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Adenomas per colonoscopy (APC) may be a better measure of colonoscopy quality than adenoma detection rate (ADR) because it credits endoscopists for each detected adenoma. There are few data examining the association between APC and postcolonoscopy colorectal cancer (PCCRC) incidence. We used data from the New Hampshire Colonoscopy Registry to examine APC and PCCRC risk. We included New Hampshire Colonoscopy Registry patients with an index examination and at least 1 follow-up event, either a colonoscopy or a colorectal cancer (CRC) diagnosis. Our outcome was PCCRC defined as any CRC diagnosed ≥6 months after an index examination. The exposure variable was endoscopist-specific APC quintiles of.25,.40,.50, and.70. Cox regression was used to model the hazard of PCCRC on APC, controlled for age, sex, year of index examination, index findings, bowel preparation, and having more than 1 surveillance examination. In 32,535 patients, a lower hazard for PCCRC (n = 178) was observed for higher APCs as compared to APCs of <.25 (reference):.25 to <.40: hazard ratio (HR),.35; 95% confidence interval (CI),.22-.56;.40 to <.50: HR,.31; 95% CI,.20-.49;.50 to <.70: HR,.20; 95% CI,.11-.36; and ≥.70: HR,.19; 95% CI,.09-.37. When examining endoscopists with an ADR of at least 25%, an APC of <.50 was associated with a significantly higher hazard than an APC of ≥.50 (HR, 1.65; 95% CI, 1.06-2.56). A large proportion of endoscopists—one-fifth (32 of 152; 21.1%)—had an ADR of ≥25% but an APC of <.50. Our novel data demonstrating lower PCCRC risk in examinations performed by endoscopists with higher APCs suggest that APC could be a useful quality measure. Quality improvement programs may identify important deficiencies in endoscopist detection performance by measuring APC for endoscopists with an ADR of ≥25%. [Display omitted] [ABSTRACT FROM AUTHOR]

Whānau Pakari is a family-centred healthy lifestyle programme for children/adolescents with overweight/obesity in New Zealand. This secondary analysis from our randomised trial within the clinical service assessed 5-year BMI changes in accompanying caregivers (n = 23), mostly mothers. Overall, baseline and 5-year caregivers' BMI were similar (32.50 vs 31.42 kg/m2, respectively; p = 0.31) but two-thirds (65%) experienced BMI reductions. Five-year BMI change was similar in High-intensity and Low-intensity randomisation groups [–1.37 kg/m2 (–4.95, 2.21); p = 0.44]. Caregiver's BMI change was not associated with child's BMI change. Despite no overall BMI reduction, our findings contrast with upward BMI trajectories predicted for NZ adults with overweight/obesity. [ABSTRACT FROM AUTHOR]

Inhibitory control is a fundamental mechanism for adaptive behavior and cognition that features in theories across psychology and cognitive science. Although inhibitory control is thought to regulate processes ranging from actions to memories, most neuroscientific work studies these domains of inhibition separately. Recent crossdomain comparisons have converged on the view that inhibitory control arises from common, domain-general neural mechanisms. We propose that an input inhibition mechanism, acting via fronto-subthalamic inhibitory pathways may contribute to domain-general inhibitory control by suppressing thalamic drive of cortical activity. We argue that β-band activity in local circuits constitutes a potential domain-general signature of inhibitory control. Inhibitory control is a fundamental mechanism underlying flexible behavior and features in theories across many areas of cognitive and psychological science. However, whereas many theories implicitly or explicitly assume that inhibitory control is a domain-general process, the vast majority of neuroscientific work has hitherto focused on individual domains, such as motor, mnemonic, or attentional inhibition. Here, we attempt to close this gap by highlighting recent work that demonstrates shared neuroanatomical and neurophysiological signatures of inhibitory control across domains. We propose that the regulation of thalamocortical drive by a fronto-subthalamic mechanism operating in the β band might be a domain-general mechanism for inhibitory control in the human brain. Inhibitory control is a fundamental mechanism underlying flexible behavior and features in theories across many areas of cognitive and psychological science. However, whereas many theories implicitly or explicitly assume that inhibitory control is a domain-general process, the vast majority of neuroscientific work has hitherto focused on individual domains, such as motor, mnemonic, or attentional inhibition. Here, we attempt to close this gap between by highlighting recent work that demonstrates shared neuroanatomical and neurophysiological signatures of inhibitory control across domains. We propose that the regulation of thalamocortical drive by a fronto-subthalamic mechanism operating in the β band might be a domain-general mechanism for inhibitory control in the human brain. [ABSTRACT FROM AUTHOR]

Vaccinations for seasonal influenza and pertussis have been recommended for pregnant women in England since 2010 and 2012, respectively. Uptake rates are suboptimal with large regional variations. To improve uptake, from 2016 onwards maternity trusts were commissioned to offer pertussis (and other) vaccinations in addition to these being available in primary care. Since 2021, Covid-19 vaccination has also been recommended for pregnant women. Overall maternal vaccination rates are routinely available, but not the relative provision by maternity trusts. We aimed to describe the national picture of maternity trust provision of maternal vaccinations, including how the maternity trust vaccination programme has progressed. Cross-sectional survey plus comparisons with 2017–18 figures for maternity trust provision of pertussis vaccination, and with UKHSA data for total pertussis vaccination. Twelve NHS commissioners participated (from 13/06/22 to 31/03/23) providing data for 120 (of a total 124) maternity trusts across England. All 120 (100%) trusts were commissioned to deliver influenza, and 107 (89%) to deliver pertussis vaccinations, though not all actually administered the vaccines; 29% offered Covid-19 vaccinations. For 2021–22 we found a mean of 25% (range 0–81.3%) women were vaccinated for pertussis (a large increase compared with previous estimates for 2017–18); and 11% (range 0–74.2%) for influenza, via their maternity trust. Commissioners reported a negative impact of the pandemic on routine vaccination provision. There was indication of efficiency by vaccinating women attending for other appointments. There are diverse mechanisms for reporting pertussis and influenza vaccinations administered at maternity trusts back to primary care, which may be inefficient for maternity staff workload and accuracy of data transfer (especially for pertussis). A high proportion of maternity trusts provide both pertussis and influenza vaccinations, despite a negative impact of the pandemic. Reasons for large between-trust variation in vaccination rates should be explored to improve uptake and equity. [ABSTRACT FROM AUTHOR]

To evaluate the efficacy and safety of molnupiravir for intra-household post-exposure prophylaxis (PEP) of COVID-19. MOVe-AHEAD was a randomized, controlled, double-blind, phase 3 trial comparing molnupiravir (800 mg twice daily for 5 days) with placebo. Eligible participants were adult, unvaccinated, asymptomatic household contacts of patients with laboratory-confirmed COVID-19. The primary efficacy endpoint was the incidence of COVID-19 through day 14 in modified intention-to-treat (MITT) participants (those who received ≥1 dose of study intervention) without detectable SARS-CoV-2 at baseline, termed the MITT-VN population. Superiority of molnupiravir was prespecified as a stratified one-sided p-value of <0.0249 for the treatment difference in this endpoint. The MITT population comprised 763 participants randomized to molnupiravir and 764 to placebo; 83.6% had anti-SARS-CoV-2 antibodies at baseline. In the MITT-VN population, COVID-19 rates through day 14 were 6.5% with molnupiravir and 8.5% with placebo (one-sided p-value: 0.0848). In the molnupiravir arm, 25/35 of confirmed COVID-19 events (71.4%) occurred after completion of treatment (versus 17/49 [34.7%] for placebo). Adverse event rates were low and similar between molnupiravir and placebo. Molnupiravir was well-tolerated but did not meet the prespecified superiority criterion, possibly influenced in part by the high pre-existing immunity in the trial population. [Display omitted] • Phase 3 trial evaluating molnupiravir for post-exposure prophylaxis of COVID-19. • About 84% of the trial population had anti-SARS-CoV-2 antibodies at baseline. • Day 14 COVID-19 rates (molnupiravir 6.5%, placebo 8.5%) were similar between arms. • Onset of COVID-19 was mostly after the end of therapy in the molnupiravir arm. • Molnupiravir was well tolerated but did not meet the superiority criterion. [ABSTRACT FROM AUTHOR]