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Chin Moi Chow,1,2 Mirim Shin,2 Trevor J Mahar,3 Mark Halaki,1,2 Angus Ireland31Charles Perkins Centre, University of Sydney, Sydney, NSW, Australia; 2Exercise, Heath & Performance Research Group, Faculty of Health Sciences, University of Sydney, Sydney, NSW, Australia; 3Australian Wool Innovation Limited, The Woolmark Company, Sydney, NSW, AustraliaCorrespondence: Chin Moi ChowDiscipline of Exercise and Sport Science, The University of Sydney, 75 East street, Lidcombe, NSW 2141, AustraliaTel +61 2 9351 9332Email chin-moi.chow@sydney.edu.auBackground: Sleep disturbance in adults with no health concerns is often linked to the thermal environment. This study assesses the impact on sleep quality of sleepwear made from fibers with different thermal insulation and hygral properties. This randomized cross-over study investigated the effects on sleep quality of sleepwear made from cotton, polyester and Merino wool in adults aged 50–70 years, at an ambient temperature of 30 °C and a relative humidity of 50%.Methods: Thirty-six healthy participants completed four nights of sleep study with polysomnography. Participants were categorized by body mass index as

Chin Moi Chow,1 Shi Ngar Wong,1 Mirim Shin,1 Rebecca G Maddox,2 Kristy-Lee Feilds,3 Karen Paxton,4 Catherine Hawke,4 Philip Hazell,3 Katharine Steinbeck5 1Discipline of Exercise and Sport Science, Faculty of Health Sciences, 2Sydney Medical School, 3Discipline of Psychiatry, 4School of Rural Health, 5Discipline of Paediatrics and Child Health, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia Abstract: Actigraphy is increasingly used for sleep monitoring. However, there is a lack of standardized methodology for data processing and analysis, which often makes between study comparisons difficult, if not impossible, and thus open to flawed interpretation. This study evaluated a manual method for detection of the rest interval in actigraph data collected with Actiwatch 2. The rest interval (time in bed), defined as the bedtime and rise time and set by proprietary software, is an essential requirement for the estimation of sleep indices. This study manually and systematically detected the rest interval of 187 nights of recording from seven healthy males and three females, aged 13.5±0.7 (mean ± standard deviation) years. Data were analyzed for agreement between software default algorithm and manual scoring. Inter-rater reliability in manual scoring was also tested between two scorers. Data showed consistency between default settings and manual scorers for bedtime and rise time, but only moderate agreement for the rest interval duration and poor agreement for activity level at bedtime and rise time. Manual detection of rest intervals between scorers showed a high degree of agreement for all parameters (intraclass correlations range 0.864 to 0.995). The findings demonstrate that the default algorithm on occasions was unable to detect rest intervals or set the exact interval. Participant issues and inter-scorer issues also made difficult the detection of rest intervals. These findings have led to a manual detection protocol to define bedtime and rise time, supplemented with an event diary. Keywords: actigraph recording, activity level, light level

Mirim Shin,1 Mark Halaki,1 Paul Swan,2 Angus Ireland,2 Chin Moi Chow1 1Exercise, Health and Performance Research Group, Faculty of Health Sciences, The University of Sydney, Lidcombe, 2Australian Wool Innovation Limited, The Woolmark Company, Sydney, NSW, Australia Abstract: The fibers used in clothing and bedding have different thermal properties. This study aimed to investigate the influences of textile fabrics on sleep under different ambient temperature (Ta) conditions. Seventeen healthy young participants (ten males) underwent nine nights of polysomnography testing including an adaptation night. Participants were randomized to each of the three binary factors: sleepwear (cotton vs wool), bedding (polyester vs wool), and Ta (17°C vs 22°C with relative humidity set at 60%). Skin temperature (Tsk) and core temperature (Tc) were monitored throughout the sleep period. Sleep onset latency (SOL) was significantly shortened when sleeping in wool with trends of increased total sleep time and sleep efficiency compared to cotton sleepwear. At 17°C, the proportion of sleep stages 1 (%N1) and 3 (%N3) and rapid eye movement sleep was higher, but %N2 was lower than at 22°C. Interaction effects (sleepwear × Ta) showed a significantly shorter SOL for wool than cotton at 17°C but lower %N3 for wool than cotton at 22°C. A significantly lower %N2 but higher %N3 was observed for wool at 17°C than at 22°C. There was no bedding effect on sleep. Several temperature variables predicted the sleep findings in a stepwise multiple regression analysis and explained 67.8% of the variance in SOL and to a lesser degree the %N2 and %N3. These findings suggest that sleepwear played a contributory role to sleep outcomes and participants slept better at 17°C than at 22°C.Keywords: cotton, polyester, wool, polysomnography, skin temperature, core body temperature

Shi Ngar Wong, Mark Halaki, Chin Moi ChowDiscipline of Exercise and Sport Science, University of Sydney, Sydney, NSW, AustraliaAbstract: The sleep–wake cycle is a process not only dictated by homeostatic and circadian factors but also by social and environmental influences. Thus, the total sleep time partly reflects sleep need, which is integral to the dynamics of sleep loss recovery. This study explored the nature of the observed oscillations in total sleep time in healthy adults under spontaneous living conditions. Actigraph-measured sleep data for 13 healthy young male adults were collected over 14 consecutive days and analyzed for habitual sleep duration. The total sleep time periodicity was modeled using the cosinor method for each individual across the 14 days. The findings confirm the existence of periodicity in habitual sleep duration as there were clear periodic patterns in the majority of the participants. Although exclusive to each individual, the observed oscillations may be a resultant response of homeostatic sleep need, circadian timing, and/or social and environmental influences. These findings instigate further indepth studies into the periodicity of sleep duration in healthy individuals to provide a better understanding of sleep need in short versus long sleepers, in predicting work performance, and reducing sleepiness-related accidents following shift work, and how this periodicity may impact sleep treatment outcome in clinical populations.Keywords: sleep regulation, homeostasis, habitual sleep, spontaneous living, healthy males

This report describes an unusual presentation and complication of extravasation of intravenous fluid in an infant who presented with a large hypopigmented skin lesion distant from the site of intravenous cannulation. The infusion was immediately discontinued and an alternate intravenous site secured. A chest radiograph revealed that the catheter was not in the external jugular vein site, and a large fluid collection was apparent over the right lateral chest wall. The hypopigmented skin lesion disappeared within 48 h, and the infant remained stable. This article serves to alert the physician to consider the extravasation of intravenous fluid as a potential cause of acute development of skin hypopigmentation in an at-risk patient. [ABSTRACT FROM AUTHOR]

The purpose of this study was to explore the effects of local unemployment rates on evidence-based supported employment (SE) programs tailored for people with psychiatric disabilities. Participants (n=1,273) from 7 states in the US were randomly assigned to experimental SE or services as usual/comparison conditions and followed for 24 months. Mixed-effects random regression analysis found that both local unemployment rate and study condition were significant predictors of competitive employment and working 40 or more hours per month. An interaction between study condition and unemployment rate was found, in which participants in areas with low unemployment receiving best practice SE had consistently better outcomes than all others. However, even in areas with high unemployment, those who received evidence-based SE had outcomes superior to those in the control condition. This confirms the influence of local labor market forces on individuals with psychiatric disabilities participating in vocational rehabilitation programs. It also suggests that those who are attempting to return to work in areas with weak local economies are likely to fare especially poorly if they are not receiving high quality SE interventions. Thus, use of evidence-based SE can help to ameliorate the effects of high unemployment on work outcomes. [ABSTRACT FROM AUTHOR]

Ipratropium bromide (0.5 mg) and fenoterol (2 mg) produced equivalent peak bronchodilatation between 1 and 2 h after administration to eight patients with chronic partially reversible airways obstruction. The duration of action compared with saline was 6 h for ipratropium and 4 h for fenoterol. Both drugs in combination produced greater bronchodilatation than either drug alone. The increase in FVC was disproportionately greater than FEV1 with both drugs and saline, suggesting relief of obstruction of small airways. [ABSTRACT FROM AUTHOR]

Aim. To examine the efficacy of a six-month Kung Fu (KF) program on physical fitness in overweight/obese adolescents. Methods. Subjects were randomly assigned to the KF or sham exercise (Tai Chi, TC) control group. Physical measurements in cardiovascular fitness and muscle fitness occurred at baseline and after 6 months of training thrice weekly. Results. Twenty subjects were recruited. One subject was lost to follow-up, although overall compliance to the training sessions was 46.7 +/- 27.8%. At follow-up, the cohort improved in absolute upper (P = .002) and lower (P = .04) body strength, and upper body muscle endurance (P = .02), without group differences. KF training resulted in significantly greater improvements in submaximal cardiovascular fitness (P = .03), lower body muscle endurance (P = .28; significant 95% CI: 0.37-2.49), and upper body muscle velocity (P = .03) relative to TC training. Conclusions. This short-term KF program improved submaximal cardiovascular fitness, lower body muscle endurance, and muscle velocity, in overweight/obese adolescents with very low baseline fitness. [ABSTRACT FROM AUTHOR]

Pseudosymmetric hetero-oligomers with three or more unique subunits with overall structural (but not sequence) symmetry play key roles in biology, and systematic approaches for generating such proteins de novo would provide new routes to controlling cell signaling and designing complex protein materials. However, the de novo design of protein hetero-oligomers with three or more distinct chains with nearly identical structures is a challenging unsolved problem because it requires the accurate design of multiple protein-protein interfaces simultaneously. Here, we describe a divide-and-conquer approach that breaks the multiple-interface design challenge into a set of more tractable symmetric single-interface redesign tasks, followed by structural recombination of the validated homo-oligomers into pseudosymmetric hetero-oligomers. Starting from de novo designed circular homo-oligomers composed of 9 or 24 tandemly repeated units, we redesigned the inter-subunit interfaces to generate 19 new homo-oligomers and structurally recombined them to make 24 new hetero-oligomers, including ABC heterotrimers, A2B2 heterotetramers, and A3B3 and A2B2C2 heterohexamers which assemble with high structural specificity. The symmetric homo-oligomers and pseudosymmetric hetero-oligomers generated for each system have identical or nearly identical backbones, and hence are ideal building blocks for generating and functionalizing larger symmetric and pseudosymmetric assemblies., Competing Interests: Competing interests: A provisional patent application has been filed (63/486,872) by the University of Washington, listing R.D.K., B.I.M.W., B.L.S., S.L., and D.B. as inventors or contributors. The remaining authors declare no competing interests., (© 2024. The Author(s).)

Sleepwear and bedding materials can affect sleep quality by influencing the skin and body temperature and thermal comfort. This review systematically evaluates the impact of sleepwear or bedding of different fibre types on sleep quality. A systematic search was conducted in six data bases plus Google Scholar and manual searches. Original articles that compared human sleep quality between at least two fibre types of bedding or sleepwear were included, resulting in nine eligible articles included in the review. The fibre types included cotton, polyester, wool, and blended materials for sleepwear; cotton, duck down, goose down, polyester and wool for duvet; and linen and a combination of cotton and polyester for bedding. The interplay between fibre materials and sleep quality is complex. Blended sleepwear demonstrated potential benefits for specific populations. Wool sleepwear showed benefits for sleep onset in adults (cool conditions) and in older adults (warm conditions). Linen bedsheets improved sleep quality under warm conditions in young adults. Goose down-filled duvets increased slow-wave sleep under cool conditions in young adults. However, a systematic comparison of fibre types is challenging due to the diverse nature of the studies evaluating sleep quality. Further research employing standardised methodologies with standard fibre samples in different populations and in different temperature conditions is imperative to elucidate comprehensively the effects of fibre choices on sleep quality. Despite the limitations and heterogeneity of the included studies, this analysis offers valuable insights for individuals seeking to optimise their sleep experiences and for manufacturers developing sleep-related products., (© 2024 The Authors. Journal of Sleep Research published by John Wiley & Sons Ltd on behalf of European Sleep Research Society.)

Evidence supports the existence of cardiac remodeling in obesity; however, no standard diagnostic criteria has been proposed or validated. This study aimed to identify echocardiographic features of cardiac remodeling according to obesity class and assess the effect of nonsurgical weight loss on cardiac structure and function. A total of 120 patients were divided according to their obesity class (group 1: body mass index [BMI] 18.5 to 24.9, group 2: 25 to 29.9, group 3: 30 to 39.9, and group 4: >40) and underwent cross-sectional transthoracic echocardiography. Echocardiographic parameters of cardiac chamber quantification and function were compared among the 4 groups. Echocardiographic parameters were compared before and after nonsurgical weight loss in a subgroup of patients. Overall, there was an incremental increase in left ventricular (LV), left atrial (LA), and right ventricular dimensions, LV mass (LVM), and LV stroke volume (all p <0.0001) across the obesity classes. There was no significant difference in LV ejection fraction or right ventricular systolic function, as assessed by tricuspid annular plane systolic excursion; however, there was a significant decrease in global longitudinal strain (BMI 18.5 to 24.9: 22.8 ± 1.7%, BMI 25 to 29.9: 22.0 ± 1.4%, BMI 30 to 39.9: 20.8 ± 1.1%, BMI >40: 20.6 ± 1.3%, p <0.0001) and LA strain (BMI 18.5 to 24.9: 37.7 ± 2.3%, BMI 25 to 29.9: 32.8 ± 2.1%, BMI 30 to 39.9: 31.5 ± 1.8%, BMI >40: 29.0 ± 2.8%, p <0.0001). Allometric height-indexed LV and LA dimensions increased with increasing BMI class (p <0.0001). Echocardiographic parameters did not change significantly after nonsurgical weight loss. In conclusion, echocardiographic features can be described according to obesity class. Allometric height indexation may better reflect cardiac remodeling in obesity than body surface area indexation. Nonsurgical weight loss was not associated with significant changes in cardiac chamber dimensions and function., Competing Interests: Declaration of competing interest The authors have no competing interests to declare., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: Diabetic peripheral neuropathy (DPN) impairs glucose and fat metabolism and physical functioning. This study examined the effects of low-intensity resistance exercise training (LI-RT) and a lower limb conditioning program (LLCP) on physical function and lipid profile in DPN., Methods: Forty-five diabetic women with mild to moderate neuropathy (55.5 ± 3.1 y) were randomly assigned to one of three groups: LI-RT (n = 15), LLCP (n = 15), and control (n = 15). The LI-RT and LLCP groups trained 3 times/week (90 min/session) for 12 weeks. The LI-RT group completed 3 sets of 10 repetitions for ten exercises at 30-repetition maximum; the LLCP group performed 12 lower extremity motions designed for peripheral neuropathy; and the control group followed their routine daily activities. Physical function was assessed using the Timed Up and Go Test (TUG), Five Times Sit-to-Stand (FTSTS) test, and 6-min walking test (6MWT). Blood lipid profile was assessed., Results: Both the LI-RT and LLCP groups significantly improved in TUG scores compared to the control group (p ≤ 0.05). No significant changes between groups were observed for the FTSTS and 6MWT. The LI-RT and LLCP groups, compared to the control group, showed a significant reduction in low-density lipoprotein (p ≤ 0.05), and triglycerides (p ≤ 0.001). High-density lipoproteins showed non-significant changes., Conclusion: Low intensity training involving resistance exercises or lower limb range of motion enhance physical function and lipid profile in patients with DPN. High intensity exercise could be risky and deter adherence. Hence, these gentler exercise programs offer viable options for enhancing health and fitness in DPN patients., Competing Interests: Declaration of competing interest The authors report no conflict of interest., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Introduction: This study examined the mediating role of general negative affect and body-specific negative affect between the association between negative body talk occurring within the mother-daughter relationship and restrained and disinhibited disordered eating., Methods: Adolescent girls (N = 100; M age  = 14.25; 49.5% White) completed self-report measures of general negative affect (depression and anxiety), body-specific negative affect (body dissatisfaction), and perceptions of the frequency that negative body talk occurred in interactions with their mother (initiated by the mother or daughter) as part of a cross-sectional study. While the same set of questionnaires was administered to both mothers and daughters, only the data reported by the daughters were analyzed and included in this study. Data were gathered in the Ann Arbor/Ypsilanti area of Michigan, USA, around the year 2015., Results: Path analysis showed that general negative affect, but not body-specific negative affect, mediated the association from mother-daughter negative body talk to disinhibited eating behaviors (emotional and external eating). Conversely, body-specific negative affect, but not general negative affect, mediated the association from negative body talk to restrained eating behaviors., Conclusions: Our findings suggest there are distinct affective mechanisms that mediate the relationship between mother-daughter negative body talk and restrained versus disinhibited eating behavior. Future work should continue to explicate the role of general and body-related negative affect in different eating behaviors., (© 2024 Foundation for Professionals in Services to Adolescents.)

Body dissatisfaction and eating behaviors are disproportionately elevated amongst adolescent girls. Family relationships represent a context in which adolescent girls' body image issues emerge. Thus, we integrated attachment and confirmation theories to examine whether weight related supportive messages (i.e., acceptance and challenge) mediated the relationship between attachment style (i.e., anxiety and avoidance) and body image outcomes (i.e., body dissatisfaction (BD), restrained eating (RE), and disordered eating (DE)). Acceptance refers to weight related support that is characterized by warmth and accepting messages; challenge refers to weight related support that is characterized by instrumental assistance and problem-solving messages. A sample of 106 adolescent girls, ages 11 to 21, completed self-report measures on attachment (Relationship Structures Questionnaire), acceptance and challenge (weight related Parental Behavior Questionnaire), body dissatisfaction (Eating Disorders Inventory), and eating behaviors (Dutch Eating Behavior Questionnaire; Eating Disorder Diagnostic Scale). Attachment anxiety directly related to all body image outcomes, whereas attachment avoidance only directly related to RE. Attachment avoidance only related to BD and DE indirectly through perceived acceptance. Those with high anxiety endorsed lower perceived challenge, whereas avoidant individuals endorsed lower perceived acceptance and challenge. We concluded that attachment dimension characteristics to be either hyperactivated regarding relationships (i.e., anxiety), or deactivated and distant (i.e., avoidance), are associated with how individuals perceive support, and in turn, are related to body image and eating behavior outcomes. Further, we clarify the differential roles of acceptance and challenge. Although both supportive, acceptance encompasses a layer of warmth that is more meaningful in body image, particularly for avoidantly attached individuals. By integrating qualities of attachment and supportive weight communication, we reveal that potential pathways of attachment to body image and eating behaviors., Competing Interests: Declaration of competing interest No conflict of interest., (Published by Elsevier Ltd.)

Traumatic brain injury (TBI) profoundly affects sleep, mood, and fatigue, impeding daily functioning and recovery. This systematic review evaluates the efficacy of morning shorter wavelength lighting in the visible (blue) range and broad-spectrum or blue-enriched bright white light exposure in mitigating these challenges among TBI patients. Through electronic database searches up to May 2023, studies assessing sleep, circadian rhythm, sleepiness, mood, and fatigue outcomes in TBI patients exposed to morning shorter wavelength lighting in the visible (blue) range and broad-spectrum or blue-enriched bright white light were identified. Seven studies involving 309 participants met the inclusion criteria. Results indicated consistent advancement in sleep timing among individuals with mild TBI, alongside improvements in total sleep time, mood, and reduced sleepiness with both types of light exposure, particularly in mild TBI cases. Notably, two studies demonstrated alleviation of fatigue exclusively in severe TBI cases following light exposure. Despite promising findings, evidence remains limited, emphasizing the need for future research with standardized protocols to confirm the potential and optimize the benefits of light therapy for TBI recovery.

Background: Bacterial vaginosis (BV) is a highly prevalent vaginal infection., Objectives: Primary objectives of this study were to examine treatment patterns among female patients with Medicaid coverage who were diagnosed with incident BV, the frequency of BV-associated complications, and health care resource utilization (HCRU) and associated costs of incident BV and its recurrence. Secondary objectives were to identify predictors of total all-cause health care costs and number of treatment courses., Methods: Female patients aged 12-49 years with an incident vaginitis diagnosis and ≥1 pharmacy claim for a BV medication were selected from the Merative MarketScan Medicaid database (2017-2020). Additional treatment courses were evaluated during a ≥12-month follow-up period, in which new cases of BV-associated complications and HCRU and the associated costs were also measured. Generalized linear models were used to identify baseline predictors of total all-cause health care costs and number of treatment courses., Results: An incident vaginitis diagnosis and ≥1 BV medication claim were present in 114 313 patients (mean age: 28.4 years; 48.6% black). During the follow-up, 56.6% had 1 treatment course, 24.9% had 2, 10.2% had 3, and 8.3% had ≥4; 43.4% had BV recurrence. Oral metronidazole (88.5%) was the most frequently prescribed medication. Nearly 1 in 5 had a new occurrence of a BV-associated complication; most (76.6%) were sexually transmitted infections (STIs). Total all-cause and BV-related costs averaged $5794 and $300, respectively, per patient; both increased among those with more treatment courses. Older age, pregnancy, comorbidity, any STIs, postprocedural gynecological infection (PGI), and infertility were predictive of higher total all-cause health care costs, while race/ethnicity other than white was predictive of lower costs. Older age, black race, any STIs, pelvic inflammatory disease, and PGI were predictive of >1 treatment courses., Conclusion and Relevance: The high recurrence of BV represents an unmet need in women's health care and better treatments are necessary., Competing Interests: Declaration of Conflicting InterestsThe authors declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Eren Watkins, Candice Yong, Krishna Tangirala, Kevin Collins, and James Li are employees of Organon. Clifton M. Chow, Roy Brooks, and Jennifer Amico are external consultants for Organon which provided consulting fees in connection with this study and the development of this article. Melissa Lingohr-Smith and Jay Lin are employees of Novosys Health, which received financial support from Organon in connection with this study and the development of this article.

Tobacco use has been established as a possible risk factor for psychosis, but the effect of electronic nicotine delivery systems (ex. nicotine vapes) has not been independently established. Using the Population Assessment of Tobacco and Health study, we found that use of electronic nicotine products was significantly associated with later first episode psychosis after controlling for substance use and other confounders, and that this relationship was only significant among the heaviest users (>20 puffs/day). Given the rapid rise in electronic nicotine products use, clinicians and public health professionals should consider potential impacts and closely monitor trends in the coming years., Competing Interests: Declaration of competing interest The authors have no competing interests to declare., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Inadequate clearance of protein-bound uremic toxins (PBUTs) during dialysis is associated with morbidities in chronic kidney disease patients. The development of high-permeance membranes made from materials such as graphene raises the question whether they could enable the design of dialyzers with improved PBUT clearance. Here, we develop device-level and multi-compartment (body) system-level models that account for PBUT-albumin binding (specifically indoxyl sulfate and p-cresyl sulfate) and diffusive and convective transport of toxins to investigate how the overall membrane permeance (or area) and system parameters including flow rates and ultrafiltration affect PBUT clearance in hemodialysis. Our simulation results indicate that, in contrast to urea clearance, PBUT clearance in current dialyzers is mass-transfer limited: Assuming that the membrane resistance is dominant, raising PBUT permeance from 3 × 10 -6 to 10 -5  m s -1 (or equivalently, 3.3 × increase in membrane area from ~ 2 to ~ 6 m 2 ) increases PBUT removal by 48% (from 22 to 33%, i.e., ~ 0.15 to ~ 0.22 g per session), whereas increasing dialysate flow rates or adding adsorptive species have no substantial impact on PBUT removal unless permeance is above ~ 10 -5  m s -1 . Our results guide the future development of membranes, dialyzers, and operational parameters that could enhance PBUT clearance and improve patient outcomes., (© 2023. The Author(s).)

Background: Pervasive differences in cancer screening among race/ethnicity and insurance groups presents a challenge to achieving equitable healthcare access and health outcomes. However, the change in the magnitude of cancer screening disparities over time has not been thoroughly examined using recent public health survey data., Methods: A retrospective cross-sectional analysis of the 2008 and 2018 National Health Interview Survey (NHIS) database focused on breast, cervical, and colorectal cancer screening rates among race/ethnicity and insurance groups. Multivariable logistic regression models were used to assess the relationship between cancer screening rates, race/ethnicity, and insurance coverage, and to quantify the changes in disparities in 2008 and 2018, adjusting for potential confounders., Results: Colorectal cancer screening rates increased for all groups, but cervical and mammogram rates remained stagnant for specific groups. Non-Hispanic Asians continued to report consistently lower odds of receiving cervical tests (OR: 0.42, 95% CI: 0.32-0.55, p<0.001) and colorectal cancer screening (OR: 0.55, 95% CI: 0.42-0.72, p<0.001) compared to non-Hispanic Whites in 2018, despite significant improvements since 2008. Non-Hispanic Blacks continued to report higher odds of recent cervical cancer screening (OR: 1.98, 95% CI: 1.47-2.68, p<0.001) and mammograms (OR: 1.32, 95% CI: 1.02-1.71, p<0.05) than non-Hispanic Whites in 2018, consistent with higher odds observed in 2008. Hispanic individuals reported improved colorectal cancer screening over time, with no significant difference compared to non-Hispanics Whites in 2018, despite reporting lower odds in 2008. The uninsured status was associated with significantly lower odds of cancer screening than private insurance for all three cancers in 2008 and 2018., Conclusion: Despite an overall increase in breast and colorectal cancer screening rates between 2008 and 2018, persistent racial/ethnic and insurance disparities exist among race/ethnicity and insurance groups. These findings highlight the importance of addressing underlying factors contributing to disparities among underserved populations and developing corresponding interventions., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Sun et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Aim: Bacterial vaginosis (BV) is a common vaginal dysbiosis associated with adverse clinical sequelae, most notably, increased risk of sexually transmitted infections (STIs). The aims of this study were to estimate the frequency of BV recurrence, treatment patterns, other gynecological (GYN) conditions, and the associated healthcare resource utilization (HCRU) and costs among commercially insured patients in the USA. Patients & methods: Female patients aged 12-49 years with an incident vaginitis diagnosis and ≥1 pharmacy claim for a BV medication (fungal treatment only excluded) were selected from the Merative™ MarketScan commercial database (2017-2020). During a minimum 12-month follow-up, additional treatment courses, treatment patterns, frequency of other GYN conditions, and HCRU and costs were assessed. Generalized linear models were used to identify baseline predictors of total all-cause healthcare costs and number of treatment courses. Results: The study population included 140,826 patients (mean age: 31.5 years) with an incident vaginitis diagnosis and ≥1 BV medication claim. During the follow-up, 64.2% had 1 treatment course, 22.0% had 2, 8.1% had 3, and 5.8% had ≥4; 35.8% had a BV recurrence (≥2 BV medication claims). The most commonly prescribed BV medication was oral metronidazole (73.6%). Approximately 12% (n = 16,619) of patients had a new diagnosis of another GYN condition in the follow-up; 8.2% had a new STI, which were more common among patients with ≥4 treatment courses (12.9%). During follow-up, total all-cause healthcare costs averaged $8987 per patient per year (PPPY) of which $470 was BV-related. BV-related healthcare costs increased from $403 PPPY among those with 1 treatment course to $806 PPPY among those with ≥4 with nearly half the costs attributed to outpatient office visits. Conclusion: BV recurrence among this population represented a substantial clinical and healthcare economic burden warranting improvements in women's healthcare.

Firearm-related injuries are a major public health concern in the USA. Given the increased racism endured by Asian Americans during the COVID-19 pandemic, the current study aims to investigate the direct and indirect effects of racism, mental distress, and substance use on firearm purchase among Asian Americans. To fulfill this purpose, we collected data from a national sample of 916 Asian Americans in 2021. The study results showed that Asian Americans' racism experience is directly related to increased mental distress, substance abuse, and firearm purchase. Both mental distress and alcohol use were also linked to firearm purchase. It was found that racism links to more mental distress and increased alcohol use, which in turn link to increased firearm purchases. The findings add new information on how racism can have compounded effects on mental distress and alcohol use in addition to firearm-related risk behavior among Asian Americans and posing serious public health concerns., (© 2023. W. Montague Cobb-NMA Health Institute.)

Competing Interests: CM Chow has disclosed no conflicts of interest. PK Cheong is an employee of GenieBiome Limited. J Hu is a scientist at GenieBiome Limited. JYL Ching is a clinical research consultant for GenieBiome Limited.

Rationale: Right ventricular (RV) dysfunction is common among patients hospitalized with coronavirus disease (COVID-19); however, its epidemiology may depend on the echocardiographic parameters used to define it. Objectives: To evaluate the prevalence of abnormalities in three common echocardiographic parameters of RV function among patients with COVID-19 admitted to the intensive care unit (ICU), as well as the effect of RV dilatation on differential parameter abnormality and the association of RV dysfunction with 60-day mortality. Methods: We conducted a retrospective cohort study of ICU patients with COVID-19 between March 4, 2020, and March 4, 2021, who received a transthoracic echocardiogram within 48 hours before to at most 7 days after ICU admission. RV dysfunction and dilatation, respectively, were defined by guideline thresholds for tricuspid annular plane systolic excursion (TAPSE), RV fractional area change, RV free wall longitudinal strain (RVFWS), and RV basal dimension or RV end-diastolic area. Association of RV dysfunction with 60-day mortality was assessed through logistic regression adjusting for age, prior history of congestive heart failure, invasive ventilation at the time of transthoracic echocardiogram, and Acute Physiology and Chronic Health Evaluation II score. Results: A total of 116 patients were included, of whom 69% had RV dysfunction by one or more parameters, and 36.3% of these had RV dilatation. The three most common patterns of RV dysfunction were the presence of three abnormalities, the combination of abnormal RVFWS and TAPSE, and isolated TAPSE abnormality. Patients with RV dilatation had worse RV fractional area change (24% vs. 36%; P  = 0.001), worse RVFWS (16.3% vs. 19.1%; P  = 0.005), higher RV systolic pressure (45 mm Hg vs. 31 mm Hg; P  = 0.001) but similar TAPSE (13 mm vs. 13 mm; P  = 0.30) compared with those with normal RV size. After multivariable adjustment, 60-day mortality was significantly associated with RV dysfunction (odds ratio, 2.91; 95% confidence interval, 1.01-9.44), as was the presence of at least two parameter abnormalities. Conclusions: ICU patients with COVID-19 had significant heterogeneity in RV function abnormalities present with different patterns associated with RV dilatation. RV dysfunction by any parameter was associated with increased mortality. Therefore, a multiparameter evaluation may be critical in recognizing RV dysfunction in COVID-19.

The RGD (Arg-Gly-Asp)-binding integrins αvβ6 and αvβ8 are clinically validated cancer and fibrosis targets of considerable therapeutic importance. Compounds that can discriminate between homologous αvβ6 and αvβ8 and other RGD integrins, stabilize specific conformational states, and have high thermal stability could have considerable therapeutic utility. Existing small molecule and antibody inhibitors do not have all these properties, and hence new approaches are needed. Here we describe a generalized method for computationally designing RGD-containing miniproteins selective for a single RGD integrin heterodimer and conformational state. We design hyperstable, selective αvβ6 and αvβ8 inhibitors that bind with picomolar affinity. CryoEM structures of the designed inhibitor-integrin complexes are very close to the computational design models, and show that the inhibitors stabilize specific conformational states of the αvβ6 and the αvβ8 integrins. In a lung fibrosis mouse model, the αvβ6 inhibitor potently reduced fibrotic burden and improved overall lung mechanics, demonstrating the therapeutic potential of de novo designed integrin binding proteins with high selectivity., (© 2023. Springer Nature Limited.)

Chest pain/discomfort (CP) is a common symptom and can be a diagnostic dilemma for many clinicians. The misdiagnosis of an acute or progressive chronic cardiac etiology may carry a significant risk of morbidity and mortality. This review summarizes the different options and modalities for establishing the diagnosis and severity of coronary artery disease. An effective test selection algorithm should be individually tailored to each patient to maximize diagnostic accuracy in a timely fashion, determine short- and long-term prognosis, and permit implementation of evidence-based treatments in a cost-effective manner. Through collaboration, a decision algorithm was developed (www.chowmd.ca/cadtesting) that could be adopted widely into clinical practice., (© 2023 The Authors.)

The narrative review was planned to qualitatively analyse the experiences, factors and context of parents screening positive for perinatal depression in Karachi. Semi structured in-depth interviews were conducted to explore the experiences and perceptions of participants during pregnancy, birth and 10-12 weeks after birth. Seven men and 20 women participated in the in-depth interviews. Factors in the perinatal period that affected new parents included sleep disturbances, emotional stressors linked to preference for a male child, a lack of social support, financial burdens of perinatal care, personal frustrations caused by an inability to comprehend the signs and symptoms of perinatal depression, denial to admit challenging issues concerning mental health and social disapproval with expressing mental health issues. There is an imminent need for appropriate initiatives to raise awareness about perinatal depression, and the provision of adequate perinatal mental health services for Pakistani women and men.

The Long COVID syndrome has now been documented clearly in the literature, but whether or not psychiatric symptoms are prominent is unclear. We performed a retrospective chart review of all patients receiving medical care during the pandemic in an outpatient Long-COVID specialty clinic that serves a large racial and ethnic minority population. As many as 44% of patients had symptoms that necessitated referrals to psychiatrists, predominantly depression or anxiety. Spanish speaking patients had greater COVID severity (48%) than did predominantly English speakers (15%). We conclude that the long COVID syndrome is predominantly a cluster of physical symptoms that are sequelae of the viral infection., (Copyright © 2023. Published by Elsevier B.V.)

General approaches for designing sequence-specific peptide-binding proteins would have wide utility in proteomics and synthetic biology. However, designing peptide-binding proteins is challenging, as most peptides do not have defined structures in isolation, and hydrogen bonds must be made to the buried polar groups in the peptide backbone 1-3 . Here, inspired by natural and re-engineered protein-peptide systems 4-11 , we set out to design proteins made out of repeating units that bind peptides with repeating sequences, with a one-to-one correspondence between the repeat units of the protein and those of the peptide. We use geometric hashing to identify protein backbones and peptide-docking arrangements that are compatible with bidentate hydrogen bonds between the side chains of the protein and the peptide backbone 12 . The remainder of the protein sequence is then optimized for folding and peptide binding. We design repeat proteins to bind to six different tripeptide-repeat sequences in polyproline II conformations. The proteins are hyperstable and bind to four to six tandem repeats of their tripeptide targets with nanomolar to picomolar affinities in vitro and in living cells. Crystal structures reveal repeating interactions between protein and peptide interactions as designed, including ladders of hydrogen bonds from protein side chains to peptide backbones. By redesigning the binding interfaces of individual repeat units, specificity can be achieved for non-repeating peptide sequences and for disordered regions of native proteins., (© 2023. The Author(s).)

Small beta barrel proteins are attractive targets for computational design because of their considerable functional diversity despite their very small size (<70 amino acids). However, there are considerable challenges to designing such structures, and there has been little success thus far. Because of the small size, the hydrophobic core stabilizing the fold is necessarily very small, and the conformational strain of barrel closure can oppose folding; also intermolecular aggregation through free beta strand edges can compete with proper monomer folding. Here, we explore the de novo design of small beta barrel topologies using both Rosetta energy-based methods and deep learning approaches to design four small beta barrel folds: Src homology 3 (SH3) and oligonucleotide/oligosaccharide-binding (OB) topologies found in nature and five and six up-and-down-stranded barrels rarely if ever seen in nature. Both approaches yielded successful designs with high thermal stability and experimentally determined structures with less than 2.4 Å rmsd from the designed models. Using deep learning for backbone generation and Rosetta for sequence design yielded higher design success rates and increased structural diversity than Rosetta alone. The ability to design a large and structurally diverse set of small beta barrel proteins greatly increases the protein shape space available for designing binders to protein targets of interest.

Aim: To describe the process of engaging underserved communities of color that designs, conducts, and evaluates community-engaged COVID-19 Community Health Navigator training on COVID-19: Vaccination, Prevention, and Contact Tracing., Subject and Methods: The project used a mixed-methods design; 18 community health navigators (CHNs) representing Asian American, Arab American, Black/African American, and Hispanic/Latinx communities completed the pretest, training, and post-test. Demographic characteristics, along with knowledge and confidence level questions regarding COVID-19 issues, were gathered in pre- and post-tests. Qualitative data were collected via open-ended questions in post-tests., Results: Findings suggest that the community health navigator training successfully increased participants' knowledge of COVID-19-related topic areas and confidence in educating community members regarding COVID-19 vaccination and prevention. Qualitative evaluation contained information learned and found most helpful, and application and utilization plans for CHNs' follow-up work., Conclusion: The process of community health navigator training and evaluation results adds important insights to the current COVID-19 pandemic workforce literature and can inform future trainings., Competing Interests: Conflicts of interest/competing interestsThe authors declare that they have no conflicts of interest/competing interests., (© The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature 2023, Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.)