Background: Approximately one in ten US children report an allergy to antibiotics. However, ~95% of these pediatric allergy labels are inaccurate upon evaluation. Inaccurate allergy labels lead to suboptimal antibiotic prescribing, increasing patients’ risk of treatment failure and adverse effects. Successfully removing inaccurate pediatric allergy labels (i.e., delabeling) requires engagement from primary caregivers. This study examined caregiver (e.g., parents, stepparents) perceptions and attitudes toward delabeling in pediatric care. Methods: We invited US adults to an online survey about antibiotics (March-April, 2024). Respondents identifying as a primary caregiver for a child with an antibiotic allergy answered questions about the child’s allergy (e.g., type, severity), their willingness to try methods to assess whether the child was non-allergic (oral medication vs. skin-scratch challenge), and their anticipated reaction to a negative skin-scratch test result for the child (i.e., indicating no allergy). Results: Table 1 shows characteristics of the 37 caregivers of a child with an antibiotic allergy, 31 described the child’s allergies as mild/moderate (83.8%), 5 as severe (13.5%), and 1 as life-threatening (2.7%). Penicillin was the most common allergy (27 of 37 [73.0%]). More caregivers were willing to try skin-scratch testing (33 of 37 [89.2%]) than were willing to try oral challenge (26 of 37 [70.3%], p=.02). Yet, 21.6% of caregivers (n=8) would not accept the results of a negative skin-scratch test for the child and 29.7% (n=11) would not agree to remove the allergy from the child’s medical record based on that test. Almost all caregivers (35 of 37 [94.6%]) said they would try to re-add the child’s allergy onto their medical record if removed following a negative skin-scratch test. Caregivers listed various concerns about delabeling in free-text boxes including fear of harm or distress to the child, negative past experiences, distrust of clinicians, and belief that, as caregivers, they know the child best and should not knowingly do something that could harm them. Other concerns included keeping allergy labels as a safety net, worrying allergies could return, and preferring to be ‘safe than sorry’. Conclusions: In this survey of US adults, caregivers of children with self-reported antibiotic allergies expressed hesitancy toward delabeling efforts. Findings suggest increased testing efforts alone are likely insufficient as caregiver attitudes may present a major barrier to effective antibiotic allergy delabeling in pediatric care. Strategies for addressing caregiver concerns that persist after negative test results are needed to ensure safe, guideline-concordant antibiotic prescribing through childhood and beyond.

Background: Artificial intelligence (AI) chatbots are increasingly used by patients and caregivers seeking quick, conversational answers to medical questions. This trend raises concerns about the clinical accuracy and appropriateness of responses, which can influence illness beliefs, treatment expectations, and care-seeking. These concerns are relevant for conditions like asymptomatic bacteriuria (ASB), which is often mistaken for urinary tract infection (UTI), leading to unnecessary antibiotic use. We examined how AI chatbots respond to simulated caregiver questions about ASB/UTIs. Methods. We created two clinical scenarios of hypothetical medical advice questions involving a positive urinalysis without specific UTI symptoms (i.e., ASB) that asked explicitly whether the parent had a UTI (Table 1). Scenario A described only a positive test, whereas scenario B included a fever and malodorous urine. For each scenario, we varied the parents’ gender (mother vs. father) and age (68 vs. 84 years). The eight questions were entered into three publicly available AI chatbots (ChatGPT v5, Gemini v3, and Copilot v5) on December 15, 2025, using private sessions with no memory enabled. Two team members independently coded responses, with discrepancies resolved by two additional reviewers. Results. Most responses endorsed the suggestion of UTI (22/24, 91.7%; Table 2). Responses frequently acknowledged alternative explanations for symptoms (17/24, 70.9%) and over half mentioned ASB (16/24, 66.7%). Antibiotics were mentioned in 8 responses (33.3%), with 6 of those noting potential harms. Most responses recommended seeking immediate care (19/24, 79.2%). Tone varied: 9 (37.5%) stressed urgency (e.g., “this is not something to wait on—he needs urgent medical evaluation.”), 5 (20.8%) were reassuring (e.g., “I hear your concern”), and 10 (41.7%) neutral. Only 7 responses (29.2%) provided citations. Responses varied between scenarios. For instance, antibiotic harms were given for scenario A but not scenario B. Within scenarios (Table 3), responses varied by chatbot (e.g., mentioning ASB [0/4; Gemini] vs. [2/4; ChatGPT] vs. [2/4; Copilot]), parent’s gender (e.g., antibiotics suggested [1/6; father] vs. [3/6; mother]); and age (e.g., alternative diagnoses suggested [4/6; 68 years] vs. [1/6; 84 years]). Conclusions: In response to simulated caregiver medical advice requests about ASB, AI chatbots often endorsed the suggestion of UTI and inconsistently referenced ASB, with variability by platform and patient attributes. These patterns may reinforce misperceptions of ASB and promote antibiotic misuse in older adults. Monitoring and improvement of chatbot outputs, alongside patient-facing guidance on how to use and interpret responses, are needed to support guideline-aligned care.

In 250 men (21·4 (sd 2·9) years; BMI 24·2 (sd 3·0) kg·m–2) commencing arduous military training during winter, we investigated the effect of 12 weeks of vitamin D supplementation on lower body (pelvic girdle, sacrum, coccyx and lower limb) overuse musculoskeletal injury risk in a randomised, placebo-controlled trial. Participants received either simulated sunlight (1·3 × standard erythemal dose in T-shirt and shorts, three times per week for 4 weeks and then once per week for 8 weeks), oral vitamin D3 (1000 IU · d–1 for 4 weeks and then 400 IU · d–1 for 8 weeks) or placebo for each intervention. Serum vitamin D metabolites and bone metabolism biomarkers were measured at baseline, week 5 and week 12. At baseline, 29 % of participants were vitamin D sufficient (25-hydroxyvitamin D ≥ 50 nmol·L–1). Vitamin D supplementation achieved vitamin D sufficiency in 95 % of participants after 4 weeks. During 6 months of training and subsequent 3 years of military service, 100 lower body overuse musculoskeletal injuries were diagnosed by clinicians. Frailty models indicated no difference in injury risk between vitamin D and placebo during military training (HRplacebo:vitamin D = 1·23 (95 % CI 0·57, 2·66), P = 0·597) or military service (HRplacebo:vitamin D = 0·94 (95 % CI 0·60, 1·46), P = 0·782). Both safe simulated sunlight and oral vitamin D3 were effective in achieving and maintaining vitamin D sufficiency in almost all. There was no clear evidence that vitamin D affects the risk of lower body overuse musculoskeletal injury during 6 months of military training or subsequent 3 years of military service.

This study investigated changes in serum folate and B12, and associations with endurance performance and bone outcomes, in women during military training. Women (n 137) had serum folate and B12, haematological markers and endurance performance (2·4 km run) measured at the start (week 1) and end (week 13) of British Army basic training. Whole-body areal bone mineral density and markers of bone metabolism were measured at week 1. Training decreased serum folate (mean change (95 % CI), −2·3 (−3·0, −1·6) nmol ∙ l−1, P < 0·001), B12 (−16 (−32, 0) pmol ∙ l−1, P = 0·042), Hb (−0·7 (−0·9, −0·5) g ∙ dl−1, P < 0·001) and erythrocyte count (−0·2 (−0·3, −0·2) × 10^9 ∙ l−1, P < 0·001), but had no effect on mean corpuscular volume (P = 0·438) or erythrocyte distribution width (P = 0·088). There was no association between serum folate, serum B12, Hb or erythrocyte count with run time (P ≥ 0·518). Serum B12 was not associated with areal bone mineral density or bone metabolism at week 1 (P ≥ 0·152). Higher serum folate was associated with lower plasma c-telopeptide cross-links of type I collagen (standardised β (95 % CI) = −0·31 (−0·48, −0·15), P < 0·001), but not whole-body bone mineral density or plasma procollagen type I N-terminal propeptide (P ≥ 0·152). Serum folate and B12 decreased after military training in women, resulting in a high prevalence of folate deficiencies at the end of training. Low serum folate may contribute to increased bone resorption, the implications of which are unclear.

Hormone exposure in utero affects male- and female-typical behavior in animals, and these effects may persist in the next generation. Prenatal exposure to diethylstilbestrol (DES), a potent estrogen and endocrine disruptor, has been associated with a tendency toward greater heterosexual behavior in women, but the association in the next generation has not been studied. We evaluated the associations of maternal prenatal DES exposure with sexual behavior, sexual identity, and gender identity in 982 female offspring participating in the National Cancer Institute’s DES Third Generation Study, a cohort born to mothers who were prenatally exposed and unexposed to DES. Odds ratio (OR) and 95% confidence intervals (CIs) were estimated from logistic regression models that included birth year. The ORs were 0.71 (CI 0.46–1.1) for DES in relation to non-heterosexual compared with heterosexual behavior, and 0.99 (CI 0.55–1.8) for non-heterosexual identity, compared with heterosexual identity. Results were similar after additional adjustment for education. Only three individuals reported a gender identity distinct from what was reported by the mother at cohort inception, preventing meaningful quantitative analysis of DES and gender identity. These data do not provide evidence of differences in sexual behavior and sexual identity in female offspring of mothers with and without prenatal exposure to DES.

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.

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.

Vascular rings represent a heterogeneous set of aberrant great vessel anatomic configurations which can cause respiratory symptoms or dysphagia due to tracheal or oesophageal compression. These symptoms can be subtle and may present at varied ages. More recently, many have been identified in patients without symptoms, including fetal echocardiogram, resulting in a conundrum for practitioners when attempting to determine who will benefit from surgical correction. Here, we provide a review of vascular rings and a guide to the practitioner on when to consider additional imaging or referral. Additionally, we discuss the changing landscape regarding asymptomatic patients and fetal echocardiogram.

This systemwide quality improvement project examined whether a bundle of antimicrobial stewardship interventions reduced the proportion of inappropriate antibiotic prescriptions in ambulatory encounters for adults with acute uncomplicated bronchitis. There was an overall reduction in the proportion of inappropriate prescriptions from pre- to postinterventions (44.9%–32.5% [P < 0.001]).

Staphylococcus aureus nasal carriers were randomized (1:1) to XF-73 or placebo nasal gel, administered 5x over ∼24hrs pre-cardiac surgery. S. aureus burden rapidly decreased after 2 doses (–2.2log10 CFU/mL; placebo –0.01log10 CFU/mL) and was maintained to 6 days post-surgery. Among XF-73 patients, 46.5% received post-operative anti-staphylococcal antibiotics versus 70% in placebo (P = 0.045).