Distinct comorbidity phenotypes among post-9/11 Veterans with epilepsy are linked to diverging outcomes and mortality risks.

Objective: To investigate phenotypes of comorbidity before and after an epilepsy diagnosis in a national cohort of post-9/11 Service Members and Veterans and explore phenotypic associations with mortality.

Methods: Among a longitudinal cohort of Service Members and Veterans receiving care in the Veterans Health Administration (VHA) from 2002 to 2018, annual diagnoses for 26 conditions associated with epilepsy were collected over 5 years, ranging from 2 years prior to 2 years after the year of first epilepsy diagnosis. Latent class analysis (LCA) was used to identify probabilistic comorbidity phenotypes with distinct health trajectories.

Continuous Glucose Monitoring in Older Adults: What We Know and What We Have Yet to Learn.

Objective: To assess the growing use of continuous glucose monitoring (CGM) systems by older adults and explore additional areas integration that could benefit adults with frailty.

Background: The use of CGM devices has expanded rapidly in the last decade. This has been supported by substantial data showing significant benefit in glycemic metrics: hemoglobin A1c improvements, less hypoglycemia, and improved quality of life.

Care Retention Among Veterans with Serious Mental Illness who were once lost-to-Veterans Health Administration care.

Objective: To evaluate care retention among Veterans with serious mental illness (SMI) who were lost to Veterans Health Administration (VHA) care for at least one year and subsequently returned to VHA care via the SMI Re-Engagement program, an outreach program for Veterans with SMI who are lost-to-care.

Methods: For the 410 Veterans with SMI who returned to care via SMI Re-Engagement between April 4th, 2016 and January 31, 2018, we assessed VHA in-person and telehealth utilization (overall, primary care, mental health care) for two years following the date of return to care.

Results: Care retention was common: 70.

An Executive Functioning Composite Does Not Moderate the Relationship Between Combat Exposure and Posttraumatic Stress Disorder Symptom Clusters.

Objective: Posttraumatic stress disorder (PTSD) is prevalent among U.S. combat Veterans, and associated with poor health and wellbeing.

A Mathematical Model for Determining the Body's Fluctuating Need for and Synthesis of Active Vitamin D.

The process by which 1,25(OH)D is synthesized and degraded and how it is transported out of the cell and body is described. The changing demand for the synthesis of 1-25(OH)D during different conditions experienced by the body is reviewed. A method of determining 1,25(OH)D synthesis and demand, and the percent utilization of 25(OH)D to make 1,25(OH)D is presented based on the measurement of the end metabolites of 1,25(OH)D and of its immediate precursor, 25(OH)D.

Antiracism and mental health recovery: Bridging the gap to improve health disparities among veteran populations.

Viewing the Substance Abuse and Mental Health Services Administration's recovery principles through an antiracist lens has guided the authors' vision of recovery-oriented systems for all. In this brief letter, they present some considerations arising from their application of recovery principles to areas affected by racial bias. They are also identifying best practices for incorporating micro and macro antiracism efforts into recovery-oriented health care.

Altered lateralization of the cingulum in deployment-related traumatic brain injury: An ENIGMA military-relevant brain injury study.

Traumatic brain injury (TBI) in military populations can cause disruptions in brain structure and function, along with cognitive and psychological dysfunction. Diffusion magnetic resonance imaging (dMRI) can detect alterations in white matter (WM) microstructure, but few studies have examined brain asymmetry. Examining asymmetry in large samples may increase sensitivity to detect heterogeneous areas of WM alteration in mild TBI.

Improving engagement and retention to treatment within VHA PTSD specialty care: Evolution of an outpatient program design.

The Veteran's Health Administration (VA) and Department of Defense (DoD) posttraumatic stress disorder (PTSD) clinical practice guidelines (2017) recommend individual, trauma-focused therapy as the gold standard of treatment for PTSD (i.e., evidence-based practices [EBP]).

Sound Tolerance Conditions (Hyperacusis, Misophonia, Noise Sensitivity, and Phonophobia): Definitions and Clinical Management.

Unlabelled: For some people, exposure to everyday sounds presents a significant problem. The purpose of this tutorial was to define and differentiate between the various sound tolerance conditions and to review some options for their clinical management.

Method: We informally reviewed the literature regarding sound tolerance conditions.

Dupilumab-induced ocular surface disease: a primer.

The management of atopic diseases has been revolutionised by precision therapies and biological drugs that target specific immune proteins. This report elucidates a unique complication from the use of the monoclonal antibody, dupilumab, that primary care providers and subspecialists need to be aware of. A patient in her 40s consulted us for severe atopic asthma, food allergy and eczema involving the face and body.

The neuroscience of empathy and compassion in pro-social behavior.

Research in the scientific literature increasingly demonstrates that empathy consists of multiple dimensions, and that defining empathy as a single encompassing term may be imprecise. Recent calls have been made for increasing empathy as means to increase pro-social behavior. However, contradictory evidence exists that empathy may reduce pro-social behavior.

A prospective trial of abiraterone acetate plus prednisone in Black and White men with metastatic castrate-resistant prostate cancer.

Background: Retrospective analyses of randomized trials suggest that Black men with metastatic castration-resistant prostate cancer (mCRPC) have longer survival than White men. The authors conducted a prospective study of abiraterone acetate plus prednisone to explore outcomes by race.

Methods: This race-stratified, multicenter study estimated radiographic progression-free survival (rPFS) in Black and White men with mCRPC.

Intraoperative Botulinum Toxin Chemodenervation and Analgesia in Abdominal Wall Reconstruction.

To analyze the impact of botulinum toxin chemodenervation on postoperative opiate consumption through a novel intraoperative injection protocol. A retrospective review of the implementation of a novel intraoperative botulinum toxin injection into both rectus and oblique musculature. Patients undergoing open retrorectus release, with and without intraoperative chemodenervation with Botox, were retrospectively collected between 2015 and 2019.

Pan-Pseudothrombocytopenia in COVID-19: A Harbinger for Lethal Arterial Thrombosis?

Pseudothrombocytopenia in the setting of COVID-19-associated coagulopathy prompts the question whether it is representative of increased platelet aggregation activity in vivo.

Dialysis Access: At the Intersection of Policy, Innovation, and Clinical Care.

The Advancing American Kidney Health executive order aims to reduce the incidence of end-stage kidney disease, promote home dialysis therapies, increase the number of kidney transplants, and encourage innovation in new technologies, evidence-based practice, and early detection of kidney disease. Improvements in dialysis access care are essential to the success and expansion of this program, and to being able to provide high-quality, cost-efficient care to this patient population. Specifically, the need for expanded access to home dialysis will require surgeons and interventionalists to become proficient and trained in peritoneal dialysis catheter placement and for the referral process to be streamlined to accommodate the increased interest in this modality.

Racial Disparity in Response to Prostate Cancer Systemic Therapies.

Purpose Of Review: In this review, we aim to describe racial differences in response to treatment for metastatic castration-resistant prostate cancer (mCRPC).

Recent Findings: Recent data suggests that, despite higher risk features, African Americans may respond better than Caucasians to systemic therapies for advanced prostate cancer. This improved response is not limited to one class of drugs but can be seen with androgen-pathway directed therapies, chemotherapy, bone-targeted therapy, and immunotherapy.

Low Vitamin D States Observed in U.S. Marines and Navy Sailors with Early Multi-Symptom Illness.

Research has implicated immune system inflammation as an underlying etiology of multi-symptom illnesses, and vitamin D has been shown to have a significant role in immune system function. In this retrospective review performed on the medical charts of service members who presented with signs and symptoms of multi-symptom illnesses, we focused on serum 25(OH)D levels and looked for associations of vitamin D status (deficient, insufficient, and normal) with age (20-31 years versus 31-56 years) and deployment status (war zones versus other). Two groups (U.

Nicotine promotes brain metastasis by polarizing microglia and suppressing innate immune function.

Up to 40% of lung cancer patients develop brain metastasis, and the median survival of these patients remains less than 6 months. Smoking is associated with lung cancer. However, how smoking impacts the development of brain metastasis remains elusive.

Differential recovery rates of fitness following U.S. Army Ranger training.

Objectives: To investigate tactically-related physical performance and body composition recovery following U.S. Army Ranger training.