Parental behavior problems have long-term effects on children’s limbic brain structures and functions. Parental behavior problems-related brain changes in children may lead to mental disorders and behavior dysfunction later in life. However, our understanding of the relationship between parental behavior and children’s brain structures is less obvious when children and adolescents are studied in a general population without mental disorders. The majority of studies on the relationship between parental behavior and adolescent brain structure have been focused on severe forms of the following parental behavior problems: (1) internalizing behavior associated with mood and anxiety disorders, and (2) externalizing behavior associated with substance use and violence. A few studies examined the effect of normative variations or subtle differences in parental behavior. Therefore, we utilized a large study—Adolescent Brain Cognitive Development (ABCD)—to determine relationships between normative variation in parental internalizing and externalizing behavior and limbic brain structures in children and adolescents without mental disorders. Quantile (median) regression models were used to compute associations between parental behavior and children’s limbic structures. We found that parental internalizing and externalizing behaviors are uniquely associated with children’s limbic structures after adjustment for biological confounders and parental socioeconomic status. Our findings indicate that normative parental behavior may have a significant early influence on limbic structures of normally developing children and adolescents. Accelerated or delayed limbic structure maturation may account for children’s and adolescents’ behavioral inadequacies and a risk of developing specific mood disorders or substance abuse problems later in life.

Objective: Although preventable through established infection control practices, catheter-associated urinary tract infections (CAUTIs) remain prevalent in acute-care settings. Our goal was to improve the CAUTI rates through multiple hospitals through implementing sustainable practices, including enhancing communication, provider engagement, accountability, and transparency in reporting to achieve long-term improvements. Design: Quality improvement with multiple levels of interventions Setting: A health system in northern Ohio with 21 affiliated hospitals across 16 counties. Patients: Adult patients admitted to the hospital between June 2020 and June 2023. Methods: A broad set of quality improvement (QI) strategies was developed by an interdisciplinary team and guided by the Fractal Management System framework to ensure accountability, communication, and alignment across teams and facilities. Key drivers were indwelling urinary catheter (IUC) alternatives, insertion, maintenance, removal, and smart diagnostics. The main outcome measures were standardized infection ratios (SIR) and standardized utilization ratio (SUR), comparing period 1 (P1, June 2020 to December 2021) and period 2 (P2, January 2022 to June 2023). Results: Enhanced communication and management played crucial roles in minimizing IUC placement. Updated policies and protocols, coupled with clear guidelines and decision support tools, facilitated effective urinary management. Performance tracking and visual management boards provided real-time insights, while collaborative efforts, including staff huddles and multidisciplinary teamwork, ensured consistent adherence to best practices. Conclusions: A systemwide QI initiative focused on enhanced communication, management, and collaboration contributed to improved SIR and reduced CAUTI rates across multiple hospitals, highlighting the impact of strong communication and proactive management in healthcare settings.

Purpose: Raynaud’s phenomenon (RP) is defined as frequent ischaemic attacks in the fingers and toes due to vascular vasospasm. Studies have been conducted in many countries worldwide to determine the prevalence of RP. The aim of the current study was to assess the prevalence of RP in the Saudi Arabian population. Patients and Methods: An online survey based on international consensus criteria used to diagnose RP was conducted to collect data from individuals from the Saudi population. Participants were considered positive if they had triphasic or biphasic colours of the extremities with cold-related sensitivity. Awareness of RP was also assessed. Results: A total of 1025 responses were collected and included in the final analysis. The prevalence of RP was 4.29%, including 22% men and 77% women. The most common age group among women was 26– 40 years (36.3%). Familiarity with RP was low, with 56.82% of participants lacking adequate awareness regarding RP. Only 32% of patients with RP reported attending doctor visits regarding symptoms of the disease. Conclusion: The RP prevalence in Saudi Arabia is comparable to that reported in the international literature. Public awareness activities should be conducted to increase knowledge about RP. Trial Registration: Not applicable.

Lipohypertrophy (central adipose tissue (AT) accumulation) is a common and significant problem in people with HIV (PWH). Pathogenesis remains elusive; yet, AT abnormalities are key drivers of cardiometabolic co-morbidities in HIV. We aimed to assess effects of semaglutide, a glucagon-like peptide-1 receptor agonist, on AT in PWH with lipohypertrophy. We conducted a randomized, double-blinded, placebo-controlled trial of virologically-suppressed, non-diabetic PWH ≥ 18 years of age on stable antiretroviral therapy (ART) with body mass index (BMI) ≥ 25 kg/m², increased waist circumference/waist-to-hip ratio, and subjective increased abdominal girth after ART initiation. Participants were randomized 1:1 to 32 weeks semaglutide (8-week titration + 24 weeks 1.0 mg weekly subcutaneous injection) or matching placebo. Computed tomography and whole-body dual-energy X-ray absorptiometry were used to measure area/density in abdominal AT [total (TAT), visceral (TAT), and subcutaneous (SAT)] and body composition [lean body mass (LBM), limb/trunk/total body fat (TBF)], resp. Semaglutide effects were estimated using generalized estimating equations or simultaneous quantile regressions on outcome variables. Grace A. McComsey, MD, Gilead Sciences: Advisor/Consultant|Gilead Sciences: Grant/Research Support|Janssen: Advisor/Consultant|Merck: Advisor/Consultant|Merck: Grant/Research Support|ViiV Healthcare: Advisor/Consultant|ViiV Healthcare: Grant/Research Support

Objective: To evaluate the impact of implementation of a conditional reflex urine culturing strategy on urine culture rates, antimicrobial use, and clinical outcomes in hospitalized adults. Design: Pre-post quasi-experimental study. Setting: Emergency departments and inpatient units within a large, integrated healthcare system in Northeast Ohio, comprising 10 medical centers. Patients: Adult patients with a urine culture ordered from June 1, 2018, to May 31, 2023. Methods: A system-wide intervention was implemented on June 1, 2020, requiring urinalysis (UA) with pyuria findings to trigger a urine culture order. We compared urine culture rates, antimicrobial use (measured by days of therapy [DOT] and days of antimicrobial spectrum coverage [DASC]), and clinical outcomes between pre-and post-intervention periods. Results: The intervention resulted in an 85.4% reduction in urine culture rates (0.54 vs 3.71 per 100 patient days). Antimicrobial use decreased, with DOT per 100 patient days dropping by 11.5% and DASC/DOT by 16.1%. No significant differences were observed in Clostridioides difficile infection rate, subsequent bloodstream infections with urinary pathogens, or mortality between pre- and post-intervention groups. Conclusions: A conditional reflex urine culturing strategy implemented as part of a diagnostic stewardship framework reduced urine culture and antimicrobial use without adverse clinical outcomes. This highlights the potential of diagnostic stewardship to optimize antimicrobial use in hospitalized adults.