LifeSpan Medical Institute

Transgender and gender diverse (TGD) individuals demonstrate elevated risk for eating disorders (EDs) and ED symptoms compared to cisgender individuals. Rates of ED symptoms in TGD populations may be inaccurately estimated due to item bias or interpretation differences on assessments of ED diagnostic criteria. Differential item functioning (DIF) can indicate if individuals respond differently to assessment items at the same latent level of ED psychopathology. We aimed to assess for DIF in the ED diagnostic criteria, represented by items on the Eating Disorder Diagnostic Scale (EDDS), among cisgender men/women and TGD individuals. We expected small-to-moderate DIF between cisgender men/women. We hypothesized that items assessing body image, shape, and fear of fatness would demonstrate significant DIF with moderate-to-large effect sizes in TGD individuals relative to cisgender men/women. College students identifying as cisgender men (n = 1240), cisgender women (n = 3750), and TGD individuals (n = 271) completed the EDDS. DIF was tested using likelihood ratio tests. The magnitude of the effect was estimated to identify moderate-to-large effects. Results indicated large, significant response bias to items assessing weight concerns, psychosocial impairment, compensatory behavior frequency, and select binge-eating symptoms. Specifically, cisgender men and TGD individuals weresignificantly less likely to endorse these ED symptoms than cisgender women at the same latent level of ED psychopathology. This study was the first to investigate DIF in an assessment of ED diagnostic criteria in TGD individuals. Our findings identified a need for unbiased assessments of ED diagnostic criteria to more accurately assess ED symptoms across gender groups.

Laboratory-based word learning research demonstrates that retrieval-based practice supports learning and retention more than passive training strategies. The goal of the current study was to determine whether incorporating retrieval-based practice into an interactive book reading intervention contributed to better learning and retention for children with developmental language disorder (DLD) than a more passive version. Kindergarten children with DLD (N = 37) completed the intervention administered twice a week for a total of 15 sessions. The between-participants conditions varied in the proportion of retrieval opportunities (high, mid, low). Learning of word forms and meanings were assessed throughout training, immediately after training, and after 4-, 8-, and 12-week delays. The proportion of retrieval opportunities did not relate to learning or retention. Children who started the intervention with more language knowledge and skills produced more forms and meanings correctly during and after treatment. Few factors related to the learning and forgetting rates. Maternal education related positively to learning rate of forms. Children who produced more definitions during training and females, as opposed to males, demonstrated a shallower forgetting rate of definitions. Both the more passive version and the retrieval-based version of the intervention were effective to support word learning in children with DLD. Overall, pretreatment characteristics did not provide a good indication of children's learning rate or posttraining forgetting rate. Thus, it is likely that frequent assessments during training are the best indicator of intervention effectiveness for a given child. Additionally, retention should be periodically assessed post-intervention to monitor forgetting. https://doi.org/10.23641/asha.29696552.

There are few routine outcomes monitoring (ROM) tools available to track changes in eating-disorder (ED) symptom expression. Given that ROM is critical for providing measurement-based care, there is a pressing need to develop ROM tools for EDs. The present study developed and validated the Eating Pathology Clinical Outcomes Tracker (EPCOT). Study 1 included administering the initial EPCOT item pool to college students (N = 380). In Study 2 (Recovery Record), a revised EPCOT item pool was administered to adolescents and adults with an ED (N = 2,196). Participants were retested at 1- to 2-week (n = 964) and 1-month (n = 473) follow-up. Finally, Study 3 (Mechanical Turk sample) was a longitudinal study of community adults who were tested at baseline (N = 305), 1-week (n = 240), and 6-month (n = 172) follow-up. Analyses included exploratory and confirmatory analysis and item response theory to identify differential item functioning across weight categories and ED diagnostic groups. The final version of the EPCOT had 24 items and eight scales. The EPCOT showed evidence for moderate-to-good test-retest reliability and good-to-excellent internal consistency, discriminant and convergent validity, and criterion-related validity. Finally, in Study 3, several EPCOT scales demonstrated predictive validity for predicting general and ED-specific psychiatric impairment at 6-month follow-up. The EPCOT showed initial promise as a tool that can be used to help clinicians track progress in therapy over time and may have utility in research contexts. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Abstract Idiopathic Pulmonary Fibrosis (IPF) is a chronic and progressive lung disease that primarily afflicts people over the age of 65. IPF is characterized by lung scarring, an elevated senescence burden, and interstitial pneumonia, resulting in disability and mortality. The growing aging population worldwide, limited effectiveness of current treatments, and high economic burden underscore the need for robust models to investigate the underlying mechanisms and test novel interventions. Despite broad preclinical use, the bleomycin-induced murine model has notable limitations. Animals subjected to a single dose of bleomycin administration undergo recovery in weight and behavior between 21 and 28 days after administration, which is contrary to the progressive nature of IPF. Previous reports have shown that repetitive instillation of bleomycin phenocopies this aspect of the human disease. However, these methods are time-consuming and complex. Although IPF is typically associated with advanced age, most research is conducted in 6 to 8-week-old mice, which lack the age-related structural and metabolic deficits seen in humans. In this study, we report an improved model of IPF using 17-month-old UM-HET3 mice subjected to a single oropharyngeal bleomycin dosing that better mimics the persistent nature of the disease. Lung histology and immunohistochemistry (IHC) confirm persistence of fibrosis and senescence in mice 10 weeks after bleomycin administration. Furthermore, bulk RNA sequencing (RNA-Seq) analysis revealed a distinct set of gene expression signatures that is more consistent with chronic human fibrosis. This model offers greater insight into IPF pathogenesis, and we anticipate that it will enhance confidence in the human translatability of candidate therapeutic interventions.

BackgroundRespiratory illness is consistently the leading cause of death and hospitalization in severe cerebral palsy (CP). Respiratory Exacerbations-Plan for Action and Care Transitions (RE-PACT) is a just-in-time adaptive intervention to prevent respiratory illness in severe CP. RE-PACT combines early illness detection with rapid clinical response to address varying causes of respiratory illness early enough to modify illness trajectory. This study’s objective was to determine RE-PACT’s feasibility, acceptability, fidelity, and estimated effect size.MethodsThis two-site randomized controlled trial occurred from April 2022-February 2024 in demographically and geographically distinct locations. Caregiver-child pairs were recruited from complex care programs, and children had both gross motor function classification system level 4–5 CP and either pulmonologist care or daily respiratory treatments. Children were randomized to usual care or RE-PACT for six months. Primary outcomes were feasibility, acceptability, and fidelity measures having a priori definitions of success. The primary clinical outcome was the severe respiratory illness (SRI) event rate, defined as hospitalizations due to respiratory diagnoses. Clinicaltrials.gov registration is NCT05292365.ResultsSixty children were enrolled, of which 26 were randomized into RE-PACT. Measures confirmed RE-PACT’s feasibility, acceptability, and fidelity, e.g., text message response rates were 97.5%, and no action planning or clinical responder activities were missed. System usability scale scores were “good to excellent” (mean [SD], 79.5 [11.7]). The RE-PACT SRI event rate (95% confidence interval, CI) was 0.71 (0.36–1.14) per person-year compared to the usual care event rate 1.08 (0.61–1.91) per person-year, a risk ratio of 0.66 (0.28–1.56). Secondary outcomes and qualitative data reinforced RE-PACT’s positive impact.ConclusionsRE-PACT is a feasible, acceptable intervention that can be delivered with high fidelity to diverse families caring for children with severe CP. These data inform the sample and design characteristics needed for efficacy testing of RE-PACT’s ability to prevent severe respiratory illness.

Objective: Adolescent and young adult (AYA) survivors of pediatric cancer require risk-based follow-up care to mitigate long-term health concerns yet estimates suggest less than 50% of AYA cancer survivors successfully transition from pediatric to adult-based survivorship care. Several treatment-related and social factors may impact timely transition from pediatric to adult-based survivorship care, including socioeconomic status, treatment history, and geographic location, but few studies have investigated these factors and no studies have examined how they impact age of transition. The purpose of this study was to evaluate predictors of 1) transition from pediatric to adult-based survivorship care and 2) older age at transition. Methods: Survivors of pediatric cancer who attended a Midwest Hospital based survivorship clinic ( N = 203) consented to participate in a pediatric cancer survivorship registry. Demographic and illness-related variables were collected at the time of consent. Binary logistic regression examined commercial insurance, sex, distance to hospital, rurality, cancer type, and treatment intensity as predictors of transition (i.e., attended at least one survivorship appointment) and age group at transition. Results: Findings demonstrated that survivors with commercial insurance, those who lived closer to the hospital (<30 miles), and those who underwent more intense treatment regimens were more likely to transition from pediatric to adult-based care, than those without commercial insurance, who lived farther away, and who had comparatively less intense treatment. People who lived closer to the hospital were more likely to transition at an older age (26–32). Conclusions: These barriers and facilitators provide important clinical implications for providers.

ChatGPT and other large language models have the potential to transform the health information landscape online. However, lack of domain-specific expertise and known errors in large language models raise concerns about the widespread adoption of content generated by these tools for parents making healthcare decisions for their children. The aim of this study is to determine if health-related text generated by ChatGPT under the supervision of an expert is comparable to that generated by an expert regarding persuasiveness and credibility from the perspective of a parent. In a cross-sectional study 116 parents aged 18-65 years (M = 45.02, SD = 10.92) were asked to complete a baseline assessment of their behavioral intentions regarding pediatric healthcare topics. Subsequently, participants were asked to rate text generated by either an expert or by ChatGPT under supervision of an expert. Results indicate that prompt engineered ChatGPT is capable of impacting behavioral intentions for medication, sleep, and diet decision-making. Additionally, there was little distinction between prompt engineered ChatGPT and content experts on perceived morality, trustworthiness, expertise, accuracy, and reliance. Notably, when differences were present, prompt engineered ChatGPT was rated as higher in trustworthiness and accuracy, and participants indicated they would be more likely to rely on the information presented by prompt engineered ChatGPT compared to the expert. Given that parents will trust and rely on information generated by ChatGPT, it is critically important that human domain-specific expertise be applied to healthcare information that will ultimately be presented to consumers (e.g., parents).

Behavioral economic frameworks emphasize the importance of contextual influences on alcohol use; therefore, identifying relative demand for alcohol versus other commodities is of importance. Cross-commodity purchase tasks allow participants to make choices across multiple concurrently available commodities and can thereby pinpoint interactions among those commodities. These tasks may help identify relevant substance-free alternative activities to target in alcohol treatment by determining whether the activity functions as a substitute for alcohol use. While substance-free activity promotion is a promising behavioral component of alcohol interventions, no research to-date has used behavioral economic methods to assess the substitutability of alternative activities for alcohol use. The present studies were preliminary assessments of novel single- and cross-commodity purchase tasks of various alternative activities (e.g., exercise, hobbies, civic involvement). Participants in Study 1 recruited from Amazon's Mechanical Turk (n = 110) were administered a series of novel activity purchase tasks and an alcohol purchase task. Results showed excellent fit of the exponential demand equation to activity purchase task data and provided initial support for adaptation of purchase task methodology to alternative activity demand. In Study 2, participants recruited from Amazon's Mechanical Turk (n = 108) were administered both single-commodity and cross-commodity purchase tasks of alcohol and exercise. While most participants demonstrate independent consumption of alcohol and exercise, a subset of participants substituted exercise for alcohol as indicated by quantitative cross-price elasticity indices. These response patterns highlight the importance of individual differences and hold implications for recovery efforts that promote alternative activity engagement and public policy. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Background:Electronic patient-reported outcome (ePRO)-based symptom management improves cancer patients’ outcomes. However, implementation of ePROs is challenging, requiring technical resources for integration into clinical systems, substantial buy-in from clinicians and patients, novel workflows to support between-visit symptom management, and institutional investment.Methods:The SIMPRO Research Consortium developed eSyM, an electronic health record-integrated, ePRO-based symptom management program for medical oncology and surgery patients and deployed it at six cancer centers between August 2019 and April 2022 in a type II hybrid effectiveness-implementation cluster randomized stepped-wedge study. Sites documented implementation strategies monthly using REDCap, itemized them using the Expert Recommendations for Implementation Change (ERIC) list and mapped their target barriers using the Consolidated Framework for Implementation Research (CFIR) to inform eSyM program enhancement, facilitate inter-consortium knowledge sharing and guide future deployment efforts.Results:We documented 226 implementation strategies: 35 ‘foundational’ strategies were applied consortium-wide by the coordinating center and 191 other strategies were developed by individual sites. We consolidated these 191 site-developed strategies into 64 unique strategies (i.e., removed duplicates) and classified the remainder as either ‘universal’, consistently used by multiple sites (N=29), or ‘adaptive’, used only by individual sites (N=35). Universal strategies were perceived as having the highest impact; they addressed eSyM clinical preparation, training, engagement of patients/clinicians, and program evaluation. Across all documented SIMPRO strategies, 44 of the 73 ERIC strategies were addressed and all 5 CFIR barriers were addressed.Conclusion:Methodical collection of theory-based implementation strategies fostered the identification of universal, high-impact strategies that facilitated adoption of a novel care-delivery intervention by patients, clinicians, and institutions. Attention to the high-impact strategies identified in this project could support implementation of ePROs as a component of routine cancer care at other institutions.

When designing cluster-randomized trials (CRTs), one important consideration is determining the proper sample sizes across levels and treatment conditions to cost-efficiently achieve adequate statistical power. This consideration is usually addressed in an optimal design framework by leveraging the cost structures of sampling and optimizing the sampling ratios across treatment conditions and levels of the hierarchy. Traditionally, optimization is done through the first-order derivative approach by setting the first-order derivatives equal to zero to solve for the optimal design parameters. However, the first-order derivative method is incapable of properly handling the optimization task when statistical power formulas are complex, such as those for CRTs detecting mediation effects under the joint significance test. The current study proposes using an ant colony optimization (ACO) algorithm to identify optimal allocations. We evaluate the algorithm’s performance for CRTs detecting main and mediation effects. The results show that the ACO algorithm can identify optimal sample allocations for CRTs investigating main effects with the same design efficiency as those identified through the first-order derivative method. Furthermore, it can efficiently identify optimal sample allocations for CRTs investigating mediation effects under the joint significance test. We have implemented the proposed methods in the R package odr.