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Objective: Assess the association of BMI and BMI change with mortality. Methods: Using data from the Wisconsin Longitudinal Study (WLS) on participants born mainly in 1939 ( n=4922), we investigated the associations between various measures of BMI across the life course (age 54 BMI; age 65 BMI; age 72 BMI; lifetime maximum BMI; BMI change between ages 54 and 65; BMI change between ages 65 and 72) and mortality. We also assessed whether these associations are mediated by late life health. Results: BMI at age 54 was more strongly associated with late life mortality than BMI at older ages. The association between BMI change and mortality varied based on the timing of weight change. Health at age 72, particularly self-rated health, diabetes, and physical functioning, mediated the observed associations. Conclusion: Knowing older people’s weight at midlife and how their weight has changed may be more important in assessing late life mortality risk than their current weight.

Congenital diaphragmatic hernia (CDH) is often detectable prenatally. Advances in genetic testing have made it possible to obtain a molecular diagnosis in many fetuses with CDH. Here, we review the aneuploidies, copy number variants (CNVs), and single genes that have been clearly associated with CDH. We suggest that array-based CNV analysis, with or without a chromosome analysis, is the optimal test for identifying chromosomal abnormalities and CNVs in fetuses with CDH. To identify causative sequence variants, whole exome sequencing (WES) is the most comprehensive strategy currently available. Whole genome sequencing (WGS) with CNV analysis has the potential to become the most efficient and effective means of identifying an underlying diagnosis but is not yet routinely available for prenatal diagnosis. We describe how to overcome and address the diagnostic and clinical uncertainty that may remain after genetic testing, and review how a molecular diagnosis may impact recurrence risk estimations, mortality rates, and the availability and outcomes of fetal therapy. We conclude that after the prenatal detection of CDH, patients should be counseled about the possible genetic causes of the CDH, and the genetic testing modalities available to them, in accordance with generally accepted guidelines for pretest counseling in the prenatal setting.

Objective: Our goal was to analyze the electrophysiological response to direct electrical stimulation (DES) systematically applied at a wide range of parameters and anatomical sites, with particular focus on neural activities associated with memory and cognition. Methods: We used a large set of intracranial EEG (iEEG) recordings with DES from 45 subjects with electrodes implanted both subdurally on the cortical surface and subcortically into the brain parenchyma. Subjects were stimulated in blocks of alternating frequency and amplitude parameters during quiet wakefulness. Results: Stimulating at different frequencies and amplitudes of electric current revealed a persistent pattern of response in the slow and the fast neural activities. In particular, amplification of the theta (4–7 Hz) and attenuation of the gamma (29–52 Hz) power-in-band was observed with increasing the stimulation parameters. This opposite effect on the low and high frequency bands was found across a network of selected local and distal sites proportionally to the proximity and magnitude of the electric current. Power increase in the theta and decrease in the gamma band was driven by the total electric charge delivered with either increasing the frequency or amplitude of the stimulation current. This inverse effect on the theta and gamma activities was consistently observed in response to different stimulation frequencies and amplitudes. Conclusion: Our results suggest a uniform DES effect of amplifying theta and suppressing gamma neural activities in the human brain. Significance: These findings reveal the utility of simple power-in-band features for understanding and optimizing the effects of electrical stimulation on brain functions.

BACKGROUND The need for scalable delivery of mental health care services that are efficient and effective is now a major public health priority. Artificial intelligence (AI) tools have the potential to improve behavioral healthcare services by helping clinicians collect objective data on patients’ progress, streamline their workflow, and automate administrative tasks. OBJECTIVE To determine the feasibility, acceptability, and preliminary efficacy of an AI platform for behavioral health in facilitating better clinical outcomes for patients receiving outpatient therapy. METHODS The study was conducted at a community-based clinic in the U.S. Participants were 47 adults referred for outpatient, individual cognitive behavioral therapy for a main diagnosis of a depressive or anxiety disorder. The platform provided by Eleos Health compared to treatment-as-usual (TAU) during the first two months of therapy. This AI platform summarizes and transcribes the therapy session, provides feedback to therapists on the usage of evidence-based practices (EBPs), and integrates these data with routine standardized questionnaires completed by patients. The information is also used to draft the session’s progress note. Patients were randomized to receive either therapy provided with the support of an AI platform developed by Eleos Health or TAU at the same clinic. Data analysis was carried out based on intention-to-treat from December 2022 to January 2023. The primary outcomes included the feasibility and acceptability of the AI platform. Secondary outcomes included changes in depression (Patient Health Questionnaire-9) and anxiety (Generalized Anxiety Disorder-7) scores as well as treatment attendance, satisfaction, and perceived helpfulness. RESULTS Seventy-two patients were approached, of whom 47 (67%) agreed to participate. Participants were adults (34 [72.34%] women and 13 [27.65%] men; mean [SD] age was 30.64 [11.02] years old), 23 randomized to the AI platform group, and 24 to TAU. Participants in the AI group attended, on average, 67% more sessions (n = 5.24, SD = 2.31) than those in TAU (n = 3.14, SD = 1.99). Depression and anxiety symptoms were reduced by 34% and 29% in the AI platform group versus 20% and 8% for TAU, respectively, with large effect sizes for the therapy delivered with the support of the AI platform. No group difference was found in 2-month treatment satisfaction and perceived helpfulness. CONCLUSIONS In this RCT, therapy provided with the support of Eleos Health demonstrated superior depression and anxiety outcomes as well as patient retention, compared with TAU. These findings suggest that complementing the mental health services provided in community-based clinics with an AI platform specializing in behavioral treatment was more effective in reducing key symptoms than standard therapy. CLINICALTRIAL ClinicalTrials.gov NCT05745103

The intra-uterine components of labor, namely, myometrial contractility, cervical ripening, and decidua/membrane activation, have been extensively characterized and involve a local pro-inflammatory milieu of cellular and soluble immune mediators. Targeted profiling has demonstrated that such processes extend to the intra-amniotic space, yet unbiased analyses of the proteome of human amniotic fluid during labor are lacking. Herein, we utilized an aptamer-based platform to characterize 1,310 amniotic fluid proteins and found that the proteome undergoes substantial changes with term labor (251 proteins with differential abundance, q 1.25). Proteins with increased abundance in labor are enriched for immune and inflammatory processes, consistent with prior reports of labor-associated changes in the intra-uterine space. By integrating the amniotic fluid proteome with previously generated placental-derived single-cell RNA-seq data, we demonstrated the labor-driven upregulation of signatures corresponding to stromal-3 and decidual cells. We also determined that changes in amniotic fluid protein abundance are reflected in the maternal plasma proteome. Collectively, these findings provide novel insights into the amniotic fluid proteome in term labor and support its potential use as a source of biomarkers to distinguish between true and false labor by using maternal blood samples.

Background: The need for scalable delivery of mental health care services that are efficient and effective is now a major public health priority. Artificial intelligence (AI) tools have the potential to improve behavioral healthcare services by helping clinicians collect objective data on patients’ progress, streamline their workflow, and automate administrative tasks.Objective: To determine the feasibility, acceptability, and preliminary efficacy of an AI platform for behavioral health in facilitating better clinical outcomes for patients receiving outpatient therapy.Methods: The study was conducted at a community-based clinic in the U.S. Participants were 47 adults referred for outpatient, individual cognitive behavioral therapy for a main diagnosis of a depressive or anxiety disorder. The platform provided by Eleos Health compared to treatment-as-usual (TAU) during the first two months of therapy. This AI platform summarizes and transcribes the therapy session, provides feedback to therapists on the usage of evidence-based practices (EBPs), and integrates these data with routine standardized questionnaires completed by patients. The information is also used to draft the session’s progress note. Patients were randomized to receive either therapy provided with the support of an AI platform developed by Eleos Health or TAU at the same clinic. Data analysis was carried out based on intention-to-treat from December 2022 to January 2023. The primary outcomes included the feasibility and acceptability of the AI platform. Secondary outcomes included changes in depression (Patient Health Questionnaire-9) and anxiety (Generalized Anxiety Disorder-7) scores as well as treatment attendance, satisfaction, and perceived helpfulness. Results: Seventy-two patients were approached, of whom 47 (67%) agreed to participate. Participants were adults (34 [72.34%] women and 13 [27.65%] men; mean [SD] age was 30.64 [11.02] years old), 23 randomized to the AI platform group, and 24 to TAU. Participants in the AI group attended, on average, 67% more sessions (n = 5.24, SD = 2.31) than those in TAU (n = 3.14, SD = 1.99). Depression and anxiety symptoms were reduced by 34% and 29% in the AI platform group versus 20% and 8% for TAU, respectively, with large effect sizes for the therapy delivered with the support of the AI platform. No group difference was found in 2-month treatment satisfaction and perceived helpfulness. Further, therapists using the AI platform submitted their progress notes, on average, 55 hours earlier than therapists in the TAU group (t = -.73, p < .001). Conclusions: In this RCT, therapy provided with the support of Eleos Health demonstrated superior depression and anxiety outcomes as well as patient retention, compared with TAU. These findings suggest that complementing the mental health services provided in community-based clinics with an AI platform specializing in behavioral treatment was more effective in reducing key symptoms than standard therapy. Trial Registration: ClinicalTrials.gov NCT05745103

Conservatives are more likely than liberals to support the concept of federalism. In this article, we look at this support in the context of particular issues. Using multiple national surveys, including an original module on the 2020 Congressional Election Study, we find that conservatives are more likely to prefer a devolution of power to state and local jurisdictions, even if doing so might make it harder to achieve conservative policy aims, whereas liberals are more instrumental, more likely to prioritize policy aims and to support whichever level of government seems most likely to achieve them. We then examine reasons why conservatives might display a stronger adherence to the federalist structure of the American government. We find that the idea of “states’ rights” continues to loom large for self-identified conservatives, as does a generalized level of trust toward political units described as small versus large.

Hearing loss has been associated with individual cardiovascular disease (CVD) risk factors and, to a lesser extent, CVD risk metrics. However, these relationships are understudied in clinical populations. We conducted a retrospective study of electronic health records to evaluate the relationship between hearing loss and CVD risk burden. Hearing loss was defined as puretone average (PTA0.5,1,2,4) > 20 dB hearing level (HL). Optimal CVD risk was defined as nondiabetic, nonsmoking, systolic blood pressure (SBP)

In Córdoba Spanish, speech has been hypothesized to consist of wide f0 range and a lengthened pre-tonic syllable in nuclear (phrase-final, accented) position. Proposed correlates of pre-tonic lengthening are analyzed in read and conversational speech, and visual analyses of f0 contours are conducted across both speech styles. In Study 1, speakers recited three repetitions of 40 utterances in which the number of pre-tonic syllables in target words and the prosodic position of those targets were manipulated. Study 2 investigates the same variables in a corpus of informal conversation. The results support many claims made in previous, impressionistic studies: Córdoba Spanish possesses lengthened pre-tonic syllables in which f0 range increases as does lengthening. However, the length discrepancy between the pre-tonic and the tonic vowels is greatest in pre-nuclear rather than nuclear position. This is attributed to phrase-final lengthening of the tonic—but not the pre-tonic—syllable, which provides evidence that lexical stress is at most weakly correlated to duration in this variety. Nuclear accents in read speech were level (L*), but in conversational data they were falling (H+L*), both of which are common to Spanish. However, while the rising prenuclear accents have delayed peaks like many other varieties (L+>H*), they possess a local minimum in the pre-tonic syllable and a gradual ascent through the tonic syllable toward a high tone in the post-tonic. This ‘long rise’ voids the tonic syllable of an f0 critical point and may distinguish Córdoba from other varieties of Spanish.

Surveillance data indicate that food security rates increased among Supplemental Nutrition Assistance Program (SNAP) participants during the COVID-19 pandemic (2020 and 2021) compared with pre-pandemic (2019), but this could have been due to increased participation from better resourced households. Our objective was to examine if demographic differences between SNAP-participating households in each year were responsible for the increased prevalence of food secure households. We calculated the observed 30-d food security prevalence among SNAP-participating households for each year. We used indirect standardisation to produce expected 2020 and 2021 prevalences with 2019 as the standard population using household size, income, age, sex, race, Hispanic ethnicity, presence of children, single parent household, metropolitan status and census region. We calculated standardised prevalence ratios (SPRs) to understand if the observed prevalence was higher than expected given any changes in the demographic profile compared to 2019. The Current Population Survey data were collected by the United States Census Bureau and Department of Agriculture. Our sample included 5,245 SNAP-participating households. The observed prevalence of food secure households increased by 3⋅6 percentage points comparing 2019 to 2020 (SPR = 1⋅06, 95 % confidence interval = 1⋅00, 1⋅11) and by 8⋅6 percentage comparing 2019 to 2021 (SPR = 1⋅13, 95 % confidence interval = 1⋅07, 1⋅18). The greater prevalence of food secure SNAP households during the pandemic did not appear to be attributable to socio-demographic differences compared to pre-pandemic. Despite hesitance among policymakers to expand or enhance social safety net programmes, permanently incorporating COVID-19-related policy interventions could lessen food insecurity in years to come.

Background Osteoarthritis (OA) is the most common form of arthritis, with the knee being the joint most frequently affected, and symptomatic knee OA affecting around one quarter of the general population. For patients who do not respond to non-pharmacologic or pharmacologic treatment, surgery is a recommended option. The objectives of this study were to compare the willingness of patients with knee OA to undergo surgery, together with reasons for delaying surgery, and factors affecting successful outcomes. Methods A point-in-time survey was conducted in 729 primary care physicians, rheumatologists, orthopedic surgeons, and 2,316 patients with knee OA across three geographical regions: Japan, the United States (US), and Europe (EUR: France, Spain, Italy, Germany, and the United Kingdom), in order to garner their perceptions of knee surgery. Regression models were used to identify factors that might affect patients’ and physicians’ perceptions of surgery, including severity of OA (mild/moderate/severe), number of affected joints, surgery status, and willingness to undergo or delay surgery. Results Baseline demographics were similar between US and EUR, although patients in Japan were more likely to be female, older, and only 7% in fulltime employment. We found that few patients with end-stage knee OA, across all regions, but particularly Japan, were willing to undergo surgery (Japan 17%, US 32%, EUR 38%), either through fear, or the lack of awareness of the risk/benefits. Moreover, surgeons are prepared to delay surgery in elderly or unwilling patients, due to their dissatisfaction with the outcome, and may defer surgery in younger patients due to the need for future revision. We also identified a disconnect between physicians, of whom over 80% consider improved functioning to be the most important outcome of surgery, and patients, who seek pain relief (Japan 60%, US 35%, EUR 14%). Since physicians across all regions considered pain reduction to be an indication of surgery success (Japan 27%, US 47%, EUR 43%), this may indicate a need for improved communication to patients on the potential benefits of surgery. Conclusion Managing the expectations of patients undergoing surgery remains an important goal in the treatment of knee OA and may help guide physician choice.