Proton Beam Therapy for Pancreatic Tumors: A Consensus Statement from the Particle Therapy Cooperative Group Gastrointestinal Subcommittee.

Objectives: Radiotherapy manages pancreatic cancer in various settings; however, the proximity of gastrointestinal (GI) luminal organs-at-risk (OAR) poses challenges to conventional radiotherapy. Proton beam therapy (PBT) may reduce toxicities compared to photon therapy. This consensus statement summarizes PBT's safe and optimal delivery for pancreatic tumors.

Coronary artery disease and percutaneous coronary intervention in patients with severe chronic kidney disease.

Coronary artery disease (CAD) is the leading cause of mortality among patients with chronic kidney disease (CKD), presenting unique challenges in diagnosis and management. Advanced CKD patients often present with atypical symptoms, and conventional diagnostic and interventional approaches carry risks, including contrast-induced nephropathy and the potential need for renal replacement therapy. These risks have led to the phenomenon of "renalism," where necessary procedures may be deferred due to concerns over renal injury.

Baseline gray matter volume associates with working memory performance after prefrontal transcranial direct current stimulation.

Working memory is crucial for daily life and is often impaired in neuropsychiatric conditions. Attempts to enhance it using transcranial direct current stimulation (tDCS) have shown mixed results, possibly due to large inter-individual variability. This study assessed whether baseline regional brain volume was associated with working memory performance following tDCS.

Diffusion tensor imaging with free-water correction reveals distinctions between severe and attenuated subtypes in Mucopolysaccharidosis type I.

Mucopolysaccharidosis type I (MPS I) is an inherited lysosomal storage disorder leading to deleterious brain effects. While animal models suggested that MPS I severely affects white matter (WM), whole-brain diffusion tensor imaging (DTI) analysis was not performed due to MPS-related morphological abnormalities. 3T DTI data from 28 severe (MPS IH, treated with hematopoietic stem cell transplantation-HSCT), 16 attenuated MPS I patients (MPS IA) enrolled under the study protocol NCT01870375, and 27 healthy controls (HC) were analyzed using the free-water correction (FWC) method to resolve macrostructural partial volume effects and unravel differences in DTI metrics accounting for microstructural abnormalities.

Target product profile for cell-based and gene-based therapies to achieve a cure for HIV.

This target product profile (TPP) highlights the minimal and optimal characteristics for ex-vivo and in-vivo cell and gene therapy-based products aimed at achieving an HIV cure (ie, durable antiretroviral-free viral control). The need for an effective, safe, scalable, affordable, accessible, and acceptable cure for HIV infection remains a major global priority. The possibilities for cell and gene therapy-based products for an HIV cure are rapidly expanding.

Assessing the Risk for Falls in Older Adults After Initiating Gabapentin Versus Duloxetine.

Background: The evidence informing the harms of gabapentin use are at risk of bias from comparing users with nonusers.

Objective: To describe the risk for fall-related outcomes in older adults starting treatment with gabapentin versus duloxetine.

Design: New user, active comparator study using a target trial emulation framework.

Benign, but Ominous, Pseudotumor in the Post-Sleeve Gastrectomy Hiatal Hernia: A Case Series.

We have incidentally observed a finding not yet described in the literature, on both cross-sectional imaging and fluoroscopy, to correlate with increased obstructive symptoms in our post sleeve gastrectomy patients. This case series aims to show postsurgical imaging cases with the common underlying finding of a pseudotumor associated with hiatal herniae and obstructive symptoms. Because this clinical presentation may, in some cases, warrant postsurgical revision, knowledge of the imaging findings and their potential clinical significance is useful to radiologists who interpret routine cross-sectional imaging examinations as well as fluoroscopic evaluations of these post sleeve gastrectomy patients.

Veterans May Be Seeing Lower-Quality Clinicians In The VHA Community Care Network.

With the rapid expansion of veterans' access to community care under the Veterans Affairs Maintaining Internal Systems and Strengthening Integrated Outside Networks (VA MISSION) Act of 2018, ensuring that veterans receive high-quality community care has become a national priority. Using Veterans Health Administration (VHA) data and Medicare performance scores, we assessed how clinicians' performance on quality measures differed between those who treated veterans within the VHA Community Care Network and those who did not. We found that in 2022, 66.

Use Of Patient Health Survey Data For Risk Adjustment To Limit Distortionary Coding Incentives In Medicare.

A core problem with the current risk-adjustment system in Medicare Advantage and accountable care organization (ACO) programs-the Hierarchical Condition Categories (HCC) model-is that the inputs (coded diagnoses) can be influenced for gain by risk-bearing plans or providers. Using existing survey data on health status (which provide less manipulable inputs), we found that the use of a hybrid risk score drawing from survey data and a scaled-back set of HCCs would, in addition to mitigating coding incentives, modestly lessen risk-selection incentives, strengthen payment incentives to deliver efficient care, allocate payment across ACOs more efficiently according to markers of population health that are not as affected by practice patterns or coding efforts, and redistribute payment in a manner that supports equity goals. Although sampling error and survey nonresponse present challenges, analyses suggest that these should not be prohibitive.

User-centered adaption of , A novel mhealth application integrating medication reminders with virtual peer support and social/financial incentives to improve medication adherence.

Youth living with HIV (YLWH) have high rates of virologic failure due to medication non-adherence. is a novel, gamified mobile health (mHealth) application designed with user-centered principles to improve medication adherence by integrating medication reminders with social and financial incentives, virtual peer social support and early clinic outreach for non-adherent YLWH in Nigeria. Focus Group Discussions (FGDs) were conducted to identify reactions to key prototype features (user interface, medication reminders, incentives, and peer support), facilitators and barriers to app use, and how well the app would meet adherence needs.

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.

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.

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.

A low pre-existing anti-NS1 humoral immunity to DENV is associated with microcephaly development after gestational ZIKV exposure.

Background: Gestational Zika virus (ZIKV) infection is associated with the development of congenital Zika syndrome (CZS), which includes microcephaly and fetal demise. The magnitude and quality of orthoflavivirus-specific humoral immunity have been previously linked to the development of CZS. However, the role of ZIKV NS1-specific humoral immunity in mothers and children with prenatal ZIKV exposure and CZS remains undefined.

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.

Expanding first-line options for depression: Protocol of a pragmatic comparative effectiveness trial of yoga vs. behavioral activation (the COMPARE study).

Depression is a prevalent mental health condition in the United States and a significant cause of morbidity and mortality. The treatment guidelines for depression recommends either psychotherapy, such as behavioral activation (BA), or a second-generation antidepressant as a first-line treatment for adult patients with depression. However, many individuals with depression do not experience improvement from first-line treatments or choose not to engage in them due to stigma, cost, difficulty with access, and/or side effects.

Telehealth equity and access communication skills pilot simulation for practicing clinicians.

Objectives: This pilot study evaluated a telehealth training simulation program for practicing clinicians, specifically focused on addressing patient issues of equity and access to healthcare via improving telehealth communication.

Methods: Participants participated in a one-hour simulation experience with two cases. Performance was assessed pre- and post-intervention using a checklist measuring communication domains related to equity and access in telehealth.

The unraveling of a Nobel Prize: How Hermann Muller was awarded the Nobel Prize: A front for eugenics.

This paper asserts that the Nobel Prize for Medicine/Physiology that Hermann J. Muller received in 1946 was a front to enhance the legitimacy, acceptance, and application of eugenics, a strategy to guide the direction and rate of human evolutionary change. Seven of the nine people nominating (1932-1946) Muller were proponents of eugenics with Muller being among the most visible of the scientific leaders.