VA Puget Sound Health Care System

Modeling the heterogeneity of cognitive dysfunction in Parkinson’s disease using partially ordered set models

Abstract Traditional binary classifications of Parkinson’s disease (PD) cognitive dysfunction fail to capture its inherent heterogeneity. This study introduces the Partially Ordered Set (POSET) model, a Bayesian framework, to analyze cognitive heterogeneity using Parkinson’s Prec...

Prognostication in Amyotrophic Lateral Sclerosis: A Narrative Review of Pre-Diagnosis and Functional Outcomes

Amyotrophic Lateral Sclerosis (ALS) is a very heterogeneous disease, yet some of the most common questions received by physicians in the ALS clinic are “how much time do I have?” and “what can I expect to happen next?” This line of inquiry is not strictly limited to patients; cli...

Rheumatoid arthritis, frailty, and outcomes of surgical hospitalizations: A national population‐based analysis

OBJECTIVE: Hospitalization, particularly for surgery, represents a period of heightened stress. We evaluated how frailty attenuates the association of rheumatoid arthritis (RA) with negative health outcomes after elective non-cardiac surgery. METHODS: We conducted a cross-section...

Perceptions of Incidental Findings on Lung Cancer Screening Exams: A National Survey of Primary Care Clinicians and Radiologists

RATIONALE: Unlike other common cancer screenings, annual lung cancer screening often identifies a spectrum of incidental findings unrelated to lung cancer. While these findings could be actionable, how to best communicate and manage them can be a challenge, often falling upon pri...

Maximum Allowable Contrast Dose and Risk of Acute Kidney Injury After Coronary Procedures

BACKGROUND: Recent studies have questioned whether iodinated contrast is causally related to acute kidney injury (AKI). AIM: We pursed a contemporary analysis to determine the impact of contrast dose on AKI following coronary procedures in an era of lower contrast doses and less...

Specificity, frequency, and phenotype of citrullinated-specific T cells vary with disease activity in rheumatoid arthritis

In rheumatoid arthritis (RA), CD4 + T cells specific for citrullinated antigens (cit-antigens) are key drivers of disease, but knowledge about epitopes and phenotypes remains limited. We characterized the frequency and phenotype of cit-specific CD4 + T cells in peripheral blood u...

Radiology considerations for the PREMIUM study: a multicenter randomized controlled trial of abbreviated MRI versus ultrasound for liver cancer screening in cirrhosis

Abstract This paper describes the rationale and radiology considerations in the implementation of the Preventing Liver Cancer Mortality through Imaging with Ultrasound versus MRI (PREMIUM) study. PREMIUM is a multicenter, randomized controlled trial sponsored by the Department of...

Military Service and Survival Among Persons With ALS in the U.S. National ALS Registry, 2011–2023

ABSTRACT Introduction/Aims Military service has been associated with increased risk of amyotrophic lateral sclerosis (ALS) but less is known about survival after diagnosis. We evaluated the association between military service and survival after ALS diagnosis among U.S. National...

Continued high mortality following diagnosis of HIV-associated Kaposi sarcoma in East Africa in the “Treat All” antiretroviral therapy era ― 2021-2024

Abstract Background Stage at time of diagnosis and survival after diagnosis are critical parameters regarding control of any cancer in any geographical setting. In earlier research focusing on the initial years of the “Treat All” era (2016-2019), we found that HIV-associated Kapo...

Distinguishing between clinical interventions and implementation strategies in trials

Abstract Background Trialists sometimes find it difficult to determine whether the innovation they are evaluating is a clinical intervention or an implementation strategy. The inaccurate classification of innovations can lead to negative consequences such as the misspecification...

Amputee gait performance symmetry may be affected by how prosthetic socket shape is captured: A preliminary investigation

BACKGROUND: Socket fit is a critical determinant of comfort, mobility, and long-term prosthesis use in individuals with transtibial amputation. Traditional hand-casting techniques are labor-intensive and variable, whereas digital socket shape capture may improve reproducibility a...