Publications by Year: 2025

Rumination, or perseverative negative self-referential thinking, is a hallmark of depression. In adults, a dynamic resting-state fMRI model of trait rumination was recently identified through predictive modelling. In adolescents, a development period during which rumination and depression increase, the neurobiological correlates of ruminative thinking are less clear. In the current preregistered study, we examine dynamic connectivity correlates of self-reported rumination in the largest sample of adolescents to date (n = 443, containing clinical and non-clinical individuals). Notably, the adult model failed to generalize to our sample. In addition, linear models trained on default-mode network (DMN) connectivity, as well as whole-brain connectome models, failed to generalize to held-out data. In an exploratory random forest analysis, we found significant prediction performance of a model where increased variability between DMN-cerebellum, DMN-dorsal attention network, and DMN-DMN connections was nominally associated with higher rumination. However, the model did not generalize to an external sample with lower rumination scores and a distinct scanner protocol. Our findings illustrate the difficulty of characterizing the neurodevelopment of risk factors for depression.

Ehlers-Danlos syndrome often presents with patellofemoral instability and, less commonly, proximal tibiofibular joint (PTFJ) instability, leading to compounded symptoms and functional impairment. This Technical Note describes a combined surgical approach for managing dual instability in patients with Ehlers-Danlos syndrome, involving medial patellofemoral ligament reconstruction and tibial tubercle osteotomy, in conjunction with PTFJ stabilization using an adjustable-loop cortical suspension device. This technique addresses biomechanical abnormalities and improves joint stability. Postoperative rehabilitation emphasizes controlled mobilization and progressive weightbearing. This comprehensive approach optimizes functional outcomes in patients with complex patellofemoral instability and PTFJ.

BACKGROUND: Obesity is a cardiovascular risk factor and coronary artery calcium (CAC) is frequently used to assess coronary atherosclerosis burden. The purpose of this study was to evaluate body mass index (BMI), waist circumference (WC), and waist-to-height ratio (WHtR) as predictors of CAC incidence.

METHODS: We analyzed ELSA-Brasil cohort participants with no cardiovascular disease who had an initial CAC score of zero and repeated the test. Multivariate logistic regression analyses were performed to assess BMI, WC, and WHtR as predictors of CAC incidence.

FINDINGS: A total of 2721 participants (mean age 48.1 ± 7.56 years, 62.6% females) self-reported as White (57%), Brown/mixed (22.8%), Black (15.4%), Asian (4%) or Native/Indigenous (0.9%) were analyzed. CAC incidence after a mean of 5.24 years was 15.5% (confidence interval [CI] 95%: 14.2-17%). In unadjusted analysis, BMI, WC, and WHtR were positively associated with CAC incidence with an odds ratio (OR) of 1.19 (CI 95%: 1.08-1.31), 1.37 (CI 95% 1.23-1.52) and 1.39 (CI 95%: 1.25-1.54) per standard deviation, respectively. In the fully adjusted model, WHtR was the only independent predictor of CAC incidence, OR: 1.18 (CI 95% 1.03-1.35) per standard deviation. This effect was mainly driven by individuals with BMI <30 kg/m2.

INTERPRETATION: WHtR was the only independent anthropometric measure predictor of atherosclerosis incidence assessed by coronary artery calcium score. This effect is particularly relevant in individuals with BMI <30 kg/m2.

FUNDING: National Council for Scientific and Technological Development (CNPq), Brazil.

Men who have sex with men (MSM) living with HIV who use substances often report internalized stigma associated with aspects of their identities and behaviors, which can negatively influence health behaviors including engagement in HIV care. Given the de-valuing nature of stigma, one's perception of their hierarchical rank in society may account for the relationships between internalized stigma and suboptimal engagement in HIV care. This study investigated relationships between internalized stigmas (i.e., linked to HIV-status, sexual orientation, and substance use), subjective social status in relation to one's community and the U.S., and missed HIV appointments among 143 MSM living with HIV who use substances. In bivariate regression models, internalized HIV stigma related to disclosure (OR = 1.46; confidence interval [CI]: 1.02, 2.09), and substance use stigma (OR = 1.07; CI:1.02, 1.12) were associated with greater odds of missing HIV appointments. Selfperception of higher social status in one's community (OR = 0.81; CI: 0.69, 0.96) and the U.S. (OR= 0.80; CI: 0.69, 0.94) were associated with lower odds of missing HIV appointments. Indirect effects models demonstrated that subjective social status in the U.S., but not in one's community, explained variance in the relationship between internalized HIV and sexual orientation stigmas and missing HIV appointments. Results suggest that perceptions of social status in the U.S. may partially account for the associations between internalized HIV and sexual orientation-related stigmas and sub-optimal engagement in HIV care, potentially related to the discriminatory policies and practices across the U.S., in contrast to more liberal states such as where this study took place. Efforts, including policies, are needed to stop the devaluation of people with stigmatized identities nationally, including those living with HIV and those who identify as sexual minorities, to improve the health and well-being of all people.

The electroencephalogram (EEG) offers physicians a window into their patients' neurologic and broader physiologic states. Frontal EEG interpretation is emerging as a core competency for anesthesiologists and intensivists. Part 1 of this series reviewed the basics of frontal EEG, including relevant biophysics, neuroanatomy, and anesthetic-mediated frontal EEG signatures of sedation and unconsciousness. In part 2, the authors outline a set of physiologic signatures that integrate the basics of EEG interpretation presented in part 1 with the systemic pathophysiology commonly seen in critical illness. They organize these signatures into a systematic framework to facilitate use of frontal EEG monitoring in the active management of critically ill patients. Finally, the authors use case examples to illustrate how the signatures and framework can guide patient-specific management.

AbstractType 2 diabetes (T2D) is a complex chronic disorder with an increasing prevalence. Treatment of T2D involves both lifestyle and pharmacologic interventions aimed at lowering blood glucose levels to help counteract the negative effects of long-term hyperglycemia. The range of pharmacologic treatments for T2D has grown substantially, with newer agents demonstrating not only glucose-lowering efficacy, but also reductions in long-term cardiometabolic complications. This review discusses the newest pharmacologic agents for the treatment of T2D and the evidence regarding their cardiometabolic benefits. We highlight key considerations for their use based on patient characteristics and clinical context. In addition, we discuss emerging pharmacologic therapies that target the underlying pathogenesis of T2D, underscoring ongoing advances in diabetes care.

This paper examines how people-centered accountability initiatives are operating to enforce the right to health amid Israel's genocide in Gaza. Drawing on a critical case study of Doctors Against Genocide, Healthcare Workers Watch, and the Freedom Flotilla Coalition, we situate these actors' work within international human rights law, social accountability scholarship, and decolonial and abolitionist critiques. We show how these actors are able to combine clinical documentation, survivor testimony, and direct action to monitor human rights violations, generate medically literate records of the harm inflicted, and press for remedies that state-centered mechanisms have failed to deliver despite findings of war crimes and genocide by United Nations bodies and human rights groups. Across these cases, we identify some common practices and tensions surrounding coalition-building, risks to documentation, navigating a media environment of mis/disinformation, and engaging strategically with institutions that often reproduce health harms or are directly complicit. We argue that these movements treat people-centered accountability as part of their professional duty and act on a mandate to prevent mass atrocity crimes rather than being silent. We conclude by outlining some practical implications for clinicians, professional associations, and health systems seeking to align their global health practice with a people-centered approach to accountability.

Among the many crimes committed during the Tigray war from 2020 to 2022, the systematic destruction of health care has been extensively documented and contributed to the suffering and death of hundreds of thousands of civilians. Despite the direct harm that Tigray's health care workers experienced and their role in sustaining care under siege, these professionals have been excluded from a transitional justice process that remains performative rather than substantive. We argue that this exclusion represents a violation of international legal obligations and a failure of both the Ethiopian government and the multilateral organizations involved through financing and diplomacy. Despite their marginalization, Tigrayan health workers have continued to exercise agency through sustained grassroots advocacy, documentation, and collective action. In this case study, we amplify the voices of these professionals as they assert their rights, record unacknowledged harms, and demand meaningful participation in the very mechanisms intended to deliver justice. Their experience demonstrates that truly centering victims requires centering health workers as well-addressing their material, legal, and psychological needs as part of any effort to uphold health as a human right.