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Toward a Mechanistic Understanding of LGBTQ-Affirmative Cognitive-Behavioral Therapy: Testing Treatment Mediators in a Randomized Controlled Trial with Young Gay and Bisexual Men
No full textYoung gay and bisexual men (YGBM) face elevated risk for co-occurring mental (e.g., depression, anxiety), behavioral (e.g., substance use), and sexual (e.g., HIV-transmission-risk behavior) health challenges compared to their heterosexual peers. LGBTQ-affirmative cognitive-behavioral therapy (CBT) targets psychosocial pathways through which minority stress is hypothesized to contribute to these disparities. We evaluated whether LGBTQ-affirmative CBT operates through these candidate mechanisms.
We analyzed trial data from 254 HIV-negative YGBM (ages 18–35; 67.2% racial/ethnic minority) with mental, behavioral, and/or sexual health concerns randomly assigned to receive LGBTQ-affirmative CBT or one of two control conditions: LGBTQ-affirmative community counseling or HIV testing and counseling. Using baseline and 4-, 8-, and 12-month follow-up assessments, trajectories of identity-specific (i.e., sexual orientation-related acceptance concerns, concealment motivation, and internalized stigma) and general (i.e., assertiveness, emotion regulation difficulties, rumination, self-esteem, and social support) mechanisms were examined. Additionally, latent change score structural equation models tested whether these mechanisms mediated the relative impact of LGBTQ-affirmative CBT (vs. control) on depression, anxiety, substance use, HIV-transmission-risk behavior, or their co-occurrence.
Across the LGBTQ-affirmative CBT and control conditions, participants showed improvements in all mediators and clinical outcomes. While no formal mediation effects were detected, improvements in sexual orientation-related acceptance concerns were associated with improvements in problematic substance use across conditions, suggesting that this process may represent one promising target irrespective of treatment condition.
Identifying treatment mechanisms may help to maximize the efficacy of LGBTQ-affirmative CBT. While no definitive mediators emerged in this study, the consistent improvement across all candidate processes underscores their potential importance. Our findings highlight several challenges in establishing mechanisms of LGBTQ-affirmative CBT, including statistical power, active comparators, and measurement. We provide recommendations for advancing mechanistic tests in future work.
•Young gay and bisexual men face higher health risk compared to heterosexual peers.•LGBTQ-affirmative CBT targets underlying pathways arising from exposure to minority stress.•We tested treatment mechanisms hypothesized in minority stress theory.•Improvements in minority stress processes and clinical outcomes occurred across all study conditions.•Reductions in sexual orientation–related acceptance concerns were associated with lower problematic substance use, suggesting a potential treatment mechanism
ChatGPT-4o as a Tool for Patient Education in Plastic Surgery
No full textArtificial intelligence (AI), particularly large language models (LLMs), has demonstrated potential to improve patient communication by delivering accurate, readable, and empathetic medical information. In plastic surgery-a specialty where preoperative counseling is essential-patients often seek online information to understand procedures, risks, and recovery. However, limited research exists on ChatGPT-4o's utility in this context.BACKGROUNDArtificial intelligence (AI), particularly large language models (LLMs), has demonstrated potential to improve patient communication by delivering accurate, readable, and empathetic medical information. In plastic surgery-a specialty where preoperative counseling is essential-patients often seek online information to understand procedures, risks, and recovery. However, limited research exists on ChatGPT-4o's utility in this context.This prospective qualitative study evaluated ChatGPT-4o's responses to 25 standardized patient questions across 5 plastic surgery procedures: rhinoplasty, breast augmentation, abdominoplasty, blepharoplasty, and rhytidectomy. Each procedure was queried with 5 common preoperative questions covering indications, alternatives, risks, surgical steps, and recovery. Responses were reviewed independently by a board-certified plastic surgeon and 2 researchers for accuracy, completeness, and appropriateness. Strengths, weaknesses, omissions, and potentially unsafe guidance were identified and summarized.METHODSThis prospective qualitative study evaluated ChatGPT-4o's responses to 25 standardized patient questions across 5 plastic surgery procedures: rhinoplasty, breast augmentation, abdominoplasty, blepharoplasty, and rhytidectomy. Each procedure was queried with 5 common preoperative questions covering indications, alternatives, risks, surgical steps, and recovery. Responses were reviewed independently by a board-certified plastic surgeon and 2 researchers for accuracy, completeness, and appropriateness. Strengths, weaknesses, omissions, and potentially unsafe guidance were identified and summarized.ChatGPT-4o provided generally accurate, well-structured, and patient-friendly answers across all procedures, with no unsafe recommendations. Strengths included clear explanations of surgical rationale, common risks, general procedural steps, and recovery expectations. The model promoted safety and professional consultation. However, notable limitations included a lack of procedural nuance, omission of less common but clinically important risks, failure to tailor guidance to individual variables, and incomplete recovery or postoperative care details.RESULTSChatGPT-4o provided generally accurate, well-structured, and patient-friendly answers across all procedures, with no unsafe recommendations. Strengths included clear explanations of surgical rationale, common risks, general procedural steps, and recovery expectations. The model promoted safety and professional consultation. However, notable limitations included a lack of procedural nuance, omission of less common but clinically important risks, failure to tailor guidance to individual variables, and incomplete recovery or postoperative care details.ChatGPT-4o offers significant promise as a supplementary patient education tool in plastic surgery. Its ability to deliver coherent, empathetic, and accessible responses may help bridge health literacy gaps. However, it should not replace detailed, individualized surgeon-patient discussions. Further refinement and real-world validation are needed to enhance its clinical reliability and integration into patient care.CONCLUSIONSChatGPT-4o offers significant promise as a supplementary patient education tool in plastic surgery. Its ability to deliver coherent, empathetic, and accessible responses may help bridge health literacy gaps. However, it should not replace detailed, individualized surgeon-patient discussions. Further refinement and real-world validation are needed to enhance its clinical reliability and integration into patient care
What's New With Under Eye Treatment: A Multispecialty Systematic Review of Recent Under Eye Treatments
No full textBACKGROUNDInfraorbital hollowing and hyperpigmentation are common cosmetic concerns resulting from structural volume loss, pigmentary changes, vascular prominence, and skin laxity.OBJECTIVETo systematically review current and emerging treatments for infraorbital concerns with an emphasis on patient selection and anatomy-driven approaches.MATERIALS AND METHODSA systematic PubMed search was conducted in March 2025 per Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines for English-language studies published after 2010. Fifty studies were selected and categorized by treatment type. Each modality was evaluated for efficacy, safety, and patient suitability.RESULTSTreatments were organized into injectables, energy-based devices, microneedling, peels, topicals, polynucleotides, platelet-rich plasma/platelet-rich fibrin, neuromodulators, and surgery. Fillers remain foundational for volume loss; lasers address melanin, vascularity, and skin laxity. Microneedling and polynucleotides target texture and fine rhytides. Chemical peels and topicals are effective for superficial dyschromia. Botulinum toxin benefits orbicularis oculi hypertrophy and sequelae. Surgery is preferred for herniated fat and poor lower eyelid support. Patient-specific factors, including fat pad integrity, skin quality, and eyelid support, are critical for optimal results.CONCLUSIONInfraorbital concerns are multifactorial and require individualized treatment strategies. This review integrates evidence and clinical expertise to guide personalized, anatomy-driven interventions that optimize outcomes in periorbital rejuvenation
The Illiquidity of Water Markets
No full textWe investigate the efficiency of a market relative to a non-market institution—an auction relative to a quota—as allocation mechanisms in the presence of frictions. We use data from water markets in southeastern Spain and explore a specific change in the institutions to allocate water. On the one hand, frictions arose because poor farmers were liquidity constrained. On the other hand, farmers who were part of the wealthy elite were not liquidity constrained. We estimate a structural dynamic demand model by taking advantage of the fact that water demand for both types of farmers is determined by the technological constraint imposed by the crop's production function. This approach allows us to differentiate liquidity constraints from unobserved heterogeneity. We show that the institutional change from an auction to a quota increased total efficiency for the farmers considered. Welfare increased by 23.4 real pesetas per farmer per tree, a 6 percent increase in total production relative to the market
Impact of Systemic Anticoagulation on Traumatic Cervical Arterial Repairs: An Analysis of the PROspective Observational Vascular Injury Trial (PROOVIT) Registry
No full textSystemic anticoagulation (SAC) is standard in elective arterial repairs but controversial in trauma due to bleeding risks, with unclear benefits in this population. This is the first study to investigate SAC’s impact on cervical artery repairs.
Using the PROOVIT database (2012–2023), we included all cervical arterial injuries (common carotid, internal/external carotid, or vertebral) who underwent surgical or endovascular repair, categorized by intraoperative SAC use. Primary outcomes included in-hospital complications; secondary outcomes were re-intervention, stroke, 24-hour packed red blood cell (pRBC) transfusions, and length of stay (LOS).
One hundred forty patients met inclusion criteria. Median age was 34, and 79% were male. 67.1% sustained penetrating trauma, and 77% had moderate to severe head trauma. SAC was used in 41 (29.3%) patients. SAC use was more common in patients with higher Glasgow Coma Scale (GCS) scores and those undergoing primary surgical repair. Univariate analysis showed similar complication, re-intervention, and stroke rates. Multivariate analysis (adjusted for age, sex, mechanism, ISS, SBP <90, and GCS, see Figure) revealed SAC was associated with higher re-intervention rates (aOR = 3.9, 95% CI: 1–13, p = 0.03) but not with overall complications (aOR = 2.4, p = 0.07), stroke (aOR = 1.6, p = 0.35), 24-hour PRBC transfusions (B = -2.6, p = 0.27), or LOS (B = -4.5, p = 0.40).
SAC during cervical arterial repair was associated with increased re-intervention rates without impacting complications, stroke, or LOS. Further research is needed to clarify its risk-benefit balance in trauma care.
•SAC increased re-intervention rates without reducing stroke or complications•No benefit observed in hospital stay, transfusion, or mortality outcomes•SAC in blunt trauma was associated with higher complication rates•Findings question the routine use of SAC in traumatic cervical arterial repair
Abstract WP134: Predictive Models for 30-Day Readmission After Stroke: A Systematic Review and Meta-Analysis
No full textBackground: Stroke readmissions highlight gaps in post-discharge care that require urgent action. In the United States, 18.2% of stroke patients are readmitted within 30 days of discharge, with a 12.4% readmission rate for ischemic stroke. While several predictive models have been developed to identify factors associated with readmission, evidence on their performance and clinical utility remains limited We aimed to evaluate and compare the performance of logistic regression and machine learning models for predicting all cause and stroke-specific 30-day readmissions using data from existing literature.
Methods: Following the PRISMA guidelines, we systematically searched PubMed, Embase, Web of Science, and Google Scholar for studies published between January 2021 and July 2025. Of 292 records identified, 13 studies met inclusion criteria. We evaluated model quality using rehospitalization rates and AUC, performed subgroup analysis comparing of all-cause (AC) versus stroke-specific (SS) readmissions using logistic regression (4) and machine learning methods (13) approaches.
Results: Total number of subjects were 203,399 (SS readmissions = 280; AC readmissions = 20340). 17 models provided AUCs for meta-analysis: SS readmission models (n = 2; pooled readmission rate: 2.0%), and AC readmission models (n = 15; readmission rate: 8.0%). Chen et.al.2022 demonstrated the highest AUCs for AC readmissions (0.94 and 0.89) despite low readmission rates, followed by Hu et al. (2025) with an AUC of 0.91 and Lv et al. (2023) with an AUC of 0.80. The overall readmission proportion across all studies was 11% (95% CI: 7%-16%), with a weighted combined proportion of 6.8%, based on subgroup contribution of 80% AC and 20% SS. The AUC across studies was 0.72 (95% CI: 0.67-0.78). Subgroup-specific AUCs were 0.67 (95% CI: 0.54-0.79) for SS and 0.70 (95% CI: 0.69-0.70) for AC. (Figure) Between-study heterogeneity was considerable (Q = 829.35, p < 0.001; I2=98.07%; τ2 = 0.01).
Conclusion: Our results suggest that overall predictive accuracy of 30-day readmissions remain limited, regardless of strong potential of some models. The high level of heterogeneity indicates that methodological and population differences influence performance, emphasizing the need for external validation and standardization of modeling approaches. Future studies should focus on developing robust, generalizable readmission risk models refined and multi-site validation and transparent reporting standards
Preliminary evaluation of the acceptability, appropriateness, and feasibility of an online sexual health educational video series for breast cancer patients
No full textSexual health-related side effects during breast cancer treatment are common and distressing but not always expected by patients. We created an online sexual health educational video series to increase patients' awareness of these issues. In this exploratory study, we aimed to evaluate the acceptability, appropriateness, and feasibility of the video series among newly diagnosed breast cancer patients.
This was a repeat-measure, single-arm preliminary study where eligible and interested patients completed a baseline questionnaire within one month of diagnosis or surgical evaluation. Enrolled participants accessed the online sexual health video series. A follow-up questionnaire evaluating acceptability, appropriateness, and feasibility was administered after 6 months. Descriptive statistics, paired t-tests, and thematic analysis were utilized.
Twenty-eight participants (January-June 2024) with mean age of 48 years (± 8 years) comprised the present analysis with 86%White, 4% Hispanic, 89% straight/heterosexual, 86% married/partnered, and 68% Stage I at diagnosis. Eleven participants (39%) completed the 6-month survey. Of the nine participants who reported watching the online videos, mean acceptability, appropriateness, and feasibility on a 5-point Likert scale was 4.1 (± 1.0), 4.3 (± 0.7), and 4.4 (± 0.7), respectively. Qualitative feedback showed strong endorsement for the video series and offered suggested improvements.
Breast cancer patients lack access to adequate sexual health resources during treatment, but an online educational video series has the potential to be acceptable, appropriate, and feasible as an educational resource. This video series fills a unique gap in patient care and has the potential to significantly advance the sexual health resources available to breast cancer patients and survivors.
ClinicalTrials.gov, Registration No. NCT06121258, Registration Date: 11/7/2023
Clinical Impact of Continuous Glucose Monitoring in Noninsulin Treated Type 2 Diabetes: A Review
No full textContinuous glucose monitoring (CGM) technology is becoming increasingly available to people with diabetes using insulin therapy; however, availability for people with type 2 diabetes (T2D) not on insulin remains limited. For people with T2D, there is strong evidence of glycemic benefit with CGM use for those treated with insulin, and CGM is accepted as standard of care. This review explores the impact of CGM use on glycemic and patient-reported outcomes in noninsulin treated populations with T2D, reporting outcomes from 10 identified randomized controlled trials and 15 nonrandomized studies. We report evidence that supports the use of this technology in people with T2D not using insulin
Prospective, non-randomized, controlled investigation of prostate (P) artery embolization (E) compared to holmium (Ho) laser enucleation of prostate for the treatment of symptomatic benign prostatic hyperplasia with prostate volume 80-250 cc: the hope trial outcome at 1 year
No full textBackground To compare outcomes of Prostate Artery Embolization (PAE) with Holmium Laser Enucleation of Prostate (HoLEP) for management of symptomatic benign prostate hyperplasia in men with prostate volume 80 to 250 cc. Methods In this open-label prospective clinical-trial, 45 patients were enrolled in a 2:1 ratio to undergo PAE and HoLEP, respectively. The voiding parameter, sexual function, and complications were evaluated at 1, 3, 6, and 12-months. The primary endpoint was a reduction in the International Prostate Symptom Score (IPSS) at 3 months. Secondary-outcomes were change in the International Index of Erectile Function-15 (IIEF-15), International Consultation on Incontinence Questionnaire-urinary incontinence (ICIQ-UI), Quality-of-Life (QoL), IPSS, uroflow (Qmax) and Prostate Specific Antigen (PSA). Adverse-events were recorded and graded using the Clavien-Dindo Adverse-event (CD-AE) classification. Results No significant difference in median IPSS and quality of life improvement was observed at any follow-up point. PAE had significantly better IIEF-15 and ICIQ-UI outcomes than HoLEP at 1 and 3 months. HoLEP outperformed PAE in PSA reduction, Qmax, and post-void residual (PVR) improvement at 3 and 12-months. However, PAE had shorter hospital stays and avoided catheterization. No major adverse events (Clavien-Dindo >= grade 3) occurred in either group. Conclusion In men with BPH and prostate sizes 80-250gm, PAE and HoLEP produce similar IPSS and QoL improvement at medium-term follow-up. PAE had better IIEF-15 and ICIQ-UI, in addition to the advantage of avoiding catheterization and reduced hospital stay. HoLEP performed better in PSA reduction, Qmax, and PVR improvement at 3 and 12 months. No serious adverse events occurred in either treatment group. Small sample size and short-term follow-up were important limitations.</p
Changing the paradigm: are two sets of blood cultures always needed?
No full textWe describe a multifaceted intervention deployed amidst a blood culture (BC) bottle shortage and its impact on BC yields.
Cross-sectional study conducted at a large safety-net hospital. BC bottle conservation strategies focused on improving blood volume collection, discouraging orders for low-yield conditions, limiting BC orders to one set per patient and restricting repeat BC to greater than 48-hour intervals. Trends in BC positivity rates and bloodstream infection events were analyzed using control charts, with a 13-months baseline period, and 12-months intervention period.
A total of 35,449 BCs were analyzed. The overall median percent positivity increased from 8.6% to 12.6% (p=0.001). In the Emergency Department, the median percent positivity rose from 12.4% to 14.3% (p=0.03); in Intensive Care Units (ICU), from 6.8% to 11.6% (p=0.001); and in Medical-Surgical units, from 4.9% to 9.0% (p=0.001). No significant variability in the counts of positive BCs was observed. The median blood volume per set increased from 5.7 mL to 7.5 mL (p=0.001). Vancomycin use and acute ICU transfers remained stable.
The implementation of BC bottle conservation measures did not negatively impact BC yields or patient safety indicators. Prospective studies are needed to re-evaluate traditional BC ordering and collection practices.
•Bloodstream infections are diagnosed by collecting 2-3 blood culture (BC) sets.•Advances in blood culturing techniques may allow diagnosis using fewer BC sets.•We responded to a sudden BC bottle shortage using diagnostic stewardship strategies.•To conserve BC bottles, use of single BC sets was implemented in specific scenarios.•Using single BC sets did not decrease BC yields