2-year Period Research Articles

Critical evaluation of Pap test adherence to routine screening in Amazonas State, Brazil.

This study critically evaluates adherence to Pap test screening practices in cytology-based cervical cancer screening in the state of Amazonas over a 10-year period. A retrospective analysis was conducted of the results of cytological screening examinations (Pap test) in Amazonas State from 2013 to 2023. For this purpose, Brazilian public databases Cervical Cancer Information System (SISCOLO) and Cancer Information System (SISCAN) (from The Department of Information and IT of the Unified Health System - DATASUS) were consulted. There was a decrease in the number of Pap tests performed during the period from 2019 to 2021, likely related to the COVID-19 pandemic. This was followed by a subsequent increase in the post-pandemic period. Notably, in municipalities with fewer than 10,000 annual Pap examinations there was a decrease in the average number of tests when comparing the years 2016-2018 to 2013-2015, and an even greater decrease during the pandemic. There is considerable variation in utilization of the cytological Pap test across different municipalities. This lack of uniformity throughout the State likely compromises the capacity to detect early stage cervical intraepithelial lesions. Cervical cancer screening, cervical cytology, cytology in low-resource settings, Primary screening, Public health.

Pre-race medical clearance in 60,609 distance running race entrants: which entrants sought clearance, what physicians did, and what was the outcome? SAFER XXXVII.

Medical clearance is often recommended for athletes prior to endurance exercise. The primary aim was to determine the percentage (%) of race entrants that sought medical clearance prior to participation in endurance running events, describe the diagnostic modalities used by doctors to assess entrants seeking medical clearance, and the clearance advice given. Secondary aims were to investigate the factors associated with seeking and outcome of clearance. All consenting race entrants who completed an online screening questionnaire during registration to participate in the 21.1 km or 56 km Two Oceans marathon races from 2013-2015 (N.=60,609) were included. Runners were stratified into four risk categories: low risk (LR), intermediate risk (IR), high risk (HR) and very high risk (VHR). Runners were asked if they consulted with a medical doctor to obtain medical clearance. Follow-up questions enquired about what the doctor did when they sought medical clearance and what advice the doctor gave as an outcome of the medical clearance consultation. Prevalence (%, 95% CI) and Prevalence Ratios (PRs) are reported. Over the 3-year period, 14.8% of entrants sought medical clearance. For clearance, doctors used history only (9.9%), history and physical examination (36.7%) and history, physical examination, and special investigations (53.0%). Most entrants seeking medical clearance were fully cleared to race (87.7% in 21.1 km and 85.9% in 56 km) (P=0.0156). Factors associated with seeking medical clearance include longer race distance, older age and a higher risk category (P<0.0001). The methods doctors use when conducting medical clearance consultations vary greatly. Further research is suggested to develop a protocol that doctors can use for medical consultations.

Long-term Cognitive Trajectories in Older Adults After Surgery: A Population-based Cohort Study.

Postoperative cognitive decline (POCD) is a common, but often unrecognized condition after surgery. We evaluate postsurgical cognitive changes in a longitudinal population-based study. The study cohort comprises an age-stratified population-based random sample of individuals aged 65+ years from a small-town region of the United States. We identified as cases those participants who, during annual assessments, self-reported having undergone surgery under general anesthesia during the preceding year. We identified as controls those who reported no surgery for at least 6 consecutive years. The outcome variable changed over time (4y) in annual cognitive test composite scores encompassing the domains of attention/processing speed, executive function, memory, language, and visuospatial functions, which were modeled using Generalized Estimating Equations. A total of 436 participants had the required cognitive data; 179 participants (cases) had undergone surgery, while 257 participants (controls) had not undergone surgery. After adjusting for age, years of education, gender, race, heart failure, irregular heartbeat, and stroke, participants who underwent surgery had a greater decline in executive function, memory, and attention over a 2-year period. Participants who underwent surgery had a significant subsequent decline in cognitive function over the long term.

Empagliflozin-based quadruple oral therapy for type 2 diabetes: a prospective cohort study

The management of Type-2 Diabetes Mellitus (T2DM) remains challenging in cases of poor glycemic control despite triple Oral Hypoglycemic Agent (OHA) therapy. This prospective cohort study aimed to assess the effectiveness of Empagliflozin as part of a quadruple OHA regimen over a 7-year follow-up period in 575 adult patients with uncontrolled T2DM on a triple OHA regimen and who were unwilling to initiate insulin therapy. Overall, 92.5% of patients achieved their target HbA1c levels. Significant reductions were observed in all glycemic parameters after 68 months (p < 0.001). Weight and BMI significantly decreased, whereas waist circumference remained unchanged. Lipid profiles showed significant improvements in total cholesterol, LDL, and triglycerides, while HDL levels did not change significantly. Blood pressure trends revealed significant reductions in both diastolic blood pressure (DBP) and mean arterial pressure (MAP), though systolic blood pressure (SBP) remained relatively stable. Our study indicates that adding empagliflozin to a drug regimen consisting of multiple OHAs can effectively control glycemia in T2DM patients with more pronounced target achievement (< 7%) and HbA1c reduction along with improvement in cardiometabolic parameters, suggesting its potential as a promising alternative for long-term glycemic management.

Distinct patterns of volcano deformation for hot and cold magmatic systems

Volcano deformation can be detected over timescales from seconds to decades, offering valuable insights for magma dynamics. However, these signals are shaped by the long-term evolution of magmatic systems, a coupling that remains poorly understood. Here we integrate thermal models of crustal-scale magmatism with thermo-mechanical simulations of ground deformation. This allows us to determine the influence of magmatic flux over 105–106 years on viscoelastic deformation spanning a 10-year observation period. Our results reveal a coupling between surface deformation and the thermal evolution of magma systems, modulated by magma flux and system lifespan. Relatively cold magma systems exhibit cycles of uplift and subsidence, while comparatively hot plumbing systems experience solely uplift. These findings align with geophysical observations from caldera systems, emphasizing the potential of surface deformation measurements as tool for deciphering the state and architecture of magmatic systems. Considering long-term magmatic system evolution is imperative for accurate interpretation of volcanic unrest.

Restoration of Impounded Forests of Coastal Louisiana Using Spoil Bank Gapping

Impoundment and increased flood duration are some of the most common stressors to declining forested wetlands in coastal Louisiana, USA. One type of restoration that has shown itself to be cost-effective is spoil bank gapping. This type of hydrologic restoration has occurred within the Lac des Allemands swamp of Barataria Basin. After 60 years of impoundment, the hydrogeomorphic processes in the study area were improved. The study area included eight paired 625 m2 sites. Basal area growth over the 7-year period varied between 5.93% and 14.39%, with an average of 8.31%, or just over 1% wood growth per year. Post-restoration basal areas indicate that all our study areas are improving. Pooled together, the 2018–2023 years had significantly higher net production than the pre-project 2017 growing season. The distribution between leaf and wood production was remarkably similar within species types across years, with leaf production consistently exceeding wood production, particularly due to Taxodium distichum. Canopy cover has increased by 20 percent since project construction, and as a result, herbaceous cover tends to decrease over time.

Unicuspid unicommissural aortic valves: A surgical pathology analysis.

The unicuspid unicommisural aortic valve is an uncommon congenital malformation that often manifests as stenosis with or without regurgitation in adults in their third to fifth decades of life. This report characterizes the morphological features of surgically excised unicuspid valves in adults with clinical correlation. Among the surgically excised aortic valves over a period of 10 years, the clinical data and morphological features of unicuspid aortic valves were analyzed. The patients were grouped by the type of valvular function. Pathological features noted were the shape of the orifice, the status of the commissure and raphe, presence of fibrous thickening, calcification, and other complications. Twenty-three UAVs, excised over a 10-year period, represented 4.16% of the excised diseased aortic valves. There was a male preponderance with a mean age of 47.7 years. Majority of the patients (22 cases) had moderate to severe stenosis with varying degrees of regurgitation, and the valvular disease had been clinically attributed to rheumatic heart disease, bicuspid aortic valve, or senile degenerative changes. Most of the valves (18) had been cut at their commissural regions, and 2 rudimentary commissures or raphes were seen in 21 valves. Cuspal fibrosis/calcification was often associated with complications like ulceration, hemorrhage, and bland vegetations. Aneurysm of the ascending aorta had been present in 1 patient. The unicuspid unicommisural aortic valve while rare is usually clinically classified with the more common, congenitally bicuspid aortic valve. Clinical or imaging diagnosis can be challenging since calcification may obscure the morphology creating difficulties in distinguishing such valves from other congenital or acquired valvular pathologies, especially in older patients. Often it is only the gross examination that leads to the differentiation as was our observation.

Morbidity, Mortality, and Epidemiological Features of Clinical Invasive Listeriosis Isolates from Sentinel Surveillance in Beijing, China, 2013-2022.

Listeriosis is a relatively rare but severe foodborne disease, which has significant public health concern of persons with underlying conditions and pregnant women. This study aimed to estimate the morbidity, mortality, and fatality rates of listeriosis over a 10-year period and clarify the epidemiological features of the pathogen in Beijing, China, based on voluntary reporting of sentinel surveillance. A total of 228 listeriosis cases were reported with annual morbidity rate of 1.054 per million inhabitants, including 113 maternal-neonatal cases with mean annual morbidity rate of 63.401 per million live births in Beijing from 2013 to 2022.The morbidity rate increased from 0.094 to 0.868 per million inhabitants from 2013 to 2019 (p for trend = 0.003). The overall and maternal-neonatal fatality rate were 31.82% and 42.86%, respectively. Four serogroups were identified in this study, and 1/2b predominated (89 strains). We observed the morbidity rate of listeriosis increased in Beijing over the past 10 years. Maternal-neonatal cases accounted for a higher proportion than that described in other countries, considering population base and fertility policy in China, official recommendations targeting pregnant women should be actively promoted.

Alternative Formulations of Job Strain and Sleep Disturbances: A Longitudinal Study in the United States.

Sleep disturbances are a major public health concern in the United States, leading to adverse health outcomes. In the working population, job strain has been identified as an important risk factor for sleep disturbances, but evidence from the United States remained limited. This study aimed to examine longitudinal associations between job strain and sleep disturbances in the United States, with a focus on the alternative formulations of job strain. A total of 1721 participants were drawn from two waves of the Midlife in the United States (MIDUS) study, with an average 9-year follow-up period. Job strain was measured using Karasek's Job-Demand-Control model and operationalized in six formulations: standard quadrant, simplified quadrant, linear, quotient, logarithm quotient, and quartile based on quotient. Generalized Estimating Equations were used to estimate longitudinal associations of alternative formulations of job strain at baseline with sleep disturbances across follow-up. Corrected Quasi-likelihood Information Criterion (QICu) was used to assess the goodness of fit. All approaches showed that higher job strain at baseline was significantly associated with an increase in sleep disturbances across follow-up. QICu scores indicated that continuous Demand-Control formulations (linear, quotient, logarithm quotient) had better model performance of 4602.66, 4604.28, and 4601.99, respectively. The logarithm quotient showed the best fit. Our findings imply the importance of early workplace interventions in reducing job strain to improve sleep hygiene. They further show that the continuous formulations quantifying job strain were more consistent and robust, which provides suggestions for future workplace health research in the United States.

Impact of TCF7L2 rs7903146 on clinical presentation and risk of complications in patients with type 2 diabetes.

TCF7L2 rs7903146 is the most impactful single genetic risk variant for type 2 diabetes. However, its role on disease progression, complications and mortality among people with type 2 diabetes at diagnosis remains unclear. We assessed the per allele impact of the rs7903146 T-allele on clinical characteristics and complication risk in 9231 individuals with type 2 diabetes at diagnosis and over a 10-year follow-up period. Log-binomial and robust Poisson regression analyses were used to estimate prevalence ratios for clinical characteristics and macro- and microvascular complications at diabetes onset, while Cox regression was applied to estimate the risk of complications post-diagnosis. Analyses were adjusted for sex, calendar year at birth, age at enrollment and diabetes duration. The per T-allele impact was associated with 0.6 kg/m2 (95% CI: 0.4, 0.8) lower BMI, 1.4 cm (95% CI: 1.0, 1.8) smaller waist circumference, 5.6% (95% CI: 4.2, 7.0) lower insulin secretion and 5.0% (95% CI: 3.3, 6.7) higher insulin sensitivity. Over 10 years, the per T-allele impact was associated with lower risks for major adverse cardiovascular events (0.87 [95% CI 0.79, 0.95]), myocardial infarction (0.82 [95% CI: 0.72, 0.93]) and heart failure (0.85 [95% CI 0.73, 1.00]), with no significant impact on microvascular complications. The TCF7L2 variant is associated with less obesity, lower insulin secretion and higher insulin action at diabetes onset, and decreased risk of cardiovascular events following type 2 diabetes onset.

Effect of healthy lifestyle score trajectory on all-cause mortality in the late middle-aged and older population: Finding from 17-year retrospective cohort study.

Recently, the World Health Organization has emphasized the importance of a healthy lifestyle in reducing severe illnesses and premature mortality. To evaluate this, the Healthy Lifestyle Score (HLS), which focuses on health protecting behaviors (e.g., smoking, alcohol consumption, physical activity, body mass index), is widely used. However, as HLS may fluctuate over time, there is increasing focus on monitoring HLS trends. Accordingly, this study aims to track HLS trajectories (HLST) and examine their association with mortality among middle-aged and older Koreans. After excluding missing values, data from 6249 participants were analyzed using the group-based trajectory model (GBTM) to classify HLST, based on the first to fourth waves of the Korean Longitudinal Study of Aging (KLoSA). The chi-square test and Cox proportional hazards model were employed to examine the association between HLST and all-cause mortality over a 10-year follow-up period (December 31, 2012, to December 31, 2022; 3650 days). Three HLST groups were identified in the GBTM analysis. These were the Poor HLST (17.8 %), Average HLST (42.9 %), and Good HLST (39.4 %) groups. Compared to the good HLST, the poor HLST had higher mortality at 1 year (hazard ratio [HR]: 1.98, p: 0.029), 3 years (HR: 1.78, p: 0.001), 5 years (HR: 1.52, p: 0.002), 7 years (HR: 1.39, p: 0.002), and 10 years (HR: 1.40, p: 0.000). Furthermore, stratified analysis by sex, age, marital status and residential region showed that male, ≥65 years, single and urban area groups had a strong association between HLST and all-cause mortality. The findings of this study underscore the necessity of policies and institutional measures grounded in community networks to mitigate the risk of all-cause mortality among vulnerable groups with persistently poor HLST.

Association between urate-lowering therapy and kidney failure in patients with chronic kidney disease.

Hyperuricemia is a hallmark of gout and a suspected risk factor for the progression of chronic kidney disease (CKD). However, the impact of urate-lowering therapy on CKD progression is subject to debate. The objective of the present study was to describe the prevalence of inappropriate urate-lowering therapy prescriptions and evaluate the association between urate-lowering therapy prescription and the progression of kidney disease in patients with CKD. CKD-REIN is a French, nationwide, prospective cohort of 3,033 nephrology outpatients with CKD (eGFR < 60mL/min/1.73 m2). Prescriptions of urate-lowering therapy drugs (allopurinol or febuxostat) were recorded prospectively. The appropriateness of each prescription was evaluated according to the patient's kidney function at baseline and during follow-up. Propensity score-matched, cause-specific Cox proportional hazards regression models were used to assess the association between incident urate-lowering therapy use and CKD progression (defined as the initiation of kidney replacement therapy (KRT) but also in other ways). At baseline, 987 of the 3009 patients included in this study (median age: 69; men: 66%) were receiving urate-lowering therapy; 396 of these 987 patients were receiving an inappropriate prescription with regard to their kidney function. During a 5-year follow-up period, 70% of the 396 urate-lowering therapy prescriptions remained inappropriate. In the propensity score-matched cohort (n = 674), 136 patients started KRT. Compared with non- urate-lowering therapy use, urate-lowering therapy use was not significantly associated with a slowing in CKD progression, regardless of the definition used (HRKRT 0.89, 95% CI 0.67-1.20). Our real-world data emphasized the lack of reassessment of urate-lowering therapy prescriptions in patients with CKD. Urate-lowering therapy was not associated with a slowing of CKD progression.

Date estimation for the control of avocado (Persea americana Mill.) anthracnose (Colletotrichum sp.)

Objective: To generate a program that estimates the dates or times for the control of avocado anthracnose, based on the meteorological conditions required for the infection, establishment, and development process. Design/Methodology/Approach: An Excel program was developed to estimate temperature (T), relative humidity (RH), dew point (PR), leaf wetness (LW), and probability of precipitation (PoP) and to evaluate, on an hour-per-hour basis, the fulfillment of the climate thresholds required for the establishment and development of Colletotrichum sp. The maximum and minimum daily temperature must be determined with an 80% probability of occurrence and the probability of precipitation. This information was obtained from the daily records of the CONAGUA (National Water Commission) weather stations for three avocado-producing municipalities in Puebla during a 16-year period (2007-2022). Results: The resulting program estimates the meteorological variables for the following ten days. The conditions in January were not optimal for the onset and development of avocado anthracnose in the three municipalities of Puebla taken as a case study. On the contrary, June had optimal temperature and relative humidity, as well as a higher probability of precipitation. Study Limitations/Implications: Accurate data on the meteorological conditions of the orchards under study are required to increase efficiency. Findings/Conclusions: The program will help producers to determine application dates, developing a more user-friendly and efficient management proposal for controlling avocado anthracnose.

Positional obstructive sleep apnea in children prescribed continuous positive airway pressure therapy for obstructive sleep-disordered breathing.

Positional obstructive sleep apnea, in which there is a ≥ 2:1 predominance of obstructive events in the supine position, is a sleep-disordered breathing phenotype with a targeted treatment in the form of positional device therapy. We sought to determine the prevalence of positional obstructive sleep apnea in a cohort of children prescribed continuous positive airway pressure therapy, ascertain risk factors for the condition, and determine the associated continuous positive airway pressure treatment adherence rate. A retrospective cohort study of all children > 2 years old from a single tertiary paediatric centre prescribed continuous positive airway pressure therapy over an 8-year period was conducted. Positional obstructive sleep apnea prevalence was established by analysing positional and respiratory event data from the participants' original diagnostic polysomnography. Continuous positive airway pressure therapy adherence was determined using data from machine download. Univariable and multivariable logistic regression modelling was used to determine participant demographic and clinical factors associated with positional obstruction. Positional obstructive sleep apnea (defined by Bignold's criteria modified for paediatric use) prevalence in the cohort of 237 analysed participants was 38%. Suboptimal continuous positive airway pressure adherence was noted in 30% of this group based on initial machine download, performed a median of 96 days post-treatment initiation. Higher age and lower obstructive apnea-hypopnea index were independent predictors of positional obstructive sleep apnea, whereas neurodevelopmental diagnosis, presence/absence of rapid eye movement-related obstructive sleep apnea, overweight/obesity status and history of adenoidectomy/adenotonsillectomy were not. For children, positional device therapy is a treatment option worthy of further consideration and research.

The MyGuide Web-Based Self-Management Tool for Concussion Rehabilitation: Mixed Methods Cross-Sectional Study.

Web-based concussion self-management education programs for adolescents can improve functional outcomes, reduce concussion symptoms, and increase self-efficacy. However, there are a limited number of studies examining the perceptions and acceptance of these programs and the use of these tools in the adult concussion population. This study aimed to investigate the perceptions and acceptance of clinicians and adults with concussions using MyGuide Concussion (Vancouver Coastal Health), a web-based concussion self-management tool. Using a mixed methods sequential explanatory design, a convenience sample of 8 adults with concussions and 8 clinicians who used MyGuide Concussion over a 2-year period were interviewed, and their responses were analyzed. Participants reported two key benefits of using the web-based self-management tool: (1) the tool's emphasis on the interconnectedness of physical and psychological symptoms, and (2) the ability to provide reassurance that symptom being experienced were a normal part of the concussion experience. Clinicians described the tool as being useful as a supplementary source of information for clients in addition to clinical sessions and believed the content was useful for increasing clients' independence in managing their own recovery. Overall, the evaluation of the MyGuide tool is an acceptable and well-perceived tool for adults with concussions who require a basic understanding of concussion recovery, particularly in the early stages of recovery. Future research may include optimizing MyGuide by targeting promotional strategies and addressing other barriers to use.

The real-world efficacy and safety of frontline therapy of obinutuzumab plus bendamustine for untreated high-tumor-burden follicular lymphoma.

While R-CHOP has been one of the standard therapies for untreated high-tumor-burden (HTB) follicular lymphoma (FL) for over 2 decades, obinutuzumab plus bendamustine (OB) is also currently regarded as the standard of care since its approval in 2018 in Japan; however, the long-term efficacy and safety of OB in the daily clinical practice has not been thoroughly evaluated. We conducted a multicenter retrospective study for the clinical outcome of 53 patients with HTB FL treated by OB as the frontline therapy between 2018 and 2021 in the Kyoto Hematology Clinical Study Group (KOTOSG). All patients had at least 2-year follow-up period. The median age was 67, and 60.4% were classified as high risk according to the Follicular Lymphoma International Prognostic Index. The overall and complete response rates after induction therapy with OB were 98% and 83%, respectively. With a median follow-up of 38.5months, the 3-year progression-free survival (PFS) and overall survival (OS) were 77.3% and 91.2%, respectively. Grade 3-4 hematological adverse events (AEs) were common, including neutropenia (58.5%) and lymphopenia (98.1%). Non-hematological AEs included infections, such as lung infections, coronavirus disease 2019, and sepsis, with two cases (3.8%) being fatal. Finally, propensity score-matched analysis showed no significant difference in PFS between 46 FL patients treated by the frontline OB and 46 FL patients treated by R-CHOP between 2001 and 2019 in KOTOSG. This study highlighted the need for careful treatment selection based on patient background and disease condition in real-world practice with more elderly patients.

Uveitic macular oedema in ocular tuberculosis patients in a non-endemic country: characteristics, management, and visual Outcomes.

To describe clinical features, treatment strategies and visual acuity changes of eyes with uveitic macular oedema (UMO) in ocular tuberculosis (OTB) patients from a non-TB-endemic country. This retrospective study was conducted using a 10-year period registry of OTB patients diagnosed in Erasmus MC, Rotterdam. Longitudinal analysis of visual acuity trajectory in eyes with and without UMO was performed using linear mixed effect model. Out of 93 included patients, 23 (24.7%; 26 eye episodes) presented with baseline UMO. Older age (p = 0.024) and diabetes coexistence (p = 0.048) were associated with UMO. Eyes with baseline UMO showed lower presenting best-corrected visual acuity (BCVA) (p = 0.024). Posterior uveitis (p = 0.005), the presence of active vitreous cells (p = 0.016) and retinal vasculitis (p = 0.008) were ocular signs associated with UMO. A step-wise treatment approach primarily initiated with local steroids, followed by a combination with oral acetazolamide and, if necessary, additional systemic immunosuppressants. Overall, this approach resulted in complete UMO resolution in 77% (20/26) of cases. UMO resolution was shorter among eyes co-managed with ATT, although statistically not significant (p = 0.144). Eyes experiencing at least one UMO episode exhibited lower visual acuity at the last-follow-up than those without (p = 0.020). Active vitreous cells, retinal vasculitis and posterior uveitis are associated with UMO among OTB patients. The time-to-resolution of UMO for eyes co-managed with ATT was shorter compared to those without, suggesting that patients with UMO in OTB should be treated with ATT.

A Time-Series Analysis of News Media Coverage of Suicide in Canada from 2019 to 2023: Une analyse de séries chronologiques de la couverture responsable du suicide par les médias au Canada de 2019 à 2023.

Evidence suggests that the media can play a role in preventing suicide, as well as contributing to suicide contagion. As such, the primary objective is to assess adherence to responsible reporting of suicide recommendations in news articles about suicide over time. A secondary objective is to assess whether reporting changed significantly during the COVID-19 pandemic. The tertiary objective is to assess overall patterns regarding types of suicide reported. We collected news articles with the keyword "suicide" from 47 Canadian news sources between April 1, 2019, and March 31, 2023. Articles were coded for adherence to key responsible reporting of suicide guidelines. Frequency counts and percentages of adherence were calculated for all key variables. Time series analyses using a Generalized Linear Autoregressive Moving Average model assessed for adherence trends over time, including measuring for any changes during the COVID-19 years. Study procedures resulted in 3,232 coded news articles. Overall, the results indicate that adherence to the guidelines has moderately improved over the course of the 4-year period. This is especially true for recommendations regarding avoiding putatively harmful content, such as detailed descriptions of the suicide method. Similar improvements were seen in adherence to guidelines related to the inclusion of putatively helpful content, with significantly more articles providing help-seeking information. However, in the final year of the study, less than a third of articles included educational content about suicide, help-seeking information, or quotes from suicide experts. Reporting of suicide during the COVID-19 period showed some positive improvements; however, these were not sustained after the pandemic ended. On the plus side, adherence to responsible suicide reporting guidelines improved over the 4-year period, especially for recommendations concerning putatively helpful content. However, there remains room for improvement regarding the inclusion of putatively protective content such as including help-seeking information, educating about suicide, and quoting experts.

Insights from social media into public perspectives on investigative genetic genealogy

Social media sites like X (formerly Twitter) increasingly serve as spaces for the public to discuss controversial topics. Social media can spark extreme viewpoints and spread biased or inaccurate information while simultaneously allowing for debate around policy-relevant topics. The arrest of Joseph J. DeAngelo in April 2018 ignited a barrage of social media conversations on how DNA and genetic genealogy led to the suspect. These conversations continued over the following years as policies changed and as the use of the approach expanded. We examined social media coverage of investigative genetic genealogy (IGG) to characterize the volume and temporal patterns in the topics and sentiments of these public conversations. First, using a data analytics tool Brandwatch Consumer Research, we built flexible search strings to collect tweets from the social media platform Twitter/X for IGG-relevant content published from 2018 to 2022, resulting in 24,209 tweets. Second, we applied informatics tools to the dataset to generate topic clusters and analyze trends in cluster volume and distribution over time to define the top 25 peaks in tweet volume, representing the 25 events that generated the highest volume of conversation over the 5-year period. Third, drawing on the contextual framework of key IGG events, we selected three of the top ten events to code for sentiment along with a randomly sampled subset of tweets across the timeframe. Qualitative coding for position on IGG revealed a majority of tweets were supportive of the use of IGG, but key concerns were also voiced about the ethics of IGG. Over a third of conversations on Twitter/X were on either cases solved or suggestions for use of IGG. We archived the social media data for future research. These data highlight key areas of public support and concern within IGG processes and across application contexts.

A 5-Year Review of Characteristics and Outcomes of Trauma Surgery Patients Leaving Against Medical Advice.

The objective of this study was to characterize the demographic, social, economic, and clinical factors of trauma surgery patients leaving against medical advice (AMA). Data were retroactively obtained from a level-one trauma center in a medium-sized metropolitan area from January 2017 to December 2021. The sample population consisted of patients admitted or treated by the trauma surgical service. In the 5-year study period, 130 surgical patients left AMA and met the inclusion criteria for this study. The average patient was 38.8 years old. The majority were male (77.7%) and White (47.7%). It was found that 74.6% of patients had insurance, 23.6% were experiencing homelessness, and 6.2% required an interpreter. A large percentage of patients had a past medical history significant for depression (31.5%), anxiety disorders (25.4%), and substance use disorder (68.5%). Analysis of the hospital time course of this patient population indicated that patients were most often admitted to trauma surgery (70.0%) and most often required consults by neurosurgery (28.5%). Procedures were performed for 81.5% of patients and social services were consulted for 60.8% of patients. Only 50.8% of patients who left AMA were noted to receive discharge instructions. Nearly half (44.6%) of the patients returned to a hospital to receive additional care within 1 month of their initial AMA discharge date. A concerning number of trauma surgery patients left without discharge instructions, possibly leading to a high rate of 30-day hospital readmission. Future studies are needed to examine and further characterize the relationship between discharge protocol and outcomes of patients leaving AMA.