypothesise that this novel modification of myosin binding protein-C represents a new level of control that acts to alter the relaxation kinetics of cardiac myocytes., Competing Interests: Declaration of Competing Interest The authors declare that no conflicts of interest exist., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)