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BACKGROUND: The natural history of primary sclerosing cholangitis (PSC) among African Americans (AA) is not well understood. METHODS: Transplant-free survival and hepatic decompensation-free survival were assessed using a retrospective research registry from 16 centers throughout North America. Patients with PSC alive without liver transplantation after 2008 were included. Diagnostic delay was defined from the first abnormal liver test to the first abnormal cholangiogram/liver biopsy. Socioeconomic status was imputed by the Zip code. RESULTS: Among 850 patients, 661 (77.8%) were non-Hispanic Whites (NHWs), and 85 (10.0%) were AA. There were no significant differences by race in age at diagnosis, sex, or PSC type. Inflammatory bowel disease was more common in NHWs (75.8% vs. 51.8% p=0.0001). The baseline (median, IQR) Amsterdam-Oxford Model score was lower in NHWs (14.3, 13.4-15.2 vs. 15.1, 14.1-15.7, p=0.002), but Mayo risk score (0.03, -0.8 to 1.1 vs. 0.02, -0.7 to 1.0, p=0.83), Model for End-stage Liver Disease (5.9, 2.8-10.7 vs. 6.4, 2.6-10.4, p=0.95), and cirrhosis (27.4% vs. 27.1%, p=0.95) did not differ. Race was not associated with hepatic decompensation, and after adjusting for clinical variables, neither race nor socioeconomic status was associated with transplant-free survival. Variables independently associated with death/liver transplant (HR, 95% CI) included age at diagnosis (1.04, 1.02-1.06, p

PURPOSE: The murine oxygen-induced retinopathy (OIR) model is one of the most widely used animal models of ischemic retinopathy, mimicking hallmark pathophysiology of initial vaso-obliteration (VO) resulting in ischemia that drives neovascularization (NV). In addition to NV and VO, human ischemic retinopathies, including retinopathy of prematurity (ROP), are characterized by increased vascular tortuosity. Vascular tortuosity is an indicator of disease severity, need to treat, and treatment response in ROP. Current literature investigating novel therapeutics in the OIR model often report their effects on NV and VO, and measurements of vascular tortuosity are less commonly performed. No standardized quantification of vascular tortuosity exists to date despite this metrics relevance to human disease. This proof-of-concept study aimed to apply a previously published semi-automated computer-based image analysis approach (iROP-Assist) to develop a new tool to quantify vascular tortuosity in mouse models. DESIGN: Experimental study. SUBJECTS: C57BL/6J mice subjected to the OIR model. METHODS: In a pilot study, vasculature was manually segmented on flat-mount images of OIR and normoxic (NOX) mice retinas and segmentations were analyzed with iROP-Assist to quantify vascular tortuosity metrics. In a large cohort of age-matched (postnatal day 12 [P12], P17, P25) NOX and OIR mice retinas, NV, VO, and vascular tortuosity were quantified and compared. In a third experiment, vascular tortuosity in OIR mice retinas was quantified on P17 following intravitreal injection with anti-VEGF (aflibercept) or Immunoglobulin G isotype control on P12. MAIN OUTCOME MEASURES: Vascular tortuosity. RESULTS: Cumulative tortuosity index was the best metric produced by iROP-Assist for discriminating between OIR mice and NOX controls. Increased vascular tortuosity correlated with disease activity in OIR. Treatment of OIR mice with aflibercept rescued vascular tortuosity. CONCLUSIONS: Vascular tortuosity is a quantifiable feature of the OIR model that correlates with disease severity and may be quickly and accurately quantified using the iROP-Assist algorithm. FINANCIAL DISCLOSURES: Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Transition to circular economy for lithium-ion batteries used in electric vehicles requires integrating multiple stages of the value cycle. However, strategies aimed at extending the lifetime of batteries are not yet sufficiently considered within the European battery industry, particularly regarding repurposing. Using second-life lithium-ion batteries (SLBs) before subsequent recycling can offer several advantages, such as the development of sustainable business models, the reduction of emissions, and alignment with UN Sustainable Development Goals 7, 12, and 13. Using expert and problem-centred interviews along with an exploratory workshop, this study guides stakeholders in the battery sector by illustrating the necessary changes for a more holistic circular economy. Moreover, an extended political, economic, social, technological, environmental, legal, and additionally safety-related (PESSTEL) analysis approach is carried out, which has not yet been used in this context. In this process, barriers, as well as necessary institutional framework conditions and organisational requirements for a successful market entry of SLB applications are investigated. Among others, key barriers relate to the competition with first-life applications and safety concerns. SLBs require high manual labour costs for repurposing, along with expenses for expired warranties and re-certifications. Ownership structures in traditional business models often result in SLBs and their corresponding usage data staying under the control of the manufacturers. Market viability, however, requires a level playing field for both first-life and second-life operators as well as circular battery and data-sharing business models. Gathering data on the ageing performance and performing improved safety testing according to test protocols facilitates the reliable assessment of SLBs.

To inform culturally relevant HIV prevention interventions, we explore the complexity of sex work among Peruvian transgender women. In 2015, we conducted twenty in-depth interviews and demographic surveys with transgender women in Lima, Peru to examine how transgender women enact individual- and community-level resistance strategies within a context of pervasive marginalization. Although 40% self-identified as "sex workers," 70% recently exchanged sex for money. Participants described nuanced risk-benefit analyses surrounding paid sexual encounters. Classification of clients as "risky" or "rewarding" incorporated issues of health, violence, and pleasure. Interviews highlighted context-informed decision-making (rejecting disrespectful clients, asserting condom use with specific partner types) demonstrating that motivations were not limited to HIV prevention or economic renumeration, but considered safety, health, attraction, gender validation, hygiene, and convenience. These findings underscore the complex risk assessments employed by Peruvian trans women. These individual-level decision-making and context-specific health promotion strategies represent critical frameworks for HIV prevention efforts.

Background. SHELTER is a trial of transplanting lungs from deceased donors with hepatitis C virus (HCV) infection into HCV-negative candidates (sponsor: Merck; NCT03724149). Few trials have reported outcomes using thoracic organs from HCV-RNA+ donors and none have reported quality of life (QOL). Methods. This study is a single-arm trial of 10 lung transplants at a single center. Patients were included who were between 18 and 67 y of age and waitlisted for lung-only transplant. Patients were excluded who had evidence of liver disease. Primary outcome was HCV cure (sustained virologic response 12 wk after completing antiviral therapy). Recipients longitudinally reported QOL using the validated RAND-36 instrument. We also applied advanced methods to match HCV-RNA+ lung recipients to HCV-negative lung recipients in a 1:3 ratio at the same center. Results. Between November 2018 and November 2020, 18 patients were consented and opted-in for HCV-RNA+ lung offers in the allocation system. After a median of 37 d (interquartile range [IQR], 6–373) from opt-in, 10 participants received double lung transplants. The median recipient age was 57 y (IQR, 44–67), and 7 recipients (70%) had chronic obstructive pulmonary disease. The median lung allocation score at transplant was 34.3 (IQR, 32.7–86.9). Posttransplant, 5 recipients developed primary graft dysfunction grade 3 on day 2 or 3, although none required extracorporeal membrane oxygenation. Nine patients received elbasvir/grazoprevir, whereas 1 patient received sofosbuvir/velpatasvir. All 10 patients were cured of HCV and survived to 1 y (versus 83% 1-y survival among matched comparators). No serious adverse events were found to be related to HCV or treatment. RAND-36 scores showed substantial improvement in physical QOL and some improvement in mental QOL. We also examined forced expiratory volume in 1 s—the most important lung function parameter after transplantation. We detected no clinically important differences in forced expiratory volume in 1 s between the HCV-RNA+ lung recipients versus matched comparators. Conclusions. SHELTER adds important evidence regarding the safety of transplanting HCV-RNA+ lungs into uninfected recipients and suggests QOL benefits.

With the rise of electric vehicles (EVs) and thus lithium‐ion batteries (LIBs), the number of end‐of‐life (EoL) LIBs after their first life in EVs is about to increase significantly. These end‐of‐first‐life (EoFL) EV LIBs still have sufficient energy density for less‐demanding second‐life applications like stationary battery energy storage systems (BESSs) or mobile applications (e.g., forklifts, tools). Repurposing EoFL EV LIBs extends their lifespan, offering sustainability benefits and supporting several United Nations (UN) Sustainable Development Goals (SDGs). However, prevailing market entry barriers, such as high repurposing costs, little information on battery history and aging, or lacking performance indicators, hinder the widespread implementation of second‐life applications. Thus, this study aims to identify preconditions for considering and selecting useful EoFL LIBs and to determine key performance indicators (KPIs) to minimize economic risks for a successful second‐life market launch. KPIs were rated according to importance using a Likert scale, and reference values were introduced. A mixed‐methods approach, using expert interviews, an exploratory workshop, and an online survey, was applied. Twelve important preconditions were identified, with the "availability of information on battery specification" and "compliance with standards and regulations" considered very important. In addition, 12 KPIs were derived, covering six economic, three environmental, and three technical and safety‐related indicators. The KPIs "state of safety (SoS)" and "resource savings (Rsav)" were rated as highly important. Overall, the findings provide performance measurement guidance for repurposing companies, facilitating the market launch and adoption of second‐life applications. Future research can build on these results and investigate variations among different battery types, ultimately promoting a circular economy. [ABSTRACT FROM AUTHOR]

The lanthanide metal gadolinium has been used in the healthcare industry as a paramagnetic contrast agent for years. Gadolinium deposition in brain tissue and kidneys has been reported following gadolinium-based contrast agent administration to patients undergoing MRI. This study demonstrates the detrimental effects of gadolinium exposure at the level of the cell membrane. Biophysical analysis using fluorescence spectroscopy and dynamic light scattering illustrates differential interactions of gadolinium ions with key classes of brain membrane lipids, including phosphatidylcholines and sphingomyelins, as well as brain polar extracts and biomimetic brain model membranes. Electrostatic attraction to negatively charged lipids like phosphatidylserine facilitates metal complexation but zwitterionic phosphatidylcholine and sphingomyelin interaction was also significant, leading to membrane rigidification and increases in liposome size. Effects were stronger for fully saturated over monounsaturated acyl chains. The metal targets key lipid classes of brain membranes and these biophysical changes could be very detrimental in biological membranes, suggesting that the potential negative impact of gadolinium contrast agents will require more scientific attention.

The application of nature-based solutions for climate change adaptation in cities has increased in recent years. To improve microclimatic conditions and to preserve the natural components of related assets, water supply is necessary. As an alternative to drinking water, stream water might serve as a natural source for irrigation. However, due to continuous urbanisation, water courses have often been banned underground in pipes or integrated in the combined sewer network, both making them not directly available for further usage. This article focuses on the perspectives of decoupling captured streams from underground infrastructure to support nature-based urban climate adaptation measures. It introduces a method to identify suitable locations for practical implementation considering the hydrological potential of the stream and the urban microclimatic sensitivity of the concerned area. The approach was applied in a case study in the north-western part of Vienna, including 16 streams with a total length of about 39 km covering an area of approximately 95 km2 with about half a million inhabitants. This work proved the general practicality of the suggested method. It also revealed that about one-third of the investigated stream lengths appears high or medium suitable to support climate adaption measures, leading to notable cost savings for irrigation (for the substitution of drinking water) and wastewater treatment. Concluding, the decoupling of captured streams could contribute to a more sustainable and nature-based urban water management. The introduced method for suitability pre-assessment is applicable with rather easily available input data, which makes it transferable to other cities. HIGHLIGHTS In-sewer captured stream water provides a possible water source for nature-based urban climate adaptation measures.; The proposed method supports the evaluation of hydrological potential and urban microclimatic sensitivity.; The application on the case study of Vienna reveals promising results.; Results of the pre-assessment method act as a strategic guidance and decision support for practical implementation.;