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Advanced urothelial cancer is a frequently lethal disease characterized by marked genetic heterogeneity1. In this study, we investigated the evolution of genomic signatures caused by endogenous and external mutagenic processes and their interplay with complex structural variants (SVs). We superimposed mutational signatures and phylogenetic analyses of matched serial tumours from patients with urothelial cancer to define the evolutionary dynamics of these processes. We show that APOBEC3-induced mutations are clonal and early, whereas chemotherapy induces mutational bursts of hundreds of late subclonal mutations. Using a genome graph computational tool2, we observed frequent high copy-number circular amplicons characteristic of extrachromosomal DNA (ecDNA)-forming SVs. We characterized the distinct temporal patterns of APOBEC3-induced and chemotherapy-induced mutations within ecDNA-forming SVs, gaining new insights into the timing of these mutagenic processes relative to ecDNA biogenesis. We discovered that most CCND1amplifications in urothelial cancer arise within circular ecDNA-forming SVs. ecDNA-forming SVs persisted and increased in complexity, incorporating additional DNA segments and contributing to the evolution of treatment resistance. Oxford Nanopore Technologies long-read whole-genome sequencing followed by de novo assembly mapped out CCND1ecDNA structure. Experimental modelling of CCND1ecDNA confirmed its role as a driver of treatment resistance. Our findings define fundamental mechanisms that drive urothelial cancer evolution and have important therapeutic implications.

Respiratory syncytial virus vaccines first recommended for use during 2023 were efficacious against lower respiratory tract disease in clinical trials. Limited real-world data regarding respiratory syncytial virus vaccine effectiveness are available. To inform vaccine policy and address gaps in evidence from the clinical trials, we aimed to assess the effectiveness against respiratory syncytial virus-associated hospitalisations and emergency department encounters among adults aged at least 60 years.

The US Kidney Allocation System (KAS) prioritizes candidates with a≤20% estimated posttransplant survival (EPTS) to receive high-longevity kidneys defined by a≤20% Kidney Donor Profile Index (KDPI). Use of EPTS in the KAS deprioritizes candidates with older age, diabetes, and longer dialysis durations. We assessed whether this use also disadvantages race and ethnicity minority candidates, who are younger but more likely to have diabetes and longer durations of kidney failure requiring dialysis.

Proximity-enhanced chemical cross-linking is an invaluable tool for probing protein–protein interactions and enhancing the potency of potential peptide and protein drugs. Here, we extend this approach to covalently stabilize large macromolecular assemblies. We used SuFEx chemistry to covalently stabilize an 18-subunit pore-forming complex, CsgG:CsgF, consisting of nine CsgG membrane protein subunits that noncovalently associate with nine CsgF peptides. Derivatives of the CsgG:CsgF pore have been used for DNA sequencing, which places high demands on the structural stability and homogeneity of the complex. To increase the robustness of the pore, we designed and synthesized derivatives of CsgF-bearing sulfonyl fluorides, which react with CsgG in very high yield to form a covalently stabilized CsgG:CsgF complex. The resulting pores formed highly homogeneous channels when added to artificial membranes. The high yield and rapid reaction rate of the SuFEx reaction prompted molecular dynamics simulations, which revealed that the SO2F groups in the initially formed complex are poised for nucleophilic reaction with a targeted Tyr. These results demonstrate the utility of SuFEx chemistry to structurally stabilize very large (here, 280 kDa) assemblies.

Giant cell arteritis (GCA) is characterized by granulomatous inflammation of the medium‐ and large‐sized arteries accompanied by remodeling of the vessel wall. Fibroblast activation protein alpha (FAP) is a serine protease that promotes both inflammation and fibrosis. Here, we investigated the plasma levels and vascular expression of FAP in GCA. Plasma FAP levels were measured with enzyme‐linked immunosorbent assay in treatment‐naive patients with GCA (n = 60) and polymyalgia rheumatica (PMR) (n = 63) compared with age‐ and sex‐matched healthy controls (HCs) (n = 42) and during follow‐up, including treatment‐free remission (TFR). Inflamed temporal artery biopsies (TABs) of patients with GCA (n = 9), noninflamed TABs (n = 14), and aorta samples from GCA‐related (n = 9) and atherosclerosis‐related aneurysm (n = 11) were stained for FAP using immunohistochemistry. Immunofluorescence staining was performed for fibroblasts (CD90), macrophages (CD68/CD206/folate receptor beta), vascular smooth muscle cells (desmin), myofibroblasts (α‐smooth muscle actin), interleukin‐6 (IL‐6), and matrix metalloproteinase‐9 (MMP‐9). Baseline plasma FAP levels were significantly lower in patients with GCA compared with patients with PMR and HCs and inversely correlated with systemic markers of inflammation and angiogenesis. FAP levels decreased even further at 3 months on remission in patients with GCA and gradually increased to the level of HCs in TFR. FAP expression was increased in inflamed TABs and aorta of patients with GCA compared with control tissues. FAP was abundantly expressed in fibroblasts and macrophages. Some of the FAP+fibroblasts expressed IL‐6 and MMP‐9. FAP expression in GCA is clearly modulated both in plasma and in vessels. FAP may be involved in the inflammatory and remodeling processes in GCA and have utility as a target for imaging and therapeutic intervention.

The progressive growth of the hospitalist model of practice over the past 20 years has solidified the role of the obstetrics and gynecology (ob/gyn) hospitalists as an essential component of quality inpatient care. The ob/gyn hospitalist as an educator is proving to be an important role in the future of hospitalist practice. The role as an educator has long-term benefits and implications for the standardization of education and evidence-based patient care both in community-based and academic practice settings.

Subclinical, device-detected atrial fibrillation (AF) is frequently recorded by pacemakers and other implanted cardiac rhythm devices. Patients with device-detected AF have an elevated risk of stroke, but a lower risk of stroke than similar patients with clinical AF captured with surface electrocardiogram. Two randomized clinical trials (NOAH-AFNET 6 and ARTESiA) have tested a direct oral anticoagulant (DOAC) against aspirin or placebo. A study-level meta-analysis of the two trials found that treatment with a DOAC resulted in a 32% reduction in ischaemic stroke and a 62% increase in major bleeding; the results of the two trials were consistent. The annualized rate of stroke in the control arms was ∼1%. Several factors point towards overall net benefit from DOAC treatment for patients with device-detected AF. Strokes in ARTESiA were frequently fatal or disabling and bleeds were rarely lethal. The higher absolute rates of major bleeding compared with ischaemic stroke while on treatment with a DOAC in the two trials are consistent with the ratio of bleeds to strokes seen in the pivotal DOAC vs. warfarin trials in patients with clinical AF. Prior research has concluded that patients place a higher emphasis on stroke prevention than on bleeding. Further research is needed to identify the characteristics that will help identify patients with device-detected AF who will receive the greatest benefit from DOAC treatment.

Background: The purpose of this study was to (1) evaluate the rates of postoperative complications following ankle or hindfoot arthrodesis among current smokeless tobacco users and people who smoke compared to matched controls, and (2) compare rates of postoperative complications in current smokeless tobacco users vs people who smoke tobacco cigarettes.Methods: A retrospective cohort study was conducted using a large national database. For patients who underwent ankle or hindfoot arthrodesis, smokeless tobacco users (n = 131) and people who smoke (n = 1948) were matched 1:4 with controls, and smokeless tobacco users (n = 131) were matched 1:4 with people who smoke tobacco cigarettes (n = 524). Orthopaedic complications within 90 days, 1 year, and 2 years were compared using multivariable logistic regressions.Results: Within 90 days of ankle or hindfoot arthrodesis, smokeless tobacco users demonstrated significantly higher rates of hardware removal (odds ratio [OR] 5.01, 95% CI 1.65-15.20), wound disruption or dehiscence (OR 3.00, 95% CI 1.21-7.44), and pooled complications (16.0% vs 5.9%, OR 2.84, 95% CI 1.50-5.38) compared with tobacco-naïve controls. The rates of hardware removal, wound disruption and dehiscence, and pooled complications remained significant in the smokeless tobacco cohort at 1 and 2 years. At 2 years following ankle or hindfoot arthrodesis, smokeless tobacco users additionally demonstrated significantly higher rates of infection (OR 6.08, 95% CI 1.15-32.05) and nonunion (OR 2.35, 95% CI 1.31-4.20) compared with tobacco-naïve controls. Within 90 days of ankle or hindfoot arthrodesis, smokeless tobacco users demonstrated significantly lower rates of malunion or nonunion than patients who smoke tobacco cigarettes (OR 0.34, 95% CI 0.12-0.97), whereas all other complications were not significantly different.Conclusion: Smokeless tobacco use is associated with higher rates of complications following ankle or hindfoot arthrodesis compared with tobacco-naïve controls, and physicians should screen for smokeless tobacco use specifically and encourage cessation before operating electively.Level of Evidence: Level III, retrospective cohort study.

Background and study aims: Endoscopic ultrasound-guided gastrojejunostomy (EUS-GJ) has been well utilized in treating malignant gastric outlet obstructions (GOO) given its efficacy and lower risk profile compared to surgery. However, its efficacy and potential for use in patients with benign GOO who are poor surgical candidates is not well documented. The aim of this study was to examine the role of EUS-GJ in treatment of benign GOO in select patients. Patients and methods: This is a single-center, open-label, retrospective descriptive study that included all consecutive patients undergoing EUS-GJ to treat benign causes of GOO. Direct antegrade and direct retrograde methods were utilized. Results: A total of 18 patients were included, 38.9% female with an average age of 63.3 years. Extrinsic GOO was present in (10 of 18) 55.5% of patients and intrinsic etiology was present in (8 of 18) 45.5% of patients. Technical success was achieved in 100% (18 of 18) patients and clinical success was achieved in 94% (17 of 18) patients. In total, 13 patients had follow-up endoscopy, 2 patients were treated relatively recently in time, 1 patient was lost to follow-up, and 2 patients died of other chronic illnesses. Stents remained in place for a median of 286 days (range 88–1444 days). In patients whose stents were removed, 75% (3 of 4) had extrinsic etiologies of GOO. Conclusions: This study reports a favorable long-term patency with excellent technical and clinical success of EUS-GJ in patients with benign GOO. Despite the limitations of sample size and retrospective nature, it adds to the extremely limited literature of EUS-GJ in management of patients with benign GOO. Graphical abstract:

Abstract:Most modern biographies of Dickens refer to his first major assignment for the Morning Chronicle: a trip to Edinburgh to report on a Festival in honor of Lord Grey. The visit has become celebrated by the inclusion, in the resulting newspaper copy, of a 238-word passage which, it has been remarked, "would not have been out of place in one of Boz's Monthly tales" (Slater 43). The present paper considers the fiercely bipartisan political atmosphere at the time, its expression in the contemporary press, and the impact on it of the famous passage. It is suggested that a jokey contemporary comment on the passage represents the earliest recovered quasi-personification of Dickens's authorial presence.

The safety and efficacy of sofosbuvir–velpatasvir in children aged 3–17 years with chronic hepatitis C virus (HCV) infection of any genotype were evaluated. In this Phase 2, multicenter, open‐label study, patients received once daily for 12 weeks either sofosbuvir–velpatasvir 400/100 mg tablet (12–17 years), 200/50 mg low dose tablet or oral granules (3–11 years and ≥17 kg), or 150/37.5 mg oral granules (3–5 years and <17 kg). The efficacy endpoint was sustained virologic response 12 weeks after therapy (SVR12). Dose appropriateness was confirmed by intensive pharmacokinetics in each age group. Among 216 patients treated, 76% had HCV genotype 1% and 12% had genotype 3. Rates of SVR12 were 83% (34/41) among 3–5‐year‐olds, 93% (68/73) among 6–11‐year‐olds, and 95% (97/102) among 12–17‐year‐olds. Only two patients experienced virologic failure. The most common adverse events were headache, fatigue, and nausea in 12–17‐year‐olds; vomiting, cough, and headache in 6–11‐year‐olds; and vomiting in 3–5‐year‐olds. Three patients discontinued treatment because of adverse events. Four patients had serious adverse events; all except auditory hallucination (n= 1) were considered unrelated to study drug. Exposures of sofosbuvir, its metabolite GS‐331007, and velpatasvir were comparable to those in adults in prior Phase 2/3 studies. Population pharmacokinetic simulations supported weight‐based dosing for children in this age range. The pangenotypic regimen of sofosbuvir–velpatasvir is highly effective and safe in treating children 3–17 years with chronic HCV infection. For treating chronic hepatitis C virus (HCV) infection, the combination antiviral regimen sofosbuvir–velpatasvir is highly effective in treating adults with any HCV genotype.In children, the safety, efficacy, and pharmacokinetics of sofosbuvir–velpatasvir had not been evaluated. For treating chronic hepatitis C virus (HCV) infection, the combination antiviral regimen sofosbuvir–velpatasvir is highly effective in treating adults with any HCV genotype. In children, the safety, efficacy, and pharmacokinetics of sofosbuvir–velpatasvir had not been evaluated. In 216 children aged 3–17 years with chronic HCV infection, sofosbuvir–velpatasvir given once daily for 12 weeks had a cure rate of 92%.Rates of cure were 95% among 12–17‐year‐olds (97/102), 93% in 6–11‐year‐olds (68/73), and 83% in 3–5‐year‐olds (34/41).Overall, sofosbuvir–velpatasvir was well tolerated in both tablet and granule formulations; 1.4% (3/216) of participants discontinued because of an adverse event. Pharmacokinetic simulations supported weight‐based dosing for children. In 216 children aged 3–17 years with chronic HCV infection, sofosbuvir–velpatasvir given once daily for 12 weeks had a cure rate of 92%. Rates of cure were 95% among 12–17‐year‐olds (97/102), 93% in 6–11‐year‐olds (68/73), and 83% in 3–5‐year‐olds (34/41). Overall, sofosbuvir–velpatasvir was well tolerated in both tablet and granule formulations; 1.4% (3/216) of participants discontinued because of an adverse event. Pharmacokinetic simulations supported weight‐based dosing for children.

Bermudagrass (Cynodon dactylon(L.) Pers.) is one of the primary perennial forages in the southeastern USA. Newer hybrid cultivars have superior production and nutritive value compared to common ecotypes. However, there are many challenges facing bermudagrass production in the region. First, the bermudagrass stem maggot (BSM; Atherigona reversuraVilleneuve) has severely damaged bermudagrass throughout the region. Strategically timed pyrethroid applications significantly reduce adult BSM populations, but efforts are needed to develop integrated pest management plans. Second, an increasing number of producers are noting challenges with green‐up following winter dormancy. This may be attributed to disease, unbalanced soil fertility, and weed pressure. Perhaps one of the most limiting factors for continued production is the deficit of sprigs and trained personnel to sprig hybrid bermudagrasses. This research is critically important as the need for cold‐tolerant bermudagrass is increasing as tall fescue (Lolium arundinaceum(Schreb.) S. J. Darbyshire) is declining due to changes in temperature and precipitation throughout the northern parts of the region. Plant breeders are investigating hybrid bermudagrass at latitudes >35° with respect to freeze or cold tolerance. Despite the many challenges facing hybrid bermudagrass in the southeastern USA, researchers are working to ensure its persistence, productivity, and availability for the future. The bermudagrass stem maggot is one of the most persistent pests in the southeastern USA. The damage is evident by chlorosis of the top two to three leaves of the pseudostem. Fine stem cultivars (left) are more susceptible than coarse stem cultivars (right).

IMPORTANCE: Catheter ablation is associated with reduced heart failure (HF) hospitalization and death in select patients with atrial fibrillation (AF) and heart failure with reduced ejection fraction (HFrEF). However, the benefit in patients with HF with preserved ejection fraction (HFpEF) is uncertain. OBJECTIVE: To investigate whether catheter ablation for AF is associated with reduced HF-related outcomes according to HF phenotype. DATA SOURCE: A systematic search of MEDLINE, Embase, and Cochrane Central was conducted among studies published from inception to September 2023. STUDY SELECTION: Parallel-group randomized clinical trials (RCTs) comparing catheter ablation with conventional rate or rhythm control therapies in patients with HF, New York Heart Association functional class II or greater, and a history of paroxysmal or persistent AF were included. Pairs of independent reviewers screened 7531 titles and abstracts, of which 12 RCTs and 4 substudies met selection criteria. DATA EXTRACTION AND SYNTHESIS: Data were abstracted in duplicate according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline. Pooled effect estimates were calculated using random-effects Mantel-Haenszel models. Interaction P values were used to test for subgroup differences. MAIN OUTCOMES AND MEASURES: The primary outcome was HF events, defined as HF hospitalization, clinically significant worsening of HF, or unscheduled visits to a clinician for treatment intensification. Secondary outcomes included cardiovascular and all-cause mortality. RESULTS: A total of 12 RCTs with 2465 participants (mean [SD] age, 65.3 [9.7] years; 658 females [26.7%]) were included; there were 1552 participants with HFrEF and 913 participants with HFpEF. Compared with conventional rate or rhythm control, catheter ablation was associated with reduced risk of HF events in HFrEF (risk ratio [RR], 0.59; 95% CI, 0.48-0.72), while there was no benefit in patients with HFpEF (RR, 0.93; 95% CI, 0.65-1.32) (P for interaction = .03). Catheter ablation was associated with reduced risk of cardiovascular death compared with conventional therapies in HFrEF (RR, 0.49; 95% CI, 0.34-0.70) but a differential association was not detected in HFpEF (RR, 0.91; 95% CI, 0.46-1.79) (P for interaction = .12). Similarly, no difference in the association of catheter ablation with all-cause mortality was found between HFrEF (RR vs conventional therapies, 0.63; 95% CI, 0.47-0.86) and HFpEF (RR vs conventional therapies, 0.95; 95% CI, 0.39-2.30) groups (P for interaction = .39). CONCLUSIONS AND RELEVANCE: This study found that catheter ablation for AF was associated with reduced risk of HF events in patients with HFrEF but had limited or no benefit in HFpEF. Results from ongoing trials may further elucidate the role of catheter ablation for AF in HFpEF.

Asteroids with diameters less than about 5 km have complex histories because they are small enough for radiative torques (that is, YORP, short for the Yarkovsky–O’Keefe–Radzievskii–Paddack effect)1to be a notable factor in their evolution2. (152830) Dinkinesh is a small asteroid orbiting the Sun near the inner edge of the main asteroid belt with a heliocentric semimajor axis of 2.19 au; its S-type spectrum3,4is typical of bodies in this part of the main belt5. Here we report observations by the Lucy spacecraft6,7as it passed within 431 km of Dinkinesh. Lucy revealed Dinkinesh, which has an effective diameter of only 720 m, to be unexpectedly complex. Of particular note is the presence of a prominent longitudinal trough overlain by a substantial equatorial ridge and the discovery of the first confirmed contact binary satellite, now named (152830) Dinkinesh I Selam. Selam consists of two near-equal-sized lobes with diameters of 210 m and 230 m. It orbits Dinkinesh at a distance of 3.1 km with an orbital period of about 52.7 h and is tidally locked. The dynamical state, angular momentum and geomorphologic observations of the system lead us to infer that the ridge and trough of Dinkinesh are probably the result of mass failure resulting from spin-up by YORP followed by the partial reaccretion of the shed material. Selam probably accreted from material shed by this event.

Roads are expanding at the fastest pace in human history. This is the case especially in biodiversity-rich tropical nations, where roads can result in forest loss and fragmentation, wildfires, illicit land invasions and negative societal effects1–5. Many roads are being constructed illegally or informally and do not appear on any existing road map6–10; the toll of such ‘ghost roads’ on ecosystems is poorly understood. Here we use around 7,000 h of effort by trained volunteers to map ghost roads across the tropical Asia-Pacific region, sampling 1.42 million plots, each 1 km2in area. Our intensive sampling revealed a total of 1.37 million km of roads in our plots—from 3.0 to 6.6 times more roads than were found in leading datasets of roads globally. Across our study area, road building almost always preceded local forest loss, and road density was by far the strongest correlate11of deforestation out of 38 potential biophysical and socioeconomic covariates. The relationship between road density and forest loss was nonlinear, with deforestation peaking soon after roads penetrate a landscape and then declining as roads multiply and remaining accessible forests largely disappear. Notably, after controlling for lower road density inside protected areas, we found that protected areas had only modest additional effects on preventing forest loss, implying that their most vital conservation function is limiting roads and road-related environmental disruption. Collectively, our findings suggest that burgeoning, poorly studied ghost roads are among the gravest of all direct threats to tropical forests.

Sweet corn (Zea maysL.) cultivars must meet stringent quality standards to be accepted in the marketplace. Breeding for eating‐quality traits, such as sweetness, typically involves taste ratings or quantification of carbohydrate content. Total soluble solids (TSS) content is used as a proxy for sweetness in many fruit crops. Using a diallel of near‐isogenic corn lines for sugary1, shrunken2, waxy1, and wild‐type (WT) endosperm types, a combining ability analysis for carbohydrate traits and TSS content determined the relationship of these traits over three harvest dates. Variation existed for total sugar, sucrose, glucose, fructose, total polysaccharides, and starch content within and across endosperm types and harvest dates, but strong correlations with TSS content were present only when assessed across all endosperm types. Strong similarities existed among WT, waxy1, and sugary1near‐isogenic lines for general combining ability for carbohydrate traits, while shrunken2near‐isogenic lines had different desirable combiners. Line C40 was a desirable general combiner for carbohydrate traits among WT, waxy1, and sugary1endosperm types, while Ia5125, P39, and Ia453 were desirable general combiners for shrunken2endosperm. This experiment also determined that TSS content is not a useful trait in sweet corn breeding for quality traits. Variation existed for carbohydrate traits among hybrids within and across endosperm types and harvest dates.Variation existed for total soluble solids (TSS) content across endosperm types and for hybrids within an endosperm type.TSS differed between 19 and 22 or 25 days after pollination for su1, sh2, and wx1endosperm.TSS content correlates with soluble carbohydrates only when assessed across all endosperm types.Wild‐type, wx1, and su1near‐isogenic lines exhibit strong similarities for carbohydrate trait general combining ability.

‘Coastcross II’ (CC II; Reg. no. CV‐49, PI 673409) forage bermudagrass (Cynodonsp.) was released as an associate cultivar in Georgia in July 2014. Coastcross II originated from gamma‐ray irradiation of sprigs of Coastcross I (CC I) in 1971. After irradiation, greater than a half million sprigs were planted in north Georgia (Blairsville), where CC II was one of four surviving plants after winter freezes. Subsequent testing has shown that CC II has superior yields to CC I and is comparable to ‘Tifton 85’. Coastcross II also has significantly higher tolerance to bermudagrass stem maggot than fine‐stemmed cultivars. Coastcross II has significantly finer stems than Tifton 85, which makes it more conducive to hay production. CC II has higher in vitro dry matter digestibility than Coastal and is similar to Tifton 85.CC II has better spring vigor than CC I.CC II has similar yields to Tifton 85.CC II has thinner stems than Tifton 85 for easier hay dry‐down times.CC II has a higher tolerance to the bermudagrass stem maggot than four released forage bermudagrass cultivars.

Background: The purpose of this study was to characterize the prevalence of venous thromboembolism (VTE; including deep vein thrombosis [DVT] and pulmonary embolism [PE]) after sports medicine knee procedures by a single surgeon at an academic institution, identify factors associated with increased risk of VTE, and determine risk factor thresholds for beyond which VTE risk is elevated.Hypothesis: We hypothesized that the prevalence of VTE after sports medicine knee procedures is low, but that increasing weight and body mass index (BMI) would be associated with elevated risk.Study Design: Retrospective case-control study.Level of Evidence: Level 3.Methods: A retrospective case-control study analyzing sports medicine knee surgeries from 2017 to 2020 was conducted using current procedural terminology codes to identify cases. Optimal cutoff points for specific continuous patient characteristics were calculated to determine elevated risk of postoperative VTE. Overall VTE-free survival was assessed using Kaplan-Meier analysis and Cox proportional hazard regression models.Results: Among the 724 eligible patients, there were 13 postoperative VTE events (1.79% prevalence; 12 DVTs, 1 DVT/PE). Increasing weight and BMI were significant risk factors for postoperative VTE (P= 0.03 and P= 0.04, respectively), with weight >94.7 kg and BMI >27.9 kg/m2associated with elevated risk in male patients and weight >79.1 kg and BMI >28.1 kg/m2associated with elevated risk for female patients. Cox regression demonstrated a significantly increased risk of postoperative VTE for male patients with BMI ≥27.9 kg/m2.Conclusion: Patients who undergo sports medicine knee surgery with increased weight and BMI are at an elevated risk of postoperative VTE. An individualized approach should be considered for chemoprophylaxis in patients with these risk factors.Clinical Relevance: Consider chemoprophylaxis in patients with increased weight and BMI who undergo sports medicine knee surgery since they are at an elevated risk of postoperative VTE.

AbstractThis essay addresses personal and professional values underlying (but not necessarily consciously articulated) how we practice and what we define as healthy outcomes for our efforts as transactional analysts. It is an invitation to consider the importance of a professional culture of curiosity and respect, one that can welcome and make use of difference and conflict, stressing the need for the elaboration of theories and values that actively attend to social and political forces that shape beliefs and behaviors. Central to this essay is a critique of the incorporation of “I’m OK, You’re OK” as a central value of transactional analysis.

Sociodemographic disparities in physician decisions to withhold and withdraw life-sustaining treatment exist. Little is known about the content of hospital policies that guide physicians involved in these decisions.