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This paper presents a study examining how pre-service teachers understand and experience the limit(s) of classroom creativity in a Canadian higher education class. Participants first completed a modified version of the Harris Creativity Audit to assess their preliminary understandings of creativity policies and practices, as well as perceptions of the value and feasibility of incorporating creativity into their own teaching. The survey results informed the content of a two-part workshop where participants utilized participatory design and sketch modeling to further explore their understanding of classroom creativity. Data analysis resulted in three themes: (a) the impact of physical space; (b) assessing creativity and assessing in creative ways; (c) challenging the educational system. This study is part of a multisite Social Sciences and Humanities Research Council-funded project that aims to explore creativity in higher education to empower educators and students to develop creative agency through creative ecologies and collaborative assessment., Competing Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2024.)

Abstract: King, BW, Snow, TK, and Millard-Stafford, M. Peak lower-extremity power unadjusted for body mass predicts fastball velocity in collegiate baseball pitchers. J Strength Cond Res 39(2): 217-226, 2025-The relationship between lower-extremity power production and fastball velocity in collegiate pitchers remains unclear. This study aimed to evaluate the relationship between lower-extremity power and throwing velocity in 33 National Collegiate Athletic Association Division I baseball pitchers. Lower-extremity power was quantified using countermovement jump (CMJ) testing on force plates and the Wingate anaerobic cycling test. In-game fastball velocities were collected using TrackMan technology. Pearson correlations and linear regressions were used to evaluate the association between lower-body power and fastball velocity. The strongest predictor of peak fastball velocity was body mass ( r = 0.58, p = 0.0004), followed by lean mass ( r = 0.52, p = 0.002). Peak power (W) produced on the Wingate and CMJ tests were each statistically significant predictors of peak velocity ( r = 0.44, p = 0.011; r = 0.43, p = 0.014, respectively), but CMJ power relative to body mass ( r = 0.19), jump height ( r = 0.07), and Sparta Scores ( r = -0.06) were not ( p > 0.05). Linear regression indicated Wingate and CMJ absolute peak power tests each independently explained 19% of the variance in fastball velocity but added little to the model when combined with body mass (∼34 vs. 32% of total variance). Because total body mass and lower-body power are important predictors of pitching velocity, absolute power output is a more relevant predictor of baseball pitching velocity than lower-body power variables influenced by body mass (e.g., jump height and Sparta Score)., (Copyright © 2024 National Strength and Conditioning Association.)

Summary Statement: Interprofessional simulation-based team training (ISBTT) is promoted as a strategy to improve collaboration in healthcare, and the literature documents benefits on teamwork and patient safety. Teamwork training in healthcare is traditionally grounded in crisis resource management (CRM), but it is less clear whether ISBTT programs explicitly take the interprofessional context into account, with complex team dynamics related to hierarchy and power. This scoping review examined key aspects of published ISBTT programs including (1) underlying theoretical frameworks, (2) design features that support interprofessional learning, and (3) reported behavioral outcomes. Of 4854 titles identified, 58 articles met inclusion criteria. Most programs were based on CRM and related frameworks and measured CRM outcomes. Only 12 articles framed ISBTT as interprofessional education and none measured all interprofessional competencies. The ISBTT programs may be augmented by integrating theoretical concepts related to power and intergroup relations in their design to empower participants to navigate complex interprofessional dynamics., Competing Interests: The authors declare no conflict of interest., (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the Society for Simulation in Healthcare.)

The present evaluation aimed to begin development of a survey tool for measuring workplace stressors specific to behavioral health providers in clinical settings for autism and related developmental disabilities: the Burnout Assessment for Developmental Disability Settings (BADDS). BADDS development was guided by Patient-Reported Outcomes Measurement Information System (PROMIS ® ; Cella et al., (Journal of Clinical Epidemiology, 63(11), 1179-1194, 2010) procedures. We used a qualitative analysis to define the target conceptual model (Phase 1). Using the analysis and reported lived experiences, we generated individual items for the BADDS. We then piloted these items in an online survey study to examine correlations with established measures of burnout (Phase 2). Finally, we used a modified Delphi approach to refine items with an expert panel, resulting in a preliminary item pool for the BADDS (Phase 3). Qualitative interviews produced a framework of four themes and nine sub-themes for analysis. Initial items were written across each theme and sub-theme. Findings from preliminary psychometric evaluation in Phase 2 demonstrated promising internal consistency, score stability, and positive associations with validated measures of burnout level. Finally in Phase 3, an expert panel edited items for relevance and clarity across three iterations of feedback. Though further analysis is needed, the BADDS tool has the potential to provide a conceptual analysis of burnout by identifying workplace stressors impacting behavioral health providers in autism service settings. This is in contrast to existing measures that solely inquire burnout level, but do not identify causes of job stress. Organizations may develop more effective strategies for mitigating burnout within their specific setting by incorporating assessments such as the BADDS into burnout interventions for providers., Competing Interests: Declarations. Ethical Approval: All research procedures followed best practices for human subjects research as outlined the Declaration of Helsinki on Medical Research. Procedures were approved by the State University of New York - Binghamton University and Emory University Institutional Review Boards. Competing Interests: N/A, (© 2025. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Objective: A better understanding of factors associated with cervical cancer screening can inform strategies for cervical cancer prevention. This study examined the relationship between age at human papillomavirus (HPV) vaccination and participation in cervical cancer screening among a nationally representative sample of women in the United States., Methods: We utilized data from the National Survey of Family Growth for the years 2015-2019 focusing on women aged 18-24 vaccinated against HPV. Age at first HPV immunization was analyzed as both a dichotomous (vaccinated at 9-12 vs. 13-23 years) and a continuous variable. The outcome measured was ever having a Pap smear. Multivariable logistic regression that accounted for complex survey design was employed to estimate adjusted prevalence ratios and differences from average marginal predictions., Results: The study comprised 981 individuals, representing 6.05 million women. Over half of the study population had a Pap test (57.4%). Women vaccinated at ages 9-12 were less likely to participate in screening compared to those vaccinated at ages 13-23 [risk difference: -9.1, 95% confidence interval (CI) -16.7 to -1.5)] which translates into 120,260 fewer women nationwide getting cervical cancer screening. Each 1-year increase in age at first vaccination was associated with a 1.1% (95% CI, -0.1 to 2.4%) higher probability of having a Pap test, but this linear trend was not statistically significant., Conclusions: Our study underscores the importance of promoting cervical cancer screening not only among unvaccinated women but also among those who received the HPV vaccine at the recommended ages of 9-12., Competing Interests: Declaration of conflicting interestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Importance: The increasing use of glucagon-like peptide-1 receptor agonists (GLP-1RA) demands a better understanding of their association with thyroid cancer., Objective: To estimate the risk of incident thyroid cancer among adults with type 2 diabetes being treated with GLP-1RA vs other common glucose-lowering medications., Design, Setting, and Participants: This was a prespecified secondary analysis of a target trial emulation of a comparative effectiveness study using claims data for enrollees in commercial, Medicare Advantage, and Medicare fee-for-service plans across the US. Eligible participants were adults with type 2 diabetes at moderate risk for cardiovascular disease and without history of thyroid cancer who had newly filled prescriptions for GLP-1RA, sodium-glucose cotransporter 2 inhibitor (SGLT2i), dipeptidyl peptidase-4 inhibitor (DPP4i), or sulfonylurea from January 1, 2014, to December 31, 2021. Data were analyzed February 1 to October 31, 2024., Main Outcomes and Measures: Overall and piecewise (<1, 1-2, and ≥2 years since treatment initiation) hazard ratios (HRs) for thyroid cancer with use of GLP-1RA vs the other 3 drug classes were estimated using inverse propensity score weighted Cox proportional hazards models. Modified intention-to-treat (mITT) (primary) and as-treated (sensitivity) analyses were performed., Results: Of 351 913 patients (mean [SD] age, 65.3 [8.5] years; 173 391 [49.3%] females and 178 522 [50.7%] males), 41 112 started treatment with GLP-1RA; 76 093, with DPP4i; 43 499, with SGLT2i; and 191 209, with sulfonylurea therapy. The numbers of patients diagnosed with thyroid cancer were 69 (0.17%) in the GLP-1RA group, 172 (0.23%) in the DPP4i group, 72 (0.17%) in the SGLT2i group, and 381 (0.20%) in the sulfonylurea group. In the mITT analysis, GLP-1RA initiation was not significantly associated with increased overall risk for thyroid cancer compared to the other 3 diabetes drugs (HR, 1.24; 95% CI, 0.88-1.76). However, the risk for thyroid cancer was significantly higher within the first year after GLP-1RA initiation (HR, 1.85; 95% CI, 1.11-3.08) and was amplified in the overall as-treated analysis that censored patients when therapy was discontinued or another medication was added (HR, 2.07; 95% CI, 1.10-3.95)., Conclusions and Relevance: This secondary analysis of a target trial emulation of a comparative effectiveness study found that despite the low absolute risk of thyroid cancer among patients receiving GLP-1RA therapy, there was an increased risk of new thyroid cancer diagnoses within the first year of GLP-1RA initiation compared to 3 other diabetes drugs. This finding may have been due to enhanced early detection; therefore, further research is necessary to understand the underlying causes of this association.

Introduction: Population risk for neural tube defects (NTDs) can be determined using red blood cell (RBC) folate. However, a paucity of biomarker and surveillance data among non-lactating, non-pregnant women of reproductive age (NPWRA) from Africa limits accurate assessment. Our study assessed folate and vitamin B12 status among non-lactating NPWRA and predicted population risk of NTDs in Tanzania., Methods: A cross-sectional biomarker survey of non-lactating NPWRA (15-49 years) in the Morogoro region, Tanzania was conducted during June-October 2019. Questionnaire interview responses and non-fasting blood samples were collected. Folate was assessed using the CDC microbiologic assay kit and vitamin B12 was measured using an electrochemiluminescence immunoassay. Complex survey design analyses were conducted using SAS-callable SUDAAN (v11.0.1)., Results: Of the 761 participating non-lactating NPWRA, 294 (39.8%) had RBC folate insufficiency (<748 mol/L). The prevalence of RBC folate insufficiency was lower among non-lactating NPWRA living in urban than rural areas (PR: 0.72, 95% CI: 0.52-0.99) but did not differ by age or household wealth index. Vitamin B12 insufficiency was uncommon (< 221 pmol/L, 2.7%). The estimated NTD risk was 10.5 (95% uncertainty interval: 8.1-13.3) per 10,000 births., Discussion: Elevated NTD risk was predicted in the Morogoro region of Tanzania, where ∼ 40% of non-lactating NPWRA had RBC folate insufficiency and < 3% had vitamin B12 insufficiency. The NTD risk is consistent with surveillance data for the area, limited folic acid fortification of staple foods, and low vitamin B12 insufficiency. Further studies are needed to better understand the context of these findings, especially the impact of micronutrient fortification in Tanzania., Competing Interests: Declarations. Ethical Approval: This study received ethical approval from the Tanzania National Institute for Medical Research (NIMR). Disclaimer: The findings and conclusions in this paper are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention. Consent to Participate: All participants provided written informed consent in Swahili prior to data collection. An additional informed consent was obtained from women of reproductive age who participated in the survey and provided blood samples. Consent for Publication: Not applicable. Conflicts of interest/Competing Interests: The authors declare no conflicts of interest., (© 2025. This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply.)

Purpose: To study the association between clinicopathologic characteristics of ductal carcinoma in situ (DCIS) and risk of subsequent invasive breast cancer (IBC)., Methods: We conducted a case-control study nested in a multicenter, population-based cohort of 8175 women aged ≥ 18 years with DCIS diagnosed between 1987 and 2016 and followed for a median duration of 83 months. Cases (n = 497) were women with a first diagnosis of DCIS who developed a subsequent IBC ≥ 6 months later; controls (2/case; n = 959) were matched to cases on age at and calendar year of DCIS diagnosis. Univariable and multivariable conditional logistic regression models were used to examine the associations between the DCIS characteristics of interest (non-screen detection of DCIS, tumor size, positive margins, grade of DCIS, necrosis, architectural pattern, microcalcification, and estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER2) status) and risk of IBC., Results: In the total study population, the associations were largely null. In subgroup analyses, there were strong position associations with punctate necrosis (pre/perimenopausal women), detection by physical exam (postmenopausal women), architectural patterns other than the main types (breast-conserving surgery [BCS]), and DCIS margins (ipsilateral cases), and inverse associations with HER2 positivity (BCS) and microcalcification (mastectomy); however, the associated confidence intervals were mostly very wide., Conclusion: The results of this study provide limited support for associations of the DCIS clinicopathologic characteristics studied here and risk of IBC., Competing Interests: Declarations. Conflict of interest: The authors have no relevant financial or non-financial interests to disclose. Ethical approval: The study was approved by the Institutional Review Boards of all participating institutions. Consent to participate: In accordance with the OHRP Guidance on Research Involving Coded Private Information or Biological Specimens, this study did not meet the definition of human subject research as defined by 45 CFR 46.102(f), as the data/specimens were not collected specifically for the proposed research project and the data/specimens received did not contain a code derived from individual personal information. Given the foregoing, consent was not required., (© 2025. The Author(s).)

Recent theoretical work has argued that moral psychology can be understood through the lens of "resource rational contractualism." The view posits that the best way of making a decision that affects other people is to get everyone together to negotiate under idealized conditions. The outcome of that negotiation is an arrangement (or "contract") that would lead to mutual benefit. However, this ideal is seldom (if ever) practical given the resource demands (time, information, computational processing power) that are required. Instead, the theory proposes that moral psychology is organized around a series of resource-rational approximations of the contractualist ideal, efficiently trading off between more resource-intensive, accurate mechanisms and less. This paper presents empirical evidence and a cognitive model that test a central claim of this view: when the stakes of the situation are high, then more resource-intensive processes are engaged over more approximate ones. We present subjects with a case that can be judged using virtual bargaining-a resource-intensive process that involves simulating what two people would agree to-or by simply following a standard rule. We find that about a third of our participants use the resource-rational approach, flexibly switching to virtual bargaining in high-stakes situations, but deploying the simple rule when stakes are low. A third of the participants are best modeled as consistently using the strict rule-based approach and the remaining third as consistently using virtual bargaining. A model positing the reverse resource-rational hypothesis (that participants use more resource-intensive mechanisms in lower stakes situations) fails to capture the data., (© 2025 The Author(s). Topics in Cognitive Science published by Wiley Periodicals LLC on behalf of Cognitive Science Society.)

Background and Objectives: Despite screening procedures, a few blood donors confirm positive for transfusion-transmissible infections and are deferred. Effective notification of laboratory results is essential to ensure that donors are advised of confirmed results and to seek medical care. Here we report results from post-notification interviews of Canadian Blood Services donors., Materials and Methods: Over 17 years, 2006-2022, all donors with confirmed positive results for hepatitis B virus (HBV), hepatitis C virus (HCV), human T-cell lymphotropic virus (HTLV) and syphilis were notified by registered mail of their result and advised to see a physician. In a separate communication, all donors were later invited to participate in a scripted interview asking whether they tested positive for an infection; if yes, which one, what their reaction was, whether they consulted a physician and whether public health contacted them. Frequencies of responses were calculated., Results: Of 2654 donors with confirmed positive test results, 876 (33%) participated; 90% said they were informed of a positive test result. Of these, about a quarter did not know for which infection they were positive. Most were surprised, and some were sad or disappointed. Most saw a physician after notification (77%). About two-thirds with HBV or HCV said they were contacted by public health, slightly fewer (58%) with syphilis, 27% of those with HTLV., Conclusion: Most donors recalled being notified and were aware of their positive test, but details of the infection were sometimes not understood or recalled, and not all donors consulted a physician about the infection., (© 2025 The Author(s). Vox Sanguinis published by John Wiley & Sons Ltd on behalf of International Society of Blood Transfusion.)

Natural products are ligands and in vitro inhibitors of Alzheimer's disease (AD) tau. Dihydromyricetin (DHM) bears chemical similarity to known natural product tau inhibitors. Despite having signature polyphenolic character, DHM is ostensibly hydrophobic owing to intermolecular hydrogen bonds that shield hydrophilic phenols. Our research shows DHM becomes ionized at near-neutral pH, allowing the formulation of salts with transformed solubility. The MicroED co-crystal structure with trolamine reveals DHM salts as metastable co-crystalline solids with unlocked hydrogen bonding and a thermodynamic bent to solubilize in water. All co-crystal formulations show better inhibitory activity against AD tau than the nonsalt form, with efficacies correlating to enhanced solubilities. In vitro and in vivo pharmacokinetic measures demonstrate that DHM co-crystals display enhanced absorption and distribution with altered rates of elimination, suggesting that co-crystal formulations could be strategically used to fine-tune delivery properties. These results underscore the role of structural chemistry in guiding the selection of solubilizing agents for chemical formulation. We propose DHM co-crystals are appropriate formulations for research as dietary supplements to promote healthy aging by combating protein misfolding, although central nervous system (CNS) delivery remains a major limitation. DHM may be a suitable backbone for medicinal chemistry and possible development of pharmaceuticals with enhanced CNS exposure., (© The Author(s) 2025. Published by Oxford University Press on behalf of National Academy of Sciences.)

People who are higher in conscientiousness, extraversion, and agreeableness and lower in neuroticism tend to live longer. The present research tested the hypothesis that personality trait change in middle and older adulthood would also be associated with mortality risk, above and beyond personality trait level. Personality trait change may causally influence mortality risk through corresponding changes in health behaviors, social processes, and stress experience. Alternatively, personality trait change may be a marker of successful or unsuccessful adaptation to life circumstances, which in turn influences mortality risk, or shared risk factors may impact personality trait change and mortality risk. In the latter case, personality trait change may serve as a "psychosocial vital sign" pointing toward increased risk. In 11 samples of middle-aged and older adults (combined N = 32,348), we used multilevel growth curve models to estimate personality trait level and personality trait change across three to 11 measurement occasions spanning 6-43 years. Next, we used Cox proportional hazards models to test whether personality trait level and personality trait change were associated with mortality risk. Higher conscientiousness (hazard ratio [HR] = 0.83), extraversion (HR = 0.93), and agreeableness (HR = 0.88) were associated with longer survival while higher neuroticism was associated with shorter survival (HR = 1.22). In contrast to personality trait level, we found limited evidence for associations between personality trait change and mortality risk. We discuss conceptual and methodological implications of the present findings that may guide future research on associations between personality trait change, health, and mortality. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Background: Chronic pelvic pain is a common yet undertreated condition that significantly impacts quality of life for women worldwide. Digital exercise therapy designed to target pelvic pain can improve symptomology while reducing time and cost-related barriers to in-person clinical care., Methods: This longitudinal, observational study of a digital women's pelvic health program examined pelvic pain, anxiety, and depression at 4 and 12 weeks in female adults experiencing chronic pelvic pain. Intervention participants received a digital pelvic health program including personalized exercise therapy sessions, health education articles, and health coaching. A comparison group of nonparticipants received a series of education articles related to pelvic health. Data were collected at baseline, 4 and 12 weeks. Unadjusted and adjusted linear mixed effects models were conducted to model changes in clinical outcomes over time., Results: A total of 797 participants (intervention: 495, nonparticipants: 302) were included in the sample. Baseline mean (SD) age was 41.5 (11.7) years and mean pain was 45.7 (18.5) out of 100. Compared to baseline, the intervention group showed significantly more pain improvement at 4 and 12 weeks versus nonparticipants after adjusting for baseline factors. The intervention group's pain scores decreased by 44.5% at 4 weeks and 53.6% at 12 weeks. The intervention group's adjusted pain scores decreased from 42.0 (95% CI: [39.4, 44.7]) at baseline to 23.3 (95% CI: [20.5, 26.2]) at 4 weeks to 19.5 (95% CI: [16.7, 22.4]) at 12 weeks. In contrast, nonparticipants' pain scores decreased by 21.6% at 4 weeks and 32.7% at 12 weeks. Nonparticipants' adjusted pain scores decreased from 42.1 (95% CI: [38.4, 45.9]) at baseline to 33.0 (95% CI: [29.2, 36.8]) at 4 weeks to 28.3 (95% CI: [24.5, 32.2]) at 12 weeks. After adjustments, the probability of the intervention group screening for moderate or severe depression was significantly lower by 11.0% at 12 weeks versus nonparticipants. There were no significant differences in anxiety outcomes between groups at baseline, week 4, or week 12.  CONCLUSIONS: A digital women's pelvic health program may help reduce short-term pelvic pain and depression symptoms., Trial Registration: The WIRB-Copernicus Group Institutional Review Board (registration number IRB20234932) approved this study on November 6, 2023., Competing Interests: Declarations. Ethics approval and consent to participate: Study subjects provided informed consent online prior to joining the study. The WIRB-Copernicus Group Institutional Review Board (Office of Human Research Protections/Food and Drug Administration Institutional Review Board registration number IRB20234932) reviewed and approved this study. Consent for publication: Written informed consent for publication was obtained for all human images included in the manuscript. Competing interests: M.H. was employed at Hinge Health, Inc. during the conduct of the study. R.FK, B.T., C.CS, C.P., J.K., and T.G. are employed at Hinge Health, Inc. and receive salary and equity compensation. , (© 2024. The Author(s).)

Background: The assessment of suicide risk in patients with major depressive disorder (MDD) is somewhat subjective in clinical diagnosis and may lead to diagnostic bias and serious consequences. Therefore, the aim of this study was to determine whether MDD patients with suicidal ideation or suicide attempts exhibited local brain functional synchrony and spontaneous activity intensity, thus providing certain imaging basis for suicide assessment., Methods: This study was conducted using ReHo and ALFF analyses on 213 first episode drug-naïve MDD patients from the REST-meta-MDD consortium. All patients were categorized into MDD with SI or SA group and MDD without SI and SA. A voxel-based two-sample t-test was then used to identify brain regions with significant differences in ReHo or ALFF values. Finally, Reho or ALFF values of those brain regions in MDD with SI or SA group were extracted for correlation analysis with suicide severity., Results: Compared with MDD patients without SI or SA, MDD patients with SI or SA had increased ReHo in the triangular part of left inferior frontal gyrus, orbital part of right inferior frontal gyrus and right precuneus gyrus, and increased ALFF in the middle occipital gyrus. All of these brain region characteristics were positively correlated with suicide severity on the HAMD 3th item score and HAMD 9th item score., Conclusion: Our findings suggest that abnormalities of regional spontaneous brain activity were found in IFG, precuneus gyrus, and MOG among MDD patients with suicidal thoughts or attempts, which provides a reliable imaging basis for identifying and preventing suicide., 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. Published by Elsevier Inc.)

A focus on contraceptive preferences is essential to the provision of person-centered care. Adolescent girls and young women (AGYW) in the WHO African Region experience disparities in contraceptive access and use and reproductive health outcomes. Despite increasing recognition of AGYW needs as unique, their preferences are understudied, limiting strategies to improve contraceptive care access and quality among marginalized youth populations. We designed and conducted a discrete choice experiment among five hundred 15-20-year-old AGYW in Kisumu, Kenya, to examine the relative importance of trade-offs between contraceptive methods and service delivery attributes. Participants answered eight choice sets including three alternatives: two hypothetical contraceptive options characterized by seven attributes (effectiveness, bleeding pattern, duration of use, privacy, access location, counseling source, and cost) and a "no method" opt-out. We used random-parameters logit models to estimate preference weights and trade-offs among alternatives. The bleeding pattern was the most important determinant of stated choice, with a strong preference for unchanged or irregular bleeding over heavier bleeding or amenorrhea. Participants preferred the lowest chance of method failure as well as the longest duration of use (one year) over daily use or use during/after sex. Parous AGYW were more likely to prefer the longest duration of use. The ability to keep method use completely private was also an influential choice, particularly among 15-17-year-olds. AGYW traded effectiveness and increased cost for preferred bleeding patterns and privacy. The opt-out "no method" alternative was chosen only 2.7 percent of the time, indicating a strong preference for pregnancy prevention. Our findings highlight key insights for enhancing the person-centeredness of contraceptive care for AGYW: Kenyan AGYW place a high value on preferred menstrual bleeding patterns, high method effectiveness, longer duration of use, and the ability to keep method use private. Preference data can inform programs, including contraceptive decision-support interventions, to improve AGYW access to quality preference-sensitive contraceptive services., (© 2024 The Population Council, Inc.)

Biophysical constraints limit the specificity with which transcription factors (TFs) can target regulatory DNA. While individual nontarget binding events may be low affinity, the sheer number of such interactions could present a challenge for gene regulation by degrading its precision or possibly leading to an erroneous induction state. Chromatin can prevent nontarget binding by rendering DNA physically inaccessible to TFs, at the cost of energy-consuming remodeling orchestrated by pioneer factors (PFs). Under what conditions and by how much can chromatin reduce regulatory errors on a global scale? We use a theoretical approach to compare two scenarios for gene regulation: one that relies on TF binding to free DNA alone and one that uses a combination of TFs and chromatin-regulating PFs to achieve desired gene expression patterns. We find, first, that chromatin effectively silences groups of genes that should be simultaneously OFF, thereby allowing more accurate graded control of expression for the remaining ON genes. Second, chromatin buffers the deleterious consequences of nontarget binding as the number of OFF genes grows, permitting a substantial expansion in regulatory complexity. Third, chromatin-based regulation productively co-opts nontarget TF binding for ON genes in order to establish a "leaky" baseline expression level, which targeted activator or repressor binding subsequently up- or down-modulates. Thus, on a global scale, using chromatin simultaneously alleviates pressure for high specificity of regulatory interactions and enables an increase in genome size with minimal impact on global expression error., Competing Interests: Competing interests statement:The authors declare no competing interest.

Aim: This study aimed to explore healthcare experiences of rural-living patients both with (attached) and without (unattached) a local primary care provider., Background: Primary care providers serve a gatekeeping role in the Canadian healthcare system as the first contact for receiving many health services. With the shortage of primary care providers, especially in rural areas, there is a need to explore attached and unattached patient experiences when accessing healthcare., Methods: A cross-sectional survey of rural patients both with (attached) and without (unattached) a primary care provider was conducted July-September 2022. An open-ended question gathered participants' thoughts and experiences with provider shortages., Findings: Overall, 523 (Mean age = 51 years, 75% female) rural British Columbia community members (306 attached; 217 unattached) completed the survey. Despite similar overall health, unattached patients received care less frequently overall compared to attached patients, including less frequent non-urgent and preventive care. The vast majority of attached patients sought care from a regular provider whereas unattached patients were more likely to use walk-in, emergency department, and urgent care and 29% did not seek care at all. Overall, 460 (88.0%) provided a response to the open-ended doctor shortage question. Similar themes were found among both attached and unattached participants and included: i) the ubiquity of the doctor shortage, ii) the precariousness or fluidity of attachment status, and iii) solutions and recommendations. Greater attention is needed on the negative and cyclical impacts provider shortages have for both attached and unattached patients alike.

Background: Physical activity has been associated with a wide range of health benefits including long-term benefits for cognitive and brain health. Whether episodes of everyday physical activity are associated with immediate cognitive benefits remains unknown., Purpose: The purpose of the current study was to examine whether episodes of physical activity, occurring over the course of participants' daily lives, are associated with short-term improvements in cognitive health., Methods: Participants completed a 9-day ecological momentary assessment protocol involving 5 daily assessments of self-reported physical activity and ambulatory cognitive assessments of processing speed and visuospatial working memory. Data were analyzed in a multilevel modeling framework to explore changes in performance on each task associated with physical activity during the period leading up to the assessment as well as individual differences in average frequency of physical activity., Results: Results of MLMs indicated that engaging in physical activity during the period (~3.5 hr) leading up to an assessment was associated with improvements in processing speed equivalent to 4 years of cognitive aging. Such improvements were observed for both light and moderate-to-vigorous physical activity levels. No association was observed for visuospatial working memory accuracy; however, response time during the working memory task reliably mirrored the association observed for processing speed. The short-term benefits were observed, particularly, for individuals with an overall higher frequency of reported physical activity., Conclusions: Our findings suggest that engaging in everyday physical activity of any intensity level may have short-term, acute benefits for cognitive health and point to new potential targets for intervention., Clinical Trial Information: NCT03240406., (© 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.)

Advances in imaging techniques have evolved, allowing for early noninvasive diagnosis and improved management of high-risk patients with hepatocellular carcinoma (HCC). The hallmark imaging features of HCC on multiphasic cross-sectional imaging can be explained by the multistep process of hepatocarcinogenesis and is seen in 60% of cases. However, approximately 40% of cases do not abide by the classic imaging appearance and may pose a diagnostic challenge for radiologists. These may be accounted by their morphologic subtypes with differing molecular and/or genetic features. Additionally, various malignant and benign lesions and pseudolesions may mimic HCC. This article aims to highlight the unusual cross-sectional imaging manifestations of HCC and describe its pitfalls and mimics., Competing Interests: Declarations. Competing interests: The authors declare no competing interests., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Purpose: Caregivers in pediatric oncology need accurate and understandable information about their child's condition, treatment, and side effects. This study assesses the performance of publicly accessible large language model (LLM)-supported tools in providing valuable and reliable information to caregivers of children with cancer., Methods: In this cross-sectional study, we evaluated the performance of the four LLM-supported tools-ChatGPT (GPT-4), Google Bard (Gemini Pro), Microsoft Bing Chat, and Google SGE-against a set of frequently asked questions (FAQs) derived from the Children's Oncology Group Family Handbook and expert input (In total, 26 FAQs and 104 generated responses). Five pediatric oncology experts assessed the generated LLM responses using measures including accuracy, clarity, inclusivity, completeness, clinical utility, and overall rating. Additionally, the content quality was evaluated including readability, AI disclosure, source credibility, resource matching, and content originality. We used descriptive analysis and statistical tests including Shapiro-Wilk, Levene's, Kruskal-Wallis H-tests, and Dunn's post hoc tests for pairwise comparisons., Results: ChatGPT shows high overall performance when evaluated by the experts. Bard also performed well, especially in accuracy and clarity of the responses, whereas Bing Chat and Google SGE had lower overall scores. Regarding the disclosure of responses being generated by AI, it was observed less frequently in ChatGPT responses, which may have affected the clarity of responses, whereas Bard maintained a balance between AI disclosure and response clarity. Google SGE generated the most readable responses whereas ChatGPT answered with the most complexity. LLM tools varied significantly (p < 0.001) across all expert evaluations except inclusivity. Through our thematic analysis of expert free-text comments, emotional tone and empathy emerged as a unique theme with mixed feedback on expectations from AI to be empathetic., Conclusion: LLM-supported tools can enhance caregivers' knowledge of pediatric oncology. Each model has unique strengths and areas for improvement, indicating the need for careful selection based on specific clinical contexts. Further research is required to explore their application in other medical specialties and patient demographics, assessing broader applicability and long-term impacts., (© 2025 The Author(s). Cancer Medicine published by John Wiley & Sons Ltd.)

Objective: The authors sought to examine the association between the increased use of videoconferencing and image-enhancing software filters during the COVID-19 pandemic and the corresponding rise in interest in cosmetic procedures. We aimed to discern if heightened exposure to one's digital self-image correlates with a greater inclination toward cosmetic interventions., Methods: In this cross-sectional questionnaire survey study, adult participants living in the United States were recruited on Amazon's Mechanical Turk platform. Self-reported demographic data, videoconferencing usage, related behaviors, and attitudes concerning cosmetic procedures were assessed. Questionnaire prompts allowed participants to express in a Likert scale format their levels of agreement with certain statements. Frequencies and proportions of responses to each questionnaire item were collected, categorized, and recoded for comparison and analysis. Chi-squared tests were performed to examine associations between questionnaire responses and demographic characteristics, while significant predictors of videoconferencing and image-enhancing filter options were explored via multivariable logistic regression models., Results: The majority of study participants (n=505, 505/545 = 92.7% completion rate) were 18 to 39 years old (80.1%), female (68.1%), and non-White (58.2%). Income levels varied, and 89.2 percent had completed college or graduate school. Videoconferencing was frequent, with 88.6 percent using it more than three days a week, and 68.1 percent using ";touch-up my appearance"; filters more than half the time. Videoconferencing influenced the desire for cosmetic procedures in 55.9 percent of participants, and 57.8 percent were influenced by filter use. Frequent self-viewing was reported by 67 percent, strongly associated with interest in cosmetic procedures. Significant predictors of filter use included higher income (OR 2.436, p <0.001) and frequent self-viewing behavior (OR 5.034, p <0.001). Notably, mask-wearing was associated with increased self-esteem (68.8%) and reduced desire for cosmetic procedures (67.4%) in frequent self-viewers., Limitations: Recall bias and the demographic composition of the study participant population may limit the generalizability of these self-reported responses., Conclusion: The data reflect the emergence of what may be termed 'videoconferencing dysmorphia,' indicating a significant association between videoconferencing, the application of filters, and the heightened interest in cosmetic procedures among users. This study suggests that digital self-viewing behavior instigates a distinct self-awareness that may drive individuals toward considering cosmetic interventions. These insights are vital for dermatologists in understanding patient motivations, managing expectations, and fostering realistic treatment outcomes., Competing Interests: DISCLOSURES: Dr. Vashi is a consultant for L’Oreal, Procter & Gamble, Pfizer, Janssen, UpToDate, and Unilever. All other authors have nothing to disclose., (Copyright © 2025. Matrix Medical Communications. All rights reserved.)

Type 2 diabetes (T2D) is a common metabolic disorder in which only 25% of patients meet management targets. While the primary care setting is positioned to provide lifestyle management education, studies are lacking which integrate behavior interventions in this setting utilizing clinic staff. Thus, we evaluated a 90-day lifestyle intervention for management of glycemia at a family practice clinic administered by clinic medical assistants. Twenty patients with non-insulin-dependent T2D completed a 90-day intervention driven by patient choices of nutrition and physical activity. Medical assistants were trained by members of the study team and administered the intervention under nurse practitioner supervision. HbA1c trended toward significant reduction 8.59 ± 0.9% to 8.15 ± 1.2% (p = 0.051, 95% CI: -0.88 to 0.003). Modest reductions were observed for waist circumference (115.5 ± 12.6 vs. 112.5 ± 15.2 cm; p = 0.014, 95% CI: -5.66 to -0.26), body weight (97.7 ± 21.9 vs. 95.6 ± 23.9 kg; p = 0.016. 95% CI: -3.84 to -0.31), and BMI (33.7 ± 7.2 vs. 32.8 ± 7.5 kg/m 2 ; p = 0.028, 95% CI: -1.29 to -0.12). This 90-day, patient choice-intervention was successful at lowering HbA1c in patients with T2D. Our study is limited by a lack of control group, and results should be interpreted as such. These data have implications for team-based care models in clinic settings to improve health outcomes in patients with T2D., (© 2024 The Author(s). Physiological Reports published by Wiley Periodicals LLC on behalf of The Physiological Society and the American Physiological Society.)

Key Points: Positive pressure transmitted from continuous positive airway pressure (CPAP) to the sinuses and skull base in the early post-operative period has not been studied in live subjects and controversy exists in when to restart this post-operatively. This study found that approximately 32.76% and 13.52% of the delivered CPAP pressures reached the post-surgical sphenoid sinus and the mid-nasal cavity, respectively, suggesting that surgical factors such as tissue edema, nasal packing, blood, and nasal secretions may provide a protective effect., (© 2024 The Author(s). International Forum of Allergy & Rhinology published by Wiley Periodicals LLC on behalf of American Academy of Otolaryngic Allergy and American Rhinologic Society.)

Background: Wheezing in childhood is prevalent, with over one-half of all children experiencing at least 1 episode by age 6. The pathophysiology of wheeze, especially why some children develop asthma while others do not, remains unclear., Objectives: This study addresses the knowledge gap by investigating the transition from preschool wheeze to asthma using multiomic profiling., Methods: Unsupervised, group-agnostic integrative multiomic factor analysis was performed using host/bacterial (meta)transcriptomic and bacterial shotgun metagenomic datasets from bronchial brush samples paired with metabolomic/lipidomic data from bronchoalveolar lavage samples acquired from children 1-17 years old., Results: Two multiomic factors were identified: one characterizing preschool-aged recurrent wheeze and another capturing an inferred trajectory from health to wheeze and school-aged asthma. Recurrent wheeze was driven by type 1-immune signatures, coupled with upregulation of immune-related and neutrophil-associated lipids and metabolites. Comparatively, progression toward asthma from ages 1 to 18 was dominated by changes related to airway epithelial cell gene expression, type 2-immune responses, and constituents of the airway microbiome, such as increased Haemophilus influenzae., Conclusions: These factors highlighted distinctions between an inflammation-related phenotype in preschool wheeze, and the predominance of airway epithelial-related changes linked with the inferred trajectory toward asthma. These findings provide insights into the differential mechanisms driving the progression from wheeze to asthma and may inform targeted therapeutic strategies., Competing Interests: Disclosure statement The study is supported by a Wellcome Trust grant (108818), a L.E.W. Carty Charitable Fund awarded to C.P., funding from The Hospital Research Foundation Group (2022-SF-EOI-001) awarded to B.J.M. and C.P., and a National Health and Medical Research Council Senior Research Fellowship (1154344) awarded to B.J.M. Disclosure of potential conflict of interest: The authors declare that they have no relevant conflicts of interest., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Objective:  Venous thromboembolism (VTE) is a major cause of maternal morbidity and mortality. Current expanded treatment recommendations result in the inclusion of a large percentage of the obstetric population, which has limited their adoption. The purpose of this study was to identify a population at high risk for VTE, with minimal impact on the number of patients that would qualify for expanded treatment., Study Design:  We performed a retrospective analysis of a large obstetric population. International Classification of Diseases, 10th Revsion (ICD-10) codes for VTE were used to identify patients presenting for obstetric or postpartum (PP) care from January 2016 to March 2018. The review focused on high-risk factors (history of VTE or high-risk thrombophilia), antepartum hospital admissions that were >72 hours in the previous 30 days, use of sequential compression devices, body mass index (BMI; kg/m 2 ), age, and mode of delivery. Pharmacologic treatment efficacy was set at 90, 75, or 50%., Results:  During the 27-month review period, there were 120,235 deliveries and 93 had a VTE event in the index pregnancy or within 4 weeks PP (7.7/10,000 births). A history of VTE or high-risk thrombophilia was seen in 25.8% of cases. Antepartum admission was noted in 40.9%, and the combination of cesarean delivery (CD) with age and BMI ≥35 (Age + BMI + CD) was noted in 17.3% of PP cases. Targeting these latter two groups for VTE prophylaxis with a 75% efficacy suggests that 34% of the VTE events would likely have been prevented while increasing the total population treated by approximately 2%., Conclusion:  Expanding pharmacologic prophylactical coverage to include an antepartum admission of >72 hours and those with Age + BMI + CD would result in about a one-third reduction in total VTE events with about 2% requiring treatment. These data support some of the suggested recommendations for expanded pharmacological deep venous thrombosis prophylaxis., Key Points: · CD, and BMI and age >35 are high-risk factors for VTE.. · Antepartum admission >72 hours is a high-risk factor for VTE.. · Targeting antepartum admissions, CD, and BMI and age >35 would reduce VTE events by about 33%.., Competing Interests: None declared., (Thieme. All rights reserved.)

The Society of Radiologists in Ultrasound convened a multisociety panel to develop a first-trimester US lexicon based on scientific evidence, societal guidelines, and expert consensus that would be appropriate for imagers, clinicians, and patients. Through a modified Delphi process with consensus of at least 80%, agreement was reached for preferred terms, synonyms, and terms to avoid. An intrauterine pregnancy (IUP) is defined as a pregnancy implanted in a normal location within the uterus. In contrast, an ectopic pregnancy (EP) is any pregnancy implanted in an abnormal location, whether extrauterine or intrauterine, thus categorizing cesarean scar implantations as EPs. The term pregnancy of unknown location is used in the setting of a pregnant patient without evidence of a definite or probable IUP or EP at transvaginal US. Since cardiac development is a gradual process and cardiac chambers are not fully formed in the first trimester, the term cardiac activity is recommended in lieu of 'heart motion' or 'heartbeat.' The terms 'living' and 'viable' should also be avoided in the first trimester. 'Pregnancy failure' is replaced by early pregnancy loss (EPL). When paired with various modifiers, EPL is used to describe a pregnancy in the first trimester that may or will not progress, is in the process of expulsion, or has either incompletely or completely passed., Competing Interests: Disclosures of conflicts of interest S.K.R. Book royalties from Elsevier. M.M.H. Payment for lectures, travel, or visiting professorship from Massachusetts General Hospital/Brigham Women’s Hospital, University of Toronto, McMaster University, World Class CME, and Hoag Medical Group; section editor for RadioGraphics. P.M.D. No relevant relationships. M.C.F. Payment for panel discussion from GE HealthCare. A. Kennedy Royalties and writer’s fees from Elsevier; honoraria from World Class CME and University of California Davis; support for travel from the RSNA; secretary of the Society of Radiologists in Ultrasound. R.A. No relevant relationships. K.B. Patents planned, issued, or pending with Kristyn Brandi MD MPH LLC. L.D. No relevant relationships. S.K.H. Grants from the National Center for Advancing Translational Sciences at the National Institutes of Health; payment for presentations from Organon; payment for expert testimony from Huff Powell Bailey; support for attending meeting from the American College of Obstetricians and Gynecologists (ACOG); section secretary of the Pennsylvania ACOG. A. Kamaya Book royalties from Elsevier. A. Koyama No relevant relationships. P.C.L. Honoraria for editor role from RoshReview (now Blueprint); support to attend meeting from Individuals with Intellectual or Development Disability Engaged, Aligned and Leading project workgroup funded by the Patient-Centered Outcomes Research Institute; secretary-treasurer of the New York Chapter of the American College of Emergency Physicians and past chair of the American College of Emergency Physicians Emergency Ultrasound Section. K.E.M. No relevant relationships. T.M. Book royalties from Elsevier. S.G.O. No relevant relationships. K.O. No relevant relationships. R.S. Honoraria and support for travel to meetings from World Class CME. S.S. Grants from the National Institutes of Health, AbbVie, and Organon. L.M.S. No relevant relationships., (Copyright © 2024 Elsevier Inc., RSNA. Published by Elsevier Inc. All rights reserved.)

Background: Kawasaki disease (KD) is a pediatric vasculitis that has a predilection for coronary artery involvement. Activated macrophages play an important role in the destruction of the coronary arteries in KD. Although intravenous immunoglobulin (IVIG) is standard therapy, corticosteroids are sometimes given to patients at a higher risk of IVIG non-responsiveness. In this study, we examined the effect of IVIG and corticosteroids in U937 derived M1 and M2 a macrophages., Methods: A total of 40 children with KD and 30 healthy controls were enrolled. U937-derived macrophages were stimulated with patient plasma to examine its effect on macrophage polarization. U937 derived M1 and M2 macrophages were then stimulated with IVIG and methylprednisolone. RNA was extracted from cell cultures and the expression levels of STAT1, interleukin (IL)-1β, PPARγ and IL-10 were determined by RT-PCR., Results: IVIG was effective at suppressing IL-10 expression in M2 macrophages (relative mRNA expression mean ± SE, high dose IVIG Vs. untreated 0.304 ± 0.095 Vs. 2.541 ± 0.157, p = 0.002), but did not suppress the production of IL-1β in M1 macrophages. In contrast, methylprednisolone both suppressed the IL-1β in M1 macrophages and also enhanced IL-10 in M2 macrophages even at low doses (relative mRNA expression mean ± SE, low dose methylprednisolone Vs. untreated IL-1β 6.353 ± 0.414 Vs. 93.838 ± 1.321, p < 0.001, IL-10 61.117 ± 2.319 Vs. 46.867 ± 2.893, p = 0.005)., Discussion: In this study we found that methylprednisolone was effective at suppressing the inflammatory cytokine IL-1β in M1 macrophages, and enhanced the production of anti-inflammatory IL-10 in M2 macrophages, an effect that could not be produced by IVIG. Our findings provide further mechanistic evidence that corticosteroid therapy, even at low doses may be a cost-effective adjuvant to IVIG therapy in patients with high-risk KD., 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 Ltd. All rights reserved.)

ABSTRACT Pre-exposure prophylaxis (PrEP) dramatically reduces HIV transmission risk. PrEP is underutilized among men who have sex with men who use substances (SU-MSM) in the Southern U.S., for whom there is limited research and high PrEP need. Using cross-sectional data from the National Institute on Drug Abuse (NIDA) Clinical Trials Network (CTN) 0082 study, we explored factors associated with PrEP awareness and use among 225 SU-MSM in the Southern U.S. Participants were recruited from community-based sexually transmitted infection clinics, syringe services programs and outpatient substance use treatment programs in eight cities across five Southern states with high HIV incidence. Multinomial logistic regressions examined PrEP awareness and use relative to sociodemographic factors, sexual behaviors and substance use. Results demonstrated overall high awareness, yet limited uptake of PrEP. Younger age, higher education, condomless anal sex and more frequent popper use were associated with greater odds of PrEP awareness. Higher education, condomless anal sex and more frequent popper use were associated with greater odds of PrEP use. Results highlight the need for innovative PrEP outreach to Southern SU-MSM that accounts for age, education and substances used.

Objective: To compare intrauterine balloon tamponade and vacuum-induced hemorrhage-control devices in a multicenter hospital system using a standardized three-stage postpartum hemorrhage response algorithm., Methods: As part of a quality improvement project, data were prospectively collected through ongoing detailed hemorrhage case audits from 65 facilities from August 2022 to February 2024. Postpartum hemorrhage-control devices are recommended for stage 2 or 3 of the postpartum hemorrhage algorithm. The primary outcomes were 1) quantitative blood loss after device placement, 2) rate of packed red blood cell (RBC) transfusion, 3) use of 3 units of packed RBCs or more, and 4) device failure., Results: During the 17-month observation period, there were 123,292 deliveries, and postpartum hemorrhage occurred in 5,931 (4.8%). Postpartum hemorrhage-control devices were used in 11.2% of cases (666 total, intrauterine balloon tamponade n=300, and vacuum-induced hemorrhage control n=366). For intrauterine balloon tamponade and vacuum-induced hemorrhage-control devices, quantitative blood loss (median and interquartile range) after device placement was similar at 194 (67-440) mL and 240 (113-528) mL ( P =.40), respectively, as was the rate of any packed RBC transfusion (59.7% vs 50.0%, P =.08), transfusion of 3 packed RBC units or more (27.0% vs 24.9%, P =.53), and device failure (7.7% vs 8.5%, P =.70). Placement of either device at a quantitative blood loss between 1,000 and 1,499 mL compared with 1,500 mL or more resulted in significantly lower rates of packed RBC transfusion (39.1% vs 70.3%, P <.001), transfusion of 3 or more packed RBC units (13.7 vs 38.1%, P <.001), and device failure (3.4% vs 12.9%, P <.001)., Conclusion: Transfusion and blood loss after device placement were similar with both hemorrhage-control devices. Earlier hemorrhage-control device placement reduced device failure and the need for transfusion., Competing Interests: Financial Disclosure The authors did not report any potential conflicts of interest., (Copyright © 2024 by the American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.)

In Southern U.S. states with high HIV incidence and low HIV Pre-Exposure Prophylaxis (PrEP) uptake, enhanced efforts to increase interest in and willingness to use PrEP are needed. This implementation survey examined the associations of sociodemographic background, substance use, and sexual risk behaviors with willingness to use daily oral and long-acting injectable (LAI) PrEP among substance using men who have sex with men (SU-MSM). Participants were 225 SU-MSM recruited from sexually transmitted infection (STI) clinics, syringe services programs (SSPs), and substance use treatment programs (SUTPs) in eight Southern U.S. cities. Rates of willingness were high for both daily oral PrEP (78%) and LAI PrEP (66%). In multivariable analyses, distinct factors were associated with willingness towards each. For daily oral PrEP, greater willingness was associated with condomless anal sex, less frequent non-injection opioid use, prior PrEP awareness, and past use of PrEP. For LAI PrEP, greater willingness was associated with Black race, identifying as gay, being single, and higher injection drug use frequency. Lower willingness to use LAI PrEP was associated with higher non-injection opioid use frequency. Findings about willingness to use LAI PrEP, as a relatively newer modality, and greater willingness among Black SU-MSM as a disproportionately HIV-impacted population, are especially important. These findings argue for the necessity to enhance PrEP promotion efforts that distinguish between oral and LAI PrEP and that are specifically tailored to major SU-MSM subgroups in the Southern U.S., Competing Interests: Declarations. Ethical approval: The University of Washington Human Subjects Division determined that this study (STUDY00007617) was exempt from federal human subjects regulations, including the requirement for a full IRB review approval and continuing review. Competing Interests: The authors declare that they have no competing interests., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Background: Immunization against influenza and respiratory syncytial virus (RSV) protects pregnant individuals and their infants against infection via transplacental transport of immunoglobulin G (IgG). We sought to evaluate the quantity and efficiency of maternal influenza- and RSV-specific IgG transfer in pregnancies with preterm and full-term deliveries., Methods: Delivery samples from 115 maternal-infant pairs (2018-2021) were analyzed for RSV prefusion F and IAV-H3 and IAV-H1 antibodies using electrochemiluminescence assays. We used Wilcoxon rank sum tests, t tests, Pearson correlation coefficients (PCCs), and linear regression to evaluate distributions of IgG results by maternal influenza vaccination status and preterm birth (<37 weeks)., Results: Approximately 70% of pregnant persons received influenza vaccine. Maternal and cord antibody concentrations were highest in the influenza-vaccinated group for IAV-H3 and IAV-H1 regardless of preterm birth status (maternal H3, P = .004; cord H3, P = .03; maternal H1, P = .0001; cord H1, P = .0002). Preterm infants had significantly lower cord to maternal IgG transfer ratios for IAV-H3 and RSV when compared with full-term infants ( P ≤ .05). Correlations between maternal and cord IgG concentrations were significant ( P ≤ .001) for all 3 viruses, with the strongest correlation for H3 (PCC: IAV-H3, 0.77; IAV-H1, 0.68; RSV, 0.62). Associations between maternal IgG transfer and preterm birth were significant for IAV-H3 and RSV (IAV-H3, β = -0.42; RSV, β = -0.63; P ≤ .05)., Conclusions: Maternal antibody following vaccination or infection is readily transferred across the placenta. Preterm infants have higher influenza IgG following maternal influenza vaccination and are at highest risk of lower IgG transfer ratios without vaccination., Competing Interests: Potential conflicts of interest. Outside of this work, A. B. K. was an unpaid consultant for Pfizer and GlaxoSmithKline and is coinvestigator on studies funded by Merck and Pfizer. J. A. E. also receives grant support to her institution from Merck, GlaxoSmithKline, AstraZeneca, and Pfizer and is a consultant for Abbvie, Ark Biopharma, AstraZeneca, GlaxoSmithKline, Moderna, Pfizer, Sanofi Pasteur, and Meissa Vaccines, Inc outside of the described work. All other authors report no potential conflicts., (© The Author(s) 2024. Published by Oxford University Press on behalf of Infectious Diseases Society of America.)

Objective: Research examining (MCI) criteria in diverse and/or health-disparate populations is limited. There is a critical need to investigate the predictive validity for incident dementia of widely used MCI definitions in diverse populations., Method: Eligible participants were non-Hispanic White or Black Bronx community residents, free of dementia at enrollment, with at least one annual follow-up visit after baseline. Participants completed annual neurological and neuropsychological evaluations to determine cognitive status. Dementia was defined based on DSM-IV criteria using case conferences. Cox proportional hazard models assessed predictive validity for incident dementia of four specific MCI definitions (Petersen, Jak/Bondi, number of impaired tests, Global Clinical Ratings) at baseline, controlling for age, sex, education, and race/ethnicity. Time-dependent sensitivity and specificity at 2-7 years for each definition, and Youden's index were calculated as accuracy measures., Results: Participants (N = 1073) ranged in age from 70 to 100 (mean = 78.4 ± 5.3) years at baseline. The sample was 62.5% female, and educational achievement averaged 13.9 ± 3.5 years. Most participants identified as White (70.0%), though Black participants were well-represented (30.0%). In general, MCI definitions differed in sensitivity and specificity for incident dementia. However, there were no significant differences in Youden's index for any definition, across all years of follow-up., Conclusions: This work provides an important step toward improving the generalizability of the MCI diagnosis to underrepresented/health-disparate populations. While our findings suggest the studied MCI classifications are comparable, researchers and clinicians may choose to consider one method over another depending on the rationale for evaluation or question of interest.

Background: This study aims to develop Z-Score models to normalize measurements of three coronary arteries and enhance the diagnosis of Kawasaki disease (KD) in children from newborns to 10 years old. Developing a reliable Z-Score model is challenging, as some existing models fail the normality test. Overcoming these challenges is crucial for improving KD diagnosis., Method: Detailed measurements of the left main coronary artery (LCA), left anterior descending coronary artery (LAD), and right coronary artery (RCA) were collected, along with patient demographics such as age, height, weight, and body surface area (BSA). Several Z-Score models, named the Kuo Z-Score models, were proposed, with separate designs for different coronary arteries and different age groups, resulting in multiple Z-Score models. The Z-Score model for the RCA employs the Box-Cox method for data transformation. Finally, we tested various age group combinations, selecting models that passed the Anderson-Darling normality test and had higher R-square values for robustness and best data fit., Results: The study included 1180 participants free from coronary or heart diseases. The Kuo Z-Score models were optimized for LCA, LAD, and RCA across the five age groups 0-6 years, 6-7 years, 7-8 years, 8-9 years, and 9-10 years. Only the normality test for the RCA in the 7-8 year age group failed. The proposed model fitted to the normality assumption outperforming the other models., Conclusion: The Kuo Z-Score models, applicable across a broad age range, provides robust identification of coronary artery dilatation and aneurysm in KD. The models' capability to normalize diverse data sets marks a significant advancement in KD diagnostic sensitivity, aiding in better clinical decision-making and potentially improving patient outcomes., Competing Interests: Declarations. Ethics approval and consent to participate: The echocardiographic images utilized in this study were obtained from Chang Gung Memorial Hospital. The study was conducted in accordance with the guidelines set by the Institutional Review Board (IRB) of the hospital and received approval with the IRB number No. 202101666B0. Consent for publication: Not applicable. Competing interests: The authors declare that they have no competing interests., (© 2024. The Author(s).)

This article reports the results of a 33-wave longitudinal study of relations between job insecurity and physical and mental health based on monthly data collected between April 2020 and December 2022 among n = 1,666 employees in Germany. We integrate dynamic theorizing from the transactional stress model and domain-specific theorizing based on stressor creation and perception to frame hypotheses regarding dynamic and reciprocal relations between job insecurity and health over time. We find that lower physical health predicted subsequent increases in job insecurity and higher physical health predicted subsequent decreases in job insecurity. However, job insecurity did not have a significant influence on physical health. Furthermore, higher job insecurity predicted subsequent decreases in mental health, and higher mental health predicted subsequent decreases in job insecurity. This pattern of findings suggests a dynamic and reciprocal within-person process wherein positive deviations from one's average trajectory of job insecurity are associated with subsequently lower levels of mental health and vice versa. We additionally find evidence for linear trends in these within-person processes themselves, suggesting that the strength of the within-person influence of job insecurity on mental health becomes more strongly negative over time (i.e., a negative amplifying cycle). This research provides practical insights into job insecurity as a health threat and shows how concerns about job loss following deteriorations in physical and mental health serve to further threaten well-being. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Unlabelled: The Global Burden of Disease (GBD) study aims to characterize the worldwide prevalence and morbidity of major diseases, while PatientsLikeMe (PLM) is an online community providing patient-generated insights into lived experiences; for dermatologic conditions, quantitative comparisons of GBD and PLM data revealed expected demographic differences but also notable correlations, highlighting their potential as complementary data sources elucidating unmet patient needs and priorities., (© Mindy D Szeto, Lina Alhanshali, Chandler W Rundle, Madeline Adelman, Michelle Hook Sobotka, Emily Woolhiser, Jieying Wu, Colby L Presley, Jalal Maghfour, John Meisenheimer, Jaclyn B Anderson, Robert P Dellavalle. Originally published in JMIR Dermatology (http://derma.jmir.org).)

Introduction: Anticoagulants (AC) are associated with epistaxis in atrial fibrillation (AF) patients. Left atrial appendage occlusion (LAAO) is a treatment that allows AF patients to stop AC. The aim of this study is to evaluate the risk of developing epistaxis following LAAO versus direct oral anticoagulants (DOAC) and warfarin., Methods: This study uses the TriNetX database as well as institutional records. The TriNetX database was searched for AF patients on a DOAC, warfarin, or treated with LAAO. Epistaxis odds ratios were compared 1 day-6 months and 6 months-3 years following initiation of DOAC, warfarin, or LAAO. Records of LAAO patients at our institution were also reviewed., Results: The TriNetX query returned 1,185,862 patients. On TriNetX, LAAO patients had significantly higher odds of epistaxis likely due to antiplatelet therapy from 1 day-6 months compared to warfarin patients with DOAC patients (p < 0.0001). From 6 months-3 years after treatment initiation, LAAO patients experience reduced odds of epistaxis and epistaxis requiring nasal packing compared to warfarin patients (OR: 0.69 p = 0.0003; OR: 0.58 p = 0.0043). Institutionally, epistaxis resolved in 66% (8/12) LAAO patients with a history of epistaxis with an average follow-up of 1.5 years., Discussion: LAAO decreased the frequency of epistaxis and epistaxis requiring nasal packing in AF patients on warfarin after 6 months. Our institutional experience demonstrates long-term improvement in epistaxis after LAAO for DOAC and warfarin patients. Additional studies need to be performed to account for dual antiplatelet following LAAO on epistaxis risk., Level of Evidence: Level 3 Laryngoscope, 2024., (© 2024 The American Laryngological, Rhinological and Otological Society, Inc.)

Background Aims: The need for large-scale production of mesenchymal stromal cell (MSC)-based cellular therapeutics continues to grow around the globe. Manual cell expansion processes can be highly variable between operators, require significant hands-on time from skilled staff and, because of the large number of open manipulation steps required to produce cells in dose-relevant quantities, be prone to greater risk of contamination relative to automated processes. All of these can increase overall production costs and risks to the patient. In order to meet the needs of this growing industry, viable options for large-scale automation coupled with consistent and compliant ancillary materials needed to drive cell expansion are needed., Methods: In the work described herein, the automated and functionally closed hollow-fiber bioreactor system Quantum Flex (Terumo Blood and Cell Technologies, Inc., Lakewood, CO, USA) was used in conjunction with Good Manufacturing Practice (GMP)-compliant, virus-inactivated human fibronectin (FN) from Akron Bio (Boca Raton, FL, USA) to expand MSCs to clinically relevant numbers. In order to assess the performance of Akron Bio's GMP-grade FN, use of this product in the production of MSCs was referenced against use of a research-use-only (RUO)-grade FN product used extensively for MSC expansion in Quantum. Because many MSC-based processes require passaging of cells to attain the appropriate number of cells needed, a two-passage process was employed comparing the transfer of MSCs expanded on RUO FN to RUO FN, GMP FN to GMP FN and RUO FN to GMP FN to assess the impacts of transitioning from one grade of FN to another, as a product might be required to do as it moves from pre-clinical to clinical stages and beyond., Results: No statistically significant differences were noted when MSCs were transferred from RUO FN to RUO FN, GMP FN to GMP FN or RUO FN to GMP FN in terms of harvest yield, population doubling time, seeding efficiency estimates or fold expansion. All MSCs harvested from all groups met International Society for Cell & Gene Therapy standards for MSCs in terms of protein marker expression measured by flow cytometry, adherence to plastic, downstream cell morphology and trilineage differentiation., Conclusions: The combination of Quantum Flex as an expansion platform and Akron Bio's GMP FN is seen as an attractive option for larger-scale manufacture of GMP-grade MSC products., Competing Interests: Declaration of competing interest NDF, SLG, and MMM are employed by Terumo Blood and Cell Technologies and EZ and MBR are employed by Akron Bio., (Copyright © 2025. Published by Elsevier Inc.)

Thyroid dysfunction is commonly seen in major depressive disorder (MDD), and is particularly prevalent in female patients. Moreover, gender differences occur in many aspects of MDD, including suicide attempts (SAs). We aimed to explore gender differences in the prevalence and clinical correlates of SAs in young first-episode drug-naïve MDD patients with thyroid dysfunction, which have not yet been reported. We recruited 509 patients in this study. Demographic and clinical characteristics were collected. We used HAMD-17, HAMA-14, the positive subscale of PANSS, and CGI-S to assess every participant. We found no significant difference in the prevalence of SAs between male and female subgroup. Gender differences in factors associated with SAs were found with anxiety, body mass index, serum anti-thyroid antibodies (A-TPO), and free triiodothyronine levels in male patients and anxiety, CGI-S score, and A-TPO in female patients. We found no gender differences in the prevalence of SAs; however, there were gender differences in several clinical correlates of SAs, highlighting specific strategies to avoid SAs in male and female MDD patients., Competing Interests: Declarations. Ethics approval and consent to participate: The study was approved by the medical ethics committee at the First Hospital of Shanxi Medical University. Informed consent was obtained from all subjects and/or their legal guardian(s). Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Dihydrochalcones (DHCs) are flavonoids produced as a side branch of the phenylpropanoid pathway. DHCs are found at high concentrations in apples (Malus spp.) but not in pears (Pyrus spp.) or other members of the Rosaceae. Biosynthesis of DHCs in apple has been hypothesized to occur via reduction of p-coumaroyl CoA by a Malus × domestica hydroxycinnamoyl CoA double-bond reductase (MdHCDBR) followed by the action chalcone synthase to produce phloretin or via direct reduction of naringenin chalcone to phloretin via an unknown enzyme. In this study, we report that genetic downregulation of MdHCDBR does not reduce DHC concentrations in apple leaves. We used comparative transcriptome analysis to identify candidate naringenin chalcone reductases (NCRs), designated MdNCR1a-c, expressed in apple leaves but not fruit. These MdNCR1 genes form an expanded gene cluster found exclusively in apple. Transient expression of MdNCR1 genes in Nicotiana benthamiana leaves indicated they produced DHCs at high concentrations in planta. Recombinant MdNCR1 utilized naringenin chalcone to produce phloretin at high efficiency. Downregulation of NCR genes in transgenic apple reduced foliar DHC levels by 85% to 95%. Reducing DHC production redirected flux to the production of flavonol glycosides. In situ localization indicated that NCR proteins were likely found in the vacuolar membrane. Active site analysis of AlphaFold models indicated that MdNCR1a-c share identical substrate binding pockets, but the pockets differ substantially in related weakly active/inactive NCR proteins. Identifying the missing enzyme required for DHC production provides opportunities to manipulate DHC content in apple and other fruits and has other applications, e.g. in biofermentation and biopharming., Competing Interests: Conflict of interest statement. None declared., (© The Author(s) 2024. Published by Oxford University Press on behalf of American Society of Plant Biologists.)

Long COVID, also known as PASC (post-acute sequelae of SARS-CoV-2), is a complex infection-associated chronic condition affecting tens of millions of people worldwide. Many aspects of this condition are incompletely understood. Among them is how this condition may manifest itself in older adults and how it might impact the older population. Here, we briefly review the current understanding of PASC in the adult population and examine what is known on its features with aging. Finally, we outline the major gaps and areas for research most germane to older adults., (© 2024. The Author(s), under exclusive licence to American Aging Association.)

Scaling up the manufacture of cell therapies can be complex and challenging. Maintaining critical quality attributes of the cell product during its final formulation and fill-finish into multiple containers can be especially difficult and laborious. Here, we tested the automated Finia™ Fill and Finish System to efficiently scale up the formulation and fill-finish of a T cell product, and then assessed cell quality and product consistency across different sub-lots filled during this expanded process. We found that this automated system could be effectively scaled to 4 times its singular capacity in a 2-h time interval, with variation in cell number and product volume less than 12% across all containers. Analysis of the different sub-lots of the final product revealed high cell viability and consistent T cell phenotype, with a high proportion of effector memory and central memory T cells and low expression of T cell senescence and exhaustion markers. The functionality of the T cell product was compared by measuring cytokine response after restimulation, with secreted levels of effector cytokines like IFN-γ and TNF-α being similar across the different sub-lots. Collectively, these results show that automation can scale up the formulation and fill-finish of a cell manufacturing process while maintaining the phenotype and functionality of the cell product. Better understanding of how to maintain product uniformity and quality during final manufacturing is important to the further scale-up and development of successful cell therapies., Competing Interests: Declaration of competing interest All authors are paid employees of Charles River Laboratories Inc. or Terumo BCT, as indicated by the author affiliations. The authors report no other conflict of interest beyond these respective employments., (Copyright © 2024 International Society for Cell & Gene Therapy. Published by Elsevier Inc. All rights reserved.)

Introduction: Amid the spread of the novel coronavirus (COVID-19), racially and economically marginalized communities experienced a disproportionate burden of disease and social consequences (e.g., unemployment, increased exposure). This study seeks to understand strategies that these communities employed to cope with unequal burdens of the pandemic., Methods: We utilized qualitative data collected between 2020 and 2021 from a mobile mapping platform designed to facilitate real-time, geocoded data collection on individual's experiences and perceptions of their neighborhoods. Reports were iteratively coded by an academic researcher and community partner. We employed an inductive approach to analysis, which allowed findings to emerge organically without constraint of researcher hypotheses., Results: A total of 19 respondents (14 under the age of 45, 16 non-White, 15 with less than half a year of emergency savings) provided 236 qualitative reports. Participants described innovative strategies for exchanging resources as a means of informally networking and building community, the importance of tailored programming (e.g., for specific racial/ethnic groups) in fostering belonging and comfort, and the importance of two specific dimensions of services-interactions with service providers and the quality of goods or services-in providing dignified care., Discussion: Amidst exacerbated racial and economic disparities emerging from the COVID-19 pandemic, our study highlights the need for investment in mutual aid, the importance of tailored services and support, and promoting dignity in social services. As other macro-level social stressors become more prevalent as the pandemic continues, these findings can inform how we examine and address them., Competing Interests: Declarations Ethics Approval Ethical approval was granted by the Institutional Review Board at the University of California, San Francisco. Consent to Participate and Publish Informed consent was obtained from all participants included in this study. This manuscript does not include individual details, images or videos. Competing Interests The authors declare no competing interests., (© 2023. The Author(s).)