Minimizing unnecessary sedation/anesthesia for pediatric brain MRI has been identified as an area for improvement. However, data on its use across a national sample of children's hospitals is lacking.

To understand patient demographics, clinical outcomes, hospital variation, and trends over time associated with sedation/anesthesia use for pediatric brain MRIs.

This retrospective cohort study utilized Pediatric Health Information System (PHIS) data for children < 18 years old who received an inpatient brain MRI from 2014 to 2024 (N = 215,377). Outcomes included the need for a repeat brain MRI, length of stay (LOS, in days), cost, and mortality. The likelihood of receiving sedation/anesthesia was modeled using Generalized Estimating Equations (GEE), clustered on hospital and adjusted for clinical and demographic factors. Outcomes were also modeled using GEEs.

Sedation/anesthesia was used for 36% of children with no significant change over time. There was significant hospital variation in sedation/anesthesia use, ranging from 4.8% to 54.9%. Age, mental health diagnoses, and MRI type (contrast, limited) were associated with the likelihood of receiving sedation/anesthesia. Compared to no sedation/anesthesia, sedation/anesthesia use was associated with a lower likelihood of repeat MRI (1.7% vs. 5.6%, aOR 0.29, 95% CI: 0.25-0.34) and higher cost ($12,819 vs. $10,122, aRR 1.27, 95% CI: 1.13-1.42). There were no meaningful differences in LOS or mortality.

There is currently wide variability in the use of sedation/anesthesia across children's hospitals, and its use was associated with lower repeat MRIs but higher costs. Identification of appropriate patients and MRI techniques may be strategies to reduce unnecessary sedation/anesthesia.

Stroke affects one in four people globally, highlighting the need for novel approaches to primary prevention. The Love Your Brain digital platform comprises an online course and text messages to improve stroke knowledge and motivate behavior change for stroke prevention.

To evaluate the efficacy of the platform over 12 weeks in increasing medical practitioner visits for cardiovascular risk assessment/management.

We conducted a single-blinded, multi-arm randomized controlled trial. Eligible participants were community-dwelling Australians aged ≥45 years with no history of cardiovascular events. Participants were randomized (1:1:1) to interventions (either online course or text messages) or control, stratified by age and gender. The primary outcome was a change from baseline to 12 weeks in self-reported medical practitioner visits for cardiovascular risk assessment/management. Secondary outcomes were knowledge of stroke, uptake of risk-modifying behaviors, and medication adherence. Log-binomial/generalized linear model regression was used, adjusting for stratification variables. Analysis was based on intention-to-treat.

941 participants (median age 67 years; 82·4% women) were randomized between 18 Feb 2025 and 17 Sep 2025 to control (n=311), online course (n=318) or text messages (n=312). At 12 weeks, 82.6% completed follow-up. Self-reported visits to a medical practitioner at 12 weeks exceeded those of the control (29·0%) in the text message arm (41·3%; RR: 1·43, 95% CI: 1·14-1·80, p=0·002), but not the online course arm (31·2%; RR: 1·08, 95% CI: 0·83-1·40). Stroke knowledge increased in both intervention arms (Online: Coeff: 1·13, 95%CI: 0·75-1·50; Text message: Coeff: 0·58, 95%CI: 0·19-0·96) compared to the control. No differences were observed for other outcomes.

The text message intervention increased medical practitioner visits for cardiovascular risk assessment/management among community-dwelling adults without prior cardiovascular events. The online course was ineffectual, potentially due to low completion. The text message intervention warrants scale-up to support primary stroke prevention.

ACTRN12625000124437.

Bipolar depression (BDD) and major depressive disorder (MDD) share similar depressive symptoms but differ in diagnosis, treatment, and prognosis. Clarifying their neurobiological distinctions may improve diagnostic characterization and mechanistic understanding.

We studied 453 participants, including 85 patients with BDD, 190 with MDD, and 178 healthy controls. Individual morphometric similarity networks (MSN) were constructed using seven structural and diffusion MRI features. Regional MSN differences between BDD and MDD were examined at the parcel level. To characterize the biological relevance of the distinct MSN pattern, we performed imaging-transcriptomic analysis using Allen Human Brain Atlas data, followed by gene enrichment, cell-type enrichment, receptor/transporter dominance analysis, and cognitive meta-analytic decoding. Sensitivity analyses evaluated the effects of medication exposure and demographic imbalance.

Compared with MDD, BDD showed distinct MSN alterations mainly in parietal and occipital regions, including higher MSN in the left lateral occipital cortex and lower MSN in the right inferior and superior parietal cortices. The spatial transcriptomic pattern was enriched for ribosomal and protein synthesis/modification pathways. Cell-type enrichment analyses showed that the transcriptomic pattern associated with the MSN differences was enriched for microglial and inhibitory-neuron gene signatures, while receptor dominance analysis identified the 5-HT_2A density map as having the largest relative contribution to the explained spatial variance.

Our findings identify distinct cortical morphometric organization in BDD and MDD, and these differences are linked to transcriptomic, cellular, and neurotransmitter-related annotations, providing multiscale insights into the neurobiological divergence between the two disorders.

The Genesee County Prevention Coalition (GCPC) was established in 2007 and supports youth and families in Genesee County, the fifth most populous county located in southeast Michigan. GCPC has received funding from the Drug-Free Communities (DFC) Support Program since 2018, charged with mobilizing its community to prevent youth substance use. Over nearly 2 decades, GCPC has established infrastructure and implemented best practices to sustain its coalition efforts. Using local data to drive action, focusing on upstream prevention strategies, and diversifying the funding received and investing it strategically in the organization, GCPC has adapted to changes in society and community conditions to meet the needs of youth in the community. The purpose of this report was to discuss GCPC's capacity building approach to coalition development and implementing community-based strategies to affect substance use and mental health concerns among youth in Genesee County, Michigan.

Objective: To compare the predictive accuracy of the risk stratification strategies from the 2025 Chinese Respiratory Guideline and the 2019 European Society of Cardiology (ESC) Guideline for the prognosis of patients with acute pulmonary embolism (APE). Methods: A retrospective cohort study was conducted, including 713 patients with first-onset APE presented to West China Hospital of Sichuan University between September 1, 2016, and December 30, 2019. Clinical data were collected. Patients were risk-stratified (low-risk, intermediate-low-risk, intermediate-high-risk, high-risk) according to the Chinese Respiratory Guideline and the ESC Guideline. Mortality rates in each stratum were calculated. Using the low-risk group as reference, odds ratios (OR) and 95% confidence intervals (CI) for the association between other strata and in-hospital mortality were computed. Receiver operating characteristic (ROC) curves were plotted to calculate the area under the curve (AUC), and predictive performance indicators such as sensitivity and specificity were compared. The Kaplan-Meier method was used to draw survival curves during hospitalization and for 12 months after discharge. Results: Both guideline risk stratification strategies showed a significant increase in in-hospital mortality with rising risk strata [Chinese respiratory guideline low-risk vs intermediate-low-risk vs intermediate-high-risk vs high-risk: 1.15%(3/260) vs 11.84%(29/245) vs 12.24%(24/196) vs 33.33%(4/12); ESC guideline: 0.69%(1/144) vs 8.20%(36/439) vs 16.10%(19/118) vs 33.33%(4/12), all P<0.001]. The Cochran-Armitage trend test further confirmed a significant ascending linear trend in mortality across the increasing risk categories (P_trend<0.001 for both guidelines). Compared to the low-risk group, the ESC guideline showed a more pronounced incremental gradient in OR for mortality risk across strata (intermediate-low-risk OR=12.77, 95%CI: 1.74-94.03, intermediate-high-risk OR=27.44, 95%CI: 3.62-208.37, high-risk OR=71.50, 95%CI: 7.14-716.08), and the difference in mortality between the intermediate-low-risk and intermediate-high-risk groups was statistically significant (P=0.011). In contrast, the mortality rates and OR values for the intermediate-low-risk and intermediate-high-risk groups in the Chinese Respiratory Guideline were close, with no statistically significant difference between groups. The AUC for predicting in-hospital death were similar between the two guidelines [Chinese respiratory guideline: 0.689 (95%CI: 0.630-0.747); ESC Guideline: 0.673 (95%CI: 0.607-0.740)], with no statistically significant difference (P>0.05). Long-term follow-up (12 months) showed that the ESC guideline low-risk group had the lowest mortality rate [2.10% (3/143)], and the survival curves of the different risk groups showed good separation (log-rank P=0.001). In contrast, there were no significant differences in long-term mortality among the risk groups of the Chinese respiratory guideline (P=0.682). Conclusions: Both the Chinese respiratory guideline and the ESC guideline demonstrate good overall predictive value for in-hospital mortality risk in APE patients. The ESC Guideline shows superior ability to discriminate risk among intermediate-risk patients and better predictive capability for long-term prognosis.

Objective: To investigate the association between continuation, discontinuation, or dose reduction of proton pump inhibitor (PPI) and clinical outcomes in patients with hospital-acquired acute kidney injury (AKI). Methods: This retrospective cohort study included patients hospitalized in Jiangsu Province Hospital between January 2021 and June 2025. According to the PPI management strategy within 48 hours after diagnosis of hospital-acquired AKI, patients were divided into a continued-use group, a dose-reduction group, and a discontinuation group. The primary outcome was 30-day AKI progression, and the secondary outcomes were 30-day kidney replacement therapy (KRT) requirement and non-recovery of renal function before discharge. Propensity score matching was used to control for confounding bias. Matching variables included demographic characteristics, laboratory indicators, AKI stage, comorbidities, indications for PPI use, concomitant medications, and life-support treatments. After matching, outcomes were evaluated using conditional logistic regression models. The primary analysis compared outcomes between the continued-use and discontinuation groups, while exploratory analyses compared outcomes between the dose-reduction group and the other two groups. Results: A total of 2 203 patients with hospital-acquired AKI were included, with a median (Q₁, Q₃) age of 67.0 years (56.0, 74.0), and 1 526 patients (69.3%) were male. There were 1 273 patients in the continued-use group, 525 in the dose-reduction group, and 405 in the discontinuation group, respectively. After propensity score matching, 391 patients in each of the continued-use and discontinuation groups were included in the primary analysis. The primary analysis showed that, compared with discontinuation, continued PPI use was associated with increased risks of 30-day AKI progression (OR=1.45, 95%CI: 1.03-2.03, P=0.032) and 30-day KRT requirement (OR=2.61, 95%CI: 1.76-3.87, P<0.001), while there was no statistically significant difference in non-recovery of renal function before discharge (OR=0.90, 95%CI: 0.66-1.23, P=0.514). Exploratory analyses of the dose-reduction strategy showed that, compared with continued use, dose reduction was associated with lower risks of 30-day AKI progression (OR=0.59, 95%CI: 0.44-0.80, P<0.001) and KRT requirement (OR=0.69, 95%CI: 0.50-0.93, P=0.016). Compared with the discontinuation group, the dose-reduction group showed no statistically significant difference in 30-day AKI progression (OR=0.67, 95%CI: 0.43-1.04, P=0.075), but was associated with a higher risk of 30-day KRT requirement (OR=1.67, 95%CI: 1.05-2.67, P=0.030) and a lower risk of non-recovery of renal function before discharge (OR=0.62, 95%CI: 0.39-0.97, P=0.036). Conclusions: Among patients with AKI who have been using PPI before AKI diagnosis, continued PPI use after AKI is associated with higher short-term risks of AKI progression and KRT requirement. PPI dose reduction may reduce the risk of some adverse renal events.

To assess the inadequate dietary diversity (IDD) and factors associated with it among 5-9 years old children in Bangladesh.

The study was based on cross-sectional data from the second wave of a longitudinal food security and nutrition surveillance in 2023.

Data were collected from 90 clusters (64 rural, 16 non-slum urban and 10 slums) in all 8 administrative divisions of Bangladesh.

A total of 5764 (2850 boys and 2914 girls) children were included in the study. Information was collected from their mothers.

The primary outcome measure was IDD. Dietary data were collected using a list-based (24 food categories) recall method, which was further grouped into 10 food groups. IDD was defined as consumption of fewer than 5 food groups out of 10.

More than half of the children (52.7%) had IDD (<5 recommended food groups), with slightly higher prevalence among boys (55.0%) than girls (53.2%). Poor parental education (e.g., grade 0-4 (adjusted prevalence ratio (APR): 1.22 for mother, 1.15 for father), grade 5-9 (APR: 1.16 for mother)), unimproved sanitation (APR: 1.07), mild food insecurity (APR: 1.09), severe food insecurity (APR: 1.12) and lower household wealth (APR: 1.19 for the poorest, 1.18 for the poorer), increased the prevalence of IDD. However, children aged 8-9 years (APR: 0.94) and being overweight or obese (APR: 0.82) had a decreased prevalence of IDD compared with their counterparts.

To address IDD among children, multisectoral interventions should be targeted linking improving household wealth and sanitation, reducing food insecurity and advancing parental education.

Left atrial appendage occlusion (LAAO) is a treatment option to prevent thromboembolic events in patients with atrial fibrillation. However, it remains unclear whether LAAO offers superior efficacy and safety compared with oral anticoagulation for these patients.

This study aimed to assess the efficacy and safety of LAAO vs direct oral anticoagulants (DOACs).

We reviewed randomized controlled trials comparing oral anticoagulation and LAAO, using MEDLINE and CENTRAL. The primary outcome was a composite of stroke, systemic embolism, and cardiovascular death, whereas the safety outcome was major bleeding. Two network meta-analyses were conducted to assess LAAO vs DOAC, incorporating indirect comparisons: 1 comparing LAAO, DOACs, and vitamin K antagonist (3 arms), and the other comparing Watchman, Amulet, DOACs, and vitamin K antagonist (4 arms).

A total of 67,693 patients from 11 randomized controlled trials were included, of whom 5,735 underwent LAAO. In the three-arm network meta-analysis, LAAO and DOACs demonstrated statistically similar risks for both the primary efficacy outcome (HR: 1.02; 95% CI: 0.88-1.19; I² = 0%) and the safety outcome (HR: 0.98; 95% CI: 0.78-1.23; I² = 70.5%). In the 4-arm network meta-analysis, both Amulet and Watchman were associated with similar risks of the primary outcome, comparable to those of DOACs, as well as the risk of major bleeding.

LAAO devices did not demonstrate statistical superiority over DOACs in reducing thromboembolic events and major bleeding. Further trials are warranted to define patients for whom LAAO may offer the most significant benefit, such as those with high bleeding risk (CRD420251237886).

Patients with atrial fibrillation and type 2 diabetes remain at high risk of stroke despite anticoagulation and glucose-lowering treatment. We examined whether tirzepatide was associated with lower cerebrovascular risk than established glucagon-like peptide-1 receptor agonists in a retrospective cohort from a large international federated electronic health-record network. Here we show that, among 14,118 matched pairs of adults initiating tirzepatide or another glucagon-like peptide-1 receptor agonist, tirzepatide use was associated with lower risks of any stroke, ischemic stroke, hemorrhagic stroke, and death from any cause. The absolute difference in stroke risk was 2.1 percentage points at one year, and the absolute difference in mortality was 6.2 percentage points. These observational findings support further assessment of tirzepatide as a potential option for people with both conditions, but randomized trials are required before treatment recommendations can change.

Diabetes affects one in ten adults worldwide, yet clinicians lack tools to simultaneously predict which complications a given patient is most likely to develop in the near term. Existing risk models typically address single complications, were developed in specialized cohorts, and use heterogeneous time horizons, limiting their utility for individualized clinical decision-making. Here, we show that machine learning models trained on nationwide U.S. administrative claims data for 400,400 adults with newly diagnosed type 1 or type 2 diabetes can accurately predict the monthly risk of nine acute and chronic complications (cardiovascular disease, cerebrovascular disease, peripheral vascular disease, nephropathy, neuropathy, retinopathy, and hypoglycemic and hyperglycemic crises) with predictions that update dynamically as new clinical data become available. Using Regularized Logistic Regression (GLMnet) and Extreme Gradient Boosting (XGBoost) with walk-forward temporal validation, we demonstrate strong discrimination in external validation against an independent electronic health record cohort (areas under the receiver operating characteristic curve 0.77-0.85 across complications for the best-performing model). The Diabetes Complications Risk Calculator therefore provides encounter-specific near-term risk estimates for multiple diabetes complications using routinely available clinical data, offering a potential framework for personalized risk stratification that could support shared decision-making and population health management across healthcare settings. The generalizability of the Diabetes Complications Risk Calculator to other cohorts will need to be tested.