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Genetically modified organisms (GMOs) and their uses are often misunderstood. Consumers are regularly unsure what GMOs are, or if they are safe for consumption and the environment. Contradictory and sometimes inaccurate information is available from numerous sources, and challenges consumers and others to separate the facts from sensationalized stories. Agricultural producers often communicate with consumers, neighbors, and members of the general public; however, they do not have information to share about GMOs. Multimedia resources can provide agricultural producers with science- based information to share with consumers. Agricultural communicators and Extension educators can create science- based multimedia resources to bridge the communication gap.

Systemic low-grade inflammation is a feature of chronic disease. C-reactive protein (CRP) is a common biomarker of inflammation and used as an indicator of disease risk; however, the role of inflammation in disease is not completely understood. Methylation is an epigenetic modification in the DNA which plays a pivotal role in gene expression. In this study we evaluated differential DNA methylation patterns associated with blood CRP level to elucidate biological pathways and genetic regulatory mechanisms to improve the understanding of chronic inflammation. The racially and ethnically diverse participants in this study were included as 50% White, 41% Black or African American, 7% Hispanic or Latino/a, and 2% Native Hawaiian, Asian American, American Indian, or Alaska Native (total n = 13,433) individuals. We replicated 113 CpG sites from 87 unique loci, of which five were novel (CADM3, NALCN, NLRC5, ZNF792, and cg03282312), across a discovery set of 1,150 CpG sites associated with CRP level (p

Rationale & objectiveTubulointerstitial damage is a feature of early chronic kidney disease (CKD), but current clinical tests capture it poorly. Urine biomarkers of tubulointerstitial health may identify risk of CKD.Study designProspective cohort (Atherosclerosis Risk in Communities [ARIC]) and case-cohort (Multi-Ethnic Study of Atherosclerosis [MESA] and Reasons for Geographic and Racial Differences in Stroke [REGARDS]).Setting & participantsAdults with estimated glomerular filtration rate (eGFR) ≥60 mL/min/1.73 m2 and without diabetes in the ARIC, REGARDS, and MESA studies.ExposuresBaseline urine monocyte chemoattractant protein-1 (MCP-1), alpha-1-microglobulin (α1m), kidney injury molecule-1, epidermal growth factor, and chitinase-3-like protein 1.OutcomeIncident CKD or end-stage kidney disease.Analytical approachMultivariable Cox proportional hazards regression for each cohort; meta-analysis of results from all 3 cohorts.Results872 ARIC participants (444 cases of incident CKD), 636 MESA participants (158 cases), and 924 REGARDS participants (488 cases) were sampled. Across cohorts, mean age ranged from 60 ± 10 to 63 ± 8 years, and baseline eGFR ranged from 88 ± 13 to 91 ± 14 mL/min/1.73 m2. In ARIC, higher concentrations of urine MCP-1, α1m, and kidney injury molecule-1 were associated with incident CKD. In MESA, higher concentration of urine MCP-1 and lower concentration of epidermal growth factor were each associated with incident CKD. In REGARDS, none of the biomarkers were associated with incident CKD. In meta-analysis of all 3 cohorts, each 2-fold increase α1m concentration was associated with incident CKD (HR, 1.19; 95% CI, 1.08-1.31).LimitationsObservational design susceptible to confounding; competing risks during long follow-up period; meta-analysis limited to 3 cohorts.ConclusionsIn 3 combined cohorts of adults without prevalent CKD or diabetes, higher urine α1m concentration was independently associated with incident CKD. 4 biomarkers were associated with incident CKD in at least 1 of the cohorts when analyzed individually. Kidney tubule health markers might inform CKD risk independent of eGFR and albuminuria.

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

BACKGROUND: Plasma proenkephalin A (PENK-A) is a precursor of active enkephalins. Higher blood concentrations have been associated with estimated glomerular filtration rate (eGFR) decline in European populations. Due to the significant disparity in incident chronic kidney disease (CKD) between White and Black people, we evaluated the association of PENK-A with incident CKD and other kidney outcomes among a biracial cohort in the U.S. METHODS: In a nested cohort of 4,400 participants among the REasons for Geographic And Racial Differences in Stroke, we determined the association between baseline PENK-A concentration and incident CKD using the creatinine-cystatin C CKD-EPI 2021 equation without race coefficient, significant eGFR decline, and incident albuminuria between baseline and a follow-up visit 9.4 years later. We tested for race and sex interactions. We used inverse probability sampling weights to account for the sampling design. RESULTS: At baseline, mean (SD) age was 64 (8) years, 49% were women, and 52% were Black participants. 8.5% developed CKD, 21% experienced ≥ 30% decline in eGFR and 18% developed albuminuria. There was no association between PENK-A and incident CKD and no difference by race or sex. However, higher PENK-A was associated with increased odds of progressive eGFR decline (OR: 1.12; 95% CI 1.00, 1.25). Higher PENK-A concentration was strongly associated with incident albuminuria among patients without diabetes mellitus (OR: 1.29; 95% CI 1.09, 1.53). CONCLUSION: While PENK-A was not associated with incident CKD, its associations with progression of CKD and incident albuminuria, among patients without diabetes, suggest that it might be a useful tool in the evaluation of kidney disease among White and Black patients.

People sometimes display moral flexibility by deciding that a commonly accepted moral norm ought not to apply in particular circumstances. But how? We explore this question in the context of queuing. We show that people's judgements about the moral permissibility of queue-cutting can be explained through cognitive processes related to moral contractualism: universalization, virtual bargaining, and functional thinking. Participants were presented vignettes depicting prospective queue-cutters, and asked whether it was morally permissible to queue-cut in those circumstances. We model these judgements with reference to the existence of a game-theoretic equilibrium supporting queue cutting in a repeated game, and to considerations of whether queue cutting would subvert or enact the function of a queue: if you pay the waiting cost, you should get the reward. These results support the notion that moral flexibility is in part related to contractualist moral principles.

For contractualist accounts of morality, actions are moral if they correspond to what rational agents would agree to do, were they to negotiate explicitly. This, in turn, often depends on each party's bargaining power and on their outside options: what each of them could get in the absence of agreement. If there is an asymmetry, with one party enjoying higher bargaining power than another, this party can usually get a better deal — as often happens in real negotiations. A strong test of contractualist accounts of morality, then, is whether moral judgments do take bargaining power into account. We explore this in three preregistered experiments (n = 1,616). We construct scenarios depicting everyday interactions between two parties in which one of them can perform a mutually beneficial but unpleasant action. We find that the same actions (asking the other to perform the unpleasant action, or explicitly refusing to do it) are perceived as less morally appropriate when performed by the party with worse outside options, as compared to the party with better outside options. Thus, participants tend to give more moral leeway to the party with higher bargaining power, and to hold the disadvantaged party to stricter moral standards. This effect appears to depend only on the relative ordering of outside options, but not the magnitude of the difference between them. We discuss implications for contractualist theories of moral cognition and the emergence and persistence of unfair norms and inequality.

Arteriovenous malformations (AVMs) are rare vascular anomalies that present complex diagnostic and therapeutic challenges, particularly in uncommon locations such as the lower extremities. A 72-year-old female with chronic atrial fibrillation, hypertension, and peripheral vascular disease presented with severe lower extremity edema due to multiple AVMs below the knee. This case underscores the importance of a multidisciplinary, individualized approach in managing complex AVMs and highlights the need for advanced imaging and diverse interventional techniques to ensure effective treatment and long-term outcomes.

A 41-year-old male with a history of tobacco and alcohol use presented to our clinic for a follow up of an incidentally diagnosed splenic mass. The patient was sent for further diagnostic evaluation, and computed tomography showed a large splenic mass with heterogenous enhancement raising concern for neoplasm. Due to the uncertain nature of the splenic lesion and high complication rate of percutaneous splenic biopsy, a splenectomy was performed. The specimen was sent to pathology, and the report favored neoplasm but was inconclusive. The samples were sent to another institution for a consult, where the patient's spleen was determined to be the result of a previously suffered hemorrhagic infarct. This case demonstrates the difficulty of diagnosing splenic lesions using diagnostic imaging and the discrepancy that may occur between radiology and pathology assessments. In the setting of uncertain pathology, the removal of what might be a functional spleen is often preferred over a percutaneous biopsy due to concerns of intraabdominal bleeding and tumor dissemination.

Visceral artery pseudoaneurysms, particularly those in the gastroduodenal artery (GDA), are rare but serious complications associated with chronic pancreatitis, posing a significant risk of rupture due to their structural fragility. In this case, a 61-year-old male with a history of chronic pancreatitis, alcohol cirrhosis, duodenal ulcer, and COPD presented with persistent abdominal pain and recurrent fevers. Imaging revealed a 7 cm pseudoaneurysm between the GDA and superior mesenteric vein, which was successfully treated with coil embolization. This case highlights the importance of prompt recognition and intervention in managing GDA pseudoaneurysms, particularly when complicated by an arterioportal fistula, and demonstrates the efficacy of endovascular therapy as a minimally invasive treatment option that can significantly improve patient outcomes in complex vascular complications associated with chronic pancreatitis.

Abstract Protected areas are an important tool for wildlife conservation; however, research is increasingly revealing both biases and inadequacies in the global protected area network. One common criticism is that protected areas are frequently located in remote, high-elevation regions, which may face fewer threats compared to more accessible locations. To explore the conservation implications of this issue, we consider a thought experiment with seven different counterfactual scenarios for the Sunda clouded leopard’s conservation on Borneo. This allows us to examine two contrasting paradigms for conservation: “proactive conservation” which prioritises areas with high biodiversity and high risk of development, and “expedient conservation” which focusses on areas with the lowest development risk. We select clouded leopards as our focal species not only because of their emerging conservation importance, but also because, as top predators, they represent both keystone species and ambassadors for wider forest biodiversity. Furthermore, a published analysis of the likely impacts of forest loss in their habitat provides a benchmark for evaluating the modelled outcomes of alternative hypothetical conservation scenarios. We find that, across all metrics, expedient reserve design offered few benefits over the business-as-usual scenario, in contrast to the much greater conservation effectiveness of proactive protected area design. This paper sheds light on the challenging trade-offs between conservation goals and the competing land uses essential for the economic development and well-being of local communities.

The right posterior segmental duct (RPSD) draining into the cystic duct is exceedingly rare. Ligation of the cystic duct in proximity to the junction of an aberrant right hepatic duct after a cholecystectomy can lead to life threatening complications. The present case study reveals a severed anomalous RPSD and subsequent Roux-en-Y hepaticojejunostomy procedure employed to fix biliary anomaly.

BACKGROUND: Acute kidney injury (AKI) in patients with COVID-19 is partly mediated by thromboinflammation. In noncritically ill patients with COVID-19, therapeutic-dose anticoagulation with heparin increased the probability of survival to hospital discharge with reduced use of cardiovascular or respiratory organ support. OBJECTIVES: We investigated whether therapeutic-dose heparin reduces the incidence of AKI or death in noncritically ill patients hospitalized for COVID-19. METHODS: We report a prespecified secondary analysis of the ACTIV4a and ATTACC open-label, multiplatform randomized trial of therapeutic-dose heparin vs usual-care pharmacologic thromboprophylaxis on the incidence of severe AKI (≥2-fold increase in serum creatinine or initiation of kidney replacement therapy (KDIGO stage 2 or 3) or all-cause mortality in noncritically ill patients hospitalized for COVID-19. Bayesian statistical models were adjusted for age, sex, D-dimer, enrollment period, country, site, and platform. RESULTS: Among 1922 enrolled, 23 were excluded due to pre-existing end stage kidney disease and 205 were missing baseline or follow-up creatinine measurements. Severe AKI or death occurred in 4.4% participants assigned to therapeutic-dose heparin and 5.5% assigned to thromboprophylaxis (adjusted relative risk [aRR]: 0.72; 95% credible interval (CrI): 0.47, 1.10); the posterior probability of superiority for therapeutic-dose heparin (relative risk < 1.0) was 93.6%. Therapeutic-dose heparin was associated with a 97.7% probability of superiority to reduce the composite of stage 3 AKI or death (3.1% vs 4.6%; aRR: 0.64; 95% CrI: 0.40, 0.99) compared to thromboprophylaxis. CONCLUSION: Therapeutic-dose heparin was associated with a high probability of superiority to reduce the incidence of in-hospital severe AKI or death in patients hospitalized for COVID-19.

BACKGROUND: COVID-19 has been associated with endothelial injury, resultant microvascular inflammation and thrombosis. Activated endothelial cells release and express P-selectin and von Willebrand factor, both of which are elevated in severe COVID-19 and may be implicated in the disease pathophysiology. We hypothesized that crizanlizumab, a humanized monoclonal antibody to P-selectin, would reduce morbidity and death in patients hospitalized for COVID-19. METHODS: An international, adaptive, randomized controlled platform trial, funded by the National Heart, Lung, and Blood Institute, randomly assigned 422 patients hospitalized with COVID-19 with moderate or severe illness to receive either a single infusion of the P-selectin inhibitor crizanlizumab (at a dose of 5 mg/kg) plus standard of care or standard of care alone in an open-label 1:1 ratio. The primary outcome was organ support-free days, evaluated on an ordinal scale consisting of the number of days alive free of organ support through the first 21 days after trial entry. RESULTS: The study was stopped for futility by the data safety monitoring committee. Among 421 randomized patients with known 21-day outcomes, 163 patients (77%) randomized to the crizanlizumab plus standard-of-care arm did not require any respiratory or cardiovascular organ support compared with 169 (80%) in the standard-of-care-alone arm. The adjusted odds ratio for the effect of crizanlizumab on organ support-free days was 0.70 (95% CI, 0.43-1.16), where an odds ratio >1 indicates treatment benefit, yielding a posterior probability of futility (odds ratio 1] = 0.879). CONCLUSIONS: Crizanlizumab, a P-selectin inhibitor, did not result in improvement in organ support-free days in patients hospitalized with COVID-19. REGISTRATION: URL: https://www. CLINICALTRIALS: gov; Unique identifier: NCT04505774.

Species distribution modeling (SDM) is a fundamental tool in theoretical and applied ecology. However, relatively little is known about the performance of different approaches for scale optimization, model selection, and algorithmic prediction in the context of nonlinear, multiscale and interactive relationships between environmental variables and species occurrence. Modelers often struggle to optimize a tradeoff between ecological relevance, model robustness, complexity, and overfitting. In this paper, we investigated several methods designed to optimize spatial scale and variable selection in SDMs, in each case evaluating model fitness, parsimony and predictive performance. We used a simulation approach to produce a large pool of alternative underlying habitat relationships that reflect a broad range of realistic habitat associations. We also compared several different modeling algorithms, including logistic regression with a generalized linear model (GLM), Lasso and Elastic-Net Regularized GLMs (GLMNet), and random forest (RF), as well as alternative variable and scale selection methods. We found that GLM methods employing all-subsets dredge routines for variable selection were consistently the best predictors based on all criteria of our model performance assessment and across all attributes of the simulated underlying relationship, including nonlinearity and interaction. We had expected machine learning approaches, such as random forest, to perform better in these more complex forms of species-environment relationships. GLM using dredge variable selection was also the method that included the fewest spurious covariates and included the most correct predictors as a proportion of all predictors. We found that univariate scaling was the most robust method of variable and scale selection, along with Minimal Redundancy Maximal Relevancy (MRMR) which performed equivalently. The simulation experiment presented here provides a robust assessment of simulated multi-species distribution model performance, complexity and fidelity. By simulating a large range of potential habitat relationships with varying spatial scale, effect sizes, linearity, and interactions, we comprehensively evaluated model performance across gradients of complexity of the underlying relationships and violations of classical statistical assumptions. This study provides a valuable assessment and a broader example of the power and utility of controlled simulation experiments in habitat relationships and other ecological spatial predictive modeling.

Background Among patients diagnosed with high blood pressure (BP), initial dual therapy has been recommended for patients with high pretreatment systolic BP (≥160 mm Hg) since 2003, and first‐line β‐blocker use without a compelling condition has fallen out of favor in US guidelines. Methods and Results This serial cross‐sectional study of national Veterans Health Administration data included adult Veterans with incident hypertension initiating antihypertensive medication between January 1, 2000, and December 31, 2019. We assessed annual trends in initial regimens dispensed (index date: first antihypertensive dispense date) by number of classes and unique class combinations used overall and by pretreatment systolic BP (

Female gymnasts are the athletes that are most likely to experience Achilles tendon rupture, due to the high energy and eccentric load place on their Achilles tendon related to their sport. It is postulated that degenerative changes, watershed vascular supply, calcifications, and high amounts of inflammatory cells may play a role. This case report highlights an athlete with an asymptomatic Achilles tendon that was visualized to be normal utilizing ultrasound. She was found to have no evidence of underlying tendon pathology. The athlete then ruptured her Achilles tendon 8 months later during a gymnastic meet with no proceeding symptoms. This case report challenges the accepted theory that preexisting tendinosis or pathology proceeds Achilles tendon rupture. In this case, it is postulated that tendon rupture may be secondary to significant mechanical force even without underlying pathology.Level of evidence: Level 4.