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Childhood obesity has surged dramatically in the United States over the past three decades, with over 30% of children now classified as overweight or obese. This rising trend presents a major public health and economic challenge, with obesity-related costs rising from just over 1% of United States gross domestic product in 2005 to 3.3% in 2019 and projected to reach 4.6% by 2060 if left unaddressed. While conventional narratives often attribute obesity to poor individual choices, this policy brief highlights the broader social determinants that shape childhood obesity across different levels of influence. Using a Socio-ecological Model Framework, the brief explores individual, interpersonal, community, and policy-level contributors, including genetic factors, psychosocial stress, family and cultural influences, school and neighborhood food environments, targeted marketing by food corporations, and regulatory gaps. The brief concludes by recommending four upstream policy interventions. These include banning the sale of unhealthy foods within school premises and promoting healthy school food environments through regulation and education, implementing fiscal measures by taxing unhealthy foods and subsidizing healthier alternatives, integrating physical activity into children's daily routines through school based and urban planning policies and Strengthening evidence systems and context-specific research. These strategies provide transferrable policy lessons for addressing childhood obesity in other settings including in low-and middle-income countries experiencing similar nutrition transitions. However, their implementation should be adapted to local health system capacities, food environments and policy contexts.

Syringe services programs (SSPs) decrease HIV and overdose incidence among people who use drugs (PWUD). In May 2024, Pueblo, Colorado, banned syringe distribution, citing public complaints about syringe litter. The ban was overturned in June 2024. The two SSPs in Pueblo halted syringe distribution during the three-week ban but continued other services. The effect of short-term syringe bans on harm reduction services is unknown. We analyzed program data from one SSP in Pueblo, Colorado, and syringe litter pickup data from the Pueblo Department of Parks and Recreation from January to September 2024. We used Interrupted Time Series analysis to evaluate the association between the syringe distribution ban and four weekly outcomes: SSP visits, naloxone kits distributed, syringes distributed, and syringe litter collected. The ban was associated, on average, with 31 fewer visits (95% CI: -48, -15), 23 fewer naloxone kits distributed (95% CI: -34, -12), and 2406 fewer syringes distributed (95% CI: -3308, -1504) every week. There was an immediate decrease of 120 syringe litter units collected (95% CI: -285, 46) weekly. After the ban was overturned, there was an immediate increase and increasing trend in visits, naloxone kits, and syringes distributed, and no changes in syringe litter. Naloxone distribution did not return to expected levels in the 16 weeks following the ban being overturned. Banning syringe distribution in Pueblo, Colorado was associated with sustained decreases in SSP usage and naloxone distribution. Eliminating funding for certain SSP activities could inadvertently decrease access to naloxone.

Accumulation of insoluble extracellular amyloid-β (Aβ) plaques and intraneuronal fibrillary hyperphosphorylated tau fibrils in the brain are widely believed to contribute to the progressive neurodegeneration and neuronal loss characteristic of the Alzheimer's disease and the associated dementia. Anti-amyloid immunotherapies that reduce cerebral Aβ burden in affected individuals have been approved based on biological outcomes from clinical trials. However, the extent to which Aβ clearance translates into improved meaningful clinical, cognitive, and functional benefit versus risk and cost is unclear based on available data. Here, the critical barriers that limit the impact of anti-amyloid immunotherapies, including aducanumab, lecanemab, and donanemab, are discussed. Treatment slows cognitive decline by ∼20-30% in certain patient subsets, but absolute improvements in cognitive and functional outcomes remain modest. Independent analyses of how treatment impacts health span suggests statistically significant trial results may not translate into significant real-world benefit. Response is most significant in cases of early-stage disease where levels of copathology tau are low. Edema and brain hemorrhage occur frequently, particularly in carriers of APOE-e4 alleles, an established genetic risk factor for Alzheimer's disease, raising safety concerns which led to some regulators banning treatment in this patient group. Strict clinical trial eligibility criteria, high treatment costs relative to patient benefit, intensive during-treatment monitoring, and the absence of population-level screening programs further limit treatment accessibility and generalizability. Emerging evidence of accelerated brain atrophy and immunotherapy tolerance further complicates benefit-risk consultation. Sustaining drug- discovery pipelines by exploring combination therapies, tau-targeted approaches, drug repositioning, and novel small molecules through will be essential to provide comprehensive treatment options and personalized treatment plans for affected patients.

Hexahydrocannabinol (HHC) is a semi-synthetic cannabinoid that recently emerged as a legal alternative to Δ9-tetrahydrocannabinol. Due to emerging concerns regarding its neuropsychiatric safety profile, including psychosis, it was banned in July 2025. We report two cases of HHC-induced psychosis in adolescents requiring inpatient psychiatric admission, both with no prior psychiatric history. Both individuals required about six weeks of inpatient treatment, with their symptoms resolving following abstinence from HHC and antipsychotic medications. These cases support recent regulatory measures banning HHC and highlight the need for ongoing clinician awareness of this agent and its associated risk of psychosis.

Cosmetics are defined by the U.S. Food and Drug Administration (FDA) as "articles intended to be rubbed, poured, sprinkled, or sprayed on, introduced into, or otherwise applied to the human body&#x2026;for cleansing, beautifying, promoting attractiveness, or altering the appearance". However, the safety of cosmetic ingredients is the responsibility of the manufacturer and exposure to some of these chemicals can result in unintentional harmful effects in humans. Thus, some states are banning specific chemicals, at the state legislation level, from being used in cosmetics, which includes known endocrine disruptors such as dibutyl phthalate, diethylhexyl phthalate, and per- and polyfluoroalkyl substances (PFAS). In this study, we aim to determine the toxicity pathways significantly affected by the cosmetic ingredients (both banned and non-banned), compared to the non-cosmetics compounds in the Tox21 10K library. The Tox21 10K compound library (which includes 113 banned, 927 non-banned cosmetic ingredients and 8,185 non-cosmetic compounds) was previously screened against a panel of ~&#x2009;90 cell-based and biochemical assays. The hit rates (i.e., the percentage of compounds active in an assay) of the cosmetic and non-cosmetic compounds, as well as banned and non-banned compounds, in each Tox21 assay were compared using a Fisher's exact test, and a p-value&#x2009;<&#x2009;0.05 was considered statistically significant. We found that the evaluated cosmetic compounds were significantly more active in 11 antagonist mode assays and 23 agonist mode assays compared to the non-cosmetic compounds. The banned compounds were significantly more active in 7 antagonist mode and 6 agonist mode assays compared to the non-banned compounds. The targets of the antagonist assays included enzymes such as CYP2C19 and aromatase (CYP19A1), and the agonist assays included the Keap1/Nrf2 antioxidant response element pathway. In the present study, we compared the bioactivity profiles of cosmetic ingredients and non-cosmetic compounds (not used in cosmetics), as well as the banned and non-banned cosmetic ingredients, across the Tox21 assays. The analyses revealed distinct molecular pathways for these chemicals which furthers our mechanistic understanding of cosmetics ingredient toxicity and may help direct the selection of cosmetic ingredients in the future with potentially less bioactivity. Not applicable.

Domestic dogs are widely distributed and exert profound effects on ecosystems, through competition, disease transmission, and killing of native species. Nevertheless, little is known about how the presence of domestic dogs interacts with habitat structure and food availability in determining habitat use of native carnivores. We investigated how the habitat use and activity of an ecologically sensitive mesopredator, the clouded tiger-cat (Leopardus pardinoides), is affected by habitat structure, prey availability, anthropogenic pressures, and dog (Canis lupus familiaris) activity in an isolated protected area of the Colombian Andes. We collected data on the occurrence and activity of both species from 23 single-camera traps placed in the cloud forest of the Alto del Nudo Soil Conservation District between July 2022 and September 2023. We used negative binomial generalized linear models to assess the habitat use of clouded tiger-cats and dogs in relation to habitat structure (topography, vegetation productivity, and connectivity), prey availability (for clouded tiger-cats), and human pressure (human modification and road proximity). We used kernel density functions and diel niche models to assess temporal relationships of clouded tiger-cats with dogs and small mammals. Clouded tiger-cat habitat use increased with topographic slope, but decreased with human modification. Dog detections did not affect clouded tiger-cat habitat use, being detected in 100% of the sampling stations with clouded tiger-cat presence (ratio of 4:1 dog-clouded tiger-cat detections). There was a low temporal overlap between both species, with dogs being mainly diurnal and clouded tiger-cats nocturnal. Human modification and widespread invasion of dogs can negatively affect clouded tiger-cats in this degraded protected area, but they reduce these pressures using well-preserved forest at steep slopes in the night. We advise taking actions to reduce the spatial contact between clouded tiger-cats and dogs through banning the unsupervised incursion of dogs into the protected area while implementing neutering and adoption campaigns.

Flavored tobacco sales restriction policies, including menthol cigarette restriction policies and flavored e-cigarette restriction policies, reduce access to tobacco products that are easier to initiate and harder to quit. Flavored products are targeted to minority populations, including African American and Black and LGBT+ communities. This work aims to understand if these minoritized communities report differences in support for flavor policies, which address products that are marketed to their communities. A 2025 non-probability sample of N&#x2009;=&#x2009;1542 U.S. adults were asked how much they support banning menthol cigarettes and flavored e-cigarettes. Participants provided demographic information including sexual orientation, gender identity, sex at birth, and race/ethnicity. Logistic regression analyses were used to investigate race/ethnicity and LGBT+ identity as predictors of flavored tobacco policy support. No significant relationship was found between racial/ethnic identity and support for a menthol ban. LGBT+ identity predicted lower odds of support for a flavored e-cigarette restriction policy (aOR: 0.62, 95% CI: 0.41, 0.93). There is no evidence of differential support for a menthol cigarette ban according to race/ethnicity and there is lower support of a flavored e-cigarette ban among LGBT+ adults. Further research is needed to inform messaging strategies to mobilize support among these populations.

Electronic (E)-scooters have become increasingly common in Ireland. This study provides the first Irish orthopaedic-focused analysis of paediatric E-scooter-related injuries over a six-year period. It assesses the impact of the legislation change in 2024 banning E-scooter use in those under 16 years of age. We conducted a retrospective analysis of e-scooter-related orthopaedic trauma presenting to our emergency department (ED). Ninety-eight paediatric patients were identified between January 2020 and August 2025. This period included fourteen months prior to and subsequent to the legislation change. Four primary outcomes were analysed: Injury Severity Score (ISS)&#x2009;>&#x2009;16, surgical intervention, injuries per patient, and fractures per patient. Medical records and patient imaging were reviewed. There were 98 paediatric patients who presented to our ED with e-scooter-related orthopaedic trauma. The average age was 12 years old with a 3:1 male-to-female ratio. There was a notable rise in cases presenting in 2025. Post-legislation comparisons showed: an increase in major trauma, a 27% increase in injuries per patient, a stable fracture rate and a decline in surgical intervention. Post-legislation injury trends remain concerning. Despite legislation, injury rates rose, with widespread non-compliance. Upper limb injuries and traumatic brain injuries were common. Multidisciplinary care was often required. A national paediatric trauma database is needed to guide prevention and policy. Systemic reforms and targeted interventions are essential to mitigate this growing public health issue.

Flavoured e-cigarettes are attractive to youth, and flavour descriptors on packaging can increase product appeal and reduce perceived risk. In October 2022, China banned non-tobacco-flavoured e-cigarettes and published a list of 101 permitted additives. We examined e-cigarette packs for the prevalence of flavour descriptors and additives approximately 6&#x2009;months after the ban implementation. Using a systematic protocol, we purchased 143 unique e-cigarette packs from six major Chinese cities in April-May 2023. Trained, native Chinese speakers coded flavour descriptors on packs (tobacco, non-tobacco, concept or none). Additive presence was determined from ingredient lists on the packs. Permitted additives were reviewed for flavouring properties. Prevalence of flavour descriptors and additives by flavour category was examined. Of 143 packs, 84 were manufactured after full enforcement of the flavour ban and included an ingredient list. Of these, 19% displayed tobacco descriptors, 48% concept descriptors and 33% both concept and tobacco descriptors. Forty-two per cent listed at least one permitted additive capable of imparting non-tobacco flavour (tobacco: 44%; concept: 30%; tobacco-plus-concept: 57%). Ethyl maltol (12%) and coffee extract (11%) were the most common additives, appearing in package ingredient lists in about one-third of tobacco-flavoured (31%) and tobacco-plus-concept descriptor (32%) packs. No packs featured a non-tobacco characterising flavour descriptor or listed any unpermitted additives. Concept descriptors and flavouring additives are commonly listed on Chinese tobacco-flavoured e-cigarette packs, sustaining product appeal and undermining the flavour ban. Stricter regulations, such as a ban on concept descriptors, tighter additive restrictions and strengthened enforcement, could better protect public health.

Ethylene oxide (EtO) is a sterilant widely used for medical devices, but its use is controversial due to its carcinogenicity. In some countries, EtO is also used to fumigate food to eliminate foodborne pathogens, though this practice is banned in others. National regulations on EtO use in food vary widely; exporting countries prioritize trade facilitation and prevention of foodborne illness, while importing countries emphasize maintaining food safety and promoting domestic public health. These divergent public health priorities present challenges to establishing universal maximum residue limits (MRLs) for EtO and 2-chloroethanol (2-CE) and have resulted in the rejection of food items treated with EtO by some importing national authorities. In response, exporters have advocated for internationally harmonized tolerance levels for EtO and its derivatives to facilitate trade. This paper reviews the use of EtO in food products and the potential health effects, describes conflicting perspectives among global stakeholders, and explores the need for harmonized international standards.

The tobacco industry exploits legislative loopholes by introducing products with novel constituents, sensory features and/or branding to bypass flavour restrictions and maintain appeal, particularly among young populations. Post California's 2022 flavour ban, the leading oral nicotine pouch (ONP) brand (ZYN) started marketing two new 'unflavoured' products, Classic and Original, but it is unknown if they differed from preban products marketed as 'flavour-ban approved' (Chill and Smooth) in their chemical composition, sensory characteristics and human appeal. Nicotine, menthol and synthetic coolants, WS-3 and WS-23, were quantified using gas chromatography-mass spectrometry. Menthol receptors (TRPM8 and TRPA1) activity was measured by calcium-microfluorimetry to assess cooling- and irritation-potential. ONP sensory attributes and appeal were assessed in young adults (21-25 year old) after 5 min standardised use in a double-blind, randomised remote trial. 'Chill' and 'Classic' ONPs contained WS-3 exclusively (0.24&#xb1;0.02 mg/pouch), with consistent levels across nicotine strengths; 'Smooth' and 'Original' contained neither menthol nor WS-3. Extracts of 'Chill' and 'Classic' robustly activated the cold/menthol TRPM8-receptor with similar potency and efficacy while weakly activating the sensory irritant TRPA1 receptor. Compared with 'Smooth', human participants rated 'Chill' and 'Classic' as having stronger cooling sensations (p<0.05), while 'Classic' was rated as more minty flavoured (p<0.005). Preban and postban ONPs showed similar chemical, sensory and appeal profiles based on WS-3 presence. By using concept names and sensory cues to disguise flavours and additives, the industry exploits regulatory loopholes to sustain marketing of banned products. NCT06506162.

Although many organophosphate pesticides are now banned in European countries, they continue to be used in various parts of the world and can still be detected as pollutants of surface waters. Organophosphates are well characterized for their acute neurotoxic effects, while the long-term effects of sub-lethal concentrations, closer to the levels that can be found in the environment, remain poorly understood. In this study, we examined the intergenerational epigenetic effects of diazinon exposure in the freshwater keystone species Daphnia magna. Using chronic exposure to an environmentally relevant concentration (30&#xa0;ng/L), combined with genome-wide DNA methylation profiling at nucleotide resolution, we found that diazinon induces distinct and context-dependent changes in DNA methylation, without significantly affecting global methylation levels. Methylation patterns varied across generations and exposure windows, with the strongest effects observed following indirect embryonic exposure. Despite such exposure-specific epigenetic signature, we identified a core set of twelve genes whose methylation levels were consistently altered in exposed parents (F0) and their direct offspring (F1). These genes are involved in key biological processes, including reproduction, regulation of gene expression and development, in line with previously reported phenotypic effects of diazinon. Further supporting the impact of diazinon on developmental programs, we found a significant reduction in body size in both F0 and F1. Together, our results show that low-dose diazinon exposure reshapes the epigenetic landscape of D. magna in a developmental stage-dependent manner and suggest that DNA methylation changes may contribute to the response associated with diazinon exposure accross multiple generations.

To quantify geographic accessibility to abortion services for servicewomen in the continental United States after the Dobbs v. Jackson Women's Health Organization decision. We extracted ZIP code of residence for 203,139 servicewomen (18-49 years of age) from the Military Health System Data Repository in December 2024. We performed point density analyses and spatiotemporal network modeling of servicewomen's locations and distance to 389 geocoded abortion clinics using ArcGIS Pro. We calculated travel times to abortion clinics by state-level legal restrictions (most restrictive, restrictive, and somewhat/protective based on the Guttmacher Institute state abortion restriction categories) and geographic region. We estimated mean driving times and the proportion of servicewomen within 30-, 60-, and 90-minute travel-time thresholds. Mean driving time to the nearest clinic for the 193,029 successfully geocoded servicewomen was 164.1 minutes. More than half (55.5%) required more than 90 minutes of travel time, and 8.5% lived within 30 minutes. Mean driving time was significantly higher in the most restrictive states (381.7 minutes) compared with restrictive states (118.9 minutes, difference of means 262.8, 95% CI, 260.1-265.5) and to somewhat/protective states (68.7 minutes, difference of means 313.1, 95% CI, 310.7-315.4). Of 47,672 servicewomen stationed in most restrictive states, 99.7% required travel times exceeding 90 minutes compared with 60.1% (n=41,811) in restrictive states (odds ratio [OR 0.51], 95% CI, 0.50-0.53) and 23.5% (n=17,846) in somewhat/protective states (OR 0.27, 95% CI, 0.26-0.28). Servicewomen in Western Interior and South regions averaged almost 3 and more than 7 hours of travel time for care, respectively. Travel time exceeded 90 minutes for over 99% in the South and for the majority in the Western Interior (90.1%), East Coast (62.7%), and Midwest (54.7%). Over half of reproductive-aged servicewomen in the continental United States face significant travel burdens to access abortion services. One-quarter reside in banned states with nearly universal geographic constraints. Current legal and policy environments create substantial structural differences that may affect servicewomen's reproductive health.

The anatomical synergy between percutaneous coronary intervention with TAXUS and cardiac surgery (SYNTAX) score remains a cornerstone for quantifying coronary artery disease complexity and guiding decisions between percutaneous coronary intervention and coronary artery bypass grafting. Developed from the SYNTAX trial in 2009, the score uses a standard methodological approach to systematically define coronary lesion attributes and yields an overall score that allows stratification of coronary complexity. A commonly accepted stratification divides patients into low (&#x2264;&#xa0;22), intermediate (23-32), and high (&#x2265;&#xa0;33) SYNTAX score, with higher categories associated with an increased risk of adverse cardiovascular events. This review article traces the history, evolution, and integration of the SYNTAX score in ESC and ACC/AHA guidelines. We also discuss its role in clinical trials and its contribution to Heart Team deliberations in patients with complex coronary artery disease. Patient benefits include adding precision for treatment selection with a historical potential to lower mortality in high-score cases by favoring coronary artery bypass grafting. Artificial intelligence and advanced imaging, such as coronary computed tomography angiography, are advancing automated, noninvasive SYNTAX score computation with superior accuracy. Future directions involve artificial intelligence-hybrid models for real-time, personalized assessments. This review article evaluates the enduring impact of the SYNTAX score and its evolving role in precision medicine.

Artificial intelligence (AI) continues to transform our society, with direct impacts on the field of emergency management. As AI becomes increasingly integrated into educational institutions, scholars have expressed concerns regarding the ethical and educational implications of AI usage in higher education. This impact and use of AI will have tremendous implications for the scholarship of teaching and learning and the core competencies of the emergency management profession. This study argues that, within the discipline of emergency management, a lesser-used but valuable metric for academic AI guidance can be found in the policies of the most revered journal publications in the field. This study provides a snapshot of how journal publications in emergency management currently approach AI usage with regard to authorship, peer review, and the editorial process. This study presents a cross-sectional analysis of 108 emergency management journals across multiple databases, identifying 71 journals with publicly available AI guidelines for authors, reviewers, or editors. For potential authors, our qualitative thematic findings reveal consensus support for AI use in proofreading and moderate support for use in statistical analysis. There is moderate support for the use of generative AI/large language models (LLMs) in passage creation, and low support for image/figure creation; however, both require full disclosure and accountability when used. There was a unanimous stance against granting authorship or coauthorship to AI. Guidelines for reviewers show strong opposition against using AI, especially LLMs, due to confidentiality and privacy concerns. Likewise, editors are mostly banned from using LLMs, unless they are used only for identifying potential reviewers or provided with an in-house publisher-owned AI tool. Our study concludes with a discussion on the contradictory nature of existing guidelines and pedagogical advice to current and future instructors in emergency management.

Two of the most used hormones in sport, included in the WADA list of banned molecules, are human chorionic gonadotropin (hCG) and insulin-like growth factor (IGF-I). Male athletes may use pharmaceutical preparations of hCG to stimulate the production of testosterone before competition and IGF-I to stimulate muscle protein synthesis, promote glycogen storage, and improve lipolysis. Dry matrix microsampling and dried blood spots (DBS) are very promising strategies to improve current doping control activities, as they can lead to a significant improvement in compound stability, the simplification of sample collection and pre-analytic phases, the facilitation of their automation and a reduction of the risks of sample contamination and tampering. In this study, a protein extraction protocol from DBS, specifically hCG and IGF-I, was developed. Through the testing of various extraction solvents and subsequent analysis by Qubit fluorometry and nanoLC-MS/MS, we established an effective protein extraction procedure from DBS, specifically targeting hCG and IGF-I. The nanoLC-MS/MS bottom-up proteomic study reported a good protein extraction protocol from DBS, demonstrating good reproducibility and abundance related to the peptide sequences of hCG and IGF-I detected.

Cervical clear cell adenocarcinoma is a rare malignancy in adolescents and young girls. Since the prescription of diethylstilbestrol (DES) was banned in 1971, only 11 cases have been reported in girls under 10 years in the literature. However, treatment with ovary preservation has not been reported. Here, we report an 8-year-old prepubertal girl without a history of exposure to DES who was diagnosed with cervical clear cell adenocarcinoma. Hysterectomy and unilateral oophorectomy were performed. The remaining ovary was transposed to the left iliac fossa to preserve ovarian function for the future. Additionally, ovarian cortical tissue from the removed ovary was cryopreserved. Chemotherapy, including paclitaxel and carboplatin, was started after surgery for four cycles via an implantable venous access port. Additionally, genetic analysis did not identify any known gene mutations in the tumour tissue.

The fumigant pesticide 1,2-dibromo-3-chloropropane (DBCP) was widely used in California agriculture during the 1960s and 1970s before being banned in 1979. Despite this ban, DBCP continues to contaminate groundwater due to its persistence and mobility. This study evaluates the distribution, historical trends, and projected persistence of DBCP in California using data from over 13,000 public supply wells and additional domestic, irrigation, and observation wells (1980-2022). Since 2010, DBCP has been detected in 9% of public-supply wells statewide, with higher frequencies in the San Joaquin Valley (21%) and upper Santa Ana River watershed (13%), where DBCP use was most prevalent. Approximately 70% of wells had decreasing concentration trends, whereas increases were more common in deeper wells, indicating downward vertical migration of the DBCP front. Groundwater-age estimates show that recharge timing aligns with the 1960s-1970s loading period, enabling reconstruction of peak inputs and providing a basis for age-based modeling. To estimate future persistence, we applied a one-dimensional advection-dispersion model that simulates long-term declines in peak concentrations based on groundwater age, historical loading, and a 38-year degradation half-life. Model projections suggest that concentrations above the maximum contaminant level may persist in a declining number of wells until approximately 2080 (range: 2048-2109), with longer persistence in the San Joaquin Valley. The simplified modeling framework, based on age distributions typical of wells capturing peak concentrations, can provide practical regional-scale assessment of non-point source contaminants where long-term monitoring exists. This study highlights how the legacy of DBCP contamination will likely affect California's groundwater resources throughout the 21st century.