Publications

Grip strength modifies the association between blood-based alzheimer's biomarkers and cognitive function.

Blood-based biomarkers are increasingly used to characterize Alzheimer's disease (AD)-related pathology, yet substantial heterogeneity exists in how biomarker burden relates to cognitive performance. Grip strength, a marker of frailty and functional reserve, may modify this relationship. We conducted a cross-sectional analysis of 348 participants from the Aging Adult Brain Connectome (AABC) study. Global cognition was assessed using the Preclinical Alzheimer Cognitive Composite (PACC). Plasma biomarkers included phosphorylated tau-217 (pTau217), glial fibrillary acidic protein (GFAP), neurofilament light chain (NfL), and total tau (tTau). Multiple linear regression models tested biomarker × grip strength interactions, adjusting for demographic factors, APOE ε4 status, cardiometabolic risk factors, body mass index, and creatinine. Sensitivity analyses included age-based propensity score matching and age-stratified models. Participants with low PACC were older, had lower grip strength, and higher plasma biomarker levels than those with normal cognition (all p < 0.001). In adjusted models, significant interactions between low grip strength and biomarkers were observed for pTau217 (β = - 0.046, p < 0.01), NfL (β = - 0.002, p < 0.001), and GFAP (β = - 0.005, p < 0.05). Age-matched showed attenuation of some interaction effects except for low grip strength and NfL. Age-stratified analyses showed a significant interaction for NfL among adults ≥ 65 years and for GFAP among those < 65 years. Grip strength moderated the association between plasma AD-related biomarkers and cognitive performance, supporting physical strength as an indicator of vulnerability. Integrating simple strength measures with blood biomarkers may improve cognitive risk stratification in community-dwelling adults.

GeroScience

Enhancing capacity in faith-based organizations to implement and sustain multilevel innovations to improve physical activity: study protocol for the faith in action type II hybrid implementation-effectiveness trial.

BMC public health

The Year We Lost Medicaid.

JAMA health forum

Feasibility and acceptability of an integrated economic empowerment and substance use risk reduction intervention for youth living with HIV in Uganda: a pilot cluster randomized study.

Youth living with HIV (YLHIV) in sub-Saharan Africa experience high rates of alcohol and drug use (ADU), yet evidence-based interventions remain limited. We conducted a pilot cluster randomized trial to assess the feasibility, acceptability, and short-term outcomes of a life-skills-based Alcohol and Drug Use Risk Reduction intervention (ADURR), delivered alone or combined with economic empowerment (EE) through financial literacy training and matched savings accounts. Ninety-five YLHIV aged 18 to 24 years were enrolled from six clinics in southwestern Uganda and followed at baseline, 3 months, and 6 months using surveys and urine toxicology. Participants had a mean age of 21.9 years, and 65.3% were female. Retention at 6 months was 94.7%. Compared with ADURR-only, the ADURR+EE intervention was associated with larger declines in self-reported past-6-month drug use (-20.1 vs -5.8 percentage points), alcohol use (-17.9 vs -6.5 percentage points). Urine-confirmed drug use decreased in both arms (-30.4 vs -26.7 percentage points), while urine-confirmed alcohol use declined only in ADURR+EE (-33.1 percentage points). Psychosocial changes were modest; hopelessness decreased in ADURR+EE (-6.4%) but increased in ADURR-only (+13.0%). Qualitative findings indicated high acceptability, though savings uptake faced structural barriers. Findings support progression to a fully powered trial.

AIDS care

Understanding Cervical Spine Injury Imaging Decision-Making in Pediatric Trauma Patients.

The Pediatric Emergency Care Applied Research Network (PECARN) cervical spine injury (CSI) clinical prediction rule (CPR) was developed to reduce unnecessary imaging in pediatric trauma patients while ensuring accurate diagnosis. This study aimed to identify barriers and facilitators to future implementation of this rule in diverse emergency department settings.

Pediatrics open science

Feasibility pilot trial for the Trajectories of Recovery after Intravenous propofol versus inhaled VolatilE anesthesia (THRIVE) Pragmatic Randomized Clinical Trial.

The Trajectories of Recovery after Intravenous propofol versus inhaled VolatilE anesthesia (THRIVE) Trial is a multicenter prospective, randomized comparative effectiveness trial examining patients' experiences and outcomes after receiving either total intravenous anesthesia with propofol or inhaled volatile anesthesia for general anesthesia (NCT05991453). Prior to the 13,000-patient trial, a pilot trial (NCT05346588) was performed to establish feasibility and determine percent success of: 1) patient enrollment, 2) intervention adherence, and 3) data completion.

Anesthesiology

Prenatal smoking and child psychopathology associations by age and sex in the ECHO cohort.

Maternal tobacco smoking during pregnancy (MSDP) is associated with an increased risk of child externalizing problems. It remains unclear whether these associations are externalizing-specific, or better explained by comorbidity between externalizing and internalizing domains, or vary by age and sex. To address comorbidity and differentiation between domains, we leveraged the severity-directional model of psychopathology. Severity reflects the overall level of psychopathology symptoms across both domains (high levels of severity can only be reached by having symptoms of both types simultaneously), whereas directionality captures the balance/differentiation of internalizing vs. externalizing symptoms regardless of number of total symptoms. Participants included 16,335 children aged 1-19 years old (47.78% female, 58.17% White, 75.46% non-Hispanic) from 55 U.S.-based cohorts within the Environmental Influences on Child Health Outcomes (ECHO) consortium. MSDP predicted differentiation toward externalizing problems in 2-year age bins 1-2 through 7-8 and 13-14 years; remaining (non-significant) age bins had similar magnitudes. MSDP predicted higher symptom severity in all age bins. Findings likely reflect a combination of MSDP associations with comorbid symptom severity and specificity toward externalizing problems, with little evidence of age or sex differences. Additional analyses explored e-cigarette use, other prenatal substance use, and postnatal smoke exposure; associations were sparse and unsystematic.

Development and psychopathology

Provider and caregiver perspectives on vision services for childhood cancer survivors: a qualitative study.

BMC health services research

Committed to climate action? Opportunities for scientific societies to lead the change we need in the world.

The international journal of behavioral nutrition and physical activity