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What women want to hear: the helpful and unhelpful comments reported by women struggling with infertility amidst the COVID-19 pandemic

Introduction Many women struggling with infertility report that they frequently experience unhelpful social interactions with well-meaning loved ones and healthcare providers, contributing to a reluctance to confide in others about their infertility and emotional distress. However, it remains unclear what interaction content women experience as ‘helpful’ versus ‘unhelpful,’ making it difficult to provide concrete recommendations to the public about how best to support individuals struggling with infertility. Methodology Eighty women from Canada and the United States (ages 20–45 years) whose fertility treatments had been cancelled due to the COVID-19 pandemic were recruited via social media to complete an online survey, which included two open-ended questions about the most helpful and unhelpful social interactions they had had about their infertility. Two independent researchers conducted content analysis to identify categories of helpful and unhelpful social interactions. Results The following six categories were identified by women as helpful: 1) Listening, 2) Fostering hope, 3) Talking to individuals with lived experience, 4) Distraction, 5) Validating emotions, and 6) Tangible support. Responses about unsupportive interactions fell into four categories: 1) Toxic positivity, 2) Advice-giving, 3) Invalidation, and 4) Intruding. Sample quotes from each category are provided. Conclusion These findings provide valuable insights that can be used to develop future educational materials for the general public on how to interact with individuals experiencing infertility.

Correction to: Abstract 4139303: Temporal Trends in Cardiovascular Risk Factors and Cardiovascular Disease among Middle Eastern Immigrants in the National Health Interview Survey 2004-2018

Cardiology involvement and mortality in adult patients with advanced solid cancer complicated by atrial fibrillation

Background The association between comorbid atrial fibrillation (AF) and survival in adult patients with advanced solid cancer, as well as the impact of cardiology involvement in such patients, remains unclear. Methods This retrospective cohort study included adult patients diagnosed with advanced solid cancers. We calculated prevalence of AF in different cancer types and compared all-cause mortality between patients with and without AF. We further examined the association between cardiology involvement and mortality in the subset of participants with AF. Results Among the 1,349 adult patients with advanced solid cancer, 122 (9.0%) had AF. The risk of AF was the highest in lung and mediastinal cancer (15.6%). AF was associated with higher all-cause mortality, which became neutral after adjustment for age, sex, comorbidities, cancer types and cancer treatments (crude hazard ratio [HR] 1.39, 95% confidence interval [CI] 1.11–1.75, p =  0.004; adjusted HR 1.08, 95%CI 0.84–1.39, p =  0.552). In those with AF, cardiology involvement was independently associated with lower all-cause mortality (age, sex, comorbidities, cancer types and cancer treatments-adjusted HR 0.50 [95%CI 0.28–0.88], p =  0.017), though the cumulative incidence of neither cardiovascular nor non-cardiovascular death differed significantly between patients who received cardiology care and those who did not. Conclusions In adult patients with advanced solid cancer, AF per se was not independently associated with increased mortality. Cardiology involvement in patients with advanced solid cancer and AF was linked to a better overall survival, but with low certainty that this finding is not attributable to unmeasured confounding.

State of the Heart (and Brain) in 2025

Structure-activity studies of bispyridinium antinicotinics to select candidates to treat soman intoxication as part of a combined therapy

The standard treatment of atropine and oximes is insufficiently effective against all organophosphorus nerve agents. Bispyridinium non-oxime nicotinic antagonists are promising components to add to treatments. One of these, MB327, improves the survival of guinea-pigs after intoxication with tabun, sarin or soman. We extend our previous study of unsubstituted bispyridinium non-oximes with C1 to C10 alkane linkers to analogues having 4-tert-butylpyridinium rings and the same linker range. We report their effects on nicotinic-mediated calcium responses in muscle-derived (CN21) cells where nicotinic responses were inhibited in a concentration-dependent manner. A clear structure-activity relationship resulted: the inhibitory potency increased as the linker lengthened. Previous data showed the inhibition of human acetylcholinesterase in vitro increased similarly and that in general the toxicity to mice increased accordingly. However, the shorter analogues MB327 (4-tert-butyl C3) and MB442 (unsubstituted C5) compared favourably in toxicity to some oximes used to treat nerve agent poisoning. Like MB327, the non-oxime MB442, selected by the process described, improved the survival of guinea-pigs intoxicated with soman when combined with hyoscine and physostigmine or atropine and avizafone. Our research has now afforded two compounds able to protect guinea-pigs against nerve agent toxicity through a mechanism not previously exploited deliberately for this purpose.

CXCL12 Derived From ACKR1 ⁺ Intraplaque Neovessels Mediates CD8 ⁺ T Cell Recruitment in Human Atherosclerosis

Accurate and efficient insulator maintenance: A DETR algorithm for drone imagery

With the increasing demand for electricity, the safety and stability of power grids become paramount, highlighting the critical need for effective maintenance and inspection. Insulators, integral to power grid maintenance as protective devices on outdoor high-altitude conductors, are often subject to suboptimal image quality during drone-based inspections due to adverse weather conditions such as rain, snow, fog, and the challenges posed by sunlight, high-speed movement, and long-distance imaging. To address these challenges and achieve a more accurate inspection system, this manuscript introduces an insulator defect detection algorithm tailored for the low-quality images collected by drone-based imaging systems. Utilizing a patch diffusion model, high-quality images are obtained, enhancing the precision of insulator defect detection methods. Furthermore, to improve detection accuracy, we introduce an optimized DETR method that incorporates a Spatial Information Interaction Module to further strengthen the characteristics of minor defects. Additionally, a special convergence network is employed to augment the detection capabilities of the DETR. Experimental results demonstrate that our proposed insulator detection technique has achieved a detection accuracy of 95.8%, significantly outperforming existing defect detection methods in complex environments. It overcomes the drawbacks of traditional methods by employing sophisticated computational models, leading to more efficient, economical, and secure maintenance and inspection of power grids.

Correction to: Abstract 4139285: Awareness of Myocardial Infarction and Stroke Symptoms Among Asian American Adults: Insights from the National Health Interview Survey 2014 and 2017

Identifying unmet palliative care needs of nursing home residents: A scoping review

Introduction Many nursing home residents do not receive timely palliative care despite their need and eligibility for such care. Screening tools as well as other methods and guidelines can facilitate early identification of nursing home residents unmet palliative care needs. Aim To map and summarise the evidence on identifying unmet palliative care needs of nursing home residents. Methods Any paper reporting on nursing home residents’ unmet palliative care needs were eligible for inclusion. CINAHL, MEDLINE, Embase, Web of Science, APA PsycINFO, and APA PsycArticles and grey literature were systematically searched over two months, February and March 2024. Data were extracted using data extraction forms. Data were synthesised using descriptive analysis and basic content analysis. Results Forty six records were included in this review. Nineteen methods, five screening tools, and four guidelines related to identifying residents unmet palliative care needs were identified. Most methods such as the Minimum Data Set and Palliative Care Needs Rounds were implemented as part of an intervention. Limited evidence was identified on what methods healthcare professionals use in daily practice. In total, 117 non-disease specific indicators for identifying residents unmet palliative care needs were identified, with physical indicators such as pain and weight loss being the most represented. Conclusion While developments have been made related to the concept of ‘unmet palliative care needs’, a clear definition is required. Evidence-based standardisation of methods for identifying unmet palliative care needs would ensure timely and equitable access to palliative care for nursing home residents worldwide. Achieving this goal requires incorporating screening for unmet palliative care needs into routine care.

Adapting C ₄ photosynthesis to atmospheric change and increasing productivity by elevating Rubisco content in sorghum and sugarcane

Meta-analyses and theory show that with rising atmospheric [CO 2 ], Rubisco has become the greatest limitation to light-saturated leaf CO 2 assimilation rates ( A sat ) in C 4 crops. So would transgenically increasing Rubisco increase A sat and result in increased productivity in the field? Here, we successfully overexpressed the Rubisco small subunit ( RbcS ) with Rubisco accumulation factor 1 ( Raf1 ) in both sorghum and sugarcane, resulting in significant increases in Rubisco content of 13 to 25% and up to 90% respectively. A sat increased 12 to 15% and Rubisco enzyme activity ~40% in three independent transgenic events of both species. Sorghum plants also showed increased speeds of photosynthetic induction and decreased bundle sheath leakiness. These improvements translated into average increases of 15.5% in biomass in field-grown sorghum and a 37 to 81% increase in greenhouse-grown sugarcane. This suggests a potential opportunity to achieve substantial increases in productivity of this key economically important clade of C 4 crops, future proofing their value under global atmospheric change.

Assessing and Addressing Cardiovascular and Obstetric Risks in Patients Undergoing Assisted Reproductive Technology: A Scientific Statement From the American Heart Association

The use of assisted reproductive technology (ART) is growing, both to assist individuals with infertility and for fertility preservation. Individuals with cardiovascular disease (CVD), or risk factors for CVD, are increasingly using ART. Thus, knowing how to care for patients undergoing ART is important for the cardiovascular clinician. In this scientific statement, we review the ART process and known short-term and long-term risks associated with ART that can adversely affect patients with CVD. We review current knowledge on risks from ART for specific cardiac conditions and provide a suggested approach to evaluating and counseling patients with CVD contemplating ART as well as suggested management before and during the ART process. Individuals with CVD are at increased risk for pregnancy complications, and management of this unique population has been discussed previously. The focus of this scientific statement is on ART. Therefore, discussions on risk assessment, counseling, and management of individuals with CVD during pregnancy are limited, and established guidelines are referenced.

The relationship between social participation and cognitive function early after surgery of glioma patients

Objective Social Participation (SP) is known to benefit cognitive function. However, whether this positive relationship holds across the people with glioma has not been studied. The present study aimed to investigate the current status of SP and cognitive function of patients early after surgery with glioma, and therefore, explore the associations between cognitive function and SP. Methods This study included 179 postoperative patients with gliomas within 6 months of surgery. Cognitive functioning was measured by the Montreal Cognitive Assessment (MoCA) including orientation, attention, learning and memory, executive functioning and verbal fluency. Social participation was obtained also by questionnaire survey with the Impact on Participation and Autonomy Questionnaire (IPA). The Pearson correlation analysis was used to explore the relation between cognitive functioning and social participation, and the efficacy of social participation in predicting cognitive functioning was evaluated using the receiver operating characteristic (ROC). Results The prevalence of cognitive impairment in early postoperative glioma patients was 77.65%. The mean level of social participation was 37.96 ± 26.85 points, with poorer scores in the autonomy participation of family role and outdoor engagement dimensions. Patients’ cognitive functioning was positively correlated with social participation (r = −0.64, P < 0.001). And The areas under the ROC curve for social participation predicting cognitive function were 0.884. Conclusion Early post-operative cognitive impairment was more common in glioma patients, which was positively correlated with social participation. Social rehabilitation programs for glioma patients should be actively constructed to promote the social participation of patients early after surgery in order to protect their cognitive function.

Coronary CT Anatomy-Based Prediction of Invasively Assessed Hemodynamic Significance in Middle-Aged Patients With Right Coronary Artery Anomaly: The NARCO Study

A life course study of genetic and environmental influences on sustainable working life

Genetics plays a role in short- and long-term sustainable working life (i.e., not having interruptions due to sickness absences (SA), disability pensions (DP), or unemployment), but the life course effects are not known. Thus, we aimed to investigate the age-specific genetic and environmental influences on sustainable working life from young adulthood until old-age pension. We used classical twin modeling based on the genetic relatedness of mono- and dizygotic twins in a longitudinal design. The final sample (n =  49 372) of Swedish same-sex twins with known zygosity born between 1929 and 1990 (52.8% women) with detailed national register data of employment, SA, DP, unemployment, old-age pension, emigration, and death. Genetic influences for sustainable working life were 54% at ages 18–27 years, 59% at 28–37 years, 37% at 38–47 years, 69% at 48–57 years, and 34% at 58–65 years. We observed genetic influences transferred from 18–27 years to 28–37 years and to 38–47 years explaining 28% and 17% of the variance, respectively, from 28–37 years to 38–47 years 60%, and from 48–57 years to 58–65 years 47%. Unique environmental influences were 57–72% in five age groups. Age group-specific common environment explained 63% of the variance for 18–27 years, 27% for 28–37 years, 12% for 48–57 years, and 25% for 58–65 years (none for 38–47 years). From age 48–57 years, the common environment explained 24% of the variance among those aged 58–67. To conclude, stability and change in genetic effects are important for a sustainable working life across the life course. The unique environmental effects were important for the middle age groups between 28 and 57 years. Thus, society and workplaces should support health and well-being to promote a sustainable working life.

Declining Trend of Sudden Cardiac Death in Younger Individuals: A 20-Year Nationwide Study

BACKGROUND: Declining cardiovascular mortality rates have been well-documented, yet temporal trends of sudden cardiac death (SCD) in young individuals remain unclear. We provide contemporary nationwide estimates of the temporal trends of SCD in young individuals (1–35 years of age) from 2000 through 2019 and correlate these trends to changes in out-of-hospital cardiac arrest (OHCA) patterns, rates of inherited cardiac diseases, and implantations of implantable cardioverter defibrillators (ICD). METHODS: All individuals between 1 and 35 years of age living in Denmark from 2000 through 2019 were included, with annual re-evaluation of the at-risk population in regard to age. Adjudication of SCD cases relied on multiple sources, including death certificates, medical files, and autopsy reports. Information on OHCA, diagnostic rates, and ICD implantations were captured from nationwide administrative registries. Annual incidence rates of SCD were calculated, and temporal trends in SCD incidence were computed as percentage change annualized. Trends in OHCA survival and characteristics, diagnostic rates of inherited cardiac diseases, and ICD implantations were assessed. RESULTS: During the 20-year study period (47.5 million person-years), 1057 SCDs were identified (median age, 29 years; 69% male). The overall incidence of SCD was 2.2 per 100 000 person-years and declined by 3.31% (95% CI, 2.42–4.20) annually, corresponding to a 49% (95% CI, 38.7–57.6) reduction during the study. Rates of witnessed SCD declined markedly (percentage change annualized −7.03% [95% CI, −8.57 to −5.48]), but we observed no changes in the rate of unwitnessed SCD (percentage change annualized −0.09% [95% CI, −1.48 to 1.31]). Therefore, the proportion of unwitnessed SCD increased by 79% ( P <0.001). Survival after OHCA in young individuals (1 to 35 years of age) increased from 3.9% to 28%, mainly because of increased bystander cardiopulmonary resuscitation and defibrillation rates. Diagnostic rates of inherited cardiac diseases increased 10-fold (incidence rate ratio, 10.4 [95% CI, 8.46–12.90]) and the ICD implantation rate increased 2-fold (incidence rate ratio, 1.97 [95% CI, 1.51–2.60]). CONCLUSIONS: SCD incidence rates in young individuals declined by 49% over the past 2 decades. The decline was paralleled by improved survival of OHCA, higher diagnostic rates of inherited cardiac diseases, and higher ICD implantation rates. However, rates of unwitnessed SCD were unchanged, which calls for new perspectives in preventive strategies.

Vocational rehabilitation for people with multiple sclerosis in the national health service of the United Kingdom: A realist evaluation

Background There is limited evidence about how vocational rehabilitation (VR) for people with multiple sclerosis (MS) can be delivered through the United Kingdom’s (UK) National Health Service (NHS) and how it works. Aim To understand the mechanisms and context for implementing a VR intervention for people with MS in the NHS and develop an explanatory programme theory. Methods A realist evaluation, including a review of evidence followed by semi-structured interviews. A realist review about VR for people with MS in the NHS was conducted on six electronic databases (PubMed, MEDLINE, PsychINFO, Web of Science, CINAHL, and EMBASE) with secondary purposive searches. Included studies were assessed for relevance and rigour. Semi-structured interviews with people with MS, employers, and healthcare professionals, were conducted remotely. Data were extracted, analysed, and synthesised to refine the programme theory and produce a logic model. Results Data from 13 studies, and 19 interviews (10 people with MS, five employers, and four healthcare professionals) contributed to producing the programme theory. The resulting programme theory explains the implementation of VR in the NHS for MS populations, uncovering the complex interplay between the healthcare and employment sectors to influence health and employment outcomes. VR programmes that offer timely support, tailored to the needs of the person with MS, and that support and empower the employee beyond the healthcare context are most likely associated with improved employment outcomes, for example, job retention. Conclusion Embedding VR support within the NHS requires substantial cultural and organisational change (e.g., increased staff numbers, training, and awareness about the benefits of work). This study emphasises the need to routinely identify people with MS at risk of job loss and follow a collaborative approach to address employment issues. This realist evaluation provides insight on how to improve the quality of care available to people with MS.

S100A1ct: A Synthetic Peptide Derived From S100A1 Protein Improves Cardiac Performance and Survival in Preclinical Heart Failure Models

BACKGROUND: The EF-hand Ca 2+ sensor protein S100A1 has been identified as a molecular regulator and enhancer of cardiac performance. The ability of S100A1 to recognize and modulate the activity of targets such as SERCA2a (sarcoplasmic reticulum Ca 2+ ATPase) and RyR2 (ryanodine receptor 2) in cardiomyocytes has mostly been ascribed to its hydrophobic C-terminal α-helix (residues 75–94). We hypothesized that a synthetic peptide consisting of residues 75 through 94 of S100A1 and an N-terminal solubilization tag (S100A1ct) could mimic the performance-enhancing effects of S100A1 and may be suitable as a peptide therapeutic to improve the function of diseased hearts. METHODS: We applied an integrative translational research pipeline ranging from in silico computational molecular modeling and in vitro biochemical molecular assays as well as isolated rodent and human cardiomyocyte performance assessments to in vivo safety and efficacy studies in small and large animal cardiac disease models. RESULTS: We characterize S100A1ct as a cell-penetrating peptide with positive inotropic and antiarrhythmic properties in normal and failing myocardium in vitro and in vivo. This activity translates into improved contractile performance and survival in preclinical heart failure models with reduced ejection fraction after S100A1ct systemic administration. S100A1ct exerts a fast and sustained dose-dependent enhancement of cardiomyocyte Ca 2+ cycling and prevents β-adrenergic receptor–triggered Ca 2+ imbalances by targeting SERCA2a and RyR2 activity. In line with the S100A1ct-mediated enhancement of SERCA2a activity, modeling suggests an interaction of the peptide with the transmembrane segments of the sarcoplasmic Ca 2+ pump. Incorporation of a cardiomyocyte-targeting peptide tag into S100A1ct (cor-S100A1ct) further enhanced its biological and therapeutic potency in vitro and in vivo. CONCLUSIONS: S100A1ct is a promising lead for the development of novel peptide-based therapeutics against heart failure with reduced ejection fraction.

Self-rehabilitation strategy for rural community-dwelling stroke survivors in a lower-middle income country: a modified Delphi study

Background More than half of stroke survivors in lower-middle income countries lack access to stroke rehabilitation services. The promotion of self-rehabilitation could be promising for addressing stroke rehabilitation inadequacies in lower-middle income countries. Self-rehabilitation interventions are more readily acceptable to community-dwelling stroke survivors, and therefore, have the potential to boost the successful realization of the Sustainable Development Goals and other WHO rehabilitation goals. We report a consensus-building process that sought to identify which task trainings are relevant to include in a task-specific self-rehabilitation strategy for rural community-dwelling stroke survivors. Methods An iterative two-stage mixed-method consensus-building approach was used: (1) focus group discussions (n =  5) with rural community-dwelling chronic stroke survivors were conducted to explore personal life experiences in performing daily activities, and the results were used to develop a list of candidate task trainings that could be included in a task-specific self-rehabilitation intervention model for improving functional ability of survivors; (2) a three-round Delphi exercise with a panel of stroke rehabilitation experts to establish consensus on the importance/relevance of the developed task trainings. Consensus was pre-defined to be the point where the proportion of items given a rating of 3 (quite relevant) or 4 (highly relevant) by expert panellists is ≥  0.8. Kendall’s coefficient of concordance (W) was used to assess the level of agreement among the expert panellists. Results A list of 74 task trainings was generated from the results of the focus group discussions involving 29 chronic stroke survivors. The tasks were classified as follows: training for the upper extremity (37); lower extremity training (21); trunk training (7); and balance training (9). A panel of 13 stroke rehabilitation experts reviewed these task trainings using the Delphi method and consensus was reached on keeping 28 task trainings in the first round (Kendall’s W =  0.252, p <  0.001) and an additional 7 in the second round (Kendall’s W =  0.409, p <  0.001). In the study team’s analysis of open text responses, several areas of debate were identified and some task trainings were modified. The exercise yielded 49 task trainings (66% of 74) on which there was consensus (the mean proportion of items given a rating of 3 or 4 by panellists was 0.93; Kendall’s W =  0.291, p <  0.001) to keep 3 task training groups relating to: upper extremity (27), lower extremity/balance (8), trunk strength (4) as well as warm up exercises (10). Conclusion The study provides a consensus-based view of the features of a task-specific self-rehabilitation training strategy to improve outcomes following a stroke. This self-rehabilitation training strategy can be used as an intervention approach to augment and promote stroke rehabilitation among rural community-dwelling stroke survivors, especially in sub-Saharan Africa.

Digital Twins: The Future for Ventricular Tachycardia Ablation?

Quantifying variation of non-point source pollution and its impact factors: A study of Nansi Lake Basin

Agricultural non-point source (NPS) pollution directly affects the quality of soil and water, ecological balance and human health, and is a key challenge to achieve sustainable environmental development and efficient resource management. Taking the Nansi Lake Basin (NLB) as the study area, this study explores the main sources of agricultural NPS pollution and its influencing factors, aiming to provide scientific basis for the management of water resources in the basin. Current studies usually use the runoff pollution partitioning method to estimate agricultural NPS pollution loads in runoff, but the accuracy of the analyses is limited by the incompleteness of water quality monitoring data, especially the lack of complete runoff records in some years. To compensate for this deficiency, this study simulated the river runoff based on the Long-Term Hydrological Impact Assessment (L-THIA) model, and applied the simulation results to the quantitative calculation of agricultural NPS pollution loads after verifying the model reliability through accuracy calibration. Based on L-THIA model, the spatial and temporal distribution data of agricultural NPS pollution in the basin from 2010 to 2020 were obtained, the distribution characteristics of chemical oxygen demand (COD) and ammonia nitrogen (NH3-N) were quantitatively assessed, and the impacts of natural and socio-economic factors on them were analyzed. A regression model was developed to simulate future agricultural NPS pollution through multiple regression analysis. The results showed that the total agricultural NPS pollution in the NLB showed an increasing trend during the study period. In particular, among the socio-economic factors, COD and NH3-N were significantly correlated with fertilizer application, pesticide use, rural employment and total population. Among the natural factors, topographic index, watershed area and gully density were positively correlated with pollutants, while slope and soil organic matter were negatively correlated. The results of this study raise awareness of the contribution of influencing factors and allow researchers and planners to focus on the most important NPS pollution sources and influencing factors. The study provides an important reference for the prevention and control of agricultural NPS pollution in the NLB, which is of great practical importance.