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Understanding the brain's mechanisms in individuals with obesity is important for managing body weight. Prior neuroimaging studies extensively investigated alterations in brain structure and function related to body mass index (BMI). However, how the network communication among the large‐scale brain networks differs across BMI is underinvestigated. This study used diffusion magnetic resonance imaging of 290 young adults to identify links between BMI and brain network mechanisms. Navigation efficiency, a measure of network routing, was calculated from the structural connectivity computed using diffusion tractography. The sensory and frontoparietal networks indicated positive associations between navigation efficiency and BMI. The neurotransmitter association analysis identified that serotonergic and dopaminergic receptors, as well as opioid and norepinephrine systems, were related to BMI‐related alterations in navigation efficiency. The transcriptomic analysis found that genes associated with network routing across BMI overlapped with genes enriched in excitatory and inhibitory neurons, specifically, gene enrichments related to synaptic transmission and neuron projection. Our findings suggest a valuable insight into understanding BMI‐related alterations in brain network routing mechanisms and the potential underlying cellular biology, which might be used as a foundation for BMI‐based weight management. [ABSTRACT FROM AUTHOR]

Background: There is a lack of evidence on the importance of pain or other aspects of clinical care in the overall patient experience and patient-centered outcomes in cesarean delivery. The purpose of this study was to discover patient priorities in cesarean delivery anesthesia experience, to compare patient and provider perspectives, and to explore attitudes on shared decision-making around anesthesia choices for cesarean delivery., Methods: Patients with recent cesarean deliveries and clinical care providers were approached using a purposeful sampling strategy for this prospective observational qualitative study. Patients were included if they were in the hospital within 72 hours of a cesarean delivery (scheduled or unscheduled), spoke English fluently, and had term gestation. Providers were included if they currently provide regular clinical care to patients having cesarean deliveries and have at least 3 years of practice experience. Semi-structured interviews were conducted using an interview guide. Interview transcripts were independently coded by three coders and qualitatively analyzed for major themes until thematic saturation was achieved., Results: A total of 42 participants (20 patients and 22 providers) completed interviews. Five major themes emerged reflecting patient attitudes and beliefs toward cesarean delivery experience: 1) effective communication, education, and respect; 2) emotional support by care team; 3) intraoperative pain or discomfort; 4) varying acceptability around pain therapies; 5) stigma surrounding cesarean delivery. Five major themes emerged reflecting provider attitudes and beliefs toward cesarean delivery priorities: 1) complexity of pain responses; 2) multiple pain control strategies; 3) effective communication during emergency cesarean delivery; 4) patient psychological well-being during cesarean delivery; 5) barriers to observing the patients' birth plans., Conclusions: Patients and providers alike prioritize pain management, psychological well-being, and effective communication during cesarean delivery experiences. Patients emphasize relationships and trust in their cesarean experience, while clinicians emphasize clinical complexities and physical treatments. Our results guide future research in patient perspectives in cesarean deliveries., Competing Interests: Competing interests: Dr Lim receives salary and research support from NIH UH3CA261067, NIH R01MH134538, and PCORI. Dr Lim receives research support, consulting honoraria, and chairs or is member of advisory board from industry: Octapharma, Heron Pharmaceuticals, Edwards Lifesciences, Haemonetics all not related to this publication. Dr Lim receives stipends for medical expert testimony not related to this publication. Dr Lim receives royalties from Cambridge University Press for a textbook. Dr Lim is a past member of the SOAP board of directors, consultant reviewer for ACOG, and ASA liaison to the ACOG Alliance for Innovation on Maternal Health’s (AIM) Clinical and Community Advisory Group. All other authors declare no disclosures.