What's been tried: a curated catalogue of efforts to improve access to general practice.

Background: Although increasing numbers of appointments are being provided, public satisfaction with access to UK general practice is declining. Previous attempts to improve access have not been systematically collated.

Aim: We aimed to identify interventions to improve access to general practice in the UK, to organise these interventions into thematic categories, and to identify which aspects of access are targeted.

Virtual Care Appointments and Experience Among Older Rural Patients with Chronic Conditions in New South Wales: An Analysis of Existing Survey Data.

This retrospective, descriptive study, conducted in 2024, analysed Virtual Care Survey (2020-2022) data of patients' self-reported reflections on use and experiences to investigate relationships between demographics, the number of chronic conditions, and virtual care use among older rural patients (≥65 years with at least one chronic condition) living in New South Wales, and their satisfaction with virtual care. Associations between categorical variables were assessed using chi-squared tests, and Kruskal-Wallis tests were used for continuous variables. Qualitative feedback was analysed thematically.

Leveraging cancer mutation data to inform the pathogenicity classification of germline missense variants.

Innovative and easy-to-implement strategies are needed to improve the pathogenicity assessment of rare germline missense variants. Somatic cancer driver mutations identified through large-scale tumor sequencing studies often impact genes that are also associated with rare Mendelian disorders. The use of cancer mutation data to aid in the interpretation of germline missense variants, regardless of whether the gene is associated with a hereditary cancer predisposition syndrome or a non-cancer-related developmental disorder, has not been systematically assessed.

Association of patient- and hospital-level predictors with patterns of initial treatment in patients with Rheumatoid Arthritis: findings from a national cohort study.

Objectives: To update the first-line conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) prescribing pattern, describe change and variation across demographical and geographical factors in the Rheumatoid arthritis (RA) population, and identify individual and hospital factors associated with it.

Methods: This retrospective cohort study included newly diagnosed RA adult patients from 1 May 2018-1 April 2023 in the UK. We used adjusted multinomial logistic regression with random effect to explore associations with different first-line csDMRAD prescription and to account for hospital-level clustering.

Whole grain modified Nova ultra-processed food (UPF) definitions: a cross-sectional analysis of the impact on cardiometabolic risk measures when excluding high whole-grain foods from the UPF category in Australia.

Ultra-processed foods (UPF), defined using the Nova classification system, are associated with increased chronic disease risk. More recently, evidence suggests the UPF subgroup of whole-grain breads and cereals is in fact linked with reduced chronic disease risk. This study aimed to explore associations of cardiometabolic risk measures with Nova UPF intake versus when foods with ≥25% or ≥50% whole grain are excluded from the definition.

Family Caregiver Knowledge in the Outpatient Management of Pediatric Tracheostomy-Related Emergencies.

Tracheostomy-related emergencies (TREs) contribute significantly to preventable mortality. The retention of caregiver knowledge and skills acquired through simulation-based training (SBT) is unknown. This study aimed to assess the management of TREs by caregivers who did and did not receive SBT.

AURA: Accelerating drug discovery with accuracy, utility, and rank-order assessment for data-driven decision making.

Biopharmaceutical companies generate a wealth of data, ranging from in silico physicochemical properties and machine learning models to both low and high-throughput in vitro assays and in vivo studies. To effectively harnesses this extensive data, we introduce a statistical methodology facilitated by Accuracy, Utility, and Rank Order Assessment (AURA), which combines basic statistical analyses with dynamic data visualizations to evaluate endpoint effectiveness in predicting intestinal absorption. We demonstrated that various physicochemical properties uniquely influence intestinal absorption on a project-specific basis, considering factors like intestinal efflux, passive permeability, and clearance.

Canine Multidrug-Resistant Pseudomonas aeruginosa Cases Linked to Human Artificial Tears-Related Outbreak.

We report 2 canine cases of carbapenemase-producing Pseudomonas aeruginosa within a United States veterinary hospital associated with a human outbreak linked to over-the-counter artificial tears. We investigated veterinary hospital transmission. Veterinary antimicrobial resistance surveillance and infection prevention and control enhancements are needed to reduce transmission of carbapenemase-producing organisms.

Tumor Morphology for Prediction of Poor Responses Early in Neoadjuvant Chemotherapy for Breast Cancer: A Multicenter Retrospective Study.

Background: This multicenter and retrospective study investigated the additive value of tumor morphologic features derived from the functional tumor volume (FTV) tumor mask at pre-treatment (T0) and the early treatment time point (T1) in the prediction of pathologic outcomes for breast cancer patients undergoing neoadjuvant chemotherapy.

Methods: A total of 910 patients enrolled in the multicenter I-SPY 2 trial were included. FTV and tumor morphologic features were calculated from the dynamic contrast-enhanced (DCE) MRI.

Identification of raccoon rabies virus variant in a stray kitten: the role of veterinary practitioners in detection and reporting of a non-native zoonotic pathogen-Nebraska, 2023.

Rabies is a fatal encephalitic disease affecting all mammals. This report describes identification of raccoon rabies virus variant isolated from a stray kitten in an urban Midwestern city that is nonendemic for this virus variant. The kitten originally presented with nonspecific neurologic abnormalities.

Women's Experiences of Adult Sexual Assault, by Perpetrator Gender and Participant Sexual Orientation.

The vast majority of theoretical and empirical research assessing sexual assault (SA) focuses on man-against-woman SA (MWSA), leaving other forms such as woman-against-woman SA (WWSA) understudied. Relatively simple questions, such as the relative frequency of WWSA for women of different sexual orientations, the tactics (e.g.

Exploring the reporting, intake and recommendations of primary food sources of whole grains globally: a scoping review.

Whole-grain intake is associated with reduced risk of non-communicable diseases. Greater understanding of major food sources of whole grains globally, and how intake has been quantified, is essential to informing accurate strategies aiming to increase consumption and reduce non-communicable disease risk. Therefore, the aim of this review was to identify the primary food sources of whole-grain intake globally and explore how they are quantified and reported within literature, and their recommendation within respective national dietary guidelines.

Software-driven chronic disease management: Algorithm design and implementation in a community-based blood pressure control pilot.

Background: Optimal guideline-directed medical therapy is rarely attained in practice, resulting in inadequate control of diseases such as hypertension, with poorer results in under-resourced communities. Technology, including artificial intelligence-driven decision support and software-driven workflow transformation, can potentially improve disease outcomes at a reduced cost, although it must be integrated with a holistic approach.

Methods: We describe the design of a software platform that enables rapid iterative remote management of >20 conditions across cardiac-kidney-metabolic disease.

Influence of Race Modifiers in Estimated Glomerular Filtration Rate Calculations on Medication Dosing, Access, and Transplant Eligibility.

The 2021 Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation for estimation of glomerular filtration rate (GFR) lower values for Black individuals relative to previous equations, which may change medication eligibility or trigger the need to reevaluate dosing decisions. Major drug classes such as antibiotics, antidiabetic medications, cardiovascular agents, medications for the treatment of psychiatric illness, and chemotherapy drugs all have estimated GFR thresholds for prescribing eligibility. However, the use of strict thresholds for medication eligibility should be heavily scrutinized, and individualized comprehensive approaches should be used for patients on the cusps of these thresholds.

Temporal and regional variation in the use of biologic and targeted synthetic DMARDs for rheumatoid arthritis: a nationwide cohort study.

Objective: To evaluate temporal and regional variation in biologic and targeted synthetic DMARD (b/tsDMARD) initiation for rheumatoid arthritis (RA) in England and Wales.

Methods: An observational cohort study was conducted for people with RA enrolled in the National Early Inflammatory Arthritis Audit (NEIAA) between May 2018 and April 2022 who had 12-month follow-up data. Temporal trends in escalation to b/tsDMARDs within 12 months of initial rheumatology assessment were explored, including comparisons before and after publication (July 2021) of national guidelines that lowered the threshold for b/tsDMARD initiation to include moderate-severity RA.

"I Have Come Because I See You Care About Me": Recruiting Older Black Americans for Genomic Research.

The lack of diversity in genomic studies is a disparity that influences our understanding of human genomic variation and threatens equity in the benefits of precision medicine. Given our current genomic research with Black older adults, we conducted a qualitative study to elucidate participants' knowledge, attitudes, and beliefs about genomic research and research participation and what factors contribute to their willingness to participate and to gain insights into barriers that researchers may have in recruiting Black Americans. We conducted semistructured interviews (N=16) with previous genomic research participants, and an inductive thematic approach was used to code and interpret the data.

Diagnosis of Menopause in a Captive Sumatran Orangutan (Pongo abelii).

Humans were long thought to be the only mammal to experience menopause, the permanent cessation of reproduction followed by a long post-reproductive lifespan. More recently, evidence has been found for the existence of menopause in other long-lived mammals, including chimpanzees and gorillas. However, orangutans, which have the longest interbirth interval of any primate, have rarely been studied in this period of their lives.

Notes from the Field: Enhanced Surveillance for Raccoon Rabies Virus Variant and Vaccination of Wildlife for Management - Omaha, Nebraska, October 2023-July 2024.

On September 28, 2023, a kitten aged approximately 6 weeks found in Omaha, Nebraska, had test results positive for rabies at the Nebraska Veterinary Diagnostic Center (NVDC) after dying with neurologic signs and having bitten and scratched its caretakers. Preliminary investigation identified 10 exposed persons for whom postexposure prophylaxis (PEP) was recommended. Subsequent variant-typing by NVDC yielded a presumptive positive result for the Eastern raccoon rabies virus variant (RRVV), which CDC confirmed on October 6.

What is the real value of omics data? Enhancing research outcomes and securing long-term data excellence.

A wealth of high-throughput biological data, of which omics constitute a significant fraction, has been made publicly available in repositories over the past decades. These data come in various formats and cover a range of species and research areas providing insights into the complexities of biological systems; the public repositories hosting these data serve as multifaceted resources. The potentially greater value of these data lies in their secondary utilization as the deployment of data science and artificial intelligence in biology advances.

Datopotamab-deruxtecan plus durvalumab in early-stage breast cancer: the sequential multiple assignment randomized I-SPY2.2 phase 2 trial.

Sequential adaptive trial designs can help accomplish the goals of personalized medicine, optimizing outcomes and avoiding unnecessary toxicity. Here we describe the results of incorporating a promising antibody-drug conjugate, datopotamab-deruxtecan (Dato-DXd) in combination with programmed cell death-ligand 1 inhibitor, durvalumab, as the first sequence of therapy in the I-SPY2.2 phase 2 neoadjuvant sequential multiple assignment randomization trial for high-risk stage 2/3 breast cancer.