Background RSV vaccine effectiveness (VE) has not been described among nursing home (NH) residents, despite their increased risk for severe disease related to age and chronic heart and lung disease. We assessed bivalent RSVpreF VE in Veterans Affairs (VA) NH residents, overall and stratified by age and comorbidities. Methods We conducted a retrospective cohort study of NH residents over two RSV seasons (October 2023–April 2024; October 2024–April 2025). Inclusion criteria were a confirmed RSVpreF vaccination status (received RSVpreF or no RSV vaccine; other formulations and unconfirmed status excluded) and residing in a NH with RSV testing during the study period. Vaccination status was a three-level time-varying exposure: unvaccinated, vaccinated in current season, or vaccinated in the prior season. Time-at-risk for RSV was limited to continuous stays in VA NH or acute care settings. The primary outcome was laboratory-confirmed RSV infection; severe infections were defined as those requiring transfer to acute care or escalation within acute care. VE was calculated as 1 minus the hazard ratio from Cox models stratified by age and cardiopulmonary disease defined by diagnoses of congestive heart failure (CHF) and/or chronic obstructive pulmonary disease (COPD), adjusted for demographics, calendar year, and conditional on calendar month. Results Among 15,078 unique residents, those aged 60-74 had similar VE when vaccinated in the prior season vs current season, while those aged ≥Figure 1). Similarly, current-season model-adjusted VE was similar for those with and without cardiopulmonary disease. VE for vaccination in the prior season declined modestly among those with cardiopulmonary disease (76% [51–89] to 54% [4–78]). Of 220 total laboratory-confirmed RSV infections, 15 were severe (Table 1). Of the infections, 29 occurred among vaccinated residents of which 1(3%) was severe. Among unvaccinated residents, 14/191 infections (7%) were severe. Residents with severe infections were more likely to be ? Conclusion In this first RSV Vaccine VE study among NH residents, a frail population at high risk for severe RSV disease, bivalent RSVpreF vaccination was associated with a meaningful reduction in laboratory-confirmed RSV infection risk that persisted across two seasons, but with some diminished second-season protection for those with advanced age or cardiopulmonary disease. These subgroups were also overrepresented among those with severe disease and remain an important target for disease prevention.

Background: Antibiotic-resistant infections cause 2 million illnesses and 35,000 deaths annually in the U.S., driven partly by unnecessary antibiotic prescribing. Emerging evidence raises concern over prescription rates in primary and urgent care telemedicine settings, where limitations to conducting physical exams and fewer dedicated antibiotic stewardship resources pose challenges. More information is needed about how to implement antibiotic stewardship in these settings. To reduce inappropriate antibiotic prescribing over telemedicine, we implemented the first large-scale quality improvement (QI) intervention for antibiotic stewardship in telemedicine. Methods: The Safety Program for Telemedicine enrolled 522 practices representing 49 organizations offering telemedicine in an 18-month QI program. Participating organizations varied in size (1-100+ clinicians), care type (e.g., primary, urgent, pediatric), and structure (e.g., direct-to-consumer, integrated health system). The program included: 1) 18 webinars on antibiotic stewardship, diagnosing and treating common infections over telemedicine, virtual physical exams, and patient communication; 2) QI adviser support; 3) office hours; 4) practical tools (e.g., patient and clinician handouts); 5) benchmarking reports; and 6) sustainability guidance. We conducted 25 virtual interviews with program participants from 23 practices to identify challenges and opportunities to improve antibiotic prescribing in telemedicine and program facilitators and barriers. Transcripts were coded in NVivo. Using rapid deductive qualitative analysis, we organized data into predefined domains while identifying emergent themes and synthesized summaries to identify cross-cutting patterns. Monthly QI adviser reports on implementation successes and challenges were also qualitatively analyzed to explore themes. Results: Key themes revealed 1) challenges to appropriate antibiotic prescribing in telemedicine, 2) resources to support antibiotic stewardship, 3) facilitators to successful program implementation, and 4) barriers to program engagement. Challenges reported by participants included concerns about patient satisfaction, limitations in conducting physical exams, and inadequate telemedicine-specific education. Patient communication tools and telemedicine-specific clinical guidance were noted as resources to support appropriate prescribing. Facilitators to successful program implementation included live and asynchronous learning options, case-based materials in various formats (discussion guides, handouts, slides), one-on-one support, and sharing prescribing data in benchmarking reports. Barriers included limited provider time, competing organizational priorities, and difficulties extracting data from electronic health record systems. Conclusions: Leaders of antibiotic stewardship efforts in telemedicine settings can apply these findings by offering telemedicine-specific guidance to clinicians, flexible learning, ongoing support/coaching, individualized benchmarking reports, and proactively addressing patient satisfaction through patient education. This program also provides a scalable model for implementing QI interventions in telemedicine settings that can be adapted to other clinical areas.

Global mortality rates continue to decline, and life expectancy continues its upward trend. Besides mortality levels, policymakers and providers of financial and health services would also be interested in disability prevalence and its potential future trajectories. The length of time in good health versus the duration with major disabilities or long-term illnesses has significant financial implications for both individuals and society. In this paper, we develop Bayesian common factor models to analyse Australian age- and sex-specific disability prevalence rates. In particular, there are one or more common factors shared by both sexes, as well as specific factors for each sex. Retirement villages are purpose-built residential complexes designed for relatively healthy retirees to live as neighbours and share a communal lifestyle. We apply the model forecasts and simulations to valuate a typical retirement village contract. The cost of this accommodation service is determined by the resident’s total length of stay, which can be estimated using forecasted and simulated disability prevalence rates and mortality rates from our proposed models.

The mechanical feedback from the central active galactic nuclei (AGNs) can be crucial for balancing the radiative cooling of the intracluster medium (ICM) at the cluster centre. We aim to understand the relationship between the power of AGN feedback and the cooling of gas in the centres of galaxy clusters by correlating the radio properties of the brightest cluster galaxies (BCGs) with the X-ray properties of their host clusters. We used the catalogues from the first SRG/eROSITA All-Sky Survey (eRASS1) along with radio observations from the Australian SKA Pathfinder (ASKAP). In total, we identified 134 radio sources associated with BCGs of the 151 eRASS1 clusters located in the PS1, PS2, and SWAG-X ASKAP fields. Non-detections were treated as upper limits. We correlated the radio properties of the BCGs (radio luminosity, largest linear size/LLS, and BCG offset from the cluster centre) with the integrated X-ray luminosity of the host clusters. We utilised the concentration parameter, $c_{R_{500}}$, to categorise the clusters into cool cores (CCs) and non-cool cores (NCCs). By combining $c_{R_{500}}$ with the BCG offset, we assessed the dynamical states of the clusters in our sample. Furthermore, we analysed the correlation between radio mechanical power and X-ray luminosity within the CC subsample. We observe a potential positive trend between LLS and BCG offset, which may hint at an environmental influence on the morphology of central radio sources. We find a weak trend suggesting that more luminous central radio galaxies are found in clusters with higher X-ray luminosity. Additionally, there is a positive but highly scattered relationship between the mechanical luminosity of AGN jets and the X-ray cooling luminosity within the CC subsample. This finding is supported by bootstrap resampling and flux-flux analyses. The correlation observed in our CC subsample indicates that AGN feedback is ineffective in high-luminosity (high-mass) clusters. At a cooling luminosity of $L_{\mathrm{X},\,r} \lt \mathrm{R}_{\mathrm{cool}}\approx 5.50\times10^{43}\,\mathrm{erg\,s^{-1}}$, on average, AGN feedback appears to contribute only about $13\%-22\%$ of the energy needed to offset the radiative losses in the ICM.

Loneliness and social isolation are prevalent concerns among older adults and can lead to negative health consequences and a reduced lifespan. New technologies are increasingly being developed to help address loneliness and social isolation in older adults, including monitoring systems, social networks, robots, companions, smart televisions, augmented reality (AR) and virtual reality (VR) applications. This systematic review maps human-centered design (HCD) and user-centered design (UCD) approaches, human needs, and contextual factors considered in current technological interventions designed to address the problems of loneliness and social isolation in older adults. We conducted a scoping review and in-depth examination of 98 papers through a qualitative content analysis. We found 12 studies applying either an HCD or UCD approach and observed strengths in continuous user involvement and implementation in field studies but limitations in participant inclusion criteria and methodological reporting. We also observed the consideration of important human needs and contextual factors. However, more research is needed on stakeholder perspectives, the functioning of applications in different housing environments, as well as studies that include diverse socio-economic groups.

Plant growth requires the integration of internal and external cues, perceived and transduced into a developmental programme of cell division, elongation and wall thickening. Mechanical forces contribute to this regulation, and thigmomorphogenesis typically includes reducing stem height, increasing stem diameter, and a canonical transcriptomic response. We present data on a bZIP transcription factor involved in this process in grasses. Brachypodium distachyon SECONDARY WALL INTERACTING bZIP (SWIZ) protein translocated into the nucleus following mechanostimulation. Classical touch-responsive genes were upregulated in B. distachyon roots following touch, including significant induction of the glycoside hydrolase 17 family, which may be unique to grass thigmomorphogenesis. SWIZ protein binding to an E-box variant in exons and introns was associated with immediate activation followed by repression of gene expression. SWIZ overexpression resulted in plants with reduced stem and root elongation. These data further define plant touch-responsive transcriptomics and physiology, offering insights into grass mechanotranduction dynamics.

OBJECTIVES/GOALS: To demonstrate the value of the Competency Index for Clinical Research Professional (CICRP) as a tool in program evaluation using a pre- and post- design to evaluate student perceived self-efficacy in clinical trial competencies at program entry and at program completion. METHODS/STUDY POPULATION: Using a separate-sample pre-post study design, we administered the CICRP questionnaire to students in the entry and exit courses of the Master of Clinical Research (MCR) Program during the 2021-2022 academic year, using QualtricsTM (Provo, Utah) survey instrument for use on desktop or mobile device. We included the 20 CICRP competency items asking students to rate their self-efficacy in performing each item using a Likert Scale (from 0-10) (0=not at all confident; 10= extremely confident). Links to the survey were included in the courses for the foundational entry course and for the final culminating project course. RESULTS/ANTICIPATED RESULTS: Overall, 54 students took the CICRP during the entry course and 56 during the exit. Cronbach’s alpha for each assessment ranged from 0.93 to 0.98. Both the Welch’s two-sample t-test and Wilcoxon rank-sum test show very significant differences between the group of students entering the program and leaving the program (p value < 0.001). A significant increase in mean CICRP total score is seen at each experience level between program entry and program exit (p<0.001) A linear regression, adjusting for available covariates, individuals taking the exit course have a mean CICRP total score 92.690 (p value < 0.001) higher than individuals taking the entry course. DISCUSSION/SIGNIFICANCE: Competency indices have been used to measure self-efficacy in translational research scientists, thus the use of CICRP to measure self-efficacy can be useful in assessing whether our competency-based program is meeting the JTF Competency needs of students.

Inflammatory diets are increasingly recognised as a modifiable determinant of mental illness. However, there is a dearth of studies in early life and across the full mental well-being spectrum (mental illness to positive well-being) at the population level. This is a critical gap given that inflammatory diet patterns and mental well-being trajectories typically establish by adolescence. We examined the associations of inflammatory diet scores with mental well-being in 11–12-year-olds and mid-life adults. Throughout Australia, 1759 11–12-year-olds (49 % girls) and 1812 parents (88 % mothers) contributed cross-sectional population-based data. Alternate inflammatory diet scores were calculated from a twenty-six-item FFQ, based on the prior literature and prediction of inflammatory markers. Participants reported negatively and positively framed mental well-being via psychosocial health, quality of life and life satisfaction surveys. We used causal inference modelling techniques via generalised linear regression models (mean differences and risk ratios (RR)) to examine how inflammatory diets might influence mental well-being. In children and adults, respectively, a 1 sd higher literature-derived inflammatory diet score conferred between a 44 % (RR 95 % CI 1·2, 1·8) to 57 % (RR 95 % CI 1·3, 2·0) and 54 % (95 % CI 1·2, 2·0) to 86 % (RR 95 % CI 1·4, 2·4) higher risk of being in the worst mental well-being category (i.e. <16th percentile) across outcome measures. Results for inflammation-derived scores were similar. BMI mediated effects (21–39 %) in adults. Inflammatory diet patterns were cross-sectionally associated with mental well-being at age 11–12 years, with similar effects observed in mid-adulthood. Reducing inflammatory dietary components in childhood could improve population-level mental well-being across the life course.

The two-dimensional laminar flow of a viscous fluid induced by peristalsis due to a moving wall wave has been studied previously for a rectangular channel, a circular tube and a concentric circular annulus. Here, we study peristaltic flow in a non-axisymmetric annular tube: in this case, the flow is three-dimensional, with motions in the azimuthal direction. This type of geometry is motivated by experimental observations of the pulsatile flow of cerebrospinal fluid along perivascular spaces surrounding arteries in the brain, which is at least partially driven by peristaltic pumping due to pulsations of the artery. These annular perivascular spaces are often eccentric and the outer boundary is seldom circular: their cross-sections can be well matched by a simple, adjustable model consisting of an inner circle (the outer wall of the artery) and an outer ellipse (the outer edge of the perivascular space), not necessarily concentric. We use this geometric model as a basis for numerical simulations of peristaltic flow: the adjustability of the model makes it suitable for other applications. We concentrate on the general effects of the non-axisymmetric configuration on the flow and do not attempt to specifically model perivascular pumping. We use a finite-element scheme to compute the flow in the annulus driven by a propagating sinusoidal radial displacement of the inner wall. Unlike the peristaltic flow in a concentric circular annulus, the flow is fully three-dimensional: azimuthal pressure variations drive an oscillatory flow in and out of the narrower gaps, inducing an azimuthal wiggle in the streamlines. We examine the dependence of the flow on the elongation of the outer elliptical wall and the eccentricity of the configuration. We find that the time-averaged volumetric flow is always in the same direction as the peristaltic wave and decreases with increasing ellipticity or eccentricity. The additional shearing motion in the azimuthal direction will increase mixing and enhance Taylor dispersion in these flows, effects that might have practical applications.

Social media research during natural disasters has been presented as a tool to guide response and relief efforts in the disciplines of geography and computer sciences. This systematic review highlights the public health implications of social media use in the response phase of the emergency, assessing (1) how social media can improve the dissemination of emergency warning and response information during and after a natural disaster, and (2) how social media can help identify physical, medical, functional, and emotional needs after a natural disaster. We surveyed the literature using 3 databases and included 44 research articles. We found that analyses of social media data were performed using a wide range of spatiotemporal scales. Social media platforms were identified as broadcasting tools presenting an opportunity for public health agencies to share emergency warnings. Social media was used as a tool to identify areas in need of relief operations or medical assistance by using self-reported location, with map development as a common method to visualize data. In retrospective analyses, social media analysis showed promise as an opportunity to reduce the time of response and to identify the individuals’ location. Further research for misinformation and rumor control using social media is needed.

Recent archaeological survey and excavation in China have demonstrated that large sites of the late fourth and third millennia BC were situated not on the Central Plains—where the later dynastic centres were located—but along the Yangtze and lower Yellow River Basins. Their decline in the late third and second millennia BC coincided with the growth of sites to the north of the Central Plains. Evidence for settlement size and a new chronology constructed from radiocarbon dates emphasise discontinuities in the geographic distribution of settlements, combined with continuity in cultural practices of ritual feasts and the use of symbolic jades.

The construction chronology of three of the earliest Dunhuang Mogao Grottoes (Caves 268, 272, and 275) has been the subject of ongoing debate for over half a century. This chronology is a crucial topic in terms of further understanding of the establishment of the Dunhuang Mogao Grottoes, early Buddhism in the Gansu corridor, and its relationship with Buddhism developed in the Central Plains. Building upon archaeological, art historical and radiocarbon (14C) dating studies, we integrate new 14C data with these previously published findings utilizing Bayesian statistical modeling to improve the chronological resolution of this issue. Thus, we determine that all three of these caves were constructed around AD 410–440, suggesting coeval rather than sequential construction.

Lead is a major component of Chinese ritual bronze vessels. Defining its sources and usage is thus highly significant to understanding the metal industries of the Chinese Bronze Age. A new, simplified method has been developed for examining data, thereby providing insight into diachronic change in the origins of lead sources used in artefacts. Application of this method to the existing corpus of lead isotope data from the Erlitou (c. 1600 BC) to the Western Zhou (c. 1045–771 BC) periods reveals changes in the isotope signal over this time frame. These changes clearly reflect shifts in the sourcing of ores and their use in metropolitan foundries. Further data are required to understand these complex developments.