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Background: Androgen deprivation therapy (ADT) is a common treatment modality for men with prostate cancer. Increases in adipose tissue mass and decreases in skeletal muscle mass are known on-target adverse effects of standard ADT. The effects of newer agents such as abiraterone acetate (ABI) and enzalutamide (ENZA) on body composition and how these compare with standard luteinizing hormone-releasing hormone agonists (aLHRHs) are unclear. Objective: To assess the effects of different forms of androgen deprivation therapy on body composition in men with prostate cancer. Design, setting, and participants: Using a retrospective design, 229 patients receiving aLHRHs alone (n = 120) or in combination with ABI (n = 53) or ENZA (n = 56) were studied. Outcome measurements and statistical analysis: Muscle, visceral adipose tissue (VAT), and subcutaneous adipose tissue (SAT) were assessed at baseline, 6 mo, and 18 mo after initiating therapy using a cross-sectional densitometry analysis performed on standard of care computed tomography images. Response trajectories for all treatment groups were calculated via a two-way analysis of variance post hoc test, for both within-group and between-group differences. Results and limitations: Treatment with aLHRHs, ABI, and ENZA was associated with a median muscle volume loss of –1.4%, –4.8%, and –5.5% at 6 mo, and –7.1%, –8.1%, and –8.3% at 18 mo, respectively. Therapy with aLHRHs was associated with minimal changes in VAT (0.3% at 6 mo and –0.1% at 18 mo). ABI therapy was associated with significant increases in VAT at 6 mo (4.9%) but not at 18 mo (0.5%), and ENZA therapy was associated with significant decreases in VAT (–4.6% at 6 mo and –5.4% at 18 mo). With respect to SAT, treatment with aLHRHs was associated with increases over time (8.6% at 6 mo and 4.7% at 18 mo), ABI was associated with decreases over time (–3.6% at 6 mo and –6.8% at 18 mo), and ENZA had no clear effects (1.7% at 6 mo and 3.3% at 18 mo). Conclusions: ADT regimens cause significant short-term losses in muscle mass, with the most rapid effects occurring with ABI and ENZA. The three regimens have disparate effects on SAT and VAT, suggesting distinct roles of androgens in these tissues. Patient summary: Androgen deprivation therapy alters body composition in men with prostate cancer. Abiraterone and enzalutamide are associated with losses in muscle mass compared with luteinizing hormone-releasing hormone agonists. These treatments impact subcutaneous and visceral fat mass, suggesting distinct roles of androgens in these tissues.

Invasive freshwater fish can often have severe negative effects on native fishes in river systems. The interactions between hydrology and habitat variability can mediate the speed and success of individual invasions and the consequent impact on biodiversity. The rivers within Addo Elephant National Park (AENP) in the Eastern Cape, South Africa experience cyclical droughts and wet periods and as a result are naturally episodic. These rivers were recently invaded by three non-native species, the invasive largemouth bass (Micropterus salmoides) as well as the extralimital sharptooth catfish (Clarias gariepinus) and Mozambique tilapia (Oreochromis mossambicus). Monitoring of key sampling sites along two rivers over a 12-year period that included two major droughts revealed unexpected patterns in the spread of these species and their interactions with native fishes. On the Coerney River, C. gariepinus repeatedly invaded and was extirpated from a seasonal reach of the river, wherein O. mossambicus was only occasionally captured. On the Wit River, two apparently independent introductions of M. salmoides in the lower and upper reaches of the river resulted in patchy habitat occupancy over the course of 12 years. While C. gariepinus regularly co-occurred with native species, M. salmoides appeared to locally extirpate the endangered Eastern Cape redfin (Pseudobarbus afer). During drought, both species persisted in close but disconnected pools, suggesting that the episodic hydrology and geomorphology of these rivers may offer temporary predation refugia for native species during drought. Conservation implications: Drought in episodic rivers can mitigate against the impact and spread of freshwater invasions within protected areas. Effects of drying on invasion corridors and spatial interactions with native species should be taken into consideration when managing such invasions. Severe droughts also offer an opportunity to actively control invasive species when they are confined to accessible drought refugia within the protected area.

Forests in the United States continue to lose biodiversity and many fail to regenerate due to high deer (family Cervidae) abundance. Declines in biodiversity and overall ecosystem health due to high deer populations increases prevalence of wildlife and human diseases associated with increasing tick abundances and decreases forest resilience and the ability to deliver benefits provided by healthy ecosystems. In the eastern and midwestern United States, white-tailed deer (Odocoileus virginianus) are the main stressor, while in the western U.S. elk (Cervus elaphus) and black-tailed and mule deer (Odocoileus hemionus) can become equally problematic. Federal and State Wildlife Agencies are responsible for environmental stewardship and management of deer, migratory and endangered species, yet they lack authority to address human health concerns or commercial interests (we acknowledge tribal authority to manage wildlife as an important contributor to conservation). Furthermore, State Wildlife Agencies have retained their traditional focus to manage wildlife for recreational hunters while neglecting their obligations to manage wildlife in the interest of all citizens rather than special interest groups. Fragmented institutional arrangements and widely scattered responsibilities for human health, environmental conservation and management, agriculture, and commerce among tribal, federal, and state agencies have allowed deer impacts to grow into nationwide conservation and human health crises. Given that local, regional, and state-level initiatives have failed to provide appropriate remedies, federal leadership is now essential to integrate concerns among disciplines, policy domains, regions, habitats, and biota. We recommend developing a National Strategy to build strong collaborative efforts and diverse and inclusive relationships across environmental, human health and economic interests. These should reach beyond state boundaries to comprehensively address interrelated deer, human health, forest, and conservation crises. A well-coordinated and collaborative approach has the potential to overcome traditional turf battles between tribal, state, and federal interests by recognizing joint responsibilities and obligations to manage wildlife as a public trust resource. This collective approach can protect species before they become endangered, avoiding further declines in environmental and human health.

BackgroundMen who have sex with men (MSM) are at high risk for human papillomavirus (HPV)-related anal cancer. Little is known about the prevalence of low-grade squamous intraepithelial lesions (LSILs) and the anal cancer precursor, high-grade squamous intraepithelial lesions (HSILs), among young MSM with HIV (MSMLWH). HPV vaccination is recommended in this group, but its safety, immunogenicity, and protection against vaccine-type HPV infection and associated LSILs/HSILs have not been studied.MethodsTwo hundred and sixty MSMLWH aged 18-26 years were screened at 17 US sites for a clinical trial of the quadrivalent (HPV6,11,16,18) HPV (qHPV) vaccine. Those without HSILs were vaccinated at 0, 2, and 6 months. Cytology, high-resolution anoscopy with biopsies of lesions, serology, and HPV testing of the mouth/penis/scrotum/anus/perianus were performed at screening/month 0 and months 7, 12, and 24.ResultsAmong 260 MSMLWH screened, the most common reason for exclusion was detection of HSILs in 88/260 (34%). 144 MSMLWH were enrolled. 47% of enrollees were previously exposed to HPV16. No incident qHPV type-associated anal LSILs/HSILs were detected among men naive to that type, compared with 11.1, 2.2, 4.5, and 2.8 cases/100 person-years for HPV6,11,16,18-associated LSILs/HSILs, respectively, among those previously exposed to that type. qHPV was immunogenic and safe with no vaccine-associated serious adverse events.Conclusions18-26-year-old MSMLWH naive to qHPV vaccine types were protected against incident qHPV type-associated LSILs/HSILs. Given their high prevalence of HSILs, there is an urgent need to vaccinate young MSMLWH before exposure to vaccine HPV types, before initiating sexual activity, and to perform catch-up vaccination.

After a long period of relative neglect, the mental well-being and the mental health of researchers and employees in academia are increasingly entering the limelight. The growing body of evidence suggests that a high number of doctoral researchers work under elevated levels of stress and frustration, and that this has a significant impact not only on their personal health and research output, but also on their future career development. In this paper, therefore, we first discuss what a dystopian and a utopian learning journey of early career researchers may look like from a well-being perspective. Subsequently, and based on extensive dialogues with more than 250 researchers and professionals active in the researcher mental health domain, we highlight a number of key focal points that both early career researchers, their supervisors, and institutions alike should consider when it comes to planning and delivering mental health oriented educational activities for doctoral researchers.

Background: Individuals with intellectual and developmental disabilities demonstrate disparities in sexual and reproductive health (SRH) compared to individuals without disabilities (e.g., lack of sexual education and knowledge, increased rates of abuse, unplanned pregnancies and sexually transmitted infections). Therefore, the purpose of this study was to identify topics healthcare providers address and perceived barriers and supports to SRH education. Methods: We conducted semi-structured interviews with healthcare providers (N = 12). Results: Providers address relationships, safety, protection and appropriate sexual behaviours with clients with intellectual and developmental disabilities. Parent education and client-centred care were identified as supports, while the patient's level of understanding, the provider's lack of knowledge or access to resources and to appropriate referrals were identified as barriers to SRH education. Conclusion: Future studies are needed to link providers to resources they can use to provide comprehensive, accessible SRH education for clients with intellectual and developmental disabilities.

Circulating autoantibodies (auto-Abs) neutralizing high concentrations (10 ng/mL, in plasma diluted 1 to 10) of IFN-α and/or -ω are found in about 10% of patients with critical COVID-19 pneumonia, but not in subjects with asymptomatic infections. We detect auto-Abs neutralizing 100-fold lower, more physiological, concentrations of IFN-α and/or -ω (100 pg/mL, in 1/10 dilutions of plasma) in 13.6% of 3,595 patients with critical COVID-19, including 21% of 374 patients > 80 years, and 6.5% of 522 patients with severe COVID-19. These antibodies are also detected in 18% of the 1,124 deceased patients (aged 20 days-99 years; mean: 70 years). Moreover, another 1.3% of patients with critical COVID-19 and 0.9% of the deceased patients have auto-Abs neutralizing high concentrations of IFN-β. We also show, in a sample of 34,159 uninfected subjects from the general population, that auto-Abs neutralizing high concentrations of IFN-α and/or -ω are present in 0.18% of individuals between 18 and 69 years, 1.1% between 70 and 79 years, and 3.4% >80 years. Moreover, the proportion of subjects carrying auto-Abs neutralizing lower concentrations is greater in a subsample of 10,778 uninfected individuals: 1% of individuals 80 years. By contrast, auto-Abs neutralizing IFN-β do not become more frequent with age. Auto-Abs neutralizing type I IFNs predate SARS-CoV-2 infection and sharply increase in prevalence after the age of 70 years. They account for about 20% of both critical COVID-19 cases in the over-80s, and total fatal COVID-19 cases.

BackgroundFactors that lead human papillomavirus (HPV) infections to persist and progress to cancer are not fully understood. We evaluated co-factors for acquisition, persistence, and progression of non-HPV-16/18 infections among HPV-vaccinated women.MethodsWe analyzed 2153 women aged 18-25 years randomized to the HPV-vaccine arm of the Costa Rica HPV Vaccine Trial. Women were HPV DNA negative for all types at baseline and followed for approximately 11 years. Generalized estimating equation methods were used to account for correlated observations. Time-dependent factors evaluated were age, sexual behavior, marital status, hormonally related factors, number of full-term pregnancies (FTPs), smoking behavior, and baseline body mass index.ResultsA total of 1777 incident oncogenic non-HPV-16/18 infections were detected in 12 292 visits (average, 0.14 infections/visit). Age and sexual behavior-related variables were associated with oncogenic non-HPV-16/18 acquisition. Twenty-six percent of incident infections persisted for ≥1 year. None of the factors evaluated were statistically associated with persistence of oncogenic non-HPV-16/18 infections. Risk of progression to Cervical Intraepithelial Neoplasia grade 2 or worst (CIN2+) increased with increasing age (P for trend = .001), injectable contraceptive use (relative risk, 2.61 [95% confidence interval, 1.19-5.73] ever vs never), and increasing FTPs (P for trend = .034).ConclusionsIn a cohort of HPV-16/18-vaccinated women, age and sexual behavior variables are associated with acquisition of oncogenic non-HPV-16/18 infections; no notable factors are associated with persistence of acquired infections; and age, parity, and hormonally related exposures are associated with progression to CIN2+.

BackgroundWomen living with HIV (WLWH) experience high rates of anal cancer. Screening using anal cytology, high-resolution anoscopy (HRA) with biopsies, can histologically diagnose anal cancer precursors called high-grade squamous intraepithelial lesions (HSIL). The low specificity of screening using anal cytology results in HRA referral for many WLWH without HSIL. Screening using high-risk human papillomavirus (HR-HPV) may improve specificity.MethodsTwo hundred seven WLWH (63% non-Hispanic black) were screened for anal histologic HSIL (hHSIL) using cytology, HRA-guided biopsies, and Xpert HPV. Xpert performance for predicting anal hHSIL was compared with that of cytology. Usng Xpert 5 HPV genotypic results and accompanying cycle thresholds, receiver operator characteristic curve and recursive partitioning analyses were used to create predictive models for hHSIL.ResultsThe performance of Xpert to predict hHSIL was not different from that of cytology with a sensitivity (Sn) of 89% and specificity (Sp) of 49%. Interpretation of Xpert was modified using genotypic results and receiver operator characteristic curve analysis, which produced a screen with an Sn and Sp of 75% and 84% for hHSIL, respectively. Another reinterpretation of Xpert was created using recursive partitioning and cycle thresholds, which predicted hHSIL with an Sn and Sp of 75% and 86%, respectively. The detection of HPV-16 was highly predictive of hHSIL in all analyses. These modified screening tests would reduce HRA referral in this population by almost half compared with anal cytology.ConclusionsXpert HPV is an alternative to anal cytology to screen for anal HSIL and can be optimized to reduce the number of unnecessary HRAs performed in WLWH.

Abstract Hamstring strain injuries (HSI) are one of the most common sport-related injuries. They have a high injury burden and a high recurrence rate. The development of novel muscle injury grading systems has provided new insights into the possible impact of injury location on the time to return to play (TTRTP) and re-injury following HSI. In particular, injuries to the intramuscular tendon (IMT) may be present in up to 41% of all HSI and have been described as a ‘serious thigh muscle strain’. Re-injury rates as high as 60% have been described in elite track and field athletes, as well as prolonged TTRTP. A systematic search was carried out using appropriate keywords to identify articles reporting on HSI involving the IMT in athletes. The primary aim was to determine whether IMT injuries warrant being classified as a distinct clinical entity with different expected outcomes to other hamstring muscle injuries. This narrative review summarises the existing evidence on: (1) the anatomy of the IMT and its response to injury; (2) the role of MRI and novel grading scales in IMT injury management (3) clinical assessment of IMT injuries, (4) TTRTP and re-injury rates across sports following IMT, (5) conservative rehabilitation and the role of specific ‘IMT-oriented’ strategies, and (6) indications for and approaches to surgery. The review found that important clinical outcomes such as re-injury rates and TTRTP vary across populations, cohorts and sports which suggest that outcomes are specific to the sporting context. Bespoke rehabilitation, tailored to IMT injury, has been shown to significantly reduce re-injuries in elite track and field athletes, without compromising TTRTP. Continued prospective studies across other sports and cohorts, are warranted to further establish relevant clinical findings, indications for surgical intervention and outcomes across other sporting cohorts.

While telemetry technology has undoubtedly revolutionized ecological research, the impacts to conservation remain in question. Conservation is, after all, an applied discipline with research that is intentionally designed to inform policies and practices that can demonstrably protect biodiversity. Though telemetry is a tool that is commonly used to raise conservation funding, the technology itself cannot generate these policies and practices. Rather, it is the outputs of the analytical processes interrogating the data deriving from telemetry systems that can do so. This distinction is not semantic but rather fundamental to creating more actionable research. We developed conceptual frameworks to delineate the pathways by which telemetry research can be structured to inform conservation policies, practices, and the decisions of funders motivated to support conservation. We demonstrate how the application of these frameworks can reduce the research-implementation gap so as to make biodiversity conservation more effective. While our assessment uses collaring as a case study, our conceptual frameworks are applicable to all research using animal-borne technology seeking to promote the recovery of species of conservation concern.

This paper summarizes a ground-motion database developed for the NGA-Sub Project. The database consists of two- and three-component ground-motion recordings from selected earthquakes in subduction zones. The database also includes the supporting data such as source, path, and site metadata. The earthquakes are located in Japan, Taiwan, the Pacific Northwest region of North America, Alaska, Mexico, Central and South America, and New Zealand. The events in the database are classified as interface, intraslab, or outer-rise, and have magnitudes ranging from 4 to 9. The database includes more than 71,000 three-component recordings, most of which are from digital accelerograms. The database includes PGA, PGV, pseudo-spectral acceleration for eleven damping values between 0.5% and 30%, Fourier amplitude spectra for frequencies from 0.1 to 100 Hz, and significant-shaking durations based on Arias Intensity. These data are analyzed in the project to model various ground-motion properties.

Immunogenomics studies have been largely limited to individuals of European ancestry, restricting the ability to identify variation in human adaptive immune responses across populations. Inclusion of a greater diversity of individuals in immunogenomics studies will substantially enhance our understanding of human immunology.

ObjectivesThe Lower Anogenital Squamous Terminology (LAST) recommendations classify human papillomavirus-associated squamous lesions into low- and high-grade squamous intraepithelial lesions (LSILs/HSILs). Our study aimed to assess interobserver agreement among 6 experienced pathologists in assigning 40 anal lesions previously diagnosed as anal intraepithelial neoplasia 2 (AIN 2) to either HSIL or non-HSIL categories.MethodsAgreement based on photomicrographs of H&E alone or H&E plus p16 immunohistochemistry was calculated using κ coefficients.ResultsAgreement was fair based on H&E alone (κ = 0.42; 95% confidence interval [CI], 0.34-0.52). Adding p16 improved agreement to moderate (κ = 0.55; 95% CI, 0.54-0.62). On final diagnosis, 21 cases (53%) had unanimous diagnoses, and 19 (47%) were divided. When designating p16 results as positive or negative, agreement was excellent (κ = 0.92; 95% CI, 0.83-0.95). Among variables (staining location, extent, and intensity), staining of the basal/parabasal layers was a consistent feature in cases with consensus for positive results (20/20). Of the 67 H&E diagnoses with conflicting p16 results, participants modified 32 (48%), downgrading 23 HSILs and upgrading 9 non-HSILs.ConclusionsAlthough p16 increased interobserver agreement, disagreement remained considerable regarding intermediate lesions. p16 expression, particularly if negative, can reduce unwarranted HSIL diagnoses and unnecessary treatment.

Surgical simulators are crucial in early craniofacial and plastic surgical training, necessitating synthetic materials that accurately replicate tissue properties. Recent critiques of our lab’s currently deployed silicone surrogate have highlighted numerous areas for improvement. To further refine our models, our group’s objective is to find a composition of materials that is closest in fidelity to native oral mucosa during surgical rehearsal by expert craniofacial surgeons. Fifteen platinum silicone-based surrogate samples were constructed with variable hardness and slacker percentages. These samples underwent evaluation of tactile sensation, hardness, needle puncture, cut resistance, suture retention, defect repair, and tensile elasticity. Expert craniofacial surgeon evaluators provided focused qualitative feedback on selected top-performing samples for further assessment and statistical comparisons. An evaluation revealed surrogate characteristics that were satisfactory and exhibited good performance. Sample 977 exhibited the highest performance, and comparison with the original surrogate (sample 810) demonstrated significant improvements in critical areas, emphasizing the efficacy of the refined composition. The study identified a silicone composition that directly addresses the feedback received by our team’s original silicone surrogate. The study underscores the delicate balance between biofidelity and practicality in surgical simulation. The need for ongoing refinement in surrogate materials is evident to optimize training experiences for early surgical learners.

Camera-based object detection is integral to advanced driver assistance systems (ADAS) and autonomous vehicle research, and RGB cameras remain indispensable for their spatial resolution and color information. This study investigates exposure time optimization for such cameras, considering image quality in dynamic ADAS scenarios. Exposure time, the period during which the camera sensor is exposed to light, directly influences the amount of information captured. In dynamic scenarios, such as those encountered in typical driving scenarios, optimizing exposure time becomes challenging due to the inherent trade-off between Signal-to-Noise Ratio (SNR) and motion blur, i.e., extending exposure time to maximize information capture increases SNR, but also increases the risk of motion blur and overexposure, particularly in low-light conditions where objects may not be fully illuminated. The study introduces a comprehensive methodology for exposure time optimization under various lighting conditions, examining its impact on image quality and computer vision performance. Traditional image quality metrics show a poor correlation with computer vision performance, highlighting the need for newer metrics that demonstrate improved correlation. The research presented in this paper offers guidance into the enhancement of single-exposure camera-based systems for automotive applications. By addressing the balance between exposure time, image quality, and computer vision performance, the findings provide a road map for optimizing camera settings for ADAS and autonomous driving technologies, contributing to safety and performance advancements in the automotive landscape.