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Real-time ultrasound (RTU) provides non-invasive information for carcass composition in live cattle. On this basis, the present study aimed to quantify the associations of Year (2021-2023), Sex, Coat colour (Black Angus vs. Red Angus), and Dam age class (<3, 3-5, 5-8, >8 years)-and their interactions-with RTU-dCT (rump fat depth, P8; 12th/13th rib backfat; eye muscle area, EMA; and intramuscular fat, IMF) in Angus cattle. RTU measurements were collected in 1097 Angus cattle from 15 farms in Portugal. Year was associated with all RTU traits (P < 0.05), with a dip in subcutaneous fat (P8, 12th/13th rib) and EMA in 2022 relative to 2021/2023, and the highest IMF in 2021. Females exhibited greater subcutaneous fat, while males showed larger EMA; IMF did not differ by sex. Red Angus had higher mean values than Black Angus for P8, 12th/13th rib, EMA, and IMF. Dam age > 8 years was associated with greater subcutaneous fat (P8 and 12th/13th rib), with no differences detected for EMA or IMF among dam-age classes. Significant (P < 0.05) interactions included Year x Sex (P8 and 12th/13th rib), Year x Coat colour (IMF), Year x Dam age class (P8, 12th/13th rib, and IMF), and Year x Sex x Coat colour (IMF); other higher-order interactions were non-significant. RTU-dCT phenotypes in Angus cattle reflect consistent sex, coat colour, and maternal-age profiles, with clear year-to-year modulation. These findings support the inclusion of sex, coat colour, and dam-age class as fixed effects in RTU-based genetic-evaluation models for Angus cattle, while quantitative prediction of carcass endpoints awaits validation against paired chiller measurements.
Adolescence is a critical developmental stage characterized by significant physical, emotional, and cognitive changes, including sexual maturation. However, this population group faces challenges such as early sexual initiation, limited contraceptive access, high sexually transmitted infection risks, including HIV (with 43% of new HIV infections in Tanzania occurring among youth, with higher rates found among young women), and unintended pregnancies, negative outcomes of limited access to sexual and reproductive health (SRH) information and services. Social, cultural, and policy constraints restrict access to SRH services, highlighting the need to understand adolescents' preferences to improve accessibility and health outcomes. The study aimed to explore the preferences for accessing sexual and reproductive health information and services among adolescent girls and young women (AGYW) in higher learning institutions in Tanzania. This qualitative descriptive study was conducted at two universities in Dodoma, Tanzania. Purposive sampling recruited 13 sexually active students aged 19-24. Data were collected through in-depth interviews conducted in Swahili, audio-recorded, and transcribed verbatim. Data saturation was reached at the 13th interview. Young women reported different preferences for accessing sexual and reproductive health (SRH) information and services. They accessed SRH information through community, media, and healthcare-based sources. Family members,(particularly sisters)and friends, were key information sources, though parental reluctance limited access. Social media and search engines provided privacy but raised concerns about misinformation. Healthcare facilities were perceived as reliable yet unwelcoming, leading many participants to prefer over-the-counter services. Participants advocated for reliable online platforms to enhance the accessibility and accuracy of SRH information. This study highlights AGYW's preferences for accessing SRH information, emphasizing digital platforms and peer education. Strengthening these approaches while improving the youth-friendliness of healthcare settings is essential for improving SRH outcomes among this population.
To conduct a systematic review and meta-analysis of studies that compared minimally invasive surgery (MIS) to open surgery on postoperative outcomes in patients with symptomatic hiatal hernia (HH). Early literature raised questions about whether MIS was associated with higher HH recurrence rates compared to open surgery. Previous systematic reviews comparing the two approaches did not formally address recurrence as an outcome. Searches were conducted in MEDLINE, EMBASE, and reference lists up to June 13th, 2024. English-language studies comparing MIS (laparoscopy and robotic-assisted) to open surgery (laparotomy and thoracotomy) in symptomatic HH patients were eligible. A generic inverse variance using fixed-effects meta-analysis was performed. Evidence quality was assessed using GRADE. The analysis included 21 studies (n = 184,381). No randomized controlled trials were identified. MIS was not associated with increased risk of hiatal hernia recurrence (RR = 0.87 [95% CI: 0.57, 1.33]; p = 0.52; GRADE: very low) and was associated with lower 30-day mortality (RR = 0.21 [0.15, 0.29]; p < 0.0001; GRADE: low), wound infection (RR = 0.24 [0.18, 0.32]; p < 0.00001; GRADE: very low), and shorter hospital stay (MD = -4.44 [- 4.69, - 4.20]; p < 0.00001; GRADE: low). MIS compared to open surgery was not associated with an increased risk of HH recurrence and was associated with a lower risk of 30-day mortality, wound infection, and shorter hospital stays. Evidence quality ranged from low to very low. Higher quality studies are needed to confirm the current findings. CRD42020164419.
Internalizing disorders such as anxiety and depression can be especially severe during adolescence, presenting significant challenges for affected individuals. While cognitive-behavioural therapy (CBT) has shown promise as an effective treatment for these conditions, a significant proportion of youth do not benefit sufficiently from CBT. One critical factor that may influence the effectiveness of CBT is adherence to therapy homework, with evidence suggesting a relationship between homework completion and therapy outcomes, including symptom reduction. In this context, smartphone apps have emerged as a potentially helpful tool to enhance adherence by providing engaging ways for adolescents to complete their therapy homework. However, in Germany, there is currently a lack of evaluated smartphone apps that can be deployed as adjuncts to CBT for adolescents. This study is designed as a randomized controlled trial (RCT). It will evaluate the effects of the JAY smartphone app on therapy homework adherence during CBT for adolescents with internalizing disorders (n = 35) compared to CBT with standard paper-and-pencil homework (n = 35). The findings of the JAY trial may contribute to the understanding of how smartphone apps can be integrated into CBT for adolescents to enhance therapy homework adherence and ultimately treatment outcomes. German Clinical Trials Register (DRKS) DRKS00026623. Registered on 13th October 2023, https://drks.de/search/de/trial/DRKS00026623/details .
Tenebrio molitor (Coleoptera: Tenebrionidae) is a suitable candidate for use as a biomass resource, recognized for its large-scale breeding and the high nutritional value of its protein content. Feeding obese Zucker rats the cuticle of T. molitor enhances fatty liver metabolism through the mediation of gut microorganisms. Cuticular proteins are demonstrated to be pivotal in the formation of the insect cuticle throughout the developmental stage. The endocuticle structural glycoprotein (Abd) belongs to the RR-1 subclass, a major group of structural cuticular proteins characterized by the conserved Rebers-Riddiford (RR) motif. Nevertheless, there remains a paucity of research into the molecular properties and functions of SgAbd (endocuticle structural glycoprotein) in Coleoptera. In this study, we successfully identified and described the gene TmAbd5 in T. molitor. The coding sequence of TmAbd5 is 306 bp, corresponding to a 101-aa protein. The functional domain predicted that TmAbd5 consists of a signal peptide and a chitin-binding domain 4 (ChtBD4). Motif prediction analysis indicated that TmAbd5 belongs to the CPR (cuticular proteins with Rebers-Riddiford consensus) family with the RR-1 motif. Expression analysis revealed that TmAbd5 is upregulated in the integument, particularly during the first three days of development in the 13th instar stage. Although the RNAi-mediated silencing of TmAbd5 did not cause apparent phenotypic abnormalities and the insects successfully molted into pupae, histological examination revealed a substantial thickening of the endocuticle at 72 h post-pupation, along with a notable increase in lamellar spacing and a disrupted pore canal. In summary, TmAbd5 contributes to the formation and structural organization of the endocuticle, which provides a theoretical basis for the screening of target genes for cuticle development and for the effective utilization of cuticle resources in T. molitor.
This study examines how Chinese provincial governments adapt central sports policies for older adults. It aims to measure the degree of local policy reinvention and to identify the combinations of conditions under which substantive local redesign is more likely to occur. A total of 109 central and provincial policy documents on sports for older adults issued between 2015 and 2024 were collected and systematically analyzed. First, a cosine similarity method based on TF-IDF is used to compare the one-to-one matching central and provincial policy texts to construct a policy reinvention coefficient. Second, fsQCA was applied in a periodized design aligned with the 13th and 14th Five-Year Plan stages to examine how per capita provincial-level sports fiscal expenditure, population aging, public sports service resources, policy salience in aging planning, horizontal pressure, and adoption timing jointly shape high reinvention outcomes within each planning stage. The overall level of policy reinvention is relatively high, with clear provincial variation but no extreme polarization. Reinvention fluctuated in the earlier years and became more stable after 2020. The periodized fsQCA further shows that the mechanisms of high reinvention differ across planning stages. In the 13th Five-Year Plan stage, five configurations were identified and grouped into delayed learning-adjustment, rapid capacity-response, and constraint-compensating types. In the observed 14th Five-Year Plan stage, seven configurations were identified and grouped into fiscal-demand, horizontal-learning, and aging-response types. These results suggest that provincial governments redesign central directives through stage-specific combinations of demographic demand, sports sector fiscal support, service resources, policy attention, adoption timing, and interprovincial learning. The local adaptation of sports policies for older adults in China follows multiple pathways rather than a single uniform model. Policy reinvention is shaped by both stable provincial conditions and stage-specific governance contexts. The periodized results show that early-stage reinvention relied more on learning, adjustment time, and resource preparation, while later stage reinvention was more strongly associated with aging pressure, sports sector fiscal support, and horizontal policy learning. These findings contribute to research on sports policy for older adults and offer evidence for improving the local implementation of healthy aging policies.
The wildland-urban interface (WUI) fires have adverse effects on both physical and mental health. However, early biosignals changes related to fires are not well understood. Digital wearables can capture real-time changes in physiological stress and activity patterns, providing insight into the mechanisms of health effects of WUI fires and identifying vulnerable populations during and after WUI fires. This study aimed to assess the immediate and sustained changes in physical activity patterns and physiological stress markers during and after the 2025 Los Angeles wildfires. We conducted a longitudinal study of 15 older adults (mean age 73.2 years) during the 2025 Eaton Fire in Los Angeles, using the digital Oura Ring (Gen 3) continuously. Data were collected at baseline (Dec 9th, 2024 to Jan 6th, 2025), during the fire (Jan 7th, 2025 to Jan 12th, 2025), and after the fire (Jan 13th, 2025 to Jan 27th, 2025). Daily activity patterns (physical activity and sleep duration) and physiological stress (sleep heart rate, heart rate variability, sleep fragmentation, and breath rate) were collected, and linear mixed-effects models were used to investigate how these biosignals changed and how evacuation alerts impacted these changes. During the fire, six out of fifteen participants received evacuation alerts. We observed a 41-minute increase in sedentary time (P = .007), a 34 min reduction in sleep duration (P = .002), and a 0.4 BPM increase in sleep breath rate (P = .009). Although activity patterns returned to baseline post-fire, markers of physiological stress, including sleep heart rate and breath rate, remained elevated. Among participants who received evacuation alerts, the immediate and prolonged impacts are larger. The changes in activity patterns and increases in physiological stress during and after the 2025 Los Angeles wildfire in this cohort can indicate potential health effects. Digital bio-signals may serve as early indicators of adverse health outcomes following a wildfire.
The extracellular matrix (ECM) is a dynamic structural network that supports tissue architecture and regulates cell function. It is primarily composed of collagens, elastin, proteoglycans, and glycoproteins, which are synthesized by canonical and non-canonical ECM-producing cells. During aging, the ECM undergoes progressive changes in structure and composition, a process recently recognized as the 13th hallmark of aging. In skeletal muscle (SKM), age-associated ECM remodeling, largely regulated by immune system-ECM crosstalk, contributes to sarcopenia and impaired regeneration. Macrophages (MΦs), as key innate immune cells, regulate ECM dynamics both indirectly by activating canonical ECM-producing cells and directly by synthesizing ECM components. Notably, a distinct subset of ECM-producing MΦs that express collagen (COL+ MΦs) has been identified across multiple tissues, although their function in SKM homeostasis and aging remains poorly understood. Here, we review current knowledge of ECM production and remodeling, with special emphasis on MΦ involvement, including COL+ MΦs, as critical regulators of fibrogenesis, especially during SKM aging and regeneration.
Forest ecosystems are the dominant terrestrial carbon sink and play a critical role in mitigating climate change. However, conventional approaches based on single methods often fail to accurately characterize background carbon dioxide (CO2) concentrations, limiting the reliability of regional carbon accounting. An integrated forest carbon sink monitoring framework was developed and applied in Kunyu Mountain, China, for reconstructing net ecosystem productivity (NEP). Within this framework, satellite observations, mobile ground-based measurements, the Gradient Boosting Regression Trees (GBRT) algorithm, and the Boreal Ecosystem Productivity Simulator model were combined. With the GBRT-derived prior CO2 field incorporated, the BEPS model's performance improved: the correlation between simulations and observations increased from 0.571 to 0.802. Results indicate that Kunyu Mountain's NEP exhibited a sustained increase, with a marked acceleration after 2016, coinciding with China's 13th Five-Year Plan, leading to a >40% rise in annual carbon sequestration by 2024 relative to 2001. Seasonal analyses likewise indicate that the carbon uptake period became both longer and more intense. Further attribution analysis reveals that ecological conservation policies generated an additional 5%-7% increase (approximately 30-50 gC·m-2). This framework provides a novel approach to more accurately account for regional carbon sinks and evaluate the effectiveness of ecological policies.
Leukaemias are malignant neoplasms that affect the bone marrow, compromising the production of functional blood cells. In Brazil, leukaemia is the 13th most frequent cancer and the most common among individuals up to 20 years old. This study analysed the incidence and mortality of acute and chronic myeloid and lymphoid leukaemias in Brazil from 1990 to 2021, using adjusted and estimated data from the Global Burden of Diseases Study 2021. This is an ecological time-series study with age-standardised rates, expressed per 100,000 inhabitants. Trends were assessed using Joinpoint regression, considering the average annual percentage change. The results indicated an increase in the incidence of chronic lymphocytic leukaemia (CLL) and Acute Myeloid Leukaemia in males, as well as an increase in AML-related mortality in both sexes. On the other hand, a reduction in the incidence and mortality of acute lymphocytic leukaemia (ALL) and chronic myeloid leukaemia (CML) was observed in both sexes. ALL-related mortality also decreased in females, whereas CLL-related mortality increased in males. According to age group and sex, varied trends were observed for these neoplasms. These findings highlight the need for further studies on haematologic neoplasms to inform public health policies, foster research on targeted therapies and promote advancements in the management of these diseases in Brazil.
To evaluate the efficacy of 8% arginine-based desensitizing toothpaste and photobiomodulation (PBM), used alone or in combination, in the treatment of dentin hypersensitivity (DH). This randomized, double-blind, parallel-group clinical trial included participants with DH who were allocated into four groups: laser group (LG), arginine group (AG), combined laser and arginine group (LAG), and control group (CG). Clinical assessments were performed at baseline and after 2, 4, and 8 weeks. DH was evaluated using evaporative (air stimulus) and tactile tests applied to the cervical-buccal surface of the teeth, with pain intensity recorded using the Visual Analog Scale (VAS). Linear mixed-effects models were used for longitudinal continuous outcomes (Schiff and VAS scores), while generalized estimating equations were applied for tactile sensitivity outcomes, adopting a significance level of 5%. A total of 60 participants were enrolled, and 54 completed the study. A significant reduction in DH was observed over time for both Schiff scores and VAS values (p < 0.001). Mean Schiff scores decreased from 5.0 (± 0.8) at baseline to 1.9 (± 1.3) at 8 weeks, while VAS scores also showed significant reductions. All groups demonstrated improvement in DH symptoms; however, no statistically significant differences were observed between interventions at any time point (p > 0.05). All evaluated therapies were effective in reducing DH over the 8-week follow-up period, with a progressive reduction in symptoms over time. However, no statistically significant differences were observed between the interventions, and no additive effect was identified for the combined therapy. Brazilian Clinical Trials Registry ReBEC; RBR2vxzvkz, October 13th, 2023.
This paper investigates the accuracy of conventional inductive current transformers (iCTs) and Rogowski coils (RCs) in measuring distorted currents, evaluating compliance with the WB0 (up to the 13th harmonic) and WB1 (up to the 60th harmonic) accuracy classes according to the IEC 61869-1 standard. A custom reference iCT, calibrated via the ampere-turns method to achieve a superior baseline accuracy (0.02%), served as the primary benchmark. A zero-flux electronic transducer was utilized strictly to verify this reference. Despite inherent core nonlinearity, tested conventional iCTs with reduced to minimum secondary burdens successfully met the class 0.5-WB1 requirements. In the case of tested Rogowski coils, the study reveals that their wideband performance depends on physical design of the particular type. High-sensitivity coils suffer from increased parasitic capacitance and self-inductance, causing significant additional phase shift at higher frequencies, whereas low-sensitivity, small-diameter coils offer superior linearity. Overall, the tested RCs generally ensured compliance with the 0.5-WB1 class across the evaluated frequency range, with certain units successfully achieving the more restrictive 0.2-WB1 class. Ultimately, conventional iCTs remain a highly reliable solution for metering purposes in low-voltage networks, while properly selected Rogowski coils provide a valuable alternative for power quality analysis and harmonic distortion measurements.
Prevalence rates and psychological correlates of anauralia (absence of auditory imagery) and aphantasia were examined in a large and representative sample (N = 32,784), by presenting two questions about sensory imagery in the 13th wave of the New Zealand Attitudes and Values Study (NZAVS). The single auditory and visual items employed showed excellent concordance with multi-item imagery questionnaires (Plymouth Sensory Imagery Questionnaire, VVIQ) and revealed closely similar prevalence rates for anauralia and aphantasia (.8%), with the latter showing excellent agreement with earlier estimates of aphantasia prevalence. Importantly, anauralia and aphantasia were associated with distinct psychological profiles. Anauralia, but not aphantasia, was associated with higher conscientiousness and contrary to our initial hypothesis anauralics reported better self-control, including superior control of health-related behaviours compared with individuals who experience typical auditory imagery. Aphantasics, but not anauralics, reported: higher levels of perfectionism and psychological distress; poorer wellbeing; lower self-esteem; and stronger feelings of being an outsider compared to participants reporting typical visual imagery. The latter comparisons of anauralic and aphantasic participants with those reporting typical imagery were highly reliable but relatively small in size (Glass's delta = .2 - .3). Contrary to hypothesis, individual differences in auditory imagery were unrelated to religious beliefs or frequency of praying. Implications of these findings are discussed.
Ischaemic heart disease (IHD) remains a major cause of mortality among individuals with type 2 diabetes mellitus (T2DM) in Malaysia. Conventional cardiovascular risk models, such as the Framingham risk score, often show limited calibration in Asian populations. Artificial intelligence (Al)-calibrated models have emerged as potential alternatives, yet their generalisability and clinical utility across different populations remain uncertain. This narrative review aimed to summarise existing prognostic models for IHD in patients with T2DM and identify methodological gaps relevant to the development of a locally calibrated model. This narrative review employed a structured search strategy guided by PRISMA principles but was not conducted as a full systematic review. We synthesised evidence from epidemiological and prognostic research. Studies comparing conventional statistical approaches (e.g. logistic regression and Cox models) with AI-calibrated models such as extreme gradient boosting, random forest and support vector machines were reviewed. Eleven studies met the inclusion criteria; four used conventional statistical methods, and seven applied AI or machine learning algorithms. The reported discrimination (area under the curve=0.66-0.94) varied widely. Conventional models commonly lacked external validation and demonstrated restricted applicability beyond their original cohorts. AI-calibrated models showed promising discrimination in some datasets but similarly experienced limited validation and lacked benchmarking against traditional statistical methods. Across the studies, limited calibration and validation reduced generalisability to heterogeneous Malaysian populations. Developing a locally AI-calibrated i-IHD score could enable early risk identification, guide targeted interventions and support national health initiatives, including the Health White Paper 2023 and 13th Malaysia Plan.
The Kotrupi landslide area has remained active since the 1970s, with a major landslide occurring on 13th August 2017. Since then, the site has experienced repeated reactivations. This study integrates UAV mapping; satellite image analysis; field investigations; and numerical simulation, to evaluate the landslide reactivation and slope stability. TanDEM-X (10 m) and UAV derived DEMs (Digital Elevation Model) were used for establish the pre and post event boundary conditions for stability assessment. Seven representative profiles were selected to characterize the deformation regime and analyze the reactivation potential zones. The Factor of Safety (FoS) was estimated using the Limit Equilibrium Method (LEM) and maximum displacement values inferred using a Finite Element Model (FEM). The results indicate that the right flank exhibits the lowest FoS values, ranging between 0.35 and 0.5 making it highly susceptible to reactivation. In contrast, the left and central portions are comparable stable, as these portions have relatively higher FoS. However, all seven profiles have FoS values lower than 1, indicating overall slope instability. Satellite image analysis further conformed the progressive reactivation if the right flank, whereas the left flank remained comparatively stable over time. Extensive field surveys were conducted to collect geological, geotechnical, and hydrological information. The dataset consists of rock orientation, fault mapping, joint planes, tension crack development, rock type, and hydrological data. Temporal satellite image analysis confirmed continued enlargement of the affected zone and identified significant reactivation events during the monsoon periods of 2021 and 2022. The findings reveal that the Kotrupi landslide is progressively expanding, particularly toward the right flank, with widening observed in the crown area. The reactivation and expansion is primarily controlled by unfavorable rock orientation, presence of thrust (Main Boundary Thrust), tectonic activity; development of extensive joint planes, and tension cracks, all of which reduce the strength of the rock mass and soil during prolonged rainfall. The integrated methodology used in this study provides valuable insight into landslide reactivation mechanisms and helps identify areas susceptible to future slope failure. These findings can support hazard mitigation and risk reduction strategies for local communities and government agencies.
Non-allergy specialist healthcare workers removing low-risk penicillin allergy (penA) records, enabling patients to receive penicillin antibiotics, is safe but not common practice. We developed a behavioural change implementation intervention to support non-allergist healthcare workers to remove incorrect penA records from adult inpatients (penicillin allergy de-labelling; PADL). This study aimed to evaluate the effectiveness of the implementation intervention strategy and its impact on delabelling and antibiotic prescribing. The implementation intervention was launched 10th June 2024. This prospective, single centre, type 2 hybrid effectiveness-implementation study was evaluated using mixed methods: process evaluation, qualitative and quantitative study designs. The proportion of patients delabelled was measured. Antibiotics were grouped into the three WHO AWaRe categories with differences in antibiotic use between the de-labelled and non-de-labelled measured. Pearson chi-squared tests, Welch's t-tests or Wilcoxon matched-pairs signed-rank tests were used. Between 10th June and 13th December 2024, the mean number of penicillin allergy records removed from the inpatient electronic prescribing system increased from 18.2/month pre-intervention to 42.7/month post intervention. Of 186 patients de-labelled with full data capture, the majority 126 (67.7%) were de-labelled by the antimicrobial pharmacists and the remainder by ward doctors or ward pharmacists across 21 clinical specialties. Antibiotic exposure, when grouped by WHO AwARe category, was not significantly different between de-labelled and not de-labelled groups. Of 138 patients with a penA record in their primary care records, there was evidence of communication with the GP to amend the primary care penA record for 94 (68.1%) patients of which 42 (44.7%) were actioned by GP surgeries. The PADL intervention was accepted by most patients, who considered hospital a safe place to be tested. Awareness of the PADL intervention was generally high across all healthcare workers. The PADL process was acceptable to all interviewed healthcare workers and aligned with staff roles and hospital processes but competing priorities were commonly cited as a barrier. The PADL implementation intervention successfully increased non-specialist workforce PADL of low-risk patients. There is opportunity to further optimise PADL but competing priorities are a challenge. We found non-statistically significant impact of PADL on antibiotic use.
The point at which surgeons become technically independent in laparoscopic colectomy remains unclear. We analyzed learning curves by postgraduate year (PGY) to determine when proficiency was gained. We analyzed 391 laparoscopic colectomies performed by 52 surgeons with ≤ 15 years of experience. The cases were grouped as R (ileocecal/right hemicolectomy) or S (sigmoid colectomy/high anterior resection). Learning curves were evaluated using CUSUM, logistic regression was used to identify the factors influencing operative time, and complication rates by PGY were examined. The mean operative time improved from 232 min (4th PGY) to 165 min (7th PGY) in Group R and from 212 min (4th PGY) to 132 min (11th PGY) in Group S. A CUSUM analysis showed plateaus at the 7th PGY for Group R and the 11th PGY for Group S. Logistic regression revealed that the number of surgeries performed before these plateaus independently predicted the operative time (Group R: OR 3.32, p < 0.01; Group S: OR 3.67, p < 0.01). Complication rates peaked in the first two years and around the 12th PGY. Surgical experience improved efficiency, with operative time plateauing at approximately the 11th PGY. Bimodal complication peaks in the first two years and the 12th PGY suggest proficiency after the 13th year.
Patient portals can support adolescent engagement and autonomy in their health care, but institutional policies may unintentionally create barriers to use. This study evaluated how automatic patient portal deactivation at age of 13 years, which requires re-enrollment, influences portal access and reactivation among adolescents and their guardians. We conducted a retrospective longitudinal cohort study of patients who enrolled in the patient portal before age of 13 years and had outpatient encounters between ages of 13 and 17 years at a large academic children's hospital and its affiliated ambulatory clinics. The primary outcome was time to patient portal reactivation after automatic proxy deactivation on the patient's 13th birthday. We compared patient characteristics by reactivation status and used a multivariable Cox proportional hazards model to assess demographic and clinical factors associated with reactivation. We observed 21,443 patients whose proxy accounts were deactivated and eligible for reactivation. Overall, 13,474 (62.8%) reactivated their portal account. Accounts of patients with chronic conditions reactivated 43% more quickly than those without chronic conditions (HR [95% confidence interval, CI], 1.43 [1.38-1.49]). Accounts of patients who were White and English-speaking reactivated more quickly than those who were Black (HR [95% CI], 0.78 [0.74-0.81]) or Spanish-speaking (HR [95% CI], 0.44 [0.38-0.50]). Patients whose accounts were never reactivated continued receiving care at our organization, averaging appointments on 4.6 days after turning 13 years. Automatic portal deactivation at age of 13 years reduced patient portal access among adolescent patients. These findings underscore the need for tailored access policies that balance privacy, parental involvement, and digital engagement with the health-care system.
The Balearic Islands, off the NE coast of the Iberian Peninsula, have a rich and diverse history. We had previously reported that genomic diversity in one of the Balearics, Eivissa, shows the signs of a reduced effective population size and founder effect when compared not only to populations of the mainland but also to Menorca, another Balearic Island of comparable area and population size but with a more open historic trajectory. In the current work, we investigate whether the same pattern can be observed in the mitogenomes, and leverage the rich phylogeographic information contained in mitochondrial DNA (mtDNA) to detect the sources of the maternal lineages in Eivissa and Menorca. Indeed, Eivissa shows a reduced mtDNA haplotype diversity compared to Menorca and mainland populations, but similar to that in islands in other archipelagos (Canaries, Orkney, Shetland). However, other measures of diversity, such as number of segregating sites or nucleotide diversity do not show this reduction, probably because one of the founder lineages in Eivissa belongs to the deeply divergent L2c haplogroup, which is of Sub-Saharan origin and with a time to the most recent common ancestor that suggests that it was introduced during the Punic colonization of the island. Still, direct comparison with ancient DNA samples of various periods did not yield any sequence match that could indicate continuity with the population present in the islands before the Catalan-Aragonese conquest of the 13th century.