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In 2024, the average annual premium for employer-sponsored family health coverage was $25,572, an increase of $1,604 (7 percent) from 2023. Over the course of the past five years, the average family premium has increased 24 percent, which is similar to growth seen in inflation (23 percent) and wages (28 percent). On average, covered workers contributed 16 percent ($1,368) of the cost of single coverage and 25 percent ($6,296) of the cost of family coverage. The average general annual deductible for single coverage for workers with a deductible was $1,787, similar to that in recent years but 47 percent higher than a decade ago. In 2024, 18 percent of large firms offering health benefits, including 28 percent of those with 5,000 or more employees, covered GLP-1 antagonists for weight loss. Large employers were more likely to perceive their overall provider networks as broader than their networks for mental health and substance use conditions.

Most membrane fusion reactions in eukaryotic cells are mediated by multisubunit tethering complexes (MTCs) and SNARE proteins. MTCs are much larger than SNAREs and are thought to mediate the initial attachment of two membranes. Complementary SNAREs then form membrane-bridging complexes whose assembly draws the membranes together for fusion. Here we present a cryo-electron microscopy structure of the simplest known MTC, the 255-kDa Dsl1 complex of Saccharomyces cerevisiae, bound to the two SNAREs that anchor it to the endoplasmic reticulum. N-terminal domains of the SNAREs form an integral part of the structure, stabilizing a Dsl1 complex configuration with unexpected similarities to the 850-kDa exocyst MTC. The structure of the SNARE-anchored Dsl1 complex and its comparison with exocyst reveal what are likely to be common principles underlying MTC function. Our structure also implies that tethers and SNAREs can work together as a single integrated machine.

In 2023 the average annual premium for employer-sponsored family health insurance coverage was $23,968—an increase of $1,505 (7 percent) from 2022. Both single and family premiums increased faster in 2023 than in 2022, in a period of generally high inflation throughout the US economy. On average, covered workers contributed 17 percent ($1,401) of the cost of single coverage and 29 percent ($6,575) of the cost of family coverage. When compared to employers’ perceptions of the number of primary care providers in their networks, a smaller share of employers believed that their provider networks had a sufficient number of mental health and substance abuse providers to provide timely access to services. One-quarter of employers indicated that their employees had a “high” level of concern with the level of cost sharing required by their plans. When asked about abortion coverage in the wake of the Supreme Court Dobbsdecision, almost a third of large employers reported that their largest plan covered abortion in most or all circumstances.

Our multicentric prospective interventional study led to the creation of a deep learning classifier accurately predicting visual improvement > 15 ETDRS letters 1 year after epiretinal membrane peeling. Image processing enhanced a significantly higher prevalence of fibrillary changes in preoperative images of patients with <15-letter improvement at 1 year postoperatively.

While scientific consensus about human‐caused climate change has been clear for decades, denial of this science anddenial about the need for timely, responsive action continue in the United States and around the world. The Climate Denial Inquiry Modelcan help educators grapple with the complex components of this denial with critical literacy+ and eco‐civic practices of deliberation, reflexivity, and counter‐narration to help investigate climate denial texts, stories, contexts, and philosophies. This charts a pathway toward ecojustice‐centered stories‐To‐live by.

Background: Maternal undernutrition has been associated with psychiatric and neurological disorders characterized by learning and memory impairment.Objective: Considering the lack of evidence, we aimed to analyze the effects of gestational protein restriction on learning and memory function associated with hippocampal cell numbers and neurodegenerative protein content later in life.Methods: Experiments were conducted in gestational low- (LP, 6% casein) or regular-protein (NP, 17% casein) diet intake offspring. Behavioral tests, isolated hippocampal isotropic fractionator cell studies, immunoblotting, and survival lifetime were observed.Results: The birthweight of LP males is significantly reduced relative to NP male progeny, and hippocampal mass increased in 88-week-old LP compared to age-matched NP offspring. The results showed an increased proximity measure in 87-week-old LP compared to NP offspring. Also, LP rats exhibited anxiety-like behaviors compared to NP rats at 48 and 86-wk of life. The estimated neuron number was unaltered in LP rats; however, non-neuron cell numbers increased compared to NP progeny. Here, we showed unprecedented hippocampal deposition of brain-derived neurotrophic factor, amyloid-ß peptide (Aß), and tau protein in 88-week-old LP relative to age-matched NP offspring.Conclusion: To date, no predicted studies showed changes in hippocampal morphological structure in maternal protein-restricted elderly offspring. The current data suggest that gestational protein restriction may accelerate hippocampal function loss, impacting learning/memory performance, and supposedly developing diseases similar to Alzheimer’s disease (AD) in elderly offspring. Thus, we propose that maternal protein restriction could be an elegant and novel method for constructing an AD-like model in adult male offspring.

Several trials have demonstrated the benefit of the CDK 4/6 inhibitors for postmenopausal women with luminal advanced breast cancer. This research aims to compare the cost-utility of the CDK 4/6 inhibitors in patients with no history of resistance to endocrine therapy.

The objective of this study was to evaluate the cost-utility of the Oxford, CoronaVac, and Janssen COVID-19 vaccines from the perspective of the Brazilian public health system.

IMPORTANCE: Unilateral vocal fold paralysis (UVFP) is a common and life-changing complication of cancer, trauma, and an estimated 500 000 head, neck, and chest surgeries performed annually in the US, among other causes (eg, idiopathic). Consequent disabilities are profound and often permanent and can include severe voice, swallowing, and breathing dysfunction and concomitant anxiety, isolation, and fear. Physiological measures often correlate poorly with patient-reported disability. The measure described herein was designed to be a comprehensive, psychometrically sound UVFP-specific patient-reported outcome measure (PROM) for use in clinical trials or at point of care. OBJECTIVE: To evaluate the reliability and validity of the CoPE (vocal Cord Paralysis Experience) PROM in a nationally representative sample for both clinical and research use. DESIGN, SETTING, AND PARTICIPANTS: This survey validation study was performed at 34 tertiary care centers across the US and included English-speaking adults with unilateral vocal fold immobility confirmed via laryngoscopy. MAIN OUTCOMES AND MEASURES: Reliability (internal consistency, alternate form, and test-retest) and validity (convergent and known-group). RESULTS: In total, 613 patients (mean [SD] age, 58 [15.3] years; 394 [64.5%] women) were recruited, and 555 (92.3%) completed surveys for all time points. Internal consistency was high in the overall 22-item PROM and psychosocial, swallow, and voice subscales (Cronbach α > 0.91). Intraclass correlations for individuals between the baseline and 2-week administrations were moderate for the overall score and subscales (intraclass correlations range, 0.66-0.80). There were significant differences between the online and 2-week paper administrations for the overall score and voice and psychosocial subscales (overall scale mean: 54.4 [95% CI, 49.7-59.1] vs 48.9 [95% CI, 43.7-54.0] at 2 weeks). The confirmatory model was found to be suitably fitted based on average r2 values 0.5 or greater for subscale and overall scores. Correlations between subscales and existing PROMs (Voice-Related Quality of Life, Eating Assessment Tool, and Communication Participation Item Bank) were all greater than 0.69, and mean PROM subscale scores were significantly different across known quartiles of existing PROMs. CONCLUSIONS AND RELEVANCE: The findings of this survey validation study suggest that the CoPE PROM could serve as a psychometrically sound, comprehensive measure of UVFP-attributed disability suitable for use in clinical and research settings to assess within-person changes. The results will inform a user manual to facilitate use in clinical trials comparing the effectiveness and durability of treatments including behavioral (speech therapy), temporary (eg, injection augmentation), and permanent surgical treatments for UVFP.

Oral reading fluency is recognized as an important variable associated with the assessment of reading proficiency. Frequently, fluency assessments distill a child’s overall reading fluency to a single numerical score. Even when multiple dimensions are considered, the processes informing the nuance of the reading fluency variations are ignored. In order to shed light on the issue, we use an instrumental case study approach to illuminate how a reader’s fluency varies within a passage. We describe the insight this variability provides to teachers and researchers interested in understanding how readers transact with print. Specifically, we apply a multiple lens approach to analyze one child’s oral reading fluency and address the question: What variables contribute to a reader’s fluency? We combine eye movement miscue analysis and Flurkey’s oral reading flow and compare these assessments to Rasinski’s well-established fluency instrument. This methodology led to the identification of six variables influencing oral reading fluency. Five of the influential factors could not be observed using the traditional fluency measure. These five variables illuminate the complexity of oral reading fluency and support greater understanding of a reader’s abilities. This strengths-based conceptualization of fluency offers supportive rather than subtractive insight into a reader’s fluctuations in oral reading fluency. Our findings highlight a need for professionals to more adequately consider the conceptualizations of oral reading fluency.

•This feasibility study showed thyroid sparing in head and neck cancer patients.•Thyroid sparing with acceptable target volume coverage was possible with IMRT.•Average mean dose to thyroid was significantly reduced with thyroid optimization.•Thyroid optimized plans had relatively unchanged doses to surrounding OARs.

ABSTRACTSupplementary motor area (SMA) syndrome refers to varying degrees of transient hemiparesis and mutism following insult to the medial posterior frontal lobe. We describe a rare case of an isolated lower limb SMA deficit with associated pre- and post-operative multimodality neurophysiological monitoring data. We review the literature on SMA somatotopy and the prognostic abilities of intraoperative motor evoked potentials in suspected SMA dysfunction. A 45-year-old male underwent staged resection of a complex parasagittal WHO grade II meningioma involving the posterior superior frontal gyrus bilaterally. Intraoperative neurophysiological monitoring with transcranial motor evoked potentials (TCMEP) and direct cortical motor evoked potentials (DCMEP) were used during both stages of resection. The patient developed an isolated left foot drop despite unchanged DCMEP and TCMEP data obtained during the first stage of the procedure. During the second stage of resection 3 days later, repeat neurophysiological monitoring confirmed intact corticospinal tracts. Deep peroneal somatosensory evoked potentials (SSEPs) revealed good morphology, appropriate latency and amplitudes during the second stage of resection. These results suggested a diagnosis of focal SMA dysfunction. Left foot drop persisted 7 days post-operatively. At one month follow up, the patient was neurologically intact with full strength noted in all muscle groups of the left lower extremity. An improved understanding of the somatotopic organization of the SMA with additional neuromonitoring data can allow neurosurgeons to better predict and understand perioperative SMA dysfunctions.

Patients with COPD who experience pulmonary hypertension (PH) have worse mortality than those with COPD alone. Predictors of poor outcomes in COPD-PH are not well-described. Diffusing capacity of the lung (Dlco) assesses the integrity of the alveolar-capillary interface and thus may be a useful prognostic tool among those with COPD-PH.

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Three biomarkers, soluble suppression of tumorigenicity 2 (ST2), galectin 3 (Gal3), and N-terminal brain natriuretic peptide prohormone (NT-proBNP), are approved for noninvasive risk assessment in left-sided heart failure, and small observational studies have shown their prognostic usefulness in heterogeneous pulmonary hypertension cohorts. We examined associations between these biomarkers and disease severity and survival in a large cohort of patients with pulmonary arterial hypertension (PAH) (ie, group 1 pulmonary hypertension). We hypothesized that additive use of biomarkers in combination would improve the prognostic value of survival models.

Literacy educators can guide students to examine the stories we live by, or the larger narratives that guide individual and collective sensemaking about relationships between humans and the environment. Drawing from the field of ecolinguistics, the authors consider two ecologically destructive stories we live by: Humans are the center of existence, and consumerism is a main pathway to happiness and fulfillment. The authors also explore three intersecting beneficial stories we live by that center on indigenous perspectives, feminist foundations of climate justice, and youth activism. This work is rooted in three essential understandings about climate change: It is a complex socioscientific topic and escalating problem, engaging with climate change is mediated primarily by a complicated array of motivated digital texts and motivated readers, and climate change is about climate (in)justice. The authors conclude with ideas about being a climate justice literacy educator.

PurposeThe purpose of this clinical focus article is to present an overview of the Life Participation Approach to Aphasia as it relates to issues in long-term care (LTC) and provide practical recommendations for implementing the approach in this setting. The Framework for Living With Aphasia is used as a guide to (a) highlight specific challenges to life participation for residents with aphasia in LTC and (b) propose clinical tools that might help clinicians move through the therapeutic process when implementing the Life Participation Approach to Aphasia.RecommendationsClinicians in LTC facilities have the responsibility of delivering services that have a positive impact on communication, social relationships, emotional health, and quality of life. Clinical tools and approaches most appropriate for LTC settings are identified that help to address these goals. Approaches are discussed across several stages representing the therapeutic process, which is ultimately aimed at moving a resident toward recovery and increased independence. Case demonstrations are provided to illustrate approaches.