It is unclear whether on-going fibrillation in isolated pulmonary veins (OFIP) may coexist with AF in patients undergoing ablation for non-paroxysmal AF (PAF). This study explored the prevalence of OFIP in non-PAF ablation with the aim of developing an algorithm to distinguish between OFIP and isolation failure, thereby minimising excessive ablation. Non-PAF patients undergoing first-time ablation were divided into a retrospective induction cohort (IC; n=300) and a prospective validation cohort (VC; n=263). In the case of on-going pulmonary vein (PV) fibrillation after ablation, the completeness of PV isolation was assessed based on the change in PV potential and after additional ablation. Among 563 patients, 20 (3.55%) had OFIP (9 in the IC; 11 in the VC). No significant predictors of OFIP were identified in terms of baseline characteristics or procedural factors. Based on three right-sided, five left-sided and one bilateral case of OFIP in the IC, the disappearance of PV potential (either spontaneous or mechanical bumping-induced) or a combination of bipolar voltage reduction >80%, local activation time later than PV recordings and no response to carina ablation were adopted as major criteria in the algorithm to discriminate between OFIP and isolation failure. Among the 20 patients in the VC with on-going PV fibrillation, the algorithm identified true OFIP in 11, false OFIP in three and true incomplete PV isolation in six. The sensitivity, specificity and positive and negative predictive values of the algorithm were 100%, 66.7%, 78.6% and 100%, respectively. The rate of OFIP was not negligible in non-PAF patients undergoing ablation procedures to achieve efficient and safe PV isolation. A novel four-step algorithm was developed to discriminate OFIP from isolation failure, with good predictive value.
Aesthetic flat closure (AFC) is a surgical option following mastectomy that aims to create a smooth chest wall. Although formally recognized by the National Cancer Institute in 2020, patients continue to report challenges in accessing AFC. Social media platforms may serve as an important source of support and education for patients considering this option. We characterized patient perspectives and experiences related to AFC through analysis of discussions on Reddit and TikTok. Using the search term "flat," posts from the r/breastcancer forum were reviewed within Reddit's 1,000 post-and-comment visibility limit. AI-assisted thematic analysis was used to identify recurring discussion themes. TikTok was searched using the terms "going flat," "going flat mastectomy," and "aesthetic flat closure." A total of 370 Reddit posts and 74 TikTok posts met inclusion criteria for relevance to AFC. Posts were most often neutral in tone; however negative sentiment was nearly three times more common on Reddit than TikTok (28.9% vs. 11%). On Reddit, the most common area of discussion was comparison of AFC with other post-mastectomy reconstructive options. "Flat denial," defined as neglecting to perform a true AFC either intentionally or inadvertently, appeared more frequently on Reddit (8.4% vs. 4.0%). AI analysis identified recurring themes including flat denial, inadequate counseling, and misinformation regarding AFC. While discussions surrounding AFC were often neutral or positive, concerns regarding inadequate information, patient counseling, and flat denial persist. These findings highlight the need for greater surgeon familiarity with AFC and more comprehensive patient education on post-mastectomy options.
Calcium pyrophosphate deposition (CPPD) disease is a common crystalline arthritis in older adults, yet few data are available to guide management. In contrast to gout--another common crystalline arthritis for which chronic treatment can reduce the burden of monosodium urate crystals--targeted therapies to prevent formation of or dissolve calcium pyrophosphate (CPP) crystals do not currently exist. Patients with CPPD disease identify substantial unmet treatment needs. Current treatment paradigms focus on managing joint pain and inflammation using medications that have generally not been rigorously tested in CPPD disease. Challenges to effectively treating CPPD disease include: confusing terminology, a spectrum of clinical manifestations, under-diagnosis, difficulties in symptom attribution, and lack of disease-modifying therapies. This review provides an overview of the issues, author's approach to treatment, and review of the evidence base. Ongoing and future trials in CPPD disease are outlined.
Survivors of sex trafficking often experience co-occurring substance use and face significant barriers to accessing care. Harm reduction offers a nonjudgmental, survivor-centered approach to mitigating health risks associated with substance use and commercial sex. However, limited research has explored how harm reduction is understood and implemented by service providers working with this population. This study aimed to examine service providers' perspectives on the role, impact, and challenges of harm reduction in supporting survivors of sex trafficking who use substances. This qualitative study employed purposive and snowball sampling to recruit 21 service providers from human trafficking, domestic violence, and other agencies across the southwestern US who serve survivors of sex trafficking. Semi-structured interviews were conducted to explore participants' experiences with harm reduction strategies, perceived barriers, and relational dynamics in service provision. Interviews were transcribed verbatim and analyzed using thematic analysis, following Braun and Clarke's six-step process. A constant comparative method was used to refine codes and identify emergent themes. Five major themes were identified: (1) comprehensive harm reduction as a lifesaving strategy, (2) education and health literacy as critical intervention tools, (3) navigating barriers to harm reduction, (4) relational foundations of harm reduction, and (5) ambivalence toward harm reduction as a standalone strategy. Participants described harm reduction as essential to preventing overdose, reducing disease transmission, and fostering engagement through nonjudgmental care. They emphasized the importance of peer-led outreach, trauma-informed education, and holistic support that includes meeting basic needs. However, providers also reported legal and institutional constraints, funding challenges, and public misconceptions that hindered implementation. A minority of participants expressed ambivalence about harm reduction, reflecting ongoing tensions between abstinence-based and non-abstinence approaches. Harm reduction is viewed by providers as a vital, relational, and flexible approach to supporting survivors of sex trafficking who use substances. Findings highlight the need for policy reform, increased investment in peer-led and trauma-informed models, and broader cultural shifts to reduce stigma. Future research should include survivor perspectives and explore harm reduction strategies across diverse geographic and demographic contexts.
Measles is a highly contagious viral infection that can cause serious health problems. While measles can be eradicated through vaccination in our country and worldwide, in recent years, vaccine refusal, difficulties in accessing vaccines during the coronavirus disease 2019 (COVID-19) pandemic, and insufficient immunity in young adults have brought the "measles virus" back into the spotlight. The aim of this study was to compare ELISA results for measles IgM and IgG in samples from patients examined at our hospital in in 2024 who were suspected of having measles, with respect to variables such as age, gender, and season. In serum samples taken from patients with suspected measles who came to Kars Kafkas University Faculty of Medicine Medical Microbiology Laboratory, Measles IgG, measles IgM tests (Anti-Measles Virus IgM, Anti-Measles Virus IgG) were studied with kits of the same device in the Enzyme-Linked Immunosorbent Assay (ELISA) method, and the results were evaluated in line with the manufacturer's recommendations. In our study, 30 (63.8%) of 47 patients tested were seropositive for measles IgG antibodies. Measles IgM antibodies were detected in 2 (4.3%) of the 47 patients tested. One patient had intermediate values for both measles IgG and IgM. In our study, no significant relationships were found between age, gender, and season and the Measles IgG and IgM tests. In our study, 34% of the patients in Kars province with measles antibody responses were found to be susceptible to measles infection. Cite this article as: Balkan Bozlak ÇE, Uçar M, Çelebi ., Yılmaz A. Seropositivity status in patients with suspected measles: are we going back to the beginning with measles? 2026, 58(3), 1203, doi: 10.5152/eurasianjmed.2026.251181.
The United States' first state-sanctioned overdose prevention center (OPC) opened in Rhode Island in January 2025. In addition to OPC services, the site offers co-located basic needs services, case management, healthcare, and substance use treatment. We aimed to understand clients' initial engagement with the OPC as well as their consequent service patterns. Between May and August 2025, semi-structured interviews were conducted with 30 people who had used the OPC services. Team members also conducted approximately 40 hours of ethnographic fieldwork in the OPC from January to August 2025. Informed by the intersectional risk environment framework, transcripts and fieldnotes were analyzed thematically with a focus on how the site's integrated design shaped participants' experiences and service use trajectories. Participants' immediate needs motivated their initial engagement with the site, whether it be to access the OPC or co-located ancillary services. The provision of OPC services was a particularly important motivator for engagement among participants who were not previously well-engaged with the site's operating organization and existing harm reduction services. Clients' initial engagement with the site was also shaped by word-of-mouth communication between partners, friends, and other people in their existing drug use networks. Once engaged, participants described regularly utilizing multiple on-site services, with site staff playing a key role in connecting and navigating them through these services. Our findings underscore how an integrated service model supported clients' individualized patterns of access and engagement over time by offering a range of low-threshold, co-located services.
To determine the prevalence of depression and sociodemographic factors associated with depressive symptoms among adolescents. The descriptive, cross-sectional study was conducted from July to November 2024 at public and private schools in Rawalpindi, Pakistan, ZA Public Secondary School, Government Graduate College Dhoke khabba, FG Sir Syed Model Public School (Boys), and Zia-ul-Islam National secondary school, and comprised students of either gender aged 14-17 years. The Patient Health Questionnaire-9 was used to screen and classify the severity of depressive symptoms. The association of demographic variables with depression severity was explored. Data was analysed using SPSS 27.0.1. Of the 358 adolescents, comprising 190(53.1%) were boys, 168(46.9%) were girls and 116(38%) were aged 16 years. The level of depressive symptoms was minimal in 169(47.2%) cases, mild in 98(27.4%), moderate in 66(18.4%), moderately severe in 22(6.1%) and severe in 3(0.8%). Depression severity was significantly correlated with age, female gender and family income (p<0.05). Parental marital status and a history of mental illness in the parents did not significantly correlate (p>0.05) with severity of depressive symptoms. Depression was found to be highly prevalent among school-going adolescents, with more than half reporting mild to severe symptoms. Age and family income were the significant factors associated with depressive symptoms.
Obesity is a heterogeneous chronic disease traditionally defined by body mass index, yet individuals with similar body mass index values can exhibit substantial variability in the presence of cardiometabolic risk factors independent of adiposity. Such discordance has led to the concept of "metabolically healthy obesity", describing individuals with excess adiposity but without overt metabolic abnormalities. However, the validity and clinical relevance of metabolically healthy obesity remain controversial. We conducted a narrative review of PubMed-indexed studies examining obesity phenotypes considering the recent preclinical/clinical obesity framework proposed by the Lancet Commission on Diabetes and Endocrinology. Preference was given for large epidemiological cohorts and mechanistic studies with detailed phenotyping. The metabolically healthy obesity concept is limited by inconsistent definitions, reliance on cardiometabolic risk factors, and poor long-term stability. Emerging evidence supports a shift toward a disease-based framework distinguishing preclinical obesity (excess adiposity with preserved organ and tissue function) from clinical obesity which is associated with organ dysfunction. Replacing binary metabolic phenotypes with the preclinical and clinical obesity framework proposed by the Lancet Commission provides a biologically grounded, clinically actionable model that aligns obesity classification with organ dysfunction and disease progression. Adopting a continuum-based, function-oriented approach may improve risk stratification, guide therapeutic prioritization, and reduce misconceptions surrounding "benign" obesity.
Medical infrared thermography, which involves the use of infrared thermal cameras for the non-invasive assessment of skin surface temperature distribution, has gained increasing interest in recent years as a tool supporting diagnosis and treatment monitoring. The aim of this article is to present the historical background and critically reassess the current role of infrared thermography in medicine, with particular emphasis on standardization as a key determinant of its clinical utility. This Perspective highlights the fundamental impact of methodological variability on diagnostic performance and reproducibility. A structured framework for standardization is proposed, encompassing patient preparation, environmental conditions, device parameters and calibration, image acquisition protocols, region-of-interest definition and analysis, as well as reporting and clinical interpretation. The analysis demonstrates how inconsistencies at each of these levels reduce measurement reliability, limit inter-study comparability, and weaken clinical confidence in infrared thermography. The article also addresses the growing availability of mobile thermal imaging systems and their integration with artificial intelligence, while emphasizing the need for stronger evidence-based support across all methodological domains. The presented analysis suggests that, despite existing limitations, medical infrared thermography holds considerable potential as a supportive clinical tool. However, its broader clinical implementation remains limited by several factors, with the lack of standardized protocols constituting a major and practically addressable translational barrier. Wider adoption will require standardization efforts alongside rigorous validation studies and application-specific interpretative guidelines. Addressing these challenges through technological advances and coordinated international standardization may facilitate meaningful progress over the next decade.
Immigrants' involvement in crime has been extensively assessed, yet far less attention has been given to their experiences as victims. This study centers on the voices of immigrants to examine their experiences with victimization. Drawing from a larger multimethod study, we analyze qualitative narrative responses from 56 Latin American immigrants. Of the participants interviewed (63% women, age range 18-68), 29 had permanent or temporary resident status, and 27 were undocumented (average 20.4 years in the United States). Our results identified four themes: experiences with violent victimization, gender-based violence, labor exploitation, and escalated police interactions. Our findings reveal that many participants did not initially recognize their experiences as victimization, instead normalizing exposure to violence, exploitation, and institutional harm. Gender-based violence was prevalent, with survivors often silenced by threats of deportation and limited knowledge of legal protections. Labor exploitation emerged as a routine form of abuse, compounded by legal precarity and fear of retaliation. Notably, police interactions were frequently described as traumatic, further eroding trust in formal systems. These results highlight the urgent need for trauma-informed, culturally responsive, and immigration-sensitive services that address both the direct and structural forms of victimization undocumented immigrants face. Implications for policy, community practice, and future research are discussed.
Personalization is increasingly emphasized in postgraduate medical education. While competency-based medical education (CBME) is theoretically positioned to support personalization, practical challenges such as fixed learning outcomes, workplace constraints, time-fixed rotations, and assessment requirements, often limit its realization. This case study aimed to explore how residents experience and make use of individualized development trajectories within a program that combined fixed outcomes with flexible program components. We conducted a case study using semi-structured interviews and template analysis. The study was situated in the Dutch national Obstetrics and Gynecology residency program, which includes formally embedded individualized development trajectories with open-ended learning goals and no pre-determined assessment. We interviewed 12 residents and discussed their portfolios. All participants engaged in individualized development trajectories. The level of engagement varied and motivation sprang from: personal interest, moral values and dilemma's, clinical exposure, role models, and workplace possibilities. Three interacting factors enabled this: 1) formal program structure legitimized and fostered engagement; 2) time and workplace exposure allowed participants to recognize personally meaningful goals; 3) program directors' support facilitated engagement. Program directors varied in their guidance: some coached, endorsed, or role-modeled; others merely monitored activity; and a few did neither. Participants engaged with the individualized development trajectories, despite the absence of assessment. Structured autonomy, workplace exposure and personal motivation can support personalized learning in CBME. Personalization requires intentional design, supportive structures, trust towards residents, and coaching attuned to the individual learner.
Methadone is the gold standard treatment for opioid use disorder (OUD). In the U.S., methadone is usually only available through licensed opioid treatment programs (OTPs), but a 2021 federal rule provided an opportunity for OTPs to provide methadone on mobile medication units (MMUs). MMUs operate under the license of an OTP and are subject to complex regulatory requirements. New York State provided grant funding to support OTPs to adopt MMUs, aligned with the broader goal to improve methadone access statewide. This study explored barriers and facilitators to MMU implementation across New York State from the perspectives of treatment staff and administrators. We conducted semi-structured interviews between June 2024 and June 2025 with 16 staff from four OTPs that adopted MMUs and one residential treatment program served by an MMU. Interviews were audio-recorded, transcribed, and analyzed using a hybrid deductive-inductive thematic analysis approach to identify implementation barriers and facilitators. Staff described a variety of potential models for using MMUs to expand access. In New York City, MMUs were used to serve a residential substance use program. In upstate NY, MMUs were deployed to reduce travel distance in counties with few OTP options. Key facilitators of MMU implementation included leadership persistence in the face of community pushback, creativity and workarounds in the face of logistical hurdles, and support from the state agency. Key barriers included community resistance to MMUs, unclear or inconsistent guidance from the Drug Enforcement Administration, and a variety of operational challenges, such as vehicle maintenance and workforce shortages. Staff generally were positive about the opportunity to use MMUs to address access challenges. MMUs provide a novel approach to expand methadone access, particularly to populations not currently served by brick-and-mortar OTPs. Early implementers can provide important lessons about how to manage start-up challenges, which can guide later adopters.
The EULAR Research Center was established around 5 years ago, so it is opportune to take stock of the developments since then and its current status. We here describe the 7 major initiatives that are currently active through the EULAR Research Center, and the additional ongoing processes for supporting researchers.
Patients undergoing radiotherapy (RT) often face substantial out of pocket costs (OOPC), putting patients at risk of going into debt. Unpaid medical debt sent to collections is a proxy for severe financial distress. We identified patients treated with RT at a tertiary care center and its affiliated community sites in fiscal years 2023-2024. Charges for physician and hospital fees for RT, billed OOPC, and unpaid debt (i.e., billed OOPC that is not paid and sent to collections) were collected. Multivariable analyses (MVA) were performed to assess factors associated with unpaid debt. We identified 14,774 patients (mean age of 64 years (SD 14.7), 55.6% female (n=8,212), 6.3% Hispanic (n=932), and half never smokers (55.2%, n=7,863)). Most paid OOPC (61.1%, n=8,711), with mean of $1,350.70 (SD 2,569.3) and median $182.80 (IQR 29.7-1,894.7). A minority had debt sent to collections (2.7%, n=397), with a mean of $1109.90 outstanding (SD 4215.5) after a mean of 9.3 months (SD 3.9). On MVA, older patients (odds ratio (OR) 0.99 [0.98-1.00], p=0.005) were less likely to have debt sent to collections. Patients who were single (OR 1.32 [95% CI 1.06-1.64], p=0.012), current smokers (OR 2.20 [1.56-3.05], p<0.001; Figure 1), with commercial insurance (OR 1.95 [1.50-2.54], p<0.001; referent government insurance), living in more disadvantaged neighborhoods, or with higher OOPC (OR 1.08 per $1000 [1.05-1.12], p<0.001) were more likely to have unpaid debt. An OOPC threshold of $49.10 was associated with being twice as likely to have unpaid debt (AUC of 0.724; OR 2.36 [1.31-3.14], p<0.001). In patients undergoing RT, most patients pay OOPC for treatment and a minority of patients incur debt going to collections. Patients who are single, Hispanic, current smokers or with non-government issued insurance, and higher OOPC were more likely to incur unpaid debt.
Deep mutational scans across receptor-binding domains (RBDs) of diverging SARS-CoV-2 variants reveal ongoing changes to the effects of mutations, a phenomenon known as epistasis. Careful accounting for these altered mutational effects is important in viral surveillance and forecasting, and more broadly, for understanding the impacts of epistasis on real-world viral evolutionary trajectories. Using a yeast-display RBD deep mutational scanning (DMS) platform, we measure the impacts of virtually all single amino acid mutations and single-residue deletions in the Omicron KP.3.1.1 and LP.8.1 RBDs on folded RBD expression and binding affinity for the human ACE2 receptor. Our comprehensive maps reveal patterns of evolutionary accessibility and constraint at single-residue resolution and, when compared to prior datasets, highlight sites whose amino acid preferences continue to change across viral variants. Notably, sites 455, 456, and 493 - which have exhibited repeated substitutions and epistatic dependencies across Omicron subvariants going back to BA.1 - again demonstrate altered patterns of mutational accessibility and constraint. Therefore, it appears that these hotspots of repeated RBD evolution have not yet converged on fixed amino acid solutions but instead remain sites of ongoing epistatic reconfiguration. We compare our measurements of direct RBD:ACE2 affinity with recently published measurements of mutation impacts on ACE2 binding in the full quaternary spike context, which also integrates the effects of spike conformational dynamics; our analysis uncovers mutations like H505W that could favor adoption of the down/closed RBD conformation as a viral strategy for future antigenic evolution.
To address the gap between global sustainability commitments and action, piecemeal solutions targeting singular impacts fall short. Interventions remain fragmented across sectors and frequently prioritize downstream remediation over upstream prevention. Emphasizing the pressing importance of moving toward more systemic approaches, this paper introduces an integrated sustainability hierarchy framework. Reviewing existing hierarchies on waste, climate change, biodiversity, and more, we provide a cross-domain compass that transcends siloed debates and enables systematic development of policy agendas, impact-oriented financial portfolios, and assessment of interventions. Using the ongoing Global Plastics Treaty negotiations as an illustration, we demonstrate the value of the sustainability hierarchy for multi-dimensional sustainability challenges, going beyond existing domain-specific hierarchies. The framework contributes a practical and theoretically grounded tool for advancing systemic sustainability under conditions of accelerating socio-ecological risk and political backsliding.
Occupational therapists in the Australian context provide significant value to mental health, including through Better Access, a Medicare initiative that gives individuals access to up to 10 sessions with a psychologist, social worker, or occupational therapist following a referral from a medical practitioner. However, the experiences of occupational therapists working under the initiative are not widely understood, with no recent occupational therapy-specific research. This study aims to explore the experiences of occupational therapists working under Better Access, their distinct role, and how the system shapes the care clients receive. The study used a qualitative, inductive approach. Thirteen occupational therapists who work with people funded by Better Access participated in 30-minute, semi-structured interviews. Data were analysed via thematic analysis. The lead researcher for this study has lived experience of mental illness and Better Access, but further consumer and community involvement was not undertaken. Analysis generated themes highlighting the complexity of occupational therapy practice within a psychology-centric system. Participants described how occupational therapists drew on specialised skills to support clients with complex needs, yet worked within structural constraints such as restrictive practice rules, session caps, and limited remuneration. Themes also reflected the undervaluation of occupational therapy and the need for ongoing advocacy to ensure equitable access to services, appropriate funding, and recognition of the profession's contribution. The design of Better Access restricts the ability of occupational therapists to provide meaningful and sustainable occupational therapy services. Findings provide further evidence that longstanding issues identified in early research have persisted and that the burden occupational therapists face of consistently advocating for the profession and their clients is symptomatic of broader structural inequities. Findings highlight the need for systemic reform. This study looked at the experiences of occupational therapists working under the Better Access initiative. Better Access is a program that helps people with mental health concerns see professionals like psychologists, social workers, and occupational therapists. Whereas there is a lot of research about psychology in Better Access, there is very little about occupational therapy. We wanted to understand what occupational therapists do in this program and how the system affects the care people receive. We interviewed 13 occupational therapists about their work under Better Access. They told us that occupational therapists are skilled at helping people with complex needs. However, Better Access is not designed for this type of care. The program focusses more on psychology, which limits how occupational therapists can use their own approaches. Many referrers do not know that occupational therapy is an option, that the program offers only 10 sessions, or that the payment for occupational therapy is much lower than for psychology. These factors make it hard for occupational therapists to provide recovery‐focussed, practical support and to keep their practices going. These issues mean that clients often cannot get the occupational therapy care they need. Changes are needed to make the system fairer and more effective. These could include raising awareness of occupational therapy, allowing greater flexibility in care, and increasing payments to align with psychology. Our study was small and did not include doctors or clients, which is a limitation. Still, it helps show the challenges occupational therapists face and why Better Access needs reform.
Going-to-sleep position from 28 weeks' gestation has been identified as a modifiable risk factor for stillbirth. This study assessed awareness of, and barriers to, adopting advised maternal sleep positions in Ireland. A national online survey was conducted in September 2024 across the Republic of Ireland among women who had given birth beyond 28 weeks' gestation in the previous two years. A total of 769 responses were analysed using descriptive statistics, chi-square tests, and logistic regression. Findings were interpreted using the Capability, Opportunity, Motivation-Behaviour (COM-B) framework. Most respondents reported an advised going-to-sleep position in the third trimester (85%, n = 645) and recognised advised positions when asked about third-trimester recommendations (90.4%, n = 628). While 73% believed following recommendations benefited the baby, only 60% linked recommendations to stillbirth prevention, and reported that stillbirth risk was rarely mentioned by healthcare professionals. Employment predicted accurate knowledge of recommended sleep position (OR=2.54, p = .011), while having received information about sleep position approached significance (OR=1.61, p = .054). Key predictors of adopting an advised sleep position included accurate knowledge (OR=4.22, p < .001), good sleep quality (OR=2.87, p < .001), and bed-sharing (OR=2.49, p = .019). Citing "it was better for the baby" as a reason to choose a sleep position in the third trimester increased the likelihood of adopting an advised position (OR=2.69, p < .001), whereas citing reflux relief as the reason, reduced it (OR=0.14, p < .001). Findings highlight gaps in stillbirth prevention awareness and missed opportunities for antenatal education in Ireland. Clear, consistent messaging and COM-B-informed behavioural approaches may improve adherence to advised sleep position recommendations.
Influenza B virus (IBV) is a significant contributor to annual and severe cases of influenza, particularly in the young and elderly. Late in the 2024-25 Northern Hemisphere influenza season, a surge of IBV cases was identified in the Johns Hopkins Hospital Systems. The IBV responsible for the surge, C.3.1/re, was a clade C.3 virus that had reassorted with clade C.5.1 viruses and acquired the D197N mutation in hemagglutinin, restoring a putative N-linked glycan predicted to mask a key neutralizing antibody epitope. The C.3.1/re viruses preferentially infected children but showed no significant change in disease severity. C.3.1/re viruses were poorly neutralized by pre- and post-influenza vaccination serum in a human cohort. The removal of the glycan at residue 197 restored neutralizing antibody recognition. The C.3.1/re IBV genotype that emerged late in the 2024-25 influenza season was antigenically mismatched with IBV vaccine strains for the 2025 and 2026 Southern hemisphere, as well as the 2025-26 Northern Hemisphere influenza seasons. While the 2026-27 Northern Hemisphere vaccine strain is a C.3.1/re, the egg-adapted isolate selected (B/Tokyo/EIS13-175/2025) lacks the 197 glycosylation which is predicted to have poor recognition with circulating IBV clades. Phylogenetic analysis of currently circulating IBVs shows a diversification of circulating C.3 clades with multiple reassortment events between C.3 and C.5 clades in addition to independent acquisitions of D197N mutations, suggesting IBV is going through a period of significant antigenic and genetic expansion.IMPORTANCEInfluenza B viruses are undergoing a period of antigenic and genetic expansion, with several reassorted viruses emerging that also contain point mutations in key hemagglutinin antigenic sites proximal to the receptor binding domain. This has important impacts on vaccine strain choice, as only one IBV component is included in current influenza vaccines. We demonstrate a significant shift in the demographics of IBV-infected individuals with the emergence of the antigenically drifted and reassorted IBV C.3.1/re. Furthermore, we show that 197 glycosylation of hemagglutinin is critical for C.3.1/re antigenic drift, and we document several emergent C.3 reassortments encoding the D197N mutation. With the IBV vaccine component for the Northern Hemisphere 2026-27 season having lost a key N-linked glycan on the hemagglutinin protein, and multiple independent emergences of antigenically drifted and reassorted viruses, attention to IBV infections should be increased in the upcoming Southern and Northern hemisphere influenza seasons.