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Background: An estimated 3 billion people, largely in low- and middle-income countries, rely on unclean fuels for cooking, heating, and lighting to meet household energy needs. The resulting exposure to household air pollution (HAP) is a leading cause of pneumonia, chronic lung disease, and other adverse health effects. In the last decade, randomized controlled trials of clean cooking interventions to reduce HAP have been conducted. We aim to provide guidance on how to interpret the findings of these trials and how they should inform policy makers and practitioners.Methods: We assembled a multidisciplinary working group of international researchers, public health practitioners, and policymakers with expertise in household air pollution from within academia, the American Thoracic Society, funders, nongovernmental organizations, and global organizations, including the World Bank and the World Health Organization. We performed a literature search, convened four sessions via web conference, and developed consensus conclusions and recommendations via the Delphi method.Results: The committee reached consensus on 14 conclusions and recommendations. Although some trials using cleaner-burning biomass stoves or cleaner-cooking fuels have reduced HAP exposure, the committee was divided (with 55% saying no and 45% saying yes) on whether the studied interventions improved measured health outcomes.Conclusions: HAP is associated with adverse health effects in observational studies. However, it remains unclear which household energy interventions reduce exposure, improve health, can be scaled, and are sustainable. Researchers should engage with policy makers and practitioners working to scale cleaner energy solutions to understand and address their information needs.

LGBTQ+ communities experience significant healthcare and academic success disparities due to barriers in care, negative attitudes towards them, and lack of awareness among healthcare providers and educators. Addressing the unique health and wellbeing concerns of LGBTQ+ individuals in the classroom and clinic requires cultural competency among educators and health professionals, yet knowledge and training in this content is lacking. Thus, we created, piloted, and assessed a six-month interdisciplinary professional development program to enhance knowledge, attitudes, awareness, and cultural humility around LGBTQ+ health for educators, administrators, and clinicians in higher education. Participants were surveyed with standardized assessments pre- and post-program to measure their knowledge, skills, and readiness to teach these topics and incorporate them into their curricula and practice. Participants (n = 33) completed LGBTQ+ inclusivity training including six structured learning sessions, small group mentoring meetings, and a virtual visit to an LGBTQ+ community center. Participants consistently displayed interest and engaged actively in training sessions. In a follow-up survey seven months post-intervention, respondents reported changes in their practice to create inclusive environments. Data analysis demonstrated improved knowledge and comfort with LGBTQ+ care and readiness and willingness to integrate LGBTQ+ care into their curricula and interactions with students. These findings suggest that this interdisciplinary professional development pilot offers a useful program to enable educators and clinicians to support the unique needs of LGBTQ+ communities.

Type 2 diabetes (T2D) is a heterogeneous disease that develops through diverse pathophysiological processes1,2 and molecular mechanisms that are often specific to cell type3,4. Here, to characterize the genetic contribution to these processes across ancestry groups, we aggregate genome-wide association study data from 2,535,601 individuals (39.7% not of European ancestry), including 428,452 cases of T2D. We identify 1,289 independent association signals at genome-wide significance (P

Seok Woo Moon,1 Jee Wook Kim,2 Do Hoon Kim,3,4 Michael Adair,5 Daniel Oudin Åström,6 Elin Heldbo Reines,5 Minah Lee,7 Gayoung Kim7 1Department of Psychiatry and Research Institute of Medical Science, Konkuk University School of Medicine, Chungju, South Korea; 2Department of Neuropsychiatry, Hallym University Dongtan Sacred Heart Hospital, Dongtan, Korea; 3Department of Psychiatry, Hallym University Chuncheon Sacred Heart Hospital, Chuncheon, Korea; 4Mind-Neuromodulation Laboratory, College of Medicine, Hallym University, Chuncheon, Korea; 5Department of MSC Vortioxetine & Established Products, H. Lundbeck A/S, Valby, Denmark; 6Department of Real-World Evidence & Epidemiology, H. Lundbeck A/S, Valby, Denmark; 7Department of RA&MA, Lundbeck Korea Co., Ltd., Seoul, KoreaCorrespondence: Seok Woo Moon, Department of Psychiatry and Research Institute of Medical Science, Konkuk University School of Medicine, 82 Gugwon-daero, Chungju-si, Chungcheongbuk-do, 27376, South Korea, Tel +82-10-3276-1641, Email hessem@naver.comBackground: Patients with major depressive disorder (MDD) experience depressive symptoms such as anhedonia as well as cognitive dysfunction which can subsequently impair their work performance.Purpose: To assess the effectiveness and safety of vortioxetine in working patients with MDD in South Korea.Patients and Methods: This was a subgroup analysis of a prospective, multicenter, non-interventional, non-comparative post-marketing surveillance (PMS) study. Vortioxetine-naïve patients aged > 18 years who were administered with vortioxetine were followed for up to 24± 2 weeks. Working patients were defined as those who were working or studying full- (≥ 6 hours/day) or part-time (< 6 hours/day) at baseline. Effectiveness and adverse events (AEs), assessed by both clinician and patient-reported measured, were analyzed.Results: A total of 1082 working patients (mean age: 39.56 years) were included in the subgroup analysis. Clinically significant improvements in depressive symptoms, including anhedonia, were observed over the 24 weeks of follow-up, with mean scores for the total Montgomery-Asberg Depression Rating Scale (MADRS) and anhedonia subscale both significantly decreasing from baseline by mean±standard deviation (SD) of 9.73± 9.08 and 5.37± 5.24 points, respectively, at 24 weeks (both p< 0.001 vs baseline). The vast majority of patients (80.01%) treated with vortioxetine also showed improvements in mental health symptoms over the 24 weeks, measured using the Clinical Global Impression – Improvement (CGI-I) scores. Significant improvements in cognitive symptoms were also observed over the study period, measured by the Korean Version of the Perceived Deficits Questionnaire-Depression as well as Digit Symbol Substitution Test (all p< 0.0001 from baseline at Visits 2 and 3). Vortioxetine was well tolerated in working patients, with the respective rates of any AEs and serious AEs being 18.67% and 1.20%.Conclusion: Working patients treated with vortioxetine had improvements in their depressive symptoms (including anhedonia), cognitive function and performance. Vortioxetine was found to be well tolerated in this study.Keywords: major depressive disorder, non-interventional, post-marketing surveillance, South Korea, vortioxetine, work performance

Abstract Background In the United States (US), premature cardiovascular disease (CVD) mortality rates (35–74 years) have exhibited increases in recent years, particularly in younger adults, and large differentials by educational attainment. This trend has occurred concurrently with high and increasing obesity prevalence, which also show significant differences by education. This study aims to jointly model premature CVD mortality trends in the US according to obesity status and educational attainment. Methods We used multiple cause of death data from the National Center for Health Statistics, obesity prevalence data from the National Health and Nutrition Examination Survey (NHANES), and educational attainment data from the American Community Survey and NHANES. We applied Bayes’ theorem to these data to calculate the conditional probability of premature CVD mortality given obesity status and educational attainment for 2003–2019. We then projected this conditional probability for 2020–2029 using the Lee-Carter model. Results The probability of premature CVD mortality was greatest for obesity and low education (not graduated high school) and was substantially higher (females 6.7 times higher, males 5.9) compared with non-obesity and high education (Bachelor’s degree or higher) in 2019. There was a widening of the gap in premature CVD mortality from 2003 to 2019 between the obese and non-obese populations, which occurred at each education level and was projected to continue in 2020–2029, especially for males. The conditional probability of premature CVD death for obesity and middle education (finished high school but no Bachelor’s degree) increased substantially and was projected to surpass the level for non-obesity and low education in coming years for males and in younger age groups. At high education, the conditional probability of premature CVD death for the obese population was projected to increase to 2029, while for non-obesity it was projected to remain steady for females and fall for males; this projected widening is greatest at older age groups. Conclusions The findings demonstrate the public health challenge to reduce premature US CVD mortality posed by continued high obesity prevalence, especially for younger ages, lower education groups and males. The relative importance of obesity in influencing premature CVD mortality trends has risen partly due to the decline in CVD mortality attributable to other risk factors.

An uncommon benign histiocytic illness, Rosai-Dorfman disease (RDD) mostly affects lymph nodes but can also manifest as extranodal involvement. We describe a case of a female patient, sixty years of age, who had joint discomfort, sleeplessness, weight loss, and headache and eye problems. A heterogeneously hypodense perirectal mass was seen on imaging. Other histiocytic diseases, metastatic cancer, and lymphoma were among the differential diagnosis. Through biopsy and immunohistochemistry staining, which revealed S-100 and CD68 positivity with CD1a negative, a definitive diagnosis of RDD was made. Over a 2-year period following surgical excision, the patient's symptoms significantly improved and there was no sign of recurrence. This example emphasizes the significance of taking RDD into account when making a differential diagnosis for perirectal tumors and the function of imaging in conjunction with histological testing in guiding management.

Abstract Venous thrombosis (VT) is a common vascular disease associated with reduced survival and a high recurrence rate. VT is initiated by the accumulation of platelets and neutrophils at sites of endothelial cell activation. A role for platelet αIIbβ3 in VT is not established, a task complicated by the increased bleeding risk caused by partial agonists such as tirofiban. Here, we show that m-tirofiban, a modified version of tirofiban, does not agonize αIIbβ3 based on lack of neoepitope expression and the cryo-EM structure of m-tirofiban/full-length αIIbβ3 complex. m-tirofiban abolishes agonist-induced platelet aggregation while preserving clot retraction ex vivo and, unlike tirofiban, it suppresses venous thrombogenesis in a mouse model without increasing bleeding. These findings establish a key role for αIIbβ3 in VT initiation and suggest that m-tirofiban and compounds with a similar structurally-defined mechanism of action merit consideration as potential thromboprophylaxis agents in patients at high risk for VT and hemorrhage.

United States policymakers and education leaders continue to assess young children as if their learning contexts are neutral and harmless. This article draws upon examples from the multi-sited Civic Action and Young Children study to show why contexts that actively refuse deficit, racist thinking and support agency have the best chance of showing children's diverse ranges of skills and knowledge and so should be the focus of assessment.

This longitudinal inductive research unpacks the process of African post-secondary students' Chinese language identity (CLI) with the purpose of exploring a model of CLI development. We traced how 12 multilingual African students developed their CLI during the first year in a Chinese university. Data coded from three rounds of interviews conducted at different times reveal that over time, there are fewer distractors and more contributors to the development of CLI. We also found three bidirectional factors that both facilitate and impede CLI construction. In terms of dimensions of language identity, Chinese language expertise and positive affiliation with the new language increased over time without change in students' original language inheritance. Results inform both African students' adaptation in China and the instruction and administration of African students in Chinese universities. This study helps to discover patterns of change in language identity from a micro perspective and informs models of language identity development among multilingual adult learners.

How can academic developers support Early Career Academics (ECAs) to increase in confidence as they step into their new responsibilities? Previous work has demonstrated the negative impacts of ECAs' low self-efficacy, focusing recommendations on the need for systemic changes. Going further than previous academic development work to apply social cognitive theories of personality, we explore how ECAs can be equipped to understand, reflect on and increase their own confidence. We point to evidence-based approaches and recommend practical steps that can be taken to implement this approach in increasing the confidence of ECAs.

The early-life gut microbiome development has long-term health impacts and can be influenced by factors such as infant diet. Human milk oligosaccharides (HMOs), an essential component of breast milk that can only be metabolized by some beneficial gut microorganisms, ensure proper gut microbiome establishment and infant development. However, how HMOs are metabolized by gut microbiomes is not fully elucidated. Isolate studies have revealed the genetic basis for HMO metabolism, but they exclude the possibility of HMO assimilation via synergistic interactions involving multiple organisms. Here, we investigate microbiome responses to 2-fucosyllactose (2FL), a prevalent HMO and a common infant formula additive, by establishing individualized microbiomes using fecal samples from three infants as the inocula. Bifidobacterium breve, a prominent member of infant microbiomes, typically cannot metabolize 2FL. Using metagenomic data, we predict that extracellular fucosidases encoded by co-existing members such as Ruminococcus gnavus initiate 2FL breakdown, thus critical for B. breves growth. Using both targeted co-cultures and by supplementation of R. gnavus into one microbiome, we show that R. gnavus can promote extensive growth of B. breve through the release of lactose from 2FL. Overall, microbiome cultivation combined with genome-resolved metagenomics demonstrates that HMO utilization can vary with an individuals microbiome.

Despite growing recognition of the need for increased diversity among students, trainees, and faculty in health care, the medical workforce still lacks adequate representation from groups historically underrepresented in medicine (URiM). The subspecialty field of pediatric pulmonology is no exception. Although there have been efforts to address issues of diversity, equity, and inclusion (DEI) in our own field, gaps persist. To address these gaps, the members of the Diversity, Equity, and Inclusion Advisory Group (DEI-AG) of the American Thoracic Society Pediatrics Assembly created and distributed a Needs Assessment Survey in the United States and Canada to better understand the racial and ethnic demographics of the pediatric pulmonary workforce and to learn more about successes, gaps, and opportunities to enhance how we recruit, train, and retain a diverse workforce. The DEI-AG leadership cochairs convened a workshop to review the findings of the DEI Needs Assessment Survey and to develop strategies to improve the recruitment and retention of URiM fellows and faculty. This Official ATS Workshop Report aims to identify barriers and opportunities for recruitment, training, and career development within the field of pediatric pulmonology. Additionally, we offer useful strategies and resources to improve the recruitment of URiM residents, the mentorship of trainees and junior faculty, and the career development of URiM faculty in academic centers. This Workshop Report is an important first deliverable by the DEI-AG. We hope that this work, originating from within the Pediatrics Assembly, will serve as a model for other Assemblies, disciplines across the ATS, and other fields in Pediatrics.