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\"This book helps modern institutions, particularly today's military service academies, to solve concrete problems on how to inculcate the pursuit of the honorable in 21st Century leaders and soldiers and to provide a methodology for instilling honor in character formation.\" --Provided by publisher.

People with severe mental illness (SMI), including bipolar disorder, major depression, and schizophrenia, face significantly increased morbidity and mortality from cardiovascular disease (CVD). Common CVD risk factors in these populations comprise health behaviours such as smoking and poor diet, and physical factors, including diabetes mellitus, obesity and dyslipidaemia. Thus, there is a need to identify interventions to prevent CVD in SMI patients, for which general practice may be ideal for delivery. This scoping review aimed to explore the interventions to reduce CVD risk in patients with SMI in primary care, with a focus on general practice. This scoping review was guided by Arksey and O'Malley's six-step methodological framework, barring step six - consultation. A systematic search was performed across four electronic databases: PubMed, Embase, APA PsycINFO and CINAHL, following the Preferred Reporting Items for Systematic Reviews and Meta-analyses extension for Scoping Reviews (PRISMA-ScR) guidelines. Narrative synthesis was conducted to identify key themes informed by the Popay et al. framework. A total of 10 studies were included in the final analysis. Five themes were identified, namely (1) Primary Care Interventions, (2) Intervention Implementation, (3) Collaborative or Intermediary Structures, (4) Barriers and Facilitators, and (5) Participant Experiences and Viewpoints. Identified intervention types included tailored behavioural change interventions, the patient centred medical home model, clinical tool use and provider education. Promising aspects of interventions included effective staff training, collaborative structures and peer support involvement. Challenges to implementation included patient mental health symptoms impacting ability to attend sessions, lack of knowledge and experience among staff of working with SMI patients, and resource constraints, including time and workload concerns. This scoping review highlights a research gap regarding primary care interventions to reduce CVD risk in SMI patients, as only 10 relevant studies were identified published from 2015 to July 2025 in the English language. However, aspects of existing literature, such as promising intervention features, implementation barriers and feedback for consideration were also identified. Future research regarding this topic could address identified barriers and feedback points. Further randomised controlled trials assessing clinical-effectiveness and cost-efficiency of interventions in primary care settings may also be required.

When General Chemistry at West Point switched from interactive lectures to guided inquiry, it provided an opportunity to examine what was expected of students in classrooms and on assessments. Learning objectives and questions on mid-term exams for four semesters of General Chemistry I (two traditional semesters and two guided inquiry semesters) were analyzed by the Cognitive Process and Knowledge dimensions of Bloom’s revised taxonomy. The results of this comparison showed the learning objectives for the guided inquiry semesters had a higher proportion of Conceptual and Understand with a corresponding decrease of Factual, Procedural, Remember and Apply learning objectives. On mid-term exams, the proportion of Remember, Understand, Analyze/Evaluate, Factual, and Conceptual questions increased. We found that guided inquiry learning objectives and mid-term exam questions are more conceptual than traditional courses and may help explain how active learning improves equity in introductory chemistry.

Type 2 diabetes (T2D) is associated with increased risk of cardiovascular disease (CVD). As disturbed angiogenesis and endothelial dysfunction are strongly implicated in T2D and CVD, we aimed to investigate the association between a novel anti-angiogenic protein, FK506-binding protein like (FKBPL), and these diseases. Plasma FKBPL was quantified by ELISA cross-sectionally in 353 adults, consisting of 234 T2D and 119 non–diabetic subjects with/without CVD, matched for age, BMI and gender. FKBPL levels were higher in T2D (adjusted mean: 2.03 ng/ml ± 0.90 SD) vs. non-diabetic subjects (adjusted mean: 1.79 ng/ml ± 0.89 SD, p  = 0.02), but only after adjustment for CVD status. In T2D, FKBPL was negatively correlated with fasting blood glucose, HbA1c and diastolic blood pressure (DBP), and positively correlated with age, known diabetes duration, waist/hip ratio, urinary albumin/creatinine ratio (ACR) and fasting C-peptide. FKBPL plasma concentrations were increased in the presence of CVD, but only in the non-diabetic group (CVD: 2.02 ng/ml ± 0.75 SD vs. no CVD: 1.68 ng/ml ± 0.79 SD, p  = 0.02). In non-diabetic subjects, FKBPL was positively correlated with an established biomarker for CVD, B-type Natriuretic Peptide (BNP), and echocardiographic parameters of diastolic dysfunction. FKBPL was a determinant of CVD in the non-diabetic group in addition to age, gender, total-cholesterol and systolic blood pressure (SBP). FKBPL may be a useful anti-angiogenic biomarker in CVD in the absence of diabetes and could represent a novel CVD mechanism.

Abstract Aims There is growing recognition of the burden and prognostic significance of WHF treated in the outpatient setting. However, there is currently a lack of prospective real-world data in this area of HF care. This study aims to analyse the natural history of outpatient WHF. Methods and results This is a prospective, observational study of consecutive patients treated for WHF in our ambulatory HF clinic from August 2022 to March 2024. The diagnosis of WHF was made according to two definitions. The first required meeting strict pre-specified diagnostic criteria. The second included patients not meeting these diagnostic criteria but deemed to have WHF by a senior cardiologist. All patients required escalation in diuretic therapy (oral and/or intravenous) for inclusion. Clinical endpoints included outcomes from the presenting WHF episode and over the subsequent 3 months. Of the 234 patients treated for outpatient WHF, stabilisation was achieved in 78.6% (184) with 16.2% (38) requiring HF hospitalisation. A further 3.4% (8) experienced non-HF-related admissions, 2 (0.9%) patients died without hospitalisation and 2 (0.9%) patients requested follow up in other units for geographic ease. Bailout therapies (oral metolazone and/or IV loop diuretic) were used in 45.3% (106), and adverse clinical outcomes were significantly higher in this group than among those treated with oral loop diuretic only (35.8%, 38/106 and 9.4%, 12/128 respectively; odds ratio 7.24, P < 0.001). Of those who initially stabilised, 24.5% (45/184) had recurrent outpatient WHF during the subsequent 3-month period of follow-up, and 4.9% (9/184) were hospitalised for HF. Conclusions Outpatient WHF was successfully treated in the majority of patients in the community. However, despite initial stabilisation, there is a persistent risk of recurrent deterioration. This may reflect challenges in defining stability clinically in HF patients. Biologic markers of stability and closer follow-up may help to address this challenge and improve outlook for this at-risk group.

•Prompt initiation of diuretic therapy was not correlated with faster decongestion in acute heart failure.•The timing of decongestion but not diuretics was associated with better biomarker trajectories.•Residual congestion rather than the timing of decongestion or diuretics predicted prognosis. Prompt treatment may mitigate the adverse effects of congestion in the early phase of heart failure (HF) hospitalization, which may lead to improved outcomes. We analyzed 814 acute HF patients for the relationships between time to first intravenous loop diuretics, changes in biomarkers of congestion and multiorgan dysfunction, and 1-year composite end point of death or HF hospitalization. B-type natriuretic peptide (BNP), high sensitivity cardiac troponin I (hscTnI), urine and serum neutrophil gelatinase–associated lipocalin, and galectin 3 were measured at hospital admission, hospital day 1, 2, 3 and discharge. Time to diuretics was not correlated with the timing of decongestion defined as BNP decrease ≥ 30% compared with admission. Earlier BNP decreases but not time to diuretics were associated with earlier and greater decreases in hscTnI and urine neutrophil gelatinase–associated lipocalin, and lower incidence of the composite end point. After adjustment for confounders, only no BNP decrease at discharge was significantly associated with mortality but not the composite end point (p = 0.006 and p = 0.062, respectively). In conclusion, earlier time to decongestion but not the time to diuretics was associated with better biomarker trajectories. Residual congestion at discharge rather than the timing of decongestion predicted a worse prognosis.

At conferences or meetings, West Point faculty are often asked, “What’s it like to teach at West Point?” Previously, we reported on this question within the context of the cadet’s West Point experience and how STEM courses and opportunities are integrated. Now we turn our focus to the West Point faculty and their unique position of both educating cadets in a traditional sense and helping with the cadets’ character development. In this article, we discuss who the West Point faculty are; what is expected of each faculty member; and how faculty members within chemistry, physics, mechanical engineering, and civil engineering educate and develop future leaders of character for the U.S. Army.

Dilated cardiomyopathy (DCM) is the most common cause of heart failure, with a complex aetiology involving multiple cell types. We aimed to detect cell-specific transcriptomic alterations in DCM through analysis that leveraged recent advancements in single-cell analytical tools. Single-cell RNA sequencing (scRNA-seq) data from human DCM cardiac tissue were subjected to an updated bioinformatic workflow in which unsupervised clustering was paired with reference label transfer to more comprehensively annotate the dataset. Differential gene expression was detected primarily in the cardiac fibroblast population. Bulk RNA sequencing was performed on an independent cohort of human cardiac tissue and compared with scRNA-seq gene alterations to generate a stratified list of higher-confidence, fibroblast-specific expression candidates for further validation. Concordant gene dysregulation was confirmed in TGFβ-induced fibroblasts. Functional assessment of gene candidates showed that AEBP1 may play a significant role in fibroblast activation. This unbiased approach enabled improved resolution of cardiac cell-type-specific transcriptomic alterations in DCM.