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Objective The 2007 Maternal-Fetal Medicine Units Network vaginal birth after cesarean (VBAC) calculator included race and ethnicity among the score criteria. These variables were removed in 2021 to decrease the risk of systemic biases impacting counseling regarding birth after cesarean delivery (CD). This study compares test performance of each version of the calculator within our population. Study design Retrospective cohort study of pregnant patients ≥18 years old eligible for TOLAC after one CD between September 2019 and August 2022. Predicted VBAC success scores were calculated for each patient using both the 2007 and 2021 calculators. Predicted scores were separated into categories and patients were stratified by self-identified race/ethnicity for comparison. Receiver operating characteristic (ROC) curves were created to compare sensitivity and specificity of each calculator using predicted scores as continuous variables and as categories (>50%, >60%, and >70%) with actual VBAC outcomes. Calibration metrics were also calculated for each calculator. Results 457 patients met inclusion criteria. Race/ethnicity distribution was 55.0% White, 8.1% Black, 33.7% Hispanic. VBAC success rate was 76.4%. A higher proportion of Black patients had lower predicted scores with the 2007 calculator vs. the 2021 calculator. ROC curves showed similar areas under the curve for both calculators (AUC 0.74 2007 vs. AUC 0.75 2021; p=.22), consistent with similar predictive values between both calculators. The revised calculator had better agreement between observed and predicted VBAC rates within deciles of predicted probabilities. Conclusions In our population, predicted VBAC success rates were lower among Black patients with the 2007 calculator. Both calculators performed similarly in predicting VBAC success with the new calculator having better agreement within deciles of predicted probability. Our data contribute to supporting the VBAC calculator revision, which removed race and ethnicity as criteria in obstetric management of pregnant patients with one CD desiring to attempt TOLAC.

Rates of advance care planning (ACP) are lower and preferences for life-prolonging treatment are higher among Black compared to White older adults. We examined whether these differences persisted during the COVID-19 pandemic. Between February 2021 and September 2022, we conducted a cross-sectional COVID-19-focused survey of seriously ill adults &#x2265;&#x2009;65&#x2009;years in 10 primary care clinics participating in a clinical trial of two ACP interventions. Logistic regression models examined associations between COVID-19 related ACP discussion (defined as discussions with family, friends, or doctors about COVID-related medical care) and treatment preferences if very sick with COVID-19 (life-prolonging treatment, comfort care, trial of life-prolonging with transition to comfort care if no improvement) overall and by race, controlling for baseline characteristics. Among 428 participants (55.9% Black, 44.2% White; mean age 74.6), 25% reported discussing COVID-19 treatment preferences with family/friends and 6% with doctors. Most reported no change in willingness to participate in ACP due to the pandemic, though increased willingness was more common among Black than White participants (22.4% vs. 14.0%, p&#x2009;=&#x2009;0.016). Despite this, COVID-19-related ACP discussion did not differ by race (family/friends: 22.7% vs. 28.3%, p&#x2009;=&#x2009;0.19; doctors: 6.9% vs. 4.8%, p&#x2009;=&#x2009;0.37). Most seriously ill older adults preferred a time-limited trial of life-prolonging treatment (71% White, 56.2% Black); though preferences varied by race (p&#x2009;<&#x2009;0.0001); Black participants compared to White participants more often preferred life-prolonging treatment (28.5% vs. 10.3%). In adjusted models, race was not associated with COVID-19-related ACP discussion (OR 0.72, 95% CI 0.44-1.18), while preferences for life-prolonging treatments predicted greater COVID-19 related ACP discussion (OR 1.98, 95% CI 1.14-3.44). In contrast to pre-pandemic ACP research, no racial differences were observed in COVID-19-related ACP discussion, though differences in treatment preferences persisted. These findings underscore the need for culturally responsive, context-sensitive ACP approaches among seriously ill older adults.

Atherosclerosis results from cellular and extracellular changes in the arterial wall, preceded by molecular shifts that initiate disease and drive tissue conversion, yet these changes are not yet fully described. More data are needed concerning these early changes in the coronary artery molecular landscape that signify the initiation of atherosclerosis and the subsequent tissue pheno-conversion to atherosclerotic plaque. This report summarizes results from a large biorepository of human coronary artery tissue, applying state-of-the-art omics technology, advanced data analytic methods, and an arterial organoid model system to predict molecular dynamics and identify potential regulatory mechanisms that could interrupt molecular changes that contribute to the earliest stages of disease pathogenesis. The long-term goal of this effort is to identify and develop new therapies to further mitigate the persistently high burden of clinical coronary disease. Mass spectrometry-based proteomic analysis and RNA sequencing (RNASeq) were used to analyse proximal coronary arterial samples from young adults who died of trauma with no ante mortem suspicion of coronary disease [n = 322, mean age (range): 34.1 years (15-59); sex: M-239, F-83; race: W-218, B-88, other-16]. Despite the absence of clinical disease, 56% of samples had morphologic evidence of pre-clinical atherosclerosis. Analyses of the proteomic data (n = 1900 proteins) using state-of-the-art dimensionality reduction and deconvolution techniques generated an estimate of molecular disease progression (e.g. pseudo-time) and identified selected proteomic latent features (LFs) (i.e. large groups of co-ordinated proteins) associated with its initiation and progression. Computational genomics, machine learning models, and multi-omic network mapping of these proteomic LFs and associated mRNA gene transcripts suggested potential transcriptional regulators which were subsequently confirmed in publicly available single-cell coronary artery data. The effects of one of the leading regulatory transcription factors (TFs), MLXIPL, predicted to regulate two LFs, were further validated in a human arterial cell organoid model system. Four proteomic LFs, composed of n = 100 signature proteins/LF, exhibited distinct patterns with respect to disease progression [false discovery rate (FDR) P < .01]. These LFs illuminate the earliest changes in the arterial proteome during tissue pheno-conversion from normal coronary artery to atherosclerotic plaque, including dramatic declines in mitochondrial energy biosynthesis proteins, evidence of vascular unit activation (including pericytes), and neurovascular and neuroimmune modulation (all FDR P < .01). These early changes preceded the expected immune cell recruitment and innate immune response characteristic of atherosclerotic plaque formation. Analysis of transcriptional regulatory networks identified from RNASeq data highlighted both known and novel TFs and master regulators of LF proteins that may drive the initial and early stages of disease progression. Publicly available single-cell RNASeq data from normal and atherosclerotic coronary arteries validated the LFs and several of their likely master transcriptional regulators (all P < .01); and manipulation of the levels of one of top regulatory TFs, MLXIPL, in human arterial cell organoids resulted in the expected changes in expression of the proteins associated with its two targeted LFs (P = .0003 and P < .00001, respectively). The unique nature of this human coronary biorepository with samples ranging from entirely normal to mature pre-clinical atherosclerotic plaque facilitated prediction of molecular disease progression and identification of several potential transcriptional regulators for further evaluation as potential novel targets to interrupt early initiation and progression of atherosclerotic coronary disease.

Lethal prostate cancer (PCa) disproportionately affects African American (AA) men, who experience a higher incidence and earlier onset compared to European American (EA) men, reflecting a persistent biological and clinical disparity. Recent studies have implicated race-associated differences in lipid metabolic reprogramming as key contributors to this disparity. We recently identified carcinoma-associated fibroblasts (CAFs) as a major stromal component that mediates racial disparities in tumor progression. Here, we demonstrate that lipid-laden CAF from AA patients (AACAF) display enhanced pro-tumorigenic properties compared with CAFs from EA patients (EACAF). Lipid droplet (LD) biogenesis and storage analysis revealed a robust diacylglycerol O-acyltransferase 1 (DGAT1) enzyme-dependent LD accumulation in AACAF. Ectopic DGAT1 expression in benign fibroblasts induced CAF markers (FAP1 and &#x237a;SMA) expression linked to fibroblast activation, altered the secretome, and significantly enhanced PCa cells' growth in vivo. Integrative transcriptomic and secretome analyses identified novel DGAT1-regulated genes involved in CAF linked to metabolism, cell-cell communication, motility, and angiogenesis, mediated mainly through ERK1/2 signaling activation. Pharmacological DGAT1 inhibition suppressed these pathways and elicited racially distinct regulation of tumor-promoting mediators, including BDNF, VEGF, and TSP1. Mechanistic experiments show that functionally, lipid-laden CAF from AA patients exhibit increased fibroblast activation and a secretory phenotype with greater pro-tumor activity compared to CAF from EA patients. Collectively, these findings reveal that DGAT1 is a pivotal enzymatic regulator of fibroblast activation and lipid-driven remodeling in the PCa tumor microenvironment (TME) of AA men. Targeting DGAT1 represents a promising strategy to disrupt metabolic-stromal crosstalk and mitigate race-associated disparities in PCa progression.

Racial disparities in the incidence of, and mortality from, aggressive breast cancers are a pressing public health issue. Many factors have been investigated in these inequities; however, the role of toxicant exposures is not well characterized. We and others have identified substantial inequities in chemical biomarker concentrations by race. The goal of this study was to test the hypothesis that exposure to these chemicals is linked to biological changes relevant to aggressive breast cancers, such as dysregulation of the Hallmarks of Cancer. We used high throughput transcriptomic profiling of normal primary human breast epithelial cells from diverse donors ( n=6 ) to test effects of 8 chemicals (cadmium, lead, arsenic, copper, PFNA, BPA, BPS, p,p'-DDE) with documented exposure disparities by race/ethnicity across 3 concentrations (100nM, 1&#xb5;M, 10&#xb5;M). Across chemicals, we identified that pathways related to cell cycle regulation and protein secretion were commonly affected. Through bioinformatic estimation of cell type proportions, we found that metals like lead and cadmium induced cell-type shifts, consistent with the dysregulated cellular plasticity cancer hallmark. Lead and arsenic response genes were enriched for genes associated with poor breast cancer survival in the Cancer Genome Atlas. Integrating concentration-response modeling and chemical biomonitoring data, BPA, p,p'-DDE, copper, and lead elicited expression changes at concentrations relevant to the US population. Finally, we identified substantial interindividual heterogeneity in response to organic compounds, but less so in metals. These findings highlight the value of high-throughput transcriptomics as a New Approach Methodology (NAM) in quantifying how common exposures may impact aggressive breast cancer associated biological processes.

Efforts to generalize findings from the Environmental influences on Child Health Outcomes (ECHO) Cohort across rural and urban areas are challenged by limitations in both sample composition and the classification schemes used to define place. We evaluated how rural-urban stratification affects the interpretation and generalizability of preterm birth (PTB) prevalence proportions in the ECHO Cohort compared to national benchmarks. We used a population data science approach to compare bootstrap estimates of PTB prevalence in ECHO (2017-2019, 2020-2022) to county-level prevalence from the National Center for Health Statistics, stratified by rural-urban classification (RUCC, UIC, NCHS), race/ethnicity, education, and income. We applied post-stratification weights and conducted sensitivity analyses. Overall PTB prevalence in ECHO was statistically similar to that in US live births. Estimates varied by rural-urban classification scheme but showed no consistent directional difference. Stratifying by race and education revealed variability in PTB differences and gaps in subgroup representation within the analytic sample. Post-stratification increased PTB estimates slightly and stabilized rural estimates. Two predominantly rural cohort sites strongly influenced rural means; excluding one reversed the direction of rural-urban difference while excluding the other increased it. Supplemental analyses showed regional variability in PTB prevalence and suggested that living above 130% of the federal poverty level may be protective. Rural-urban stratification alone, without accounting for the context of rural places, limits generalizability and may obscure differences between samples drawn from large cohort studies and the broader population. Context-aware stratification may improve validity and equity in population health research.

Medicare home health is a critical postacute care source for individuals with Alzheimer disease and related dementias (ADRD). The Home Health Value-Based Purchasing (HHVBP) program has substantially reshaped financial incentives in home health, but its implications for patients with ADRD are unclear. To assess the association between residence in a state with an HHVBP program and home health service volume within 30 days of home health initiation among Medicare beneficiaries with ADRD, and how this varies by patient race and/or ethnicity, dual eligibility, and home health agency (HHA) racial composition. This cohort study linked 2021 to 2022 Medicare claims data with Home Health Focus and Provider of Services files for Medicare fee-for-service beneficiaries with ADRD older than 65 years who initiated home health care within 14 days of hospital discharge in the 9 states in which an HHVBP program was piloted compared with non-HHVBP states. The analysis was conducted from November 2024 to June 2025. Residence in an HHVBP pilot state vs a non-HHVBP state. Number of nursing and therapy visits received within 30 days (main analysis) and 14 days (sensitivity analysis) of home health initiation. Negative binomial regression models with HHA random effects were estimated, and average marginal effects were reported. The analytic cohort included 264&#x202f;601 Medicare beneficiaries with ADRD (median [IQR] age, 83 [77-89] years; 160&#x202f;947 males [60.8%]), of whom 68&#x202f;765 (26.0%) resided in HHVBP states. The overall racial and ethnic composition included Asian (3.1%; n = 8099), non-Hispanic Black (8.9%; n = 23&#x202f;634), Hispanic (6.3%; n = 16&#x202f;562), and non-Hispanic White (81.7%; n = 216&#x202f;306) individuals, as determined by Research Triangle Institute race codes from the Master Beneficiary Summary File. Adjusted 30-day outcomes showed HHVBP state residence vs non-HHVBP state residence was associated with 0.46 fewer nursing visits (3.94 vs 4.40 visits; average marginal effect [AME]&#x2009;=&#x2009;-0.46; 95% CI, -0.52 to -0.41; P < .001) and 0.32 more therapy visits (6.37 vs 6.05 visits; AME = 0.32; 95% CI, 0.24-0.39; P < .001). In non-HHVBP states, dual-eligible beneficiaries and those receiving care from HHAs primarily serving a racial and ethnic minority population received more nursing but fewer therapy visits compared with non-dual-eligible beneficiaries and those receiving care from HHAs serving a predominantly White population. These differences became smaller in HHVBP states. For example, therapy visit gaps between patients receiving care from HHAs primarily serving a racial and ethnic minority population and those receiving care from HHAs serving a predominantly White patient population narrowed from -0.81 (95% CI, -0.90 to -0.73) to -0.27 (95% CI, -0.44 to -0.09) visits in non-HHVBP vs HHVBP states (P < .001). The findings of increasing use of therapy visits and smaller group differences were consistent within a 14-day window. In this cohort study of Medicare beneficiaries with ADRD, residence in an HHVBP state was associated with increased therapy use and smaller differences in home health service patterns between racial and/or ethnic minority and White patients, dual-eligible and non-dual-eligible beneficiaries, and patients receiving care from minority-serving HHAs and those receiving care from HHAs serving a predominantly White patient population compared with residence in a non-HHVBP state. These findings suggest that VBP models could reduce differences in postacute care.

This study aimed to examine the acute and chronic effects of a standard race load and an eight-week training period on heart rate and respiratory function parameters in short-, middle-, and long-distance runners. The study was designed as a quasi-experimental study with a repeated-measures design. The research group consisted of short-distance (n&#x2009;=&#x2009;11), middle-distance (n&#x2009;=&#x2009;13), and long-distance (n&#x2009;=&#x2009;10) female runners who were actively engaged in athletics. Resting, post-race, and recovery heart rate values (1 and 15&#xa0;min post-exercise) were measured. Respiratory function parameters (FVC, FEV1, and PEF) were assessed before and immediately after exercise. Measurements were conducted at baseline and repeated after an eight-week training period. A mixed-design repeated-measures ANOVA was used to examine the effects of group, time, and period on physiological variables. Resting heart rate values were similar in short- and middle-distance runners, whereas long-distance runners exhibited lower values. Heart rate responses during post-race and recovery periods differed across disciplines, with short-distance runners showing a faster decline in the early recovery phase and long-distance runners reaching lower levels during the later recovery stage. Regarding respiratory function, post-exercise increases in FVC were observed in short- and middle-distance runners during the second measurement period, while FEV1 remained unchanged. PEF values increased only in short-distance runners during the same period. The eight-week training period did not significantly affect heart rate, and a significant increase was observed in FVC, whereas FEV1 remained unchanged. Recovery patterns also differed between disciplines, with short-distance runners showing a faster decline in heart rate during the early recovery phase, whereas long distance runners reached lower heart rate values during the later stages of recovery. These findings indicate that the changes observed following an 8-week period differ across running disciplines and exhibit a discipline-specific pattern. Not applicable, as this study is not a clinical trial.

Pregnant patients were surveyed to determine marijuana use, their interest in additional education of the risks marijuana use in pregnancy, and if they had been educated by their providers about these. Fisher's exact tests were used to determine significant differences in both demographics and survey answers on provider education between those who used and did not use marijuana during pregnancy. 409 patients were surveyed with 367 completing the survey. 87 participants (23.7%) of those surveyed endorsed marijuana use in their current pregnancy. Significant differences between those who used marijuana and those who did not were seen in race/ethnicity (17.1% among White people versus 38.9% among those of other race/ethnicity; p&#x2009;=&#x2009;0.017), age (with 33.3% of 18-24 year olds reporting the highest use vs. 0.0% of &#x2265;&#x2009;40 year olds reporting the lowest use; p&#x2009;=&#x2009;0.014) and education level (with those who had not completed high school reporting the highest rates of use, p&#x2009;=&#x2009;0.001). 15.3% of all respondents received counseling on the risks of marijuana use during pregnancy. Among those who used marijuana, 25.3% received the counseling, compared to 12.1% of those who did not use (p&#x2009;=&#x2009;0.003). 41.4% of those who used marijuana expressed an interest in additional information on this topic, significantly higher than those who did not use (p&#x2009;<&#x2009;0.001). A gap exists in the area, as only 25%of pregnant patients who used marijuana reported receiving counseling, compared to the 41% who stated a desire for additional information. This emphasizes the need for both accessible resources on how marijuana affects both the pregnant mother and infant, as well as education for providers on this gap in care.

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&#x202f;773 and 32&#x202f;515 noncitizen American Community Survey respondents in California aged 19 to 25 years and 26 to 32 years, respectively, and 28&#x202f;535 and 43&#x202f;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&#x202f;665 and 25&#x202f;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.

GBC is an aggressive biliary tract malignancy with limited survival. Although actionable genomic alterations (AGAs) are increasingly recognized in GBC, their prognostic association in real-world practice remains incompletely defined because genomic status is often confounded by stage at presentation and treatment selection. We evaluated the association between documented AGA status and overall survival (OS) using a tiered matching strategy to account for major clinical confounders. Using the TriNetX Global Collaborative Network, we identified adults with GBC and stratified them into patients with at least one documented AGA in KRAS, TP53, ERBB2, IDH1, FGFR1, PIK3CA, or ARID1A, and a comparison cohort with no documented AGA (representing a real-world population of untested and wild-type patients). Two 1:1 propensity score-matched models were constructed: Model 1 matched for age, sex, and race/ethnicity; Model 2 additionally matched for metastatic disease, surgical resection, and chemotherapy history. Outcomes were evaluated using risk analysis and Kaplan-Meier survival methods. A marked disparity in genomic documentation was observed before matching, with unknown race recorded in 51.0% of the comparison cohort versus 3.7% of the documented AGA cohort. In the demographic-matched analysis (Model 1), the documented AGA cohort had higher mortality (52.8% vs. 42.5%, p < 0.001) and shorter median OS (684 vs. 948 days; HR 1.23, p = 0.006). In the primary stage- and treatment-matched analysis (Model 2), mortality remained higher in the documented AGA cohort (56.2% vs. 43.0%), corresponding to an absolute risk difference of 13.2% (p < 0.001). Median OS was numerically shorter in the documented AGA cohort (750 vs. 784 days), although the proportional hazards assumption was violated, supporting interpretation based primarily on absolute risk measures. In exploratory subgroup analyses, KRAS alterations were associated with worse survival, whereas the TP53 subgroup was limited by small sample size. In this real-world matched analysis, the presence of documented AGAs in GBC were associated with higher mortality even after matching for major demographic, stage-related, and treatment-related variables. These findings support the prognostic relevance of genomic status in GBC and underscore the need to address disparities in access to genomic documentation and testing.

After methotrexate administration to treat and ectopic pregnancy, patients follow-up for a laboratory evaluation to measure human chorionic gonadotropin (hCG) response. This follow up occurs on day 4 and 7, with day 1 being the day of methotrexate administration. With no validated alternative, patients may have difficulty adhering to this follow-up schedule. The objective of this retrospective cohort study was to compare outcomes of monitoring patients on days 4 and 7 to days 5 and 8 following methotrexate administration for confirmed or suspected ectopic pregnancies. We performed a retrospective cohort analysis within the Military Health System, identifying individuals treated with methotrexate for either confirmed or suspected ectopic pregnancy between 2016 and 2025. Cases were identified using ICD-10 diagnostic codes, followed by manual chart review to collect: demographics, obstetric history, initial hCG level, follow-up schedule, subsequent hCG levels after treatment, dose(s) of methotrexate administered, whether surgical intervention was required. Regardless of cohort, treatment response was characterized by a&#x2009;&#x2265;15% decline in serum hCG between monitoring days without surgical intervention. Patients monitored on post-treatment days 5 and 8 following methotrexate were compared with those followed on days 4 and 7. Exclusion criteria included an initial hCG level greater than 5,000 mIU/mL, planned two-dose methotrexate protocols, or lost to follow-up. Treatment success was defined as a final hCG level less than 25 mIU/mL. Statistical comparisons were conducted using Fisher's exact test and Mann-Whitney U test, as appropriate. This study was deemed exempt by our institution's IRB (WRNMMC-EDO-2025-1355). We identified 136 patients, 100 patients monitored on days 4 and 7, and 36 patients monitored on days 5 and 8. There were no statistical differences in patient age at time of methotrexate administration, ethnicity/race, gravidity and parity, and history of ectopic pregnancy. Baseline methotrexate dose (4/7: 91.5 mg/m2, 5/8: 92.2 mg/m2) and initial hCG (4/7: 1350.2 mIU/mL, 5/8: 1341.1 mIU/mL) were similar between groups. The majority of patients in both cohorts had a successful response to methotrexate (4/7: 60.0%, 5/8: 63.9%). Of these responders, methotrexate without additional intervention was successful in the majority of cases (4/7: 96.7%, 5/8: 91.3%). Frequencies of treatment success were 79/83 (95.2%) in patients who did versus 45/54 (83.3%) in patients who did not have a treatment response (OR 3.95, 95% CI [1.21, 15.3]). Following up on days 5 and 8 or days 4 and 7 post-methotrexate treatment led to similar outcomes in ectopic pregnancies. These data provide reassuring evidence that the appropriately counseled patient can follow-up on day 5 and 8, rather than 4 and 7, after methotrexate administration and still be safely managed.

Phenotyping and genotyping initiatives within the Integrated Islet Distribution Program (IIDP), the largest source of human islets for research in the U.S., provide standardized assessment of islet preparations distributed to researchers and enable the integration of multiple data types. Data from islets of the first 299 organ donors without diabetes analyzed using this pipeline highlights substantial heterogeneity in islet cell composition associated with hormone secretory traits, sex, reported race and ethnicity, genetically predicted ancestry, and genetic risk for type 2 diabetes (T2D). While &#x3b1; and &#x3b2; cell composition influenced insulin and glucagon secretory traits, the abundance of &#x3b4; cells showed the strongest association with insulin secretion and was also associated with the genetic risk score (GRS) for T2D. These findings have important implications for understanding mechanisms underlying diabetes heterogeneity and islet dysfunction and may provide insight into strategies for personalized medicine and &#x3b2; cell replacement therapy.

We investigated associations between community-level environmental, social, and health burdens in relation to sleep-disordered breathing (SDB) prevalence and evaluated effect modification by age, sex, race, and ethnicity. We conducted a cross-sectional study using electronic health records from 1,406,727 patients (median age: 44.0 years; 40.3% men) at U.S. community health centers in 2022. Patients' residential addresses in 2022 were linked to a census tract-level environmental, social, and health burden (ESHB) index, reflecting community socioeconomic, environmental, and health burden (percentile rank range: 0-1; higher values indicate greater burden). SDB was identified via diagnostic and procedural codes and categorized as obstructive (OSA), central (CSA), other/unspecified (OUSA), multiple sleep apneas, or procedure-based cases. Log-binomial regression estimated adjusted prevalence ratios (aPRs) and 95% confidence intervals (CIs), with effect modification assessed using interaction terms. SDB prevalence was 6.0% (OSA: 4.1%; CSA: 0.03%; OUSA: 1.5%; multiple apneas: 0.04%; procedure-based: 0.2%). Each 0.1-unit increase in ESHB percentile rank was associated with higher prevalence of SDB (aPR&#xa0;=&#xa0;1.01 [1.01-1.01]), OUSA (aPR&#xa0;=&#xa0;1.01 [1.01-1.02]), and procedure-based cases (aPR&#xa0;=&#xa0;1.04 [1.02-1.05]) but not CSA, OSA, or multiple sleep apneas. Stronger ESHB-OSA associations were observed among younger (18-49 vs. &#x2265;50 years), American Indian/Alaska Native and White (vs. Asian and multiracial groups), and non-Hispanic (vs. Hispanic) patients. Higher overall census tract-level environmental, social, and health burden, as measured by the ESHB index, was associated with higher SDB prevalence with variation by sociodemographic group. Although prospective studies are warranted, our findings illuminate the potential for community-level factors to inform SDB interventions.

Meaning in life is closely linked to physical, cognitive, and mental health in older adulthood, yet little is known about how low-income older adults residing in Medicaid-funded assisted living facilities (MALF) experience and sustain meaning. This qualitative descriptive study explored how MALF residents make and ascribe meaning in their lives to inform person-centered care and intervention development in this understudied population. We conducted a qualitative descriptive study guided by Wong's PURE Model of meaning in life (Purpose, Understanding, Responsible action, Enjoyment). We completed semi-structured interviews with residents from three MALF in the New York City metropolitan area. A purposive sample of 24 interviews was analyzed using a five-phase process, combining deductive and inductive content analysis methods. Participants were diverse in age, race and ethnicity, and length of residence, with many experiencing functional impairment, depression, hopelessness, or stress. Two cross-cutting themes - (in)dependence and (dis)connection - shaped residents' experiences of meaning across all PURE domains. Maintaining independence and surviving within physical, financial, and environmental constraints were central to purpose and understanding, while meaningful relationships and opportunities for reciprocity supported connection, enjoyment, and responsible action. Findings highlight the central role of independence and connection in meaning making among low-income assisted living residents while highlighting key issues critical to this population. Assisted living environments and care practices that support autonomy, accessibility, and sustained relationships may enhance meaning in life and well-being for this population.