Rapid and reliable identification of multivariate geochemical anomalies is critical for delineating prospective mineralized zones and reducing uncertainty in mineral exploration targeting. Extended isolation forest (EIF) is a powerful unsupervised ensemble learning algorithm that efficiently isolates anomalies from high-dimensional geochemical datasets using randomly oriented hyperplane partitions. Previous studies have demonstrated the effectiveness of EIF in multivariate geochemical anomaly detection and mineral potential modeling. However, its performance can be significantly affected by stochastic variability arising from random partitioning and random subsampling during isolation tree construction, which may result in unstable anomaly patterns and inconsistent exploration targets in complex geological environments. To mitigate this limitation, we developed a robust unsupervised framework for the identification of multivariate geochemical anomalies associated with gold mineralization in the Southwestern Yilgarn Craton, Australia. The proposed framework integrates robust factor analysis (RFA), a Jaccard-based stability index and EIF to enhance the reliability and reproducibility of anomaly detection. RFA was first applied to compositional soil geochemical data to identify the most significant pathfinder elements associated with gold mineralization, which were subsequently used as input variables for the EIF model. The model was then optimized using a Jaccard-based stability criterion to ensure consistent anomaly detection across repeated independent runs. Model performance was assessed using area under the receiver operating characteristic curve (AUC). The obtained AUC value of 0.82 indicates strong predictive capacity, confirming that the generated anomaly map effectively delineates mineralization-related geochemical patterns and provides a reliable proxy for mineral prospectivity mapping. Overall, the proposed framework offers a robust and reproducible unsupervised approach for multivariate geochemical anomaly detection with strong applicability in both greenfield and brownfield mineral exploration settings.
The objective of this narrative review is to provide a comprehensive overview of sleep disruptions during menopause by examining primary sleep disorders and secondary disruptors, the biopsychosocial etiology of these disruptions, and approaches to clinical diagnosis. Literature published between January 2015 and March 2026 was searched using PubMed and MEDLINE, Embase, and Google Scholar databases. Findings are summarized into a narrative review that addresses primary sleep disorders that commonly occur during menopause, specifically insomnia, obstructive sleep apnea, restless legs syndrome, and periodic limb movement disorder, as well as the biopsychosocial etiology of sleep pathophysiology. Prevalence of sleep disruption varies by menopausal stage (perimenopause or postmenopause), the presence of vasomotor symptoms, and the definition and measurement of sleep disruptions (self-report questionnaires or objective measures), and can be influenced by a variety of modifiable and nonmodifiable factors. Compared with premenopausal women, prevalence is higher in women during perimenopause and postmenopause, highlighting an increased burden and effect on quality of life in this population. Individual biological, psychological, and social disruptors and their contributions to and effects on sleep are described, as well as practical clinical considerations in the assessment of sleep disruption symptoms. Finally, salient points are discussed.
Combined oral contraceptives (COCs), oral contraceptives containing an estrogen and a progestin, are a common, effective, and generally well-tolerated form of contraception with a wide variety of noncontraceptive benefits. Combined oral contraceptives have been most limited by the potential severe adverse event of venous thromboembolism throughout their history and development. In recent years, natural-estrogen-containing COCs have emerged with an improved safety profile while maintaining high efficacy and should likely be recommended as first line for new-start patients. It is important for clinicians to understand the evolution of COC regimens and the specific hormones within each formulation to best optimize benefits while minimizing risks to patients.
Cardiovascular disease (CVD) remains the leading cause of death among women, yet CVD risk is frequently underrecognized during midlife, when the menopause transition is accompanied by significant biological changes. Emerging evidence demonstrates that menopause represents a critical window for adverse cardiometabolic and vascular changes that extend beyond the effects of chronologic aging alone. Because obstetrician-gynecologists often serve as the primary clinicians for midlife care in women, they are uniquely positioned to recognize emerging cardiovascular risk, implement preventive strategies, and coordinate care with primary care or cardiology when appropriate. This Clinical Expert Series synthesizes current evidence on menopause-related characteristics associated with CVD risk, including timing and type of menopause, as well as menopause-related symptoms, including vasomotor symptoms, sleep disturbances, and depression. We also review longitudinal data characterizing changes in lipids, blood pressure, glucose metabolism, body composition, and vascular structure and function across the menopause transition. Collectively, these data support framing menopause as a key opportunity for CVD risk identification and early intervention. Incorporating menopause-specific factors into routine CVD risk assessment may enable earlier prevention strategies and ultimately improve long-term cardiovascular outcomes for women.
Genitourinary syndrome of menopause (GSM) is a chronic hypoestrogenic condition characterized by diffuse vulvovaginal pallor, epithelial thinning, loss of rugae, and mucosal atrophy, often accompanied by genitourinary symptoms such as dryness, dysuria, urgency, and dyspareunia. Because many vulvar dermatoses share overlapping symptoms with GSM, accurate diagnosis relies heavily on careful clinical evaluation, with particular emphasis on lesion morphology, distribution, and associated mucocutaneous findings. This review provides a practical, morphology-driven framework for distinguishing GSM from common inflammatory, infectious, and neoplastic vulvar conditions. Given the high degree of diagnostic overlap between vulvar dermatoses and GSM, a structured approach incorporating targeted history, focused physical examination, and timely biopsy when indicated is essential. Referral to dermatology or a vulvar specialist is recommended in cases of diagnostic uncertainty, refractory or multisite disease, or scarring or functional impairment or when escalation to systemic or advanced therapies is required. This approach aims to improve diagnostic accuracy, reduce misclassification as GSM, and facilitate earlier, targeted treatment of vulvar dermatoses.
OBJECTIVE:To determine whether scheduled vibrator use with an educational handout improves sexual and pelvic floor health for women with sexual dysfunction and pelvic floor disorders than the educational handout alone. METHODS:Randomized controlled trial conducted at a single-site tertiary referral center in the United States. Enrollment occurred from November 2024 to April 2025. Women aged at least 18 years with sexual dysfunction and a pelvic floor disorder diagnosis were included. Participants were randomized to receive either a vibrator approved by the U.S. Food and Drug Administration with scheduled use three times weekly for 8 weeks and an educational handout (vibrator group) or the educational handout, alone (handout group). The primary outcome was sexual function measured by the FSFI (Female Sexual Function Index). Secondary outcomes included results of the SSI (Sexual Satisfaction Index), PISQ-12 (Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire-12), PFDI-20 (Pelvic Floor Distress Inventory-20), F-GUPI (Female Genitourinary Pain Index), and PHQ-9 (Patient Health Questionnaire-9). RESULTS:Of 84 randomized participants, 81 completed the study (41 handout group, 40 vibrator group; 57.9±14.1 years). At 8 weeks, FSFI total scores were significantly higher in the vibrator group (22.2±7.5) than the handout group (16.3±8.7; P=.002), with improvements recorded across arousal, lubrication, orgasm, satisfaction, and pain domains (all P<.05). Although both groups improved from baseline, the vibrator group demonstrated greater mean FSFI improvement (8.8 points vs 4.9 points; mean difference, 4.0 points; P=.002). More participants in the vibrator group achieved normal FSFI total scores (higher than 26.5; 35.0% vs 12.2%; P=.02). CONCLUSION:For women with sexual dysfunction and pelvic floor disorders, scheduled vibrator use with an educational handout resulted in greater improvement in sexual function than an educational handout alone and may reduce urinary distress symptoms. CLINICAL TRIAL REGISTRATION:ClincalTrials.gov, NCT06677541.
Water conservancy and hydropower projects enhance regional climate resilience and watershed water security yet inevitably trigger large-scale involuntary reservoir resettlement. As representative involuntarily displaced populations, reservoir resettlees' social identity directly impacts local social stability and regional sustainable socioeconomic development. Based on a ten-year longitudinal qualitative investigation including in-depth interviews and participant observation in Village Y of Wuxikou Reservoir, Jiangxi Province, this paper divides the entire resettlement process into three stages: relocation, stabilization and development. From the dual perspectives of host community identity and out-groups identity, this study explores the dynamic evolutionary rules of resettlees' social identity. The results indicate that resettlees sequentially develop alienated identity, superficial adaptive identity and segregated identity across different phases. On this basis, the core concept of differential identity is proposed, which features a dual structure of vertical temporal differentiation and horizontal spatial differentiation. This paper expands the applicable scope and explanatory power of the “differential mode of association” and social identity theory in involuntary resettlement contexts. Grounding on the differential identity framework, this paper puts forward targeted integrated governance solutions to break intergroup segregation, facilitate cross-group integration and build resilient resettlement communities consistent with Sustainable Development Goals (SDGs) 11 and 13.
The discrimination of ore deposit types is primarily based on geological, geochemical, and isotopic characteristics. Conventionally, these types are identified using specific element diagrams. However, traditional geochemical methods often fail to determine scheelite deposit types of the complex Xuefengshan Sb-Au-W metallogenic belt in China, where mineralization resulted from the superposition of multiphase geological events. Machine learning (ML) methods, have been increasingly applied to identify deposit genesis by establishing relationships between deposit characteristics and genetic types using extensive datasets. However, inaccurate data labels, the limitations of single models, and poor model interpretability lead to decreased accuracy. This study proposes a ML framework based on interpretable ensemble learning. We collects geochemical element data from typical orogenic and magmatic-hydrothermal scheelite deposits globally. Deep clustering is used to filter data and overcome the subjectivity of original data labels. An ensemble learning model is used to construct a classifier to improve the model's robustness and generalization ability. An interpretable model is introduced to analyze the contribution of individual feature elements, revealing the metallogenic genesis. This method demonstrates high accuracy on the test set. According to this method, the scheelite deposit type of the Xuefengshan metallogenic belt is primarily magmatic-hydrothermal in origin, with orogenic superposition. This helps resolve a long-standing controversy in the region and establishes a repeatable and interpretable new paradigm for ML-based discrimination of ore deposit genetic types.
Though volcanogenic massive sulfide (VMS) deposits are major global sources of indium (In), the physicochemical mechanisms and key factors controlling its significant enrichment remain poorly understood. To address the issue, this study investigates the Tiemurt VMS Pb-Zn-Cu deposit, utilizing detailed petrography, in-situ LA-ICP-MS analysis, and thermodynamic modeling to reveal the In enrichment mechanisms in VMS deposits. Petrographic observations identified two distinct generations of sphalerite corresponding to different mineralization stages. The early-stage sphalerite (Sp1) is euhedral-subhedral, associated with pyrite, and displays darker colors (red to brown), whereas the late-stage sphalerite (Sp2) is anhedral, intimately intergrown with chalcopyrite, and shows lighter colors (mainly yellow). The trace element results demonstrate that Sp1 has a significantly higher In content (average 317 ppm) than Sp2 (average 220 ppm). Additionally, In concentrations positively correlate with Fe contents. Because Fe is the primary chromophore that darkens sphalerite, this strong coupled enrichment mechanism allows macroscopic sphalerite color (red > brown > yellow) to serve as a reliable indicator for In concentration. Crystallization temperatures calculated using the GGIMFis thermometer range from 344 to 382 °C for Sp1 and 312 to 355 °C for Sp2, indicating a cooling trend during fluid evolution. Thermodynamic modeling data showed that in the early-stage hydrothermal fluids (≥360 °C), Zn2+ preferentially complexes with Cl−, leaving InCl2+ or In3+ as unstable species, and In efficiently precipitates into Sp1 under the environment of log fO2 = −32 to −26 and pH = 6–8. As the fluids cool at ~340 °C, weakened Zn2+ competition allows In3+ to form stable InCl3, and In precipitates into Sp2 under the conditions of log fO2 = −42 to −32 and pH = 5.5–11. We therefore conclude that the key factor controlling the difference in In content between Sp1 and Sp2 is the precipitation mechanism rather than migration capacity. This may be different from the In enrichment mechanism associated with magmatic hydrothermal systems, where In is mainly present as InCl3 complexes with strong migration capacity. These new findings enable us to understand how the physicochemical conditions of fluids control the enrichment of In in VMS deposits, and also highlight that the color of sphalerite can be used to target potential In resources in PbZn deposits.
This Clinical Practice Update provides updated information further supporting the benefit of complete, bilateral salpingectomy at the time of obstetric and gynecologic surgery and to expand the availability of salpingectomy during nongynecologic abdominopelvic surgery for the primary prevention of epithelial ovarian cancer. This document updates Committee Opinion No. 774, Opportunistic Salpingectomy as a Strategy for Epithelial Ovarian Cancer Prevention (Obstet Gynecol 2019;133:e279-84).
OBJECTIVE:To assess the recurrence risk of severe hypertensive disorders of pregnancy (HDP) in a U.S. cohort because prior studies report inconsistent recurrence rates for severe HDP. METHODS:This is a retrospective cohort study using the Premier Inpatient database. Individuals with two or more observed pregnancies between October 2015 and December 2020 were identified. Clinical characteristics were identified with International Classification of Diseases, Tenth Revision codes. The risk and relative risk (RR) of developing a severe HDP, defined as preeclampsia with severe features, superimposed preeclampsia, HELLP (hemolysis, elevated liver enzymes, and low platelet count) syndrome, or eclampsia, in a subsequent pregnancy were estimated with multivariable risk regression. Risk was stratified according to the presence and severity of HDP in the first observed (index) pregnancy and gestational age at delivery. RESULTS:During the study period, 560,295 patients had two or more pregnancies. Of the included patients 57,584 (10.3%) had HDP and 11,433 (2.0%) had severe HDP during the index pregnancy. Of these patients, 1,703 individuals (14.9%) experienced recurrent HDP in a subsequent pregnancy. Compared with patients with no HDP in the index pregnancy, those with severe HDP at any gestational age had an increased risk of severe HDP in a subsequent pregnancy (14.9%, RR 16.0, 95% CI, 15.2-17.0); those with a history of a severe HDP before 28 weeks of gestation had the highest risk (22.9%, RR 23.1, 95% CI, 19.1-27.9). Having a severe HDP before 28 weeks of gestation conferred the highest risk of HDP before 28 weeks in a subsequent pregnancy (4.7%, RR 184.9, 95% CI, 107.2-318.9). Patients with a history of HELLP syndrome or eclampsia also had elevated risk of severe HDP in a subsequent pregnancy (11.5%, RR 9.7, 95% CI, 8.3-11.3; and 11.0%, RR 9.2, 95% CI, 7.2-11.8 respectively), including recurrent HELLP syndrome (4.6%, RR 61.0, 95% CI, 46.2-80.6) and eclampsia (1.1%, RR 40.1, 95% CI, 16.3-98.3), but these phenotypes occurred infrequently. CONCLUSION:The risk of recurrent severe HDP was 14.9% and was influenced by the severity and timing of HDP in the index pregnancy, with the highest risk of recurrence in patients with early-onset severe HDP. These results inform counseling about risk of future HDP to inform patient decision making.
OBJECTIVE:To assess the midlife and menopause experiences and unmet health needs of servicewomen and veterans. METHODS:For this qualitative study, we conducted virtual focus groups with servicewomen and veterans aged 45-60 years using a semi-structured, open-ended interview guide focused on midlife and menopause experiences and related health care access. Focus groups were held from June to August 2025 until thematic saturation was met. Transcripts were coded and thematic analysis performed using Atlas.ti software. RESULTS:We conducted five focus groups with 30 participants (mean age 51.5 years; 53.3% active duty). Participants received health care across the Military Health System, Veterans Health Administration (VHA), and private sector. Four categories emerged: effects on personal life, menopause-related care delivery, effects on military and professional career, and recommendations for improvements. Within these categories, seven themes were identified: feeling unprepared and navigating menopause independently, effects on relationships, frustration with care delivery, positive care delivery experiences, effects on military performance and readiness, unique military settings complicating symptoms and treatment, and recommendations to improve menopause experiences and care delivery in the military. Frustration with care delivery included feeling dismissed, symptom misattribution or treatment of individual symptoms, lack of menopause knowledge among clinicians, inconsistent access to knowledgeable clinicians, and seeking care outside the Military Health System or VHA. Positive care experiences included symptom validation, provision of treatment, and continuity of care. CONCLUSION:Menopause symptoms substantially affect quality of life and occupational functioning among servicewomen and veterans, with system-level gaps in menopause care overshadowing positive experiences. Findings highlight deficiencies in anticipatory guidance, workplace support, clinician education, access to care, and continuity of care across health systems. Targeted interventions to improve workplace culture surrounding menopause, menopause-specific clinical competency, and access to evidence-based care are needed to support quality of life and maintain military readiness.
Menopause care in the United States is limited by inadequate access, insufficient clinician training, and the absence of scalable care models. Despite increasing awareness and intolerance of menopause symptoms, few health systems offer coordinated menopause services, and no published frameworks exist to guide program development. We present a practical, evidence-informed flexible nine-step blueprint for designing, implementing, and sustaining comprehensive menopause programs, including a structured needs assessment and a resource-tiered implementation framework for program development. Drawing on implementation science, multidisciplinary care models, and the authors' real-world experience from large academic health systems, we describe each of the essential steps. This approach provides practical strategies for developing standardized clinical workflows, scalable care pathways, and workforce capacity. Case examples demonstrate stepwise adoption across diverse settings, beginning with foundational activities and expanding as resources grow. This blueprint offers a scalable approach to addressing persistent gaps in women's health for midlife and beyond.
OBJECTIVE:To evaluate the clinical performance of cell-free DNA (cfDNA) screening as a primary screening tool for autosomal recessive conditions in a large, prospective, general-risk population. METHODS:We conducted a prospective analysis of pregnant individuals who underwent carrier screening with a reflex cfDNA fetal risk assessment at nine participating U.S. institutions. The conditions evaluated included cystic fibrosis, spinal muscular atrophy, and beta and alpha hemoglobinopathies. The cfDNA results were categorized as high risk (at least 1-in-4 predicted fetal risk) or low risk. Test performance metrics were calculated using Wilson Score 95% CIs. RESULTS:There were 2,403 cfDNA results among 2,212 pregnant carriers with singleton pregnancies at a gestational age of at least 10 weeks at participating sites (188 individuals were carriers for more than one condition). The neonatal or fetal outcome was known for 2,369 (98.6%) cfDNA results. A cfDNA fetal risk of at least 1 in 4 was returned for 1.3%, and the cfDNA fetal risk test had a specificity of 99.5%, a negative predictive value of 99.9%, a sensitivity of 94.4%, and a positive predictive value (PPV) of 58.6%. CONCLUSION:In this large, racially and ethnically diverse general-risk pregnant carrier sample, cfDNA fetal risk assessment accurately distinguished high-risk and low-risk pregnancies with greater PPV than traditional carrier screening, without requiring a partner sample. Combined with prior peer-reviewed studies that assessed cfDNA fetal risk screens, these findings support the possibility of cfDNA fetal risk assessment as a primary screen to identify pregnancies at high risk for autosomal recessive conditions.
Recent evidence suggests that use of menopausal estrogen-only therapy in patients who have undergone hysterectomy reduces breast cancer risk among patients at population risk for breast cancer as well as in those with pathogenic high-risk BRCA variants. A meta-analysis of 10 randomized trials of estrogen therapy compared with placebo among 14,282 participants at population risk noted that 3.6% those randomized to estrogen alone were diagnosed with breast cancer, compared with 4.7% of those randomized to placebo (relative risk 0.77; 95% CI, 0.65-0.91, P=.002). A matched prospective cohort study of 676 patients with BRCA mutations and intact breasts who used menopausal hormone therapy (MHT) found that the estimated 15-year cumulative incidence of breast cancer with estrogen alone compared with no MHT was 24.3%, compared with 47.3% in the matched nonusers of MHT (P<.0001). This evidence underscores the need for more data that specifically assess the effect of estradiol therapy among patients who have undergone hysterectomy. Until such data are available, counseling patients at risk for breast cancer who have completed childbearing and are planning surgery for benign gynecologic conditions should involve shared decision-making that addresses the future risk of breast and endometrial cancers, cardiovascular disease, as well as the morbidity associated with hysterectomy. When appropriate, such counseling should also describe the availability of uterine-sparing alternatives.
