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We introduce a new approach to the numerical simulation of Scanning Transmission Electron Microscopy images. The Lattice Multislice Algorithm takes advantage of the fact that the electron waves passing through the specimen have limited bandwidth and therefore can be approximated very well by a low-dimensional linear space spanned by translations of a well-localized function. Just like in the PRISM algorithm recently published by C. Ophus, we utilize the linearity of the Schrödinger equation but perform the approximations with functions that are well localized in real space instead of Fourier space. This way, we achieve a similar computational speedup as PRISM, but at a much lower memory consumption and reduced numerical error due to avoiding virtual copies of the probe waves interfering with the result. Our approach also facilitates faster recomputations if local changes are made to the specimen such as changing a single atomic column., Competing Interests: Conflict of Interest: No competing interest is declared., (© The Author(s) 2025. Published by Oxford University Press on behalf of the Microscopy Society of America. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)

Background: Preserved ratio impaired spirometry (PRISm) is defined as forced expiratory volume in one second (FEV 1 )/forced vital capacity (FVC)≥0.70 and FEV 1 <80% predicted. Previous studies have shown that individuals with PRISm may develop airflow obstruction and have an increased mortality risk. However, studies with long-term follow-up are lacking, and this topic has not been evaluated in the general population. We explored the all-cause mortality risk of individuals with PRISm in a large sample of the general population., Methods: We used data from the National Health and Nutrition Examination Survey III and 2007-2012. Participants aged 20-79 years at baseline and who underwent spirometry were included. Normal spirometry was defined as a prebronchodilator FEV 1 /FVC≥0.70 and FEV 1 ≥80% predicted. We used Cox proportional hazards regression models to compare all-cause mortality between the groups. We performed sensitivity analyses stratified by the lower limit of normal definition of spirometry criteria. Subgroup analyses by sex, age, smoking status, race, body mass index, level of education, poverty-to-income ratio, respiratory symptoms, and comorbidities were performed in participants with the different spirometry classifications., Results: Overall, 24,691 participants were included, with a median follow-up time of 25.7 years. Of these, 19,969 had normal spirometry and 1,452 had PRISm. PRISm was associated with a high all-cause mortality risk (unadjusted hazard ratio [HR]=2.47, 95% confidence interval [CI]: 2.25-2.71, P<0.001; adjusted HR=1.69, 95% CI: 1.54-1.86, P<0.001) compared with normal spirometry. Sensitivity analyses and subgroup analyses showed a similar increased all-cause mortality risk in PRISm., Conclusion: Our finding revealed that PRISm was significantly associated with increased risk of all-cause mortality in the general population compared with normal spirometry. Further research is needed to explore the intervention effect of PRISm., Competing Interests: The authors report no conflicts of interest in this work., (© 2025 Xiao et al.)

Background: Preserved ratio impaired spirometry (PRISm) is heterogeneous and includes restrictive lung disease. Interstitial lung abnormalities (ILA) may represent early interstitial lung disease. The relationship between PRISm and ILA is not well understood., Research Question: What is the prevalence of ILA in PRISm compared to normal spirometry, what are risk factors for ILA within PRISm, and how do ILAs modify the association of PRISm and mortality?, Study Design and Methods: In COPDGene participants with baseline spirometry and chest computed tomography (CT) scans, we examined those with normal spirometry (FEV 1 ≥ 80% predicted and FEV 1 /FVC ≥ 0.7) and PRISm (FEV 1 < 80% predicted with FEV 1 /FVC ratio ≥ 0.7) with and without ILA, per Fleischner Society guidelines. We used logistic regression to examine the odds of ILA in PRISm. We modeled all-cause mortality with Cox regression. We evaluated the association of baseline ILA status on change in spirometry at followup., Results: We included 4,494 normal spirometry and 1,262 PRISm participants. ILAs were present in 93 (7%) participants with PRISm, and 180 (4%) participants with normal spirometry. PRISm was associated with increased odds (1.74, 95% CI 1.33-2.27, p < 0.001) of ILA compared with normal spirometry. Among participants with PRISm, older age, increased smoke exposure, lower lung function, and increased airway wall thickness were associated with ILA. ILAs were associated with increased mortality (adj. HR 2.58, [95%CI:1.49-4.45])., Interpretation: Within PRISm, ILA is associated with increased all-cause mortality, as well as increased age, smoke exposure, lower lung function, and increased airway wall thickness., (Copyright © 2025 American College of Chest Physicians. All rights reserved.)

Background: Preserved Ratio Impaired Spirometry (PRISm) is increasingly recognized as a precursor to Chronic Obstructive Pulmonary Disease (COPD). The impact of Ultra-Processed Foods (UPFs) intake on PRISm and lung function remains underexplored, and we aimed to explore their associations., Methods: This study included 8,336 U.S. adults. Weighted logistic and linear regression models were employed for main analysis. Dose-response relationship was examined through restricted cubic spline (RCS) analysis, and subgroup analyses explored interactions with selected covariates., Results: Participants in the PRISm group were older and exhibited various adverse health characteristics. The percentage of total daily energy intake from UPFs (%Kcal) intake was associated with a non-significant increase in PRISm risk (OR 1.67, 95% CI: 0.96-2.92, p  = 0.07). However, the highest quartile of UPFs (%Kcal) intake was significantly linked to increased PRISm risk (OR 1.36, 95% CI: 0.99-1.86, P for trend = 0.043). Furthermore, higher UPFs (%Kcal) intake negatively affected lung function, with participants in the highest quartile showing a significant reduction in forced expiratory volume in 1 s (FEV1) of -45.5 mL (95% CI: -87.6 to -3.4, P for trend = 0.045) and a decrease in forced vital capacity (FVC) of -139.4 mL (95% CI: -223.5 to -55.4, p  < 0.001) compared to those in the lowest quartile. RCS analysis demonstrated linear relationships for both PRISm and lung function. Subgroup analysis revealed increased susceptibility primarily among individuals with occupational exposure. Additionally, sensitivity analysis indicated that a higher percentage of total daily intake from UPFs (%Grams) intake was significantly associated with an increased risk of PRISm (OR 1.86, 95% CI: 1.07-3.25, p  = 0.03)., Conclusion: Higher intake of UPFs is linked to an increased risk of PRISm and negatively affects lung function, particularly in individuals with occupational exposure., Competing Interests: The author declares that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2025 Kong.)

Background: Low muscle oxidative capacity is an extrapulmonary manifestation of chronic obstructive pulmonary disease (COPD) with unclear etiology. We sought to determine clinical and behavioral features associated with muscle oxidative capacity in smokers with and without COPD and never smoker individuals., Methods: 243 adults enrolled in the Muscle Health Study , an observational study ancillary to COPDGene. G astrocnemius oxidative capacity was measured by near-infrared spectroscopy from muscle oxygen uptake recovery rate constant ( k ). Physical activity by accelerometry (vector magnitude units, VMU/min). Pulmonary assessments included spirometry (FEV 1 %predicted), diffusing capacity (DL CO ), and quantitative chest computed tomography (CT). Eighty-seven variables related to COPD features were considered. Variables selected by univariate analysis of log-transformed k with p≤0.20, and filtered by machine learning, were entered into multivariable linear regression to determine association with k ., Results: 241(99%) participants were allocated to analysis. FEV 1 %predicted, DL CO , CT, pack-years, age and VMU/min were among 24 variables selected by univariate analysis. After machine learning filtering on 161(66%) cases with complete data, 11 variables were included in multivariable analysis. Only FEV 1 %predicted, age and race were significantly associated with k (R 2 =0.26). Model coefficients equate a 10% lower FEV 1 %predicted to a 4.4% lower k , or 10-years of aging to a 9.7% lower k . In 118 cases with CT available, FEV 1 %predicted and age remained associated with k (R 2 =0.24). Physical activity was not retained in any model., Conclusions: Locomotor muscle oxidative capacity was positively associated with FEV 1 %predicted and negatively associated with age. Physical activity or radiographic COPD manifestations were not significantly associated with muscle oxidative impairment., Competing Interests: Alessandra Adami is supported by National Health Institute grant R01HL151452. Fenghai Duan reports consulting fee from EarlyDiagnostics Inc. Richard Casaburi reports consulting fees from Inogen, Harry Rossiter is supported by grants from National Health Institute (R01HL151452, R01HL166850, R01HL153460, P50HD098593, R01DK122767) and the Tobacco Related Disease Research Program (T31IP1666). He reports consulting fees from the National Health Institute RECOVER-ENERGIZE working group (1OT2HL156812), and is involved in contracted clinical research with United Therapeutics, Genentech, Regeneron, Respira, Mezzion and Intervene Immune. He is a visiting Professor at the University of Leeds, UK. All other authors have nothing to disclose.

Background: Some individuals never achieve normal peak FEV 1 in early adulthood. It is unknown if this is due to airflow limitation and/or lung restriction., Methods: To investigate this, we: (1) looked forward in 19,791 participants in the Dutch Lifelines general population cohort aged 25-35 years with 5-year follow-up; and (2) looked backwards in 2032 participants in the Swedish BAMSE birth cohort with spirometry at 24 years of age but also at 16 and/or 8 years., Results: (1) In Lifelines 8.5% of participants had reduced FEV 1 at 25-35 years, 68% due to Preserved Ratio Impaired Spirometry ('PRISm') and 32% to airflow limitation ('low-limited'); besides, 3.8% participants with normal FEV 1 showed airflow-limitation ('normal-limited'). Low-limited and normal-limited, but not PRISm, reported higher smoking exposures and asthma diagnosis than normal (p < 0.05). At 5-year follow-up, 91.2% of participants remained in the same group, and FEV 1 decline was similar in normal and normal-limited participants, but statistically smaller (p < 0.05) in PRISm and low-limited; (2) these observations were largely reproduced in BAMSE at 24 years of age; and, (3) in BAMSE, low-limited or PRISm individuals were already identifiable at 8-16 years of age., Conclusion: Low peak FEV 1 in early adulthood is most often due to PRISm and results in a significant burden of respiratory symptoms. Only low-limited and normal-limited, but not PRISm, associate with a doctor diagnosis of asthma, and FEV 1 decline was statistically different in PRISm indicating a need for differentiated clinical approaches. These spirometric abnormalities can be already identified in childhood and adolescence., (© 2025 The Author(s). Respirology published by John Wiley & Sons Australia, Ltd on behalf of Asian Pacific Society of Respirology.)

Rationale and Objectives: The structural lung features that characterize individuals with preserved ratio impaired spirometry (PRISm) that remain stable overtime are unknown. The objective of this study was to use machine learning models with computed tomography (CT) imaging to classify stable PRISm from stable controls and stable COPD and identify discriminative features., Materials and Methods: A total of 596 participants that did not transition between control, PRISm and COPD groups at baseline and 3-year follow-up were evaluated: n = 274 with normal lung function (stable control), n = 22 stable PRISm, and n = 300 stable COPD. Investigated features included: quantitative CT (QCT) features (n = 34), such as total lung volume (%TLC CT ) and percentage of ground glass and reticulation (%GG+Reticulation texture ), as well as Radiomic (n = 102) features, including varied intensity zone distribution grainy texture (GLDZM ZDV ). Logistic regression machine learning models were trained using various feature combinations (Base, Base+QCT, Base+Radiomic, Base+QCT+Radiomic). Model performances were evaluated using area under receiver operator curve (AUC) and comparisons between models were made using DeLong test; feature importance was ranked using Shapley Additive Explanations values., Results: Machine learning models for all feature combinations achieved AUCs between 0.63-0.84 for stable PRISm vs. stable control, and 0.65-0.92 for stable PRISm vs. stable COPD classification. Models incorporating imaging features outperformed those trained solely on base features (p < 0.05). Compared to stable control and COPD, those with stable PRISm exhibited decreased %TLC CT and increased %GG+Reticulation texture and GLDZM ZDV ., Conclusion: These findings suggest that reduced lung volumes, and elevated high-density and ground glass/reticulation patterns on CT imaging are associated with stable PRISm., Competing Interests: Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Wan C. Tan MD reports financial support was provided by Canadian Institute of Heath Research(CIHR), Astra Zeneca Canada Ltd., Boehringer Ingelheim Canada Ltd., GlaxoSmithKline Canada Ltd., Merck Canada Inc., Novartis Pharmaceuticals Canada Inc., Nycomed Canada Inc., Pfizer Canada Ltd. Jean Bourbeau MD reports financial support was provided by Canadian Institute of Heath Research (CIHR), Réseau en santé respiratoire du FRQS, McGill University, McGill University Health Centre, AstraZeneca Canada Ltd., Boehringer Ingelheim Canada Ltd., GlaxoSmithKline Canada Ltd., Grifols Canada Ltd., Novartis Pharmaceuticals Canada Inc., Sanofi, Trudell Canada Ltd., COVIS Pharma Canada Ltd. Miranda Kirby PhD reports financial support was provided by Natural Sciences and Engineering Research Council (NSERC) Discovery Grant, The Early Researchers Award Program, The Canada Research Chair Program (Tier II). Miranda Kirby PhD reports a relationship with VIDA Diagnostics Inc that includes consulting or advisory. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Association of University Radiologists. Published by Elsevier Inc. All rights reserved.)

Introduction: Hazardous drinking is a public health problem affecting approximately 20 % of the U.S. primary care population. Clinical trials have documented the efficacy and effectiveness of Alcohol Screening and Brief Intervention (ASBI), yet widespread implementation remains elusive, and questions remain regarding optimal implementation and sustainment strategies. Kaiser Permanente Northern California (KPNC) implemented systematic ASBI in adult primary care in mid-2013. We used 8 years of electronic health record (EHR) data, combined with surveys which captured primary care provider perceptions organized into PRISM (Practical, Robust Implementation and Sustainability Model) implementation framework domains (Intervention, External Environment, Implementation Infrastructure, and Recipients), to characterize ASBI implementation and sustainment and test how various factors are associated with ASBI rates., Methods: Using EHR data, we calculated yearly screening rates of adults with a primary care visit, and brief intervention (BI) rates among those with a positive hazardous drinking screen, (exceeding the age and sex-specific daily and weekly low-risk NIH guidelines (≤3 per day and ≤ 7 per week for women and older men; ≤4 per day and ≤ 14 per week for men 18-65)), across KPNC, from 2014 to 2021. We collected web-based survey data, informed by the PRISM domains, from primary care providers (n = 796; 35.5 % RR) to assess perceptions on ASBI implementation and sustainability., Results: Between 1/1/2014 and 12/31/21 there were 5,072,270 completed screenings and 624,167 BIs. After adjusting for patient panel characteristics, we found that facilities with higher Implementation Infrastructure domain scores, indicating more robust implementation capacity, had higher screening and BI rates; facilities with higher Intervention domain scores, indicating positive perceptions of SBIRT evidence, and facilities with higher Recipients domain scores, indicating perceived organizational robustness, clinician culture and management support; and greater perceived patient needs and their likely benefit from SBIRT, had higher BI rates., Conclusions: Results provide information on factors which may facilitate successful ASBI implementation and sustainability and could inform future ASBI implementation efforts in healthcare system settings. In particular, efforts toward bolstering an organization's implementation infrastructure capacity, prior to embarking on implementation of a systematic ASBI program, could potentially help pave the way for successful implementation., Competing Interests: Declaration of competing interest The authors have no financial relationships relevant to this article or potential conflicts of interest to disclose., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background/Objectives : Ocular proprioception is implicated in balance control and heterophoria is associated with abnormal posture, though previous research focused mainly on the role of vertical phoria and the use of vertical prisms. This study aims to evaluate whether ocular misalignment and prismatic correction of horizontal phoria affect posture. Methods : Sixty-nine ( N = 69) young healthy subjects were included and equally divided by horizontal distance phoria: orthophoria ( n = 23), esophoria ( n = 23) and exophoria ( n = 23). A prism of low power (two-diopter) was placed base out on the non-dominant eye, reducing misalignment in esophorics and increasing it in exophorics more than in orthophorics. Dynamic computerized posturography was performed with the sensory organization test protocol (SOT) of the EquiTest ® NeuroCom ® version 8 platform both without and with prism, always maintaining subjects unaware of prism use. A mixed model for repeated measures analysis of variance was run to evaluate the main effect of prism and the interaction effect of prism with baseline phoria. Results : Composite movement strategy score without prism was 88.1 ± 2.8% (ankle-dominant strategy) and slightly increased to 89.0 ± 3.1% with prism insertion ( p = 0.004), further shifting toward ankle strategy. Composite equilibrium score without prism was 80.3 ± 6.5% and remained stable with prism insertion (81.3 ± 8.2%, p = 0.117), medio-lateral and antero-posterior projection of center of gravity did not displace significantly under prism insertion ( p = 0.652 and p = 0.270, respectively). At baseline, posturographic parameters were statistically independent of individual phoria, and no significant interaction between prism insertion and individual phoria was documented for any parameters ( p > 0.05 for all). Secondary analysis and pairwise comparisons confirmed that the effect of prism was strongly selective on condition SOT 5 (eyes-closed, platform sway-referenced) with improvement of equilibrium (70.4 ± 9.7% with prism vs. 65.7 ± 11.6% without) and more use of ankle strategy (81.6 ± 5.3% with prism vs. 78.2 ± 6.0% without), without any interaction of phoria and ocular dominance, while the other conditions were comparable with and without prism. Conclusions : A two-diopter prism base out on the non-dominant eye induces the body to use the ankle joint more independently of individual phoria, suggesting a small improvement in postural control, while maintaining oscillations of the center of gravity unaltered. Prism seems to enhance the function of vestibular system selectively. Phoria adjustments with prismatic correction enable intervention in postural behavior. Extraocular muscles could act as proprioceptors influencing postural stability.

Background: Preserved ratio impaired spirometry (PRISm) represents a population with spirometry results that do not meet standardized COPD obstruction criteria, yet present with high respiratory symptom burden and might benefit from respiratory management and treatment. We aimed to determine prevalence of PRISm in US primary care patients diagnosed with COPD, describe their demographic, clinical, and CT scan characteristics., Methods: An observational registry study utilizing the US APEX COPD registry, composed of patients diagnosed with COPD aged 35+ years. Demographic and clinical data were collected from EHRs and complemented by questionnaires. Multivariable logistic regression was performed to assess whether PRISm predicts lung function decline., Results: Prevalence of PRISm within a primary care population clinically diagnosed with COPD was 23.6% (678/2866, 95% CI 22.0-25.1). Those with PRISm were more likely female (55.9% vs 46.9%), younger (66.3±11.1 vs 69.2±10.3 years), with a greater mean BMI (33.5±9.2 vs 27.8±7.2 kg/m 2 ), more often African American or Hispanic (37.2% vs 26.3%), and with fewer current smokers (33.1% vs 36.8%) when compared to those meeting COPD spirometry criteria (all p<0.05). Compared to COPD GOLD 0 patients, individuals with PRISm had greater BMI (33.5±9.2 vs 30.6±7.8), and were more likely current smokers (33.1% vs 23.4%), both p<0.05. Patients with PRISm had similar respiratory symptoms (chronic bronchitis, CAT, and mMRC) to overall COPD patients, but more frequently than GOLD 0 COPD patients (p<0.01). Emphysema was more commonly reported in CT scans from patients with PRISm 70.3% (260/369, 95% CI 65.8-75.3) than those with GOLD 0 COPD 64.1% (218/340, 95% CI 58.8-69.2) (p<0.05). PRISm status was not predictive of lung function decline., Interpretation: One in four primary care patients with clinically diagnosed COPD in a large US registry fulfil the spirometric definition of PRISm rather than COPD, but suffers from emphysema in CT and significant respiratory symptoms., Competing Interests: Yasir Tarabichi, Chester Fox and Joan B Soriano report no conflicts of interest in this work. Wilson Pace has received funding via subcontracts with his organization from CDC, PCORI, NIH, Boehringer Ingelheim, ONC, Tabula Rasa Healthcare, and Astra-Zeneca; his organization received consulting fees for his work from Boehringer Ingelheim; he is/was on an Advisory board and Executive Committee member (unpaid) for COPD Foundation 360 Network; he owns stock through a trust in Johnson and Johnson, Eli Lily, Novo-Nordisk, Pfizer, Novartis, Moderna, and Amgen; he received grant and writing support for an unrelated project from Boehringer Ingelheim and grant from Circasso for collecting FeNO data; and was an unpaid member of the Colorado Medicaid Provider Rate Review Committee. In addition, he provided free ICS and distribution support for a large PCORI around asthma care - clinical site management for entire project for Teva. Barry Make reports funding from the NHLBI for the COPDGene study; grants and medical advisory boards from Boehringer Ingelheim, GlaxoSmithKline, AstraZeneca, Regeneron, Sanofi and Sunovian; CME personal fees from WebMD, National Jewish Health, American College of Chest Physicians, American Lung Association, Projects in Knowledge, Hybrid Communications, SPIRE Learning, Ultimate Medical Academy, Catamount Medical, Eastern Pulmonary Society, Catamount Medical Communications Medscape, Eastern VA Medical Center, Academy Continued Healthcare Learning, and Mt. Sinai Medical Center; royalties from Up-To-Date, Wolters Kluwer Health; medical advisory boards from Novartis, Phillips, Third Pole, Science 24/7, and Verona; grants from Pearl, US Department of Defense; personal fees from Optimum Patient Care Global Limited, Quintiles, Web MD, outside the submitted work. He also presented at GOLD conference. MeiLan K. Han reports personal fees from GlaxoSmithKline, AstraZeneca, Boehringer Ingelheim, Cipla, Chiesi, Novartis, Pulmonx, Teva, Verona, Merck, Mylan, Sanofi, DevPro, Aerogen, Polarian, Regeneron, Amgen, UpToDate, Altesa Biopharma, Medscape, NACE, MDBriefcase, Integrity and Medwiz. She has received either in kind research support or funds paid to the institution from the NIH, Novartis, Sunovion, Nuvaira, Sanofi, AstraZeneca, Boehringer Ingelheim, Gala Therapeutics, Biodesix, the COPD Foundation and the American Lung Association. She has participated in Data Safety Monitoring Boards for Novartis and Medtronic with funds paid to the institution. She has received stock options from Meissa Vaccines and Altesa Biopharma. Alan Kaplan reports speakers bureau or Advisory Board for AstraZeneca, ALK, Belus, Boehringer Ingelheim, Covis, Eisai, GSK, Idorsia, Merck Frosst, Moderna, Novo Nordisk, Pfizer, Sanofi, Teva, Trudel, Valeo. Ku-lang Chang declares grant funding from Abbvie, Afimmune, Akero Therapeutics, Inc. Anji Pharma, Arrowhead Pharmaceuticals, Astrazeneca Pharmaceuticals, Axcella Health Inc, Boehringer Ingelheim Pharmaceuticals, Eli Lilly and Company, Enanta Pharmaceuticals, Inc, Esperion, Galectin Therapeutics, Gilead Sciences, Inc, Glympse Bio, Hanmi Pharmaceutical Co, LTD, Intercept Pharmaceuticals, Inventiva Pharma, Kowa Pharmaceuticals America, Inc, Lexicon Pharmaceuticals, Madrigal Pharmaceuticals, Inc, Merck & Co., Inc, Metacrine, Inc, Moderna, New Amsterdam Pharma, Novartis Pharmaceuticals, Novartis Pharmaceuticals Corp, Novo Nordisk, Romark Laboratories, Sagimet Biosciences, Sanofi Pasteur, Inc, Valneva, Viking Therapeutics, Zydus Discovery DMCC. Janwillem W. H. Kocks Janwillem Kocks reports grants, personal fees and non-financial support from AstraZeneca, Boehringer Ingelheim, GSK; grants and personal fees from Chiesi, Teva; non-financial support from Mundi Pharma; personal fees from MSD, COVIS Pharma, ALK-Abello; grants from Valneva outside the submitted work; and Janwillem Kocks holds <5% shares of Lothar Medtec GmbH and 72.5% of shares in the General Practitioners Research Institute. Neil Skolnik is on advisory boards for AstraZeneca, Teva, Lilly, Boehringer Ingelheim, Novartis, Bayer, Genentech, Abbott, Novo Nordisk, Heartland, Astellas, Proteomics International, Sanofi, Janssen Pharmaceuticals, Intarcia, Mylan, and GlaxoSmithKline; Payment for lectures/speaking engagements from AstraZeneca and Boehringer Ingelheim; Research Support from Sanofi, AstraZeneca, Boehringer Ingelheim, and GlaxoSmithKline. Barbara Yawn received fees for consulting and serving on COPD-related advisory boards for GlaxoSmithKline, AstraZeneca, Novartis, Boehringer Ingelheim, and Teva; received travel support from Boehringer Ingelheim and AstraZeneca for international presentations and received COPD-related investigator-initiated research funds from GlaxoSmithKline, Sanofi, Boehringer Ingelheim, AstraZeneca, Mylan and Novartis. Alexander Evans is an employee of Observational and Pragmatic Research Institute. Victoria Carter is an employee of Optimum Patient Care Ltd. Chantal Le Lievre, Alexander Roussos, and Nicholas Bushell are employees of Optimum Patient Care, Australia. David Price has advisory board membership with AstraZeneca, Boehringer Ingelheim, Chiesi, GlaxoSmithKline, Novartis, Viatris, Teva Pharmaceuticals; consultancy agreements with AstraZeneca, Boehringer Ingelheim, Chiesi, GlaxoSmithKline, Novartis, Viatris, Teva Pharmaceuticals; grants and unrestricted funding for investigator-initiated studies (conducted through Observational and Pragmatic Research Institute Pte Ltd) from AstraZeneca, Chiesi, Viatris, Novartis, Regeneron Pharmaceuticals, Sanofi Genzyme, and UK National Health Service; payment for lectures/speaking engagements from AstraZeneca, Boehringer Ingelheim, Chiesi, Cipla, Inside Practice, GlaxoSmithKline, Medscape, Viatris, Novartis, Regeneron Pharmaceuticals and Sanofi Genzyme, Teva Pharmaceuticals; payment for travel/accommodation/meeting expenses from AstraZeneca, Boehringer Ingelheim, Novartis, Medscape, Teva Pharmaceuticals.; stock/stock options from AKL Research and Development Ltd which produces phytopharmaceuticals; owns 74% of the social enterprise Optimum Patient Care Ltd (Australia and UK) and 92.61% of Observational and Pragmatic Research Institute Pte Ltd (Singapore); 5% shareholding in Timestamp which develops adherence monitoring technology; is peer reviewer for grant committees of the UK Efficacy and Mechanism Evaluation programme, and Health Technology Assessment; and was an expert witness for GlaxoSmithKline. The authors report no other conflicts of interest in this work., (© 2024 Evans et al.)

In low- and middle-income countries (LMICs), barriers such as low system readiness, contextual mismatches, and resource limitations impede effective implementation of evidence-based interventions. This commentary offers insights into overcoming these challenges with a case study of the PRISM project, designed to reduce behavioral and psychological symptoms of dementia in older adults living in Thailand. The case highlights how combining two evidence-based models - the Reducing Disability in Alzheimer's Disease clinical intervention and the Getting To Outcomes implementation science process enhances program success. Using interviews with stakeholders across various health system levels, we identify factors critical to successful program implementation: (1) integrating interventions into policy frameworks, (2) empowering local implementers, (3) fostering collaborative learning, and (4) adapting interventions to local contexts. The case demonstrates that building system readiness through local engagement and ownership is central to scaling up health programs in LMICs. This commentary's contribution lies in its emphasis on the role of implementation science as a vehicle for translating research into practice. It presents a practical, adaptive model for embedding interventions into routine health systems, thereby offering a pathway for successfully scaling up evidence-based programs in LMICs. Such findings provide lessons for overcoming barriers to implementation in resource-limited environments., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Sepsis continues to be a major contributor to illness and death in children, necessitating effective risk assessment tools. Incidence of pediatric sepsis in intensive care units is on increasing trend. Over the years, the concept of sepsis scoring systems has evolved to enhance the prediction of outcomes and mortality in pediatric age group. To better identify sepsis and septic shock status in the pediatric age group, various sepsis scores were developed. Properly applying these scores can significantly enhance timely decision making and ultimately reduce mortality rates. Selecting appropriate score should match the settings where they were designed. Scoring system is broadly categorized into two types - prognostic scores and descriptive or outcome scores. To improve care for critically ill children, it is important to develop tools that can better predict long-term mortality and morbidity and identify factors related to intensive care related events. This review article aims to discuss the evolution of various sepsis scoring systems, highlighting their development over time and their practical utility in clinical settings., Competing Interests: Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Mishra et al.)

There is a growing emphasis on reducing the gap between research and routine practice. Dissemination and Implementation (D&I) science offers theories, models, and frameworks to enhance the implementation, impact, and sustainment of new programs and interventions. Few training opportunities are available that help leaders, researchers, clinicians, and staff (implementers) translate original research into practice settings in a more timely and effective manner without requiring significant time away from their primary clinical duties. To address these needs, we designed a virtual Designing for Dissemination and Implementation (D4D&I) Learning Hub that offered foundational D&I knowledge and opportunities for skill building. We developed the D4D&I Learning Hub curricula to train novice participants in the multicomponent D4D&I implementation strategy bundle when implementing new programs or innovations. The components of the D4D&I strategy bundle include (i) Pre-implementation assessment for proactive planning and multilevel contextual assessment, (ii) Multilevel partner engagement to learn what is important to end-users and obtain buy-in, (iii) Implementation and adaptations guided by a pre-implementation assessment while retaining program fidelity, and (iv) Program evaluation. We utilized a virtual e-learning platform, expert trainers, mentorship, and a Virtual Learning Collaborative to deliver the six-module curricula to support participants' growth and success. We used quantitative and qualitative methods informed by the Kirkpatrick Evaluation Model to evaluate the D4D&I Learning Hub. Thirty-one participants completed the D4D&I Learning Hub across four cohorts. Participants found the D4D&I curricula relevant and favorable, indicating they acquired the intended knowledge and skills. In presentations of their key takeaways, participants cited a greater understanding of how to apply various D&I theories, models, and frameworks to their research, engage multilevel partners during all phases of implementation and evaluation, and assess fidelity and adaptations. Participants planned to incorporate the acquired D&I knowledge and skills in future publications, grant applications, and when implementing new programs and projects in clinical settings. The D4D&I Learning Hub provides foundational education for novice participants of D&I science. It promotes designing, disseminating, implementing, and evaluating effective programs in clinical settings. This article discusses the development and implementation of the D4D&I Learning Hub. In addition, we evaluated the first four cohorts using the Kirkpatrick Evaluation Model., (Published by Oxford University Press on behalf of the Society of Behavioral Medicine 2024.)

Background: Epidemiological evidence regarding the association between air pollutants and cardiopulmonary disease, mortality in individuals with preserved ratio impaired spirometry (PRISm), and their combined effects remains unclear., Methods: We followed 36,149 participants with PRISm in the UK Biobank study. Annual concentrations of PM 2.5 , PM 10 , NO 2 , NO x , and SO 2 at residential addresses were determined using a bilinear interpolation method, accounting for address changes. A multistate model assessed the dynamic associations between air pollutants and cardiopulmonary diseases and mortality in PRISm. Quantile g-computation was used to investigate the joint effects of air pollutants., Results: Long-term exposure to PM 2.5 , PM 10 , NO 2 , NO x , and SO 2 was significantly associated with the risk of cardiopulmonary disease in PRISm. The corresponding hazard ratios (HRs) [95 % confidence intervals (95 % CIs)] per interquartile range (IQR) were 1.49 (1.43, 1.54), 1.52 (1.46, 1.57), 1.34 (1.30, 1.39), 1.30 (1.26, 1.34), and 1.44 (1.41, 1.48), respectively. For mortality, the corresponding HRs (95 % CIs) per IQR were 1.36 (1.25, 1.47), 1.35 (1.24, 1.46), 1.27 (1.18, 1.36), 1.23 (1.15, 1.31), and 1.29 (1.20, 1.39), respectively. In PRISm, quantile g-computation analysis demonstrated that a quartile increase in exposure to a mixture of all air pollutants was positively associated with the risk of cardiopulmonary disease and mortality, with HRs (95 % CIs) of 1.84 (1.76, 3.84) and 1.45 (1.32, 1.57), respectively., Conclusion: Long-term individual and joint exposure to air pollutants (PM 2.5 , PM 10 , NO 2 , NO x , and SO 2 ) might be an important risk factor for cardiopulmonary disease and mortality in high-risk populations with PRISm., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Introduction: This study endeavors to decipher the association between Activin A and PRISm, thereby addressing the potential of Activin A as a serum biomarker for early detection and long-term clinical outcome prediction of PRISm and subsequent all-cause mortality., Methods: The study sample comprised middle-aged and older adults from the I-Lan Longitudinal Aging Study. Pulmonary function including forced vital capacity (FVC) and forced expiratory volume in one second (FEV 1 ) were measured. Demographic data and laboratory data (including serum Activin A levels) were also collected. Multivariate logistic regression and Cox proportional hazards models were used to identify independent predictors of PRISm and all-cause mortality, respectively., Results: Among 711 eligible participants, 34 % had PRISm. The risk of PRISm elevated with Activin A levels in group quartiles (adjusted odds ratio (aOR), Q2: 1.606 [95 % CI 0.972-2.652], p = 0.064, Q3: 2.666 [1.635-4.348], p < 0.001, Q4: 3.225 [1.965-5.293], p < 0.001). On the other hand, lower hemoglobin (aOR: 1.122, p = 0.041) and higher blood urea nitrogen (BUN) levels (aOR: 1.033, p = 0.048) were associated with increased risk of PRISm. In addition, the PRISm group had a higher all-cause mortality rate (non-PRISm 4.5% vs. PRISm 8.3 %, p = 0.038). Multivariate Cox models also identify a higher level of Activin A as a risk factor of all-cause mortality (aHR: 1.001 [1.000-1.003], p = 0.042)., Conclusions: Higher Activin A quartiles were linked to increased risk of PRISm, along with lower hemoglobin and higher BUN levels. Additonally, elevated Activin A was a significant risk factor of all-cause mortality., Competing Interests: Declaration of competing interest The authors declare that they have no competing interests., (Copyright © 2024. Published by Elsevier B.V.)

Aim: To investigate the effect of using base-out prisms on nystagmus, visual acuity and contrast sensitivity in patients with albinism., Methods: In this interventional study, patients with albinism who had nystagmus were enrolled. A comprehensive eye exam was conducted, which included refraction, assessment of far and near vision acuity, and contrast sensitivity measurements. To check for the nystagmus, a videonystagmography was used. The tests were carried out in three modes: without any correction, with optical correction, and with correction using base-out prisms in three different powers, including 4, 6, and 8 prism diopters., Results: Totally 23 patients with average age of 28.65±12.13 were examined. It was found that the use of optical correction and optical correction with prisms resulted in a statistically significant improvement in both far (at least: P <0.006) and near visual acuity (at least: P <0.001 except for prism 8; P <0.02). In addition, contrast sensitivity significantly improved at all low and medium frequencies except for correction with prism 8 in frequency 1.5 (at least: P <0.01 except for prism 4, frequency 6; P =0.04). no significant improvement was observed in the evaluation of nystagmus characteristics., Conclusion: Optical correction with a prism can improve visual acuity and some spatial frequencies, but failed to improve nystagmus parameters., Competing Interests: Conflicts of Interest: Dashti M, None; Riazi A, None; Ashrafi M, None; Rahmani S, None; Tabatabaei SM, None., (International Journal of Ophthalmology Press.)

Introduction: Chronic obstructive pulmonary disease (COPD) is a dynamic disease with a high socioeconomic burden. Using data collected prospectively from the general population, we examined factors related to the transition of at-risk individuals to COPD., Methods: We used the Korean Genome Epidemiology Study (KoGES) database, defining pre-COPD based on respiratory symptoms and radiological abnormalities suggestive of COPD; the preserved ratio impaired spirometry (PRISm) was defined as a forced expiratory volume in 1s (FEV 1 )/forced vital capacity ratio≥70% and FEV 1 <80%, as predicted by spirometry. We determined group differences in the rate of lung function decline, risk of future airflow obstruction (AFO)., Results: The study included 4762 individuals, and longitudinal analysis revealed distinct trends in pulmonary function indicators. Compared to the normal group, the pre-COPD group showed a more rapid decline in lung function, while the PRISm group showed a slower decline. In the pre-COPD and PRISm groups, 4.4% and 3.5%, and 13.6% and 10.8%, respectively, of patients had progressed to COPD at the first and second visits. Pre-COPD and PRISm contributed to an earlier time to first AFO, but consideration of comorbid cardiovascular disease weakened this relationship in the PRISm group. Multivariate logistic regression showed that pre-COPD and PRISm are significant risk factors for future development of COPD (OR 1.80, p<0.001; OR 4.26, p<0.001, respectively)., Conclusion: Pre-COPD and PRISm patients showed different trends in lung function changes over time and both were significant risk factors for future development of COPD., (Copyright © 2024 SEPAR. Published by Elsevier España, S.L.U. All rights reserved.)

Background: Preserved Ratio Impaired Spirometry (PRISm) is considered to be a precursor of chronic obstructive pulmonary disease. Radiomics nomogram can effectively identify the PRISm subjects from non-COPD subjects, especially when during large-scale CT lung cancer screening., Methods: Totally 1481 participants (864, 370 and 247 in training, internal validation, and external validation cohorts, respectively) were included. Whole lung on thin-section computed tomography (CT) was segmented with a fully automated segmentation algorithm. PyRadiomics was adopted for extracting radiomics features. Clinical features were also obtained. Moreover, Spearman correlation analysis, minimum redundancy maximum relevance (mRMR) feature ranking and least absolute shrinkage and selection operator (LASSO) classifier were adopted to analyze whether radiomics features could be used to build radiomics signatures. A nomogram that incorporated clinical features and radiomics signature was constructed through multivariable logistic regression. Last, calibration, discrimination and clinical usefulness were analyzed using validation cohorts., Results: The radiomics signature, which included 14 stable features, was related to PRISm of training and validation cohorts (p < 0.001). The radiomics nomogram incorporating independent predicting factors (radiomics signature, age, BMI, and gender) well discriminated PRISm from non-COPD subjects compared with clinical model or radiomics signature alone for training cohort (AUC 0.787 vs. 0.675 vs. 0.778), internal (AUC 0.773 vs. 0.682 vs. 0.767) and external validation cohorts (AUC 0.702 vs. 0.610 vs. 0.699). Decision curve analysis suggested that our constructed radiomics nomogram outperformed clinical model., Conclusions: The CT-based whole lung radiomics nomogram could identify PRISm to help decision-making in clinic., (© 2024. The Author(s).)

Rationale: Preserved ratio impaired spirometry (PRISm) is a recently recognized spirometric pattern defined by a ratio of forced expiratory volume in 1 second to forced vital capacity of at least 0.70 and a forced expiratory volume in 1 second  <80% of reference. For unclear reasons, PRISm is associated with increased cardiovascular (CV) morbidity and mortality. Arterial stiffness is a major mechanism of CV disease, which can be measured by carotid-femoral pulse-wave velocity (cfPWV). Objectives: We explored the hypothesis that cfPWV would be increased in individuals with PRISm and airflow limitation (AL). Methods: We measured forced spirometry, lung volumes by body plethysmography, and cfPWV in 9,466 subjects recruited from the general population in the Austrian cross-sectional LEAD (Lung, Heart, Social, Body) study and tested the association of arterial stiffness with PRISm and AL by multivariable linear regression analysis. Individuals younger than 18 years were excluded from the study. Results: Individuals with PRISm ( n  = 431; 4.6%) were of similar age to those with normal spirometry ( n  = 8,136; 85.9%) and significantly younger than those with AL ( n  = 899; 9.5%). Arterial hypertension, diabetes mellitus, coronary artery disease, heart failure, and peripheral arterial occlusive disease were significantly more common in individuals with PRISm than in those with normal lung function and similar to those with AL. There was a significant association between PRISm and arterial stiffness on bivariate linear regression analysis (crude model, β = 0.038; 95% confidence interval [CI], 0.016-0.058), which persisted after robust adjustment for clinical confounders upon multivariable analysis (final model, β = 0.017; 95% CI, 0.001-0.032). cfPWV was significantly higher in individuals with PRISm irrespective of the presence of established CV disease or pulmonary restriction. AL also showed a significant association with arterial stiffness on multivariable linear regression analysis (final model, β = 0.025; 95% CI, 0.009-0.042). Conclusions: Arterial stiffness measured by cfPWV is increased in individuals with PRISm independent of CV disease and risk factors. The pathobiological mechanisms underlying this association deserve further research.

Background: The Collaboration for Evidence-based Healthcare and Public Health in Africa (CEBHA+) developed and offered a course on evidence-based public health (EBPH) in five sub-Saharan African (SSA) countries to enhance individual and institutional capacity., Aim: This study aims to assess, compare and learn from implementing the CEBHA+ EBPH course using the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework and Practical, Robust, Implementation and Sustainability Model (PRISM)., Setting: This study involved CEHBA+ partner universities in five countries in SSA., Methods: We developed a framework that draws on signalling questions for RE-AIM and PRISM dimensions. Country teams reflected on, discussed and mapped unique experiences. Using this framework, we then elicited common themes across countries and distilled country-specific experiences through virtual discussions., Results: Across countries, 130 public health practitioners, researchers and students completed the course (Reach). The course increased EBPH knowledge and skills and the capacity to teach EBPH and resulted in immediate opportunities for applying skills (Effectiveness). Hybrid offering in two countries presented challenges regarding Internet connectivity and hybrid discussions. Facilitators had previous training in teaching EBPH. While learning material was the same across countries, the content was adapted to represent local public health priorities (Implementation, Adoption). Course materials have informed other related training leading to spin-offs (Maintenance). Institutionalisation is dependent on external funding., Conclusion: Strengthening EBPH capacity across contexts is feasible. Curricula containing both core and contextualised elements create an authentic learning environment. Formal evaluations should be embedded within capacity-strengthening initiatives., Contribution: This is the first study evaluating EBPH training in SSA using an implementation science lens, offering learning about context-relevant adaptations that assist with plans for sustainability and scale., Competing Interests: The authors declare that they have no financial or personal relationships that may have inappropriately influenced them in writing this article., (© 2024. The Authors.)

Objective: Pulmonary function is associated with the development of chronic liver disease. However, evidence of the association between pulmonary function and cirrhosis risk is still lacking. This study aimed to investigate the longitudinal associations of pulmonary function with the development of cirrhosis, and to explore whether genetic predisposition to cirrhosis could modify these associations., Methods: Of 294,835 participants free of cirrhosis and had undergone spirometry at baseline from the UK Biobank were included. Cirrhosis diagnoses were ascertained through linked hospital records and death registries. Cox proportional hazard models were employed to investigate the longitudinal associations between pulmonary function, genetic predisposition, and cirrhosis risk., Results: During a median follow-up of 12.0 years, 2598 incident cirrhosis cases were documented. Compared to individuals with normal spirometry findings, those with preserved ratio impaired spirometry (PRISm) findings (hazard ratio [HR] and 95% confidence interval [CI]: 1.32 [1.18, 1.48]) and airflow obstruction (HR [95%CI]: 1.19 [1.07, 1.31]) had a higher risk of developing cirrhosis after adjustments. These associations were consistent across all categories of genetic predisposition, with no observed modifying effect of genetic predisposition. In joint exposure analyses, the highest risk was observed in individuals with both a high genetic predisposition for cirrhosis and PRISm findings (HR [95% CI]: 1.74 [1.45, 2.08])., Conclusions: Our findings indicate that worse pulmonary function is a significant risk factor of cirrhosis, irrespective of genetic predisposition. Early identification and appropriate intervention for pulmonary function may lead to more effective healthcare resource utilization and reduce the burden associated with cirrhosis., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Although waste-to-energy (WtE) incineration projects have boosted the economic effectiveness of the waste management system, locals frequently view them with suspicion, opposition, or even outright rejection because of potential environmental and health risks. In this study, by incorporating two additional variables, namely, objective knowledge and benefit perceptions, the planned risk information seeking model (PRISM) was extended in the context of the WtE incineration project. A total of 1726 respondents were interviewed in person. Results from the structural equation modeling indicated that the extended PRISM achieved excellent fits, suggesting the generalizability of the model in these contexts. Objective knowledge and subjective knowledge have a positive and direct impact on perceived knowledge insufficiency. The impact of benefit and risk perceptions on worry is the opposite, with risk perceptions having a greater direct effect on worry. However, compared with risk perceptions, the direct effect that benefit perceptions have on perceived knowledge insufficiency is stronger. Additionally, perceived knowledge insufficiency partially or completely mediates the relationships between all antecedents, except perceived seeking control, and information-seeking intention. This study suggests that risk managers carefully consider how to establish powerful communication tactics to shape these antecedents when introducing a "not in my backyard" project to the local community., (© 2024 Society for Risk Analysis.)

Pediatric patients with multiple organ failures in the pediatric intensive care unit (PICU) are at a higher risk of mortality. Assessing the mortality risk when patients are admitted to PICU is important to allocate treatment and care properly. The aim of this study was to compare the performance of the PRISM IV score within the first 24 and 72 hours to predict mortality in the PICU. Demographic, clinical, and laboratory data were collected to compute the PRISM IV in the first 24 and 72 hours among critically ill pediatric patients in the PICU at H. Adam Malik General Hospital, Medan, Indonesia, from April 2021 to February 2022. The comparison of the PRISM IV scores and its components within the first 24 and 72 hours was analyzed using the Wilcoxon test, Student's independent t-test or McNemar test. The role of PRISM IV score in predicting mortality was assessed using the receiver operating characteristic (ROC) curve. Out of 35 pediatric patients, 17 (48.6%) of them died. Platelet count ( p =0.022), pCO 2 ( p =0.026), HCO 3 ( p =0.009), total CO 2 ( p =0.015), and base excess ( p =0.001) were statistically different between 24 and 72 hours groups. The area under curve (AUC) for the first 24 hours using PRISM IV scores was 47.4% with p =0.792 (95%CI, 27.7%-67.1%). Meanwhile, the AUC of 72 hours group was 65.4%, p =0.121 (95%CI, 47.1%-83.6%). This study suggested that PRISM IV scores in the first 24 and 72 hours may not be a reliable screening tool for predicting mortality. However, further studies are suggested to validate these findings., Competing Interests: The authors declare that there is no conflict of interest., (© 2024 The Author(s).)

Background: Diabetes is a serious public health problem affecting 37.3 million Americans. Diabetes shared medical appointments (SMAs) are an effective strategy for providing diabetes self-management support and education in primary care. However, practices delivering SMAs experience implementation challenges. This analysis examined conditions associated with successful practice implementation of diabetes SMAs in the context of participation in a pragmatic trial., Methods: Mixed methods study using qualitative and quantitative data collected from interviews, observations, surveys, and practice-reported data, guided by the practical, robust implementation and sustainability model (PRISM). Data were analyzed using qualitative comparative analysis (QCA). Successful implementation was defined as meeting patient recruitment targets (Reach) during the study period. Participants were clinicians and staff members from 22 primary care practices in Colorado and Missouri, USA., Results: The first necessary condition identified from the QCA was the presence of additional resources for patients with diabetes in the practice. Within practices that had these additional resources, we found that a sufficiency condition was the presence of an effective key person to make things happen with the SMAs. A second QCA was conducted to determine conditions underlying the presence of the effective key person (often performing functions of an implementation champion), which revealed factors including low or managed employee turnover, a strong baseline practice culture, and previous experience delivering SMAs., Conclusions: Identification of key factors necessary and sufficient for implementation of new care processes is important to enhance patient access to evidence-based interventions. This study suggests that practice features and resources have important implications for implementation of diabetes SMAs. There may be opportunities to support practices with SMA implementation by enabling the presence of skilled implementation champions., Trial Registration: Registered at clinicaltrials.gov under trial ID NCT03590041, registered on July 18, 2018., (© 2024. The Author(s).)

Background: We aimed to evaluate the validity and reliability of the Turkish version of the Patient-Reported Impact of Spasticity Measure (PRISM-TR)., Methods: Expert opinions and the forward-back translation method were used for linguistic validation. Cronbach α and test-retest analysis were performed for reliability analysis. Correlations between the PRISM-TR and the Modified Ashworth Scale (MAS), the Numerical Rating Scale (NRS), and the Expanded Disability Status Scale (EDSS) were assessed., Results: A total of 206 individuals with multiple sclerosis (MS; 139 women; mean age, 47.7 ± 11.3 years; mean EDSS score, 5.2 ± 1.5) who had not had a relapse in the previous 3 months were included in the study. Test-retest correlation coefficients were high for all subdimensions of the scale (0.95-0.99). All Cronbach α values for the PRISM-TR subdimensions, except for Positive Impact, were likewise quite high (0.85-0.94). PRISM-TR subscale scores were correlated with MAS, NRS, and EDSS scores ( P < .001)., Conclusions: PRISM-TR is a valid and reliable scale for use with Turkish individuals with MS. It is simple to use in the clinic and can be helpful in detecting patients' spasticity early in the disease course., Competing Interests: CONFLICT OF INTEREST: The authors declare no conflicts of interest., (© 2024 Consortium of Multiple Sclerosis Centers.)

Understanding the prevalence of abnormal lung function and its associated factors among patients recovering from COVID-19 is crucial for enhancing post-COVID care strategies. This study primarily aimed to determine the prevalence and types of spirometry abnormalities among post-COVID-19 patients in Malaysia, with a secondary objective of identifying its associated factors. Conducted at the COVID-19 Research Clinic, Faculty of Medicine, University Technology MARA, from March 2021 to December 2022, this study included patients at least three months post-discharge from hospitals following moderate-to-critical COVID-19. Of 408 patients studied, abnormal spirometry was found in 46.8%, with 28.4% exhibiting a restrictive pattern, 17.4% showing preserved ratio impaired spirometry (PRISm), and 1.0% displaying an obstructive pattern. Factors independently associated with abnormal spirometry included consolidation on chest X-ray (OR 8.1, 95% CI 1.75-37.42, p = 0.008), underlying cardiovascular disease (OR 3.5, 95% CI 1.19-10.47, p = 0.023), ground-glass opacity on chest X-ray (OR 2.6, 95% CI 1.52-4.30, p < 0.001), and oxygen desaturation during the 6-min walk test (OR 1.9, 95% CI 1.20-3.06, p = 0.007). This study highlights that patients recovering from moderate-to-critical COVID-19 often exhibit abnormal spirometry, notably a restrictive pattern and PRISm. Routine spirometry screening for high-risk patients is recommended., (© 2024. The Author(s).)

Pulmonary function tests (PFTs) are pivotal in diagnosing and managing a broad spectrum of respiratory disorders. These tests provide critical insights into lung health, guiding diagnoses, assessing disease severity, and shaping patient management strategies. This review addresses the complexities and nuances inherent in interpreting PFT data, particularly in light of recent updates from the European Respiratory Society (ERS) and American Thoracic Society (ATS). These updates have refined interpretive strategies, moving away from definitive diagnostic uses of spirometry to a more probabilistic approach that better accounts for individual variability through the use of Z-scores and lower limits of normal (LLNs). Significantly, this narrative review delves into the philosophical shift in spirometry interpretation, highlighting the transition from direct clinical diagnostics to a more nuanced evaluation geared towards determining the likelihood of disease. It critiques the reliance on fixed ratios and emphasizes the need for reference values that consider demographic variables such as age, sex, height, and ethnicity, in line with the latest Global Lung Function Initiative (GLI) equations. Despite these advances, challenges remain in ensuring uniformity across different predictive models and reference equations, which can affect the accuracy and consistency of interpretations. This paper proposes a streamlined three-step framework for interpreting PFTs, aiming to unify and simplify the process to enhance clarity and reliability across various medical specialties. This approach not only aids in accurate patient assessments but also mitigates the potential for misdiagnosis and ensures more effective patient management. By synthesizing contemporary guidelines and integrating robust physiological principles, this review fosters a standardized yet flexible approach to PFT interpretation that is both scientifically sound and practically feasible.

Purpose: It is vital to develop noninvasive approaches with high accuracy to discriminate the preserved ratio impaired spirometry (PRISm) group from the chronic obstructive pulmonary disease (COPD) groups. Radiomics has emerged as an image analysis technique. This study aims to develop and confirm the new radiomics-based noninvasive approach to discriminate these two groups., Methods: Totally 1066 subjects from 4 centers were included in this retrospective research, and classified into training, internal validation or external validation sets. The chest computed tomography (CT) images were segmented by the fully automated deep learning segmentation algorithm (Unet231) for radiomics feature extraction. We established the radiomics signature (Rad-score) using the least absolute shrinkage and selection operator algorithm, then conducted ten-fold cross-validation using the training set. Last, we constructed a radiomics signature by incorporating independent risk factors using the multivariate logistic regression model. Model performance was evaluated by receiver operating characteristic (ROC) curve, calibration curve, and decision curve analyses (DCA)., Results: The Rad-score, including 15 radiomic features in whole-lung region, which was suitable for diffuse lung diseases, was demonstrated to be effective for discriminating between PRISm and COPD. Its diagnostic accuracy was improved through integrating Rad-score with a clinical model, and the area under the ROC (AUC) were 0.82(95 %CI 0.79-0.86), 0.77(95 %CI 0.72-0.83) and 0.841(95 %CI 0.78-0.91) for training, internal validation and external validation sets, respectively. As revealed by analysis, radiomics nomogram showed good fit and superior clinical utility., Conclusions: The present work constructed the new radiomics-based nomogram and verified its reliability for discriminating between PRISm and COPD., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Authors.)

Objective: To identify the frequency and relative importance of symptoms experienced by adults with fibromyalgia (FM) and determine factors associated with a higher disease burden., Methods: We conducted semistructured interviews with 15 participants with FM, collecting 1479 quotes regarding the symptomatic burden of FM. We then performed an international cross-sectional study involving 1085 participants with FM to determine the prevalence and relative importance (scale 0-4) of 149 symptoms representing 14 symptomatic themes. We performed subgroup analysis to determine how age, sex, disease duration, medication use, employment status, change in employment status, missing work due to FM, and ability level are related to symptomatic theme prevalence., Results: The symptomatic themes with the highest prevalence in FM were pain (99.8%), muscle tenderness (99.8%), and fatigue (99.3%). The symptomatic themes that had the greatest effect on patients' lives were related to fatigue (2.88), pain (2.85), muscle tenderness (2.79), and impaired sleep and daytime sleepiness (2.70). Symptomatic theme prevalence was most strongly associated with the modified Rankin Scale level of disability, disability status, and change in employment status (on disability vs not on disability)., Conclusion: Participants with FM identify a variety of symptoms that significantly affect their daily lives. Many of these symptoms, such as fatigue, sleep disturbance, and activity limitation, are life-altering and not related to traditional diagnostic criteria. Symptom prevalence in this population varies across subgroups based on demographic categories and disability status., (Copyright © 2024 by the Journal of Rheumatology.)

One of the primary theories regarding the development of schizophrenia revolves around genetics, indicating the involvement of hereditary factors in various processes, including inflammation. Research has demonstrated that inflammatory reactions occurring in microglia can impact the progression of the disease. It has also been established that genetically determined changes in IL-1 can contribute to schizophrenia, thereby confirming the role of the IL-1 gene cluster in disease susceptibility. The aim of this study is a computer-based assessment of the structural interactions of IL-1 proteins with their receptors in schizophrenia. The study utilized the DisGeNET database, enabling the assessment of the reliability of identified IL-1 polymorphisms. Polymorphisms were also sought using NCBI PubMed. The NCBI Protein service was employed to search for and analyze the position of the identified polymorphisms on the chromosome. Structures for modeling were extracted from the Protein Data Bank database. Protein modeling was conducted using the SWISS-MODEL server, and protein interaction modeling was performed using PRISM. Notably, this study represents the first prediction of the interactions of IL-1α, IL-1β, and IL- 1RA proteins, taking into account the presence of single-nucleotide polymorphisms associated with schizophrenia in the sequence of the corresponding genes. The results indicate that the presence of SNP rs315952 in the IL-1RA protein gene, associated with schizophrenia, may lead to a weakening of the IL-1RA binding to receptors, potentially triggering the initiation of the IL-1 signaling pathway by disrupting or weakening the IL-1RA binding to receptors and facilitating the binding of IL-1 to them. Such alterations could potentially lead to a change in the immune response. The data obtained contribute theoretically to the development of ideas about the molecular mechanisms through which hereditary factors in schizophrenia influence the interactions of proteins of the IL-1 family, which play an important role in the processes of the immune system., Competing Interests: The authors declare no conflict of interest., (Copyright © AUTHORS.)

Background: Although the therapeutic relationship (or 'alliance') is well known to be a key component of psychiatric treatment, there has been no simple way to objectively measure the patient-therapist relationship. Here, we measured the psychological distance between patients and their therapists by using the Pictorial Representation of Illness and Self Measure (PRISM)., Patients and Methods: We analyzed the patient-therapist relationship of 112 patients from two hospitals in Japan (54 males, 57 females, 1 unknown; age 46.20 ± 15.03 years [mean ± SD]) who completed the PRISM and self report questionnaires (LSNS-6, K6, and BASIS-32) about their social network, psychological distress, and outcomes of mental health treatment., Results: PRISM measurements were available for all patients who consented to participate. In the comparison by disease category, schizophrenia recorded the closest distance to the psychiatrist in charge, followed by bipolar disorder, depression, and neurotic disorder. Regarding the distance to the psychiatrist in charge, PRISM showed a weak negative correlation (r = -0.23, p < 0.05) with age, indicating that with increasing age, the therapeutic rela tionship was more important to the patients., Conclusion: Our findings indicate the possibility of implementing PRISM to assess the impact of the therapeutic relationship in patients with a wide range of psychiatric disorders, and they suggest that PRISM holds great potential for clinical application.

Background: To track improvement in diplopia symptoms with strabismus-specific health-related quality of life (HRQOL) questionnaire across a treatment consisting of prism correction followed by vision therapy/orthoptics when prism treatment alone has not succeeded., Methods: Forty-eight participants with diplopia and a mean age of 62.45 were asked to complete an Adult Strabismus-20 (AS-20) questionnaire and a Diplopia Questionnaire (DQ) before and after prism correction. Inclusion criteria were diplopia reported on the DQ as "sometimes", "often" or "always" at reading or straight-ahead distance. The prism correction was classified as successful if the participant reported "never" or "rarely" on the DQ for reading and straight-ahead distance; and unsuccessful if the perceived diplopia worsened or remained the same. For all participants, mean initial AS-20 scores were compared with mean post-prism correction scores, taking into account AS-20 subscales (reading and general functions, and self-perception and interaction). Participants in the failed prism treatment subgroup subsequently underwent a programme of vision therapy wearing their prism correction, the results of which were again determined by participants' responses on the AS-20 questionnaire, completed before and after the vision therapy., Results: Five of the 48 participants dropped out of the study. Prism correction was classified as successful in 22 of 43 participants (51%), and unsuccessful in 21 (49%). Those participants for whom the prism correction was classified as a success showed a statistically significant improvement ( p = 0.01) in both reading and general functions. In the failed treatment subgroup, no significant change in AS-20 score was recorded for any of the domains ( p = 0.1). After treatment with vision therapy/orthoptics, however, 13 of the 20 participants in the unsuccessful prism correction subgroup (one of them dropped out the study) achieved binocular vision and statistically significant improvement in reading and general functions ( p = 0.01)., Conclusions: Although effective prism correction of diplopia is correlated with enhanced HRQOL, prism correction alone is frequently not sufficient to achieve this objective. In these cases, vision therapy/orthoptics treatment as a coadjutant to prism correction is shown to improve HRQOL., Competing Interests: Santiago Martín-González and Juan Antonio Portela-Camino promoted, with the support of the University of Oviedo, the creation of the startup VisionaryTool. Both have assisted VisionaryTool, S.L. (sociedad limitada, www.visionarytool.com) to create a commercial version of vergence games program. VisionaryTool has not had any role (writing, analysis, or control over publication) in the production of the article., (© 2024 Portela-Camino et al.)

Phenylketonuria (PKU) is a genetic disorder caused by deficiency of the enzyme phenylalanine hydroxylase (PAH), which results in phenylalanine (Phe) accumulation in the blood and brain, and requires lifelong treatment to keep blood Phe in a safe range. Pegvaliase is an enzyme-substitution therapy approved for individuals with PKU and uncontrolled blood Phe concentrations (>600 μmol/L) despite prior management. Aggregated results from the PRISM clinical trials demonstrated substantial and sustained reductions in blood Phe with a manageable safety profile, but also noted individual variation in time to and dose needed for a first response. This analysis reports longer-term aggregate findings and characterizes individual participant responses to pegvaliase using final data from the randomized trials PRISM-1 (NCT01819727) and PRISM-2 (NCT01889862), and the open-label extension study 165-304 (NCT03694353). In 261 adult participants with a mean of 36.6 months of pegvaliase treatment, 71.3%, 65.1%, and 59.4% achieved clinically significant blood Phe levels of ≤600, ≤360, and ≤ 120 μmol/L, respectively. Some participants achieved blood Phe reductions with <20 mg/day pegvaliase, although most required higher doses. Based on Kaplan-Meier analysis, median (minimum, maximum) time to first achievement of a blood Phe threshold of ≤600, ≤360, or ≤ 120 μmol/L was 4.4 (0.0, 54.0), 8.0 (0.0, 57.0), and 11.6 (0.0, 66.0) months, respectively. Once achieved, blood Phe levels remained below clinical threshold in most participants. Sustained Phe response (SPR), a new method described within for measuring durability of blood Phe response, was achieved by 85.5%, 84.7%, and 78.1% of blood Phe responders at blood Phe thresholds of ≤600, ≤360, or ≤ 120 μmol/L, respectively. Longer-term safety data were consistent with previous reports, with the most common adverse events (AEs) being arthralgia, injection site reactions, headache, and injection site erythema. The incidence of most AEs, including hypersensitivity AEs, was higher during the early treatment phase (≤6 months) than later during treatment. In conclusion, using data from three key pegvaliase clinical trials, participants treated with pegvaliase were able to reach clinically significant blood Phe reductions to clinical thresholds of ≤600, ≤360, or ≤ 120 μmol/L during early treatment, with safety profiles improving from early to sustained treatment. This study also supports the use of participant-level data and new ways of looking at durable blood Phe responses to better characterize patients' individual PKU treatment journeys., Competing Interests: COH has received consulting and speaker fees from BioMarin and has participated as a clinical trial investigator for BioMarin. NL has received consulting fees from BioMarin, PTC Therapeutics, Moderna, and Nestlé; speaker fees from Recordati; travel support from BioMarin and Sanofi; and has participated as a clinical trial investigator for BioMarin, PTC Therapeutics, Moderna, Nestlé, and Homology Medicines. HN has participated as a clinical trial investigator for BioMarin, Synlogic, Jnana Therapeutics, Sanofi, and PTC Therapeutics; has received consulting fees from BioMarin, Synlogic, Jnana Therapeutics, and PTC Therapeutics; and has received speaker's fees from BioMarin. SS has participated as a clinical trial investigator for BioMarin, Synlogic, and PTC Therapeutics and received funding for investigator-initiated research from BioMarin. SS also reports participation in advisory boards for BioMarin (without personal compensation since 2018) and paid speaker engagement. RS has participated as a clinical trial investigator, received grant funding, and funding for investigator-initiated research from BioMarin. JT has participated as a clinical trial investigator and advisory board member for BioMarin. JV has received consulting fees from BioMarin, LogicBio Therapeutics, Sangamo Therapeutics, Orphan Lab, Synlogic, Sanofi, Axcella Health, Agios Pharmaceuticals, and Applied Therapeutics, and has received travel grants from BioMarin and LogicBio Therapeutics. RTZ is a consultant for BioMarin and is a principal investigator for Synlogic and PTC Therapeutics. KBW, JL, KL, and DGL are employees of BioMarin Pharmaceutical Inc. SJ is an employee of BioMarin UK. BKB has received consulting fees and/or honoraria from Agios Pharmaceuticals, Aro, BioMarin, Chiesi, Horizon Therapeutics, JCR Pharmaceuticals, Maze Therapeutics, Moderna, Orchard Therapeutics, Passage Bio, Sanofi, Takeda, Travere Therapeutics, and Ultragenyx, and has conducted clinical trials funded by BioMarin, Denali Therapeutics, Homology Medicines, JCR Pharmaceuticals, Sangamo Therapeutics, Takeda, and Ultragenyx., (© 2024 Published by Elsevier Inc.)

Preserved Ratio Impaired Spirometry (PRISm) manifests notable epidemiological disparities across the globe, with its prevalence and influential factors showcasing pronounced diversities among various geographical territories and demographics. The prevalence of PRISm fluctuates considerably among regions such as Latin America, the United States, and Asian nations, potentially correlating with a myriad of determinants, including socioeconomic status, environmental factors, and lifestyle modalities. Concurrently, the link between PRISm and health risks and other disorders, especially its distinction and interrelation with chronic obstructive pulmonary disease (COPD), has become a pivotal subject of scientific enquiry. Radiographic anomalies, such as perturbations in the pulmonary parenchyma and structural alterations, are posited as salient characteristics of PRISm. Furthermore, PRISm unveils intricate associations with multiple comorbidities, inclusive of hypertension and type 2 diabetes, thereby amplifying the intricacy in comprehending and managing this condition. In this review, we aim to holistically elucidate the epidemiological peculiarities of PRISm, its potential aetiological contributors, its nexus with COPD, and its association with radiographic aberrations and other comorbidities. An integrative understanding of these dimensions will provide pivotal insights for the formulation of more precise and personalised preventative and therapeutic strategies., Competing Interests: The authors report no conflicts of interest in this work., (© 2024 Huang et al.)

Background: Self-assessment and self-reflection of competencies are crucial skills for undergraduate students. This monocentric cross-sectional study aims to assess the self-perceived knowledge, skills and interests in conservative dentistry and periodontology of third-, fourth-, and fifth-year dental students by the Pictorial Representation of Illness and Self-measure (PRISM)., Methods: Seventy-five undergraduate dental students (n = 25 of each year) who studied between 2021 and 2022 at the Department of Cariology, Endodontology and Periodontology at the University of Leipzig, Germany, were included. All of them underwent a PRISM-based interview regarding their perceived knowledge, practical skills, and interests in conservative dentistry as well as its sub-disciplines. The distances in the PRISM task (in millimeters) were measured and compared between the groups. Spearman's Rho was used to reveal correlations between knowledge, skills, and interests in the cohort., Results: Perceived theoretical knowledge and practical skills differed significantly between groups for the sub-disciplines periodontology, cariology, restorative dentistry and preventive dentistry (p < 0.05). However, students' interests did not significantly vary between groups (p > 0.05). In the field of conservative dentistry and its sub-disciplines, significant moderate to high positive correlations were found between knowledge and skills (p < 0.01), and weak to moderate positive correlations were found between interests and knowledge (p < 0.05). Regarding the relationship between perceived interests and skills, only restorative dentistry, endodontology and periodontology were significant and only moderate to weak correlations were found (p < 0.05)., Conclusion: PRISM revealed differences in perceived knowledge and skills between third-, fourth-, and fifth-year dental students. Correlations were found between perceived knowledge and skills, as well as between interests and knowledge. PRISM may be a promising tool to support students and teachers in dental education., (© 2024. The Author(s).)

Background: Early diagnosing Chronic Obstructive Pulmonary Disease (COPD) is relatively difficult. Therefore, the concepts of preserved ratio impaired spirometry (PRISm) and small airway disease (SAD) were proposed to achieve early diagnosis for COPD. Besides, the occurrence of COPD is positively related to age. However, the relationship among COPD, PRISm, and SAD still requires clarification. Thus, we estimated the proportions and risk factors of COPD and PRISm in the positive screening participants, and searched the methods of early diagnosing COPD via the SAD indicators., Methods: A total of 53,641 residents aged more than 60 years old from Shaoxing City, Zhejiang Province, China, completed a series of screening projects. And 2327 of positive screening participants ultimately finished bronchodilator tests. The data were statistically analyzed to figure out the proportions and risk factors of COPD and PRISm, and the efficacy of early diagnosing COPD by the SAD indicators., Results: Totally 2229 positive screening participants were included, the proportion of PRISm was 6.3% (141/2229), and of COPD was 78.2% (1743/2229). Statistical analyses showed that COPD patients were more likely to be smokers, males, and older. And COPD patients had higher questionnaire scores, meaning that they were more prone to have family history of respiratory diseases and more severe respiratory symptoms. Additionally, COPD patients had lower maximal mid-expiratory flow (MMEF) pred, forced expiratory flow (FEF) 75pred, and FEF50pred. And we found that male sex and presence of respiratory symptoms might lead to COPD and PRISm. Also, the methods of early diagnosing COPD through the SAD indicators might be acceptable., Conclusion: There is a close association between COPD and decreased small airway function (SAF) among the participants included. Age, smoking, male sex, worse SAF, and respiratory symptoms might cause the progressing from normal people to PRISm, then to COPD patients. Besides, the SAD indicators such as MMEFpred, FEF75pred, and FEF50pred were included in lung function tests and bronchodilator tests. Intriguingly, it was found that early diagnosing COPD via the SAD indicators might be feasible. In the future, early diagnosis for COPD requires further research., (© 2024. The Author(s).)

Background: COPD has been found to be associated with frailty. However, longitudinal evidence for associations of COPD with frailty progression is inadequate. Furthermore, recent studies revealed a new phenotype of lung function impairment: preserved ratio impaired spirometry (PRISm) findings. Associations of PRISm findings and their transitions with frailty progression are unclear., Research Question: What are the associations of PRISm findings, transitions of PRISm findings, and COPD with frailty progression?, Study Design and Methods: To analyze the associations of PRISm findings and COPD with frailty progression, 5,901 patients were included from the English Longitudinal Study of Ageing. Patients were classified into three lung function patterns of normal spirometry (NS) findings, PRISm findings, and COPD. Frailty progression was assessed by repeated measurements of the frailty index (FI) during follow-up. Among these 5,901 patients, 3,765 patients were included to analyze the associations of PRISm findings transitions with frailty progression. PRISm findings transitions were assessed based on the changes of lung function patterns after a 4-year interval. Linear mixed-effect models were used for statistical analyses., Results: The median follow-up periods were 9.5 years for the analyses of PRISm findings and COPD with frailty progression and 5.8 years for PRISm findings transitions with frailty progression. When compared with participants with NS findings, patients with PRISm findings and COPD demonstrated accelerated FI progression with additional annual increases of 0.301 (95% CI, 0.211-0.392; P < .001) and 0.172 (95% CI, 0.102-0.242; P < .001), respectively. Patients who transitioned from NS findings to PRISm findings also demonstrated accelerated FI progression when compared with those with stable NS findings (β = 0.242; 95% CI, 0.008-0.476; P = .042). However, no accelerated FI progression was found in patients with PRISm findings who transitioned to NS findings (β = 0.119; 95% CI, -0.181 to 0.418; P = .438)., Interpretation: Our findings indicate that PRISm findings and COPD are associated with accelerated frailty progression. Further studies are needed to elucidate the causality of the association of PRISm findings and COPD with frailty., Competing Interests: Financial/Nonfinancial Disclosures None declared., (Copyright © 2023 The Author(s). Published by Elsevier Inc. All rights reserved.)

Objective: A pilot study to preliminarily examine the effects of Prism EFP NeuroFeedback (NF) in adult ADHD., Method: Prism EFP NF is a form of NF specifically designed to target emotional dysregulation (ED) through down regulation of amygdala activity. Prism EFP NF has been shown to improve other disorders with significant ED. Nine participants with adult ADHD received an open trial of Prism EFP NF consisting of fifteen sessions over 8 weeks; all completed at least 5 weeks of treatment with seven completing all 8 weeks. Outcomes were assessed by change in ADHD symptoms from baseline to End of Treatment., Results: About two-third reduction was seen in total DSM ADHD symptom scores (primary outcome measure) with improvement observed in all other clinical measures. No significant adverse events were seen., Conclusion: This preliminary trial found substantial effects of Prism EFP NF on ADHD/ED symptoms and global impairment., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Lenard A. Adler MD has the following disclosures over the last 3 years: Grant/Research support to NYU Grossman School of Medicine from Shire/Takeda, Otsuka Pharmaceuticals, Corium; Consultant to Supernus Pharmaceuticals, Bracket/Signant, SUNY, Neurocentria, National Football League, Major League Baseball, Otsuka; Royalty payments (as inventor) from NYU Grossman School of Medicine for license of adult ADHD scales and training materials since 2004.; Charles R Marmar MD serves on Advisory Board of Receptor Life Sciences, Otsuka Pharmaceuticals and Roche Products Limited. He has the following disclosures over the last 3 years: National Institute on Alcohol Abuse and Alcoholism, National Institute of Mental Health, Department of Defense- CDMRP US Army Research Office (DARPA), Bank of America Foundation, Brockman Foundation, McCormick Foundation, Home Depot Foundation, New York City Council, New York State Health, Mother Cabrini Foundation, Tilray Pharmaceutical, Ananda Scientific.; Talma Hendler MD PhD is an employee of GrayMatters Health that has patent owned PRISM software provided for the study. Dr. Hendler has stock options as an employee and innovator for GrayMatters.; Yaakov Stern PhD is an employee of GrayMatters Health, which provided the PRISM software for this research.; Oded Kraft is a co-founder and the CEO of GrayMatters Health, which provided the PRISM software for this research.; Deepti Anbarasan MD declared no potential conflicts of interest in the last 3 years.; Dayeon Cho declared no potential conflicts of interest in the last 3 years.; Terry L. Leon declared no potential conflicts of interest in the last 3 years.; Taylor Sardoff declared no potential conflicts of interest in the last 3 years.; Olivia Descorbeth declared no potential conflicts of interest in the last 3 years.

Despite growing acceptability of health-related social needs (HRSN) screening and increasing policy incentives for adoption, clinical implementation of HRSN screening remains low. HRSN screening has been particularly difficult for Community Health Centers (CHCs), which have limited resources to implement and sustain new workflows. While CHCs provide care to patients with disproportionately high levels of unmet social needs, identifying HRSN screening implementation strategies that take CHC-specific contexts into account remains elusive. This study uses the Practical Robust Implementation and Sustainability Model (PRISM) to design an implementation strategy accounting for the unique context of CHCs. We used Rapid Ethnographic Assessment observations and stakeholder focus groups to identify current workflow barriers and facilitators to HRSN screening, and to develop implementation strategies that include multi-level contexts and perspectives. We identified eight themes contributing to low screening implementation: perceived stigma around screening; need for community-based solutions; re-confirming organizational priorities and values; Electronic Medical Record (EMR) limitations; multi-tasking pressures limiting implementation; staff turnover; limited knowledge of regulatory requirements; and community resource availability for referral. Based on the themes, we identified implementation strategies including non-EMR data collection; integration into the workflow for multiple staff members; creation of new training and educational modules; and identification of peer champions for retraining in real time. Administrative requirements are necessary but not sufficient for implementation of HRSN screening in CHCs. Resource-constrained settings benefit from context-specific stakeholder engagement to improve implementation success. The use of PRISM ensured contextual factors were central to the implementation strategy design., (Published by Oxford University Press on behalf of the Society of Behavioral Medicine 2023.)

Background: The prevalence, epidemiological and clinical heterogeneities, and impact profiles of individuals with preserved ratio impaired spirometry (PRISm), pre-COPD, young COPD, and mild COPD in general Chinese population were not known yet., Methods: Data were obtained from the China Pulmonary Health study (2012-2015), a nationally representative cross-sectional survey that recruited 50,991 adults aged 20 years or older. Definitions of the four early disease status were consistent with the latest publications and the Global Initiative for Chronic Obstructive Lung Disease criteria., Findings: The age-standardised prevalences of PRISm, pre-COPD, young COPD, and mild COPD were 5.5% (95% confidence interval, 4.3-6.9), 7.2% (5.9-8.8), 1.1% (0.7-1.8), and 3.1% (2.5-3.8), respectively. In summary, mild COPD was under more direct or established impact factor exposures, such as older age, male gender, lower education level, lower family income, biomass use, air pollution, and more accumulative cigarette exposures; young COPD and pre-COPD experienced more personal and parents' events in earlier lives, such as history of bronchitis or pneumonia in childhood, frequent chronic cough in childhood, parental history of respiratory diseases, passive smoke exposure in childhood, and mother exposed to passive smoke while pregnant; pre-COPD coexisted with heavier symptoms and comorbidities burdens; young COPD exhibited worse airway obstruction; and most of the four early disease status harbored small airway dysfunction. Overall, older age, male gender, lower education level, living in the urban area, occupational exposure, frequent chronic cough in childhood, more accumulated cigarette exposure, comorbid with cardiovascular disease and gastroesophageal reflux disease were all associated with increased presence of the four early COPD status; different impact profiles were additionally observed with distinct entities. Over the four categories, less than 10% had ever taken pulmonary function test; less than 1% reported a previously diagnosed COPD; and no more than 13% had received pharmaceutical treatment., Interpretation: Significant heterogeneities in prevalence, epidemiological and clinical features, and impact profiles were noted under varied defining criteria of early COPD; a unified and validated definition for an early disease stage is warranted. Closer attention, better management, and further research need to be administrated to these population., Funding: Chinese Academy of Medical Sciences Institute of Respiratory Medicine Grant for Young Scholars (No. 2023-ZF-9); China International Medical Foundation (No. Z-2017-24-2301); Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences (No. 2021-I2M-1-049); National High Level Hospital Clinical Research Funding (No. 2022-NHLHCRF-LX-01); Major Program of National Natural Science Foundation of China (No. 82090011)., Competing Interests: We declare no competing interests., (© 2024 The Author(s).)

Climate change is escalating the threat of heat stress to global public health, with the majority of humans today facing increasingly severe and prolonged heat waves. Accurate weather data reflecting the complexity of measuring heat stress is crucial for reducing the impact of extreme heat on health worldwide. Previous studies have employed Heat Index (HI) and Wet Bulb Globe Temperature (WBGT) metrics to understand extreme heat exposure, forming the basis for heat stress guidelines. However, systematic comparisons of meteorological and climate data sets used for these metrics and the related parameters, like air temperature, humidity, wind speed, and solar radiation crucial for human thermoregulation, are lacking. We compared three heat measures (HI max , WBGT Bernard , and WBGT Liljegren ) approximated from gridded weather data sets (ERA5-Land, PRISM, Daymet) with ground-based data, revealing strong agreement from HI and WBGT Bernard ( R 2 0.76-0.95, RMSE 1.69-6.64°C). Discrepancies varied by Köppen-Geiger climates (e.g., Adjusted R 2 HI max 0.88-0.95, WBGT Bernard 0.79-0.97, and WBGT Liljegren 0.80-0.96), and metrological input variables (Adjusted R 2 T max 0.86-0.94, T min 0.91-0.94, Wind 0.33, Solar max 0.38, Solar avg 0.38, relative humidity 0.51-0.74). Gridded data sets can offer reliable heat exposure assessment, but further research and local networks are vital to reduce measurement errors to fully enhance our understanding of how heat stress measures link to health outcomes., Competing Interests: The authors declare no conflicts of interest relevant to this study., (© 2024 The Authors. GeoHealth published by Wiley Periodicals LLC on behalf of American Geophysical Union.)

Implementation science theories, models, and frameworks (TMF) should help users understand complex issues in translating research into practice, guide selection of appropriate implementation strategies, and evaluate implementation outcomes. They should also be sensitive to evidence from projects that apply the framework, evolve based on those experiences, and be accessible to a range of users. This paper describes these issues as they relate to the Practical, Robust Implementation and Sustainability Model (PRISM). PRISM was created to assess key multilevel contextual factors related to the reach, effectiveness, adoption, implementation, and maintenance (RE-AIM) outcomes of health interventions. We describe key aspects of PRISM and how it has been applied, evolved, and adapted across settings, time, and content areas. Since its development in 2008 PRISM has been used in over 200 publications, with increased use in recent years. It has been used for a wide variety of purposes and more recent applications have focused on increasing its accessibility for non-researcher groups and more rapid and iterative application for use in learning heath systems. PRISM has been applied to address health equity issues including representation, representativeness, and co-creation activities in both US and non-US settings. We describe common types of adaptations made by implementation teams when applying PRISM to fit with the resources and priorities of diverse and low-resource settings. We conclude by summarizing lessons learned and providing recommendations for future research and practice using PRISM., Competing Interests: Conflict of interestThere are no conflicts of interest to disclose., (© The Author(s) 2024.)

Purpose: Determining the correct power and orientation of prism to be prescribed for patients with symptomatic, oblique-angle strabismus can be challenging and confusing, prone more to clinician gestalt than science or methodology. The author shares a simplified, approach not previously described in the scientific literature that utilizes commercially available equipment and freely available on-line prism calculators for choosing the correct Press-On™ prism power, positioning the prism correctly on the spectacle lens, and ultimately determining the correct prism prescription to be incorporated into the patient's spectacles., Competing Interests: The author has no competing interests to declare. Presented virtually at the XIV International Orthoptic Association Congress on June 10, 2022., (Copyright: © 2023 The Author(s).)

Background: Whether the metabolic syndrome plays a role for the prognosis of individuals with lung function impairment (preserved ratio impaired spirometry (PRISm) or airflow limitation) is unclear. We hypothesised that the metabolic syndrome in individuals with lung function impairment is associated with increased cardiopulmonary morbidity and mortality., Methods: The Copenhagen General Population Study was initiated in 2003 based on a random sample of white men and women aged 20-100 years drawn from the Danish general population. The risk of ischemic heart disease/heart failure, respiratory disease, and all-cause mortality was analysed with Cox models adjusted for age, sex, current smoking, and asthma during 15 years of follow-up., Findings: Among 106,845 adults, 86,159 had normal lung function, 6126 had PRISm, and 14,560 had airflow limitation. We observed 10,448 hospital admissions for ischemic heart disease/heart failure, 21,140 for respiratory disease, and 11,125 deaths. Individuals with versus individuals without the metabolic syndrome generally had higher 5-year absolute risk of all outcomes, including within those with normal lung function, mild-moderate-severe PRISm, and very mild-mild-moderate-severe airflow limitation alike. Compared to individuals without the metabolic syndrome and with normal lung function, those with both the metabolic syndrome and severe PRISm had hazard ratios of 3.74 (95% CI: 2.53-5.55; p < 0.0001) for ischemic heart disease/heart failure, 5.02 (3.85-6.55; p < 0.0001) for respiratory disease, and 5.32 (3.76-7.54; p < 0.0001) for all-cause mortality. Corresponding hazard ratios in those with both the metabolic syndrome and severe airflow limitation were 2.89 (2.34-3.58; p < 0.0001) for ischemic heart disease/heart failure, 5.98 (5.28-6.78; p < 0.0001) for respiratory disease, and 4.16 (3.50-4.95; p < 0.0001) for all-cause mortality, respectively. The metabolic syndrome explained 13% and 27% of the influence of PRISm or airflow limitation on ischemic heart disease/heart failure and all-cause mortality., Interpretation: The metabolic syndrome conferred increased risk of cardiopulmonary morbidity and mortality at all levels of lung function impairment., Funding: Danish Lung Foundation, Danish Heart Foundation, Capital Region of Copenhagen, and Boehringer Ingelheim. JV is supported by the NIHR Manchester BRC., Competing Interests: J.L.M. received an unrestricted grant from The Danish Lung Foundation in relation to the present work. T.S.I. received an advisory board fee from AstraZeneca. Y.Ç. received speaking fees from Sanofi Genzyme, AstraZeneca, GlaxoSmithKline, and Boehringer Ingelheim. H.K. reports funding from The Swedish Science Council, The Swedish Heart and Lung Foundation, The Swedish Asthma and Allergy Foundation, The Tampere Tuberculosis Foundation, The Swedish ALF-funding, and The Finnish Anti-Tuberculosis Association Foundation outside the submitted work; being a committee member of the research council of the Swedish Heart and Lung Foundation; consulting fees from GlaxoSmithKline, AstraZeneca, MSD, Novartis, Orion Pharma, and Sanofi Genzyme; and speaking fees from AstraZeneca, Boehringer Ingelheim, GlaxoSmithKline, and Orion Pharma. P.S.B. received lecture fees from AstraZeneca and Boehringer Ingelheim and advisory board fees from GlaxoSmithKline and AstraZeneca. J.V. received consulting fees from ALK, AstraZeneca, Boehringer Ingelheim, GlaxoSmithKline, and Teva, as well as speaking fees from AstraZeneca, Boehringer Ingelheim, Chiesi, and GlaxoSmithKline and advisory board fees from AstraZeneca. P.L. received an unrestricted grant in relation to the present work from Boehringer Ingelheim; advisory board fees from AstraZeneca, GlaxoSmithKline, Boehringer Ingelheim, and Sanofi; and speaking fees from AstraZeneca, Boehringer Ingelheim, and GlaxoSmithKline. B.G.N. declares no potential conflicts of interest., (© 2023 The Author(s).)

Background: The aim of the observational, prospective study was to validate a novel, nonverbal assessment tool for perceived disease burden-Pictorial Representation of Illness and Self-Measure (PRISM)-in ulcerative colitis (UC) against established patient health questionnaires. The cumulative burden of patients recently diagnosed (<3 years) with UC was also evaluated., Methods: "ICONIC" - Understanding the impact of ulcerative colitis and its associated disease burden on patients - was a noninterventional, multicountry, multicenter study performed in a 2-year follow-up format in adult patients with recently diagnosed UC in 33 countries, regardless of disease severity or treatment. Data collection consisted of five visits, scheduled at approximately 6-month intervals. For the current analysis, patient data from Saudi Arabia and Kuwait were evaluated. The collected data comprised demographics, disease-related data, UC treatment, and healthcare resources, as well as physician- and patient-assessed quality-of-life and disease burden questionnaires. Correlations between selected questionnaire scores were performed using Spearman's rho., Results: Disease severity at baseline and throughout the study was slightly less favorable in this country analysis compared with the global study cohort. Disease burden was assessed by PRISM and improved within 24 months., Conclusions: The detected moderate correlation between PRISM and other assessment methods supports the validity of PRISM. Differences in perceptions of UC-related burden between physician and patient may reflect to some degree insufficient patient-physician communication., Competing Interests: None

Background: To increase uptake of implementation science (IS) methods by researchers and implementers, many have called for ways to make it more accessible and intuitive. The purpose of this paper is to describe the iPRISM webtool (Iterative, Practical, Robust Implementation and Sustainability Model) and how this interactive tool operationalizes PRISM to assess and guide a program's (a) alignment with context, (b) progress on pragmatic outcomes, (c) potential adaptations, and (d) future sustainability across the stages of the implementation lifecycle., Methods: We used an iterative human-centered design process to develop the iPRISM webtool., Results: We conducted user-testing with 28 potential individual and team-based users who were English and Spanish speaking from diverse settings in various stages of implementing different types of programs. Users provided input on all aspects of the webtool including its purpose, content, assessment items, visual feedback displays, navigation, and potential application. Participants generally expressed interest in using the webtool and high likelihood of recommending it to others. The iPRISM webtool guides English and Spanish-speaking users through the process of iteratively applying PRISM across the lifecycle of a program to facilitate systematic assessment and alignment with context. The webtool summarizes assessment responses in graphical and tabular displays and then guides users to develop feasible and impactful adaptations and corresponding action plans. Equity considerations are integrated throughout., Conclusions: The iPRISM webtool can intuitively guide individuals and teams from diverse settings through the process of using IS methods to iteratively assess and adapt different types of programs to align with the context across the implementation lifecycle. Future research and application will continue to develop and evaluate this IS resource., (© 2023. BioMed Central Ltd.)