Early Miocene land mammals from eastern North America are exceedingly rare. Over the past several decades a small, but significant, vertebrate fauna has been recovered by paleontologists and citizen scientists from the Belgrade Formation at the Martin Marietta Belgrade Quarry in eastern North Carolina. This assemblage has 12 land mammal taxa, including beaver (Castoridae), stem lagomorph, carnivorans (Mustelidae, Ailuridae), horses (Equidae), rhinoceros (Rhinocerotidae), tapir (Tapiridae), peccary (Tayassuidae), anthracothere (Anthracotheriidae), entelodont (Entelodontidae), and protoceratid (Protoceratidae). Taken together, the biochronology of this Maysville Local Fauna indicates a late Arikareean (Ar3/Ar4) to early Hemingfordian (He1) North American Land Mammal Age (NALMA). This interval, which includes the Runningwater Chronofauna, documents numerous important Holarctic immigrants, including Amphictis, Craterogale, and cf. Menoceras found at this locality. Strontium isotope stratigraphy (SIS) of shark teeth collected in situ from the Belgrade Formation yield an age of 21.4 ± 0.13 Ma, which validates the age of interbedded land mammals within this unit. It also is consistent with the late Arikareean (Ar3/Ar4) biochronology and Aquitanian Neogene marine stage. New SIS analyses of oysters (Striostrea gigantissima) and clams (Chione) from this mine, previously assigned to late Oligocene or Late Miocene, are significantly older (28.0 ± 0.22 Ma and 27.6 ± 0.26 Ma, respectively) than the land mammals. Depending upon stratigraphic interpretations, these may confirm an older marine facies within the Belgrade Formation. This locality is important because of its marine and terrestrial tie-ins that facilitate intercalibration of both NALMAs and Cenozoic marine stages.

Cardiometabolic pregnancy complications, including gestational diabetes mellitus (GDM), hypertensive disorders of pregnancy (HDP), intrauterine growth restriction (IUGR) and preterm birth (PTB) are prevalent pregnancy complications that adversely affect maternal and neonatal health during pregnancy, and increase women’s risk of future type 2 diabetes mellitus (T2DM) and cardiovascular disease (CVD)1–5. Pregnancy and postpartum, including intrapartum periods, are critical windows of opportunity to deliver care to support sustained behaviour change(6). There is currently a gap in lifestyle (diet and physical activity) interventions specific to cardiometabolic disease risk awareness and prevention during and following pregnancy(5,7). These are key life stages where early risk factors for cardiometabolic disease may present, women are actively engaged in the healthcare system and their health priorities are shifting as they transition into parenthood. Early intervention in pregnancy may enable commencement of pharmacological and/or lifestyle intervention to reduce the risk or severity of cardiometabolic pregnancy complications(8), whereas postpartum intervention may enable commencement of sustainable lifestyle change for reduction of long-term cardiometabolic risks(9). There are a range of settings where pregnant and postpartum women receive healthcare, including hospitals, primary care clinics, community health institutions and online platforms(8,10,11). The optimum timing and setting to deliver an intervention to these high-risk women is not known. Designing interventions to align with the needs and priorities of stakeholders is a critical first step in developing an acceptable intervention. The aims of this research were to explore stakeholder perspectives and prioritise the optimal timing and setting to deliver a lifestyle intervention to improve long-term cardiometabolic health amongst women at high-risk of or diagnosed with a cardiometabolic pregnancy complication. An embedded mixed-methods research design was utilised. Facilitator-led workshops were used to prioritise the preferred timing (pregnancy or postpartum) and setting (hospital, general practice, community health program, maternal and child health services or online) for an intervention. Women with prior GDM, HDP, IUGR and/or PTB (n = 9), and research partners (n = 15) (obstetricians, endocrinologists, community health representatives, researchers, midwife, general practitioner, dietitian) participated. Workshops were audio recorded, transcribed verbatim and thematically analysed using template analysis. Online polls were used to assess participants preferred timing and setting for an intervention. Women preferred a postpartum intervention delivered online, whereas research partners preferred a pregnancy intervention delivered via hospital antenatal care. Both groups suggested commencing interventions during pregnancy and continuing postpartum. Participants recommended ensuring interventions consider healthcare system barriers to intervention delivery, equity and sustainment, as well as consumer-specific barriers to intervention engagement and lifestyle change during pregnancy and postpartum. Commencing patient-centred interventions during pregnancy and continuing postpartum should be considered to support continuity of care and improve health outcomes across both life stages for this high-risk group of women.

Polycystic ovary syndrome (PCOS) is a common endocrine condition(1) associated with an increased risk of developing type 2 diabetes (T2D) and cardiovascular disease. Healthy lifestyle habits are critical in the management of PCOS(1), however, the public health system provides limited support for the lifestyle management of PCOS. Diabetes Victoria delivers a free program, ‘Life!’, to Victorian Residents at high risk of developing T2D, including those with PCOS. Life! is currently designed to meet general high-risk population needs, not specifically designed with PCOS in mind. This study aimed to evaluate the current Life! Program’s design, content and delivery against the needs of those with PCOS through co-design workshops with previous Life! participants who have PCOS (n = 14) and program facilitators (n = 5). A series of mixed-methods workshops were used to assess the current program, design an ideal program and prioritise unmet needs. Co-design was informed by the Linking and Amplifying User-Cantered Networks through Connected Health (LAUNCH) Roadmap(2) and the TiDiER checklist(3). Online worksheets, polls, open-ended questions and annotation of current material were used to aid participation and input. Four workshops (WS) were conducted online: two 3-hr (WS 1) and two 2-hr (WS 2). All were audio recorded and transcribed. Data was thematically synthesised using template analysis and findings from WS 1 were used to inform WS 2. Those with PCOS participated in the Life! program between 2018 and 2023, were aged between 24 and 52 years and the majority (93%) had a BMI greater than 25kg/m2. Program facilitators included dietitians, diabetes educators and a physiotherapist with 80% having more than 10 years’ experience. Overall participants wanted less generic and more PCOS-centric topics, less of an emphasis placed on weight loss with an equal focus on a range of health outcomes. Recommended topics included PCOS-centric lifestyle advice across diet, physical activity, sleep and mental health with an emphasis on how (practical strategies) and why (mechanistic understanding) healthy lifestyle behaviours should be applied. Participants desired the tone and sentiment used in the program’s language and imagery to be inclusive, gentle, non-stigmatising and positive. Participants desired a flexible approach to program delivery (a mix of in-person, online, one-on-one and group). One-on-one sessions were desired when receiving individualised advice and discussing sensitive topics, while group sessions were preferred for peer support, learning activities and reflections. People with PCOS desire a PCOS-centric lifestyle program with a focus on meaningful health outcomes, reducing the focus on weight loss, blended delivery, tailored and practical strategies with long-term support. Results will inform the development of a tailored lifestyle program that aims to better engage those with PCOS. Future community-based PCOS programs and clinicians are strongly recommended to incorporate these findings to improve engagement and consumer satisfaction.