Desensitization strategies for highly sensitized kidney transplant candidates remain limited in efficacy. Tocilizumab, an interleukin-6 receptor antagonist, has been proposed as an adjunct to IVIg to reduce HLA antibody burden. In this prospective controlled cohort study, highly sensitized candidates (median calculated panel reactive antibody [cPRA], 98.0%) were (n = 19) or were not (n = 15) treated with tocilizumab and IVIg. All tocilizumab-treated patients had failed ≥3 mo of IVIg-based desensitization. We assessed changes in cPRA, unacceptable antigens (U/As), transplant rates, and posttransplant outcomes. Tocilizumab-treated patients were more likely to demonstrate any reduction in cPRA during the study period (84.2% versus 33.3%; P = 0.002). Median cPRA change at nadir was -0.9% versus 0.0% (P = 0.02), although end-of-study differences were not statistically significant. Treated patients more frequently achieved removal of high-impact U/As (median cPRA of removed U/As 31.7% versus 0.0%; P = 0.004), and 3 underwent transplantation across antigens previously listed as unacceptable. Transplant rates (89.5% versus 73.3%; P = 0.4) and early posttransplant outcomes-including rejection, graft loss, BK viremia, renal function, de novo donor-specific antibody, and donor-specific antibody rebound-were similar between groups. In this controlled cohort, tocilizumab combined with IVIg was associated with greater reductions in HLA antibody burden without an apparent increase in early posttransplant immunologic risk. These findings support further evaluation of interleukin-6 (IL-6) blockade as an adjunctive desensitization strategy, particularly in candidates with limited transplant access despite high allocation priority.

Recent increasing interest in hallucinogens has underscored the critical gaps in our understanding of their adverse health effects and healthcare usage over time. The current study aimed to examine changes in emergency department (ED) visit rates involving hallucinogens, clinical outcomes of visits and the characteristics of individuals with ED visits involving hallucinogens. Repeated cross-sectional study using health administrative data. Ontario, Canada. All individuals aged 10 years and older living in Ontario, Canada, from 2008 to 2023 (population of 13 492 974 in 2023). Annual rates of ED visits involving hallucinogens overall and by demographic and clinical subgroups. Linear regression was used to calculate the average annual percent change (AAPC) in rates of visits. We identified 7735 individuals with an ED visit involving hallucinogens [median (interquartile range) age at the time of visit, 24 (19-33) years; 71.5% male] who incurred 8274 visits. Visits displayed high acuity, with 54% arriving by ambulance and 13.2% requiring hospitalization. In 42% of visits another substance or co-morbid mental health diagnosis was noted as contributing to the visit. Annual rates of ED visits involving hallucinogens increased by 97.9% between 2008 and 2023 (3.3 to 6.5 visits per 100 000 individuals) with visits increasing on average by 5.6% per year [AAPC = 5.6%; 95% confidence interval (CI) = 3.9%, 7.3%]. Relative increases between 2008 and 2023 were higher in those aged 25-44 (relative change (RC) 192.5%: AAPC = 8.5%; 95% CI = 6.0, 11.0] compared with other ages (age 45 + RC 125%: AAPC = 5.5%; 95% CI = 3.6, 7.3; age 19-24 RC 75.0%: AAPC = 5.3%; 95% CI = 3.4, 7.3). Visits increased more in individuals with anxiety disorders (RC 247%: AAPC = 7.5%; 95% CI = 5.2%, 9.9%) or prior diagnosis of schizophrenia (RC 401%: AAPC = 12.2; 95% CI = 8.2%, 16.4%) than those without any mental health disorder (RC 85.5%: AAPC = 4.9%; 95% CI = 3.1, 6.7). Comparable changes over time were observed in males (RC 101.1%: AAPC = 4.7; 95% CI = 2.9, 6.5) and females (RC 85.9%: AAPC = 6.0%;95% CI = 4.2, 7.8) and for those in the richest (RC 124.0%:AAPC = 5.7%; 95% CI = 4.6%, 6.9%) or poorest neighbourhoods (RC 70.2%: AAPC = 5.2%; 95% CI = 3.7%, 6.7%). The 97.9% increase in emergency department visits involving hallucinogens in Ontario, Canada, from 2008 to 2023 may reflect rising hallucinogen use and the need for ongoing monitoring, particularly in adults aged 25-44 years and those with co-morbid mental health diagnoses.

Sacral neuromodulation is an effective therapy to control overactive bladder symptoms, yet the underlying mechanisms and optimal stimulation parameters remain unclear. Analysis of 45 clinical studies from 1994 to 2023 demonstrated no significant change in rates of long-term symptom control despite technological advancements, and analysis of recent studies (2015 onward) showed that more than 40% of patients receiving test stimulation do not benefit from sacral neuromodulation. Critical knowledge gaps persist. A lack of evidence guiding stimulation parameter selection has resulted in largely unchanged programming protocols since initial US Food and Drug Administration (FDA) approval in 1997. There is little knowledge of sacral nerve anatomy or nerve fiber organization, and the specific neural pathways mediating therapeutic effects remain unclear. Additionally, there is a limited understanding of how anatomical variations affect stimulation outcomes and few validated predictors of long-term success. We propose that developing detailed computational models incorporating realistic nerve morphology and tissue properties, combined with systematic documentation of programming parameters and outcomes will enable development of more effective stimulation protocols and electrode designs. Bridging these knowledge gaps is essential for improving the consistency and efficacy of sacral neuromodulation for refractory overactive bladder.

In 2016, France reformed its health system by requiring public hospitals to form territorial groups. Policymakers, following experiences with integrated care provision in the United States and NHS-type networks in Italy and England, expected these groups to improve coordination and system efficiency. However, it remains unclear whether such administrative integration creates new care pathways within groups or substitutes for existing referral relationships with external providers. We analyzed national hospital administrative data from 2013 to 2021. Changes in inter-facility transfer rates were estimated using a synthetic difference-in-differences approach. The main outcome was the annual percentage of patients transferred to another hospital, overall and within the same group. Following group formation, smaller local hospitals experienced an average increase of 1.25 percentage points in transfers to hospitals within their group. Transfers to hospitals outside the group remained broadly stable, suggesting limited substitution away from pre-existing referral channels. Territorial grouping are associated with an increase in internal patient mobility, particularly among local hospitals, without reducing exchanges with external providers. These findings suggest that administrative integration may have layered new coordination arrangements onto existing care pathways and reinforced patterns of functional specialization. The results contribute to understanding how network-based integration reshapes organizational behaviour and patient mobility in regulated health systems.

Keratinocytes, the dominant cell type in the melanoma microenvironment during tumor initiation, exhibit diverse effects on melanoma progression. Using a zebrafish model of melanoma and human cell co-cultures, we observed that keratinocytes undergo an epithelial-mesenchymal transition (EMT)-like transformation in the presence of melanoma, reminiscent of their behavior during wound healing. Surprisingly, overexpression of the EMT-transcription factor Twist in keratinocytes led to improved overall survival in zebrafish melanoma models, despite no change in tumor initiation rates. This survival benefit was attributed to reduced melanoma invasion, as confirmed by human cell co-culture assays. Single-cell RNA-sequencing revealed a unique melanoma cell cluster in the Twist-overexpressing condition, exhibiting a more differentiated, less invasive phenotype. Further analysis nominated homotypic jam3b-jam3b and pgrn-sort1a interactions between Twist-overexpressing keratinocytes and melanoma cells as potential mediators of the invasive restraint. Our findings suggest that EMT in the tumor microenvironment may paradoxically limit melanoma invasion through altered cell-cell interactions.

Emergency policies designed to protect populations can inadvertently cause diagnostic harm when essential services are suspended. How such policies reshape gender gaps in cancer detection, and whether either sex faces disproportionate harm, remains underexplored. We leveraged Taiwan's 2021 level 3 alert-a precautionary directive implemented during minimal COVID-19 transmission (0.07%) that mandated hospital capacity reductions and school closures-as a natural experiment to test whether the alert produced gendered diagnostic disruptions. Using Taiwan Cancer Registry and National Health Insurance claims (N=312 522; 2015-2021), we employed interrupted time series and difference-in-differences models to estimate changes in cancer detection rates and tumour size at diagnosis; robustness was confirmed through sensitivity and falsification tests. The alert disproportionately reduced detection of early-stage cancers, consistent with a collapse of preventive and opportunistic detection pathways. Women experienced larger declines in detection than men (-43.9% vs -32.0%; p=0.001) and greater increases in tumour size (17.3% vs 11.5%; p=0.026). These gaps were most pronounced among women under 50 (-50.7% vs -25.5%; p=0.001) and disadvantaged women, whose tumour size increase was nearly double that of disadvantaged men (16.6% vs 8.8%; p=0.049). The gap was particularly large for opportunistically detected cancers (lung: -47.1% women vs -22.6% men; p=0.011). These findings reveal a system-level patient safety failure. Women's higher engagement with routine care, ordinarily a health advantage, became a structural vulnerability when these pathways were suspended, possibly amplified by intensified caregiving, employment shocks and infection-risk avoidance. As health systems prepare for recurring shocks, resilience planning must incorporate gender-sensitive safeguards that prevent diagnostic harm. Protecting early detection pathways is both a clinical imperative and a patient safety requirement for equitable emergency response.

Pedestrian-motor vehicle crashes are a major cause of preventable injury in urban environments. They have increased markedly over the past several decades, especially overnight, and with a disproportionate impact on pedestrians of color. Streetlights represent a potential tool to combat these trends, but empirical studies of their relationship with pedestrian trauma are limited. We use geospatial data from Boston (2016-2023) to assess the relationship between streetlight density (lights/road kilometer) by census tract on (1) pedestrian crashes, (2) changes in crash rates over time, (3) racial disparities in crash incidence, and (4) proportion of crashes occurring overnight. Pedestrian crashes decreased from 2016 to 2023 from 616 (0.55/km) to 421 (0.37/km), with higher streetlight densities associated with greater overall reductions (an additional -0.002 crashes/km/year per streetlight/km (95% CI [-0.003, -0.001]). Persistent racial disparities were observed, with 0.04 additional crashes/km/year (95% CI [0.02, 0.06]) per 10% residents of color. However, this association decreased by 0.004 crashes/km/year (95% CI [-0.01, -0.001]), and higher streetlight densities were associated with greater reductions (additional annual decrease of 0.0004 crashes/km/year for every streetlight/km (95% CI [-0.001, -0.0001]). Finally, the proportion of crashes occurring overnight increased from 37.6% to 45.1%. Streetlight density was negatively associated with overnight timing (adjusted odds ratio of 0.991; 95% CI [0.986, 0.997] per streetlight/km) but had no relationship with the time trend. We conclude that there may be a beneficial relationship between streetlight density and pedestrian safety, where census tracts with higher streetlight densities demonstrated greater improvements in overall crash rates and racial disparities.

Association of Michigan Medicaid's Depression Screening Requirement With Changes in Racial and Ethnic Inequities in Diagnosis and Treatment for Perinatal Mental Health Conditions.

The COVID-19 pandemic disrupted healthcare service utilisation, but evidence on its impact on perinatal outcomes is conflicting. We investigated the impact of the pandemic public health measures (eg, lockdowns, reduced healthcare access, altered health-seeking behaviour) on preterm birth (PTB), stillbirth, low birth weight (LBW), small for gestational age, caesarean delivery, breastfeeding initiation (BFI) and neonatal intensive care unit (NICU) admissions. Using linked administrative health databases, we conducted a population-based study of pregnancies before (January 2008-February 2020) or during (March 2020-March 2022) the pandemic; for the latter period, they were categorised by exposure duration. We conducted interrupted time series analyses using season-adjusted generalised linear models, and analyses were stratified by income. Among 222 636 pregnancies (190 694 prepandemic and 31 942 during pandemic), PTB rates increased from 8% prepandemic to 9.1% during the pandemic, with a 19.0% relative increase overall (p<0.01). In stratified analyses, PTB rose by 27.1% in the lower-income group (8.8% to 10.1%, p=0.01) and by 19.7% in the higher income group (7.3% to 8.2%, p=0.02); however, effect modification by income was statistically non-significant. Pregnancies 100% exposed during the first and second year of the pandemic experienced higher rates of PTB by 15.0% (p=0.01) and 11.6% (p<0.01) compared with the prepandemic period, respectively. The pandemic measures were associated with no changes in stillbirth (0.7‰ vs 0.61%; p=0.37) or NICU admission rates (8.3% vs 8.2%; p=0.69). LBW rates increased from 5.5% to 6.3% (13.9% relative increase, p=0.05). Pregnancies spanning the entire first year of the pandemic experienced higher rates of caesarean deliveries (24.6% relative increase, p<0.01). BFI rates decreased from 82.5% to 81.8% (3.9% relative decrease, p=0.01) compared with prepandemic, followed by a slight increase (p=0.02) during the pandemic period. The COVID-19 pandemic measures were associated with increased PTB and caesarean delivery rates, particularly among pregnancies fully exposed to pandemic measures. Over the 2-year pandemic period, stillbirth, NICU admissions and BFI rates were stable.

ABSTRACTBackgroundMost ovarian cancers are detected at advanced stages, with poor outcomes. Ovarian cancer is heterogeneous; the most common subtype, serous ovarian carcinoma, may originate outside of the ovaries. To inform etiologic heterogeneity, prevention, and treatment of ovarian cancer, we conducted the first evaluation of oophorectomy‐corrected incidence and mortality trends of ovarian, fallopian tube, and peritoneal cancers.MethodsOvarian cancer incidence, survival, and incidence‐based mortality overall and by subtype were analyzed using the U.S. Surveillance, Epidemiology, and End Results (SEER)‐22 and SEER17 databases including cases from 2000 to 2019, with oophorectomy correction based on data from the National Health and Nutrition Examination Survey (NHANES). Rates were age adjusted per 100,000 person‐years; annual percent changes in rates were calculated.ResultsAge‐adjusted prevalence of oophorectomy changed minimally between 2000 and 2019 and was highest among Non‐Hispanic White women. Oophorectomy‐correction increased ovarian cancer incidence rates by 23% on average. Ovarian cancer incidence decreased by 2% between 2000 and 2019, with a stronger reduction observed in recent years. Fallopian tube cancer incidence increased by 7% from 2000 to 2019. Relative 5‐year survival was lowest among Non‐Hispanic Black women even after accounting for histotype and stage. Ovarian cancer mortality decreased by 1.8% between 2000 and 2019. Serous carcinomas contributed to 68% of ovarian cancer cases, but 83% of all ovarian cancer deaths.ConclusionsThe reasons for decreasing ovarian cancer incidence are not understood. There is evidence for some reclassification of primary ovarian to primary fallopian tube cancers. Low survival rates in Non‐Hispanic Black women point to disparities along the continuum of care.

This study described the implementation of the Registered Nurses' Association of Ontario® (RNAO) Vascular Access Best Practice Guideline in a hospital in the Basque health system and evaluated its impact on vascular access care by comparing changes in phlebitis rates before and after implementation. A longitudinal pre-post observational study was conducted using routinely collected data on peripheral venous catheters from 2020 to 2023. A retrospective analysis of prospectively collected institutional data was performed. To describe the implementation process, implementation logs were reviewed, including meeting minutes, audit reports, and internal monitoring documents. Data on peripheral venous catheter insertions and phlebitis cases were extracted from the hospital's clinical data system. Annual phlebitis rates were calculated and compared using the χ2 test, with statistical significance set at p-value <0.05. The implementation process followed the RNAO Best Practice Guideline Implementation Toolkit and was structured around three components: knowledge dissemination, professional training, and changes in clinical practice. A total of 3,272 peripheral venous catheter insertions was recorded in 2020 and 1,210 insertions in 2023. The phlebitis rate in 2020 was 6.3% (95% CI: 5.5%-7.2%), and decreased to 3.9% (95% CI: 2.9%-5.2%) in 2023, representing a statistically significant reduction and reaching values below the 5% threshold recommended by the Infusion Nurses' Society. The implementation of the RNAO Vascular Access Guideline was associated with a statistically and clinically significant reduction in phlebitis rates. These findings support the use of structured implementation strategies in improving vascular access care. http://links.lww.com/IJEBH/A612.

Objective: To analyze the trend of pesticide-related suicide incidents in Jiangsu Province, and factors influencing changes in pesticide suicide rates, in order to provide reference for suicide prevention and pesticide management policy formulation. Methods: In December 2022, data on pesticide-related suicides in Jiangsu Province from 2006 to 2021 were collected. The autoregressive integrated moving average (ARIMA) and generalized autoregressive conditional heteroskedasticity (GARCH) models were used for time series analysis. Granger causality test was used to analyze the causal relationship between pesticide-related suicide related indicators and socio-economic and agricultural related indicators. Results: From 2006 to 2021, a total of 41419 cases of pesticide poisoning were reported in Jiangsu Province, including 26426 cases of pesticide-related suicide poisoning, with a mortality rate of 7.84%. The pesticide-related suicide rate among women was 1.25/100000, which was significantly higher than that among men (0.78/100000, OR=0.61, 95%CI: 0.60-0.63, P<0.001). Pesticide-related suicide had obvious seasonal characteristics, with the highest proportion of cases in summer (35.11%). Granger causality test shows that the number of pesticide-related suicides was a one-way Granger cause of the average annual population, and the number of pesticide-related suicide deaths was a one-way Granger cause of pesticide-related suicide (P<0.05). No Granger causality was found between pesticide use, unemployment rate, per capita GDP, with the number of pesticide-related suicides. Conclusion: The number of pesticide-related suicide cases in Jiangsu Province has shown a continuous downward trend from 2006 to 2021, with women having a higher risk of suicide than men, and summer being high-risk periods.

The purpose of this study was to ascertain the status and patterns of pinworm Enterobius vermicularis infection among preschool children in Jeollanam-do from 2023 to 2025. Further, it aimed to assess changes in infection rates during the implementation of the test-and-treatment strategy. Cellophane tape swabs were collected from 12,608 children aged 0-6 years enrolled in daycare or kindergarten facilities in 8 cities and counties of Jeollanam-do. The samples were examined under a light microscope to diagnose pinworm infection. The overall infection rate over the 3-year period was 0.22% (28/12,608). The annual infection rate declined continuously from 0.35% in 2023 to 0.06% in 2025 (trend P<0.05). The infection rate did not vary significantly with sex (P>0.05), but was significantly higher in the 4-6 year age group (P<0.05), and was highest in Jangheung-gun (0.65%) and Goheung-gun (0.37%). The overall infection rate in this study was substantially lower than previously reported. However, this may represent a transient phenomenon reflecting environmental or behavioral factors associated with this specific period. Therefore, continuous monitoring is necessary.

The Veterans Health Administration (VHA) Life-Sustaining Treatment Decisions Initiative (LSTDI) aims to improve documentation of patient preferences for life-sustaining treatment (LST), particularly in high-risk populations such as those served by Home Based Primary Care (HBPC) programs. Despite this mandate, LST documentation in HBPC remains variable. Previous studies suggest audit and feedback may be insufficient when used alone. This study evaluated whether combining audit and feedback with tailored implementation facilitation can increase and sustain LST documentation rates in HBPC. We evaluated the prospective implementation of a longitudinal intervention using retrospective data design with data from the VA Corporate Data Warehouse and HBPC Masterfile between October 2019 and December 2024. Eleven HBPC programs with historically low (< 50%) LST documentation rates participated in a phased intervention consisting of a 6-month pre-implementation phase, a 15-month implementation phase, and a 12-month sustainability phase. The intervention combined monthly audit and feedback reports with site-specific implementation facilitation. We used a difference-in-differences (DID) analysis to compare changes in monthly site-level LST documentation rates at intervention sites (Cohorts 1-3) versus non-intervention sites (Cohort 4). The primary site-level outcome was the percentage of Veterans with a completed LST template. The analysis included a total of 140 VA sites, with 11 intervention sites across six VA regions. Intervention sites demonstrated a significant and sustained increase in LST documentation during implementation. The overall average treatment effect was 0.21 (95% CI: 0.144-0.276), corresponding to an average increase over expected trends of 21 percentage points across all intervention cohorts. This effect was maintained throughout the 12-month sustainability period across all cohorts. Pairing audit and feedback with implementation facilitation produced a substantial and durable improvement in LST documentation in HBPC settings. These findings support the use of these two complementary, data-driven implementation strategies to achieve policy goals of goal-concordant care for seriously ill Veterans.

To evaluate the association between physician experience and the use of forceps-assisted vaginal delivery, and to assess whether increasing experience is associated with changes in cesarean delivery rates in a tertiary academic health care network. We conducted a retrospective longitudinal cohort study including all physician-attended deliveries within a tertiary academic healthcare network in Santiago, Chile, between 2014 and 2024. The unit of analysis was the physician-year. Physician experience was defined as years since completion of residency and analyzed as a continuous variable. Outcomes included forceps-assisted and cesarean deliveries, modeled using volume-weighted logistic regression at the physician-year level. Asensitivity analysis restricted the data set to physician-years with ≥20 deliveries. The data set included 109 physicians, 641 physician-year observations, and 26 898 deliveries. Cesarean delivery accounted for 46.05%, spontaneous vaginal delivery for 46.18%, and forceps-assisted delivery for 7.75%. Increasing physician experience was associated with higher odds of forceps delivery (odds ratio [OR] per year, 1.013 [95% confidence interval [CI], 1.008-1.018]; p < 0.001). Although a statistically significant association was observed for cesarean delivery (OR per year, 1.007 [95% CI, 1.005-1.010]; p < 0.001), the magnitude was minimal and not clinically meaningful. Findings were consistent in the ≥20-delivery sensitivity analysis. Increasing physician experience is associated with greater use of forceps-assisted delivery, while cesarean delivery rates remain largely unchanged. These findings suggest that operative vaginal delivery depends on sustained clinical exposure, and preserving training opportunities may help maintain its role as an alternative to cesarean delivery in appropriately selected patients.

Healthcare-associated infections remain a major challenge in resource-constrained hospitals, particularly surgical-site infections (SSI) and bloodstream infections (BSI). We evaluated the association of a context-adapted Minimum Antibiotic and Sterilisation Guideline (MASG) with infection rates in a secondary-level teaching hospital. We conducted a single-centre interrupted time-series study using 18 consecutive monthly observations, including 9 months before and 9 months after MASG implementation. The intervention combined enhanced environmental cleaning, reinforced aseptic wound care, structured 48-72 h antibiotic review, and surveillance-feedback measures. Primary outcomes were monthly SSI and BSI rates per 1000 patient-days. Segmented regression analysis was used to assess level and trend changes. A total of 7120 patient-days, 328 surgical procedures, and 2715 ICU patient-days were included. Mean SSI rates decreased from 3.52 to 1.47 per 1000 patient-days following MASG implementation (58.2% reduction). Interrupted time-series analysis demonstrated a significant immediate reduction in SSI rates (β2 = -1.71, p < 0.001) and a significant post-intervention downward trend (β3 = -0.22 per month, p < 0.001). Mean BSI rates decreased from 1.04 to 0.66 per 1000 patient-days (36.5% reduction). No significant immediate level change in BSI rates was observed (β2 = -0.05, p = 0.54), although a significant post-intervention declines in trend occurred (β3 = -0.11 per month, p < 0.001). Antimicrobial consumption, environmental contamination, healthcare-worker carriage, and multidrug-resistant organisms also decreased during the post-intervention period. MASG implementation was associated with reduced infection burden and antimicrobial utilisation in a resource-constrained hospital setting, supporting the potential value of low-cost multimodal infection prevention and stewardship strategies.

Many mitigation processes have been introduced to reduce septic transfusion reactions (STRs) caused by the transfusion of bacterially contaminated PLTs. The efficacy of primary culture and pathogen reduction is assessed in this review using data from long-term hemovigilance programs in the US, Canada, UK, France, Switzerland, and Australia. These surveillance programs are passive, with under-reporting of cases and differences in diagnostic criteria and reporting requirements between countries and institutions, but changes in rates over time reflect changes in the incidence of reported STRs. Prior to the introduction of these mitigation methods, reported STR rates ranged from 10 to 100 per million PLT units transfused. Reported STR rates were lowered following the introduction of primary culture using aerobic culture of 8-20 mL samples of PLT pools and apheresis collections around 24 h after collection, ranging from 2 to 24 per million PLT units. Use of large volume, delayed sampling (LVDS) primary culture of 16-20 mL, using both aerobic and anaerobic culture bottles, of pools and apheresis split units performed 36-48 h after collection was associated with a further decrease in reported STR rates, ranging from 0.56 to 4 per million PLT units transfused. Pathogen reduction of apheresis and whole-blood derived PLTs using amotosalen/UVA was associated with a low incidence of reported STR rates, ranging from 0 to 1.1 per million PLT units transfused. Reported STR rates using LVDS primary culture were lower than rates using other primary culture methods, with even lower rates using the amotosalen/UVA for pathogen reduction.

Language barriers in surgical care are linked to reduced patient satisfaction and care quality. Preoperative education improves patient understanding and postoperative outcomes, but its impact on disparities among non-English-speaking patients remains unclear. In January 2023, our institution implemented a Spanish-speaking nurse educator to provide language-concordant preoperative education to patients undergoing hip and knee arthroplasty. This study evaluated whether this intervention affected readmission rates compared to English-speaking patients. This retrospective, single-center cohort study included 1,381 total knee arthroplasty (TKA) surgeries between January 2022 and January 2024, including 221 among Spanish-speaking patients. Demographic data and 30- and 90-day emergency department and inpatient readmissions were obtained from the electronic medical record. Patients were categorized by self-reported primary language. Difference-in-differences (DiD) analyses assessed changes in readmission rates among Spanish-speaking patients after the nurse educator's implementation, compared to English-speaking patients over the same period. Multivariable logistic regressions adjusted for age, sex, body mass index, American Society of Anesthesiologists Physical Status Classification, and primary surgeon. Before the intervention, Spanish-speaking patients had higher odds of 30- and 90-day readmission than English-speaking patients (odds ratio (OR) = 12.6, 95% confidence interval (CI) [2.32 to 99.4], P = 0.006; and OR = 6.25, 95% CI [1.62 to 27.5], P = 0.010, respectively). After the intervention, 30- and 90-day readmissions decreased for Spanish-speaking patients relative to English-speaking patients (DiD OR = 0.11, 95% CI [0.01 to 0.62], P = 0.019; and DiD OR = 0.18, 95% CI [0.04 to 0.74], P = 0.021). Spanish-speaking patients also demonstrated improvement in Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) Pain scores at one year (DiD Beta = -40 points, 95% CI [-76 to -5.2], P = 0.025). Implementation of a language-concordant nurse educator was associated with reduced readmissions and improved postoperative pain outcomes for Spanish-speaking patients undergoing TKA.

To assess the effect of a population-wide implementation of intermittently scanned continuous glucose monitoring (isCGM) on hospitalization rates and trends, length of stay, and inpatient health care costs among adults with insulin-treated type 2 diabetes (T2D). This population-based, longitudinal, quasi-experimental cohort study included adults with T2D taking multiple daily insulin injections who initiated publicly funded isCGM between April 2022 and December 2023. Hospitalizations for acute diabetes-related complications (diabetic ketoacidosis, hyperglycemic hyperosmolar state, simple hyperglycemia, and hypoglycemia) and cardiovascular complications (myocardial infarction, stroke, and major lower-extremity amputation) were identified using ICD-10 codes. Incidence rates and rate ratios (RRs) were estimated using Poisson models. Interrupted time series analyses were used to estimate counterfactual trends. Among 15,413 participants, the mean follow-up was 22.5 ± 4.6 months before and 19.1 ± 4.4 months after isCGM initiation. Mean HbA1c decreased from 8.09 to 7.65% (mean difference -0.44 [95% CI -0.47 to -0.42]). Diabetes-related hospitalization rates decreased from 74.6 to 27.5 per 10,000 person-years (RR 0.37 [95% CI 0.28-0.49]). Cardiovascular hospitalization rates remained stable (228.8 vs. 215.8 per 10,000 person-years; RR 0.94 [0.84-1.06]). Interrupted time series analyses showed a change in cardiovascular admission rates after isCGM initiation relative to the preintervention trend. Median length of stay decreased from 4 (interquartile range 5) to 3 (4) days. Total inpatient costs decreased by $3,806,776.90 (-$955,186.70 per 10,000 person-years). In this real-world study, implementation of isCGM among insulin-treated adults with T2D was associated with substantial reductions in acute diabetes-related hospitalizations, shorter hospital stays, lower health care costs, and changes in cardiovascular hospitalization trends.

Transcription by RNA polymerase II (RNAPII), which is essential for protein-coding gene expression and cellular function, is increasingly understood to become dysregulated with aging. Here, we use a multimodal approach to comprehensively characterize age-dependent changes in RNAPII-mediated transcription in both mouse and human tissues. Short-read total RNA sequencing (RNA-seq) to profile nascent transcription reveals a global reduction in overall transcriptional activity/frequency in aged tissues, without apparent change in elongation rates. Transcriptomic analysis reveals a shift toward preferential expression of short genes in aged tissues, with notable upregulation of short stress-response genes and downregulation of long neurodevelopmental genes in the aged mouse brain. These results are recapitulated by analysis of total RNA-seq data from human tissues. Leveraging long-read RNA-seq, we determine that the representation of aberrant mono-exonic and intron-retention splice isoforms is increased in the aged mouse brain. Finally, we characterize the composition of RNAPII transcriptional machinery, finding that interactions between RNAPII and the Mediator complex are decreased in the chromatin of aged mouse liver and brain. Collectively, these analyses provide insight for future aging studies and reveal potential transcriptional control targets for anti-aging drug development.