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"Sleep is Not Getting the Attention It Deserves": A Qualitative Study of Patient and Provider Views on Sleep Management in the Veterans Health Administration
No full textBackground: Unique characteristics and service exposures of the post-9/11 cohort of U.S. Veterans can influence their sleep health and associated comorbidities. The objectives of this study were to learn about men and women post-9/11 Veterans' and "front line" VA providers' knowledge about sleep and experiences with Veterans Health Administration (VA) sleep management.
Research design: One sample included post-9/11 Veterans who received VA care (n=23; 60% women; Mage: 45 y). To complement those views, primary care and mental health providers were recruited from VA medical centers (n=27). Semistructured qualitative interviews were conducted using Microsoft Teams. Questions pertained to sleep knowledge, care practices, and perceived barriers to sleep-related VA care. Interview data were synthesized with content analysis and inductive coding to characterize major themes.
Results: Four main themes emerged: (1) Sleep is viewed as foundational but Veterans and providers often have limited related knowledge and more routine education is needed. (2) Men and women have distinct sleep management needs. Relative to men, women are more likely to advocate for sleep assessment and for behavioral versus pharmacological treatment. (3) Sleep management practices vary considerably between clinics and providers. (4) Veterans and their providers each experience unique barriers to sleep management.
Conclusions: Post-9/11 Veterans and providers view sleep as critical. Yet, VA sleep management needs to be more uniform. Providers are motivated to assess sleep but require standardized education and low-burden opportunities to incorporate sleep into their practice, perhaps with mental health screening. Ultimately, more specialized care is required to meet the responsibility of Veterans' sleep health.No embarg
Association Between Contextual Isolation and Self-Reported Pain among US Nursing Home Residents
No full textBackground and objectives: Despite living in congregate settings, residents may not feel a sense of belonging. Contextual isolation measures the extent to which a resident does not share socially salient characteristics with others in the nursing home (e.g., sex). Because the experience of pain may be impacted by emotional factors, we quantified the association between contextual isolation and five self-reported pain measures.
Research design and methods: Using a cross-sectional study design, we identified long-stay residents without dementia using national 2022 Minimum Data Set 3.0. Five self-reported pain measures were used. Residents were categorized as being contextually isolated on multiple, one, or no characteristics. Poisson and ordinal multinomial models were used to estimate adjusted prevalence ratios (aPR) and odds ratios (aOR), respectively, with generalized estimating equations to account for clustering of residents within nursing homes.
Results: Among the 255,462 residents, 22.5% were contextually isolated on multiple characteristics and 32% reporting pain in the past five days. Relative to residents not contextually isolated, residents contextually isolated on multiple characteristics were less likely to report any pain (aPR: 0.98, 95% CI: 0.96-0.99) and pain that limits daily activities (aPR : 0.92, 95% CI: 0.88-0.96) Residents contextually isolated on multiple characteristics had decreased odds of higher pain frequency (aOR: 0.96, 95% CI: 0.93-0.98) and pain severity (aOR: 0.96, 95% CI: 0.93-0.99) than residents without contextual isolation.
Discussion and implications: Interventions to improve welcoming and inclusive nursing home environments may reduce the potential adverse effects of contextual isolation on pain underreporting among long-stay residents without dementia.No embarg
Associations between residential segregation, ambient air pollution, and hippocampal features in recent trauma survivors [preprint]
Get PDFThis article is a preprint. Preprints are preliminary reports of work that have not been certified by peer review.Background: Residential segregation is associated with differential exposure to air pollution. Hippocampus structure and function are highly susceptible to pollutants and associated with posttraumatic stress disorder (PTSD) development. Therefore, we investigated associations between residential segregation, air pollutants, hippocampal neurobiology, and PTSD in recent trauma survivors.
Methods: Participants ( N = 278; 34% non-Hispanic white, 46% Non-Hispanic Black, 16% Hispanic) completed multimodal neuroimaging two weeks after trauma. Yearly averages of air pollutants (PM 2.5 and NO 2 ) and racial/economic segregation (Index of Concentration at the Extremes) were derived from each participant's address. Linear models assessed if air pollutants mediated associations between segregation and hippocampal volume, threat reactivity, or parahippocampal cingulum fractional anisotropy (FA) after covarying for age, sex, income, and 2-week PTSD symptoms. Further models evaluated if pollutants or segregation prospectively predicted PTSD symptoms six months post-trauma.
Results: Non-Hispanic Black participants lived in neighborhoods with significantly greater segregation and air pollution compared to Hispanic and non-Hispanic white participants ( ps <.001). There was a significant indirect effect of NO 2 between segregation and FA values (β = 0.08, 95% CI[0.01, 0.15]), and an indirect effect of PM 2.5 between segregation and threat reactivity (β = -0.08, 95% CI[-0.14, -0.01]). There was no direct effect of segregation on hippocampal features. Pollutants and segregation were not associated with PTSD symptoms.
Conclusion: Residential segregation is associated with greater air pollution exposure, which is in turn associated with variability in hippocampal features among recent trauma survivors. Further research is needed to assess relationships between other environmental factors and trauma and stress-related disorders.No embarg
Funding and incentives for resident education in an era of radiologist shortages, increasing workload, and financial constraints
No full textTraining the next generation of radiologists is essential given the ongoing national radiologist shortage. However, funding residency positions and incentivizing high-quality resident education remains a challenge. Increasing demand for imaging leading to increased radiologist workloads and moonlighting, the rise of remote work, and the use of productivity measures that value clinical work over time spent on resident education may create barriers to high-quality resident education. This paper outlines graduate medical education (GME) funding sources, the direct and indirect costs of training radiology residents, resident contributions to their departments, and the support needed to facilitate academic faculty to deliver high-quality resident education. Incorporating teaching activities into productivity measures, offering a clinician-educator path to promotion, supporting professional development, and recognizing excellence in teaching can help incentivize a focus on resident education. Additionally, diversifying clinical work with educational activities and appropriately compensating faculty may help increase faculty's enthusiasm for resident education, promote job satisfaction, and improve morale.No embarg
Data-Driven Modeling for Infectious Disease Prediction: Navigating Irregularities in Resource-Limited Settings
No full textInfectious diseases continue to impose heavy burdens in low- and middle-income countries, where prediction and response are hindered by scarce, irregular data. Clinical and surveillance datasets in these settings are typically small, incomplete, imbalanced, and uncertain—conditions that challenge conventional machine learning models. Yet it is precisely under such imperfect circumstances that predictive modeling can save lives. This dissertation advances a data-diagnostic-first framework for infectious disease prediction that systematically addresses three pervasive data irregularities—class imbalance, missingness, and uncertainty—through methodological innovation and empirical validation. First, I introduce SMARTSMOTE (Structure- and Manifold-Aware Technique for Synthetic Minority Oversampling), a resampling method developed after evaluating deficiencies in existing techniques that distort data geometry or amplify noise. By preserving manifold structure and local variance, SMARTSMOTE improves minority recall and interpretability for rare infections such as Borrelia and Lassa fever. Next, I present MICE-GAIN, a hybrid imputation approach combining multiple chained equations and generative adversarial inference to recover missing clinical variables in resource-limited datasets. Sensitivity analyses on Lassa fever data reveal that imputation choice substantially influences downstream reliability and calibration, highlighting the importance of aligning data recovery with model interpretability. Finally, I incorporate Bayesian and variance-based modeling to quantify aleatoric and epistemic uncertainty, revealing how preprocessing reshapes predictive confidence. Together, these components form an irregularity-aware modeling pipeline validated across pathogen datasets in Senegal, Nigeria, and the United States. The framework enhances predictive accuracy, calibration, and interpretability under data scarcity, advancing a paradigm that treats data irregularities not as obstacles but as diagnostic signals for building equitable and trustworthy AI in global health.Interdisciplinary Graduate Program1 year2026-11-1
Defensive Responses to Implicit Association Tests and Bias Awareness in an Implicit Bias Mitigation Training
Get PDFBackground: Implicit bias education that utilizes the Implicit Association Test (IAT) to raise self-awareness of bias can induce defensiveness.
Objective: To describe clinical learners' bias awareness, self-perceptions of bias relative to colleagues (better-than-average), implicit and explicit biases and defensive response to the IATs.
Design: Cross-sectional study.
Participants: Internal medicine and family medicine residents, and Doctor of Nursing Practice students at a public medical and nursing school affiliated with a disproportionate share hospital and who completed an implicit bias recognition and mitigation educational program (including didactics, IATs, and communication skills training and practice with standardized patients) in 2018-2019.
Main measures: We measured implicit and explicit attitudes and stereotypes, reactions to IAT results (defensive or not defensive), better-than-average perceptions, bias awareness and participants' characteristics. We examined associations between defensive responses to the IAT and participant characteristics, self-reported explicit biases, bias awareness within self, society, and healthcare, and IAT scores.
Key results: Of N=61 respondents, 57% were female and 59% White. We found moderate implicit bias favoring White people versus Black people, weak bias favoring White people versus Hispanic/Latinx people and moderate bias favoring White people on both race and ethnicity medical compliance stereotype IATs. Participants demonstrated awareness of bias in society and healthcare, but not within self. Eighteen percent were defensive regarding their IAT results. Perceptions of own bias (self) were always of their having less bias than their colleagues, and they were better-than-average. There were no statistically significant associations between IAT scores and participant demographics and no interaction effect between implicit bias, defensiveness and better-than-average scores.
Conclusion: Clinical learners hold moderate implicit biases, believe they have less bias than others, and almost 1-in-5 have a defensive response to IAT feedback. It is important to design implicit bias educational interventions to include reflection on personal bias and provide a safe environment to minimize defensiveness.No embarg
A framework for analyzing C. elegans neural activity using multi-dimensional hyperbolic embedding [preprint]
No full textThis article is a preprint. Preprints are preliminary reports of work that have not been certified by peer review.Abstract
Neurons represent changes in external and internal environments by altering their activity patterns. While coherent brain-wide patterns of neural activity have been observed in neuronal populations, very little is known about their dimensionality, geometry, and how they are correlated with sensory inputs. Here, we recorded the activity of most head neurons in Caenorhabditis elegans experiencing changes in bacterial or control buffer stimuli around their nose. We first classified active neurons into six functional clusters: two sensory neuron clusters (ON and OFF responding to addition and removal of stimuli, respectively) and four motor/command neuron clusters (AVA, RME, SMDD and SMDV). Next, we estimated stimulus selectivity for each cluster and found that while sensory neurons exhibit their maximal responses within 15 seconds, changes in bacterial stimuli drive maximal responses in command and motor neuron clusters after tens of seconds. Furthermore, we show that bacterial stimuli induce neural dynamics that are best described by a hyperbolic, not Euclidean, space, of dimensionality eight. The hyperbolic space provided a better description of neural activity than the standard Euclidean space. This space can be separated into three components – one sensory, and two motor directions (forward-backward and dorsal-ventral). Collectively, we show that C. elegans neural activity can be effectively represented in low-dimensional hyperbolic space to describe a sensorimotor transformation.
Significance statement A major function of a nervous system is to transform sensory information into behavioral outputs. As the first receiver of sensory input, sensory neuronal activity is often most correlated with stimulus features. However, this sensory activity is modified as it travels to other neurons, where it integrates with network activity before altering motor neurons and driving corresponding behavior. Activity in non-sensory neurons is driven by ongoing network activity and sensory input, but distinguishing between their relative contributions is often difficult. Here, we identify two sensory and four command/motor neuron clusters in the C. elegans neural network responding to bacterial stimuli and define their receptive fields. We then use a hyperbolic embedding to identify how these clusters interact with each other and identify the relevant dimensions that might alter behavior. Our method is fully scalable to other systems, including those without neuronal identities, and allows us to attribute neural activity to network states and behavioral outputs.No embarg
Predictors of In-Stent Stenosis After Flow Diversion of Intracranial Aneurysms Using the FRED-X Device: A Multicenter Analysis of 6-month and 12-Month Outcomes
No full textBackground and objectives: In-stent stenosis (ISS) occurs in approximately 0% to 55.3% of cases after flow diversion. The Flow Redirection Endoluminal Device-X (FRED-X) is a newer generation flow diverter with surface modifications. Our study identifies predictors of ISS after flow diversion using the FRED-X.
Methods: This was a multicenter retrospective study of patients who underwent flow diversion of an intracranial aneurysm using the FRED-X device between February 2022 and February 2024. Multivariate logistic regression was used to analyze for predictors of ISS at 6-month or 12-month follow-up.
Results: One fifty-four patients with 161 aneurysms underwent flow diversion with 164 FRED-X devices. At 6 months, 15.1% of cases (n = 21) developed ISS. Overall, 61.9% of patients (n = 13) developed mild ISS, 33.3% (n = 7) patients had moderate ISS, and 4.7% (n = 1) patients had severe ISS. On multivariate regression, cardiovascular disease and FRED-X stent length were associated with 6.25-fold (95% CI: 1.19-32.86) and 1.09-fold (95% CI: 1.00-1.20) higher odds of developing ISS at 6 months, whereas aneurysm width was associated with decreased odds of developing ISS (odds ratio: 0.61, 95% CI: 0.38-0.88). At 12 months, 12.0% of cases (n = 10) developed ISS. Overall 80% of this cohort (n = 8) developed mild ISS, whereas 1 patient each developed moderate and severe ISS.
Conclusion: Our study identified cardiovascular disease, smaller aneurysm width, and stent length as independent predictors of ISS after flow diversion using the FRED-X. Patients with ISS were asymptomatic and did not require retreatment. Further prospective studies are necessary to validate these findings.No embarg
Investigating An Intestinal Microbiome Signal That Prompts Colonic Tuft Cells in Homeostasis and Pathogen Protection
Get PDFThere is a complex multitude of interactions occurring between the members of the intestinal microbiome, and between the microbiome and host cells. These interactions represent an intricate dance, balancing homeostasis and compromised immunity. A small but mighty population of chemosensory cells lies at this vibrant intersection of microbiome dynamics and host-microbe interactions: the tuft cell (TC). TCs were discovered in the mid-20th century, but their function in sensing and responding to the intestinal luminal environment was not elucidated until 2016. TCs have been a major focus of immunological research since, though much of the literature on intestinal TCs has focused on the small intestine, the role of the microbiome in modulating TC dynamics in the large intestine and the relevance of this pathway to infections is unknown. Multiple methods of microbiome modulation are utilized to demonstrate that a microbiome rich in succinate-producing bacteria can drive colonic TC hyperplasia and type II cytokine production. This phenotype resulting from a succinate-producing microbiome is not seen in other intestinal compartments, highlighting a novel mechanism for TC-microbe interaction in the colon, the heart of intestinal microbial richness and diversity. Microbiome-driven colonic TC hyperplasia is demonstrated to protect against morbidity and mortality from infection with the colonic pathogen, Clostridioides difficile, and depends on microbially produced succinate and Pou2f3 TCs. This work expands understanding of how and where TCs sense alterations in the microbiome, the role of microbes and their metabolites in colonic TC communication, and the potential for harnessing TC-microbial interactions for promoting intestinal homeostasis.Immunology and Microbiology6 months2025-08-1
College Students and Mental Health: Current Status
Get PDFStudent mental health and resiliency are critical components of college. Research has consistently shown a strong connection between mental health and academic success during college. Positive mental health is critically important as a foundation for academic success, personal development and adult resiliency. More and more students in higher education live with mental health challenges. This infographic provides a snapshot of college students’ mental health.The contents of this infographic were supported with funding from the National Institute on Disability, Independent Living, and Rehabilitation Research, (NIDILRR), United States Departments of Health and Human Services (NIDILRR grant number 90RTEM0005, The Learning and Working Transitions RRTC). NIDILRR is a Center within the Administration for Community Living (ACL), Department of Health and Human Services (HHS). The contents of this infographic do not necessarily represent the policy of NIDILRR, ACL, or HHS and you should not assume endorsement by the Federal Government.No embarg