Ohio University

Avoidant/restrictive food intake disorder (ARFID) involves restrictive eating driven by sensory sensitivity, low interest in food, or fear of negative consequences of eating. ARFID affects males and females equally and presents across the weight spectrum. Leptin, an anorexigenic hormone linked to adiposity, may contribute to low hunger and early satiety in ARFID. Prior findings indicate low leptin levels in low-weight females with ARFID; however, the role of leptin in ARFID across weight status and sex remains unknown. We hypothesized that youth with full/subthreshold ARFID, including a subgroup of low-weight males, would exhibit lower fasting leptin levels than healthy controls (HCs). We explored cross-sectional and longitudinal associations between leptin and clinical characteristics. Participants were youth aged 10-23 years (BMI percentile M [SD] = 41.4 (33.6)) with full/subthreshold ARFID (n = 95; 49.5% female) and HCs (n = 28; 50.0% female). At baseline, participants completed questionnaires, a fasted blood draw, and a diagnostic interview for ARFID, readministered at 1- and 2year follow-ups. Leptin levels did not differ between ARFID and HC groups. Low-weight ARFID males had significantly lower leptin than HC males (η 2 = 0.258); however, this difference was nonsignificant after adjusting for BMI percentile. Leptin showed medium-to-large positive associations with age, BMI, and anxiety but not appetite or ARFID severity. Baseline leptin did not predict symptom or weight changes longitudinally. Hypoleptinemia was only evident in low-weight ARIFD and strongly correlated with BMI percentile. However, relationships with anxiety may suggest additional roles of leptin in underlying ARFID psychopathology. Findings should be replicated in larger, more representative samples.

A large number of flexible pipeline structures exist under roadways. When the cover thickness over the pipeline is limited, effects of live loads can be more pronounced on the structure, especially when a relatively heavy vehicle is moving at low speeds or comes to stop over it. There is a need to address the topic of this paper because only a small number of publications made about buried flexible pipes have paid attention to their performances under static live loads. In this paper, first a few published field tests are examined to find out how shallowly buried flexible pipes respond differently to live loads than to the dead loads. In the second part of the paper, new equations are derived so that the deflection responses of a shallowly installed flexible pipe can be estimated under a static live load. The new equations fill a gap that currently exists in the AASHTO LRFD Bridge Design Specifications. The new deflection equations produced mixed results when their estimates were compared to the field test pipe deflection measurements reported in the literature. This may be partially because of the way the loading tests were carried out in the field. The new equations point out the importance of having a stiff layer above the pipe when the cover thickness is very limited.

Background:In most clinical specialties, including plastic surgery, saying “no” to unnecessary, ill-timed, or simply frivolous referrals is discouraged and never taught. Carried forward into practice, this inability leads to overwhelming workloads, chaotic schedules, loss of professional autonomy, and exhaustion—well-known triggers for burnout. Providing communication tools to politely frame a refusal without jeopardizing professional relationships is essential.Methods:This narrative review provided a broad overview of existing literature on the topic across medical and nonmedical customer-service sectors, combined with the authors’ own experience. It established a context for a comprehensive summary and used the available material to create vignette-based training modules for residents and junior attendings.Results:Specifically, the traditional teaching is to always say yes to all clinical consults, no matter what they are or how overworked one already is. In contrast, publications on physician-burnout strongly recommend setting boundaries, none of which teach physicians how to do so. Although communication skills are taught during training, specific skills for politely refusing referrals, especially if inappropriate or ill-timed, are lacking.Conclusions:Using the reviewed material and our experience, a rich source of teaching materials, including clinical vignettes, was created that can be used by program leaders and younger faculty to say “no,” while maintaining honesty, professionalism, and positive referral relationships. Removing the stigma of self-guilt associated with saying “no” when appropriate, and doing so via clear and respectful communication, builds credibility, maintains professional autonomy, demonstrates integrity, and also ensures that patients receive the best possible care.

The single mental barbel is a distinctive feature of the benthic Antarctic fishes of the «cryonotothenioid» subfamily Artedidraconinae. These barbels are unusual because their primary sensory modality is tactility, not chemosensation as in most other teleosts. They also exhibit considerable interspecific and intraspecific variation in length and in the appearance of the terminal expansion and its epidermis. Barbels range from short to long and the terminal expansion can be nonexistent, small and round, or large and oblong. In most species, the epidermal surface of the terminal expansion exhibits projections of various shapes and sizes. These range from smooth and furrowed, to ridged and furrowed, to pointed, to palmate (having lobes originating from a common point), and to fringed and leaf-like. Barbels are also subject to intraspecific variation among the species in the genera Dolloidraco, Histiodraco, Artedidraco and Pogonophryne. The various epidermal surface patterns all increase the sensory surface area exposed to the substrate and may enhance detection of their prey, primarily polychaetes. They also enhance surface roughness of the epidermis, thereby dissipating mechanical forces and providing some protection from abrasion by the substrate. The various patterns are likely an epigenetic response to different local conditions of the substrate. This variation warrants caution in their use as a defining taxonomic character.

Semaglutide, a glucagon-like peptide-1 receptor agonist, and resmetirom, a thyroid hormone receptor-β agonist, are approved therapies for noncirrhotic metabolic dysfunction–associated steatohepatitis (MASH) with moderate to advanced fibrosis. Their comparative economic value has not been established. To evaluate the cost-effectiveness of semaglutide and resmetirom compared with standard of care (SOC) in patients with noncirrhotic MASH and F2–F3 fibrosis. A state-transition model simulated disease progression in a hypothetical cohort with F2–F3 fibrosis over 5- and 10-year horizons from a U.S. healthcare payer perspective. Clinical efficacy inputs were derived from phase 3 trials (ESSENCE and MAESTRO-NASH), with costs and utilities obtained from published sources. Scenario analyses incorporated semaglutide’s cardiovascular mortality benefit. Deterministic and probabilistic sensitivity analyses assessed uncertainty. Semaglutide was cost-effective versus SOC at 5 years (ICER, $42,200/QALY) and 10 years (ICER, $44,138/QALY). Resmetirom produced higher ICERs ($95,981/QALY at 5 years; $107,002/QALY at 10 years) but remained below a $150,000/QALY threshold. Inclusion of cardiovascular mortality benefits improved semaglutide’s ICER to $38,324/QALY. Probabilistic analyses showed semaglutide had the highest probability of cost-effectiveness across willingness-to-pay thresholds. Over a 10-year horizon, treatment of 100,000 patients with F2–F3 MASH was projected to prevent 270 cases of decompensated cirrhosis, 10 cases of hepatocellular carcinoma, and 1,040 liver-related deaths with semaglutide, compared with 310 cases of decompensated cirrhosis, 10 cases of hepatocellular carcinoma, and 1,180 liver-related deaths with Resmetirom. Semaglutide demonstrated superior cost-effectiveness compared with SOC and resmetirom, with cardiovascular benefits further strengthening its economic value. Not applicable.

Background: Evidence of the diverse genetic architecture of dilated cardiomyopathy (DCM) continues to emerge and requires reassessment of the clinical relevance of implicated disease genes. Building on the 2019-2020 Clinical Genome Resource (ClinGen) evaluation, the DCM Gene Curation Expert Panel (GCEP) reconvened in 2024-2025 to conduct a reassessment of genes in DCM. Methods: The ClinGen semi-quantitative clinical validity classification framework was applied with specifications to DCM to classify genes into categories based upon strength of published evidence for a DCM phenotype. Previously curated genes were reassessed and newly reported gene-disease-mode of inheritance (MOI) relationships, termed ?curations,? were evaluated. Results: Sixty-eight genes were evaluated, inclusive of 72 unique gene-disease-MOI relationships across 51 previously evaluated and 17 newly assessed genes. Thirty-five curations were classified as high evidence (16 Definitive, 10 Strong, 9 Moderate), increasing by 16 from the prior assessment. Nine newly assessed genes were classified as high evidence, including BAG5, FLII, LMOD2, MYLK3, MYZAP, NRAP, PPA2, PPP1R13L, and RPL3L. Twelve genes (11 newly appraised) were rated as high evidence with an autosomal recessive (AR) MOI. Five re-evaluated genes from 2019-2020 had clinically significant changes in classification. Except for JPH2, for which curation was modified to separate autosomal dominant (-AD) and -AR MOI curations, clinically significant changes involved upgrades from low to high evidence categories (PLEKHM2, PRDM16, TBX20, TNNI3K), demonstrating the robustness of the ClinGen gene curation process over time. An additional 29 gene-disease-MOI curations were classified as Limited, including six newly evaluated genes and one new MOI for a previously evaluated gene, MYBPC3-AR; four were classified as No Known Disease Relationship, and four remained Disputed. Four previously evaluated genes were curated for both AD and AR MOIs, including JPH2 (AD-Strong, AR-Limited), LDB3 (AD-Limited, AR-Strong), MYBPC3 (AD-Limited, AR-Limited), and TNNI3 (AD- and AR- Strong). Conclusions: With substantial new evidence, the genetic architecture of DCM has rapidly expanded. This updated assessment of genes reported in DCM yielded 35 high evidence curations, an increase from 19 only five years ago. The results of this evidence-based evaluation process informs clinical interpretation of genetic information in the care of DCM patients and families.