Functional Involvement of Human Periaqueductal Gray and Other Midbrain Nuclei in Cognitive Control.

Recent theoretical advances have motivated the hypothesis that the periaqueductal gray (PAG) participates in behaviors that involve changes in the autonomic control of visceromotor activity, including during cognitively demanding tasks. We used ultra-high-field (7 tesla) fMRI to measure human brain activity at 1.1 mm resolution while participants completed a working memory task.

Promoting Health Equity through De-Implementation Research.

Ensuring equitable access to quality health care historically has focused on gaps in care, where patients fail to receive the high-value care that will benefit them, something termed underuse. But providing high-quality health care sometimes requires reducing low-value care that delivers no benefit or where known harms outweigh expected benefits. These situations represent health care overuse.

Disclosure experiences and challenges among adolescents living with HIV and their caregivers in China.

Background And Objectives: With increasing access to antiretroviral therapy, HIV-infected youth are living longer, but are vulnerable as they navigate the transition to adulthood while managing a highly stigmatized condition. Knowing one's HIV status is critical to assuming responsibility for one's health. The process of disclosure to adolescents living with HIV is not well understood globally, even less so in China.

Helpful ways providers can communicate about persistent medically unexplained physical symptoms.

Background: Communication between patients and providers about persistent "medically unexplained" physical symptoms (MUS) is characterized by discordance. While the difficulties are well documented, few studies have examined effective communication. We sought to determine what veterans with Gulf War Illness (GWI) perceive as the most helpful communication from their providers.

Recommendations for increasing research on co-occurring serious mental illness and gambling problems.

Psychiatric disorders frequently co-occur with gambling disorder. Although community and clinical samples show frequent co-occurrence between gambling and psychotic disorders, relatively little research has been conducted on this population. Here, we comment on a recent study conducted in Brazil on the clinical correlates of psychotic disorders in treatment-seeking individuals with gambling disorder, relate the findings to those from the northeastern region of the United States, and discuss implications with respect to promoting responsible gambling in the setting of the expansion of legalized gambling.

Outcomes of Genitourinary Injury in U.S. Iraq and Afghanistan War Veterans Receiving Care from the Veterans Health Administration.

Introduction: In the recent conflicts, unprecedented numbers of US service personnel have survived with genitourinary (GU) injury, but few reports have focused on outcomes of these injuries. Outcomes of combat-related GU injury were investigated in wounded US male veterans of Operations Enduring/Iraqi Freedom and New Dawn receiving Veterans Health Administration (VHA) care.

Materials And Methods: Department of Defense Trauma Registry (DoDTR) data for male service members injured in theater were linked with VHA electronic health records (EHRs) for veterans who received VHA care at least once from October 2001 through September 2011.

Evaluating broad-scale system change using the Consolidated Framework for Implementation Research: challenges and strategies to overcome them.

Objective: The objective of this paper is to demonstrate the utility of the CFIR framework for evaluating broad-scale change by discussing the challenges to be addressed when planning the assessment of broad-scale change and the solutions developed by the evaluation team to address those challenges. The evaluation of implementation of Patient-centered Care and Cultural Transformation (PCC&CT) within the Department of Veterans Affairs (VA) will be used as a demonstrative example. Patient-Centered Care (PCC) is personalized health care that considers a patient's circumstances and goals.

Standardizing an approach to the evaluation of implementation science proposals.

Background: The fields of implementation and improvement sciences have experienced rapid growth in recent years. However, research that seeks to inform health care change may have difficulty translating core components of implementation and improvement sciences within the traditional paradigms used to evaluate efficacy and effectiveness research. A review of implementation and improvement sciences grant proposals within an academic medical center using a traditional National Institutes of Health framework highlighted the need for tools that could assist investigators and reviewers in describing and evaluating proposed implementation and improvement sciences research.

Balance deficits in Chronic Fatigue Syndrome with and without fibromyalgia.

Objective: Chronic Fatigue Syndrome (CFS) is a disorder of unknown etiology associated with debilitating fatigue. One symptom commonly reported is disequilibrium. The goal of this study was to determine if CFS patients demonstrated verified balance deficits and if this was effected by comorbid fibromyalgia (FM).

Emotion fingerprints or emotion populations? A meta-analytic investigation of autonomic features of emotion categories.

The classical view of emotion hypothesizes that certain emotion categories have a specific autonomic nervous system (ANS) "fingerprint" that is distinct from other categories. Substantial ANS variation within a category is presumed to be epiphenomenal. The theory of constructed emotion hypothesizes that an emotion category is a population of context-specific, highly variable instances that need not share an ANS fingerprint.

Screening for Lung Cancer: CHEST Guideline and Expert Panel Report.

Background: Low-dose chest CT screening for lung cancer has become a standard of care in the United States in the past few years, in large part due to the results of the National Lung Screening Trial. The benefit and harms of low-dose chest CT screening differ in both frequency and magnitude. The translation of a favorable balance of benefit and harms into practice can be difficult.

Racial Differences in Hospital Death for Atrial Fibrillation: The National Inpatient Sample 2001-2012.

Background: Understanding racial differences in outcomes for atrial fibrillation (AF) may guide interventions to diminish health inequities.

Methods And Results: In a retrospective, cross-sectional study of adults hospitalized with a principal diagnosis of AF using the 2001-2012 National Inpatient Sample, we assessed racial differences for in-hospital. We accounted for case-mix and clustering by race within hospitals to estimate odds ratios (OR) for death associated with individual patient race and hospital racial composition.

Less Engagement in Pleasure Activities is associated with poorer quality of life for Veterans with Comorbid Post-Deployment Conditions.

Objective: The presence of multiple comorbid conditions is common after combat deployment and complicates treatment. A potential treatment approach is to target shared mechanisms across conditions that maintain poorer health-related quality of life (HRQOL). One such mechanism may be decrements in pleasurable activities.

Resident Choice: A Nursing Home Staff Perspective on Tensions and Resolutions.

Unlabelled: A central component of person-centered care, resident choice in daily life, has received little research attention in the U.S.

Context: This study investigated nursing home staff experiences in realizing resident choice.

Health literacy assessment in adults with neurofibromatosis: electronic and short-form measurement using FCCHL and Health LiTT.

Determining health literacy level is an important prerequisite for effective patient education. We assessed multiple dimensions of health literacy and sociodemographic predictors of health literacy in patients with neurofibromatosis. In 86 individuals with a confirmed diagnosis of neurofibromatosis 1 (NF1), neurofibromatosis 2 (NF2), or schwannomatosis, we assessed health literacy status using two HL tools-the adapted functional, communicative, and critical health literacy scale (adapted FCCHL) and health literacy assessment using talking touchscreen technology (Health LiTT).

Physician Approaches to Conflict with Families Surrounding End-of-Life Decision-making in the Intensive Care Unit. A Qualitative Study.

Rationale: Families of critically ill patients are often asked to make difficult decisions to pursue, withhold, or withdraw aggressive care or resuscitative measures, exercising "substituted judgment" from the imagined standpoint of the patient. Conflict may arise between intensive care unit (ICU) physicians and family members regarding the optimal course of care.

Objectives: To characterize how ICU physicians approach and manage conflict with surrogates regarding end-of-life decision-making.

Pulmonary Nodules: A Small Problem for Many, Severe Distress for Some, and How to Communicate About It.

Every year, millions of patients are diagnosed with pulmonary nodules, and as increasing numbers of people undergo lung cancer screening, even more patients will be found to have a nodule. The vast majority of patients cannot benefit from the detection of a pulmonary nodule because most are benign. Accordingly, it is important to develop strategies to minimize harm, in particular the distress of a "near-cancer" diagnosis.

Evidence for a Large-Scale Brain System Supporting Allostasis and Interoception in Humans.

Large-scale intrinsic brain systems have been identified for exteroceptive senses (e.g., sight, hearing, touch).

A Randomized Trial of Off-Site Collaborative Care for Depression in Chronic Hepatitis C Virus.

Objective: To test the effectiveness of a collaborative depression care model in improving depression and hepatitis C virus (HCV) care.

Data Sources/study Setting: Hepatitis C virus clinic patients who screened positive for depression at four Veterans Affairs Hospitals.

Study Design: We compared off-site depression collaborative care (delivered by depression care manager, pharmacist, and psychiatrist) with usual care in a randomized trial.

A Qualitative Study of Participation in Cardiac Rehabilitation Programs in an Integrated Health Care System.

Introduction: Despite strong incentives to use cardiac rehabilitation (CR), patient participation is low in the Veterans Health Administration (VHA). This is paradoxical given that VHA is an integrated health care system that offers a range of CR programs which should logically reduce barriers to access to CR participation. The purpose of this study was to better understand the contextual factors that influence patient participation in CR and how patients consider factors together when making decisions about CR participation.