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Abstract Background The 24-h urine protein (24-hUP) excretion is the gold standard for evaluating proteinuria. This study aimed to evaluate the diagnostic efficacy of protein/creatinine ratio (PCR) for estimating 24-hUP at various levels of renal function and proteinuria levels. Methods A cross-sectional study was conducted between December 2021 and December 2023 in Salvador, Bahia-Brazil, as an extension of previously published data from the TUNARI study. The study included 217 samples from 152 patients with various levels of renal function and proteinuria. PCR in isolated samples and 24-hUP were determined conventionally within a 24-h timeframe. Patients were classified into three groups according to the level of renal function (Group 1 = 10 to 60 mL/min) and level of proteinuria ( 3.5 g/day). The data were analyzed using the Spearman correlation (rs), coefficient of determination (r2), Bland–Altman plots and receiver operating characteristic (ROC) curve. Likelihood ratios, positive (LR +), and negative (LR-) were derived from the sensitivity and specificity of PCR. Results Mean age was 41.5 ± 15.7 years, 61.8% were women, 36.8% Black and 52% Mixed-race. Glomerulopathies constituted 80.3%; 46.1% with lupus nephritis. Of the total urine samples, we observed a high correlation between PCR in the total sample of 24-hUP sample (rs = 0.86, p 0.3–3.5 g/day, the sensitivity was 64.1%, the specificity was 84.6%, and the AUC was 0.76 (95% CI = 0.67; 0.84), PCR detected all cases > 3.5 g/day. Conclusions PCR is a suitable measure to be used as an indicator of 24-hUP at different levels of renal function, but may have limitations at higher levels of proteinuria. Analysis of PCR by proteinuria level found that agreement as well as sensitivity decreases at higher levels, but it maintains good specificity and is able to identify nephrotic range proteinuria.

Abstract Oncolytic viruses (OV) are designed to selectively infect and kill cancer cells, while simultaneously eliciting antitumour immunity. The mechanism is expected to originate from infected cancer cells. However, recent reports of tumour regression unaccompanied by cancer cell infection suggest a more complex mechanism of action. Here, we engineered vesicular stomatitis virus (VSV)ΔM51-sensitive and VSVΔM51-resistant tumour lines to elucidate the role of OV-infected cancer and non-cancer cells. We found that, while cancer cell infections elicit oncolysis and antitumour immunity as expected, infection of non-cancer cells alone can also contribute to tumour regression. This effect is partly attributed to the systemic production of cytokines that promote dendritic cell (DC) activation, migration and antigen cross-presentation, leading to magnified antitumour CD8+ T cell activation and tumour regression. Such OV-induced antitumour immunity is complementary to PD-1 blockade. Overall, our results reveal mechanistic insights into OV-induced antitumour immunity that can be leveraged to improve OV-based therapeutics.

Abstract 3D brain atlases are key resources to understand the brain’s spatial organization and promote interoperability across different studies. However, unlike the adult mouse brain, the lack of developing mouse brain 3D reference atlases hinders advancements in understanding brain development. Here, we present a 3D developmental common coordinate framework (DevCCF) spanning embryonic day (E)11.5, E13.5, E15.5, E18.5, and postnatal day (P)4, P14, and P56, featuring undistorted morphologically averaged atlas templates created from magnetic resonance imaging and co-registered high-resolution light sheet fluorescence microscopy templates. The DevCCF with 3D anatomical segmentations can be downloaded or explored via an interactive 3D web-visualizer. As a use case, we utilize the DevCCF to unveil GABAergic neuron emergence in embryonic brains. Moreover, we map the Allen CCFv3 and spatial transcriptome cell-type data to our stereotaxic P56 atlas. In summary, the DevCCF is an openly accessible resource for multi-study data integration to advance our understanding of brain development.

The role of incretin-based therapies, including glucagon-like peptide-1 receptor agonists (GLP1RAs) and dual GLP-1/glucose-dependent insulinotropic polypeptide (GIP) receptor agonists, in the management of type 2 diabetes mellitus (T2DM) and obesity has been increasingly recognized, along with significant cardiovascular (CV) benefits. Despite the clinical efficacy of incretin-based therapies, high costs, suboptimal access, limited insurance coverage, and therapeutic inertia present substantial barriers to widespread adoption. Overcoming these obstacles is essential for the equitable initiation, access, and utilization of incretin-based therapies. Clinicians must make targeted efforts to ensure health equity in the use of these and other advanced therapies.

Hypertension is one of the leading risk factors for cardiovascular disease. The ACC/AHA/Multisociety hypertension guideline covered all aspects of the recommendations for optimal blood pressure diagnosis and management to improve cardiovascular outcomes. Despite this, there remains a growing prevalence of hypertension within the United States, largely in non-Hispanic Black women at earlier stages of their life course. This highlights the evident racial disparities, but offers a targeted opportunity for improved outcomes. With hypertension increasingly seen in the antenatal and immediate postpartum period, and obstetrics societies weighing in on the need to alter pharmacotherapy initiation goals, national initiatives have purposefully targeted pregnant and postpartum women in an effort to improve outcomes. This same energy must also re-focus health care efforts across the entire health continuum. Public health and system strategies are in place to do so, with the strongest enforcing initiatives as early as childhood with a greater focus on primordial prevention.

Density-dependent competition for food influences the foraging behaviour and demography of colonial animals, but how this influence varies across a species’ latitudinal range is poorly understood. Here we used satellite tracking from 21 Northern Gannet Morus bassanus colonies (39% of colonies worldwide, supporting 73% of the global population) during chick-rearing to test how foraging trip characteristics (distance and duration) covary with colony size (138–60 953 breeding pairs) and latitude across 89% of their latitudinal range (46.81–71.23° N). Tracking data for 1118 individuals showed that foraging trip duration and maximum distance both increased with square-root colony size. Foraging effort also varied between years for the same colony, consistent with a link to environmental variability. Trip duration and maximum distance also decreased with latitude, after controlling for colony size. Our results are consistent with density-dependent reduction in prey availability influencing colony size and reveal reduced competition at the poleward range margin. This provides a mechanism for rapid population growth at northern colonies and, therefore, a poleward shift in response to environmental change. Further work is required to understand when and how colonial animals deplete nearby prey, along with the positive and negative effects of social foraging behaviour.

Abstract Background Narrative medicine demonstrated positive impact on empathy in medicine and nursing students. However, this pedagogical approach had not been evaluated in pharmacy education. This study sought to apply and evaluate the narrative medicine approach in extending empathy in Asian undergraduate pharmacy students. Methods Narrative medicine was applied through workshops which used narratives of people with different experiences and perspectives. First-year undergraduate pharmacy students who volunteered and attended these workshops formed the intervention group (N = 31) and the remaining first-year cohort formed the control group (N = 112). A sequential explanatory mixed methods approach was adopted in which quantitative methods were first used to measure impact on pharmacy students’ empathy using the Jefferson Scale of Empathy– Health Professions Student (JSE-HPS), and qualitative methods (i.e. group interviews) were then used to assess pharmacy students’ emotional responses to narratives, and the perspectives of pharmacy students and faculty of this pedagogical approach. Results There was no difference in JSE-HPS scores between intervention and control groups across baseline (i.e. upon matriculation), pre-intervention, and post-intervention timepoints. Pharmacy students in the intervention group had lower scores in Factor 3 (“Standing in People’s Shoes”) following the intervention. Five themes, guided by internal and external factors in cognition, emerged from the Group Interviews: (1) incongruence between students’ motivation and faculty’s perception, (2) learning context, (3) academic context, (4) cognitive system, and (5) affective system. Themes 1, 4 and 5 referred to internal factors such as students’ motivation, perceived learnings, and feelings. Themes 2 and 3 referred to external factors including workshop materials, activities, content, and facilitation. Conclusion This study is the first to demonstrate that pharmacy students engaged with the narrative medicine approach as narratives elicited emotional responses, exposed them to diverse perspectives, and deepened their appreciation of the importance of empathy and complexities of understanding patients’ perspectives. Scaffolded educational interventions using narratives and real-life patient encounters, alongside longitudinal measurements of empathy, are necessary to bring about meaningful and sustained improvements in empathy.

ABSTRACT A substantial percentage of the population remains at risk for cervical cancer due to pre-existing human papillomavirus (HPV) infections, despite prophylactic vaccines. Early diagnosis and treatment are crucial for better disease outcomes. The development of new treatments heavily relies on suitable preclinical model systems. Recently, we established a mouse papillomavirus (MmuPV1) model that is relevant to HPV genital pathogenesis. In the current study, we validated the use of Papanicolaou (Pap) smears, a valuable early diagnostic tool for detecting HPV cervical cancer, to monitor disease progression in the MmuPV1 mouse model. Biweekly cervicovaginal swabs were collected from the MmuPV1-infected mice for viral DNA quantitation and cytology assessment. The Pap smear slides were evaluated for signs of epithelial cell abnormalities using the 2014 Bethesda system criteria. Tissues from the infected mice were harvested at various times post-viral infection for additional histological and virological assays. Over time, increased viral replication was consistent with higher levels of viral DNA, and it coincided with an uptick in epithelial cell abnormalities with higher severity scores noted as early as 10 weeks after viral infection. The cytological results also correlated with the histological evaluation of tissues harvested simultaneously. Both immunocompromised and immunocompetent mice with squamous cell carcinoma (SCC) cytology also developed vaginal SCCs. Notably, samples from the MmuPV1-infected mice exhibited similar cellular abnormalities compared to the corresponding human samples at similar disease stages. Hence, Pap smear screening proves to be an effective tool for the longitudinal monitoring of disease progression in the MmuPV1 mouse model.IMPORTANCEPapanicolaou (Pap) smear has saved millions of women's lives as a valuable early screening tool for detecting human papillomavirus (HPV) cervical precancers and cancer. However, more than 200,000 women in the United States alone remain at risk for cervical cancer due to pre-existing HPV infection-induced precancers, as there are currently no effective treatments for HPV-associated precancers and cancers other than invasive procedures including a loop electrosurgical excision procedure (LEEP) to remove abnormal tissues. In the current study, we validated the use of Pap smears to monitor disease progression in our recently established mouse papillomavirus model. To the best of our knowledge, this is the first study that provides compelling evidence of applying Pap smears from cervicovaginal swabs to monitor disease progression in mice. This HPV-relevant cytology assay will enable us to develop and test novel antiviral and anti-tumor therapies using this model to eliminate HPV-associated diseases and cancers.

Abstract Disease outbreaks can drastically disturb the environment of surviving animals, but the behavioural, ecological, and epidemiological consequences of disease-driven disturbance are poorly understood. Here, we show that an outbreak of High Pathogenicity Avian Influenza Virus (HPAIV) coincided with unprecedented short-term behavioural changes in Northern gannets (Morus bassanus). Breeding gannets show characteristically strong fidelity to their nest sites and foraging areas (2015–2019; n = 120), but during the 2022 HPAIV outbreak, GPS-tagged gannets instigated long-distance movements beyond well-documented previous ranges and the first ever recorded visits of GPS-tagged adults to other gannet breeding colonies. Our findings suggest that the HPAIV outbreak triggered changes in space use patterns of exposed individuals that amplified the epidemiological connectivity among colonies and may generate super-spreader events that accelerate disease transmission across the metapopulation. Such self-propagating transmission from and towards high density animal aggregations may explain the unexpectedly rapid pan-European spread of HPAIV in the gannet.

Host–parasite associations provide a benchmark for investigating evolutionary arms races and antagonistic coevolution. However, potential ecological mechanisms underlying such associations are difficult to unravel. In particular, local adaptations of hosts and/or parasites may hamper reliable inferences of host–parasite relationships and the specialist–generalist definitions of parasite lineages, making it problematic to understand such relationships on a global scale. Phylogenetic methods were used to investigate co-phylogenetic patterns between vector-borne parasites of the genus Haemoproteus and their passeriform hosts, to infer the ecological interactions of parasites and hosts that may have driven the evolution of both groups in a local geographic domain. As several Haemoproteus lineages were only detected once, and given the occurrence of a single extreme generalist, the effect of removing individual lineages on the co-phylogeny pattern was tested. When all lineages were included, and when all singly detected lineages were removed, there was no convincing evidence for host–parasite co-phylogeny. However, when only the generalist lineage was removed, strong support for co-phylogeny was indicated, and ecological interactions could be successfully inferred. This study exemplifies the importance of identifying locally abundant lineages when sampling host–parasite systems, to provide reliable insights into the precise mechanisms underlying host–parasite interactions.

Abstract In 2016, the National Oceanic and Atmospheric Administration deployed the first iteration of an operational National Water Model (NWM) to forecast the water cycle in the continental United States. With many versions, an hourly, multi-decadal historic simulation is made available to the public. In all released to date, the files containing simulated streamflow contain a snapshot of model conditions across the entire domain for a single timestep which makes accessing time series a technical and resource-intensive challenge. In the most recent release, extracting a complete streamflow time series for a single location requires managing 367,920 files (~16.2 TB). In this work we describe a reproducible process for restructuring a sequential set of NWM steamflow files for efficient time series access and provide restructured datasets for versions 1.2 (1993–2018), 2.0 (1993–2020), and 2.1 (1979–2022). These datasets have been made accessible via an OPeNDAP enabled THREDDS data server for public use and a brief analysis highlights the latest version of the model should not be assumed best for all locations. Lastly we describe an R package that expedites data retrieval with examples for multiple use-cases.

The Department of Medicinal Chemistry, together with the Institute for Structural Biology, Drug Discovery and Development, at Virginia Commonwealth University (VCU) has evolved, organically with quite a bit of bootstrapping, into a unique drug discovery ecosystem in response to the environment and culture of the university and the wider research enterprise. Each faculty member that joined the department and/or institute added a layer of expertise, technology and most importantly, innovation, that fertilized numerous collaborations within the University and with outside partners. Despite moderate institutional support with respect to a typical drug discovery enterprise, the VCU drug discovery ecosystem has built and maintained an impressive array of facilities and instrumentation for drug synthesis, drug characterization, biomolecular structural analysis and biophysical analysis, and pharmacological studies. Altogether, this ecosystem has had major impacts on numerous therapeutic areas, such as neurology, psychiatry, drugs of abuse, cancer, sickle cell disease, coagulopathy, inflammation, aging disorders and others. Novel tools and strategies for drug discovery, design and development have been developed at VCU in the last five decades; e.g., fundamental rational structure-activity relationship (SAR)-based drug design, structure-based drug design, orthosteric and allosteric drug design, design of multi-functional agents towards polypharmacy outcomes, principles on designing glycosaminoglycans as drugs, and computational tools and algorithms for quantitative SAR (QSAR) and understanding the roles of water and the hydrophobic effect.

Abstract Background Hispanic ethnic density (HED) is a marker of better health outcomes among Hispanic patients with chronic disease. It is unclear whether community HED is associated with mortality risk among ethnically diverse patients receiving maintenance hemodialysis. Methods A retrospective analysis of patients in the United States cohort of the Dialysis Outcomes and Practice Patterns Study (DOPPS) database (2011–2015) was conducted (n = 4226). DOPPS data was linked to the American Community Survey database by dialysis facility zip code to obtain % Hispanic residents (HED). One way ANOVA and Kruskal Wallis tests were used to estimate the association between tertiles of HED with individual demographic, clinical and adherence characteristics, and facility and community attributes. Multivariable Cox proportional hazards models were used to estimate the mortality hazard ratio (HR) and 95% CIs by tertile of HED, stratified by age; a sandwich estimator was used to account for facility clustering. Results Patients dialyzing in facilities located in the highest HED tertile communities were younger (61.4 vs. 64.4 years), more commonly non-White (62.4% vs. 22.1%), had fewer comorbidities, longer dialysis vintage, and were more adherent to dialysis treatment, but had fewer minutes of dialysis prescribed than those in the lowest tertile. Dialyzing in the highest HED tertile was associated with lower hazard of mortality (HR, 0.86; 95% CI, 0.72-1.00), but this association attenuated with the addition of individual race/ethnicity (HR, 0.92; 95% CI, 0.78–1.09). In multivariable age-stratified analyses, those younger than 64 showed a lower hazard for mortality in the highest (vs. lowest) HED tertile (HR, 0.66; 95% CI, 0.49–0.90). Null associations were observed among patients ≥ 64 years. Conclusions Treating in communities with greater HED and racial/ethnic integration was associated with lower mortality among younger patients which points to neighborhood context and social cohesion as potential drivers of improved survival outcomes for patients receiving hemodialysis.

Abstract Objectives To compare hospitals that did and did not participate in clinical trials evaluating potential inpatient COVID-19 therapeutics. Methods We conducted a cross-sectional study of hospitals participating in trials that were registered on clinicaltrials.gov between April and August 2020. Using the 2019 RAND Hospital Dataset and 2019 American Community Survey, we used logistic regression modeling to compare hospital-level traits including demographic features between trial and non-trial hospitals. Results We included 488 hospitals that were participating in 298 interventional trials and 4232 non-participating hospitals. After controlling for demographic and other hospital traits, we found that teaching status (OR 2.11, 95% CI 1.52–2.95), higher patient acuity (OR 7.48, 4.39, 13.1), and location in the Northeast (OR 1.83, 95% CI 1.18, 2.85) and in wealthier counties (OR: 1.32, 95% CI 1.16–1.51) were associated with increased odds of trial participation, while being in counties with more White residents was associated with reduced odds (OR 0.98, 95% CI 0.98–0.99). Conclusions Hospitals participating and not participating in COVID-19 inpatient treatment clinical trials differed in many ways, resulting in important implications for the generalizability of trial data.

Abstract Background Inequities in COVID-19 vaccine accessibility and reliable COVID-related information disproportionately affected marginalized racial and ethnic communities in the U.S. The Get Out the Vaccine (GOTVax) program, an innovative statewide government-funded COVID-19 vaccine canvassing program in California, aimed to reduce structural barriers to COVID-19 vaccination in high-risk communities with low vaccination rates. GOTVax consisted of a community-academic-government partnership with 34 local trusted community-based organizations’ (CBOs) to conduct COVID-19 vaccine outreach, education, and vaccine registration. The purpose of this qualitative evaluation study was to explore the barriers and facilitators of using local CBOs to deploy a geographically, racially, and ethnically diverse state-wide COVID-19 vaccine outreach program. Methods Semi-structured online interviews were conducted with participating GOTVax CBO leaders from November 2021 to January 2022. Transcripts were analyzed using reflexive thematic analysis. Results Thirty-one of 34 CBOs participated (91% response rate). Identified themes encompassed both facilitators and barriers to program participation. Key facilitators included leveraging trust through recognized entities; promoting empathetic, tailored outreach; and flexibility of milestone-based CBO funding contracts for rapid program implementation. Barriers included navigating community sociopolitical, geographic, and cultural factors; managing canvassers’ safety; desiring metrics for self-evaluation of outreach success; mitigating canvassing technology challenges; and concerns of program infrastructure initially limiting outreach. CBOs problem-solved barriers with academic and government partners. Conclusions Between May and December 2021, the GOTVax program reached over 2 million California residents and registered over 60,000 residents for COVID-19 vaccination. Public health campaigns may improve benefits from leveraging the expertise of community-trusted CBOs and universities by providing flexible infrastructure and funding, allowing CBOs to seamlessly tailor outreach most applicable to local minoritized communities.

Elevated lipoprotein(a) (Lp[a]) is an independent, genetic risk factor for atherosclerotic cardiovascular disease (ASCVD) that impacts ~1.4 billion people globally. Generally, Lp(a) levels remain stable over time; thus, most individuals need only undergo Lp(a) testing through a non-fasting blood draw once in their lifetime, unless elevated Lp(a) is identified. Despite the convenience of the test for clinicians and patients, routine Lp(a) testing has not been widely adopted. This review provides a guide to the benefits of Lp(a) testing and solutions for overcoming common barriers in practice, including access to testing and lack of awareness. Lp(a) testing provides the opportunity to reclassify ASCVD risk and drive intensive cardiovascular risk factor management in individuals with elevated Lp(a), and to identify patients potentially less likely to respond to statins. Moreover, cascade screening can help to identify elevated Lp(a) in relatives of individuals with a personal or family history of premature ASCVD. Overall, given the profound impact of elevated Lp(a) on cardiovascular risk, Lp(a) testing should be an essential component of risk assessment by primary and specialty care providers.

Micro-CT imaging is a powerful tool for generating high-resolution, isotropic, three-dimensional datasets of whole, centimeter-scale model organisms. At histological resolutions, micro-CT can be used for whole-animal qualitative and quantitative characterization of tissue and organismal structure in health and disease. The small size, global freshwater distribution, wide range of cell size and structures of micron scale, and common use of Daphnia magna in toxicological and environmental studies make it an ideal model for demonstrating the potential power of micro-CT-enabled whole-organism phenotyping. This protocol details the steps involved in D. magna samples preparation for micro-CT, including euthanasia, fixation, staining, and resin embedding. Micro-CT reconstructions of samples imaged using synchrotron micro-CT reveal histological (microanatomic) features of organ systems, tissues, and cells in the context of the entire organism at sub-micron resolution and in 3D. The enabled "3D histology" and 3D renderings can be used for morphometric analyses across cells, tissues, and organ systems.

We report Bayesian inference of the mass, radius, and hot X-ray emitting region properties—using data from the Neutron Star Interior Composition ExploreR (NICER)—for the brightest rotation-powered millisecond X-ray pulsar, PSR J0437−4715. Our modeling is conditional on informative tight priors on mass, distance, and binary inclination obtained from radio pulsar timing using the Parkes Pulsar Timing Array (PPTA; Reardon et al.), and we use NICER background models to constrain the nonsource background, cross-checking with data from XMM-Newton. We assume two distinct hot emitting regions and various parameterized hot region geometries that are defined in terms of overlapping circles; while simplified, these capture many of the possibilities suggested by detailed modeling of return current heating. For the preferred model identified by our analysis, we infer a mass of M = 1.418 ± 0.037 M _⊙ (largely informed by the PPTA mass prior) and an equatorial radius of $R={11.36}_{-0.63}^{+0.95}$ km, each reported as the posterior credible interval bounded by the 16% and 84% quantiles. This radius favors softer dense matter equations of state and is highly consistent with constraints derived from gravitational wave measurements of neutron star binary mergers. The hot regions are inferred to be nonantipodal and hence inconsistent with a pure centered dipole magnetic field.

We present the discovery, with the Neutron Star Interior Composition Explorer (NICER), that SRGA J144459.2−604207 is a 447.9 Hz accreting millisecond X-ray pulsar (AMXP), which underwent a 4 week long outburst starting on 2024 February 15. The AMXP resides in a 5.22 hr binary, orbiting a low-mass companion donor with M _d > 0.1 M _⊙ . We report on the temporal and spectral properties from NICER observations during the early days of the outburst, from 2024 February 21 through 2024 February 23, during which NICER also detected a type I X-ray burst that exhibited a plateau lasting ∼6 s. The spectra of the persistent emission were well described by an absorbed thermal blackbody and power-law model, with blackbody temperature kT ≈ 0.9 keV and power-law photon index Γ ≈ 1.9. Time-resolved burst spectroscopy confirmed the thermonuclear nature of the burst, where an additional blackbody component reached a maximum temperature of nearly kT ≈ 3 keV at the peak of the burst. We discuss the nature of the companion as well as the type I X-ray burst.

Abstract Trichomonas gallinae, a protozoan parasite infecting a wide range of birds, has been a cause for conservation concern since its recognition as an emerging infectious disease, having had notable impacts on several avian species, including causing widespread mortality in greenfinches (Chloris chloris), and chaffinches (Fringilla coelebs), and hindering the recovery of the endangered pink pigeon (Nesoenas mayeri). Horizontal transmission between birds congregating at feeding sites, such as those provided for conservation and species management purposes, is an important driver in the spread of T. galliane. Supplementary feeding is a key conservation intervention for the European turtle dove (Streptopelia turtur), which is declining across its range, driven at least partially by a loss of natural food resources. Due to the link between T. gallinae transmission and supplementary feeding, we consider the prevalence of this parasite among European turtle dove in relation to diet, in the first study to analyze these two factors in the decline of this species together. Using birds sampled from breeding and wintering grounds, the dietary composition of individuals was compared to the presence of T. gallinae, and specific T. gallinae strains. Dietary variation was summarized into two axes using detrended correspondence analysis; neither was associated with the presence of T. gallinae or any specific strains. The proportion of diet accounted for by cultivated seeds did not affect parasite presence, despite the spread of this parasite being associated with supplementary feeding due to an increase in contact between potentially infected and uninfected birds gathering at high densities at feeding sites. Significant dietary overlap was observed between infected and uninfected individuals in all sites, with almost complete dietary overlap being observed in one breeding site. The level of dietary overlap between individuals infected with specific strains fluctuated between sampling seasons, indicating no consistent relationship between diet and infection status.

Abstract Objective: The primary objective of this study was to determine whether Healthy Eating Index (HEI) and Alternative Healthy Eating Index (AHEI) scores were associated with incident metabolic syndrome. Design: This study is a secondary analysis of data from the Jackson Heart Study. HEI and AHEI scores were divided into quintiles and Cox proportional hazards regression models were analysed for 1864 African American adults free from metabolic syndrome at Exam 1 to examine the incidence of metabolic syndrome by quintile of dietary quality score. Setting: Hinds, Madison and Rankin counties, Mississippi, USA. Participants: African American adults, ages 21–94 years, 60·9 % female. Results: Over a mean follow-up time of 6·7 years, we observed 932 incident cases of metabolic syndrome. After adjusting for multiple covariates, a higher HEI score at Exam 1 was not associated with the risk of incident metabolic syndrome, except when looking at the trend analysis for the subgroup of adults with two metabolic syndrome components at Exam 1 (P -trend = 0·03). A higher AHEI score at Exam 1 was associated with the risk of incident metabolic syndrome (hazard ratio for those in the highest quintile compared to the lowest: 0·80 (95 % CI: 0·65, 0·99), P-trend = 0·03). Conclusion: These findings suggest that a dietary pattern that scores higher on the AHEI may help reduce the risk of metabolic syndrome, even for adults who already have two of the minimum of three components required for a diagnosis of metabolic syndrome.

Abstract Background Patients with type 2 diabetes (T2D) treated with glucagon-like peptide-1 receptor agonists may experience reductions in weight and blood pressure. The primary objective of the current study was to determine the weight-dependent and weight-independent effects of ~ 6 months treatment with dulaglutide 1.5 mg treatment in participants with T2D. Methods Mediation analysis was conducted for five randomized, placebo-controlled trials of dulaglutide 1.5 mg to estimate the weight-dependent (i.e., mediated by weight) and weight-independent effects from dulaglutide vs. placebo on change from baseline for systolic blood pressure (SBP), diastolic blood pressure (DBP), and pulse pressure. A random-effects meta-analysis combined these results. To investigate a dose response between dulaglutide 4.5 mg and placebo, mediation analysis was first conducted in AWARD-11 to estimate the weight-dependent and weight-independent effects of dulaglutide 4.5 mg vs. 1.5 mg, followed by an indirect comparison with the mediation result for dulaglutide 1.5 mg vs. placebo. Results Baseline characteristics were largely similar across the trials. In the mediation meta-analysis of placebo-controlled trials, the total treatment effect of dulaglutide 1.5 mg after placebo-adjustment on SBP was − 2.6 mmHg (95% CI − 3.8, − 1.5; p

We developed and tested MivacunaLA/MyshotLA, a community-informed mobile phone intervention, to increase COVID-19 vaccination among Latino parents/caretakers of minors in under-resourced areas of Los Angeles by addressing misinformation and building trust. We recruited Latino parents/caregivers with at least one unvaccinated child in East and South Los Angeles in the summer of 2021 and evaluated MivacunaLA as a randomized controlled trial with a wait-list control group. A difference-in-difference analysis showed Latino parents/caregivers that participated in MivacunaLA (n = 246), in comparison to the control group, were 15 percentage points more likely (p = 0.04) to report vaccination of minors aged 12–17 years, and 12 percentage points more likely (p = 0.03) to report a positive intention to vaccinate minors aged 2–11 years (when COVID-19 vaccines became available). Mobile phone-delivered digital interventions using videos and culturally tailored educational material to promote COVID-19 vaccine confidence can be an effective way to combat misinformation and deliver timely information to marginalized communities. Community-based participatory research approaches are crucial to advance health equity among minority communities, especially immigrant Spanish-speaking underserved communities.

ABSTRACT Peatlands are large carbon sinks with primary production outpacing decomposition of organic matter. Results from the Spruce and Peatland Responses Under Changing Environments (SPRUCE) study show net losses of organic matter and increased greenhouse gas production from peatlands in response to whole-ecosystem warming. Here, we investigated how warming and elevated CO2 impact peat microbial communities and peat soil decomposition rates and characterized microbial communities through amplicon sequencing and compositional changes across four depth increments. Microbial diversity and community composition were significantly impacted by soil depth, temperature, and CO2 treatment. Bacterial/archaeal α-diversity increased significantly with increasing temperature, and fungal α-diversity was lower under elevated CO2 treatments. Trans domain microbial networks showed higher complexity of microbial communities in decomposition ladder depths from the warmed enclosures, and the number of highly connected hub taxa within the networks was positively correlated with temperature. Methanogenic hubs were identified in the networks constructed from the warmest enclosures, indicating increased importance of methanogenesis in response to warming. Microbial community responses were not however reflected in measures of peat soil decomposition, as warming and elevated CO2 had no significant short-term effects on soil mass loss or composition. Regardless of treatment, on average only 4.5% of the original soil mass was lost after 3 years and variation between replicates was high, potentially masking treatment effects. Previous results at the SPRUCE experiment have shown warming is accelerating organic-matter decomposition and CO2 and CH4 production, and our results suggest these changes may be driven by warming-induced shifts in microbial communities. IMPORTANCE Microbial community changes in response to climate change drivers have the potential to alter the trajectory of important ecosystem functions. In this paper, we show that while microbial communities in peatland systems responded to manipulations of temperature and CO2 concentrations, these changes were not associated with similar responses in peat decomposition rates over 3 years. It is unclear however from our current studies whether this functional resiliency over 3 years will continue over the longer time scales relevant to peatland ecosystem functions.

Population genomic analyses and palaeogeographical modelling combine to help infer the ancient migration of humans into South Asia from Sundaland, driven by rapid sea level rises.

Abstract Hypertension is the main cause of cardiovascular disease, especially in women. Black women (58%) are affected by higher rates of hypertension than other racial/ethnic groups contributing to increased cardio‐metabolic disorders. To decrease blood pressure (BP) in this population, a pilot randomized controlled trial was conducted to examine the effects of Interactive Technology Enhanced Coaching (ITEC) versus Interactive Technology (IT) alone in achieving BP control, adherence to antihypertensive medication, and adherence to lifestyle modifications among Black women diagnosed with and receiving medication for their hypertension. Participants completed a 6‐week Chronic Disease Self‐Management Program (CDSMP), and 83 participants were randomly assigned to ITEC versus IT. Participants were trained to use three wireless tools and five apps that were synchronized to smartphones to monitor BP, weight, physical activity (steps), diet (caloric and sodium intake), and medication adherence. Fitbit Plus, a cloud‐based collaborative care platform was used to collect, track, and store data. Using a mixed‐effects repeated measures model, the main effect of group means indicated no significant difference between the treatment and referent groups on study variables. The main effect of time indicated significant differences between repeated measures for systolic BP (p

Our interest in the genetic basis of skin color variation between populations led us to seek a Native American population with genetically African admixture but low frequency of European light skin alleles. Analysis of 458 genomes from individuals residing in the Kalinago Territory of the Commonwealth of Dominica showed approximately 55% Native American, 32% African, and 12% European genetic ancestry, the highest Native American genetic ancestry among Caribbean populations to date. Skin pigmentation ranged from 20 to 80 melanin units, averaging 46. Three albino individuals were determined to be homozygous for a causative multi-nucleotide polymorphism OCA2NW273KV contained within a haplotype of African origin; its allele frequency was 0.03 and single allele effect size was –8 melanin units. Derived allele frequencies of SLC24A5A111T and SLC45A2L374F were 0.14 and 0.06, with single allele effect sizes of –6 and –4, respectively. Native American genetic ancestry by itself reduced pigmentation by more than 20 melanin units (range 24–29). The responsible hypopigmenting genetic variants remain to be identified, since none of the published polymorphisms predicted in prior literature to affect skin color in Native Americans caused detectable hypopigmentation in the Kalinago.

Introduction The goal of academic mentoring relationships is to enable the mentee to identify/achieve professional advancement. Although mentors of clinician educators (CEs) must understand the criteria for successful career advancement, few have received formal CE mentor training. Methods The National Research Mentoring Network convened an expert panel to develop a 90-minute module for training CE mentors. This module included individual development plans, case studies involving challenges for CE faculty, and examples of the broadened scope of scholarly activity. The workshop was delivered to 26 participants across four institutions and evaluated by a retrospective pre/post survey. Results Using a 7-point scale (1 = very low, 4 = average, 7 = very high), participants rated the overall quality of their CE mentoring as slightly below average preworkshop (M = 3.9) and as above average postworkshop (M = 5.2, p < .001). Areas of greatest self-perceived change in skills on a 7-point scale (1 = not at all skilled, 4 = moderately skilled, 7 = extremely skilled ) included setting clear expectations of the mentoring relationship (pre M = 3.6, post M = 5.1, p < .001), aligning mentor expectations with those of mentees (pre M = 3.6, post M = 5.0, p < .001), and helping mentees set career goals (pre M = 3.9, post M = 5.4, p < .001). Discussion This module trains CE mentors using an interactive and collective problem-solving approach. Workshop participants better defined demonstrable markers for CE progression with potential to impact tailored guidance for mentees.

XTE J1829−098 is a transient X-ray pulsar with a period of ∼7.8 s. It is a candidate Be star system, although the evidence for this is not yet definitive. We investigated the twenty-year-long X-ray light curve using the Rossi X-ray Timing Explorer Proportional Counter Array (PCA), Neil Gehrels Swift Observatory Burst Alert Telescope, and the Monitor of All-sky X-ray Image. We find that all three light curves are clearly modulated on the ∼244 days orbital period previously reported from PCA monitoring observations, with outbursts confined to a narrow phase range. The light curves also show that XTE J1829−098 was in an inactive state between approximately 2008 December and 2018 April, and no strong outbursts occurred. Such behavior is typical of Be X-ray binary systems, with the absence of outbursts likely related to the dissipation of the Be star's decretion disk. The mean outburst shapes can be approximated with a triangular profile and, from a joint fit of this to all three light curves, we refine the orbital period to 243.95 ± 0.04 days. The mean outburst profile does not show any asymmetry and has a total phase duration of 0.140 ± 0.007. However, the PCA light curve shows that there is considerable cycle-to-cycle variability of the individual outbursts. We compare the properties of XTE J1829−098 with other sources that show short phase-duration outbursts, in particular GS 1843−02 (2S 1845−024), which has a very similar orbital period, but longer pulse period, and whose orbit is known to be highly eccentric.

We present the tidal disruption event (TDE) AT2022lri, hosted in a nearby (≈144 Mpc) quiescent galaxy with a low-mass massive black hole (10 ^4 M _⊙ < M _BH < 10 ^6 M _⊙ ). AT2022lri belongs to the TDE-H+He subtype. More than 1 Ms of X-ray data were collected with NICER, Swift, and XMM-Newton from 187 to 672 days after peak. The X-ray luminosity gradually declined from 1.5 × 10 ^44 erg s ^−1 to 1.5 × 10 ^43 erg s ^−1 and remains much above the UV and optical luminosity, consistent with a super-Eddington accretion flow viewed face-on. Sporadic strong X-ray dips atop a long-term decline are observed, with a variability timescale of ≈0.5 hr–1 days and amplitude of ≈2–8. When fitted with simple continuum models, the X-ray spectrum is dominated by a thermal disk component with inner temperature going from ∼146 to ∼86 eV. However, there are residual features that peak around 1 keV, which, in some cases, cannot be reproduced by a single broad emission line. We analyzed a subset of time-resolved spectra with two physically motivated models describing a scenario either where ionized absorbers contribute extra absorption and emission lines or where disk reflection plays an important role. Both models provide good and statistically comparable fits, show that the X-ray dips are correlated with drops in the inner disk temperature, and require the existence of subrelativistic (0.1–0.3 c ) ionized outflows. We propose that the disk temperature fluctuation stems from episodic drops of the mass accretion rate triggered by magnetic instabilities or/and wobbling of the inner accretion disk along the black hole’s spin axis.

We present the results obtained from timing and spectral studies of 15 thermonuclear X-ray bursts from 4U 1820–30 observed with the Neutron Star Interior Composition Explorer (NICER) during its 5 yr of observations between 2017 and 2022. All bursts showed clear signs of photospheric radius expansion (PRE), where the neutron star (NS) photosphere expanded more than 50 km above the surface. One of the bursts produced a superexpansion with a blackbody emission radius of 902 km for the first time with NICER. We searched for burst oscillations in all 15 bursts and found evidence of a coherent oscillation at 716 Hz in a burst, with a 2.9 σ detection level based on Monte Carlo simulations. If confirmed with future observations, 4U 1820–30 would become the fastest-spinning NS known in X-ray binary systems. The fractional rms amplitude of the candidate burst oscillation was found to be 5.8% in the energy range of 3–10 keV. Following the variable persistent model from burst time-resolved spectroscopy, an anticorrelation is seen between the maximum scaling factor value and the (preburst) persistent flux. We detected a low value of ionization at the peak of each burst based on reflection modeling of burst spectra. A partially interacting inner accretion disk or a weakly ionized outer disk may cause the observed ionization dip during the PRE phase.

PSR J0740+6620 is the neutron star with the highest precisely determined mass, inferred from radio observations to be 2.08 ± 0.07 M _⊙ . Measurements of its radius therefore hold promise to constrain the properties of the cold, catalyzed, high-density matter in neutron star cores. Previously, Miller et al. and Riley et al. reported measurements of the radius of PSR J0740+6620 based on Neutron Star Interior Composition Explorer (NICER) observations accumulated through 2020 April 17, and an exploratory analysis utilizing NICER background estimates and a data set accumulated through 2021 December 28 was presented in Salmi et al. Here we report an updated radius measurement, derived by fitting models of X-ray emission from the neutron star surface to NICER data accumulated through 2022 April 21, totaling ∼1.1 Ms additional exposure compared to the data set analyzed in Miller et al. and Riley et al., and to data from XMM-Newton observations. We find that the equatorial circumferential radius of PSR J0740+6620 is ${12.92}_{-1.13}^{+2.09}$ km (68% credibility), a fractional uncertainty ∼83% the width of that reported in Miller et al., in line with statistical expectations given the additional data. If we were to require the radius to be less than 16 km, as was done in Salmi et al., then our 68% credible region would become $R={12.76}_{-1.02}^{+1.49}$ km, which is close to the headline result of Salmi et al. Our updated measurements, along with other laboratory and astrophysical constraints, imply a slightly softer equation of state than that inferred from our previous measurements.

We detected a giant X-ray flare from the RS CVn–type binary star UX Ari using the Monitor of All-sky X-ray Image on 2020 August 17 and started a series of Neutron star Interior Composition Explorer observations 89 minutes later. For a week, the entire duration of the flare was covered with 32 snapshot observations including the rising phase. The X-ray luminosity reached 2 × 10 ^33 erg s ^−1 , and the entire energy release was ∼10 ^38 erg in the 0.5–8.0 keV band. X-ray spectra characterized by continuum emission with lines of Fe xxv He α and Fe xxvi Ly α were obtained. We found that the temperature peaks before the flux does, which suggests that the period of plasma formation in the magnetic flare loop was captured. Using the continuum information (temperature, flux, and their delay time), we estimated the flare loop size to be ∼3 × 10 ^11 cm and the peak electron density to be ∼4 × 10 ^10 cm ^−3 . Furthermore, using the line ratio of Fe xxv and Fe xxvi , we investigated any potential indications of deviation from collisional ionization equilibrium (CIE). The X-ray spectra were consistent with CIE plasma throughout the flare, but the possibility of an ionizing plasma away from CIE was not rejected in the flux rising phase.

We present the results obtained from detailed X-ray timing and spectral studies of X-ray pulsar Swift J0243.6+6124 during its giant and normal X-ray outbursts between 2017 and 2023 observed by the Neutron star Interior Composition Explorer (NICER). We focused on a timing analysis of the normal outbursts. A distinct break is found in the power density spectra of the source. The corresponding break frequency and slopes of the power laws around the break vary with luminosity, indicating a change in the accretion dynamics with the mass accretion rate. Interestingly, we detected quasiperiodic oscillations within a specific luminosity range, providing further insights into the underlying physical processes. We also studied the neutron star spin period evolution and a luminosity variation in the pulse profile during the recent 2023 outburst. The spectral analysis was conducted comprehensively for the giant and all other normal outbursts. We identified a double transition at luminosities of ≈7.5 × 10 ^37 and 2.1 × 10 ^38 erg s ^−1 in the evolution of continuum parameters like the photon index and cutoff energy with luminosity. This indicates three distinct accretion modes experienced by the source, mainly during the giant X-ray outburst. A soft blackbody component with a temperature of 0.08–0.7 keV is also detected in the spectra. The observed temperature undergoes a discontinuous transition when the pulsar evolves from a sub- to super-Eddington state. Notably, in addition to an evolving 6–7 keV iron line complex, a 1 keV emission line was observed during the super-Eddington state of the source, implying X-ray reflection from the accretion disk or outflow material.

We report on X-ray polarization measurements of the extragalactic Crab-like PSR B0540-69 and its Pulsar Wind Nebula (PWN) in the Large Magellanic Cloud, using a ∼850 ks Imaging X-ray Polarimetry Explorer (IXPE) exposure. The PWN is unresolved by IXPE. No statistically significant polarization is detected for the image-averaged data, giving a 99% confidence polarization upper limit (MDP _99 ) of 5.3% in the 2–8 keV energy range. However, a phase-resolved analysis detects polarization for both the nebula and pulsar in the 4–6 keV energy range. For the PWN defined as the off-pulse phases, the polarization degree (PD) of (24.5 ± 5.3)% and polarization angle (PA) of (78.1 ± 6.2)° is detected at 4.6 σ significance level, consistent with the PA observed in the optical band. In a single on-pulse window, a hint of polarization is measured at 3.8 σ with PD of (50.0 ± 13.1)% and PA of (6.2 ± 7.4)°. A “simultaneous” PSR/PWN analysis finds two bins at the edges of the pulse exceeding 3 σ PD significance, with PD of (68 ± 20)% and (62 ± 20)%; intervening bins at 2–3 σ significance have lower PD, hinting at additional polarization structure.

Despite the established role of low-density lipoprotein cholesterol (LDL-C) as a major risk factor for cardiovascular disease (CVD), and the persistence of CVD as the leading cause of morbidity and mortality in the United States, national quality assurance metrics no longer include LDL-C measurement as a required performance metric. This clinical perspective reviews the history of LDL-C as a quality and performance metric and the events that led to its replacement. It also presents patient, healthcare provider, and health system rationales for re-establishing LDL-C measurement as a performance measure to improve cholesterol control in high-risk groups and to stem the rising tide of CVD morbidity and mortality, cardiovascular care disparities, and related healthcare costs.

Beyond pharmacotherapy in adulthood, primordial prevention in United States (U.S.) children and adolescents is needed to avoid the upcoming tsunami of cardiometabolic and cardiovascular disease (CVD). Healthcare disparities were unmasked by the disparate morbidity and mortality of COVID-19 in racial/ethnic populations, especially in persons with obesity, diabetes, and CVD. One potential successful strategic improvement of childhood cardiovascular health is to reduce sugar consumption in early life as CVD is the number one cause of death in patients with Type 2 diabetes (T2D). Furthermore, cardiologists treat more patients with T2D than endocrinologists. This commentary challenges cardiovascular specialists and other clinicians to address the increasing burden of cardiometabolic and CVD in adults, especially in racial/ethnic populations, by supporting primordial prevention in childhood.

Background: Few church-based health interventions have evaluated the influence of neighborhood-level social determinants of health (SDOH) on adopting heart-healthy lifestyles; none has occurred in Louisiana. We aimed to characterize neighborhood-level SDOH that may influence the ability to adopt a heart-healthy lifestyle among Black community church members in New Orleans, LA. Methods: This mixed methods study used quantitative data (surveys) and qualitative data (focus groups) to explore SDOH at the neighborhood- and church-area- level, including factors related to the physical (e.g., walkability, accessibility to recreational facilities) and social (e.g., social cohesion, perceived safety) environments. Descriptive analyses were conducted for quantitative data. Qualitative data were coded and analyzed using grounded theory and thematic analysis. Results: Among survey respondents (n = 302, 77 % female, 99 % Black), most reported having walkable neighborhood sidewalks and high neighborhood social cohesion. Two-thirds did not feel violence was a problem in their neighborhood and felt safe walking, day, or night. Focus group participants (n = 27, 74 % female, 100 % Black) reported facilitators to heart-healthy living, including social support promoting physical activity, intentionality in growing, buying, and preparing produce, and the neighborhood-built environment. Reported barriers included: crime, the COVID-19 pandemic, individual-level factors limiting physical activity, and city-wide disparities influencing health. Participants discussed strategies to promote healthy living, centered around the theme of establishing and rebuilding community relationships. Conclusions: Future health interventions aimed at improving cardiovascular outcomes among church communities should continue to inquire about neighborhood-level SDOH and tailor interventions, as appropriate, to address barriers and leverage facilitators within these communities.

Abstract Background Recombinant human pentraxin-2 (rhPTX-2) significantly decreased decline in percent predicted forced vital capacity (FVC) and stabilized 6-min walk distance (6MWD) in patients with idiopathic pulmonary fibrosis (IPF) during the 28-week, placebo-controlled, randomized period of the Phase II PRM-151–202 study. Interim (76-week) data from the open-label extension (OLE) demonstrated sustained safety and efficacy with rhPTX-2 treatment. Here, we present the entire long-term OLE safety and efficacy data to 128 weeks. Methods Patients who completed the randomized PRM-151–202 study period were eligible for the OLE, during which all patients received rhPTX-2, having started rhPTX-2 (i.e., crossed from placebo) or continued rhPTX-2 after Week 28. rhPTX-2 was administered in 28-week cycles, with 10 mg/kg intravenous infusions (60 min) on Days 1, 3, and 5 in the first week of each cycle, then one infusion every 4 weeks up to Week 128. The OLE primary objective was to assess the long-term safety and tolerability of rhPTX-2. Other outcomes included FVC, 6MWD, and patient-reported outcomes (descriptive analysis). Results All 111 patients who completed the randomized period entered the OLE (n = 37 started rhPTX-2; n = 74 continued rhPTX-2); 57 (51.4%) completed to Week 128. The treatment-emergent adverse event (TEAE) profile was consistent with the randomized period, with the majority of TEAEs graded mild or moderate. Serious TEAEs occurred in 47 patients (42.3%), most frequently IPF (n = 11; 9.9%), pneumonia (n = 7; 6.3%), and acute respiratory failure (n = 3; 2.7%). Three patients underwent lung transplantation. Most serious TEAEs (and all 14 fatal events) were considered unrelated to rhPTX-2 treatment. For patients starting vs continuing rhPTX-2, mean (95% confidence interval) changes from baseline to Week 128 were, respectively, − 6.2% (− 7.7; − 4.6) and − 5.7% (− 8.0; − 3.3) for percent predicted FVC and − 36.3 m (− 65.8; − 6.9) and − 28.9 m (− 54.3; − 3.6) for 6MWD; however, conclusions were limited by patient numbers at Week 128. Conclusions Long-term treatment (up to 128 weeks) with rhPTX-2 was well tolerated in patients with IPF, with no new safety signals emerging in the OLE. The limited efficacy data over 128 weeks may suggest a trend towards a treatment effect. Trial registration NCT02550873; EudraCT 2014-004782-24.

Ideal three-dimensional imaging of complex samples made up of micron-scale structures extending over mm to cm, such as biological tissues, requires both wide field of view and high resolution. For existing optics and detectors used for micro-CT (computed tomography) imaging, sub-micron pixel resolution can only be achieved for fields of view of

Study objective: Non-Hispanic Black (NHB) adults have high hypertension (HTN) and cardiovascular disease (CVD) burden. Medication nonadherence limits control and self-measured blood pressure (SMBP) improves diagnosis and adherence. This predominantly NHB cohort pilot, via community-clinical linkages, with uncontrolled HTN and low adherence, utilized bidirectional electronic messaging (BEM) with team-care, to assess medication adherence, quality of life, and BP. Setting: Academic clinic and community sources. Design: Recruitment included: uncontrolled HTN (BP ≥130/80 mm Hg), low adherence (Krousel-Wood Medication Adherence Scale (K-Wood-MAS-4) ≥1 score), and smartphone access. Participants and interventions: Participants (N = 36) received validated Bluetooth-enabled BP devices, synced to smartphones, via a secured cloud-based application. Main outcome measures: Demographics, adherence scores, Centers for Disease Control and Prevention (CDC) health-related quality of life (HRQOL-14), BP, body mass index (BMI), 8 weeks daily BEM, SMBP and text reminders were obtained. Results: Age was 58.7 ± 12.8 years; BMI 34.8 ± 7.9; 63.9 % female; 88.9 % self-identified NHB adults; 72.2 % with obesity; 74.3 % with diabetes. K-Wood-MAS-4 adherence composite score improved: 2.19 to 1.58 (median −0.5, p = 0.0001). Systolic BP decreased by 10.5 ± 20.0 mm Hg (median −11.0, p = 0.0027). QOL did not significantly change. Mean 7-day average SBP/DBP differences were −4.94 ± 16.82 (median −3.5, p = 0.0285) and −0.17 ± 7.42 (median 0, p = 0.7001), respectively. Social support with taking BP medication was: “yes” (n = 19); 143.8 mm Hg to 131.5 mm Hg (median −12.5, p = 0.0198) and “no” (n = 14); 142.32 mm Hg to 130.25 mm Hg (median −4.0, p = 0.0771). Conclusions: Community-clinical linkages and SMBP with BEM significantly improved medication adherence and SBP without modifying pharmacotherapy.

We report the discovery of the unusually bright long-duration gamma-ray burst (GRB), GRB 221009A, as observed by the Neil Gehrels Swift Observatory (Swift), Monitor of All-sky X-ray Image, and Neutron Star Interior Composition Explorer Mission. This energetic GRB was located relatively nearby ( z = 0.151), allowing for sustained observations of the afterglow. The large X-ray luminosity and low Galactic latitude ( b = 4.°3) make GRB 221009A a powerful probe of dust in the Milky Way. Using echo tomography, we map the line-of-sight dust distribution and find evidence for significant column densities at large distances (≳10 kpc). We present analysis of the light curves and spectra at X-ray and UV–optical wavelengths, and find that the X-ray afterglow of GRB 221009A is more than an order of magnitude brighter at T _0 + 4.5 ks than that from any previous GRB observed by Swift. In its rest frame, GRB 221009A is at the high end of the afterglow luminosity distribution, but not uniquely so. In a simulation of randomly generated bursts, only 1 in 10 ^4 long GRBs were as energetic as GRB 221009A; such a large E _γ _,iso implies a narrow jet structure, but the afterglow light curve is inconsistent with simple top-hat jet models. Using the sample of Swift GRBs with redshifts, we estimate that GRBs as energetic and nearby as GRB 221009A occur at a rate of ≲1 per 1000 yr—making this a truly remarkable opportunity unlikely to be repeated in our lifetime.

Rationale & Objective: Studies in the United States and United Kingdom generally report better survival for Black than White patients undergoing maintenance hemodialysis, a finding not explained by differences in sociodemographics or comorbid conditions. It is not clear if such findings can be generalized to other countries. We investigated the association between race and mortality among a Black, White, and Mixed-Race sample of maintenance hemodialysis patients in Salvador, Brazil. Study Design: Prospective cohort study. Baseline data collection from July 1, 2005 through December 31, 2010. The follow-up period ended on December 31, 2017. Setting & Participants: The Prospective Study of the Prognosis of Chronic Hemodialysis Patients (PROHEMO) is a cohort of 1,501 patients from 4 dialysis units in Salvador, Brazil. Predictor: Race categorized as White (12.9%), Mixed-Race (62.4%), and Black (24.8%), using White as the reference category. Outcome: Survival. Analytical Approach: Using Cox regression models, we tested the association between race and mortality, with adjustments for age, sex, social factors, laboratory results, and comorbid conditions. Results: The mean age was 49 years for Black and Mixed-Race patients and 55 years for White patients. In a Cox model adjusted for age, mortality did not differ between Black and White patients (HR, 1.10; 95% CI, 0.66-1.83) or between Mixed-Race and White patients (HR, 1.00; 95% CI, 0.65-1.54). Adjustment for sociodemographics and comorbid conditions had minimal impact on these results. Limitations: Potential residual confounding and lack of adjustment for time-varying variables. Conclusions: Contrary to studies in the United States and United Kingdom, we did not find racial difference in mortality among patients in our Brazilian setting who were being treated by maintenance hemodialysis. These results underscore the importance of investigating racial differences in mortality among patients undergoing maintenance hemodialysis in different populations and countries.

Remarkable transformations in science and healthcare have resulted in declines in mortality from cardiovascular disease over the past several decades, largely driven by progress in prevention and treatment of persons at risk. However, these trends are now beginning to stall, as our county faces increases in cardiovascular risk factors including overweight and obesity, type 2 diabetes mellitus, and metabolic syndrome. Furthermore, poor long-term adherence to a healthy lifestyle and lifesaving pharmacotherapy have exacerbated these trends, with recent data suggesting unprecedented increases in cardiovascular morbidity and mortality. A paradigm shift is needed to improve the cardiovascular health of our nation. Preventive cardiology, a growing subspecialty of cardiovascular medicine, is the practice of primordial, primary, and secondary prevention of all cardiovascular diseases. Preventive cardiologists and preventive cardiology specialists are well equipped with the knowledge and skill-set necessary to reduce deaths related to the growing burden of heart disease and its risk factors. Despite dedicated efforts, cardiovascular disease remains the leading killer of men and women in the United States. Although there is little debate regarding the importance of prevention, many healthcare professionals question the need for preventive cardiology as a distinct subspecialty. Additionally, the field's growth has been hampered by a lack of organization and standardization, and variability of training within programs across the country. The purpose of this document is to delineate the key attributes that define the field of preventive cardiology according to the American Society for Preventive Cardiology.