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People with lower levels of social connection are at increased risk for suicidal thoughts and behaviors. This extends to populations at greater risk of death by suicide, including U.S. military veterans. Despite this well-established association, it is unclear which measures of social connection are most useful in identifying veterans who could benefit from intervention to prevent suicide. To this end, we used data from the Million Veteran Program (MVP) to investigate the measures of social connection most strongly associated with suicidal thoughts and behaviors. Our sample included 264,626 veterans who reported on three measures of social connection-marital status, household size, and perceived social support-and were assessed for suicidal thoughts and behaviors using electronic health records. Veterans who were partnered (OR = 0.78, 95% CI [0.76-0.80], p < .001), living with others (OR = 0.71, 95% CI [0.70-0.73], p < .001), or reported higher levels of social support (OR = 0.67, 95% CI [0.65-0.69], p < .001), were less likely to have suicidal thoughts and behaviors. These associations varied by veterans' age, sex, and era of military service. When combined into a single risk score, lower levels of social connection were associated with greater likelihood of suicidal thoughts and behaviors (β = 1.42, 95% CI [1.40-1.43], p < .001). Social support, particularly positive social interactions, showed the strongest associations with suicidal thoughts and behaviors in elastic net regression models. Common measures of social connection, particularly social support, could be useful in assessing suicide risk and treatment needs for veterans., Competing Interests: Declaration of competing interest The authors have no outside interests to declare., (Published by Elsevier Ltd.)

Background: Human herpesvirus 8 (HHV-8) is a critical causative agent behind Kaposi sarcoma (KS), an oncogenic disease with profound consequences in immunocompromised individuals. Studies suggested HHV-8 seroprevalence in healthy populations is uncommon, but comprehensive investigations within the Middle East region remain scarce. This study aimed to bridge this knowledge gap by meticulously assessing HHV-8 seroprevalence among healthy blood donors in Qatar, leveraging serological methodologies and PCR., Methods: We used sera samples collected from 621 healthy blood donors (median age = 36 years, IQR 30-43) from different nationalities residing in Qatar, mainly from the MENA region and Southeast Asia. All sera samples were tested for total anti-HHV-8 IgG antibodies using ELISA. The presence of lytic HHV-8 antibodies was confirmed by an immunofluorescence assay (IFA). Further, HHV-8 DNA was tested and quantitated by qRT-PCR., Results: ELISA detected anti-HHV-8 IgG total antibodies in 6.9 % [43/621, 95 %CI 5.2-9.2] of the tested samples. Subsequent testing by IFA revealed that 14 % [6/43, 95 %CI 3.6-24.3] of these anti-HHV-8 IgG were classified as HHV-8 lytic antibodies. This suggests that 0.97 % [6/621, 95 %CI 0.2-1.7] of these donors had a recent or ongoing active infection and viral replication. Only one seronegative Qatari blood donor had detectable HHV-8 DNA in his blood. No significant difference was observed between HHV-8 seropositivity and the demographic characteristics of the donors., Conclusion: Our study showed that HHV-8 prevalence in Qatar aligns closely with global reports. Moreover, our findings raise considerations regarding HHV-8's potential transmission via transfusion, which suggests the value of routine HHV-8 screening, particularly for immunocompromised patients vulnerable to KS., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

The major focus of neonatal research for many years has been the smallest and most vulnerable infants born before 32 weeks of gestation. More recently it has become clear that a gradient of risk for adverse outcomes spans the whole spectrum of gestational age, from those born at the margins of viability, to those born close to their estimated date of delivery. Whilst effect sizes may be smaller for the more mature babies born late preterm and early term, the size of the problem is related to very large numbers with less severe difficulties, yet whose problems affect many domains of health, development and education, and may have impact across the whole life course. Our knowledge of the mechanisms and influencing factors contributing to outcomes of individuals born late preterm and early term is inadequate. The unique challenges associated with managing pregnancies, babies, children, adults and families affected by late preterm or early term birth in the face of limited evidence mandate further research to guide practice and optimise short- and long-term outcomes., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Purpose: Gastric cancer (GC) incidence rates show notable differences by racial/ethnic groups in the US. We sought to determine whether stratification by race/ethnicity would reveal unique risk factors for development of non-cardia gastric cancer (NCGC) for US population., Methods: Analysis included 1,112 incident cases of NCGC and 190,883 controls from the Multiethnic Cohort Study, a prospective US cohort study that recruited individuals living in Hawaii and California, aged 45-75 years from 5 races/ethnicities. Descriptive analysis and Cox regression models examined the association of risk factors for GC and calculate hazard ratios for each race/ethnicity, adjusting for sociodemographic and dietary variables., Results: Increasing age and male sex were risk factors for NCGC for most race/ethnicities. Higher risk was associated with: GC family history for Latino and Japanese American individuals [HRs range from 1.75 to 1.98]; foreign-born for Japanese American individuals [HR: 1.52, 95% CI 1.11-2.09]; lower education for African American, Japanese American, and Native Hawaiian individuals [HRs range from 1.30 to 1.74]; daily alcohol consumption for African American individuals[HR: 1.56, 95% CI 1.04-2.35]; current smoking for Latino and Japanese American individuals [HRs range from 1.89 to 1.94]; sodium consumption in the highest quartile for White individuals [HR: 2.55, 95% CI 1.23-5.26] compared to the lowest quartile; fruit consumption in the 2nd, 3rd, and 4th highest quartile for Native Hawaiian individuals [HRs range from 2.19 to 2.60] compared to the lowest quartile; diabetes for African American individuals [HR: 1.79, 95% CI 1.21-2.64]; and gastric/duodenal ulcers for Native Hawaiian individuals [HR: 1.82, 95% CI 1.04-3.18]., Conclusion: Analyses by racial/ethnic group revealed differing risk factors for NCGC. Increased knowledge of the varying pathways to GC can support personalized GC prevention strategies and risk stratification tools for early detection., (© 2024. The Author(s).)

Aims: At the basis of many important research questions is causality - does X causally impact Y? For behavioural and psychiatric traits, answering such questions can be particularly challenging, as they are highly complex and multifactorial. 'Triangulation' refers to prospectively choosing, conducting and integrating several methods to investigate a specific causal question. If different methods, with different sources of bias, all indicate a causal effect, the finding is much less likely to be spurious. While triangulation can be a powerful approach, its interpretation differs across (sub)fields and there are no formal guidelines. Here, we aim to provide clarity and guidance around the process of triangulation for behavioural and psychiatric epidemiology, so that results of existing triangulation studies can be better interpreted, and new triangulation studies better designed., Methods: We first introduce the concept of triangulation and how it is applied in epidemiological investigations of behavioural and psychiatric traits. Next, we put forth a systematic step-by-step guide, that can be used to design a triangulation study (accompanied by a worked example). Finally, we provide important general recommendations for future studies., Results: While the literature contains varying interpretations, triangulation generally refers to an investigation that assesses the robustness of a potential causal finding by explicitly combining different approaches. This may include multiple types of statistical methods, the same method applied in multiple samples, or multiple different measurements of the variable(s) of interest. In behavioural and psychiatric epidemiology, triangulation commonly includes prospective cohort studies, natural experiments and/or genetically informative designs (including the increasingly popular method of Mendelian randomization). The guide that we propose aids the planning and interpreting of triangulation by prompting crucial considerations. Broadly, its steps are as follows: determine your causal question, draw a directed acyclic graph, identify available resources and samples, identify suitable methodological approaches, further specify the causal question for each method, explicate the effects of potential biases and, pre-specify expected results. We illustrated the guide's use by considering the question: 'Does maternal tobacco smoking during pregnancy cause offspring depression?'., Conclusions: In the current era of big data, and with increasing (public) availability of large-scale datasets, triangulation will become increasingly relevant in identifying robust risk factors for adverse mental health outcomes. Our hope is that this review and guide will provide clarity and direction, as well as stimulate more researchers to apply triangulation to causal questions around behavioural and psychiatric traits.

Endurance events are popular worldwide and have many health benefits. However, runners and Para athletes may sustain musculoskeletal injuries or experience other health consequences from endurance events. The American Medical Society for Sports Medicine (AMSSM) Runner Health Consortium aimed to generate consensus-based survey items for use in prospective research to identify risk factors for injuries in runners and Para athletes training and competing in endurance events. The study design employed a modified Delphi approach, with a panel comprising 28 experts, including healthcare professionals, coaches, and athletes. Potential survey items were generated by panel members who subsequently engaged in three rounds of voting using Research Electronic Data Capture. Items were graded by clarity, relevance, and importance. Items achieving 80% consensus on all three aspects were retained. The response rate was 100% in R round 1 and 96% in Rrounds 2 and 3. Of 124 initial survey items, consensus was reached on 53, 34 and 22 items during Rrounds 1, 2, and 3, respectively. Two accepted items were removed due to redundancy. Combined with 10 non-voting items, 117 items covered key domains, including training and injury history, dietary behaviours and associated factors (such as menstrual function), footwear, mental health, and specific considerations for Para athletes. The consensus-based survey items should be considered by researchers to better understand the health of runners and Para athletes who train and compete in endurance sports to identify risk factors for injury., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Clustering of traditional and kidney-specific risk factors leads to elevated cardiovascular disease (CVD) risk across the trajectory of chronic kidney disease (CKD) and transplantation. As kidney function declines, the prevalence of CVD, cardiovascular events, and mortality increases. This review considers recent evidence for the association between physical activity (PA) and exercise and cardiorenal health, and the effectiveness of interventions for the prevention and management of cardiorenal decline across the CKD spectrum. Evidence supports a beneficial dose-response effect of PA in the prevention of incident CKD, and growing evidence in prevalent CKD patients for the attenuation of kidney function decline, and a reduction in CVD risk, morbidity, and mortality. Broadly speaking, across the trajectory of CKD, the literature supports the efficacy of exercise interventions for improving cardiorespiratory fitness and aspects of cardiorenal health. The mechanisms underlying improvements indicate differential effects on traditional and non-traditional risk factors for CKD progression and CVD. To date, there is limited transfer of these findings into clinical care, although the evaluation of available evidence has led to the development of the first detailed clinical practice guideline for exercise and lifestyle in CKD. There is a lack of large-scale multi-centre randomised controlled trials, and trials exploring hard clinical outcomes and long-term effects of exercise on cardiorenal outcomes. However, research should also address the challenges of implementing programmes of exercise and PA as part of routine care in combination with addressing the shortfall in literature to improve cardiorenal outcomes in all patients with CKD., (© The Author(s) 2024. Published by Oxford University Press on behalf of the ERA.)

Malnutrition is the most common acquired cause of immunodeficiency worldwide. Nutritional deficiencies can blunt both the innate and adaptive immune response to pathogens. Furthermore, malnutrition is both a cause and consequence of infectious diseases. The bidirectional relationship between infectious diseases and undernutrition, as well as the inflammatory milieu of infectious diseases, can complicate nutritional assessment. This article aims to provide clinicians and researchers with an overview of commonly used tools to assess nutritional status, with a particular emphasis on their use in the context of infectious diseases. This includes anthropometric, biochemical, clinical/physical, and dietary assessments to screen and evaluate undernutrition, diet quality, and food insecurity effectively., (© The Author(s) 2024. Published by Oxford University Press on behalf of Infectious Diseases Society of America. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)

Background: The policy landscape around substance use has changed dramatically in the past decade, which may have affected the number and characteristics of treatment episodes for substance use disorder (SUD). In this study, we examine changes in the volume of SUD treatment referrals from the legal system and compare changes in the composition of substances used by referral source. We used publicly available discharge data on specialty SUD treatment episodes in the U.S. from 2015-2019 and included episodes involving adults that are discharged from specialty SUD treatment facilities during the study. We calculated descriptive statistics of specialty SUD treatment discharges in each year and aggregated across all years by referral source and substance(s) reported upon admission. To test differences by year and referral source, we conducted z-tests of proportions., Results: The proportion of referrals to specialty SUD treatment from the legal system declined between 2015 and 2019 (p < 0.001). However, referrals from probation/parole and diversionary programs grew over time (p < 0.001) in number and proportion over time. Legal referrals were most often associated with alcohol or cannabis use, though referrals for these substances declined from 2015-2019., Conclusions: This research lays the groundwork for future investigations to evaluate the effect of important policy changes on referral sources to specialty SUD treatment and the quality and outcomes associated with referrals to treatment from the legal system., (© 2024. The Author(s).)

Background: Hypertensive disorders of pregnancy (HDP) are a major contributor to maternal morbidity, mortality, and accelerated cardiovascular (CV) disease. Comorbid conditions are likely important predictors of CV risk in pregnant people. Currently, there is no way to predict which people with HDP are at risk of acute CV complications. We developed and validated a predictive model for all CV events and for heart failure, renal failure, and cerebrovascular events specifically after HDP., Methods: Models were created using the Premier Healthcare Database. The inclusion criteria for the model dataset were delivery with an HDP with discharge from October 1, 2015 to December 31, 2020. Machine learning methods were used to derive predictive models of CV events occurring during delivery hospitalization (Index Model) or during readmission (Readmission Model) using a training set (60%) to estimate model parameters, a validation set (20%) to tune model hyperparameters and select a final model, and a test set (20%) to evaluate final model performance., Results: The total model cohort consisted of 553,658 deliveries with an HDP. A CV event occurred in 6501 (1.2%) of the delivery hospitalizations. Multilabel neural networks were selected for the Index Model and Readmission Model due to favorable performance compared to alternatives. This approach is designed for prediction of multiple events that share risk factors and may cooccur. The Index Model predicted all CV events with area under the receiver operating curve (AUROC) 0.878 and average precision (AP) 0.239 (cerebrovascular events: AUROC 0.941, heart failure: AUROC 0.898, and renal failure: AUROC 0.885). With a positivity threshold set to achieve ≥90% sensitivity, model specificity was 65.0%, 83.5%, 68.6%, and 65.6% for predicting all CV events, cerebrovascular events, heart failure, and renal failure, respectively. CV events within 1 year of delivery occurred in 3018 (0.6%) individuals. The Readmission Model predicted all CV events with AUROC 0.717 and AP 0.022 (renal failure: AUROC 0.748, heart failure: AUROC 0.734, and cerebrovascular events AUROC 0.698). Feature importance analysis indicated that the presence of chronic renal disease, cardiac disease, pulmonary hypertension, and preeclampsia with severe features had the greatest effect on the prediction of CV events., Conclusions: Among individuals with HDP, our multilabel neural network model predicted CV events at delivery admission with good classification and events within 1 year of delivery with fair classification., Competing Interests: Conflicts of Interest, Funding: Please see DISCLOSURES at the end of this article., (Copyright © 2024 International Anesthesia Research Society.)

Background: Patients with parkinsonism are more likely than age-matched controls to be admitted to hospital. It may be possible to reduce the cost and negative impact by identifying patients at highest risk and intervening to reduce hospital-related costs. Predictive models have been developed in nonparkinsonism populations., Objectives: The aims were to (1) describe the reasons for admission, (2) describe the rates of hospital admission/emergency department attendance over time, and (3) use routine data to risk stratify unplanned hospital attendance in people with parkinsonism., Methods: This retrospective cohort study used Clinical Practice Research Datalink GOLD, a large UK primary care database, linked to hospital admission and emergency department attendance data. The primary diagnoses for nonelective admissions were categorized, and the frequencies were compared between parkinsonism cases and matched controls. Multilevel logistic and negative binomial regression models were used to estimate the risk of any and multiple admissions, respectively, for patients with parkinsonism., Results: There were 9189 patients with parkinsonism and 45,390 controls. The odds of emergency admission more than doubled from 2010 to 2019 (odds ratio [OR] 2.33; 95% confidence interval [CI] 1.96, 2.76; P-value for trend <0.001). Pneumonia was the most common reason for admission among cases, followed by urinary tract infection. Increasing age, multimorbidity, parkinsonism duration, deprivation, and care home residence increased the odds of admission. Rural location was associated with reduced OR for admission (OR 0.79; 95% CI 0.70, 0.89)., Conclusions: Our risk stratification tool may enable empirical targeting of interventions to reduce admission risk for parkinsonism patients., (© 2024 The Author(s). Movement Disorders Clinical Practice published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.)

Background: This review documents arts applied to health interventions and health research in Ghana, examines evidence of their impact on health outcomes, and identifies research and practice gaps., Methods: Eight databases (MEDLINE, Academic Search Complete, CINAHL, Health Source: Nursing/Academic Edition, Humanities International Complete, Scopus, African Journals Online and PsycINFO) were searched for articles published between 2000 and 2022. Following screening, seventeen articles reporting sixteen eligible studies were selected., Results: Ten art forms (including comedy, music, theatre) were applied to eight health conditions (including HIV/AIDS, mental illness, COVID-19). Most studies involved artists and artist-researchers. The majority of studies were cross-sectional. Impact was reported on health education, illness management and community health development. Some studies engaged with health policy communities, but none reported impact on health policy change., Conclusion: Creative arts have a reported measurable impact on selected health outcomes in Ghana. Participatory arts-based projects have the greatest potential for sustainable and transformational social health impact.

Background: Short sleep duration has been associated with an increased risk of cognitive impairment and dementia. Short sleep is associated with elevated blood pressure, yet the combined insult of short sleep and hypertension on brain health remains unclear. We assessed whether the association of sleep duration with cognition and vascular brain injury was moderated by hypertensive status., Methods and Results: A total of 682 dementia-free participants (mean age, 62±9 years; 53% women) from the Framingham Heart Study completed assessments of cognition, office blood pressure, and self-reported habitual and polysomnography-derived sleep duration; 637 underwent brain magnetic resonance imaging. Linear regressions were performed to assess effect modification by hypertensive status on total sleep time (coded in hours) and cognitive and magnetic resonance imaging outcomes. There was a significant interaction between sleep duration and hypertensive status when predicting executive function/processing speed (Trail Making B-A) and white matter hyperintensities. When results were stratified by hypertensive status, longer sleep duration was associated with better executive functioning/processing speed scores in the hypertensive group (meaning that shorter sleep duration was associated with poorer executive function/processing speed scores) (self-report sleep: β=0.041 [95% CI, 0.012-0.069], P =0.005; polysomnography sleep: β=0.045 [95% CI, 0.002-0.087], P =0.038), but no association was observed for the normotensive group. Similarly, shorter subjective sleep duration was associated with higher white matter hyperintensity burden in the hypertensive group (β=-0.115 [95% CI, -0.227 to -0.004], P =0.042), but not in the normotensive group., Conclusions: In individuals with hypertension, shorter sleep duration was associated with worse cognitive performance and greater brain injury.

The economics of health care and payment policy are complex and continually evolving. Breast imaging radiologists may not feel equipped to understand the financial aspect of their practice, but this is a critical competency from residency to senior leadership, especially for breast imaging radiologists. From conducting effective negotiations for new equipment as technology evolves to understanding how insurance benefit design affects patient access to care, breast imaging radiologists need to grasp the financial structures that underpins their practice. Fortunately, resources exist that are appropriate for each career stage, and this article directs the breast imaging radiologist to those resources., (© Society of Breast Imaging 2024. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)

Objective: To assess utilization and perceptions of 2D synthesized mammography (SM) for digital breast tomosynthesis (DBT) among practicing U.S. breast radiologists., Methods: An IRB-exempt 23-question anonymized survey was developed by the Society of Breast Imaging (SBI) Patient Care and Delivery Committee and emailed to practicing U.S. radiologist SBI members on October 9, 2023. Questions assessed respondents' demographics, current mammographic screening protocol, confidence interpreting SM for mammographic findings, and perceived advantages and disadvantages of SM., Results: Response rate was 13.4% (371/2771). Of 371 respondents, 208 were currently screening with DBT/SM (56.1%), 98 with DBT/SM/digital mammography (DM) (26.4%), 61 with DBT/DM (16.4%), and 4 with DM (1.1%). Most respondents felt confident using DBT/SM to evaluate masses (254/319, 79.6%), asymmetries (247/319, 77.4%), and distortions (265/318, 83.3%); however, confidence was mixed for calcifications (agreement 130/320, 40.6%; disagreement 156/320, 48.8%; neutral 34/320, 10.6%). The most frequently cited disadvantage and advantage of SM were reconstruction algorithm false-positive results (199/347, 57.4%) and lower radiation dose (281/346, 81.2%), respectively. Higher confidence and fewer disadvantages were reported by radiologists who had more SM experience, screened with DBT/SM, or exclusively used Hologic vendor (all P <.05)., Conclusion: For most survey respondents (56.1%), SM has replaced DM in DBT screening. Radiologists currently screening with DBT/SM or with more SM experience reported greater confidence in SM with fewer perceived disadvantages., (© Society of Breast Imaging 2024. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)

Introduction: This scoping review mapped evidence on physical activity (including structured exercise) and sedentary behaviour interventions (interventions to reduce sedentary behaviour) in people living with both frailty and multiple long-term conditions (MLTCs) and their informal carers., Methods: Ten databases and grey literature were searched from 2000 to October 2023. Two reviewers screened studies and one extracted data. Results were shared with three stakeholder groups (n = 21) in a consultation phase., Results: After screening, 155 papers from 144 studies (1 ongoing) were retained. The majority were randomised controlled trials (86, 55%). Participants' mean age was 73 ± 12 years, and 73% were of White ethnicity. MLTC and frailty measurement varied widely. Most participants were pre-to-moderately frail. Physical health conditions predominated over mental health conditions.Interventions focused on structured exercise (83 studies, 60%) or combined interventions (55 studies, 39%). Two (1%) and one (0.7%) focused solely on habitual physical activity or sedentary behaviour. Adherence was 81% (interquartile range 62%-89%) with goal setting, monitoring and support important to adherence. Carers were only involved in 15 (11%) studies. Most interventions reported positive outcomes, primarily focusing on body functions and structures., Conclusions: A modest volume of evidence exists on multicomponent structured exercise interventions, with less focus on habitual physical activity and sedentary behaviour. Interventions report largely positive effects, but an updated systematic review is required. The field could be advanced by more rigorous characterisation of MLTCs, socioeconomic status and ethnicity, increased informal carer involvement and further evaluation of habitual physical activity and sedentary behaviour interventions., (© The Author(s) 2024. Published by Oxford University Press on behalf of the British Geriatrics Society.)

Importance: Young adults aged 18 to 39 years represent the minority of breast cancer diagnoses but are particularly vulnerable to financial hardship. Factors contributing to sustained financial hardship are unknown., Objectives: To identify financial hardship patterns over time and characterize factors associated with discrete trajectories; it was hypothesized that treatment-related arm morbidity, a key source of expense, would be associated with long-term financial difficulty., Design, Setting, and Participants: This cohort study included US young adults aged 40 years or younger treated between 2006 and 2016. Eligible patients were treated for stage 0 to stage III breast cancer at institutions participating in the Young Women's Breast Cancer Study, which included a specialized cancer institute and 12 other academic and community hospitals. Patients who responded at baseline and returned a 1-year survey were included in analysis. Data were analyzed in March 2024., Main Outcomes and Measures: Trajectory modeling classified patterns of financial difficulty from baseline through 10 years postdiagnosis using the Cancer Rehabilitation Evaluation System (CARES) scale. Multinomial regression examined characteristics, including treatment-related arm morbidity, associated with each trajectory., Results: A total 1008 patients were included (median [IQR] age at diagnosis, 36 [33-39] years; 60 Asian [6.0%], 35 Black [3.5%], 47 Hispanic [4.7%], 884 White [87.7%]); 840 patients were college graduates (83.3%), 764 were partnered at baseline (75.8%), 649 were nulliparous (64.4%), and 908 were without comorbidities at enrollment (90.1%). Patients' tumors were primarily stage I-II (778 [77.2%]), estrogen receptor/progesterone receptor-positive (754 [74.8%]), and ERBB2-negative (formerly HER2) (686 [68.1%]). Patients were more frequently treated with mastectomy than breast conservation (771 [76.5%] vs 297 [29.5%]; P < .001). A majority of patients received radiation therapy (627 [62.2%]), chemotherapy (760 [75.4%]), and endocrine therapy (610 [60.6%]). A total of 727 patients (72.1%) reported arm symptoms within 2 years of surgery. Three distinct trajectories of experiences with finances emerged: 551 patients (54.7%) had low financial difficulty (trajectory 1), 293 (29.1%) had mild difficulty that improved (trajectory 2), and 164 (16.3%) had moderate to severe difficulty peaking several years after diagnosis before improving (trajectory 3). Hispanic ethnicity (OR, 3.71; 95% CI, 1.47-9.36), unemployment at baseline and 1 year (OR, 2.66; 95% CI, 1.63-4.33), and arm symptoms (OR, 1.77; 95% CI, 1.06-2.96) were associated with increased odds of experiencing trajectory 3. Having a college degree (OR, 0.20; 95% CI, 0.12-0.34) or being partnered (OR, 0.24; 95% CI, 0.15-0.38) were associated with increased odds of experiencing trajectory 1., Conclusion: In this cohort study of young adults with breast cancer, we identified a subset of patients who experienced a high degree of financial difficulty persisting into early survivorship. Targeted interventions to mitigate financial toxicity-modifiable factors that include support for the employability or return to work support for those experiencing arm symptoms after treatment-are needed.

Importance: Children born very preterm (<32 weeks) are at risk of ongoing morbidity and admission to pediatric intensive care units (PICUs) in childhood. However, the influence of the timing of neonatal discharge on unplanned PICU admission has not been established., Objective: To examine whether the timing of neonatal discharge (postmenstrual age and season) is associated with subsequent unplanned PICU admission., Design, Setting, and Participants: This retrospective cohort study used linked national data from the National Neonatal Research Database and Paediatric Intensive Care Audit Network (PICANet) for children born from January 2013 to December 2018 at 22 to 31 weeks' gestational age who were admitted to a neonatal unit in England and Wales and were discharged home at 34 weeks' postmenstrual age or later. All National Health Service (NHS) neonatal units and PICUs in England and Wales were included. Children were followed up until 2 years of chronological age. Data analysis was conducted from October 2023 to August 2024., Exposures: Timing of discharge., Main Outcomes and Measures: The primary outcome was unplanned PICU admission between neonatal discharge and chronological age 2 years to any PICU within England and Wales. Survival analysis using a flexible parametric model was conducted with season of discharge (time-dependent factor), gestation, sex, birth weight less than the 10th centile, bronchopulmonary dysplasia, necrotizing enterocolitis, brain injury, and earlier neonatal discharge (lower quartile of postmenstrual age at discharge for gestation) as variables., Results: Of 39 938 children discharged home (median [IQR] gestational age, 29 [27-31] weeks; 21 602 [54.1%] male), 1878 (4.7%) had unplanned PICU admission. More than half of admissions occurred within 50 days of neonatal discharge (1080 [57.5%]). Compared with summer, the risk of unplanned PICU admission following neonatal discharge was 2.58 times higher in winter and 2.35 times higher in autumn (winter: adjusted hazard ratio [aHR], 2.58; 95% CI, 1.68-3.95; autumn: aHR, 2.35; 95% CI, 1.84-2.99). Among children born at 28 to 31 weeks' gestational age, earlier neonatal discharge was associated with increased risk (aHR, 1.30; 95% CI, 1.13-1.49), but this was not true for children born younger than 28 weeks' gestational age., Conclusions and Relevance: In this retrospective cohort study of preterm children, autumn and winter discharge were associated with the highest risk of unplanned PICU admission following neonatal discharge. For children born at 28 to 31 weeks' gestational age, discharge at lower postmenstrual age was also associated with increased risk. Further work is required to understand whether delaying neonatal discharge for some children born at 28 to 31 weeks' gestational age is beneficial and to consider the wider costs and implications of prolonging neonatal care.

Competing Interests: Conflicts of interest Dr Lipner has served as a consultant for Ortho-Dermatologics, Eli Lilly, Moberg Pharmaceuticals, and BelleTorus Corporation. Ms Hill, Dr Bartolotta, Dr Laur, Mr Shaikh, and Dr Lipner have no conflicts of interest to disclose.

Almost every recent Alzheimer's disease (AD) genome-wide association study (GWAS) has performed meta-analysis to combine studies with clinical diagnosis of AD with studies that use proxy phenotypes based on parental disease history. Here, we report major limitations in current GWAS-by-proxy (GWAX) practices due to uncorrected survival bias and nonrandom participation in parental illness surveys, which cause substantial discrepancies between AD GWAS and GWAX results. We demonstrate that the current AD GWAX provide highly misleading genetic correlations between AD risk and higher education, which subsequently affects a variety of genetic epidemiological applications involving AD and cognition. Our study sheds light on potential issues in the design and analysis of middle-aged biobank cohorts and underscores the need for caution when interpreting genetic association results based on proxy-reported parental disease history., (© 2024. The Author(s), under exclusive licence to Springer Nature America, Inc.)

Competing Interests: Conflicts of interest Please see ICMJE form(s) for author conflicts of interest. These have been provided as supplementary materials.

Objectives: This study aims to examine the relationship between left atrial appendage closure (LAAC) and post-operative atrial fibrillation (POAF) in cardiac surgery patients with no pre-operative atrial fibrillation (AF)., Methods: We analyzed a cohort of 2059 adult patients in our Society of Thoracic Surgery (STS) database who underwent at least one of the following procedures between 2018 and 2021: coronary artery bypass grafting (CABG), aortic valve replacement, or mitral valve replacement. All patients had no pre-operative AF, and 169 (8.2%) of them received a left atrial appendage closure (LAAC). Primary outcome was new-onset POAF and secondary outcomes included 1-year mortality, 30-day readmission, 1-year incident stroke, and post-operative hospital length of stay (LOS). Patients without an LAAC were matched to patients with LAAC using a 1:1 nearest neighbor propensity score method to reduce the bias due to potential confounding. Associations between LAAC and postoperative adverse outcomes were assessed using appropriate statistical tests for matched analyses., Results: The matched cohort included 162 pairs. LAAC was associated with elevated risk of new-onset POAF (41.4% vs. 25.3%, p = 0.003), and postoperative hospital LOS (142.1 vs. 120.5 h, p = 0.001). The LAAC did not significantly impact all-cause 1-year mortality, 30-day readmission, and 1-year incident stroke., Conclusions: In cardiac surgery patients with no pre-operative history AF, LAAC was associated with substantially higher rates of new-onset POAF, without a corresponding impact on risk of 1-year incident stroke, 30-day readmission, or 1-year mortality., (© 2024. The Author(s).)

Objective: To evaluate the validity of the Utah statewide All-Payer Claims Database (APCD), we compared breast cancer-specific treatments and dosages with gold-standard abstraction of medical records., Study Design: In this pilot study, breast cancer treatments were abstracted by a certified tumor registrar at the Utah Cancer Registry (UCR) for patients diagnosed in 2013 with breast cancer. The abstraction of medical records was the gold standard for comparison with treatments identified in the APCD. The reliability and agreement between the treatment identified in the APCD and abstraction data were measured with sensitivity and specificity. Dose consistency was measured with the intraclass correlation coefficients (ICC)., Results: Compared with the 186 abstractions, the sensitivity of the APCD to identify chemotherapy agents was high: 89% for any agent, 91% for carboplatin, 83% for docetaxel, 82% for doxorubicin, or 94.7% for biologic therapy. The consistency between the chemotherapy dosage identified in the claims and the abstraction varied from 63% to 76%. For radiotherapy, the sensitivity of the claims to identify the completed radiotherapy regimen was 66%. The ICC between radiotherapy doses identified in the claims and the abstraction was 54% (95% confidence interval [CI], 48%, 67%)., Conclusions: Employing these novel methods, the claims were highly reliable in identifying cancer treatment agents overall, namely carboplatin, docetaxel, and trastuzumab. The claims were of moderate utility in capturing the treatment dose information. In addition to the APCD, the use of multiple data sources improved the completeness of cancer treatment information., (© 2024 The Author(s). Cancer Medicine published by John Wiley & Sons Ltd.)

The psychological study of resilience has increasingly underscored the need for children and families to access material and psychological resources to positively adapt to significant stress. Redistributive policies-policies that downwardly reallocate society's social and economic resources-can offer economically disadvantaged families sustained access to these resources and mitigate the harmful impacts of adversity. This conceptual article builds upon and integrates insights from psychological and policy research to develop a unifying multilevel resilience framework, which we call the Social Determinants of Resilience. We examine four U.S. redistributive policies that have been extensively studied for their effects on child and family outcomes as case studies: (1) Medicaid expansion; (2) the Earned Income Tax Credit; (3) childcare subsidies; and (4) Temporary Assistance for Needy Families. Informed by a scoping review of each policy, we propose that redistributive policies promote children's resilience through three mechanisms by (1) increasing families' resource and service access; (2) reducing family stress; and (3) enhancing adaptive cognitions, emotions, behaviors, and interpersonal processes that protect against the development of psychopathology and promote positive mental health outcomes. Highlighting current evidence for these resilience mechanisms as well as gaps in knowledge, we conclude by setting a multidisciplinary research agenda that can leverage this conceptual framework to advance the science on how redistributive policies enable children and families to thrive. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Little is known about the impact of clinician discontinuity on quality of care for nursing home residents. We examined the association between clinician discontinuity and outcomes of residents with long-term care stays up to 3 years using claims for a national 20% sample of Medicare fee-for-service beneficiaries from 2014 through 2019. We used an event study analysis that accounted for staggered treatment timing. Estimates were adjusted for resident, clinician, and nursing home characteristics. Three sensitivity analyses were conducted. The first excluded small nursing homes, which were in the lowest quartile based on the number of beds. The second attributed residents to clinician practices rather than individual clinicians. The third removed the 3-year long-term care stay restriction. We found that, compared to residents who did not experience a clinician change, those with a clinician change had a 0.7 percentage point higher likelihood of an ambulatory care sensitive hospitalization in a given quarter (a 36.8% relative increase). Clinician discontinuity was not associated with ambulatory care sensitive emergency department visits. Results from our 3 sensitivity analyses were consistent with those from the primary analysis. Policymakers may consider using continuity in clinicians as a marker of nursing home quality., Competing Interests: Conflicts of interest Please see ICMJE form(s) for author conflicts of interest. These have been provided as supplementary materials. M.A.U serves as an unpaid member of the Moving Forward Nursing Home Quality Coalition., (© The Author(s) 2024. Published by Oxford University Press on behalf of Project HOPE - The People-To-People Health Foundation, Inc.)

Summary: Mendelian randomization is being utilized to assess causal effects of polygenic exposures, where many genetic instruments are subject to horizontal pleiotropy. Existing methods for detecting and correcting for horizontal pleiotropy have important assumptions that may not be fulfilled. Built upon the core gene hypothesis, we developed MR Corge for performing sensitivity analysis of Mendelian randomization. MR Corge identifies a small number of putative core instruments that are more likely to affect genes with a direct biological role in an exposure and obtains causal effect estimates based on these instruments, thereby reducing the risk of horizontal pleiotropy. Using positive and negative controls, we demonstrated that MR Corge estimates aligned with established biomedical knowledge and the results of randomized controlled trials. MR Corge may be widely applied to investigate polygenic exposure-outcome relationships., Availability and Implementation: An open-sourced R package is available at https://github.com/zhwm/MRCorge., (© The Author(s) 2024. Published by Oxford University Press.)

Objective: This manuscript describes the uptake of the AIM-Back Pain Navigator Pathway (PNP) designed to encourage use of non-pharmacologic care options within the Veterans Health Administration (VHA)., Design: This manuscript describes the implementation of a telehealth intervention from one arm of a multisite, embedded, cluster-randomized pragmatic trial comparing the effectiveness of two novel clinical care pathways that provide access to non-pharmacologic care for Veterans with low back pain (LBP)., Setting: Ten VHA clinics., Subjects: 19 pain navigators, >200 primary care physicians, and over 1000 Veterans were involved in the PNP implementation., Methods: Data were generated within the VHA electronic health record (EHR) for the ongoing AIM-Back trial to describe PNP implementation for system-level findings in terms of number of visits, and type of care received., Results: Over a 3-year period, 9 of 10 clinics implemented the PNP within the context of the AIM-Back trial. The most frequent care recommended in the PNP included physical therapy, chiropractic, acupuncture, and yoga/tai chi. During follow-up at six-weeks, ∼50% of Veterans elected to receive a different care choice than what was initially prescribed. Notable variation across clinics was documented for PNP based on time to initiation of care and follow-up rates., Conclusions: Implementation of the telehealth delivered PNP provides a nuanced understanding of the introduction of novel care programs within diverse clinical settings. These findings are most applicable to care programs that are delivered remotely and involve facilitation of existing care options., (© The Author(s) 2024. Published by Oxford University Press on behalf of the American Academy of Pain Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Background: Rising metastatic prostate cancer incidence has renewed debate regarding benefits of prostate-specific antigen (PSA) screening. Identifying barriers to accessing screening for individuals at high risk of lethal prostate cancer may slow this rise. We examined associations of access barriers with receipt of PSA testing, stratified by sociodemographic factors., Methods: We pooled data from male respondents to Behavior Risk Factor Surveillance Systems (BRFSS) surveys from 2006 to 2020. Questions related to affordability (insurance, cost of visits) and accommodation (regular primary care provider (PCP), physician recommending a PSA test) were considered as individual-level barriers. For availability, we linked provider density from the 2012 Area Health Resource File and estimated driving times to closest health facility within Micropolitan and Metropolitan Statistical Area (MMSA) using Google Earth Engine. These measures were used to compute a spatial accessibility index. We fit survey-weighted, covariate-adjusted logistic regression models to estimate associations of barriers with receipt of PSA within the past 2 years and examined effect modification by sociodemographic factors., Results: There were 185,643 participants, of whom 73% were White, 11% were Black, 4% were Asian, and 11% were Hispanic. Physician recommendation was the strongest predictor of having a PSA test (aOR: 14.5, 95% CI: 13.6, 15.6). Not having a regular PCP (aOR: 0.29, 95% CI: 0.27, 0.31), insurance (aOR: 0.64, 95% CI: 0.58, 0.71), and prohibitive cost of care (aOR: 0.82, 95% CI: 0.75, 0.90) were associated with lower PSA testing. Access barriers were stronger predictors of PSA testing for Asian and White participants compared to other groups (P het  < 0.004 for insurance and regular PCP) and for those with college education compared to those without (P het  < 0.05 for insurance, perceived unaffordability)., Discussion: Physician recommendation was the strongest predictor of receipt of PSA testing, regardless of sociodemographic grouping. Future studies should consider access barriers jointly and across sociodemographic strata., (© 2024 The Author(s). Cancer Medicine published by John Wiley & Sons Ltd.)

Objective: Although deep learning techniques have shown significant achievements, they frequently depend on extensive amounts of hand-labeled data and tend to perform inadequately in few-shot scenarios. The objective of this study is to devise a strategy that can improve the model's capability to recognize biomedical entities in scenarios of few-shot learning., Methods: By redefining biomedical named entity recognition (BioNER) as a machine reading comprehension (MRC) problem, we propose a demonstration-based learning method to address few-shot BioNER, which involves constructing appropriate task demonstrations. In assessing our proposed method, we compared the proposed method with existing advanced methods using six benchmark datasets, including BC4CHEMD, BC5CDR-Chemical, BC5CDR-Disease, NCBI-Disease, BC2GM, and JNLPBA., Results: We examined the models' efficacy by reporting F1 scores from both the 25-shot and 50-shot learning experiments. In 25-shot learning, we observed 1.1% improvements in the average F1 scores compared to the baseline method, reaching 61.7%, 84.1%, 69.1%, 70.1%, 50.6%, and 59.9% on six datasets, respectively. In 50-shot learning, we further improved the average F1 scores by 1.0% compared to the baseline method, reaching 73.1%, 86.8%, 76.1%, 75.6%, 61.7%, and 65.4%, respectively., Conclusion: We reported that in the realm of few-shot learning BioNER, MRC-based language models are much more proficient in recognizing biomedical entities compared to the sequence labeling approach. Furthermore, our MRC-language models can compete successfully with fully-supervised learning methodologies that rely heavily on the availability of abundant annotated data. These results highlight possible pathways for future advancements in few-shot BioNER methodologies., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Objective: Individuals living with obesity are differentially susceptible to cardiometabolic diseases. We hypothesized that an integrative multi-omics approach might improve identification of subgroups of individuals with obesity who have distinct cardiometabolic disease patterns., Methods: We performed machine learning-based, integrative unsupervised clustering to identify proteomics- and metabolomics-defined subpopulations of individuals living with obesity (BMI ≥ 30 kg/m 2 ), leveraging data from 243 individuals in the Multi-Ethnic Study of Atherosclerosis (MESA) cohort. Omics that contributed to the observed clusters were functionally characterized. We performed multivariate regression to assess whether the individuals in each cluster demonstrated differential patterns of cardiometabolic traits., Results: We identified two distinct clusters (iCluster1 and 2). iCluster2 had significantly higher average BMI values, fasting blood glucose, and inflammation. iCluster1 was associated with higher levels of total cholesterol and high-density lipoprotein cholesterol. Pathways mediating cell growth, lipogenesis, and energy expenditures were positively associated with iCluster1. Inflammatory response and insulin resistance pathways were positively associated with iCluster2., Conclusions: Although the two identified clusters may represent progressive obesity-related pathologic processes measured at different stages, other mechanisms in combination could also underpin the identified clusters given no significant age difference between the comparative groups. For instance, clusters may reflect differences in dietary/behavioral patterns or differential rates of metabolic damage., (© 2024 The Obesity Society.)

Background: Patient navigation (PN) is a promising yet underused approach to address Hispanic/Latino (H/L) cancer survivors' unmet supportive care needs. The authors conducted a randomized trial to evaluate the effect of a culturally tailored PN program with the LIVESTRONG Foundation's Cancer Navigation Services (PN-LCNS) on reducing unmet needs in H/L survivors., Methods: From 2012 to 2015 at two US sites, 288 H/L survivors diagnosed with breast, prostate, or colorectal cancer were randomized to a PN-LCNS program or to standard PN. Participants assigned to the PN-LCNS program received 3-month PN services; access to phone-based, bilingual, one-on-one support; and additional resources (i.e., guidebook, health journal, and care plan). Participants completed assessments at baseline and at 3, 9, and 15 months post-baseline. The Supportive Care Needs Survey was used to assess unmet needs across five domains: psychological, health system and information, physical and daily living, patient care and support, and sexuality. Intervention effects were tested by using separate multilevel growth models for women and men., Results: Women randomized to the PN-LCNS program, relative to those who received standard PN, had a statistically significant reduction in unmet needs (i.e., overall and for the health systems and information, physical and daily living, and patient care and support domains). Among men, younger age was associated with greater unmet needs at baseline. Prostate cancer survivors reported greater unmet sexual health needs compared with colorectal cancer survivors. There was no significant change in unmet needs among H/L men., Conclusions: A culturally tailored PN program can reduce unmet supportive care needs among H/L women cancer survivors. However, interventions specifically targeting unmet needs in H/L men and sexual health are still necessary (ClinicalTrials.gov identifier NCT02275754)., Plain Language Summary: Hispanic/Latino (H/L) cancer survivors often report concerns or needs that are not adequately addressed by the health care team, which could be related to psychological, health system and information, patient care and support, physical and daily living, and sexuality issues. In this randomized controlled trial of 288 H/L survivors diagnosed with breast, prostate, or colorectal cancer, women assigned to a culturally tailored patient navigation program experienced a reduction in unmet needs compared with those who received standard patient navigation. H/L men did not experience a change in unmet needs., (© 2024 The Author(s). Cancer published by Wiley Periodicals LLC on behalf of American Cancer Society.)

Background: Various social determinants of health have been established as significant risk factors for COVID-19 transmission, prevalence, incidence, and mortality. Area deprivation index (ADI, a composite score made up of educational, housing, and poverty markers) is an accepted multidimensional social determinants of health measure. Little is known about how structural social determinants of health before hospitalization, including ADI, may affect mortality related to COVID-19 in critically ill patients., Objectives: To examine the association of ADI with intensive care unit (ICU) mortality in patients with COVID-19 and compare its predictive power with that of clinical factors., Methods: This was a retrospective cohort study of critically ill adults with COVID-19 in 3 hospitals within a single health system. Multivariable logistic regression models (adjusted for demographic and clinical variables) were used to examine the association of ADI with ICU mortality., Results: Data from 1784 patients hospitalized from 2020 to 2022 were analyzed. In multivariable models, no association was found between national ADI and ICU mortality. Notable factors associated with ICU mortality included treatment year, age, van Walraven weighted score, invasive mechanical ventilation, and body mass index., Conclusion: In this study, clinical factors were more predictive of mortality than ADI and other social determinants of health. The influence of ADI may be most relevant before hospital admission. These findings could serve as a foundation for shaping targeted public health strategies and hospital interventions, enhancing care delivery, and potentially contributing to better outcomes in future pandemics., (©2024 American Association of Critical-Care Nurses.)

Aims: Venous thromboembolism (VTE) is a potential complication of foot and ankle surgery. There is a lack of agreement on contributing risk factors and chemical prophylaxis requirements. The primary outcome of this study was to analyze the 90-day incidence of symptomatic VTE and VTE-related mortality in patients undergoing foot and ankle surgery and Achilles tendon (TA) rupture. Secondary aims were to assess the variation in the provision of chemical prophylaxis and risk factors for VTE., Methods: This was a multicentre, prospective national collaborative audit with data collection over nine months for all patients undergoing foot and ankle surgery in an operating theatre or TA rupture treatment, within participating UK hospitals. The association between VTE and thromboprophylaxis was assessed with a univariable logistic regression model. A multivariable logistic regression model was used to identify key predictors for the risk of VTE., Results: A total of 13,569 patients were included from 68 sites. Overall, 11,363 patients were available for analysis: 44.79% were elective (n = 5,090), 42.16% were trauma excluding TA ruptures (n = 4,791), 3.50% were acute diabetic procedures (n = 398), 2.44% were TA ruptures undergoing surgery (n = 277), and 7.10% were TA ruptures treated nonoperatively (n = 807). In total, 11 chemical anticoagulants were recorded, with the most common agent being low-molecular-weight heparin (n = 6,303; 56.79%). A total of 32.71% received no chemical prophylaxis. There were 99 cases of VTE (incidence 0.87% (95% CI 0.71 to 1.06)). VTE-related mortality was 0.03% (95% CI 0.005 to 0.080). Univariable analysis showed that increased age and American Society of Anesthesiologists (ASA) grade had higher odds of VTE, as did having previous cancer, stroke, or history of VTE. On multivariable analysis, the strongest predictors for VTE were the type of foot and ankle procedure and ASA grade., Conclusion: The 90-day incidence of symptomatic VTE and mortality related to VTE is low in foot and ankle surgery and TA management. There was notable variability in the chemical prophylaxis used. The significant risk factors associated with 90-day symptomatic VTE were TA rupture and high ASA grade., Competing Interests: J. Mangwani reports support from the Leicester Hospitals Charity, related to this study. J. Mangwani reports payment or honoraria for lectures, presentations, educational events from Orthosolutions, and royalties from Meshworks, unrelated to this study. K. Malhotra reports payment or honoraria for lectures, presentations, speaker bureaus, manuscript writing or educational events from NewClip Technics, unrelated to this study. L. W. Mason reports royalties or licenses, consulting fees, and patents planned, issued or pending from Orthosolutions, unrelated to this study., (© 2024 The British Editorial Society of Bone & Joint Surgery.)

Background: Household transmission of SARS-CoV-2 is a driver of the ongoing COVID-19 pandemic. Understanding factors that contribute to secondary infection risks (SIRs) can define changing trends and inform public health policies., Methods: The ORegon CHild Absenteeism due to Respiratory Disease Study (ORCHARDS) prospectively monitors respiratory viruses within the Oregon School District (OSD) in southcentral Wisconsin. Households with students who had ≥ 2 respiratory symptoms were eligible and opted to participate in ORCHARDS. Between October 28, 2020, and May 16, 2022, all household members provided self-collected nasal specimens on days 0, 7, and 14 for SARS-CoV-2 detection using real-time reverse-transcription-polymerase chain reaction. We used logistic regression to investigate individual- and household-level characteristics associated with SARS-CoV-2 transmission., Results: Overall, 127 households comprising 572 individuals (48% female; 52% male; 0.4% nonbinary; 77% ≥ 18 years) had at least one detection of SARS-CoV-2. The overall SIR was 47% and decreased over time (pre-Delta = 72% [95% CI: 58%-83%]; Delta = 51% [40%-63%]; and Omicron = 41% [36%-47%]). Odds of household transmission were 63% lower during the Omicron period compared with the pre-Delta period (OR = 0.36 [95% CI: 0.13-0.94] p = 0.037). Greater household density (members/bedroom) was significantly associated with household transmission during the Omicron period (OR = 6.8, [2.19-21.37] p = 0.001). Index case age, illness severity, and individual symptoms were not significantly associated with odds of household transmission., Conclusions: Greater household density was associated with a higher risk of SARS-CoV-2 transmission, but the risk declined over time with subsequent variants. Interplay between variants, prior infection, and individual/household factors may identify modifiable factors (e.g., behavior and vaccination) to reduce future transmission risk., (© 2024 The Author(s). Influenza and Other Respiratory Viruses published by John Wiley & Sons Ltd.)

Significance: Non-Hispanic Black patients diagnosed with prostate cancer between 2014 and 2019 and treated at a comprehensive cancer center were less likely to use tumor-specific genomic testing compared with non-Hispanic White patients. Disparities in the use of precision oncology technologies should be monitored and addressed to ensure equitable cancer care., (©2024 The Authors; Published by the American Association for Cancer Research.)

Subcortical brain structures are involved in developmental, psychiatric and neurological disorders. Here we performed genome-wide association studies meta-analyses of intracranial and nine subcortical brain volumes (brainstem, caudate nucleus, putamen, hippocampus, globus pallidus, thalamus, nucleus accumbens, amygdala and the ventral diencephalon) in 74,898 participants of European ancestry. We identified 254 independent loci associated with these brain volumes, explaining up to 35% of phenotypic variance. We observed gene expression in specific neural cell types across differentiation time points, including genes involved in intracellular signaling and brain aging-related processes. Polygenic scores for brain volumes showed predictive ability when applied to individuals of diverse ancestries. We observed causal genetic effects of brain volumes with Parkinson's disease and attention-deficit/hyperactivity disorder. Findings implicate specific gene expression patterns in brain development and genetic variants in comorbid neuropsychiatric disorders, which could point to a brain substrate and region of action for risk genes implicated in brain diseases., (© 2024. The Author(s), under exclusive licence to Springer Nature America, Inc.)

Background: Robust evidence demonstrates inequities in communication during family-centered rounds for families who use a language other than English (LOE) for health care. This study aimed to characterize the type of interpreter alterations occurring on family-centered rounds and identify medical team communication practices associated with alterations., Methods: In this observational study of interpreter-supported family-centered rounds, we recorded and transcribed family-centered rounds encounters for Spanish-speaking families. We assessed measures of medical team communication behaviors and interpreter alterations (omissions, additions, and substitutions) using previously described instruments. We used a content analysis approach to apply defined codes to each interpreted segment and to characterize the nature of interpreter alterations. We assessed the association between medical team communication behaviors and interpreter alterations using χ2 tests., Results: We recorded, transcribed, and coded 529 interpreted segments of 10 family-centered rounds encounters. At least 1 alteration was present in 72% (n = 382/529) of interpreted segments. Omissions were the most common alteration (n = 242/529, 46%) followed by substitutions (n = 177/529, 34%) and additions (n = 71/529, 13%). Interpretation resulted in a potentially negative alteration in 29% (n = 155/529) and a positive alteration in 9% (n = 45/529) of segments. Greater number of sentences in the segment preceding interpretation was associated with an increase in loss of information (P < .001), loss of social support (P = .003), and loss of partnership (P = .020)., Conclusions: To improve communication with families that use an LOE, medical teams must abide by best practices for using an interpreter such as frequent pausing to prevent loss of both biomedical and psychosocial information., (Copyright © 2024 by the American Academy of Pediatrics.)

Introduction: Migraine is an established risk factor for cerebral ischemic stroke, with an especially robust association in patients with migraine with aura. However, it is not known if migraine is a risk factor for retinal stroke (central or branch retinal artery occlusion; CRAO or BRAO)., Methods: We performed a retrospective, observational, cohort study using population-based data from the State Inpatient Databases and State Emergency Department Databases from New York (2006-2015), California (2003-2011), and Florida (2006-2015) to determine the association between hospital-documented migraine and retinal stroke. The primary exposure was hospital-documented migraine (ascertained from admission or emergency department diagnosis codes). The primary endpoint was time to hospital-documented CRAO (ICD-9-CM code 362.31 in the primary diagnosis position) and secondary endpoints included time to BRAO and any retinal artery occlusion (RAO). Cause-specific hazard models were used to model the association between migraine and subsequent CRAO., Results: Of 39,835,024 patients included in the study, 1109,140 had migraine documented during our two year ascertainment window. Patients with migraine were younger (40.2±15.2 vs. 46.9±19.8, standardized difference (SD) 0.38), more likely to be female (81.4 % vs. 54.7 %, SD 0.6), and had a lower burden of atrial fibrillation (4.5 % vs. 6.9 %, SD 0.1), chronic kidney disease (1.9 % vs. 3.6 %, SD 0.2), and congestive cardiac failure (2.7 % vs. 5.1 %, SD 0.12). Migraine was not associated with CRAO in the primary diagnostic position (adjusted hazard rate (aHR) 1.15 (95 % CI: 0.79-1.67). However, it was associated with CRAO in any diagnostic position (aHR 1.39 (95 % CI: 1.08-1.78). As positive controls, we replicated previously established associations of migraine with cerebral ischemic stroke (aHR 1.35 (95 % CI: 1.32-1.38) and embolic ischemic stroke (aHR 1.15 (95 % CI: 1.08-1.22)., Conclusions: In a large, nationally-representative, claims-based study of patients from 3 regions in the United States (US), we did not find an adjusted association between migraine and a primary discharge diagnosis of CRAO. Our hypothesis-generating finding that migraine was associated with CRAO when using a broader definition sets the stage for future work leveraging both outpatient and pharmacy based claims to further explore this finding., Competing Interests: Declaration of Competing Interest JL reported none. AS reported none. SU reported none. HRA reported none. ADH is supported by NIH-NINDS (K23NS105924), has received investigator initiated clinical research funding from the AAN, has received consultant fees from Integra and Novo Nordisk, has equity in TitinKM and Certus, and receives author fees from UpToDate. VB is supported by the National Institutes of Health’s National Eye Institute core grant P30-EY06360 (Department of Ophthalmology, Emory University School of Medicine) and by a departmental grant from Research to Prevent Blindness (New York, NY), and is a consultant for GenSight Biologics and Neurophoenix. MS is supported by the National Institutes of Health (R56AG074279, K76AG060001, R01AG078803, RF1NS129735, RF1NS130334 and R21AG070859). He has received fees from Labaton Sucharow and Raymond James and Associates for consulting unrelated to this work and receives a stipend for chairing the DSMB for the ongoing REVISION trial. ES reported none. SP received research support from BMS/Pfizer, Boehringer-Ingelheim, Daiichi Sankyo, European Union, German Federal Joint Committee Innovation Fund, and German Federal Ministry of Education and Research, Helena Laboratories and Werfen as well as speakers’ honoraria/consulting fees from Alexion, AstraZeneca, Bayer, Boehringer-Ingelheim, BMS/Pfizer, Daiichi Sankyo, Portola, and Werfen (all outside the submitted work). NOP reported none. YX is funded by the NIA (R01AG062770, R01AG066672), has research funding from the American Heart Association, Genentech, Daiichi Sankyo and Janssen and has received honoraria from Boehringer Ingelheim, and Portola. EO reported none. BMG is supported by the National Institutes of Health (K23HL161426) and the American Heart Association (23MRFSCD1077188)., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Background: Mediation by multiple agents can affect the relation between neighborhood deprivation and segregation indices and ovarian cancer survival. In this paper, we examine a variety of potential clinical mediators in the association between deprivation indices (DIs) and segregation indices (SIs) with all-cause survival among women with ovarian cancer in the African American Cancer Epidemiology Study (AACES)., Methods: We use novel Bayesian multiple mediation structural models to assess the joint role of mediators (stage at diagnosis, histology, diagnostic delay) combined with the DIs and SIs (Yost, ADI, Kolak's URB, ICE-income) and a set of confounders with survival. The confounder set is selected in a preliminary step, and each DI or SI is included in separate model fits., Results: When multiple mediators are included, the total impact of DIs and SIs on survival is much reduced. Unlike the single mediator examples previously reported, the Yost, ADI and ICE-income indices do not display significant direct effects. This suggests that when important clinical mediators are included, the impact of neighborhood SES indices is significantly attenuated. It is also clear that certain behavioral and demographic measures such as physical activity, smoking, or adjusted family income do not have a significant role in survival when mediated by clinical factors., Conclusion: Multiple mediation via clinical and diagnostic-related measures reduces the contextual effects of neighborhood measures on ovarian cancer survival. The robust association of the Kolak URB index on survival may be due to its relevance to access to care, unlike SES-based indices whose impact was significantly reduced when important clinical mediators were included., Competing Interests: Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Andrew B Lawson reports financial support was provided by National Institutes of Health. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024. Published by Elsevier Inc.)

Diarrhoeal disease caused by Cryptosporidium is a major cause of morbidity and mortality in young and malnourished children from low- and middle-income countries, with no vaccine or effective treatment. Here we describe the discovery of EDI048, a Cryptosporidium PI(4)K inhibitor, designed to be active at the infection site in the gastrointestinal tract and undergo rapid metabolism in the liver. By using mutational analysis and crystal structure, we show that EDI048 binds to highly conserved amino acid residues in the ATP-binding site. EDI048 is orally efficacious in an immunocompromised mouse model despite negligible circulating concentrations, thus demonstrating that gastrointestinal exposure is necessary and sufficient for efficacy. In neonatal calves, a clinical model of cryptosporidiosis, EDI048 treatment resulted in rapid resolution of diarrhoea and significant reduction in faecal oocyst shedding. Safety and pharmacological studies demonstrated predictable metabolism and low systemic exposure of EDI048, providing a substantial safety margin required for a paediatric indication. EDI048 is a promising clinical candidate for the treatment of life-threatening paediatric cryptosporidiosis., (© 2024. The Author(s).)

Objectives: To evaluate the comparative effectiveness of sotorasib monotherapy versus docetaxel as monotherapy or combination therapy in patients with pretreated KRAS G12C-mutated advanced NSCLC in the real-world., Methods: A US-based electronic health record-derived de-identified database was used in this study. Patients with pretreated KRAS G12C-mutated advanced NSCLC who initiated sotorasib between May 28, 2021, and September 30, 2022, and docetaxel between January 1, 2019, and September 30, 2022 (to enhance sample size), were included, with a minimum of 12-month opportunity for follow-up. Treatment groups were balanced via overlap weighting propensity score methods. Median OS in the 2L and 2L+ settings were calculated using Kaplan-Meier estimates. Hazard ratios (HRs) were estimated via Cox proportional hazard models., Results: Overall, the clinical characteristics in sotorasib and docetaxel cohorts were balanced after propensity score weighting. At baseline, most patients were > 65 years of age, had ECOG performance status of 0-1, were from the community practice setting, had advanced stage at initial diagnosis, and had prior anti-PD-(L)1 treatment and/or platinum-based chemotherapy. In the 2L setting, the median OS (95 % CI) for sotorasib (N=102) and docetaxel (N=58) patients was 10.2 (7.6-16.3) and 6.0 (4.2-11.0) months, respectively, with a corresponding mortality HR (95 % CI) of 0.62 (0.41-0.93). In the 2L+ setting, the median OS (95 % CI) for sotorasib (N=164) and docetaxel (N=116) was 10.2 (8.0-14.6) and 7.2 (5.1-10.6) months, respectively, with a corresponding mortality HR (95 % CI) of 0.65 (0.49-0.87). In patients with prior anti-PD-(L)1 treatment, the mortality HR (95 % CI) in the sotorasib group versus docetaxel was 0.61 (0.39-0.94) and 0.65 (0.48-0.89) in the 2L and 2L+ settings, respectively. Findings from other subgroups were consistent with the primary analyses., Conclusion: In this real-world comparative analysis of patients with pretreated KRAS G12C-mutated advanced NSCLC, sotorasib monotherapy demonstrated a longer median OS compared to docetaxel monotherapy or combination therapy., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Melissa Johnson reports research funding from AbbVie (Inst); Adaptimmune (Inst); Amgen (Inst); Apexigen (Inst); Arcus Biosciences (Inst); Array BioPharma (Inst); ArriVent Biopharma (Inst); Artios (Inst); AstraZeneca (Inst); Atreca (Inst); Bayer (Inst); BeiGene (Inst); BerGenBio (Inst); BioAtla (Inst); Black Diamond Therapeutics (Inst); Boehringer Ingelheim (Inst); Bristol-Myers Squibb (Inst); Calithera Biosciences (Inst); Carisma Therapeutics (Inst); Checkpoint Therapeutics (Inst); City of Hope (Inst); Corvus Pharmaceuticals (Inst); Curis (Inst); CytomX Therapeutics (Inst); Daiichi Sankyo (Inst); Dracen (Inst); Dynavax Technologies (Inst); Elicio Therapeutics (Inst); EMD Serono (Inst); EQRx (Inst); Erasca, Inc (Inst); Exelixis (Inst); Fate Therapeutics (Inst); Genentech/Roche (Inst); Genmab (Inst); Genocea Biosciences (Inst); GlaxoSmithKline (Inst); Gritstone Bio (Inst); Guardant Health (Inst); Harpoon (Inst); Helsinn Healthcare (Inst); Hengrui Pharmaceutical (Inst); Hutchison MediPharma (Inst); IDEAYA Biosciences (Inst); IGM Biosciences (Inst); Immunitas (Inst); Immunocore (Inst); Incyte (Inst); Janssen (Inst); Jounce Therapeutics (Inst); Kadmon (Inst); Kartos Therapeutics (Inst); Lilly (Inst); LockBody Therapeutics (Inst); Loxo (Inst); Lycera (Inst); Memorial Sloan-Kettering Cancer Center (Inst); Merck (Inst); Merus (Inst); Mirati Therapeutics (Inst); Mythic Therapeutics (Inst); NeoImmuneTech (Inst); Neovia Oncology (Inst); Novartis (Inst); Numab (Inst); Nuvalent, Inc. (Inst); OncoMed (Inst); Palleon Pharmaceuticals (Inst); Pfizer (Inst); PMV Pharma (Inst); Rain Therapeutics (Inst); RasCal (Inst); Regeneron (Inst); Relay Therapeutics (Inst); Revolution Medicines (Inst); Ribon Therapeutics (Inst); Rubius Therapeutics (Inst); Sanofi (Inst); Seven and Eight Biopharmaceuticals (Inst); Shattuck Labs (Inst); Silicon Therapeutics (Inst); Stem CentRx (Inst); Syndax (Inst); Taiho Oncology (Inst); Takeda (Inst); Tarveda Therapeutics (Inst); TCR2 Therapeutics (Inst); Tempest Therapeutics (Inst); Tizona Therapeutics, Inc. (Inst); Tmunity Therapeutics, Inc. (Inst); Turning Point Therapeutics (Inst); University of Michigan (Inst); Vyriad (Inst); WindMIL (Inst); Y-mAbs Therapeutics (Inst), consulting fees from AbbVie (Inst); Alentis Therapeutics (Inst); Amgen (Inst); Arcus Biosciences (Inst); ArriVent Biopharma (Inst); AstraZeneca (Inst); Boehringer Ingelheim (Inst); Bristol-Myers Squibb (Inst); D3 Bio (Inst); Daiichi Sankyo (Inst); Fate Therapeutics (Inst); Genentech/Roche (Inst); Genmab (Inst); Genocea Biosciences (Inst); Gilead Sciences (Inst); GlaxoSmithKline (Inst); Gritstone Bio (Inst); Hookipa Biotech (Inst); Immunocore (Inst); Janssen Oncology (Inst); Jazz Pharmaceuticals (Inst); Lilly (Inst); Merck (Inst); Mirati Therapeutics (Inst); Molecular Axiom (Inst); Normunity (Inst); Novartis (Inst); Novocure (Inst); Pfizer (Inst); Pyramid Biosciences (Inst); Revolution Medicines (Inst); Sanofi (Inst); SeaGen (Inst); Synthekine (Inst); Takeda (Inst); VBL Therapeutics (Inst), and travel and accommodation grants from AbbVie; AstraZeneca; Genentech; Incyte; Merck; Pfizer; Sanofi. Alexander Spira reports research funding support from AbbVie (Inst); ADC Therapeutics (Inst); ADC Therapeutics (Inst); Alkermes (Inst); Amgen (Inst); Arch Therapeutics (Inst); ArriVent Biopharma (Inst); Astellas Pharma (Inst); Astex Pharmaceuticals (Inst); AstraZeneca (Inst); Black Diamond Therapeutics (Inst); Blueprint Medicines (Inst); BluPrint Oncology (Inst); Boehringer Ingelheim (Inst); Bristol-Myers Squibb (Inst); CytomX Therapeutics (Inst); Daiichi Sankyo (Inst); Gritstone Bio (Inst); Ignyta (Inst); Incyte (Inst); Janssen Oncology (Inst); LAM Therapeutics; Loxo (Inst); Loxo (Inst); Macrogenics (Inst); Medikine (Inst); MedImmune (Inst); Mersana (Inst); Mirati Therapeutics (Inst); nalo therapeutics (Inst); Novartis (Inst); Plexxikon (Inst); Regeneron; Revolution Medicines (Inst); Revolution Medicines (Inst); Roche (Inst); Rubius Therapeutics (Inst); Scorpion Therapeutics (Inst); Synthekine (Inst); Synthekine (Inst); Takeda (Inst), consulting fees from Amgen; Array BioPharma (Inst); AstraZeneca/MedImmune (Inst); AstraZeneca/MedImmune (Inst); Black Diamond Therapeutics; Blueprint Medicines (Inst); Bristol-Myers Squibb (Inst); Daiichi Sankyo/Astra Zeneca; Gritstone Bio; Gritstone Bio; incyte; Janssen Research & Development; Jazz Pharmaceuticals; Lilly; Merck (Inst); Mersana; Mirati Therapeutics; Novartis; Regeneron; Sanofi; Takeda, honoraria from Amgen; AstraZeneca/MedImmune; Bayer; Bristol-Myers Squibb; CytomX Therapeutics; Janssen Oncology; Merck; Novartis; Takeda, leadership role at Next Oncology, and stock or stock options from Lilly. Diana Younan, Shia T. Kent, Marco Mesa-Frias, and Akhila Balasubramanian are employees and stockholders of Amgen Inc. M Alan Brookhart reports participation in advisory board at Accompany Health, American Academy of Allergy, Asthma & Immunology, Amgen, Astellas/Seagen, Atara Biotherapeutics, Brigham and Women's Hospital, Gilead/Kite, Intercept, National Institute of Diabetes and Digestive and Kidney Diseases, Regeneron, and Vertex and stock or stock options at Accompany Health and Target RWE., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Background: Medications for opioid use disorder (MOUD) are a crucial intervention for pregnant and postpartum individuals with opioid use disorder (OUD). However, there is paucity of data on the factors associated with MOUD treatment success in this population. This scoping review aimed to evaluate factors associated with MOUD success during the pregnancy and postpartum period., Methods: We completed a structured search of MEDLINE, CINAHL, PsycINFO, Web of Science, and ProQuest databases. Eligible studies included a metric of success in outpatient treatment in the pregnancy and postpartum period and were conducted in the United States after the Food and Drug Administration's approval of buprenorphine in 2002. Reviewers independently screened studies for inclusion and extracted data. The primary outcome was treatment success (i.e., treatment adherence, abstinence from illicit opioids, or retention in care) during pregnancy and up to 12 months postpartum., Results: Data from 15 studies were included. Medications included methadone, naltrexone and buprenorphine (mono or combination therapy). High daily dose of buprenorphine as mono or combination therapy, early initiation and longer duration of MOUD were associated with treatment success. Legal involvement, homelessness, and rural residency were negatively associated with treatment success. There were no differences in outcomes of individuals receiving telemedicine versus in-person care., Conclusion: We identified several factors associated with MOUD treatment success among individuals with OUD during the pregnancy and postpartum periods. These factors may help guide future research and inform the development and adaptation of interventions tailored to better meet the needs of this key population., Competing Interests: Declaration of Competing Interest None, (Copyright © 2024 Elsevier B.V. All rights reserved.)

Interventions designed to address COVID-19 needed to be rapidly scaled up to the population level, and to address health equity by reaching historically marginalized populations most affected by the pandemic (e.g., racial/ethnic minorities and rural and low socioeconomic status populations). From February 2021 to June 2022, SCALE-UP Utah used text messaging interventions to reach 107 846 patients from 28 clinics within seven safety-net health care systems. Interventions provided informational and motivational messaging regarding COVID-19 testing and vaccination, and were developed using extensive community partner input. ( Am J Public Health . 2024;114(11):1207-1211. https://doi.org/10.2105/AJPH.2024.307770).

The authors conducted a review of pharmacologic therapy in older adults with hypertension. They reviewed the evidence supporting their use in older adults, understanding the physiologic changes and potential adverse drug effects associated with aging and antihypertensive medication use, exploring guideline recommendations for antihypertensive use in older adults, and evaluating the associated risks and benefits of specific classes of antihypertensive medications., Competing Interests: Disclosure The work of Dr O.M. Todd is funded by the UK National Institute for Health and Care Research (NIHR) via an Academic Clinical Lectureship. The work of Dr. M. Knight is funded by the UK NIHR via a Specialized Foundation Programme. The work of Dr. J. Sheppard receives funding from the Wellcome Trust, United Kingdom/Royal Society via a Sir Henry Dale Fellowship (ref: 211182/Z/18/Z), the National Institute for Health and Care Research, United Kingdom (NIHR), and from the British Heart Foundation, United Kingdom (refs: PG/21/10,341; FS/19/13/34,235). The work of Dr. A.P. Bress is supported by R01AG74989, K24AG080168, and R01AG065805 from the National Institute on Aging, United States (Bethesda, MD) and R01HL139837 from the National Heart, Lung, and Blood Institute, United States (Bethesda, MD). This research was funded in part by the Wellcome Trust [211182/Z/18/Z]. For the purpose of open access, the author has applied a CC BY public copyright license to any Author Accepted Manuscript version arising from this submission., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Importance: Childhood exposure to mild traumatic brain injury (mTBI) is common. Individuals with a childhood history of mTBI experience more frequent criminal justice involvement in mid to late adolescence and adulthood. No study had been conducted to examine whether the link is causal or spurious., Objective: To determine whether mTBI in childhood causes criminal justice involvement in mid to late adolescence., Design, Setting, and Participants: This cohort study used population-based data for all children born between 1995 and 2000 in Denmark, with data linked to emergency department (ED) visits and hospitalizations before age 10 years and all criminal charges and convictions from ages 15 to 20 years. The exposure group contained all individuals diagnosed with mTBI before age 10 years without other intracranial or extracranial injuries; the comparison group was individuals not diagnosed with mTBI or intracranial or extracranial injuries. Sibling and twin fixed-effects models were used to evaluate the association after controlling for family-level confounding. Data were analyzed from May 2021 to July 2024., Exposures: Mild TBI before age 10 years without other intracranial or extracranial injuries before or at the time of diagnosis., Main Outcomes and Measures: Associations between mTBI before age 10 years and criminal charges and convictions from ages 15 to 20 for the entire study population and separately by sex at birth, controlling for additional covariates., Results: The final analytic sample consisted of 343 027 individuals, 13 514 in the exposure group and 329 513 in the comparison group. Of the total sample, 166 455 (49%) were female and 176 572 were male (51%). A total of 326 191 participants (95%) had at least 1 parent with Danish citizenship, and 79 386 mothers (23%) held a college degree. There was a positive association between mTBI and criminal charges (odds ratio [OR], 1.26; 95% CI, 1.19-1.34) and convictions (OR, 1.24; 95% CI, 1.16-1.33). When controlling for family-level confounding, the associations became statistically insignificant and, in most models, greatly reduced. Results were robust across multiple model specifications., Conclusions and Relevance: This study found that although mTBI in childhood was predictive of adolescent criminal justice involvement, there was no evidence that mTBI caused criminal charges or convictions.

Background: Adiposity is a known risk factor for certain cancers; however, it is not clear whether the risk of cancer differs between individuals with high adiposity but different metabolic health status. The aim of this systematic literature review and meta-analysis of cohort studies was to evaluate associations between metabolic obesity phenotypes and overall and site-specific cancer risk., Methods: PubMed and Embase databases were used to identify relevant cohort studies up to the 6th of June 2023. Random-effects models were used to estimate summary relative risks (SRRs) and 95% confidence intervals (CIs) for the association between metabolic obesity phenotypes and cancer risk. Certainty of evidence was assessed using the Cochrane methods and the GRADE tool. This study is registered with PROSPERO, number CRD42024549511., Results: A total of 15,556 records were screened, and 31 publications covering 15 unique cohort studies were included in this analysis. Of these studies, 22 were evaluated as being at low risk of bias and 9 at moderate risk of bias. Compared to metabolically healthy normal-weight individuals (MHNW), metabolically unhealthy overweight/obese (MUOW/OB) individuals had a higher risk of overall (SRR = 1.21, 95% CI = 1.02-1.44, n = 3 studies, high certainty) and obesity-related cancers (SRR = 1.42, 95% CI = 1.15-1.74, n = 3, very low certainty). Specifically, MUOW/OB individuals were at higher risk of cancers of the postmenopausal breast (SRR = 1.32, 95% CI = 1.17-1.48, n = 7, low certainty), colorectum (SRR = 1.24, 95% CI = 1.16-1.31, n = 6, moderate certainty), endometrium (SRR = 2.31, 95% CI = 2.08-2.57, n = 4, high certainty), thyroid (SRR = 1.42, 95% CI = 1.29-1.57, n = 4, moderate certainty), kidney (SRR = 1.71, 95% CI = 1.40-2.10, n = 3, low certainty), pancreas (SRR = 1.35, 95% CI = 1.24-1.47, n = 3, high certainty), liver (SRR = 1.81, 95% CI = 1.36-2.42, n = 2, moderate certainty), gallbladder (SRR = 1.42, 95% CI = 1.17-1.73, n = 2, high certainty), bladder (SRR = 1.36, 95% CI = 1.19-1.56, n = 2, moderate certainty), and stomach (SRR = 1.50, 95% CI = 1.12-2.01, n = 2, high certainty). In addition, we found elevated risks of most of these cancers among individuals classified as MUNW and MHOW/OB phenotypes compared to those with MHNW phenotype. Our stratified analyses according to metabolic obesity phenotypes suggested that the elevated risks of some cancers were stronger in individuals with MUOW/OB versus those with MHOW/OB or MUNW phenotypes., Conclusion: These findings suggest that both higher adiposity and metabolic dysfunction were independently associated with increased risk of several cancers, with the strongest associations generally observed among those with both metabolic dysfunction and obesity., (© 2024. The Author(s).)

Background: Integrating artificial intelligence (AI) in healthcare settings has the potential to benefit clinical decision-making. Addressing challenges such as ensuring trustworthiness, mitigating bias, and maintaining safety is paramount. The lack of established methodologies for pre- and post-deployment evaluation of AI tools regarding crucial attributes such as transparency, performance monitoring, and adverse event reporting makes this situation challenging., Objectives: This paper aims to make practical suggestions for creating methods, rules, and guidelines to ensure that the development, testing, supervision, and use of AI in clinical decision support (CDS) systems are done well and safely for patients., Materials and Methods: In May 2023, the Division of Clinical Informatics at Beth Israel Deaconess Medical Center and the American Medical Informatics Association co-sponsored a working group on AI in healthcare. In August 2023, there were 4 webinars on AI topics and a 2-day workshop in September 2023 for consensus-building. The event included over 200 industry stakeholders, including clinicians, software developers, academics, ethicists, attorneys, government policy experts, scientists, and patients. The goal was to identify challenges associated with the trusted use of AI-enabled CDS in medical practice. Key issues were identified, and solutions were proposed through qualitative analysis and a 4-month iterative consensus process., Results: Our work culminated in several key recommendations: (1) building safe and trustworthy systems; (2) developing validation, verification, and certification processes for AI-CDS systems; (3) providing a means of safety monitoring and reporting at the national level; and (4) ensuring that appropriate documentation and end-user training are provided., Discussion: AI-enabled Clinical Decision Support (AI-CDS) systems promise to revolutionize healthcare decision-making, necessitating a comprehensive framework for their development, implementation, and regulation that emphasizes trustworthiness, transparency, and safety. This framework encompasses various aspects including model training, explainability, validation, certification, monitoring, and continuous evaluation, while also addressing challenges such as data privacy, fairness, and the need for regulatory oversight to ensure responsible integration of AI into clinical workflow., Conclusions: Achieving responsible AI-CDS systems requires a collective effort from many healthcare stakeholders. This involves implementing robust safety, monitoring, and transparency measures while fostering innovation. Future steps include testing and piloting proposed trust mechanisms, such as safety reporting protocols, and establishing best practice guidelines., (© The Author(s) 2024. Published by Oxford University Press on behalf of the American Medical Informatics Association.)

Background: Pre-eclampsia is a leading cause of maternal morbidity and mortality in the United States. Emerging data suggests that postpartum pre-eclampsia may be associated with a higher incidence of maternal morbidity compared to hypertensive disorders of pregnancy (HDP) diagnosed antenatally. Understanding postpartum maternal risk across facilities with a spectrum of obstetric services is critical with the rising rates of pre-eclampsia in all healthcare settings., Objective: We investigated the relationship between facility delivery volume and rates of nontransfusion severe maternal morbidity (SMM) among patients readmitted postpartum for pre-eclampsia with severe features., Study Design: This is a retrospective cohort study using the Nationwide Readmissions Database (2015-2019) of postpartum patients readmitted for pre-eclampsia with severe features. Our primary outcome was nontransfusion SMM during readmission, defined per U.S. Centers for Disease Control and Prevention criteria. We also evaluated SMM, cardiac SMM, and individual morbidities. The exposure variable was the number of annual deliveries at the readmitting facility. Restricted cubic splines with 4 knots were used to assess the functional form of the relationship between obstetric delivery volume and nontransfusion SMM; a linear relationship was identified as optimal. Logistic regression was used to estimate adjusted odds ratios (aOR) which controlled for maternal age, nontransfusion SMM at delivery, expanded obstetric comorbidity index, and HDP during delivery., Results: The cohort included 29,472 patients readmitted with postpartum pre-eclampsia with severe features. The primary payer was 55% private and 42% governmental. Median age was 31.4 years. Most patients did not have prior HDP (65%) or chronic hypertension (86%) diagnosis antenatally. The median interval from delivery hospitalization to readmission was 3.9 days (25th percentile-75th percentile: 2.2-6.5). Nontransfusion SMM occurred in 7% of patients readmitted to facilities with >2000 deliveries compared to 9% with 1 to 2000 deliveries, and 52% without any delivery hospitalizations. The most common SMM was pulmonary edema and heart failure, observed in 4% of readmissions. We observed that for every increase in 1000 deliveries, the odds of a nontransfusion SMM at readmission decreased by 3.5% (aOR: 0.965; 95% confidence interval: 0.94, 0.99)., Conclusion: Nontransfusion SMM for postpartum readmissions with pre-eclampsia with severe features was inversely associated with readmitting hospital delivery volume. This information may guide risk-reducing initiatives for identifying strategies to optimize postpartum care at facilities with lower or no delivery volume. El resumen está disponible en Español al final del artículo., (Copyright © 2024 Elsevier Inc. All rights reserved.)