Public debate about policing highlights competing views about whether community initiatives build trust or reinforce surveillance. We argue that perceptions depend on prior state orientations, which can polarize opinions across groups. Using a preregistered survey experiment in Chicago, we examined responses to the police department's "Sentiment Dashboard," a project designed to enhance legitimacy by collecting community feedback. Results show that the dashboard increased trust in police among non-Black respondents but reduced trust among Black respondents, especially when framed as monitoring. Among non-Black respondents, dashboard exposure also reduced support for the Black Lives Matter movement and racial equity policies unrelated to policing, such as diverse hiring and climate justice. Mechanism testing with qualitative evidence suggests that treated non-Black participants were more likely to regard police reforms as substitutes for racial equity policies, rendering further measures unnecessary. These findings reveal how state legitimacy initiatives may instead widen racial divides and weaken coalitions for structural reform.
Parastomal hernias remain a persistent challenge for hernia surgeons due to significant wound morbidity and high rates of hernia recurrence. Enlarging of the stomal aperture due to suture pull-through or de novo fascial separation can lead to recurrence despite repair technique. Mesh suture (Duramesh, Mesh Suture Inc, Chicago, IL) is designed to distribute tension across multiple filaments, theoretically reducing pull-through. We analyzed our outcomes of the use of Duramesh as an alternative to primary suture closure in the repair of primary and recurrent parastomal hernias. We conducted a single-center, retrospective review of a prospectively maintained series of patients who underwent primary repair of parastomal hernias using Duramesh between January 2024 and July 2025. We included both primary and recurrent parastomal hernias with no exclusion based on prior repair type or defect size. Forty-two patients were included. Mean age was 66 ± 10.9 years, mean BMI was 31 kg/m2, and 54.8% were male. Stoma types included colostomy (47.6%), ileostomy (28.6%), and urostomy (21.4%). Fifty-four percent had undergone at least one prior PSH repair. Median hernia defect size was 20 cm2 (range 2-120 cm2). Mean operative time was 225 min and mean length of stay was 6.4 days. Surgical site occurrences were identified in 26.2% of patients, including a 7.1% SSI rate. At a mean follow-up of 7.1 months, 54.8% of patients developed hernia recurrence, with a mean time to recurrence of 6.4 months. Patients undergoing redo parastomal hernia repair had significantly higher recurrence rates compared to those undergoing first time repair (61.5% vs 30.8%, p = 0.050). Primary PSH repair with Duramesh alone is associated with high recurrence rates (54.8%) and should not be considered a durable standalone strategy. Though suture pull-through was not identified as a failure mechanism in this limited series, the persistent stomal aperture renders primary repair insufficient regardless of suture construct.
While most literature on the history of neurosurgery departments features only celebratory accounts of achievements, this article represents an instrument for genuine reflection on the rich and complex medical past of the Loyola University Chicago Department of Neurosurgery. This culmination examines the evolution of Loyola University Medical Center, a quaternary-care academic hospital centered on its 61-acre campus in Maywood, Illinois. The campus houses Loyola University Medical Center, the Stritch School of Medicine, the Parkinson School of Health Sciences and Public Health, and the Marcella Niehoff School of Nursing, along with major centers for cancer, cardiovascular, and translational research. Beyond Maywood, the Loyola University Health System includes Gottlieb Hospital in Melrose Park and MacNeal Hospital in Berwyn and has been a part of Trinity Health since 2011. Initially established as a division shortly after the hospital's founding, the Department of Neurological Surgery formalized its residency program in 1977, marking a pivotal step in its academic development. Since that time, Loyola Neurosurgery has evolved into a comprehensive program distinguished by innovation, high clinical volume, research, and education. Faculty contributions include advances in microsurgical, cerebrovascular, and endoscopic endonasal techniques, early work in extracranial-intracranial (EC-IC) bypass, participation in the MISTIE III trial, and the development of novel operative approaches such as ventral pontine trigeminal tractotomy. The department has also produced one of the largest single-center experiences in vestibular schwannoma surgery in the Midwest. Loyola Neurosurgery maintains active participation in multicenter clinical trials, alongside a growing portfolio of NIH-funded research and translational collaborations.
Atherosclerotic cardiovascular disease remains a leading cause of morbidity and mortality worldwide. Established risk equations guide prevention but rely mainly on static, clinic-based variables and incompletely capture physical activity, sedentary behavior, and cardiorespiratory fitness. This narrative review synthesizes evidence from epidemiological studies, clinical trials, and methodological frameworks on the roles of physical activity, sedentary behavior, and cardiorespiratory fitness (CRF) in cardiovascular risk prediction, with emphasis on digital phenotyping, mechanistic exercise physiology, and multimodal clinical prediction models. Cardiorespiratory fitness reflects integrated physiological reserve and is strongly associated with cardiovascular and all-cause outcomes. Cardiopulmonary exercise testing extends fitness assessment by identifying mechanisms of exercise limitation, including cardiac, ventilatory, autonomic, pulmonary vascular, and peripheral contributors. Wearable technologies provide longitudinal, real-world measures of physical activity and sedentary behavior that complement static clinical risk factors. Multimodal models integrating electronic health records, electrocardiography, imaging, wearable signals, and exercise testing may support more personalized and actionable risk stratification. However, the current evidence base remains limited by insufficient external and prospective validation, incomplete calibration reporting, limited decision-analytic evaluation, and inadequate assessment of subgroup performance and equity. Physical activity and cardiorespiratory fitness should be considered clinically relevant and modifiable phenotypes in contemporary cardiovascular risk prediction. Future models should prioritize standardized measurement, mechanistic validation of digital phenotypes, calibration, external validation, subgroup evaluation, workflow feasibility, and prospective evidence of clinical utility before widespread implementation.
To describe the implementation of a holistic review process in an academic general surgery residency program. Creation of a Residency Recruitment Committee and formal applicant evaluation using a 5-attribute rubric. The rubric evaluates clinical and academic excellence, leadership skills, integrity, work ethic, and interest in academic surgery. We incorporated implicit bias training in this process. Recommendations were made on whether to offer interviews. A single academic institution in the United States. Faculty and residents serving as application reviewers. The holistic review process was successfully implemented, with 26 to 38 evaluators reviewing 22 to 28 applications each. A transparent, structured approach helped select applicants for interviews whose missions and values aligned with the program. Once chosen for an interview, applicants are asked standardized interview questions, such as their reaction to stressful circumstances and ability to work in a team. Finally, all members of the Resident Recruitment Committee are invited to attend the rank list meeting. Holistic review is a comprehensive and feasible approach to improving transparency in residency selection while promoting the recruitment of diverse candidates. While our program prioritizes academic development, the rubric and process can be adapted for programs with different priorities. Long-term evaluation of outcomes is needed to assess its broader impact on resident recruitment and retention.
To evaluate the use of standardized protocols for reflexing to broad, multigene panels in non-small cell lung cancer (NSCLC) and identify barriers that limit timely pathologist‑ordered biomarker reflex testing. A cross-sectional survey was administered to a national sample of health care professionals involved in NSCLC biomarker testing. Of 111 respondents in the dataset, 77.5% reported using an institutional standardized protocol for comprehensive biomarker testing (CBT), and 88.4% of these protocols included reflexing to a multigene panel. Most respondents with reflex protocols indicated that 80% or more of newly diagnosed patients with NSCLC received CBT; however, fewer respondents reported that results were available before the oncology visit to select first‑line treatment. Pathologists were the primary ordering providers in institutions with standardized protocols. Respondents agreed that pathologist‑ordered reflex biomarker testing improves cancer care and supported Centers for Medicare & Medicaid Services (CMS) recognition of pathologists as ordering physicians for broad biomarker panels. Despite protocol adoption, respondents cited persistent barriers-including reimbursement, insurance authorization delays, and the Medicare 14-day rule. Locally standardized protocols incorporating reflex multigene panel testing have been reported and are associated with high rates of CBT. Institutional and operational barriers delay the availability of results and limit the impact of these protocols on first‑line treatment decisions. Clarifying CMS guidance on pathologists as valid ordering physicians for broad biomarker panels, strengthening coordination with multidisciplinary teams, addressing workflow constraints, and educating the laboratories and payers on pathologists having ordering authority may enhance the effectiveness and adoption of reflex biomarker testing models.
Implementation science (IS) plays a critical role in translating research into real-world health outcomes. Few studies have evaluated models that provide technical assistance and other resources to build IS capacity. The Coordinating and Capacity-Building Hubs to Enhance the Science of HIV Implementation Research (CHESHIRE) network supports US-based HIV research awardees participating in the Ending the HIV Epidemic in the US (EHE) initiative. The objective of this study is to describe the evaluation protocol for CHESHIRE and assess the effect of the implementation of hub technical assistance activities on EHE-funded research team outcomes, including IS competencies, scientific collaboration, and research productivity. This protocol describes a mixed methods evaluation using qualitative interviews with EHE project leads (n=36); social network analysis of CHESHIRE-affiliated researchers and hub members (n=265); and secondary data analysis of National Institutes of Health (NIH) RePORTER, PubMed, and NIH Implementation Science Coordination Initiative EHE Project Final Progress Report Survey data (n=248). We will use descriptive analyses, network metrics, and thematic coding to describe outcomes following CHESHIRE implementation, including IS competencies, interinstitutional partnerships, and research productivity. CHESHIRE coordinating center and hub activities were funded through NIH Center for AIDS Research and AIDS Research Center supplements beginning in 2019, with hubs funded between 2019 and 2024. Available survey data include EHE projects that completed the EHE Project Final Progress Report Survey between August 2021 and February 2025. As of January 2026, we have completed enrollment, with 265 network members in the final recruiting list. Data abstraction and analysis of the evaluation components are ongoing. Publication of findings is anticipated for December 2026. Evaluation findings will be disseminated after completion of data analysis. The findings will provide insights on whether structured IS support through CHESHIRE increases researchers' IS competencies, interinstitutional partnerships, and research productivity. This evaluation will provide empirical evidence to guide the development and optimization of technical assistance hubs in public health research and inform their future evaluation of hub-based IS capacity-building models. Findings will inform strategies to optimize IS capacity building and accelerate the translation of evidence-based interventions into practice, especially in HIV prevention and treatment. DERR1-10.2196/91374.
Insulin resistance (IR) is a pathological condition in which peripheral tissues and the brain fail to respond effectively to circulating insulin, contributing to metabolic disorders and cognitive decline. Adipose distribution, and hormonal regulation modulate IR, resulting in distinct molecular and metabolic profiles between men and women. Physical exercise is a potent intervention for improving insulin sensitivity, impacting both peripheral and central mechanisms. At the molecular level, exercise enhances insulin signaling, glucose uptake, and mitochondrial function in skeletal muscle, liver, and adipose tissue. In the brain, exercise-induced factors such as PGC-1α and irisin mediate neuroplasticity, neuroprotection, and energy metabolism, contributing to improved cognitive function and reduced risk of neurodegenerative disease. Physical exercise modulates lipid intermediates, inflammatory markers, and transcriptional networks that contribute to IR, highlighting its systemic and tissue-specific effects. Understanding these mechanisms is essential for the development of precision exercise prescriptions tailored to individual metabolic and neurological profiles. This review synthesizes current evidence on the molecular mechanisms underlying peripheral and brain IR and examines how aerobic, resistance, and high-intensity interval training influence these pathways. By integrating molecular, physiological, and behavioral perspectives, this work underscores the critical role of physical exercise in mitigating IR and promoting metabolic and cognitive health.
To describe the prevalence of clinical exercise physiologists (CEPs), hiring criteria, and job tasks in early outpatient cardiac and pulmonary rehabilitation (CR/PR) programs in the United States. In this cross-sectional study, a survey was sent by the American Association of Cardiovascular and Pulmonary Rehabilitation to CR/PR program leaders. Data were analyzed using descriptive statistics. Among 311 programs, 96% (n = 297) offered CR, 71% (n = 222) offered PR, and CEPs were the most frequently reported staff in both CR (86%; n = 256) and PR (83%; n = 185). Staff were exclusively CEPs in 10% (n = 30) of CR and 5% (n = 12) of PR. Hiring criteria for CEPs were a bachelor's degree in 92% (n = 240) and a master's in the remaining programs. Advanced Cardiac Life Support certification was required before or within 1 year of hire in 70% (n = 183) of programs. The American College of Sports Medicine Clinical Exercise Physiologist (ACSM-CEP) credential was required before or within 1 year of hire in 24% (n = 62) of programs. In 75% (n = 196) of programs, CEPs were responsible for the majority (≥23 of 29) of job tasks that are common to CR/PR. Clinical exercise physiologists serve integral roles in CR/PR programs in the United States with job responsibilities that allow them to work at the top of their scope of practice in many programs. Underutilization of CEPs at some institutions might be improved by better understanding the variability in academic preparation and the importance of the ACSM-CEP credential.
Women with unilateral breast cancer continue to choose (unilateral or bilateral) mastectomy. We aim to determine decision regret and its relationship with psychosocial outcomes after breast cancer surgery. We performed a prospective cohort study of women with unilateral, sporadic stage 0-III breast cancer at University Health Network (Toronto, Canada) who underwent unilateral lumpectomy (UL), unilateral mastectomy (UM), or bilateral mastectomy (BM). Unilateral mastectomy was further categorized into oncologically indicated (UMO) versus patient choice (UMC). Participants completed the Decision Regret Scale (DRS), BREAST-Q, Impact of Event Scale, and Hospital Anxiety and Depression Scale at 12 or 18 months after surgery. Univariable and multivariable linear regression models were adjusted for demographic, clinical, and treatment-related factors. P < 0.05 was deemed significant. In total, 217 women were included, including 51 UL, 95 UM (71 UMO, 24 UMC), and 71 BM. There was a difference in DRS scores between UL and UM (8.3 vs. 17.4; P <0.01). Bilateral mastectomy was not associated with higher regret. After adjustment for covariates, UMC remained significantly associated with greater decision regret (β = 16.0, SE = 7.6, P = 0.04). Among women having UMC, women with higher regret had lower scores of breast satisfaction (β = -1.0, SE = 0.5, P = 0.03) and psychosocial well-being (β = -0.8, SE = 0.4, P = 0.02). Decision regret is influenced by surgical procedure in women with unilateral breast cancer. Women who have unilateral mastectomy, particularly those who choose the procedure when eligible for lumpectomy, report higher decision regret and worse breast satisfaction and psychosocial well-being.
To compare radiographic and clinical outcomes of vestibular schwannoma management using stereotactic radiosurgery (SRS) and microsurgical resection, with emphasis on paired pre- and post-treatment changes in tumor size and patient outcomes. A retrospective review was conducted of 87 patients treated for vestibular schwannoma between 2013 and 2024 at a single tertiary center. Demographic, clinical, and radiographic variables, including hearing loss, facial weakness, brainstem compression, tumor area, and Koos grade, were analyzed. Tumor area was determined from radiology reports and compared using nonparametric statistical tests, with significance defined as p < 0.05. Microsurgery achieved a median 76% reduction in tumor area, while SRS was associated with relative stability or modest growth (+ 5%) (p < 0.001). Post-treatment rates of hearing loss and facial weakness were similar between groups, suggesting that substantial tumor reduction following microsurgery was not associated with increased morbidity in this cohort. Koos grade correlated with both brainstem compression and hearing loss, with higher grades favoring surgical management (p = 0.049). In the Koos IV subset, surgery achieved significant tumor reduction without disproportionate postoperative deficits compared with lower grades. Microsurgery provides immediate and substantial tumor reduction without increased morbidity, while SRS maintains radiographic stability with favorable clinical outcomes. These findings underscore the complementary roles of both modalities and support the Koos classification as a practical and reliable framework for treatment selection.
Pair instability should prevent the direct formation of black holes above about 50 M ⊙, creating a 'pair-instability' mass gap. Yet gravitational-wave observations have detected black holes in this mass range. These systems can be explained with uncertainties in massive-star evolution, or hierarchical mergers in stellar clusters, which are expected to produce large spins with isotropic orientations. Here we present evidence for the pair-instability mass gap in the LIGO-Virgo-KAGRA fourth transient catalogue, with a lower edge at 44 . 3 - 3.5 + 5.9 M ⊙ . We also obtain a measurement of the 12C(α, γ)16O reaction rate, yielding an S-factor of 26 8 - 116 + 195 keV b , a parameter critical for modelling helium burning and stellar evolution. The data reveal two populations: a low-spin group with no black holes above the gap, and a high-spin, isotropic group that extends across the full mass range and occupies the gap, consistent with hierarchical mergers. These findings are consistent with pair instability playing a role in shaping the black hole mass spectrum, point to a connection between gravitational-wave astronomy and nuclear astrophysics, and highlight dense stellar clusters as key environments in the growth of black holes.
Chromatin organization shapes gene regulation by linking distal elements across megabase scales, yet most predictive genomics models still treat the genome as linear, without incorporating 3D structure. Hi-C provides genome-wide chromatin conformation information, but its contact maps are population-averaged, distance-biased, and noisy, obscuring biologically specific contacts. We present CHROME, a framework built on a self-avoiding polymer ensemble null model that identifies physically specific, nonrandom Hi-C contacts. By integrating these contacts into graph representations, CHROME enables efficient information transfer across spatially connected loci. It integrates sequence, chromatin accessibility, or pretrained embeddings into a graph attention architecture to predict cell-line-specific ChIP-seq profiles, improving performance over matched local encoder baselines. In a held-out cell line, CHROME demonstrates improved performance in selected settings, suggesting potential for cross-cell-type transfer. The resulting graph embeddings also enhance prediction on tissue-specific eQTL and ClinVar variant pathogenicity, compared with local sequence-based embeddings. Beyond predictive performance, CHROME provides interpretability through attention-derived neighbor-to-center contributions that reveal how spatially connected loci influence local regulatory activity over multi-megabase distances. Together, these results highlight the value of incorporating physically validated chromatin interactions for improving regulatory prediction and variant interpretation.
The endoscopy subscore is a therapeutic endpoint in ulcerative colitis trials but is limited by reader variability and inability to fully capture the degree of inflammation across the colon. We developed the artificial intelligence assessment of endoscopic severity and extent (AI-ESe), a continuous, more granular assessment of inflammation throughout the colon to better capture the totality of inflammation, rather than a single score based on the worst lesion. AI-ESe analyzes endoscopic videos through a multistep process including preprocessing for image quality, endoscope stalling (pausing) detection to mitigate mucosal oversampling, and disease severity assessments, generating an inflammatory heatmap. We aimed to validate the stalling and severity algorithms and analyze the overall output of AI-ESe to measure the construct validity and the heterogeneity of inflammation on holdout endoscopic video datasets. Stalling detection reduced the mean absolute temporal disagreement in position estimates from 39 seconds with uniform sampling to 23 seconds using this novel model against a human reference standard, which is comparable to the interreader variability of humans (16 seconds). Model assessment of disease severity achieved a quadratic weighted kappa of 0.80. The overall output of AI-ESe correlated with conventional classifications of the endoscopy subscore, while capturing substantial heterogeneity in inflammation severity. Among videos with an endoscopy subscore of 3, the proportion of moderately to severely inflamed mucosa ranged from 17.9% to 100%. AI-ESe enabled detailed assessment of endoscopic inflammation, capturing heterogeneous burden of disease within conventional endoscopic severity classifications in ulcerative colitis. Granular disease assessments using AI-ESe demonstrate an enhanced approach to disease evaluation.
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Bulevirtide (BLV) 2 mg/day is approved for the treatment of compensated chronic hepatitis D virus (HDV) infection in Europe; however, understanding HDV-RNA, HBsAg and ALT dynamics under 96 weeks of BLV monotherapy is lacking. 38 HDV-infected patients with compensated cirrhosis and clinically significant portal hypertension (CSPH) received BLV. HDV, ALT, and HBsAg were measured at baseline, weeks 4, 8 and every 8 weeks thereafter. Mathematical modeling was used to explain the observed HDV, ALT, and HBsAg kinetics. Median baseline HDV, HBsAg, and ALT were 5.1 log IU/ml [IQR:4.0-5.8], 3.7 log IU/ml [IQR:3.4-3.9] and 90 U/L [IQR:55-150], respectively. During therapy, patients fit into four main HDV kinetic patterns: biphasic (n =7), flat-partial response, FPR (n=18), viral breakthrough, VB (n=6) and non-responder (n=7). ALT normalization was achieved in 29 patients (76%) at a mean of 11.9 (95% CI: 5.9-17.9) weeks. HBsAg remained at pre-treatment levels. Modeling indicated that BLV inhibited infection with efficacy η=80% (95%CI:62-91%) and that HDV-infected cell half-life (t1/2) = 11.6 (95% CI:6.6-16.6) days. BLV efficacy was less than the critical drug efficacy (ηc) for most patients (32/38) explaining the high rates of FPR, VB, and nonresponse despite a prolonged course of BLV. The HDV FPR and VB observed in patients during 96 weeks of BLV are consistent with modeling prediction that BLV 2 mg/day is suboptimal (η≤ηc) in a high percentage of patients (84%) with compensated cirrhosis and CSPH and therefore is unlikely to achieve cure even with prolonged duration of therapy.
Sodium-ion batteries (SIBs) are promising low-cost alternatives to lithium-ion batteries (LIBs), but their energy density remains limited. Hard carbon (HC) offers only modest capacity, while high-capacity LIB anode materials, notably silicon (Si), are ineffective in SIBs due to the unfavorable thermodynamics of Na-rich alloy formation. Here, we report a scalable mechanochemical synthesis of magnesium tetraphosphide (MgP4) and demonstrate that hybrid carbon matrix engineering enables durable and high-capacity anodes. A two-step multi-walled carbon nanotube (MWCNT, T)/graphene(G) assembly, denoted as T2G1 (2:1 T:G by weight), where CNTs are introduced prior to graphene, constructs a continuous conductive and mechanically robust network. In contrast, reversing the assembly order (G2T1) leads to fragmented conductive pathways and inferior structural stability. Multiscale analyses, including cross-sectional resistance mapping and structural characterization, reveal that the optimized matrix promotes uniform charge transport and suppresses structural degradation during cycling. As a result, the MgP4/T2G1 anode delivers stable high-rate performance, retaining 468.5 mAh g-1 over 500 cycles at 1000 mA g-1 (85.3% retention). Furthermore, integrating 30 wt.% MgP4/T2G1 into commercial HC yields a practical composite with a reversible capacity of 146.5 mAh g-1 after 2000 cycles at 1000 mA g-1, corresponding to ∼2.6 times higher capacity than that of pristine HC electrode.
Incarcerated individuals bear a disproportionate burden of cardiovascular disease and face significant barriers to specialty care, including in cardiac electrophysiology. The impact of incarceration on electrophysiology care remains underrecognized and incompletely characterized. To characterize how incarceration disrupts the delivery of cardiac electrophysiology care, identify clinical and system-level barriers, and propose opportunities to improve access and quality. We conducted a narrative review of the literature on incarceration, cardiovascular disease, and electrophysiology care. High-quality EP care depends on care continuity, specialized diagnostics, procedural access, and longitudinal device and medication management - features that conflict with the structural, financial, and logistical constraints of incarceration. This review describes healthcare delivery in carceral systems, highlights the unique vulnerability of heart rhythm care in these environments, and identifies opportunities to improve access and quality. Electrophysiology care in incarcerated populations is understudied and likely falls below community standards. As the incarcerated population ages, demand for quality EP care will grow. Addressing this gap will require coordinated policy, health system, and research initiatives to ensure equitable access to EP care for incarcerated and formerly incarcerated individuals.
This Viewpoint discusses per diem vs diagnosis-related group–based payments in psychiatric care and outlines alternative payment models to better balance access, quality, and efficiency.
Spina bifida (SB) can cause neurogenic bladder dysfunction and renal deterioration. Guidelines recommend renal ultrasound (RUS) for surveillance, but its utility in screening for high-risk bladder is unclear. We evaluated the performance of RUS findings for detecting high-risk bladder in youth with SB. We conducted a retrospective cohort study of patients with myelomeningocele at a pediatric SB clinic who had a RUS within three months of urodynamic studies (UDS). RUS parameters included hydronephrosis, thinned parenchyma, hypoplasia, and scarring. High-risk bladder was defined as end-fill pressures/detrusor leak point pressures of 40 cmH2O or greater. We calculated sensitivity, specificity, and overall diagnostic accuracy (AUC) of RUS parameters for high-risk bladder, adjusting for repeat measurements. Various subgroup and sensitivity analyses were performed. We analyzed 575 UDS-RUS dyads from 244 unique patients. Median age was 7.2 years, 70% had ventricular shunts. 25% of dyads had high-risk bladder. Any hydronephrosis by Society for Fetal Urology (SFU) grading demonstrated an overall sensitivity 50%, specificity 57%, and clustered AUC of 55% for detecting high-risk bladder. RUS had similar performance across additional analyses, including non-ambulatory patients, high-grade hydronephrosis (SFU 3-4), any RUS abnormality, and using Urinary Tract Dilation (UTD) grading instead of SFU grading. Any hydronephrosis had higher test sensitivity for high-risk bladder in fuller bladders on RUS (RUS-bladder volume >75% of UDS-bladder capacity). RUS should not be used alone as a screening tool to identify high-risk bladder in youth with SB given its limited sensitivity and diagnostic utility. UDS remains an essential and necessary tool for surveilling at-risk bladders.