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Admins perceive different barriers to PRO implementation vs nonadmins; those at centers with PRO infrastructure perceived less barriers.

IMPORTANCE: Cardiovascular disease (CVD) is increased in people with HIV (PWH) and is characterized by premature noncalcified coronary plaque. In the Randomized Trial to Prevent Vascular Events in HIV (REPRIEVE), pitavastatin reduced major adverse cardiovascular events (MACE) by 35% over a median of 5.1 years. OBJECTIVE: To investigate the effects of pitavastatin on noncalcified coronary artery plaque by coronary computed tomography angiography (CTA) and on inflammatory biomarkers as potential mechanisms for MACE prevention. DESIGN, SETTING, AND PARTICIPANTS: This double-blind, placebo-controlled randomized clinical trial enrolled participants from April 2015 to February 2018 at 31 US clinical research sites.PWH without known CVD who were taking antiretroviral therapy and had low to moderate 10-year CVD risk were included. Data were analyzed from April to November 2023. INTERVENTION: Oral pitavastatin calcium, 4 mg per day. MAIN OUTCOMES AND MEASURES: Coronary CTA and inflammatory biomarkers at baseline and 24 months. The primary outcomes were change in noncalcified coronary plaque volume and progression of noncalcified plaque. RESULTS: Of 804 enrolled persons, 774 had at least 1 evaluable CTA. Plaque changes were assessed in 611 who completed both CT scans. Of 611 analyzed participants, 513 (84.0%) were male, the mean (SD) age was 51 (6) years, and the median (IQR) 10-year CVD risk was 4.5% (2.6-7.0). A total of 302 were included in the pitavastatin arm and 309 in the placebo arm. The mean noncalcified plaque volume decreased with pitavastatin compared with placebo (mean [SD] change, −1.7 [25.2] mm3 vs 2.6 [27.1] mm3; baseline adjusted difference, −4.3 mm3; 95% CI, −8.6 to −0.1; P = .04; 7% [95% CI, 1-12] greater reduction relative to placebo). A larger effect size was seen among the subgroup with plaque at baseline (−8.8 mm3 [95% CI, −17.9 to 0.4]). Progression of noncalcified plaque was 33% less likely with pitavastatin compared with placebo (relative risk, 0.67; 95% CI, 0.52-0.88; P = .003). Compared with placebo, the mean low-density lipoprotein cholesterol decreased with pitavastatin (mean change: pitavastatin, −28.5 mg/dL; 95% CI, −31.9 to −25.1; placebo, −0.8; 95% CI, −3.8 to 2.2). The pitavastatin arm had a reduction in both oxidized low-density lipoprotein (−29% [95% CI, −32 to −26] vs −13% [95% CI, −17 to −9]; P < .001) and lipoprotein-associated phospholipase A2 (−7% [95% CI, −11 to −4] vs 14% [95% CI, 10-18]; P < .001) compared with placebo at 24 months. CONCLUSIONS AND RELEVANCE: In PWH at low to moderate CVD risk, 24 months of pitavastatin reduced noncalcified plaque volume and progression as well as markers of lipid oxidation and arterial inflammation. These changes may contribute to the observed MACE reduction in REPRIEVE. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02344290

Baleen whales (mysticetes) use vocalizations to mediate their complex social and reproductive behaviours in vast, opaque marine environments1. Adapting to an obligate aquatic lifestyle demanded fundamental physiological changes to efficiently produce sound, including laryngeal specializations2–4. Whereas toothed whales (odontocetes) evolved a nasal vocal organ5, mysticetes have been thought to use the larynx for sound production1,6–8. However, there has been no direct demonstration that the mysticete larynx can phonate, or if it does, how it produces the great diversity of mysticete sounds9. Here we combine experiments on the excised larynx of three mysticete species with detailed anatomy and computational models to show that mysticetes evolved unique laryngeal structures for sound production. These structures allow some of the largest animals that ever lived to efficiently produce frequency-modulated, low-frequency calls. Furthermore, we show that this phonation mechanism is likely to be ancestral to all mysticetes and shares its fundamental physical basis with most terrestrial mammals, including humans10, birds11, and their closest relatives, odontocetes5. However, these laryngeal structures set insurmountable physiological limits to the frequency range and depth of their vocalizations, preventing them from escaping anthropogenic vessel noise12,13and communicating at great depths14, thereby greatly reducing their active communication range.

Growing concerns over synthetic plastic pollution have spurred interest in biodegradable food packaging. Starch edible films are an eco-friendly alternative that can enhance the shelf life of fruits and vegetables thanks to their excellent oxygen barrier properties. Nonetheless, Starch edible films have several disadvantages, such as low water resistance and poor mechanical properties. Modifying starch through reactive extrusion, particularly succinylation, offers a solution. Therefore, this research aims to prepare edible films using starch modified by succinylation with different safe-food-use degrees of substitution (DS, 0–0.05) through the extrusion process and Glycerol Content (GC, 15–30%). The succinylated starch edible films’ (SSEF) functional properties and their effectiveness as a coating for mango preservation were evaluated. Results show that as the DS increased, SSEF had lower barrier properties and higher mechanical properties. Additionally, mangoes coated with SSEF exhibited better postharvest quality (weight loss, ΔE, firmness, pH, TA, and °Brix) than control fruit.

•In PWH, CD4 nadir associates with clonal hematopoiesis, a risk factor of atherosclerosis and cancer.•Clonal hematopoiesis is less common outside of North America among PWH.

Stories—and story-tellers—can build resilience. A body of interdisciplinary research demonstrates that personal stories collected and shared in the immediate wake of a flood disaster can improve disaster preparedness and engagement in flood management. This article explores methods and principles for community story-sharing about destructive floods that are not as recent. Agnes, Revisited is a multi-disciplinary, mixed-methods study of the history of Tropical Storm Agnes (1972) in the Susquehanna River Valley (Pennsylvania, United States). “Agnes” was the costliest natural disaster in US history at the time ($3B in 1972; $91B in 2023) and the Susquehanna River Valley withstood catastrophic flooding. Working with partners on and off campus, we wrote an original play based on 48 interviews with storm survivors and archival research on state records, historical images, and historical newspapers. The play both represented a multi-vocal account of Tropical Storm Agnes and catalyzed continued story-sharing about flooding—in the past, present, and future—including an hour-long documentary on Pennsylvania public television and a book with a regional newspaper. This article details the methods we used to devise and execute the play, as well as pursue opportunities for public scholarship that arose because of the play. We highlight seven principles for community engagement that we followed across the project. In support of broader, community-level flood resilience efforts, we encourage scholars to identify anniversaries of historic flood disasters approaching in the next 3 to 5 years and design community-engaged research projects to meet them.

PurposeTo understand reasons why adult cancer survivors do not seek assistance as they transition from the end of cancer treatment to follow-up care. Understanding these reasons should inform survivorship care, help reduce the burden of suffering and increase quality of life for survivors.MethodsA national survey was conducted in collaboration with ten Canadian provinces to identify unmet needs and experiences with follow-up for cancer survivors between one and 3 years post-treatment. The survey included open-ended questions to allow respondents to add topics of importance and details that offered a deeper insight into their experiences. This publication presents the analysis of the quantitative data and open-ended responses regarding reasons why the adult cancer population does not seek help with their concerns.ResultsIn total, 13 319 respondents answered the question about seeking help. 87% had a physical concern of which 76% did not seek help; 77% had an emotional concern of which 82% did not seek help; and 45% had a practical concern of which 71% did not seek help. Frequently identified reasons for not seeking help included being told it was normal and not thinking anything could be done, not wanting to ask, not thinking services were available, handling it on their own and not thinking it was serious enough to seek help.ConclusionsSurvivors have multiple reasons for not seeking help for their concerns. These findings can be useful to healthcare providers in proactively identifying and addressing the needs of these survivors.

In the fiercely competitive landscape of modern manufacturing, small and medium-sized enterprises (SMEs) are navigating an intricate web of challenges and opportunities. This environment demands constant adaptation and innovation to remain relevant and profitable while upholding sustainable practices. Nowadays, Model-based Systems Engineering (MBSE) capabilities have evolved to a state where collaboration, handling complexity, and integrating sustainability into design processes are streamlined. By leveraging digital models to holistically represent and analyze complex systems, MBSE empowers designers to systematically incorporate sustainability issues and make informed decisions. This research elucidates the application of MBSE in fulfilling stakeholders' needs, tracing integrated functional requirements, and finding solution alternatives for accelerating the movement toward sustainable factories. In this regard, the Cameo System Modeler is utilized for sustainable factory design decomposition. To facilitate factories' sustainability assessment, the first level of functional requirements is defined based on axiomatic design theory and sustainability metrics which are highlighted in the European Sustainability Report Standard (ESRS). To present the application of Cameo, the Austrian Post sustainability report is analyzed based on assumed sustainability targets. Results show how MBSE can help stakeholders, managers, and designers have a big picture of a sustainable factory in one place and provide a resilient decision-making environment.

This article presents responses from a range of Australian scholars on communication research and teaching in the context of a roundtable in celebration of the 40th anniversary of the Australian Communication Association (ACA), the precursor organisation to the Australian and New Zealand Communication Association (ANZCA). Emphasising the range and diversity of approaches and epistemologies in this field, the roundtable invited a ‘situated’ response to questions considering scholarship, frameworks, and theoretical perspectives useful in thinking through the near and mid-term challenges facing the area. Emerging from the exercise is a snapshot of different agendas for research and teaching, many of them future-oriented and reformist in their emphasis on responsible practice and social change.

Health disparities in childhood‐onset systemic lupus erythematosus (SLE) disproportionately impact marginalized populations. Socioeconomically patterned missing data can magnify existing health inequities by supporting inferences that may misrepresent populations of interest. Our objective was to assess missing data and subsequent health equity implications among participants with childhood‐onset SLE enrolled in a large pediatric rheumatology registry. We evaluated co‐missingness of 12 variables representing demographics, socioeconomic position, and clinical factors (e.g., disease‐related indices) using Childhood Arthritis and Rheumatology Research Alliance Registry childhood‐onset SLE enrollment data (2015–2022; n = 766). We performed logistic regression to calculate odds ratios (ORs) and 95% confidence intervals (95% CIs) for missing disease‐related indices at enrollment (Systemic Lupus Erythematosus Disease Activity Index 2000 [SLEDAI‐2K] and/or Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index [SDI]) associated with data missingness. We used linear regression to assess the association between socioeconomic factors and SLEDAI‐2K at enrollment using 3 analytic methods for missing data: complete case analysis, multiple imputation, and nonprobabilistic bias analyses, with missing values imputed to represent extreme low or high disadvantage. On average, participants were missing 6.2% of data, with over 50% of participants missing at least 1 variable. Missing data correlated most closely with variables within data categories (i.e., demographic). Government‐assisted health insurance was associated with missing SLEDAI‐2K and/or SDI scores compared to private health insurance (OR 2.04 [95% CI 1.22, 3.41]). The different analytic approaches resulted in varying analytic sample sizes and fundamentally conflicting estimated associations. Our results support intentional evaluation of missing data to inform effect estimate interpretation and critical assessment of causal statements that might otherwise misrepresent health inequities.

Emerging zoonoses (new infectious diseases where pathogens circulate between humans and domestic and wild animals) follow ecological and evolutionary processes that are becoming more common, undermining our ability to achieve the sustainable development goal of good health and well-being. Agriculture has been implied as a major force promoting emerging zoonoses. However, agricultural systems are variable, with some agricultural modes of production expressing social formations that condition biological interactions that can promote (or protect us from) the emergence of new zoonoses in the same way they destroy (or protect) species biodiversity. Consequently, the socioecological characteristics of the agricultural system influence the probability of zoonosis emergence. Here, we propose an approach to examining the relationship between agriculture and zoonoses that suggests that the agricultural matrix, within which other elements of the landscape are positioned, confers various degrees of landscape immunity. Highly simplified, homogeneous, and chemically intensive agricultural landscapes are unlikely to provide such immunity, while diverse agroecological matrices populated by small-/medium-scale farmers and a robust local food system likely will; i.e., they will decrease the probability of zoonosis emergence. In addition, such a landscape is also expected to enhance food sovereignty and security, mitigate climate change, reduce poverty, and protect biodiversity.

Li3N is an excellent protective coating material for lithium electrodes with very high lithium-ion conductivity and low electronic conductivity, but the formation of stable and homogeneous coatings is technically very difficult. Here, we show that protective Li3N coatings can be simply formed by the direct reaction of electrodeposited lithium electrodes with N2gas, whereas using battery-grade lithium foil is problematic due to the presence of a native passivation layer that hampers that reaction. The protective Li3N coating is effective at preventing lithium dendrite formation, as found from unidirectional plating and plating–stripping measurements in Li–Li cells. The Li3N coating also efficiently suppresses the parasitic reactions of polysulfides and other electrolyte species with the lithium electrode, as demonstrated by scanning transmission X-ray microscopy, X-ray photoelectron spectroscopy, and optical microscopy. The protection of the lithium electrode against corrosion by polysulfides and other electrolyte species, as well as the promotion of smooth deposits without dendrites, makes the Li3N coating highly promising for applications in lithium metal batteries, such as lithium–sulfur batteries. The present findings show that the formation of Li3N can be achieved with lithium electrodes covered by a secondary electrolyte interface layer, which proves that the in situ formation of Li3N coatings inside the batteries is attainable.

The goal was to characterize short‐term kidney status and describe variation in early care utilization in a multicenter cohort of patients with childhood‐onset systemic lupus erythematosus (cSLE) and nephritis. We analyzed previously collected prospective data from North American patients with cSLE with kidney biopsy‐proven nephritis enrolled in the Childhood Arthritis and Rheumatology Research Alliance (CARRA) Registry from March 2017 through December 2019. We determined the proportion of patients with abnormal kidney status at the most recent registry visit and applied generalized linear mixed models to identify associated factors. We also calculated frequency of medication use, both during induction and ever recorded. We identified 222 patients with kidney biopsy–proven nephritis, with 64% class III/IV nephritis on initial biopsy. At the most recent registry visit at median (interquartile range) of 17 (8–29) months from initial kidney biopsy, 58 of 106 patients (55%) with available data had abnormal kidney status. This finding was associated with male sex (odds ratio [OR] 3.88, 95% confidence interval [95% CI] 1.21–12.46) and age at cSLE diagnosis (OR 1.23, 95% CI 1.01–1.49). Patients with class IV nephritis were more likely than class III to receive cyclophosphamide and rituximab during induction. There was substantial variation in mycophenolate, cyclophosphamide, and rituximab ever use patterns across rheumatology centers. In this cohort with predominately class III/IV nephritis, male sex and older age at cSLE diagnosis were associated with abnormal short‐term kidney status. We also observed substantial variation in contemporary medication use for pediatric lupus nephritis between pediatric rheumatology centers. Additional studies are needed to better understand the impact of this variation on long‐term kidney outcomes.

Study Design: Cadaveric biomechanics study.Objective: Subchondral bone mineral density (sBMD) reflects the long-term mineralization and distribution of stress on joints. The use of 3-dimensional (3-D) methods to evaluate sBMD, including computed tomography osteoabsorptiometry (CT-OAM), enables the assessment of density distribution with emphasis on subchondral bone. This study sought to measure the sBMD of cervical endplates using CT-OAM and correlate it to mechanical implant subsidence in a cadaveric model.Methods: Fourteen fresh human cadaveric cervical spines were subjected to dynamic testing after single level discectomy and instrumentation using a PEEK interbody spacer. Specimens were imaged with CT 3 times: 1st) whole intact cervical spine, 2nd) after implantation, and 3 rd)after testing. These images were used to assess sBMD distributions using CT-OAM directly underneath the spacer. Subsidence was defined as the displacement of the device into the endplates.Results: The observed “failure mode” was consistently recorded as subsidence, with a mean of 0.45 ± 0.36 mm and 0.40 ± 0.18 mm for the C4-5 and C6-7 levels, respectively. There were no differences by level. The experimental cyclic test showed that denser endplates experienced less deformation under the same load.Conclusions: This study achieved its stated aim of validating the use of CT-OAM as a method to analyze the sBMD of the cervical endplates. Studies such as this are providing new information on available technology such as CT-OAM, providing new tools for clinicians treating spinal conditions in need of augmentation and stabilization via interbody devices.

Children with well‐controlled juvenile idiopathic arthritis (JIA) frequently experience flares after medication discontinuation, but the outcomes of these flares have not been well described. The objective of this study was to characterize the rates and predictors of disease recapture among children with JIA who restarted medication to treat disease flare. Children with JIA who discontinued conventional synthetic or biologic disease‐modifying antirheumatic drugs for well‐controlled disease but subsequently experienced a flare and restarted medication were identified from the Childhood Arthritis and Rheumatology Research Alliance (CARRA) registry. The primary outcome was inactive disease (ID) (physician global assessment <1 and active joint count = 0) 6 months after flare. A total of 333 patients had complete data for ID at 6 months after flare. The recapture rate for the cohort was 55%, ranging from 47% (persistent oligoarthritis) to 69% (systemic arthritis) (P= 0.4). Approximately 67% of children achieved ID by 12 months. In the multivariable model, history and reinitiation of biologic drugs were associated with increased odds of successful recapture (odds ratio [OR] 4.79 [95% confidence interval (95% CI) 1.22–18.78] and OR 2.74 [95% CI 1.62–4.63], respectively). Number of joints with limited range of motion was associated with decreased odds (OR 0.83 per 1 joint increase [95% CI 0.72–0.95]). Approximately half of JIA flares post‐discontinuation were recaptured within 6 months, but rates of recapture varied across JIA categories. These findings inform shared decision‐making for patients, families, and clinicians regarding the risks and benefits of medication discontinuation. Better understanding of biologic predictors of successful recapture in JIA are needed.

There is great interest in developing edible films (EFs) with functional properties made from renewable resources to solve environmental problems associated with plastic waste and improve food preservation and safety. Corn starch is the main raw material employed for producing EFs due to its biodegradability, and availability. Nonetheless, the hydrogen bonding interactions of the native starch structure are strong, limiting its use in the development of bioplastics. In addition, starch-based materials are hydrophilic and lack mechanical integrity. A measure to overcome these disadvantages is the starch native structure modification by a reactive extrusion, where acetylation is one of the most applied chemical modifications. The functionality of acetylated modified corn starch is determined by the degree of substitution (DS). Glycerol is a widely used plasticizer in the food area and is essential in forming starch-based EFs, improving their flexibility and elongation. Hence, this research aimed to develop acetylated modified corn starch edible films (AcEFs) with a DS (0–0.2) and Glycerol Content (GC) (15–30%) to improve its functional properties. The acetylated modified corn starch was obtained by reactive extrusion. The casting technique was used to obtain AcEFs; these were characterized and optimized, evaluating the deformation, puncture resistance, carbon dioxide permeability, water vapor permeability, and water solubility. The data was analyzed using the surface response methodology, and the optimization was carried out using the numerical method. According to the optimization study, the AcEFs with the best mechanical and barrier properties were obtained with 0.16 DS and 18.30% GC.

ObjectivesTo describe physical, emotional and practical concerns and access to help of Canadian cancer survivors aged 75+ years following treatment.MethodsA survey was designed to identify concerns and access to help across three supportive care domains for cancer survivors 1–3 years post-treatment. Random samples were drawn from 10 provincial cancer registries. Survey packages were mailed to 40 790 survivors with option to reply by mail or online in French or English. Descriptive analysis was conducted.ResultsIn total, 3274 (25%) survivors aged 75+ years responded to the survey. Fifty-five per cent were men, 72% had not experienced metastatic spread and 75% reported comorbid conditions. Eighty-one per cent reported experiencing at least one physical concern, 63% experienced at least one emotional concern and 30% experienced at least one practical concern. The most commonly reported concerns were for two physical changes (fatigue 62% and bladder/urinary problems 39%) and one emotional change (anxiety/fear of recurrence 53%). More than 50% did not receive assistance for 15 concerns across the three domains. The most frequently cited reason for not seeking help for a concern was that they were told it was normal and they did not think anything could be done. Unmet needs existed for all physical, emotional and practical changes ranging from 41% to 88% of respondents.ConclusionsMany older adults are at risk for experiencing physical, emotional and practical concerns following cancer treatment yet are not obtaining help. Action is needed for early identification of these individuals to mitigate the impact of unmet needs for older cancer survivors.

Historically, the development of valid and reliable methods for assessing higher-order cognitive abilities (e.g., rule learning and transfer) has been difficult in rodent models. To date, limited evidence supports the existence of higher cognitive abilities such as rule generation and complex decision-making in mice, rats, and rabbits. To this end, we sought to develop a task that would require mice to learn and transfer a rule. We trained mice to visually discriminate a series of images (image set, six total) of increasing complexity following three stages: (1) learn a visual target, (2) learn a rule (ignore any new images around the target), and finally (3) apply this rule in abstract form to a comparable but new image set. To evaluate learning for each stage, we measured (1) days (and performance by day) to discriminate the original target at criterion, (2) days (and performance by day) to get back to criterion when images in the set were altered by the introduction of distractors (rule learning), and (3) overall days (and performance by day) to criterion when experienced versus nai¨ve cohorts of mice were tested on the same image set (rule transfer). Twenty-seven wild-type male C57 mice were tested using Bussey–Saksida touchscreen operant conditioning boxes (Lafayette Instruments). Two comparable black–white image sets were delivered sequentially (counterbalanced for order) to two identical cohorts of mice. Results showed that all mice were able to effectively learn their initial target image and could recall it >80 d later. We also found that mice were able to quickly learn and apply a “rule” : Ignore new distractors and continue to identify their visual target embedded in more complex images. The presence of rule learning was supported because performance criterion thresholds were regained much faster than initial learning when distractors were introduced. On the other hand, mice appeared unable to transfer this rule to a new set of stimuli. This is supported because visual discrimination curves for a new image set were no better than an initial (nai¨ve) learning by a matched cohort of mice. Overall results have important implications for phenotyping research and particularly for the modeling of complex disorders in mice.

Persistent airflow limitation (PAL) occurs in a subset of patients with asthma. Previous studies on PAL in asthma have included relatively small populations, mostly restricted to severe asthma, or have no included longitudinal data. The aim of this post-hoc analysis was to investigate the determinants, clinical implications, and outcome of PAL in patients with asthma who were included in the ATLANTIS study.

BackgroundNatural disasters are associated with increased mental health disorders and suicidal ideation; however, associations with suicide deaths are not well understood. We explored how Hurricane Florence, which made landfall in September 2018, may have impacted suicide deaths in North Carolina (NC).MethodsWe used publicly available NC death records data to estimate associations between Hurricane Florence and monthly suicide death rates using a controlled, interrupted time series analysis. Hurricane exposure was determined by using county-level support designations from the Federal Emergency Management Agency. We examined effect modification by sex, age group, and race/ethnicity.Results8363 suicide deaths occurred between January 2014 and December 2019. The overall suicide death rate in NC between 2014 and 2019 was 15.53 per 100 000 person-years (95% CI 15.20 to 15.87). Post-Hurricane, there was a small, immediate increase in the suicide death rate among exposed counties (0.89/100 000 PY; 95% CI −2.69 to 4.48). Comparing exposed and unexposed counties, there was no sustained post-Hurricane Florence change in suicide death rate trends (0.02/100 000 PY per month; 95% CI −0.33 to 0.38). Relative to 2018, NC experienced a statewide decline in suicides in 2019. An immediate increase in suicide deaths in Hurricane-affected counties versus Hurricane-unaffected counties was observed among women, people under age 65 and non-Hispanic black individuals, but there was no sustained change in the months after Hurricane Florence.ConclusionsAlthough results did not indicate a strong post-Hurricane Florence impact on suicide rates, subgroup analysis suggests differential impacts of Hurricane Florence on several groups, warranting future follow-up.

The human pharmacokinetics, metabolism, and excretion of [14C]-ganaxolone (GNX) were characterized in healthy male subjects (n= 8) following a single 300-mg (150 μCi) oral dose. GNX exhibited a short half-life of 4 hours in plasma, whereas total radioactivity had a half-life of 413 hours indicating extensive metabolism to long-lived metabolites. Identification of the major GNX circulating metabolites required extensive isolation and purification for liquid chromatography-tandem mass spectrometry analysis, together with in vitro studies, NMR spectroscopy, and synthetic chemistry support. This revealed that the major routes of GNX metabolism involved hydroxylation at the 16α-hydroxy position, stereoselective reduction of the 20-ketone to afford the corresponding 20α-hydroxysterol, and sulfation of the 3α-hydroxy group. This latter reaction yielded an unstable tertiary sulfate, which eliminated the elements of H2SO4to introduce a double bond in the A ring. A combination of these pathways, together with oxidation of the 3β-methyl substituent to a carboxylic acid and sulfation at the 20αposition, led to the major circulating metabolites in plasma, termed M2 and M17. These studies, which led to the complete or partial identification of no less than 59 metabolites of GNX, demonstrated the high complexity of the metabolic fate of this drug in humans and demonstrated that the major circulating products in plasma can result from multiple sequential processes that may not be easily replicated in animals or with animal or human in vitro systems.SIGNIFICANCE STATEMENTStudies on the metabolism of [14C]-ganaxolone in humans revealed a complex array of products that circulated in plasma, the two major components of which were formed via an unexpected multi-step pathway. Complete structural characterization of these (disproportionate) human metabolites required extensive in vitro studies, along with contemporary mass spectrometry, NMR spectroscopy, and synthetic chemistry efforts, which served to underscore the limitations of traditional animal studies in predicting major circulating metabolites in man.

Drawing on communication, feminist studies and public relations scholarship, this interdisciplinary paper contributes to feminist perspectives on public relations in order to draw attention to the disciplinary implications of the ongoing exclusion of diverse women’s voices and the ways gendered exclusion is exacerbated by the marginalisation of voices from Global South, Indigenous and settler colonial contexts. Writing from three countries located in the Asia-Pacific region, the authors interrogate the field as feminist public relations scholars and highlight the need for more inclusive practices in academic processes that shape disciplinary knowledge. The paper challenges liberal feminist and postfeminist perspectives, arguing these have significant implications for the production of public relations knowledge. Instead, it argues that feminist public relations scholarship needs to foreground intersectionality and social justice and embrace perspectives and research outside the US and Europe. It calls for greater awareness of the ways power is associated with privilege and determines ‘legitimate’ disciplinary knowledge within public relations in order to challenge structural and institutional inequalities. In advocating for critical, intersectional and transnational feminist public relations, the paper argues for greater reflexivity and vigilance in opening up the field to new and diverse perspectives and improving disciplinary processes.

Obesity remains a leading serious chronic disease and cause of death in the U.S. Despite previous research in diets (i.e., caloric restriction), physical activity levels, and biochemical markers, no studies to date have investigated the combination of an obesity medicine physician with a health coach alongside a commercial program for reducing body weight. As a result, this pilot study aims to assess the relationship between a commercial diet program and health and wellness coaching (HWC) for weight reduction outcomes when delivered in conjunction with an obesity medicine physician chronic disease care model, as a proof-of-concept study.

Cartilage-hair hypoplasia (CHH) is an inherited skeletal dysplasia associated with Hirschsprung Disease and variable immunodeficiency, including severe combined immunodeficiency (SCID).