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In the context of the rapidly evolving modern food environment, there is a need for dietary assessment tools to accurately assess current food intake. The objective of this research was to develop and validate a new food frequency questionnaire (FFQ). A 265 item web-based, self-administered FFQ (PREDICT-FFQ-v1) was developed using information from two FFQs and US and UK cohort level data. Over a 1-month period, 68 participants completed the PREDICT-FFQ-v1 and six 24-h recalls (reference tool; Intake24). Relative validity was assessed using Bland–Altman plots, cross-classification food group analysis, and Spearman’s rank correlation for food groups and nutrients. From the Bland–Altman plots, the median bias between the PREDICT-FFQ-v1 and Intake24 were energy (414 kcal (95%CI 289 to 609) (1734 kj (95% CI 1208 to 2549)), carbohydrate (2.3 %EI, 95%CI 0.08 to 3.68), fat (2.5 %EI, 95%CI 0.23 to 3.52), protein (−1.14 %EI, 95% CI −1.64 to −0.23), and fibre (1.86 g/1000 kcal, 95% CI 1.05 to 2.65). Cross-classification by quartiles of diet quality (plant-based diet index) categorised >76% of participants into the same or adjacent quartiles. Correlation coefficients for food groups assessed using both tools ranged from 0.38 (legumes) to 0.78 (meat), and for energy-adjusted nutrients ranged from 0.28 (total fat) to 0.82 (alcohol). The PREDICT-FFQ-v1 captures intakes of foods that are commonly consumed in modern diets, with greater resolution at the food level than previous tools. The PREDICT-FFQ-v1 has acceptable relative validity in comparison to 24-h dietary recall and provides a valuable alternative for assessing dietary intake in nutritional epidemiology.
Diets low in diverse fibre-rich plant foods contribute to the rise of chronic disease. The BIOME study (NCT06231706; 6-week parallel randomised controlled trial) in 399 adults (35–65 years; BMI 18·5–40 kg/m2; fibre intake < 20 g/d) investigated a whole-food plant blend containing > 30 ingredients, rich in (poly)phenols, fibre and micronutrients. Participants were randomised (1:1:1) to the blend (30 g/d), an isoenergetic control (bread croutons, 28 g/d) or probiotic (Lactobacillus rhamnosus, 15bn CFU/d). Analysts were blinded to allocation. The primary outcome was change in ‘favourable’ and ‘unfavourable’ gut microbiome species (ZOE Microbiome Health Ranking 2025); secondary outcomes included blood metabolites, symptoms, stool output, anthropometry, hunger, sleep, energy and mood. A crossover sub-study explored postprandial glucose, hunger and mood. Of 349 participants analysed (fifty excluded), self-reported adherence was > 98 %. The 30+ plant blend resulted in more species changing relative abundance at 6 weeks v. control (57 v. 14 species-level genome bins (SGB), P < 0·001) and probiotic (57 v. 4 SGB, P < 0·001). There were no significant between-group differences in microbiome health ranks of significantly changing species (increasing or decreasing). Blend participants self-reported reduced indigestion, constipation, heartburn and flatulence and increased energy v. control (all P < 0·05). Six related but no serious adverse events occurred. In the sub-study, adding the blend to a high-carbohydrate meal (v. meal alone) reduced hunger, increased fullness and energy (3-h incremental AUC, all P < 0·05), with no effect on postprandial glucose. This 30+ plant blend represents a simple strategy to modify gut microbiome composition and benefit gastrointestinal symptoms in healthy adults.
Attention Deficit Hyperactivity Disorder (ADHD) is one of the most common neurodevelopmental disorders in children and adolescents with an estimated prevalence of up to 5% in children. Since 2019 there has been an average annual increase of 18% nationally, in ADHD medication prescriptions. Therefore with the uncertainty around the long-term effects of medication use and the side effects as we currently understand them, there is the need for other interventions to be available for children with ADHD.
This research evaluated the feasibility of a yoga and mindfulness-based family programme developed specifically for children with an ADHD diagnosis; designed to reduce ADHD behaviours, improveparent-child relationships, and emotional regulation.
Methods:
17 families with children aged 6–11 completed a 6-week yoga and mindfulness programme. Families completed the E SWAN assessment forms which include questionnaires for ADHD, Disruptive Mood Dysregulation Disorder, Depression, Anxiety and Panic Disorder. Families were also interviewed post intervention.
Results:
The quantitative findings were positive with significant outcomes: 94.1% of participants were reported to show an improvement in ADHD symptoms post intervention, with an overall 38.6% reduction in symptoms. The qualitative findings evidenced that post intervention the children were able to independently implement emotional regulation techniques, parents/carers were also able to implement strategies to regulate their own emotions, improving their ability to co-regulate their child.
Conclusion:
This is the first study using this particular family intervention that has been developed specifically for children with ADHD diagnosis. The results highlighted the programme was effective in reducing ADHD symptoms, improving the parent-child relationship and emotional regulation.
Objectives/Goals: Ovarian cancer is the most lethal gynecologic cancer with emergence of recurrent and resistant disease being frequent. We sought to identify novel ways to effectively kill chemotherapy-resistant forms of ovarian cancer and to prevent recurrence following curative intent with surgical and adjuvant regimens. Methods/Study Population: Our group identified CTPS1 as a novel dependency in triple negative breast cancer (TNBC) and ovarian cancer. We found CTPS1 was highly expressed in breast and ovarian tumor tissues and therapy-resistant models. We demonstrated siRNA knockdown of CTPS1 reduced proliferation in sensitive and resistant cell lines. In collaboration with Step Pharma, who developed the first CTPS1 inhibitor (STP938), we performed genome-wide CRISPR KO screens on STP938-sensitive and -resistant cells. Top synthetic lethal hits identified included TSC1, TSC2, and PPP2R2A. Synergy assays were conducted with STP938 in combination with mTOR inhibitors (Everolimus, Sirolimus, and Temsirolimus) and the PPP2R2A inhibitor LB-100 to evaluate the therapeutic benefit of combination therapies. Results/Anticipated Results: We identified CTPS1 as a novel vulnerability in many ovarian cancer cell line models, including models of chemotherapy and/or PARP inhibitor resistance. The first-in-class CTPS1 inhibitor (STP938) was shown to be a highly effective anticancer agent in sensitive and resistant forms of ovarian cancer, both in vitro and in vivo. Genome-wide CRISPR KO screens identified central components of the mTOR pathway (TSC1 and TSC2), as well as PPP2R2A, as synthetic lethal targets in the setting of STP938 exposure. We anticipate that combinatorial treatment of mTOR inhibitors and PP2R2A inhibitors with STP938 will further enhance efficacy and reduce the risk of recurrence when used in the adjuvant treatment of ovarian cancer patients. Discussion/Significance of Impact: This study will validate synthetic lethal interactions from our CRISPR screen, reveal genes that could be mutated in ovarian cancer patients that may be driving resistance to STP938, and uncover combination therapies that can be used to increase efficacy in ovarian cancer patients treated with STP938.
1. Delirium is an acute-onset disruption in attention and cognition and is very common in patients with advanced malignancy. It can present as hypoactive, hyperactive, or mixed delirium.
2. Episodes of delirium in malignancy are associated with increased length of hospitalization, healthcare cost, and mortality.
3. Rapid identification of delirium and treatment of potential reversible causes is the mainstay of treatment, and there should be emphasis on non-pharmacological interventions for management.
4. There is no specific recommended workup of delirium, therefore lab and imaging studies should be ordered based on the patient’s clinical presentation and risk factors.
5. Physical restraints and psychotropic medications such as antipsychotics and benzodiazepines should be avoided when able as they are associated with worse outcomes, particularly in older patients.
Precision applications of herbicides are gaining interest as a sustainable approach to managing turfgrass pests. For instance, controlling turfgrass weeds with precision application could effectively reduce herbicide volume without sacrificing weed control. Machine learning models have been a common method for precision application, but machine learning requires intensive labor and expertise to collect and label imagery. The objective of this study was to develop and test a new system that uses the dark green color index (DGCI) to precisely apply glyphosate to detect and spray winter weeds in dormant bermudagrass turf. For this study, a sprayer prototype was constructed that used machine vision and DGCI. The prototype consisted of three primary components: 1) a camera that streamed video frames, 2) a control system that stored computer code focused on the integration of DGCI, and 3) solenoid valves that activated upon detection of winter weeds growing in dormant bermudagrass. Four field trials with different weed species and weed densities were established to test the DGCI system among traditional application methods (i.e., broadcast application and manual spot application with a backpack sprayer). In the lowest weed density scenario, the DGCI system accurately detected and sprayed 90% of the weed population, reducing herbicide volume by 62% compared to a broadcast application. Additionally, the DGCI system required less time for treatment than the spot application with a backpack sprayer. The results from these trials suggest that vegetative indices, such as DGCI, have potential in dormant bermudagrass systems to optimize herbicide volume.
Concerns about the environmental impact of animal-source foods have led to a shift towards plant-based alternatives (PBA). While dairy products and seafood are rich in iodine, an essential nutrient for thyroid function and cognitive development, PBA often lack iodine fortification. As the market expands, there is increasing concern that individuals replacing dairy products and seafood with unfortified PBA may be at risk of iodine deficiency. This study assessed changes in the iodine fortification of plant-based milk, yogurt, cheese and seafood alternatives through a cross-sectional survey of UK supermarkets (2020–2024). Supermarkets were surveyed online each December, and product nutrition and ingredient data were extracted. Between 2020 and 2024, the number of PBA increased by 55 %, with 466 PBA identified in 2024, including milk (n 246), yogurt (n 81), cheese (n 110) and seafood alternatives (n 29). Iodine fortification was inconsistent: in 2024, 48 % of non-organic milk alternatives were fortified, while only 5 % of non-organic yogurt and 4 % of cheese alternatives contained iodine. In comparison, 28 %, 6 % and 0 % of non-organic milk, yogurt and cheese alternatives were fortified with iodine in 2020. No fortified seafood alternatives were identified. Fortified PBA provided 75–83 % of the iodine content of cow’s milk, but most remained poor iodine sources. Although iodine fortification has increased, it lags behind that of calcium and vitamin B12 (48 % v. 88 % and 71 %, respectively). Given iodine’s critical role in health, clearer public health guidance and improved fortification policies are needed. Increased reliance on PBA may exacerbate iodine insufficiency in the UK without intervention.
Species of the Burkholderia (B.) cepacia complex (Bcc) have been implicated in multiple nosocomial outbreaks linked to contaminated water-based products, including liquid soaps, mouthwash, and other non-alcoholic aqueous solutions.
Objective:
We describe two substantial healthcare-associated outbreaks of Bcc (B. cepacia and B. contaminans) in the United Kingdom and Ireland associated with contaminated products. We highlight the challenges during investigation and mitigation, and provide recommendations.
Methods:
A multidisciplinary, multi-stakeholder investigation across both outbreaks was adopted, involving interviews, trawling questionnaires, and targeted product sampling.
Results:
There were 153 and 66 confirmed cases in the B. cepacia and B. contaminans outbreaks, respectively. Cases predominantly comprised hospitalized individuals, and 70% of isolates were recovered from an invasive site. The outbreak strain of B. cepacia was isolated from non-sterile ultrasound gel. An analytical study suggested the B. contaminans cluster was also linked to ultrasound gel; however, a disinfectant wipe product was subsequently identified as the source (0–3 single nucleotide polymorphism differences between case and wipe isolates).
Outbreak control measures:
The affected disinfectant wipes were withdrawn. The ultrasound gel was not recalled but health system procurement was suspended, rapid clinical guidance was produced and a National Patient Safety Alert was issued. Inter-organizational partnership was required to mitigate risks.
Conclusion:
Identifying the source of outbreaks associated with contaminated products can be challenging, requiring complex multi-stakeholder interventions. We recommend a low threshold for investigation of Bcc clusters, adopting a multidisciplinary approach to investigation and mitigation, implementing interventions focusing on practice, and prompt product removal to protect patients.
We examine the arguments made by Onitiu and colleagues concerning the need to adopt a “backward-walking logic” to manage the risks arising from the use of Large Language Models (LLMs) adapted for a medical purpose. We examine what lessons can be learned from existing multi-use technologies and applied to specialized LLMs, notwithstanding their novelty, and explore the appropriate respective roles of device providers and regulators within the ecosystem of technological oversight.
To combat the decline in North American grasslands and prairies, innovative strategies to establish new native grass and forb plantings must be considered. Integrated vegetation management entails the use of many practices to cultivate desirable vegetation along roadsides, including mowing, applying herbicides, burning, and replanting. Currently, only a limited selection of postemergence herbicides are available to improve native plant establishment along roadsides. A greenhouse herbicide screen that included four postemergence herbicides registered for use on Conservation Reserve Program (CRP) acres and rights-of-way was conducted to test their safety for use on four native grasses (big bluestem, buffalograss, sideoats grama, and switchgrass) and seven forb species (ashy sunflower, black-eyed Susan, butterfly milkweed, desert false indigo, Illinois bundleflower, Mexican hat plant, and purple coneflower). Clopyralid (689 g ae ha−1), metsulfuron (4.18 g ai ha−1), and quinclorac (418 g ai ha−1) applied at labeled rates caused no injury to the native grass species or butterfly milkweed. However, florpyrauxifen-benzyl (38.4 g ai ha−1) caused significant injury to buffalograss and switchgrass. None of the herbicides tested were universally safe to use on all forb species evaluated in this trial, with each herbicide causing unacceptable injury (≥25%) to one or more forb species. None of the herbicides studied here would be completely safe for use on mixed stands of native grasses and native forbs at the seedling growth stage, indicating that prairie establishment must use alternative chemistries, plant mixes with fewer species, or avoid postemergence applications shortly after emergence of native forbs.
This study aimed to evaluate the general practitioner (GP) referral pathway for adult attention deficit hyperactivity disorder (ADHD) devised by the Irish Health Service Executive’s (HSE) National Clinical Programme for Adult ADHD (NCPAA). Primary objectives were to (i) quantify GP referrals to community mental health teams (CMHTs) for adult ADHD screening, (ii) measure workload on CMHTs related to screening adult ADHD referrals without comorbid mental health problems, and (iii) quantify access to adult ADHD screening through CMHTs and subsequent assessment and treatment access through specialist adult ADHD teams.
Methods:
An observational cohort design was used to retrospectively analyse ADHD-related referral data collected by clinical staff across 11 Irish CMHTs, and three specialist adult ADHD teams from January to December 2023.
Results:
There was high variability in adult ADHD referrals to CMHTs, ranging from 14 to 122 over one year. There was also high variability in the number of referrals seen by CMHTs, ranging from 9 to 82. From 304 referrals seen across 11 CMHTs, 25.3% required initial treatment for another mental health condition. Specialist adult ADHD teams received 3–4 times more referrals than they were able to assess during this timeframe.
Conclusions:
The NCPAA has provided crucial services for adults with ADHD in Ireland. However, an increase in neurodiversity awareness and demand for services suggests that a range of referral pathways depending on complexity level may be required. Alternative models are proposed, which require allocation of resources and training through primary care, secondary mental health services and specialist teams.
Study coding is an essential component of the research synthesis process. Data extracted during study coding serve as a direct link between the included studies and the synthesis results, allowing reviewers to justify claims about the findings from a set of related studies. The purpose of this tutorial is to provide authors, particularly those new to research synthesis, with recommendations to develop study coding manuals and forms that result in efficient, high-quality data extraction. Each of the 10 easy-to-follow practices is supported with additional resources, examples, or non-examples to help authors develop high-quality study coding materials. With the increase in publication of meta-analyses in recent years across many disciplines, a primary goal of this article is to enhance the quality of study coding materials that authors develop.
The adoption of anaerobic digesters (ADs) and technologies stacked with them (AD+) has the potential to offer benefits to dairy producers and the environment. Production of biochar, hydrochar, and bioplastics can reduce greenhouse gas emissions, offer economic benefits to farmers through the sale of value-added products, reduce the need for fertilizer purchases, and promote a circular economy for dairy producers. We use a diffusion of innovations framework augmented to include economic, environmental, social, and regulatory considerations in addition to the operational aspects of the technologies. We conducted interviews with 21 participants representing for-profit, not-for-profit, governmental, and community service agencies in Idaho, the third-largest U.S. dairy state. Semi-structured interviews explored participants’ experiences with and perceptions of how relative advantage, compatibility, complexity, observability, trialability, environmental, economic, and social factors may facilitate or hinder the adoption of AD and three related emerging AD+ technologies. Interviews were analyzed using inductive coding and thematic analysis. Results show that participants were familiar with the need to address dairy manure waste and were interested in the potential benefits to farm revenue and the environment. However, the same factors associated with the relatively low adoption of AD in Idaho may also hinder the adoption of newer AD+ technologies. These include a lack of observability and trialability, installation and maintenance costs, access to technology, uncertain environmental impacts, unrealized economic benefits to dairy producers, and regulatory burden.
To describe the real-world clinical impact of a commercially available plasma cell-free DNA metagenomic next-generation sequencing assay, the Karius test (KT).
Methods:
We retrospectively evaluated the clinical impact of KT by clinical panel adjudication. Descriptive statistics were used to study associations of diagnostic indications, host characteristics, and KT-generated microbiologic patterns with the clinical impact of KT. Multivariable logistic regression modeling was used to further characterize predictors of higher positive clinical impact.
Results:
We evaluated 1000 unique clinical cases of KT from 941 patients between January 1, 2017–August 31, 2023. The cohort included adult (70%) and pediatric (30%) patients. The overall clinical impact of KT was positive in 16%, negative in 2%, and no clinical impact in 82% of the cases. Among adult patients, multivariable logistic regression modeling showed that culture-negative endocarditis (OR 2.3; 95% CI, 1.11–4.53; P .022) and concern for fastidious/zoonotic/vector-borne pathogens (OR 2.1; 95% CI, 1.11–3.76; P .019) were associated with positive clinical impact of KT. Host immunocompromised status was not reliably associated with a positive clinical impact of KT (OR 1.03; 95% CI, 0.83–1.29; P .7806). No significant predictors of KT clinical impact were found in pediatric patients. Microbiologic result pattern was also a significant predictor of impact.
Conclusions:
Our study highlights that despite the positive clinical impact of KT in select situations, most testing results had no clinical impact. We also confirm diagnostic indications where KT may have the highest yield, thereby generating tools for diagnostic stewardship.
Improving access to and quality of maternal and infant healthcare are important leverage points to address worsening maternal and infant health disparities in the USA. This study evaluates the comprehensiveness of existing maternal and infant quality-of-care measures to identify aspects of quality that need greater attention in quality measurement.
Study design:
We conducted a structured, team-based qualitative review of 88 maternal and infant health measures indexed by the National Quality Forum (NQF), the Agency for Healthcare Research and Quality (AHRQ), the Centers for Medicare and Medicaid Services (CMS), and the National Committee for Quality Assurance (NCQA). We assessed discrete elements relevant to meaningfulness, feasibility, and usability following AHRQ National Quality Strategy (NQS) criteria, with input from researcher, clinician, and citizen scientist investigators. Descriptive statistics on coded measures were calculated using SPSS.
Results:
The most common AHRQ NQS priorities addressed were mortality (60%) and safety (48%). Average scores across elements were 59% for feasibility, 61% for practice usability, and 31% for policy usability. Fewer measures addressed coordination, affordability, or patient engagement in the postpartum period. Only 23% of measures were endorsed by NQF, only 17% of measures had publicly available benchmarks, and only 14% had specifications updated in the year prior to review.
Conclusions:
Findings from this study can inform the specification of a comprehensive, updated system for maternal and infant quality-of-care evaluation and can facilitate the development of new quality-of-care measures that address underrepresented maternal and infant health issues.
In Georgia plasticulture vegetable production, a single installation of plastic mulch is used for up to five cropping cycles over an 18-mo period. Preplant applications of glyphosate and glufosinate ensure fields are weed-free before transplanting, but recent data suggest that residual activity of these herbicides may pose a risk to transplanted vegetables. Glyphosate and glufosinate were applied preplant in combination with three different planting configurations, including 1) a new plant hole into new mulch, 2) a preexisting plant hole, 3) or a new plant hole spaced 15 cm from a preexisting plant hole (adjacent). Following herbicide application, overhead irrigation was used to remove residues from the mulch before punching transplanting holes for tomato, cucumber, or squash. Visible injury; widths; biomass; and yield of tomato, cucumber, or squash were not influenced by herbicide in the new mulch or adjacent planting configurations. When glyphosate was applied at 5.0 kg ae ha−1 and the new crop was planted into preexisting holes, tomato was injured by 45%, with reduced heights, biomass, and yields; at 2.5 kg ae ha−1 injury of 8% and a biomass reduction was observed. Cucumber and squash were injured by 23% to 32% by glyphosate at 5.0 kg ae ha−1, with reductions in growth and early-season yield; lower rates did not influence crop growth or production when the crop was placed into a preexisting plant hole. Glufosinate applied at the same rates did not affect tomato growth or yield when planted into preexisting plant holes. Cucumber, when planted into preexisting plant holes, was injured by 43% to 75% from glufosinate, with reductions in height and biomass, and yield losses of 1.3 to 2.6 kg ai ha−1; similar results from glufosinate were observed in squash. In multi-crop plasticulture production, growers should ensure vegetable transplants are placed a minimum of 15 cm away from soil exposed to these herbicides.
Shakespeare Survey is a yearbook of Shakespeare studies and production. Since 1948, Survey has published the best international scholarship in English and many of its essays have become classics of Shakespeare criticism. Each volume is devoted to a theme, or play, or group of plays; each also contains a section of reviews of that year's textual and critical studies and of the year's major British performances. The theme for Volume 77 is 'Shakespeare's Poetry'. The complete set of Survey volumes is also available online at www.cambridge.org/core/publications/collections/cambridge-shakespeare. This searchable resource enables users to browse by author, essay and volume, search by play, theme and topic, and save and bookmark their results.