Current evidence underscores a need to transform how we do clinical research, shifting from academic-driven priorities to co-led community partnership focused programs, accessible and relevant career pathway programs that expand opportunities for career development, and design of trainings and practices to develop cultural competence among research teams. Failures of equitable research translation contribute to health disparities. Drivers of this failed translation include lack of diversity in both researchers and participants, lack of alignment between research institutions and the communities they serve, and lack of attention to structural sources of inequity and drivers of mistrust for science and research. The Duke University Research Equity and Diversity Initiative (READI) is a program designed to better align clinical research programs with community health priorities through community engagement. Organized around three specific aims, READI-supported programs targeting increased workforce diversity, workforce training in community engagement and cultural competence, inclusive research engagement principles, and development of trustworthy partnerships.

Multicenter clinical trials are essential for evaluating interventions but often face significant challenges in study design, site coordination, participant recruitment, and regulatory compliance. To address these issues, the National Institutes of Health’s National Center for Advancing Translational Sciences established the Trial Innovation Network (TIN). The TIN offers a scientific consultation process, providing access to clinical trial and disease experts who provide input and recommendations throughout the trial’s duration, at no cost to investigators. This approach aims to improve trial design, accelerate implementation, foster interdisciplinary teamwork, and spur innovations that enhance multicenter trial quality and efficiency. The TIN leverages resources of the Clinical and Translational Science Awards (CTSA) program, complementing local capabilities at the investigator’s institution. The Initial Consultation process focuses on the study’s scientific premise, design, site development, recruitment and retention strategies, funding feasibility, and other support areas. As of 6/1/2024, the TIN has provided 431 Initial Consultations to increase efficiency and accelerate trial implementation by delivering customized support and tailored recommendations. Across a range of clinical trials, the TIN has developed standardized, streamlined, and adaptable processes. We describe these processes, provide operational metrics, and include a set of lessons learned for consideration by other trial support and innovation networks.

The emerging perspectives and implementation aspects presented in this review article outline infection prevention core components supported by recent research relevant to the mitigation of Hospital Onset Bacteremia and Fungemia in a surveillance setting that includes expanded efforts to all vascular access devices.

Psychological tests often involve item clusters that are designed to solicit responses to behavioral stimuli. The dependency between individual responses within clusters beyond that which can be explained by the underlying trait sometimes reveals structures that are of substantive interest. The paper describes two general classes of models for this type of locally dependent responses. Specifically, the models include a generalized log-linear representation and a hybrid parameterization model for polytomous data. A compact matrix notation designed to succinctly represent the system of complex multivariate polytomous responses is presented. The matrix representation creates the necessary formulation for the locally dependent kernel for polytomous item responses. Using polytomous data from an inventory of hostility, we provide illustrations as to how the locally dependent models can be used in psychological measurement.

Improving the quality and conduct of multi-center clinical trials is essential to the generation of generalizable knowledge about the safety and efficacy of healthcare treatments. Despite significant effort and expense, many clinical trials are unsuccessful. The National Center for Advancing Translational Science launched the Trial Innovation Network to address critical roadblocks in multi-center trials by leveraging existing infrastructure and developing operational innovations. We provide an overview of the roadblocks that led to opportunities for operational innovation, our work to develop, define, and map innovations across the network, and how we implemented and disseminated mature innovations.

Partial anomalous venous connection with sinus venosus atrial septal defect is repaired with different approaches including the Warden procedure. Complications include stenosis of the superior caval vein and pulmonary venous baffle; however, cyanosis is rarely seen post-operatively. We report a patient presenting with cyanosis 5 years after a Warden, which was treated with a transcatheter approach.

The Triassic–Jurassic Upper Karoo Group of the Mid-Zambezi Basin (MZB; Zimbabwe) includes a thick succession of terrestrial sediments with high palaeontological potential that has been neglected since the 1970s. Here, we review the Upper Karoo Group stratigraphy, present detailed sedimentological work and identify new vertebrate-bearing sites at several measured sections along the southern shore of Lake Kariba. These fossil-bearing sites fall within the Pebbly Arkose and Forest Sandstone formations, and are the first to be recorded from the region since the discovery of Vulcanodon karibaensis nearly 50 years ago. The unique and diverse assemblage of aquatic and terrestrial fauna reported includes phytosaurs, metoposaurid amphibians, lungfish, non-dinosaurian archosauromorphs and non-sauropod sauropodomorph dinosaurs. This improvement of Upper Karoo Group biostratigraphy is important in refining its temporal resolution, and impacts both regional and global studies. Finally, the new fossil sites demonstrate the palaeontological importance of the MZB and its role in providing a holistic understanding of early Mesozoic ecosystems in southern Gondwana.

River mouths on the steep, high-relief coast of the French Riviera exhibit thick sequences of Holocene marine, estuarine, deltaic, and river channel-floodplain sediments that overlie basal fluvial Pleistocene gravel. Gravel is uncommon in most of the early to middle Holocene aggradational-progradational marine, estuarine, deltaic sediments, despite an ample supply from rock units in the steep adjoining uplands. River-mouth gravel is common only in late Holocene river channels and in barrier beaches perched on finer-grained nearshore sediments. Neither downslope grain-size fining on alluvial fans nor sediment stacking patterns during sea-level (base-level) rise readily account for the lack of early to middle Holocene gravel in the river-mouth sediment wedges. Holocene sea-level rise led to the storage of fine-grained sediments in shallow marine, estuarine, and deltaic environments in the present coastal zone. We infer that humid temperate conditions, a dense forest cover, landscape stabilization, and a regular quiescent river flow regime associated with the Atlantic climatic optimum limited gravel supply in the adjoining catchments and gravel entrainment downstream during the early Holocene. Sea-level stabilization in the middle and late Holocene coincided with a marked change in bioclimatic conditions toward the present Mediterranean-type regime, which is characterized by a less dense forest cover, soil erosion, and episodic catastrophic floods. The late Holocene was thus a time of downstream bedload channel aggradation, fine-grained floodplain and paludal sedimentation, and seaward flushing of clasts leading to the formation and consolidation of the gravel barrier beaches that bound the rivermouths and embayments.

Epidemiological evidence regarding the association between carbohydrate intake, glycaemic load (GL) and glycaemic index (GI) and risk of ovarian cancer has been mixed. Little is known about their impact on ovarian cancer risk in African-American women. Associations between carbohydrate quantity and quality and ovarian cancer risk were investigated among 406 cases and 609 controls using data from the African American Cancer Epidemiology Study (AACES). AACES is an ongoing population-based case–control study of ovarian cancer in African-Americans in the USA. Cases were identified through rapid case ascertainment and age- and site-matched controls were identified by random-digit dialling. Dietary information over the year preceding diagnosis or the reference date was obtained using a FFQ. Multivariable logistic regression models were used to estimate odds ratios and 95 % CI adjusted for covariates. The OR comparing the highest quartile of total carbohydrate intake and total sugar intake v. the lowest quartile were 1·57 (95 % CI 1·08, 2·28; P trend=0·03) and 1·61 (95 % CI 1·12, 2·30; P trend<0·01), respectively. A suggestion of an inverse association was found for fibre intake. Higher GL was positively associated with the risk of ovarian cancer (OR 1·18 for each 10 units/4184 kJ (1000 kcal); 95 % CI 1·04, 1·33). No associations were observed for starch or GI. Our findings suggest that high intake of total sugars and GL are associated with greater risk of ovarian cancer in African-American women.

Folate is essential for fetal development, and its deficiency during gestation causes behavioural deficits in the offspring. The present study investigated its influence during weaning on brain function in the pups of rats that were put on a folate-deficient (FD) diet on postnatal day (PND) 1. Systemic folate deficiency in pups on the FD diet (n 15) was evident from the dramatically lower hepatic folate concentrations (median 23·7, range 8·1–48·4 ng/mg protein) and higher homocysteine concentrations (median 27·7, range 14·7–45·5 pmol/mg protein), respectively, compared with those of pups on the normal diet (ND; n 9) (median 114·5, range 64·5–158·5 ng/mg protein and median 15·5, range 11·6–18·9 pmol/mg protein) on PND 23. Brain folate concentrations although low were similar in pups on the FD diet (median 10·5, range 5·5–24·5 ng/mg protein) and ND (median 11·1, range 7·1–24·2 ng/mg protein). There was a high accumulation of homocysteine in the brain of FD pups, mostly in the hippocampus (median 58·1, range 40·8–99·7 pmol/mg protein) and cerebellum (median 69·1, range 50·8–126·6 pmol/mg protein), indicating metabolic folate deficiency despite normal brain folate concentrations. Developmental deficits or autistic traits were more frequent in the FD group than in the ND group and repetitive self-grooming occurred, on average, three times (range 1–8) v. once (range 0–3) during 5 min, respectively. Long-term memory or spatial learning and set-shifting deficits affected 12 to 62 % of rats in the FD group compared with none in the ND group. Post-weaning folic acid supplementation did not correct these deficits. These observations indicate that folate deficiency during weaning affects postnatal development even when gestational folate supply is normal.