We surveyed physicians and patients to create a novel Desirability of outcome ranking (DOOR) for non-severe community-acquired pneumonia (CAP). Patients generally ranked uncomfortable but non-life-threatening symptoms as less desirable, while physicians focused on traditional medical outcomes. When developing DOORs, both patient and clinician perspectives should be considered.

In sub-Saharan Africa’s endemic areas for urogenital schistosomiasis, male genital schistosomiasis (MGS) can cause significant morbidity. As part of the Hybridization in UroGenital Schistosomiasis investigation, an MGS sub-study examined a cohort of adult men over a calendar year to better ascertain general infection dynamics and putative zoonotic schistosome transmission. During follow-up, demographic, health and socio-economic data were collected through individual questionnaire interviews. Collected urine and semen were analysed using urine filtration, urine and semen microscopy and molecular DNA analyses of semen. Ten participants with reported MGS-associated symptoms had Schistosoma eggs in their urine and semen at 6-month follow-up, with seven at 12 months. Ten out of 11 participants with Schistosoma haematobium eggs on semen microscopy at baseline had persistent infection at 6-month follow-up, together with 6 new participants, giving an MGS prevalence of 84·2% (n = 19). Two also had Schistosoma mattheei eggs co-infection. Four of the 13 participants at 12-month follow-up had S. haematobium eggs in their semen which were persistent at all the time points. Using semen PCR, 14 participants (73·7%) had Schistosoma infection at 6 months, with only 2 participants being infected for first time. Upon DNA analysis, three participants also had hybrid co-infection at this time point. At 12 months, only 6 participants had Schistosoma infection with no hybrids detected. In summary, like S. haematobium and despite praziquantel treatment, both zoonotic and hybrid schistosomes can continue to cause MGS, which pose a further tangible challenge in future management and control measures.

Background: Dichotomous outcomes rarely capture the range of potential outcomes important to patients and clinicians. To address this limitation, the Desirability of Outcome Ranking (DOOR) score was created to rank potential outcomes from least to most desirable. Currently, there is no standardized method to develop a DOOR score and data are limited on whether patients and their clinicians rank outcomes similarly. We aimed: (a) to develop a novel DOOR score for adults hospitalized with community-acquired pneumonia (CAP) by surveying patients and clinicians on their preferred outcome ranking and (b) to compare their relative DOOR rankings. Methods: We created nine clinical scenarios describing the spectrum of potential outcomes of patients with CAP two weeks after initial emergency department visit. To ascertain clinician DOOR score, we used a snowball sampling method to recruit a target of 25 clinicians in specialties that regularly treat CAP. For the patient DOOR score, we recruited patients hospitalized with CAP by reviewing electronic patient lists for adults hospitalized with pneumonia. Respondents were asked to rank the 9 cases from most to least desirable in REDCap. To create the final DOOR score, we used Friedman rank sum tests to combine/collapse DOOR outcomes with scores that did not significantly differ. We used the Mann Whitney U test to compare DOOR rankings between physicians and patients. Final study results were presented to a national hospital medicine patient and family advisory committee (PFAC) for their impressions. Results: 22 patients (71% response rate) and 25 clinicians responded to our DOOR survey. Their ranked order of DOOR outcomes is shown in Table 1. Combining non-significantly different DOOR outcomes resulted in collapsing of 6 cases into 2 categories for 5 overall DOOR scores that significantly differed from each other (Table 1 for final ranking). Patients and clinicians had significantly different preferred ranking for 6 DOOR cases. Our PFAC had several hypotheses as to why rankings differed (Table 2). Conclusion: We present a novel DOOR score derived from patient and clinician reported preferences for outcomes of hospitalized adult patients with CAP. Clinicians and patients differed in their perception of certain outcomes with patients ranking symptoms that were uncomfortable but not potentially life-threatening as less desirable than physicians. Physicians tended to rank quality linked metrics such as readmission as worse than patients. When designing future trials using DOOR scores, researchers should consider including patients in DOOR score design as their perspectives may differ from clinicians.

We present the first results from the COS-EDGES survey, targeting the kinematic connection between the interstellar medium and multi-phase circumgalactic medium (CGM) in nine isolated, near-edge-on galaxies at $z\sim0.2$, each probed along its major axis by a background quasar at impact parameters of $D=13-38$ kpc. Using VLT/UVES and HST/COS quasar spectra, we analyse Mgi, Mgii, Hi, Cii, Ciii, and Ovi absorption relative to galaxy rotation curves from Keck/LRIS and Magellan/MagE spectra. We find that low ionisation absorption for 8/9 galaxies lies below the halo escape velocity, indicating bound inflow or recycling gas, while 6/9 galaxies have high ionisation gas reaching above the halo escape velocity, suggesting some unbound material. We find that at lower $D/R_{\textrm{vir}}$ ($0.12\leq D/R_{\textrm{vir}} \leq0.20$), over 80% of absorption in all ions lies on the side of systemic velocity matching disk rotation, and the optical-depth–weighted median velocity ($v_{abs}$) is consistent with the peak rotation speed. At higher $D/R_{\textrm{vir}}$ ($0.21\leq D/R_{\textrm{vir}} \leq0.31$), the kinematics diverge by ionisation state: For the low ionisation gas, the amount of co-rotating absorption remains above 80%, yet $v_{abs}$ drops to roughly 60% of the galaxy rotation speed. For the high ionisation gas (Ovi), only 60% of the absorption is consistent with co-rotation and $v_{abs}$ drops to 20% of the galaxy rotation speed. Furthermore, the velocity widths, corresponding to 50% of the total optical depth ($\Delta v_{50}$) for low ionisation gas is up to 1.8 times larger in the inner halo than at larger radii, while for Ciii and Ovi $\Delta v_{50}$ remains unchanged with distance. The 90% optical-depth width ($\Delta v_{90}$) shows a modest decline with radius for low ionisation gas but remains constant Ciii and Ovi. At high $D/{R}_{\textrm{vir}}$, both $\Delta v_{50}$ and $\Delta v_{90}$ increase with ionisation potential. These results suggest a radially dependent CGM kinematic structure: the inner halo hosts cool, dynamically broad gas tightly coupled to disk rotation, whereas beyond $\gtrsim 0.2 R_{\textrm{vir}}$, particularly traced by Ovi and Hi, the CGM shows weaker rotational alignment and lower relative velocity dispersion. Therefore, low-ionisation gas likely traces extended co-rotating gas, inflows and/or recycled accretion, while high-ionisation gas reflects a mixture of co-rotating, lagging, discrete collisionally ionised structures and volume-filling warm halo, indicating a complex kinematic stratification of the multi-phase CGM.

Diagnostic classification models assume the existence of latent attribute profiles, the possession of which increases the probability of responding correctly to questions requiring the corresponding attributes. Through the use of longitudinally administered exams, the degree to which students are acquiring core attributes over time can be assessed. While past approaches to longitudinal diagnostic classification modeling perform inference on the overall probability of acquiring particular attributes, there is particular interest in the relationship between student progression and student covariates such as intervention effects. To address this need, we propose an integrated Bayesian model for student progression in a longitudinal diagnostic classification modeling framework. Using Pòlya-gamma augmentation with two logistic link functions, we achieve computationally efficient posterior estimation with a conditionally Gibbs sampling procedure. We show that this approach achieves accurate parameter recovery when evaluated using simulated data. We also demonstrate the method on a real-world educational testing data set.

Multicenter clinical trials are essential for evaluating interventions but often face significant challenges in study design, site coordination, participant recruitment, and regulatory compliance. To address these issues, the National Institutes of Health’s National Center for Advancing Translational Sciences established the Trial Innovation Network (TIN). The TIN offers a scientific consultation process, providing access to clinical trial and disease experts who provide input and recommendations throughout the trial’s duration, at no cost to investigators. This approach aims to improve trial design, accelerate implementation, foster interdisciplinary teamwork, and spur innovations that enhance multicenter trial quality and efficiency. The TIN leverages resources of the Clinical and Translational Science Awards (CTSA) program, complementing local capabilities at the investigator’s institution. The Initial Consultation process focuses on the study’s scientific premise, design, site development, recruitment and retention strategies, funding feasibility, and other support areas. As of 6/1/2024, the TIN has provided 431 Initial Consultations to increase efficiency and accelerate trial implementation by delivering customized support and tailored recommendations. Across a range of clinical trials, the TIN has developed standardized, streamlined, and adaptable processes. We describe these processes, provide operational metrics, and include a set of lessons learned for consideration by other trial support and innovation networks.

Aims: Specialist mood disorder services in the UK are diverse in structure and spread over different clinical-academic centres in the UK. Relationships between these centres are strong but often based on academic projects, with limited opportunities for clinical case discussions. The NIHR Mental Health Translational Research Collaboration, together with the ASCEnD trial team, has set up an online monthly meeting of tertiary mood disorder services: the Mood Disorders Grand Rounds (MDGR). The aims are: 1) to bring together people with expertise and interest from different centres across the UK; 2) to discuss complex and difficult to treat (or interesting) cases; 3) to consider treatment options. The format includes a 20-minute anonymised case presentation by a specialist, covering clinical and thematic aspects, followed by a 40-minute panel discussion focusing on case management, related themes, and relevant research studies. The presentership rotates between centres around the country and encourages a multidisciplinary approach.

Following the first 12 months of MDGR, we distributed a survey to evaluate and develop the meetings.

Methods: An evaluation form was developed and sent to all registered attendees over the course of six months, on a rolling basis. Participants were asked to both rate the effectiveness of various aspects of the programme and to submit suggestions for improvement, including suggestions for future speakers. Questions included both Likert scored items and free text responses.

Results: We received 21 responses (12% of those registered). 75% of respondents had not been to a similar regular collaborative programme previously. 50% of respondents stated that the MDGR had directly influenced their clinical practice, examples being of “Using MAOIs in a case where I hadn’t considered it before” and “identification of a patient with likely autoimmune encephalitis”. The remaining 50% stated that whilst the programme was relevant it had not had a direct result on practice.

Conclusion: A high proportion of respondents reported their clinical practice had been directly influenced by attendance. This suggests the MDGR is fulfilling the stated aim of focusing on clinical discussions and is of value to attenders. The rate of response is low and could be biased to those who found it more useful.

Recent changes to US research funding are having far-reaching consequences that imperil the integrity of science and the provision of care to vulnerable populations. Resisting these changes, the BJPsych Portfolio reaffirms its commitment to publishing mental science and advancing psychiatric knowledge that improves the mental health of one and all.

The global utility of acceptance and commitment therapy highlights the need for adapting measures that can effectively capture the richness of psychological flexibility. One such instrument is the Comprehensive Assessment of Acceptance and Commitment Therapy Processes (CompACT). We translated the CompACT into Luganda and adapted it for use in Uganda. The original CompACT was translated into the Luganda language and reviewed through a series of evaluations. Nine mental health professionals participated in one-on-one interviews, while a focus group of eight culturally competent laypersons provided further insights. Their feedback resulted in revisions to enhance the instrument’s clarity, relevance, acceptability and completeness. The revised version was then cognitively tested with n = 25 trainees at Makerere University. Input from these various groups was synthesized and triangulated to develop the final version. A total of 23 items were adapted to improve the comprehensibility and completeness of the scale. Overall, respondents deemed the tool clear and acceptable. This study highlights the importance of a rigorous adaptation process, including translation, expert review, cognitive testing and feedback triangulation, to ensure psychological measures remain valid and relevant across cultures. Such an approach ensures accuracy in diverse contexts and provides a model for adapting psychological instruments for non-Western populations.

The stars of the Milky Way carry the chemical history of our Galaxy in their atmospheres as they journey through its vast expanse. Like barcodes, we can extract the chemical fingerprints of stars from high-resolution spectroscopy. The fourth data release (DR4) of the Galactic Archaeology with HERMES (GALAH) Survey, based on a decade of observations, provides the chemical abundances of up to 32 elements for 917 588 stars that also have exquisite astrometric data from the Gaia satellite. For the first time, these elements include life-essential nitrogen to complement carbon, and oxygen as well as more measurements of rare-earth elements critical to modern-life electronics, offering unparalleled insights into the chemical composition of the Milky Way. For this release, we use neural networks to simultaneously fit stellar parameters and abundances across the whole wavelength range, leveraging synthetic grids computed with Spectroscopy Made Easy. These grids account for atomic line formation in non-local thermodynamic equilibrium for 14 elements. In a two-iteration process, we first fit stellar labels to all 1 085 520 spectra, then co-add repeated observations and refine these labels using astrometric data from Gaia and 2MASS photometry, improving the accuracy and precision of stellar parameters and abundances. Our validation thoroughly assesses the reliability of spectroscopic measurements and highlights key caveats. GALAH DR4 represents yet another milestone in Galactic archaeology, combining detailed chemical compositions from multiple nucleosynthetic channels with kinematic information and age estimates. The resulting dataset, covering nearly a million stars, opens new avenues for understanding not only the chemical and dynamical history of the Milky Way but also the broader questions of the origin of elements and the evolution of planets, stars, and galaxies.

Objectives/Goals: Cerebral amyloid angiopathy (CAA) characterized by the accumulation of amyloid-beta in the cerebrovasculature, affects blood vessel integrity leading to brain hemorrhages and an accelerated cognitive decline in Alzheimer’s disease patients. In this study, we are conducting a genome-wide association study to identify genetic risk factors for CAA. Methods/Study Population: We genotyped 1253 additional AD cases using and curated existing genome-wide genotype data from 110 AD and 502 non-AD donors from the Mayo Clinic Brain Bank. We performed QC and imputation of all datasets. We conducted GWAS in AD only (N =  1,363), non-AD only, as well as the combined cohort (N = 1,865) by testing imputed variant dosages for association with square root transformed CAA using linear regression, adjusting for relevant covariates. To assess associations in the context of major CAA risk factors, we performed interaction analysis with APOEe4 presence and sex; and pursued stratified analyses. We collected peripheral gene expression measures using RNA isolated from 188 PAXgene tube samples of 95 donors collected across multiple time points. More than 1/3 of these participants have MRI measures collected. Results/Anticipated Results: Variants at the APOE locus were identified as the most significant in our study. In addition, several other variants with suggestive association were found under the main model adjusting for AD neuropathology (Braak and Thal). LINC-PINT splice variant remained associated with lower CAA scores in AD cases without the APOEe4 risk allele. To enhance the robustness of our findings, we are pursuing further expansion of our study cohort. In the periphery, we expect to identify expression changes associated with neuroimaging indicators of CAA and determine if variants and genes discovered via GWAS are implicated in these changes. Discussion/Significance of Impact: We expect this study will provide further insight into the genetic architecture underlying risk for CAA both in the context of significant AD pathology and without. Characterization of genetic variants and functional outcomes in the context of neuropathology may lead to new avenues of research aimed at identifying biomarkers and therapies to treat CAA