Randomized clinical trials comparing the breadth and long-term persistence of immunity between different COVID-19 vaccine types and between ancestral and Omicron-targeted vaccines are limited. The PRIBIVAC study (Phase D) is a randomized clinical trial comparing the immunogenicity of monovalent mRNA vs bivalent mRNA vs protein-based NVX-CoV2373 administered as second booster in 176 triple mRNA-vaccinated adults. Primary objective was neutralizing antibody levels against Omicron subvariants at day 28. A 4th vaccine dose significantly boosted 50% neutralization titers against emerging strain XBB.1.16 by 3.2-, 4.1- and 1.6-fold in monovalent mRNA, bivalent mRNA and NVX-CoV2373 group respectively at day 28. The largest absolute increase in inhibition level at day 28 post-booster was observed against the KP.2 subvariant, with bivalent mRNA vaccines exhibiting the highest neutralization level (91.7%) compared with monovalent mRNA (84.4%; p = .027) and NVX-CoV2373 (81.4%; p < .0001). While bivalent mRNA vaccines elicited the highest early immunogenicity, neutralization levels against all Omicron variants tested waned to similar levels between groups by 12 months post-vaccination. Although NVX-CoV2373 induced a lower peak anti-S antibody response, anti-S decay rate was slower in NVX-CoV2373 compared with mRNA vaccines. The geometric mean anti-S fold change (D360/D28) in NVX-CoV2373 group was higher (0.51) relative to both mRNA vaccines (monovalent: 0.31, p = .010 and bivalent: 0.35, p = .017). Improved neutralizing antibody responses against diverse SARS-CoV-2 variants by the ancestral or variant vaccine highlight the immunological benefits of COVID-19 vaccine boosters regardless of the latest variant-based vaccine. Further studies to determine if different vaccine combinations translate to differing protection against infection remain necessary.
Dental caries is one of the most prevalent chronic oral diseases worldwide, affecting populations of all ages and posing significant socioeconomic and healthcare challenges. Early detection of carious lesions is critical for implementing preventive strategies and minimally invasive treatment approaches, thereby preserving tooth structure and improving oral health outcomes. Traditional diagnostic methods, including visual-tactile examination and radiography, are limited in their sensitivity for early enamel lesions and are influenced by examiner subjectivity. Over the past decade, significant advancements in diagnostic technologies have emerged, including laser and quantitative light induced fluorescence, fiber optic and near infrared transillumination, optical coherence tomography (OCT), electrical conductance and impedance methods, photothermal radiometry, salivary biomarker analysis, and artificial intelligence (AI)-assisted detection. OCT allows high-resolution imaging of subsurface enamel and dentin lesions, while salivary biomarkers provide a non-invasive assessment of caries risk and biological activity. AI integration improves diagnostic accuracy and reproducibility while reducing operator dependency. Despite these advancements, barriers such as high costs, lack of standardized protocols, limited clinical adoption, and ethical considerations remain. This narrative review provides a detailed analysis of current and emerging technologiesfor dental caries detection, critically evaluates their diagnostic performance, and explores future directions emphasizing multimodal and personalized approaches.
Recovery in elite professional sport is now widely understood as a multidimensional process spanning physiological, psychological, cognitive, and social domains, yet recovery models applied in professional clubs and sporting organisations have been slow to reflect this. Most remain reactive and athlete-centred, leaving the full complexity of competitive fatigue inadequately addressed and the equivalent recovery demands on coaching and performance staff entirely unrecognised. No structural framework currently places initiative-taking, calendar-embedded multidimensional recovery as a deliberate component of seasonal planning. Main body. We introduce micro-recovery dosing (MRD): proactively planned, pre-scheduled 36-hour multidimensional recovery periods embedded within the competitive season as a proposed starting point at five to eight instances per year, extending to all members of the high-performance organisation. Drawing on neuromuscular recovery kinetics, autonomic science, sleep architecture research, occupational recovery psychology, and complex systems theory, we construct a convergent theoretical rationale for the proposed parameters and distinguish MRD from related constructs. We present a role-differentiated implementation framework with supporting evidence and a discussion of emerging AI-driven monitoring tools. Conclusions. Taken together, the four-domain convergent rationale and the complex systems perspective provide a theoretically coherent basis for MRD’s proposed structure. We argue for a specific organisational transformation: the shift from recovery as an incidental gap between performance demands to an intentionally designed recovery architecture that encompasses athletes and staff alike. The article identifies the active ingredient problem as the central scientific challenge and sets out a structured empirical agenda.
Accurate estimates of the prevalence of chronic hepatitis B virus (HBV) in the United States (US) are necessary for policy makers and community-based organisations to make informed decisions regarding the allocation of resources to work towards the elimination of HBV as a public health threat. The primary aim of this study was to quantify the current HBV prevalence in the US at the state, county, and territorial level. The secondary aim was to quantify which countries of birth lead HBV infections. Using previously validated and published population-based country level Markov models, the prevalence of HBV among immigrants in the US by country of birth was estimated in 2021. These estimates were then applied to county level population estimates from the 2018-2022 American Community Survey. This resulted in new county, state, territorial (Puerto Rico and Washington, D.C.), and national level HBV prevalence estimates. The total number of HBV infections in the US was estimated to be 1.7 million (UI: 795,000-4.1 million) corresponding to a prevalence of 0.50% (UI: 0.24%-1.23%). The state with the highest prevalence was Hawai'i, 1.3% (UI: 0.5%-40%), while Wyoming was estimated to have the lowest prevalence, 0.2% (UI: 0.1%-1.1%). The largest number of total infections was found in California, 347,100 (UI: 193,700-729,200). The Aleutians West Census Area was the county with the highest prevalence, 2.9% (UI: 0.8%-9.7%), while Los Angeles County had the highest number of infections, 96,700 (UI: 54,800-190,600). These data can aid planners at all levels to better understand the complexities of HBV in the US. Thus, providing evidence for targeted public health interventions that will reduce the burden of HBV and improve the lives of those living with the disease.
BACKGROUND:The continuum of metabolic syndrome encompasses a spectrum of dysfunctions impacting obesity-linked insulin resistance, glucose homeostasis, lipid metabolism and pro-inflammatory immune responses. The global prevalence of metabolic diseases, including diabetes, chronic liver disease, cardiometabolic disease and kidney disease, has surged in recent decades, contributing significantly to population mortality. Metabolic dysfunction-associated steatotic liver disease (MASLD), formerly known as non-alcoholic fatty liver disease, is a leading cause of liver disease worldwide. MASLD poses a significant global health challenge with its rising prevalence, placing a substantial burden on healthcare systems, impacts patient well-being and incurs significant economic costs. Addressing MASLD requires a comprehensive understanding of its interconnected factors, including its prevalence, healthcare burden and economic implications. Lack of awareness, imprecise non-invasive diagnostic methods and ineffective preventive interventions are core components of the MASLD-related problem. AIM:The aim of this article was to summarise the global burden of MASLD from the payer's perspective. METHODS:We carried out a review of the global comprehensive burden of MASLD. These topics led to discussions and insights by an expert panel during the 7th Metabolic Continuum Roundtable meeting, which took place in November 2023. This meeting focused on the burden, patient-reported outcomes and health economics, from payor and societal perspectives, and aimed to identify opportunities for improving patient care, optimise resource allocation and mitigate the overall impact on individuals and society related to MASLD. During the roundtable, an emphasis emerged on the need for greater awareness and strategic deployment of diagnostic, therapeutic and preventative measures to address MASLD effectively. CONCLUSION:The global burden of MASLD is high and growing. Prioritising the prevention of metabolic dysregulation and timely therapeutic interventions can yield a holistic strategy to combat MASLD, its progression and potentially lower disease costs. TRIAL REGISTRATION:NCT06309992.
