Department of Health and Human Services

In the austral summer of 2021–2022, Australia experienced an unprecedented Japanese encephalitis virus (JEV) outbreak, with detections over 3000 km south of previous occurrences. Given the limited knowledge of JEV transmission ecology in Australia, we developed geospatial models of transmission risk to support the public health response. We created time-varying habitat suitability models for suspected mosquito vectors and ardeid hosts using month-scaled occurrence and covariate data from 2000–2023. Ardeid host presence-absence data were obtained from eBird and BirdLife Australia, with habitat suitability estimated using gradient-boosted regression tree models. A national dataset of Culex occurrences was compiled from mosquito surveillance records, literature, and biodiversity databases. Penalised logistic regression was used to model mosquito vector habitat suitability. Vector and host habitat predictions for the outbreak peak in February 2022 were rescaled using JEV infection locations in the public domain to create a combined habitat suitability surface. Our models aligned with detected JEV infections at the continental scale, highlighting transmission suitability across tropical northern Australia and major inland drainage basins in the East. Unlike existing models, we predicted lower suitability along the eastern seaboard, suggesting a delimiting effect of the Great Dividing Range. Our approach provides the most comprehensive and temporally dynamic models for JEV hosts and vectors in Australia, with a significantly larger vector dataset than previous studies. The novel method of rescaling host and vector outputs into a combined surface offers new insights into JEV transmission risk. Favourable conditions were repeated in 2023 with few detected infections, emphasising that JEV ecology in Australia remains poorly understood. This study’s results can support improvements in arbovirus surveillance systems, promoting earlier detection of circulating viruses. Increased focus on vector ecology and distributions is crucial for better understanding JEV transmission in Australia.

The constituents of tobacco smoke that specifically contribute to lung cancer risk have yet to be fully identified. We evaluated associations between biomarkers of potentially harmful constituents-polycyclic aromatic hydrocarbons (PAHs), tobacco-specific nitrosamines (TSNAs), nicotine, and volatile organic compounds (VOCs)-and lung cancer incidence among US women. In a case-cohort study nested within the Sister Study (women aged 35 to 74 years at baseline, enrolled 2003 to 2009), data were obtained for a random subcohort and all remaining incident lung cancers through September 2017 (median follow-up 9.6 years), stratified by race and ethnicity (Hispanic, non-Hispanic Black, non-Hispanic White, others) and smoking status (current, former, never). The analytic sample included 356 cases and 433 non-cases. We quantified 30 biomarkers in baseline urine samples and calculated hazard ratios (HRs) for associations between one-unit increase in biomarker concentrations (log-scale) and lung cancer incidence using weighted Cox regression models adjusted for urinary creatinine and demographic, health, and lifestyle factors. Among women who were currently smoking at enrolment, positive associations were observed for biomarkers of PAHs (naphthalene, phenanthrene, pyrene, fluorene; HRs 1.4 to 5.3), TSNAs (particularly 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone (NNK); HRs : 1.3-2.2), and VOCs (xylene, acrylamide, acrylonitrile, 1,2-dibromoethane/vinyl-chloride/ethylene-oxide/acrylonitrile, acrolein, styrene/ethylbenzene, benzene, dimethylformamide/methylisocyanate, 1,3-butadiene, crotonaldehyde, isoprene; HRs : 1.6-4.4). Associations with biomarkers of most PAHs, NNK, xylene, and dimethylformamide/methylisocyanate remained after additional adjustment for smoking frequency, duration, and nicotine metabolites. In women who did not smoke, positive associations were observed for styrene/ethylbenzene and dimethylformamide/methylisocyanate biomarkers. Exposure to PAHs, TSNAs and several VOCs through tobacco smoking were associated with increased lung cancer risk among women.

Wearable sensors that track physical activity in daily life may offer insights that help health care providers optimize care plans for individuals with cancer. Therefore, we examined the links between lower health-related fitness and worse patient-reported health and various step-based metrics. The Alberta Moving Beyond Breast Cancer Study enrolled 1528 women recently diagnosed with breast cancer and measured health-related fitness and patient-reported health outcomes near diagnosis and 1 yr later. Step counts and intensity (cadence, peak steps) were measured by activPAL® over 7 d at baseline. We estimated cross-sectional associations (odds ratios (OR)) at baseline and prospective associations between low baseline stepping and low fitness and poorer health at 1 yr, adjusting for age, demographics, height, weight, and cancer diagnosis/treatment. At baseline, 1408 breast cancer survivors (mean age, 56 yr; early stage (90%)) provided valid activPAL measures (mean, 5.5 d of wear). Taking <5000 steps per day (lower quintile) at baseline was associated with lower aerobic fitness, muscular strength and endurance, lower physical and mental quality of life, and greater fatigue and upper extremity disability at baseline and 1 yr later. Taking <5000 steps per day at baseline was associated with a greater risk of moving from favorable to unfavorable categories of aerobic fitness (OR, 2.64), curlups (OR, 1.84), chest endurance (OR, 2.38), self-reported health (OR, 2.37), physical quality of life (OR, 2.13), and fatigue (OR, 1.81) 1 yr later. Preferred cadence and peak stepping were inconsistently associated after adjustment for total steps. Although our findings need to be replicated, they suggest that simple step counts measured near diagnosis could help health care providers assess the fitness and health status of women recently diagnosed with breast cancer and improve their survivorship care plans.

ABSTRACTBackgroundNext‐generation sequencing (NGS) is becoming more commonly used for diagnosis in dermatopathology. It's critical to appraise its efficacy and limitations. Distinguishing benign deep penetrating nevi (DPN) from deep penetrating like‐melanoma (DPN‐M) is a challenging diagnostic scenario even for experienced dermatopathologists.MethodsWe sent a two‐phase survey (pre‐and postgenomics) to 32 experienced dermatopathologists to evaluate 39 diagnostically challenging cases from the DPN/WNT‐activated family of melanocytic neoplasms.ResultsWith NGS data, interobserver agreement improved from 0.41 to 0.51 (p < 0.0001) in distinguishing DPN‐M from nonmelanoma cases. Overall diagnostic accuracy improved, mostly driven by a 16% increase in accurate diagnosis of DPN‐M. However, in two cases, the inclusion of genomics shifted the majority vote from a correct to an incorrect diagnosis. A total of 218 diagnostic changes occurred between Survey 1 and 2. Among the changes, 132 votes moved toward the correct diagnosis while 86 moved toward an incorrect diagnosis. The shift in voting which resulted in improved diagnostic accuracy was statistically significant (p = 0.0001).ConclusionsNGS has the potential to improve interobserver agreement and diagnostic accuracy. We provide guidance on the utilization of bioinformatic data to maximize its benefits and improve diagnostic accuracy and interobserver agreement.

The Voice and Communication Situation Questionnaire developed with and for transgender and gender-diverse People Presumed Female At Birth (VCSQPFAB) is the first questionnaire developed with and for transgender and gender-diverse (TGD) people presumed female at birth (PFAB) that considers all possible gender identifications and intersections with other aspects of human diversity. It is informed by contemporary conceptual models of person-centered care, minority stress, and voice and gender as a dynamic, biocultural assemblage of agents, as well as reflections and feedback from intended users. Previous work confirmed content validity and developed guidance for implementation that would foster its use as a tool for person-centered care. This study aimed to psychometrically evaluate and finalize the VCSQPFAB for use as a patient-reported outcome measure. Seventy-three TGD people PFAB and 88 cisgender speakers completed the VCSQPFAB. Thirty-one of the TGD people PFAB completed the VCSQPFAB twice to evaluate test-retest reliability. We evaluated whether scores on the VCSQPFAB were robustly different for the two groups (criterion validity) and calculated the test-retest reliability and the amount of measurement error. The VCSQPFAB had strong criterion validity (area under the receiver operating characteristic curve = .997). Reliability was excellent (intraclass correlation coefficient = 93%), and the degree of measurement error in the VCSQPFAB was small (17% of the total range of the scale). The VCSQPFAB is a reliable and valid tool that can be used to provide person-centered and culturally responsive professional voice and communication support for TGD people PFAB. https://doi.org/10.23641/asha.30615281.

In September, the Office of the Surgeon General issued a clear warning about vaping and adolescents — cigarette smoking is going down, but vaping is going up.

ObjectivesTo inform initiatives to improve the interoperability of healthcare data, we described the experience of distinct phenotypes of physicians when obtaining information from outside sources.Materials and MethodsA total of 6175 family physicians across the United States responded to information technology questions on the 2022 and 2023 American Board of Family Medicine Continuous Certification Questionnaire (100% response rate). Latent class analysis grouped physicians by individual and practice characteristics and then compared reported experience with interoperability.ResultsA 4-class model (“Safety Net,” “Health System,” “Independent Practice,” and “Large Practice”) best fit. Health system and large practice physicians (predominately Epic users) were more likely to report information was integrated in their Electronic Health Record (EHR) than independent practice physicians (38% and 40%, respectively, compared to 24%), and to report that information from organizations using the same EHR was usable (52% and 51%, respectively, compared to 25%). Safety net physicians were least likely to report that information from outside organizations was usable (17% compared to 23% of independent physicians). Between 42% and 50% of each phenotype reported commonly encountering external records with a large volume of low-value information.DiscussionIndependent practice and safety net physicians reported worse experience in some dimensions of interoperability, likely driven by differences in access to information from organizations using the same EHR. Many other challenges were consistent across physician phenotypes.ConclusionInitiatives to improve interoperability among physicians may be most effective if targeted at independent practices and safety net practices; however, broad improvements will be necessary to address similar challenges across phenotypes.