In adults aged ≥75 y with NSTEMI, an invasive vs. conservative strategy did not improve a composite outcome at a median 4.1 y.

GIM/FP/GP: [Formula: see text] Cardiology: [Formula: see text] Geriatrics: [Formula: see text].

Transient Hypoadrenocorticism in a 7-Week-Old Kitten.

A 7 wk old female spayed domestic shorthair was evaluated for 3 days of lethargy and anorexia 1 wk after ovariohysterectomy. On presentation, she was weak, dehydrated, and hypotensive. Blood work showed azotemia, hyponatremia, hyperkalemia, hyperphosphatemia, and hyperproteinemia.

Trastuzumab Plus Pertuzumab Versus Cetuximab Plus Irinotecan in Patients With Wild-Type, HER2-Positive, Metastatic Colorectal Cancer (S1613): A Randomized Phase II Trial.

Purpose: overexpression/amplification in wild-type (WT) metastatic colorectal cancer (mCRC; human epidermal growth factor receptor 2 [HER2]-positive mCRC) appears to be associated with limited benefit from anti-EGFR antibodies and promising responses to dual-HER2 inhibition; however, comparative efficacy has not been investigated. We conducted a randomized phase II trial to evaluate efficacy and safety of dual-HER2 inhibition against standard-of-care anti-EGFR antibody-based therapy as second/third-line treatment in HER2-positive mCRC.

Methods: Patients with -WT mCRC after central confirmation of HER2 positivity (immunohistochemistry 3+ or 2+ and in situ hybridization amplified [HER2/CEP17 ratio >2.

Adverse Childhood Experiences: Increased Likelihood Of Socioeconomic Disadvantages For Young Adults.

More than 60 percent of US adults report that they had adverse childhood experiences (ACEs). For this study of 930,000 children born during the period 1999-2003, we used linked administrative, survey, and criminal justice data to measure the association between ACEs (parental death; separation; incarceration; or criminal charge for intimate partner violence, substance use disorder, or child sexual or nonsexual abuse) and socioeconomic disadvantages at ages 18-22 during 2017-21. After childhood socioeconomic status was controlled for, young adults with ACEs were more likely to have been charged with felonies, have become teenage parents, live in a household with poverty or housing assistance, be enrolled in Medicaid, and be employed, and were less likely to be enrolled in an educational institution.

Medicare Advantage Networks Include Few Black Or Hispanic Physicians, Making Concordant Care Inaccessible For Many.

Black and Hispanic patients who receive care from Black and Hispanic physicians have greater use of preventive care. However, receiving care from racially concordant physicians requires that such physicians are included in private insurance plan networks. Using data from 2019, we examined the extent to which racially concordant physicians are available in the Medicare Advantage (MA) program, which disproportionately enrolls Black and Hispanic Medicare beneficiaries, by linking MA physician networks to physician race and ethnicity to measure the diversity of in-network physicians.

Can Innovative Financing Move The Needle On Health Equity?

Communities and health organizations are testing novel ways to fund costly initiatives to advance health equity.

Tubal Sterilization And Vasectomy Increased Among US Young Adults After The Supreme Court Decision In 2022.

Young adults' access to contraception is shifting after the June 2022 United States Supreme Court decision. This concurrent mixed-methods study measured young adults' use of and perceptions about tubal sterilization and vasectomy after the leaked opinion in May 2022. Using national-level medical claims data from IQVIA, we conducted difference-in-differences analyses of tubal sterilizations and vasectomies by age and state policy; using open-text survey responses from national MyVoice surveys in 2022 and 2023, we thematically analyzed young adults' perspectives.

Medicare Enrollment Increased Visits To Primary Care Providers But Not Mental Health Care Providers, 2014-21.

Medicare enrollment increases provider visits among older adults; however, it remains unclear whether this increase is uniform across all types of providers. Using data from the 2014-21 Medical Expenditure Panel Surveys, we examined the effect of Medicare enrollment on office and outpatient visits across providers, using a regression discontinuity design. We found that Medicare enrollment at age sixty-five led to a 14 percent increase in visits to primary care providers and a 31 percent increase in visits to other providers, with the former more prominent among Medicare Advantage enrollees.

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.

Organic matter and biomarkers: Why are samples required?

The search for evidence of past prebiotic or biotic activity on Mars will be enhanced by the return of samples to Earth laboratories. While impressive analytical feats have been accomplished by in situ missions on the red planet, accessing the capabilities of Earth's global laboratories will present a step change in data acquisition. Highly diagnostic markers of past life are biomarkers, organic molecules whose architecture can be attributed to once living organisms.

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.

Starch-rich plant foods 780,000 y ago: Evidence from Acheulian percussive stone tools.

In contrast to animal foods, wild plants often require long, multistep processing techniques that involve significant cognitive skills and advanced toolkits to perform. These costs are thought to have hindered how hominins used these foods and delayed their adoption into our diets. Through the analysis of starch grains preserved on basalt anvils and percussors, we demonstrate that a wide variety of plants were processed by Middle Pleistocene hominins at the site of Gesher Benot Ya'aqov in Israel, at least 780,000 y ago.

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.

Nurse Experiences in an Electronic Health Record Transition: A Mixed Methods Analysis.

Transitions from one EHR to another can be enormously disruptive to care. Nurses are the largest group of EHR users, but nurse experiences with EHR transitions have not been well documented. We sought to understand nurse experiences with an EHR transition at the US Department of Veterans Affairs.

Emergency care knowledge, utilization, and barriers in Northern Tanzania: A community-based survey.

Background: Emergency care systems are critical to improving care for time-sensitive emergency conditions. The growth and development of these systems in Sub-Saharan Africa is becoming a priority. Layperson knowledge and recognition of emergency symptoms and subsequent care-seeking behavior are key to achieving timely access to care and appropriate treatment.

Genetic variation of hemolysin co-regulated protein 1 affects the immunogenicity and pathogenicity of Burkholderia pseudomallei.

Hemolysin co-regulated protein 1 (Hcp1) is a component of the cluster 1 Type VI secretion system (T6SS1) that plays a key role during the intracellular lifecycle of Burkholderia pseudomallei. Hcp1 is recognized as a promising target antigen for developing melioidosis diagnostics and vaccines. While the gene encoding Hcp1 is retained across B.

Influenza vaccine effectiveness against medically attended outpatient illness, United States, 2023-24 season.

Background: The 2023-24 U.S. influenza season was characterized by a predominance of A(H1N1)pdm09 virus circulation with co-circulation of A(H3N2) and B/Victoria viruses.

Exploring the Experience of Loneliness among People Living with Schizophrenia: A Qualitative Study.

Background: People living with schizophrenia or schizoaffective disorder are at heightened risk for experiencing loneliness, which is associated with negative health, quality of life, and symptom-specific outcomes.

Aims: This study aimed to better understand the experience of loneliness among adults living with schizophrenia or schizoaffective disorder.

Methods: Using a semi-structured interview guide, researchers interviewed twelve participants living with schizophrenia or schizoaffective disorder.

Interspecies Comparison of Multilayer Mechanical Properties of Synovium Using Atomic Force Microscopy.

The synovium is a loose connective tissue that separates the intra-articular (IA) joint compartments of all diarthrodial joints from the systemic circulation. It can be divided into two layers: the intima, a thin and cell-dense layer atop a more heterogeneous subintima, composed of collagen and various cell types. The subintima contains penetrating capillaries and lymphatic vessels that rapidly clear injected drugs from the joint space which may vary not only with drug size and charge but also with the microstructure and composition of the intima and subintima of the synovium.

Doxycycline Postexposure Prophylaxis and Bacterial Sexually Transmitted Infections Among Individuals Using HIV Preexposure Prophylaxis.

Importance: Doxycycline postexposure prophylaxis (doxyPEP) has been shown to decrease the incidence of bacterial sexually transmitted infections (STIs) among people assigned male sex at birth in clinical trials, but data from clinical practice are limited.

Objective: To describe early uptake of doxyPEP and evaluate changes in STI incidence following doxyPEP initiation.

Design, Setting, And Participants: This retrospective cohort study of adults (aged ≥18 years) dispensed HIV preexposure prophylaxis (PrEP) at Kaiser Permanente Northern California during November 1, 2022, to December 31, 2023, examined electronic health record data to compare HIV PrEP users dispensed and not dispensed doxyPEP and rates of bacterial STIs before and after starting doxyPEP.

Modulating intestinal neuroimmune VIPergic signaling attenuates the reduction in ILC3-derived IL-22 and hepatic steatosis in MASLD.

Background: Metabolic dysfunction-associated steatotic liver disease (MASLD, formerly known as NAFLD) is a major driver of cirrhosis and liver-related mortality. However, therapeutic options for MASLD, including prevention of liver steatosis, are limited. We previously described that vasoactive intestinal peptide-producing neurons (VIP-neurons) regulate the efficiency of intestinal dietary fat absorption and IL-22 production by type 3 innate lymphoid cells (ILC3) in the intestine.

Neuropeptide Y in cancer-biological functions and potential clinical implications.

Neuropeptide Y (NPY) is a sympathetic neurotransmitter widely distributed in the peripheral and central nervous system, affecting many physiological functions. Consequently, dysregulation of the NPY system contributes to numerous pathological disorders, including stress, obesity, and cancer. The pleiotropic functions of NPY in humans are mediated by G protein-coupled receptors (Y1R, Y2R, Y5R), which activate several signaling pathways and thereby regulate cell growth, differentiation, apoptosis, proliferation, angiogenesis, and metabolism.

Artificial Intelligence in Physical Therapy: Evaluating ChatGPT's Role in Clinical Decision Support for Musculoskeletal Care.

Background: The integration of artificial intelligence into medicine has attracted increasing attention in recent years. ChatGPT has emerged as a promising tool for delivering evidence-based recommendations in various clinical domains. However, the application of ChatGPT to physical therapy for musculoskeletal conditions has yet to be investigated.