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Avoidant/restrictive food intake disorder (ARFID) is a relatively new diagnosis in the Diagnostic and Statistical Manual of Mental Disorders (DSM)-5, since 2013. The restrictive and/or selective eating-driven by a lack of interest, sensory sensitivity, and/or concern over aversive consequences-is associated with significant medical and/or psychosocial problems. However, little is known about risk factors of this feeding/eating disorder. Our objective was to investigate which factors predispose to ARFID in children. Databases CINAHL, Embase, PsycINFO, PubMed, and Web of Science were searched to identify peer-reviewed articles published from inception to August 27, 2024. Articles that included children with ARFID, a control group, and a potential risk factor were selected. A total of six studies were included in this review. In these studies, data regarding potential risk factors and their risk of bias were evaluated. All studies were of cross-sectional design. Despite an extensive search strategy, only a small number of studies could be included for analysis. A total of 18 factors were reported, of which 10 factors were significantly associated with ARFID. These factors include physical factors, psychiatric comorbidities, and maternal psychopathological risk. This systematic review shows which factors are associated with ARFID in children. To better clarify the direction of associations between potential risk factors and ARFID, longitudinal and interventional studies are needed. This knowledge may support early recognition and timely intervention in ARFID.

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High-curl-pattern hair has unique structural characteristics that increase its susceptibility to breakage and to seborrheic dermatitis (SD). The paper discusses the challenges in effectively treating patients with high-curl-pattern hair and SD, and the role of ceramide-containing products in improving the condition. Following a systematic literature review, a panel of dermatologists developed five consensus statements on the relationship between SD and scalp barrier health in hair with a high curl pattern. Certain hair care practices common among individuals with high-curl-pattern hair may contribute to the development or exacerbation of SD, leading to considerable psychological distress. These statements reflect expert opinion and highlight key treatment challenges in this population. Further research is needed to better understand racial and ethnic variations in SD and to support individualized, culturally sensitive approaches to its treatment and management.

Meditation training can influence various self-related traits, such as self-judgment (SJ), self-kindness (SK), rumination (RUM) and reflection (REF), but little is known about the underlying neural mechanisms. This study aimed to elucidate the neural correlates of changes in traits of SJ, SK, RUM, and REF in response to mindfulness meditation training. Secondary data analyses were conducted on pre- and post-intervention questionnaires and resting state fMRI data collected in a prior mechanistic neuroimaging Randomized Controlled Trial (RCT) that compared 8 weeks of Mindfulness-Based Stress Reduction (MBSR, n=39) to an active control program of Stress Management Education (SME) (n=25) among healthy adults. Voxelwise Amplitudes of Low Frequency Fluctuations (ALFF) were calculated from resting state fMRI as a measurement of magnitudes of spontaneous brain activity. Linear mixed effects model analyses found no significant group by time interaction effects with any of the outcome measures. The MBSR group had significant improvements in all four trait measures, whereas the control group only had significant improvements in SJ and SK (p < 0.05). Linear regression analyses were conducted to predict voxelwise ALFF changes (&#x394;ALFF) using questionnaire score changes (&#x394;). Within the MBSR group, &#x394;SK was positively associated with &#x394;ALFF at the right dorsolateral prefrontal cortex (DLPFC), while &#x394;RUM and &#x394;REF respectively had negative and positive associations with &#x394;ALFF in the Temporal Parietal Junction (TPJ). Different neural correlates were observed in the control group. These findings suggest that meditation training can influence self-related traits through adaptive changes in brain regions involved in executive functioning (DLPFC) and empathy (TPJ). The original RCT was registered as NCT01488422 at ClinicalTrials.gov, accessible at: https://clinicaltrials.gov/study/NCT01488422.

Staphylococcus aureus bacteremia is associated with high mortality. Whether cefazolin or an antistaphylococcal penicillin should be preferred for the treatment of methicillin-susceptible S. aureus bacteremia is unclear. In an ongoing international Bayesian adaptive platform trial, we conducted an open-label, randomized comparison of cefazolin with an antistaphylococcal penicillin (flucloxacillin or cloxacillin) in adult patients with penicillin-resistant, methicillin-susceptible S. aureus bacteremia. The primary outcome, which was evaluated with a hierarchical Bayesian logistic-regression model, was death from any cause within 90 days after enrollment in the platform. We assessed the posterior probability of the noninferiority of cefazolin to flucloxacillin or cloxacillin (with the criterion for noninferiority prespecified as an adjusted odds ratio of <1.2, which approximates an absolute difference in mortality of <2.5 percentage points if mortality in the antistaphylococcal-penicillin group is 15%), as well as the posterior probability of superiority (with the criterion of an adjusted odds ratio of <1.0). Secondary safety outcomes included the development of acute kidney injury within 14 days. This domain of the ongoing trial was conducted between February 17, 2022, and August 7, 2024, by which time the criterion for noninferiority had been met. Mortality at 90 days among adults who could be evaluated was 15.0% (97 deaths among 645 patients) in the cefazolin group and 17.0% (109 deaths among 642 patients) in the antistaphylococcal-penicillin group (adjusted odds ratio, 0.81; 95% credible interval, 0.59 to 1.12; probability of noninferiority, 99.2%; probability of superiority, 89.8%). Acute kidney injury occurred in 92 of 660 patients (13.9%) in the cefazolin group, as compared with 127 of 648 (19.6%) in the antistaphylococcal-penicillin group (adjusted odds ratio, 0.67; 95% credible interval, 0.50 to 0.89; probability of superiority, 99.7%). In patients with methicillin-susceptible S. aureus bacteremia, cefazolin was noninferior to flucloxacillin or cloxacillin with respect to 90-day mortality and was associated with a lower incidence of acute kidney injury. (Funded by the National Health and Medical Research Council and others; SNAP ClinicalTrials.gov number, NCT05137119.).

The natural environment is increasingly acknowledged as an important factor for influencing human health and wellbeing, with growing agreement among policymakers, researchers, and practitioners of its benefits. While nature access and quality are important considerations, wellbeing benefits may be more closely linked to individuals' perceptions as opposed to the environmental characteristics. Due to a complex of personal and socio-cultural factors influencing the nature-wellbeing relationship, traditional linear models may not be sensitive enough to explore the nuanced, context dependent processes of how people relate to nature. To address this gap, we carried out a qualitative metasynthesis review of 49 studies exploring how direct experiences of living nature can impact human wellbeing for adults. Through iteration, interpretation and critique, the findings were organised into a theoretical framework. The review provides deeper and more nuanced understandings of the nature-wellbeing relationship than existing pathway models by unpacking how therapeutic nature encounters are formed through embodied sense-making, shifting attention from objective exposure to subjective experience. Findings highlight the importance of how we relate to nature through multisensory experiences and attunement. The review also demonstrates that the diverse wellbeing outcomes people experience from nature, both hedonic and eudemonic, can only be fully understood by acknowledging how individuals make meaning from their lived experiences, recognising that emotion-laden interpretation is central to human nature. The findings have both theoretical and practical relevance, highlighting the importance of: integrating experimental and more tacit forms of knowledge; relational values; and person-centred approaches to designing nature programmes and spaces.

Incontinence can have a significant impact on the wellbeing of children with different developmental profiles. Due to a growing emphasis on interventions that respect the individual's dignity, promote self-determination, and support meaningful participation in daily life, a video modeling based treatment package is an intervention that aligns with these values. This study aimed to evaluate the effectiveness of a video-modeling based treatment package on the incontinence in children with and without developmental disabilities. The current study used a single-case research design using a multiple probe design across participants. The sample consisted of 12 children, of whom five had average intelligence, six children scored within the mild to moderate range and one child had a severe intellectual disability and who displayed daytime urinary incontinence and/or fecal incontinence/constipation. Data were analyzed using visual analysis of the multiple probe design and effect sizes were calculated using Tau-U and Cohens h scores. The data showed that 83% of the children who exhibited episodes of fecal incontinence achieved a full treatment response, whereas 17% demonstrated a partial response. Among the three children with constipation accompanied by severe stool-withholding behavior (i.e., no toilet defecation during baseline), all subsequently learned to produce successful bowel movements in the toilet. Of the nine children with daytime urinary incontinence, 67% achieved a full response and 33% showed a partial response. Tau-U analyses indicated a large effect of the intervention on reducing episodes of urinary incontinence, a moderate effect on increasing successful bowel movements, and a small effect on reducing episodes of fecal incontinence. Additionally, the intervention produced a large effect (h &#x2265; 0.80) in teaching 78% of the children to perform toileting behaviors independently. A video-modeling based intervention may be effective in reducing episodes of urinary and/or fecal incontinence in children and may simultaneously promote greater independence by increasing independent toileting skills. Therefore, when standard interventions are not sufficient, video modeling can be a useful and effective component of specific urotherapy that can be provided in an outpatient setting.

Patients with recurrent acute flares of pancreatitis&#x2014;especially those receiving frequent opioid treatment for pain&#x2014;can develop physiologic dependence to opioids. This can complicate the clinical picture, making it difficult to distinguish between true pancreatitis flares and opioid withdrawal presenting with similar symptoms. We describe two cases of patients admitted recurrently for pancreatitis: a 24-year-old Haitian male with alcohol use disorder, and a 37-year-old Indian female with hypertriglyceridemia. Both developed iatrogenic physiologic opioid dependence after frequent hospitalizations and opioid prescriptions. Both patients stabilized after initiation of buprenorphine, remaining in care and hospitalization-free for over a year. These cases illustrate the importance of identifying and treating the underlying etiology of abdominal pain, judiciously prescribing opioids to treat pancreatitis flares, and having a low threshold for considering iatrogenic physiologic opioid dependence in patients evaluated for recurrent pancreatitis. They also highlight the potential role that buprenorphine can play to mitigate recurrent admissions by providing safer pain control and treatment for physiologic opioid dependence.

Motor position sensors are critical parts for traction motors control in electrified automotive powertrains. As motors are becoming more compact due to the advance of technology the packaging space for motor position sensors is becoming increasingly restricted. This study presents a two-layer (2L) printed circuit board (PCB) routing strategy for inductive motor position sensors with limited area. A prototype was fabricated and tested on a test bench using a comprehensive design of experiments that contains 625 combinations of X- and Y-offsets, tilt angle, and airgap at various levels (&#xb1;0.5 mm in X/Y, &#xb1;0.5&#xb0; tilt, 1.9-3.1 mm airgap). Across the tolerance box, the accuracy under all test cases remained within &#xb1;1 electrical degree. The accuracy analysis through Fourier series on a circle shows that the DC offset and magnitude mismatches of the 3 Rx signals are the dominant error contributors due to the routing modification. An Extreme Gradient Boosting (XGBoost) model was trained and validated with R2 = 0.9951. A comparison with a Multiple Linear Regression baseline (R2 = 0.0565) demonstrates that installation-induced accuracy degradation is inherently non-linear. The SHapley Additive exPlanations (SHAP) and interaction intensity analysis identified tilt and Y-offset as dominant error drivers, revealing a strong coupled influence (interaction intensity = 0.9581). The model revealed a mild Y-axis asymmetry introduced by routing modifications. This integrated workflow provides a general, quantitative framework for optimizing and analyzing inductive sensor layouts and establishing installation tolerances.

Artificial intelligence-based systems for player risk detection have become central to harm prevention efforts in the gambling industry. However, growing concerns around transparency and effectiveness have highlighted the absence of standardized methods for evaluating the quality and impact of these tools. This makes it impossible to gauge true progress; even as new systems are developed, their comparative effectiveness remains unknown. We argue the critical next innovation is developing a framework to measure these systems. This paper proposes a conceptual benchmarking framework to support the systematic evaluation of player risk detection systems. Benchmarking, in this context, refers to the structured and repeatable assessment of artificial intelligence models using standardized datasets, clearly defined tasks, and agreed-upon performance metrics. The goal is to enable objective, comparable, and longitudinal evaluation of player risk detection systems. We present a domain-specific framework for benchmarking that addresses the unique challenges of player risk detection in gambling and supports key stakeholders, including researchers, operators, vendors, and regulators. By enhancing transparency and improving system effectiveness, this framework aims to advance innovation and promote responsible artificial intelligence adoption in gambling harm prevention.

This study builds on a growing body of research seeking to define multidimensional loss chasing. Analyzing data from 36,325 online sports bettors, the focus was to identify which loss accumulation period (loss period; i.e., immediate losses vs. daily, weekly, monthly, and total cumulative losses) maximizes the predictive relationship between loss chasing and diverse potential harm outcomes. We found that the daily loss period yielded the best predictive efficacy for two harm outcomes (loss trajectory and voluntary self-exclusion [VSE]). Loss chasing was not associated with a third harm outcome (percent change in net loss) for any loss period. Overall, the findings suggest that the loss accumulation period for loss chasing matters for predicting harms, with daily losses presenting the most potential importance and relevance to potential gambling harm. These findings can be used to inform new predictive models for identifying risk for gambling harm from betting records.

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The introduction and scale-up of HIV treatment and prevention programmes have resulted in steady declines in orphanhood prevalence in sub-Saharan Africa, but orphanhood incidence and its associated factors are less understood. We aimed to describe the incidence and prevalence of orphanhood after HIV treatment and prevention programmes became available in Rakai, Uganda. In this population-based cohort study, we used data from all children and adolescents younger than 18 years with censused parents residing in 28 continuously surveyed Rakai Community Cohort Study (RCCS) communities from 1995 to 2022 (N=92&#x2008;441), to calculate maternal, paternal, and double orphanhood prevalence by census round. Orphanhood incidence was estimated by use of a non-parametric hierarchical Bayesian model over time among children whose parents were alive during their first census interview and who were censused at least twice without missing more than two consecutive census visits (N=54&#x2008;411). Poisson regression models estimated incidence rate ratios of orphanhood and 95% CIs by time period (pre-antiretroviral therapy [ART; 1995-2003], ART partial availability [2004-14], and ART full availability [2015-22]), age at orphanhood, and socioeconomic status of the household. Population attributable fractions of incident orphanhood due to parents' HIV-positive status were estimated among those with surveyed parents who were tested for HIV. Orphanhood prevalence declined considerably over the study period, with steepest declines after ART became available; from 21&#xb7;5% (3421 of 15&#x2008;941 individuals) in 2003-04 to 6&#xb7;3% (1449 of 23&#x2008;082 individuals) in 2020-22. In adolescents aged 15-17 years, orphanhood prevalence declined from 49&#xb7;4% (1057 of 2138) in 2002-03 to 14&#xb7;4% (526 of 3661 individuals) in 2020-22. Incidence rates declined sharply; double orphanhood declined from 5&#xb7;13 (95% CI 4&#xb7;02-6&#xb7;45) per 1000 person-years in 2003-04 to 0&#xb7;68 (0&#xb7;42-1&#xb7;05) per 1000 person-years in 2020-22. The proportion of new cases of orphanhood attributed to parental HIV status declined from 67% in 2004 to 11% in 2022 for paternal orphanhood and from 71% to 12% for maternal orphanhood. Scale-up of ART in this Ugandan setting drove substantive declines in orphanhood incidence. Yet, a considerable burden of orphanhood persisted in 2022, particularly among adolescents. To consolidate these gains, sustained investment and adaptation of HIV programmes are crucial to mitigate the ongoing risk of orphanhood for this vulnerable population. National Institute of Allergy and Infectious Diseases, National Institute of Child Health and Development, Gates Foundation, National Institute of Mental Health, and National Institutes of Health Fogarty International Center.

Wear assessment of prosthetic feet is critical for monitoring device performance and replacement, especially in rural or resource constrained areas where clinical follow-ups can be infrequent. Standardised, reliable methods for wear evaluation are limited. This study investigates the inter-observer reliability of a method for quantifying patterns and relative magnitudes of plantar surface wear of prosthetic feet and presents preliminary results for intra-observer error. Sixty-two plantar images of used SACH feet from Sri Lanka were scored by four independent groups a published method for quantifying prosthetic foot wear. A 20x10 grid was applied to each image, and wear was scored from 0-9 per cell based on visual indicators. Interobserver agreement was assessed on full (48 feet, 4 raters) and reduced (62 feet, 3 raters) datasets. Intraobserver reliability was tested by 2 raters re-scoring five images after 5&#x2009;+&#x2009;days. Kendall's W evaluated agreement, and a modified scoring method was developed and evaluated. Interobserver agreement ranged from fair to excellent and was higher in the reduced dataset. Intraobserver agreement appears high, especially in central, less-worn areas of the foot. The modified method showed reduced intraobserver variability but lower interobserver agreement, largely due to increased ties affecting Kendall's W, not increased disagreement. The original and modified methods for wear qualification demonstrate high reliability, supporting their use as a low-cost, field-appropriate tool for monitoring prosthetic foot wear to enhance the evaluation and design of prosthetic feet, particularly in resource-limited settings. While the full method provides higher resolution data, the reduced method is more broadly applicable to different foot types. Clinically, this method offers a reliable, scalable approach to assessing prosthetic foot wear, potentially supporting community-based monitoring. Further testing and methodological alterations to encompass additional foot designs are required for clinical use.

Hair type classification is crucial for developing personalized hair care, maximizing hair health, and selecting appropriate treatment for scalp disorders, yet it remains underutilized in clinical practice. This review aimed to address three main questions: (1) How can hair types be defined according to specific shape criteria, without referring to race/ethnicity? (2) Why does certain hair exhibit a curly pattern, and how does curly hair behave uniquely? (3) How is the classification of curly hair clinically relevant to the development of seborrheic dermatitis? PubMed and Google Scholar were the primary and secondary platforms used for the literature search, respectively. The scope of the search included English-language human studies published between 2000 and 2025 that investigated classification systems defining hair types based on specific shape criteria. The literature review revealed four mainstream hair classification systems: the Andr&#xe9; Walker Hair Typing System, the LOIS Hair Typing System, the FIA Hair Typing System, and the L'Or&#xe9;al Curl Classification System. There are shared characteristics across the systems, as each was built on previous ones to incorporate nuances of different hair types and curl patterns. The L'Or&#xe9;al Curl Classification System acknowledges the broader continuum of hair types by categorizing straight, wavy, curly, and coiled hair using four morphological parameters. There are several existing hair classification systems that dermatologists and other health care professionals can use to optimize communication with patients. Dermatologists' use of these classification systems and increased awareness of practices for high-curl-pattern hair could ultimately improve treatment outcomes. Curl pattern classification may also have predictive value in the treatment of scalp diseases (e.g., seborrheic dermatitis), but further validation is required.

Digital surveys and electronic health records (EHR) can be combined to provide comprehensive assessments of vaccine safety. Limited post-marketing safety data exists for two new RSV vaccines among older adults (Pfizer RSVPreF and GSK RSVPreF3&#xa0;+&#xa0;ASO1). We used digital survey data from adults &#x2265;60&#xa0;years receiving RSV vaccines through Kaiser Permanente Southern California from November 8, 2023, to February 29, 2024. Enrolled participants received 14-day post-vaccination surveys soliciting local and systemic reactions. Survey results were combined with EHR data. Medical chart reviews were conducted among participants self-reporting receiving medical care for vaccine-related symptoms within 21&#xa0;days of vaccination. We recruited 14,482 participants aged &#x2265;60&#xa0;years following RSV vaccination (GSK: 7873 [59%]; Pfizer: 5555 [41%]), including 1054 participants receiving COVID-19 vaccinations on the same day (GSK:618; Pfizer:436). Local and systemic reactions were reported more frequently following GSK vaccinations than Pfizer. The most frequently reported reactions were pain at injection site (56.5% and 14.4%, respectively), fatigue (35.5% and 21.8%), myalgia (26.2% and 13.0%), headache (21.5% and 12.8%) and fever (7.8% and 3.3%). Participants rarely reported seeking medical care (GSK: 158/7873;2.0%; Pfizer: 104/5555;1.9%). Of these, 229 had &#x2265;1 EHR-documented medical encounter 0-21&#xa0;days post-vaccination, of which 102 (0.8%) were considered possibly related to vaccination (GSK:69; Pfizer:33; RSV&#xa0;+&#xa0;COVID-19:0). Via chart review, the most common diagnoses identified as possibly related to vaccination included respiratory symptoms, such ascough (n&#xa0;=&#xa0;20 and n&#xa0;=&#xa0;9, respectively) and congestion (n&#xa0;=&#xa0;13 and n&#xa0;=&#xa0;6). No severe events were deemed related to vaccination. Reported reactogenicity symptoms were higher among participants receiving COVID-19 vaccines on the same day compared to participants receiving RSV vaccines alone. The most common reactions after RSV vaccines were local pain, fatigue, myalgia, and headache. GSK vaccine recipients containing the AS01E adjuvant reported reactions more frequently than Pfizer vaccine recipients. Consistent with pre-licensure safety data, most symptoms were transient and did not require medical care.

Maternal mortality ratio (MMR) is a key indicator of maternal health, but heterogeneity across cities has been infrequently explored. We aimed to investigate variation in MMR across cities and the association between social and built environment features of urban areas and MMR in Latin American countries. This ecological study used harmonised data from the Salud Urbana en Am&#xe9;rica Latina study comprising 340 cities across eight countries (Argentina, Brazil, Chile, Colombia, Costa Rica, Guatemala, Mexico and Panama). MMRs were calculated for each city using vital statistics registries for the years 2012-2016 and a correction factor applied for under-reporting of maternal deaths. Predictors of interest included city social environment characteristics (living conditions, services provision and population educational attainment), built environment characteristics (isolation of urban development, population density and mass transit availability) and total population. Mixed negative binomial regression models with country-level random intercepts were used. Rate ratios (RRs) were estimated. MMR was 47.3 maternal deaths (SD 25.3) per 100&#x2009;000 live births. Cities with better living conditions and with better services provision had lower MMRs (RR=0.89 per SD, 95%&#x2009;CI=0.82 to 0.97; and RR=0.92 per SD, 95%&#x2009;CI=0.87 to 0.97, respectively), while those with higher urban isolation and population density had higher MMRs (RR=1.07 per SD, 95%&#x2009;CI=1.03 to 1.13; and RR=1.11 per SD, 95%&#x2009;CI=1.04 to 1.19, respectively). We found that better living conditions, service provision and mass transit availability were associated with lower MMR, whereas higher population density and urban isolation were associated with higher ratios. These findings suggest that multisectoral urban policies aimed at improving social conditions, infrastructure and mobility may help reduce maternal mortality in Latin American cities, contributing to improving maternal health and advancing health equity.

As of 2026, physicians must complete an Accreditation Council for Graduate Medical Education (ACGME)-accredited addiction medicine fellowship to seek addiction medicine board certification. While the ACGME has developed general goals and objectives, they also allow for curricular flexibility. Little is known, however, about how individual programs meet these requirements. To describe how addiction medicine fellowship training programs meet ACGME requirements, including commonalities and innovative curricular and education strategies. In 2025, 5 experts in addiction education developed a survey tool to capture comparisons of addiction medicine fellowship curricula. The principal investigator (R.S.) sent this survey via e-mail to 104 addiction fellowship program directors; responses were kept anonymous and not linked to individual programs. Data were analyzed using quantitative descriptive statistics and inductive and deductive thematic analysis. Forty-seven of 104 program directors (45%) completed the survey. Program directors described both shared elements and unique features of their curricula, reflecting differences in program settings, available community resources, specialty focus, faculty diversity and expertise, and patient population. There is a wide array of curricula that meet addiction medicine fellowship ACGME requirements. Future research and efforts should describe individual programs' curricula in more depth to support new and existing programs in growing and improving their programs to suit the growing demand for diverse practices in addiction medicine and to recruit fellows with aligned interests.

Mild cognitive impairment (MCI) is a transitional stage between healthy aging and dementia, underscoring the urgent need for accessible, low-cost, and scalable preventive strategies beyond pharmacological approaches. In this single-blind randomized feasibility trial (NCT06814483), 32 older adults with MCI were assigned to a 12-week, telehealth-delivered, computer-based multimodal mind-body approach (cbMMBA) or an active computer-based cognitive fitness program (cbCFP) used as control condition. Recruitment rate was 66.7%; retention rate was 78.6% vs. 100.0% (cbMMBA vs. cbCFP); intervention fidelity was 85.3% vs. 98.2%; satisfaction score was 4.80 vs. 4.47; and there were no serious intervention-related adverse events. Exploratory analyses indicated domain-specific cognitive improvements in both cbMMBA and cbCFP, favoring cbMMBA in memory, language, and visuospatial abilities, with within-group gains in global cognition. These findings support the feasibility, safety, and acceptability of a fully remote mind-body program for older adults with MCI; however, as a feasibility study, it was not powered to establish efficacy, and larger, longer trials are needed to confirm benefits and scalability for equitable dementia prevention.