Psoriasis has been linked to various diet-related comorbidities such as metabolic syndrome, type 2 diabetes, and cardiovascular disease(1). Evidence for the role of diet in the management of psoriasis and its comorbidities is lacking, and there is no dietary guidance for people with psoriasis. This study aimed to characterise the dietary patterns and quality by adherence to the UK Eatwell guide and a Mediterranean-style diet in UK individuals living with psoriasis and assessed associations between diet quality and risk of psoriasis comorbidities, psoriasis severity and cardiometabolic risk markers.

Using the UK Biobank cohort, we identified 2,615 patients with psoriasis by self-report or health records at baseline, with a comparison group of 122,572 non-psoriasis participants who have valid dietary data. The dietary intake was assessed through online 24h-recalls (Oxford WebQ) conducted every 3-4 months over one year. The average nutrient and food groups intake were calculated from at least 2 recalls to determine adherence to the UK Eatwell Guide (Eatwell Score, range: 0-9(2)) and the Mediterranean-style diet (alternative Mediterranean diet (aMED) score(3), range: 0-9). Associations between diet quality and the risk of 13 selected comorbidities, psoriasis severity (assumed from treatment type), and cardiometabolic risk markers were evaluated using multivariate regression models, adjusted for confounders including age, sex, Townsend deprivation factor, physical activity levels, smoking, alcohol, supplement use and the reporting source of psoriasis.

Both psoriasis and non-psoriasis groups showed similar average scores for Eatwell (3.9±1.7 for both groups) and aMED (3.6±1.8 and 3.3±1.7, respectively). Higher Eatwell scores were associated with a 15% reduced risk of myocardial infarction (OR = 0.85, 95%CI: 0.74−0.98, P = 0.025) and 23% increased risk of osteoporosis (OR = 1.23, 95% CI: 1.05-1.45, P = 0.010) in participants with psoriasis. Additionally, higher Eatwell scores were associated with lower BMI (StdBeta, adjusted P: −0.049, 0.013) and improved plasma lipid profiles (cholesterol: −0.058, 0.004; LDL: −0.068, 0.001; triglycerides: −0.076, <0.001). A higher aMED score is positively associated with better plasma lipid profiles (cholesterol −0.051, 0.012; LDL −0.051, 0.012) in individuals with psoriasis fully adjusted. No significant association was found between diet quality and psoriasis severity. However, participants with the highest severity (on systemic treatment) had a 34% lower chance of meeting guidelines for fruit and vegetable intakes (5 servings/day) compared with those on no treatment or topical treatment only (OR = 0.66, 95% CI: 0.46−0.95, P = 0.024).

Our findings suggest that higher dietary quality is associated with a reduced risk of certain cardiometabolic diseases in people with psoriasis, emphasising the importance of dietary management in this population. Longitudinal and intervention studies are needed to further explore the role of diet in psoriasis and its associated health outcomes.

The role of diet in the prevention and management of menopausal symptoms is poorly understood1,2. Digital health platforms have the potential to optimise collection of population-level menopause symptom data particularly in a rapidly changing environment2,3. This study explored the prevalence of menopause symptoms utilising data collection capabilities of a mobile app in a large population of peri- and postmenopausal women and to investigate novel associations between diet quality and symptoms.

Baseline data on diet, 20 menopause symptoms (i.e. 3 vasomotor, 3 sexual, 4 psychological and 10 somatic) and other characteristics of 70,412 participants of the ZOE PREDICT 3 app-based study in UK (n = 27,932 peri- and n = 42,480 postmenopausal) were analysed (NCT04735835). Dietary assessment was performed through an app-based food frequency questionnaire (PREDICTFFQ)4 and diet quality assessed using the Healthy Eating Index-2020 (HEI, score 0-100)5.

The burden of menopausal symptomatology was high; with 99.8% and 92.7% of peri- and postmenopausal participants reporting 1 or more symptoms respectively and 66.0% and 41.2% of peri- and postmenopausal participants experiencing >12 symptoms, respectively (P<0.001). Mean ( ±SD) symptom number was greater in the peri- versus postmenopausal group; 13.5±3.8, vs. 10.5±5.5 (P<0.001). HEI (mean±SD) was slightly lower in the peri- versus postmenopausal group; 73.9±9.7 vs. 76.6±8.9 respectively (P<0.001). Logistic regression analyses showed that a 20 unit increase in HEI was associated with reduction of 6%-37% and 12%-43% in likelihood of symptom presence (dependent on the symptom) in peri- and postmenopausal participants, respectively (P<0.05). ORs remained significant in adjusted models (for age, BMI, use of hormone replacement therapy, total energy intake and home environment (urban, rural) showing reductions of 7%-19% and 6-21%, respectively (P<0.05). Logistic regression analyses revealed that a similar increase in HEI (20 units) was associated with 17% and 19% reductions in the number of symptoms reported by peri- and postmenopausal women after multiple adjustments (P<0.05).

This large observational study confirms the high prevalence of menopausal symptoms among peri- and postmenopausal women and provides new evidence between adherence to healthy eating and reduced likelihood of menopausal symptoms, increasing the potential for symptom reduction by specific dietary approaches. Further studies should examine this relationship in longitudinal and dietary intervention settings.

Digital health technologies delivering dietary and lifestyle advice1,2 may offer a contemporary approach to menopause symptom mitigation in a large population base3. This study aimed to evaluate alterations in both diet quality and menopause symptom burden following the implementation of an app-based, personalised dietary intervention in peri- and postmenopausal participants.

Baseline and follow-up data (mean follow-up time, 207 ± 72 days) on diet, menopause symptom number (from 20 vasomotor, sexual, psychological and somatic symptoms), symptom severity (0-not at all, 1-a little, 3-quite a bit and 5-extremely) and other characteristics of 4,287 UK based participants of the ZOE PREDICT 3 study (1,000 perimenopausal and 3,287 postmenopausal) were analysed (NCT04735835). Dietary assessment was performed through an app-based food frequency questionnaire (PREDICT-FFQ)2 and diet quality assessed using the Healthy Eating Index-2020 (HEI, score 0-100)4. A novel Menopause Symptom Tracker Score (MSTS 0-100, Copyright © 2024 Zoe Limited) was used to capture symptom number and severity.

There was a modest increase in diet quality after the intervention in both peri- and postmenopausal participants; mean HEI from 76.4 ± 8.4 to 79.7 ± 6.8 (P<0.001) and from 78.7 ± 7.8 to 81.1 ± 6.4 (P<0.001), respectively. Baseline MSTS was higher in peri- versus postmenopausal participants 28.9 ± 15.1 vs. 18.1 ± 15.0 (P<0.001). However, both groups showed a significant decrease in mean MSTS after the intervention compared to baseline; mean change (95%CI) in perimenopausal was -8.7 (-9.5, -7.9; 30.1% reduction) and in postmenopausal was -6.6 (-6.9, -6.2; 36.5% reduction) (P for both <0.001).

The reduction in the overall MSTS was greater in perimenopausal compared to postmenopausal (P<0.001). Reductions in domain-specific MSTS for peri- and postmenopausal groups respectively, were as follows: vasomotor −0.56 (−0.71, −0.40; 24.9% reduction) and −0.47 (−0.54, −0.41; 31.8% reduction), sexual −0.72 (−0.87, −0.57; 18.6%) and -1.08 (-1.16, −0.99; 28.7%), psychological -2.3 (-2.5, 2.0; 35.0%) and -1.2 (-1.3, -1.1; 44.2%), somatic -5.1 (-5.6, -4.7; 31.5%) and -3.8 (-4.0, -3.6; 37.5%) (P for all <0.001). The reduction in the psychological and somatic domain-specific MSTS was greater in peri-compared to postmenopausal group (P for both <0.001).

This study supports the potential of personalised app-based dietary interventions in the mitigation of menopausal symptoms during menopause transition and its potential to affect the health and quality of life of millions. Further studies should investigate their efficacy in a randomised, controlled dietary intervention setting.

Little is known about the life cycle and mode of transmission of Dientamoeba fragilis. Recently it was suggested that fecal–oral transmission of cysts may play a role in the transmission of D. fragilis. In order to establish an infection, D. fragilis is required to remain viable when exposed to the pH of the stomach. In this study, we investigated the ability of cultured trophozoites to withstand the extremes of pH. We provide evidence that trophozoites of D. fragilis are vulnerable to highly acidic conditions. We also investigated further the ultrastructure of D. fragilis cysts obtained from mice and rats by transmission electron microscopy. These studies of cysts showed a clear cyst wall surrounding an encysted parasite. The cyst wall was double layered with an outer fibrillar layer and an inner layer enclosing the parasite. Hydrogenosomes, endoplasmic reticulum and nuclei were present in the cysts. Pelta-axostyle structures, costa and axonemes were identifiable and internal flagellar axonemes were present. This study therefore provides additional novel details and knowledge of the ultrastructure of the cyst stage of D. fragilis.

Influenced by proposals (spanning back to the Kaiser Reich) to hinder the urban-rural divide, Hessian Social Democrats introduced the Hessenplan in 1951 to rebuild the war-torn cities, reconstruct state infrastructure, and integrate displaced persons. A key component of this plan was the establishment of rural community centres, which provided modern amenities and leisure activities, attempted to reduce the hardship of the rural lifestyle through the mechanisation of labour, as well as reinforced democratic principles – all in an attempt to hinder the rural exodus. Branded ‘Castles of Peace’, the rural community centres also represented an environment and a tool for political transformation through democratic re-education. They provided an opportunity to help balance the social, cultural, and economic inequalities between urban and rural communities, were used to prevent further individual anomie, and to instill within the rural populace the importance of becoming responsible citizens in the new democratic age.

Protected areas (PAs) are critical for achieving conservation, economic and development goals, but the factors that lead households to engage in prohibited resource collection in PAs are not well understood. We examine collection behaviours in community forests and the protected Chitwan National Park in Chitwan, Nepal. Our approach incorporates household and ecological data, including structured interviews, spatially explicit data on collection behaviours measured with computer tablets and a systematic field survey of invasive species. We pair our data with a framework that considers factors related to a household’s demand for resources, barriers to prohibited resource collection, barriers to legal resource collection and alternatives to resource collection. The analysis identifies key drivers of prohibited collection, including sociodemographic variables and perceptions of an invasive plant (Mikania micrantha). The social-ecological systems approach reveals that household perceptions of the presence of M. micrantha were more strongly associated with resource collection decisions than the actual ecologically measured presence of the plant. We explore the policy implications of our findings for PAs and propose that employing a social-ecological systems approach leads to conservation policy and scientific insights that are not possible to achieve with social or ecological approaches alone.

Psychological attachment to political parties can bias people’s attitudes, beliefs, and group evaluations. Studies from psychology suggest that self-affirmation theory may ameliorate this problem in the domain of politics on a variety of outcome measures. We report a series of studies conducted by separate research teams that examine whether a self-affirmation intervention affects a variety of outcomes, including political or policy attitudes, factual beliefs, conspiracy beliefs, affective polarization, and evaluations of news sources. The different research teams use a variety of self-affirmation interventions, research designs, and outcomes. Despite these differences, the research teams consistently find that self-affirmation treatments have little effect. These findings suggest considerable caution is warranted for researchers who wish to apply the self-affirmation framework to studies that investigate political attitudes and beliefs. By presenting the “null results” of separate research teams, we hope to spark a discussion about whether and how the self-affirmation paradigm should be applied to political topics.

The coronavirus disease 2019 (COVID-19) pandemic forced American medical systems to adapt to high patient loads of respiratory disease. Its disruption of normal routines also brought opportunities for broader reform. The purpose of this article is to describe how the Carl R. Darnall Army Medical Center (CRDAMC), a medium-sized Army hospital, capitalized on opportunities to advance its strategic aims during the pandemic. Specifically, the hospital sequentially adopted virtual video visits, surged on preventative screenings, and made-over its image to appeal to patients seeking urgent care. These campaigns supported COVID-19 efforts and larger strategic goals simultaneously, and they will endure for years to come. Predictably, CRDAMC encountered obstacles in the course of its transformation. These obstacles and their follow-on lessons are provided to assist future medical leaders seeking quantum change in the opportunities made available by health crises.

Innovation Concept: EM Sim Cases is an innovative, open-access website that was created in 2015 to publish medical simulation resources including standardized, peer-reviewed simulation cases. Herein we describe our interim analysis. Methods: We performed a massive online needs assessment using a methodology previously described by Chan et. al. to determine how we can shape EM Sim Cases to meet the needs of learners and educators who use it. We engaged with simulation experts from the Emergency Medicine Simulation Education Research Collaborative to design a Google Forms survey using best practices in survey design. We distributed the survey to our target community of practice via Twitter, email, and a blog post published on emsimcases.com. Curriculum, Tool, or Material: We received 81 responses from simulation educators representing 8 medical specialties and 13 countries. Most survey respondents identified themselves as staff physicians (n = 44) and specialized in emergency medicine (n = 39). They had 0-21+ years of experience. 37% of respondents (n = 30) stated that material from EM Sim Cases makes up 25% or more of their simulation curriculum. Several respondents noted that using this content made them feel more confident and more current. Respondents praised EM Sim Cases for a well-organized case format, the proper level of detail, consistency between case designs, and the wide variety of cases. Suggested improvements included an opportunity to directly comment on cases and more cases in pediatric, rural, and advanced airway management situations. Suggestions were made to improve the navigability of the website. Respondents wanted to see additional blog content on debriefing strategies and self-made task/skill trainers. Conclusion: EM Sim Cases is a novel, free open-access simulation resource. Using a massive online needs assessment we were able to determine future directions including case topics, website reorganization, and educational material. We were also able to capture how impactful a resource like this can be to clinical and educational practice outside of the simulation setting.