Antibiotic overuse at hospital discharge is common and often overlooked. We conducted interviews with 91 clinicians across 9 Veterans Health Administration hospitals to assess perceptions of a metric comparing discharge antibiotic-prescribing. Clinicians found the metric valid and meaningful, but successful implementation will require more granular contextual data and quality-improvement framing.

Lakes can serve as cradles of biodiversity by facilitating adaptive radiation linked to distinct environmental conditions and ecological opportunities. On San Salvador Island, the Bahamas, karstification during Holocene transgressive flooding created anchialine lakes that have supported rapid evolutionary diversification, most notably among endemic pupfishes with specialized feeding strategies. To assess whether similar phenotypic divergence occurs in other members of these lake communities, we investigated morphological variation in shells of the chemosymbiotic infaunal bivalve Ctena sp. (Lucinidae). Live and dead Ctena specimens were sampled from muddy sediment filling karst pockets along the shorelines of three anchialine lakes, a habitat type from which chemosymbiotic bivalves have not previously been reported. Using two-dimensional geometric landmarks of shell interiors and valve margins, we found significant differences in shell shape, size, and allometric relationships among living populations from each lake. Death assemblages preserved similar among-lake patterns, suggesting that morphological divergence predates the window of time averaging represented by death assemblages. Living and dead-shell assemblages within each lake also differed significantly in shell shape, and temporal shape-change vectors from the dead to living included both shared and distinct trends among lakes.

Ongoing genomic work suggests that lake-dwelling Ctena on San Salvador represent a single endemic species. Thus, spatiotemporal patterns among lake populations likely reflect ecophenotypic responses to distinct sedimentological and geochemical conditions that influence their chemosymbiotic lifestyle. These results demonstrate the potential of combined life and death assemblage analyses to detect patterns of phenotypic divergence over geologically instantaneous timescales.

We study the number $M_n(T)$ of integer $n\times n$ matrices A with entries bounded in absolute value by T such that the Galois group of the characteristic polynomial of A is not the full symmetric group $S_n$. One knows $M_n(T) \gg T^{n^2 - n + 1} \log T$, which we conjecture is sharp. We first use the large sieve to get $M_n(T) \ll T^{n^2 - 1/2}\log T$. Using Fourier analysis and the geometric sieve, as in Bhargava’s proof of van der Waerden’s conjecture, we improve this bound for some classes of A.

The overturning of Roe v. Wade sent shockwaves through the American political system. Running on women’s reproductive health care rights, Democrats vastly outperformed expectations in the 2022 midterm elections. The 2024 US presidential election provided a test of whether broad public support for reproductive health care access would continue to translate into electoral gains for Democrats. Using a novel set of survey questions, this article examines attitudes toward abortion and the abortion pill (i.e., mifepristone) as well as preferences over whether policy should be decided federally or by individual states (i.e., locus of authority). Our findings provide partial support for the expectation that locus-of-authority preferences shape vote choice. Whereas support for a constitutional protection for abortion remained strongly associated with voting against Trump regardless of locus-of-authority preferences, the pattern for mifepristone access more closely matched our expectations. Among voters who supported mifepristone access, those who were comfortable leaving the issue to the states were significantly more likely to support Donald Trump. His emphasis on state control may have functioned as strategic ambiguity, especially on a less-polarized reproductive health issue such as mifepristone access.

We investigated associations between food liking and risk of health outcomes in a prospective cohort and explored if associations were potentially explained by body mass index (BMI). We included 182,181 participants from UK Biobank. Food liking was measured using a 9-point hedonic scale, covering liking (points 6-9)/disliking (points 1-5) for high fat savoury (HFSa), high fat sweet (HFSw), vegetable, low fat savoury (LFSa), and fruit-based, low fat sweet (LFSw) foods. Cox proportional hazard models assessed associations with health outcomes, as hazard ratios (HR) with 95% confidence intervals (CI), adjusted for relevant confounders. Compared to disliking, liking HFSa was associated with higher risks of type-2-diabetes (T2D) (HR 1.14; 95% CI: 1.09-1.19) and lung cancer (HR 1.10; 95% CI: 1.01-1.20). Liking HFSw was associated with higher risks of all-cause mortality, and cancer (HR range 1.03-1.07; 95% CI range: 1.00-1.14). Liking LFSa was associated with lower risks of all-cause mortality, T2D, cardiovascular disease (CVD), all-cause cancer, and colorectal cancer (HR range 0.85-0.97; 95% CI range: 0.79-0.99). Liking LFSw was associated with lower risks of T2D, CVD, and colorectal cancer (HR range 0.91-0.96; 95% CI range: 0.86-1.00). Associations between food liking and health outcomes differed between food groups, with most appearing not to be attenuated after adjusting for BMI. The key findings were that associations with adverse health outcomes were strongest for higher-fat containing food preference patterns, while sweet preference alone was not associated with increased risk. Our study highlighted the potential role of food liking in designing and targeting health promotion interventions.

We present the second data release (DR2) of Spectra and Polarisation in Cutouts of Extragalactic sources from RACS (SPICE-RACS). SPICE-RACS DR2 is derived from the third low-band epoch of the Rapid ASKAP Continuum Survey (RACS-low3) and covers the entire sky from the South celestial pole up to a declination of $+{49}^{\circ}$; approximately 87.5% of the celestial sphere. We produce ‘cutout’ spectral cubes in Stokes I, Q, U around 4 million radio sources and extract spectra towards 5 million radio components. Across our observed band of 799.5–1 087.5 MHz we find an rms noise of $\sim\!{200}\,\unicode{x03BC}\text{Jy}/\text{PSF}$, an angular resolution of $\sim\!{15}^{\prime\prime}$, and residual wide-field instrumental polarisation on the order of 0.1%. After de-duplication, our polarisation catalogue contains the detection of $2.5\times10^5$ ($3.4\times10^5$) Faraday rotation measures (RM) for components with a linearly polarised signal above $8\sigma$ ($6\sigma$). This places SPICE-RACS DR2 as the largest single RM catalogue ever produced by nearly an order of magnitude; the number of RMs in our catalogue alone is $\sim\!{5}$ times larger than every previous RM catalogue combined. Our resulting RM grid has an areal density of $6.7 \substack{+1.8\\-1.7}\,\mathrm{deg}^{-2}$, providing an effective ‘resolution’ of $\sim\!{23}^{\prime}$, and reveals striking features across the sky. The broad-band RMs have a median uncertainty of $\sim\!{2}\mathrm{rad}\,\mathrm{m}^{-2}$, and include complexity metrics and information from the time domain. The breadth and quality of the SPICE-RACS DR2 dataset will enable a new generation of RM science. Further, SPICE-RACS will provide an ideal reference for forthcoming deep polarisation surveys such as the ASKAP POSSUM survey. All of our data products are publicly available on the CSIRO Data Access Portal (DAP) and the CSIRO ASKAP Science Data Archive (CASDA).

Objectives/Goals: Previous studies of nanoparticles in a penetrating spinal cord injury demonstrated their ability to modulate immune responses to reduce secondary injury. This study investigated nanoparticles in contusion injury models, which is more common clinically, to quantify their efficacy as a function of injury severity. Methods/Study Population: Female C57BlJ/6 mice were anesthetized, and a T9/T10 laminectomy was performed to expose the spinal cord. A stereotactic setup with an Infinite Horizon impactor was used to position the spinal cord to receive a mild (30 kdyne), moderate (50 kdyne), or severe (70 kdyne) contusive injury. Within two hours of injury, poly(lactide-co-glycolide) nanoparticles, formed via a single emulsion with sonication protocol, or phosphate-buffered saline (PBS) vehicle were injected intravenously via tail vein injection. Nanoparticles (NPs) or PBS were administered daily for 7 days. Function was evaluated using the Basso Mouse Scale (BMS) test for hind limb function starting 3 days post-injury and repeated weekly thereafter, as well as a horizontal ladder beam test once they had recovered to at least occasional plantar stepping. Results/Anticipated Results: In the moderate injury group, NP-treated mice had significantly higher BMS scores starting 6 weeks post-injury (p=0.009), with the NP-treated mice performing better than control to the end of the study. In the mild injury group, NP-treated mice scored significantly better on BMS starting at 3 days post-injury (p=0.005). This difference persisted through week 4, and then the vehicle-treated mice maintained a slightly lower score through the end of the study. In the severe injury group, no significant difference on BMS scores was observed between groups and animals did not recover enough function to be evaluated via ladder beam. Scoring of the ladder beam test for moderate and mild injury studies is underway. Animals treated with NPs are anticipated to have a significantly higher number of successful steps compared to control. Discussion/Significance of Impact: Spinal cord injury consists of a primary injury and secondary injury caused by inflammation at the injury site. Nanoparticles present an opportunity to reduce secondary injury to improve functional outcomes of individuals with SCI. This study of NPs in a graded severity contusion model further illustrates the feasibility and utility of NPs in SCI.

Objectives/Goals: This project evaluates the acceptability to patients of offering free tax preparation and joint charity-care enrollment in a clinical setting, leveraging an Internal Revenue Service-supported free income tax preparation program. The goal is to reduce administrative barriers and promote continuous access to care. Methods/Study Population: In September 2025, three members of our study team conducted in-person surveys with patients and visitors in outpatient waiting areas at Parkland Health, the county safety-net health system serving Dallas County in North Texas. The 16-item bilingual (English/Spanish) survey was developed in partnership with a large, Internal Revenue Service-supported, local VITA program, Dallas Community Tax Centers (DCTC). The survey collected sociodemographic information, household income, tax-filing practices, current charity care program enrollment status, and interest in combined VITA–charity care enrollment/renewal services. Data were entered into REDCap and analyzed descriptively in Excel. Results/Anticipated Results: Of 300 approached patients, 232 completed the survey, yielding a response rate of 77% (28% Spanish-preferring). Most respondents (86%) estimated that their household income was below $67,000, which would qualify them for VITA tax preparation, yet 82% of those eligible reported that they paid a tax preparer last year. More than half (54%) of respondents were enrolled in the charity care program for the county health system, and 87%of these adults indicated that integrated tax-and-charity care enrollment/renewal services would be helpful. Awareness and reported uptake of the Earned Income Tax Credit (EITC) was low: only 11% of respondents reported applying for EITC during the recent tax season. Interest in shifting to free on-site tax prep services was high, with 72% of respondents indicating a favorable response. Discussion/Significance of Impact: Embedding tax preparation and streamlining charity-care assistance applications in clinical environments was well received and highly acceptable. Future steps include piloting joint VITA–charity-care applications services to assess impact on operational workflows, uptake of both programs, continuity of care, and health outcomes.

Using public opinion surveys conducted in the member states of the European Union, this paper seeks to provide a systematic understanding of public support for the EMU project and European–level monetary policy authority. We develop models of support for EU monetary policy that incorporate a utilitarian component and elements of multilevel governance that is emerging within the EU. These models are tested at the aggregate level of survey respondents. The results show that variations in attitudes to the common currency are driven by collectively–based considerations of the costs and benefits associated with the common currency project as well as the interaction of European–level politics and the domestic politics of the member states.

Paleontology provides insights into the history of the planet, from the origins of life billions of years ago to the biotic changes of the Recent. The scope of paleontological research is as vast as it is varied, and the field is constantly evolving. In an effort to identify “Big Questions” in paleontology, experts from around the world came together to build a list of priority questions the field can address in the years ahead. The 89 questions presented herein (grouped within 11 themes) represent contributions from nearly 200 international scientists. These questions touch on common themes including biodiversity drivers and patterns, integrating data types across spatiotemporal scales, applying paleontological data to contemporary biodiversity and climate issues, and effectively utilizing innovative methods and technology for new paleontological insights. In addition to these theoretical questions, discussions touch upon structural concerns within the field, advocating for an increased valuation of specimen-based research, protection of natural heritage sites, and the importance of collections infrastructure, along with a stronger emphasis on human diversity, equity, and inclusion. These questions offer a starting point—an initial nucleus of consensus that paleontologists can expand on—for engaging in discussions, securing funding, advocating for museums, and fostering continued growth in shared research directions.

These guidelines update the 2013 “Updated US Public Health Service (PHS) Guidelines for the Management of Occupational Exposures to Human Immunodeficiency Virus and Recommendations for Postexposure Prophylaxis,” hereafter referred to as the 2013 PHS Guidelines.1,2 The availability of new medication options, new information on the window of detection for different human immunodeficiency virus (HIV) tests, and the risk of transmission from people with undetectable viral loads prompted this update. The primary intended audience for these recommendations remains anyone involved in the provision of HIV post-exposure management to healthcare personnel (HCP).

The U.S. Centers for Disease Control and Prevention assembled a working group of representatives from federal agencies in the U.S. Department of Health and Human Services (HHS) who identified the priority topics for update and conducted systematic literature reviews to formulate recommendations (see Appendix). All recommendations were reviewed by the Healthcare Infection Control Practices Advisory Committee (HICPAC) at public meetings, and by a non-consensus forming panel of external experts. New evidence-based recommendations are developed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework and classified according to the HICPAC recommendation scheme when evidence supported recommendation development.3,4 Other recommendations in this document are classified as good practice statements according to the criteria set forth by GRADE.5 The working group solicited additional feedback on recommendations from relevant agencies, subject-matter experts, and the public.

Recommendations that have changed since the 2013 PHS guidelines include:

• new antiretroviral drug regimens for post-exposure prophylaxis (PEP);

• a shortened duration of post-exposure follow-up HIV testing;

• elimination of routine laboratory tests for antiretroviral drug toxicity; and

• considerations for PEP for HCP with exposures to source patients with undetectable viral loads.

Important strategies in the principles of exposure management remain: primary prevention strategies; the prompt reporting and management of occupational exposures; adherence to recommended HIV PEP regimens when indicated; the role of expert consultation in management of exposures; and follow-up of exposed HCP.

Complex machines are increasingly expensive to develop and build, which causes many to be maintained in service for longer than initially designed, as they still effectively perform valuable tasks. Longlasting, effective service lives of centuries rather than decades are a valuable characteristic for certain machines in several industries, whether for continual service, extended storage, or extremely remote deployment, such as in military service, agriculture and space exploration. Although there are various archival publications that focus on longevity, we seek to identify product architecture decisions which impact a machine’s longevity and can then be extrapolated out for timescales greater than 100 years. We refer to this as hyper-longevity. This paper seeks to find patterns in the literature that can identify causes linked to longevity effects, their frequency in the literature, and the types of impacts they have in facilitating longevity.

Some of us recently discussed the problems existing in describing the channels that permit interventricular shunting. We offered suggestions for improvement, particularly when assessing the channel that is found when both arterial trunks arise from the morphologically right ventricle. Our proposals engendered significant debate, with several criticisms appearing in an editorial commentary. The commentator now accepts that not all of the criticisms were justified. In an attempt to seek further consensus, we have now joined with additional colleagues so as to clarify the aspects of our initial work that created potential confusion. Having reviewed the aspects producing the misconceptions, we again provide an overview of the evidence relevant to deficient ventricular septation now provided by knowledge of cardiac development. We show how remodelling of the primary interventricular communication involves the provision of an inlet for the developing right ventricle and an outlet for the developing right ventricle. During this process, the secondary interventricular foramen, which is a subaortic-left ventricular communication when the outflow tract remains supported exclusively by the right ventricle, becomes the outflow tract for the left ventricle, with a subaortic-right ventricular communication then being closed to complete ventricular septation. We show how knowledge of these processes, coupled with an appreciation of the mechanism of formation of the muscular ventricular septum and the separate formation of an embryonic muscular outlet septum, which with normal development becomes the subpulmonary infundibulum, provides the basis for understanding the various phenotypic lesions that permit interventricular shunting in the postnatal heart.

We present the serendipitous radio-continuum discovery of a likely Galactic supernova remnant (SNR) G305.4–2.2. This object displays a remarkable circular symmetry in shape, making it one of the most circular Galactic SNRs known. Nicknamed Teleios due to its symmetry, it was detected in the new Australian Square Kilometre Array Pathfinder (ASKAP) Evolutionary Map of the Universe (EMU) radio–continuum images with an angular size of 1 320$^{\prime\prime}$$\times$1 260$^{\prime\prime}$ and PA = 0$^\circ$. While there is a hint of possible H$\alpha$ and gamma-ray emission, Teleios is exclusively seen at radio–continuum frequencies. Interestingly, Teleios is not only almost perfectly symmetric, but it also has one of the lowest surface brightnesses discovered among Galactic SNRs and a steep spectral index of $\alpha$=–0.6$\pm$0.3. Our best estimates from Hi studies and the $\Sigma$–D relation place Teleios as a type Ia SNR at a distance of either $\sim$2.2 kpc (near-side) or $\sim$7.7 kpc (far-side). This indicates two possible scenarios, either a young (under 1 000 yr) or a somewhat older SNR (over 10 000 yr). With a corresponding diameter of 14/48 pc, our evolutionary studies place Teleios at the either early or late Sedov phase, depending on the distance/diameter estimate. However, our modelling also predicts X-ray emission, which we do not see in the present generation of eROSITA images. We also explored a type Iax explosion scenario that would point to a much closer distance of $\lt$1 kpc and Teleios size of only $\sim$3.3 pc, which would be similar to the only known type Iax remnant SN1181. Unfortunately, all examined scenarios have their challenges, and no definitive Supernova (SN) origin type can be established at this stage. Remarkably, Teleios has retained its symmetrical shape as it aged even to such a diameter, suggesting expansion into a rarefied and isotropic ambient medium. The low radio surface brightness and the lack of pronounced polarisation can be explained by a high level of ambient rotation measure (RM), with the largest RM being observed at Teleios’s centre.

This study explores the potential of applying machine learning (ML) methods to identify and predict areas at risk of food insufficiency using a parsimonious set of publicly available data sources. We combine household survey data that captures monthly reported food insufficiency with remotely sensed measures of factors influencing crop production and maize price observations at the census enumeration area (EA) in Malawi. We consider three machine-learning models of different levels of complexity suitable for tabular data (TabNet, random forests, and LASSO) and classical logistic regression and examine their performance against the historical occurrence of food insufficiency. We find that the models achieve similar accuracy levels with differential performance in terms of precision and recall. The Shapley additive explanation decomposition applied to the models reveals that price information is the leading contributor to model fits. A possible explanation for the accuracy of simple predictors is the high spatiotemporal path dependency in our dataset, as the same areas of the country are repeatedly affected by food crises. Recurrent events suggest that immediate and longer-term responses to food crises, rather than predicting them, may be the bigger challenge, particularly in low-resource settings. Nonetheless, ML methods could be useful in filling important data gaps in food crises prediction, if followed by measures to strengthen food systems affected by climate change. Hence, we discuss the tradeoffs in training these models and their use by policymakers and practitioners.