Comparative effectiveness of perioperative physical activity in older adults with lung cancer and their family caregivers: design of a multicenter pragmatic randomized trial.

BACKGROUND: With a median age at diagnosis of 70, lung cancer remains a significant public health challenge for older Americans. Surgery is a key component in treating most patients with non-metastatic lung cancer. These patients experience postoperative pain, fatigue, loss of respiratory capacity, and decreased physical function. Data on quality of life (QOL) in older adults undergoing lung cancer surgery is limited, and few interventions are designed to target the needs of older adults and their family caregivers (FCGs). The primary aim of this comparative effectiveness trial is to determine whether telephone-based physical activity coaching before and after surgery will be more beneficial than physical activity self-monitoring alone for older adults and their FCGs. METHODS: In this multicenter comparative effectiveness trial, 382 older adults (≥ 65 years) with lung cancer and their FCGs will be recruited before surgery and randomized to either telephone-based physical activity coaching or physical activity self-monitoring alone. Participants allocated to the telephone-based coaching comparator will receive five telephone sessions with coaches (1 pre and 4 post surgery), an intervention resource manual, and a wristband pedometer. Participants in the self-monitoring only arm will receive American Society of Clinical Oncology (ASCO) physical activity information and wristband pedometers. All participants will be assessed at before surgery (baseline), at discharge, and at days 30, 60, and 180 post-discharge. The primary endpoint is the 6-minute walk test (6MWT) at 30 days post-discharge. Geriatric assessment, lower extremity function, self-reported physical function, self-efficacy, and QOL will also be assessed. DISCUSSION: The trial will determine whether this telephone-based physical activity coaching approach can enhance postoperative functional capacity and QOL outcomes for older adults with lung cancer and their FCGs. Trial results will provide critical findings to inform models of postoperative care for older adults with cancer and their FCGs. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT06196008.

Predictors of Discharge with Supplemental Oxygen after Lobectomy for Lung Cancer.

BACKGROUND: Before lung cancer resection, patients inquire about dyspnea and the potential need for supplemental oxygen. Our objective was to identify predictors of discharge with supplemental oxygen for patients undergoing lobectomy for lung cancer. METHODS: Using the Society of Thoracic Surgeons General Thoracic Surgery Database, we conducted a retrospective cohort study of patients undergoing lobectomy for lung cancer from July 2018 - December 2021. Multivariable logistic regression was used to determine the adjusted association of pulmonary function with discharge on supplemental oxygen and identify independent predictors of discharge with supplemental oxygen. Pulmonary function was modeled as the minimum of either ppoFEV1 or ppoDLCO. RESULTS: Overall, 2,100 (8.4%) patients undergoing lobectomy were discharged with supplemental oxygen. Those with a minimum of either ppoFEV1 or ppoDLCO ≤60% had a progressively increased risk of discharge with supplemental oxygen than those with minimum function >60%. The two strongest predictors of discharge with supplemental oxygen were increasing BMI (25-29 aOR 1.38, 95%CI 1.21-1.57, 30-39 aOR 2.14, 95%CI 1.88-2.45, ≥40 aOR 3.51, 95%CI 2.79-4.39, reference 18.5-24) and former (aOR 2.04, 95%CI 1.67-2.52) and current (aOR 2.61, 95%CI 2.10-3.26) smoking status (reference never smoker). CONCLUSIONS: Of those undergoing lobectomy for lung cancer, 8.4% were discharged with supplemental oxygen. We identified preoperative independent predictors of discharge with supplemental oxygen that may be useful during shared decision-making discussions of treatment options for lung cancer and setting expectations with patients.

Associations of humor, morale, and unit cohesion on posttraumatic stress disorder symptoms.

Military personnel experience many stressors during deployments that can lead to symptoms of posttraumatic stress disorder (PTSD). However, not all military personnel who are exposed to deployment stressors develop PTSD symptoms. Recent research has explored factors that contribute to military personnel resilience, a multifaceted and multidetermined construct, as a means to mitigate and prevent PTSD symptoms. Much of this research has focused on the effects of individual-level factors (e.g., use of coping strategies like humor, the morale of individual unit members), with some research focusing on unit-level factors (e.g., the cohesiveness of a unit). However, there is little research exploring how these factors relate to each other in mitigating or reducing PTSD symptoms. In this study, we examined the association between deployment stressors, perceived unit cohesion, morale, humor, and PTSD symptoms in a sample of 20,901 active-duty military personnel using structural equation modeling. Results indicated that perceived unit cohesion, humor, and morale were positively associated with each other and negatively associated with PTSD symptoms over and above the effect of deployment stressors. These findings highlight the influence of resilience factors on PTSD symptoms beyond their substantial overlap and have implications for future research as well as the potential development of interventions for military personnel.

Depression and Anxiety in Long-Term Care Residents During the COVID-19 Pandemic: The Influence of Telehealth Availability, Cognitive Status, and Trauma History.

OBJECTIVES: The present study investigates the impact of disrupted mental health services during the COVID-19 pandemic on depression and anxiety symptoms in long-term care (LTC) residents. METHODS: The study examined clinical data from 5,645 residents who received at least two psychological services in a long-term care (LTC) or assisted living (AL) setting between March 2019 and March 2021. A series of multiple regressions were run to explore the effects of the COVID-19 shutdown on depression and anxiety symptoms while examining the effects of COVID-19-related facility closure and facility telehealth capabilities. Follow-up regression analyses explored the impact of cognitive impairment and positive trauma history on depression and anxiety symptoms. RESULTS: Post-COVID levels of anxiety and depression were higher for residents with higher levels of pre-COVID anxiety and depression. The interaction between facility closure and availability of telehealth services and trauma history predicted self-report anxiety symptoms. Clinician-observed anxiety symptoms were predicted by cognitive impairment. Residents with a history of trauma had an increase in self-reported anxiety symptoms. CONCLUSIONS: Telehealth appeared to mitigate anxiety during the pandemic for residents with higher pre-COVID anxiety. CLINICAL IMPLICATIONS: For those individuals with severe anxiety, results suggest the importance of ensuring that mental health services are available to mitigate symptoms via telehealth when infection control disrupts the usual delivery of treatment.

The Society of Thoracic Surgeons General Thoracic Surgery Database: 2023 Update on Outcomes and Research.

The Society of Thoracic Surgeons General Thoracic Surgery Database (GTSD) continues its trajectory of growth and enhancement, solidifying its stature as a premier global thoracic surgical database. The past year witnessed a notable expansion with the inclusion of 10 additional participating sites, now totaling 287, augmenting the database's repository to more than 800,000 procedures. A significant stride was made in refining the data audit process, thereby elevating the accuracy and completeness metrics, a testament to the relentless pursuit of data integrity. The GTSD further broadened its research apparatus, with 15 scholarly publications, a 50% uptick from the preceding year. These publications underscore the database's instrumental role in advancing thoracic surgical knowledge. In a concerted effort to alleviate data entry exigencies, the GTSD Task Force also instituted streamlined data submission protocols, a move lauded by participant sites. This report delineates the recent advancements, volume trajectories, and outcome metrics and encapsulates the prolific research output emanating from the GTSD, reflecting a year of substantial progress and academic fecundity.

Imaging of lung cancer.

Lung cancer is the leading cause of cancer-related mortality globally. Imaging is essential in the screening, diagnosis, staging, response assessment, and surveillance of patients with lung cancer. Subtypes of lung cancer can have distinguishing imaging appearances. The most frequently used imaging modalities include chest radiography, computed tomography, magnetic resonance imaging, and positron emission tomography. Artificial intelligence algorithms and radiomics are emerging technologies with potential applications in lung cancer imaging.

Effects of the COVID-19 Pandemic on Anxiety Symptoms in Long-Term Care Residents: A Multilevel Growth Curve Analysis.

OBJECTIVES: The coronavirus disease 2019 (COVID-19) pandemic has negatively impacted the mental health functioning of older adults residing in long-term care (LTC) settings. This study examines the impact of the lockdown on anxiety symptoms over time in LTC residents. DESIGN: Secondary data analysis was conducted on clinical data obtained with permission from a large behavioral health company that provides behavioral health services in long-term care (LTC) and assisted living (AL) facilities. SETTING AND PARTICIPANTS: Data were obtained from 1149 adults (mean age 72.37, 70% female) in LTC and AL facilities across the United States who were receiving psychological services 1 year prior, and 1 year after, the COVID-19 pandemic lockdown. METHODS: Changes in anxiety (measured using a clinician rating scale) over time before and after the pandemic were assessed using latent growth curve modeling with psychiatric diagnosis, psychiatric medication, and demographic factors included as covariates. RESULTS: Anxiety severity decreased over time before and after the onset of the COVID-19 pandemic. Although pandemic-level factors such as facility closure and telehealth availability did not affect anxiety over time, individual treatment factors such as obsessive compulsive disorder diagnosis, initial anxiety severity, bipolar disorder diagnosis, and prescriptions for anxiolytic and antipsychotic medications affected the trajectory of anxiety during the pandemic. CONCLUSIONS AND IMPLICATIONS: These results demonstrate that individual covariates such as diagnosis, symptom severity, and medication use impacted the trajectory of anxiety symptoms before and during the COVID-19 pandemic more strongly than pandemic-related circumstances (facility closure, telehealth availability). The impact of the COVID-19 pandemic may be better observed through treatment-relevant variables, rather than pure symptom severity. In preparation for future pandemics or other large-scale disasters potentially impacting service delivery, facilities should continue to prioritize continuity of care or a timely resumption of services attending to individual treatment factors.

Health inequities and social determinants of health in refugee and immigrant communities.

This article evaluates and elucidates the intersections across social and economic determinants of health and social structures that maintain current inequities and structural violence with a focus on the impact on imMigrants (immigrants and migrants), refugees, and those who remain invisible (e.g., people without immigration status who reside in the United States) from Black, Indigenous, and People of Color communities. Psychology has a history of treating individuals and families without adequately considering how trauma is cyclically and generationally maintained by structural violence, inequitable resources, and access to services. The field has not fully developed collaboration within an interdisciplinary framework or learning from best practices through international/global partnerships. Psychology has also been inattentive to the impact of structural violence prominent in impoverished communities. This structural harm has taken the form of the criminalization of imMigrants and refugees through detention, incarceration, and asylum citizenship processes. Most recently, the simultaneous occurrence of multiple catastrophic events, such as COVID-19, political polarization and unrest, police violence, and acceleration of climate change, has created a hypercomplex emergency for marginalized and vulnerable groups. We advance a framework that psychologists can use to inform, guide, and integrate their work. The foundation of this framework is select United Nations Sustainable Development Goals to address health inequities. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

A novel ground truth dataset enables robust 3D nuclear instance segmentation in early mouse embryos.

For investigations into fate specification and cell rearrangements in live images of preimplantation embryos, automated and accurate 3D instance segmentation of nuclei is invaluable; however, the performance of segmentation methods is limited by the images' low signal-to-noise ratio and high voxel anisotropy and the nuclei's dense packing and variable shapes. Supervised machine learning approaches have the potential to radically improve segmentation accuracy but are hampered by a lack of fully annotated 3D data. In this work, we first establish a novel mouse line expressing near-infrared nuclear reporter H2B-miRFP720. H2B-miRFP720 is the longest wavelength nuclear reporter in mice and can be imaged simultaneously with other reporters with minimal overlap. We then generate a dataset, which we call BlastoSPIM, of 3D microscopy images of H2B-miRFP720-expressing embryos with ground truth for nuclear instance segmentation. Using BlastoSPIM, we benchmark the performance of five convolutional neural networks and identify Stardist-3D as the most accurate instance segmentation method across preimplantation development. Stardist-3D, trained on BlastoSPIM, performs robustly up to the end of preimplantation development (> 100 nuclei) and enables studies of fate patterning in the late blastocyst. We, then, demonstrate BlastoSPIM's usefulness as pre-train data for related problems. BlastoSPIM and its corresponding Stardist-3D models are available at: blastospim.flatironinstitute.org.

A Comparison of Psychosocial Services for Enhancing Cultural Adaptation and Global Functioning for Immigrant Survivors of Torture.

Forced migrants suffer from significant psychological distress. However, they often prioritize urgent practical resettlement needs over mental health needs. The present study used a quasi-experimental design to compare pathways of treatment for survivors of torture (N = 369) from 42 different counties receiving care from a refugee health clinic. Random intercept ANOVAs were used to compare combined case management services and psychological treatment (CM-PT) to case management services only (CM) on changes in cultural adaptation and global functioning over time. Results showed that both groups improved on each outcome. Importantly, the CM-PT group endorsed greater improvements in cultural adaptation (b = 0.28, 95% CI 0.14, 0.41, p ≤ 0.001) and global functioning (b = 3.29, 95% CI 1.33, 5.25, p = 0.001) compared to the CM group. These findings suggest that treatment for survivors of torture should be multifaceted and include case management and psychological treatment. Case management services alone may be beneficial when socio-cultural and resource barriers exist for mental health treatment.

Addressing isolation, loneliness and mental health during COVID: A university training partnership with senior living communities.

Older adults living in congregate housing have been uniquely impacted by the COVID-19 pandemic. The sudden interruption of routine activities, social isolation, and support adversely affected the wellbeing of residents in retirement facilities around the country and world. The stress of social isolation was fueled by the interruption of routine activities and support that in turn, adversely affected the wellbeing, mood, and cognition of many residents. Therefore, university clinical programs in psychology and counseling can address the needs of community older residents by preparing student clinicians to work with the aging population and to engage in telehealth models of outreach and interventions. This manuscript outlines a model of partnership between long-term care assisted living organizations and clinical training programs at a west coast university to meet community and educational needs of older residents.

The Society of Thoracic Surgeons General Thoracic Surgery Database: 2022 Update on Outcomes and Research.

The Society of Thoracic Surgeons General Thoracic Surgery Database (STS GTSD) remains the largest and most robust thoracic surgical database in the world. Participating sites receive risk-adjusted performance reports for benchmarking and quality improvement initiatives. The GTSD also provides several mechanisms for high-quality clinical research using data from 274 participant sites and 781,000 procedures since its inception in 2002. Participant sites are audited at random annually for completeness and accuracy. Over the last year and a half, the GTSD Task Force continued to refine the data collection process, implementing an updated data collection form in July 2021, ensuring high data fidelity while minimizing data entry burden. In addition, the STS Workforce on National Databases has supported a robust GTSD-based research program, which led to eight scholarly publications in 2021. This report provides an update on volume trends, outcomes, and database initiatives as well as a summary of research productivity resulting from the GTSD over the preceding year.

Racial Health Disparities Research in Cardiothoracic Surgery Under-represented in Major Meetings.

INTRODUCTION: Black/African Americans and Latinos face significant health disparities and systemic inequities. Heart and lung disease are leading factors affecting morbidity and mortality in these groups. Given this disparity, we sought to determine how often this topic is presented at the most relevant United States annual cardiothoracic surgery meetings. METHODS: Specialty-specific annual meeting abstract books were queried between 2015 and 2021. We included the Society of Thoracic Surgeons, American Association for Thoracic Surgery, Western Thoracic Surgical Association, and the Southern Thoracic Surgical Association. Scientific abstract titles and content were searched for the following keywords and phrases: "racial health disparities," "race," "racism," "racial bias," "institutional racism," and "health disparities". If an abstract included a keyword or phrase, it was counted as a racial health disparity abstract. We calculated the proportion of racial health disparity abstracts and abstracts published as manuscripts in the meeting-associated journals. RESULTS: A total of 3664 abstracts were presented between 2015 and 2021. Of those, 0.90% (33/3664) abstracts presented contained at least one of the keywords or phrases. Of these abstracts, the percentage that went on to publication represented 0.38% (14/3664) of the total number of abstracts presented. CONCLUSIONS: Abstracts on racial health disparities in cardiothoracic surgery represent a very small fraction of total meeting peer-reviewed content. There is a significant gap in research to identify and develop best practice strategies to address these disparities and mitigate structural racism within the care of underserved patients with cardiothoracic diseases.

BDNF Val66Met Moderates the Effects of Hypertension on Executive Functioning in Older Adults Diagnosed With aMCI.

OBJECTIVE: To investigate whether the BDNF Val66Met polymorphism influences the associations of hypertension, executive functioning and processing speed in older adults diagnosed with amnestic Mild Cognitive Impairment (aMCI). DESIGN: Secondary data analysis using moderation modeling. SETTING: Veterans Affairs Hospital, Palo Alto, CA. PARTICIPANTS: Sample included 108 community-dwelling volunteers (mean age 71.3 ± 9.2 years) diagnosed with aMCI. MEASUREMENTS: Cognitive performance was evaluated from multiple baseline assessments (Trail Making Test; Stroop Color-Word Test; Symbol Digit Modality Test) and grouped into standardized composite scores representing executive function and processing speed domains. BDNF genotypes were determined from whole blood samples. Hypertension was assessed from resting blood pressures or by self-report. RESULTS: Controlling for age, BDNF Val66Met moderated the effects of hypertension on executive functioning, but added no significant variance to processing speed scores. Specifically, hypertensive carriers of the BDNF Met allele performed significantly below the sample mean on tasks of executive functioning, and evidenced significantly lower scores when compared to Val-Val homozygotes and normotensive participants. CONCLUSIONS: Results posit that the executive functioning of non-demented older adults may be susceptible to interactions between BDNF genotype and hypertension, and Val-Val homozygotes and normotensive older adults may be more resilient to these effects of cognitive change. Further research is needed to understand the underlying processes and to implement strategies that target modifiable risk factors and promote cognitive resilience.

NCCN Guidelines® Insights: Lung Cancer Screening, Version 1.2022.

The NCCN Guidelines for Lung Cancer Screening recommend criteria for selecting individuals for screening and provide recommendations for evaluation and follow-up of lung nodules found during initial and subsequent screening. These NCCN Guidelines Insights focus on recent updates to the NCCN Guidelines for Lung Cancer Screening.