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Functional brain networks in schizophrenia (SZ) are often characterized by covariance-based measures, yet covariance matrices live on a curved geometric structure rather than in ordinary Euclidean space, complicating noise-robust inference from scalp EEG. We develop a Riemannian Geometry-based Adaptive Nonlinear Coupling Analysis (RGA-NCA) framework that integrates the affine-invariant Riemannian metric (AIRM), tangent space mapping (TSM), and an anatomically adaptive artifact rejection (AAAR) strategy accounting for regional signal-to-noise heterogeneity. The framework is grounded in the observation that Euclidean summaries of symmetric positive definite matrices are sensitive to noise-driven volume inflation, whereas geodesic distances on the manifold emphasize shape deformation. RGA-NCA was evaluated on four benchmark dynamical systems, a supplementary multichannel EEG-like sample covariance simulation, and a public button-tone SZ/HC EEG dataset associated with the auditory feedback paradigm described by Ford et al. (81 subjects; 49 SZ, 32 healthy controls). Compared with Euclidean and linear baselines, RGA-NCA showed lower sensitivity to noise-driven distance distortion and yielded clearer group-level contrasts in the tested ROI analyses; all four pre-specified frontotemporal and parietal channel pairs remained significant after Benjamini-Hochberg FDR correction. The resulting patterns are consistent with reduced long-range connectivity together with localized hyper-synchronization-like effects in SZ. Quantitatively, the Riemannian structural sensitivity index (sim=exp(-d2/4)) remained high across all tested SNR levels (-20 to +10 dB; 50 Monte Carlo trials per level; range 0.936-0.964), with only a 0.026 endpoint change between +10 and -20 dB, whereas the Euclidean metric fell from 0.922 at +10 dB to 0.000 at -20 dB. These findings support Riemannian modeling as a candidate strategy for noisy covariance-based neural data, pending validation in larger independent cohorts.

Several studies have demonstrated the efficacy of paclitaxel drug-coated balloons (DCBs) for the treatment of femoropopliteal (FP) lesions in patients with peripheral artery disease (PAD). Despite the available evidence, long-term real-world efficacy data are limited. To report the 3-year outcomes of the prospective, multicenter, single-arm real-world registry conducted in the United States, assessing the clinical use of the Lutonix 035 DCB in arteries of the superficial femoral artery (SFA) and popliteal artery (PA). In the SAFE-DCB US Registry, a total of 1005 subjects at 74 investigational sites were treated with the Lutonix 035 DCB and were followed up to 36 months. The per protocol included 966 patients (mean age 69.1 years; 56.7% male). A total of 1237 target lesions were treated, in which 93.3% were de novo, 85.2% were located in the SFA, and 88% had mild-to-severe calcification. Forty-five percent of the patients were Rutherford 3, and 35.1% had critical limb-threatening ischemia. The primary efficacy endpoint is target lesion revascularization (TLR) at 12 months. Secondary endpoints included rate of primary patency at 12 months and freedom from TLR and freedom from target vessel revascularization (TVR) evaluated through 36 months. The safety endpoints evaluated through 36 months were freedom from the composite of device- and/or procedure-related perioperative (≤30 day) death, TVR, and freedom from major amputation of the target limb. Primary patency at 12 months post-index procedure by Kaplan-Meier estimates was 83.7%. Freedom from TLR at 12 months was 88.6%, 75.7% at 24 months, and 74.4% at 36 months. At 36 months, freedom from TVR post-index procedure by Kaplan-Meier estimates was 69.5%. Freedom from primary safety events at 30 days was 98.2%. Freedom from composite of all-cause perioperative (≤30 day) death and from the following: index limb amputation, index limb reintervention, and index-limb-related death by Kaplan-Meier estimates at 12 months was 80.8%, at 24 months 67.4% and 58.4% at 36 months. Freedom from major amputation of the target limb at 36 months was 95.6%. The results from the SAFE-DCB US Registry for femoral popliteal (FP) disease demonstrated sustained safety and efficacy over 3 years following the Lutonix 035 DCB intervention.Clinical ImpactThis prospective real-world population study supports long-term clinical outcomes of Lutonix and provides meaningful insights into the sustained efficacy of drug-coated balloon (DCB) therapy in real-world femoropopliteal population. The low-bailout stenting rate (1.7%), and the 36-month sustained Freedom from target lesion revascularization rate (74.4%) supporting DCB usage when a "leave nothing behind" approach is favored. Furthermore, these results reinforce the effectiveness of DCBs in the endovascular treatment peripheral artery disease.

Because LiDAR sensors acquire point clouds with a fixed angular resolution, the resulting data can be systematically parameterized and efficiently compressed in the spherical coordinate system. Traditional spherical coordinate-based point cloud compression methods have shown strong rate-distortion (RD) performance, with the predictive geometry coding (PredGeom) method in the geometry-based point cloud compression (G-PCC) standard being a prominent example. While PredGeom includes an inter-frame prediction mode, it relies on a simple linear model, which limits its ability to capture complex motion patterns or structural dependencies. On the other hand, existing learning-based compression methods in the spherical domain do not exploit inter-frame correlations to reduce geometry redundancy. To address these limitations, we propose a learning-based inter-frame predictive coding method (Inter-LPCM). For azimuth prediction, we use a delta coding strategy based on the predefined angular resolution. To improve compression for radii, we introduce an inter-frame radius predictive (Inter-RP) model that estimates the current point's radius using neighboring points from both the current frame and the registered reference frame. In addition, we design a lightweight attention-based prediction (LAEP) model to predict elevation angles by capturing long-range geometric correlations across different coordinates. For quantization, we propose an RD-optimized method to select the quantization steps in the spherical coordinate system. For entropy coding, we design distinct models for each spherical coordinate component. These models are adapted to the statistical priors of each coordinate, which enables more accurate probability estimation. Experimental results show that Inter-LPCM, in its best RD configuration, achieved a D1-PSNR BD-rate reduction of 26.1% compared with the G-PCC lossless octree-based coding mode on SemanticKITTI, and 8.3% compared with the inter-frame prediction mode of PredGeom on Ford, using the latest G-PCC test model TMC13 v31.0. Our source code is publicly available at https://github.com/SDUChangSun/Inter-LPCM.

Appendiceal endometriosis is a rare form of extragenital endometriosis that can mimic acute appendicitis. This reports presents the case of a 19-year-old woman with no significant medical history who presented with right-sided abdominal pain, nausea, and lightheadedness. Physical examination revealed right lower quadrant tenderness and a positive Rovsing sign. Laboratory studies showed no leukocytosis, and her modified Alvarado score was 4. Computed tomography of the abdomen and pelvis demonstrated mild fluid and inflammatory changes near the base of the cecum extending toward the right adnexa, raising concern for acute appendicitis versus a ruptured ovarian cyst. Pelvic ultrasound identified a complex cystic structure in the right ovary with adjacent free fluid, while appendicitis could not be excluded. Due to persistent symptoms and diagnostic uncertainty, laparoscopic appendectomy was performed. Intraoperative findings included hemoperitoneum, endometriotic lesions, and possible rupture of a right ovarian follicle. Histopathological examination revealed appendiceal serosal endometriosis. This case underscores the diagnostic challenge of appendiceal endometriosis and the importance of considering gynecologic etiologies in young women presenting with right lower quadrant pain.

Returning citizens with substance use disorders (SUD) make numerous decisions that involve engaging in behaviors with short-term, immediate rewards (i.e. the pleasurable effects of returning to use) relative to those with longer-term, but delayed, benefits (i.e. engaging in treatment), often in the context of resource-poor and unstable environments. Successful navigation of the reentry period may require making future-oriented decisions; yet previous research suggests that incarcerated individuals and those with SUD evidence steeper rates of delay discounting, or tendency to devalue something as a function of the delay of its receipt. Episodic future thinking has been shown to reduce delay discounting and improve decision-making, suggesting it may be particularly well-suited to support healthy decision-making among justice-involved populations. The current study evaluated the implementation potential and preliminary effectiveness of an episodic future thinking intervention adapted for individuals during the reentry period to reduce delay discounting and improve related clinical outcomes. Returning citizens (n = 40) who identified as in recovery from SUD and had experienced incarceration within 12 months prior to enrollment were recruited to participate in a randomized controlled trial. Participants received either a brief (60-min) adapted episodic future thinking intervention or a control intervention that did not activate future thinking. Both interventions were administered by a peer recovery coach in a community setting. Participants then completed weekly check-ins for up to four weeks and were assessed one month after the intervention. Findings suggest that peer-delivered episodic future thinking was feasible and acceptable, and could be delivered with fidelity. Additionally, participants in the active condition experienced significant decreases in delay discounting, significant increases in considerations of future consequences, and increases in the presence of protective factors that may support longer-term recovery. Participants in the control condition did not experience changes in clinically-relevant outcomes. Results of this study provide preliminary support for the implementation potential and effectiveness of brief, peer-delivered intervention focused on improving decision-making during the reentry period.

Generalized myasthenia gravis (gMG) is an autoimmune disorder that is marked by fluctuating muscle weakness and poor health-related quality of life (HRQoL). This pre-specified analysis of the phase 3 Vivacity-MG3 study (NCT04951622) assessed the effect of nipocalimab (fully human anti-FcRn monoclonal antibody) on HRQoL in patients with gMG. Seropositive adults (anti-AChR/anti-MuSK/anti-LRP4) with gMG were randomized (1:1) to intravenous nipocalimab (30 mg/kg loading, followed by 15 mg/kg every 2 weeks) or placebo, in addition to standard-of-care (SOC) for 24 weeks. The Myasthenia Gravis-Quality-of-Life 15-item revised scale (MG-QoL15r), Neuro-QoL Fatigue, EQ-5D-5L, Patient Global Impression (PGI) of Severity-Fatigue (PGI-S), and PGI-Change Fatigue (PGI-C) were used to measure patient-reported HRQoL. Nipocalimab + SOC improved MG-QoL15r scores versus placebo + SOC (Least square (LS) mean change -5.87 vs -4.42; difference -1.45). By week 2, the fatigue had improved (-10 points) and continued to improve during the double-blind phase; LS mean change in Neuro-QoL Fatigue was -13.17 vs -10.02 (difference: -3.15) over weeks 22-24. Nipocalimab showed greater improvements at week 24 than placebo in EQ-5D-5L index values (0.13 vs 0.07), VAS scores (14.55 vs 7.27) and PGI-C perceived fatigue status (56.5% vs 41.0% reporting "moderate" and "much better"). The correlation analyses confirmed association between fatigue improvement and gains in physical function, MG-ADL, QMG, and overall health status. Nipocalimab + SOC demonstrated early and sustained fatigue and HRQoL improvements over 24 weeks. Consistency across patient-reported outcomes and correlation with clinical measures support the clinical meaningfulness of these HRQoL benefits in gMG.

Introduction: Intravenous push (IVP) beta-lactam antibiotics have been adopted during parenteral solution shortages to conserve resources. Data evaluating the safety and efficacy of cefepime administered IVP versus intravenous piggyback (IVPB) infusion in Gram-negative bacteremia remain limited. We compared clinical outcomes of cefepime administered IVP versus IVPB in hospitalized patients with Gram-negative bacteremia. Methods: This was a retrospective cohort study across a five-hospital health system from 1 January 2014 through 31 December 2021. Adults receiving cefepime for Gram-negative bacteremia were included. The primary outcome was a tailored desirability of outcome ranking (DOOR) composite assessed through 30 days or hospital discharge, integrating clinical cure and cefepime-associated neurologic adverse effects. Clinical cure was defined as absence of recurrent bacteremia with the index pathogen after 48 h, no antibiotic escalation, and no in-hospital mortality. Results: A total of 254 met the inclusion criteria (127 IVPB; 127 IVP). Baseline severity was similar between groups. The primary outcome assessed by DOOR revealed no difference between IVPB and IVP groups (p = 0.656). Vasopressor support during therapy was more frequent in the IVP group (22.0% vs. 10.2%, p = 0.011), and median hospital length of stay was longer (10 vs. 7 days, p = 0.020). No differences were noted in other endpoints. General ward admission (OIR [aOR] 2.563, 95% CI 1.271-5.168; p = 0.009) and genitourinary source of bacteremia (aOR 3.398, 95% CI 1.509-7.652; p = 0.003) independently predicted clinical cure. Conclusions: In patients with Gram-negative bacteremia, cefepime administered IVP demonstrated similar safety and efficacy to IVPB infusion.

Andes virus (ANDV) is a high-consequence infectious disease with substantial mortality. On May 2, 2026, the World Health Organization reported a multinational ANDV outbreak, raising questions regarding risk of transmission to healthcare personnel (HCP). We performed a systematic review per PRISMA guidelines (PROSPERO:CRD420261283806) for studies describing healthcare-associated ANDV exposure or transmission events to HCP. Eight studies reporting on 7 events were included, describing a total of 17 healthcare-associated cases. Overall, 207 individuals were exposed, including 118 HCP, resulting in 8 infections and 4 deaths among HCP. Studies describing HCP infections reported none or inadequate personal protective equipment (PPE) use. Transmission of ANDV to HCP has been reported in the setting of delayed implementation of transmission-based precautions or breaches in infection control practice. Limitations in published exposure events highlight the need for standardized reporting of exposure events and outcomes as well as infection prevention measures implemented.

Inferior vena cava (IVC) filter retrieval is generally considered safe in the setting of deep vein thrombosis, but complications can arise during extraction. In this report, we describe the case of a 64-year-old male who underwent IVC filter placement prior to spine surgery for intractable pain and inability to ambulate. Filter extraction was attempted approximately 1 month later, when one of the filter struts fractured and embolized into the pulmonary artery. This case demonstrates a novel physician-modified retrieval technique using a telescoping T24-T16 catheter system and a customized snare, successfully employed to extract an embolized IVC filter strut from the pulmonary artery.

Caregiving-related early adversities (crEAs) are potent risk factors for the development of internalizing psychopathology (e.g., depression, anxiety). Alterations to the dopaminergic mesocorticolimbic system, which supports the construction of reward-related experiences, are commonly observed following crEA exposure and are thought to mediate this risk. Indeed, many internalizing disorders are characterized by disruptions in how reward-related information is represented and used to guide affective and motivational states. Critically, the effects of crEA on mesocorticolimbic functioning may be shaped by input from peripheral systems, such as the gut microbiome, though such bottom-up signaling has been markedly understudied in humans. The Teen Bugs study was thus developed to identify gut microbiome-dependent metabolic pathways linking crEA exposure to mesocorticolimbic functioning and internalizing symptoms in adolescents, a group that experiences a disproportionate incidence of psychopathology relative to other age groups and is underrepresented in the gut microbiome literature. Adolescents aged 12-15 years, with and without histories of crEA exposure, will be followed across three timepoints over five years. At each timepoint, participants will complete a semi-structured clinical interview, a reward-guided decision-making task, and self-report questionnaires assessing mental health, previous caregiving experiences, reward-related behaviors, as well as developmental and lifestyle factors. Participants will also undergo multimodal neuroimaging that leverages MRI-based proxy markers of dopaminergic neurobiology and provide stool and blood samples for metagenomic and metabolomic profiling, respectively. This integrative design has the potential to clarify developmentally salient mechanisms that may serve as novel therapeutic targets for youth most at risk of, or already experiencing, internalizing psychopathology.

Medical thoracoscopy (MT) is a minimally invasive procedure with a well-established role in the diagnosis and management of malignant pleural disease; however, its therapeutic applications in benign pleural conditions remain variably adopted and inconsistently defined. In response to increasing clinical utilisation and emerging evidence, the World Association for Bronchology and Interventional Pulmonology (WABIP) and the American Association for Bronchology and Interventional Pulmonology (AABIP) convened a multidisciplinary, international expert panel to develop a consensus statement examining the therapeutic role of MT in benign pleural disease. Six clinically relevant PICO (patient, intervention, comparison and outcome) questions were formulated to guide a systematic literature review of PubMed, Scopus and Cochrane databases from 1980 through 2025. Evidence was appraised using standardised risk-of-bias tools and consensus was achieved using a modified Delphi methodology. This consensus statement summarises the available evidence regarding MT across a spectrum of benign pleural conditions, including recurrent benign pleural effusions, primary and secondary spontaneous pneumothorax, empyema, and tuberculous pleural disease. Emphasis is placed on procedural outcomes, complication profiles and comparative effectiveness relative to alternative medical and surgical approaches. The document also highlights key considerations related to patient selection, procedural complexity and the influence of operator expertise and local resources on clinical outcomes. Given the heterogeneity of underlying disease processes and the predominance of observational data, this work is presented as a consensus statement rather than a formal clinical practice guideline. Overall, it aims to consolidate current knowledge, identify gaps in evidence and provide a practical framework to inform multidisciplinary decision-making and future research on the therapeutic use of MT in benign pleural disease.

There are now six anaplastic lymphoma kinase (ALK) tyrosine kinase inhibitors (TKIs) approved for first-line ALK-positive non-small cell lung cancer (NSCLC) therapy, improving survival and quality of life. However, real-world data on treatment outcomes, predictors of discontinuation, and sequencing strategies remain scarce, while direct comparisons between second- and third-generation TKIs are limited. This global longitudinal observational study evaluated patients with ALK-positive NSCLC, with data collected via online surveys from September 2022 to April 2025. Treatment patterns, outcomes, and factors associated with time to discontinuation (TTD) were assessed using descriptive statistics and univariable regression. Overall, 1,111 patients from 71 countries were included (64% female; median age at diagnosis 53 years; 28% with a smoking history). Crizotinib was predominantly the first TKI administered, although prescribing patterns shifted over time (crizotinib before 2016, alectinib between 2017 and 2022, and lorlatinib thereafter). After the follow-up period (median of 20.7 months), 60% of patients remained on their initial TKI, with TTD varying significantly across agents. Factors associated with prolonged TTDs included radiotherapy, prior chemotherapy, delayed therapy initiation, and treatment in India (crizotinib) and retirement, prior chemotherapy, and treatment in the United Kingdom (alectinib). Gastroesophageal reflux disease, thyroid disease, TP53 mutations, and ALK V3a/b fusions were associated with a short TTD. Globally, alectinib to lorlatinib was the most common treatment sequence. Discontinuations because of toxicity were the highest with crizotinib and ceritinib and the lowest with lorlatinib and alectinib. This multinational registry-based analysis highlights evolving global treatment patterns, supports newer TKIs' effectiveness, and identifies clinical and molecular factors associated with treatment duration.

Preventing posttraumatic psychopathology (e.g., depression or posttraumatic stress disorder [PTSD]) following an acute traumatic event requires attention to modifiable factors that may protect against such psychopathology. In this study, we aimed to identify the relative contributions of resiliency factors across multiple domains to posttraumatic psychopathology and to delineate subcomponents that may be most influential. This study leveraged prospective data from 2,043 trauma-exposed individuals recruited from emergency departments in the Advancing Understanding of RecOvery afteR traumA Study. We first used structural equation modeling to examine higher level regulatory and interpersonal strength domains following acute trauma exposure and their relative associations with symptoms of depression or PTSD at 3 months posttrauma. We then tested which specific factors within these domains were associated with 3-month symptoms. Both regulatory and interpersonal strength domains were linked to fewer symptoms of depression and PTSD 3 months later, though relational strengths were more strongly associated than regulatory strengths when modeled together. Within interpersonal strengths, higher levels of emotional support and supportive networks, but not social engagement, were associated with lower depressive and PTSD symptoms. Within regulatory strengths, trait resilience was associated with lower depressive and PTSD symptoms, and self-efficacy showed mixed associations, whereas mindfulness (measured as nonreactively observing internal experiences) was associated with higher symptoms. Findings suggest enhancing interpersonal resiliency, above and beyond regulatory strengths, may be crucial in the aftermath of acute trauma, with emotional support and supportive networks as especially strong potential buffers against posttraumatic psychopathology. (PsycInfo Database Record (c) 2026 APA, all rights reserved).

Dietary trials methodology in the field of translational gastrointestinal research is fraught with constraints, relating to cost, practicalities of executing dietary trials, and the particulars of manipulating foods that often cannot be overcome. As such, dietary interventions may be unfairly judged as low quality. However, dietary trials are commonly poorly designed, based principally on drug trial methodology, which is often not appropriate in the setting of food, has a very different composition, and is not delivered like pharmaceuticals. This risks accurate interpretation of data and a lack of translatability to clinic. Careful attention should be given to the design of dietary trials to ensure studies remain high quality and clinically relevant. This review summarizes the key factors necessary for consideration when executing a well-designed dietary trial for gastrointestinal conditions and examples of how they have been used and reported on. Key factors include modeling dietary composition to meet the research question, appraising pre-exposure diets and their impact on the study, interpretation and potential use of placebo and nocebo effects, and the use of sham diets. Finally, measuring and reporting on blinding and adherence, which is essential, as for all trials methodology.

•Tricuspid valve-in-ring using balloon-expandable valves appeared feasible via both transjugular and transfemoral approaches in this small single-center series.•Procedural success was higher with the transjugular approach (86%) than the transfemoral approach (60%).•No access-site complications occurred with transjugular access, whereas 1 groin complication (20%) occurred transfemorally.•Paravalvular leak rates were lower with transjugular (29%) versus transfemoral access (60%).•Paravalvular leak was most frequent with rigid Contour 3D and semirigid Carpentier-Edwards rings, and lowest with MC3 and CG Future bands.

State and local health departments and the Centers for Disease Control and Prevention (CDC) routinely investigate multistate outbreaks of salmonellosis associated with backyard poultry (BYP). Here, we describe antimicrobial resistance in multistate outbreaks of nontyphoidal salmonellosis associated with BYP from 2018 to 2023. We analyzed patient and outbreak data from CDC's National Antimicrobial Resistance Monitoring System and System for Enteric Disease Response, Investigation, and Coordination databases. Isolate resistance was determined by antimicrobial susceptibility testing or predicted by whole genome sequencing. We classified isolates as resistant, multi-drug resistant (MDR; resistant to ≥3 antimicrobial classes), or having clinically relevant resistance (CRR; resistant to ampicillin, azithromycin, ceftriaxone, or trimethoprim-sulfamethoxazole; or nonsusceptibility to ciprofloxacin), and outbreaks as resistant, MDR, or CRR if ≥3 isolates and ≥10% of isolates met the corresponding resistance definitions. Statistical analyses comparing patient variables, outbreak size, and annual number of outbreaks with resistance status were performed. Among 78 multistate BYP-associated salmonellosis outbreaks, 36 (46%) exhibited resistance, 10 (13%) were classified as MDR, and 12 (15%) were classified as CRR. Enteritidis was the most frequent serotype, causing 22 (28%) outbreaks; three were resistant (two CRR only outbreaks, one CRR and MDR outbreak). Among the 6,262 patient isolates included in multistate BYP-associated salmonellosis outbreaks, 2,248 (36%) were resistant, 209 (3%) were MDR, and 395 (6%) were CRR. Although nearly half of BYP-associated salmonellosis outbreaks and one-third of outbreak isolates were resistant, CRR and MDR outbreaks and isolates were infrequent. Continued monitoring for antimicrobial resistance is warranted because of the persistence of BYP-associated salmonellosis and the potential for BYP to serve as a reservoir for resistant Salmonella that can spread to people.

Concerns persist within the surgical community that completion of an accredited surgical residency no longer consistently ensures that trainees are ready for independent practice. In response, the Independent Committee for Graduate Surgical Education (ICGSE) was established in January 2025 to address the unique requirements of surgical training. The committee's mandate was to recommend program standards that would potentially optimize education and training for surgical residents, with the goal of improving patient care. The ICGSE, consisting of 71 surgeons across 16 specialties, reviewed the history of surgical accreditation and relevant literature. Workgroup-led discussions identified strategies for improving trainee readiness and modernization of program accreditation standards. A literature review showed a "readiness gap" affecting 20%-30% of surgical trainees across multiple specialties. Key areas for improvement include:1. Designing curricula that increase clinical exposure, promote progressive autonomy, and facilitate transition to independent practice.2. Aligning training with the realities of surgical practice.3. Balancing accreditation requirements with efforts to reduce administrative burden and enhance faculty development.4. Emphasizing program evaluation beyond board passage rates and surveys to include real-time and longitudinal tracking of skill and clinical judgment acquisition.5. Supporting faculty education in teaching and assessment.6. Providing clear developmental roadmaps for lifelong learning. 1. Modernize accreditation through application of continuous quality improvement processes.2. Implement an outcomes-focused curriculum adaptable to each specialty that encourages innovation.3. Supplement case logs with an evidence-based framework for assuring procedural competency.4. Require standardized nontechnical skills training and assessment.5. Establish a longitudinal, competency-based assessment system.6. Mandate verifiable faculty development with institutional support. The ICGSE recommends that the graduate surgery education community, in collaboration with oversight organizations and professional associations, work to develop common surgery-focused accreditation standards that would drive the excellence required in surgical care.

Adolescent substance use imposes lasting costs on education, mental health, and lifetime earnings, with early initiation strongly predicting adult dependence. Despite legal prohibition, approximately 21% of U.S. high school students report current alcohol use, 18% report current nicotine vaping, and 16% report current cannabis use. Social media plausibly contributes to these patterns, yet prior studies rely on broad screen time measures that conflate passive consumption with compulsive checking. We analyzed 2023 Youth Risk Behavior Survey (YRBS) data, the first standalone measure of social media frequency in the YRBS series, from 10,027 U.S. high school students. We estimated survey weighted Linear Probability Models with state fixed effects, adjusting for demographics, mental health, electronic bullying, sleep, and physical activity. Students checking social media more than once per hour show a 19 %age point (pp) higher probability of current alcohol use, a 16 pp higher probability of current nicotine vaping, and a 13 pp higher probability of current cannabis use relative to nonusers, following a dose response gradient. Applied to 17.1 million U.S. high school students, this associates with approximately 1 million additional students drinking alcohol, 870,000 additionally nicotine vaping, and 681,000 additionally using cannabis among the 5.4 million students checking social media more than once per hour. Associations concentrate in alcohol, cannabis, and nicotine vaping, which are prominently normalized online. These findings inform legislative debates over engagement maximizing design features targeting adolescents and support extending content restrictions on alcohol and cannabis influencer marketing. Adolescent substance use imposes lasting costs on educational attainment, mental health, and lifetime earnings, with initiation during adolescence strongly predicting adult dependence. Despite legal prohibition, approximately 21% of U.S. high school students report current alcohol use, 18% report current nicotine vaping, and 16% report current cannabis use. Social media plausibly contributes to these patterns, yet most prior studies rely on composite screen time measures that conflate passive consumption with compulsive social media checking, limiting inference about frequency-specific risk. We analyzed 2023 Youth Risk Behavior Survey (YRBS) data, the first standalone measure of social media frequency in the YRBS series, comprising 10,027 U.S. high school students. We estimated survey-weighted Linear Probability Models with state fixed effects, adjusting for sociodemographic characteristics, mental health status, electronic bullying, sleep, and physical activity. Students checking social media more than once per hour show 19 %age point (pp) higher probability of current alcohol use, a 16 pp higher probability of current nicotine vaping, and a 13 pp higher probability of current cannabis use relative to students reporting no use of social media, each following a dose-response gradient. Applied to 17.1 million U.S. high school students, these estimates associate with approximately 1 million additional students currently drinking alcohol, 870,000 additionally nicotine vaping, and 681,000 additionally using cannabis among the 5.4 million students checking social media more than once per hour. Associations between social media use frequency and substance use concentrate in alcohol, cannabis, and nicotine vaping, the three substances most prominently normalized in platform content, while lower for cigarettes which are subject to platform content bans and strong social stigma. These findings inform ongoing legislative debates over engagement-maximizing platform design features targeting adolescents and support extending content restrictions on alcohol and cannabis influencer marketing equivalent to those already applied to tobacco.

Patent foramen ovale (PFO) closure is a common intervention aimed at reducing recurrent stroke in patients with cryptogenic embolism. Complex PFO anatomies, characterized by features such as long tunnels, large defect sizes, atrial septal aneurysms, multifenestrated septa, prominent Eustachian valves or Chiari networks, and rigid or thickened septal tissue, pose significant challenges for successful device deployment and closure. Advances in imaging technologies, including transesophageal echocardiography, intracardiac echocardiography, and 3-dimensional imaging, have significantly enhanced the detection and characterization of these complex variants. This review summarizes contemporary evidence and procedural approaches tailored to overcome anatomic complexities, highlighting techniques such as tunnel angioplasty and transseptal puncture, alongside device selection considerations. Such advancements have led to acceptable procedural success rates and favorable long-term clinical outcomes. Ongoing innovations and dedicated research are essential to optimize these techniques further, improving patient safety and efficacy in complex PFO closure procedures.