Background: While efgartigimod usage is expected to reduce immunoglobulin (IG) utilization, evidence in clinical practice is limited. Methods: In this retrospective cohort study, patients with gMG treated with efgartigimod for ≥1-year were identified from US medical/pharmacy claims data (April 2016-January 2024) and data from the My VYVGART Path patient support program (PSP). The number of IG courses during 1-year before and after efgartigimod initiation (index date) were evaluated. Patients with ≥6 annual IG courses were considered chronic IG users. Myasthenia Gravis Activities of Daily Living (MG-ADL) scores before and after index were obtained from the PSP where available. Descriptive statistics were used without adjustment for covariates. Results: 167 patients with ≥1 IG claim before index were included. Prior to efgartigimod initiation, the majority of patients (62%) received IG chronically. During the 1-year after index, the number of IG courses fell by 95% (pre: 1531, post: 75). 89% (n=149/167) of patients fully discontinued IG usage. Mean (SD) best-follow up MG-ADL scores were significantly reduced after index (8.0 [4.1] to 2.8 [2.1], P<0.05, n=73/167, 44%). Conclusions: Based on US claims, IG utilization was substantially reduced among patients who continued efgartigimod for ≥1-year, with patients demonstrating a favorable MG-ADL response.

Recent changes to US research funding are having far-reaching consequences that imperil the integrity of science and the provision of care to vulnerable populations. Resisting these changes, the BJPsych Portfolio reaffirms its commitment to publishing mental science and advancing psychiatric knowledge that improves the mental health of one and all.

Carbohydrates are an important source of energy, playing a crucial role in the growth and development of children(1). Carbohydrate intakes in adults are well studied, but the intake and key food sources of carbohydrates during early childhood are poorly understood. Assessing carbohydrate intake and identifying key food sources of carbohydrates and their subtypes will aid in dietary monitoring to identify suboptimal intake and food sources. Thus, the current study aimed to describe the intakes of total carbohydrates and their subtypes (starch and total sugar), identify their main food sources, and examine tracking among young Australian children over the first 5 years of life. Data from children who participated in follow-ups at ages 9 months (n = 393), 18 months (n = 284), 3.5 years (n = 244), and 5 years (n = 240) in the Melbourne InFANT Program(2) were used. Child dietary intake was collected using three 24-hour recalls. Descriptive statistics were used to summarise the total carbohydrate and subtype intakes and their main food sources. Tracking was examined using Pearson’s correlations of the residualised scores across different time points. From ages 9 months to 5 years, total carbohydrate intake increased from 99.7 g/d to 174 g/d. Total sugar and starch intakes (g/d) also increased throughout early childhood. The percentage of energy (%E) from total carbohydrates remained stable over time (48.4–50.5%). However, the %E from total sugar decreased from 29.4% at 9 months to 22.6% at 5 years, while the %E from starch increased from 16.7% at 9 months to 26.0% at 5 years. The primary source of total carbohydrates at 9 months was infant formula. At later ages (18 months, 3.5 years, and 5 years), the key sources of total carbohydrate intake were bread/cereals, fruits, and milk/milk products. The major sources of total sugar intake at all time points were fruits and milk/milk products. However, intakes of total sugar from discretionary foods such as cakes/cookies increased with age. The main food sources for starch intake were consistent across all ages which included breads/cereals, cakes/cookies, and pasta. Weak to moderate tracking of total carbohydrate, total sugar, and starch (g/d) was observed from as early as age 9 months to age 5 years. Given the detrimental effects of discretionary foods on health, our results reinforce the importance of reducing sugar intake from discretionary foods and promoting healthy alternatives, such as wholegrains, from early childhood. The tracking of carbohydrate intake from as early as age 9 months suggest that carbohydrate intakes were established early in life, emphasising the importance of early dietary interventions. Our findings revealed in-depth insights into carbohydrate intake trends during early childhood, which may contribute valuable evidence to inform the refinement of carbohydrate intake recommendations in young Australian children.

Mapping reviews (MRs) are crucial for identifying research gaps and enhancing evidence utilization. Despite their increasing use in health and social sciences, inconsistencies persist in both their conceptualization and reporting. This study aims to clarify the conceptual framework and gather reporting items from existing guidance and methodological studies. A comprehensive search was conducted across nine databases and 11 institutional websites, including documents up to January 2024. A total of 68 documents were included, addressing 24 MR terms and 55 definitions, with 39 documents discussing distinctions and overlaps among these terms. From the documents included, 28 reporting items were identified, covering all the steps of the process. Seven documents mentioned reporting on the title, four on the abstract, and 14 on the background. Ten methods-related items appeared in 56 documents, with the median number of documents supporting each item being 34 (interquartile range [IQR]: 27, 39). Four results-related items were mentioned in 18 documents (median: 14.5, IQR: 11.5, 16), and four discussion-related items appeared in 25 documents (median: 5.5, IQR: 3, 13). There was very little guidance about reporting conclusions, acknowledgments, author contributions, declarations of interest, and funding sources. This study proposes a draft 28-item reporting checklist for MRs and has identified terminologies and concepts used to describe MRs. These findings will first be used to inform a Delphi consensus process to develop reporting guidelines for MRs. Additionally, the checklist and definitions could be used to guide researchers in reporting high-quality MRs.

Preventing neonatal calf diarrhea (NCD) and bovine respiratory disease (BRD) in cow–calf herds is essential to optimizing calfhood health. Disease control can prevent morbidity and mortality; however, evidence concerning the effectiveness of practices to achieve this is limited. The objective of this systematic review was to assess and summarize the evidence on the effectiveness of management practices to prevent calf morbidity and mortality from NCD and BRD in beef cow–calf herds. The population of interest was preweaned beef calves. The outcomes were calf morbidity and mortality caused by NCD and BRD. Only studies reporting naturally occurring diseases were included. Seventeen studies were deemed relevant, 6 studies of which were controlled trials or randomized controlled trials (RCTs), and 11 were observational studies. Most management practices had some evidence to support their use; however, the certainty of the findings was low to very low. Most of the practices were shown to impact both NCD and BRD. Yet, the different levels of consistency in the directionality of the findings suggest that some outcomes are more affected by some practices than others. More well-designed RCTs and cohort studies are required to provide reliable estimates to support recommended practices for cow–calf herds.

Calves sold at weaning are the main source of income for cow–calf operations, and their survival should be a priority. Given this, the effective use of management practices for pregnant dams and calves to prevent calf mortality is essential; however, decision-makers often do not have access to information about the effectiveness of many management practices. A systematic review was conducted to summarize the evidence of the effectiveness of biosecurity, vaccination, colostrum management, breeding and calving season management, and nutritional management practices for preventing preweaned beef calf mortality. The population of interest was preweaned beef calves from birth until at least 3 months of age. The outcome of interest was general preweaning calf mortality with stillbirths excluded. Eleven studies were deemed relevant. Ten were observational cross-sectional studies, and one was a randomized controlled trial (RCT). The practices that were statistically significantly associated with calf mortality were intervening with colostrum in case a calf had not nursed from its dam or was assisted at calving, timing and length of the calving season, and injecting selenium and vitamin E at birth. More well-executed RCTs and cohort studies are needed to provide evidence of effectiveness and help support implementation of recommended practices in herds.

Imagine that you are given access to an AI chatbot that compellingly mimics the personality and speech of a deceased loved one. If you start having regular interactions with this “thanabot,” could this new relationship be a continuation of the relationship you had with your loved one? And could a relationship with a thanabot preserve or replicate the value of a close human relationship? To the first question, we argue that a relationship with a thanabot cannot be a true continuation of your relationship with a deceased loved one, though it might support one’s continuing bonds with the dead. To the second question, we argue that, in and of themselves, relationships with thanabots cannot benefit us as much as rewarding and healthy intimate relationships with other humans, though we explain why it is difficult to make reliable comparative generalizations about the instrumental value of these relationships.

Caribbean health research has overwhelmingly employed measures developed elsewhere and rarely includes evaluation of psychometric properties. Established measures are important for research and practice. Particularly, measures of stress and coping are needed. Stressors experienced by Caribbean people are multifactorial, as emerging climate threats interact with existing complex and vulnerable socioeconomic environments. In the early COVID-19 pandemic, our team developed an online survey to assess the well-being of health professions students across university campuses in four Caribbean countries. This survey included the Perceived Stress Scale, 10-item version (PSS-10) and the Brief Resilient Coping Scale (BRCS). The participants were 1,519 health professions students (1,144 females, 372 males). We evaluated the psychometric qualities of the measures, including internal consistency, concurrent validity by correlating both measures, and configural invariance using confirmatory factor analysis (CFA). Both scales had good internal consistency, with omega values of 0.91 for the PSS-10 and 0.81 for the BRCS. CFA suggested a two-factor structure of the PSS-10 and unidimensional structure of the BRCS. These findings support further use of these measures in Caribbean populations. However, the sampling strategy limits generalizability. Further research evaluating these and other measures in the Caribbean is desirable.