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Stigmatized women's health issues, such as polycystic ovary syndrome (PCOS) and endometriosis, are often marginalized or dismissed in traditional clinical settings. This drives individuals to seek peer support in anonymous online communities such as Reddit. While these digital platforms host critical discussions, they are often designed as static information repositories, failing to account for the complex emotional, temporal, and cultural dynamics that shape users' support needs. There is a disconnect between the lived experiences of users-particularly feelings of clinical dismissal and the need for culturally specific advice-and the design of the sociotechnical systems they rely on. This study aimed to deconstruct support practices in online women's health forums to provide a formative basis for designing more responsive digital health systems. We analyzed the intersections of discussion topics, emotional expression, temporal shifts (specifically the impact of the COVID-19 pandemic), and culturally situated discourse to identify unmet user needs and effective peer-support patterns. We conducted a large-scale, mixed-methods analysis of 4995 posts and 460,317 comments from 5 major women's health subreddits (r/WomensHealth, r/TwoXChromosomes, r/BirthControl, r/Endometriosis, and r/PCOS). Computational methods included Latent Dirichlet Allocation for topic modeling, Valence Aware Dictionary for Sentiment Reasoning for sentiment analysis, and the NRC Emotion Lexicon for granular emotion classification. We segmented the data into pre-, during-, and post-COVID-19 periods to analyze temporal shifts. This quantitative analysis was complemented by a 2-phase qualitative thematic analysis to identify and characterize engagement patterns within 147 validated culturally situated threads. Our analysis revealed that the most prevalent and emotionally negative topic was "Pain & Doctor Visits," which was uniquely characterized by high levels of fear and sadness linked to systemic clinical dismissal. The COVID-19 pandemic triggered a significant topical "turn inward," with discussions shifting away from social or political issues and toward somatic concerns (eg, "PCOS" "Pain & Doctor Visits"). Paradoxically, this period saw a simultaneous rise in both negative emotions (eg, fear and sadness) and expressions of community trust. Critically, our qualitative analysis of culturally situated discourse uncovered a consistent three-stage "playbook" for effective support: (1) Affirmation to establish psychological safety and validate cultural experiences; (2) Information Scaffolding to provide actionable, culturally tailored advice; and (3) Intercultural Bridging to facilitate community-wide learning and empathy. Online health forums operate as essential, resilient sociotechnical infrastructures that actively compensate for failures and gaps in formal health care. The "Affirmation-Scaffolding-Bridging" model identified in our research provides a clear, formative framework for designing future digital health interventions. These findings can guide the development of new platforms that are emotionally aware, culturally responsive, and adaptive to user needs and external crises.

Peptidoglycan Recognition Proteins (PGRPs) are conserved pattern-recognition receptors that detect microbe-associated molecular patterns (MAMPs) and activate host immune responses. Compared to other dipterans, the tsetse fly (Glossina morsitans morsitans) genome encodes only five PGRPs- PGRP-LA, -LB, -LC, -SA, and -SB - far fewer than most dipterans, likely reflecting its sterile blood diet and streamlined microbiota. Here, we identify PGRP-LA as a critical regulator of peritrophic matrix (PM) integrity in the cardia (proventriculus), the tissue responsible for PM production. The PM is a chitinous sleeve-like barrier that separates the midgut epithelium from the ingested bloodmeal, supporting digestive homeostasis and infection resistance. We show that pgrp-la is prominently expressed in the cardia, transiently induced after a bloodmeal in newly eclosed flies, and reinduced following subsequent feedings, likely in response to blood- constituents or mechanical stretch. This induction is sustained during microbial exposure and prolonged in trypanosome-infected flies. RNAi-mediated reduction of pgrp-la significantly increased the prevalence of midgut trypanosome infections, indicating a protective role during early infection. PGRP-LA did not mediate infection resistance via canonical IMD pathway signaling, as its silencing did not affect antimicrobial peptide expression. Instead, PGRP-LA modulated the expression of PM-associated genes and gut barrier integrity. Silencing pgrp-la reduced PM structure, increased midgut weights and enhanced fly survival following oral challenge with entomopathogen Serratia marcescens, likely due to earlier epithelial immune responses through a compromised PM. Similar phenotypes were observed when flies were fed anti-PGRP-LA antibodies, supporting a structural role for PGRP-LA. In addition, soluble variant surface glycoproteins (sVSGs) from trypanosomes and knockdown of microRNA-275 (miR-275), also decreased pgrp-la expression, suggesting that PGRP-LA is part of a broader regulatory network, including the miR-275/Wingless signaling. Collectively, our results identify PGRP-LA as novel regulator of PM biogenesis and vector competence in tsetse, expanding the functional repertoire of PGRPs in insect gut barrier maintenance beyond canonical immune signaling pathways.

A robust characterization of geomagnetic field strength in the Southern Hemisphere over the past millennia is critical for understanding the (multi)centennial evolution of the South Atlantic Anomaly (SAA), one of the most prominent geomagnetic features at Earth's surface. Yet, robust absolute paleointensity records remain scarce in this region, introducing significant uncertainty into geomagnetic field reconstructions. Here, we present 41 absolute archeointensity determinations obtained using the Thellier-Thellier method from central South America spanning the last two millennia. Combined with a selection of high-quality records from the same region, these new data yield virtual axial dipole moment values broadly consistent with the other few available Southern Hemisphere datasets but generally lower than those from Europe, indicating a persistent north-south asymmetry in geomagnetic field strength. A new global geomagnetic field model incorporating these new data suggests that the observed asymmetry reflects a persistently northward-shifted eccentric dipole. In addition, the model tentatively suggests a westward migration of a nondipolar low-intensity anomaly between 1 and 850 CE, from the Indian Ocean to northern South America, following a trajectory broadly similar to that of the modern SAA, which appears in the Indian Ocean after 1100 CE and progresses across Africa before reaching South America. These findings support the hypothesis of a recurrent large-scale geomagnetic pattern and highlight multiscale geodynamic control on geomagnetic field morphology, in which mantle and core processes interact to shape secular variation patterns on centennial to millennial timescales.

Being overweight and obese are major health concerns worldwide, contributing to lifestyle-related diseases such as hypertension, dyslipidemia, type 2 diabetes, and cardiovascular disease. Increasing physical activity is an effective strategy for weight management. However, earlier step count studies have remained limited to small populations, short-term measurements of 1-2 weeks, and mainly cross-sectional comparisons of average step counts. The effects of long-term step count changes on weight loss remain unclear. This study was conducted to assess the effects of long-term patterns of step counts on weight loss using data from the "Asmile" mobile health app in Japan. We hypothesized that participants with continuously increasing step counts over time would have a higher likelihood of significant weight reduction than participants who show steady or fluctuating patterns, even if their average step counts were similar. We analyzed data of 2778 Asmile users aged 40-74 years with BMI ≥25 kg/m² who underwent a specific health checkup during fiscal years 2019-2023 and who had valid step count records for 10-14 months. Step count trajectories, reflecting long-term trends in physical activity, were classified using a latent class mixed model into four patterns: UP (increasing), FLAT (steady), DOWN (decreasing), and UP/DOWN (increasing then decreasing). Logistic regression was applied to estimate odds ratios for achieving ≥3% weight loss, with step trajectory as the explanatory variable and weight loss as the outcome. Among participants, 1601 (57.6%) were men and 1177 (42.4%) were women, with respective mean ages of 65.8 (SD 7.9) and 64 (SD 8.2) years. Step count trajectories were distributed as 28.5% UP, 36.2% FLAT, 20.1% DOWN, and 15.2% UP/DOWN. Compared with the FLAT group, participants in the UP group had a significantly higher likelihood of achieving ≥3% weight loss (adjusted odds ratio 2.45, 95% CI 1.78-3.38). Long-term tracking of step counts using the Asmile app revealed distinct activity patterns. Continuous increases in step counts were associated with the greatest likelihood of weight loss, emphasizing the importance of sustained physical activity. These findings support the use of long-term step monitoring to guide interventions for obesity and lifestyle-related disease prevention.

Patterning graphene into nanoribbons is an efficient approach for tuning its band gap. The significant variation in band gaps among different typical types of nanoribbons highlights the importance of understanding their fundamental π-electron structures, which, however, remains systematically underexplored. Herein, acenes, building blocks of nanoribbons, are regarded as two-dimensional (2D) superatomic-molecules composed of ◊O and ◊F superatoms based on the 2D superatomic-molecule theory. The energy gap of acenes decreases with increasing length, resulting from the conjugation effect of P-type lone pairs (LPs) in SP-hybridized ◊O superatom and ◊F superatom. Several series of staggered acenes were constructed by introducing SP2-hybridized ◊O superatoms to break the overall conjugation, thereby increasing the energy gap. These staggered acenes were further extended into nanoribbons, whose band gaps are widely tuned across a broad range from 0.00 to 2.45 eV. This work reveals the role of P-type LP conjugation in governing the electronic properties of nanoribbons and provides a strategic pathway for band gap engineering in graphene-based materials.

The insula is involved in the pathophysiology of chronic pain. However, the possible role of the insula in people with anterior shoulder pain (ASP) remains unclear. To assess insula-related structural and functional abnormalities in people with ASP compared to healthy controls (HCs). Cross-sectional study. Structural and functional magnetic resonance imaging data were acquired from 27 people with ASP and 20 HCs. Voxel-based morphometry method was used to detect changed gray matter volume (GMV) in the insula between the two groups. The changed insular regions were selected as seeds to further evaluate the structural and functional abnormalities in the two groups using sample entropy, structural covariance and functional connectivity (FC) methods. Receiver operating characteristic (ROC) curves were used to evaluate potential biomarkers for ASP. Correlations between neuroimaging findings and clinical characteristics were then assessed in people with ASP. Compared to HCs, people with ASP showed increased GMV in the bilateral anterior insula (AI). The AI-based sample entropy analysis showed significant differences between the two groups. Altered AI-based patterns of structural covariance and FC between the two groups were connected to certain regions within the salience network, default mode network and sensorimotor network. ROC analysis exhibited better classification accuracies in FC of the right AI with the left posterior insula and right superior temporal gyrus. The current findings suggest that aberrant insula-related structure and function may be associated with abnormal sensory information processing, dysfunction of relevant brain networks and disturbed motor control in people with ASP.

AI technologies increasingly influence dental education, but their instructional value, stakeholder perspectives, and institutional implications require further study. To synthesise evidence on AI's impact in undergraduate dental education, focusing on learning outcomes, stakeholder perspectives, and curriculum design. Following PRISMA 2020 guidelines, researchers searched PubMed, Scopus, Web of Science, IEEE Xplore, and Google Scholar for articles published between January 2015 and February 2025. Eligibility followed an adapted PECO framework: undergraduate dental students or faculty (Population); AI use in teaching, clinical training, or administration (Exposure); conventional or non-AI digital methods (Comparator); and outcomes including knowledge retention, skills, critical thinking, stakeholder perspectives, and curriculum effectiveness (Outcome). The initial pool of 402 references underwent systematic screening, quality appraisal, and AI-focused refinement across four stages, resulting in a final dataset of 107 studies meeting a minimum quality threshold (≥ 3) using validated appraisal tools. AI-powered educational resources, including adaptive learning platforms, intelligent tutoring systems, and generative AI tools, improved knowledge retention, technical skills, and clinical decision-making. Students benefited from personalised feedback, adaptive instruction, and increased engagement. Faculty expressed cautious optimism, tempered by gaps in training, technical readiness, and ethical guidance. Adoption patterns were shaped by generational, cultural, and infrastructural factors. AI enhances cognitive, technical, and clinical learning while complementing traditional instruction. Successful integration requires structured faculty development, clear ethical frameworks, institutional support, and close collaboration among educators, researchers, and technologists to ensure AI supports, rather than replaces, core clinical training and professional decision-making. Coordinated strategies addressing pedagogy, technical competence, and ethics will maximise AI's educational impact and support sustainable curriculum transformation in dental education.

To address the challenges of complex acoustic patterns and limited interpretability in pertussis cough sound recognition, this study proposes an interpretable deep learning framework based on adaptive time-frequency fusion and medically guided attention mechanisms. The framework first employs an Adaptive Time-Frequency Fusion Transformer to extract multi-scale temporal and spectral features of cough sounds, followed by a Medically-Guided Interpretable Attention Mapping module that aligns attention distributions with medically relevant acoustic features, achieving explicit interpretability in the diagnostic process. Experiments were conducted on three publicly available pertussis cough sound datasets from Kaggle, containing 68, 66, and 44 recordings, respectively. Under an 8:2 training-testing split with strict data leakage prevention, the proposed method achieved AUC scores of 0.994, 0.984, and 0.996 on the three datasets, outperforming the best existing baselines by an average of approximately 2%. Ablation studies demonstrated that the ATF module significantly enhances time-frequency dependency modeling, while the MGIAM module improves attention consistency in medically relevant regions. In noise robustness experiments, performance degradation remained below 3%, confirming the model's reliability and generalization ability in clinical applications. Overall, the proposed framework achieves unified high accuracy and strong interpretability for pertussis sound recognition, providing a reusable modeling paradigm for medical acoustic analysis.

Asthma is a prevalent chronic respiratory condition among children worldwide. Inhalation therapy is the primary treatment method, but children often make errors in its use and exhibit poor adherence, which impacts treatment effectiveness. Therefore, interventions to improve inhalation techniques and enhance adherence are urgently needed. This study aimed to develop and evaluate BreatheBuddy, developed by Haoyu Zhang, a training system incorporating gamified feedback designed to enhance inhalation skills and treatment adherence in children with asthma. This study used a single-factor repeated-measures design and recruited 20 children aged 6 to 8 years (10 boys and 10 girls), all of whom had prior experience with inhalers. The experimental group used the BreatheBuddy system, which combines a physical inhaler with an interactive game-based software. The system provides real-time animated feedback based on data from inhalation, breath-holding, and exhalation to guide the rhythm and depth of inhalation. The control group used a conventional inhaler method without a gamified system. Inhalation accuracy, adherence, and satisfaction were assessed using the respiration sensor, the Player Experience of Need Satisfaction scale, the Game User Experience Satisfaction Scale (GUESS), and the System Usability Scale (SUS) scales. Statistical comparisons between the groups were conducted using paired t tests and Mann-Whitney U tests to analyze differences. The experimental group demonstrated significant improvements in inhalation accuracy, with longer breath-holding times and more stable breathing patterns compared to the control group (P<.001). The experimental group also exhibited significantly higher engagement and motivation, with Player Experience of Need Satisfaction (standardized score=93.83) and GUESS (median 87.92, IQR 86.54-88.46) scores markedly higher than those of the control group. Usability scores for the experimental group were also superior, with an SUS score of 88.96 (P<.001). Additionally, children in the experimental group showed reduced anxiety and improved focus during training. BreatheBuddy effectively optimized children's inhalation skills, boosted treatment adherence, and relieved inhalation-related anxiety. Different from conventional non-gamified training or simple game-based distraction, this study integrated breathing behaviors into core game interaction. With dynamic respiratory rhythm feedback, the system unifies skill training, motivation promotion, and emotional regulation. Combined with standard inhaler operation and immersive gamified interaction, it presents a novel behavior-oriented design paradigm. This work provides empirical evidence for gamified intervention in pediatric respiratory treatment and offers a practical auxiliary tool for clinical daily training to strengthen children's self-management. Further research will focus on personalized adjustment and wider clinical application of the system.

Major evolutionary transitions in Homo (e.g., increased brain size, complex social behavior) are linked to reliance on high-quality foods. Increased meat consumption likely contributed to this shift, but whether hominins practiced carcass acquisition and processing strategies consistently across time and environments remains unclear. The Koobi Fora Formation spans much of the Plio-Pleistocene and is central to reconstructing the ecology of early Homo. However, zooarchaeological research has focused almost entirely on the Okote Member (~1.56 to 1.38 Ma), while the KBS Member (~1.87 to 1.56 Ma) has yielded important hominin fossils but relatively few faunal assemblages comparably well preserved for similar analysis. We present an analysis of FwJj 80 (~1.6 Ma), an assemblage from the KBS Member that preserves butchered fauna associated with early Homo fossils. Results show that behaviors documented in the Okote Member, including early access to carcasses, selective transport of limbs, and systematic marrow extraction within riparian settings, were also practiced at FwJj 80. This provides the most comprehensive and systematically analyzed evidence of such behaviors within the KBS Member, demonstrating continuity in carcass-exploitation patterns between the KBS and Okote Members. Comparisons with FLK Zinj (~1.84 Ma, Tanzania) and Kanjera South (~2.0 Ma, Kenya) demonstrate a consistent foraging niche sustained across varied environmental contexts, underscoring behavioral flexibility as central to early Homo's evolutionary success.

Immunomodulatory agents (IMiDs) are critical in treating multiple myeloma (MM). We aimed to identify patterns of adherence to IMiD treatment, patient characteristics associated with adherence, and the corresponding survival among Medicare beneficiaries with newly diagnosed MM. Using group-based trajectory modeling, we identified distinct adherence groups among patients with MM in the SEER-Medicare database. Multinomial logistic regression models were used to identify factors associated with each adherence group. Cox proportional hazards regression models were sued to evaluate the impact of different adherence groups on survival. We identified four distinct adherence groups among 4,452 patients with newly diagnosed MM between 2007 and 2019: (1) persistently-high (33.1%), (2) quick-decline-then-increase (17.5%), (3) moderate-decline (21.2%), and (4) quick-decline (28.2%). Factors related to poor-adherence groups included early treatment initiation years, patients with multiple comorbid conditions, hypercalcemia, renal failure, anemia, and bone disease and receiving a low-income subsidy. Patients age &#x2265;85 years had higher odds of being in groups 3 and 4 than those age 66-69 years. Additionally, non-Hispanic Black patients were more likely to be in the quick-decline group than non-Hispanic White patients. Mortality was significantly associated with adherence. Patients in poor-adherence groups had a >20% increased mortality risk, compared with the persistently-high group. Old age, low-income subsidy recipients, and those with high comorbidity burden are less likely to be adherent to the IMiD treatment, and their survival outcomes are inferior compared with those in the high adherence group. Targeted intervention to assist adherence to their IMiD treatment may improve the survival for these populations with newly diagnosed MM.

Hospitalization for alcohol use disorder (AUD) offers an opportunity to initiate evidence-based medications for alcohol use disorder (MAUDs). To describe patterns and factors associated with hospital initiation of MAUD. Retrospective cohort study. Veterans Health Administration (VHA). Veterans hospitalized with a primary diagnosis of AUD in 2022 or 2023. Patients had MAUD initiated as an inpatient or within 7 days of discharge. Logistic regression models estimated the predicted probabilities of MAUD initiation based on hospital fixed effects and demographic and clinical characteristics. Among 29&#x2009;041 hospitalizations for AUD of veterans without MAUD at baseline in 142 hospitals (median age, 55 years; 94% male), in 8932 hospitalizations (30.8%), MAUD was initiated as an inpatient or within 7 days; MAUDs were naltrexone (57.9%), acamprosate (16.5%), and injectable naltrexone (13.9%). Of MAUD initiations, 6221 (69.6%) were during an inpatient stay and the rest were within 7 days. Of the 6221 inpatient initiations, 97.7% had a prescription for MAUD within 30 days after discharge. In adjusted analyses, MAUD initiation was more likely for hospitalizations with a specialty addiction consultation and those receiving psychiatry versus medicine service. Initiation of MAUD was less likely for persons aged 65 years or older, men, American Indian or Alaska Native versus White veterans, frail veterans, veterans diagnosed with opioid use disorder, and those in the intensive care unit. The median hospital-level rate of MAUD initiation was 29.9% (IQR, 22.6% to 36.3%). Generalizability to other health care systems. Within the VHA, 30% of hospitalizations for AUD resulted in MAUD initiation as an inpatient or within 7 days of discharge, with substantial variation across hospitals and patient demographic and clinical factors. These data indicate a need to identify and disseminate successful hospital-based strategies to increase prescribing of MAUD. U.S. Department of Veterans Affairs and National Institute on Aging.

Neck remnants after coil embolization are usually attributed to coil compaction or aneurysm regrowth, but their longitudinal spatial behavior has rarely been examined. The authors report an unruptured posterior communicating artery aneurysm treated with coil embolization, followed by serial silent MR angiography (MRA) and computational fluid dynamics (CFD). Fusion imaging from an intradome perspective showed progressive migration of a small residual cavity, rather than concentric enlargement, along the aneurysm neck plane at 6, 12, and 18 months. CFD demonstrated that remnant location corresponded to temporal changes in inflow targeting, best reflected by the flow rate ratio, whereas wall shear stress magnitude alone did not correlate consistently with remnant evolution. Directional WSS patterns and streamlines suggested shifting hemodynamic guidance of the residual cavity. The authors term this phenomenon a "migratory neck remnant" or "remnant drift." Serial silent MRA combined with CFD can visualize longitudinal migration of neck remnants. Hemodynamic inflow targeting appears to determine remnant location, whereas blood pressure-related wall stress may govern long-term stability. Recognition of remnant drift may improve prediction of aneurysm recurrence and guide surveillance strategies. https://thejns.org/doi/10.3171/CASE26109.

The relationship between video game experience and cognitive plasticity remains a central focus of research, particularly given its potential applications in clinical rehabilitation. Although both first-person shooter (FPS) and multiplayer online battle arena (MOBA) games have been shown to enhance cognitive functions, the specific associations between the cognitive effects of different game genres and brain network structure remain unclear. This study aimed to examine whether long-term experience with FPS and MOBA games is associated with genre-specific patterns of cortical thickness covariation across brain regions. A total of 116 male participants (mean age 21.2, SD 1.9 y) were recruited via online advertisements for this cross-sectional study. On the basis of strict inclusion criteria (gaming experience >5 years, gaming frequency >5 hours per week, and ranking within the top 15%), participants were categorized into FPS players (n=39, 33.6%) and MOBA players (n=40, 34.5%). An additional group of healthy controls (n=37, 31.9%) with no gaming experience in the past 2 years was also included. High-resolution structural magnetic resonance imaging data were acquired using a 3-T scanner. Individualized differential structural covariance networks were constructed based on the cortical thickness values extracted from 68 brain regions using the Desikan-Killiany atlas. Statistical analysis included one-way ANOVA to identify significant structural covariance edges (SCEs), network-based statistic prediction analysis for weekly gaming hours, and support vector machine analysis for group classification. One-way ANOVA identified 30 significant SCEs across the 3 groups (P<.001, false discovery rate corrected). Post hoc analysis (P<.02, Bonferroni corrected) revealed that, compared to the MOBA and control groups, the FPS group exhibited 2 dominant networks: a temporo-fronto-parietal network anchored in auditory regions and a visuo-sensorimotor network. Both gaming groups showed enhanced SCEs in visual-attentional networks compared to the control group. The network-based statistic-predict analysis demonstrated that structural covariance matrices could effectively predict weekly gaming hours in FPS players (r=0.34, 95% CI 0.26-0.42). The positive edges primarily formed a temporo-fronto-parietal-occipital network, whereas the negative edges were centered on the entorhinal cortex. The support vector machine classifier successfully differentiated FPS players from controls (area under the curve=82.95%) and from MOBA players (area under the curve=72.37%). Long-term FPS and MOBA gaming experiences are associated with different brain structural network architectures. The uniqueness of FPS gaming lies in the extensive structural covariance between the primary auditory cortex and regions supporting visual attention and sensorimotor processing, which may reflect higher demands on cognitive skills. This suggests potential utility in auditory-visual rehabilitation and provides a theoretical basis for the assessment and selection of professional electronic sports players. However, the negative edges involving the entorhinal cortex in FPS players indicate that an overreliance on response learning strategies may come at the expense of the spatial memory system. Consequently, caution is warranted when applying such games to ameliorate age-related memory decline.

The syndromic approach is a widely applied strategy for managing sexually transmitted infections (STIs) in settings where laboratory diagnostics are limited. This study aimed to describe temporal patterns in syndromic STI diagnoses and identify factors independently associated with these diagnoses over a period of 10 years at a reference center in the state of Amazonas, Brazilian Amazon. A retrospective review was conducted using medical records from patients attending a reference center for STI care in Amazonas, Brazil, from 2014 to 2023. Sociodemographic, clinical, and behavioral data were analyzed. The syndromic classification followed World Health Organization guidelines and included vaginal discharge, cervical discharge, urethral discharge, genital ulcers, and genital warts. A total of 32,485 medical records were reviewed, with 14,931 (46.0%) syndromic diagnoses identified. The most frequent syndromes were genital warts (41.0%), urethral discharge (31.5%), genital ulcer (21.3%), cervical discharge (3.8%), and vaginal discharge (2.3%). In multivariate analysis, factors independently associated with receiving a syndromic diagnosis were age&#x2009;&#x2265;&#x2009;30 years (OR = 1.16; 95% CI: 1.05-1.20), male sex (OR = 2.31; 95% CI: 1.75-2.45), single marital status (OR = 1.82; 95% CI: 1.43-2.21), irregular condom use (OR = 3.21; 95% CI: 2.46-3.60), and having two or more casual partners (OR = 3.42; 95% CI: 2.94-3.90). Despite inherent limitations, the syndromic approach remains an essential strategy for STI control in resource-constrained contexts such as the Amazon. It facilitates prompt treatment and broadens access to care where laboratory confirmation is unavailable. Integrating syndromic and etiological approaches is vital to improve diagnostic accuracy, optimize antimicrobial use, and strengthen public health responses to STIs in the region.

Land subsidence poses major threats to human and environmental systems in river deltas worldwide, increasing risks of flooding and damage to civil infrastructure. In deltaic settings, land subsidence can be induced by multiple superimposing processes, including autocompaction, groundwater depletion and infrastructural surface loading. The quantification of each individual process is often uncertain, yet crucial for effective adaptation and mitigation. The Vietnamese Mekong Delta (VMD) is a prominent example of such a subsiding delta, with satellite-derived subsidence rates of up to 30&#xa0;mm a-1 and surface elevations largely below 1&#xa0;m above mean sea level. By presenting a fully coupled flow-deformation model with geomechanical parameterization at high vertical resolution, this study, supported by local geodetic leveling observations, provides an unprecedentedly detailed local-scale assessment of land subsidence dynamics for the VMD. The simulation results indicate subsidence rates of 5-6&#xa0;mm a-1 due to groundwater depletion and local infrastructure loading. Additionally integrating one or multiple well-casing failures as localized subsurface disturbances in the model yields spatially heterogeneous subsidence patterns and increases local subsidence rates by an additional 1-20&#xa0;mm a-1, depending on the number of implemented failures. While well-casing failures are known consequences of land subsidence, the hypothesis-driven exploratory simulations employed here indicate that such damage may in turn accelerate subsidence by facilitating subsurface drainage pathways and local head equilibration between aquitards and tapped aquifers. This suggests that well-casing failures could contribute to heterogeneous and locally extreme subsidence dynamics. The results reveal significant delays in subsidence due to past groundwater depletion at the investigated site, underscoring the need for proactive water management strategies in the VMD, supported by comprehensive land subsidence modelling. The insights derived from this localized high-resolution analysis suggest that effective management will require preventing shallow aquifer depletion to avoid triggering the Holocene's pronounced, yet largely inactivated subsidence potential.

BackgroundSleep is an essential component of memory consolidation and waste clearance, including pathology associated with Alzheimer's disease (AD). Facilitation of sleep decreases amyloid-&#x3b2; (A&#x3b2;) and tau accumulation and is important for memory consolidation.ObjectiveWe previously found that 6-month female 3xTg-AD mice were impaired at spatial reorientation learning and memory. Given the association between sleep and AD, we assessed the impact of added rest on impaired spatial reorientation that we previously observed.MethodsWe randomly assigned 3xTg-AD mice to a sleep (n&#x2009;=&#x2009;7; 50-60&#x2005;min pre- & post-task induced rest) or a non-sleep group (n&#x2009;=&#x2009;7; remained in home cage pre- & post- task). Mice in both groups were compared to non-Tg, age-matched, non-sleep controls (n&#x2009;=&#x2009;6). To confirm that our rest condition induced sleep, we performed the same experiment with rest sessions for both 3xTg-AD and non-Tg mice (n&#x2009;=&#x2009;5/group) implanted with recording electrodes to capture local field potentials, which were used to classify sleep states. Markers of pathology (AT8, 6E10, M78, and M22) were also assessed in the parietal-hippocampal network, where we previously showed pTau (AT8) positive cell density predicted spatial reorientation ability.ResultsWe found that 3xTg-AD sleep mice were unimpaired at spatial reorientation compared to non-Tg mice and performed better than 3xTg-AD non-sleep mice (replicating our previous work). This recovered behavior was apparent despite no change in the density of pathology-positive cells. Further, theta-gamma coupling during sleep may explain the facilitated cognition in 3xTg-AD sleep mice, suggesting brain activity patterns during sleep may mediate the restored cognition.ConclusionsImproving sleep in early stages of AD pathology offers a promising approach for facilitating memory consolidation and improving cognition.

Attention control predicts academic achievement, professional success, and health outcomes. However, the neural basis of stable, individual differences in attention control remains unclear. Prior research has emphasized momentary fluctuations in attentional engagement, often overlooking enduring individual differences. Here, we applied the quasi-periodic pattern analysis of infraslow functional magnetic resonance imaging (fMRI) dynamics in a large sample (N = 196) to test whether trait attention control is reflected in network-level brain activity as well as the locus coeruleus (LC). Using latent-variable measures of attention control, working memory capacity, and fluid intelligence, we isolated the unique contribution of attention control across rest, 1-back, and 3-back conditions. As cognitive demand increased, individuals with higher attention control exhibited more coordinated activity of the frontoparietal control network (FPCN): they showed enhanced coupling with the dorsal attention network (DAN), and greater engagement with the LC and stronger decoupling from the default mode network (DMN). Even at rest, high attention individuals demonstrated stronger FPCN-DAN coupling and little to no correlation between FPCN-DMN, indicating that attentional capacity is reflected in both task-evoked reconfiguration and baseline network architecture. These findings reveal how attention control, as an ability, is instantiated in the brain's dynamic architecture.

To characterise CGM-derived glycaemic trajectories over 12months in people receiving maintenance haemodialysis, with a particular focus on hypoglycaemia burden and composite glycaemic risk. We conducted a longitudinal observational study. CGM data were collected at baseline, 6 and 12&#x2009;months. Descriptive statistics summarised characteristics. Outcomes included time in range (TIR), time below range (TBR), time above range (TAR), glycaemic variability (GV), hypoglycaemia burden and glycaemic risk index (GRI). Metrics were summarised using means or medians, and changes between timepoints were assessed using paired t-tests or Wilcoxon signed-rank tests. In 125 participants (mean age 63.7&#x2009;years; 54.5% men), TIR increased from 51.6% at baseline to 56.6% at 6&#x2009;months (mean difference 5.09%, 95% CI 1.06 to 9.12; p&#x2009;=&#x2009;0.014) but was not sustained at 12&#x2009;months (50.5%; p&#x2009;=&#x2009;0.568), with a decline between 6 and 12&#x2009;months (-6.11%, 95% CI -9.03 to -3.19; p&#x2009;<&#x2009;0.001). TBR remained low, with a small increase between 6 and 12&#x2009;months (1.61%, 95% CI 0.59-2.64; p&#x2009;=&#x2009;0.002). TAR and GV were unchanged across timepoints. Hypoglycaemia burden increased over follow-up (p&#x2009;<&#x2009;0.001), while GRI showed no change. HbA1c showed moderate concordance with CGM-derived glucose at baseline (&#x3c1;&#x2009;=&#x2009;0.39; p&#x2009;=&#x2009;0.0001) and 12&#x2009;months (&#x3c1;&#x2009;=&#x2009;0.59; p&#x2009;<&#x2009;0.0001). CGM revealed evolving glycaemic patterns. Early improvements in TIR were not sustained, hypoglycaemia increased modestly and the overall GRI remained unchanged. These findings support CGM-informed, individualised diabetes management, prioritising safety and stability.