The United States is experiencing a prolonged syphilis epidemic, with high rates of infection and increasing cases of congenital syphilis. Despite these trends, there is no coordinated national approach to syphilis screening outside of pregnancy, and many individuals at highest risk lack access to routine outpatient care. Emergency departments (EDs), which serve as a critical safety net for populations at highest risk of syphilis and its complications, represent an important and underutilized setting for syphilis screening. To address this gap, a national convening of multidisciplinary experts was organized by the Emergency Medicine Transmissible Infectious Diseases and Epidemics consortium, with support from the Centers for Disease Control and Prevention and the National Association of County and City Health Officials. Participants reviewed available evidence and shared implementation experience to identify feasible and effective strategies for ED-based syphilis screening. Inperson discussion was followed by iterative review and revision of manuscript drafts until consensus was achieved. A tiered framework for ED syphilis screening is proposed, including universal, population-focused, and minimum screening strategies, allowing adaptation to local resources and epidemiology. Key operational considerations include consent processes, laboratory testing approaches, electronic health record integration, and systems for follow-up and treatment. Successful implementation requires infrastructure beyond the ED, including partnerships with public health agencies, supportive policy, and sustainable financing. ED-based syphilis screening represents a critical opportunity to improve early detection, reduce transmission, and prevent congenital syphilis. Coordinated national guidance and investment are needed to support widespread adoption and maximize public health impact.

Systematic reviews are a key component of evidence-based medicine, playing a critical role in synthesizing existing research evidence and guiding clinical decisions. However, with the rapid growth of research publications, conducting systematic reviews has become increasingly burdensome, with title and abstract screening being one of the most time-consuming and resource-intensive steps. To mitigate this issue, we designed a two-stage dynamic few-shot learning (DFSL) approach aimed at improving the efficiency and performance of large language models (LLMs) in the title and abstract screening task. Specifically, this approach first uses a low-cost LLM for initial screening, then re-evaluates low-confidence instances using a high-performance LLM, thereby enhancing screening performance while controlling computational costs. We evaluated this approach across 10 systematic reviews, and the results demonstrate its strong generalizability and cost-effectiveness, with potential to reduce manual screening burden and accelerate the systematic review process in practical applications.

Glucagon-like peptide-1 receptor agonists and dual agonists of the glucose-dependent insulinotropic polypeptide and glucagon-like peptide-1 receptors, exemplified by semaglutide and tirzepatide, respectively, have reshaped care for obesity-related heart failure with preserved ejection fraction (HFpEF). Their benefits extend beyond weight reduction to symptoms and physical function and, for tirzepatide, a lower risk of worsening heart failure. Yet kilograms lost do not reveal whether treatment preferentially reduces harmful adiposity, preserves muscle function, or maintains nutritional adequacy. Against this background, we examine how medical nutrition therapy (MNT) can be integrated with incretin-based therapy to support high-quality weight loss-a working construct used here to denote loss of excess adiposity without avoidable compromise of nutritional status or functional reserve. The discussion centers on three linked questions: how appetite suppression and gastrointestinal intolerance alter nutritional risk; how body composition relates to muscle and patient-centered outcomes; and how nutrition care should evolve from treatment initiation through plateau, maintenance, and discontinuation. Available evidence supports early nutrition assessment, attention to protein and overall diet quality, and coordinated resistance and aerobic exercise, while showing that body composition cannot replace direct assessment of strength, walking capacity, symptoms, and health status. We therefore outline a phase-based MNT pathway for obesity-related HFpEF, while emphasizing that no randomized trial has tested a protocolized nutrition program alongside incretin-based therapy in this population. The next advance should be judged not only by the amount of weight lost, but by whether that loss is safe, function-preserving, durable, and meaningful to patients.

To investigate the long-term risk of rheumatoid arthritis (RA) among individuals with autism spectrum disorder (ASD), addressing potential immune comorbidity in ASD populations. A population-based matched cohort was assembled using Swedish registers, including 46,164 individuals diagnosed with ASD between 1987 and 2017, matched to 4,634,895 controls by sex and birth year. Cohort members were followed from age 18 until RA diagnosis, death, emigration, or end of follow-up, providing up to 30 years of observation into adulthood. Cox proportional hazards models estimated hazard ratios (HR) for RA, with sensitivity analyses adjusting for parental autoimmune, psychiatric history, and socioeconomic status. RA diagnosis rates were similar between individuals with ASD (n = 58, 0.13%) and controls (n = 5484, 0.12%), with no increased risk: overall HR = 1.06 (95% CI 0.82-1.37), seropositive HR = 1.00 (0.67-1.48), and seronegative HR = 1.12 (0.79-1.57). Complementary analyses adjusting for parental psychiatric history, autoimmune conditions, and socioeconomic factors yielded consistent null findings (HR = 1.34, 95% CI 0.97-1.84). Sensitivity analyses, including accelerated failure time models and alternative RA subtype definitions, confirmed these results. This large-scale population study does not suggest an increased RA risk in individuals with ASD. Despite suggested immune dysfunction in ASD and shared genetic pathways with autoimmune conditions, we did not observe evidence that ASD is associated with elevated RA risk during adulthood; In conclusion, these findings inform understanding of autoimmune comorbidity patterns in autism and may guide evidence-based clinical monitoring for autistic adults.