Oncogenic viruses cause high-risk cancers in humans and are responsible for nearly 20% of all cancer cases worldwide. Currently, very limited data exist in the realm of wastewater-based viral epidemiology (WBE) for cancer-causing viruses, with existing studies using targeted approaches (i.e., PCR-based approaches) that lack genomic resolution. In this study, we used a hybrid-capture approach to detect, filter, and sequence all known oncogenic virus signals from wastewater samples collected over 3 years (May 2022-May 2025) in 16 Texas cities, covering nearly 25% of the state's population. Once sequenced, we used custom computational tools designed for wastewater metagenomics to assign reads into their respective virus of origin, estimate viral abundances over time, and measure genomic read coverage. Our data indicate that we successfully detected oncogenic viruses, including six known oncogenic viruses, and three suspected oncogenic viruses, across all sampling locations within Texas. We observed a gradual increase in the viral abundance of oncogenic viruses over 3 years, with distinct peaks and dips over the summer and winter months. The prevalence of high-risk viruses such as human papillomavirus (HPV) and Epstein-Barr virus (EBV) rose, with sharp increases in viral abundance observed post-2024. We also obtained nearly 100% genome coverage with viral reads captured using this hybrid-capture technique for nearly all oncogenic viruses, with resolution down to the species and type taxonomic levels in some cases, such as that of HPV. Our study showcases the utility of hybrid-capture techniques to detect and track multiple oncogenic viruses simultaneously.IMPORTANCECancer-causing viruses are of major clinical significance, responsible for nearly 20% of all recorded cancer incidences in humans worldwide. There is a need for improved detection, tracking, and control of oncogenic viruses across the globe. To our knowledge, this work is the first comprehensive WBE approach used to detect all known oncogenic viruses concurrently, demonstrating the feasibility of monitoring the presence and levels of cancer-causing viruses and enabling the possibility of public health interventions in the future. Using this method, we obtain broad genomic coverage at strong depth and specificity, coupled with consistent real-time tracking dynamics of multiple oncogenic viruses. Furthermore, we showcase the ability to identify genomic regions on viral reference genomes from which sequenced reads originate. This information can be an invaluable tool toward understanding the viral prevalence dynamics in general populations, their relationship to cancer incidences in humans, and their mechanisms of viral evolution, including mutations.
Background/ObjectivesThis study explores how individuals form first impressions when encountering a hospital lobby in the United States. It examines the roles of emotional responses and decision-making during brief environmental exposure, focusing on how sensory cues and emotional reactions shape visitor judgments.MethodsAs part of a larger mixed-methods project, this paper presents findings from the quantitative phase. Data were collected between June 2023 and February 2024 from participants visiting a hospital lobby in West Texas. Participants were randomly assigned to either a 5-min or unlimited exposure condition. Three newly developed self-report scales measured environmental perceptions, emotional responses, and first impression judgments. Due to non-normal data distribution, nonparametric analyses (Spearman's rho, Mann-Whitney U) were conducted. Age and gender were also analyzed.ResultsParticipants formed first impressions rapidly, often within 5 min. Emotional responses significantly influenced the relationship between environmental perceptions and judgments. Negative emotions, such as nervousness, fear, and distress, had a stronger influence on first impressions than positive emotions. No significant differences were found between exposure durations or across age and gender. Sensory and visual cues were critical in shaping emotional reactions and first impressions.ConclusionsFirst impressions in hospital lobbies are formed quickly and are strongly shaped by the physical environment and emotional responses. Reducing negative emotional triggers such as confusion, poor signage, or unwelcoming interactions is more effective than incorporating positive features. Visitors rely on brief, "thin-slice" cues to evaluate and emotionally respond to a space, making initial moments of experience crucial for forming first impressions.
To conduct a bibliometric analysis of the literature on C-shaped canal systems in mandibular second molars (MSMs) and to review key research themes and evolving trends. A comprehensive search of the Web of Science Core Collection (WoS-CC) was conducted for publications through 31 December 2024. Following study selection and data extraction, bibliometric data such as publication years, authors, citation counts, institutions, countries/regions, journals, and keywords were analyzed using VOSviewer, CiteSpace, SPSS, and Microsoft Excel. A related review was also performed to synthesize key research themes and evolving trends. 166 publications from 1979 to 2024 met the inclusion criteria, with 50.6% published within the past 5 years. The most cited article received 239 citations. Research originated from 52 countries/regions, with China contributing the largest number of publications (n=34), followed by the United States (n=26). Wuhan University, the University of Hong Kong, and Texas A&M University were the leading institutional contributors. Journal of Endodontics (JOE) published the most articles (n=38), while International Endodontic Journal (IEJ) accumulated the highest total citations (n=1 666). James L. Gutmann was the most prolific author (n=12), and Bing Fan was the most cited (n=577). Keyword co-occurrence analysis revealed "C-shaped canal" and "cone-beam computed tomography" as the most frequent terms, while "deep learning" demonstrated a recent and marked citation burst. This study provides an overview of influential studies on C-shaped canal systems in MSMs and identifies key research themes and evolving trends, serving as a reference for future research and clinical practice.
Undocumented immigrants are more than 5 times as likely as US citizens to be uninsured. Before 2020, undocumented young adults aged 19 to 25 years in California were eligible for restricted-scope Medi-Cal, which only covers emergency services. To examine the association of the California 2020 full-scope Medi-Cal expansion to young adults aged 19 to 25 years regardless of immigration status with coverage outcomes and to assess subgroup differences by race and ethnicity, sex, and age. This cross sectional study included American Community Survey respondents who were noncitizens aged 19 to 25 years before (2016-2019) and after (2021-2022) the policy's implementation in California; the treatment group was compared with California noncitizens aged 26 to 32 years and young adults aged 19 to 25 and 26 to 32 years from 6 comparison states (Arizona, Florida, Illinois, Nevada, New York, and Texas). Analysis was conducted from January 2024 to August 2025. California's 2020 Medi-Cal expansion. Triple difference analysis was used to estimate the association of the California Medi-Cal expansion with health insurance coverage (any, Medicaid, and private coverage) among noncitizens aged 19 to 25 years relative to California noncitizens aged 26 to 32 years and young adults in the 6 comparison states. The sample included 19 773 and 32 515 noncitizen American Community Survey respondents in California aged 19 to 25 years and 26 to 32 years, respectively, and 28 535 and 43 213 individuals aged 19 to 25 years and 26 to 32 years, respectively, residing in comparison states. Baseline weighted percentages for the 19- to 25-year treatment group included 52.1% (95% CI, 51.0%-53.2%) male, 31.9% (95% CI, 30.7%-33.0%) Asian non-Hispanic, 1.8% (95% CI, 1.5%-2.2%) Black non-Hispanic, 54.6% (95% CI, 53.4%-55.9%) Hispanic, 9.7% (95% CI, 8.9%-10.5%) White non-Hispanic, and 2.0% (95% CI, 1.6%-2.3%) other race non-Hispanic. Medi-Cal expansion was associated with a 4.2 (95% CI, 1.3-7.1)-percentage-point increase in Medicaid and a 3.5 (95% CI, 0.2-6.8)-percentage-point increase in any coverage. In subgroup analyses, percentage-point increases in Medicaid were statistically significant for Hispanic young adults (6.7 [95% CI, 2.6-10.9] percentage points), males (3.6 [95% CI, 0.1-7.1] percentage points), females (5.0 [95% CI, 0.7-9.3] percentage points), those aged 19 to 22 years (4.4 [95% CI, 0.7-8.1] percentage points), and those aged 23 to 25 years (4.0 [95% CI, 0.7-7.3] percentage points). In post hoc analyses, the estimates translated to increases in Medi-Cal and any coverage of 24.4 and 20.3 percentage points, or 30 665 and 25 554 young adults, respectively. In this cross-sectional study, the California 2020 Medi-Cal expansion was associated with significant coverage gains. Because the American Community Survey did not distinguish between restricted- and full-scope Medi-Cal, the analysis may have underestimated coverage increases, and further research is warranted to understand the health care and economic costs and benefits of California's expansion.
Trauma exposure and posttraumatic stress (PTS) symptoms are well-documented health disparities in Latinx migrants, explaining a diverse array of physical and mental health complaints as well as role limitations for both youth and adults. Few studies have examined the influence of the migration journey on PTS in Latinx migrants. We examined the added effect of migration-related predictors, above and beyond general trauma exposure, of PTS in two samples of Latinx migrants with the broad aim of uncovering unique predictors of PTS in this high-risk population. Both studies investigated predictors of posttraumatic distress using information collected about individuals' demographics (e.g., age, gender, country of birth) and migration journey to the U.S., while controlling for pre-migration trauma exposure. The current studies used one sample of Latinx adult migrants seeking asylum (N = 276) collected at the Texas-Mexico border and one sample of recently immigrated Latinx youth (N = 69) collected at an urban school in the Southwestern United States. Across both samples, hierarchical regression analyses revealed that witnessing or experiencing something frightening during migration (p = 0.009 in youth; p <0.001 in adults) predicted PTS, even after controlling for general trauma exposure. Our results underscore the importance of routinely screening Latinx migrants for migration-related trauma in clinical and community settings. As the U.S. halts asylum processing as part of its sweeping immigration enforcement actions, our findings highlight the urgent need to expand legal paths to entry to prevent migrants from being forced into traumatic and dangerous routes.
The annual San Antonio Breast Cancer Symposium (SABCS) combines the principles of multidisciplinary management, with the basic science underlying pathobiological processes in breast cancer. The 48th meeting was held at the Henry B Gonzales Convention Center in downtown San Antonio, Texas, United States of America on 9-12 December 2025. The symposium delivers a range of presentations covering basic, translational, and clinical sciences with input from patient advocates and an increasingly patient-centric approach and focus on standards of clinical care and survivorship issues. Important trials that are potentially practice changing are often presented as late-breaking news and published concurrently or shortly thereafter. This second of a two-part report covers a range of topics related to indications for pre-operative breast magnetic resonance imaging (MRI), benefits of acupuncture on cognitive function, age as a prognostic factor in younger patients, primary irradiation, antibody-drug conjugates for advanced human epidermal growth factor receptor 2 (HER2) positive/negative disease, and selective estrogen receptor down-regulators for early-stage breast cancer.
The processing of positive memories technique (PPMT) is a promising new treatment for posttraumatic stress disorder (PTSD) involving the detailed narration and processing of specific positive autobiographical memories. This study used an interrupted time series design with daily diary reports to assess changes in daily-level affect, cognitions, and PTSD symptoms pre- to post-PPMT. A convenience sample of trauma-exposed U.S.-based adults (n = 70) recruited through social media and flyers received the 4-week PPMT intervention and completed 21 daily surveys pre- and post-PPMT (42 total surveys) assessing daily positive event pleasantness, negative event unpleasantness, PTSD symptoms, posttraumatic cognition levels, and positive and negative affect levels. Mixed-effects models found post-PPMT reductions in daily negative event unpleasantness ratings, β = -.25, p < .001; PTSD symptoms, β = -.24, p < .001; posttraumatic cognition levels, β = -.32, p < .001; and negative affect levels, β = -.32, p < .001, alongside increases in daily positive affect levels, β = .12, p = .021, compared with the preintervention phase. The association between daily negative event unpleasantness and daily negative affect levels (negative affect reactivity) was weaker postintervention compared with preintervention. There was no significant change post-PPMT in positive event pleasantness ratings, β = -.03, p = .619, or the association between daily positive event pleasantness and daily positive affect levels (positive affect reactivity), β = .00, p = .931. These findings provide support for the beneficial therapeutic effects of PPMT at the daily level for trauma-exposed populations. Further studies should test these patterns with clinical samples.
Commercial sexual exploitation of youth (CSEY) causes significant physical and emotional harm, yet prevention research and intervention is nascent and scant. This paper describes how our study team developed and refined a logic model to guide a rigorous, multi-site, randomized control trial evaluation of a curriculum for youth to prevent commercial sexual exploitation and trafficking through increased problem recognition and help-seeking. We combined community-based and mixed methods research (CB-MMR) approaches in an iterative process we created to develop our research methodology. First, we describe our five-phased, iterative, research design process, including the engagement of an 18-member research advisory board (RAB) made up of diverse practitioners, administrators, and those with lived expertise. Then we show how that process shaped the logic model content and structure including: 1) substantive changes to outcome categories the study will measure; 2) attention to the potential for victim blaming and stigma in outcome measurement; and 3) insights on how implementation context shapes outcome measurement. We highlight the important contributions and leadership of community (including lived experience experts) in research design and argue that this inclusion is necessary for rigorous research attuned to real-world contextual factors and the holistic impact of CSEY prevention efforts. Our aim is to contribute to better understanding the research design foundations of evaluative research to prevent CSEY to strengthen the evidence base, and ultimately to improve outcomes for youth.
Autonomous odor source localization remains a challenging problem for aerial robots due to turbulent airflow, sparse and delayed sensory signals, and strict payload and computation constraints. While prior unmanned aerial vehicle (UAV)-based olfaction systems have demonstrated gas distribution mapping or reactive plume tracing, they rely on predefined coverage patterns, external infrastructure, or extensive sensing and coordination. In this work, we present a complete, open-source UAV system for online odor source localization using a minimal sensor suite. The system integrates custom olfaction hardware, onboard sensing, and a learning-based navigation policy that we train in simulation and deploy on a real quadrotor. Through our minimal framework, the UAV is able to navigate directly toward an odor source without constructing an explicit gas distribution map or relying on external positioning systems. We incorporate vision as an optional complementary modality to accelerate navigation under certain conditions. We validate the proposed system through real-world flight experiments in a large indoor environment using an ethanol source, demonstrating consistent source-finding behavior under realistic airflow conditions. The primary contribution of this work is a reproducible system and methodological framework for UAV-based olfactory navigation and source finding under minimal sensing assumptions. We elaborate on our hardware design and open-source our UAV firmware, simulation code, olfaction-vision dataset, and circuit board to the community.
Despite a wide amount of evidence regarding vascular improvements in overweight/obesity condition, little is known about similar vascular benefits from exercise training without weight loss. This study aimed to evaluate the effects of a 6-week concurrent training (CT) program on pulse wave velocity (PWV), flow-mediated dilation (FMD), and carotid intima-media thickness (cIMT) average (cIMTav) and maximum (cIMTmax) in overweight/obese women who did not report weight loss. Additionally, the relationship between vascular outcomes and anthropometric and body composition measurements was examined. We conducted a secondary analysis of a clinical trial assessing the effects of CT on cardiovascular markers. Forty-three overweight/obese women (age = 42.4 ± 12.8 years; BMI = 29.7 ± 3.2 kg/m²) were divided into control (CG, n = 21), 'exercise without weight loss' (EG-NWL; n = 9), and 'exercise with weight loss' (EG-WL; n = 13) groups. The primary outcomes included PWV, FMD, cIMTav, and cIMTmax, and the secondary outcomes included waist circumference (WC), body fat (BF), skeletal muscle mass (SMM), lean mass, and other vascular measures, reported as absolute and delta (Δ) values. ΔPWV differed between CG and EG-NWL (0.2 vs. -1.2 m·s-1, P = 0.0002) and between CG and EG-WL (0.2 vs. -0.7 m·s-1, P = 0.0002). ΔFMD showed differences between CG and EG-NWL (-0.6 vs. 6.9%) and between CG and EG-WL (-0.6 vs. 4.5%). Each delta of ΔPWV, ΔFMD, ΔcIMTav, and ΔcIMTmax was significantly associated with ΔWC (r s = 0.920; 0.912; 0.597; 0.767, P < 0.05), ΔBF% (r s = 0.847; 0.791; 0.465; 0.695, P < 0.05), ΔSMM (r s = 0.889; 0.566; 0.934; 0.940, P < 0.05). Overweight and obese women who did not lose weight after CT experienced a decrease in PWV and an increase in FMD. The correlations between changes in ΔPWV, ΔFMD, ΔcIMTav, and ΔcIMTmax with body composition measures suggest directions for future research.
War and armed conflict profoundly disrupt cancer care systems, with radiation therapy services among the most severely affected due to their static geography, reliance on stable infrastructure, specialized equipment, and a highly trained multidisciplinary workforce. Drawing on intercontinental narratives shared by clinicians and medical physicists from Sudan, Yemen, Syria, Palestine, and Ukraine, this work synthesizes frontline experiences of delivering radiation therapy amid instability, displacement, and resource collapse. Beyond documenting challenges, the manuscript articulates a collective call to action for the global radiation oncology community, outlining priority areas for intervention, including education, workforce development, technology support, research, and advocacy, and proposing practical, ethically grounded pathways for translating awareness into sustained, collaborative resilience planning. Cancer care in conflict settings is framed not as a peripheral humanitarian concern, but as a central issue of patient safety, equity, and professional responsibility, central to today's new challenges.
Randomized trials evaluating multiarterial grafting (MAG) vs single arterial grafting (SAG) during coronary artery bypass grafting (CABG) have not demonstrated a long-term survival benefit, whereas conventional retrospective studies have consistently reported improved survival with MAG. Whether this discordance reflects true treatment effect heterogeneity or bias from unmeasured confounding in observational analysis remains unclear. Our objective was to evaluate whether the apparent survival advantage associated with MAG in conventional observational analyses persists after accounting for unmeasured confounding using a quasi-experimental instrumental variable (IV) approach and to assess the implications of these findings for long-term survival in an older Medicare population. We retrospectively analyzed Medicare beneficiaries who underwent CABG from 2001 to 2019. Surgeon MAG rate during the 12 months preceding each operation was leveraged as an IV. Flexible parametric survival models with time-dependent effects were developed with MAG vs SAG as the exposure variable. The non-IV model adjusted for patient demographics, pre-existing comorbidities, hospital and surgeon characteristics, and procedural details. The IV model incorporated these same covariates plus the IV (surgeon MAG rate) using a 2-stage residual inclusion approach. Regression standardization was used to derive standardized survival probabilities and their differences. Among 1,291,314 beneficiaries, 1,145,760 (88.7%) underwent SAG and 145,554 (12.3%) underwent MAG. In the non-IV model, MAG recipients had improved risk-adjusted median survival as compared with SAG recipients: 10.74 years (95% CI: 10.70-10.79 years) vs 10.33 years (95% CI: 10.31-10.35 years), a difference of 0.41 years. Across 4,164 surgeons, the MAG rate during the 12 months preceding the index CABG was 7.7% ± 9.5% in SAG recipients and 32.9% ± 25.8% in MAG recipients. In the IV model, MAG recipients had similar risk-adjusted median survival compared with SAG recipients: 10.38 years (95% CI: 10.29-10.48 years) vs 10.38 years (95% CI: 10.35-10.40 years), a difference of 0.01 years. MAG was associated with a modest improvement in long-term survival in a conventional risk-adjusted analysis. However, this association was not robust to a quasi-experimental analysis in which surgeon MAG rate was incorporated as an IV to address unmeasured confounding. The contrast between these models suggests that traditional observational studies may overestimate the survival benefit of MAG because of unmeasured or difficult-to-measure patient characteristics that influence a surgeon's decision to offer MAG.
Introduction: Colorectal cancer remains a leading cause of cancer-related morbidity and mortality, with adenomatous polyps representing a common precursor. Post-polypectomy polyp recurrence represents a significant risk of colorectal cancer, driving periodic colonoscopy surveillance and polypectomy as needed. In this study, we explore a multimodal machine learning approach that integrates endoscopic imaging with clinical and pathology data to improve recurrence risk prediction and support individualized surveillance planning. Methods: We developed and evaluated a multimodal artificial intelligence (AI) model to predict post-polypectomy colorectal polyp recurrence using the ERCPMP-v5 dataset. The cohort included 217 patients with 796 high-resolution endoscopic RGB images and 21 endoscopic videos; video data were converted to still frames at 2 frames per second. Images and frames were resized to 224 × 224 pixels and normalized. Patient-level demographic, morphological (Paris, Kudo Pit, JNET), anatomical, and pathological variables were encoded using standard scaling for continuous features and one-hot encoding for categorical features. Visual representations were extracted using a pretrained Vision Transformer backbone (ViT-Base-Patch16-224) with frozen weights. Structured metadata (79 variables) was encoded using a multilayer perceptron. A late fusion framework used image and metadata representations to generate a recurrence probability via a sigmoid classifier; probabilities were thresholded at 0.5 for binary prediction. Model performance was evaluated on a held-out test set using accuracy, precision, recall, F1-score, and area under the receiver operating characteristic curve (AUC). We additionally compared fusion performance with image-only and metadata-only baselines. Predicted probabilities were translated to surveillance recommendations using risk tiers: low risk (0.00 ≤ p < 0.20), moderate risk (0.20 ≤ p < 0.50), and high risk (p ≥ 0.50). Results: On the test set, the multimodal fusion model achieved 90.4% accuracy, 86.7% precision, 83.1% recall, 84.9% F1-score, and an AUC of 0.920. The image-only model achieved 84.6% accuracy (AUC 0.880), and the metadata-only model achieved 81.9% accuracy (AUC 0.850), indicating improved performance with multimodal fusion. Risk stratification enabled surveillance recommendations of 1-3 years for low risk, 6-12 months for moderate risk, and 3-6 months for high risk. Conclusions: A late-fusion multimodal model integrating endoscopic imaging with structured clinical and pathology variables demonstrated excellent performance for predicting post-polypectomy recurrence and generated actionable risk-based surveillance intervals. This approach may support individualized follow-up planning and more efficient allocation of surveillance resources, while prioritizing timely evaluation for patients at higher predicted risk.
Despite evidence that enhanced recovery protocols (ERPs) improve outcomes in adults undergoing surgery, adoption for pediatric populations has lagged. To assess the implementation and clinical effectiveness of a consensus-based ERP for pediatric patients undergoing elective gastrointestinal (GI) surgery. A prospective type 2 hybrid implementation-effectiveness, stepped-wedge, cluster-randomized by entry date into implementation phase, trial of pediatrics patients, 10 to 18 years of age, undergoing elective GI surgery at 18 US sites from September 2019 to June 2024. Sites were randomized into 3 groups, each spending at least 9 months in a control phase, with usual care, followed by an implementation phase at 6-month intervals that included a 21-element ERP supported by a structured Implementation Toolkit, based on 5 Active Implementation Frameworks (5AIFs), and a sustainment phase (12-24 months). Implementation was facilitated by a 1-year, group-based Learning Collaborative curriculum, a repository of tools, ERP adherence feedback, and implementation report cards. Site-level scores were created based on 5AIFs domains. ERP adherence was assessed by ERP elements delivered at patient and site level. The primary effectiveness outcome, postoperative length of stay (LOS), and secondary effectiveness outcomes (including opioid use, time to regular diet, complications, readmission, and patient-reported health-related quality of life [HRQOL]) were evaluated across study phases (baseline, implementation, and sustainability). Correlations between site-level implementation scores and fidelity were estimated. Of the 597 enrolled pediatric patients (median [IQR] age, 15 [13-17] years; 274 [45.9%] female; 323 [54.1%] male), 433 (72.5%) had inflammatory bowel disease. No significant differences were found by study phase in LOS or secondary outcomes, except shorter time to regular diet and decreased opioid use during hospitalization. Patients who received at least 13 ERP elements had shorter median LOS (-1.14 days [95% CI -2.01 to -0.27]) and fewer complications (adjusted odds ratio, 0.48 [95% CI, 0.28-0.82]). Patient-level adherence increased by study phase (number of ERPs: 11 [10-13], 14 [12-15], and 14 [13-15], [P < .001]). ERP integration into order sets and site culture were moderately correlated with fidelity. This stepped-wedge cluster-randomized trial found that despite multifaceted implementation strategies, a pediatric GI surgery ERP did not significantly reduce LOS. However, when accounting for implementation fidelity at the patient level, it resulted in significantly lower LOS and complications. ClinicalTrials.gov Identifier: NCT04060303.
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Ecological niche models (ENMs) are used to assess the abiotic preferences of species by linking their occurrences to the environmental conditions in which they live. We developed a fossil-informed ENM framework that integrates mid-Holocene and modern occurrences to test niche stability and reconstruct abiotic niche characteristics for four critical reef-building Caribbean coral species (elkhorn coral [Acropora palmata], staghorn coral [Acropora cervicornis], boulder brain coral [Colpophyllia natans], and mustard hill coral [Porites astreoides]). Given evidence of niche stability, we used fossil-improved niche estimates to predict area and location of habitat for future climate scenarios in 2050 and 2100. We built species distribution models with environmental predictors and compared models trained with modern-only versus combined fossil and modern occurrences to evaluate differences in niche breadth, model performance, and projected habitat distributions under future climate scenarios. Including mid-Holocene fossil data in ENMs broadened niche estimates, resulting in a larger area of predicted habitat than models based solely on modern data (up to 114,559 km2 more in 2100). Although our models showed that suitable habitats existed for most corals in 2100, the amount declined dramatically (45-100% decrease in area from the present day), there was a significant restriction of lower latitude habitat suitability, and marine protected areas did not overlap the majority of predicted future suitable habitat (8-20% overlap by 2100). Fossil-informed models expanded niche estimates in environmental space and incorporated environmental conditions not represented in modern data, resulting in broader projections of future habitat. Our results suggest that actions to reduce emissions and expand protected areas in the northern Caribbean are imperative to prevent significant degradation and that using fossil occurrences in niche estimation can improve the reliability of conservation forecasting, an approach that is transferable across taxa and regions. Incorporación de datos fósiles en modelos de nicho ecológico para mejorar las predicciones sobre el hábitat futuro de los corales del Caribe Resumen Los modelos de nicho ecológico (MNE) se utilizan para evaluar las preferencias abióticas de las especies, relacionando su distribución con las condiciones ambientales en las que viven. Desarrollamos un marco de MNE basado en fósiles que integra la presencia de especies en el Holoceno medio y en la actualidad para evaluar la estabilidad del nicho y reconstruir las características del nicho abiótico de cuatro especies críticas de corales constructores de arrecifes del Caribe (el coral cuerno de alce [Acropora palmata], el coral cuerno de ciervo [Acropora cervicornis], el coral cerebro de roca [Colpophyllia natans] y el coral colina de la mostaza [Porites astreoides]). Dadas las pruebas de estabilidad del nicho, utilizamos estimaciones del nicho mejoradas con datos fósiles para predecir el área y la ubicación del hábitat en escenarios climáticos futuros para 2050 y 2100. Creamos modelos de distribución de especies con predictores ambientales y comparamos modelos entrenados solo con datos modernos frente a modelos combinados con datos fósiles y modernos para evaluar las diferencias en la amplitud del nicho, el rendimiento de los modelos y las distribuciones de hábitat proyectadas en escenarios climáticos futuros. La inclusión de datos fósiles del Holoceno medio en los modelos de redes de ecología (MNE) amplió las estimaciones de nicho, lo que dio lugar a una superficie de hábitat previsto mayor que la de los modelos basados únicamente en datos actuales (hasta 114 559 km2 más en 2100). Aunque nuestros modelos mostraron que existían hábitats adecuados para la mayoría de los corales en 2100, la superficie se redujo drásticamente (una disminución del 45‐100 % con respecto a la actualidad), se produjo una restricción significativa de la idoneidad del hábitat en latitudes más bajas y las áreas marinas protegidas no se solapaban con la mayor parte del hábitat adecuado previsto para el futuro (un solapamiento del 8‐20 % para 2100). Los modelos basados en fósiles ampliaron las estimaciones de nicho en el espacio ambiental e incorporaron condiciones ambientales no representadas en los datos modernos, lo que dio lugar a proyecciones más amplias del hábitat futuro. Nuestros resultados sugieren que las medidas para reducir las emisiones y ampliar las áreas protegidas en el norte del Caribe son imperativas para evitar una degradación significativa, y que el uso de hallazgos fósiles en la estimación de nichos puede mejorar la fiabilidad de las previsiones de conservación, un enfoque que es transferible entre taxones y regiones.
Background: Melatonin has antioxidant and anti-inflammatory properties that may attenuate ischemia-reperfusion injury, but randomized cardiovascular trial data remain inconsistent. Objectives: This study sought to evaluate the association of melatonin supplementation with cardiovascular outcomes across randomized trials. Methods: We performed a systematic review and meta-analysis of randomized trials comparing melatonin with placebo, usual care, or no melatonin in patients with cardiovascular disease. PubMed, Embase, and CENTRAL were searched from inception to 1 January 2026. Random-effects models with Hartung-Knapp-Sidik-Jonkman confidence intervals were used. Prespecified outcomes included left ventricular ejection fraction (LVEF), change in LVEF, troponin, infarct size by cardiac magnetic resonance, heart failure outcomes, inflammatory and oxidative stress biomarkers, and adverse events. Results: A total of 14 randomized controlled trials involving 1027 participants were included. Melatonin significantly improved change in LVEF from baseline to follow-up (mean difference: 3.95 percentage points; 95% CI: 1.70-6.20; p < 0.001), with the most consistent signal in coronary artery bypass grafting studies (mean difference: 4.65 percentage points; 95% CI: 2.56-6.74). Final LVEF was numerically higher with melatonin but not statistically significant. Troponin reduction was not significant. Narrative synthesis suggested lower inflammatory and oxidative stress markers after coronary artery bypass grafting and improvement in heart failure symptoms and quality of life, whereas infarct size findings in ST-segment elevation myocardial infarction were mixed and timing-dependent. Conclusions: Melatonin was associated with improved LVEF change, particularly in coronary artery bypass grafting settings, but benefit was not consistently demonstrated across final LVEF, troponin, or infarct size outcomes.
Although hepatocellular carcinoma (HCC) incidence has decreased in the US, it is unclear if rural residents have experienced similar trends. To examine rural-urban differences in HCC incidence and incidence-based mortality trends by sex, race and ethnicity, and stage at diagnosis. This cohort study analyzed HCC diagnoses from 2001 to 2022 and deaths from 2007 to 2022 using data from the National Program of Cancer Registries and the Surveillance, Epidemiology, and End Results (SEER) programs for incidence and the SEER-21 program for incidence-based mortality. Rurality was classified using the 2013 Rural-Urban Continuum Codes. All analyses were performed from October 2025 to February 2026. Annual incidence and incidence-based mortality rates per 100 000 people were calculated and age standardized to the 2000 US standard population. The annual percentage change (APC) and the average APC in incidence and incidence-based mortality rates were then estimated using Joinpoint regression. The study analyzed 264 633 HCC cases (77.0% among men and 86.6% in urban areas). Among men, HCC incidence was 4.5 (95% CI, 4.4-4.5) per 100 000 people in rural counties and 5.8 (95% CI, 5.8-5.8) per 100 000 people in urban counties; among women, HCC incidence was 1.2 (95% CI, 1.2-1.2) per 100 000 people in rural counties and 1.5 (95% CI, 1.5-1.5) per 100 000 people in urban counties. In rural counties, HCC incidence increased by 1.1% (95% CI, 0.6%-1.6%) per year among men from 2007 to 2022 and 1.7% (95% CI, 1.2%-2.3%) per year among women from 2001 to 2022, whereas in urban counties, HCC rates decreased by 1.4% (95% CI, -1.7% to -1.1%) per year among men from 2008 to 2022 and by 1.0% (95% CI, -1.4% to -0.6%) per year among women from 2009 to 2022. Among men, incidence-based mortality rates were 2.7 (95% CI, 2.3-3.0) per 100 000 people in rural counties and 3.8 (95% CI, 3.6-3.9) per 100 000 people in urban counties; among women, the incidence-based mortality rates were 0.8 (95% CI, 0.6-0.9) per 100 000 people in rural counties and 0.9 (95% CI, 0.8-1.0) per 100 000 people in urban counties. In rural counties, incidence-based mortality rates increased by 1.2% (95% CI, 0.3%-2.1%) per year among men and remained stable among women (APC, 0.3% [95% CI, -1.1% to 1.7%]), whereas in urban counties, incidence-based mortality rates decreased by 1.4% per year (95% CI, -1.7% to -1.1%) among men and 1.0% (95% CI, -1.7% to -0.4%) per year among women. This cohort study revealed rural-urban disparities in HCC incidence and incidence-based mortality trends. These findings highlight the need for targeted prevention strategies and improved access to early detection and specialty care for rural populations.
This study examines trends in cardiovascular disease (CVD)-related mortality among individuals with diabetes mellitus (DM) in the United States from 1999 to 2020, focusing on age-adjusted mortality rates (AAMRs) across demographic and geographic subgroups. Using the CDC WONDER database, we analyzed death certificate data and calculated AAMRs standardized to the 2000 US population. Joinpoint regression was used to analyze annual percentage changes (APCs) in AAMRs by sex, race/ethnicity, and geographic region. Statistical significance was determined at p < 0.05. From 1999 to 2020, 1,854,384 deaths were attributed to circulatory disorders and DM, with an average AAMR of 25.1%. AAMRs showed a steady decline from 1999 (31.3/100,000) to 2014 (21.9/100,000), followed by an increase to 25.6/100,000 in 2020. Gender analysis revealed significant declines in AAMRs for both males and females, though the rate of decline slowed after 2012. Racial disparities were evident: non-Hispanic Whites and Asian or Pacific Islanders experienced reversals in mortality trends after earlier declines, while Hispanic or Latino groups exhibited a steep rise in AAMRs from 2016 to 2020 (APC = 10.84%). Geographic analysis highlighted considerable variation in mortality rates across states, with Oklahoma reporting the highest AAMR (59.3/100,000). While overall CVD mortality in individuals with DM has improved, recent increases in AAMRs and persistent demographic and geographic disparities underscore the need for targeted public health strategies. Addressing these disparities is critical to sustaining progress and improving outcomes for vulnerable populations.
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