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Little research has assessed detailed occupational exposures in relation to the dementia exposome. We characterized patterns of multidimensional workplace stressors in relation to cognitive trajectories and racial disparities. We included 704 participants from the Michigan Cognitive Aging Project (MageT1 = 63.32 ± 2.99). Main lifetime occupations were linked to 26 Occupational Information Network-measured workplace stressors. Latent profile analysis identified stressor profiles. Global cognition was measured with a comprehensive neuropsychological battery. Latent growth curve models assessed how stressor profiles related to cognitive trajectories. We examined racial differences in profile membership and profile-cognition associations. Five profiles emerged. Black participants were more likely to show higher-stress profiles; this difference was explained by education. The profile with low job control/limited other stressors had the lowest initial cognition, especially among Black participants. The profile with high emotional labor/job demands had the fastest cognitive decline. Workplace stress is a relevant, under-recognized aspect of the dementia exposome.
Ambient artificial intelligence (AI) scribes are systems that automatically generate clinical documentation from clinician-patient conversations and are being deployed at accelerating pace across US health systems. Early evaluations report reduced documentation burden, improved clinician well-being, and perceived efficiency gains, reinforcing a narrative of inevitability. Yet this frontline framing understates a more consequential issue: ambient scribes outsource the "first mile" of clinical documentation, thereby reshaping the production of clinical data and the learning health systems (LHSs) that depend on documentation as foundational infrastructure. This paper argues that ambient AI scribes should be understood not merely as workflow tools, but as emerging infrastructure that will materially shape the capacity and capabilities of LHSs. Drawing on infrastructure studies and LHS frameworks, we conceptualize clinical documentation as the epistemic substrate through which encounters are translated into analyzable data that power quality measurement, predictive modeling, clinical decision support, and institutional learning. When this translation is algorithmically mediated by proprietary systems, design choices, training data, and integration pathways can introduce systematic documentation errors that propagate downstream, often invisibly, through analytic pipelines. Synthesizing emerging evidence, we highlight risks including hallucinated clinical details, omission of safety-critical information, and differential performance across patient populations with diverse accents or speech patterns. These risks mirror classic infrastructural properties described by Star: embeddedness, dependence on the installed base, wide propagation, and visibility primarily upon breakdown. From this perspective, ambient scribes may quietly reshape documentation norms, data quality, and learning trajectories well before downstream effects are routinely assessed. We conclude by outlining a governance agenda grounded in LHS principles: documentation-quality metrics, drift monitoring, equity-focused evaluation, transparency, and multi-stakeholder stewardship. Without such oversight, ambient AI scribes risk stabilizing an infrastructural layer that delivers short-term relief while eroding the long-term integrity, equity, and trustworthiness of learning health systems.
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Noting differences in active and passive lumbar contributions to trunk extension moment across harvesting postures and ground slopes, this study examined whether a back-support exosuit reduces tissue loads and suggests the exosuit can effectively reduce lumbar muscle activity during kneeling/squatting and passive moment during stooping, with consistent effects across slopes.
Studies have shown variation in thyroidectomy use across geographic settings but have not examined statewide, procedure-specific (total thyroidectomy [TT] versus thyroid lobectomy [TL]) rates for thyroid cancer at the surgeon or facility level. This study aimed to characterize variation and trends across hospitals at the surgeon and facility levels in utilization of TT and TL for low-risk thyroid cancer. This retrospective cohort study analyzed adults who underwent thyroidectomy for thyroid cancer in a statewide claims registry (2015-2022). Patients receiving radioactive iodine <180 days after thyroidectomy were excluded to identify low-risk cancers. Analyses examined variation in TT rates using mixed-effect models with random clustering effect by surgeon or facility. Poisson regression evaluated thyroidectomy trends. Of 2615 patients (75.3% female; 56.8 ± 15.2 y old) treated by 297 surgeons across 80 facilities, 1741 (66.6%) underwent TT, while 874 (33.4%) underwent TL. Wide variation existed in TT use at the surgeon (38%-87%) and facility- (51%-80%) levels. At the surgeon level, Medicare beneficiaries were more likely to undergo TT (odds ratio [OR] 1.36, 95% confidence interval [CI] 1.04-1.77) compared to other insurance types, while patients treated by an otolaryngologist were less likely (OR 0.57, 95% CI 0.40-0.81) compared to general surgeons. At the facility level, male patients were less likely to undergo TT (OR 0.81, 95% CI 0.66-0.98). From 2015 to 2022, annual TL rates doubled (22.5%-40.9%; P < 0.001), TT rates decreased (68.4%-50.9%; P = 0.047), and completion thyroidectomy rates remained stable (P = 0.75). Significant variation exists in utilization of TT for low-risk thyroid cancer with increasing TL rates. Opportunities to intervene at the surgeon level to reduce variation and decrease TT use are most actionable.
Artificial intelligence (AI) is rapidly reshaping health care and higher education, yet physician associate (PA) education lacks a unified framework for its integration. This consensus statement from the PA Education Association (PAEA) AI Special Interest Group (SIG) offers guidance for PA programs navigating the challenges and opportunities presented by AI technologies.The PAEA AI SIG used a modified Delphi method following the RAND/UCLA Appropriateness Method framework. Following a twelve-month qualitative phase of iterative discussion and collaborative document development, 13 expert panelists rated 20 consensus position items on a 9-point Likert scale. Consensus was defined a priori as a median rating of 7 to 9 without disagreement (per the interpercentile range method for a 13-member panel).All 20 position items achieved consensus endorsement in round 1 (median range: 7-9; overall mean 8.3). The SIG achieved consensus across 5 domains: assessment and academic integrity, AI as a learning tool, admissions processes, faculty workflow, and AI competencies. Items with the greatest variation related to lifting AI prohibitions in application preparation (item 9, median 7) and restricting general-purpose AI in admissions review (item 10, median 8).This consensus statement provides a foundation for PA programs to transition from reactive policies toward proactive, evidence-informed AI integration strategies. The recommendations emphasize rigorous competency validation, equitable access considerations, and the primacy of human judgment in clinical education.
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Bone surface modifications (BSMs) provide data for modeling predator-prey dynamics and trophic interactions in the fossil record. However, the utility of BSM data depends on our ability to correctly infer which unobservable actions or ecological agents produced these marks, and commonly used qualitative methods may be insufficient to discriminate among BSMs that exhibit substantial macromorphological overlap. Recently, quantitative BSM identification methods have been employed to overcome this taphonomic equifinality, which, despite their methodological rigor, remain underused because they require large databases of experimentally generated BSMs. In the present study, we introduce TaphoSource, an open-source database containing point cloud and measurement data for 942 experimentally generated BSMs, created by replicating five possible taphonomic and depositional actions, as well as 12 fossilized BSMs from the 1.7-million-year-old HWK EE site in Olduvai Gorge, Tanzania. To highlight the utility of this dataset, we used random forest models to distinguish among the five experimentally generated BSM categories based on measurement variability, achieving approximately 73% accuracy. These data were then used to train a random forest model to identify the actions responsible for the 12 fossilized BSMs in the TaphoSource database. We openly disseminate these data so that other researchers can conduct quantitative BSM modeling studies without the need to generate expensive and time-consuming experimental datasets. We anticipate that these data will have broader applications for reconstructing and modeling spatiotemporal trends in carnivory, providing deeper insights into the evolution of both hominin and non-hominin mammalian carnivory and behavior throughout the Plio-Pleistocene.
[This corrects the article DOI: 10.1016/j.lana.2026.101524.].
There is an increased risk of hazardous alcohol use following metabolic and bariatric surgery (MBS). Identifying risk factors of hazardous alcohol use, particularly factors that may differentiate risk among those with regular postoperative alcohol consumption, would inform postoperative monitoring. Participants (N = 100) who were up to 5 years post-MBS and were consuming alcohol at least 2-3 times per month completed an assessment as part of a larger study. Measures assessed hazardous alcohol use, drinking motives, psychiatric symptoms, and disordered eating behaviors. Participants were primarily female (87.0%), White (49.0%) or Black (44.0%), with a mean age of 48 years. Approximately 1 in 5 met the threshold for hazardous alcohol use. In bivariate analyses, clinically significant symptoms of depression (OR = 4.88, p = .01) and anxiety (OR = 8.21, p < .001) were associated with the presence of hazardous alcohol use. All four types of drinking motives were associated with greater likelihood of hazardous alcohol use: social (OR = 1.10, p = .03), coping (OR = 1.33, p < .001), enhancement (OR = 1.24, p < .001), and conformity (OR = 1.25, p = .01). Emotional eating scores and the presence of a food addiction were not significantly associated with hazardous alcohol use (p > .05). In a multivariable analysis, only the coping drinking motive remained statistically significant (OR = 1.26, p = .003). Drinking to cope with negative emotions may be a factor associated with increased risk of hazardous drinking among individuals who regularly consume alcohol after MBS. Interventions aimed at improving coping strategies could mitigate risk of hazardous alcohol use.
This study examines trends and cost disparities between retail and mail order pharmaceutical dispensing within the workers' compensation system. Pharmacy benefit management (PBM) data were obtained for ankle sprain claims filed with a nationwide workers' compensation carrier between 2012-2024. During the study period, the ratio of mail order versus retail pharmacies scripts increased. Mail order prescriptions demonstrated higher cost ratios per unit (pill) than retail pharmacies for opioids (1.75), and a sleep agent (1.46), similar costs for analgesics (1.08), antiseizure (0.95), and nonsteroidal medications (0.94) but lower costs for muscle relaxants (0.84). Mail order pharmacies dispensed a longer duration supply per script. Mail-order prescriptions consistently provided longer days' supply across all major drug classes, yet they sometime carried higher costs per unit-especially for opioids and sleep agents.
Glioblastoma, IDH-wildtype, CNS WHO grade 4, is a highly aggressive primary tumor of the central nervous system characterized by infiltrative growth, marked antigenic heterogeneity, and resistance to treatment. Despite advances in immunotherapy, clinical responses of glioblastoma remain transient and non-durable. Emerging evidence suggests that glioblastomas and related high-grade gliomas reside within a highly regulated neuro-immunologic tumor microenvironment (TME), which may contribute to these limitations. Within this microenvironment, structural, biochemical, and cellular remodeling reduce the efficacy of current immunotherapy, including chimeric antigen receptor (CAR) T-cell therapy and immune checkpoint inhibitors, by impairing lymphocytic infiltration across the blood-brain barrier (BBB) and promoting T-cell exhaustion. The refractory nature of these tumors is further influenced by the neural circuitry that surrounds the TME. Through signaling molecules, such as glutamate and neuroligin-3 (NLGN3), neuronal activity can predispose the TME to an immunosuppressive baseline while simultaneously advancing tumor cell proliferation. These upstream signaling pathways and regionally heterogeneous neural interactions may contribute to diverse immune phenotypes and behaviors that ultimately influence clinical outcomes. These findings support a shift from a tumor-centered view to a neuro-immunological network model. Future therapeutic strategies will likely require a multidisciplinary approach that integrates neural signaling pathways, immune system modulation, and spatially defined landscapes, thereby reframing glioblastoma and related high-grade gliomas as a systems-level disorder rather than an isolated malignancy.
Microbial necromass-mineral associations are key to long-term soil organic matter (SOM) persistence. However, how soil pH and mineralogy interact to regulate SOM stability remains poorly understood. Here, we used artificial soils to test how three clay minerals (bentonite, kaolinite, and goethite), adjusted to four pH levels (5-8), affect microbial activity (respiration), microbial physiology (carbon use efficiency, CUE), microbial-derived residue material (necromass), and the formation and stability of mineral-associated organic matter (MAOM). Artificial soils were inoculated with a rhizosphere-derived microbial community cultured under the same pH conditions and on two representative simulated exudate types (organic acids and carbohydrates) and incubated for 6 weeks. In two complementary experiments, we added necromass from known microbial taxa to the same minerals across pH levels to isolate the role of necromass chemistry and loading. We found that soil pH shaped MAOM chemistry by altering microbial activity and necromass composition. In interaction with mineral type, pH also controlled MAOM thermal stability. Higher necromass loading weakened mineral-organic bonding, reducing MAOM stability, consistent with zonal mineral-organic interaction models. Our results demonstrate that microbial activity, rather than carbon use efficiency, better predicts MAOM formation and that pH-dependent necromass composition and loading govern MAOM persistence. These findings advance mechanistic understanding of SOM stabilization and have implications for predicting soil carbon dynamics under shifting environmental conditions.
The increasing resistance and adverse effects associated with conventional chemotherapeutic agents such as cisplatin have prompted the investigation of natural compounds that act synergistically with chemotherapy to combat cancer. This study investigates the cytotoxic effects of an aqueous extract of Artemisia vulgaris L. in conjunction with cisplatin on A549 human lung cancer cells. The research analyzes the phytochemical composition of the extract and its potential mechanisms of action by assessing apoptosis and autophagy. Cytotoxicity studies demonstrated a synergistic interaction between A. vulgaris and cisplatin. We utilized molecular docking to examine the interactions of the extract components with critical proteins involved in these processes. Liquid chromatography-tandem mass spectrometry (LC-MS/MS) was employed to characterize the phytochemicals in A. vulgaris. A549 cells were subjected to various concentrations of A. vulgaris L. aqueous extract, cisplatin, and their combination. We utilized the SRB assay to assess cell viability and the combination index (CI) analysis to evaluate the synergistic interaction between the two compounds. Molecular docking was performed for selected compounds against apoptotic and autophagic target proteins. The combination treatment showed a greater cytotoxic effect than either treatment alone, suggesting a synergistic improvement of anticancer action through the induction of both apoptosis and autophagy. This was manifested by a significant decrease in the IC50 values of A. vulgaris and cisplatin to 13.32 ± 1.66 μg/mL and 0.44 ± 0.02 μM, respectively, with a combination index (CI) of 0.7. LC-MS/MS profiling showed a wide array of bioactive compounds such as flavonoids, terpenoids, coumarins, and phenolic acids many of which have been found to possess anticancer effects. The results indicated that A. vulgaris L. may potentiate the anticancer effect of cisplatin, potentially allowing dose reduction and minimizing side effects.
South Asian American gay, bisexual, and other men who have sex with men (GBM) experience multiple minority stressors, such as internalized homophobia, racial prejudice, and homonegative discrimination, thereby elevating their risk of HIV. Due to the scarcity of HIV scientific literature focusing on South Asian American GBM, little is known about their use of pre-exposure prophylaxis (PrEP) or the upstream factors influencing its uptake. This study seeks to address this gap by describing PrEP use history among South Asian American GBM and comparing PrEP users and nonusers with respect to their demographic and behavioral characteristics, as well as PrEP knowledge, attitudes, stigma, social norms, and self-efficacy-elements that reflect key constructs of the information-motivation-behavioral (IMB) skills model. Sexually active South Asian American GBM were recruited from across the United States via social media advertising and peer referral and were administered a Qualtrics survey, for which they received a US $25 Amazon e-gift card. In addition to demographic and behavioral variables, the survey included previously validated scales to measure IMB model constructs. Fisher exact tests and Mann-Whitney U tests were conducted to compare the demographic and behavioral characteristics of PrEP users with nonusers, as well as their scores on each scale, respectively. Of the 103 participants, 34 (33%) were currently using PrEP, 52 (50%) had never used it, and 17 (17%) had discontinued its use. Greater proportions of PrEP users were in open relationships (P<.001), had at least 2 male sex partners in the past 6 months (P<.001), and had condomless anal sex with at least 2 male partners in the past 6 months (P<.001). Frequently cited reasons for never using or discontinuing PrEP included being in or starting a relationship, respectively, and concern about its long-term safety. Consistent with the IMB model, PrEP users exhibited greater PrEP knowledge (P<.001), stronger motivational elements (PrEP attitudes P=.002; PrEP stigma P=.09; PrEP subjective norms P=.003; PrEP descriptive norms P=.06), and higher PrEP self-efficacy (P=.003). Suboptimal PrEP use among South Asian American GBM, despite high PrEP knowledge, positive attitudes, low stigma, positive social norms, and high PrEP self-efficacy, represents a disconnect between individual readiness and actual use. Future research exploring their sexual health needs through an intersectional lens could help identify possible points for intervention.
Staff in opioid treatment programs (OTPs) face elevated risk of secondary traumatic stress, yet the availability and effectiveness of training and clinical supervision to address this risk remain unclear. This study characterized current OTP training and supervision practices and examined their associations with staff vicarious trauma (VT) and burn-out. In a cross-sectional survey of OTPs, administrators (N = 44, 21 U.S. states) reported on staff training. Staff (N = 83) completed validated measures of VT and burnout. Counselors (n = 30) reported on clinical supervision. Training in VT and burnout was widely available, and most administrators (83.3%) and staff (89.6%) expressed interest in reflective supervision tailored to OTPs. In regression models, clinical supervision was associated with lower VT and burnout, whereas training availability was associated with higher VT and burnout. Findings suggest existing training models may be insufficient to address OTP staff stress. Expanding relationally-focused supervision may buffer the emotional toll of substance use treatment work.
Parathyroid carcinoma (PC) is a rare endocrine malignancy accounting for less than 1% of primary hyperparathyroidism cases. It carries significant morbidity due to severe hypercalcemia and a high rate of recurrence post-resection. This literature review synthesizes current evidence on the diagnostic challenges, surgical management, and outcomes associated with parathyroid carcinoma. Diagnosis of parathyroid carcinoma remains difficult due to a large overlap with parathyroid adenoma in clinical presentation, laboratory findings, and imaging characteristics. However, markedly elevated serum calcium and parathyroid hormone levels, palpable neck mass, and evidence of local invasion may raise suspicion for malignancy. Definitive diagnosis relies on histopathologic features such as capsular, vascular, or perineural invasion. Also, many immunohistochemical markers are currently under review, including mutation of the CDC73 gene, loss of parafibromin, and elevated Ki-67, which support the diagnosis. Complete en bloc resection at the initial operation represents the most critical determinant of long-term outcomes. Achieving negative margins significantly reduces recurrence rates and improves survival, while limited resection and capsular disruption are associated with increased risk of locoregional recurrence. While lymph node involvement is relatively uncommon, selective rather than routine lymph node dissection is recommended. Adjuvant therapies, including radiation and systemic treatments, play a limited and largely palliative role, particularly in advanced or unresectable disease. Parathyroid carcinoma commonly recurs, requiring multiple reoperations, with morbidity primarily driven by persistent hypercalcemia. Long-term surveillance with serial biochemical monitoring is essential due to the risk of late recurrence. Overall, evidence consistently demonstrates that outcomes are contingent on the adequacy of the initial surgical resection, highlighting the importance of early recognition and complete en bloc resection.
To investigate pharmacological treatment patterns in individuals with bipolar disorder (BD) with and without comorbid substance use disorder (SUD) and anxiety disorder (AX), we leveraged the Global Bipolar Cohort to analyze cross-regional practices across North America, Europe, and the Pacific. Fourteen cohorts contributed aggregate data on pharmacotherapy, demographics, diagnostic subtypes, and comorbidities. Proportional meta-analyses using generalized linear mixed models were conducted to examine prescription trends and identify clinical differences. The sample (N = 11,521) was 60% female and 84% Caucasian. Participants were categorized into four mutually exclusive groups based on comorbidity status: those with comorbid AX only, comorbid SUD only, both AX and SUD, or neither. The AX+SUD subgroup showed higher rates of attention-deficit/hyperactivity disorder (ADHD), post-traumatic stress disorder (PTSD), rapid cycling, obesity, and unemployment, reflecting a more severe clinical profile. Regional variations were notable: North American cohorts reported higher prevalence of AX and SUD than European and Pacific cohorts. Antidepressants use for AX were more common in Europe and the Pacific, while North American prescribing patterns were more variable. Benzodiazepine use was high among individuals with SUD across all regions. Lithium and first-generation antipsychotic prescriptions varied, with higher rates observed in Europe. Findings underscore the heterogeneity of BD and the influence of comorbid AX and SUD on illness burden and treatment. Regional prescribing variations underscore the need for context-specific guidelines. Gaps in data on medication-assisted treatment for SUD point to areas for future research. These insights can support more individualized and effective care for complex BD presentations.
Ventricular arrhythmia (VA) risk in patients with chronic total coronary occlusion (CTO) without advanced left ventricular (LV) dysfunction is poorly defined, and whether revascularization reduces VA compared with optimal medical therapy (OMT) remains unknown. We conducted a single-center retrospective cohort study of 100 patients with angiographically confirmed CTO, LVEF > 35%, and no coronary artery bypass surgery after diagnosis between January 2010 and January 2019. CTO percutaneous coronary intervention (CTO-PCI) was performed in 44 patients, while 56 received OMT. Primary outcomes were VA and all-cause mortality at study end. Secondary cardiovascular outcomes were assessed. Kaplan - Meier methods were used for VA and mortality analyses, performed with STATA 15 and RStudio. Mean age was 59.9 ± 13.1 years, BMI was 31.8 ± 7.4 kg/m2, 66% were male, 64% White, and 23% Black. Baseline characteristics, including LVEF, CTO number and location, and use of antiarrhythmics, beta-blockers, and statins, were similar between groups. During 4.1 ± 2.5 years of follow-up, OMT was associated with higher VA (21.4% vs 2.3%, p = 0.01) and mortality (37.5% vs 15.9%, p = 0.03) than successful CTO-PCI. Among CTO patients with LVEF > 35%, VA and mortality were frequent, particularly with OMT, supporting prospective studies to confirm benefit and refine patient selection for revascularization strategies. What we did: A chronic total occlusion (CTO) is a coronary artery that has been completely blocked for at least three months. We studied 100 patients at one US hospital who had a CTO between 2010 and 2019 and whose hearts were still pumping reasonably well (an ejection fraction above 35%). About four in ten of these patients had the blocked artery opened with a procedure called percutaneous coronary intervention (PCI), while the remaining six in ten were treated with medications alone. We followed all of them for an average of about four years and recorded how many developed dangerous heartbeat disturbances (called ventricular arrhythmias) and how many died from any cause.What we found: Patients treated with medications alone were more likely to develop dangerous heart rhythms (about 21%) compared with those who had the artery opened (about 2%). They were also more likely to die during follow-up (about 38% versus 16%). The strength of the heart’s pumping function did not change much in either group. Patients who took a beta-blocker, a common heart medication, did better overall.What it means: In patients whose hearts were still pumping reasonably well, leaving a CTO untreated may carry a higher risk of dangerous arrhythmias and death than treating it with PCI. However, patients in the two groups were not randomly assigned, the study was small, and other factors may explain the differences we saw. Our results should be confirmed by larger randomized studies before changing clinical practice.