Genomics yields biological and phenotypic insights into bipolar disorder.

Bipolar disorder is a leading contributor to the global burden of disease. Despite high heritability (60-80%), the majority of the underlying genetic determinants remain unknown. We analysed data from participants of European, East Asian, African American and Latino ancestries (n = 158,036 cases with bipolar disorder, 2.

Impact and Recovery of VHA Epilepsy Care Services During the COVID-19 Pandemic.

Background: The Epilepsy Centers of Excellence (ECoE) is a network of facilities within the Veterans Health Administration that evaluates and treats veterans with epilepsy and seizure disorders. This article outlines how the COVID-19 pandemic impacted ECoE services and recovery.

Methods: Directors of 17 ECoEs were surveyed 4 times between May 2020 and July 2022 on 5 domains: functioning of outpatient epilepsy clinics, outpatient electroencephalogram, epilepsy monitoring unit, anticipated permanent operational changes, and utility of national and local recommendations.

Functional capacity at rehabilitation discharge predicts physical activity characteristics twenty-four weeks later for people with total knee arthroplasty: a secondary analysis of a randomized controlled trial.

Objective: To determine the association between performance-based and patient-reported functional capacity at the conclusion of 12-week rehabilitation with average daily step counts and peak walking cadence 38 weeks following total knee arthroplasty (TKA).

Design: Secondary analysis of an RCT.

Setting: Veterans Affairs Medical Center.

New onset refractory status epilepticus: Long-term outcomes beyond seizures.

We propose and prioritize important outcome domains that should be considered for future research investigating long-term outcomes (LTO) after new onset refractory status epilepticus (NORSE). The study was led by the international NORSE Institute LTO Working Group. First, literature describing the LTO of NORSE survivors was identified using a PubMed search and summarized to identify knowledge gaps.

Characterization of a novel PET radioligand for mitochondrial complex I in nonhuman primate.

The role of mitochondrial complex I (MC-I) dysfunction is well-documented across a range of neurodegenerative disorders. Recently, a novel positron emission tomography (PET) radioligand, [F]CNL02, has been synthesized to target MC-I. In this paper, we provide a comprehensive characterization of [F]CNL02, using nonhuman primate as a model system.

Drivers of Palliative Care and Hospice Use Among Patients With Advanced Lung Cancer.

Purpose: Despite rigorous evidence of improved quality of life and longer survival, disparities in the utilization of palliative and hospice care persist for racial and ethnic minority patients with cancer. This study evaluated the impact of psychosocial factors on utilization of these services.

Methods: Patients with advanced lung cancer were recruited at a large academic urban hospital.

THE WHO, WHAT, AND HOW OF INTERAGENCY CRIMINAL JUSTICE-BEHAVIORAL HEALTH TEAMS: Developing and Sustaining Collaborations.

Interagency teams are considered an evidence-based change practice, but there is a paucity of research examining them in criminal justice (CJ) and behavioral health (BH) reform contexts. This study draws on qualitative interviews ( = 52) and survey data ( = 791) from BH and CJ leaders across the United States to examine who is on them, what they do, and effective strategies for building and sustaining them. Findings indicated that CJ-BH interagency teams often incorporate agencies from a range of CJ, BH, social service, and health agencies.

Blood culture bottle shortage mitigation efforts: analysis of impact on ordering and patient impact.

Objective Design: In June of 2024, Becton Dickinson experienced a blood culture bottle shortage for their BACTEC system, forcing health systems to reduce usage or risk exhausting their supply. Virginia Commonwealth University Health System (VCUHS) in Richmond, VA decided that it was necessary to implement austerity measures to preserve the blood culture bottle supply.

Setting: VCUHS includes a main campus in Richmond, VA as well as two affiliate hospitals in South Hill, VA (Community Memorial Hospital (CMH)) and Tappahannock Hospital in Tappahannock, VA.

Phase 1b/2a safety study of lemborexant as an adjunctive treatment for insomnia to buprenorphine-naloxone for opioid use disorder: A randomized controlled trial.

Background: Evidence supports the common incidence of sleep disturbance in opioid use disorder (OUD) as a potential marker of disrupted orexin system functioning. This study evaluated the initial safety and tolerability of a challenge dose of lemborexant, a dual orexin antagonist, as an adjunct to buprenorphine/naloxone.

Methods: Patients (18-65 years old) with OUD receiving sublingual buprenorphine/naloxone, with a Pittsburgh Sleep Quality Index total score of 6 or higher, were recruited from outpatient clinics.

Protocol for a multisite randomised controlled trial assessing the effect of the Telehealth for Early Developmental Intervention in babies born very preterm (TEDI-Prem) programme on neurodevelopmental outcomes and parent well-being.

Introduction: Infants born very preterm (VPT, <32 weeks' gestation) are at increased risk for neurodevelopmental impairments including motor, cognitive and behavioural delay. Parents of infants born VPT also have poorer mental health outcomes compared with parents of infants born at term.We have developed an intervention programme called TEDI-Prem (Telehealth for Early Developmental Intervention in babies born very preterm) based on previous research.

Increased Afferent Nerve Firing Is Correlated With the Detection of Bladder Wall Micromotion in a Perfused Ex-Vivo Porcine Model.

Introduction And Objective: Observable autonomous rhythmic changes in intravesical pressure, termed bladder wall micromotion, is a phenomenon that has been linked to urinary urgency, the key symptom in overactive bladder (OAB). However, the mechanism through which micromotion drives urinary urgency is poorly understood. In addition, micromotion is inherently difficult to study in human urodynamics due to challenges distinguishing it from normal cyclic physiologic processes such as pulse rate, breathing, rectal contractions, and ureteral jetting.

Dietary Interventions in Heart Failure With Preserved Ejection Fraction: A Scoping Review.

Patients with heart failure with preserved ejection fraction (HFpEF) are burdened by multiple diet-sensitive comorbidities, including obesity and malnutrition. Despite this, a low percentage of patients with HFpEF have been enrolled in dietary intervention trials in heart failure and few dietary interventions have been conducted in HFpEF exclusively. This scoping review will examine available evidence regarding dietary interventions in patients with HFpEF, highlight existing gaps in knowledge, and discuss emerging dietary therapies in this population.

The Paradigm Shift From Patient to Health Consumer: 20 Years of Value Assessment in Health.

Health care is undergoing a "revolution," where patients are becoming consumers and armed with apps, consumer review scores, and, in some countries, high out-of-pocket costs. Although economic analyses and health technology assessment (HTA) have come a long way in their evaluation of the clinical, economic, ethical, legal, and societal perspectives that may be impacted by new technologies and procedures, these approaches do not reflect underlying patient preferences that may be important in the assessment of "value" in the current value-based health care transition. The major challenges that come with the transformation to a value-based health care system lead to questions such as "How are economic analyses, often the basis for policy and reimbursement decisions, going to switch from a societal to an individual perspective?" and "How do we then assess (economic) value, considering individual preference heterogeneity, as well as varying heuristics and decision rules?" These challenges, related to including the individual perspective in cost-effectiveness analysis (CEA), have been widely debated.

Multiomics dissection of human RAG deficiency reveals distinctive patterns of immune dysregulation but a common inflammatory signature.

Human recombination-activating gene (RAG) deficiency can manifest with distinct clinical and immunological phenotypes. By applying a multiomics approach to a large group of -mutated patients, we aimed at characterizing the immunopathology associated with each phenotype. Although defective T and B cell development is common to all phenotypes, patients with hypomorphic variants can generate T and B cells with signatures of immune dysregulation and produce autoantibodies to a broad range of self-antigens, including type I interferons.

Undergraduate Students' Onlooker Response Prior to Arrival of Emergency Medical Services: An Assessment of Willingness to Respond.

Objectives: This study sought to assess undergraduate students' knowledge and attitudes surrounding perceived self-efficacy and threats in various common emergencies in communities of higher education.

Methods: Self-reported perceptions of knowledge and skills, as well as attitudes and beliefs regarding education and training, obligation to respond, safety, psychological readiness, efficacy, personal preparedness, and willingness to respond were investigated through 3 representative scenarios via a web-based survey.

Results: Among 970 respondents, approximately 60% reported their university had adequately prepared them for various emergencies while 84% reported the university should provide such training.

How Are You Doing… Really? A Review of Whole Person Health Assessments.

Unlabelled: Policy Points A redirection of measurement in health care from a narrow focus on diseases and care processes towards assessing whole person health, as perceived by the person themself, may provide a galvanizing view of how health care can best meet the needs of people and help patients feel heard, seen, and understood by their care team. This review identifies key tensions to navigate as well as four overarching categories of whole person health for consideration in developing an instrument optimized for clinical practice. The categories (body and mind, relationships, living environment and finances, and engagement in daily life) include nine constituent domains.

Identifying and treating metabolic dysfunction-associated steatotic liver disease among at-risk Veterans.

Objectives: Metabolic dysfunction-associated steatotic liver disease (MASLD), an increasing public health concern, remains challenging to diagnose and risk-stratify. We assessed the 1) prevalence of MASLD risk factors among Veterans in Veterans Health Administration (VA) care, 2) factors associated with MASLD diagnosis; and 3) associations between MASLD diagnosis and receipt of care.

Methods: Veterans with MASLD risk factors, including obesity, pre-diabetes, diabetes, or dyslipidemia, were identified using International Classification of Diseases-10 codes and followed in 2019-2022.

Interaction of the Gut-Liver-Brain Axis and the sterolbiome with sexual dysfunction in patients with cirrhosis.

There is a complex interplay between the gut microbes, liver, and central nervous system, a gut-liver-brain axis, where the brain impacts intestinal and hepatic function while the gut and liver can impact cognition and mental status. Dysregulation of this axis can be seen in numerous diseases. Hepatic encephalopathy, a consequence of cirrhosis, is perhaps the best studied perturbation of this system.

Revision Triceps Reconstruction With Achilles Bone Block Allograft Augmentation: A Novel Inlay Technique.

Managing rerupture of the triceps brachii tendon after surgical repair is challenging due to poor tissue quality, retraction, and adhesions. This clinical scenario often requires augmentation with native tissue or tendon allografts. Traditional techniques include V-Y advancement, reinforced triceps advancement with double row or suture bridge fixation, and allograft tendon augmentation.

A bipartite bacterial virulence factor targets the complement system and neutrophil activation.

The complement system and neutrophils constitute the two main pillars of the host innate immune defense against infection by bacterial pathogens. Here, we identify T-Mac, a novel virulence factor of the periodontal pathogen Treponema denticola that allows bacteria to evade both defense systems. We show that T-Mac is expressed as a pre-protein that is cleaved into two functional units.

Difficulties and Disparities in Colorectal Cancer End-of-Life Care: A Patient's Story.

Patients with advanced colorectal cancer nearing the end of life require a multidisciplinary approach to address the unique challenges they face. Using a case vignette, we outline the various stages of a patient's journey with advanced rectal cancer and the common obstacles to their care as they interface with the medical system. We highlight how Black persons might be vulnerable to differences in screening, treatment, procedural interventions, end-of-life care, and health care decision-making.

Factor analysis and clustering of motor and psychiatric dimensions in idiopathic blepharospasm.

Introduction: Idiopathic blepharospasm is a clinically heterogeneous form of focal dystonia, also associated with psychiatric symptoms. The identification of the most relevant sets of motor and psychiatric manifestations may help better understand the specific phenomenology of the condition and delineate blepharospasm subtypes more accurately.

Methods: Patients with idiopathic blepharospasm were from the Dystonia Coalition project.