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Measuring Representativeness in Clinical Trials

Representativeness in randomized clinical trials remains a critical concern, affecting the external validity of trial results, equitable access to the risks and benefits of research participation, and public trust in clinical research. Although representative participation by members of groups traditionally underrepresented in clinical trials is just a surrogate for true diversity, equity, inclusion, and belonging in clinical trials, it can be quantified, allowing stakeholders to add empirical rigor to diversity, equity, inclusion, and belonging efforts. Multiple ways to measure representativeness have been proposed, including the participation-to-prevalence ratio, raw participation proportions or numbers for relevant subgroups, and enrollment fraction for relevant subgroups. These methods have strengths and weaknesses and may be appropriate to report in certain circumstances, depending on why stakeholders seek to assess representativeness. Stakeholders—including regulatory agencies, journal editors, clinical trial investigators, and trial sponsors—may use quantitative measures of representativeness to establish trial enrollment standards, monitor equitable participation in ongoing trials, and condition funding or drug or device approval on achieving specific representativeness targets. However, using quantitative measures of representativeness in this way could have unintended consequences, including researchers “gaming” recruitment strategies to meet target numbers, overlooking nuanced variations within communities, and potentially incentivizing problematic and exploitative recruitment strategies. Although no single method of measuring representativeness offers a comprehensive solution for increasing diversity, equity, inclusion, and belonging in all randomized clinical trials, a carefully designed, multifaceted approach to measuring representativeness may provide stakeholders with useful perspectives for measuring progress in increasing the diversity of clinical trial participation. For stakeholders seeking a single number to assess the representativeness of a trial enrolling patients with a disease state with well-delineated demographics, the participation-to-prevalence ratio is ideal; however, for a more nuanced view of representativeness, the combination of enrollment fraction in subgroups of relevance plus a full report of the demographics of patients approached for enrollment may be more appropriate.

The impact of the Hamas-Israel conflict on the U.S. defense industry stock market return

On October 7th, 2023, Hamas carried out a terrorist attack on Israel. The Israeli government promptly retaliated the attack with massive bombing and a major military operation in the Gaza Strip. Following these events, a period of uncertainty started about the potential escalation of the internal conflict into a widespread regional conflict, or at least causes a threat to the fragile peace in the Middle East. This uncertainty was even further exacerbated as many regional leaders strongly condemned the actions of Israel. This study investigates whether the equity value of U.S. defense companies stands to gain in the short run from the risk of regional peace instability, given the anticipated increase in demand for arms. For this purpose, we rely on different approaches to capture the threat to regional peace caused by the internal conflict, including one based on the intensification of internet searches containing information about the Hamas-Israeli conflict. The key findings of this study unequivocally reveal that there is a significant positive relationship between the conflict intensity and the daily stock market returns of U.S. arms-producing firms. This result may suggest that investors are inclined to believe that the internal conflict is a serious threat to the regional peace, thereby enhancing the business prospects of the U.S. defense industry, as the largest arms supplier in the area.

Response by Grune and Nahrendorf to Letter Regarding Article, “Virus-Induced Acute Respiratory Distress Syndrome Causes Cardiomyopathy Through Eliciting Inflammatory Responses in the Heart”

Evaluation of comorbidity burden on disease progression and mortality in patients with interstitial pneumonia with autoimmune features: A retrospective cohort study

Background Interstitial pneumonia with autoimmune features (IPAF) is a subset of interstitial lung disease that manifests with features of autoimmunity while not meeting classification criteria for a defined rheumatic disease. Comorbidity burden is an important prognostic indicator in various rheumatic and interstitial lung diseases, but few studies have commented on comorbidities in this population. This study was conducted to evaluate the association of individual comorbidities, the Charlson Comorbidity Index (CCI), and the Rheumatic Disease Comorbidity Index (RDCI) with lung disease progression and transplant/mortality outcomes in patients with IPAF. Methods In a retrospective study, we evaluated the prevalence and severity of comorbidities in an institutional cohort of patients with IPAF. Using Cox regression, we correlated the association of individual comorbidities and comorbidity indices with time to lung disease progression (relative forced vital capacity decline of 10% or more) and with time to lung transplant/death. We compared the performance of CCI and RDCI in predicting outcomes. Results History of cerebrovascular accident (CVA) or cardiovascular disease (CVD), moderate-severe chronic kidney disease, and fracture was associated with a faster onset of lung disease progression, while a history of gastroesophageal reflux was protective. History of CVA/CVD, diabetes mellitus, and lymphoma were associated with a faster onset of lung transplant/death. Both CCI and RDCI were associated with shorter time to lung disease progression and lung transplant/death in unadjusted analyses. However, only CCI was associated with shorter time to lung transplant/death in analyses adjusted for age, sex, pulmonary function, and radiographic pattern of lung lesion. Conclusions CCI and RDCI may be useful tools in assessing prognosis in patients with IPAF in terms of both lung disease progression and mortality. Prospective studies are needed to further evaluate the performance of CCI and RDCI and the impact of optimizing comorbid conditions that may mitigate poor outcomes among patients with IPAF.

Large-Bore Mechanical Thrombectomy Versus Catheter-Directed Thrombolysis in the Management of Intermediate-Risk Pulmonary Embolism: Primary Results of the PEERLESS Randomized Controlled Trial

BACKGROUND: There are a lack of randomized controlled trial data comparing outcomes of different catheter-based interventions for intermediate-risk pulmonary embolism. METHODS: PEERLESS is a prospective, multicenter, randomized controlled trial that enrolled 550 patients with intermediate-risk pulmonary embolism with right ventricular dilatation and additional clinical risk factors randomized 1:1 to treatment with large-bore mechanical thrombectomy (LBMT) or catheter-directed thrombolysis (CDT). The primary end point was a hierarchal win ratio composite of the following (assessed at the sooner of hospital discharge or 7 days after the procedure): (1) all-cause mortality, (2) intracranial hemorrhage, (3) major bleeding, (4) clinical deterioration and/or escalation to bailout, and (5) postprocedural intensive care unit admission and length of stay. Assessments at the 24-hour visit included respiratory rate, modified Medical Research Council dyspnea score, New York Heart Association classification, right ventricle/left ventricle ratio reduction, and right ventricular function. End points through 30 days included total hospital stay, all-cause readmission, and all-cause mortality. RESULTS: The primary end point occurred significantly less frequently with LBMT compared with CDT (win ratio, 5.01 [95% CI, 3.68–6.97]; P <0.001). There were significantly fewer episodes of clinical deterioration and/or bailout (1.8% versus 5.4%; P =0.04) with LBMT compared with CDT and less postprocedural intensive care unit use ( P <0.001), including admissions (41.6% versus 98.6%) and stays >24 hours (19.3% versus 64.5%). There were no significant differences in mortality, intracranial hemorrhage, or major bleeding between strategies or in a secondary win ratio end point including the first 4 components (win ratio, 1.34 [95% CI, 0.78–2.35]; P =0.30). At the 24-hour visit, respiratory rate was lower for patients treated with LBMT (18.3±3.3 versus 20.1±5.1; P <0.001), and fewer had moderate to severe modified Medical Research Council dyspnea scores (13.5% versus 26.4%; P <0.001), New York Heart Association classifications (16.3% versus 27.4%; P =0.002), and right ventricular dysfunction (42.1% versus 57.9%; P =0.004). Right ventricle/left ventricle ratio reduction was similar (0.32±0.24 versus 0.30±0.26; P =0.55). Patients treated with LBMT had shorter total hospital stays (4.5±2.8 overnights versus 5.3±3.9 overnights; P =0.002) and fewer all-cause readmissions (3.2% versus 7.9%; P =0.03), whereas 30-day mortality was similar (0.4% versus 0.8%; P =0.62). CONCLUSIONS: PEERLESS met its primary end point in favor of LBMT compared with CDT in treatment of intermediate-risk pulmonary embolism. LBMT had lower rates of clinical deterioration and/or bailout and postprocedural intensive care unit use compared with CDT, with no difference in mortality or bleeding. REGISTRATION: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT05111613.

Assessing potential reductions of agricultural GHG in countries with different land productivities: Long-term integrated efficiency in DEA hybrid meta-frontier model

Globally, the agricultural sector is responsible for the emission of ca. 9.3 gigatons of CO2 equivalent annually. A realistic efficiency model orientation, considering agricultural policy objectives in a given region of the world, is a crucial premise for finding the optimal path for achieving global targets of emission reduction. The main objective of this article is to assess agricultural greenhouse gases (GHG) potential reductions in countries with different farming productivity accounting for food security and economic performance of agricultural sector. The analysis focuses on non-radial slack that, theoretically, may be easily reduced by the improvement in available resource management. The DEA-based hybrid super-efficiency meta frontier model with undesirable output was employed, using the efficiency approach integrating three sustainability dimensions. The dataset consisted of data from 99 countries (2005–2018) divided into clusters. Several potential model orientations were tested and discussed with regard to agricultural policy objectives. It was found that by reducing slacks, agricultural emissions can be decreased by 0.74 Gt of CO2eq per year. Hence, removing only management inefficiencies would help achieve up to 80% of the global reduction targets in agriculture without a substantial technological change. However, the efficiency change component turned out to be mainly negative over the period studied; thus, a specific focus on agricultural policy is needed in terms of supporting farmers with a more rational use of their resources.

Conduction Disturbances and Outcome After Surgical Aortic Valve Replacement in Patients With Bicuspid and Tricuspid Aortic Stenosis

BACKGROUND: This study aimed to compare the incidence and prognostic implications of new-onset conduction disturbances after surgical aortic valve replacement (SAVR) in patients with bicuspid aortic valve (BAV) aortic stenosis (AS) versus patients with tricuspid aortic valve (TAV) AS (ie, BAV-AS and TAV-AS, respectively). Additionally, the study included stratification of BAV patients according to subtype. METHODS: In this cohort study, the incidence of postoperative third-degree atrioventricular (AV) block with subsequent permanent pacemaker requirement and new-onset left bundle-branch block (LBBB) was investigated in 1147 consecutive patients without preoperative conduction disorder who underwent isolated SAVR (with or without ascending aortic surgery) between January 1, 2005, and December 31, 2022. The groups were stratified by aortic valve morphology (BAV, n=589; TAV, n=558). The outcomes of interests were new-onset third-degree AV block or new-onset LBBB during the index hospitalization. The impact of new-onset postoperative conduction disturbances on survival was investigated in BAV-AS and TAV-AS patients during a median follow-up of 8.2 years. BAV morphology was further categorized according to the Sievers and Schmidtke classification system (possible in 307 BAV-AS patients) to explore association between BAV subtypes and new-onset conduction disturbances after SAVR. RESULTS: The overall incidence of third-degree AV block and new-onset LBBB after SAVR was 4.5% and 7.8%, respectively. BAV-AS patients had a higher incidence of both new-onset third-degree AV block (6.5% versus 2.5%; P =0.001) and new-onset LBBB (9.7% versus 5.7%; P =0.013) compared with TAV-AS patients. New-onset LBBB was associated with an increased all-cause mortality during follow-up (adjusted hazard ratio, 1.60 [95% CI, 1.12–2.30]; P =0.011), whereas new-onset third-degree AV block was not associated with worse prognosis. Subgroup analysis of the BAV cohort revealed that BAV-AS patients with fusion of the right- and non-coronary cusps had the highest risk of new-onset third-degree AV block (adjusted odds ratio [aOR], 8.33 [95% CI, 3.31–20.97]; P <0.001, with TAV as reference group) and new-onset LBBB (aOR, 4.03 [95% CI, 1.84–8.82]; P <0.001, with TAV as reference group), whereas no significant association was observed for the other BAV subtypes. CONCLUSIONS: New-onset LBBB after SAVR is associated with increased all-cause mortality during follow-up, and is more frequent complication in BAV AS patients compared with TAV-AS patients. BAV-AS patients with fusion of the right- and non-coronary cusps have an increased risk for conduction disturbances after SAVR. This should be taken into consideration when managing these patients.

Environmental risk factors for self-harm during imprisonment: A pilot prospective cohort study

Introduction Self-harm is a major public health issue in the imprisoned population. Limited high-quality evidence exists for the potential impact of prison environmental factors such as solitary confinement. This exploratory pilot prospective cohort study in a large male remand prison in England sought to estimate effect sizes for a comprehensive range of prison environmental factors in relation to self-harming behaviours. Methods A random sample of all prisoners (N = 149) starting a period of imprisonment at the study prison took part in a clinical research interview, which assessed a range of known risk factors for self-harm in prison. Information concerning environmental factors, including staff numbers, cell placement and movements, and engagement in work and activities were collected from prison records. Incidents of self-harm behaviour in the 3 months after entering prison were measured using medical records and self-report at end of follow-up. Multivariable logistic regression models were calculated individually for each predictor. Results 55.7% of participants completed follow-up (83/149). Single cell placement (OR 4.31, 95% CI 1.06–18.24, p = 0.041) and more frequent changes of cellmate (OR 1.52, CI 1.14–2.17, p = 0.009) and cell (OR 1.83, 95% CI 1.28–2.86, p = 0.003) were associated with an increased risk of self-harming behaviour. Time spent in areas with a higher number of prisoners per member of prison staff was significantly associated with reduced self-harm behaviour in adjusted models (OR 0.89, CI 0.78–0.99, p = 0.039). Following sensitivity analyses, the associations between frequent cell changes and self-harm behaviour, and between single cell placement and self-harm ideation, remained statistically significant. Discussion This exploratory pilot study provides prospective longitudinal data regarding relationships between prison environmental factors and self-harm behaviour. Findings regarding single cell accommodation and frequent cell changes are consistent with the prior evidence base largely derived from case-control study data. The finding regarding frequent cellmate changes predicting self-harm is novel. Findings regarding prisoner-staff ratio and self-harm most likely reflect a reverse causal relationship. Replication in larger cohort studies is required to address the limitations of this pilot study.

Arterial-Lymphatic-Like Endothelial Cells Appear in Hereditary Hemorrhagic Telangiectasia 2 and Contribute to Vascular Leakage and Arteriovenous Malformations

BACKGROUND: Arteriovenous malformations (AVMs) are characteristic of hereditary hemorrhagic telangiectasia. Loss-of-function mutations in the activin receptor‐like kinase 1 ( Alk1 ) are linked to hemorrhagic telangiectasia type 2. METHODS: Endothelial-specific deletion of Alk1, endothelial lineage tracing, transcriptomics of single-cell analysis, and electron microscopy were performed to examine the vascular phenotype and characteristics of ALK1-deficient endothelial cells (ECs) after EC-specific Alk1 deletion. Ischemia assays were used to examine the cell capacity for vascular malformation. Connectivity Map with transcriptomic analysis was applied to identify chemical compounds. Specific methods for arteriovenous malformations, such as micro–computed tomography, with other molecular and cell biological tools were also performed. RESULTS: We performed endothelial-specific deletion of Alk1 in mice and found severe arteriovenous malformations and vascular leakage. The transcriptomics of single-cell analysis revealed a new distinctive cell cluster formed after Alk1 deletion where the cells coexpressed arterial and lymphatic endothelial markers. The analysis projected that these cells potentially originated from arterial ECs after Alk1 deletion. This new population was referred to as arterial-lymphatic-like ECs according to its cellular markers, and its appearance was validated in the pulmonary small arteries after Alk1 deletion. Transplantation of these cells caused vascular malformations. Endothelial lineage tracing confirmed that these new arterial-lymphatic-like ECs were derived from ALK1 depleted ECs, potentially arterial ECs. We discovered that SOX17 (SRY-box transcription factor 17) induction was responsible for the derivation of these arterial-lymphatic-like ECs. We showed that direct binding of MDM2 (mouse double minute 2) was required for Sox17 to execute this activity. Inhibition of MDM2 reduced the arteriovenous malformations in the mouse model. CONCLUSIONS: Together, our studies revealed the mechanistic underpinnings of ALK1 signaling in regulating the endothelial phenotype and provided possibilities for new therapeutic strategies in hemorrhagic telangiectasia type 2.

Methods for identifying adverse drug reactions in primary care: A systematic review

Background Identification of real-time adverse drug reactions [ADRs] (as opposed to the risk of ADRs) in older poly-medicated people in primary care is a challenging task, often undertaken without an explicit strategy. This systematic review aims to evaluate replicable instruments and methods for identifying and addressing ADRs. Methods A systematic search was conducted in Medline, CINAHL, Scopus, Web of Science and Cochrane library, using controlled vocabulary (MeSH) and free-text terms. Randomised controlled trials (RCTs) implementing strategies to identify or resolve ADRs experienced by patients in primary care were included. Two reviewers independently screened studies, extracted data, and assessed the risk of bias using the Cochrane Risk of Bias tool. Discrepancies were resolved by discussion. Results From 2,182 unique records, 49 studies were identified for full review. Eight papers reporting results from 6 RCTs were included. All six trials utilised a list of medicine-related unwanted symptoms to identify ADRs. Two of three studies using adverse drug reaction questionnaires reported statistically significant increased rates of ADR reporting. Two of three studies that combined symptom questionnaires with prescriber consultations reported reductions in the number of health problems. Overall, results suggest that the three studies that described multidisciplinary collaborations using lists of ADRs plus prescriber reviews enhanced patient safety. However, the RCTs were unblinded and reported suboptimal retention. When considered as a whole, findings are equivocal and the data are too heterogenous to warrant any firm conclusions, beyond the need for more research to optimise strategies to safeguard patient wellbeing. Implications Adaptable and scalable instruments with decision support are needed in primary care to identify and mitigate medicine-related harm in older poly-medicated people. The effectiveness of adverse drug reaction identification instruments, the value of comprehensive instruments, and the optimum method of delivery should be explored in multicentre trials.

Letter by Wang and Peng Regarding Article, “Virus-Induced Acute Respiratory Distress Syndrome Causes Cardiomyopathy Through Eliciting Inflammatory Responses in the Heart”

The effect of interdisciplinary treatment on sickness absence and disability pension among chronic pain patients on partial disability pension

Studies evaluating the effects of interdisciplinary treatment (IDT) on sickness absence and disability pension (SA/DP) have yielded contradictory findings. Evidence indicates that positive treatment effects are restricted to patients with a poor SA/DP prognosis. This study therefore analyzed the effect of IDT in working age patients on partial disability pension, which is a group with a particularly poor prognosis. With data from 479 patients on partial disability pension, this register-based cohort study compared the effects of IDT to those of unspecified interventions. We considered two response variables: total net SA/DP days across the span of three years from the first visit to a Swedish specialist pain clinic, and the risk of having the maximum possible 1096 SA/DP days over the same period. Our results showed that both the total net SA/DP days (mean difference: 11; 95% confidence interval: -30 to 51) and the risk of 1096 SA/DP days (risk ratio: 1.0; 95% confidence interval: 0.6 to 1.4) were similar irrespective of intervention type. Under our theoretical model, we thereby found no support in favor of IDT over less intensive interventions in working age patients with partial DP. This raises questions about the specific criteria under which IDT proves effective.

Risk of Atrial Fibrillation After Hemorrhagic Stroke: A Nationwide Cohort Study With Propensity Score Matching

Bithyniid snails (Gastropoda: Bithyniidae) infected with Xiphidiocercariae in Thailand include a new record of Bithynia siamensis siamensis as the intermediate host of Plagiorchis and Paralecithodendrium

Bithyniids are freshwater snails that play a crucial role in the transmission of various parasitic trematodes of medical and veterinary importance. In this study, we explored the prevalence of cercarial trematode infections in bithyniid snails from Thailand and examined the species diversity of both the intermediate snail hosts and parasite larvae. A total of 688 bithyniid snails were collected from diverse natural habitats at 24 locations in 16 provinces across 5 regions of Thailand. The presence of larval trematode infections was examined using the cercarial shedding method. Both the collected snails and the emerging cercariae were identified at the species level using a combination of morphological and molecular techniques. The mitochondrial COI and 16S rDNA sequences of bithyniid snails, along with the ITS2 sequences of cercariae, were obtained via PCR amplification and sequencing. Three species of bithyniid snails were identified in this study: Bithynia funiculata, Bithynia siamensis siamensis, and Hydrobioides nassa. Among these species, B. s. siamensis exhibited the highest population density, followed by B. funiculata and H. nassa. The overall rate of cercarial infection in the bithyniid snails was relatively low, at 1.45%. H. nassa snails had the highest infection prevalence, at 11.11%, while B. s. siamensis had a prevalence of 1.39%. Only the morphological type of the xiphidiocercariae was detected. BLASTn searches in GenBank and phylogenetic trees based on xiphidiocercariae were used to classify the samples into four different families spanning two superfamilies of digenean trematodes. The genera Plagiorchis, Prosthogonimus, Paralecithodendrium, and cercaria of Renicolidae are reported for the first time in B. s. siamensis. Plagiorchis and Paralecithodendrium are significant genera of zoonotic trematodes. These findings indicate that B. s. siamensis and H. nassa can act as the first intermediate hosts for various parasitic trematodes in Thailand.

Data-driven insights into interhospital care fragmentation: Implications for health policy and equity among older adults

Objective To determine factors leading to interhospital care fragmentation (ICF); evaluate how ICF affects rehospitalization costs, length of stays (LOS), and delayed discharge; and analyze ICF disparity among equity-seeking groups. Materials and methods We used a 13-year retrospective cohort of older adults (65+) in Ontario, Canada. Utilizing multivariable logistic regression, we identified characteristics associated with ICF and determined its association with outcomes. Results Discharge to facilities except home and homecare and travel distance were the strongest risk factors for ICF. Patients were less likely to experience ICF if they were older, frail, or had multiple comorbidities. ICF was strongly associated with an increase in the daily costs of readmission. Moreover, the risks of a prolonged LOS after ICF and delayed discharge were higher among returning surgical patients. The rural residency was a source of health inequality. Conclusions ICF exacerbates health disparities and worsens patient outcomes. Our study identified several risk factors associated with ICF, some of which are controllable, paving the way for interventions to mitigate this issue. To promote health equity and reduce adverse outcomes, policymakers should focus on policies for reducing care discontinuity, particularly addressing the controllable risk factors.

Predicting the habitat suitability of Ilex verticillata (Aquifoliaceae) in China with field-test validations

The cut branches of Ilex verticillata are highly ornamental and have high economic value. Since its introduction to China, it has received widespread attention. In the context of climate change today, ensuring its promotion and sustainable production in China is of great significance. In this study we evaluated the habitat suitability of the species using MaxEnt, combined with climate and soil variables, to assess the impact of climate change on its potential suitable habitat. We used 121 I. verticillata occurrence data and validated the model prediction using extensive field testing (12 test sites located in areas from 23.19° N to 42.91° N and 76.17° E to 125.14° E). The habitat suitability model (AUC = 0.854) performed well. Among them, three precipitation variables and one temperature variable were the main factors determining the distribution of I. verticillata in China. Field trial tests and model predictions of the suitability of I. verticillata were consistent, indicating that our model predictions are biologically meaningful and economically valuable. Under the Shared Socioeconomic Pathways (SSPs) climate change scenario, the high and medium suitable habitats for this species will be reduced in the future climate. This study helps to better understand the impact of climate change on I. verticillata and provides suggestions for the introduction and cultivation areas and protection of this species in China.

Charles Darwin’s brilliance was continuously evolving

Identification and validation of TSPAN13 as a novel temozolomide resistance-related gene prognostic biomarker in glioblastoma

Glioblastoma (GBM) is the most lethal primary tumor of the central nervous system, with its resistance to treatment posing significant challenges. This study aims to develop a comprehensive prognostic model to identify biomarkers associated with temozolomide (TMZ) resistance. We employed a multifaceted approach, combining differential expression and univariate Cox regression analyses to screen for TMZ resistance-related differentially expressed genes (TMZR-RDEGs) in GBM. Using LASSO Cox analysis, we selected 12 TMZR-RDEGs to construct a risk score model, which was evaluated for performance through survival analysis, time-dependent ROC, and stratified analyses. Functional enrichment and mutation analyses were conducted to explore the underlying mechanisms of the risk score and its relationship with immune cell infiltration levels in GBM. The prognostic risk score model, based on the 12 TMZR-RDEGs, demonstrated high efficacy in predicting GBM patient outcomes and emerged as an independent predictive factor. Additionally, we focused on the molecule TSPAN13, whose role in GBM is not well understood. We assessed cell proliferation, migration, and invasion capabilities through in vitro assays (including CCK-8, Edu, wound healing, and transwell assays) and quantitatively analyzed TSPAN13 expression levels in clinical glioma samples using tissue microarray immunohistochemistry. The impact of TSPAN13 on TMZ resistance in GBM cells was validated through in vitro experiments and a mouse orthotopic xenograft model. Notably, TSPAN13 was upregulated in GBM and correlated with poorer patient prognosis. Knockdown of TSPAN13 inhibited GBM cell proliferation, migration, and invasion, and enhanced sensitivity to TMZ treatment. This study provides a valuable prognostic tool for GBM and identifies TSPAN13 as a critical target for therapeutic intervention.

‘Mind-boggling’: US CDC orders gender-related terms cut from scientific papers

Effects of maternal healthcare service utilization on modern postpartum family planning access in Bangladesh: insights from a National representative survey

Background Access to modern family planning is critical for improving maternal and child health outcomes, yet it remains severely lacking in low- and middle-income countries, including Bangladesh. Maternal healthcare utilization during and after pregnancy is vital for promoting postpartum family planning. This study examined the effects of maternal healthcare service utilization on postpartum family planning uptake in Bangladesh. Methods Reproductive calendar data from 4,081 women with recent live births were extracted from the cross-sectional 2017/18 Bangladesh Demographic and Health Survey and analyzed. The outcome variable was uptake of modern postpartum family planning methods and the exposure variables were different types of maternal healthcare services. Kaplan-Meier methods were used to calculate cumulative probabilities of modern postpartum family planning method uptake within 12 months post-delivery, and modified Poisson regression models were used to estimate the effects of utilizing maternal healthcare services on modern postpartum family planning method uptake. Results Modern family planning methods in the 12 month postpartum period were used by 72% of women, with over 60% starting after day 40. Less than 4% used long-acting family planning methods, while almost 40% relied on the oral contraceptive pill. Utilizing maternal healthcare services was associated with up to a 7% higher uptake of modern postpartum family planning methods compared to non-users. Conclusion Three-quarters of Bangladeshi women use modern family planning within the 12 months postpartum, but often rely on less effective methods. Additionally, 25% of these women resort to traditional or no use of contraceptive methods, increasing the risks of unintended pregnancy, short birth intervals, and adverse maternal and infant health outcomes. Maternal healthcare services, including private facilities, should prioritize modern postpartum family planning provision, along with education and counseling on the benefits of long-acting contraception.