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PURPOSE: To evaluate the safety and efficacy of ultrasound-guided percutaneous thrombin injection for the treatment of upper extremity pseudoaneurysms. METHODS: An institutional database containing 8,316,467 radiology reports was searched for suitable cases over a 241-month period. Fourteen female and 10 male patients, average age of 69.7 years (range 29-93) underwent a total of 26 procedures for the management of upper extremity pseudoaneurysms, involving the radial (n = 9), brachial (n = 9) or other upper extremity arteries (n = 6). Baseline demographic and pseudoaneurysm characteristics were documented, together with primary and secondary success, failures, and complications. All procedures were performed with real-time ultrasound guidance. RESULTS: The mean pseudoaneurysm volume was 9.93 cm3 (range 0.06-111.62 cm3). Twelve cases were related to central line placement or arterial access. Primary success was obtained in 50% (n = 12) after a single ultrasound-guided thrombin injection, and secondary success was achieved in an additional six (for a total success of 75%). Success was highest for the treatment of brachial artery pseudoaneurysms (87.5%), and in those who were diagnosed within 7 days of the inciting event, findings that were statistically significant (p-value 0.046 and 0.002, respectively). CONCLUSIONS: Ultrasound-guided percutaneous thrombin injection is safe and effective for managing upper extremity pseudoaneurysms.

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OBJECTIVE: Assessment of the readability, accuracy, quality, and completeness of ChatGPT (Open AI, San Francisco, CA), Gemini (Google, Mountain View, CA), and Claude (Anthropic, San Francisco, CA) responses to common questions about rhinoplasty. METHODS: Ten questions commonly encountered in the senior author's (SPM) rhinoplasty practice were presented to ChatGPT-4, Gemini and Claude. Seven Facial Plastic and Reconstructive Surgeons with experience in rhinoplasty were asked to evaluate these responses for accuracy, quality, completeness, relevance, and use of medical jargon on a Likert scale. The responses were also evaluated using several readability indices. RESULTS: ChatGPT achieved significantly higher evaluator scores for accuracy, and overall quality but scored significantly lower on completeness compared to Gemini and Claude. All three chatbot responses to the ten questions were rated as neutral to incomplete. All three chatbots were found to use medical jargon and scored at a college reading level for readability scores. CONCLUSIONS: Rhinoplasty surgeons should be aware that the medical information found on chatbot platforms is incomplete and still needs to be scrutinized for accuracy. However, the technology does have potential for use in healthcare education by training it on evidence-based recommendations and improving readability. LEVEL OF EVIDENCE V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

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Land use influences surface water quality, often alleviating stoichiometric constraints on primary production and altering biogeochemical cycling. However, land use effects on nutrient content and potential trace metal accumulation in aquatic plants remain unclear, and high concentrations of metals and altered nutrient ratios could impact the health of herbivores and detritivores. We tested for land use effects on nutrient and trace metal accumulation in a widespread riverine macrophyte, Podostemum ceratophyllum, collected from 91 locations from Georgia to Maine, USA in 2014-2016. We quantified carbon (C), nitrogen (N), phosphorus (P), their molar and mass ratios, N and C stable isotopes, and 17 additional elements in dried plants collected from each location to estimate relationships between plant tissue content and watershed land use, which we quantified as agriculture, forest, and development. Decreasing forest cover was correlated with increasing δ15N, Mg, Mn, and P in Podostemum tissue. Increasing urban development was correlated with increasing δ15N, Mg and P, while increasing agriculture was correlated with a decrease in C: P and the concentrations of multiple metals, along with increases in P, Mg and δ15N. Decreases in ratios of N: P and C:P with increasing agriculture and urban development in the watershed indicate more rapid P storage relative to C and N in plant tissue, and increased resource quality of the plant to consumers in these watersheds. We also observed potentially toxic dietary concentrations of some trace metals (B, Cd, Tl, Zn) in plant tissue which could be related to the plant's natural herbivory defense system or to land use. We conclude that land use influences the elemental composition of P. ceratophyllum, and potentially the quality and toxicity of the plant to herbivores and detritivores in eastern North American rivers.

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Research shows the impact of cultural stressors (e.g. perceived discrimination, bicultural stressors, negative context of reception) on adolescents' psychosocial outcomes. Given the presence of multiple cultural stressors in many Hispanic adolescents' lives, it is essential to examine the (a) developmental sequencing of cultural stressors among recent immigrant youth and (b) predictive effects of cultural stressors on adolescents' psychosocial outcomes. We employed a random intercept cross-lagged panel model to examine the longitudinal interplay among cultural stressors and their effects on youth outcomes using longitudinal data with six waves among 302 recently immigrated Hispanic adolescents (47% girls, Mage = 14.51, SD = .88). We observed bidirectional within-person relations and between-person associations among cultural stressors. At the within-person level, bidirectional cross-lagged effects emerged between perceived discrimination and bicultural stress, between perceived discrimination and negative context of reception, and between negative context of reception and bicultural stress. At the between-person level, bidirectional cross-lagged effects emerged only between perceived discrimination and bicultural stressors. Our findings indicate that cultural stressors explain heterogeneity in psychosocial outcomes: self-esteem was inversely predicted by all cultural stressors, whereas depressive symptoms were predicted only by perceived discrimination. In addition, optimism was predicted only by bicultural stressors, and externalizing behavior was predicted by both bicultural stressors and perceived discrimination. These results suggest that the longitudinal relationships among cultural stressors are (partly) bidirectional. Additionally, cultural stressors demonstrated differential predictive effects on psychosocial outcomes, indicating the added value of considering multiple cultural stressors and their longitudinal effects on adolescents' psychosocial outcomes.

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Increased temperatures are altering rates of organic matter (OM) breakdown in stream ecosystems with implications for carbon (C) cycling in the face of global change. The metabolic theory of ecology (MTE) provides a framework for predicting temperature effects on OM breakdown, but differences in the temperature dependence of breakdown driven by different organismal groups (i.e., microorganisms vs. invertebrate detritivores) and litter species remain unresolved. Over two years, we conducted 12 60-day leaf litterbag incubations in 20 headwater streams in the southern Appalachian Mountains (USA). We compared temperature dependence (as activation energy, Ea) between microbial and detritivore-mediated breakdown, and between a highly recalcitrant (Rhododendron maximum) and a relatively labile (Acer rubrum) leaf species. Detritivore-mediated breakdown had a higher Ea than microbial breakdown for both leaf species (Rhododendron: 1.48 > 0.56 eV; Acer: 0.97 > 0.29 eV), and Rhododendron breakdown had a higher Ea than Acer breakdown for both organismal groups. Similarly, the Ea of total (coarse-mesh) Rhododendron breakdown was higher than the Ea of total Acer breakdown (0.89 > 0.52 eV). These effects for total breakdown were large, implying that the number of days to 95% mass loss would decline by 40% for Rhododendron and 26% for Acer between 12°C (our mean temperature value) and 16°C (+4°C, reflecting projected increases in global surface temperature due to climate change). Despite patterns in Ea, overall breakdown rates were higher for microbes than detritivores, and for Acer than Rhododendron over most of our temperature gradient. Additionally, the Ea for a subset of the microbial breakdown data declined from 0.40 to 0.22 eV when fungal biomass was included as a model predictor, highlighting the key role of fungi in determining the temperature dependence of litter breakdown. Our results imply that, as streams warm, routing of leaf litter C to detritivore-mediated fates will increase faster than predicted by previous studies and MTE, especially for labile litter. As temperatures rise, earlier depletion of autumn-shed, labile leaf litter combined with rapid breakdown rates of recalcitrant litter could exacerbate seasonal resource limitation and alter carbon storage and transport dynamics in temperate headwater stream networks.

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BACKGROUND: Continued advances in haematopoietic cell transplantation (HCT) for children with non-malignant diseases (NMDs) have led to a growing population of survivors in whom late occurring toxic effects remain a challenge. We investigated the incidence of and risk factors for post-transplant toxicities in a contemporary cohort of children and adolescents undergoing HCT for NMDs. METHODS: In this retrospective cohort study, we extracted data from the Center for International Blood and Marrow Transplantation Research (CIBMTR) database to analyse timing and incidence of effects and risk factors associated with late effects of HCT for treatment of NMDs at age 21 years or younger. Late effects of interest were avascular necrosis, cataracts, congestive heart failure, myocardial infarction, diabetes, gonadal dysfunction, growth hormone deficiency, hypothyroidism, renal failure requiring dialysis, and neurological events (stroke and seizure). Cumulative incidence of each late effect was calculated at 5 years and 7 years after HCT. Risk factors were evaluated in Cox proportional hazards regression analyses. Main exposures were primary NMD, age, sex, ethnicity and race, insurance, donor and graft type, myoablative conditioning, total-body irradiation exposure, graft-versus-host disease (GVHD), and transplant year. Primary outcomes were rates, cumulative incidence probability (95% CI), and risk-factors for organ-specific late effects. FINDINGS: Between Jan 1, 2000, and Dec 31, 2017, 7785 patients aged 21 years or younger underwent HCT. 1995 patients were ineligible or did not consent to be included. 5790 patients from 171 centres were included in the analysis. 3505 (60·5%) of 5790 patients were male and 2285 (39·5%) were female. 2106 (36·4%) patients were White, 771 (13·3%) were Hispanic, and 773 (12·7%) were Black. 1790 (30·9%) patients were non-USA residents. Median age at HCT was 5·5 years (range 0·0-21·0). 1127 (19%) of 5790 patients had one late effect, and 381 (7%) had at least two. At 7 years post-HCT, the cumulative incidence probability was 1·9 (95% CI 1·5-2·3) for cataracts, 4·9 (4·3-5·6) for diabetes, 2·6 (2·1-3·1) for gonadal dysfunction, 3·2 (2·7-3·8) for hypothyroidism, 5·0 (4·4-5·7) for growth disturbance, 8·1 (7·4-8·9) for renal failure, 1·6 (1·3-2·0) for avascular necrosis, 0·6 (0·4-0·8) for congestive heart failure, 0·2 (0·1-0·3) for myocardial infarction, and 9·4 (8·6-10·2) for neurological effects. Age 10 years or older at HCT, unrelated donor source, total-body irradiation, and GVHD were identified as risk factors for long-term effects. INTERPRETATION: The findings highlight the need for, and access to, multidisciplinary and lifelong follow-up for children undergoing HCT for NMDs. As more children undergo treatment with cellular therapies for non-malignant conditions, further analyses of post-transplant data could increasingly guide treatment decisions and subsequent long-term surveillance. FUNDING: National Cancer Institute, National Heart, Lung and Blood Institute, National Institute of Allergy and Infectious Diseases, Health Resources and Services Administration, and Office of Naval Research.

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BACKGROUND: Olpasiran, a small interfering RNA (siRNA), blocks lipoprotein(a) (Lp(a)) production by preventing translation of apolipoprotein(a) mRNA. In phase 2, higher doses of olpasiran every 12 weeks (Q12W) reduced circulating Lp(a) by >95%. OBJECTIVES: This study sought to assess the timing of return of Lp(a) to baseline after discontinuation of olpasiran, as well as longer-term safety. METHODS: OCEAN(a)-DOSE (Olpasiran Trials of Cardiovascular Events And LipoproteiN[a] Reduction-DOSE Finding Study) was a phase 2, dose-finding trial that enrolled 281 participants with atherosclerotic cardiovascular disease and Lp(a) >150 nmol/L to 1 of 4 active doses of olpasiran vs placebo (10 mg, 75 mg, 225 mg Q12W, or an exploratory dose of 225 mg Q24W given subcutaneously). The last dose of olpasiran was administered at week 36; after week 48, there was an extended off-treatment follow-up period for a minimum of 24 weeks. RESULTS: A total of 276 (98.2%) participants entered the off-treatment follow-up period. The median study exposure (treatment combined with off-treatment phases) was 86 weeks (Q1-Q3: 79-99 weeks). For the 75 mg Q12W dose, the off-treatment placebo-adjusted mean percent change from baseline in Lp(a) was -76.2%, -53.0%, -44.0%, and -27.9% at 60, 72, 84, and 96 weeks, respectively (all P < 0.001). The respective off-treatment changes in Lp(a) for the 225 mg Q12W dose were -84.4%, -61.6%, -52.2%, and -36.4% (all P < 0.001). During the extension follow-up phase, no new safety concerns were identified. CONCLUSIONS: Olpasiran is a potent siRNA with prolonged effects on Lp(a) lowering. Participants receiving doses ≥75 mg Q12W sustained a ∼40% to 50% reduction in Lp(a) levels close to 1 year after the last dose. (Olpasiran Trials of Cardiovascular Events And LipoproteiN[a] Reduction-DOSE Finding Study [OCEAN(a)-DOSE]; NCT04270760).

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Plants undergo rapid developmental transitions, which occur contemporaneously with gradual changes in physiology. Moreover, individual plants within a population undergo developmental transitions asynchronously. Single-plant-omics has the potential to distinguish between transcriptional events that are associated with these binary and continuous processes. Furthermore, we can use single-plant-omics to order individual plants by their intrinsic biological age, providing a high-resolution transcriptional time series. We performed RNA-seq on leaves from a large population of wild-type Arabidopsis (Arabidopsis thaliana) during the vegetative-to-reproductive transition. Though most transcripts were differentially expressed between bolted and unbolted plants, some regulators were more closely associated with leaf size and biomass. Using a pseudotime inference algorithm, we determined that some senescence-associated processes, such as the reduction in ribosome biogenesis, were evident in the transcriptome before a bolt was visible. Even in this near-isogenic population, some variants are associated with developmental traits. These results support the use of single-plant-omics to uncover rapid transcriptional dynamics by exploiting developmental asynchrony.

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PURPOSE: Severe obesity is a barrier to listing for kidney transplantation due to concern for poor outcomes. This study aims to compare bariatric surgery with medical weight loss as a means of achieving weight loss and subsequent listing for renal transplant. We hypothesize that bariatric surgery will induce greater frequency of listing for transplant within 18 months of study initiation. MATERIALS AND METHODS: We performed a randomized study of metabolic bariatric surgery (MBS) vs medical weight loss (MM) in patients on dialysis with a body mass index (BMI) of 40-55 kg/m2. The primary outcome was suitability for renal transplant within 18 months of initiating treatment. Secondary outcomes included weight loss, mortality, and complications. RESULTS: Twenty patients enrolled, only 9 (5 MBS, 4 MM) received treatment. Treated groups did not differ in age, gender, or race (P ≥ .44). There was no statistically significant difference in the primary endpoint: 2 MBS (40%) and 1 MM (25%) listed for transplant ≤18 months (P = 1.00). With additional time, 100% MBS and 25% MM patients achieved listing status (P = .048); 100% of MBS and 0 MM received kidney transplants to date (P = .008). Weight, weight loss, and BMI trajectories differed between the groups (P ≤ .002). One death from COVID-19 occurred in the MM group, and 1 MBS patient had a myocardial infarction 3.75 years after baseline evaluation. CONCLUSION: These results suggest MBS is superior to MM in achieving weight loss prior to listing for kidney transplantation. Larger studies are needed to ensure the safety profile is acceptable in patients with ESRD undergoing bariatric surgery.

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PURPOSE: To assess whether neighborhood-level measures of policing are spatio-temporally associated with psychiatric hospialization among adolescents and young adults in New York City, and whether this association varies by neighborhood racial composition. METHODS: We derived population-based measures of policing from the New York City Police Department (NYPD), psychiatric hospitalization from Statewide Planning and Research Cooperative System (SPARCS) data, and socio-demographic data from the American Community Survey (ACS), aggregated by month and ZIP Code Tabulation Area (ZCTA) from 2006 to 2014. Multi-level negative binomial regression models assessed hospitalization-time of youth aged 10-24 as the dependent variable and the rate of policing events as the primary independent variable, adjusting for neighborhood poverty, unemployment, and educational attainment. Multiplicative interaction was assessed between policing and tertiles of the percentage of Black residents. RESULTS: A total of 11,900,192 policing incidents and 2,118,481 person-days of hospitalization were aggregated to 19,440 ZCTA-months. After adjusting for neighborhood-level sociodemographic characteristics, an increase in one policing incident per 1,000 residents was associated with a 0.3% increase in the rate of youth psychiatric hospitalization time (IRR 1.003 [1.001-1.005]). Neighborhood racial composition modified this effect; not only was the rate of psychiatric hospitalization and policing higher in neighborhoods with a higher proportion of Black residents, but the association between these was also significantly higher in neighorhoods with a larger share of Black residents compared with predominantly non-Black neighborhoods. CONCLUSION: Neighborhoods experiencing higher rates of policing during the study period experienced higher burdens of psychiatric hospitalization among adolescent and young adult residents. This association was larger in neighborhoods of color which have been disproportionately targeted by "hot spot" and order-maintenance policing practices and policies.

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OBJECTIVE: The present research examines the disparities among Ukrainians residing in the United States, comparing Ukrainians who migrated before the February 2022 Russian invasion against those who arrived afterward. We compare these two cohorts vis-a-vis anxiety, depressive symptoms, optimism, posttraumatic stress, life satisfaction, family economic stress, cultural stress (discrimination, negative context of reception, and language stress), hazardous alcohol use, and domestic violence perpetration and victimization. METHOD: The present sample included 703 Ukrainians (53.63% women) residing in the United States. We conducted a series of multivariate analyses of variance using arrival cohort (pre- vs. postinvasion) and gender (male vs. female) as independent variables. RESULTS: Results indicated that postinvasion participants reported greater internalizing symptoms, cultural/economic stress, and hazardous alcohol use, whereas preinvasion arrivals reported greater levels of optimism and life satisfaction. No significant interactions between cohort and gender emerged for any of the outcomes. CONCLUSION: Our findings offer valuable insights into the mental health and well-being of displaced Ukrainians within the backdrop of ongoing conflicts. These findings have significant implications for support and intervention efforts not only for Ukrainians but also for other crisis migrant groups. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

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Objective: We generated items to assess COVID-19 changes among Hispanic college students and examined the concurrent and predictive effects of these changes vis-à-vis mental health. Participants: The sample consisted of 559 Hispanic first-year (69% women; age range 18-22; 88.1% U.S.-born; 84% Mexican/Mexican American) attending a public university in Texas. Methods: Students participated in a three-wave longitudinal online survey assessing stressors, COVID-19 changes, anxious and depressive symptoms, hope, and self-esteem. Results: Students experienced negative changes across six life domains as a result of the pandemic-related lockdowns: education; health; relationships; finances; social issues; death/loss. They also reported positive changes during the lockdowns. Negative changes were positively correlated with higher, and positive changes with lower, acculturative and perceived stress. Negative COVID-19 changes predicted lower mental health. Conclusions: Hispanic students experienced both negative and positive COVID-19 changes, which were related to their mental health. Results can guide research and decision-making during future pandemics.

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OBJECTIVES: Crucial to the resettlement experiences of immigrants is the degree to which the receiving country accepts them and affords them social support and opportunities. Through the factor structure and incremental validity of scores generated by the Negative Context of Reception (NCR) Scale, in the present study, we examine Indian American youths' perception of their context of reception using a sample of youth residing in the United States. METHOD: Data came from a sample of 223 Indian American youth (aged 12-17) as part of a larger convergent mixed-methods project. Using confirmatory factor analysis, we examined the scale's validity and the relationship between perceived NCR and criterion-related factors such as perceived discrimination and depressive and anxiety symptoms. Interpretive Phenomenological Analysis was then used to analyze qualitative data from 11 of these Indian American youth. Qualitative data provided additional insights about NCR in this population. RESULTS: NCR scores evidenced strong psychometric properties among Indian American youth. Confirmatory factor models demonstrated good model fit. NCR yielded significant associations with perceived discrimination (r = .33, p < .001) and depressive symptoms (r = .25, p < .002). Two major themes (parental/family sacrifices and being treated differently from White peers) emerged from the qualitative data. CONCLUSIONS: Results validate NCR as a construct relevant to Indian American youth and associated with negative mental health symptoms such as anxiety and depression. Furthermore, these results underscore the importance of a welcoming and supportive environment for Indian American youths' well-being. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

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The clover seed weevil, Tychius picirostris Fabricius (Coleoptera: Curculionidae), is a major pest in Oregon white clover seed crops. Reliance on synthetic pyrethroid insecticides and limited availability of diverse modes of action (MoAs) has increased insecticide resistance selection in regional T. picirostris populations, emphasizing the need to evaluate novel chemistries and rotational strategies for effective insecticide resistance management (IRM). The efficacy of 8 foliar insecticide formulations for managing T. picirostris adult and larval life stages was determined in small and large-plot field trials across 2 crop years. In both years, bifenthrin (Brigade 2EC), the grower's standard, showed negligible adult and larval suppression. Insecticide formulations with isocycloseram and cyantraniliprole active ingredients reduced adult and larval populations when applied at BBCH 59-60 (prebloom) and BBCH 65-66 (full bloom) growth stages, respectively. While differences in T. picirostris abundance were observed among insecticide treatments, seed yield differences were not detected in large-plot trials. Larval abundance was correlated with reduced seed yield, and an economic threshold of ≥3 larvae per 30 inflorescences was determined as a conservative larval threshold to justify foliar applications of diamide insecticides. Additional commercial white clover seed fields were surveyed to compare larval scouting techniques, including a standard Berlese funnel and a grower's do-it-yourself funnel. Both larval extraction techniques were correlated and provided similar estimates of larval abundance. These findings demonstrate new MoAs, optimal insecticide application timing, and larval monitoring methods that can be incorporated into an effective T. picirostris IRM program in white clover seed crops.

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Intimate partner violence (IPV) impacts more than 40% of people in the U.S. Since the 1980s, the U.S. has maintained a police-centric response to IPV, which relies on arrest-via policies like mandatory arrest laws-as its primary intervention. There is mixed evidence on whether IPV policing decreases subsequent IPV at the individual level, but less is known about IPV policing's broader collateral consequences. This systematic scoping review is the first to synthesize existing evidence for the generalized consequences of IPV policing in the U.S. We searched Web of Science, ProQuest, and EBSCO Host, and identified 36 relevant articles. Survivor criminalization was the most studied generalized consequence of IPV policing and existing studies have documented positive associations between mandatory arrest laws and risk of survivor arrest. We also found numerous methodologically rigorous studies on the effects of mandatory arrest laws on population-level IPV victimization. The review also identifies gaps in the evidence base: there is a need for research on additional potential consequences of IPV policing such as police violence against survivors, involvement of child protective services, and psychosocial and physical health outcomes of survivors.

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As climate change continues to displace greater numbers of people, transnational ties are important sources of social protection for climate migrants. Migrants assemble unique configurations of formal and informal social protections depending on the resources available within their sending and receiving communities. However, the specific constellations of social protections that climate migrants use following disaster and displacement remain underexamined. Authors conducted semistructured interviews with Puerto Ricans who migrated in the aftermath of Hurricane Maria (N = 41) and used qualitative content analysis to trace the assemblages of formal and informal social protections used to navigate the resettlement process. Results suggest that informal support from migrants' transnational ties was instrumental in successfully making use of formal sources of support, including federal emergency relief programs, to leave the island and resettle on the U.S. mainland. This reliance on informal social protections often strained participants' informal networks and raised questions of equity for people internally displaced by climate change. These findings highlight the need for a more equitable and effective linkage of climate migrants with public resources.

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Internalizing symptoms associated with anxiety and depression have been correlated with harmful alcohol use among Latino/as, but little attention has been paid to assessing the association between perceived discrimination and harmful alcohol use. The present study was designed to investigate the association between perceived discrimination, internalizing symptoms associated with anxiety and depression, and harmful alcohol use among Latino/a immigrants living in the United States (US). Our sample included 426 Latino/a immigrants. Their mean age was 40.05 years (SD = 6.50), 65.50% were women, 80.00% had a partner, 54.20% lived on less than $2,000 a month, and 41.50% reported having attained a college degree. Perceived discrimination was assessed using the Perceived Discrimination Scale, anxious symptoms were assessed using the GAD-7, depressive symptoms were assessed using the CES-D short form, and harmful alcohol use was assessed using AUDIT. We estimated a linear regression model using cross-sectional, self-reported data. The model was statistically significant, R 2 = 0.38, F (8, 425) = 32.09, p < 0.01. Discrimination was significantly associated with AUDIT scores, (ß = 0.21, p < 0.01) after accounting for covariates and for symptoms of anxiety and depression. Our results indicate that experiences of discrimination in the US are associated with increased harmful alcohol use even after controlling for other variables. These findings may be useful in designing coping interventions specifically for Latino/a immigrants to reduce the risk of alcohol use disorder. This study also has political and public health implications for acknowledging the detrimental health consequences of experiencing discrimination, providing support to the position that reducing racism and discrimination represent important public health priorities.

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BACKGROUND: Female cancer survivors often experience estrogen-deprivation symptoms, which may lead to decreases in sexual desire, vulvovaginal health (lubrication, dryness, discomfort), and sexual satisfaction. Interventions are needed to address these concerns. AIM: The objective of this secondary analysis was to determine if women with higher (better) scores on the Female Sexual Function Index (FSFI) lubrication and pain subscales reported higher desire scores based on treatment with bupropion vs placebo. METHODS: Participants were part of NRG Oncology's NRG-CC004 (NCT03180294), a randomized placebo-controlled clinical trial evaluating bupropion (150 vs 300 mg) to improve sexual desire in survivors of breast or gynecologic cancer. All participants with baseline data from the FSFI lubrication, pain, and desire subscales with 5- and/or 9-week data were analyzed. The FSFI subscale scores were correlated using Spearman correlation coefficients. Logistic regression was used to determine associations between FSFI desire and other FSFI subscales while accounting for treatment arm and other covariates. OUTCOMES: The primary outcome of NRG Oncology's NRG-CC004 (NCT03180294) randomized phase II dose-finding trial was change from baseline to 9 weeks on the FSFI desire subscale score. Similar to the parent study, the primary outcome for this ancillary data study was the FSFI desire subscale score at 5 and 9 weeks. RESULTS: Overall, 230 participants completed the FSFI at baseline and 189 at 9 weeks. The strongest correlations were between lubrication and pain at baseline (all participants, rho = 0.77; bupropion arms, rho = 0.82), week 5 (all participants, rho = 0.71; bupropion arms, rho = 0.68), and week 9 (all participants, rho = 0.75; bupropion arms, rho = 0.78), and the weakest correlations were between desire and pain. In patients in the treatment arms there were no interactions between lubrication or pain.The impact of various covariates on the FSFI score for desire at 9 weeks demonstrated that participants of non-White race (odds ratio [OR], 0.42; 95% CI, 0.21-0.81; P = .010), with a high lubrication score (OR, 0.36; 95% CI, 0.21-0.61; P = .0002), with a high pain score (less pain) (OR, 0.50; 95% CI, 0.29-0.87; P = .014), or with prior pelvic surgery (OR, 0.38; 95% CI, 0.23-0.63; P = .0002) had lower odds of having low desire. CLINICAL IMPLICATIONS: Acute estrogen-deprivation symptoms should be addressed prior to sexual desire intervention. STRENGTHS AND LIMITATIONS: This secondary analysis was not powered to examine all variables. CONCLUSION: Lubrication and pain were predictors of low desire. Therefore, vulvovaginal atrophy and associated genitourinary symptoms of menopause such as vaginal dryness and dyspareunia should be addressed prior to or in parallel with interventions for sexual desire.

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