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The TLR4 (Toll-like receptor 4)-activating agonist MPLA (monophosphoryl lipid A) is a key component of the adjuvant systems AS01 and AS04, utilized in marketed preventive vaccines for several infectious pathogens. As MPLA is a biologically-derived product containing a mixture of several lipid A congeners with a 4' phosphoryl group and varying numbers of acyl chains with distinct activities, extensive efforts to refine its production and immunogenicity are ongoing; notably, the development of the BECC (Bacterial Enzymatic Combinatorial Chemistry) system in which bacteria express lipid A-modifying enzymes to produce a panoply of lipid A congeners. In an effort to characterize the adjuvant activity of these lipid A congeners, we compared biologically-derived and synthetic versions of BECC470 and BECC438 for adjuvant activity in BALB/c mice vaccinated with the HPV (Human papilloma virus) VLP-based vaccine, RG1-VLP. Synthetic BECC compounds compared favorably to biological versions and, in the case of synthetic BECC470, were routinely superior to their biologically-derived BECC counterpart. Synthetic BECC470-adjuvanted vaccines achieved broad spectrum immune activity characterized by elevated levels of total IgG and IgG2a subtype specific to HPV16 L1 VLPs and the HPV16 L2 peptide, as well as robust HPV16-neutralizing antibody titers. In addition, synthetic BECC470 promoted strong T cell responses to HPV16 L1, increased memory B cell frequency, and increased the T follicular helper cell (Tfh) population in draining lymph nodes. In contrast, the biologically-derived form of BECC470 induced an immune profile specific for highest levels of HPV16 L2-specific IgG2a as well as antibodies cross-neutralizing to HPV18 and HPV39. These data confirm that a synthetically-derived BECC compound can be combined with Alhydrogel to adjuvant the RG1-VLP vaccine as can biologically-derived BECC compounds and MPLA, albeit with subtly distinct immune responses. The distinctions in immune profiles triggered by these BECC compounds warrant further exploration for their capacity to activate TLR4 and modulate immune responses to vaccines., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Richard Roden, Reinhard Kirnbauer reports a relationship with Pathovax LLC that includes: board membership and equity or stocks. Robert Ernst reports a relationship with TollereBio Corporation that includes: board membership and equity or stocks. Richard Roden, Reinhard Kirnbauer has patent #US14/875,374 licensed to Johns Hopkins University. Robert Ernst has patent #10358667 and 11124815 pending to TollerBio Corporation. If there are other authors, they 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 Ltd.. All rights reserved.)

Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests. Ling Zhao and John R. Falck report financial support was provided by the National Institutes of Health. Dr. John R. Falck has a patent, “Preparation of Metabolically Robust Analogs of Cypeicosanoids for the Treatment of Cardiac Disease” licensed to the University of Texas Southwestern (UTSW) and Max Delbruck Center for Molecular Medicine. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Purpose: In light of COVID-19, telepractice for speech therapy has been increasingly adopted. Telepractice promotes accessibility to therapy services for those in rural environments, lowers the frequency of missed appointments, and reduces the costs of rehabilitation. The efficacy of telepractice has been scarcely explored in the aphasia literature. Preliminary research has demonstrated comparable results of telepractice and in-person therapy for people with aphasia, but the current scope of research is insufficient to guide clinical practice. The present study examined whether the virtual administration of a picture-naming therapy paradigm was as effective as in-person administration., Method: The treatment effects of two similar clinical trials, one completed in-person ( n = 13) and one completed virtually ( n = 13), are compared. Participants were adults with chronic (> 6 months) poststroke aphasia. Both clinical trials administered Cued Picture-Naming Therapy 4 days a week for 2 weeks (eight treatment sessions). Treatment outcomes were analyzed using Tau- U effect sizes and Mann-Whitney U tests., Results: Weighted Tau- U averages showed an advantage of telepractice over in-person treatment in the acquisition effects of trained words, with participants demonstrating a very large effect (0.84, p < .01) following telepractice and a large effect (0.75, p < .01) following in-person treatment. Both telepractice and in-person rehabilitation demonstrated significant treatment effects and were not significantly different from each other per Mann-Whitney U independent-samples t tests., Conclusions: The present study demonstrated that telepractice of a picture-naming paradigm is as effective as in-person treatment administration. This justifies the use of telepractice to overcome accessibility and cost barriers to speech therapy administration and justifies taking patient preference into account. Future research should explore the efficacy of telepractice for treatments that promote greater generalizability to functional communication., Supplemental Material: https://doi.org/10.23641/asha.27641031.

Background: Glucagon-like-peptide-1 receptor agonists (GLP-1s) are a newer class of obesity medications that have garnered significant attention by the public and media. Media reports suggest that medical interventions such as GLP-1s are often perceived as weight loss "shortcuts.", Purpose: The present experimental research tested the effect of exposure to medical weight loss interventions on GLP-1 policy support, dependent on body mass index., Methods: A sample of 440 participants (Mage= 37, SD = 12.6) were randomly assigned to read about a woman who lost 15% of her body weight either with a GLP-1, bariatric surgery, or diet/exercise. Participants reported on beliefs that the woman took a weight loss "shortcut" and support for three policies expanding GLP-1 coverage., Results: Exposure to a woman who lost weight with GLP-1 or bariatric surgery (vs. diet/exercise) led to higher GLP-1 policy support. However, such exposure was also indirectly associated with lower policy support, partially mediated by weight loss "shortcut" beliefs., Conclusions: This study provides evidence that exposure to medical weight loss interventions leads to higher GLP-1 policy support. Exposure may also, indirectly, lead to lower policy support due to beliefs that such interventions are shortcuts. Findings have implications for policymakers who are interested in how perceptions of medical weight loss interventions influence support for obesity treatments and related health policies., (Published by Oxford University Press on behalf of the Society of Behavioral Medicine 2024.)

DNA-stabilized silver nanoclusters (Ag N -DNAs) are emitters with tuneable structures and photophysical properties. While understanding of the sequence-structure-property relationships of Ag N -DNAs has advanced significantly, their chemical transformations and degradation pathways are far less understood. To advance understanding of these pathways, we analysed the fragmentation products of 21 different red and NIR Ag N -DNAs using negative ion mode electrospray ionization mass spectrometry (ESI-MS). Ag N -DNAs were found to lose Ag + under ESI-MS conditions, and sufficient loss of silver atoms can lead to a transition to a lesser number of effective valence electrons, N 0 . Of more than 400 mass spectral peaks analysed, only even values of N 0 were identified, suggesting that solution-phase Ag N -DNAs with odd values of N 0 are unlikely to be stable. Ag N -DNAs stabilized by three DNA strands were found to fragment significantly more than Ag N -DNAs stabilized by two DNA strands. Moreover, the fragmentation behaviour depends strongly on the DNA template sequence, with diverse fragmentation patterns even for Ag N -DNAs with similar molecular formulae. Molecular dynamics simulations, with forces calculated from density functional theory, of the fragmentation of (DNA) 2 (Ag 16 Cl 2 ) 8+ with a known crystal structure show that the 6-electron Ag 16 Cl 2 core fragments into a 4-electron Ag 10 and a 2-electron Ag 6 , preserving electron-pairing rules even at early stages of the fragmentation process, in agreement with experimental observation. These findings provide new insights into the mechanisms by which Ag N -DNAs degrade and transform, with relevance for their applications in sensing and biomedical applications.

Effective ocean management asks for up-to-date knowledge of marine biogeography. Here we compare eDNA and gear-based assessments of marine fish populations using an approach that focuses on the commonest species. The protocol takes advantage of the "hollow curve" of species abundance distributions, with a minority of species comprising the great majority of individuals or biomass. We analyzed new and published teleost eDNA metabarcoding surveys from three neighboring northwest Atlantic coastal locations representing sandy, rocky, or estuary habitat. Fish eDNA followed a hollow curve species abundance distribution at each location-the 10 commonest taxa accounted for more than 90% of eDNA copies. Top ten taxa were designated eDNA-dominant species (eDDS) and categorized as habitat-associated (top 10 in one study) or as shared. eDDS by category were similarly abundant in concurrent bottom trawl and seine surveys. eDDS habitat category profiles correctly classified most (94%-100%) individual eDNA and capture measurements within surveys and recognized estuarine sites in other regional eDNA and seine studies. Using a category metric like that for habitats, eDDS demonstrated strong seasonal turnover concordant with trawl catch weights. eDNA seasonal profiles applied to historical trawl and seine records highlighted known long-term trends in mid-Atlantic fish populations. This study provides evidence that eDNA-abundant fish species differ among coastal habitats and by season consistent with gear-based assessments. Grouping abundant species by category facilitated comparisons among habitats and integration with established surveys. eDNA metabarcoding of dominant fish species potentially offers a useful tool for marine biogeography and ocean monitoring., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Stoeckle 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.)

Background: People who use drugs (PWUD) and people who use medication-assisted treatment (MAT) to treat opioid use disorder face severe stigma. Stigma may manifest in delayed health-seeking behaviors, which adversely affects health and increases disease risk. Few validated measures assess internalized drug use stigma or MAT disclosure concerns in sub-Saharan Africa. This study examines the performance of internalized drug use stigma scales and characterizes the prevalence of these stigmas among PWUD and people who use MAT in Dar es Salaam, Tanzania., Methods: We conducted a cross-sectional survey among 250 PWUD and 251 MAT clinic clients. Internalized drug use and MAT disclosure concerns were measured using scales adapted to the Tanzanian context. We conducted exploratory factor analysis to identify latent constructs and evaluate reliability of the scales. We then used confirmatory factor analysis to assess construct validity and reliability., Results: The six-item internalized drug use stigma scale (IDUSS) was unidimensional, reflected acceptable goodness-of-fit, and acceptable reliability (Cronbach's α = 0.79). The eight-item internalized drug use stigma scale for people using MAT (IDUSS-MAT) was bidimensional. Allowing error terms of related items to covary improved goodness-of-fit. The IDUSS-MAT demonstrated acceptable reliability (Cronbach's α = 0.79). Among PWUD and MAT clinic clients, higher levels of stigma were associated with increased depression and reduced social support and quality of life., Conclusions: Both the IDUSS and IDUSS-MAT demonstrated good construct validity and acceptable reliability. These validated scales provide the foundation for collecting data to inform the development of stigma reduction interventions in Tanzania and among similar Sub-Saharan populations of PWUD and the tools needed to assess those interventions., Competing Interests: Declaration of Competing Interest None., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Background: The Patient Protection US Affordable Care Act (ACA) energy posting mandate requires restaurant chains to disclose information on the energy content of their food items. Assessments of the effect of menu energy labeling on dietary choices have reported inconsistent findings., Objectives: This study examined the impact of menu energy labeling on food items purchased by college students after the mandate was enacted nationally., Methods: Student food sales data from purchases made at 3 fast-food restaurants during the 2017/2018 and 2018/2019 academic years at a university campus were used for the analysis. The total sample included 1662 students on the university meal plan; these students generated 145,295 food transactions at the restaurants over the study period. We utilized a difference-in-differences (DiD) empirical strategy, comparing changes in transaction-level energy purchases at 2 fast-food restaurants B and C (FFRB and FFRC - treatment groups) that posted energy information in the summer of 2018 with another fast-food restaurant A (FFRA - control group) that began posting energy information before the study period., Results: We observed increases in the mean energy content per transaction after implementing the menu-labeling policy. The DiD estimates found an increase of 20.6 in the mean calories of energy purchased per transaction at the treatment restaurants relative to the control restaurant. In the subgroup analyses, the DiD estimates indicated calories of energy increased: 18.7 for female students, 20.5 for male students, 23.5 for non-Hispanic Black students, 30.2 for students eligible for federal financial aid, and 19.9 for students not eligible for federal financial aid., Conclusions: The results suggest that the ACA energy menu-labeling policy led to an increase in the energy content per transaction by students at a public university. This paper highlights the need for more research to better understand the determinants of food choice among college students., Competing Interests: Conflict of Interest The authors report no conflicts of interest., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)

The Veterans Crisis Line (VCL) is part of the U.S. Department of Veterans Affairs' suicide prevention mission. In 2021, VCL assessed the impact of a pilot implementation project of conducting six-part safety plans (SPs) instead of VCL's usual risk mitigation plan. VCL responders offered to complete six-part SPs with eligible callers. Parametric and nonparametric methods compared call characteristics and Veteran Health Administration (VHA) utilization of eligible callers, by SP completion. We forecasted the operational impact of VCL-wide implementation. 27.37% ( N = 448/1,637) of calls to designated responders were eligible for SPs. Of those, 27.23% ( N = 122/448) completed SPs. Common barriers were call interruptions and the veteran declining. Among veteran callers who use VHA, SP completers were more likely to accept clinical referrals and had more outpatient mental health appointments before and after their VCL call. Calls involving SPs had a call plus documentation time 175% longer than eligible calls without SPs (87.78 vs. 49.66 min). If SPs were implemented VCL-wide, this would require 3-5(4.12%) more responders per hour to maintain current VCL call answer speed. SPs are adaptable to VCL; however, implementation presents logistical barriers. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

People who experience out-of-hospital cardiac arrest often require care at a regional center for continued treatment after resuscitation, but many do not initially present to the hospital where they will be admitted. For patients who require interfacility transport after cardiac arrest, the decision to transfer between centers is complex and often based on individual clinical characteristics, resources at the presenting hospital, and available transport resources. Once the decision has been made to transfer a patient after cardiac arrest, there is little direct guidance on how best to provide interfacility transport. Accepting centers depend on transferring emergency departments and emergency medical services professionals to make important and nuanced decisions about postresuscitation care that may determine the efficacy of future treatments. The consequences of early care are greater when transport delays occur, which is common in rural areas or due to inclement weather. Challenges of providing interfacility transfer services for patients who have experienced cardiac arrest include varying expertise of clinicians, differing resources available to them, and nonstandardized communication between transferring and receiving centers. Although many aspects of care are insufficiently studied to determine implications for specific out-of-hospital treatment on outcomes, a general approach of maintaining otherwise recommended postresuscitation care during interfacility transfer is reasonable. This includes close attention to airway, vascular access, ventilator management, sedation, cardiopulmonary monitoring, antiarrhythmic treatments, blood pressure control, temperature control, and metabolic management. Patient stability for transfer, equity and inclusion, and communication also must be considered. Many of these aspects can be delivered by protocol-driven care.

Background: Most people with dementia (PWD) in the United States live in community settings supported by family and/or unpaid care partners. Firearms access is one of many decisions care partners navigate alongside PWD in efforts to prevent injuries and deaths. Conversations about firearms access are socially challenging, although specific challenges to be overcome have not been described., Methods: As part of the larger Safety in Dementia Trial, we interviewed care partners about their views and experiences regarding firearms access in the home where the PWD resides. Interviewees were English-speaking adults (≥18 years) in the United States who are unpaid care partners of community-dwelling PWD. Responses to interview discussions related to (1) a desire for safety, and (2) fear of firearm violence was analyzed using a focusing process to categorize views into essential themes., Results: Fifty care partners, who were primarily female (58%), White (66%), adult children (56%), and living in the same household (64%), participated in interviews between February 2023-February 2024. Dominant themes emerging from the focusing technique included (1) firearms as a necessary component of home safety; (2) fear of accidental/impulsive firearm violence; (3) observed risk and "near misses"; and (4) differing views on home firearms as a source of conflict. Thematic descriptions did not differ according to care partner's relationship to the PWD (adult child, spouse, other)., Conclusions: Considering whether and how to alter access to firearms where PWD reside can be difficult for care partners to navigate. Care partners expressed a desire to limit firearms access, but worried both about creating conflict with the PWD and the self-defense implications of making firearms inaccessible. Findings were similar across subsets of care partners indicating that standardized tools and messaging to care partners may be effective in promoting safety in homes with PWD., (© 2024 The Author(s). Journal of the American Geriatrics Society published by Wiley Periodicals LLC on behalf of The American Geriatrics Society.)

Background: Caregivers face challenges (including competing desires to prevent injury, respect autonomy, and avoid conflict) when addressing firearm access by community-dwelling persons with Alzheimer disease and related dementias (ADRD)., Objective: To test the effect of the online Safety in Dementia (SiD) decision aid on caregivers' decision making about firearm access for people with ADRD., Design: Prospective 2-group randomized trial with longitudinal follow-up. (ClinicalTrials.gov: NCT05173922)., Setting: United States., Participants: English- or Spanish-speaking caregivers (aged ≥18 years) of community-dwelling adults with ADRD and firearm access., Intervention: SiD versus a web-based information control., Measurements: The primary outcome was preparation for decision making about firearm access. The secondary outcome at follow-up was self-reported action to reduce access., Results: Among 500 participants enrolled between June 2022 and February 2024, the mean age was 47 years, 69% identified as female, half were the adult child or stepchild of the person with ADRD, and 99% chose study participation in English. Participant characteristics were similar by study group. For the primary outcome, SiD significantly increased preparation for decision making versus the control (69.8 vs. 64.8 out of 100; mean difference, 4.80 [95% CI, 0.53 to 9.07]; P = 0.024). There was no significant effect on actions to reduce firearm access at 2 weeks or 2 months., Limitation: The results may not be generalizable to non-English-speaking populations., Conclusion: The online SiD decision aid increased preparation for decision making about firearm access in this sample of ADRD caregivers in the United States. Use of such resources in clinical or community settings may support caregivers and people with ADRD in avoiding firearm injury or death., Primary Funding Source: National Institute on Aging, National Institutes of Health., Competing Interests: Disclosures: All relevant financial relationships have been mitigated. Disclosures are available with the article online.

Purpose: To test the assumption that person-first language (PFL) reduces obesity stigma, mediated by perceived personal responsibility for obesity., Design: Cross-sectional, experimental., Setting: Online, United States., Participants: 299 young adults., Measures: Participants read a vignette using PFL or identity-first language (IFL) or about someone without obesity. Participants reported perceived personal responsibility for obesity, and 3 operationalizations of obesity stigma: prejudice, stereotypes, and support for punitive policies. Mediation analyses were used to test if the manipulation affected obesity stigma, through perceived personal responsibility., Results: There was no indirect effect of PFL vs IFL on the 3 outcomes (95% CIs contained zero). However, the indirect effects of PFL vs no-obesity condition were significant (prejudice: β = -0.10, SE = 0.05, 95% CI [-0.22, -0.01]; stereotypes: ( β = 0.07, SE = 0.03, 95% CI [0.01, 0.14]); punitive punishment: ( β = -0.06, SE = 0.04, 95% CI [-0.15, -0.01]). Also, the indirect effects of IFL vs no-obesity condition on stereotypes ( β = 0.07, SE = 0.04, 95% CI [0.0003, 0.15]) and punitive punishment ( β = -0.06, SE = 0.04, 95% CI [-0.15, -0.0002]) were significant., Conclusion: PFL may not affect obesity stigma as it does in the context of other marginalized groups. The effect of PFL and IFL, compared to the no-obesity condition, suggests future routes for intervention., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Despite advances in HIV care and treatment in the U.S., disparities in outcomes along the HIV care continuum persist. The widespread replication of effective and sustainable interventions that prioritize the engagement of underserved populations has been identified as a promising path to ending the HIV epidemic in the U.S. Intervention dissemination products, however, rarely provide the comprehensive and accessible information needed to replicate interventions within community settings. To bridge the divide between research and community-based implementation, the Using Evidence-informed Interventions to Improve Health Outcomes among People Living with HIV (E2i) initiative-grounded in the HIV/AIDS Bureau Implementation Science Framework-created a suite of tools to promote the rapid replication of interventions focused on transgender women, Black men who have sex with men, behavioral health integration, and identifying and addressing trauma. The resulting dissemination products are detailed and digestible multimedia toolkits that follow adult learning theory principles and align with the Template for Intervention Description and Replication criteria for adapting non-pharmacological interventions. Each E2i toolkit consists of five components: implementation guides, narrative videos of site implementation, best practice demonstration videos, interactive learning modules, and recruitment posters and brochures. Over 2 years (2022-2024), the E2i toolkit webpages amassed 7703 unique users and 17,666 pageviews. These toolkits can serve as a blueprint for designing comprehensive and accessible dissemination products for replication of HIV interventions in care settings. Dissemination products that bridge the gap between intervention research and replication in community settings are a crucial missing tool for ending the HIV epidemic., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

DNA-stabilized silver nanoclusters (Ag N -DNAs) have sequence-tuned compositions and fluorescence colors. High-throughput experiments together with supervised machine learning models have recently enabled design of DNA templates that select for Ag N -DNA properties, including near-infrared (NIR) emission that holds promise for deep tissue bioimaging. However, these existing models do not enable simultaneous selection of multiple Ag N -DNA properties, and require significant expert input for feature engineering and class definitions. This work presents a model for multiobjective, continuous-property design of Ag N -DNAs with automatic feature extraction, based on variational autoencoders (VAEs). This model is generative, i.e., it learns both the forward mapping from DNA sequence to Ag N -DNA properties and the inverse mapping from properties to sequence, and is trained on an experimental data set of DNA sequences paired with Ag N -DNA fluorescence properties. Experimental testing shows that the model enables effective design of Ag N -DNA emission, including bright NIR Ag N -DNAs with 4-fold greater abundance compared to training data. In addition, Shapley analysis is employed to discern learned nucleobase patterns that correspond to fluorescence color and brightness. This generative model can be adapted for a range of biomolecular systems with sequence-dependent properties, enabling precise design of emerging biomolecular nanomaterials.

As breast screening services move towards use of healthcare AI (HCAI) for screen reading, research on public views of HCAI can inform more person-centered implementation. We synthesise reviews of public views of HCAI in general, and review primary studies of women's views of AI in breast screening. People generally appear open to HCAI and its potential benefits, despite a wide range of concerns; similarly, women are open towards AI in breast screening because of the potential benefits, but are concerned about a wide range of risks. Women want radiologists to remain central; oversight, evaluation and performance, care, equity and bias, transparency, and accountability are key issues; women may be less tolerant of AI error than of human error. Using our recent Australian primary study, we illustrate both the value of informing participants before collecting data, and women's views. The 40 screening-age women in this study stipulated four main conditions on breast screening AI implementation: 1) maintaining human control; 2) strong evidence of performance; 3) supporting familiarisation with AI; and 4) providing adequate reasons for introducing AI. Three solutions were offered to support familiarisation: transparency and information; slow and staged implementation; and allowing women to opt-out of AI reading. We provide recommendations to guide both implementation of AI in healthcare and research on public views of HCAI. Breast screening services should be transparent about AI use and share information about breast screening AI with women. Implementation should be slow and staged, providing opt-out options if possible. Screening services should demonstrate strong governance to maintain clinician control, demonstrate excellent AI system performance, assure data protection and bias mitigation, and give good reasons to justify implementation. When these measures are put in place, women are more likely to see HCAI use in breast screening as legitimate and acceptable., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Ensuring good quality of life (QoL) among persons with diagnosed HIV (PWH) is a priority of the National HIV/AIDS Strategy (NHAS), which established 2025 goals for improving QoL. Goals are monitored through five indicators: self-rated health, unmet needs for mental health services, unemployment, hunger or food insecurity, and unstable housing or homelessness. Among the growing population of PWH aged ≥50 years, progress toward these goals has not been assessed. Data collected during the 2017-2022 cycles of the Medical Monitoring Project, an annual complex sample survey of U.S. adults with diagnosed HIV, assessed progress toward NHAS 2025 QoL goals among PWH aged ≥50 years, overall and by age group. The recent estimated annual percentage change from baseline (2017 or 2018) to 2022 was calculated for each indicator. Among PWH aged ≥50 years, the 2025 goal of 95% PWH with good or better self-rated health is 46.2% higher than the 2022 estimate. The 2025 goals of a 50% reduction in the other indicators range from 26.3% to 56.3% lower than the 2022 estimates. Decreasing hunger or food insecurity by 50% among PWH aged ≥65 was the only goal met by 2022. If recent trends continue, other NHAS QoL 2025 goals are unlikely to be met. Multisectoral strategies to improve access to housing, employment, food, and mental health will be needed to meet NHAS 2025 goals for QoL among older PWH., Competing Interests: All authors have completed and submitted the International Committee of Medical Journal Editors form for disclosure of potential conflicts of interest. No potential conflicts of interest were disclosed.

Importance: Numerous studies show that early palliative care improves quality of life and other key outcomes in patients with advanced cancer and their caregivers, although most lack access to this evidence-based model of care., Objective: To evaluate whether delivering early palliative care via secure video vs in-person visits has an equivalent effect on quality of life in patients with advanced non-small cell lung cancer (NSCLC)., Design, Setting, and Participants: Randomized, multisite, comparative effectiveness trial from June 14, 2018, to May 4, 2023, at 22 US cancer centers among 1250 patients within 12 weeks of diagnosis of advanced NSCLC and 548 caregivers., Intervention: Participants were randomized to meet with a specialty-trained palliative care clinician every 4 weeks either via video visit or in person in the outpatient clinic from the time of enrollment and throughout the course of disease. The video visit group had an initial in-person visit to establish rapport, followed by subsequent virtual visits., Main Outcomes and Measures: Equivalence of the effect of video visit vs in-person early palliative care on quality of life at week 24 per the Functional Assessment of Cancer Therapy-Lung questionnaire (equivalence margin of ±4 points; score range: 0-136, with higher scores indicating better quality of life). Participants completed study questionnaires at enrollment and at weeks 12, 24, 36, and 48., Results: By 24 weeks, participants (mean age, 65.5 years; 54.0% women; 82.7% White) had a mean of 4.7 (video) and 4.9 (in-person) early palliative care encounters. Patient-reported quality-of-life scores were equivalent between groups (video mean, 99.7 vs in-person mean, 97.7; difference, 2.0 [90% CI, 0.1-3.9]; P = .04 for equivalence). Rate of caregiver participation in visits was lower for video vs in-person early palliative care (36.6% vs 49.7%; P < .001). Study groups did not differ in caregiver quality of life, patient coping, or patient and caregiver satisfaction with care, mood symptoms, or prognostic perceptions., Conclusions and Relevance: The delivery of early palliative care virtually vs in person demonstrated equivalent effects on quality of life in patients with advanced NSCLC, underscoring the considerable potential for improving access to this evidence-based care model through telehealth delivery., Trial Registration: ClinicalTrials.gov Identifier: NCT03375489.

Background: LI-RADS version 2018 (v2018) is used for non-invasive diagnosis of hepatocellular carcinoma (HCC). A recently proposed modification (known as mLI-RADS) demonstrated improved sensitivity while maintaining specificity and positive predictive value (PPV) of LI-RADS category 5 (definite HCC) for HCC. However, mLI-RADS requires multicenter validation., Purpose: To evaluate the performance of v2018 and mLI-RADS for liver lesions in a large, heterogeneous, multi-national cohort of patients at risk for HCC., Study Type: Systematic review and meta-analysis using individual participant data (IPD) [Study Protocol: https://osf.io/duys4]., Population: 2223 observations from 1817 patients (includes all LI-RADS categories; females = 448, males = 1361, not reported = 8) at elevated risk for developing HCC (based on LI-RADS population criteria) from 12 retrospective studies., Field Strength/sequence: 1.5T and 3T; complete liver MRI with gadoxetate disodium, including axial T2w images and dynamic axial fat-suppressed T1w images precontrast and in the arterial, portal venous, transitional, and hepatobiliary phases. Diffusion-weighted imaging was used when available., Assessment: Liver observations were categorized using v2018 and mLI-RADS. The diagnostic performance of each system's category 5 (LR-5 and mLR-5) for HCC were compared., Statistical Tests: The Quality Assessment of Diagnostic Accuracy Studies version 2 (QUADAS-2 was applied to determine risk of bias and applicability. Diagnostic performances were assessed using the likelihood ratio test for sensitivity and specificity and the Wald test for PPV. The significance level was P < 0.05., Results: 17% (2/12) of the studies were considered low risk of bias (244 liver observations; 164 patients). When compared to v2018, mLR-5 demonstrated higher sensitivity (61.3% vs. 46.5%, P < 0.001), similar PPV (85.3% vs. 86.3%, P = 0.89), and similar specificity (85.8% vs. 90.8%, P = 0.16) for HCC., Data Conclusion: This study confirms mLR-5 has higher sensitivity than LR-5 for HCC identification, while maintaining similar PPV and specificity, validating the mLI-RADS proposal in a heterogeneous, international cohort., Level of Evidence: 3 TECHNICAL EFFICACY: Stage 2., (© 2023 The Authors. Journal of Magnetic Resonance Imaging published by Wiley Periodicals LLC on behalf of International Society for Magnetic Resonance in Medicine.)

The N 6 -methyladenosine (m 6 A) modification is found in thousands of cellular mRNAs and is a critical regulator of gene expression and cellular physiology. m 6 A dysregulation contributes to several human diseases, and the m 6 A methyltransferase machinery has emerged as a promising therapeutic target. However, current methods for studying m 6 A require RNA isolation and do not provide a real-time readout of mRNA methylation in living cells. Here we present a genetically encoded m 6 A sensor (GEMS) technology, which couples a fluorescent signal with cellular mRNA methylation. GEMS detects changes in m 6 A caused by pharmacological inhibition of the m 6 A methyltransferase, giving it potential utility for drug discovery efforts. Additionally, GEMS can be programmed to achieve m 6 A-dependent delivery of custom protein payloads in cells. Thus, GEMS is a versatile platform for m 6 A sensing that provides both a simple readout for m 6 A methylation and a system for m 6 A-coupled protein expression., (© 2024. The Author(s), under exclusive licence to Springer Nature America, Inc.)

ConspectusDNA-stabilized silver nanoclusters (Ag N -DNAs) are sequence-encoded fluorophores. Like other noble metal nanoclusters, the optical properties of Ag N -DNAs are dictated by their atomically precise sizes and shapes. What makes Ag N -DNAs unique is that nanocluster size and shape are controlled by nucleobase sequence of the templating DNA oligomer. By choice of DNA sequence, it is possible to synthesize a wide range of Ag N -DNAs with diverse emission colors and other intriguing photophysical properties. Ag N -DNAs hold significant potential as "programmable" emitters for biological imaging due to their combination of small molecular-like sizes, bright and sequence-tuned fluorescence, low toxicities, and cost-effective synthesis. In particular, the potential to extend Ag N -DNAs into the second near-infrared region (NIR-II) is promising for deep tissue imaging, which is a major area of interest for advancing biomedical imaging. Achieving this goal requires a deep understanding of the structure-property relationships that govern Ag N -DNAs in order to design Ag N -DNA emitters with sizes and geometries that support NIR-II emission.In recent years, major advances have been made in understanding the structure and composition of Ag N -DNAs, enabling new insights into the correlation of nanocluster structure and photophysical properties. These advances have hinged on combined innovations in mass characterization and crystallography of compositionally pure Ag N -DNAs, together with combinatorial experiments and machine learning-guided design. A combined approach is essential due to the major challenge of growing suitable Ag N -DNA crystals for diffraction and to the labor-intensive nature of preparing and solving the molecular formulas of atomically precise Ag N -DNAs by mass spectrometry. These approaches alone are not feasibly scaled to explore the large sequence space of DNA oligomer templates for Ag N -DNAs.This account describes recent fundamental advances in Ag N -DNA science that have been enabled by high throughput synthesis and fluorimetry together with detailed analytical studies of purified Ag N -DNAs. First, short introductions to nanocluster chemistry and Ag N -DNA basics are presented. Then, we review recent large-scale studies that have screened thousands of DNA templates for Ag N -DNAs, leading to discovery of distinct classes of these emitters with unique cluster core compositions and ligand chemistries. In particular, the discovery of a new class of chloride-stabilized Ag N -DNAs enabled the first ab initio calculations of Ag N -DNA electronic structure and present new approaches to stabilize these emitters in biologically relevant conditions. Near-infrared (NIR) emissive Ag N -DNAs are also found to exhibit diverse structures and properties. Finally, we conclude by highlighting recent proof-of-principle demonstrations of NIR Ag N -DNAs for targeted fluorescence imaging. Continued efforts may future push Ag N -DNAs into the tissue transparency window for fluorescence imaging in the NIR-II tissue transparency window.

RATIONALE AND OBJECTIVES: Near-peer paradigms have been demonstrated effective in supporting how students navigate novel clinical environments. In this study, we describe an innovative model of incorporating teaching assistants (TAs) into a core radiology clerkship and investigate both its perceived educational value by clinical-year learners and its perceived impact on professional growth by TAs. MATERIALS AND METHODS: At one U.S. medical school, the core clinical year includes a clerkship in radiology incorporating both reading room exposure and a didactic curriculum. Radiology faculty deliver a variety of traditional and interactive, "dynamic" lectures, while medical student TAs deliver additional dynamic sessions, including a final TA-created review session. The educational value of each didactic session by clerkship students was assessed using a five-point scale survey, and the professional value of the experience by TAs was assessed using a five-point Likert survey. RESULTS: Spanning from 2020 to 2023, 268 (74.4%) clinical-year students submitted the post-clerkship survey, with the didactic review sessions created and led by TAs receiving the highest ratings of any didactic session. Of 16 former TAs, 12 (75%) completed the post-service survey, with all respondents agreeing or strongly agreeing that they enjoyed and would recommend their experience, and that it enhanced their interest in radiology and in academic medicine. CONCLUSION: Near-peer education in a core radiology clerkship enhances the experience of the learner through peer guidance and the experience of the teacher through professional development. These findings may increase student interest in pursuing academic radiology as a career and invite opportunities for broadening medical school education in radiology., 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 Association of University Radiologists. Published by Elsevier Inc. All rights reserved.)

The RNA modification of N 6 -methyladenosine (m 6 A) controls many aspects of RNA function that impact biological processes, including viral infection. In this review, we highlight recent work that shapes our current understanding of the diverse mechanisms by which m 6 A can regulate viral infection by acting on viral or cellular mRNA molecules. We focus on emerging concepts and understanding, including how viral infection alters the localization and function of m 6 A machinery proteins, how m 6 A regulates antiviral innate immunity, and the multiple roles of m 6 A in regulating specific viral infections. We also summarize the recent studies on m 6 A during SARS-CoV-2 infection, focusing on points of convergence and divergence. Ultimately, this review provides a snapshot of the latest research on m 6 A during viral infection., Competing Interests: Declaration of Competing Interest None., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Importance: Financial incentives in Medicare Advantage (MA), the managed care alternative to traditional Medicare (TM), were designed to reduce overutilization. For patients near the end of life (EOL), MA incentives may reduce potentially burdensome care and encourage hospice but could also restrict access to costly but necessary services., Objective: To compare receipt of potentially burdensome treatments and transfers and potentially necessary postacute services in the last 6 months of life in individuals with MA vs TM., Design, Setting, and Participants: A retrospective analysis of Medicare claims data among older Medicare beneficiaries who died between 2016 and 2018. The study included Medicare decedents aged 66 years or older covered by TM (n = 659 135) or MA (n = 360 430). All decedents and the subset of decedents with 1 or more emergent hospitalizations with a life-limiting condition (cancer, dementia, end-stage organ failure) that would likely qualify for hospice care were included., Exposure: MA enrollment., Main Outcomes: Receipt of potentially burdensome hospitalizations and treatments; receipt of postdischarge home and facility care., Results: The study included 659 135 TM enrollees (mean [SD] age at death, 83.3 [9.0] years, 54% female, 15.1% non-White, 55% with 1 or more life-limiting condition) and 360 430 MA enrollees (mean [SD] age at death 82.5 [8.7] years, 53% female, 19.3% non-White, 49% with 1 or more life-limiting condition). After regression adjustment, MA enrollees were less likely to receive potentially burdensome treatments (-1.6 percentage points (pp); 95% CI, -2.1 to -1.1) and less likely to die in a hospital (-3.3 pp; 95% CI, -4.0 to -2.7) compared with TM. However, when hospitalized, MA enrollees were more likely to die in the hospital (adjusted difference, 1.3 pp; 95% CI, 1.1-1.5) and less likely to be transferred to rehabilitative or skilled nursing facilities (-5.2 pp; 95% CI, -5.7 to -4.6). Higher rates of home health and home hospice among those discharged home offset half of the decline in facility use. Results were unchanged in the life-limiting conditions sample., Conclusions: MA enrollment was associated with lower rates of potentially burdensome and facility-based care near the EOL. Greater use of home-based care may improve quality of care but may also leave patients without adequate assistance after hospitalization.

Purpose: People with aphasia (PWA) often experience higher levels of anxiety and social isolation than people without aphasia. Although the presence of anxiety is appreciated in PWA, literature examining the etiology and persistent nature of anxiety in PWA is underdeveloped. Safety-seeking behaviors, or maladaptive acts used by individuals to decrease anxiety from a feared outcome, have been reported as key facilitators of long-term anxiety toward feared situations across a variety of clinical populations. The purpose of this viewpoint is to explore the concept of safety-seeking behaviors and discuss their potential relevance to the maintenance of anxiety in PWA. We further discuss the distinction between maladaptive (i.e., safety seeking) and adaptive (i.e., coping) behaviors and how this knowledge may improve the quality of clinical services for PWA., Conclusions: The present review advocates for further exploration of the safety-seeking behaviors that are used by PWA. Until critical attention is given to this subject, clinicians may remain ill-equipped to identify and depict whether a self-management strategy is facilitative or inhibitive to PWA's communicative participation goals. Critically, a behavior that may be "maladaptive" for one individual may be "adaptive" for another. Future research should seek to identify common behavioral and cognitive strategies that PWA implement to reduce acute perceptions of anxiety. This knowledge may help facilitate holistic aphasia rehabilitation by allowing clinicians to foster conversations around behaviors that inhibit or promote successful communicative participation.

Background: Participation in life situations has been identified by people with aphasia (PWA) as an ultimate outcome of rehabilitation and is often measured with patient-reported outcome measures (PROMs) or informant-reported measures. It is known that PWA and informants do not always produce similar scores on measures of activities and participation. However, systematic differences between PWA and informants and the causes of these differences are not well understood. Here, we investigated these differences as a function of language impairment, perceived level of activity and participation success, and depressive symptoms., Method: Participants were 29 PWA-informant dyads who completed a performance-based language assessment and three measures related to different aspects of activities and participation. Outcome variables were PWA-informant difference scores in the activities and participation measures., Results: PWA ratings of activities and participation were not statistically significantly associated with performance-based language severity. Hierarchical regression models with both language impairment and informant-reported scores as predictor variables explained 53%-71% of the variance in PWA-informant difference scores (all p < .05). In particular, mild communication challenges were associated with the PWA reporting significantly worse participation than the informant perceived. In contrast, more severe communication challenges were associated with the PWA reporting significantly better participation than the informant perceived., Discussion: These findings highlight the importance of measuring participation by PROM. The PWA's experience of participation is not related to their level of language impairment and is predictably different from their care partners' perspective. As others have also reported, "mild" aphasia is not so mild to the PWA. Similarly, "severe" may not be so severe to the PWA. Further research is needed to connect these findings with counseling and caregiver education. Research on response processes (e.g., response shift) is also warranted.

Background: GLP-1 receptor agonists (GLP-1 RAs) have dramatically altered obesity treatment. Media reports suggest that GLP-1 RAs users often report feeling judged for taking a "shortcut" to lose weight, which may be related to negative stereotypes toward people with larger bodies. Media reports also describe negative attitudes about lean people who take GLP-1 RAs to enhance their appearance. The present research used a 2 × 2 experimental design to test the effects of GLP-1 RA use and body size on attitudes and egocentric impressions., Subjects/methods: A sample of 357 U.S. adults (M age  = 37.8, SD = 13) were randomly assigned to read about a woman, who either was lean or had obesity, and who lost 15% of her body weight either with diet/exercise or a GLP-1 RA. Participants answered questions measuring endorsement of negative weight-related stereotypes and egocentric attitudes toward the woman, as well as beliefs that she took a shortcut to lose weight and beliefs that biogenetic factors caused her baseline weight., Results: Negative evaluations and egocentric impressions were stronger toward a woman who lost weight with a GLP-1 RA compared to diet/exercise. Losing weight with a GLP-1 RA led to stronger negative evaluations through higher weight loss shortcut beliefs irrespective of body size. Losing weight with a GLP-1 RA also led to higher egocentric impressions through higher shortcut beliefs, and this effect was stronger for a lean woman. Finally, losing weight with a GLP-1 RA led to more negative evaluations through stronger endorsement of biogenetic causal beliefs for a lean woman only., Conclusions: This timely study provides evidence that people with larger and smaller bodies alike are at-risk for being judged for using GLP-1 RAs due to beliefs that these medications are a shortcut. Findings also demonstrate novel reactions related to egotism when weight loss is achieved with pharmacological interventions. PRE-REGISTRATION AND DATA: osf.io/xme4w., (© 2024. The Author(s), under exclusive licence to Springer Nature Limited.)

Objectives: To evaluate associations between self-rated health (SRH) and care outcomes among United States adults with diagnosed HIV infection., Design: We analyzed interview and medical record data collected during June 2020-May 2021 from the Medical Monitoring Project, a complex, nationally representative sample of 3692 people with HIV (PWH). Respondents reported SRH on a 5-point Likert type scale (poor to excellent), which we dichotomized into "good or better" and "poor or fair". We computed weighted percentages with 95% confidence intervals (CIs) and age-adjusted prevalence ratios (aPRs) to investigate associations between SRH and HIV outcomes and demographic, psychosocial, and behavioral characteristics., Results: Nationally, 72% of PWH reported "good or better" SRH. PWH with the following characteristics had a lower prevalence of "good or better" SRH, compared with those without: any missed HIV care appointment in the last 12 months (aPR 0.86, 95% CI: 0.81-0.91), symptoms of moderate or severe depression (aPR 0.51, 95% CI: 0.43-0.59) and anxiety (aPR 0.60, 95% CI: 0.54-0.68), unstable housing or homelessness (aPR 0.77, 95% CI: 0.71-0.82), and hunger or food insecurity (aPR 0.74, 95% CI: 0.69-0.80), as well as having a mean CD4 count <200 cells/mm 3 vs. CD4 + >500 cells/mm 3 (aPR 0.70, 95% CI: 0.57-0.86)., Conclusions: Though SRH is a holistic measure reflective of HIV outcomes, integrated approaches addressing needs beyond physical health are necessary to improve SRH among PWH in the United States. Modifiable factors like mental health, unstable housing or homelessness, and food insecurity warrant further study as potential high-yield targets for clinical and policy interventions to improve SRH among PWH., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Introduction: The sexual and reproductive health of cisgender women with HIV is essential for overall health and well-being. Nationally representative estimates of sexual and reproductive health outcomes among women with HIV were assessed in this study., Methods: Data from the Centers for Disease Control and Prevention's Medical Monitoring Project-including data on sexual and reproductive health-were collected during June 2018-May 2021 through interviews and medical record abstraction among women with HIV and analyzed in 2023. Among women with HIV aged 18-44 years (n=855), weighted percentages were reported, and absolute differences were assessed between groups, highlighting differences ≥|5%| with CIs that did not cross the null., Results: Overall, 86.4% of women with HIV reported receiving a cervical Pap smear in the past 3 years; 38.5% of sexually active women with HIV had documented gonorrhea, chlamydia, and syphilis testing in the past year; 88.9% of women with HIV who had vaginal sex used ≥1 form of contraception in the past year; and 53.4% had ≥1 pregnancy since their HIV diagnosis-of whom 81.5% had ≥1 unintended pregnancy, 24.6% had ≥1 miscarriage or stillbirth, and 9.8% had ≥1 induced abortion. Some sexual and reproductive health outcomes were worse among women with certain social determinants of health, including women with HIV living in households <100% of the federal poverty level compared with women with HIV in households ≥139% of the federal poverty level., Conclusions: Many women with HIV did not receive important sexual and reproductive health services, and many experienced unintended pregnancies, miscarriages/stillbirths, or induced abortions. Disparities in some sexual and reproductive health outcomes were observed by certain social determinants of health. Improving sexual and reproductive health outcomes and reducing disparities among women with HIV could be addressed through a multipronged approach that includes expansion of safety net programs that provide sexual and reproductive health service coverage., (Published by Elsevier Inc.)

Objective: The objective of this study was to examine the association between portal use and end-of-life (EOL) outcomes in the last year of life. Methods: A retrospective cohort ( n = 6,517) study at Kaiser Permanente Colorado among adults with serious illness deceased between January 1, 2016, and June 30, 2019. Portal use was categorized into engagement types: no use, nonactive, active without a provider, and active with a provider. EOL outcomes were hospitalizations in the month before death, last-year advance directive completion, and hospice use. Association between EOL outcomes and levels of portal use was assessed using χ 2 statistics and generalized linear models. Results: Higher portal engagement types were associated with higher rates of hospitalizations ( p = 0.0492), advance directive completion ( p = 0.0226), and hospice use ( p = 0.0070). Conclusion: Portal use in the last year of life was associated with increases in a poor EOL outcome, hospitalizations, and beneficial EOL outcomes, advance directives, and hospice care.

Importance: Urinary incontinence can be a barrier to performing physical activities for many women. A midurethral sling (MUS) has shown symptom improvement for women experiencing stress urinary incontinence (SUI), suggesting the hypothesis that physical activity rates should increase after treatment., Objective: The aim of this study was to determine the change in objectively measured physical activity levels in women following placement of MUS for SUI., Study Design: In this prospective cohort study, patients undergoing MUS placement, with or without concomitant pelvic reconstructive surgery, were provided a commercial activity tracker. Physical activity was tracked for at least 1 week preoperatively and up to 6 months postoperatively. Participants were required to wear the tracker for at least 2 weeks in the postoperative period. The primary outcome, mean caloric daily expenditure (MCDE), was compared preoperatively and postoperatively., Results: Seventy-two patients met criteria for data inclusion. The device was worn for a mean of 18.4 ± 12.1 days preoperatively and 91.7 ± 53.3 days postoperatively. Mean participant age was 51.9 ± 9.4 years. The MCDE was significantly higher postoperatively (preoperatively: 1,673 kcal/d vs postoperatively: 2,018 kcal/d; P < 0.01). There were no significant differences in postoperative MCDE in participants who had only MUS as the primary procedure versus participants who also had a concomitant procedure (2,020 ± 216 kcal/d vs 2,015 ± 431 kcal/d; P = 0.95). Of participants with class II/III obesity, 45% had at least a 500 kcal/d increase postoperatively., Conclusions: Treatment of SUI with MUS is associated with a significantly greater caloric expenditure in the postoperative period., Competing Interests: The authors have declared they have no conflicts of interest., (Copyright © 2024 American Urogynecologic Society. All rights reserved.)

Group-based Metacognitive Reflection and Insight Therapy (MERITg) is the group application of Metacognitive Reflection and Insight Therapy (MERIT), an evidence-based, integrative, recovery-oriented intervention to enhance insight and understanding of oneself and others in individuals with serious mental illness (SMI). MERITg may offer therapeutic interactions between participants that uniquely support recovery. The goal of the current study was to examine the relationship between MERITg participation and recovery-oriented beliefs. Thirty-one participants (outpatient = 21; inpatient = 10) in SMI treatment programs participated in MERITg as an adjunctive treatment. A short form of the Maryland Assessment of Recovery in Serious Mental Illness (MARS-12) was used to assess recovery-oriented beliefs before and after group participation. Recovery-oriented beliefs significantly improved in the outpatient MERITg group but not in the inpatient group, and change in recovery-oriented beliefs was positively correlated with the total number of groups attended. These findings suggest the promise of MERITg for enhancing recovery-oriented beliefs. The potential role of treatment setting is discussed.

Introduction: Trauma is the leading cause of death and disability in children. Differences in mechanism, injury pattern, severity, and physiology in this population distinguish pediatric trauma patients from adults. Educational techniques including simulation and didactics may improve pediatric readiness in this setting. We summarize the literature across disciplines, highlighting the curricular approaches, target provider population, educational content, content delivery method, and Kirkpatrick level for pediatric trauma resuscitation education., Methods: The MEDLINE (via Ovid), Embase (via Elsevier), Cumulative Index to Nursing & Allied Health Literature Complete (via EBSCO), Education Database (via ProQuest), and Web of Science Social Science Citation Index and Science Citation Index (via Clarivate) were searched. We reviewed 90 manuscripts describing pediatric trauma resuscitation education programs. When available, target provider population, curricular content, delivery method, and Kirkpatrick level were obtained., Results: Nurses (50%), residents (45%), and attending physicians (43%) were the most common participants. Airway management (25%), shock (25%), and general trauma (25%) were the most frequently taught concepts, and delivery of content was more frequently via simulation (65%) or didactics (52%). Most studies (39%) were Kirkpatrick Level 1., Conclusions: This review suggests that diverse strategies exist to promote pediatric readiness. Most training programs are interdisciplinary and use a variety of educational techniques. However, studies infrequently report examining the impact of educational interventions on patient-centered outcomes and lack detail in describing their curriculum. Future educational efforts would benefit from heightened attention to such outcome measures and a rigorous description of their curricula to allow for reproducibility., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Objective: Investigate the role of the Ryan White HIV/AIDS Program (RWHAP) - which funds services for vulnerable and historically disadvantaged populations with HIV - in reducing health inequities among people with HIV over a 10-year horizon., Design: We use an agent-based microsimulation model to incorporate the complexity of the program and long-time horizon., Methods: We use a composite measure (the Theil index) to evaluate the health equity implications of the RWHAP for each of four subgroups (based on race and ethnicity, age, gender, and HIV transmission category) and two outcomes (probability of being in care and treatment and probability of being virally suppressed). We compare results with the RWHAP fully funded versus a counterfactual scenario, in which the medical and support services funded by the RWHAP are not available., Results: The model indicates the RWHAP will improve health equity across all demographic subgroups and outcomes over a 10-year horizon. In Year 10, the Theil index for race and ethnicity is 99% lower for both outcomes under the RWHAP compared to the non-RWHAP scenario; 71-93% lower across HIV transmission categories; 31-44% lower for age; and 73-75% lower for gender., Conclusion: Given the large number of people served by the RWHAP and our findings on its impact on equity, the RWHAP represents an important vehicle for achieving the health equity goals of the National HIV/AIDS Strategy (2022-2025) and the Ending the HIV Epidemic Initiative goal of reducing new infections by 90% by 2030., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Background: We compared HIV care outcomes by HIV provider type to inform efforts to strengthen the HIV provider workforce., Setting: United States., Methods: We analyzed data from Center for Disease Control and Prevention's Medical Monitoring Project collected during June, 2019-May, 2021 from 6323 adults receiving HIV medical care. Provider types include infectious disease physicians only (ID physicians), non-ID physicians only, nurse practitioners only, physician assistants only, and ID physicians plus nurse practitioners and/or physician assistants (mixed providers). We measured patient characteristics, social determinants of health, and clinical outcomes, including retention in care; antiretroviral therapy prescription; antiretroviral therapy adherence; viral suppression; gonorrhea, chlamydia, and syphilis testing; satisfaction with HIV care; and HIV provider trust., Results: Compared with patients of ID physicians, higher percentages of patients of other provider types had characteristics and social determinants of health associated with poor health outcomes and received HIV care at Ryan White HIV/AIDS Program-funded facilities. After accounting for these differences, most outcomes were not meaningfully different; however, higher percentages of patients of non-ID physicians, nurse practitioners, and mixed providers were retained in care (6.5, 5.6, and 12.7 percentage points, respectively) and had sexually transmitted infection testing in the past 12 months, if sexually active (6.9, 7.4, and 13.5 percentage points, respectively)., Conclusion: Most HIV outcomes were equivalent across provider types. However, patients of non-ID physicians, nurse practitioners, and mixed providers were more likely to be retained in care and have recommended sexually transmitted infection testing. Increasing delivery of comprehensive primary care by ID physicians and including primary care providers in ID practices could improve HIV primary care outcomes., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Objective: With the recent increase in research into public views on healthcare artificial intelligence (HCAI), the objective of this review is to examine the methods of empirical studies on public views on HCAI. We map how studies provided participants with information about HCAI, and we examine the extent to which studies framed publics as active contributors to HCAI governance., Materials and Methods: We searched 5 academic databases and Google Advanced for empirical studies investigating public views on HCAI. We extracted information including study aims, research instruments, and recommendations., Results: Sixty-two studies were included. Most were quantitative (N = 42). Most (N = 47) reported providing participants with background information about HCAI. Despite this, studies often reported participants' lack of prior knowledge about HCAI as a limitation. Over three quarters (N = 48) of the studies made recommendations that envisaged public views being used to guide governance of AI., Discussion: Provision of background information is an important component of facilitating research with publics on HCAI. The high proportion of studies reporting participants' lack of knowledge about HCAI as a limitation reflects the need for more guidance on how information should be presented. A minority of studies adopted technocratic positions that construed publics as passive beneficiaries of AI, rather than as active stakeholders in HCAI design and implementation., Conclusion: This review draws attention to how public roles in HCAI governance are constructed in empirical studies. To facilitate active participation, we recommend that research with publics on HCAI consider methodological designs that expose participants to diverse information sources., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier B.V. All rights reserved.)

Improvements in treatment have made HIV a manageable chronic condition, leading to increased life expectancy and a growing share of people with HIV who are older. Older people with HIV have higher rates of many chronic conditions, yet little is known about differences in health care utilization and spending. This study compared health care utilization and spending for Medicare beneficiaries with and without HIV, accounting for differential mortality. The data included demographic characteristics and claims-based information. Estimated cumulative spending for beneficiaries with HIV aged 67 to 77 years was 26% higher for Medicare Part A and 39% higher for Medicare Part B compared with beneficiaries without HIV; most of these differences would be larger if not for greater mortality risk among people with HIV (and therefore fewer years to receive care). Future research should disentangle underlying causes for this increased need and describe potential responses by policymakers and health care providers., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Individuals with serious mental illness (SMI) face unique and significant challenges that require evidence-based practices and clinicians who have advanced, comprehensive training to provide them. SMI affects about 5.5% of the U.S. population and results in serious health, social, and economic burdens. Despite advancements in treatment over the past 50 years, training programs for psychologists and other mental health providers have failed to keep up with these advances, underutilizing evidence-based assessments and interventions developed specifically for this population and found to be efficacious. To address this, the SMI Psychology Specialty has developed Training Guidelines to establish consistent, high-quality, and evidence-based training for postdoctoral psychologists. This article highlights selected features of the Training Guidelines for SMI Psychology. Although these were developed for postdoctoral training programs in SMI Psychology, they are applicable to training programs at all levels, and we hope that training programs in psychology and other mental health disciplines will incorporate these advances into their curricula. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Inflammation and oxidative stress are implicated in the pathogenesis of Crohn's disease. Cerium oxide nanoparticle (CNP) conjugated to microRNA 146a (miR146a) (CNP-miR146a) is a novel compound with anti-inflammatory and antioxidative properties. We hypothesized that local administration of CNP-miR146a would improve colitis in a 2,4,6-Trinitrobenzenesulfonic acid (TNBS) mouse model for Crohn's disease by decreasing colonic inflammation. Balb/c mice were instilled with TNBS enemas to induce colitis. Two days later, the mice received cellulose gel enema, cellulose gel with CNP-miR146a enema, or no treatment. Control mice received initial enemas of 50% ethanol and PBS enemas on day two. The mice were monitored daily for weight loss and clinical disease activity. The mice were euthanized on days two or five to evaluate their miR146a expression, inflammation on histology, and colonic IL-6 and TNF gene expressions and protein concentrations. CNP-miR146a enema successfully increased colonic miR146a expression at 12 h following delivery. At the end of five days from TNBS instillation, the mice treated with CNP-miR146a demonstrated reduced weight loss, improved inflammation scores on histology, and reduced gene expressions and protein concentrations of IL-6 and TNF. The local delivery of CNP-miR146a in a TNBS mouse model of acute Crohn's colitis dramatically decreased inflammatory signaling, resulting in improved clinical disease.

The availability, promotion, and price of healthy foods within the university food environment may impact students' dietary choices. This systematic review summarizes the tools and methods used to assess the healthfulness of university food environments where many students spend a significant portion of their emerging adulthood. Thirty-six global studies published between 2012 and 2022 were sourced from PubMed (NNLM), Cochrane Library (Wiley), Web of Science (Clarivate), APA PsycInfo (EBSCO), CINHAL Complete (EBSCO), ProQuest Nursing, and Allied Health, following PRISMA 2020 guidelines. Of the included studies, 58% were institutional-level audits, 17% examined individual-level perceptions, and 25% combined both. Most institutional-level audits focused on one aspect of the food environment (e.g., eateries, vending machines). For studies examining multiple spaces within the campus environment (38%), comprehensive assessments were limited, and most studies had to employ a combination of assessment tools. Surveys were most often used to gather individual perceptions about the food environment. The Nutrition Environment Measures Survey (NEMS) was the most commonly used tool across all studies. This review highlights the need for a standardized tool, method, or a "healthy" benchmark for specific use at universities to improve methodological rigor and comparability of findings across institutions.

Objective: To support a diverse sample of Australians to make recommendations about the use of artificial intelligence (AI) technology in health care., Study Design: Citizens' jury, deliberating the question: "Under which circumstances, if any, should artificial intelligence be used in Australian health systems to detect or diagnose disease?", Setting, Participants: Thirty Australian adults recruited by Sortition Foundation using random invitation and stratified selection to reflect population proportions by gender, age, ancestry, highest level of education, and residential location (state/territory; urban, regional, rural). The jury process took 18 days (16 March - 2 April 2023): fifteen days online and three days face-to-face in Sydney, where the jurors, both in small groups and together, were informed about and discussed the question, and developed recommendations with reasons. Jurors received extensive information: a printed handbook, online documents, and recorded presentations by four expert speakers. Jurors asked questions and received answers from the experts during the online period of the process, and during the first day of the face-to-face meeting., Main Outcome Measures: Jury recommendations, with reasons., Results: The jurors recommended an overarching, independently governed charter and framework for health care AI. The other nine recommendation categories concerned balancing benefits and harms; fairness and bias; patients' rights and choices; clinical governance and training; technical governance and standards; data governance and use; open source software; AI evaluation and assessment; and education and communication., Conclusions: The deliberative process supported a nationally representative sample of citizens to construct recommendations about how AI in health care should be developed, used, and governed. Recommendations derived using such methods could guide clinicians, policy makers, AI researchers and developers, and health service users to develop approaches that ensure trustworthy and responsible use of this technology., (© 2024 The Authors. Medical Journal of Australia published by John Wiley & Sons Australia, Ltd on behalf of AMPCo Pty Ltd.)

Background: The taxonomic status of the relapsing fever spirochete Borrelia hermsii in western North America was established in 1942 and based solely on its specific association with the soft tick vector Ornithodoros hermsi . Multilocus sequence typing (MLST) of the 16S rRNA , flaB , gyrB , glpQ , and 16S-23S rRNA intergenic spacer of B. hermsii isolates collected over many years from various geographic locations and biological sources identified two distinct clades designated previously as B. hermsii Genomic Group I (GGI) and Genomic Group II (GGII). To better assess the taxonomic relationship of these two genomic groups to each other and other species of Borrelia , DNA sequences of the entire linear chromosome were determined. Materials and Methods: Genomic DNA samples were prepared from 11 spirochete isolates grown in Barbour-Stoenner-Kelly-H medium. From these preparations, DNA sequences of the entire linear chromosome of two isolates of B. hermsii belonging to each genomic group and seven additional species were determined. Results: Chromosomal sequences of four isolates of B. hermsii contained 919,212 to 922,307 base pairs. DNA sequence identities between the two genomic groups of B. hermsii were 95.86-95.99%, which were more divergent than chromosomal sequences comparing Borrelia parkeri and Borrelia turicatae (97.13%), Borrelia recurrentis and Borrelia duttonii (97.07%), and Borrelia crocidurae and B. duttonii (97.09%). The 3' end of the chromosome of the two GGII isolates also contained a unique intact oppA gene absent from all other species examined. Conclusion: Previous MLST and the chromosomal sequences presented herein support the division of the B. hermsii species complex into two species, B. hermsii sensu stricto ( = GGI) and Borrelia nietonii sp. nov. ( = GGII). We name this unique relapsing fever spirochete in honor of our late friend and colleague Dr. Nathan Nieto for his outstanding contributions to our understanding of tick-borne relapsing fever.

Introduction and Hypothesis: Pelvic organ prolapse following a radical cystectomy is challenging to treat and recurrence of prolapse after primary repair is common owing to compromised pelvic floor support and tissue quality. Vaginal prolapse repairs are often preferred because of concern for patients' complex intraabdominal pathological conditions. However, for those with recurrent prolapse following colpocleisis, limited definitive treatment options exist., Methods: This surgical video presents a 64-year-old G4P4 with a history of radical cystectomy with an Indiana Pouch for invasive urothelial carcinoma who presented with recurrent stage IV vaginal prolapse two years following colpocleisis. Owing to thin vaginal tissue, a sacrocolpopexy with vaginal mesh could not be performed, thus, the patient underwent robotic-assisted vaginal hernia repair with a polypropylene-reinforced ovine tissue matrix attached to Cooper's ligament and the levator ani muscles., Results: The surgery was free from complications and her postoperative Pelvic Organ Prolapse Quantification examination revealed a leading vaginal tissue remnant at the level of the hymen. The patient reported overall improved health and quality of life following surgery and recovery on postoperative validated questionnaires., Conclusions: Vaginal and pelvic floor hernia repair with a polypropylene-reinforced tissue matrix is a feasible definitive surgical treatment for patients with prior radical cystectomy in whom colpocleisis has failed., (© 2024. The International Urogynecological Association.)

Viral RNA molecules contain multiple layers of regulatory information. This includes features beyond the primary sequence, such as RNA structures and RNA modifications, including N6-methyladenosine (m 6 A). Many recent studies have identified the presence and location of m 6 A in viral RNA and have found diverse regulatory roles for this modification during viral infection. However, to date, viral m 6 A mapping strategies have limitations that prevent a complete understanding of the function of m 6 A on individual viral RNA molecules. While m 6 A sites have been profiled on bulk RNA from many viruses, the resulting m 6 A maps of viral RNAs described to date present a composite picture of m 6 A across viral RNA molecules in the infected cell. Thus, for most viruses, it is unknown if unique viral m 6 A profiles exist throughout infection, nor if they regulate specific viral life cycle stages. Here, we describe several challenges to defining the function of m 6 A in viral RNA molecules and provide a framework for future studies to help in the understanding of how m 6 A regulates viral infection., (© 2024 Horner and Thompson; Published by Cold Spring Harbor Laboratory Press for the RNA Society.)

Background: Approximately 2 in 5 persons with HIV (PWH) in the United States are aged 55 years or older. HIV ancillary services, such as case management and transportation services, can help older PWH remain engaged in care. We used data from the Medical Monitoring Project (MMP) to describe the prevalence of unmet needs for ancillary services among persons with diagnosed HIV aged 55 years or older., Setting: MMP is an annual cross-sectional study that reports representative estimates on adults with diagnosed HIV in the United States., Methods: We used MMP data collected during June 2019-May 2021 to calculate weighted percentages of cisgender men and cisgender women with HIV aged 55 years or older with unmet needs for ancillary services, overall and by selected characteristics (N = 3200). Unmet need was defined as needing but not receiving a given ancillary service. We assessed differences between groups using prevalence ratios (PRs) and 95% confidence intervals with predicted marginal means., Results: Overall, 37.7% of cisgender men and women with HIV aged 55 years or older had ≥1 unmet need for ancillary services. Overall, 16.6% had ≥1 unmet need for HIV support services, 26.9% for non-HIV medical services, and 26.7% for subsistence services. There were no statistically significant differences in unmet needs for services by gender. The prevalence of ≥1 unmet need was higher among non-White persons (PR range: 1.35-1.63), persons who experienced housing instability (PR = 1.70), and those without any private insurance (PR range: 1.49-1.83)., Conclusion: A large percentage of older PWH have unmet needs for ancillary services. Given the challenges that older PWH face related to the interaction of HIV and aging-associated factors, deficits in the provision of ancillary services should be addressed., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Objective: To systematically review the literature on outcomes of pelvic organ prolapse (POP) surgery in patients from various body mass index (BMI) categories to determine the association between obesity and surgical outcomes., Data Sources: PubMed, EMBASE, and Cochrane databases were searched from inception to April 12, 2022; ClinicalTrials.gov was searched in September 2022 (PROSPERO 2022 CRD42022326255). Randomized and nonrandomized studies of urogynecologic POP surgery outcomes were accepted in which categories of BMI or obesity were compared., Methods of Study Selection: In total, 9,037 abstracts were screened; 759 abstracts were identified for full-text screening, and 31 articles were accepted for inclusion and data were extracted., Tabulation, Integration, and Results: Studies were extracted for participant information, intervention, comparator, and outcomes, including subjective outcomes, objective outcomes, and complications. Outcomes were compared among obesity categories (eg, BMI 30-34.9, 35-40, higher than 40), and meta-analysis was performed among different surgical approaches. Individual studies reported varying results as to whether obesity affects surgical outcomes. By meta-analysis, obesity (BMI 30 or higher) is associated with an increased odds of objective prolapse recurrence after vaginal prolapse repair (odds ratio [OR] 1.38, 95% CI, 1.14-1.67) and after prolapse repair from any surgical approach (OR 1.31, 95% CI, 1.12-1.53) and with complications such as mesh exposure after both vaginal and laparoscopic POP repair (OR 2.10, 95% CI, 1.01-4.39)., Conclusion: Obesity is associated with increased likelihood of prolapse recurrence and mesh complications after POP repair., Systematic Review Registration: PROSPERO CRD42022326255., Competing Interests: Financial Disclosure Alexandriah Alas received payments for expert testimony. Sadikah Behbehani received payments from Intuitive Surgical. Jon Pennycuff receives consulting fees from Boston Scientific, Coloplast, Corneille Law, LLC, and ICA, Inc. David Sheyn received payments from Caldera Medical, and his institution received payment from Medtronic and Axonics. Bela Kudish has served as a consultant for Proctor for Intuitive Surgical. Mikio Nihira received payment from HealthTrust and Shield Therapeutics. Cara Grimes received payments from Provepharm, Inc for consultant work and from Johnson and Johnson as an expert witness and is an SGS Board member. Ethan M. Balk receives funding from SGS as a consultant methodologist to the Systematic Review Group. Danielle Antosh received past payments from LaGrippe Research Inc. The other authors did not report any conflicts of interest., (Copyright © 2024 by the American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.)

Importance: Disparities persist across the trajectory of serious illness, including at the end of life. Patient navigation has been shown to reduce disparities and improve outcomes for underserved populations., Objective: To determine the effectiveness of a lay patient navigator intervention, Apoyo con Cariño, in improving palliative care outcomes among Hispanic patients., Design, Setting, and Participants: This was a multicenter randomized clinical trial that took place across academic, nonprofit, safety-net, and community health care systems in urban, rural, and mountain/frontier regions of Colorado from January 2017 to January 2021. Self-identifying Hispanic adults with serious noncancer medical illness and limited prognosis were recruited. Data were collected and analyzed from July 2022 to July 2023., Interventions: Participants randomized to the intervention group received 5 home visits from a bilingual, bicultural lay patient navigator; participants randomized to control received care as usual. Both groups received culturally tailored educational materials. Investigators/outcome accessors remained blinded to participant assignment., Main Outcomes and Measures: Change in score from baseline to 3 months on the Functional Assessment of Chronic Illness Therapy (FACIT) General quality of life (QOL) scale (primary outcome), Advance Care Planning (ACP) Engagement Survey, Brief Pain Inventory, Edmonton Symptom Assessment Scale, and FACIT Spiritual Well-Being subscale; at 6 months, advance directive (AD) documentation; and at 46 months or death, hospice utilization and length of stay, as well as aggressiveness of care at end of life., Results: Of 209 patients enrolled (mean [SD] age, 63.6 [14.3] years; 108 [51.7%] male), 105 patients were randomized to control and 104 patients to the intervention. There were no statistically significant differences in the change in mean (SD) QOL score between the intervention and control groups (5.0 [16.5] vs 4.3 [15.5]; P = .75). Participants in the intervention group, compared with the control group, had statistically significant greater increases in mean (SD) ACP engagement (0.8 [1.3] vs 0.1 [1.4]; P < .001) and were more likely to have a documented AD (62 of 104 [59.6%] vs 28 of 105 [26.9%]; P < .001). There were no statistically significant differences in mean (SD) change in pain intensity score (0-10) between patients in the intervention group compared with control (-0.4 [2.6] vs -0.5 [2.8]; P = .79), nor pain interference (-0.2 [3.7] vs -0.4 [3.7]; P = .71). Patients receiving the intervention were more likely to be referred to hospice compared with patients receiving control (19 of 43 patients [44.2%] vs 7 of 33 patients [21.2%]; P = .04) and less likely to receive aggressive care at end of life (27 of 42 patients [64.3%] vs 28 of 33 patients [84.8%]; P = .046)., Conclusion and Relevance: In this randomized clinical trial, a culturally tailored patient navigator intervention did not improve QOL for patients. However, the intervention did increase ACP engagement, AD documentation, and hospice utilization in Hispanic persons with serious medical illness., Trial Registration: ClinicalTrials.gov Identifier: NCT03181750.

Background: Newborn bloodspot screening is a well-established population health initiative that detects serious, childhood-onset, treatable conditions to improve health outcomes. With genomic technologies advancing rapidly, many countries are actively discussing the introduction of genomic assays into newborn screening programs. While adding genomic testing to Australia's newborn screening program could improve outcomes for infants and families, it must be considered against potential harms, ethical, legal, equity and social implications, and economic and health system impacts. We must ask not only 'can' we use genomics to screen newborns?' but 'should we'?' and 'how much should health systems invest in genomic newborn screening?'., Methods: This study will use qualitative methods to explore understanding, priorities, concerns and expectations of genomic newborn screening among parents/carers, health professionals/scientists, and health policy makers across Australia. In-depth, semi-structured interviews will be held with 30-40 parents/carers recruited via hospital and community settings, 15-20 health professionals/scientists, and 10-15 health policy makers. Data will be analysed using inductive content analysis. The Sydney Children's Hospital Network Human Research Ethics Committee approved this study protocol [2023/ETH02371]. The Standards for Reporting Qualitative Research will guide study planning, conduct and reporting., Discussion: Few studies have engaged a diverse range of stakeholders to explore the implications of genomics in newborn screening in a culturally and genetically diverse population, nor in a health system underpinned by universal health care. As the first study within a multi-part research program, findings will be used to generate new knowledge on the risks and benefits and importance of ethical, legal, social and equity implications of genomic newborn screening from the perspective of key stakeholders. As such it will be the foundation on which child and family centered criteria can be developed to inform health technology assessments and drive efficient and effective policy decision-making on the implementation of genomics in newborn screening., Competing Interests: I have read the journal’s policy and the authors of this manuscript have the following competing interests: AJN is a member of the New South Wales Ministry of Health Newborn Screening Expert Advisory Group. All other authors declare no competing interests. This does not alter our adherence to PLOS ONE policies on sharing data and materials., (Copyright: © 2024 Kariyawasam 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.)