Changes in traffic-related air pollution exposures and associations with adverse birth outcomes over 20 years in Texas.

Background: Billions of dollars have been spent implementing regulations to reduce traffic-related air pollution (TRAP) from exhaust pipe emissions. However, few health studies have evaluated the change in TRAP emissions and associations with infant health outcomes. We hypothesize that the magnitude of association between vehicle exposure measures and adverse birth outcomes has decreased over time, parallelling regulatory improvements in exhaust pipe emissions.

Evaluation of Generative Artificial Intelligence Models in Predicting Pediatric Emergency Severity Index Levels.

Objective: Evaluate the accuracy and reliability of various generative artificial intelligence (AI) models (ChatGPT-3.5, ChatGPT-4.0, T5, Llama-2, Mistral-Large, and Claude-3 Opus) in predicting Emergency Severity Index (ESI) levels for pediatric emergency department patients and assess the impact of medically oriented fine-tuning.

MYCN-amplified spinal ependymomas: a rare aggressive subtype. Illustrative cases.

Background: Spinal ependymomas are typically slow-growing tumors with a favorable prognosis. Recently, a new aggressive subtype has emerged with its own distinct histopathological and molecular features characterized by MYCN amplification. However, this subtype of spinal ependymoma is rare, and studies on its imaging characteristics are limited.

How Does the Novice Become the Expert? An Instrumental Case Study of Procedural Educators.

Purpose: The classic paradigm of procedural education in medical training has involved trainees learning and performing invasive bedside procedures and subsequently teaching these procedures to more junior trainees. Many existing resident-as-teacher curricula focus on cognitive domains; there has been a lack of literature examining the transition from learner to teacher in procedural education. This hypothesis-generating instrumental case study explored how expert procedural educators transitioned from novice procedural educators to experts.

Randomized Trial of Enhanced Versus Standard Navigation to Promote Timely Initiation of Adjuvant Radiotherapy for Head and Neck Cancer.

Purpose: National Comprehensive Cancer Network Guidelines recommend initiating postoperative radiation therapy (PORT) within 6 weeks of surgery for patients with head and neck squamous cell carcinoma (HNSCC), but delays affect 50% of patients, disproportionately burden minoritized groups, and contribute to worse oncologic outcomes. This trial evaluates the efficacy of Navigation for Disparities and Untimely Radiation thErapy (NDURE), an enhanced navigation-based intervention, relative to usual care (UC) patient navigation for starting timely PORT.

Methods: Adults with locally advanced HNSCC planning to undergo surgery and PORT were randomly assigned 1:1 to standard multidisciplinary head and neck oncology care and either NDURE, a multilevel navigation-based intervention to enhance key processes of care and overcome barriers to timely PORT, or UC, which consisted of standard patient navigation.

Assessing Medicare's Coverage With Evidence Development Program.

The Centers for Medicare and Medicaid Services (CMS) coverage with evidence development (CED) program provides coverage for items and services not meeting Medicare's "reasonable and necessary" standard while requiring participation in clinical studies. As additional evidence is available, CMS may reconsider CED decisions. Of twenty-six items and services in the CED program since its 2005 inception, CMS has reconsidered coverage for ten (38 percent).

After Risk-Adjustment Change, Dementia Diagnoses Increased In Medicare Advantage Relative To Traditional Medicare.

In 2020, the Centers for Medicare and Medicaid Services reintroduced Alzheimer's disease and related dementias to its risk-adjustment payment model for Medicare Advantage (MA) plans. Using 2017-20 data for 100 percent of community-dwelling beneficiaries enrolled in Medicare, we evaluated how the reintroduction of dementia to the risk-adjustment model affected rates of new (incident) dementia diagnoses among beneficiaries enrolled in MA relative to those enrolled in traditional Medicare. In response to the payment change, annual incident dementia diagnosis rates in MA increased by 11.

Are Fewer Diagnoses Better? Assessing A Proposal To Improve The Medicare Advantage Payment System.

Medicare Advantage (MA) plans report diagnoses more completely than they are reported in traditional Medicare. As a result, payment to MA plans is greater than it would be if coding patterns were identical in the two sectors. The Medicare Payment Advisory Commission estimates that the overpayment to MA attributable to differential coding was $50 billion in 2024.

Current Use And Evaluation Of Artificial Intelligence And Predictive Models In US Hospitals.

Effective evaluation and governance of predictive models used in health care, particularly those driven by artificial intelligence (AI) and machine learning, are needed to ensure that models are fair, appropriate, valid, effective, and safe, or FAVES. We analyzed data from the 2023 American Hospital Association Annual Survey Information Technology Supplement to identify how AI and predictive models are used and evaluated for accuracy and bias in hospitals. Hospitals use AI and predictive models to predict health trajectories or risks for inpatients, identify high-risk outpatients to inform follow-up care, monitor health, recommend treatments, simplify or automate billing procedures, and facilitate scheduling.

Plasma Lipid Metabolites, Clinical Glycemic Predictors, and Incident Type 2 Diabetes.

Objective: Plasma metabolite profiling has uncovered several nonglycemic markers of incident type 2 diabetes (T2D). We investigated whether such biomarkers provide information about specific aspects of T2D etiology, such as impaired fasting glucose and impaired glucose tolerance, and whether their association with T2D risk varies by race.

Research Design And Methods: Untargeted plasma metabolite profiling was performed of participants in the FINRISK 2002 cohort (n = 7,564).

Cell-Penetrating Peptide Like Anti-Programmed Cell Death-Ligand 1 Peptide Conjugate-Based Self-Assembled Nanoparticles for Immunogenic Photodynamic Therapy.

The tumor-specific efficacy of the most current anticancer therapeutic agents, including antibody-drug conjugates (ADCs), oligonucleotides, and photosensitizers, is constrained by limitations such as poor cell penetration and low drug delivery. In this study, we addressed these challenges by developing, a positively charged, amphiphilic Chlorin e6 (Ce6)-conjugated, cell-penetrating anti-PD-L1 peptide nanomedicine (CPPD1) with enhanced cell and tissue permeability. The CPPD1 molecule, a bioconjugate of a hydrophobic photosensitizer and strongly positively charged programmed cell death-ligand 1 (PD-L1) binding cell-penetrating peptide (CPP), is capable of self-assembling into nanoparticles with an average size of 199 nm in aqueous solution without the need for any carriers.

Completion of lunar magma ocean solidification at 4.43 Ga.

Crystallization of the lunar magma ocean yielded a chemically unique liquid residuum named KREEP. This component is expressed as a large patch on the near side of the Moon and a possible smaller patch in the northwest portion of the Moon's South Pole-Aitken basin on the far side. Thermal models estimate that the crystallization of the lunar magma ocean (LMO) could have spanned from 10 and 200 My, while studies of radioactive decay systems have yielded inconsistent ages for the completion of LMO crystallization covering over 160 My.

Utilizing Martian samples for future planetary exploration-Characterizing hazards and resources.

One of the most surprising and important findings of the first human landings on the Moon was the discovery of a very fine layer of lunar dust covering the entire surface of Moon along with the negative impacts of this dust on the well-being and operational effectiveness of the astronauts, their equipment, and instrumentation. The United States is now planning for human missions to Mars, a planet where dust can also be expected to be ubiquitous for many or most landing sites. For these missions, the design and operations of key hardware systems must take this dust into account, especially when related to crew health and safety.

Perspectives on Mars Sample Return: A critical resource for planetary science and exploration.

Mars Sample Return (MSR) has been the highest flagship mission priority in the last two Planetary Decadal Surveys of the National Academies of Science, Engineering, and Medicine (hereafter, "the National Academies") and was the highest priority flagship for Mars in the Decadal Survey that preceded them. This inspirational and challenging campaign, like the Apollo program's returned lunar samples, will potentially revolutionize our understanding of Mars and help inform how other planets are explored. MSR's technological advances will keep the NASA and European Space Agency at the forefront of planetary exploration, and data on returned samples will fill knowledge gaps for future human exploration.

Distinct and interdependent functions of three RING proteins regulate recombination during mammalian meiosis.

During meiosis, each pair of homologous chromosomes becomes connected by at least one crossover, as required for accurate segregation, and adjacent crossovers are widely separated thereby limiting total numbers. In coarsening models, this crossover patterning results from nascent recombination sites competing to accrue a limiting pro-crossover RING-domain protein (COR) that diffuses between synapsed chromosomes. Here, we delineate the localization dynamics of three mammalian CORs in the mouse and determine their interdependencies.

Sampling Mars: Geologic context and preliminary characterization of samples collected by the NASA Mars 2020 Perseverance Rover Mission.

The NASA Mars 2020 Perseverance Rover Mission has collected samples of rock, regolith, and atmosphere within the Noachian-aged Jezero Crater, once the site of a delta-lake system with a high potential for habitability and biosignature preservation. Between sols 109 and 1,088 of the mission, 27 sample tubes have been sealed, including witness tubes. Each sealed sample tube has been collected along with detailed documentation provided by the Perseverance instrument payload, preserving geological and environmental context.

Mars Sample Return: From collection to curation of samples from a habitable world.

NASA's Mars 2020 mission has initiated collection of samples from Mars' Jezero Crater, which has a wide range of ancient rocks and rock types from lavas to lacustrine sedimentary rocks. The Mars Sample Return (MSR) Campaign, a joint effort between NASA and ESA, aims to bring the Perseverance collection back to Earth for intense scientific investigation. As the first return of samples from a habitable world, there are important challenges to overcome for the successful implementation of the MSR Campaign from the point of sample collection on Mars to the long-term curation of the samples on Earth.

Fundamental constraints and questions from the study of martian meteorites and the need for returned samples.

Physical materials from planetary bodies are crucial for understanding fundamental processes that constrain the evolution of the solar system, as samples can be analyzed at high precision and accuracy in Earth-based laboratories. Mars is the only planet outside of Earth from which we possess samples in the form of meteorites. Martian meteorites (n > 350) have enabled constraints to be placed on various aspects of the red planet's formation and evolution, notably: that Mars accreted and differentiated rapidly; that the planet has a complex volatile element evolution; and that it has always been volcanically active with a rich and diverse magmatic history.

Reconciling Archean organic-rich mudrocks with low primary productivity before the Great Oxygenation Event.

The organic carbon content of ancient rocks provides a fundamental record of the biosphere on early Earth. For over 50 y, the high organic content of Archean (>2.5 Ga) mudrocks has puzzled geologists and evolutionary biologists, because high biological primary productivity was unexpected for the nascent biosphere before the rise of O.

The value of returning a sample of the Martian atmosphere.

The elemental and isotopic abundances of major species in the Martian atmosphere have been determined, but analyses often lack sufficient precision, and those of minor and trace species are frequently not well known. Many important questions about the evolution and current state of Mars require the kind of knowledge that can be gained from analysis of a returned sample of the Martian atmosphere. Key target species include the noble gases, nitrogen, and various species containing carbon, hydrogen, and oxygen, such as methane.

What we can learn about Mars from the magnetism of returned samples.

The Red Planet is a magnetic planet. The Martian crust contains strong magnetization from a core dynamo that likely was active during the Noachian period when the surface may have been habitable. The evolution of the dynamo may have played a central role in the evolution of the early atmosphere and the planet's transition to the current cold and dry state.

Proton Accumulation Modulated Surface Potential in Proton Conducting Ceramics Revealed by Near-Ambient Pressure X-ray Photoelectron Spectroscopy.

Proton conducting electrochemical cells (PCECs) are efficient and clean intermediate-temperature energy conversion devices. The proton concentration across the PCECs is often nonuniform, and characterizing the distribution of proton concentration can help to locate the position of rate-limiting reactions. However, the determination of the local proton concentration under operating conditions remains challenging.

Correlation of the Sinonasal Outcome Test-22 With the University of Washington Quality of Life in Assessing Quality of Life in Sinonasal Malignancy Utilizing a Multicenter Prospective Observational Cohort Registry.

In this multi-center sinonasal malignancies (SNM) cohort, the Sino-nasal Outcome Test has a correlation with the University of Washington Quality of Life (UWQOL) for assessing QOL. The use of both instruments remains recommended to provide complete and complementary information. Future design of an easy-to-use tool specific to SNM is needed to encompass all aspects of QOL.

Patient Factors Influence Minimal Clinically Important Difference for the SNOT-22 in Medically Treated Chronic Rhinosinusitis.

Background: The present study explores the effect of sociodemographics and comorbidities on the calculated minimal clinically important difference (MCID) for 22-item Sinonasal Outcome Test (SNOT-22) scores in patients with medically treated chronic rhinosinusitis (CRS). The importance of delineating a threshold to indicate clinically meaningful changes perceived by a patient is well acknowledged, yet the influence of patient-specific factors on MCID has not been fully elucidated.

Methods: Patients with CRS (n = 221) presenting to a tertiary care practice reported their change in disease burden with anchor questions following CRS-directed medical treatment.