Impact

BackgroundParabens and phenols (PAPs) are widely used in consumer and personal care products. Although prior studies suggest links between PAP exposure and allergic outcomes, evidence across adolescents and adults remains limited.ObjectiveTo investigate associations between urinary PAPs and allergy-related outcomes.MethodsWe conducted a cross-sectional analysis of NHANES 2005-2006. Eight urinary PAPs were considered; three with >33.3% values below the limit of detection were excluded. Allergic symptoms and sensitization were assessed based on participants' self-reported health conditions. Three survey-weighted generalized linear models (crude model: unadjusted; Model I: partially adjusted; Model II: fully adjusted) and weighted quantile sum regression were used to evaluate the associations between PAPs exposure and allergy-related outcomes in both adolescents and adults.ResultsAmong adolescents, higher triclosan (TCS) exposure was positively associated with allergic rhinitis, allergies, sinus infection, and sneezing; in the fully adjusted model, odds ratios (ORs) were 2.04 (95% CI: 1.18-3.54), 2.36 (1.25-4.47), 3.28 (1.36-7.91), and 2.12 (1.27-3.52), respectively. Higher TCS, methyl paraben (MPB), and propyl paraben (PPB) were associated with dust-mite sensitization, with ORs of 2.00 (1.16-3.45), 2.09 (1.05-4.17), and 3.87 (2.09-7.16). Among adults, MPB was positively associated with allergic rhinitis (OR = 1.95, 95% CI: 1.26-3.00) and sneezing (OR = 1.99, 1.27-3.10), and TCS was associated with hay fever (OR = 1.99, 1.22-3.23) and plant sensitization (OR = 1.40, 1.03-1.91). In mixture analyses, PAPs were positively associated with allergies (adjusted OR = 1.27, 95% CI: 1.07-1.51), sneezing (1.15, 1.00-1.33), and plant sensitization (1.21, 1.02-1.43) in adolescents, but no significant mixture associations were found in adults.ConclusionHigher levels of specific PAPs, particularly TCS, MPB, and PPB, and PAP mixtures were associated with increased risks of allergy-related outcomes in adolescents. In adults, TCS and MPB showed positive associations with multiple outcomes, whereas the overall PAP mixture was not statistically significant.

FOLFOX has emerged as a new treatment paradigm for locally advanced rectal cancer (LARC). However, whether FOLFOX, which replaces radiotherapy with chemotherapy, offers comprehensive clinical and economic advantages over conventional long-course chemoradiotherapy (LCCRT), especially in high-risk patients, remains unclear. We conducted both within-trial and Markov model-based lifetime analyses to evaluate the short- and long-term economic and health outcomes of FOLFOX compared with LCCRT. Data were derived from the 3 and 10year follow-up of the FOWARC trial (NCT01211210) in China and published data from the PROSPECT trial (NCT01515787) in the USA. Main outcomes included health utility, patient-reported outcomes of adverse events, costs, and quality-adjusted life years (QALYs). Costs were evaluated from the healthcare perspective in 2023 US dollars. Subgroup, scenario, and sensitivity analyses were performed. Within-trial analysis showed that the FOLFOX group had an increasing utility trend, while LCCRT decreased. FOWARC found that LCCRT patients experienced more severe depression and social life impact compared with PROSPECT. Over 45.2 months, FOLFOX cost $3503 less and gained 0.18 more QALYs than LCCRT. Lifetime analysis estimated that FOLFOX gained 0.81 and 0.56 more QALYs, with cost savings of $12,018 and $87,643 compared with LCCRT in China and the USA, respectively. FOLFOX remained cost-effective in high-risk patients requiring supplementary radiotherapy, with LCCRT becoming preferable only when the proportion of these patients reached 64%. Selective radiotherapy avoidance with FOLFOX may be recommended for neoadjuvant treatment of LARC, even in high-risk patients. This substitution could save significant healthcare resources while improving QALYs globally. Trial Registration ClinicalTrials.gov NCT01211210, NCT01515787.

Abstract Coastal breeze circulations [bay breeze (BB) and sea breeze (SB)] modulate weather conditions by advecting a maritime air mass onshore, altering air quality, and often initiating deep convection. Coastal breeze interactions with the planetary boundary layer (PBL) are not well simulated due to small-scale interactions being parameterized by numerical weather models. As part of the Tracking Aerosol Convection Interactions Experiment (TRACER) in Houston, Texas, PBL observations from remote sensors and uncrewed aerial systems provide a unique benchmark for evaluating model performance and investigating underlying processes. The Warn-on-Forecast System (WoFS) is a convection-allowing, 18-member ensemble designed to predict high-impact weather by combining rapidly updating data assimilation cycles with varying PBL and radiation parameterizations. The TRACER datasets are used to evaluate WoFS’s simulation of the PBL, coastal breezes, and their interactions with high vertical and temporal resolution. There is broad variability across members in the depth, arrival time, and intensity of the simulated SB case. Moreover, only a subset of members simulate the preceding BB, but none do so accurately. The radiation scheme impacts the ability to simulate a BB and the onset time of the SB. The mixing scheme for PBL parameterization lends differences in depth, intensity, and evolution. Nonlocal mixing schemes allow baroclinic circulations to develop more readily, thus simulating coastal flows better, but overestimate PBL depth and temperature. The influence parameterization schemes have on meteorological biases offers potential solutions to improve simulations of coastal PBL processes.

Complementary, alternative, and integrative medicine (CAIM) has gained popularity among patients experiencing pain, used alongside conventional medical treatments. This study aimed to explore the perceptions of pain clinicians and researchers on CAIM interventions. An anonymous, online survey was distributed to 46,223 authors who had published pain-related research in MEDLINE-indexed journals. The survey included multiple-choice questions and open-ended sections to gather detailed opinions. A total of 1024 participants responded, 900 of which were eligible to participate; most identified as either pain researchers (n = 435/900, 48.33%) or both researchers and clinicians (n = 398/900, 44.22%). Many held senior positions (n = 549/892, 61.55%). Among the CAIM modalities, mind-body therapies such as meditation, yoga, and biofeedback were viewed as the most promising for pain prevention, treatment, and management, with 68.47% (n = 569/831) of participants endorsing these approaches. While (n = 341/777, 43.89%) of the respondents believed that most CAIM therapies are safe, only 25.55% (n = 198/775) disagreed with the idea that such therapies are effective. There was broad agreement on the need for more research into CAIM therapies, with 45.88% (n = 356/776) agreeing and 42.53% (n = 330/776) strongly agreeing that further investigation is valuable. Additionally, many respondents supported the inclusion of CAIM training in clinician education, either through formal programs (n = 361/778, 46.40%) or supplementary courses (n = 409/776, 52.71%). Mind-body therapies received the most positive feedback, while biofield therapies were met with the most skepticism. These findings highlight the interest in CAIM among pain researchers and clinicians and emphasize the need for more research and education tailored to this area.

Abstract What would the practice of evaluation look like if it had originated in Africa rather than the West? This question lies at the heart of the “Made in Africa Evaluation” (MAE) movement, championed by the African Evaluation Association and national evaluation communities across the continent since the early 2000s. MAE is part of the global decolonization movement and asserts that evaluation should be rooted in African philosophies and knowledge systems and led by Africans who are deeply sensitive to the need to reflect indigenous contexts and cultures in evaluation theories and practices. Progress has been slow due to entrenched power asymmetries, systemic inertia, and persistent reliance on Western narratives and frameworks, despite their shortcomings. Many commissioners and evaluators continue to apply externally derived models, while African evaluation institutions often lack the resources and critical mass of scholars to drive sustained thought leadership. Amid a global polycrisis and lagging progress toward the Sustainable Development Goals, calls for systemic transformation are intensifying. Increasingly, African evaluators are challenging the status quo and incorporating traditional philosophies that foreground relationships, interconnectedness, and harmony between people and nature. MAE offers a pathway to reimagine evaluation so that it supports the transformation of societal systems and the natural ecosystems on which they depend. By drawing from indigenous knowledge systems and values, it seeks to produce evaluations that are contextually relevant, culturally resonant, and capable of advancing Africa’s own development priorities while contributing to global evaluation discourse.

As AI models tackle increasingly complex problems, ensuring reliable human oversight becomes more challenging due to the difficulty of verifying solutions. Approaches to scaling AI supervision include debate, in which two agents engage in structured dialogue to help a judge evaluate claims; critique, in which models identify potential flaws in proposed solutions; and prover-verifier games, in which a capable 'prover' model generates solutions that must be verifiable by a less capable 'verifier'. Evaluations of the scalability of these and similar approaches to difficult problems benefit from datasets that include (1) long-form expert-verified correct solutions and (2) long-form flawed solutions with annotations highlighting specific errors, but few are available. To address this gap, we present FindTheFlaws, a group of five diverse datasets spanning medicine, mathematics, science, coding, and the Lojban language. Each dataset contains questions and long-form solutions with expert annotations validating their correctness or identifying specific error(s) in the reasoning. We evaluate frontier models' critiquing capabilities and observe a range of performance that can be leveraged for scalable oversight experiments: models performing more poorly on particular datasets can serve as judges/verifiers for more capable models.

To summarize the effectiveness of critical care ultrasonography (CCUS) in adult patients with cardiogenic shock vs. standard of care without CCUS on patient-relevant outcomes. We performed a scoping review across MEDLINE, Embase, CENTRAL, World Health Organization, International Clinical Trials Registry, ClinicalTrials.gov, and published and unpublished sources from inception until February 2024. The emergency department, ward, or ICU. We included randomized clinical trials (RCTs) and observational studies comparing CCUS to non-CCUS care in adult patients with cardiogenic shock. We included any type of ultrasound measure for the intervention in adult patients (≥ 18 yr old). CCUS. We included two RCTs (n = 573 patients) and one observational study (n = 30 patients). RCT data suggested that CCUS, with transesophageal echocardiography in particular, in adult patients with cardiogenic shock may shorten time to resolution of hemodynamic instability at 72 hours (subhazard ratio [SHR], 1.26; 95% CI, 1.02-1.55) but failed to influence mortality (risk difference, -0.03; 95% CI, -0.1 to 0.05), time to resolution of hemodynamic instability within 6 days (SHR, 1.20; 95% CI, 0.98-1.46), ICU length of stay (LOS; p = 0.87), hospital LOS (p = 0.91), duration of mechanical ventilation (p = 0.73), or duration of renal replacement therapy (RRT; p = 0.68). In adult patients with cardiogenic shock, CCUS does not impact mortality, time to resolution of hemodynamic instability within 6 days, ICU and hospital LOS, nor mechanical ventilation or RRT duration. Notably, CCUS may hasten resolution of hemodynamic instability at 72 hours, but such evidence is limited by imprecision and indirectness.