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Reliability and validity of a newly developed Action Research Arm Test for upper limb function assessment in patients with stroke: A comparison with the conventional version

Background Following the discontinuation of the conventional Action Research Arm Test (ARAT) import in Japan, a domestically manufactured version with identical assessment protocols but modified equipment was developed. We aimed to evaluate the psychometric properties of the newly developed ARAT and compare it with the conventional ARAT in patients with stroke. Methods This single-center cross-sectional study enrolled 64 patients with stroke and hemiparesis who met predefined inclusion criteria. Participants were randomly allocated to a reliability validation (n = 33) or criterion validity validation (n = 31) group. The reliability group underwent duplicate assessments with the new ARAT at 15-min intervals, with video recording for independent inter-rater evaluation. The validity group received the new and conventional ARAT assessments in randomized order. Convergent validity was assessed using Spearman correlation coefficients with Fugl-Meyer Assessment of the Upper Extremity (FMA-UE), Box and Block Test (BBT), grip strength, Motor Activity Log (MAL), and Jikei Assessment Scale for Motor Impairment in Daily Living (JASMID). Results Intra-rater reliability demonstrated excellent agreement (intraclass correlation coefficient [ICC]: 0.997–1.000, 95% confidence interval [CI]: 0.995–1.000) across all subscales and total scores. Inter-rater reliability showed equally excellent agreement (ICC: 0.979–0.999, 95% CI: 0.963–0.999). Bland–Altman analysis revealed limits of agreement within clinically acceptable ranges for all measures. The new ARAT demonstrated very strong convergent validity with FMA-UE (ρ = 0.934, p  < 0.001) and BBT (ρ = 0.917, p  < 0.001), and moderate-to-strong correlations with grip strength (ρ = 0.683, p  < 0.001), MAL subscales (ρ = 0.610–0.666, p  < 0.001), and JASMID subscales (ρ = 0.806–0.808, p  < 0.001). Conclusions The new ARAT demonstrates measurement properties equivalent to the conventional version with excellent reliability and strong criterion-related validity. Its robust convergent validity with established upper limb assessments supports its clinical utility for comprehensive stroke rehabilitation evaluation.

Abstract TU221: The Role of Home Visiting Programs in Addressing Postpartum Cardiovascular Care Gaps: Evidence from a Large U.S. Community-Based Sample

Background: Maternal mortality in the United States has doubled over the last two decades, largely from cardiovascular disease, with over half of deaths occurring postpartum. Despite national calls to action, postpartum visit attendance remains low, even among high-risk pregnancies. Most prior studies rely on small, single-center datasets, and the role of community-based programs, such as home visiting, in supporting clinical engagement remains poorly understood. This study describes postpartum clinic visit attendance in a large national sample of home visiting participants, identifies sociodemographic and clinical determinants, and examines how enrollment timing and duration relate to follow-up. Methods: This retrospective cross-sectional study analyzed mothers enrolled in Parents as Teachers, a national home visiting program, between July 2016 and September 2024. The primary outcome was attendance at a postpartum clinic visit within 12 weeks of delivery. Participants were included if they had a live birth and follow-up through 12 weeks postpartum. Variables studied included age, race/ethnicity, community type, employment, housing, education, family stressors, prenatal enrollment in home visiting, high-risk pregnancy status, delivery mode, and location of care prior to pregnancy. Multivariable logistic regression was adjusted for age, employment, insurance, and funding source, with clustering by site and participant. Results: Among 46,899 pregnancies, median maternal age was 27 years (IQR 18–36). Overall, 30.1% (95% CI 29.6–30.5) attended a postpartum visit and 33.2% (95% CI 32.3–34.1) among high-risk pregnancies. Attendance was lower among Black (adjusted OR 0.80 [95% CI 0.75–0.86]) and American Indian/Alaska Native (0.61 [0.55–0.68]) participants and rural participants (0.77 [0.73–0.82]), and higher among first-time parents (1.36 [1.28–1.45]), recent immigrants (1.17 [1.05–1.30]), women with an established care source (1.41 [1.31–1.52]), and those enrolled prenatally in PAT (1.93 [1.84–2.04]). Among women with multiple pregnancies, postpartum attendance increased with each subsequent pregnancy. Conclusions: Postpartum clinic attendance was low, even among high-risk pregnancies. Early and sustained home visiting was associated with stronger linkage to postpartum care, underscoring the potential of community-based programs as feasible, broad-reaching strategies to address persistent postpartum care gaps, particularly for those at high postpartum cardiovascular risk.

Abstract MPTU08: Semaglutide versus liraglutide and incidence of diabetes and cardiovascular disease: a target trial emulation using real-world data

Background: The glucagon-like peptide-1 receptor agonists (GLP-1 RAs) semaglutide (2.4 mg) and liraglutide (3.0 mg) are approved for chronic weight management. Both drugs also have favorable effects on risk of developing diabetes and cardiovascular disease (CVD) compared with placebo, but their comparative effectiveness for these outcomes is unclear. Therefore, we performed a head-to-head comparison of semaglutide and liraglutide, hypothesizing a lower risk associated with semaglutide use because it causes greater weight reduction. Methods: We employed an active comparator, new user design to emulate a target trial using observational data from MarketScan deidentified administrative claims databases. Enrollees free of diabetes and CVD who were prescribed semaglutide or liraglutide during 2021-2023 were matched 1:1 on age, sex, insurance enrollment date, and GLP-1 RA initiation date. We investigated primary endpoints of incident diabetes and hard CVD (myocardial infarction, heart failure, or stroke), and a secondary endpoint of composite CVD that further included unstable angina and coronary revascularization. We used Cox regression adjusted for a propensity score reflective of comorbidities and medication use. Results: We matched a total of 57,456 GLP-1 RA users, among whom the mean age was 45 years and 83% were female. Over an average of 1 year of follow-up, we observed 1,104 incident diabetes events, 57 hard CVD events, and 154 composite CVD events. In the adjusted model, semaglutide users had an 11% lower risk of diabetes over follow-up (hazard ratio [HR]: 0.89; 95% CI: 0.79, 1.00; p=.04). For this endpoint, the proportional hazards assumption was violated (p<.0001), so we presented results stratified by follow-up time. During the first 6 months of follow-up, semaglutide use was not associated with risk of diabetes compared with liraglutide use (HR: 1.00 [0.84-1.20]), but a significant association was present thereafter (HR: 0.81 [0.69, 0.94]). We did not detect a difference in risk of hard CVD events (HR: 1.25 [0.74-2.11]) or composite CVD events (HR: 0.89 [0.65-1.23]). Results were unchanged when we applied inverse probability of treatment weighting to compare all eligible GLP-1 RA users. Conclusion: In this real-world study comparing two GLP-1 RAs head-to-head, semaglutide users were at lower risk of incident diabetes compared with liraglutide users. Additional research is needed to elucidate comparative effects of these drugs on cardiovascular risk.

High-affinity, structure-validated and selective macrocyclic peptide tools for chemical biology studies of Huntingtin

Huntington’s disease (HD) is a fatal neurodegenerative disorder caused by a Cytosine-Adenosine-Guanine (CAG) repeat expansion in the Huntingtin ( HTT ) gene, with no disease-modifying therapies currently available. The precise molecular function of the HTT protein is unclear, and the lack of selective chemical tools has limited functional studies. We have identified and characterized macrocyclic peptide binders targeting HTT. These binders exhibit low-nanomolar affinity in vitro and engage distinct HTT and HTT-HAP40 interfaces, as revealed by hydrogen–deuterium exchange mass spectrometry and cryoelectron microscopy. Chemoproteomics confirmed selective binding in cell extracts from wildtype but not HTT-null cell lines. HAP40 consistently and stoichiometrically copurified with HTT across cell lines, including with HTT variants containing different CAG repeat lengths, highlighting the broad presence of the HTT-HAP40 complex.

Molecular insights into antimicrobial resistance and virulence in hospital-associated of vancomycin-resistant Enterococcus faecium isolates in a tertiary hospital in Bangkok Thailand

Vancomycin-resistant Enterococci (VRE) are major pathogens causing nosocomial infections globally. This study investigated the genetic characteristics of vancomycin-resistant Enterococcus faecium (VREfm) in Thailand between June and November 2022. Fifty-two clinical VREfm isolates from Bangkok hospitals were analyzed for antimicrobial susceptibility, resistance genes, virulence factors, and genotypes using multilocus sequence typing (MLST). Phylogenetic analysis and goeBURST assessed genetic relationships and population structure. The VRE detection rate was 14.5%, with 97.1% E. faecium and 2.9% E. faecalis , likely reflecting the impact of an active case-finding program. All isolates exhibited resistance to penicillin, ampicillin, vancomycin, levofloxacin, ciprofloxacin, and rifampin. Resistance to erythromycin, high-level streptomycin, teicoplanin, and tetracycline occurred in 98.1%, 53.8%, 51.9%, and 17.3% of isolates, respectively. Chloramphenicol, linezolid, and high-level gentamicin remained effective against all isolates. The van A gene was the sole resistance determinant detected. Virulence genes esp and hyl were present in 100% and 88.5% of isolates, respectively. MLST identified five sequence types (STs), with ST17 (86.5%) as the dominant lineage, followed by ST262 (7.7%), ST202, ST787, and ST80 (1.9% each). All isolates belonged to Clonal Complex 17. Genome analysis revealed various resistance genes (VanHAX, aac (6')-Ii, aad (6), ant(6)-Ia , msr C, and tet M) and virulence factors ( acm , bop D, cps A/ upp S, cps B/ cds A, ebp A, ebp B, ebp C, efa A, esp , sgr A, and srt C). The van A gene primarily drives vancomycin resistance in Thailand’s VREfm. Genome analysis reveals antibiotic resistance genes, virulence factors, and mobile genetic elements that may drive antimicrobial resistance, increase diversity, and support adaptation in hospital settings. Ongoing infection control and active surveillance are essential.

Abstract TU141: Smoking-Related Proteins and Incident Chronic Obstructive Pulmonary Disease Hospitalizations: The Atherosclerosis Risk in Communities (ARIC) Study

Background: Cross-sectional studies have identified associations between smoking and various plasma proteins. Some studies have examined the association of these cross-sectional smoking-related proteins with chronic obstructive pulmonary disease (COPD). However, no studies have analyzed longitudinal associations between these proteins and COPD outcomes. Methods: A total of 10,728 participants from the Atherosclerosis Risk in Communities (ARIC) study without a prior hospitalization for COPD had approximately 5,000 plasma proteins measured using the aptamer-based SomaLogic proteomic profiling platform at visit 2 (1990-1992). For this analysis, we included 116 proteins cross-sectionally associated with smoking in a previous ARIC study. Protein concentrations were log 2 transformed and then standardized. Incident COPD hospitalizations were ascertained from hospital discharge codes between visit 2 and the end of visit 5 (2013). We used Cox proportional hazards regression to assess the association of smoking-related proteins and incident COPD hospitalization, adjusting for demographics and other potential confounders. To account for multiple comparisons, a false discovery rate (FDR) p-value of less than 0.05 was considered statistically significant. Results: This study sample had a mean age of 57 (range 46-70), 56% were female, and 24% were Black. For smoking status, 21% were current smokers, and 38% were former smokers. A total of 1,149 (11%) participants had an incident COPD hospitalization over a median follow-up of 20.2 years. Out of the 116 smoking-related proteins, 108 (93%) of the smoking-related proteins were associated with COPD hospitalization after FDR correction. The top twenty proteins based on the FDR p-value are presented in the Table and are sorted by the direction of the association and hazard ratio. We performed two sensitivity analyses: 1) restricting follow-up time to 10 years after visit 2, and 2) winsorizing at +/- 5 standard deviation units; both yielded results comparable to the primary analysis. Conclusion: Future research should test whether these smoking-associated proteins are on mechanistic pathways involved in COPD pathogenesis and susceptibility to COPD hospitalization.

Abstract WE490: Neighborhood Socioeconomic Conditions Classify Patients with Variable Recovery Trajectories After Similar Initial Treatments for Myocardial Infarction

Introduction: Healthy Places Index (HPI) is a California-based, neighborhood-level index comprising 8 domains and 23 socioeconomic metrics on local conditions (e.g., access to education, job opportunities, and clean air/water). HPI is used as a social marker for health drivers and helps guide resource allocation and program development. The independent association of these neighborhood conditions with clinical outcomes after acute myocardial infarction (AMI) is hypothesized but unknown. This study aims to cluster AMI patients based on neighborhood characteristics only and measure their association with clinical recovery post-AMI revascularization. Methods: This is a single-center retrospective review of 974 AMI adult patients (28% female) who received appropriate medical therapy at hospital discharge. Recovery was defined as survival free of heart failure or recurrent AMI (MACE) years post-event. Kaplan-Meier curves and Cox regression with and without co-variates compared outcomes per cluster. HPI metrics (23), linked to patients’ neighborhoods by zip code and normalized as percentiles, were clustered using VillageNet. This approach is based on the premise that while global cluster boundaries may be non-linear, they can be approximated as locally linear when examined at sufficiently small scales. Results: Four patient clusters were identified (C1-4). Survival curves showed variable recovery trajectories among the 4 clusters (p=0.0025). Pairwise comparison between clusters revealed a significantly higher recovery rate in C1 (p=0.0052), C2 (p=0.0011) and C4 (p=0.0069) when compared to C3. Using C3 as reference, Cox regression without covariates showed a significantly lower MACE risk (i.e., recovery) in C1 (HR:0.68, 95% CI:0.52-0.89), C2 (HR:0.54, 95% CI:0.37-0.78), and C4 (HR:0.63, 95% CI:0.44-0.88). Model 1 revealed a significant reduction in MACE risk in C1 (HR:0.73, 95% CI:0.56-0.95), C2 (HR:0.53, 95% CI:0.36-0.77), and C4 (HR:0.64, 95% CI:0.45-0.89). Model 2 revealed a significantly lower MACE risk only in C2 (HR:0.64, 95% CI:0.43-0.93). Conclusion: Following culprit vessel revascularization and appropriate medical therapies, neighborhood conditions measured by HPI metrics were significantly associated with less recovery post-AMI (Cluster 3) after adjustment for demographics and medical histories. These social conditions will need future evaluation as possible targets for community-based interventions proposed to amplify resilience when recovering from AMI.

Correction for Guo et al., A ribosomally synthesized and posttranslationally modified peptide with ADP-ribosylation

Range-doppler algorithm of multireceiver synthetic aperture sonar using nonuniform signal

When the structures of multireceiver synthetic aperture sonar (SAS) are applied, imaging techniques are not always able to acquire images with outstanding resolution in nonuniform situations. In order to cope with this issue, we present a robust imaging algorithm in this paper. Based on our method, the receivers adopted by imaging algorithms are firstly determined. Then, we model the multireceiver SAS spectrum made up of the monostatic one and bistatic one. The bistatic portion is resolved via the application of sub-block filtering in the spectral domain. In the range-Doppler domain, the spectrums of determined receivers are coherently added. In the spectral domain, the compression in the range direction relying on multiplications is handled. With the help of interpolations, the coupling between both directions is removed in the range-Doppler domain, where the subsequent step is to do the compression in the azimuth direction. Our method can well focus the SAS datasets with the slight nonuniform case and redundant receiver case. However, traditional method just works well with the slight nonuniform case. In comparison with traditional method, our method can get high-resolution image all the time. The results based on simulations and experiments fully validate our method.

Abstract WE467: Neuro-endocrine markers and Pulse Wave Analyses in young adults with Masked Hypertension: the African-PREDICT study

Background: Sustained physiological stress is an independent cardiovascular risk factor in young adults and may be key in the pathogenesis of masked hypertension (MHT). As stress-induced vascular changes may contribute to pre-clinical functional arterial remodelling and reduced compliance, this may facilitate the development of MHT in young adults, an approach not yet described. Aim: In age, sex, ethnicity and socio-economic status (SES) matched-controls and MHT we 1) compared neuroendocrine (dehydroepiandrosterone (DHEA), adrenocorticotropin (ACTH), cortisol and functional-wave characteristics (pulse-wave-velocity (PWV), augmentation index (AIx), incident-and-reflected waves); 2) determined the relationship between these stress-parameters and functional wave characteristics. Methods: We included 236 screened-to-be healthy South African young adults (25±5 years; 49% male; 50% Black) age, sex, ethnicity and SES matched controls (N=120) and MHT (N=116). Fasting blood samples were drawn and analysed for DHEA, ACTH, cortisol and cardiometabolic parameters. Carotid-femoral PWV, AIx and the incident-and-reflected arterial pulse waves were measured. Office-and 24H Ambulatory BP were measured and MHT defined by ISH guidelines. Results: In MHT versus healthy controls: MAP, HbA1c, and medication usage, MHT’s had higher DHEA and cortisol levels (P<0.05) and lower PWV and wave-reflection parameters (all P<0.028) versus controls. In MHT, cortisol associated with PWV, AIx and the forward-wave (all P<0.04); ACTH associated with PWV, Aix and forward-wave (all P<0.037) and DHEA inversely associated with PWV and the backward wave (both P<0.034). Conclusion: In MHT, higher levels of DHEA and cortisol were observed, which were associated with increased measures of arterial stiffness. A potential early neurohormonal influence on vascular function in MHT may indicate a stress-neuroendocrine linked pathophysiology.

Abstract TU148: Predicted Shallow Groundwater Nitrate Concentrations Have Little Effect on the Association between Private Well Use and Rates of Hypertensive Heart Disease, Ischemic Heart Disease, and Stroke/Cerebrovascular Deaths in Alabama

Alabama has the highest age-adjusted CVD mortality in the US. Despite this, our group showed that lower rates of hypertensive heart disease, ischemic heart disease, and stroke/cerebrovascular deaths were associated with higher percent private well use at the census block group (CGB) scale. The mechanism driving this association is unknown. Dietary nitrate has been associated with cardiovascular health benefits such as vasodilation and a decrease in myocardial infarction. Nitrate is also a common component in private well water. Therefore, we tested the hypothesis that CBGs with high percent private well use will have greater protective associations for CVD when median groundwater nitrate concentration is also high. The outcomes were hypertensive heart disease, ischemic heart disease, and stroke/cerebrovascular deaths from 2016 - 2019 in Alabama for age groups 45 - 54, 55 - 64, 65 - 74, and 75+ aggregated to the CBG scale (n = 3,924). Percent private well use and median nitrate concentration in each CBG were predictor variables in Poisson regression models, with additional adjustment by age group and rurality. We obtained percent private well use from the US Environmental Protection Agency’s domestic well dashboard. The United States Geological Survey (USGS) produced a 1km raster of shallow groundwater nitrate concentrations, and we calculated median nitrate concentration for each Alabama CBG. Results revealed that the protective associations between high percent well use and hypertensive heart disease and stroke/cerebrovascular mortality did not statistically significantly depend on median nitrate concentration. For example, the RR (95% CI) for a higher percentage of well users at the average nitrate level was 0.89 (0.83 to 0.95) for hypertensive heart disease, and the RR at the nitrate level 1 SD higher than the mean was 0.90 (0.85 to 0.95). Our findings may be due to low concentrations of nitrate included in our study (0.03 – 6.20 mg/L nitrate as N across all CBGs) compared to previous clinical studies on the blood pressure lowering effects of nitrates contained in beet root juice (~45 mg/L nitrate as N). In summary, in Alabama groundwater nitrate concentrations are likely not driving the protective association between percent private well use and hypertensive heart disease and stroke/cerebrovascular death in the state of Alabama. Future work will expand the study area to include geographic areas that have larger exposure ranges for nitrate.

Rational quantum mechanics: Testing quantum theory with quantum computers

Motivated in part by John Wheeler’s assertion that the continuum nature of Hilbert Space conceals the “it-from-bit” information-theoretic character of the quantum wavefunction, a theory of quantum physics (Rational Quantum Mechanics–RaQM) is proposed based on a specific discretization of complex Hilbert Space. The Schrödinger equation is not modified in RaQM, even during measurement. However, the bases in which the quantum state is defined must satisfy certain rational-number constraints. These constraints lead to the notion of finite qubit information capacity N max : For any N > N max qubit state, there is insufficient information in the N qubits (linearly growing in N ) to allocate even one bit to each of all 2 N + 1 − 2 continuum degrees of freedom (exponentially growing in N ) associated with quantum mechanics/theory (QM, where N max = ∞ ). It is proposed that the discretization of Hilbert Space in RaQM is due to gravity, hence QM is the (singular) continuum limit of RaQM at G = 0 . On this basis, it is estimated that N max lies between about 200 and 400 for current qubit technologies, and will never exceed 1,000. While QM and RaQM are experimentally indistinguishable for small numbers of qubits, RaQM predicts that the exponential advantage of quantum algorithms which, like Shor’s, require bases with maximal N -qubit superposition/entanglement, will have saturated at 1,000 perfect qubits. Hence, insofar as a classical computer will never factor a 2,048-bit RSA integer, RaQM predicts that a quantum computer will not either. This predicted breakdown of QM could be testable in less than 5 y.

Analysis of the spatio-temporal evolution of iron ore trade from a geopolitical perspective: A complex network model

Iron ore is the primary raw material for steel production, and the steel industry is a fundamental pillar of the national economy. Given the increasing strategic importance of iron ore, this paper introduces a complex network model to analyze the evolution characteristics of the global iron ore trade pattern from 2000 to 2023, aiming to assess the trade situation of iron ore. In addition, relevant policies have been formulated to ensure the stable supply of iron ore. The study shows that the Global Iron Ore Trade Network (GIOTN) is active and efficient. However, the iron ore trade is highly imbalanced and heavily influenced by geopolitical factors. Furthermore, under the impact of geopolitics, there is a gradual shift from resource dominance to capital dominance in the global iron ore trade. In terms of trade competition, relations between Europe and Brazil seem to be more intense, and the competitive landscape of iron ore trade in southern Africa is becoming increasingly prominent. Meanwhile, the global iron ore trade is becoming more regionalized due to geopolitical influences, with trade communities trending towards smaller and more balanced states. Emerging economies such as China, South Africa, and India are playing an increasingly important role in the global iron ore trade.

Abstract TH950: Association between psychological resilience and biological age among early midlife Black women

Background: Black women experience disproportionate exposure to chronic psychosocial stressors that may contribute to accelerated biological aging and heightened cardiovascular disease (CVD) risk. Resilience, the capacity to adapt and recover from adversity, may serve as a critical protective factor that mitigates the physiological impact of chronic stress thereby reducing premature physiological decline and CVD onset. However limited data exist on the relationship between resilience and biological age (BA) among early midlife Black women, a group at elevated risk for premature cardiometabolic aging. Methods: Resilience and BA were assessed in a cohort of healthy early midlife Black women without known CVD [n=87] from a large metropolitan city. BA was estimated using the Klemera-Doubal method from 11-different clinical biomarkers and chronological age (CA). Resilience was assessed using the 10-item Connor-Davidson resilience Scale [CD-RISC 10] with higher scores denoting greater resilience. Multivariable linear regression models examined the association between resilience and BA, adjusting for CA, socioeconomic position, marital status, CVD risk factors, health behaviors, and a composite measure of perceived chronic stress. Results: Participants had a mean (SD) CA and BA age of 37(4.4) years and 41.6(18.2) years. Higher psychological resilience scores were associated with younger BA (b= -1.04 years [95%CI: -1.67, -0.42, P =0.001]) in the unadjusted and fully adjusted model (b= -0.55 years [95%CI: -1.09, -0.01, P =0.045) accounting for CA, socioeconomic position, marital status, waist circumference, LDL-c, alcohol frequency, and chronic stress burden. Conclusion: Higher psychological resilience was associated with lower BA among early midlife Black women suggesting resilience may mitigate the impact of stress-related physiological aging and delay the onset of CVD. These findings highlight the importance of fostering resilience as part of the comprehensive management and prevention of CVD to promote healthy aging and reduction of CVD disparities in early midlife Black women.

Abstract TU132: Health Behaviors of Middle School Children by Community Type: Metropolitan, Micropolitan, and Rural

Background: Previous research examining differences in health behaviors between urban and rural children has yielded inconsistent results. This study aims to enhance understanding of these potential disparities by investigating whether health behaviors differ across community types, specifically utilizing Core Based Statistical Areas (CBSAs) for classification. CBSAs provide more granularity in community type definitions by using county data to identify areas that have economic and cultural connections to population centers, and may therefore have more access to resources (e.g., health care, employment opportunities, public transport). Methods: Using baseline data collected from the Michigan Project Healthy Schools (PHS) school-based wellness program from 2004-present, we analyzed dietary habits, physical activity levels, and screen time among 5 th -7 th grade children from 3 CBSA-defined community types, utilizing Wilcoxon rank-sum tests: metropolitan (include a population center with more than 50,000 people), micropolitan (have a center with 10,000-49,999 people), and rural (all population centers have less than 10,000 people). Due to the large cohort size, effect size was reported to reflect the magnitude of differences between groups. No adjustments were made for multiple pairwise comparisons. Results: Of 27850 children, 80.7% were from metropolitan communities, 15.8% micropolitan, and 3.5% rural. No differences were seen in dietary patterns across community types. Compared with metropolitan and micropolitan students, rural students participated more frequently in PE classes and school sports teams. Additionally, when the metro- and micro-politan groups were combined, rural students reported more days of vigorous and moderate exercise. No differences were seen in sedentary habits between rural students and those from other community types. Children from micropolitan areas reported less total screen time and time on mobile devices compared to their metropolitan counterparts. Conclusions: Despite previously documented rural health challenges, results from this study highlight better physical activity habits among rural students, when compared to other community types. School-based wellness programs like PHS are warranted to target primordial health within diverse populations, including rural locations with more limited access to health care resources.

Cannibalism, predation, and refuges of juvenile blue crabs from a 37-year experiment

This 37-y record (1989–2025) of field experiments tested seasonal and annual variation in predation on juvenile blue crabs ( Callinectes sapidus ) in a representative mesohaline site of Chesapeake Bay, USA, where the species is a dominant epibenthic predator and major fishery. We used replicated sets of individually tethered crabs to provide a relative index of lethal and sublethal predation rates on intermolt individuals as a function of size and habitats. Cannibalism by large adult crabs accounted for >97% of predation of juvenile crabs; predation by fish was not observed; and mortality from physiological stress was rare (<1%). Sampling by depth showed that juveniles occurred in nearshore shallows, while adults were in deeper water. Cannibalism was also depth-dependent: Rates were high at 75 cm depth; intermediate at 40 cm; and lowest at 15 cm shallows, which provided partial refuge. Cannibalism was size-dependent: 30 to 50 mm juveniles experienced high rates of predation; 90 to 110 mm preadults had low rates; and >120 mm adults had no predation. Cannibalism rates on juveniles varied seasonally, peaking during summer when adult crabs were most active; no tethering predation occurred in cold months. Variation in adult crab abundance accounted for 51% of annual variation in predation on tethered juveniles. Cannibalism by adult blue crabs provides a density-dependent regulation of juveniles by adults, with juvenile survivorship dependent on shallow-water refuge habitats in the mesohaline zone of the estuary. The refuge habitat appears increasingly restricted both by predatory fish common in high and recently introduced in low salinities, and by shoreline hardening.

Spectral efficient and high data rate ring topology based UWOC system with carrier-free optical add-drop nodes

In this paper, we report a ring topology based spectral efficient and high data rate underwater wireless optical communication (UWOC) system transmitting full-duplex data to five different optical add-drop nodes (OADNs) distributed in the ring. The UWOC system is designed so that all five nodes can transmit uplink (UL) channels without requiring optical source. The combined optical signal composed of five different wavelengths each modulated by the downlink (DL) data at the rate of 20 Gb/s using quadrature phase shift keying (QPSK) is transmitted towards the nodes. The DL baseband data is recovered at respective nodes using homodyne detection and the same optical carrier is re-used to transmit the UL data at the rate of 20 Gb/s encoded using on-off keying (OOK) modulation format towards central unit (CU). A specially designed pulse carver based on dual drive Mach-Zehnder modulator (DD-MZM) is employed to implement the transmission of full-duplex data in the ring. Each node in the ring operates at data rate of 20 Gb/s and is located at a fixed distance of 25 m from the next node in the ring. Underwater bubbling induced turbulence is modelled using Gamma-Gamma channel model. The performance of the DL and UL channels is evaluated using Bit-error rate (BER) results obtained for different generation rates of underwater bubbles. The simulation results clearly indicate that target forward-error correction (FEC) BER limit of 3.8 × 10 −3 is achieved for both DL and UL channels under different bubble generation rates. The failure model introduced in proposed study confirms that the system sustains 80% node connectivity under single OADN failure and 100% node connectivity under primary link failure through link redundancy without changing the path inflation. These findings reflect that the proposed ring topology based UWOC system is flexible and resilient to the adverse channel effects, making it a promising solution for high-speed, long-range future Internet of underwater things (IoUT) applications.

Abstract TH870: Elevated Lipoprotein(a) and Atherosclerotic Cardiovascular Disease Risk at Optimal Low-Density Lipoprotein Cholesterol Levels in Statin-Naive Adults

Introduction: Lipoprotein(a) [Lp(a)] is an established independent risk factor for atherosclerotic cardiovascular disease (ASCVD), but its impact among statin-naive individuals with optimal low-density lipoprotein cholesterol (LDL-C) levels remains uncertain. As emerging Lp(a)-lowering therapies target residual cardiovascular risk, clarifying the contribution of Lp(a) at optimal LDL-C levels is clinically relevant. Methods: We used the TriNetX U.S. Collaborative Network (2015–2025; 87 health systems) to identify adults aged 18–75 years with measured Lp(a) and an LDL-C level of ≤70 mg/dL. Patients were classified into two cohorts based on Lp(a) level. Elevated Lp(a) was defined as ≥50 mg/dL (≥125 nmol/L), and non-elevated as ≤49 mg/dL (≤124 nmol/L). Patients with prior lipid-lowering therapy (atorvastatin, fluvastatin, lovastatin, pitavastatin, pravastatin, rosuvastatin, simvastatin, ezetimibe, alirocumab, evolocumab, or inclisiran) or preexisting ASCVD, including acute coronary syndrome (ACS), cerebrovascular accident (CVA), transient ischemic attack (TIA), or peripheral artery disease (PAD), were excluded. We used 1:1 greedy nearest-neighbor propensity-score matching to balance baseline characteristics by demographics, tobacco use, blood pressure, and hemoglobin A1c. The primary outcome was the incidence of ASCVD (a composite of ACS, CVA/TIA, and PAD) over a longitudinal follow-up period of up to 20 years; secondary outcomes included the individual components of the composite outcome. Results: Among 19,204 total patients, 4,177 had elevated Lp(a) and 15,027 had non-elevated Lp(a) levels. After matching, 4,176 patients remained in each group with balanced baseline characteristics. No significant differences were observed in cumulative ASCVD risk between groups (11.4% vs 11.0%; risk ratio [RR] 1.04, 95% CI [0.92–1.17]; p =0.58). Rates of individual outcomes were similar for ACS (4.8% vs 4.0%; RR 1.20, 95% CI [0.98–1.46]; p =0.08), CVA/TIA (5.0% vs 5.2%; RR 0.97, 95% CI [0.81–1.17]; p =0.76), and PAD (3.8% vs 3.8%; RR 1.01, 95% CI [0.82–1.26]; p =0.91). Conclusion: In a retrospective cohort of statin-naive adults with optimal LDL-C levels (≤70 mg/dL), elevated Lp(a) was not significantly associated with increased long-term risk of ASCVD. These findings suggest that at optimal LDL-C levels, the contribution of Lp(a) to residual ASCVD risk may be attenuated. Future studies should evaluate whether targeted Lp(a)-lowering therapies can further reduce risk in such populations.

Abstract MPTU17: A Culturally Tailored, Fully Cost-Offset Community-Supported Agriculture (CSA) Program To Improve Food Security And Diet In New York City

Introduction: Community-supported agriculture (CSA) programs are an evidence-based approach to improve food security and diet. However, cost, accessibility, and cultural disconnect in produce offerings create barriers to participation, particularly for low-income individuals and communities of color. Objective: To pilot the East Flatbush Produce Program (EFPP), a 100% cost-offset, culturally tailored CSA in East Flatbush, Brooklyn, New York—a neighborhood with elevated rates of food insecurity and cardiometabolic disease. Methods: The EFPP was co-developed with four community partners and a local rooftop farm. Adults who could travel weekly to one of the pick-up sites (BCQL or CAMBA) and could speak English, Haitian Creole, or Spanish were eligible for participation. Individuals received five different types of vegetables weekly (~$20 value; 20 weeks at BCQL; 15 weeks at CAMBA); offerings were tailored to the Afro-Caribbean (BCQL) and Latine (CAMBA) communities. Bilingual nutrition education was offered throughout the program. Individuals completed pre- and post-program surveys and Veggie Meter readings—an objective measure of produce intake. Individuals at BCQL additionally completed a mid-point survey. The analytic sample includes individuals who completed the baseline assessment during June-August 2025 and did not drop out (BCQL: n =84; CAMBA: n =25) Results: On average, participants were 46 years old; 74% female; most identified as either Black (BCQL: 68%) or Latine (CAMBA: 48%); and 51% spoke a language other than English at home (BCQL: Haitian Creole; CAMBA: Spanish). Prevalence of food insecurity was high (BCQL: 59%, an additional 18% had unknown food security; CAMBA: 88%). Produce intake was below dietary recommendations (~2.5-3 cups/day). Weekly pick-up attendance was 62% at BCQL and 71% at CAMBA; 15% of BCQL and 21% of CAMBA pick-ups occurred by alternate pick-up personnel. The mid-point survey at BCQL ( n =51) showed high program satisfaction (96% would recommend the EFPP). To improve EFPP engagement, the top suggestions were: financial incentives or losses (61%), improving access via transportation vouchers or additional pick-up times (41%), and additional types of food offerings (33%). Post program assessments will be completed by November 2025. Conclusions: The EFPP demonstrated the feasibility and community acceptability of a cost-offset CSA. Preliminary data provide insights on how to tailor the CSA to improve future participation.

Dengue virus harnesses mosquito Syntenin to load and secrete viral RNA into salivary exosomes

Viruses exploit extracellular vesicles (EVs) to transfer infection-enhancing viral RNAs. However, mechanisms underlying viral RNA loading remain elusive. We leveraged our previous discovery that dengue virus secretes transmission-enhancing subgenomic flaviviral RNA (sfRNA) into mosquito salivary EVs to investigate viral RNA loading mechanism. We demonstrate that sfRNA alone promotes the secretion of sfRNA-containing EVs marked by the mosquito EV biogenesis protein AeSyntenin, by applying microscopy and viral genetic editing in in vitro and in vivo models. SfRNA via its stem loop structures interacts intracellularly with mosquito AeSyntenin and this interaction is selectively maintained within EVs as shown by complementary RNA-affinity chromatography and RNA immunoprecipitation, and AI-based prediction. Finally, we used systemic and salivary gland-specific protein depletion to establish a functional role for mosquito AeSyntenin in exosome production and salivary secretion of sfRNA. We propose that sfRNA binds AeSyntenin to drive its selective packaging and release into exosomes, elucidating a mechanism for viral RNA incorporation into EVs.