BACKGROUND: The Healthy People initiative is a national effort to lay out public health goals in the United States every decade. In its latest iteration, Healthy People 2030, key goals related to contraception focus on increasing the use of effective birth control (contraceptive methods classified as most or moderately effective for pregnancy prevention) among women at risk of unintended pregnancy. This narrow focus is misaligned with sexual and reproductive health equity, which recognizes that individuals\' self-defined contraceptive needs are critical for monitoring contraceptive access and designing policy and programmatic strategies to increase access.
OBJECTIVE: We aimed to compare 2 population-level metrics of contraceptive access: a conventional metric, use of contraceptive methods considered most or moderately effective for pregnancy prevention among those considered at risk of unintended pregnancy (approximating the Healthy People 2030 approach), and a person-centered metric, use of preferred contraceptive method among current and prospective contraceptive users.
METHODS: We used nationally representative data collected in 2022 to construct the 2 metrics of contraceptive access; the overall sample included individuals assigned female at birth not using female sterilization or otherwise infecund and who were not pregnant or trying to become pregnant (unweighted N=2760; population estimate: 43.9 million). We conducted a comparative analysis to examine the convergence and divergence of the metrics by examining whether individuals met the inclusion criteria for the denominators of both metrics, neither metric, only the conventional metric, or only the person-centered metric.
RESULTS: Comparing the 2 approaches to measuring contraceptive access, we found that 79% of respondents were either included in or excluded from both metrics (reflecting that the metrics converged when individuals were treated the same by both). The remaining 21% represented divergence in the metrics, with an estimated 5.7 million individuals who did not want to use contraception included only in the conventional metric denominator and an estimated 3.5 million individuals who were using or wanted to use contraception but had never had penile-vaginal sex included only in the person-centered metric denominator. Among those included only in the conventional metric, 100% were content nonusers-individuals who were not using contraception, nor did they want to. Among those included only in the person-centered metric, 68% were currently using contraception. Despite their current or desired contraceptive use, these individuals were excluded from the conventional metric because they had never had penile-vaginal sex.
CONCLUSIONS: Our analysis highlights that a frequently used metric of contraceptive access misses the needs of millions of people by simultaneously including content nonusers and excluding those who are using or want to use contraception who have never had sex. Documenting and quantifying the gap between current approaches to assessing contraceptive access and more person-centered ones helps clearly identify where programmatic and policy efforts should focus going forward.

Background More research is required to understand the effects of implementing structured goal-setting on trainee engagement in competency-based clinical learning environments. Objective To explore how residents experienced a rotation-specific goal-setting intervention on geriatric medicine rotations at 2 hospitals. Methods All rotating residents were expected to complete the intervention, consisting of a SMART-based (Specific, Measurable, Achievable, Relevant, and Time-Bound) goal-setting form and feedback sessions with teaching faculty. From November 2019 to June 2021, we recruited a convenience sample of rotating residents. Study participants completed pre- and postrotation 35-item Dutch Residency Educational Climate Test (D-RECT) questionnaires to compare scores from their rotation before the geriatric rotation and a postrotation semistructured interview, which we transcribed and analyzed using principles of constant comparison and reflexive thematic analysis. Results We interviewed 12 of 58 (20.7%) residents participating in the goal-setting intervention, 11 of whom completed both D-RECT questionnaires. Participants\' D-RECT scores favored the geriatric medicine rotation versus the immediately preceding clinical rotation (M=4.29±0.37; M=3.84±0.44, P=.002). Analyses of interview transcripts yielded 3 themes on how participants perceived the intervention influenced their learning experience: (1) structured forms and processes mediate, inform, and constrain goal selection; (2) interactions with faculty, patients, and system factors influenced goal enactment; and (3) unstructured assessments led to uncertainty around goal achievement. Challenges included time restrictions and unpredictable clinical opportunities. Conclusions Goal-setting appeared to help many residents direct their learning efforts and engage in collaborative processes with teaching faculty. We identified challenges limiting residents\' engagement with the goal-setting intervention, which may inform the practical implementation of goal-setting in other competency-based curricula.

BACKGROUND: A critical view of safety (CVS) is important to ensure safe laparoscopic cholecystectomy. When the CVS is not possible, subtotal cholecystectomy is performed. While considering subtotal cholecystectomy, surgeons are often concerned about preventing bile leakage from the cystic ducts. The two main types of subtotal cholecystectomy for acute cholecystitis are fenestrating and reconstituting. Previously, there were no selection criteria for these two; therefore, open conversion was performed. This study aimed to evaluate our goal-oriented approach to choose fenestrating or reconstituting subtotal cholecystectomy for acute cholecystitis.
METHODS: We introduced our goal-oriented approach in April 2019. Before introducing this approach, laparoscopic cholecystectomy for acute cholecystitis was performed without criteria for subtotal cholecystectomy. After our approach was introduced, laparoscopic cholecystectomy for acute cholecystitis was performed according to the subtotal cholecystectomy criteria. We retrospectively reviewed the medical records of patients who underwent laparoscopic cholecystectomy for acute cholecystitis between 2015 and 2021. Laparoscopic cholecystectomy for acute cholecystitis was performed by surgeons regardless of whether they were novices or veterans.
RESULTS: The period from April 2015 to March 2019 was before the introduction (BI) of our approach, the period from April 2019 to December 2021 was after the introduction (AI) of our approach. There were 177 and 186 patients with acute cholecystitis during the BI and AI periods, respectively. There were no significant differences between groups in terms of preoperative characteristics, operative time, and blood loss. No difference in the laparoscopic subtotal cholecystectomy rate between groups (10.2% [BI] vs. 13.9% [AI]; p = 0.266) was obserbed. The open conversion rate during the BI period was significantly higher than that during the AI period (7.4% vs. 1.6%; p = 0.015).
CONCLUSIONS: Our goal-oriented approach is feasible, safe, and easy for many surgeons to understand.

When the goal is to help patients improve their quality of life, it makes sense to focus directly on the activities and relationships that are most important to each patient. This can be accomplished most effectively by following a three-step process that includes 1) connecting with the patient around what matters to them, 2) co-creating a goal-oriented plan, and 3) collaborating with patient, family, team members, and consultants to increase the probability of success. Once this approach has been mastered and the necessary systems, processes, and relationships are in place, this should not take more time than a problem-oriented approach, and it will almost certainly be more satisfying for both physician and patient. The impact on population-based quality metrics is uncertain. Though fewer patients may choose to follow standard recommendations, those who do may be more likely to adhere to them.

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Voluntary National Reviews (VNRs) provide a platform for participating countries to share their experiences, failures, and successes in achieving the United Nations (UN) Sustainable Development Goals (SDGs). The objective of this study is to gain a deeper understanding of the narrative elements, particularly the sentiment, in VNRs in order to more effectively assess and support global SDG progress. A total of 232 VNRs from 166 countries are analyzed using Aspect-Based Sentiment Analysis (ABSA) to extract each country\'s sentiment toward the 17 SDGs. The sentiment scores are then compared to the corresponding official UN SDG scores, and countries are grouped by their sentiment toward all 17 SDGs to identify potential common development pathways. The analysis uncovers a notable positive correlation between the reported sentiment and official SDG scores for SDG 2 (zero hunger) and SDG 11 (sustainable cities and communities), and a negative correlation for SDG 5 (gender equality). Conversely, this relationship is not significant for the majority of SDGs, suggesting that VNR narratives may not directly reflect actual progress. A t-distributed stochastic neighbor embedding (t-SNE) approach indicates a consistent sentiment score among developed countries. In contrast, there are greater differences in reporting sentiment among Emerging Markets, Frontier Markets, and Least Developed Countries (LDCs), where there is greater dispersion (especially among LDCs) and sentiment in reporting on SDG progress that appears to have changed from one reporting year to another. These findings highlight the need to interpret VNRs in the context of each country\'s unique situation and challenges specific to each country.

This study systematically evaluates biomimicry research within the context of sustainable development goals (SDGs) to discern the interdisciplinary interplay between biomimicry and SDGs. The alignment of biomimicry with key SDGs showcases its interdisciplinary nature and potential to offer solutions across the health, sustainability, and energy sectors. This study identified two primary thematic clusters. The first thematic cluster focused on health, partnership, and life on land (SDGs 3, 17, and 15), highlighting biomimicry\'s role in healthcare innovations, sustainable collaboration, and land management. This cluster demonstrates the potential of biomimicry to contribute to medical technologies, emphasizing the need for cross-sectoral partnerships and ecosystem preservation. The second thematic cluster revolves around clean water, energy, infrastructure, and marine life (SDGs 6, 7, 9, and 14), showcasing nature-inspired solutions for sustainable development challenges, including energy generation and water purification. The prominence of SDG 7 within this cluster indicates that biomimicry significantly contributes to sustainable energy practices. The analysis of thematic clusters further revealed the broad applicability of biomimicry and its role in enhancing sustainable energy access and promoting ecosystem conservation. Emerging research topics, such as metaheuristics, nanogenerators, exosomes, and bioprinting, indicate a dynamic field poised for significant advancements. By mapping the connections between biomimicry and SDGs, this study provides a comprehensive overview of the field\'s trajectory, emphasizing its importance in advancing global sustainability efforts.

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People regularly encounter various types of conflict. Here, we ask if, and, if so, how, different types of conflict, from lab-based Stroop conflicts to everyday-life self-control or moral conflicts, are related to one other. We present a framework that assumes that action-goal representations are hierarchically organized, ranging from concrete actions to abstract goals. The framework\'s key assumption is that conflicts involving more abstract goals (e.g., self-control/moral conflict) are embedded in a more complex action space; thus, to resolve such conflicts, people need to consider more associated goals and actions. We discuss how differences in complexity impact conflict resolution mechanisms and the costs/benefits of resolving conflicts. Altogether, we offer a new way to conceptualize and analyze conflict regulation across different domains.

New tasks are often learned in stages with each stage reflecting a different learning challenge. Accordingly, each learning stage is likely mediated by distinct neuronal processes. And yet, most rodent studies of the neuronal correlates of goal-directed learning focus on individual outcome measures and individual brain regions. Here, we longitudinally studied mice from naïve to expert performance in a head-fixed, operant conditioning whisker discrimination task. In addition to tracking the primary behavioral outcome of stimulus discrimination, we tracked and compared an array of object-based and temporal-based behavioral measures. These behavioral analyses identify multiple, partially overlapping learning stages in this task, consistent with initial response implementation, early stimulus-response generalization, and late response inhibition. To begin to understand the neuronal foundations of these learning processes, we performed widefield Ca2+ imaging of dorsal neocortex throughout learning and correlated behavioral measures with neuronal activity. We found distinct and widespread correlations between neocortical activation patterns and various behavioral measures. For example, improvements in sensory discrimination correlated with target stimulus evoked activations of response-related cortices along with distractor stimulus evoked global cortical suppression. Our study reveals multidimensional learning for a simple goal-directed learning task and generates hypotheses for the neuronal modulations underlying these various learning processes.