Healthy Start

Consumer-grade natural gas leaks contribute to methane-induced climate change and can degrade air quality. However, limited leakage and gas composition data exist outside of North America. Here, we measured stove-off gas leakage in 35 homes and chemically characterized 78 unburned gas samples from residential stoves across seven cities in the United Kingdom, Netherlands, and Italy. On average, benzene in unburned gas was substantially elevated compared to North America (9 to 73 times higher), while sulfur-based odorants were lower. Modeling of indoor and outdoor benzene enhancements from gas leaks showed potential for hazardous benzene exposure, often undetectable by odor. Three of 35 homes exhibited a stove-off leak that, combined with city-median benzene in gas, resulted in modeled benzene enhancements above the European Union's annual limit value (1.6 ppbv). The combination of high benzene and relatively low odorization in natural gas suggests that hazardous leaks are likely underreported in Europe.

Background: Hypochlorous acid (HOCl) is a naturally occurring molecule that plays a key role in host defence, exhibiting broad-spectrum antimicrobial activity against bacteria, viruses and fungi while maintaining an excellent safety profile for human tissues. Its utility has been demonstrated in numerous studies in wound care, perioperative antisepsis and more recently in nasopharyngeal sprays and inhalation applications. Aim: The purpose of this study was to provide an overview of the current and potential uses of hypochlorous acid in ophthalmic practice. Materials and methods: A comprehensive narrative review of the literature was conducted using the PubMed, Web of Science, ResearchGate, Google Scholar, Scopus and Embase databases. The search strategy was based on the following combination of key terms: (“hypochlorous acid” OR HOCl) AND (ophthalmology OR keratitis OR “ocular surgery” OR “meibomian gland dysfunction” OR “dry eye” OR blepharitis OR ocular OR “ocular surface” OR “eye infections” OR conjunctivitis). Results: HOCl demonstrated broad antimicrobial activity in several studies, with meaningful reductions in bacterial load, rapid in vitro fungicidal effects and improvement in clinical parameters of blepharitis, dry eye disease and meibomian gland dysfunction. Antiseptic efficacy relative to povidone-iodine varied, with some studies showing inferior perioperative performance. Across all reports, HOCl was well tolerated, with no serious adverse events and consistently better patient comfort than povidone-iodine. Conclusions: Hypochlorous acid is a safe, well-tolerated antiseptic with potential benefits in eyelid hygiene, dry eye disease, blepharitis and as an adjunct in ocular infections. While its antimicrobial efficacy is promising, it is inconsistent compared with povidone-iodine and it should currently be viewed as a complementary rather than a replacement agent. Further standardized clinical studies are needed to clarify its optimal role.

Abstract Background Severe maternal morbidity (SMM), defined as unexpected outcomes of labor and delivery with significant health consequences, continues to rise in the United States and disproportionately affects marginalized communities. Chronic conditions such as hypertension and diabetes are known risk factors, but the interplay of these comorbidities with social determinants of health remains poorly characterized. Methods We analyzed 2019–2020 delivery hospitalizations from the National Inpatient Sample (NIS), a nationally representative dataset. SMM was defined using CDC and AIM criteria (excluding transfusion-related events). We conducted multivariate logistic regression to estimate adjusted odds ratios (aORs) for SMM, stratified by diabetes and hypertension status, while controlling demographic, clinical, and socioeconomic variables. Results Among 7 million delivery hospitalizations, 0.8% involved SMM. SMM prevalence was 1.4% among individuals with diabetes and 3.2% with hypertension. Notably, younger individuals (ages 20–24) had higher odds of SMM in the hypertension subgroup (aOR 1.49; 95% CI 1.23–1.82), contrary to general trends. Racial and income disparities persisted across subgroups. Black and Hispanic patients had lower adjusted SMM odds in diabetic and hypertensive subgroups, respectively. Increased healthcare utilization (longer stays, higher diagnosis/procedure counts) was consistently associated with SMM. Conclusions This study highlights how age, race, income, and regional factors interact with hypertension and diabetes to shape SMM risk. The elevated risk among hypertensive individuals aged 20–24 underscores the need for improved early screening and chronic disease management in younger populations. While adjusted models showed lower SMM odds among some racial/ethnic groups within comorbidity strata, these findings should be interpreted cautiously as they may reflect differences in care access rather than protective effects. Findings underscore the urgency of integrating chronic disease management into maternal care and tailoring interventions to the unique needs of socioeconomically and demographically vulnerable populations. Community-based care models and enhanced preconception screening are essential to reducing disparities.

Abstract Introduction/Objective Immunohistochemical (IHC) markers are foundational tools in pathology for identifying the tissue of origin, particularly in poorly differentiated, metastatic, or ambiguous tumors. These markers guide diagnostic decision-making and therapeutic direction. While many are presumed to exhibit tissue-specific expression, less attention has been given to how biological variables such as sex might influence baseline marker expression in non-diseased tissues. This gap poses diagnostic risks, particularly in hormone-responsive or sex-specific cancers, where subtle expression differences may impact interpretation. Although prior research has explored tissue-based protein expression using immunostaining (e.g., via the Human Protein Atlas), these approaches are limited by antibody performance, categorical scoring, and technical variability. The Genotype-Tissue Expression (GTEx) Project provides an unparalleled resource for examining transcript-level expression in over 50 normal human tissue types with matched donor metadata, including sex. In this study, we leverage GTEx v8 RNA-seq data to examine sex-based differences in the expression of five widely used diagnostic IHC markers GATA3, CDX2, TTF1 (NKX2-1), PAX8, and S100B. We hypothesize that certain markers exhibit significant sex-specific expression patterns that could influence clinical interpretation and propose that incorporating sex-aware transcriptomic references may improve diagnostic accuracy in surgical pathology. Methods/Case Report We performed a secondary analysis of publicly available transcriptomic data from the GTEx Project (v8), which includes RNA-seq expression profiles (in transcripts per million, TPM) across 54 non-diseased human tissue types. Five diagnostic immunohistochemical (IHC) markers—GATA3, CDX2, TTF1 (NKX2-1), PAX8, and S100B were selected based on their routine use in pathology for determining lineage or tissue of origin. GTEx sample-level and subject-level metadata were used to stratify expression data by tissue type and donor sex. Median TPM values were calculated for each marker across all tissues, and sex-based comparisons were made using the non-parametric Mann-Whitney U test. To assess the magnitude and direction of sex-based variation, we computed log2(female/male) fold-changes for each tissue-marker combination. Statistical significance was defined as p < 0.05, with adjustment for multiple comparisons where applicable. We visualized expression patterns using heatmaps, tissue-stratified boxplots, and barplots of sex-based fold changes. Tissue-specific patterns were further examined for markers with significant sex differences. All data analyses were conducted using Python (v3.11) with the pandas, seaborn, and matplotlib libraries. This approach enabled the development of a sex-stratified, transcript-level atlas for commonly used IHC markers in non-diseased human tissues. Results Significant sex-based expression differences were identified for several diagnostic IHC markers. PAX8 demonstrated the strongest sex-biased expression, with significantly higher transcript levels observed in female kidney and thyroid tissues (p < 1e-15), consistent with its known regulation in hormonally responsive tissues. S100B also showed marked sex-based variation, with increased expression in male brain and nerve tissues (p < 1e-8). TTF1 (NKX2-1), although more broadly expressed, exhibited modest but statistically significant differences between sexes in the lung and thyroid (p < 1e-5). In contrast, GATA3 and CDX2 showed no significant differences in transcript expression by sex across all tissues analyzed. Heatmaps and barplots of log2(female/male) fold changes highlighted tissue-specific sex effects for PAX8 and S100B, suggesting that these markers may be influenced by hormonal or genetic sex-related factors. Boxplots confirmed non-overlapping expression distributions in key tissues for these markers. The results suggest that diagnostic interpretation of these IHC markers—particularly when used as lineage indicators in cancer diagnosis may benefit from contextual sex-aware references. This study is among the first to systematically explore sex-specific variation in diagnostic marker expression using transcriptomic data, providing a foundation for more personalized pathology and machine learning-based diagnostics. Conclusion Our study reveals that biological sex significantly influences the transcript-level expression of certain diagnostic IHC markers across normal human tissues. Markers such as PAX8 and S100B show consistent and significant sex-biased expression patterns, which may affect IHC interpretation in hormone-responsive organs like the kidney, thyroid, and brain. These findings underscore the importance of integrating sex-aware data into diagnostic pathology frameworks, especially in the era of precision medicine. By leveraging GTEx v8 one of the most comprehensive transcriptomic resources from non-diseased human donors we provide a reproducible, quantitative, and antibody-independent reference for baseline IHC marker expression. This work supports more accurate diagnostic panel design and helps mitigate potential misinterpretation arising from biologic variability. Furthermore, the dataset and visual outputs generated here can serve as valuable resources for AI and digital pathology models that incorporate molecular features. Future directions include expanding the marker panel, validating findings with protein-level data, and assessing diagnostic misclassification rates in clinical cohorts. Overall, our study bridges a key gap in the field and demonstrates the relevance of sex-stratified reference data for improving interpretive accuracy, diagnostic equity, and educational resources in pathology and laboratory medicine.

Background/Objectives: Antenatal multiple micronutrient supplementation (MMS) improves birth outcomes more effectively than iron and folic acid (IFA) supplementation alone. However, the acceptability of MMS among pregnant individuals, a critical factor for adherence and program success, remains poorly defined and inconsistently assessed. This narrative review proposes a comprehensive definition of “acceptability” in the context of nutritional supplementation and evaluates the evidence on the acceptability of MMS compared to IFA in low- and middle-income countries (LMICs). Methods: We conducted a systematic literature search across Embase, Medline, and Scopus to identify studies (including grey literature) reporting on acceptability-related outcomes for MMS versus IFA among pregnant individuals. Studies exploring dimensions such as organoleptic properties, ease of consumption, side effects, cultural appropriateness, and socioeconomic factors were included. Results: Out of 1056 screened studies, five informed a novel multi-dimensional definition of acceptability. Six studies assessed acceptability-related characteristics. MMS was generally accepted across most organoleptic domains. Most studies reported fewer or comparable adverse side effects for MMS as compared to IFA. Studies consistently reported more perceived benefits for MMS than IFA. Facilitating factors included trust in health professionals, free provision, and family support. Barriers included poor taste or smell, fear of side effects, misconceptions, cost, and lack of family support. Conclusions: Antenatal MMS is widely acceptable in LMICs. Addressing socio-cultural, sensory, and socioeconomic factors is essential to increase uptake and adherence. This review provides a clear, standardized definition of acceptability to guide future research and inform effective program design.

Introduction: Ketamine is a well-established dissociative anesthetic. The discovery of its NMDA receptor antagonism revealed new potential applications in pain management. It has demonstrated promise as an analgesic for the treatment of chronic pain and has proven useful in managing acute pain, such as that resulting from sports injuries or in pediatric care settings. It is also a valuable alternative for patients who have not responded well to traditional pain medications. Materials and methods: This article reviews promising role of ketamine in pain management, especially in chronic or cancer pain, incorporating data from Google Scholar, PubMed, using keywords such as „ketamine”,„chronic pain”, „acute pain”, „pain management”. Summary: Current evidence supports the use of subanesthetic ketamine as an effective option for acute pain management across various clinical settings, with potential to reduce opioid dependence. Its unique antidepressant properties also make it beneficial for chronic pain patients, especially those with comorbid depression. In conditions like CRPS and sickle cell disease, low-dose ketamine has shown promising results in improving pain and function. However, its effectiveness in fibromyalgia appears limited, with short-term infusions offering only temporary relief. The pediatric population may particularly benefit from ketamine’s rapid, intranasal administration, though dosing and safety must be carefully considered. While early findings are encouraging, more research is needed to establish optimal protocols and to explore its role in managing sport-related injuries. Conclusions: Ketamine finds various applications in pain therapy and is a promising medication due to its efficacy in both chronic and acute pain management. However, further research is necessary to precisely determine the therapeutic dosage ranges, the long-term effects of its use, and the risk of addiction associated with its administration.

Prenatal multiple micronutrient supplementation (MMS), in comparison to iron and folic acid supplementation (IFA), improves pregnancy outcomes, but less is known about their effect on infant growth. We conducted a systematic review of trials comparing maternal MMS to IFA and assessed the effect on infants' anthropometric outcomes at birth, 3, 6, 12, 18, and 24 mo of age. We included trials from a Cochrane review and new studies identified through systematic literature searches in 3 databases. We calculated the pooled effect estimates with 95% confidence intervals (CIs) using a generic inverse variance method, with fixed (primary analysis) and random-effects, and assessed subgroup differences. The 19 included trials showed that MMS, compared to IFA, led to significantly greater length and weight from birth to 6 mo, head circumference (HC) from birth to 12 mo, and mid-upper arm circumference (MUAC) through 3 mo. Infants born to pregnant women consuming MMS were longer at birth (mean difference: 0.05 cm; 95% CI: 0.02, 0.08 cm) and had higher length-for-age z-score at birth (0.09; 95% CI: 0.06, 0.12), 3 mo (0.09; 95% CI: 0.06, 0.12), and 6 mo (0.04; 95% CI: 0.01, 0.07) of age but not thereafter. MMS resulted in significantly higher weight-for-age z-score and HC-for-age z-score until 6 mo and higher weight-for-length z-score and MUAC-for-age z-score until 3 mo. MMS reduced risk of stunting (risk ratio [RR]: 0.86; 95% CI: 0.82, 0.91), underweight (RR: 0.86; 95% CI: 0.81, 0.90), small HC (RR: 0.84; 95% CI: 0.79, 0.90), and low MUAC (RR: 0.90; 95% CI: 0.82, 0.99) at 3 mo and wasting (RR: 0.90; 95% CI: 0.85, 0.96) at birth. For some outcomes, effects were greater when MMS was continued postpartum and in settings with higher prevalence of low birthweight. Prenatal MMS improves size at birth and subsequent infant growth through 6 mo of age but not thereafter. These results strengthen the evidence on MMS benefits beyond birth outcomes. This study was registered in PROSPERO as CRD42024551864.

BackgroundIn recent years, there has been increasing recognition of the importance of patient engagement (PE) in the healthcare industry, especially throughout the product development lifecycle. However, there is limited research on the influence of PE training on the attitudes, knowledge, and skills of health advisors working in the life sciences, who have a substantial effect on decisions made throughout the product lifecycle in the healthcare industry. This study aimed to assess the effectiveness of a patient engagement training course tailored to healthcare consultants, focusing on changes in self-perceived knowledge, skills and attitudes before and after training.MethodsEighty healthcare consultants of varying seniority levels from a single company based throughout the U.S. and Europe completed a six-part online training course on patient engagement. The training covered various concepts, and the participants were assessed via a modified evidence-based practice questionnaire before and after the course to measure changes in self-perceived knowledge, skills, and attitudes. The study used paired samples t-tests and bivariate Pearson's correlation analyses to evaluate the differences.ResultsFollowing the training, the consultants reported significant improvements in their perceived KSAs toward patient engagement (PE). The most substantial increase was observed in knowledge scores, followed by skills and attitudes. These improvements were particularly notable among lower- to mid-level consultants, especially associate consultants. The training highlighted the need to further health advisors' understanding of PE and the opportunity training can provide.ConclusionsPatient engagement (PE) training significantly improves healthcare consultants' self-perceived knowledge and skills while increasing attitudes and promoting patient-centered approaches throughout the life science industry. This study highlights the importance of standardized PE training programs in enhancing healthcare outcomes and advocates for the integration of patient engagement in healthcare research and development.

Abstract Methane super-emitters from upstream oil and gas infrastructure are prevalent; local air quality may be impacted by co-emitted non-methane volatile organic compounds (NMVOCs), including benzene and other hazardous air pollutants. Risk assessment has been constrained by the uncertainty of NMVOC emissions, which can be estimated from methane emissions data and NMVOC:methane molar ratios. However, publicly available gas composition data is scattered and geographically limited, pointing to the need for harmonized data and scalable modeling for sources without available composition data. To address this gap, we compiled 4,525 non-flash and 3,487 flash upstream gas composition analyses from air permit applications spanning 11 of the top natural gas-producing states; the sampled facilities represent 46% of reported upstream methane emissions. We developed NMVOC:methane molar ratio models incorporating source basin, industry segment, equipment, and unspeciated composition data and select models via leave-one-out cross-validation. Benzene was detected in 97% of non-flash gas samples (mean; standard deviation [SD]: 230; 294 ppm) and >99% of flash gas samples (mean; SD: 1,785; 3,099 ppm). Our models of non-flash benzene:methane molar ratios empirically demonstrated low bias (normalized mean error <10%) and moderate precision (24%–45% variance explained) when infrastructure and unspeciated gas composition (methane and C6+ fraction) data were available, with lower precision when facility-specific unspeciated composition data is unavailable. Uncertainty can be expressed via appropriately-calibrated prediction intervals from quantile models. Modeling results were similar, albeit with higher bias, for flash gas. The observed variation in gas composition illustrates the importance of localized gas composition estimates for risk assessment of super-emitters. Our gas composition database and models can facilitate scalable risk assessment of NMVOC emissions, especially for non-flash gas sources with available localized, unspeciated gas composition data.

Across California, 4.4 million households face an energy affordability gap totaling $4.1 billion dollars, where energy costs in each household are greater than 8.5 percent of their net income. If the costs of dealing with power outages are added, another $900 million dollars in resilient energy affordability gap emerges, adding another 0.5 million impacted households. While the energy gap is emerging as an equity and affordability metric for energy policy decision making, considerations of resilient energy affordability gaps are so far lacking. Here we provide a method to measure the affordability gap incurred by a lack of resilient energy, using similar methods as those established for energy affordability analyses to account for equity in outage impact analysis.