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One out of four patients with pancreatic cancer experience psychological symptoms: A systematic review and meta-analysis

The death rate from pancreatic cancer is one of the highest of all cancers, with increasing incidence every year over the past decades. As the prognosis remains extremely poor, this trend brings not only a growing clinical challenge, but also a significant psychological toll for patients. In comparison to other types of cancer, our understanding of the psychological burden of such a deadly disease is still limited. Recognizing and addressing the psychological aspects of pancreatic cancer are crucial for comprehensive patient care. We, therefore, aimed to quantify the psychological burden of patients with pancreatic cancer. We conducted a systematic search (PROSPERO: CRD42022288805) of MEDLINE, Cochrane, and Embase databases to identify articles reporting on the prevalence of psychological symptoms among patients with pancreatic cancer. The symptoms examined were depression, anxiety, distress, fatigue, sleep disturbances. Study quality for the included studies was assessed using the Joanna Briggs Institute tool. Relevant data were extracted and exported for quantitative synthesis. The meta-analysis of the proportion of symptoms with a 95% confidence interval (CI) was conducted using frequentist random-effects models. Subset analyses were performed based on the severity of depression. A total of 28 articles were included in the meta-analysis and 31 in the systematic review. Our results showed that the proportion of depression (19 studies; 78,930 patients) was 0.27 (95% CI: 0.18–0.39). The proportion for anxiety (18 studies; 26,538 patients) was 0.29 (95% CI: 0.16–0.46; for distress (6 studies; 2746 patients) 0.43 (95% CI: 0.25–0.63); for fatigue (7 studies; 11 338 patients) 0.40 (95% CI: 0.21–0.63); and for sleep disturbances (3 studies; 10,645) 0.31 (95% CI: 0.06–0.77). These findings highlight the urgent need to integrate psychological care into pancreatic cancer treatment. Future research should explore sources of heterogeneity to better identify which approaches provide the most psychological benefit and tailor interventions to patient needs accordingly.

Ethnic differences in healthcare trust and patient satisfaction in England: A cross-sectional survey

Trust in healthcare is an important component of patient experience, yet ethnic minority patients in England often report lower trust and satisfaction with the NHS than White patients. We examine these differences using data from a cross-sectional survey of 1,111 adults living in England, conducted in April–May 2023. Respondents rated their agreement with 18 statements covering five domains of healthcare experience: communication, ethical treatment, perceived competence, trust in providers, and perceived discrimination. We estimate a series of linear regression models comparing responses between ethnic minority and White participants, both before and after adjustment for demographic and attitudinal factors. Ethnic minority respondents reported significantly less positive perceptions on several items, particularly those relating to ethical behaviour, personal care, trust in front-line providers and perceived discrimination. They were less likely than White respondents to agree that the NHS behaves ethically, cares for patients, or goes out of its way to help people, and reported lower trust in GPs and hospital doctors and nurses. The largest differences were observed for perceptions that NHS care quality depends on ethnic background or country of origin. By contrast, we found no ethnic differences in perceptions of NHS honesty, promise-keeping, overall competence, or trust in NHS leadership or management. Overall, the findings indicate that ethnic differences in trust and satisfaction with the NHS are concentrated in relational and experiential aspects of care rather than in assessments of technical competence. Addressing these disparities may be important for improving equity and strengthening trust in healthcare services.

The impact of university students’ computational thinking on AI literacy: A longitudinal study based on SEM-PLS

Artificial intelligence literacy is a core competency that underpins individual development. Although previous studies have demonstrated a cross-sectional association between computational thinking and artificial intelligence literacy, there has been little analysis of their longitudinal effects. This study utilized a sample of 216 undergraduate students from southern China and employed structural equation modeling (SEM-PLS) and paired-sample t-tests. Through a two-stage longitudinal data analysis, the study found that computational thinking has a significant positive effect on artificial intelligence literacy and that both competencies improved significantly over time. By tracking the evolution of these two competencies, this study offers a novel longitudinal perspective, confirms their synchronous development, and highlights the stability of their cross-sectional relationship, thereby providing theoretical foundations and methodological references for educational practice.

Climate change boredom: Exploring its predictors and the psychological factors that influence intention to act

Multiple psychological factors, from fear to hope, play a role in actions addressing climate change. However, an understanding of how these factors interact to shape such behaviors remains limited. This gap holds significant implications for advancing both research and climate practice. The present study aims to contribute to the overall effectiveness of climate change mitigation and adaptation efforts by providing an understanding of the factors influencing individuals’ intentions to act against climate change, and casting light upon a less explored dimension – climate change boredom. Climate change boredom highlights a psychological barrier that can hinder climate action. Intention to act is a key step toward a change in behavior and effective environmental efforts. Therefore, we determined the factors that predicted climate change boredom and investigated the influence of climate change boredom on people’s intention to act against climate change. Using Partial Least Squares Structural Equation Modeling (PLS-SEM) on data obtained from a survey of a representative sample of Romanian people, the study found that beliefs about climate change, climate change goal commitment, self-efficacy of cooperation, perceived health impacts of climate change, living environment, and age predicted 66.8% of climate change boredom. Results showed that climate change boredom significantly hindered the intention to act against climate change. From a practical perspective, identifying predictors of climate change boredom and intention to act is important in developing strategies, policies, and communication approaches that reinvigorate individuals’ and communities’ motivations to participate in climate action efforts. Moreover, addressing climate change boredom is essential for ensuring long-term environmental security, as disengagement from climate issues can weaken societal resilience and hinder adaptive strategies in the face of climate threats.

Estimating historic seabed carbon disturbance by port dredging and aggregate extraction in NW Europe

The extent to which different human activities disturb seabed carbon, the largest long-term organic carbon reservoir on the planet, is poorly understood. Research to date has focused primarily on bottom trawl fisheries, but industries that target and extract marine sediments are likely to disturb significant masses of sedimentary organic carbon. This can lead to its remineralisation and reduce the capacity of the ocean to absorb atmospheric CO 2 . In this study, we combine archival documents, industry records, and published seabed substrate data, to estimate historical disturbance of sedimentary organic carbon on the Northwest European Shelf (NWES) from port dredging activities and marine aggregate extraction. Monte Carlo simulations were used to provide probabilistic estimates of annual carbon disturbance and associated upper and lower bounds (5th and 95th percentiles, respectively). Based on annual Monte Carlo simulations run between 1995−2021, our results suggest that port dredging over the shelf area disturbed 2.2 ± 0.9 Mt organic carbon year -1 . In the case of marine aggregate extraction, simulations run between 1955−2022, suggest that marine aggregate extraction disturbed 0.4 ± 0.3 Mt organic carbon year -1 . At a country scale, analysis of activities in UK waters suggest that organic carbon disturbance from port dredging and aggregate extraction activities are approximately three orders of magnitude lower than published estimates of disturbance by bottom trawling. Nevertheless, historical and contemporary port dredging and aggregate extraction present substantial and spatially concentrated sources of anthropogenic carbon disturbance that have not been systematically quantified across the Northwest European Shelf until now. These findings therefore address an important knowledge gap and have the potential to inform marine management and conservation strategies aimed at minimising organic carbon loss from the seabed.

Lunar base agent-based modeling - A benchmark for simulating crewed space missions

Space exploration has progressed significantly since the mid-20th century, and recent technological advancements, along with the emergence of commercial space travel, have led to substantial leaps in planning for future space missions. The largest planned upcoming mission is the Artemis program, supported by NASA and the international Artemis Accords, which aims to create the first permanent human presence on the Moon and in deep space (the Moon to Mars architecture). Although human psychology and team science have been crucial for the success of past space missions, from the Apollo program and Skylab to the Space Shuttle (STS) and the International Space Station (ISS), human factors and social behavior will become even more ubiquitous and essential for space missions in the new era of commercial space. By simulating upcoming permanent space missions in an agent-based model (ABM), we can draw insights into the long-term effects of human factors and interactions in space. Drawing from the literature on proxy environments (extreme environments on Earth (i.e., Antarctica), space analogs, and past space missions), and on theories of small group complex systems and team science, we created a highly probable representation or simulation of expected social interactions between astronauts, and astronauts with the lunar environment for the Artemis program (i.e., Artemis IV (Lunar Gateway) and Artemis V (Lunar South Pole Base)). Our Lunar Base ABM explores the exogenous and endogenous factors that are more likely to lead to sustainable versus catastrophic scenarios on the Moon in the next couple of decades. The model represents astronauts using a new Agent_Astronaut framework with cognitive skills, emotional states, and personality traits to capture how social and environmental factors interact to affect mission outcomes. Monte Carlo simulations consisting of tens of thousands of iterations show trade-offs in productivity and psychological well-being. This approach demonstrates how agent-based modeling can help mission planners evaluate operational resilience, team structures, and workload dynamics in support of future lunar exploration.

Beyond diagonal noise: A better predator-prey modeling framework with cross-covariance

The introduction of stochasticity into continuous ecological models frequently relies on phenomenological, diagonal diffusion terms that lack a rigorous microscopic basis. We demonstrate that this standard practice fundamentally misrepresents the geometry of demographic fluctuations. By deriving a stochastic Rosenzweig–MacArthur model directly from an integer-valued, Bernoulli-coupled continuous-time Markov chain, we isolate the exact diffusion covariance structure dictated by event stoichiometry. We mathematically prove that coupled predation–conversion events inherently generate a structurally negative predator–prey cross-covariance, exposing the severe mathematical and biological limitations of standard diagonal-noise approximations. Furthermore, we resolve a persistent ambiguity in stochastic population modeling by explicitly formalizing the bifurcation between open-domain formulations (for survival-conditioned interior dynamics) and absorbed formulations (for extinction-permitting dynamics). To rigorously support this distinction, we develop a tailored two-stage Lyapunov well-posedness architecture that separates non-explosion criteria from boundary-barrier positivity invariance. By bridging microscopic event stoichiometry with macroscopic boundary-degenerate diffusions, this work replaces ad hoc noise constructs with a definitive, mathematically exact template for covariance-consistent and boundary-aware ecological modeling.

Exploring factors contributing to adolescent suicide using psychological autopsy - A scoping review

Background Adolescent suicidality and associated behaviours are an alarming global public health concern. Understanding its underlying causes and trajectories necessitates the urgent development of targeted prevention strategies. Psychological autopsy (PA) methods provide an in-depth understanding of the complex risk factors leading to suicide in this vulnerable population. Objective This scoping review aims to explore and synthesise the major risk elements contributing to adolescent suicide and to propose a synthesis of the trajectories leading to adolescent suicide. Methods A methodological search was carried out to find psychological autopsy studies centered on adolescent subjects. The selection criteria were fulfilled by 15 papers, which were scrutinized with the help of a thematic synthesis method and extracted the main themes to create an overview of the scope and character of the risk factors found. Results Four major themes emerged: (1) Individual risk factors, including psychiatric disorders, substance use, and previous self-harm; (2) Familial factors, such as parental mental illness, abuse, neglect, and family dysfunction; (3) Life events, including academic failure, interpersonal conflicts, and childhood trauma and (4) Environmental risk factors, such as access to lethal means, media influence, and lack of mental health support. The findings highlight the complex interplay of psychological, social, and contextual variables in adolescent suicide. Conclusion Psychological autopsy studies offer valuable insights into the risk factors for adolescent suicide. A multidimensional approach addressing individual vulnerabilities, family dynamics, and broader social environments is essential for effective prevention efforts. Further research is needed to strengthen the evidence base and guide policy and intervention development.

Deprotonation-Induced Strong Covalent Interfacial Bonding Stabilizes the Solid Electrolyte Interphase and Raises the Performance of Lithium-Ion Batteries

Why are Massachusetts opioid prescribing rates higher in rural versus urban areas?

Aims To examine the relationship between geographical density and opioid prescribing in a model that simultaneously accounts for both supply and demand side factors. Design Using the Massachusetts All-Payer Claims (MAPC) Database, we capture individual patient-level characteristics and combine this with county-level data on economic conditions and health care delivery systems to examine the relationship between geographical density and opioid prescribing. Population and Setting Commercially insured population residing in Massachusetts between 2010 and 2014. Methodology Using a logistic regression framework, we determine the likelihood that an individual patient with one of the three conditions (back pain, joint disease, or car accident) will receive an opioid prescription and how this varies by geographic density between patients. We also perform a two-way Blinder-Oaxaca decomposition to understand whether it is the endowments (mean levels) of these factors or the strength of the relationship (coefficients) of those factors that is more important in explaining the differences in opioid prescribing across metropolitan and non-metropolitan areas. Finally, we also explore interactions between the demand and supply side factors. Findings We find that patients in non-metropolitan areas were 10 percentage points more likely to receive an opioid prescription. About half of this differential is attributable to the underlying health of the local population. Focusing on three prevalent conditions for which an opioid is commonly prescribed (back pain, joint disease, and car accidents), we find that a little less than half of the remaining gap can be explained by supply side factors, such as differences in the health care delivery system. On the demand side both demographics, particularly veteran status, and health insurance type were important factors. Roughly 80 percent of the difference in opioid prescribing rates can be explained by the inclusion of both sets of covariates. Allowing for the interaction of some demand-side (e.g., working in a physically demanding occupation) and supply-side (e.g., healthcare delivery system) variables further reduces this differential to be less than half of a percentage point and statistically insignificant. Conclusions Our findings suggest economic conditions, such as the type of working conditions that patients might experience, interact with the healthcare system in unforeseen ways and that more targeted interventions can reduce the persistent gap in opioid prescribing among more and less densely populated areas, with possible downstream impacts on overdose and mortality.

Innate immunogenetic synergy between KIR and Neanderthal-derived OAS variants predicts COVID-19 outcomes

Background Genetic factors modulate the progression of coronavirus disease 2019 (COVID-19), but interactions between innate immune gene variants remain incompletely understood. Prior work identified Killer Immunoglobulin-like Receptor (KIR) genotypes and Neanderthal-introgressed OAS 1/2/3 haplotypes as key modulators of disease severity. Given these parallel findings, we aimed to evaluate the synergistic impact of KIR motifs, Neanderthal-inherited OAS 1/2/3 variants, and other immune-related SNPs on COVID-19 symptomatology and severity. Methods In a cohort of 175 unvaccinated severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) positive individuals (65 asymptomatic, 47 mild-intermediate, 63 severe), we genotyped KIR/KIR-ligand motifs and variants in OAS 1/2/3, IFITM3 , DPP4 , TLR7 , and APOE . Multivariate logistic regression models assessed independent and interactive predictors of symptomatic and severe disease, and ROC curve analysis was performed to quantify their discriminative ability. Results An interaction between the absence of both the protective tAB1/wL KIR motif and the Neanderthal-derived OAS 1/2/3 alleles significantly predicted symptomatic infection (OR 3.47, P = 0.006) and severe disease (OR 2.41, P = 0.038), achieving overall classification accuracies of 75.4% and 78.9%, respectively. Independent predictors included age, male gender, rs12252 ( IFITM3 ) and rs3788979 ( DPP4 ) as risk factors, and blood group A and APOE ε3ε3 status as protective factors. No rare TLR7 variants were detected. Conclusion This study identifies, for the first time, a synergistic interaction between KIR motifs and Neanderthal-derived OAS 1/2/3 variants influencing COVID-19 outcomes. These findings highlight the interplay between ancient and modern innate immune adaptations in shaping viral disease susceptibility. Future studies in larger and diverse populations are warranted to validate these immunogenetic interactions.

Lived experiences of postpartum hypertensive women in Accra, Ghana

Background Hypertension is a leading cause of adult mortality globally with postpartum hypertension posing distinct risk to women. In Ghana, particularly within the Accra Metropolis, there is a limited understanding of the lived experiences of women managing hypertension after childbirth. Aim We described the lived experiences of postpartum women diagnosed with hypertension receiving care in a resource-constrained setting in Accra, Ghana. Methods The study employed a qualitative, descriptive-phenomenological design. We purposively selected 16 postpartum women diagnosed with hypertension and receiving care. They were recruited from the postnatal clinic of the Greater Accra Regional Hospital. The data was collected via in-depth, semi-structured interviews using a pre-tested interview guide. The interviews were audio-taped and transcribed verbatim. We then conducted thematic analysis with the aid of NVivo 11.0. Results The analysis yielded three major themes; expectations about living with hypertension, self-efficacy in managing hypertension and environmental factors on the management of hypertension. On the expectation about living with hypertension, we identified the following sub-themes: optimism and hope for recovery as well as fear and uncertainty about complications. Regarding self-efficacy, the following sub-themes were identified: Confidence in adhering to treatment and challenges with lifestyle modification and monitoring. On the environmental factors influencing management of hypertension among the participants, we found the following sub-themes, spousal and family support, role of healthcare providers, social perceptions and stigma. Conclusion and recommendations Postpartum women diagnosed with hypertension face social stigma and have mixed feelings of hope, fear and uncertainty about developing complications. We recommend that midwives/nurses should design and implement targeted postpartum hypertension education programmes to promote confidence in the treatment, improve knowledge on the condition and enhance emotional resilience. Also, managers of antenatal and postnatal clinics must integrate spouses and faith-based organizations in the management of postpartum hypertension to reduce the associated social stigma.

Serum ferritin in Yemeni patients with sickle cell anemia: Association with sociodemographic factors and hematological profiles

Background Iron overload remains a critical complication secondary to transfusional therapy and altered iron metabolism in patients with sickle cell anemia (SCA). Hyperferritinemia often serves as a surrogate marker for iron overload; however, as an acute-phase reactant, it may be elevated due to chronic inflammation, infection, or liver disease, potentially overestimating true iron stores. In Yemen, the burden of SCA is high, yet local data on the frequency of hyperferritinemia are scarce. This study aimed to describe the distribution of serum ferritin (SF) levels and the proportion of SCA patients with hyperferritinemia among adolescents and young adults attending the YSTH clinic in Sana’a, and to explore associations with hematological, and sociodemographic parameters. Methods A prospective cross-sectional study was conducted between June and December 2024, involving 80 participants (aged ≥ 15 years). The data were analyzed using SPSS version 26. Due to the non-normal distribution and high dispersion of SF, the Median (IQR) and Spearman correlation were utilized. Bivariate analysis calculated crude odds ratio at (95% CI) to identify predictor of elevated SF. Statistical power was limited by the sample size ( N  = 80) to detect weak associations. Results The study enrolled 80 SCA patients with a mean (±SD) age of 18.5 (±3.69) years, of whom 65% were males and 35% were females. The median (IQR) SF level was 1645 ng/mL (414–3525), with values ranging from 77.1 to 4500.0 ng/mL. Approximately 85% of patients exhibited elevated SF level (≥300 ng/mL). While red cell indices did not significantly predict the risk of hyperferritinemia, a significant positive correlation was observed between SF levels and white blood cell count ( p  = 0.03), suggesting a possible link with the inflammatory state. No significant associations were found between sociodemographic factors and high SF levels. Conclusion A high prevalence (85%) of hyperferritinemia ( ≥ 300 ng/mL) was observed among SCA patients attending the YSTH in Sana’a, Yemen, suggesting probable iron overload. While findings support routine SF screening but highlight the need for future studies incorporating inflammatory markers (e.g., CRP) and systematic transfusion histories to definitively quantify the iron overload burden in this population.

Should We Call Every Cancer a Rare Cancer?

PCR-based detection and phylogenetic analysis of Candidatus Liberibacter asiaticus in citrus orchards across Nepal

Citrus greening disease, also known as huanglongbing (HLB), is caused by the gram-negative α-proteobacteria Candidatus Liberibacter species. This disease poses a significant threat to citrus production worldwide, including in Nepal. This study aimed to perform the diagnosis and phylogenetic analysis of the citrus greening pathogen in Nepal using both conventional PCR and computational methods. A total of 1,026 citrus leaf samples were collected from thirteen districts across six provinces in the country. PCR-based diagnosis was performed using the primer set Las606/LSS, which targets the 16S rRNA gene of Candidatus Liberibacter asiaticus. The reliability of the PCR was validated by including previously confirmed positive and negative controls in every run. Furthermore, each assay was performed in triplicate to ensure consistency and reproducibility of results. Additionally, 16S rRNA gene sequencing was performed using Sanger sequencing for five samples. The obtained sequences were deposited in GenBank and a phylogenetic tree was constructed based on these sequences. Among the 1,026 samples tested, 255 were positive, indicating the widespread distribution of HLB across Nepal. All consensus sequences from Nepal showed strong evolutionary relatedness within the Ca. L. asiaticus cluster, with over 99% genetic similarity to reference sequences from various parts of the world. Phylogenetic analysis revealed that the Nepalese sequences were closely related to Ca . L. asiaticus sequences from India (Punjab and Meerut) and sequences obtained from different regions of Nepal clustered closely together. The molecular findings from this study reveal a high prevalence of citrus greening disease across Nepal and underscore the urgent need for integrated management policies, including the use of certified clean planting material and vector (psyllid) control programs. The generated sequence data serves as a vital resource for developing regional diagnostic tools and guiding future surveillance strategies to mitigate HLB’s impact on the world’s citrus industry.

Local availability of cannabis retail outlets on parents’ cannabis use, acceptability, and perceived addictiveness: A longitudinal study in Washington State

Objective Parents represent a growing yet understudied population of people who use cannabis in the era of legalization. Studies examining how increasing availability of cannabis retail stores affects parental cannabis use, norms, and perceived harm are needed to guide interventions to support families. This longitudinal study examines whether perceived and objectively measured cannabis outlet availability are associated with parents’ cannabis use frequency, acceptability, and perceived addictiveness in Washington State, where nonmedical cannabis retail stores opened in 2014. Method Parents (n = 471) in the Seattle Social Development Project – The Intergenerational Project were surveyed in 2015, 2016, and 2017. Multilevel models were used to estimate within- and between-person associations between (a) perceived cannabis outlet availability (self-reported number of outlets in one’s neighborhood) and (b) objective cannabis outlet availability (number of outlets within a 10-minute drive time from home) with past-year cannabis use frequencies, acceptability of parental cannabis use, and perceived addictiveness. Results Local retail outlet availability was higher in later waves. There were significant between-person associations, such that parents residing in neighborhoods with greater cannabis outlet availability (both perceived and objectively measured) over the course of the study had greater cannabis use frequency, higher acceptability of use, and lower perceived addictiveness. When comparing the same parents over time, the association between objectively measured outlet availability and acceptability of use was replicated in the within-person analysis, such that parents had greater acceptability of parental cannabis use in years when they lived in neighborhoods with higher objective outlet availability. Conclusions Legal cannabis retail stores are increasingly common within neighborhoods. Prevention programming to support families residing in neighborhoods with greater outlet availability may reduce permissive cannabis norms and use among parents, which can have strong implications for youth substance use prevention and positive youth development.

The discharge process for a child with complex healthcare needs dependent on respiratory technology: A scoping review protocol

Background Children with complex healthcare needs spend a long time in hospital with frequent delays in discharge. This may be due to fluctuating health status, or contextual factors such as training carers, social circumstances, suitable housing, and community resources such as homecare nurses. Understanding the process for an effective discharge for children with complex healthcare needs who are respiratory technology dependent is essential to guide clinical practice, and shape policy that supports timely, coordinated, and family-centered transitions from hospital to home and inform evidenced-based research. Objective The aim of this scoping review is to gain an understanding of the discharge process for children with complex healthcare needs who are dependent on respiratory technology. Methods CINAHL, Medline, PsycINFO and Embase databases will be used for the literature search. Articles will be considered from peer reviews sources and English language text from 2015 owing to the increase in children with complex healthcare needs requiring respiratory technology and advances in complex care. Title and abstracts followed by full-text articles will be reviewed to determine which papers meet the inclusion criteria. Two reviewers will review each stage with further discussion as required for exclusion and inclusion. Data extracted will include information on key findings related to the aim and objectives of the scoping review and will be summarized and presented in tables and charts with a narrative summary. Expected Results International guidelines on care closer to home and caring for children with tracheostomies state the need for discharge pathways. This review will synthesis existing literature regarding the discharge processes of children with complex healthcare needs dependent on respiratory technology. Evidence will be organised across micro-level (child and family), meso-level (healthcare team and institutional processes), and macro-level (policy and system) influences. This scoping review will identify the multifaceted barriers and facilitator that impact the transition from hospital to home for children dependent on respiratory technology. Conclusion This review will identify current evidence from relevant studies in relation to discharge processes and provide detail on components and context.

Genome-wide analysis of the invasive fungal pathogen Neopestalotiopsis reveals high genomic diversity, effector repertoires, and the assessment of fungicide resistance risks

Neopestalotiopsis species (spp.) have recently emerged as major pathogens worldwide, causing leaf spot, fruit rot, and crown rot of strawberry, resulting in increased disease outbreaks and economic losses. Despite their increasing impact, there is a limited genomic resource for this pathogen group, constraining insights into pathogenic mechanisms and fungicide resistance. We conducted whole-genome sequencing of 50 Neopestalotiopsis strains from major strawberry production regions in North Carolina using the Illumina NovaSeq platform. The generated genome assemblies enabled comprehensive analyses of fungicide-resistance-associated mutations and the prediction of effector repertoires using signal-peptide screening, secretion filtering, and machine-learning-based approaches. Eight key fungicide target genes (β-tubulin, cytb , cyp51A , cyp51B , Bos1, and SDHI subunits ( sdhB/C/D ) were examined for putative resistance mutations. Phylogenomic analysis based on single orthologs from protein-coding regions and average nucleotide identity (ANI) matrices grouped the strains into two major lineages (Clades A and B) of Neopestalotiopsis rosae and a third distinct lineage (Clade C) comprising other Neopestalotiopsis spp. Between 879 and 895, CAZymes were predicted per genome, with glycoside hydrolases and auxiliary activity enzymes predominating in plant cell wall degradation. Effector prediction revealed between 87 and 95 putative secreted effectors, including many cysteine-rich proteins and species-specific candidates. Variation in target gene sequence analysis revealed benzimidazole resistance mediated by β-tubulin E198A/K and widespread QoI resistance associated with cytb G143A. The cyp 51 gene exhibited extensive polymorphism, particularly H147Y and N284H, while the L98H variant was rare. No resistance-associated mutations were detected in any SDHI- or Os-1-target genes. This study represents the first comprehensive genomic assessment of Neopestalotiopsis strains infecting strawberry in North Carolina, revealing substantial genomic diversity, various enzymes and effectors involved in host colonization, and mutations linked to resistance to benzimidazole, QoI, and DMI, but not SDHI fungicides. These findings provide a foundation for developing improved, sustainable fungicide-use and disease-management strategies.

A clustering-based trajectory analytics of functional loss and recovery among older adults

Objectives Functional loss and recovery in older adults are heterogeneous, with important implications for independence, care needs, and survival. While Activities of Daily Living (ADLs) are routinely assessed, most existing approaches reduce them to summary scores, thereby losing information about the order, timing, duration, and recurrence of functional change. We introduce a novel trajectory analytics framework designed to identify clinically interpretable trajectory phenotypes and evaluate their association with mortality. Materials and methods We analyzed 1.3 million ADL assessments from 265,530 residents in U.S. Veterans Affairs nursing homes. A hybrid trajectory clustering framework was developed, combining spell-based sequence construction, optimal-matching-based dissimilarity, and scalable quality-guided clustering. Sequence comparison was designed to preserve temporal structure while remaining computationally feasible for large-scale longitudinal data. Candidate clustering solutions were evaluated using multiple quality metrics, and mortality differences across clusters were examined using Kaplan-Meier estimation and Cox proportional hazards models adjusted for age and sex. Results Thirteen distinct ADL trajectory clusters were identified from about 110,000 unique trajectories, differing in dominant disability states, duration, recurrence, and mortality risk. Short, severe trajectories showed the highest early mortality, whereas longer, milder trajectories involving limited impairments, such as walking or bathing, were more stable and had lower mortality. The highest-risk cluster showed approximately 48% cumulative mortality within the first year and remained associated with the greatest hazard of death after adjustment. Sex-based sensitivity analyses showed broadly similar mortality ordering across males and females, although female-specific estimates were less precise because of the smaller sample size. Discussion and conclusion The proposed framework reveals substantial heterogeneity in functional trajectories and their prognostic implications, providing an interpretable and computationally efficient tool for large-scale ADL trajectory clustering. These findings support trajectory-based phenotyping as a useful approach for personalized care planning, targeted resource allocation, and policymaking in long-term care settings.

Prior contact lens wear reduces susceptibility of the superficially-injured cornea to bacterial adhesion

Contact lens wear in humans and mice is consistently associated with asymptomatic corneal parainflammation. Here, we tested the hypothesis that the corneal response to lens wear alone can function to protect it against bacterial adhesion enabled by superficial injury. One eye only of mT/mG-LysMcre mice (cell membranes red; Lyz2 + cells green) wore a contact lens for 4–6 days. After lens removal, mice were anesthetized and both corneas superficially-injured before bacterial inoculation with either a mouse eyelid commensal ( Macrococcus epidermidis ) or a corneal pathogen ( Pseudomonas aeruginosa ). Inoculation was repeated hourly for 4 hours under anesthesia before euthanasia. Enucleated eyes were fixed overnight, and adherent bacteria visualized using a universal 16S rRNA-targeted FISH probe ( M. epidermidis ) or Blue Fluorescent Protein ( P. aeruginosa ). Confocal imaging and Imaris software were used to quantify bacterial adhesion and location in the epithelium, and also the number, location and morphology of Lyz2 + cells. For both commensal and P. aeruginosa , prior lens wear resulted in reduced adhesion to the superficially-injured corneas (~46% and ~57% respectively). In both instances this correlated with increased numbers of corneal Lyz2 + cells. Other details differed for the two bacterial types. For the commensal, prior lens wear resulted in bacteria penetrating deeper into the epithelium versus contralateral eyes, with Lyz2 + cells extending their processes further into the epithelium and localizing closer to the cornea surface. For P. aeruginosa , prior lens wear resulted in adherent bacteria closer to the cornea surface, and Lyz2 + cells moving further away from it. Moreover, while overall Lyz2 + cell sphericity increased for P. aeruginosa with prior lens wear versus contralateral eyes, it showed no overall change for the commensal. Lyz2 + cell volume in the central cornea was decreased for P. aeruginosa with prior lens wear but increased for the commensal. Thus, corneal responses to prior lens wear can quantitively reduce bacterial adhesion to superficially-injured corneas correlating with a Lyz2 + cell response for both a commensal and a pathogen, with differences in details for the two bacterial types. How continued lens wear supersedes this protective response to promote P. aeruginosa infection pathogenesis remains to be determined, as does the relationship to the Lyz2 + cell response.