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Chunrui Zou,1,2 Frank Li,2,3 Jiwoong Choi,1,4 Babak Haghighi,5 Sanghun Choi,6 Prathish K Rajaraman,1,2 Alejandro P Comellas,7 John D Newell Jnr,8 Chang Hyun Lee,8,9 R Graham Barr,10 Eugene Bleecker,11 Christopher B Cooper,12 David Couper,13 Meilan Han,14 Nadia N Hansel,15 Richard E Kanner,16 Ella A Kazerooni,17 Eric C Kleerup,18 Fernando J Martinez,19 Wanda O’Neal,20 Robert Paine III,16 Stephen I Rennard,21 Benjamin M Smith,22,23 Prescott G Woodruff,24 Eirc A Hoffman,3,7,8 Ching-Long Lin1– 3,8 1Department of Mechanical Engineering, University of Iowa, Iowa City, IA, USA; 2IIHR-Hydroscience & Engineering, University of Iowa, Iowa City, IA, USA; 3Department of Biomedical Engineering, University of Iowa, Iowa City, IA, USA; 4Department of Internal Medicine, School of Medicine, University of Kansas, Kansas City, KS, USA; 5Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; 6School of Mechanical Engineering, Kyungpook National University, Daegu, Republic of Korea; 7Department of Internal Medicine, University of Iowa, Iowa City, IA, USA; 8Department of Radiology, University of Iowa, Iowa City, IA, USA; 9Department of Radiology, College of Medicine, Seoul National University, Seoul, Republic of Korea; 10Mailman School of Public Health, Columbia University, New York, NY, USA; 11Department of Medicine, The University of Arizona, Tucson, AZ, USA; 12Department of Physiology, UCLA, Los Angeles, CA, USA; 13Department of Biostatistics, University of North Carolina, Chapel Hill, NC, USA; 14Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA; 15School of Medicine, Johns Hopkins, Baltimore, MD, USA; 16School of Medicine, University of Utah, Salt Lake City, UT, USA; 17Department of Radiology, University of Michigan, Ann Arbor, MI, USA; 18Department of Medicine, UCLA, Los Angeles, CA, USA; 19Weill Cornell Medicine, Cornell University, New York, NY, USA; 20School of Medicine, University of North Carolina, Chapel Hill, NC, USA; 21Department of Internal Medicine, University of Nebraska College of Medicine, Omaha, NE, USA; 22Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, NY, USA; 23Department of Medicine, McGill University Health Centre Research Institute, Montreal, Canada; 24Department of Medicine, University of California at San Francisco, San Francisco, CA, USACorrespondence: Ching-Long Lin 2406 Seamans Center for the Engineering Art and Science, Iowa City, IA, 52242, USATel +1 319 335 5673Email ching-long-lin@uiowa.eduPurpose: Quantitative computed tomography (qCT) imaging-based cluster analysis identified clinically meaningful COPD former-smoker subgroups (clusters) based on cross-sectional data. We aimed to identify progression clusters for former smokers using longitudinal data.Patients and Methods: We selected 472 former smokers from SPIROMICS with a baseline visit and a one-year follow-up visit. A total of 150 qCT imaging-based variables, comprising 75 variables at baseline and their corresponding progression rates, were derived from the respective inspiration and expiration scans of the two visits. The COPD progression clusters identified were then associated with subject demography, clinical variables and biomarkers.Results: COPD severities at baseline increased with increasing cluster number. Cluster 1 patients were an obese subgroup with rapid progression of functional small airway disease percentage (fSAD%) and emphysema percentage (Emph%). Cluster 2 exhibited a decrease of fSAD% and Emph%, an increase of tissue fraction at total lung capacity and airway narrowing over one year. Cluster 3 showed rapid expansion of Emph% and an attenuation of fSAD%. Cluster 4 demonstrated severe emphysema and fSAD and significant structural alterations at baseline with rapid progression of fSAD% over one year. Subjects with different progression patterns in the same cross-sectional cluster were identified by longitudinal clustering.Conclusion: qCT imaging-based metrics at two visits for former smokers allow for the derivation of four statistically stable clusters associated with unique progression patterns and clinical characteristics. Use of baseline variables and their progression rates enables identification of longitudinal clusters, resulting in a refinement of cross-sectional clusters.Keywords: computed tomography, emphysema, functional small airway disease, longitudinal clustering

Introduction: Primary peritoneal drainage (PPD) is described as a temporizing procedure to treat perforated necrotizing enterocolifts (NEC) in unstable premature infants prior to laparotomy. Some infants treated with PPD survive without further intervention. Laparotomy is recommended for patients who do not significantly improve following PPD. Methods: To determine the efficacy of "salvage" laparotomy we reviewed our experience with perforated NEC in ELBW infants treated from 1993 to 98. We analyzed data using Mann-Whitney U and [chi square] tests where appropriate; significance defined as p [is less than] .05. Results: We treated 26 infants with perforated NEC and birthweight [is less than] 1000 grams. PPD was used in 17 patients, and primary laparotomy (LAP) in 9. Patients undergoing PPD had a lower birthweight, 677 [+ or -] 143g versus 807 [+ or -] 113g for LAP (p=.02) and more co-morbid conditions 2.7 versus 1.7 (p=.002). Survival was similar between these groups 7/17 versus 5/9 (p=.68). Of the 17 patients treated with PPD, 7 survived without further intervention with intact gastrointestinal (GI) function. Five of these had persistent signs of sepsis for 5-15 days following drainage but responded to continued antibiotic therapy. The remaining 10 patients deteriorated. Six died without further intervention; four within 48 hours of fulminant sepsis and two died of other causes (intracranial bleeding and pulmonary failure) with an intact GI tract. The remaining four patients were believed to be salvageable and underwent "salvage laparotomy" 5-19 days following PPD. Indications included abdominal distention, requirement for vasoactive drugs, and failure of GI function. All four of these patients died. None of them were ever weaned from mechanical ventilation or tolerated any enteral feedings. These four non-surviving patients had a mean post-operative hospital stay of 84 [+ or -] 20 days and a hospital cost of $660,000 compared to 34 [+ or -] 11 days and $306,000 for the non-surviving PPD patients who did not have salvage laparotomy. Conclusions: PPD is often successful as definitive therapy for perforated NEC in ELBW infants. Patients undergoing PPD may manifest persistent signs of sepsis for 6-10 days following PPD. This is not an indication for laparotomy as most recover fully without operation. "Salvage laparotomy" for failure of PPD was ineffective, costly, and only prolonged death. Appropriate selection criteria for PPD versus LAP are not clear and await results of a prospective study., RA Dimmitt, AH Meier, ED Skarsgard, LP Halamek, BM Smith, RL Moss (all MD, FAAP); Stanford Univ SOM Depts. Surgery and Pediatrics, Stanford, CA [...]

STUDY DESIGN.: Retrospective analysis. OBJECTIVE.: To determine if an infusion of bupivacaine will reduce the need for intravenous opioids following posterior spine fusion. SUMMARY OF BACKGROUND DATA.: Adolescent idiopathic scoliosis is estimated to occur with a frequency of 1% to 3% among the at-risk age group of 10 to 18 years. A small percentage of these patients will require surgical intervention. Data are limited regarding continuous infusion of local anesthetic after posterior spine fusion for pain control. METHODS.: Retrospective review of children 10 to 18 years with idiopathic scoliosis admitted to a tertiary care, 20-bed pediatric intensive care unit (P pediatric intensive care unit), following posterior spine fusion. The primary outcome was postoperative opioid use stratified by the presence of a catheter for continuous bupivacaine. Secondary outcomes included pain scores, side effect management, depth of catheter placement, and fluid resuscitation. RESULTS.: Two hundred and forty-four children were eligible, 129 received a catheter for continuous bupivacaine, 115 did not. There were no differences in demographics. Significantly fewer patients receiving bupivacaine required a continuous basal infusion of morphine (32.6% vs. 85.2%, P < 0.001) resulting in an overall reduction opioid use on postoperative day 1 (18.9 vs. 26.4 mg, P < 0.001). Overall, pain scores were low in both groups. Limiting the analysis to only those with a bupivacaine catheter, the depth of catheter placement did not impact postoperative opioid use (P > 0.15). CONCLUSION.: The use of a continuous infusion of bupivacaine provided good analgesia with low pain scores. The significant reduction in basal morphine use may reflect a replacement by bupivacaine, although this is limited by potential treatment bias. Multivariate analysis was required to control for ongoing changes in anesthesia practice over the many years of the study. The optimal depth of catheter placement is unclear from this analysis and should be studied prospectively. [ABSTRACT FROM AUTHOR]

OBJECTIVES: To identify patient risk factors for pressure ulcers in a sample of veterans with spinal cord injuries and disorders. DESIGN: A survey incorporating questions from the Centers for Disease Control and Prevention's Behavioral Risk Factor Surveillance System was mailed to individuals with spinal cord injuries and disorders in 2003. A multiple logistic regression model including 2574 respondents was used to examine the association between patient characteristics and the self-report of pressure ulcers. RESULTS: Approximately 36% of respondents reported having pressure ulcers during the previous year. Respondent characteristics significantly associated with report of one or more pressure ulcers included diabetes (incidence rate ratio [IRR] = 1.36, P < 0.001), smoking (IRR = 1.16, P = 0.030), injury duration >30 yrs (IRR = 1.27, P = 0.000), and reporting frequent depressive symptoms (IRR = 1.30, P < 0.001). Veterans who did not have injuries related to their military service (IRR = 1.39, P < 0.001) or who received care at non-VA facilities in addition to or instead of VA facilities (IRR = 1.13, P = 0.024) were more likely than other veterans to report pressure ulcers. CONCLUSION: Efforts to prevent pressure ulcers should include increased attention to managing diabetes and depressive symptoms. Further research to explore the association between multiple healthcare system use and the risk of pressure ulcers should be pursued. [ABSTRACT FROM AUTHOR]

Study design:Cross-sectional.Objectives:The objective of this study was to examine the association between the characteristics of individuals with spinal cord injury (SCI) and self-reported health-related quality of life (HRQoL).Setting:The United States.Methods:Questions from the Behavioral Risk Factor Surveillance System (BRFSS) survey were sent to veterans with SCI. The analyses included 2302 respondents. Logistic regression analysis was used to examine the association between subject characteristics and the following four measures of HRQoL: frequent physical distress (FPD), frequent mental distress (FMD), frequent depressive symptoms (FDS) and poor or fair self-reported health.Results:Approximately 19% of the respondents reported FMD, 27% reported FPD, 17% reported FDS and 29% reported poor or fair health. Veterans who self-reported chronic illnesses, had higher odds of reporting FPD, FMD, FDS and poor or fair health than veterans who did not report chronic illnesses. Smoking was significantly associated with decreased HRQoL. Older veterans had higher odds of reporting poor or fair health and FPD than younger veterans. Higher levels of education were associated with lower odds of FMD, FDS and poor or fair health.Conclusions:Chronic illnesses and smoking have a substantial effect on HRQoL for persons with SCI, suggesting the importance of continued efforts to improve smoking cessation methods and to treat and prevent chronic conditions.Spinal Cord (2008) 46, 507-512; doi:10.1038/sc.2008.2; published online 5 February 2008 [ABSTRACT FROM AUTHOR]

OBJECTIVES: The objectives of this study were to examine the prevalence of depression diagnoses among veterans with spinal cord injuries and disabilities (SCI&D) for a 3-yr period, and to characterize patterns of antidepressant medication use in this population. DESIGN: This study was a retrospective analysis of clinical and administrative data. The sample consisted of 3678 veterans with SCI&D who had received any health care at a Department of Veterans Affairs facility between fiscal years 1999 and 2001, a depression diagnosis, and complete data. Logistic regression analysis was used to examine associations between patient characteristics, antidepressant types, and prescription patterns. RESULTS: Approximately 22% of veterans with SCI&D received a diagnosis of depression during at least one encounter with a healthcare provider. Of those diagnosed, 72% received antidepressant prescriptions. However, a large percentage (67%) did not continue antidepressant use for 6 mos. Patients started on a selective serotonin reuptake inhibitor were more likely to have at least 6 mos of continuous use than patients started on other, newer antidepressants. CONCLUSIONS: Many veterans with SCI&D may not be receiving adequate treatment for depression. Veterans with SCI&D should be aggressively screened and treated for depression, and further research is necessary to determine which treatments for depression are most effective for persons with SCI&D. [ABSTRACT FROM AUTHOR]

This article presents data from a qualitative study of mental illness attitudes and mental health service use in a community sample of African-Americans (N=70). Specifically, we examined cultural factors that shape community norms, including mental illness stigma, attitudes and behaviors. Focus groups were used to examine the influence of culture on broad thematic categories associated with mental illness and mental health service use. The following five thematic categories were examined: (a) descriptive terms and causes of mental illness, (b) cultural norms regarding mental health, (c) attitudes toward mental health service use (d) presence and determinants of mental illness stigma, and (e) strategies for reducing mental illness stigma and increasing access and use of mental health services. Thematic categories were selected based on the applicability of the information for education and stigma reduction intervention programs. Study findings have relevance for the development of culturally appropriate education and stigma change interventions for African-Americans. [ABSTRACT FROM AUTHOR]

Background Detection of isolated tumor cells (TC) in BM from carcinoma patients can predict future relapse. Various molecular and immunocytochemical (ICC) methods have been used to detect these cells, which are present at extremely low frequencies of 10 -5 -10 -6 . The specificity and sensitivity of these techniques may vary widely. In 1996, a European ISHAGE Working Group was founded to standardize and optimize procedures used for the detection of minimal residual disease. We have attempted to develop objective criteria for the evaluation of immunocytochemically identifiable cancer cells. Methods An interlaboratory ring experiment was performed, to compare the screening and detection of micrometastasis-positive events between different laboratories. The discrepant results induced us to establish a common consensus on morphological criteria applicable to the identification of immunostained micrometastatic TC. Results Bared on this consensus evaluation, we propose a classification of stained elements into three groups: (1) 'TC's show pathognomonic signs of epithelial TC-nature, as defined by a clearly enlarged nucleus or clusters of ≥ 2 immunopositive cells. (2) 'Probable TC's represent morphological overlap between hematopoietic cells (HC) and TC which lack pathognomonic signs of TC-nature, but do not exhibit clear morphological features of HC. These cells are considered as TC if control staining with an isotype-specific, unrelated Ab is negative. (3) 'TC-negative' cells are defined as 'false positive' HC, skin squamous epithelial cells and artefacts. Discussion The proposed classification of immunostained events is a first step towards the development of standardized immunocytochemical assays for the detection of occult micrometastatic TC in BM or blood. [ABSTRACT FROM AUTHOR]

Counseling patients to trim fat from their diets -- and their waistlines -- doesn't have to be frustrating. They don't have to give up favorite foods or make a fetish of measuring ingredients. [ABSTRACT FROM AUTHOR]

Purpose: Radiation therapy is an independent risk factor for adverse sequelae to the oral cavity and dentition in childhood cancer survivors. However, dental toxicities after radiation therapy often are underreported and there are minimal published data on disturbances in tooth development after proton beam therapy (PBT). We present the long-term clinical and radiographic dental findings 8 years after treatment completion for a patient treated with PBT and chemotherapy for rhabdomyosarcoma. Materials and Methods: Clinical follow-up data of patients treated with PBT within the Proton Overseas Programme (POP) is stored in a National Database and curated by a dedicated outcomes unit at the Christie NHS PBT center. This case report was identified from the extraction and analysis of data for pediatric head and neck cancer patients in this database for a service evaluation project. Results: The permanent dentition in this patient aged 3.5 years at the time of treatment was severely affected with abnormal dental development first observed 3.5 years after treatment completion. PBT delivered mean doses of 30 Gy(RBE = 1.1) to the maxilla and 25.9 Gy(RBE = 1.1) to the mandible. Conclusion: Significant dental development abnormalities occurred in this pediatric patient, despite doses in areas being lower than the proposed thresholds in the literature. Improved descriptions of dental toxicities and routine contouring of the maxilla and mandible are needed to correlate dosimetric data. The dose to teeth should be kept as low as reasonably possible in younger patients until the dose thresholds for dental toxicities are known.

Using a sample of dental clinic patients, this study examined the relationship between night eating and oral health and obesity. For this study, 174 individuals attending an academic faculty dental practice completed the Night Eating Questionnaire and provided information about their tobacco use, medical conditions, height, and weight. Oral health data from the previous three years were obtained from their dental records by a licensed dentist. Regression analysis was used to predict oral health and obesity status when controlling for known confounding variables. Evening hyperphagia (7.1%) and frequent nocturnal eating upon awakening (2.2%) were not prevalent in this sample and reflect prevalence estimates of night eating syndrome in the general population. Nocturnal eating was a significant predictor of missing teeth, periodontal disease, and active decay; however, evening hyperphagia was not a significant predictor of oral disease. Individuals who reported nocturnal ingestions of food were 4.4 times more likely to be overweight or obese than those who did not. Evening hyperphagia was not associated with an increased risk of being overweight or obese. [ABSTRACT FROM AUTHOR]

Background and Objectives: The lung and sleep health of adults is heavily influenced by early factors, both genetic and environmental; therefore, optimizing respiratory health begins in childhood. Multiple barriers impede improvements in lung and sleep health for children. First, the traditional siloing between general pediatric care in the community, pediatric pulmonary and sleep subspecialty care, and the research community limits the translation of knowledge into practice. Additionally, identifying and addressing health disparities remains a challenge. The 2021 NHLBI-sponsored workshop "Defining and Promoting Pediatric Pulmonary Health (DAP 3 H)" was a first step in defining critical gaps in our current healthcare system in identifying and optimizing lung and sleep health in children. The workshop identified key opportunities including measuring pulmonary function in young children, sleep-focused outcomes, developing biomarkers, and longitudinal research cohorts. To expand on the work of DAP 3 H and continue initiatives to improve childhood lung and sleep health, the Pediatrics & Pulmonary Network: Improving Health Together conference was held in 2023., Study Design: A modified Delphi process was applied to form consensus surrounding gaps, barriers, and action items, with the goal of identifying the most urgent opportnities for improving childhood lung and sleep health., Results: Cross-cutting foundational principles were identified as: (1) Authentic Stakeholder Collaboration & Engagement, (2) Reach & Implementation in Real World Settings, (3) Understanding Current Landscape & Resources and (4) Purposeful Diversity, Equity, & Inclusion Initiatives., Conclusions: To improve lung and sleep health in children, these principles should be the foundation for research design, development, and implementation., (© 2024 Wiley Periodicals LLC.)

Background: Technologies, including mobile health applications (apps) and wearables, offer new potential for gathering patient-generated health data (PGHD) from patients; however, little is known about patient preferences for and willingness to collect and share PGHD with their providers and healthcare systems., Objective: Describe how patients use their PGHD and factors important to patients when deciding whether to share PGHD with a healthcare system., Design: Cross-sectional mailed longitudinal survey supplemented with administrative data within the Veterans Health Administration (VHA)., Subjects: National sample of Veterans who use VHA healthcare., Main Measures: Survey questions asked about demographics, willingness to use different devices to collect and share PGHD, what Veterans do with their PGHD, and factors important to Veterans when deciding whether to share PGHD with VHA. Administrative data provided information on Veteran health conditions. Multiple logistic regression models assessed factors associated with sharing PGHD with VHA., Key Results: Overall, 47% of our analytic cohort (n = 383/807) indicated that they share PGHD collected through apps or digital health devices with VHA. In adjusted logistic regression models, Veterans who believed the following factors were Very Important (versus Somewhat/Not At All Important) had higher odds of sharing PGHD with VHA: if their doctor (OR = 1.4; 95%CI, 1.0-2.0) or other healthcare team members (OR = 1.4; 95%CI, 1.0-1.9) recommended they do so; and knowing that their healthcare team would look at the data (OR = 1.4; 95%CI, 1.0-2.0) or use the information to inform their healthcare (OR = 1.5; 95%CI, 1.1-2.1)., Conclusions: Our data suggest that healthcare team members can influence patient sharing of PGHD, as can a patient's knowledge that PGHD will be used in clinical practice. Efforts to increase the number of patients who share PGHD with a healthcare system may benefit from buy-in among healthcare team members, who appear to play an influential role in patient decisions to share data., (© 2024. This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply.)

This study aims to demonstrate that demographics combined with biometrics can be used to predict obesity related chronic disease risk and produce a health risk score that outperforms body mass index (BMI)-the most commonly used biomarker for obesity. We propose training an ensemble of small neural networks to fuse demographics and biometrics inputs. The categorical outputs of the networks are then turned into a multi-dimensional risk map, which associates diverse inputs with stratified, output health risk. Our ensemble model is optimized and validated on disjoint subsets of nationally representative data (N~100,000) from the National Health and Nutrition Examination Survey (NHANES). To broaden applicability of the proposed method, we consider only non-invasive inputs that can be easily measured through modern devices. Our results show that: (a) neural networks can predict individual conditions (e.g., diabetes, hypertension) or the union of multiple (e.g., nine) health conditions; (b) Softmax model outputs can be used to stratify individual- or any-condition risk; (c) ensembles of neural networks improve generalizability; (d) multiple-input models outperform BMI (e.g., 75.1% area under the receiver operator curve for eight-input, any-condition models compared to 64.2% for BMI); (e) small neural networks are as effective as larger ones for the inference tasks considered; the proposed models are small enough that they can be expressed as human-readable equations, and they can be adapted to clinical settings to identify high-risk, undiagnosed populations., Competing Interests: All authors were employed by Amazon when this paper and its methods were devised., (Copyright: © 2024 Smith et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: Although it is generally accepted that aerobic exercise training does not change lung structure or function, some work suggests that greater pulmonary vascular structure and function is associated with higher exercise capacity (peak oxygen consumption [Vo 2 peak])., Research Question: Is there a cross-sectional association between the pulmonary vasculature and Vo 2 peak? We hypothesized that those with higher CT blood vessel volumes and capacity of the lungs for carbon monoxide (Dlco) would have higher Vo 2 peak, independent of airflow limitation., Study Design and Methods: Participants from the Canadian Cohort Obstructive Lung Disease (CanCOLD) study were categorized as follows: never smokers with normal spirometry (n = 263), ever smokers with normal spirometry (n = 407), and COPD: individuals with spirometric airflow obstruction (n = 334). Total vessel volume (TVV), volume for vessels < 5 mm 2 in cross-sectional area (BV5), and volume for vessels between 5 and 10 mm 2 in cross-sectional area (BV5-10) were generated from CT scans and used as indices of pulmonary vascular structure. Dlco was used as an index of pulmonary microvascular function. Vo 2 peak was evaluated via incremental cardiopulmonary exercise testing., Results: General linear regression models revealed that even after controlling for FEV 1 , emphysema severity, and body morphology, Dlco, TVV, BV5, and BV5-10, were independently associated with Vo 2 peak. Interaction effects were observed between COPD and TVV, BV5, and BV5-10, indicating a weaker association between pulmonary vascular volumes and Vo 2 peak in COPD., Interpretation: Our results suggest that pulmonary vascular structure and Dlco are independently associated with Vo 2 peak, regardless of severity of airflow limitation and emphysema, suggesting that these associations are not limited to COPD., Competing Interests: Financial/Nonfinancial Disclosures The authors have reported to CHEST the following: M. K. reports consulting fees related to the content of the manuscript from VIDA Diagnostics Inc (Coralville, IA). W. T. reports support from the Canadian Institute of Heath Research (CIHR/Rx&D Collaborative Research Program Operating Grants 93326) with industry partners Astra Zeneca Canada Ltd, Boehringer-Ingelheim Canada Ltd, GlaxoSmithKline Canada Ltd, Merck, Novartis Pharma Canada Inc, Nycomed Canada Inc, and Pfizer Canada Ltd for conducting the longitudinal population-based Canadian Cohort of Obstructive Lung Disease (CanCOLD) study on COPD. J. B. reports grants or contracts from CIHR, Réseau en santé respiratoire du FRQS, McGill University, McGill University Health Centre Foundation, AstraZeneca Canada Ltd, Boehringer Ingelheim Canada Ltd, GlaxoSmithKline Canada Ltd, Grifols, Novartis, Sanofi, and Trudell Canada Ltd, paid to his institution; and payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing, or educational events from AstraZeneca Canada Ltd, Boehringer Ingelheim Canada Ltd, GlaxoSmithKline Canada Ltd, Trudell Canada Ltd, Pfizer Canada Ltd, and COVIS Pharma Canada Ltd. S. S. reports grants from the ATS as chair for ATS/ERS Updated Technical Standard on PFT interpretation; reports consulting fees from Chiesi Pharmaceuticals; reports speaker fees from Vyaire Medical; holds a leadership position at the American Thoracic Society and European Respiratory Society; is on a medical advisory board at Ndd Technologies; and is statistical editor at Thorax, an editorial board member at the European Respiratory Journal, and associate editor at Canadian Journal of Respiratory, Critical Care and Sleep Medicine, outside the submitted work. None declared (S. É. C., B. M. S., S. T., S. D., D. J. M. K. S.)., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)

Background: Lung structure and cardiac structure and function are associated cross-sectionally. The classic literature suggests relationships of airways disease to cor pulmonale and emphysema to reduced cardiac output (CO) but longitudinal data are lacking., Methods: The Multi-Ethnic Study of Atherosclerosis Chronic Obstructive Pulmonary Disease (COPD) Study was a multi-center longitudinal COPD case-control study of participants 50-79 years with ≥10 pack-years smoking without clinical cardiovascular disease. Segmental airway wall area (WA) and percent emphysema were measured on computed tomography. Right and left ventricle (RV, LV) parameters were assessed on magnetic resonance imaging (MRI) in exams six years apart. Longitudinal and period cross-sectional associations were evaluated with mixed models adjusted for demographics, body size, and smoking., Results: The 187 participants with repeated MRI were 67±7 years old; 42% had COPD; 22% currently smoked; and the race/ethnicity distribution was 54% white, 30% Black, 14% Hispanic, and 3% Asian. Greater WA at enrollment was associated with longitudinal increase in RV mass (3.5 g per 10mm 2 WA, 95% CI: 1.1, 5.9). Greater percent emphysema was associated with stably lower LV end diastolic volume (-7.8 mL per 5% emphysema, 95% CI: -10.3, -3.0) and CO (-0.2 L·min -1 per 5% emphysema, 95% CI: -0.4, -0.1)., Conclusion: Cardiac associations varied by lung structure over six years in this multi-ethnic study. Greater WA at enrollment was associated with longitudinal increases in RV mass; whereas greater percent emphysema was associated with stable decrements in LV filling and CO., (Copyright ©The authors 2024. For reproduction rights and permissions contact permissions@ersnet.org.)

Objective: To determine frequency that ED visits are needed, and the most common chief complaints and medications prescribed to Veterans with spinal cord injuries and disorders (SCI/D)., Methods: The Veterans Health Administration (VHA) SCI and Disorders (SCI/D) Registry (VHA SCIDR) was used to identify Veterans with SCI/D over a five-year period (fiscal years 2018-2022). The primary outcome was the proportion of Veterans with SCI/D who had visits to the ED during the study period. Secondary outcomes included diagnostic codes and medications prescribed in the ED, and other healthcare encounters., Results: Overall, 18,464 Veterans with SCI/D, including 80,661 patient-years were included. Of these Veterans, 10,234 (55.4%) had at least one ED visit and 8230 (44.6%) did not. ED visits were consistent, ranging from 33.5% to 36.4% annually. The number of in-person healthcare encounters decreased over the study period. The most common ED diagnostic codes were paraplegia or quadriplegia, discharge counseling, UTI, neuromuscular dysfunction of the bladder and low back pain. The most common medications prescribed in the ED were analgesics (e.g., acetaminophen, ketorolac), antimicrobials (e.g., ceftriaxone, vancomycin) and ondansetron. Antibiotics were among the most prescribed discharge medications, including ciprofloxacin, sulfamethoxazole/trimethoprim, cephalexin, and doxycycline., Conclusion: This national study of Veterans with SCI/D characterized ED healthcare utilization. Overall, more than half of Veterans with SCI/D required an ED visit during the five-year study period and over one third of Veterans in each fiscal year required an ED visit. Interventions to target prevention of ED visits and subsequent hospitalizations could focus on these areas., Competing Interests: Declaration of competing interest We wish to confirm that there are no known conflicts of interest associated with this publication and there has been no significant financial support for this work that could have influenced its outcome. We confirm that the manuscript has been read and approved by all named authors and that there are no other persons who satisfied the criteria for authorship but are not listed. We further confirm that the order of authors listed in the manuscript has been approved by all of us. We confirm that we have given due consideration to the protection of intellectual property associated with this work and that there are no impediments to publication, including the timing of publication, with respect to intellectual property. In so doing we confirm that we have followed the regulations of our institutions concerning intellectual property. We understand that the Corresponding Author is the sole contact for the Editorial process (including Editorial Manager and direct communications with the office). He/she is responsible for communicating with the other authors about progress, submissions of revisions and final approval of proofs. We confirm that no AI tools were used to write the manuscript., (Published by Elsevier Inc.)

Background: The biological mechanisms leading some tobacco-exposed individuals to develop early-stage chronic obstructive pulmonary disease (COPD) are poorly understood. This knowledge gap hampers development of disease-modifying agents for this prevalent condition., Objectives: Accordingly, with National Heart, Lung and Blood Institute support, we initiated the SubPopulations and InteRmediate Outcome Measures In COPD Study (SPIROMICS) Study of Early COPD Progression (SOURCE), a multicenter observational cohort study of younger individuals with a history of cigarette smoking and thus at-risk for, or with, early-stage COPD. Our overall objectives are to identify those who will develop COPD earlier in life, characterize them thoroughly, and by contrasting them to those not developing COPD, define mechanisms of disease progression., Methods/discussion: SOURCE utilizes the established SPIROMICS clinical network. Its goal is to enroll n=649 participants, ages 30-55 years, all races/ethnicities, with ≥10 pack-years cigarette smoking, in either Global initiative for chronic Obstructive Lung Disease (GOLD) groups 0-2 or with preserved ratio-impaired spirometry; and an additional n=40 never-smoker controls. Participants undergo baseline and 3-year follow-up visits, each including high-resolution computed tomography, respiratory oscillometry and spirometry (pre- and postbronchodilator administration), exhaled breath condensate (baseline only), and extensive biospecimen collection, including sputum induction. Symptoms, interim health care utilization, and exacerbations are captured every 6 months via follow-up phone calls. An embedded bronchoscopy substudy involving n=100 participants (including all never-smokers) will allow collection of lower airway samples for genetic, epigenetic, genomic, immunological, microbiome, mucin analyses, and basal cell culture., Conclusion: SOURCE should provide novel insights into the natural history of lung disease in younger individuals with a smoking history, and its biological basis., (JCOPDF © 2024.)

Background: Nutritional challenges are common in early CF care and stressful for caregivers of children with CF (cwCF) to navigate. Gastrostomy tube (G-tube) placement can improve weight gain, however the decision to proceed with placement is personalized and preference-sensitive. Little is known about the experiences of caregivers of cwCF and the G-tube decision-making process., Objectives: The present study used a qualitative approach to explore the perceptions and experiences of caregivers of cwCF with G-tube introductions and recommendations, as well as factors influencing G-tube decision-making., Methods: Caregivers of cwCF aged ≤ 10 years completed audio-taped, semi-structured interviews describing their experiences with G-tube placement discussions. Interviews were transcribed and two independent researchers coded the transcripts and conducted content and thematic analysis using an inductive approach., Results: Participants included 43 caregivers, 84 % were mothers (36/43). CwCF had a mean age of 4 years (SD=2.6), 84 % were White (36/43), and 60 % reported weights below <50th percentile (26/43). All caregivers knew about G-tubes, 44 % (19/43) were recommended a G-tube and 35 % (15/43) had a G-tube placed. Major findings included descriptions of the stages of G-tube decision-making from a heads up, to the game plan, to making a first difficult decision and finally living with the decision to pursue G-tube placement., Conclusion: G-tube decision-making is an emotional and personalized journey for caregivers of cwCF. Efforts to explore the values and priorities of caregivers is imperative to supporting families making difficult decisions in CF care., Competing Interests: Declaration of competing interest All authors disclose that they have no financial interests in the subject of this manuscript. The funding sources have no role in the analysis or drafting of the manuscript., (Copyright © 2024 European Cystic Fibrosis Society. Published by Elsevier B.V. All rights reserved.)

Objective: School-based health centers (SBHCs) improve health care access, but associations with educational outcomes are mixed and limited for elementary and middle school students. We investigated whether students enrolled in a comprehensive SBHC demonstrated more growth in standardized math and reading assessments over 4 school years versus nonenrolled students. We also explored changes in absenteeism., Methods: Participants were students enrolled in 2 co-located Title I schools from 2015-19 (1 elementary, 1 middle, n = 2480). Analysis of math and reading was limited to students with baseline and postbaseline scores (math n = 1622; reading n = 1607). Longitudinal regression models accounting for within-subject clustering were used to estimate the association of SBHC enrollment with academic scores and daily absenteeism, adjusting for grade, sex, body mass index category, health conditions, baseline outcomes (scores or absenteeism), and outcome pretrends., Results: More than 70% of SBHC-enrolled students had math (1194 [73.6%]) and reading 1186 [73.8%]) scores. Enrollees were more likely than nonenrollees to have asthma (39.7% vs 19.6%) and overweight/obesity (42.4% vs 33.6%). Adjusted baseline scores were significantly lower in math and reading for enrollees. Mean change from baseline for enrollees exceeded nonenrollees by 3.5 points (95% confidence interval [CI]: 2.2, 4.8) in math and 2.1 points (95% CI: 0.9, 3.3) in reading. The adjusted rate of decrease in daily absenteeism was 10.8% greater for enrollees (incident rate ratio 0.772 [95% CI: 0.623, 0.956]) than nonenrollees (incident rate ratio 0.865 [95% CI: 0.696, 1.076])., Conclusions: SBHC enrollees had greater health and educational risk but demonstrated more growth in math and reading and less absenteeism than nonenrollees., Competing Interests: Declaration of Competing Interest The authors have received support from the following for the production of this manuscript: Dr Cheng is a consulting editor for Pediatric Clinics of North America. Dr Spin is employed by EVERSANA., (Copyright © 2024 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.)

Measurement-based care (MBC) comprises collecting patient-reported outcomes data using validated assessments and using that information to support treatment. The Veterans Health Administration (VHA) has developed technology platforms to support MBC, including the Mental Health Checkup (MHC) mobile health application (app). Our objective was to examine VHA mental health provider perspectives on the MHC app. We completed a mixed-methods, sequential explanatory evaluation of MHC. We surveyed 284 VHA mental health providers who used MHC, then conducted semistructured telephone interviews with a purposefully selected subset of survey respondents ( n = 20). Approximately half of survey respondents agreed that MHC allowed them to collect assessment data from veterans more frequently than before (51%) and that they more frequently discussed assessment results with veterans because of MHC (50%) and used those results to inform goal-setting discussions (50%) and treatment decision making (51%). Bivariate analyses indicated a positive relationship between frequency of MHC use and the aforementioned impacts on care. Interview data conveyed both advantages (e.g., increased treatment efficiency, improved treatment decision making) and challenges (e.g., limited assessment availability, difficulties engaging veterans in completing assessments through the app) to using MHC. This evaluation demonstrated how MHC supported providers working to implement MBC. The app enhanced their ability to reach and engage veterans and incorporate assessment data into clinical encounters. Still, many did not perceive that MHC was impactful on mental health care delivery; given that providers who used MHC more frequently reported more positive impressions of MHC, this may be related to how frequently they used the app. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Background: A key challenge in developing treatments for neuropsychiatric illness is the disconnect between preclinical models and the complexity of human social behavior. We integrate voluntary social self-administration into a rodent model of social stress as a platform for the identification of fundamental brain and behavior mechanisms underlying stress-induced individual differences in social motivation., Methods: Here, we introduced an operant social stress procedure in male and female mice composed of 3 phases: 1) social self-administration training, 2) social stress exposure concurrent with reinforced self-administration testing, and 3) poststress operant testing under nonreinforced and reinforced conditions. We used social-defeat and witness-defeat stress in male and female mice., Results: Social defeat attenuated social reward seeking in males but not females, whereas witness defeat had no effect in males but promoted seeking behavior in females. We resolved social stress-induced changes to social motivation by aggregating z-scored operant metrics into a cumulative social index score to describe the spectrum of individual differences exhibited during operant social stress. Clustering does not adequately describe the relative distributions of social motivation following stress and is better described as a nonbinary behavioral distribution defined by the social index score, capturing a dynamic range of stress-related alterations in social motivation inclusive of sex as a biological variable., Conclusions: We demonstrated that operant social stress can detect stable individual differences in stress-induced changes to social motivation. The inclusion of volitional behavior in social procedures may enhance the understanding of behavioral adaptations that promote stress resiliency and their mechanisms under more naturalistic conditions., (Copyright © 2024 Society of Biological Psychiatry. Published by Elsevier Inc. All rights reserved.)

Introduction: Bariatric surgery improves many obesity-related comorbidities, yet the literature remains inconclusive on the impact of bariatric surgery on asthma. Our primary objective was to identify the long-term impact of bariatric surgery on asthma severity and medication use., Methods: A retrospective review was completed of all patients with a diagnosis of asthma who underwent bariatric surgery over 10 years at a single institution. Primary outcomes were the number of asthma medications prescribed at five time points (preoperative, postoperative < 18 months, 19-36 months, 37-60 months, 60 + months) after bariatric surgery. Secondary outcomes were spirometry results and BMI., Results: There were 260 patients with 84.6% female predominance. There were 168 sleeve gastrectomy patients and 92 Roux-en-Y gastric bypass patients. Mean age was 47.6 ± 10.7 years, mean BMI was 46.0 ± 6.8 kg/m 2 , and 54.2% were previous tobacco users. The total number of patients on two or more asthma medications decreased from 46% preoperatively to 41% at 18 months, to 36% at 36 months, and to 32% at 60 months after surgery. The total number of patients free from asthma medication increased from 25% preoperatively to 33% at 60 months postoperatively. Asthma medication use decreased in both surgery groups, and neither operation demonstrated superiority. No significant improvement nor differences were found between groups at any time point regarding FEV 1 /FVC ratio spirometry measures., Conclusion: Bariatric surgery reduces the use of medications taken for management of asthma. The amount of asthma medication usage decreases with time and is sustained at 60 months after bariatric surgery., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Emerging research suggests that psychological inflexibility may be a factor contributing to the development and maintenance of insomnia. However, less is known about the potential cognitive pathways that may explain this relationship. In this study, we investigated the serial mediating effects of psychological inflexibility and daytime insomnia-related rumination on the association between dysfunctional beliefs and attitudes about sleep (DBAS) and insomnia symptoms. The sample included 490 college students who underwent assessments at two time points over a 1-month period. The results of our mediational tests yielded significant indirect effects, supporting the prediction that psychological inflexibility and daytime insomnia rumination serially mediate the relationship between DBAS and insomnia. The study provides insights into potential mechanisms for insomnia, emphasizing the role of psychological inflexibility in perpetuating maladaptive cognitive processes associated with insomnia. Future researchers should explore other maladaptive responses to insomnia-related concerns and distress, such as worry and safety behaviors, and replicate findings in clinically elevated insomnia samples., (© 2024 Springer Publishing Company.)

In response to the opioid epidemic and high rates of chronic pain among the veteran population, the U.S. Department of Veterans Affairs implemented the TelePain-Empower Veterans Program (EVP), a nonpharmacological pain management program for veterans. Delivered virtually, TelePain-EVP incorporates integrated health components (Whole Health, Acceptance and Commitment Therapy, and Mindful Movement) through interdisciplinary personalized coaching. The objective of this quality improvement project was to evaluate the implementation of TelePain-EVP to identify determinants to implementation, benefits and challenges to participation, and recommendations for future direction. We used a qualitative descriptive design to conduct semistructured telephone interviews with TelePain-EVP leaders (n = 3), staff (n = 10), and veterans (n = 22). The interview guides aligned with the Consolidated Framework for Implementation Research (CFIR). Thematic content analysis organized and characterized findings. Several CFIR domains emerged as determinants relevant to program implementation, including innovation (eg, design); individuals (eg, deliverers, recipients); inner (eg, communications) and outer settings (eg, local conditions); and implementation process (eg, reflecting and evaluating). Identified determinants included facilitators (eg, virtual delivery) and barriers (eg, staff shortages). Participants reported improvements in pain management coping skills, interpersonal relationships, and sense of community, but no self-reported reductions in pain or medication use. Program improvement recommendations included using centralized staff to address vacancies, collecting electronic data, offering structured training, and providing course materials to veteran participants. Qualitative data can inform the sustained implementation of TelePain-EVP and other similar telehealth pain management programs. These descriptive data should be triangulated with quantitative data to objectively assess participant TelePain-EVP outcomes and associated participant characteristics. PERSPECTIVE: A qualitative evaluation of a telehealth program to manage chronic pain, guided by the CFIR framework, identified determinants of program implementation. Additionally, participants reported improvements in pain management coping skills, interpersonal relationships, and sense of community, but no self-reported reductions in pain or medication use., (Published by Elsevier Inc.)

Rationale: Rates of emphysema progression vary in chronic obstructive pulmonary disease (COPD), and the relationships with vascular and airway pathophysiology remain unclear. Objectives: We sought to determine if indices of peripheral (segmental and beyond) pulmonary arterial dilation measured on computed tomography (CT) are associated with a 1-year index of emphysema (EI; percentage of voxels <-950 Hounsfield units) progression. Methods: Five hundred ninety-nine former and never-smokers (Global Initiative for Chronic Obstructive Lung Disease stages 0-3) were evaluated from the SPIROMICS (Subpopulations and Intermediate Outcome Measures in COPD Study) cohort: rapid emphysema progressors (RPs; n  = 188, 1-year ΔEI > 1%), nonprogressors ( n  = 301, 1-year ΔEI ± 0.5%), and never-smokers ( n  = 110). Segmental pulmonary arterial cross-sectional areas were standardized to associated airway luminal areas (segmental pulmonary artery-to-airway ratio [PAAR seg ]). Full-inspiratory CT scan-derived total (arteries and veins) pulmonary vascular volume (TPVV) was compared with small vessel volume (radius smaller than 0.75 mm). Ratios of airway to lung volume (an index of dysanapsis and COPD risk) were compared with ratios of TPVV to lung volume. Results: Compared with nonprogressors, RPs exhibited significantly larger PAAR seg (0.73 ± 0.29 vs. 0.67 ± 0.23; P  = 0.001), lower ratios of TPVV to lung volume (3.21 ± 0.42% vs. 3.48 ± 0.38%; P  = 5.0 × 10 -12 ), lower ratios of airway to lung volume (0.031 ± 0.003 vs. 0.034 ± 0.004; P  = 6.1 × 10 -13 ), and larger ratios of small vessel volume to TPVV (37.91 ± 4.26% vs. 35.53 ± 4.89%; P  = 1.9 × 10 -7 ). In adjusted analyses, an increment of 1 standard deviation in PAAR seg was associated with a 98.4% higher rate of severe exacerbations (95% confidence interval, 29-206%; P  = 0.002) and 79.3% higher odds of being in the RP group (95% confidence interval, 24-157%; P  = 0.001). At 2-year follow-up, the CT-defined RP group demonstrated a significant decline in postbronchodilator percentage predicted forced expiratory volume in 1 second. Conclusions: Rapid one-year progression of emphysema was associated with indices indicative of higher peripheral pulmonary vascular resistance and a possible role played by pulmonary vascular-airway dysanapsis.