UNASSIGNED: Vaccine clinical trials should strive to recruit a racially, socioeconomically, and ethnically diverse range of participants to ensure appropriate representation that matches population characteristics. Yet, full inclusion in research is often limited.
UNASSIGNED: A single-center retrospective study was conducted of adults enrolled at Brigham and Women\'s Hospital (Boston, MA) between July 2020 and December 2021. Demographic characteristics, including age, race, ethnicity, ZIP code, and sex assigned at birth, were analyzed from both HIV and COVID-19 vaccine trials during the study period, acknowledging the limitations to representation under these parameters. We compared the educational attainment of vaccine trial participants to residents of the Massachusetts metropolitan area, geocoded participants\' addresses to their census block group, and linked them to reported median household income levels from publicly available data for 2020. Frequency and quartile analyses were carried out, and spatial analyses were performed using ArcGIS Online web-based mapping software (Esri).
UNASSIGNED: A total of 1030 participants from four COVID-19 vaccine trials (n = 916 participants) and six HIV vaccine trials (n = 114 participants) were included in the analysis. The median age was 49 years (IQR 33-63) and 28 years (IQR 24-34) for the COVID-19 and HIV vaccine trials, respectively. Participants identifying as White were the majority group represented for both the COVID-19 (n = 598, 65.3%) and HIV vaccine trials (n = 83, 72.8%). Fewer than 25% of participants identified as Hispanic or Latin. Based on ZIP code of residence, the median household income for COVID-19 vaccine clinical trial participants (n = 846) was 102,088 USD (IQR = 81,442-126,094). For HIV vaccine clinical trial participants (n = 109), the median household income was 101,266 USD (IQR 75,052-108,832).
UNASSIGNED: We described the characteristics of participants enrolled for HIV and COVID-19 vaccine trials at a single center and found similitude in geographical distribution, median incomes, and proportion of underrepresented individuals between the two types of vaccine candidate trials. Further outreach efforts are needed to ensure the inclusion of individuals from lower educational and socioeconomic brackets. In addition, continued and sustained efforts are necessary to ensure inclusion of individuals from diverse racial and ethnic backgrounds.

(1) Background: Branched-chain and aromatic amino acids (BCAAs/AAAs) have been considered as markers of type 2 diabetes (T2D); however, studies on associations between these metabolites and T2D and cardiometabolic traits in Hispanic populations are limited. The aim of this study was to examine the associations between baseline BCAAs (isoleucine, leucine, valine)/AAAs (phenylalanine, tyrosine) and prevalent and incident T2D, as well as baseline and longitudinal (2 year) changes in cardiometabolic traits (measures of glycemia, dyslipidemia, inflammation, and obesity) in two large cohorts of adults of Puerto Rican descent. (2) Methods: We included participants of the Boston Puerto Rican Health Study (BPRHS, n = 670) and San Juan Overweight Adult Longitudinal study (SOALS, n = 999) with available baseline metabolite and covariate data. T2D diagnosis was defined based on American Diabetes Association criteria. Multivariable logistic (for baseline T2D), Poisson (for incident T2D), and linear (for cardiometabolic traits) regression models were used; cohort-specific results were combined in the meta-analysis and adjusted for multiple comparisons. (3) Results: Higher baseline BCAAs were associated with higher odds of prevalent T2D (OR1SD BCAA score = 1.46, 95% CI: 1.34-1.59, p < 0.0001) and higher risk of incident T2D (IRR1SD BCAA score = 1.24, 95% CI: 1.13-1.37, p < 0.0001). In multivariable longitudinal analysis, higher leucine and valine concentrations were associated with 2-year increase in insulin (beta 1SD leucine = 0.37 mcU/mL, 95% CI: 0.11-0.63, p < 0.05; beta 1SD valine = 0.43 mcU/mL, 95% CI: 0.17-0.68, p < 0.01). Tyrosine was a significant predictor of incident T2D (IRR = 1.31, 95% CI: 1.09-1.58, p < 0.05), as well as 2 year increases in HOMA-IR (beta 1SD tyrosine = 0.13, 95% CI: 0.04-0.22, p < 0.05) and insulin concentrations (beta 1SD tyrosine = 0.37 mcU/mL, 95% CI: 0.12-0.61, p < 0.05). (4) Conclusions: Our results confirmed the associations between BCAAs and prevalent and incident T2D, as well as concurrent measures of glycemia, dyslipidemia, and obesity, previously reported in predominantly White and Asian populations. Baseline leucine, valine, and tyrosine were predictors of 2 year increases in insulin, whereas tyrosine was a significant predictor of deteriorating insulin resistance over time. Our study suggests that BCAAs and tyrosine could serve as early markers of future glycemic changes in Puerto Ricans.

UNASSIGNED: Climate change is a fundamental threat to human health, and industries, including health care, must assess their respective contribution to this crisis.
UNASSIGNED: To assess the change in knowledge of clinicians who completed a quality incentive program (QIP) measure on climate change and health care sustainability and to examine clinician attitudes toward climate change and their perception of clinical and individual relevance.
UNASSIGNED: The participants in this survey study included employed physicians and psychologists who were part of a hospital physician organization in an academic medical center (AMC) in Boston, Massachusetts. The hospital physician organization provides a QIP with different measures every 6 months and provides incentive payments on completion. The study is based on a survey of participants on completion of a QIP measure focused on climate change and health care sustainability offered from July 2023 through September 2023 at the AMC.
UNASSIGNED: Structured educational video modules.
UNASSIGNED: After completion of the modules, the participants reported their baseline and postintervention knowledge on climate change impacts on health and health care sustainability, perceived relevance of the material, and attitudes toward the modules using 5-point Likert scales and free-text comments. Data were analyzed using univariate and multivariable analyses including participant age, gender, and practice specialty.
UNASSIGNED: Of the 2559 eligible clinicians, 2417 (94.5%) (mean [SD] age, 48.9 [11.5] years; range, 29-85 years; 1244 males [51.5%]) participated in the measure and completed the survey. Among these participants, 1767 (73.1%) thought the modules were relevant or very relevant to their lives and 1580 (65.4%) found the modules relevant or very relevant to their clinical practice. Age was not associated with responses. Practitioners in specialties classified as climate facing were more likely to think that the education was relevant to their clinical practice compared with those in non-climate-facing specialties (mean [SD] score, 3.76 [1.19] vs 3.61 [1.26]; P = .005). Practitioners identifying as female were also more likely to consider this education as relevant to their clinical practice compared with male practitioners (mean [SD] score, 3.82 [1.17] vs 3.56 [1.27]; P < .001).
UNASSIGNED: In this survey study, a high proportion of clinicians expressed positive attitudes toward education in climate change and health and health care sustainability, with some demographic and specialty variability. These data support that climate and health education in AMCs provides information that practitioners see as relevant and important.

Dietary inequities, influenced by sociocultural and economic factors, significantly affect health outcomes, particularly among underserved communities. To address these disparities, the Food is Medicine (FIM) movement strives to enhance access to nutritious food, provide education, and encourage behavioral changes. Boston Medical Center (BMC) \'s Nourishing Our Community Program (NOCP) exemplifies this mission by offering FIM services such as an on-site food pantry, rooftop farm, and teaching kitchen. However, persistent barriers hinder the effectiveness of programs like NOCP. This quality improvement (QI) project employed mixed methods to refine existing and develop new patient-generated nutrition education materials and resources across various FIM services.
METHODS: This QI project included surveys and focus groups conducted electronically and in person between January and May 2023. We analyzed the data using descriptive statistics and qualitative content analysis.
RESULTS: The analysis of results revealed patient preferences and experiences regarding dietary patterns, food choices, and nutrition education. These findings enhanced existing handouts, websites, and group class curricula and forged new partnerships with local community-based organizations.
CONCLUSIONS: Our findings underpin the importance of co-designing interventions, dynamic and multimodal resources, and cultural humility in care to meet individual needs.
CONCLUSIONS: This initiative is a model for hospitals aiming to improve educational resources within FIM services and tailor content to the specific needs of diverse patient populations. This project is the first step in programmatic improvement, and continuous refinement is crucial for sustained improvements and advancing health equity at our institution.

BACKGROUND: Recent studies have implicated acetyl-L-carnitine as well as other acylcarnitines in depression. To our knowledge, no untargeted metabolomics studies have been conducted among US mainland Puerto Ricans.
OBJECTIVE: We conducted untargeted metabolomic profiling on plasma from 736 participants of the Boston Puerto Rican Health Study.
METHODS: Using Weighted Gene Co-expression Network Analysis, we identified metabolite modules associated with depressive symptomatology, assessed via the Center for Epidemiologic Studies Depression scale. We identified metabolites contributing to these modules and assessed the relationship between these metabolites and depressive symptomatology.
RESULTS: 621 annotated metabolites clustered into eight metabolite modules, of which one, the acylcarnitine module, was significantly inversely associated with depressive symptomatology (β = - 27.7 (95% CI (- 54.5-0.8); p = 0.043). Several metabolite hub features in the acylcarnitine module were significantly associated with depressive symptomatology, after correction for multiple comparisons.
CONCLUSIONS: In this untargeted plasma metabolomics study among mainland Puerto Rican older adults, acylcarnitines, as a metabolite module were inversely associated with depressive symptomatology.

UNASSIGNED: Scoliosis, characterized by the lateral curvature of the spine, impacts the spine\'s alignment in three dimensions. Braces are commonly employed as a conservative treatment for individuals with scoliosis, particularly those with curves ranging from 20° to 40°. This treatment approach\'s primary objectives include arresting the deformity\'s progression, enhancing clinical appearance, alleviating pain, improving overall quality of life, and circumventing the need for surgical intervention. The aim of this study was to compare the effectiveness of Boston and Cheneau braces in individuals with scoliosis.
UNASSIGNED: In this retrospective study, 51 subjects were included and monitored over 2 years. The primary parameters under evaluation encompassed the severity of both primary and secondary curves and compliance with the prescribed treatment. The subjects were classified into 2 groups: those utilizing the Cheneau brace and those employing the Boston brace.
UNASSIGNED: The initial mean values of the primary and secondary curves during the first visit were 37.6 (±7.4) and 30.1 (±9.7) degrees, respectively. However, the in-brace curve measurements for the primary and secondary curves were 31.5 (±1.3) and 22.3 (±13.3) degrees, respectively (p-value=.0). The mean compliance values of subjects using Boston and Cheneau braces were 16.8 and 17.3 h per day, respectively (p-value=.1). No significant difference was observed in the correction achieved with the Boston and Cheneau braces during the follow-up period.
UNASSIGNED: The results of this study demonstrated a significant reduction in the scoliotic curve while under brace conditions. However, the degree of correction achieved did not significantly differ during the follow-up periods. Additionally, there was no notable variance in the correction obtained between the Boston and Cheneau braces.

Microplastics (MPs), discovered in oceans, lakes, and rivers, can infiltrate the food chain through ingestion by organisms, potentially posing health risks. Our research is the first to study the composition and distribution of MPs in Bosten Lake\'s sediment. In May, the average abundance of MPs was 0.95±0.72 particles per 10 gs, and in October, it was 0.90±0.61 particles per 10 gs. Bohu Town had the highest MP abundance, with 1.75±0.35 particles per 10 gs in spring and 2 ± 0 particles per 10 gs in autumn. In May, 53 % of the MPs were transparent, while in October, black MPs constituted 58 %. The predominant morphology was fibrous, accounting for 61 % of the total. MPs in the size range of 0.2-1 mm made up 91 % and 66 % of the total in May and October, respectively. The most common types of MPs in May were polyethylene terephthalate (PET) at 40 % and polyethylene (PE) at 26 %. In October, PET was the most prevalent at 71 %, followed by poly(ether-ether-ketone)(PEEK) at 11 %. Certain microbial taxa, such as Actinobacteriota, Pseudomonas, and Vicinamibacteraceae, associated with MP degradation or complex carbon chain breakdown, were notably enriched in sediment areas with high MP concentrations. A significant positive correlation was observed between the abundance of MPs in sediments and Actinobacteriota. Additionally, the abundance of Thiobacillus, Ca.competibacter, and other bacteria involved in soil element cycling showed a significant positive correlation with the organic matter content in the sediments. Anaerobic bacteria like Thermoanaerobacterium displayed a significant positive correlation with water depth. Our study reveals the presence, composition, and distribution of MPs in Bosten Lake\'s sediments, shedding light on their potential ecological impact.

Learning theories provide explanations for domestic violence; they can also aid in our understanding of the relation between contact sports and domestic violence. Notably, language used during sporting events and athletes\' behaviors being rewarded both on and off the field can influence the behaviors of viewers. Adubato (2016) found a statistically significant relation between an increase in domestic violence arrests and the kick-off times of Philadelphia Eagles football games. Here, we replicate and extend this work to Chicago and Boston. We examine quantitative, hourly data from the Chicago and Boston Police Departments and compare mean domestic violence arrests in an 8-hour period from the average Bears\' and Patriots\' (football) kick-off times, respectively, to the same time period on non-football Sundays, major holidays, and days of rival Blackhawks\' and Bruins\' (hockey) games, respectively. Results show a significant difference in average domestic violence arrests between hockey games and non-football Sundays in Chicago only. This work highlights the importance of context in examining domestic violence nationally and has implications for domestic violence policies in professional sports\' organizations.

BACKGROUND: Asians and Asian Americans have the lowest rate of mental health service utilization (25%) in the US compared to other racial/ethnic groups (39 - 52%), despite high rates of depression, anxiety, and suicidal ideation. The lack of culturally-responsive mental health trainings hinders access to mental health services for these populations. We assessed the mental health priorities of Asian communities in Greater Boston and evaluated cultural responsiveness of the Mental Health First Aid (MHFA), a first-responder training teaching participants skills to recognize signs of mental health and substance use challenges, and how to appropriately respond.
METHODS: This is community-based participatory research with the Boston Chinatown Neighborhood Center (BCNC), Asian Women For Health (AWFH), and the Addressing Disparities in Asian Populations through Translational Research (ADAPT) Coalition. We conducted focus groups with community-based organization staff and community members to assess mental health priorities of Asian populations in Boston, MA. We then evaluated the utility and cultural-responsiveness of the English-language MHFA for Asian populations through pre- and post-training questionnaires and focus groups with community participants. Paired t-tests were used to evaluate questionnaire responses. Thematic analysis was used to analyze interviews.
RESULTS: In total, ten staff and eight community members participated in focus groups, and 24 community members completed the MHFA and pre- and post-training questionnaires. Common mental health challenges in the Asian communities reported by participants were loneliness, high stigma around mental illnesses, academic pressure, and acculturation stress. Compared to pre-training, MHFA participants demonstrated lower personal mental health stigma (p < 0.001) and higher mental health literacy (p = 0.04) post-training. Participants also noted the lack of data statistics and case studies relevant to Asian populations in the training, and desired the training be offered in languages spoken by Asian ethnic subgroups (e.g., Chinese, Vietnamese).
CONCLUSIONS: Cultural-responsiveness of the MHFA for Asian populations could be improved with the inclusion of data and case studies that capture common mental health challenges in the Asian communities and with translation of the MHFA to non-English languages predominant in Asian communities. Increasing the cultural relevance and language accessibility of the MHFA could facilitate wider adoption of these trainings across communities and help to reduce mental health stigma and gaps in literacy and service utilization.

UNASSIGNED: Parametric g-computation is an attractive analytic framework to study the health effects of air pollution. Yet, the ability to explore biologically relevant exposure windows within this framework is underdeveloped.
UNASSIGNED: We outline a novel framework for how to incorporate complex lag-responses using distributed lag models (DLMs) into parametric g-computation analyses for survival data. We call this approach \"g-survival-DLM\" and illustrate its use examining the association between PM2.5 during pregnancy and the risk of preterm birth (PTB).
UNASSIGNED: We applied the g-survival-DLM approach to estimate the hypothetical static intervention of reducing average PM2.5 in each gestational week by 20% on the risk of PTB among 9,403 deliveries from Beth Israel Deaconess Medical Center, Boston, Massachusetts, 2011-2016. Daily PM2.5 was taken from a 1-km grid model and assigned to address at birth. Models were adjusted for sociodemographics, time trends, nitrogen dioxide, and temperature. To facilitate implementation, we provide a detailed description of the procedure and accompanying R syntax.
UNASSIGNED: There were 762 (8.1%) PTBs in this cohort. The gestational week-specific median PM2.5 concentration was relatively stable across pregnancy at ∼7μg/m3. We found that our hypothetical intervention strategy changed the cumulative risk of PTB at week 36 (i.e., the end of the preterm period) by -0.009 (95% confidence interval: -0.034, 0.007) in comparison with the scenario had we not intervened, which translates to about 86 fewer PTBs in this cohort. We also observed that the critical exposure window appeared to be weeks 5-20.
UNASSIGNED: We demonstrate that our g-survival-DLM approach produces easier-to-interpret, policy-relevant estimates (due to the g-computation); prevents immortal time bias (due to treating PTB as a time-to-event outcome); and allows for the exploration of critical exposure windows (due to the DLMs). In our illustrative example, we found that reducing fine particulate matter [particulate matter (PM) with aerodynamic diameter ≤2.5μm (PM2.5)] during gestational weeks 5-20 could potentially lower the risk of PTB. https://doi.org/10.1289/EHP13891.