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Alcohol use disorder (AUD) is marked by sensitivity to alcohol cues and stress, increasing craving and stress. Stress typically lowers heart rate variability (HRV), whereas alcohol cues may increase or decrease HRV; however, their combined effects remain unclear. We examined (1) subjective craving, stress, and HRV responses to alcohol cue exposure and stress exposure, and (2) whether exposure order (stress-alcohol vs alcohol-stress) influenced these responses. Additional exploratory analyses examined associations between subjective and physiological reactivity. Fifty-six young adult who engaged in hazardous drinking (37 women; median age = 20 years, IQR = 3) with AUDIT scores ≥ 8 (median = 14, IQR = 6) and minimal other substance use were randomized to two conditions: stress-alcohol or alcohol-stress exposure. Alcohol cues included visual, olfactory, and tactile stimuli, and stress was induced using a computerized mental arithmetic task (MAT). Craving and stress were rated on Likert scales, and HRV was continuously recorded via a portable electroencephalograph (ECG) device. Alcohol cues increased craving. While stress exposure followed by alcohol cues reduced subjective stress. Alcohol cues increased HRV, while stress-exposure raised stress without affecting craving. In an exploratory subgroup analysis, HRV reactivity during MAT was observed only in participants whose craving remained unchanged change following MAT, suggesting an inverse association between craving and autonomic responsiveness. These findings highlight linked effects of stress exposure and alcohol cues on autonomic regulation in hazardous drinking and may offer preliminary insights into mechanisms that could be relevant for relapse prevention.

Independent outdoor ambulation is a key rehabilitation goal after stroke, but it is unclear whether instrumented gait analysis adds prognostic information beyond conventional clinical measures. Do spatiotemporal gait parameters provide incremental predictive value beyond clinical assessments-independent of admission Functional Ambulation Category (FAC)-for outdoor ambulation in subacute stroke patients? We retrospectively analysed 137 subacute stroke inpatients with admission FAC 2-3 (89 outdoor, 48 indoor-only ambulators at discharge); one patient was excluded for an implausible step time. Admission FAC was excluded from candidate predictors to avoid overlap with the outcome. Hierarchical logistic regression compared a clinical model (Motricity Index [MI], time since onset) with one adding GAITRite-derived spatiotemporal parameters, using likelihood-ratio and DeLong tests with Firth-penalised sensitivity analysis. Model 1 achieved near-perfect discrimination (AUC = 0.995, 95% CI 0.984-0.999). Adding affected-side single- and double-support percentages (Model 2) significantly improved fit (likelihood-ratio χ² = 9.39, p = 0.009; AUC = 0.998); the AUC difference was not significant by DeLong's test (p = 0.262). Firth-penalised analyses produced concordant, stable coefficients. MI and gait velocity were the strongest single predictors (both AUC = 0.981); bootstrap optimism was ≤ 0.002. Beyond a near-perfect clinical model, affected-side support-phase parameters add statistically detectable model information (improved fit and calibration) rather than a clinically decisive gain in discrimination, which is constrained by a ceiling effect. Their value is best understood as quantifying paretic-limb weight-bearing and balance-related gait quality not captured by bedside scales, in subacute stroke inpatients with admission FAC 2-3. The Youden cut-offs (MI ≥ 40, velocity ≥ 32.1 cm/s, single support ≥ 29.7%) are hypothesis-generating and require external validation before clinical use.

Vaccine hesitancy has emerged as a major challenge for pediatric immunization programs, shaped by a complex interplay of structural, relational, and informational factors. In Latin America, these dynamics are further influenced by health system fragmentation and social inequities, requiring approaches that extend beyond information-based interventions. This review examines the multidimensional nature of vaccine hesitancy in pediatric populations, with a focus on Latin America. It examines the role of digital environments, clinical communication, and system-level factors, and discusses emerging strategies such as narrative communication and prebunking. The literature was identified through a targeted review of peer-reviewed publications and relevant global health reports. Addressing vaccine hesitancy requires integrated strategies that combine trust-building with anticipatory communication. Approaches such as narrative shielding and prebunking may complement traditional interventions by strengthening how caregivers interpret vaccine-related information. Future efforts should prioritize context-specific implementation and evaluation in real-world settings.

Femoroacetabular Impingement Syndrome (FAIS) is a prominent source of non-arthritic hip pain and is highly prevalent in young active populations. Decisions to undergo surgery are significant in nature and require proper understanding of potential benefits and risks. To develop and user-test a patient decision aid comparing non-surgical management and hip arthroscopy for FAIS with an additional military-related section. Mixed-methods. The initial draft of the decision aid was developed by a multidisciplinary steering group. An iterative process of semi-structured interviews, re-drafting and further interviews provided feedback on the decision aid. The interviews were analysed reflexively using thematic analysis for qualitative findings. Acceptability questionnaires were analysed using descriptive statistics for quantitative findings. We interviewed 27-participants; 13 clinicians (6 physiotherapists, 3 orthopaedic surgeons, 2 general practitioners, 1 sports medicine doctor, 1 anaesthesia pain physician) and 14 patients. Most participants rated the decision aid's acceptability as good-to-excellent. Participants agreed on most aspects of the decision aid including the introduction, treatment options, comparison of outcomes and questions to consider asking a health professional. Participants agreed on including more information on the treatment options and provide more long-term outcomes comparing the options. Our decision aid met all 6 of the International Patient Decision Aid Standards qualifying criteria. Our decision aid was considered a useful tool that may help patients choose an appropriate treatment option for the management of FAIS. A clinical trial evaluating the impact of the decision aid on decision making for patients considering surgery for FAIS is needed.

Complex extremity wounds, if not addressed properly, are a leading cause of major limb amputation. Chronic wounds in salvaged extremities contribute to long-term morbidity in the extremity. Orthoplastic surgery treats limb-threatening conditions through the combined application of orthopaedic and plastic surgical principles, applied to clinical problems simultaneously. Key components include early stakeholder evaluation of the limb and patient and open collaborative communication between orthopaedic and plastic surgeons. Meticulous débridement at the time of presentation and careful selection of fixation informed by the overall reconstructive plan should be executed when the patient presents to the emergency department. Implementation of Orthoplastic protocols results in quicker time to skeletal stabilization and soft tissue coverage, reduced risk of infection, improved functional outcomes, and less cost for care. This review presents a protocol-driven guide for establishing an Orthoplastic program and optimizing limb salvage outcomes across diverse practice settings.

Smart bioelectronics are electronic medical devices that combine hardware and artificial intelligence (AI)-based software. These convergent medical devices analyze bio-signals measured through hardware using AI algorithms and deliver physical stimulation to enhance therapeutic effects. This study aimed to systematically analyze recent research trends in smart bioelectronics to understand their evolving role in digital health care and to provide evidence-based insights for shaping future research and development strategies. A total of 92 publications indexed in PubMed between 2020 and 2024 were analyzed. Latent Dirichlet allocation-based topic modeling, optimized using coherence scores, was applied to identify latent research themes. The results indicate a steady increase in related research over the past 5 years, along with a clear shift in research focus from bio-signal sensing and bioelectronic device materials toward AI-driven analysis and disease-oriented applications, ultimately evolving into intelligent and adaptive bioelectronic therapeutic systems. Three major research topics were identified: bio-signal-based neuromodulation (n=23, 25%), AI-driven neurological disease analysis (n=32, 34.7%), and implantable bioelectronics and biomaterials (n=37, 40.2%). By mapping the evolving landscape of smart bioelectronics, this study provides valuable insights into their multidisciplinary development and highlights their potential applications in clinical decision support, personalized rehabilitation, and next-generation medical device innovation.

As systemic therapies for non-small cell lung cancer (NSCLC) have become more effective, interest in their use for improving long-term surgical outcomes has rapidly increased. Imperfect as it is, stage remains the primary means for identifying patients who might benefit from systemic therapy. Recent clinical trials have led to US Food and Drug Administration approval of osimertinib and alectinib as adjuvant treatments for resected pathologic stage II/III EGFR and ALK-mutated NSCLC; their use in the neoadjuvant setting remains subject to trials. Systemic therapy for less common oncogene-addicted NSCLC is also the subject of intense clinical trial activity. An effusion of trials has established the benefit of chemotherapy and immune checkpoint inhibitor therapy combinations in the adjuvant, neoadjuvant, and perioperative settings for patients with clinical or pathologic stage IB to III NSCLC, each of which is now part of the standard of care. Evidence-free consensus expert statements notwithstanding, two very important questions remain to be answered: Which is better-adjuvant or neoadjuvant/perioperative chemoimmunotherapy (and for whom)?; do patients who have pathologic complete response to neoadjuvant immunotherapy benefit from adjuvant immunotherapy? These questions are the subject of two ongoing National Clinical Trials Network trials: CTIU2317-A082304-S2402-Perioperative versus Adjuvant Systemic Therapy in Patients with Resectable NSCLC (PROSPECT-Lung; ClinicalTrials.gov Identifier: NCT04267848)-and S2414-A Randomized Phase III Trial Incorporating Pathologic Response in Participants with Early-Stage NSCLC to Optimize Immunotherapy in the Adjuvant Setting (INSIGHT; ClinicalTrials.gov Identifier: NCT06498635). We discuss why there is sufficient equipoise to justify seeking answers to these two extremely important, patient-centered questions.

Accurate and sensitive detection of low-abundance biomarkers in complex matrices remains challenging due to the inherent trade-off between amplification efficiency and background suppression in conventional biosensing strategies. Herein, a synergistic amplification strategy was constructed by integrating an entropy-driven autocatalysis (EDAC), a signal-on CRISPR/Cas12a assay, and a DNA triangular prism (DTP) interface. In this strategy, EDAC achieved exponential signal amplification through the recycling of target molecules and reaction byproducts, and its output strands simultaneously served as specific inhibitors of CRISPR/Cas12a. Based on this mechanism, the signal-on CRISPR/Cas12a assay strictly coupled signal generation to the presence of the target, thereby fundamentally circumventing the high background interference inherent to conventional signal-off modes. As a rigid three-dimensional interfacial scaffold, DTP provided high-density and well-ordered nucleic acid assembly sites, reduced steric hindrance through a solution-like microenvironment, suppressed nonspecific adsorption, and efficiently initiated downstream hybridization chain reaction for robust electrochemical readout via methylene blue intercalation. With hepatocellular carcinoma-associated biomarkers alpha-fetoprotein and microRNA-122 as model targets, the biosensor achieved detection limits as low as 11.37 fg/mL and 18.13 aM, respectively. In clinical serum sample assays, the biosensor showed strong agreement with the classical ELISA method, with an area under the curve value of 1.00, demonstrating its promising potential for the diagnosis of hepatocellular carcinoma. With its modular architecture and adaptable recognition elements, this strategy establishes a versatile framework for ultrasensitive biosensing and holds promise for clinical translation in early disease diagnosis.

The interconnectedness of core mental health features is associated with more severe illness impairment and less effective treatment outcomes. This study aimed to evaluate the network of relationships between obsessive-compulsive symptoms and other psychopathological symptoms in both obsessive-compulsive disorder (OCD) patients and community populations, identifying symptom interconnections. A cross-sectional study was conducted from January 1, 2020, to June 30, 2024. The Chinese versions of the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) and the Symptom Checklist-90 (SCL-90) were used to measure obsessive-compulsive symptoms and other psychopathological symptoms, respectively. Measurement invariance testing was performed using Mplus software (version 8.11). Network structure, centrality, stability, and network comparisons were analyzed using R software (version 4.4.1). The study included 4223 OCD patients and 5253 community participants. In the symptom networks of both groups, SCL3 ("Depression") and SCL4 ("Anxiety") were common core symptoms. SCL10 ("Psychoticism") was a specific core symptom for OCD patients, while SCL2 ("Interpersonal sensitivity") was specific to the community group. Additionally, SCL8 ("Obsessive symptoms") and YBOCS3 ("Distress caused by obsessions") served as bridge symptoms in both groups. The cross-sectional design limited causal inferences; self-report measures were subject to recall bias and other confounding factors; sample representativeness and the range of variables included in the analysis were limited. Depressive and anxiety symptoms emerged as common core symptoms in both OCD patients and community populations. Psychoticism was specifically identified as a core symptom in OCD patients, while obsessive symptoms and obsession-related distress served as bridging symptoms linking OCD with other psychopathological symptoms, highlighting important targets for clinical assessment.

Exploratory post-hoc analyses of the AEGIS-II trial suggested that the efficacy of CSL112 (apolipoprotein A-I infusion) may be greater in patients with high baseline LDL-C. This genetic study aimed to assess whether LDL-C levels modify the effect of apoA-I on cardiovascular outcomes. We conducted drug-target Mendelian randomization analyses using data from 339,210 UK Biobank participants. Genetic proxies for apoA-I elevation (cis-acting variants within APOA1 gene) were used to mimic the effect of CSL112 therapy. The primary outcome was a composite of ischemic heart disease, myocardial infarction, and stroke; secondary outcomes were the individual components. To mitigate collider bias, we stratified by residual LDL-C, derived from a model adjusting LDL-C for the genetic instrument, age, sex, genotyping array and top 40 genetic principal components. Sensitivity analyses included alternative genetic instruments and formal tests for effect modification. Genetically proxied apoA-I elevation was associated with elevated circulating apoA-I and HDL-C, but there was no concomitant association with any cardiovascular outcome. Null findings were consistent across strata of residual LDL-C. Sensitivity analyses with alternative instrument sets and formal interaction tests uniformly confirmed the absence of any association or effect modification. Genetically proxied lifelong elevation of apoA-I concentration was not associated with reduced cardiovascular risk, even among individuals with high residual LDL-C.

The incidence of femoral neck fractures (FNFs) is increasing, primarily due to an aging population and an increased incidence of high-energy trauma. Although fixation with three cannulated screws (TCS) is the most commonly used surgical technique, it has limitations, including suboptimal operative accuracy and dependence on repeated intraoperative fluoroscopy. In response, advanced navigation systems have been developed to improve surgical precision and outcomes. This multicenter, prospective, randomized controlled superiority trial will compare surgical outcomes between an intelligent navigation system and the conventional freehand technique for FNF, as well as long-term fracture healing and complication rates. This multicenter, prospective, randomized controlled superiority trial will compare navigation system-assisted TCS fixation with conventional freehand TCS fixation in patients with FNF from June 2024 to October 2026. Eligible participants are adults aged ≥18 years diagnosed with FNF who are indicated for internal fixation. The primary outcome is the frequency of intraoperative fluoroscopy. Secondary outcomes include the neck-shaft angle, guide wire placement quality, operative time, intraoperative blood loss, fracture healing status, the Harris Hip Score, the 36-Item Short Form Health Survey, and the Zarit Caregiver Burden Score. The sample size calculation indicated that 150 (50%) participants per group (N=300) would be needed to detect a superiority margin of 15.4 fluoroscopy images with 80% power and a 1-sided α of .025, accounting for a 15% dropout rate. All patients will undergo 12 months of follow-up. Data analysis will compare groups using 1-sided t tests and Mann-Whitney U tests, supplemented by linear mixed-effects models with study site as a random effect. The study was funded in May 2024 and received initial ethics approval from the institutional review board. Patient enrollment commenced in June 2024 and is projected to be completed by October 2026, with a target sample size of 300 participants. The final 12-month follow-up is expected to be completed by October 2027. As of manuscript submission, recruitment is ongoing, and no data analysis has been performed. Successful completion of this study may introduce a new strategy for the management of FNF and help establish a standardized protocol for the use of navigation systems, potentially enhancing clinical outcomes and reducing complication rates. ClinicalTrials.gov NCT06713018; https://clinicaltrials.gov/study/NCT06713018. DERR1-10.2196/88180.

Drug-eluting stents fail in up to 20% of patients. In failed cases, intravascular brachytherapy (IVBT) is administered with β-emitting 90Sr90Y through a guidewire. Current clinical dosimetry is water-based, neglecting attenuation from patient-specific materials such as plaques, stents, and the off-centered guidewire, leading to a discrepancy between prescribed and delivered dose. This study retrospectively performed patient-specific IVBT dose calculations using Optical Coherence Tomography (OCT) to quantify uncertainties in clinical dosimetry. Dose calculations on OCT images from ten patients were performed using RapidBrachyIVBT, a Monte Carlo-based dose calculation software. Heterogeneities, including guidewire(s), stents, and fibrotic and calcified plaques, were contoured and assigned material properties; surrounding tissue was modeled as smooth muscle. Absorbed dose to water and medium were calculated. The prescribed dose to water was 18.4 or 23 Gy at 2 mm from the source, depending on lumen diameter. The dose homogeneity index was defined as the ratio of the maximum to the minimum dose in the target volume. When heterogeneities were included, median maximum dose attenuation was 76.7% (75.0-77.1) in the artery segment and 56.2% (52.2-65.1) in the target volume. The median dose homogeneity index increased from 1.29 in water to 2.93 (2.44-3.33) with patient-specific materials. The guidewire produced asymmetric dose distributions in all patients, with the greatest attenuation where it opposed thick calcified plaques. Standard water-based IVBT dosimetry is inaccurate due to dose-attenuating materials present during treatment. Personalized, image-guided IVBT planning that accounts for patient-specific heterogeneities may improve treatment accuracy and clinical outcomes.

Ma/Ma2-associated neurologic autoimmunity is characterized by CNS involvement. However, isolated peripheral nervous system (PNS) presentations have been rarely reported. We aimed to describe the frequency and syndromes of patients with Ma/Ma2 antibodies and isolated PNS involvement. We performed a nested case series within multicenter cohorts of patients with Ma/Ma2-associated neurologic syndromes, confirmed by tissue-based assay and line-blot. Patients with isolated PNS presentations were included. Among 212 patients with Ma/Ma2 antibody-associated neurologic syndromes, 7 (3%) presented with isolated PNS involvement (median age, 68 years; 4/7 female). PNS syndromes included sensory neuronopathy (3 patients), myeloradiculopathy (1), radiculoplexopathy (1), motor neuronopathy (1), and multiple mononeuropathy. All patients were anti-Ma2-positive, whereas Ma antibodies (reactive against Ma1 and Ma2 proteins) were detected in 2 (33%)/6 tested patients. An associated cancer was identified in 6 (86%)/7 patients: pleural mesothelioma; oral squamous cell; testicular, lung, and breast cancer; and B-cell lymphoma. Five patients received immunotherapy, cancer treatment, or both. After a median follow-up of 23 months, symptoms improved or stabilized in 3 patients and progressed in 4. Isolated PNS involvement is a rare manifestation of Ma/Ma2 associated autoimmunity. Ma/Ma2 antibody testing should be considered in neuronopathies and unexplained non-length-dependent neuropathies.

Illinois is known to have established populations of four vector tick species of human health concern: Ixodes scapularis, Dermacentor variabilis, Amblyomma americanum, and Amblyomma maculatum. These ticks can transmit pathogens causing eight reportable tick-borne diseases (TBDs): anaplasmosis, babesiosis, ehrlichiosis, Lyme disease, spotted fever group rickettsioses (SFG rickettsioses), Powassan virus disease, Heartland virus disease, and Bourbon virus disease. The incidence of these diseases is spatially varied and has been changing over time. The purpose of this research is to describe factors associated with human incidence of the various tick-borne diseases in Illinois and to compare this to factors associated with canine seroprevalence to similar tick-borne diseases. All cases of tick-borne diseases in humans reported to the Illinois Department of Public Health (IDPH) between 2004 (when reporting began) and 2022 were reviewed (n = 6423), with all county-level seropositivity and canine test data reported by the Companion Animal Parasite Council between 2009 (when reporting began) and 2022. Descriptive statistics were performed to identify spatial and temporal variation. Comparison with known risk factors was conducted using zero-inflated spatiotemporal modeling for anaplasmosis, ehrlichiosis, Lyme disease, and SFG rickettsioses in humans and anaplasmosis, ehrlichiosis, and Lyme disease in dogs. Every county in Illinois reported at least one case of a human TBD from 2004 to 2022. Most reported cases were in males (61%), white (71%), and non-Hispanic (64%) residents over 40 years of age (56%). On average, the annual number of human cases increased by 23 cases every year (95% CI: 15, 31), despite large year-to-year fluctuations, with 343 in 2022 and 645 in 2021. The spatial hotspots were noted in southern Illinois for human TBDs associated with A. americanum, and D. variabilis, and for dog exposure associated with A. americanum. Hotspots were also noted in northern Illinois for diseases and exposure associated with I. scapularis for both humans and dogs and across the 2004-2022 study period. Case incidence was higher in rural counties, counties with higher deer harvests, and counties with lower median household income. These findings can be used to guide public health efforts that target self-prevention strategies to decrease the risk of a tick bite and tick-borne diseases in Illinois and are applicable in similar midwestern states with expanding TBD risk.

Postoperative urinary tract infection (UTI) following pyeloplasty remains a significant complication and continues to pose challenges in pediatric urological care. This study aimed to develop a simplified predictive model to identify risk factors for postoperative UTI after unilateral pyeloplasty and to support clinicians in implementing preventive strategies targeting modifiable risk factors. Clinical data from children who underwent unilateral pyeloplasty at the Children's Hospital of Capital Institute of Pediatrics (Beijing, China) between January 2012 and January 2022 were retrospectively analyzed. Variables including sex, age, body mass index (BMI), surgical modality, drainage tube type, and parameters from blood and urine tests were evaluated. Statistical analyses, including least absolute shrinkage and selection operator (LASSO) regression, logistic regression, and random forest modeling, were performed to identify significant predictive factors. Variables with the greatest predictive importance were used to develop a nomogram, and its clinical utility was evaluated using decision curve analysis (DCA). Among 764 patients, 265 (35%) developed postoperative UTI. Key risk factors included surgical modality, laterality of ureteropelvic junction obstruction (UPJO), drainage tube type, blood urea nitrogen (BUN) level, and patient height. LASSO regression identified 14 predictive variables, while logistic regression determined independent risk and protective factors. Ultimately, 8 variables (e.g., sex, operative time, drainage tube type, history of infection, history of fistula, age, BUN level, and renal cortical thickness) were selected for development of the nomogram predicting postoperative UTI risk after unilateral pyeloplasty. This study identified 8 factors associated with postoperative UTI following unilateral pyeloplasty in children. The developed predictive model may assist clinicians in identifying high-risk patients, thereby supporting improved perioperative planning and postoperative management.

Recent reports link GLP-1RA treatment with a higher risk of non-arteritic anterior ischemic optic neuropathy, especially in the first year, but the underlying mechanisms are unclear. This translational study investigated GLP-1RA's impact on retinal perfusion and the mediating role of intracranial pressure (ICP) using clinical observations and a mouse model. In a small retrospective cohort, fluorescein angiography revealed a trend toward prolonged arteriovenous transit time (AVTT) during active GLP-1RA treatment, which normalized post-treatment. Consistently, GLP-1RA-treated mice exhibited prolonged arterial appearance and AVTT, accompanied by diminished scotopic b-wave responses and upregulated retinal hypoxia markers. Mechanistically, these mice showed significantly reduced ICP and retinal venous diameter on day 7, corresponding with the timing of retinal perfusion delays. Significant correlations were observed between day 7 ICP and AVTT changes (R² = 0.7605, p = 0.0010), and between day 7 AVTT and venous diameter changes (R² = 0.4247, p = 0.0154). Based on these findings, we hypothesize that GLP-1RA-induced ICP reduction may lead to mechanical alterations in the subarachnoid space-such as narrowing or collapse of the optic nerve sheath-which subsequently compress the central retinal vessels and compromise arterial inflow. These hemodynamic alterations in mice were independent of systemic cardiovascular changes and were fully reversed upon treatment cessation, mirroring the transient trends observed in humans. Collectively, our results suggest that the ocular circulation may be sensitive to GLP-1RA-associated hemodynamic changes, potentially mediated by ICP reduction. Further prospective clinical investigation into the temporal relationship between ICP and retinal hemodynamics in GLP-1RA users is warranted.

The rising incidence of early-onset colorectal cancer (CRC) has prompted debate over lowering screening initiation age. However, real-world evidence on fecal immunochemical test (FIT)-based screening effectiveness in 45-49 years remains limited. Our study aimed to evaluate screening yield of FIT-based CRC screening between 45-49 and 50-54 years. Conducted within a provincial CRC screening program in China, this study employed two-sample FIT screening followed by colonoscopy for positive results. Screening outcomes, including FIT positivity, colonoscopy completion, positive predictive values (PPVs) and detection rates of adenoma and advanced colorectal neoplasia, were compared between participants aged 45-49 and 50-54 years. Robust Poisson regression was used to estimate adjusted risk ratios (aRRs), using 50-54-year-old group as reference. Among 733,137 participants, 89,446 were aged 45-49 years and 643,691 aged 50-54 years. Participants aged 45-49 years had higher FIT positivity (10.61%) and colonoscopy completion (46.75%) than those aged 50-54 years. However, detection rates for advanced neoplasia (0.30% vs. 0.39%; aRR, 0.78; 95% CI, 0.68-0.88) and any adenoma (0.78% vs. 0.95%; aRR, 0.83; 95% CI, 0.77-0.90) were significantly lower in the younger group, with similar results observed for PPVs. Within the 45-49 year group, comparable detection rates to 50-54 year age group were observed among individuals with established risk factors, most notably among smokers (RR, 1.50; 95% CI, 1.22-1.84), frequent alcohol drinkers (RR, 1.33; 95% CI, 1.01-1.75), and males (RR, 1.20; 95% CI, 1.03-1.40). Overall, adults aged 45-49 years showed higher screening participation but lower screening yield than those aged 50-54 years. These findings highlight the importance of prioritizing individuals with elevated risk profiles for CRC screening in younger populations.

Timely transition from the emergency department (ED) to definitive care is critical in severely injured patients. Deploying surgical trauma intensive care nurses (ICU) as trauma response nurses (TRNs) during highest (alpha-level) trauma activations may improve care coordination and expedite transitions; however, evidence supporting this practice remains limited. To evaluate the effect of the TRN on ED length of stay (LOS) and time to definitive care for alpha trauma activation patients. This single-center, retrospective cohort study analyzed all alpha trauma activations involving patients aged 16 years and older admitted to a Level I trauma center in the southeastern US between July 1, 2022, and June 30, 2024. Clinical outcomes were compared between patients managed with and without a TRN during trauma bay resuscitation. Among 353 patients, 193 (55%) were in the TRN group and 160 (45%) in the non-TRN group. The median ED LOS was 77 minutes (IQR, 59-105.5) for the TRN group versus 81.5 minutes (IQR, 61.5-127.3) for the non-TRN group (p = .20, r = 0.07). The median time to the operating room (OR) was 63 (IQR, 32-94.5) minutes versus 80 (IQR, 24.8-120.5) minutes (p = .88, r = 0.03). The median time to ICU was 77 (IQR, 62.5-105) minutes with a TRN, compared to 81 (IQR, 65-129.3) minutes (p = .21, r = 0.07). We did not observe statistically significant differences between groups. ED LOS, time to OR, and time to ICU were similar between groups, with slightly lower values in patients with TRN involvement. Further evaluation is needed to determine clinical relevance and impact on trauma protocol adherence.

A medical assessment to determine fitness for interview (FFI) is undertaken prior to police interview to guide officers on a suspect's interview readiness. Being fit for police interview strengthens the admissibility of evidence, supports legal compliance and integrity, and ensures that a suspect can self-advocate in a fair and honest interview process. This retrospective clinical audit describes and evaluates the biopsychosocial factors involved in FFI assessments. This is a retrospective clinical audit of all 215 cases who underwent fitness for interview assessments over a 10 year period. ACT Police referred 215 suspects for fitness for interview assessments (FFI); 6 were unable to be assessed. Physical and mental state examinations were undertaken on the remaining 209 suspects, the majority being males under the age of 40. Multiple factors were significantly associated with not being fit for interview: alcohol intoxication (41.6%), substance use (45.9%), and having less than 6 h sleep (40.2%). Mental health assessment (18.9%), administration of medications (13.9%) and transfer to a hospital (3.3%) were required in some cases. Of 122 suspects found to be initially unfit, 80.3% required a post-intervention FFI reassessment. Strong attention, concentration and clear speech were the most important medical predictors of a suspect's fitness for interview. Point-in-time FFI medical assessments consider various biopsychosocial factors critical to ensuring a fair police interview. For suspects deemed unfit, appropriate care pathways are required to enable medical intervention and reassessment.