Persons with Parkinson walk slowly, with short steps, reduced arm swing, and altered stride variability. Walking to a metronome or music may increase velocity, stride length, and cadence, yet few studies have directly compared the efficacy of these techniques. To determine the optimal auditory cue to improve Parkinson gait. This case-control study was conducted among persons with Parkinson disease (using medication) and healthy older adult controls at University of Florida Applied Neuromechanics laboratory in 2017. Changes in gait in participants with Parkinson disease and controls were compared with walking with no cue: walking to a regular metronome, walking to a fractal metronome, and walking to music. Condition order was randomized. Cueing frequency was set to natural cadence. Post hoc analyses restricted to participants with Parkinson disease were performed in 2026. Auditory cueing with a regular metronome, fractal metronome, or music while walking. Outcomes of interest were stride time detrended fluctuation analysis (DFA), velocity, stride length, and arm swing velocity. Spatiotemporal gait measures and DFA of stride time were compared using repeated measures multivariate analysis of variance. Analyses included 15 participants with Parkinson disease (mean [SD] age, 69 [6] years; 11 [73%] male; mean [SD] Hoehn and Yahr Parkinson disease stage. 2.3 [0.6]; mean [SD] age of onset, 63 [7] years) and 15 controls (mean [SD] age, 69 [5] years; 11 [73%] male). Stride time DFA was increased during the fractal metronome condition (α = 0.200; SE, 0.024; P < .001) vs no cue, the regular metronome (α = 0.320; SE, 0.032; P < .001), and music (α = 0.219; SE, 0.030; P < .001); worsened with the regular metronome vs no cue (α = -0.120; SE, 0.037; P = .003); and was not statistically different during music vs no cue (α = -0.019; SE, 0.031; P = .54). Music was associated with increased velocity (mean [SE] change, 0.041 [0.015] m/s; P = .01), stride length (mean [SE] change, 0.047 [0.013] m; P = .001), and arm swing velocity (mean [SE] change, 27.10 [7.33] °/s; P = .001) compared with no cue; velocity (mean [SE] change, 0.030 [0.011] m/s; P = .03), stride length (mean [SE] change, 0.034 [0.009] m; P = .002), and arm swing velocity (mean [SE] change, 34.7 [8.5] °g/s; P = .001) compared with the regular metronome; and increased stride length (mean [SE] change, 0.028 [0.009] m; P = .01) and arm swing velocity (mean [SE] change, 37.52 [7.89] °/s; P < .001) compared with the fractal metronome. Analyses restricted to participants with Parkinson disease found similar trends, with reduced levels of significance due to the smaller sample. In this case-control study, walking to the fractal metronome was associated with improved stride time fluctuations compared with the regular metronome or music. Walking to music was associated with improved velocity, stride length, and arm swing velocity compared with either metronome condition.

Accurate prediction of patient mortality after kidney transplant is an unmet need. To develop and validate an integrative prediction model that predicts short- and long-term patient mortality for kidney recipients. This international cohort study included patients who underwent transplants between 2004 and 2023 from 14 academic medical centers from Europe and the US. The derivation cohort consisted of 1566 consecutive adult kidney recipients in a deeply phenotyped cohort prospectively recruited in 1 French center between 2004 and 2014. External validation cohorts consisted of 10 951 kidney recipients from 7 centers in France, 3 centers in Europe, and 3 centers in North America who underwent kidney transplants between 2006 and 2023. Data were analyzed from January 2023 to June 2025. All-cause mortality was assessed, and 121 candidate prognostic factors, comprising demographics and clinical, biological, imaging, and immunological parameters, were collected. Among 12 517 kidney transplant recipients, including 1566 in the derivation cohort (mean [SD] age, 50.05 [14.31] years; 942 male [60.15%]) and 10 951 in validation cohorts (mean [SD] age, 53.32 [13.97] years; 6766 male [61.78%]), 2486 patients (19.9%) died after a median (IQR) follow-up of 5.08 (2.97-7.00) years. Fourteen prognostic factors (including clinical, biological, and imaging risk factors) were independently associated with patient death (eg, patient age: hazard ratio per 1-year increase in age, 1.07 [95% CI, 1.06-1.08]; P < .001) and were combined into a risk prediction model (mBox). The model exhibited accurate calibration and discrimination in the derivation cohort, with C statistics of 0.82 (95% CI, 0.77-0.87) and 0.80 (95% CI, 0.78-0.82) at 1 and 10 years, respectively, after the transplant. Abbreviated models were developed and validated to ensure model generalizability. Performance of abbreviated models was confirmed in external validation cohorts from France (C statistic, 0.76 [95% CI, 0.73-0.78]), Europe (C statistic, 0.74 [95% CI, 0.72-0.76]), the US (C statistic, 0.74 [95% CI, 0.70-0.78]), the Greater Paris University Hospital database (C statistic, 0.79 [95% CI, 0.77-0.81]), and the University of California at San Francisco database (C statistic, 0.70 [95% CI, 0.65-0.74]). The model was also validated in a series of subpopulations (eg, women vs men: C statistic, 0.81 [95% CI, 0.77-0.84] vs 0.79 [95% CI, 0.77-0.82]) and clinical scenarios (eg, before COVID-19 era: C statistic, 0.79 [95% CI, 0.77-0.81]) with good and stable performance. In this study, an accurate prediction model for mortality among kidney recipients, computable at the time of transplant, was developed and externally validated. Results suggest that this model may help stratify patient risk of death, allowing for improved medical decisions.

Identifying factors that explain differences in physical performance measures by race and region in the US and whether they are associated with changes over time could inform preventive strategies. To examine 10-year changes in physical performance across race and race-region among Black and White older adults and whether differences are explained by demographic, cardiovascular, socioeconomic, and cognitive factors. The prospective Atherosclerosis Risk in Communities (ARIC) cohort study recruited participants between 1987 and 1989. This study included participants from 4 US communities in North Carolina, Mississippi, Maryland, and Minnesota who underwent physical performance evaluations initiated in 2011 to 2013 (visit 5 examinations) and in 3 subsequent in-person examinations conducted over a 10-year period through 2022. Data were analyzed from January through May 2025. Self-identified race and region. Physical performance was assessed using the Short Physical Performance Battery (SPPB; score range, 0-12, with higher scores indicating better performance). Multivariable generalized estimating equations estimated cross-sectional differences as well as differences in 10-year changes by race and by race and region, adjusting for demographic, cardiovascular, socioeconomic, and cognitive factors. Among 5666 participants (mean [SD] age, 75.4 [5.1] years; 3258 [58%] women), 1233 (22%) self-identified their race as Black and 4433 (78%) self-identified their race as White. Adjusting for demographic, cardiovascular, socioeconomic, and cognitive factors explained observed cross-sectional differences in physical performance between Black participants and White participants. However, 10-year SPPB longitudinal declines were steeper for Black participants compared with White participants (absolute difference, -0.80 points; 95% CI, -1.19 to -0.41 points), even after adjusting for all factors that accounted for cross-sectional differences; this finding met the 0.50-point threshold for a clinically meaningful difference. Between-region declines within races also showed notable differences; for example, SPPB declines were steeper for White Maryland participants compared with White North Carolina participants (absolute difference, -1.14 points; 95% CI, -1.45 to -0.83 points), and declines were steeper for Black Mississippi participants compared with Black North Carolina participants (absolute difference, -1.72 points; 95% CI, -2.65 to -0.78 points). In this cohort study of older adults, meaningful racial differences in physical performance declines were not explained by commonly suggested drivers of performance differences. Other unmeasured regional features may explain racial differences in decline in physical performance and warrant investigation.

Rural-urban differences in health outcomes have worsened over time, yet the variation in exposure to social determinants of health (SDOH), which are key drivers of these outcomes, has not been adequately quantified. To explore variation in exposure to a sample of beneficial and adverse community-level SDOH across the rural-urban continuum. This cross-sectional study included all residential addresses in Maryland using GPS-Health (Geographic Patterns of SDOH), a 2025 statewide address-level dataset. The straight-line (great-arc) distance to the nearest resource (hospital, federally qualified health center [FQHC], pharmacy, Supplemental Nutrition Assistance Program [SNAP] retailer, civic center, and major roadway) or hazard (gun violence incident, eviction site, and Environmental Protection Agency [EPA]-designated site) was estimated. Addresses were categorized using Rural-Urban Commuting Area codes as urban (1-3), large rural (4-6), small rural (7-9), and isolated rural (10). Linear mixed-effects models estimated adjusted differences by rurality. The study included 2 070 970 addresses: 1 933 793 urban addresses (93.4%), 86 270 large-rural addresses (4.2%), 17 594 small-rural addresses (0.8%), and 33 313 isolated-rural addresses (1.6%). Adults aged 65 years and older were most prevalent in large-rural areas (30.8%), disability was more prevalent in small-rural areas (17.9%), and both were more common in isolated-rural than urban areas (older adults: 27.7% vs 17.1%; disability: 15.6% vs 11.6%). Compared with urban addresses in an adjusted model, isolated-rural addresses were farther from hospitals (estimated difference, 4.22 [95% CI, 3.32 to 5.13] miles), pharmacies (estimated difference, 2.16 [95% CI, 1.54 to 2.80] miles), SNAP retailers (estimated difference, 1.15 [95% CI, 0.83 to 1.47] miles), and civic centers (estimated difference, 1.09 [95% CI, 0.67 to 1.50] miles). FQHCs were closest to large-rural addresses (estimated difference, -2.13 [95% CI, -2.50 to -1.76] miles). Urban addresses were closest to hazards. In this cross-sectional study of all residential addresses in Maryland, distance from health-promoting resources increased with rurality, with isolated-rural areas farthest, despite a higher representation of populations with greater health care needs. Our findings support examining rurality as a continuum rather than a dichotomy to better characterize health outcomes and SDOH variation and to inform place-specific interventions.

Hospital-acquired infections worsen health care outcomes and increase costs. The decision-making process guiding selection of infection prevention practices for hospital-acquired infections is not well understood; understanding how health care professionals prioritize infection prevention practices is critical for guiding efficient and equitable implementation. To determine the characteristics of infection control practices that affect health care professional decision-making. This survey study was a discrete choice experiment conducted between February 27 and March 27, 2025, with data analyzed from March 28 to June 3, 2025. Health care professionals who had participated in infection prevention and control decision-making identified through authorship in related journals were eligible to participate. Attributes were identified through literature review and expert consultation. Data were analyzed using mixed logit and latent class models. Scenario and relative attribute importance analyses were performed to explore heterogeneity in preferences. Respondents chose between infection control practices varying in 4 attributes: quality of clinical evidence, economic costs and benefits, implementation duration, and additional time required per patient. Preference weights, relative attribute importance, and probability of clinical practice uptake were assessed. A total of 256 respondents were included (161 male [62.9%]), with a median age group of 40 to 49 years (84 [32.8%]) and mostly from high-income countries (160 [62.5%]). Respondents preferred infection prevention practices with strong clinical evidence, shorter implementation durations, lower time burdens, and favorable cost-effectiveness profiles. Two latent classes were identified: evidence seekers in low- and middle-income countries who prioritized high-quality evidence and showed high willingness to adopt practices, and efficiency seekers, including respondents from high-income countries who were more selective and prioritized cost-effectiveness. Economic costs and benefits were consistently the most important attribute across all regions, with marked regional variation in secondary priorities. In this survey study of health care professionals, preferences for infection control practices varied across income levels and geographic regions, reflecting the need for further research to better understand contextual factors influencing infection prevention and control decision-making, particularly in low- and middle-income settings. Strengthening economic evidence and tailored implementation support may promote sustainable adoption.

Mentorship is foundational to the career development of academic physicians. During challenging times, mentees often look to their mentors for additional support and guidance; however, there are few empirical data on best practices for mentoring during times of crisis. To describe the best practices of award-winning research mentors during challenging times. Our exploratory qualitative study included in-depth interviews with mentors who were internal medicine faculty members and had received a clinical and translational research mentoring award between 2016 and 2024 at the University of Michigan Medical School. A semistructured interview guide was used, and interviews were conducted between July 14 and October 1, 2025, audio recorded, transcribed, and deidentified. Transcripts were analyzed through a descriptive content analysis approach and included both inductive and deductive coding. With the use of audio-recorded interviews, participant views were obtained on effective mentoring strategies in academic medicine focused on mentoring during the current climate of uncertainty related to research funding. In this qualitative study of 15 physician mentors (7 [46.7%] females; 8 [53.3%] males), key themes emerged from the qualitative data, organized into 3 domains: (1) tactical strategies mentors used during challenging times (eg, help mentees identify diverse funding sources, encourage consideration of alternative career options or areas of research focus), (2) psychological strategies used during challenging times (eg, provide emotional support, coach mentees' mindsets), and (3) overall mentoring philosophies and strategies for effective mentoring (eg, provide support and honest feedback, network on behalf of the mentee). This qualitative study of notable research mentors identified several strategies and philosophies that may be used to guide mentees during uncertain times. These approaches may transcend a specific crisis and be widely applicable during future challenging times in academic medicine.

In Chinese culture, families often take primary control over disclosing a cancer diagnosis, balancing a desire to protect patients' emotional well-being with respect for their right to know. This dynamic can influence patients' psychological health and overall treatment experience. To examine decision-making dynamics, communication strategies, and power structures involved in how Chinese families balance the delivery of information with patients' psychological protection when disclosing a cancer diagnosis. This qualitative study used semistructured interviews with family members of adult patients with cancer in China. Purposive sampling ensured diversity in sex, age, and relationship to patients. Data collection and analysis were conducted simultaneously from June 1, 2024, to July 31, 2025, using thematic analysis. Key themes related to how families managed cancer diagnosis disclosure. Interviews elicited family members' expectations, decision-making processes, and strategies for balancing protection and patient autonomy. A total of 41 family members were interviewed (median [range] age, 38 [21-56] years; 24 females [58.5%]). Four themes were identified: (1) family negotiation and decision-making on diagnosis disclosure, (2) conflict and collaboration between families and health care professionals, (3) implementation of family-led initial disclosure strategies, and (4) dynamic adjustment of disclosure strategies with treatment progression. These themes illustrated how families continually balanced protection and autonomy in evolving clinical circumstances. In this qualitative study, cancer diagnosis disclosure within Chinese families unfolded as a culturally embedded and fluid process, requiring ongoing negotiation and adjustment among family members. Given the continued prominence of families in medical decision-making in China, future interventions should aim to bridge the gap between family involvement in care and patient autonomy. While offering necessary family support, these strategies should also aim to steer the disclosure model toward one that elevates and protects the patient's voice, thereby moving closer to internationally accepted ethical standards.