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Pre-exposure prophylaxis (PrEP) has proven to be a powerful tool in preventing HIV infection. There is limited information about the factors associated with willingness to use different PrEP modalities among adolescent girls and young women (AGYW) in Africa. We assessed willingness to use long-acting injectable PrEP (LAI-PrEP) among 14-24-year-old AGYW at high risk of HIV in Uganda, and associated factors determined using multivariable complementary log-log regression. Of the 285 participants, 69.8% of participants showed willingness to use LAI-PrEP despite only 3.9% having knowledge about it before enrolment. Report of recent transactional sex was high (92.6%). Participants that were divorced/separated (aOR = 1.74, 95% CI 1.03-2.92) and those with multiple sexual partners (aOR = 2.11, 95% CI 1.46-3.06) compared to those with one partner were more likely to be willing to use LAI-PrEP while those that were screened as heavy episodic drinkers (consuming 6 or more drinks on an occasion as per the AUDIT tool) were less likely to be willing to use LAI-PrEP (aOR = 0.61, 95% CI 0.42-0.87). LAI PrEP has shown efficacy in clinical trials; the product is approved for use by the Government of Uganda (MoH) and should be expedited for use by AGYW engaged in paid sex and those with multiple sexual partnerships. As it becomes available, we recommend PrEP education and counseling to increase awareness of LAI PrEP as an alternative HIV prevention method., Competing Interests: Declarations. Ethical Approval: Ethical approval was obtained from the Uganda Virus Research Institute Research Ethics Committee (GC/127/18/06/658) and Uganda National Council for Science and Technology (HS2435). Written informed consent was obtained from all volunteers who participated in the survey. Informed Consent: Informed consent was obtained from all individual participants included in the study. Consent for Publication: Not applicable. Competing Interests: The authors declare that they have no competing interests., (© 2025. The Author(s).)

Objective: Individuals with severe mental illness (SMI) have a shorter life expectancy compared to the general population, largely due to cardiovascular disease (CVD). In this report from the Fixed Dose Intervention Trial of New England Enhancing Survival in SMI Patients (FITNESS), we examined baseline CVD risk factors and their treatment in patients with SMI and second generation antipsychotic (SGA) use., Methods: FITNESS enrolled 204 participants with SMI and SGA use, but without documented history of CVD or diabetes mellitus, from several clinics in the Boston, Massachusetts, area between April 29, 2015, and September 26, 2019. We measured CVD risk factors (eg, body composition, arterial blood pressure, lipid and glucose parameters, diet, and activity) and CVD medication use prior to the initiation of the trial., Results: The mean age of participants was 37.2 (13.5) years; 40% were female. Participants frequently had cardiovascular risk factors, including obesity (40%), elevated lipid levels (58%), elevated systolic blood pressure/hypertension (60%), elevated glycosylated hemoglobin percent (25%), active smoking (36%), and sedentary lifestyle (49%). Of CVD medications, 82% of those with hypertension were not receiving antihypertensive medications, 99% of those with dyslipidemia were not receiving cholesterol medications, and 97% of those with active smoking were not receiving smoking cessation medication. Among all participants, psychiatric diagnosis was not significantly associated with body mass index and CVD risk., Conclusions: Despite well-documented CVD morbidity and mortality among people with SMI, CVD risks in individuals with SMI and SGA are common and frequently untreated across psychiatric diagnoses., Trial Registration: ClinicalTrials.gov identifier: NCT02188121., (© Copyright 2025 Physicians Postgraduate Press, Inc.)

Despite vaccines being instrumental in reducing vaccine-preventable disease, adult vaccination rates in the United States (US) are below optimal levels. To better understand factors affecting vaccination rates, we analyzed trends in adult vaccination coverage using data from the Behavioral Risk Factor Surveillance System (BRFSS) and conducted a targeted literature review (TLR) on interventions to improve adult vaccination rates in the US. Both the BRFSS analysis and the TLR focused on influenza; pneumococcal disease; tetanus and diphtheria or tetanus, diphtheria, and acellular pertussis; herpes zoster; and human papillomavirus vaccination for US adults aged 18-64 years. The TLR additionally included hepatitis A and hepatitis B vaccination. Vaccination coverage rates (VCRs) and changes in VCRs were calculated using the 2011-2019 BRFSS survey data. For the TLR, the MEDLINE and MEDLINE In-Process databases were searched for articles on vaccination interventions published between January 2015 and June 2021. The BRFSS analysis showed that changes in VCRs were generally modest and positive for most states over the study period. The TLR included 32 articles that met the eligibility criteria; intervention strategies that improved adult vaccination outcomes incorporated an educational component, vaccination reminders or reinforcement at the point of care, or authorized non-clinician members of the healthcare team to vaccinate. Furthermore, interventions combining more than one approach appeared to enhance effectiveness. The strategies identified in this TLR will be valuable for policymakers and stakeholders to inform the development and implementation of evidence-based policies and practices to improve adult vaccination coverage.

Predicting risk of future dementia is essential for primary prevention strategies, particularly in the era of novel immunotherapies. However, few studies have developed population-level prediction models using existing routine healthcare data. In this longitudinal retrospective cohort study, we predicted incident dementia using primary and secondary care health records at 5, 10 and 13 years in 144 113 Scottish older adults who were dementia-free prior to 1st April 2009. Gradient-boosting (XGBoost) prediction models were trained on two feature subsets: data-driven (using all 171 extracted variables) and clinically supervised (22 curated variables). We used a random-stratified internal validation set to rank top predictors in each model, assessing performance stratified by age and socioeconomic deprivation. Predictions were stratified into 10 equally sized risk deciles and ranked by response rate. Over 13 years of follow-up, 11 143 (8%) patients developed dementia. The data-driven models achieved marginally better precision-recall area-under-the-curve scores of 0.18, 0.26 and 0.30 compared to clinically supervised models with scores of 0.17, 0.27 and 0.29 for incident dementia at 5, 10 and 13 years, respectively. The clinically supervised model achieved comparable specificity 0.88 [95% confidence interval (CI) 0.87-0.88] and sensitivity (0.55, 95% CI 0.53-0.57) to the data-driven model for prediction at 13 years. The most important model features were age, deprivation and frailty, measured by a modified electronic frailty index excluding known cognitive deficits. Model precision was consistent across socioeconomic deprivation quintiles but lower in younger-onset (<70 years) dementia cases. At 13 years, dementia was diagnosed in 32% of the population classified as highest risk with 40% of individuals in this group below the age of 80. Personalized estimates of future dementia risk from routinely collected healthcare data could influence risk factor modification and help to target brain imaging and novel immunotherapies in selected individuals with pre-symptomatic disease., Competing Interests: K.G., A.C. and A.S. were affiliated with Red Star throughout the duration of the project and data application. Red Star was the commercial partner for this work, as part of the DataLab Innovation funding award, providing a contribution to the overall funding amount., (© The Author(s) 2024. Published by Oxford University Press on behalf of the Guarantors of Brain.)

Categorization systems for tick-borne encephalitis virus (TBEV) infection lack consistency in classifying disease severity. To evaluate the need for a standard, consensus-based categorisation system for TBEV infection across subtypes, we gathered an expert panel of clinicians and scientists with diverse expertise in TBEV infection. Consensus was sought using the Delphi technique, which consisted of 2 web-based survey questionnaires and a final, virtual, consensus-building exercise. Ten panellists representing 8 European countries participated in the Delphi exercise, with specialities in neurology, infectious disease, paediatrics, immunology, virology, and epidemiology. Panellists reached unanimous consensus on the need for a standardised, international categorisation system to capture both clinical presentation and severity of TBEV infection. Ideally, such a system should be feasible for use at bedside, be clear and easy to understand, and capture both the acute and follow-up phases of TBEV infection. Areas requiring further discussion were (1) the timepoints at which assessments should be made and (2) whether there should be a separate system for children. This Delphi panel study found that a critical gap persists in the absence of a feasible and practical classification system for TBEV infection. Specifically, the findings of our Delphi exercise highlight the need for the development of a user-friendly classification system that captures the acute and follow-up (i.e., outcome) phases of TBEV infection and optimally reflects both clinical presentation and severity. Development of a clinical categorisation system will enhance patient care and foster comparability among studies, thereby supporting treatment development, refining vaccine strategies, and fortifying public health surveillance., Competing Interests: Declaration of competing interest J.R. and M.P. are full-time employees of RTI Health Solutions, an independent nonprofit research organisation, which received funding from Pfizer in connection with the development of this manuscript. Their compensation is unconnected to the studies on which they work. M.G. was a full-time employee of RTI Health Solutions at the time this study was conducted. K.H., H.M., F.J.A., and A.P. are employees of Pfizer Inc. and hold stock and stock options in Pfizer Inc. W.E. was an employee of Pfizer Inc. at the time of the project, and holds stock options in Pfizer Inc. A.E. does not receive any personal grants or honoraria from corporate or pharmaceutical companies. Encephalitis International (of whom A.E. is Chief Executive) does receive grants, expenses, and honoraria from a range of corporate partners, including the sponsor of this study (Pfizer) and other pharmaceutical companies involved in tick-borne encephalitis. J.S. received consulting fees from Pfizer. F.S. served on the scientific advisory board on Lyme disease serological diagnostics for Roche, served on the scientific advisory board on Lyme disease and panel on TBE for Pfizer, and is an unpaid member of the steering committee of the ESCMID Study Group on Lyme Borreliosis/ESGBOR. M.V. has received consultancy funding from Bavarian Nordic and Pfizer Vaccines. D.Z. declares a research grant within the Research Collaboration to Rıga Stradinš University (employer) from Pfizer Vaccines. U.K.M.-L has received consulting and lecture fees from Pfizer and Biogen. G.D., G.K., L.K., J.K., and J.Z. have no conflicts of interest to disclose., (Copyright © 2024 The Authors. Published by Elsevier GmbH.. All rights reserved.)

This practice resource seeks to describe salient problems within reproductive psychiatry (also known as women's mental health) for the practice of forensic psychiatry. Understanding is critical and can help combat gender bias in such evaluations. Forensic psychiatric evaluations in the criminal realm, including evaluations related to neonaticide, infanticide, filicide, child abuse, and kidnapping by cesarean, require an understanding of reproductive psychiatry. Civil forensic evaluations requiring knowledge about reproductive psychiatry include parenting evaluations and risk assessments in the postpartum. Similarly, forensic psychiatrists performing a treatment role within corrections or forensic hospitals recognize the importance of understanding mental illness in pregnancy and postpartum, lactation, mother-baby units, and forced separation or custody loss. In addition to menstruation, pregnancy, and postpartum, specific concerns that bear consideration within reproductive forensic psychiatry include the periods of girlhood and menstruation. Finally, eating disorders and substance misuse bear additional attention in this group., (© 2024 American Academy of Psychiatry and the Law.)

Background and Aims: An exploratory focus group study was conducted to better understand the needs of patients living with generalized myasthenia gravis (gMG)., Methods: US-based adults with gMG and caregivers of patients with gMG participated in a Patient Engagement Research Council between August 2022 and January 2023. The study consisted of a 15-min prework survey, followed by virtual focus groups facilitated using a semi-structured interview guide. Data concepts were identified using conversational analysis and by direct observation. All transcripts were coded based on concepts using a qualitative research analysis program (MaxQDA)., Results: 16 participants (13 patients, three caregivers) were recruited. Participants reported impact on daily activities, fatigue, and psychosocial problems. Many participants experienced delayed diagnosis and difficulty accessing specialist care. Participants described multiple barriers related to their gMG, including barriers to treatment, access-related issues, and communication disconnect between patients and healthcare professionals. Achieving stable disease was the most important goal. There was a preference for the autonomy of self-administered medications at home versus infusions. Study insights led to recommendations to guide patient and healthcare professional education., Conclusion: The study illustrates the need to improve access to specialist care, achieve earlier diagnosis, prioritize patients' preferences in disease management, and develop treatments that improve outcomes without additional burden., Patient or Public Contribution: The data collected in this study was provided by the focus group participants, which included patients and caregivers of those with myasthenia gravis., Competing Interests: Jacqueline Pesa, Gabrielle Geonnotti, Zia Choudhry, Oluyemisi Falope, and Lisa Shea are employees of Janssen Pharmaceuticals US Inc. Titusville, NJ, USA. At the time of this study, Wesley Peters and Melina Taylor were employees of CorEvitas, which is now Evidera Inc. a part of Thermo Fisher Scientific Inc. Wilmington, NC, USA, which provided analytical services funded by Janssen Pharmaceuticals. Marquetta Price, Lucy Baxter, and Bruce West have no conflicts of interest to disclose., (© 2024 Janssen Scientific Affairs, LLC. Health Science Reports published by Wiley Periodicals LLC.)

Introduction: Typhoid fever is an infectious disease primarily caused by Salmonella enterica sv. Typhi ( S. Typhi), a bacterium that causes as many as 20 million infections and 600,000 deaths annually. Asymptomatic chronic carriers of S. Typhi play a major role in the transmission of typhoid fever, as they intermittently shed the bacteria and can unknowingly infect humans in close proximity. An estimated 90% of chronic carriers have gallstones; biofilm formation on gallstones is a primary factor in the establishment and maintenance of gallbladder carriage. CsgD is a central biofilm regulator in Salmonella , but the S. Typhi csgD gene has a mutation that introduces an early stop codon, resulting in a protein truncated by 8 amino acids at the C-terminus. In this study, we investigate the role of role of CsgD in S. Typhi., Methods: We introduced a fully functional copy of the csgD gene from S. Typhimurium into S. Typhi under both a native and a constitutive promoter and tested for red, dry, and rough (Rdar) colony morphology, curli fimbriae, cellulose, and biofilm formation., Results and Discussion: We demonstrate that although CsgD-regulated curli and cellulose production were partially restored, the introduction of the S. Typhimurium csgD did not induce the Rdar colony morphology. Interestingly, we show that CsgD does not have a significant role in S. Typhi biofilm formation, as biofilm-forming capacities depend more on the isolate than the CsgD regulator. This data suggests the presence of an alternative biofilm regulatory process in this human-restricted pathogen., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 González, Laipply, Sadowski, Price and Gunn.)

Background: Although multiple qualitative studies have explored participants' experiences of behavioural activation (BA) for unipolar depression, none have investigated the experiences of BA in people with bipolar depression. This is of particular interest because qualitative studies concerning the experience of receiving therapy can help inform the theory of change underpinning the intervention., Aim: The purpose of this study was to explore the experiences and perspectives of individuals with bipolar disorder who received a course of one-to-one BA for bipolar depression. We sought to explore participants' experience of the effects of BA therapy, both proximally and distally., Method: Semi-structured interviews were conducted with nine individuals meeting research diagnostic criteria for bipolar I or II disorder who had received up to 20 sessions of BA adapted for bipolar depression. Thematic analysis using a framework approach was used to explore and describe the experiences of participants., Results: Participants' perspectives on the impact of therapy were categorized under four subthemes: client behaviour inside and outside sessions, changes in clients' perspectives, the impact on symptoms and impact on life and functioning., Conclusions: Participants' accounts of the impact of therapy were broadly consistent with the theory underpinning a behavioural approach. Participants described a central role for perspective change, and particularly increased acceptance of the self and mood states, as facilitating behavioural changes and more distal benefits. Process evaluations embedded in future trials may include quantitative measures of key processes described by our participants, as well as those clearly implied by the behavioural theory of depression., (© 2024 The Author(s). British Journal of Clinical Psychology published by John Wiley & Sons Ltd on behalf of British Psychological Society.)

Background: Researchers have an ethical responsibility to share their findings with their studies' participants and those who can influence policy and practice. Storytelling is an arts-based approach increasingly used in nursing research to share findings, but little has been written about how to use the approach in participatory research involving people from minority ethnic and socioeconomically disadvantaged communities., Aim: To present a guide to cocreating digital stories to share research findings with minority ethnic and socioeconomically disadvantaged communities., Discussion: The authors and peer researchers from minority communities used a rigorous method to cocreate composite digital stories from their qualitative research's findings. The authors describe and reflect on the stages of the creative process, focusing on the actions required before, at and after the collaborative workshop., Conclusion: A rigorous process is required to create composite, naturalistic digital stories that authentically reflect research findings and are accessible to listeners., Implications for Practice: Digital stories are an engaging, feasible and equitable way to share research findings with minority ethnic and disadvantaged communities., Competing Interests: None declared, (© 2024 RCN Publishing Company Ltd. All rights reserved. Not to be copied, transmitted or recorded in any way, in whole or part, without prior permission of the publishers.)

Objectives: Left Ventricular Assist Devices (LVADs) for destination therapy (DT) are used in many countries but in some, like the UK, LVADs are not commissioned due to uncertainty around their cost-effectiveness. Existing economic evaluations of LVADs for these patients have limitations. This study aimed to estimate the cost-effectiveness of LVADs as destination therapy, compared to optimal medical therapy, in the UK., Methods: A cost-utility analysis from a UK healthcare perspective was conducted, using a Markov model. The model incorporated the impact of major events and complications. Sub-group analyses considered different severities of heart failure on cost-effectiveness. Uncertainty was measured in deterministic and probabilistic sensitivity analyses., Results: LVAD produced additional 2.78 (95% CI 2.46-3.14) QALYs at an incremental cost of £152,329 (95% CI £125,665 - £181,812) compared to medical management, giving an incremental cost-effectiveness ratio (ICER) of £54,748 per QALY. The ICER remained above the accepted thresholds of cost-effectiveness in the UK if a small proportion of patients receiving LVAD becomes eligible for a heart transplant and for all subgroups based on heart failure severity. The deterministic sensitivity analysis showed that the ongoing outpatient costs had a significant impact on the results., Conclusions: Our analysis found that LVADs are not cost-effective as destination therapy in the UK if a willingness to pay threshold of £50,000 per QALY gained or disease severity modifiers, were applied. Robust data on ongoing costs for LVAD and medical management are needed., Competing Interests: Hoong Sern Lim was the lead author of a previous study that evaluated LVADs (HM3). Dr Lim has received grants from Abbott for educational activities. The other authors declare no conflict of interest. This does not alter our adherence to PLOS ONE policies on sharing data and materials, (Copyright: © 2024 Saygın Avşar et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Self-reported height and weight is widely used to calculate Body Mass Index (BMI) and yet little is known about factors that affect accuracy. This study investigated the motivational characteristics-narcissism and social desirability-that influence the accuracy of self-reported weight and how they interact with accountability (telling participants that their weight will be verified). A two-way between-subjects design was used (accountable vs not accountable) with motivational moderators (narcissism and social desirability). Participants (N = 80; Mean Age = 34.63; 58.8% Female) were randomly allocated to accountable (told that their weight would be verified in a follow-up lab session) or not-accountable (no information given) conditions. In Session 1, participants self-reported motivational (social desirability and narcissism) and anthropometric (height and weight) measures online. In Session 2 (24 hours later), objective measures of height and weight were taken in the lab. There was a significant interaction between condition and maladaptive narcissism level. Being told that weight would be later verified improved accuracy of self-reported weight, but only for those low in maladaptive narcissism. Accountability improves the accuracy of self-report weight data, but not for individuals high in narcissism. Though based on a modest sample, these findings suggest that the under-estimation of self- report weight serves a self-protective function and maladaptive narcissism may be a useful covariate to include in research using self-report weight estimates., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Price et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Ischemic stroke is the result of a permanent or transient occlusion of a brain artery, leading to irreversible tissue injury and long-term sequelae. Despite ongoing advancements in revascularization techniques, stroke remains the second leading cause of death worldwide. A comprehensive understanding of the complex and interconnected mechanisms, along with the endogenous mediators that modulate stroke responses is essential for the development of effective interventions. Our study investigates cortistatin, a neuropeptide extensively distributed in the immune and central nervous systems, known for its immunomodulatory properties. With neuroinflammation and peripheral immune deregulation as key pathological features of brain ischemia, cortistatin emerges as a promising therapeutic candidate. To this aim, we evaluated its potential effect in a well-established middle cerebral artery occlusion (MCAO) preclinical stroke model. Our findings indicated that the peripheral administration of cortistatin at 24 h post-stroke significantly reduced neurological damage and enhanced recovery. Importantly, cortistatin-induced neuroprotection was multitargeted, as it modulated the glial reactivity and astrocytic scar formation, facilitated blood-brain barrier recovery, and regulated local and systemic immune dysfunction. Surprisingly, administration of cortistatin at immediate and early post-stroke time points proved to be not beneficial and even detrimental. These results emphasize the importance of understanding the spatio-temporal dynamics of stroke pathology to develop innovative therapeutic strategies with appropriate time windows. Premature interruption of certain neuroinflammatory processes might inadvertently compromise neuroprotective mechanisms. In summary, our study highlights cortistatin as a novel pleiotropic therapeutic approach against ischemic stroke, offering new treatment options for patients who undergo early revascularization intervention but unsuccessful recovery., Competing Interests: Declaration of Competing Interest The authors declare that they have no competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Context: Nutritional supplement use in athletes is common, accompanied by potential doping risk., Objective: To determine athletes' nutritional supplement and third-party-tested (TPT) supplement use, supplement knowledge, and factors influencing their behavior., Design: Cross-sectional study., Setting: National Collegiate Athletic Association Division I athletic departments., Patients or Other Participants: Student-athletes (n = 410, 53% female, age = 21.4 ± 1.6 years)., Main Outcome Measure(s): Survey questions addressed topics including nutritional supplement knowledge and use, TPT supplement knowledge and use, and logo recognition, and data were stratified for sex differences., Results: Athletes (91%) reported the use of supplements, but the total number of supplements used was lower in female (median = 7; interquartile range, 4-11) than in male (median = 9; interquartile range, 4-12) athletes, with U = 17 960 and P = .01. A total of 48% (n = 191, out of 402 responses) reported purchasing supplements outside of their athletic department, with significantly fewer female (40%, n = 84) than male (56%, n = 107) athletes reporting this behavior (χ2 = 11.20, P < .001). No association between TPT logo recognition and TPT use was seen (χ2 = 0.238, P = .63). Of all athletes using supplements, 38% (n = 140) reported "consistent TPT use," whereas female athletes (36%, n = 70) reported this less often than male athletes (41%, n = 70, χ2 = 0.952, P < .32). No sex differences were seen for receiving nutritional counseling (89%, P = .37) or low nutritional supplement knowledge (<50%, P = .38); however, males had 2.5 times greater odds at recognizing a TPT organization logo than females (odds ratio = 2.45; 95% CI, 1.58-3.79)., Conclusions: Most athletes use nutritional supplements. Female athletes report slightly fewer supplements than male athletes, while also less frequently purchasing them outside their athletic department, potentially explaining the lower TPT logo recognition in female athletes., (© by the National Athletic Trainers’ Association, Inc.)

Background: Non-malignant primary tumors of the spine (NMPTS) patients in rural areas face unique barriers that may limit their capacity to receive optimal care. With a lower geographical distribution of neurosurgical specialists and limited healthcare infrastructure, rural NMPTS patients may receive certain treatments at a lower frequency than metropolitan patients. NMPTS We sought to examine the association between residential urbanicity, race-ethnicity, treatment patterns, and survival outcomes for cases diagnosed with NMPTS., Methods: Cases of NMPTS diagnosed between 2004 and 2019 were identified from the Central Brain Tumor Registry of the United States (CBTRUS), a combined dataset of CDC's National Program of Cancer Registries (NPCR) and NCI's Surveillance, Epidemiology and End Results (SEER) data. Using multivariable logistic regression, we evaluated the association between urbanicity and treatment (including surgery and radiation), adjusted for age at diagnosis, sex, and race-ethnicity. Patient-level all-cause survival data were obtained from the NPCR Survival Analytical Database (2004-2018)., Results: A total of 38,414 cases were identified, 33,097 of whom lived in metropolitan and 5317 of whom lived in non-metropolitan regions. Nerve sheath tumors and meningiomas were the most common tumor histopathologies across both regions, with no clinically significant difference in other histopathologies (p<0.001). There were statistically significant differences between the frequency and type of surgery received by urbanicity (p<0.001). Overall all-cause survival was significantly lower for NH Blacks residing in non-metropolitan areas when compared to NH Blacks residing in metropolitan areas (p<0.0001)., Conclusion: Our data demonstrates significant differences in the incidence of NMPTS across both race-ethnicity and urbanicity. However, a wider analysis of all-cause mortality reveals disparities in health outcomes across both race-ethnicity and urbanicity for Black and Hispanic populations. To address the disparity in health outcomes, policymakers and health providers need to work with local communities in rural areas to improve access to equitable and quality healthcare., Competing Interests: Declaration of Competing Interest The authors have no disclosures relevant to the current work, nor any true/perceived conflicts of interest. Disclosures unrelated to the current work include:, (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Background: Little information is available regarding the TL and training practices of competitive athletes who are solid-organ recipients. This study characterized TL and practices of competitive organ-recipients at the British and World Transplant Games, 2017., Methods: Questionnaire data was gathered from 220 participants regarding sporting events and type, frequency, duration and intensity of training sessions undertaken. TL for each training session (session duration × session rating of perceived exertion [RPE]) and total TL were determined., Results: Overall participants trained 5 ± 3 times per week at an RPE of 5 ± 2 AU for between 60 and 75 min per session (TL ∼1,500-1,875 AU). Most participants ( n  = 176; 79.7%) reported training three or more times each week. Approximately half (49%) the participants reported undertaking resistance training each week (3 ± 2 sessions per week, RPE of 6 ± 2 AU, 45-60 min per session; TL ∼810-1,080 AU, respectively). Of those participants undertaking resistance training 75% undertook two or more sessions each week. Participants generally undertook most events within a predominant sport with one or two events in a secondary sport. Typical weekly TL for the whole group was 2,762 ± 3,583 AU with considerable variation within and across sports (cycling 4,383 ± 4,005 AU; field athletics 3,671 ± 6,181 AU; court-based sports 2,645 ± 3,308 AU; high physical demand sports [e.g., skiing, triathlon] 2,595 + 2,247 AU; track athletics 2,547 ± 2,664 AU; swimming 2,091 ± 1,070 AU; low physical demand sports [e.g., darts, petanque, walking] 1,182 + 801 AU). Sports-specific TL for predominant and secondary sports was ∼1,500 AU. Resistance training and gym-based aerobic training were the most frequent non-specific training components undertaken. Most competitors (79%) were active in sport prior to transplant., Conclusion: The wide range of TL and components undertaken by athletes with solid-organ transplants likely reflects the multiple and diverse event participation of competitive organ-recipients as well as the diverse physical fitness profiles and incentives to participate. Optimization of TL both for multiple competitive sports and maintenance of health should be considered for these athletes., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2024 Hames, Leddington-Wright, Thake, De Smet and Price.)

Knowledge of the number of people present in a catchment is fundamental for the assessment of spatio-temporal trends in wastewater-based epidemiology (WBE). Accurately estimating the number of people connected to wastewater catchments is challenging however, because populations are dynamic. Methods used to estimate population size can significantly influence the calculation and interpretation of population-normalised wastewater data (PNWD). This paper systematically reviews the reporting of population data in 339 WBE studies. Studies were evaluated based on their reporting of population size, the source of population data, the population calculation methods, and the uncertainties in population estimates. Most papers reported population size (96 %) and the source of population data (60 %). Fewer studies reported the uncertainties in their population data (50 %) and the methods used to calculate these estimates (28 %). This is relevant because different methods have unique strengths and limitations which can affect the accuracy of PNWD. Only 64 studies (19 %) reported all four components of population data. The reporting of population data has remained consistent in the past decade. Based on the findings, we recommend generalised reporting criteria for population data in WBE. As WBE is further mainstreamed and applied, the clear and comprehensive reporting of population data will only become increasingly important., 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 Authors. Published by Elsevier B.V. All rights reserved.)

Objectives: Despite the development of efficacious wellness interventions, sustainable wellness behavior change remains challenging. To optimize engagement, initiating small behaviors that build upon existing practices congruent with individuals' lifestyles may promote sustainable wellness behavior change. In this study, we crowd-sourced helpful, flexible, and engaging wellness practices to identify a list of those commonly used for improving sleep, productivity, and physical, emotional, and social wellness from participants who felt they had been successful in these dimensions., Method: We recruited a representative sample of 992 U.S. residents to survey the wellness dimensions in which they had achieved success and their specific wellness practices., Results: Responses were aggregated across demographic, health, lifestyle factors, and wellness dimension. Exploration of these data revealed that there was little overlap in preferred practices across wellness dimensions. Within wellness dimensions, preferred practices were similar across demographic factors, especially within the top 3-4 most selected practices. Interestingly, daily wellness practices differ from those typically recommended as efficacious by research studies and seem to be impacted by health status (e.g., depression, cardiovascular disease). Additionally, we developed and provide for public use a web dashboard that visualizes and enables exploration of the study results., Conclusions: Findings identify personalized, sustainable wellness practices targeted at specific wellness dimensions. Future studies could leverage tailored practices as recommendations for optimizing the development of healthier behaviors., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Hidalgo et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Mutations in ITM2B cause familial British, Danish, Chinese, and Korean dementias. In familial British dementia (FBD), a mutation in the stop codon of the ITM2B gene (also known as BRI2) causes a C-terminal cleavage fragment of the ITM2B/BRI2 protein to be extended by 11 amino acids. This fragment, termed amyloid-Bri (ABri), is highly insoluble and forms extracellular plaques in the brain. ABri plaques are accompanied by tau pathology, neuronal cell death and progressive dementia, with striking parallels to the aetiology and pathogenesis of Alzheimer's disease. The molecular mechanisms underpinning FBD are ill-defined. Using patient-derived induced pluripotent stem cells, we show that expression of ITM2B/BRI2 is 34-fold higher in microglia than neurons and 15-fold higher in microglia compared with astrocytes. This cell-specific enrichment is supported by expression data from both mouse and human brain tissue. ITM2B/BRI2 protein levels are higher in iPSC-microglia compared with neurons and astrocytes. The ABri peptide was detected in patient iPSC-derived microglial lysates and conditioned media but was undetectable in patient-derived neurons and control microglia. The pathological examination of post-mortem tissue supports the presence of ABri in microglia that are in proximity to pre-amyloid deposits. Finally, gene co-expression analysis supports a role for ITM2B/BRI2 in disease-associated microglial responses. These data demonstrate that microglia are major contributors to the production of amyloid forming peptides in FBD, potentially acting as instigators of neurodegeneration. Additionally, these data also suggest ITM2B/BRI2 may be part of a microglial response to disease, motivating further investigations of its role in microglial activation. These data have implications for our understanding of the role of microglia and the innate immune response in the pathogenesis of FBD and other neurodegenerative dementias including Alzheimer's disease., Competing Interests: Declarations Conflict of interest The authors declare no competing interests., (© 2024. The Author(s).)

Engineering design optimization poses a significant challenge, usually requiring human expertise to discover superior solutions. Although various search techniques have been employed to generate diverse designs, their effectiveness is often limited by problem-specific parameter tuning, making them less generalizable and scalable. This article introduces a framework inspired by evolutionary and developmental (evo-devo) concepts, aiming to automate the evolution of structural engineering designs. In biological systems, evo-devo governs the growth of single-cell organisms into multicellular organisms through the use of gene regulatory networks (GRNs). GRNs are inherently complex and highly nonlinear, and this article explores the use of neural networks and genetic programming as artificial representations of GRNs to emulate such behaviors. To evolve a wide range of Pareto fronts for artificial GRNs, this article introduces a new technique, a real value-encoded neuroevolutionary method termed real-encoded NEAT (RNEAT). The performance of RNEAT is compared with that of two well-known evolutionary search techniques across different 2-D and 3-D problems. The experimental results demonstrate two key findings. First, the proposed framework effectively generates a population of GRNs that can produce diverse structures for both 2-D and 3-D problems. Second, the proposed RNEAT algorithm outperforms its competitors on more than 50% of the problems examined. These results validate the proof of concept underlying the proposed evo-devo-based engineering design evolution., (© 2024 Massachusetts Institute of Technology.)

Background: Benzodiazepines are commonly prescribed for post-acute ischemic stroke for anxiety, insomnia, and agitation. While guidelines discourage use in those aged ≥65 years, little is known about prescription patterns at the national level., Methods: We analyzed a 20% sample of US Medicare claims from April 1, 2013, to September 30, 2021. We selected beneficiaries aged ≥65 years discharged alive following an acute ischemic stroke who had traditional Medicare coverage and 6 months' prior enrollment in Parts A (hospital insurance), B (Medical insurance), and D (drug coverage). We excluded those with prior benzodiazepine prescriptions, self-discharges, or discharge to skilled nursing facilities. We examined demographics, comorbidities, first prescription days' supply, cumulative incidences of benzodiazepine first prescription fills within 90 days after discharge, and geographic and yearly trends., Results: We included 126 050 beneficiaries with a mean age of 78 years (SD, 8); 54% were female and 82% were White. Within 90 days, 6127 (4.9%) initiated a benzodiazepine. Among new prescriptions, lorazepam (40%) and alprazolam (33%) were the most prescribed. Most (76%) of first fills had a day's supply over 7 days and 55% between 15 and 30 days. Female initiation rates were higher (5.5% [95% CI, 5.3-5.7]) than male initiation rates (3.8% [95% CI, 3.6%-3.9%]). Rates were highest in the southeast (5.1% [95% CI, 4.8%-5.3%]) and lowest in the midwest (4.0% [95% CI, 3.8%-4.3%]), with a modest nationwide initiation decline from 2013 to 2021 (cumulative incidence difference, 1.6%)., Conclusions: Despite a gradual decline in benzodiazepine initiation from 2013 to 2021, we noted excessive supplies in prescriptions post-acute ischemic stroke discharge, underscoring the need for improved policies., Competing Interests: Dr Hsu receives support from the National Institutes of Health, the Agency for Healthcare Research and Quality, Brandies University, Altmed, Cambridge Health Alliance, Columbia University, Invitrx, and the University of South Carolina and reports no conflict of interest. Dr Blacker receives support from the National Institute of Neurological Disorders and Stroke and the National Institute on Aging and reports no conflict of interest. Dr Newhouse is the director of the National Committee for Quality Assurance and reports no conflict of interest. Dr Moura receives support from the Epilepsy Foundation of America and reports no conflict of interest. The other authors report no conflicts.

Background: Palliative care (PC) has been shown to benefit patients with metastatic cancer by managing symptoms, improving quality of life, and facilitating advance care planning. Despite this, PC is often misunderstood and underutilized. Objective: To deepen our understanding of PC barriers seen among the spine metastasis population. Design/Setting: Between March 2021 and August 2022, people with metastatic spine tumors (MSTs) at a multidisciplinary oncology clinic were administered a survey on PC prior to their scheduled appointment. These responses were compared with the Health Information National Trends Survey 5 (HINTS 5), which is a validated survey created by the National Cancer Institute between February and June of 2020. Chi-squared statistical analysis was used. Results: Fifty-six people with MST were compared with 3795 patients from the HINTS 5 database. People with MST reported a significantly higher baseline understanding of PC when compared with the general population (GP) (chi-squared = 34.4, p = <0.0001). People with MST had a higher frequency of disagreement with the statement "PC is equivalent with death" when compared with the GP (chi-squared = 12.8, p = 0.0124). Over 25% of the MST group reported no understanding of PC. Conclusion: MST patients are often referred to PC services due to the extreme symptom burden of their disease. Based on this study, in comparison to the GP, people with MST tended to have a more accurate and well-adjusted perception of the goals and functions of PC. Although reassuring, there remains a high proportion of patients who have no knowledge of PC, and groups erroneously associated PC with hospice status.

Two studies show when-and how-a gene that helps us digest starchy foods proliferated in our genome.

Background: The Eastern Mediterranean Region suffers disproportionately from paediatric traffic-related injuries. Despite governmental laws, Lebanon-an eastern Mediterranean country-has low child restraint (CR) use prevalence. This study examined the impact of using car seat distribution, and child passenger safety education and awareness intervention to improve child passenger safety knowledge and practices among caregivers., Methods: This study recruited Lebanese caregivers with one child or more, using a 4-wheel motor vehicle, and not using a car seat. The intervention comprised an educational session followed by a car seat or booster seat distribution and installation check by a certified child passenger safety technician. A baseline assessment questionnaire was used to identify reasons for prior CR non-use. A child passenger safety knowledge test was administered before, immediately after and 3 months postintervention to assess child passenger safety knowledge retention and compare it to the baseline using the conditional logit model for pre-post interventions., Results: Fifty-eight participants underwent the intervention. Affordability was identified as the primary reason for car seat non-use. Three months after the intervention, compliance with CRs use was reported at 100%, and correct responses on the knowledge test significantly increased (p<0.05) for all items except for harness tightness (p=0.673)., Conclusion: Our child passenger safety intervention resulted in improved knowledge and increased self-reported use of CRs in a caregivers' cohort in Lebanon. Further efforts should address sociocultural and economic barriers and the lack of local child passenger safety technicians to mitigate the region's paediatric road traffic injury and death toll., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

PT-112 is a novel immunogenic cell death (ICD)-inducing small molecule currently under Phase 2 clinical development, including in metastatic castration-resistant prostate cancer (mCRPC), an immunologically cold and heterogeneous disease state in need of novel therapeutic approaches. PT-112 has been shown to cause ribosome biogenesis inhibition and organelle stress followed by ICD in cancer cells, culminating in anticancer immunity. In addition, clinical evidence of PT-112-driven immune effects has been observed in patient immunoprofiling. Given the unmet need for immune-based therapies in prostate cancer, along with a Phase I study (NCT#02266745) showing PT-112 activity in mCRPC patients, we investigated PT-112 effects in a panel of human prostate cancer cell lines. PT-112 demonstrated cancer cell selectivity, inhibiting cell growth and leading to cell death in prostate cancer cells without affecting the non-tumorigenic epithelial prostate cell line RWPE-1 at the concentrations tested. PT-112 also caused caspase-3 activation, as well as stress features in mitochondria including ROS generation, compromised membrane integrity, altered respiration, and morphological changes. Moreover, PT-112 induced damage-associated molecular pattern (DAMP) release, the first demonstration of ICD in human cancer cell lines, in addition to autophagy initiation across the panel. Taken together, PT-112 caused selective stress, growth inhibition and death in human prostate cancer cell lines. Our data provide additional insight into mitochondrial stress and ICD in response to PT-112. PT-112 anticancer immunogenicity could have clinical applications and is currently under investigation in a Phase 2 mCRPC study., (© 2024. The Author(s).)

Background: Meningioma risk factors include older age, female sex, and African-American race. Limited data explore how meningioma risk in African-Americans varies across the lifespan, interacts with sex, and differs by tumor grade., Methods: The Central Brain Tumor Registry of the United States (CBTRUS) is a population-based registry covering the entire U.S. population. Meningioma diagnoses from 2004-2019 were used to calculate incidence rate ratios (IRRs) for non-Hispanic Black individuals (NHB) compared to non-Hispanic white individuals (NHW) across 10-year age intervals, and stratified by sex and by WHO tumor grade in this retrospective study., Results: 53,890 NHB individuals and 322,373 NHW individuals with an intracranial meningioma diagnosis were included in analyses. Beginning in young adulthood, the NHB-to-NHW IRR was elevated for both grade 1 and grade 2/3 tumors. The IRR peaked in the seventh decade of life regardless of grade, and was higher for grade 2/3 tumors (IRR = 1.57; 95% CI: 1.46-1.69) than grade 1 tumors (IRR = 1.27; 95% CI: 1.25-1.30) in this age group. The NHB-to-NHW IRR was elevated in females (IRR = 1.17; 95% CI: 1.16-1.18) and was further elevated in males (IRR = 1.28; 95% CI: 1.26-1.30), revealing synergistic interaction between NHB race/ethnicity and male sex (PInteraction=0.001)., Conclusions: Relative to NHW individuals, NHB individuals are at elevated risk of meningioma from young adulthood through old age. NHB race/ethnicity conferred greater risk of meningioma among men than women, and greater risk of grade 2/3 tumors. Population-level differences in meningioma incidence and tumor behavior suggest potential disparities in the geographic, socioeconomic, and racial distribution of meningioma risk factors within the U.S., (© The Author(s) 2024. Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

The Central Brain Tumor Registry of the United States (CBTRUS), in collaboration with the Centers for Disease Control and Prevention and the National Cancer Institute, is the largest population-based registry focused exclusively on primary brain and other central nervous system (CNS) tumors in the United States (US) and represents the entire US population. This report contains the most up-to-date population-based data on primary brain tumors available and supersedes all previous reports in terms of completeness and accuracy. All rates are age-adjusted using the 2000 US standard population and presented per 100,000 population. Between 2017 and 2021, the average annual age-adjusted incidence rate (AAAIR) of all primary malignant and non-malignant brain and other CNS tumors was 25.34 per 100,000 population (malignant AAAIR=6.89 and non-malignant AAAIR=18.46). This overall rate was higher in females compared to males (28.77 versus 21.78 per 100,000) and non-Hispanic Black persons compared to persons who were non-Hispanic White (26.60 versus 25.72 per 100,000), non-Hispanic American Indian/Alaska Native (23.48 per 100,000), non-Hispanic Asian or Pacific Islander (19.86 per 100,000), and Hispanic persons of all races (22.37 per 100,000). Gliomas accounted for 22.9% of all tumors. The most commonly occurring malignant brain and other CNS histopathology was glioblastoma (13.9% of all tumors and 51.5% of all malignant tumors), and the most common predominantly non-malignant histopathology was meningioma (41.7% of all tumors and 56.8% of all non-malignant tumors). Glioblastomas were more common in males, and meningiomas were more common in females. In children and adolescents (ages 0-19 years), the incidence rate of all primary brain and other CNS tumors was 6.02 per 100,000 population. There were 87,053 deaths attributed to malignant brain and other CNS tumors between 2017 and 2021. This represents an average annual mortality rate of 4.41 per 100,000 population and an average of 17,411 deaths per year. The five-year relative survival rate following diagnosis of a malignant brain or other CNS tumor was 35.7%. For a non-malignant brain or other CNS tumor the five-year relative survival rate was 92.0%., (© The Author(s) 2024. Published by Oxford University Press on behalf of the Society for Neuro-Oncology. 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.)

The early components of the pupillary light reflex (PLR) are governed by the parasympathetic nervous system. The use of cheap, portable pupillometry devices may allow for the testing of parasympathetic-system health in field settings. We examined the reliability of two portable instruments for measuring the PLR and their sensitivity to individual differences known to modulate the PLR. Parameters of the PLR were measured in a community sample ( N = 108) in a variety of field settings. Measurements were taken using a commercial pupillometer (NeuroLight, IDMED) and an iPhone using the Reflex Pro PLR analyser (Brightlamp). The parameters of baseline pupil diameter, constriction latency, amplitude and relative amplitude of constriction, and constriction velocity were measured. Individual differences related to age, levels of anxiety, and post-traumatic stress disorder (PTSD) symptomology were assessed. Some measures could not be attained using the iPhone under these field conditions. The reliability of the measures was high, save for the measurement of contraction latency which was particularly unreliable for the iPhone system. The parameters of the PLR showed the same internal relationships as those established in laboratory-based measurements. Age was negatively correlated with all the reliable PLR parameters for both systems. Effects of anxiety and PTSD symptomology were also apparent. The study demonstrated that a hand-held portable infrared pupillometer can be used successfully to measure the PLR parameters under field settings and can be used to examine individual differences. This may allow these devices to be used in workplaces, sports fields, roadsides, etc., to examine parasympathetic activity where needed.

Though social support (SS) and communal mastery (CM) are resilience factors among American Indian and Alaska Natives (AIAN), they have not been examined as trauma treatment predictors in this at-risk group. This study evaluated whether SS and CM were associated with improved treatment response in a sample of 73 AIAN women with posttraumatic stress disorder (PTSD) symptoms. Participants received culturally adapted CPT and were assessed for PTSD, CM, and SS. Data were analyzed using linear mixed-effects models. SS predicted improved PTSD, β = -.16, SE = .05, p = .003, and mental health, β = .16, SE = .05, p = .005, but not physical health. CM predicted improved PTSD, β = -.93, SE = .34, p = .008; mental health, β = .90, SE = .36, p = .013; and physical health, β = .95, SE = .31, p = .003. In a combined model, SS predicted improvements in PTSD, β = -.15, SE = .04, p < .001, and mental health, β = .12, SE = .06, p = .037, whereas CM did not. CM predicted improved physical health, β = 1.04, SE = .33, p = .003, whereas SS did not. Results highlight the benefits of SS and CM in trauma treatment outcomes for AIAN women, consistent with prior work, and further underscore the differential role of SS versus CM on mental versus physical health. Future work should explore how orientation to close and communal-level relationships may inform the protective benefits of social resources among AIAN., (© 2024 International Society for Traumatic Stress Studies.)

Pathogenic changes in gut microbial composition precede the onset of HIV-1 infection in men who have sex with men (MSM). This process is associated with increased levels of systemic inflammatory biomarkers and risk for AIDS development. Using mediation analysis framework, in this report we link the effects of unprotected receptive intercourse among MSM prior to primary HIV-1 infection to higher levels of proinflammatory cytokines sCD14 and sCD163 in plasma and a significant decrease in the abundance of A. muciniphila, B. caccae, B. fragilis, B. uniformis, Bacteroides spp., Butyricimonas spp., and Odoribacter spp., and a potential increase in the abundance of Dehalobacterium spp. and Methanobrevibacter spp. in stools of MSM with the highest number of sexual partners. These differences in microbiota, together with a reduction in the pairwise correlations among commensal and short-chain fatty acid-producing bacteria with a number of sexual partners, support an increase in gut dysbiosis with the number of sexual partners. These results demonstrate the interconnectedness of sexual behavior, immune response, and microbiota composition, notably among MSM participating in high-risk sexual behaviors., (© 2024. This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply.)

Ethics is central to scientific and engineering research and practice, but a key challenge for promoting students' ethical formation involves enhancing faculty members' ability and confidence in embedding positive ethical learning experiences into their curriculums. To this end, this paper explores changes in faculty members' approaches to and perceptions of ethics education following their participation in a multi-year interdisciplinary faculty learning community (FLC). We conducted and thematically analyzed semi-structured interviews with 11 participants following the second year of the FLC. Qualitative themes suggested that, following two years of FLC participation, faculty members (1) were better able to articulate their conceptualizations of ethics; (2) became cognizant of how personal experiences, views, and beliefs informed how they introduced ethics into their curriculum; and (3) developed and lived instructional principles that guided their ethics teaching. Results thus suggested that faculty members benefitted from exploring, discussing, and teaching ethics, which (in turn) enabled them to see new opportunities and become confident in integrating ethics into their courses in meaningful ways that aligned with their scholarly identities. Taken together, these data suggest faculty became agents of change for designing, implementing, and refining ethics-related instructional efforts in STEM. This work can guide others interested in designing faculty learning communities to promote instructional skill development, faculty members' awareness of their ethical values, and their ability and agency to design and integrate ethics learning activities alongside departmental peers in an intentional and continuous manner., (© 2024. The Author(s).)

Importance: Since 2019 and 2020, Medicare Advantage (MA) plans have been able to offer supplemental benefits that address long-term services and supports (LTSS) and social determinants of health (SDOH)., Objective: To examine the temporal trends and geographic variation in enrollment in MA plans offering LTSS and SDOH benefits., Design, Setting, and Participants: This cross-sectional study used publicly available data to examine changes in beneficiary enrollment and plan offerings of LTSS and SDOH benefits from the benefits data from the second quarter of each year and other data from April of each year except 2024, for which the first quarter was the latest for benefits data and January the latest for other data at the time of analysis. Multivariable linear regression models for each type of benefit were used to investigate associations between county characteristics and enrollment in 2024. Analyses were stratified for (1) Dual Eligible Special Needs Plans (D-SNPs) that exclusively enroll dual-eligible beneficiaries and (2) non-D-SNPs., Main Outcomes and Measures: The percentage of MA enrollees in plans offering LTSS or SDOH benefits at the county level., Results: This study included 2 631 697 D-SNP and 20 114 506 non-D-SNP enrollees in 2020, which increased to 5 494 426 and 25 561 455, respectively, in 2024. From 2020 to 2024, the percentage of D-SNP enrollees in plans offering SDOH benefits increased from 9% to 46%, whereas the percentage fluctuated between 23% and 39% for LTSS benefits. There was an increase in non-D-SNP enrollees with LTSS (from 9% to 22%) and SDOH (from 4% to 20%) benefits from 2020 to 2023, which decreased in 2024. In 2024, the most offered LTSS benefit was in-home support services, and the most offered SDOH benefit was food and produce. The percentage of enrollees with these benefits varied across counties in 2024. In multivariable linear regression models, among D-SNPs, enrollment in plans offering any SDOH benefits was higher in counties with greater MA penetration (coefficient, 5.0 percentage points [pp] per 10-pp change; 95% CI, 2.1-7.9 pp), in urban counties (coefficient, 7.2 pp vs rural counties; 95% CI, 3.8-10.6 pp), in counties with greater enrollment in fully integrated D-SNPs (coefficient, 3.0 pp per 10-pp change; 95% CI, 2.2-3.9 pp), and in counties in states with approved Medicaid home- and community-based services waivers for individuals 65 years or older or those with disabilities (coefficient, 10.8 pp; 95% CI, 4.0-17.6 pp). Enrollment in D-SNPs offering LTSS benefits was also higher in counties with greater MA penetration (coefficient, 5.9 pp per 10-pp change; 95% CI, 2.4-9.5 pp), urban vs rural counties (coefficient, 4.6 pp; 95% CI, 1.1-8.1 pp), and counties with greater enrollment in fully integrated D-SNPs (coefficient, 3.0 pp per 10-pp change; 95% CI, 2.1-3.9 pp) in addition to counties with greater social vulnerability scores (coefficient, 1.4 pp per 10-pp change; 95% CI, 0.3-2.5 pp)., Conclusions and Relevance: In this cross-sectional study of MA plans and enrollees, an increase in enrollment was most consistent in D-SNPs offering SDOH benefits compared with LTSS benefits and in D-SNPs compared with non-D-SNPs. Geographic variation in enrollment patterns highlights potential gaps in access to LTSS and SDOH benefits for rural MA beneficiaries and dual-eligible enrollees living in counties with lower enrollment in fully integrated D-SNPs and states with more limited Medicaid home- and community-based services coverage.

Background: Recent outbreaks of Ebola virus disease (EVD) and Marburg virus disease (MVD) in sub-Saharan Africa illustrate the need to better understand animal reservoirs, burden of disease, and human transmission of filoviruses. This protocol outlines a systematic literature review to assess the prevalence of filoviruses that infect humans in sub-Saharan Africa. A secondary aim is to qualitatively describe and evaluate the assays used to assess prevalence., Methods: The data sources for this systematic review include PubMed, Embase, and Web of Science. Titles, abstracts, and full texts will be reviewed for inclusion by a primary reviewer and then by a team of secondary reviewers, and data will be extracted using a pre-specified and piloted data extraction form. The review will include human cross-sectional studies, cohort studies, and randomized controlled trials conducted in sub-Saharan Africa up until March 13, 2024 that have been published in peer-reviewed scientific journals, with no language restrictions. Prevalence will be stratified by pathogen, population, assay, and sampling methodology and presented in forest plots with estimated prevalence and 95% confidence intervals. If there are enough studies within a stratum, I 2 statistics will be calculated (using R statistical software), and data will be pooled if heterogeneity is low. In addition, assays used to detect infection will be evaluated. All studies included in the review will be assessed for quality and risk of bias using the JBI Prevalence Critical Appraisal Tool and for certainty using the GRADE certainty ratings., Discussion: Accurately measuring the rate of exposure to filoviruses infecting humans in sub-Saharan Africa using prevalence provides an essential understanding of natural history, transmission, and the role of subclinical infection. This systematic review will identify research gaps and provide directions for future research seeking to improve our understanding of filovirus infections. Understanding the natural history, transmission, and the role of subclinical infection is critical for predicting the impact of an intervention on disease burden., Systematic Review Registration: In accordance with the guidelines outlined in the PRISMA-P methodology, this protocol was registered with PROSPERO on April 7, 2023 (ID: CRD42023415358)., (© 2024. The Author(s).)

Background: Posttraumatic stress disorder (PTSD) has significant morbidity and economic costs. This study describes the prevalence and characteristics of patients with PTSD using primary care electronic medical record (EMR) data., Methods: This retrospective cross-sectional study used EMR data from the Canadian Primary Care Sentinel Surveillance Network (CPCSSN). This study included 1,574 primary care providers located in 7 Canadian provinces. There were 689,301 patients that visited a CPCSSN provider between 1 January 2017 and 31 December 2019. We describe associations between PTSD and patient characteristics using descriptive statistics, chi-square, and multiple logistic regression models., Results: Among the 689,301 patients included, 8,817 (1.3%, 95% CI 1.2-1.3) had a diagnosis of PTSD. On multiple logistic regression analysis, patients with depression (OR 4.4, 95% CI 4.2-4.7, P < 0.001), alcohol abuse/dependence (OR 1.7, 95% CI 1.6-1.9, P < 0.001), and/or drug abuse/dependence (OR 2.6, 95% CI 2.5-2.8, P < 0.001) had significantly higher odds of PTSD compared with patients without those conditions. Patients residing in community areas considered the most material deprived (OR 2.1, 95% CI 1.5-2.1, P < 0.001) or the most socially deprived (OR 2.8, 95% CI 2.7-5.3, P < 0.001) had higher odds of being diagnosed with PTSD compared with patients in the least deprived areas., Conclusions: The prevalence of PTSD in Canadian primary care is 1.3% (95% CI 1.25-1.31). Using EMR records we confirmed the co-occurrence of PTSD with other mental health conditions within primary care settings suggesting benefit for improved screening and evidence-based resources to manage PTSD., (© The Author(s) 2022. Published by Oxford University Press. 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: Millions of patients suffering from eye disease cannot receive proper treatment due to the lack of qualified surgeons. Medical robots have the potential to solve this problem and have attracted significant attention in the research community., Method: This paper proposes a novel parallel robot with a remote centre of motion for minimally invasive eye surgery. Kinematics models, singularity and workspace analyses, and dimension optimisation are conducted. A prototype was developed, and experiments were conducted to test its mobility, accuracy, precision and stiffness., Results: The prototype robot can successfully perform the required motions, and has a precision ranging from 7 ± 2 μm to 30 ± 8 μm, accuracy from 21 ± 10 μm to 568 ± 374 μm, and stiffness ranging from 1.22 ± 0.39 N/mm to 10.53 ± 5.18 N/mm., Conclusion: The prototype robot has a great potential for performing the minimally invasive surgery. Its stiffness meets the design requirement, but its accuracy and precision need to be further improved., (© 2024 The Author(s). The International Journal of Medical Robotics and Computer Assisted Surgery published by John Wiley & Sons Ltd.)

Crowdsourcing is an essential data collection method for psychological research. Concerns about the validity and quality of crowdsourced data persist, however. A recent documented increase in the number of invalid responses within crowdsourced data has highlighted the need for quality control measures. Although a number of approaches are recommended, few have been empirically evaluated. The present study evaluated a Cyborg Method that used automated evaluation of participant meta-data and a review of short answer responses. Two samples were recruited - in the first, the Cyborg Method was applied after data collection to gauge the extent to which invalid responses were collected when a priori quality controls were absent. In the second, the Cyborg Method was applied during data collection to determine if the method would proactively screen invalid responses. Results suggested that Cyborg Method identified a substantial portion of invalid responses and both automated and human evaluation components was necessary. Furthermore, the Cyborg Method could be applied proactively to screen invalid responses and substantially reduced the per participant cost of data collection. These results suggest that the Cyborg Method is a promising means by which to collect high quality crowdsourced data., Competing Interests: Declaration of interests 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.

Background: Selected patients with advanced heart failure ineligible for heart transplantation could benefit from left ventricular assist device therapy as 'destination therapy'. There is evidence of the efficacy of destination therapy; however, it is not currently commissioned within the United Kingdom National Health Service due to the lack of economic evidence., Objective: What is the clinical and cost-effectiveness of a left ventricular assist device compared to medical management for patients with advanced heart failure ineligible for heart transplantation (destination therapy)?, Methods: A systematic review of evidence on the clinical and cost-effectiveness of left ventricular assist devices as destination therapy was undertaken including, where feasible, a network meta-analysis to provide an indirect estimate of the relative effectiveness of currently available left ventricular assist devices compared to medical management. For the systematic reviews, data sources searched (up to 11 January 2022) were Cochrane CENTRAL, MEDLINE and EMBASE via Ovid for primary studies, and Epistemonikos and Cochrane Database of Systematic Reviews for relevant systematic reviews. Trial registers were also searched, along with data and reports from intervention-specific registries. Economic studies were identified in EconLit, CEA registry and the NHS Economic Evaluation Database (NHS EED). The searches were supplemented by checking reference lists of included studies. An economic model (Markov) was developed to estimate the cost-effectiveness of left ventricular assist devices compared to medical management from the United Kingdom National Health Service/personal social service perspective. Deterministic and probabilistic sensitivity analyses were conducted to explore uncertainties. Where possible, all analyses focused on the only currently available left ventricular assist device (HeartMate 3 TM , Abbott, Chicago, IL, USA) in the United Kingdom., Results: The clinical effectiveness review included 134 studies (240 articles). There were no studies directly comparing HeartMate 3 and medical management (a randomised trial is ongoing). The currently available left ventricular assist device improves patient survival and reduces stroke rates and complications compared to earlier devices and relative to medical management. For example, survival at 24 months is 77% with the HeartMate 3 device compared to 59% with the HeartMate II (MOMENTUM 3 trial). An indirect comparison demonstrated a reduction in mortality compared to medical management [relative risk of death 0.25 (95% confidence interval 0.13 to 0.47); 24 months; this study]. The cost-effectiveness review included 5 cost analyses and 14 economic evaluations covering different generations of devices and with different perspectives. The reported incremental costs per quality-adjusted life-year gained compared to medical management were lower for later generations of devices [as low as £46,207 (2019 prices; United Kingdom perspective; time horizon at least 5 years)]. The economic evaluation used different approaches to obtain the relative effects of current left ventricular assist devices compared to medical management from the United Kingdom National Health Service/personal social service perspective. All gave similar incremental cost-effectiveness ratios of £53,496-58,244 per quality-adjusted life-year gained - lifetime horizon. Model outputs were sensitive to parameter estimates relating to medical management. The findings did not materially differ on exploratory subgroup analyses based on the severity of heart failure., Limitations: There was no direct evidence comparing the clinical effectiveness of HeartMate 3 to medical management. Indirect comparisons made were based on limited data from heterogeneous studies regarding the severity of heart failure (Interagency Registry for Mechanically Assisted Circulatory Support score distribution) and possible for survival only. Furthermore, the cost of medical management of advanced heart failure in the United Kingdom is not clear., Conclusions: Using cost-effectiveness criteria applied in the United Kingdom, left ventricular assist devices compared to medical management for patients with advanced heart failure ineligible for heart transplant may not be cost-effective. When available, data from the ongoing evaluation of HeartMate 3 compared to medical management can be used to update cost-effectiveness estimates. An audit of the costs of medical management in the United Kingdom is required to further decrease uncertainty in the economic evaluation., Study Registration: This study is registered as PROSPERO CRD42020158987., Funding: This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: NIHR128996) and is published in full in Health Technology Assessment ; Vol. 28, No. 38. See the NIHR Funding and Awards website for further award information.

Introduction: Uganda´s fishing communities experience a high burden of sexually transmitted infections (STIs) including human immunodeficiency virus (HIV), with limited access to healthcare. Knowledge on healthcare use and treatment seeking will help identify unmet needs and facilitate appropriate allocation of resources., Methods: between 2014-2015, a mixed methods cross-sectional survey was conducted in four fishing communities on Lake Victoria, Uganda, as part of preparedness for HIV trials. The goal was to understand health problems (having any illness, medical condition, or injury in the past 12 months), perceptions of healthcare, health services use, and factors associated with seeking STI care. Data were collected from participants aged 13-49 years; quantitatively using a structured questionnaire and qualitatively via focus group discussions (FGDs) and key informant interviews (KIIs). Information covered recent health problems, health services use, and healthcare perceptions. Multivariable logistic regression modeling was used to determine factors associated with seeking care for STIs., Results: participants´ median (interquartile range) age was 29 (23-35) years, more than half (51.9%, 763/1,469), were females, and the majority (60.4%, 888/1,469) had up to seven years of formal education. Most participants reported having had health problems (76%, 1,117/1,469). The most frequently reported health issues were STI symptoms (52.6%, 587/1,117). Lack of health services was mentioned as one of the reasons for not seeking care during the FDGs and KIIs. Adolescents, 13-19 were less likely to seek care for STIs symptoms than adults of 20 or more years (aOR= 0.5 (95% CI 0.3-0.9)). Females were more likely to seek STI treatment (aOR= 1.4 (95% CI 1.0-2.1)), as were participants who worked mainly in bars, restaurants or lodges (aOR= 2.0 (95% CI 1.1-3.6))., Conclusion: in these communities, adolescents have low treatment seeking for STIs symptoms., Competing Interests: The authors declare no competing interests., (Copyright: Ali Ssetaala et al.)

This manuscript describes the development of a resource module that is part of a learning platform named "NIGMS Sandbox for Cloud-based Learning" https://github.com/NIGMS/NIGMS-Sandbox. The overall genesis of the Sandbox is described in the editorial NIGMS Sandbox at the beginning of this Supplement. This module delivers learning materials on basic principles in biomarker discovery in an interactive format that uses appropriate cloud resources for data access and analyses. In collaboration with Google Cloud, Deloitte Consulting and NIGMS, the Rhode Island INBRE Molecular Informatics Core developed a cloud-based training module for biomarker discovery. The module consists of nine submodules covering various topics on biomarker discovery and assessment and is deployed on the Google Cloud Platform and available for public use through the NIGMS Sandbox. The submodules are written as a series of Jupyter Notebooks utilizing R and Bioconductor for biomarker and omics data analysis. The submodules cover the following topics: 1) introduction to biomarkers; 2) introduction to R data structures; 3) introduction to linear models; 4) introduction to exploratory analysis; 5) rat renal ischemia-reperfusion injury case study; (6) linear and logistic regression for comparison of quantitative biomarkers; 7) exploratory analysis of proteomics IRI data; 8) identification of IRI biomarkers from proteomic data; and 9) machine learning methods for biomarker discovery. Each notebook includes an in-line quiz for self-assessment on the submodule topic and an overview video is available on YouTube (https://www.youtube.com/watch?v=2-Q9Ax8EW84). This manuscript describes the development of a resource module that is part of a learning platform named ``NIGMS Sandbox for Cloud-based Learning'' https://github.com/NIGMS/NIGMS-Sandbox. The overall genesis of the Sandbox is described in the editorial NIGMS Sandbox [1] at the beginning of this Supplement. This module delivers learning materials on the analysis of bulk and single-cell ATAC-seq data in an interactive format that uses appropriate cloud resources for data access and analyses., (© The Author(s) 2024. Published by Oxford University Press.)

Certain chemotherapy agents have an increased potential to cause allergic reactions. These reactions can vary in severity from mild to severe, and a change in treatment may be suggested for the patient to avoid the causative.

Purpose/objectives: Retrospective analysis suggests that dose escalation to a biologically effective dose of more than 70 Gy may improve overall survival in patients with pancreatic ductal adenocarcinoma (PDAC), but such treatments in practice are limited by proximity of organs at risk (OARs). We hypothesized that CT-guided online adaptive radiotherapy (OART) can account for interfraction movement of OARs and allow for safe delivery of ablative doses., Materials/methods: This is a single institution retrospective analysis of patients with PDAC treated with OART on the Ethos platform (Varian Medical Systems, a Siemens Healthineers Company, Palo Alto). All patients were treated to 40 Gy in 5 fractions. PTV overlapping with a 5 mm planning risk volume expansion on the stomach, duodenum and bowel received 25 Gy. Initial treatment plans were created conventionally. For each fraction, PTV and OAR volumes were recontoured with AI assistance after initial cone beam CT (CBCT). The adapted plan was calculated, underwent QA, and then compared to the scheduled plan. A second CBCT was obtained prior to delivery of the selected plan. Total treatment time (first CBCT to end of radiation delivery) and active physician time (first to second CBCT) were recorded. PTV&#95;4000 V95 %, PTV&#95;2500 V9 5%, and D0.03 cc to stomach, duodenum and bowel were reported for scheduled (S) and adapted (A) plans. CTCAEv5.0 toxicities were recorded. Statistical analysis was performed using a two-sided T test and α of 0.05., Results: 21 patients with unresectable or locally-recurrent PDAC were analyzed, with a total of 105 fractions. Average total time was 29 min and 16 s (16:36-49:40) and average active physician time was 19:41 min (9:25-39:34). All fractions were treated with adapted plans. 97 % of adapted plans met PTV&#95;4000 V95.0 % >95.0 % coverage goal and 100 % of adapted plans met OAR dose constraints. Median follow up was 6.6 months. Only 1 patient experienced acute grade 3+ toxicity directly attributable to radiation. Only 1 patient experienced late grade 3+ toxicity directly attributable to radiation., Conclusions: Daily CT-based OART was associated with significantly reduced dose OARs while achieving superior PTV coverage. Given the relatively quick total treatment time, radiation delivery was generally well tolerated and easily incorporated into the clinic workflow. Our initial clinical experience demonstrates OART allows for safe dose escalation in the treatment of PDAC., Competing Interests: 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., (© 2024 The Authors.)

Aim: This analysis aimed to compare the clinical outcomes associated with heart failure (HF) readmissions and to identify associations with HF hospitalizations (HFH) in patients treated with the MitraClip™ NTR/XTR System in the EXPAND study., Methods and Results: The global, real-world EXPAND study enrolled 1041 patients with primary or secondary mitral regurgitation (MR) treated with the MitraClip NTR/XTR System. Echocardiograms were analysed by an independent echocardiographic core laboratory. The study population was stratified into HFH and No-HFH groups based on the occurrence of HFH 1 year post-index procedure. Clinical outcomes including MR severity, New York Heart Association (NYHA) functional class, Kansas City Cardiomyopathy Questionnaire (KCCQ) score, and all-cause mortality were compared (HFH: n = 181; No-HFH: n = 860). Both groups achieved consistent 1-year MR reduction to ≤1+ (HFH vs. No-HFH: 87.3% vs. 89.5%, p = 0.6) and significant 1-year improvement in KCCQ scores (+16.5 vs. +22.3, p = 0.09) and NYHA functional class. However, more patients in the No-HFH group had 1-year NYHA class ≤II (HFH vs. No-HFH: 67.9% vs. 81.9%, p < 0.01). All-cause mortality at 1 year was 36.8% in the HFH group versus 10.4% in the No-HFH group (p < 0.001). The HFH rate decreased by 63% at 1 year post-M-TEER versus 1 year pre-treatment (relative risk 0.4, p < 0.001). Independent HFH associations were MR ≥2+ at discharge, HFH 1 year prior to treatment, baseline NYHA class ≥III, baseline tricuspid regurgitation ≥2+, and baseline left ventricular ejection fraction ≤40%., Conclusions: This study reports the impact of HFH on clinical outcomes post-treatment in the EXPAND study. Results demonstrate that the occurrence of HFH was associated with worse 1-year survival, and treatment with the MitraClip system substantially reduced HFH and improved patient symptoms and quality of life., (© 2024 The Authors. European Journal of Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.)

Rationale: In inflammatory diseases such as rheumatoid arthritis (RA), steroid metabolism is a central component mediating the actions of immuno-modulatory glucocorticoids and sex steroids. However, the regulation and function of cellular steroid metabolism within key leukocyte populations such as macrophages remain poorly defined. In this study, the inflammatory regulation of global steroid metabolism was assessed in RA macrophages., Methods: Bulk RNA-seq data from RA synovial macrophages was used to assess transcripts encoding key enzymes in steroid metabolism and signalling. Changes in metabolism were assessed in synovial fluids, correlated to measures of disease activity and functionally validated in primary macrophage cultures., Results: RNA-seq revealed a unique pattern of differentially expressed genes, including changes in genes encoding the enzymes 11β-HSD1, SRD5A1, AKR1C2 and AKR1C3. These correlated with disease activity, favouring increased glucocorticoid and androgen levels. Synovial fluid 11β-HSD1 activity correlated with local inflammatory mediators (TNFα, IL-6, IL-17), whilst 11β-HSD1, SRD5A1 and AKR1C3 activity correlated with systemic measures of disease and patient pain (ESR, DAS28 ESR, global disease activity). Changes in enzyme activity were evident in inflammatory activated macrophages in vitro and revealed a novel androgen activating role for 11β-HSD1. Together, increased glucocorticoids and androgens were able to suppress inflammation in macrophages and fibroblast-like-synoviocytes., Conclusions: This study underscores the significant increase in androgen and glucocorticoid activation within inflammatory polarized macrophages of the synovium, contributing to local suppression of inflammation. The diminished profile of inactive steroid precursors in postmenopausal women may contribute to disturbances in this process, leading to increased disease incidence and severity., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Introduction: Chagas disease caused by Trypanosoma cruzi (T cruzi) found in the Americas is often missed during the early stage of infection due to lack of sensitive diagnostic tests. The classic immunological and parasitological tests often fail in the acute phase due to the nonspecific and low antibody level nature of the infection and in the chronic phase due to low levels of trypanosomes in the blood. For successful control strategies, there must be a sensitive and specific diagnostic test., Objective/methods: We have demonstrated the possibility (proof of concept) of detecting T cruzi -specific repeat DNA via polymerase chain reaction (PCR) by (1) spiking 15 urine samples collected from volunteers free of prior infection with 3 different concentrations of T cruzi (3 strains), Trypanosoma brucei , and Trypanosoma rhodesiense (African strain) genomic DNA and (2) from filtered collected clinical samples from Argentina. Three sets of primers were used., Results: Our approach detected repeat DNA specific for T cruzi strains from 1 clinical sample by 2 sets of primer and from spiked urine by all 3 sets of primer but not the African species. A serial dilution (spiking) also was performed on T cruzi strains to detect sensitivities of the assay. One set of primers constantly detected satellite DNA for all T cruzi strains from 70 pg/μl to 175 fg/μl., Conclusions: We were able to demonstrate the feasibility of detecting T cruzi -specific DNA from filtered urine samples by sensitive and specific PCR assay. Besides the evident increased sensitivity and specificity of primers, our approach can be used to explore Chagas prevalence in endemic areas - especially in congenital Chagas newborn screening - and in the acute phase., (Copyright© Board of Regents of the University of Wisconsin System and The Medical College of Wisconsin, Inc.)

Introduction: Wearable devices are rapidly improving our ability to observe health-related processes for extended durations in an unintrusive manner. In this study, we use wearable devices to understand how the shape of the heart rate curve during sleep relates to mental health., Methods: As part of the Lived Experiences Measured Using Rings Study (LEMURS), we collected heart rate measurements using the Oura ring (Gen3) for over 25,000 sleep periods and self-reported mental health indicators from roughly 600 first-year university students in the USA during the fall semester of 2022. Using clustering techniques, we find that the sleeping heart rate curves can be broadly separated into two categories that are mainly differentiated by how far along the sleep period the lowest heart rate is reached., Results: Sleep periods characterized by reaching the lowest heart rate later during sleep are also associated with shorter deep and REM sleep and longer light sleep, but not a difference in total sleep duration. Aggregating sleep periods at the individual level, we find that consistently reaching the lowest heart rate later during sleep is a significant predictor of (1) self-reported impairment due to anxiety or depression, (2) a prior mental health diagnosis, and (3) firsthand experience in traumatic events. This association is more pronounced among females., Conclusion: Our results show that the shape of the sleeping heart rate curve, which is only weakly correlated with descriptive statistics such as the average or the minimum heart rate, is a viable but mostly overlooked metric that can help quantify the relationship between sleep and mental health., Competing Interests: All authors declare no financial or nonfinancial competing interests., (© 2024 The Author(s). Published by S. Karger AG, Basel.)

Background: Meningioma risk factors include older age, female sex, and African-American race. There are limited data exploring how meningioma risk in African-Americans varies across the lifespan, interacts with sex, and differs by tumor grade., Methods: The Central Brain Tumor Registry of the United States (CBTRUS) is a population-based registry covering the entire U.S. population. Meningioma diagnoses from 2004-2019 were used to calculate incidence rate ratios (IRRs) for non-Hispanic Black individuals (NHB) compared to non-Hispanic white individuals (NHW) across 10-year age intervals, and stratified by sex and by WHO tumor grade., Results: 53,890 NHB individuals and 322,373 NHW individuals with an intracranial meningioma diagnosis were included in analyses. Beginning in young adulthood, the NHB-to-NHW IRR was elevated for both grade 1 and grade 2/3 tumors. The IRR peaked in the seventh decade of life regardless of grade, and was higher for grade 2/3 tumors (IRR=1.57; 95% CI: 1.46-1.69) than grade 1 tumors (IRR=1.27; 95% CI: 1.25-1.30) in this age group. The NHB-to-NHW IRR was elevated in females (IRR=1.17; 95% CI: 1.16-1.18) and further elevated in males (IRR=1.28; 95% CI: 1.26-1.30), revealing synergistic interaction between NHB race/ethnicity and male sex (P Interaction =0.001)., Conclusions: Relative to NHW individuals, NHB individuals are at elevated risk of meningioma from young adulthood through old age. NHB race/ethnicity conferred higher risk of meningioma among men than women, and higher risk of developing WHO grade 2/3 tumors. Results identify meningioma as a significant source of racial disparities in neuro-oncology and may help to improve preoperative predictions of meningioma grade.

Exposure of the Hubble Space Telescope to space in low Earth orbit resulted in numerous hypervelocity impacts by cosmic dust (micrometeoroids) and anthropogenic particles (orbital debris) on the solar arrays and the radiator shield of the Wide Field and Planetary Camera 2, both subsequently returned to Earth. Solar cells preserve residues from smaller cosmic dust (and orbital debris) but give less reliable information from larger particles. Here, we present images and analyses from electron, ion and X-ray fluorescence microscopes for larger impact features (millimetre- to centimetre-scale) on the radiator shield. Validated by laboratory experiments, these allow interpretation of composition, probable origin and likely dimensions of the larger impactors. The majority (~90%) of impacts by grains greater than 50 μm in size were made by micrometeoroids, dominated by magnesium- and iron-rich silicates and iron sulfides, metallic iron-nickel and chromium-rich spinel similar to that in ordinary chondrite meteorites of asteroid origin. Our re-evaluation of the largest impact features shows substantially fewer large orbital debris impacts than reported by earlier authors. Mismatch to the NASA ORDEM and ESA MASTER models of particle populations in orbit may be partly due to model overestimation of orbital debris flux and underestimation of larger micrometeoroid numbers. This article is part of the theme issue 'Dust in the Solar System and beyond'.