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.
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.
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.
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.
Muscle-invasive bladder cancer (MIBC) is clinically heterogeneous, and current molecular subtyping does not capture the spatial organization of tumor states and microenvironmental context. Here, we construct a spatial atlas of MIBC by integrating spatial transcriptomics from 22 tumors with matched bulk RNA and whole-exome sequencing data. We identify a continuous, spatially organized luminal-to-basal axis within individual tumors that is associated with greater chromosomal instability and transcriptional plasticity. Luminal tumor cores are enriched for FGFR3 and NECTIN4, whereas basal-like states localize toward invasive margins and are associated with elevated EGFR signaling, epithelial-mesenchymal transition, genomic instability, immune infiltration, and greater chemotherapy sensitivity. Spatial analyses further reveal lineage- and location-associated differences in tertiary lymphoid structure states. Pan-cohort analyses across over 3,000 tumors confirm conserved FGFR3-EGFR lineage exclusivity and associated immune programs. Together, these findings define a spatial framework for understanding lineage states, immune architecture, and therapeutic vulnerabilities in MIBC.
A medical assistant (MA) works under the supervision of physicians or nurses to perform standard clinical and administrative tasks in different health care settings. There is little consistency across the United States regarding the credentialing of MAs. This study examines MAs' perceptions of their training and certification process for MAs in a southwestern hospital. Secondary data analyses were performed on survey data to examine for differences at pre- and post-training to assess MAs' perceived effectiveness of the certification on improving their clinical knowledge and skills. We triangulated by analyzing data from semistructured interviews to clarify our understanding the perception of MAs' needs for certification. Survey results of quantitative analyses revealed MA certification was viewed favorably, but its effectiveness in enhancing MAs' knowledge and skills remained debatable. In phase 2, participants expressed that certification was valuable, contributing to the MAs' willingness to engage in additional education. MAs' perceptions toward the certification were essential for professional growth, competence, and patient safety. Yet, they faced barriers such as test anxiety, limited time, and access challenges that impeded successful completion. Moreover, they believed that certification enhances confidence and career advancement; however, inconsistent skill gains and logistical difficulties highlight the need for flexible, well-supported, and balanced training approaches that integrate both online and in-person learning for sustainable professional development. Therefore, future research is warranted to evaluate the effectiveness of MA certification in enhancing health care delivery and health outcomes.
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.
Accurate estimates of daily manure production per animal are essential for designing livestock facilities and developing environmental policies. This study assessed manure production in bedded pack barns, a common type of beef cattle housing in Korea, where excreted manure is mixed with bedding and composted before removal. Because composting alters manure mass through moisture evaporation and organic matter decomposition, manure production was evaluated by season (summer, autumn, winter) and cattle growth stage (growing calf, steer, cow). A reliable baseline was established by directly measuring raw manure excretion in a pen for 12 days under controlled conditions (average temperature of -3.9°C and a wind speed of 0.1 m/s), under which moisture evaporation and organic matter decomposition were negligible. Average manure production varied by growth stage: 11.8 ± 2.9 kg/head/day for growing calf, 11.2 ± 2.7 kg/head/day for steer, and 15.8 ± 4.7 kg/head/day for cow. Manure production showed a significant correlation with feed intake (R2 = 0.69), which partially explained the variation across growth stages; however, composting processes influenced by seasonal factors also played important roles. Compared to the baseline, moisture mass decreased by 50%-55% in summer, 12%-22% in autumn, and 6%-21% in winter. Volatile solids decomposition ranged seasonally from 37% to 48% in summer to 9% to 14% in winter, with autumn values between 22% and 28%. Consequently, total manure production declined by approximately 51% in summer and 18% in winter relative to the baseline. These findings underscore the importance of considering seasonal effects, growth stages, and composting practices when estimating manure production in bedded pack barns. Estimating daily manure production is essential for designing facilities and plays a crucial role in farm management. In Korea, beef cattle are commonly raised in bedded pack barns, where manure mixes with bedding and composts over time. This study quantified manure production across seasons (summer, autumn, and winter) and growth stages (calves, steers, and cows), while assessing composting effects in bedded pack barns by accounting for moisture evaporation and organic matter decomposition. Manure production varied by growth stage and season, with cows generating the most (15.8 kg/head/day), followed by growing calves (11.8 kg/head/day) and steers (11.2 kg/head/day). Summer showed the greatest reductions due to moisture evaporation (50%–55%) and organic matter loss (37%–48%), resulting in a 51% reduction compared to baseline manure production. Seasonal and growth‐stage effects on manure mass, along with composting losses, suggest potential nutrient loss and pollutant emissions, such as ammonia.
Hepatocellular carcinoma (HCC) is a highly aggressive malignancy with poor prognosis and limited therapeutic options. Although epigenetic dysregulation is a hallmark of HCC, rational combinatorial targeting strategies remain incompletely defined. Here, we identify cooperative oncogenic functions of the chromatin modifiers enhancer of zeste homolog 2 (EZH2) and lysine-specific demethylase 1 (LSD1) in HCC. Analysis of the TCGA-LIHC cohort revealed that co-elevated EZH2 and LSD1 expressions are significantly associated with reduced overall survival. Gene set enrichment analysis demonstrated enrichment of Sonic Hedgehog (SHH) signaling and stress-responsive transcriptional programs in tumors with high EZH2/LSD1 expression. Functionally, dual pharmacological inhibition of EZH2 (GSK126) and LSD1 (SP2509) suppressed HCC cell proliferation, induced G1-phase arrest, and enhanced apoptosis, as evidenced by increased caspase-3/7 activity and decreased pro-caspase levels. Dual inhibition also impaired migration, invasion, tumor sphere formation, and stemness-associated gene expression. Mechanistically, co-targeting disrupted SHH signaling through the suppression of GLI1 expression. Chromatin immunoprecipitation revealed reduced EZH2, LSD1, and STAT3 occupancy at the GLI1 promoter following dual inhibition, leading to the repression of GLI1 and its downstream targets. Collectively, these findings demonstrate that EZH2 and LSD1 cooperatively sustain GLI1-dependent SHH signaling in HCC, and that dual epigenetic inhibition represents a mechanistically defined therapeutic strategy.
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Cancer treatments can deplete the ovarian follicle reserve causing infertility and early menopause, with subsequent decline in cardiovascular, cognitive, and overall health. Medical measures to prevent this chemotherapy-induced ovarian damage are currently not available. Anti-Müllerian hormone (AMH) is important for preserving the ovarian follicle pool via downregulation of granulosa cell replication and function. Despite proven therapeutic ability to protect the ovarian follicle number in mice exposed to chemotherapy, AMH is not approved for human use. To overcome this gap, we created and patented a peptide designed to specifically bind to the AMH receptor, AMHR2 binding peptide (AMHR2BP), that could serve as an alternative therapeutic treatment. By activating the same downstream signaling and replicating the biological effects of natural AMH, we sought to investigate whether AMHR2BP could protect the follicle pool in both natural and accelerated ovarian aging mouse models. Here, we present a series of in vitro and in vivo translational studies to verify AMHR2BP's affinity, specificity, mechanism of action, stability, and in vivo toxicity and efficacy. We performed immunofluorescence, immunoprecipitation, real-time RT-PCR, mass spectrometry, histological, and immunohistochemistry testing to validate our findings on two levels, gene activation and protein translation. We found that AMHR2BP activates the same SMAD signaling pathways as AMH and ultimately preserves the ovarian follicle pool by preventing the progression of primordial to antral follicles in naturally aging mice. Additionally, we demonstrated that AMHR2BP prevents follicle loss in an accelerated, chemotherapy-induced ovarian aging model, thereby effectively preventing identifiable ovarian damage. Importantly, AMHR2BP also portrays excellent plasma stability with no detectable toxicity. By mimicking the function of AMH, AMHR2BP represents a new medical therapeutic strategy to preserve fertility and reduce long-term reproductive and health risks from chemotherapy treatments.
BLU-451 is a potent and selective tyrosine kinase inhibitor designed to target uncommon epidermal growth factor receptor (EGFR) mutations, spare wild-type EGFR, and be active in the central nervous system (CNS). In vitro EGFR enzyme assays and engineered cell line models revealed selectivity and anti-proliferative potency of BLU-451 against a wide range of EGFR mutations in non-small cell lung cancer, including common mutations, atypical mutations, and exon 20 insertions. Particularly, BLU-451 demonstrated robust antitumor activity in EGFR exon 20 insertion cell-derived and patient-derived xenograft models and was well tolerated in animal studies. Pharmacokinetic and pharmacodynamics analyses showed that BLU-451 suppressed exon 20 insertion phosphorylated EGFR expression levels within tumor tissues but not in skin and intestinal tissues, potentially indicative of lower toxicity associated with wild-type EGFR. In intracranial tumor models with imaging-based analyses, BLU-451 showed CNS antitumor efficacy. Early clinical data from patients enrolled in the phase 1 portion of the phase 1/2 CONCERTO trial (NCT05241873) demonstrated the overall clinical potential of BLU-451, including its CNS antitumor activity in patients with EGFR exon 20 insertions and atypical mutations. Initial data suggest that BLU-451 is an active molecule. Further evaluation of the safety profile and pharmacokinetic properties of BLU-451 is needed.
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.
Asymptomatic severe aortic stenosis (AS) is characterized by a prolonged latent phase during which progressive valvular obstruction and myocardial remodeling may occur despite preserved left ventricular ejection fraction and the absence of overt clinical symptoms. Historically, management has favored watchful waiting until symptom onset or guideline-defined triggers emerge; however, recent randomized data challenge this conservative paradigm. This review summarizes the natural history, risk stratification, and contemporary management of asymptomatic severe AS, with a focus on emerging insights that inform the timing of intervention. We propose an individualized, contemporary framework for managing asymptomatic severe AS that integrates multimodal risk assessment, procedural risk, and shared decision-making, and we outline future directions aimed at refining patient selection and optimizing the personalized timing of intervention.
Cyclin-dependent kinase 4/6 inhibitors (CDK4/6is) combined with endocrine therapy are the standard of care for metastatic hormone receptor-positive, HER2-negative breast cancer (HR+ MBC). However, systemic therapy options and outcomes after progression on CDK4/6is remain poorly defined. We analyzed real-world treatment patterns and outcomes in patients with advanced HR+ MBC who received systemic therapy following CDK4/6i progression. We identified all patients with HR+ MBC treated at MD Anderson Cancer Center between January 1, 1997, and December 31, 2024. Kaplan-Meier and log-rank tests compared PFS and OS across post-CDK4/6i therapies, and a multivariable Cox model assessed prognostic factors. Among 1826 patients (99% female; median follow-up, 32.4 months), the median age at metastatic diagnosis was 56 years, and most were White (72%),with 10% Black, 9% Hispanic, 6% Asian/Pacific Islander, and <1% Native American. Following progression on CDK4/6is, 43% received chemotherapy, 38% targeted therapy, 12% endocrine therapy alone, and 7% investigational agents. Nearly half (48%) had visceral progression. Median PFS on subsequent therapy was 4.73 months (95% CI, 4.40-4.96), with no significant difference by therapy type. CDK4/6i duration ≥12 months was independently associated with improved PFS (HR 0.86; p = 0.021). Following CDK4/6i progression, most patients received chemotherapy, but PFS did not differ significantly across post-CDK4/6i treatment types. As CDK4/6is remain frontline therapy, further studies are needed to optimize treatment sequencing and improve post-CDK4/6i outcomes. Department of Defense grant (HT9425-24-1-0991) and the National Cancer Institute MDACC Support Grant (P30 CA016672).
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.
Children with developmental language disorder (DLD) show a word form learning deficit, characterized by inaccurate and variable productions of novel words. We investigated whether, when a novel word form is introduced, incremental exposure to either a sparse visual referent or a relatively semantically rich story influences the phonetic accuracy and the phonological and articulatory variability of production in children with DLD and their typically developing (TD) peers. Thirty-six preschoolers (18 DLD, 18 TD) aged 4;1-5;11 (years;months) were exposed to six novel words, two in each of three semantic cue conditions: no cues, sparse cues (visual referent), and rich cues (story). Children participated in three learning sessions. The first session consisted of nonword practice of word forms, and the present study only included the later consolidation sessions (Sessions 2 and 3) during which semantic content was incrementally incorporated. Phonetic accuracy, phonological variability, articulatory variability, referent identification, and confrontation naming measures were used to evaluate learning. The most robust result was that children with DLD were less phonetically accurate and more phonologically variable than their TD peers, although variability decreased across sessions. For only children with DLD, phonetic accuracy decreased in the rich story condition. However, both TD and DLD groups showed increased variability in the rich story condition. In the slower mapping sessions included in this study, children with DLD and TD children showed similar performance in speech motor (i.e., lower lip/jaw motion) variability as well as in comprehension and confrontation naming of semantic referents. Children with DLD demonstrate deficits in their capacity to organize phonological sequences. Phonological organization shows some malleability based on the type of semantic information presented during learning, with relatively rich and elaborated input (as opposed to simple naming) disrupting the organization of phonological sequences. https://doi.org/10.23641/asha.32118145.
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