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Abstract Breast cancer risk reduction strategies have been well-validated, but barriers remain for high-risk individuals to adopt them. We performed a study among participants with high risk of breast cancer to validate whether a virtual breast health decision tool impacted a participant’s willingness to start risk-reducing activities, identify barriers to adopting these strategies, and understand if it affects breast cancer anxiety. The study sample was 318 participants in the personalized (investigational) arm of the Women Informed to Screen Depending on Measures of risk (WISDOM) clinical trial. After reviewing the tool, these participants completed a feedback survey. We demonstrated that 15 (4.7%) women were taking endocrine risk reduction, 123 (38.7%) were reducing alcohol intake, and 199 (62.6%) were exercising. In the three-month follow-up survey of 109 respondents, only 8 of 61 (13.1%) women who considered endocrine risk reduction pursued it. In contrast, 11 of 16 (68%) participants who considered alcohol reduction pursued the activity, and 14 of 24 (58%) women who considered exercise followed through. Participants listed fear of side effects as the most common barrier to endocrine risk reduction. We also present further steps to be taken to improve the effectiveness of the Breast Health Decisions tool.

Abstract Various histopathological, clinical and imaging parameters have been evaluated to identify a subset of women diagnosed with lesions with uncertain malignant potential (B3 or BIRADS 3/4A lesions) who could safely be observed rather than being treated with surgical excision, with little impact on clinical practice. The primary reason for surgery is to rule out an upgrade to either ductal carcinoma in situ or invasive breast cancer, which occurs in up to 30% of patients. We hypothesised that the stromal immune microenvironment could indicate the presence of carcinoma associated with a ductal B3 lesion and that this could be detected in biopsies by counting lymphocytes as a predictive biomarker for upgrade. A higher number of lymphocytes in the surrounding specialised stroma was observed in upgraded ductal and papillary B3 lesions than non-upgraded (p

Abstract Background Renal transplant recipients (RTRs) experience cutaneous symptoms, some due to immunosuppressive medications, which can affect their quality of life (QOL). Previous studies noted a higher impact on QOL of younger female recipients. Objectives We sought to examine current trends in dermatology QOL in Irish RTRs. Methods Dermatology life quality index (DLQI) and dermatology conditions, past and present, were analysed in a cohort of RTRs in a single centre in the West of Ireland. Medical records were cross referenced. Results Sixty‐six RTRs participated, 70% male with a mean age 55 years ± SD13.6. Most participants (80%) described the presence of a skin condition. Despite this, many (71%) reported ‘no effect’ on their quality of life. Skin cancer, experienced by 26%, was associated with a small but significant effect on QOL. Biopsy proven actinic keratoses, on the other hand, was not. Cutaneous infections (bacterial and fungal) of the lower limb had the largest effect on QOL. Although not significant, male RTRs were more likely to report skin issues when asked and less likely to have seen dermatology for them. Unlike previous studies age or gender did not significant effect on QOL. Conclusions The findings of our study demonstrate a shift in trends of cutaneous complications of RTRs and highlights a need to consider foot care in this patient population. We illustrate a difference in health seeking behaviour of RTRs of different genders and a need for a focussed proactive skin cancer surveillance programme that targets not only early detection but also prevention in male organ recipients.

Internationally, lead agencies and consumer movements emphasise the need for high-level research participation in mental health. However, evidence suggests that people with lived experience tend to be recruited as subjects rather than as active agents in research, or are consulted in tokenistic ways. Although participatory research has the potential to rectify epistemic disparities, few studies have grappled with how to move from exclusion and tokenism to high-level research participation. This paper describes a qualitative co-evaluation of a co-produced model of research partnership, Raising the Bar , which involved deliberate establishment and facilitation of six participatory research teams, comprising 28 lived experience and ‘conventional' mental health researchers. Findings indicate that the theoretical elements of the model set the bar high from the outset, supporting research teams to address inconsistencies in knowledge about participation. It also provided researchers with the competencies and resources to undertake participatory research in egalitarian team structures, and to negotiate new forms of non-traditional research outputs - thereby challenging whom research might be for and how it might be made accessible. Finally, the model shifted collective meanings about research, lending credibility to participatory practices, which came to be seen as essential for meeting the needs of affected communities. Nonetheless, systemic barriers to participatory research remain, and need to be recognised and acted upon to promote a culture that supports high-level research participation.

This research explores the potential of using the secondary household survey data to identify key socioeconomic indicators for tracking farmland restoration progress in Malawi since 2017. A two-year panel data for the periods between 2016–2017 and 2019–2020 was created for the analysis, building on data collected from Malawi’s Integrated Household Panel Survey (IHPS). An initial data analysis shows that estimated average Household Restoration Intensity Score (HRIS) increased from 2.05 in 2016 to 2.24 in 2019, indicating increased intensification of farmland restoration at the household level over time. The average Food Consumption Score (FCS) of all the households also significantly improved over time, rising from 43.19 in 2016 to 47.43 in 2019. A Difference-in-Difference (DiD) model was developed to quantitatively estimate the causal effects of the farmland restoration interventions on the socioeconomic improvement of rural households. Overall, the model shows some promising results. All four regressions generated statistically significant results regarding the positive impact of restoration interventions over time on four socioeconomic indicators, including food and non-food expenditure, crop sales, and FCS at the household level. However, the model results should be interpreted with care due to clear caveats on secondary household survey data. In response, this study recommended three concrete ways that surveys can be improved to collect data that is relevant for assessing the socioeconomic impacts of farmland restoration. This study also calls for urgent global actions to construct a robust restoration monitoring and evaluation system that will allow systemically monitoring and tracking socioeconomic improvements resulting from restoration interventions in a consistent manner over time.

Abstract Post-mastectomy pain syndrome (PMPS) is a common and often debilitating condition. The syndrome is defined by chest wall pain unresponsive to standard pain medications and the presence of exquisite point tenderness along the inframammary fold at the site of the T4 and T5 cutaneous intercostal nerve branches as they exit from the chest wall. Pressure at the site triggers and reproduces the patient’s spontaneous or motion-evoked pain. The likely pathogenesis is neuroma formation after injury to the T4 and T5 intercostal nerves during breast surgery. We assessed the rate of long-term resolution of post-mastectomy pain after trigger point injections (2 mL of 1:1 mixture of 0.5% bupivacaine and 4 mg/mL dexamethasone) to relieve neuropathic pain in a prospective single-arm cohort study. Fifty-two women (aged 31–92) who underwent partial mastectomy with reduction mammoplasty or mastectomy with or without reconstruction, and who presented with PMPS were enrolled at the University of California San Francisco Breast Care Center from August 2010 through April 2018. The primary outcome was a long-term resolution of pain, defined as significant or complete relief of pain for greater than 3 months. A total of 91 trigger points were treated with mean follow-up 43.9 months with a 91.2% (83/91) success rate. Among those with a long-term resolution of pain, 60 trigger points (72.3%) required a single injection to achieve long-lasting relief. Perineural infiltration with bupivacaine and dexamethasone is a safe, simple, and effective treatment for PMPS presenting as trigger point pain along the inframammary fold.

Abstract Risk-reducing endocrine therapy use, though the benefit is validated, is extremely low. The FDA has approved tamoxifen and raloxifene for a 5-year Breast Cancer Risk Assessment Tool (BCRAT) risk ≥ 1.67%. We examined the threshold at which high-risk women are likely to be using endocrine risk-reducing therapies among Athena Breast Health Network participants from 2011–2018. We identified high-risk women by a 5-year BCRAT risk ≥ 1.67% and those in the top 10% and 2.5% risk thresholds by age. We estimated the odds ratio (OR) of current medication use based on these thresholds using logistic regression. One thousand two hundred and one (1.2%) of 104,223 total participants used medication. Of the 33,082 participants with 5-year BCRAT risk ≥ 1.67%, 772 (2.3%) used medication. Of 2445 in the top 2.5% threshold, 209 (8.6%) used medication. Participants whose 5-year risk exceeded 1.67% were more likely to use medication than those whose risk was below this threshold, OR 3.94 (95% CI = 3.50–4.43). The top 2.5% was most strongly associated with medication usage, OR 9.50 (8.13–11.09) compared to the bottom 97.5%. Women exceeding a 5-year BCRAT ≥ 1.67% had modest medication use. We demonstrate that women in the top 2.5% have higher odds of medication use than those in the bottom 97.5% and compared to a risk of 1.67%. The top 2.5% threshold would more effectively target medication use and is being tested prospectively in a randomized control clinical trial.

Abstract Breast cancer risk reduction has been validated by large-scale clinical trials, but uptake remains low. A risk communication tool could provide personalized risk-reduction information for high-risk women. A low-literacy-friendly, visual, and personalized tool was designed as part of the Women Informed to Screen Depending On Measures of risk (WISDOM) study. The tool integrates genetic, polygenic, and lifestyle factors, and quantifies the risk-reduction from undertaking medication and lifestyle interventions. The development and design process utilized feedback from clinicians, decision-making scientists, software engineers, and patient advocates. We piloted the tool with 17 study participants, collecting quantitative and qualitative feedback. Overall, participants felt they better understood their personalized breast cancer risk, were motivated to reduce their risk, and considered lifestyle interventions. The tool will be used to evaluate whether risk-based screening leads to more informed decisions and higher uptake of risk-reduction interventions among those most likely to benefit.

Undifferentiated pleomorphic sarcoma (UPS), an aggressive soft-tissue sarcoma of adults, has been characterized by low tumor mutational burden (TMB) and high copy number alterations. Clinical trials of programmed death-1 (PD-1) blockade in UPS have reported widely varying efficacy. We describe two patients with recurrent scalp UPS that experienced clinical benefit from PD-1 blockade. These tumors had high TMB with a UV-induced mutational pattern. Analysis of additional head and neck UPS cases identified five out of seven tumors with high TMB and an ultraviolet (UV) mutational signature. Head and neck UPS tumors also had increased programmed death-ligand 1 (PD-L1) expression and CD8+ T cell infiltration as compared with UPS tumors arising from other sites. In summary, we found that UPS tumors of the head and neck, but not elsewhere, have a PD-L1+, T-cell-inflamed tumor microenvironment and high TMB, suggesting that these tumors represent a distinct genetic subgroup of UPS for which immune checkpoint inhibitor therapy might be effective.

In the coronavirus disease 2019 (COVID-19) pandemic year 2020, the 30th European Respiratory Society (ERS) International Congress took place for the first time in a fully virtual format. Despite the challenging nature of the task to create and deliver an online event of this size and scope, it turned out to be a great success, welcoming over 33 000 delegates to the specially designed online platform and offering more than 450 scientific and educational sessions. Somewhat predictably, this year's ERS International Congress dedicated a full day to the topic of COVID-19, highlighting that infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a respiratory disease that is particularly important this year. In this article, the Early Career Members of the Assembly 10 (Respiratory Infections and Tuberculosis) review some of the most interesting sessions including presentations and posters on respiratory infections and tuberculosis that were deemed as important.

Harmful algal blooms (HABs) are increasing globally in frequency, persistence, and geographic extent, posing a threat to ecosystem and human health. To date, no occurrences of marine phycotoxins have been recorded in Mozambique, which may be due to absence of a monitoring program and general awareness of potential threats. This study is the first documentation of neurotoxin, domoic acid (DA), produced by the diatom Pseudo-nitzschia along the east coast of Africa. Coastal Inhambane Province is a biodiversity hotspot where year-round Rhincodon typus (whale shark) sightings are among the highest globally and support an emerging ecotourism industry. Links between primary productivity and biodiversity in this area have not previously been considered or reported. During a pilot study, from January 2017 to April 2018, DA was identified year-round, peaking during Austral winter. During an intense study between May and August 2018, our research focused on identifying environmental factors influencing coastal productivity and DA concentration. Phytoplankton assemblage was diatom-dominated, with high abundances of Pseudo-nitzschia spp. Data suggest the system was influenced by nutrient pulses resulting from coastal upwelling. Continued and comprehensive monitoring along southern Mozambique would provide critical information to assess ecosystem and human health threats from marine toxins under challenges posed by global change.

In co-speech gesture research, embodied cognition implies that concepts are associated with haptic and motor information that provides a framework for a gestural plan. When speakers access concepts, embodied action images are automatically activated. This study considers situations in which speakers need to create online concepts of events to investigate the aspect of the event that forms the basis of a new concept. Speakers watched short event video clips with familiar or unfamiliar attributes. They described those clips to partners who had to perform a matching task. Experimental results show that speakers gestured less and produced shorter gestures when relaying longer event descriptions. Speakers were more likely to produce gesture when some aspect of the event was unfamiliar, and they were most sensitive to the familiarity of the event’s main action. Further, when speakers did gesture, they were most likely to gesture to represent the action of the event over the physical attributes of it (the instrument used to enact or the object acted upon). These findings suggest that in creating an embodied concept for something unfamiliar, the motion of the event acts as a basis for their online embodied representation of the concept.

Background Context: As the population ages and surgical techniques improve, more elderly patients with dementia are being considered for treatment of spinal disorders. However, the combined impact of procedural intensity and anesthesia exposure can exacerbate surgical risks, leading to more complex recoveries and postoperative morbidity., Purpose: To compare postsurgical outcomes of patients living with dementia who received elective lumbar spine surgery with a comparable group of patients without dementia., Study Design/setting: Retrospective analysis using national Medicare claims., Patient Sample: We identified Medicare beneficiaries living with dementia who underwent elective lumbar spine surgery between 2017 and 2018. This cohort was compared to Medicare beneficiaries who received comparable surgeries but without a diagnosis of dementia., Outcome Measures: The primary outcome was any adverse event (AAE) within 180 days of surgery, with postoperative intensive interventions considered in parallel with other clinical outcomes., Methods: We employed inverse probability of treatment weights to adjust for confounding. We compared outcomes between cohorts using adjusted hazard ratios (aHR) from Cox-proportional hazard models and Fine-and-gray models considering death as a competing risk., Results: We included 101,313 patients. Within 180 days of surgery, patients with dementia had an increased hazard of AAE than those without dementia (aHR 1.30; 95% CI 1.21,1.40). Patients with dementia also demonstrated a greater hazard of mortality (aHR 1.75, 95%CI 1.33, 2.29) and postoperative intensive interventions (aHR 1.64, 95% CI 1.08, 2.49) over the same time frame., Conclusions: We found a significantly increased risk of adverse events among patients living with dementia undergoing lumbar spine surgery. We believe these risks were previously underappreciated because of the focus on urgent procedures (e.g., hip and odontoid fractures) in prior research evaluating postoperative outcomes for patients with dementia. Our results suggest the need for greater caution when recommending elective, high-intensity, surgical interventions for patients living with dementia., Competing Interests: Declaration of competing interest One or more of the authors declare financial or professional relationships on ICMJE-TSJ disclosure forms., (Copyright © 2025 Elsevier Inc. All rights reserved.)

Study Design: Literature review., Objective: The goal of this study was to provide a comprehensive outline of spinal injuries that may transpire over the course of military service from traumatic to repetitive stress injuries and chronic sequelae. We considered studies that assessed spinal injuries in combat and non-combat settings as reported in the literature over the last 15 to 20 years., Background: Military service places servicemembers under substantial physical demands, while also exposing them to dangerous, unpredictable environments. As a result, servicemembers are at an increased risk of spinal injuries from combat-related trauma and other causes. They may have different care needs and recovery profiles when compared with civilians with spinal disorders., Materials and Methods: We performed a review of the available literature on spinal injuries and spinal care in the Military Health System from 2001 to the present., Results: The studies discussed in this review were primarily focused on the conflicts in both Iraq and Afghanistan from over 10 years ago and do not fully capture the present-day advancements in military technology that may have an impact on the potential for spinal injuries. The long-term effects of sustained military service and the relative influence of high demand versus sedentary military occupations on the development of spinal disorders remain poorly understood. Given the changing nature of military service, both with respect to the demographic in uniform and the ever-evolving nature of modern combat, we believe that only a long-term prospective observational study dedicated to the surveillance of spinal problems could effectively answer these questions., Conclusion: Further research into the present-day characterization of spinal injuries is warranted given the advancements in both military technology and spine care that have occurred over the last 10 years., Competing Interests: The authors report no conflicts of interest., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)