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ABSTRACTBackground: Women have twice the lifetime prevalence of posttraumatic stress disorder (PTSD) relative to men, and PTSD is a known risk factor for cardiovascular disease (CVD). Two sex hormones – estradiol and progesterone – have been found to impact both PTSD and CVD symptomatology, but the way in which sex hormones influence cardiovascular physiology among individuals with PTSD is not well understood.Objective: This study sought to clarify the association between sex hormones, PTSD, and CVD among trauma-exposed women.Method: Sixty-six trauma-exposed women (M age = 31.45, SD = 8.92) completed a clinical interview for PTSD and self-reported CVD symptoms; estradiol and progesterone were assayed from blood samples. The association between each sex hormone and CVD symptoms was analyzed, controlling for age, systolic blood pressure (BP), and diastolic BP.Results: Neither estradiol nor the PTSD-by-estradiol interaction was significantly associated with CVD symptoms. Higher progesterone and, relatedly, progesterone-to-estradiol ratio (PE ratio) were each significantly associated with greater CVD symptom severity, but only for individuals with lower relative PTSD severity.Conclusions: The findings indicate that PTSD moderates the relationship between progesterone and CVD symptoms, and further research is warranted to reconcile findings in existing literature regarding the direction of and mechanisms behind this relationship.

Background: Liver cirrhosis is not included in surgical risk prediction models despite being a significant risk factor associated with high periprocedural morbidity and mortality in patients undergoing cardiac surgery. Limited contemporary data exists assessing the outcomes of transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR) in patients with cirrhosis. Methods: Patients with cirrhosis who underwent TAVR or SAVR were identified from the Nationwide Readmissions Database. Propensity-score matched analysis was performed to compare the clinical characteristics, in-hospital, and 30-day outcomes between the two groups. Results: Between 2016 and 2019, 4047 patients with cirrhosis underwent TAVR (n = 3298) or SAVR (n = 749). TAVR adoption sharply rose, doubling the number of cases performed during the study period. Following propensity matching among 718 patients, the TAVR group consistently exhibited significantly lower rates of in-hospital mortality (2.2 vs. 7.5%; p = 0.002), bleeding (14.5 vs. 52.9%; p < 0.001), vascular complications (1.4 vs. 5%; p = 0.011), hepatorenal syndrome (3.3 vs. 8.9%; p = 0.003), cardiogenic shock (2.8 vs. 7%; p = 0.015), mechanical circulatory support utilization (0.6 vs. 4.7%; p = 0.001), 30-day all-cause readmission rates (10.3 vs. 18.1%; p = 0.005), and 30-day unplanned readmission rates (10 vs. 16.6%; p = 0.015) compared to the SAVR group. The TAVR group had significantly shorter median hospital stays, lower non-home disposition rates, and reduced hospital costs. Conclusions: TAVR is associated with significantly lower rates of in-hospital mortality, bleeding, vascular complications, hepatorenal syndrome, cardiogenic shock, mechanical circulatory support utilization, and 30-day readmission rates compared to SAVR and represents a safe therapeutic option for aortic valve replacement in patients with cirrhosis.

The 1064-nm Nd:YAG laser in Q-switched and micropulsed modes has been used in rejuvenation, pore reduction, skin texture improvement, and wrinkle reduction. The aim of this study is to evaluate the combination of 1064-nm Nd:YAG laser in micropulsed and Q-switched modes in the same session for global facial treatment. Thirty female patients underwent six treatment sessions every two weeks. Three blinded dermatologists evaluated the results through clinical photographs and Visia® or Focco® images obtained before and 30 days after the last treatment session. The parameters of interest were solar melanosis, telangiectasias, wrinkles, dilated pores, melasma and skin texture. Three patients had face biopsies before and 30 days after the end of treatment. Most patients showed improvement in all evaluated parameters, except for two patients who had worsening of melasma. An increase in collagen was observed in two of the three histological examinations performed after treatment. The combination of laser modes studied herein offers a safe treatment that can improve wrinkles, skin texture, and laxity with minimal downtime.

ObjectivesThe Inside CKD programme implemented a microsimulation modelling approach to project the clinical and economic burden of chronic kidney disease (CKD) between 2024 and 2027 in Hungary.MethodsUsing the peer-reviewed Inside CKD microsimulation, a virtual Hungarian population was generated that was derived from national records, local demographic data and published epidemiological data. These inputs defined the likelihood of a change in health state for each individual as they progressed through the model in annual increments. Individual CKD status, including disease progression, cardiorenal complications and associated costs, was tracked annually to generate the population-level projections of the clinical and economic burden of CKD.ResultsBy 2027, people with CKD were projected to constitute 13.3% of the Hungarian national population. The prevalence of heart failure, myocardial infarction and stroke in people with CKD were projected to remain consistently high, reaching 323 447, 69 188 and 120 118 by 2027, respectively. Kidney replacement therapy cases were predicted to remain high at 20 515 in 2024 and 22 325 in 2027, with associated costs increasing from 71.4 billion HUF in 2024 to 79.6 billion HUF in 2027. Total annual healthcare costs associated with treating CKD were projected to constitute 5.4% of the overall national healthcare budget in 2027.ConclusionsInside CKD demonstrates that the future burden of CKD in Hungary will be substantial unless current management strategies change. The high prevalence of undiagnosed CKD and associated cardiorenal complications highlight the urgent need for policy interventions focused on early diagnosis and timely intervention to mitigate the future burden of CKD.

Abstract Chlorophyll in phytoplankton absorbs solar radiation (SR) and affects the thermal structure and dynamics within upwelling regions. However, research on this process across global‐scale coastal upwelling systems is still lacking. Here, we use a coupled ocean‐biogeochemical model to investigate differing responses to chlorophyll‐induced solar absorption between Pacific and Atlantic coastal upwelling regions. Chlorophyll‐induced solar absorption leads to colder Pacific coastal upwelling but warmer Atlantic coastal upwelling. In the Pacific, the shading effect of the surface chlorophyll maximum leads to colder subsurface water, which is then upwelled, contributing to cooling. The more stratified upper ocean leads to shallower mixed layer depth, intensifying offshore transport and upwelling. In the Atlantic, the absorption of SR by the subsurface chlorophyll maximum causes warmer and weaker upwelling. The processes described, in turn, trigger positive feedback to ocean biogeochemistry and potentially interact with climate dynamics, underscoring the necessity to incorporate them into Earth system models.

Abstract A linear relationship between rates of physical erosion and chemical weathering is apparent in slowly eroding landscapes. Whether the relationship remains linear in rapidly eroding landscapes is less clear. Field‐based research into this relationship between erosion and weathering rates has largely been conducted in temperate climates with granitic bedrock. In tropical settings, the contribution of chemical mass loss to total denudation may approach, or even exceed, that of erosion. We report 10Be‐in‐quartz cosmogenic radionuclide and soil chemistry data from the Suckling‐Dayman Metamorphic Core Complex (SDMCC) in Papua New Guinea. Despite being exhumed at cm‐per‐year rates, its lower‐plate domed and striated morphology suggests minimal denudation, which is confirmed by our 10Be‐in‐quartz data (0.02–0.18 mm/yr). We suggest that rolling hinge‐style back‐rotation of the SDMCC's lower plate and the combination of a tropical climate and highly weatherable metabasalt bedrock have played a fundamental role in preserving the tectonic topography of this remarkable metamorphic core complex.

Parent engagement is one approach to decrease the opportunity gap for Black, American Indian, and all children of color. This report from the field describes the use of the World Café participatory approach to support parent engagement in five early childhood, culturally embedded Montessori programs. Serving the Whole Child (SWC) is a community-university partnership between St. Catherine University, Montessori Center of Minnesota, five early childhood Montessori schools, and school parent leaders. Using a participatory approach, parent leaders from each school co-designed the development, implementation, and analysis of the World Café. The World Café asked school parents what was working and what parents needed help with related to three topics: parent well-being, caring for a young child, and school-community connection. Each World Café was tailored to honor the school's unique community, cultural values, and family needs. Parent leaders synthesized and coordinated with schools to develop offerings to meet the priorities of the recommendations and key topics. World Café is a participatory process that may increase parent leadership and school engagement in ways that support caregiving and child success.

Accurate estimates of vital rates like survival and reproduction are the foundation for endangered species management and recovery planning. Where new data are collected, analyses and conservation actions can be updated according to the best available knowledge. In this short communication, we update vital rate estimates for the Hawaiian Common Gallinule (Gallinula galeata sandvicensis), an endangered subspecies endemic to the Hawaiian Islands of Kaua'i and O'ahu, using newly available field data. These new data more than double the sample size used for initial vital rate estimates from a 2018 publication, and include the first ever published estimates of brood survival for this subspecies. The latter is considered a major knowledge gap for population modeling and conservation planning for this taxon. We estimated the mean probability of brood survival for the first month post-hatch at 0.90 for both islands combined, 0.82 on Kaua'i and 0.98 on O'ahu. For both populations combined, we observed a smaller mean clutch size (4.76 vs. 5.10), similar mean nest success (0.64 vs. 0.66), similar brood size (2.55 vs. 2.51), lower brood size per successful nest (3.77 vs. 3.86), and similar hatch rate (0.53 vs. 0.52) to the original study published in 2018. Received 13 May 2023. Accepted 28 December 2023. Key words: brood survival, chick survival, citizen science, nest success, Rallidae, wildlife management. Las estimaciones precisas de tasas vitales como supervivencia y reproducion son la base para la gestion de especies amenazadas y la planificacion de su recuperation. Cuando se recopilan nuevos datos, los analisis y acciones de conservation se deben actualizar de acuerdo con el mejor conocimiento disponible. En este articulo, actualizamos las estimaciones de las tasas vitales para Gallinula galeata sandvicensis, una subespecie en peligro y endemica de las islas hawaianas de Kaua'i y O'ahu, utilizando datos de campo recientemente disponi-bles. Estos nuevos datos aumentan la cantidad de datos de muestra utilizado para las estimaciones iniciales de las tasas vitales en el manuscrito original publicado en 2018. Ademas, describe las pri-meras estimaciones publicadas de la supervivencia de los polluelos durante el primer mes posterior a la eclosion para esta subespecie. El promedio de los datos de supervivencia fue 0.90 para ambas islas combinadas, 0.82 en Kaua'i y 0.98 en O'ahu. Para ambas poblaciones combinadas, se observe>> un promedio de nidada mas pequeno (4.76 contra 5.10), una tasa de exito de anidacion media similar (0.64 contra 0.66), tamano de cria similar (2.55 contra 2.51), menor tamano de cria por nido exitoso (3.77 contra 3.86), y una tasa de eclosion similar (0.53 contra 0.52) que el estudio original publicado en 2018, con un tamano de muestra 2 veces mayor del estudio original. Palabras clave: ciencia ciudadana. exito de anidacion, manejo de fauna silvestre. Rallidae, sobrevivencia de polluelos, sobrevivencia de puesta., Effective management planning for endangered species depends in part on accurate vital rate estimates (Beissinger and Westphal 1998, Reed et al. 2002). Vital rates include metrics of reproduction and survival [...]

Commercially-available location-based services (LBS) data derived primarily from mobile devices may provide an alternative to surveys for monitoring physically-active transportation. Using Spearman correlation, we compared county-level metrics of walking and bicycling from StreetLight with metrics of physically-active commuting among U.S. workers from the American Community Survey. Our strongest pair of metrics ranked counties (n = 298) similarly for walking (rho = 0.53 [95% CI: 0.44-0.61]) and bicycling (rho = 0.61 [0.53-0.67]). Correlations were higher for denser and more urban counties. LBS data may offer public health and transportation professionals timely information on walking and bicycling behavior at finer geographic scales than some existing surveys.

Abstract Introduction Gout, a common comorbidity of chronic kidney disease (CKD), is associated with high morbidity and healthcare utilization. However, a large proportion of gout remains undermanaged or untreated which may lead to worse patient outcomes and greater healthcare costs. This study estimates the present and future health and economic burden of controlled and uncontrolled gout in a virtual United States (US) CKD population. Methods A validated microsimulation model was used to project the burden of gout in patients with CKD in the USA through 2035. Databases were utilized to build a virtual CKD population of “individuals” with controlled or uncontrolled gout. Modelling assumptions were made on the basis of the literature, which was sparse in some cases. Health and economic outcomes with the current care (baseline) scenario were evaluated, along with potential benefits of urate-lowering intervention scenarios. Results The prevalence of comorbid gout and CKD in the USA was projected to increase by 29%, from 7.9 million in 2023 to 9.6 million in 2035 in the baseline scenario. Gout flares, tophi, and comorbidity development were also projected to increase markedly through 2035, with the economic burden of gout in the CKD population subsequently increasing from $38.9 billion in 2023 to $47.3 billion in 2035. An increased use of oral urate-lowering therapies in undermanaged patients, and pegloticase use in patients refractory to oral urate-lowering therapies were also project to result in 744,000 and 353,000 fewer uncontrolled gout cases, respectively, by 2035. Marked reductions in complications and costs ensued. Conclusions This study projected a substantial increase in comorbid gout and CKD. However, improved use of urate-lowering interventions could mitigate this growth and reduce the health and economic burdens of gout.

Abstract Density dependence is a fundamental ecological process. In particular, animal habitat selection and social behavior often affect fitness in a density-dependent manner. The Ideal Free Distribution (IFD) and niche variation hypothesis (NVH) present distinct predictions associated with Optimal Foraging Theory about how the effect of habitat selection on fitness varies with population density. Using caribou (Rangifer tarandus) in Canada as a model system, we test competing hypotheses about how habitat specialization, social behavior, and annual reproductive success (co)vary across a population density gradient. Within a behavioral reaction norm framework, we estimate repeatability, behavioral plasticity, and covariance among social behavior and habitat selection to investigate the adaptive value of sociality and habitat selection. In support of NVH, but not the IFD, we find that at high density habitat specialists had higher annual reproductive success than generalists, but were also less social than generalists, suggesting the possibility that specialists were less social to avoid competition. Our study supports niche variation as a mechanism for density-dependent habitat specialization.

Abstract Purpose It has previously been shown that organic acids produced by Escherichia coli suppress the growth of Pseudomonas aeruginosa in co-cultures under conditions of glucose excess, due to overflow metabolism. Inactivation of genes involved in central carbon metabolism favours fermentation of glucose over respiration and therefore increases production of organic acid by-products such as acetate and lactate. We sought to extend and refine the list of genes known to contribute to the metabolic balance between respiration and fermentation, to better understand the role of overflow metabolism in competitive survival of E. coli. Methods We confirmed the previous finding that E. coli excludes P. aeruginosa from co-cultures by producing organic acids in the presence of glucose. Using a genome-wide transposon screen we identified E. coli genes that are important for survival in co-cultures with P. aeruginosa, both with and without glucose supplementation. Results Central carbon metabolism was the dominant gene function under selection in our experimental conditions, indicating that the observed inhibition is a side-effect of overflow metabolism adopted by E. coli as a response to high glucose concentrations. The presence of a competing species increased the selective pressure for central carbon metabolism genes, with 31 important for growth in the presence of P. aeruginosa and glucose, while only 9 were significant for pure E. coli cultures grown with glucose. In our experiments, each transposon mutant was competed against all others in the pool, suggesting that overflow metabolism provides benefits to individual E. coli cells in addition to competitive inhibition derived from acidification of the growth medium. Conclusion Co-culture assays using transposon mutant libraries can provide insight into the selective pressures present in mixed species competition. This work demonstrates central carbon metabolism is the dominant gene function under selection in E. coli for aerobic growth in glucose and a side-effect of this is overflow metabolism which can inhibit growth of bystander species.

BACKGROUND: We performed an integrated biomarker evaluation in pembrolizumab-treated patients with R/M HNSCC enrolled in KEYNOTE-012 or KEYNOTE-055. The relationship between biomarkers and HPV status was explored. METHODS: We evaluated PD-L1 (combined positive score [CPS]), TMB, T-cell-inflamed gene expression profile (Tcellinf GEP), and HPV status. Associations between biomarkers were evaluated by logistic regression (ORR) and Cox regression (PFS, OS). RESULTS: Two hundred and fifty-seven patients (KEYNOTE-012, n = 106; KEYNOTE-055, n = 151) had TMB data available; of these, 254 had PD-L1 and 236 had Tcellinf GEP. TMB, PD-L1, and Tcellinf GEP were each significantly associated with ORR (p

BACKGROUND: Risk stratification of kidney cancer patients after nephrectomy may tailor surveillance intensity and selection for adjuvant therapy. Transcriptomic approaches are effective in predicting recurrence, but whether they add value to clinicopathologic models remains unclear. METHODS: Data from patients with clear cell renal cell carcinoma (ccRCC) was downloaded from The Cancer Genome Atlas. Clinicopathologic variables were used to calculate SSIGN (stage, size, grade, and necrosis) scores. The 16 gene recurrence score (RS) signature was generated using RNA-seq data. Transcriptomic risk groups were calculated using the original thresholds. SSIGN groups were divided into low, intermediate, and high risk. Disease-free status was the primary endpoint assessed. RESULTS: SSIGN and RS were calculated for 428 patients with non-metastatic ccRCC. SSIGN low-, intermediate-, and high-risk groups demonstrated 2.7%, 15.2%, and 27.5%, 3-year recurrence risk, respectively. On multivariable analysis, the RS was associated with disease-free status (sub-distribution hazard ratio (sHR) 1.43 per 25 RS [95% CI (1.00-1.43)], p = 0.05). By risk groups, RS further risk stratified the SSIGN intermediate-risk group (sHR 2.22 [95% CI 1.10-4.50], p = 0.03). SSIGN intermediate-risk patients with low and high RS had a 3-year recurrence rate of 8.0% and 25.2%, respectively. Within this risk group, the area under the curve (AUC) at 3 years was 0.69 for SSIGN, 0.74 for RS, and 0.78 for their combination. CONCLUSIONS: Transcriptomic recurrence scores improve risk prediction even when controlling for clinicopathologic factors. Utility may be best suited for intermediate-risk patients who have heterogeneous outcomes and further refinement for clinical utility is warranted.

Abstract Two key hypotheses in invasion biology are that certain traits underlie invasiveness in introduced species, and that these traits are selected for during or after introduction. We tested these hypotheses by focusing on two traits likely to confer invasiveness, high increase in growth in response to increase in nutrients and low decrease in growth in response to competition. We compared four species of Carpobrotus that differ in invasiveness, using species from four continents: Africa, Australia, Europe and North America. To test for selection for these traits in Carpobrotus edulis, a highly invasive species, we compared plants from its native range in South Africa to plants from the other three regions, where C. edulis has been introduced. Plants were propagated in a common garden. Offspring were then grown alone with or without added nutrients, and together with another species of Carpobrotus or with the grass Ammophila arenaria (a co-occurring native species in Europe) without added nutrients. Response to nutrients did not differ between species of Carpobrotus, nor was competitive response less negative in more invasive species. However, increase in growth in response to added nutrients was greater in introduced than in native C. edulis. Moreover, fresh mass per ramet at the start of treatments was higher in the two invasive species than in the two non-invasive ones. We provide new evidence that introduction can select for response to nutrient enrichment in invasive species and add to the evidence for an association between size and invasiveness in introduced plants.