Southern California Clinical and Translational Science Institute

The goal of this study was to assess the effect of enteral feeding on aspiration risk and progression of respiratory failure in adults on high-flow nasal cannula (HFNC) oxygen therapy. Single-center retrospective cohort study. Keck Hospital of the University of Southern California, a tertiary care academic hospital. Hospitalized adults treated with HFNC between January 1, 2020, and December 31, 2022, were included. Exclusion criteria were chronic total parenteral nutrition, chronic tracheostomy, history of total laryngectomy, and "Do Not Intubate" code status. None. The primary outcome was the progression of respiratory failure from HFNC to noninvasive positive pressure ventilation, mechanical ventilation, or extracorporeal membrane oxygenation. We included 220 patients in the primary analysis. The median age was 62.6 years, 54.1% of patients were male, and 43.6% of patients were White. The primary outcome of progression of respiratory failure occurred in 57 patients, of whom 19 (33.3%) were feeding enterally and 38 (66.7%) were NPO at the time of progression. Patients feeding enterally were less likely than those who were NPO to have progression of respiratory failure in a multivariate mixed effects linear regression model (odds ratio [OR], 0.33; 95% CI, 0.18-0.58; p < 0.001). Patients feeding enterally remained less likely to have progression of respiratory failure in a propensity score-matched analysis (OR, 0.30; 95% CI, 0.15-0.58; p < 0.001). In this single-center, retrospective cohort, enteral nutrition in patients on HFNC was associated with lower risk of progression of respiratory failure and was not associated with increased risk of poor clinical outcomes. Prospective multicenter studies are needed to confirm these findings.

Loud music in group fitness classes is often believed to enhance motivation and performance but poses a risk for noise-induced hearing loss. To assess whether lower music volume during fitness classes results in comparable perceived exertion compared with higher music levels and to explore hearing protection behaviors among participants. This comparative effectiveness study using a partially repeated measures design surveyed group fitness class attendees from February 1 to 28, 2025, at a fitness studio in Los Angeles, California, regarding perceived exercise intensity, music loudness, and hearing protection behaviors. Participants attended 1-hour group fitness classes under typical (louder) and reduced music volume conditions (≥3-dBA reduction). Perceived exertion was compared between louder and quieter class conditions using multivariable mixed-effects linear regression to account for repeated measurements from participants. A noninferiority framework was applied, with noninferiority defined as the lower bound of the 97.5% CI. A total of 189 participants completed 239 surveys, and 21 participants contributed surveys in both sound conditions. The median (range) age was 28 (17-59) years, and 165 (87.3%) were female. The mean sound levels were 91.4 dBA (95% CI, 91.1-91.9 dBA) for louder classes (n = 122) and 88.5 dBA (95% CI, 88.0-88.9 dBA) for quieter classes (n = 117). The lower bound of the 97.5% CI for the difference in perceived exertion (Borg CR-10) between louder and quieter classes (β = -0.66; 97.5% CI, -1.09 to -0.22) did not exceed the CI for the noninferiority threshold of -1.5, indicating noninferiority in perceived exertion in quieter classes compared to louder classes. Continuous unit-based modeling of sound intensity confirmed noninferiority for decrements up to 4 dBA. Twenty-eight individuals (14.8%) reported ever experiencing postclass tinnitus, and 4 participants (2.1%) reported consistently using hearing protection during classes. In this comparative effectiveness study, reducing music volume in group fitness classes did not lead to meaningful reductions in perceived exertion and may reduce the risk of noise-induced hearing loss. These findings support implementing safer sound practices in fitness environments and underscore the need for increased awareness and education on hearing protection.

Time-limited eating (TLE) shows promise as an adult obesity treatment; little is known in paediatrics or families. To assess the feasibility and acceptability of family-based TLE. This was a 12 week pilot randomized trial comparing family-based TLE to dietary standard of care (SOC). Families included a child aged 3-9 years and caretaker, both with obesity. TLE received instruction to end eating after the evening meal and otherwise eat adlibitum. SOC received dietary instruction. Primary outcomes, feasibility and acceptability, were measured through retention, intervention burden (i.e., treatment time) and satisfaction surveys. Anthropometrics were measured at baseline and 12 weeks. Between-arm comparisons of BMI percentile above the median (%BMIp50) used mixed effects models to account for family clustering; comparisons of adult BMI and child BMI percentage of the 95th percentile (%BMIp95) used two-sample t-tests. Eighteen families enrolled (10 TLE; 8 SOC). Retention was 94% (100% TLE, 88% SOC). TLE required significantly less total treatment time than SOC [84.3 vs. 140.9 min; p < 0.001]. Satisfaction was high; 89% TLE and 100% SOC would recommend their treatment. Overall, SOC reduced mean %BMIp50 more than TLE (mean difference: -3.9; p = 0.001), with no difference in change in child %BMIp95 between arms (-0.2, p = 0.92), but with SOC reducing parental BMI more than TLE (-1.6, p = 0.002). Family-based TLE was feasible and acceptable and required less time to implement than SOC, suggesting TLE could be an accessible dietary intervention for families. Fully powered studies are needed to determine BMI efficacy. ClinicalTrials.gov: NCT05107726.

Veterinary medical records represent a large data resource for application to veterinary and One Health clinical research efforts. Use of the data is limited by interoperability challenges including inconsistent data formats and data siloing. Clinical coding using standardized medical terminologies enhances the quality of medical records and facilitates their interoperability with veterinary and human health records from other sites. Previous studies, such as DeepTag and VetTag, evaluated the application of Natural Language Processing (NLP) to automate veterinary diagnosis coding, employing long short-term memory (LSTM) and transformer models to infer a subset of Systemized Nomenclature of Medicine - Clinical Terms (SNOMED-CT) diagnosis codes from free-text clinical notes. This study expands on these efforts by incorporating all 7,739 distinct SNOMED-CT diagnosis codes recognized by the Colorado State University (CSU) Veterinary Teaching Hospital (VTH) and by leveraging the increasing availability of pre-trained language models (LMs). 13 freely available pre-trained LMs (GatorTron, MedicalAI ClinicalBERT, medAlpaca, VetBERT, PetBERT, BERT, BERT Large, RoBERTa, GPT-2, GPT-2 XL, DeBERTa V3, ModernBERT, and Clinical ModernBERT) were fine-tuned on the free-text notes from 246,473 manually-coded veterinary patient visits included in the CSU VTH's electronic health records (EHRs), which resulted in superior performance relative to previous efforts. The most accurate results were obtained when expansive labeled data were used to fine-tune relatively large clinical LMs, but the study also showed that comparable results can be obtained using more limited resources and non-clinical LMs. The results of this study contribute to the improvement of the quality of veterinary EHRs by investigating accessible methods for automated coding and support both animal and human health research by paving the way for more integrated and comprehensive health databases that span species and institutions.

BackgroundConsumer-level drug recalls usually require action by individual patients. The Food and Drug Administration (FDA) has public-facing outlets to inform the public about drug safety information, including all recalls, but individual consumers may not be aware of them. And there is no system in place to notify individual prescribers which of their patients are affected by a specific recall.ObjectiveWe aimed to leverage the FDA’s Healthy Citizen prototype web-based software platform, which provides users with information about recalls, to automatically notify patients of relevant recalls.MethodsWe developed and evaluated an electronic notification system in the primary care and cardiology practices at a large, urban, academic medical center. The health care portal scanned the FDA Healthy Citizen application programming interface nightly to detect new recalls, identified patients who had those medications in their electronic health record (EHR) medication list, and sent them a message through the EHR patient portal with a link to a customized FDA information display. Using structured interviews, we assessed qualitative feedback on the system and portal messaging from a convenience sample of 9 patients.ResultsThe system was technically functional, but it was not possible to trace a medication prescription from the EHR to specific lot numbers dispensed to that patient by a community pharmacy. The qualitative feedback obtained from patients showed convergence of topics.ConclusionsLack of an accurate electronic audit trail from prescription to dispensed medication precludes clinical deployment of automated drug recall notification.

Abstract Background Canine hemangiosarcoma is a common and aggressive vascular malignancy predominantly affecting dogs over six years of age. Despite surgical resection followed by adjuvant chemotherapy, median survival remains around 4–6 months. Propranolol, a beta-adrenergic receptor (β-AR) antagonist, has shown efficacy in human angiosarcoma, a tumor with similar clinical and morphological characteristics, when combined with chemotherapy. Methods To determine if propranolol could be repurposed as an effective adjunct to chemotherapy, we conducted a phase I clinical study evaluating the safety and efficacy of propranolol combined with doxorubicin (PRO-DOX) in 20 dogs with stage 1 or stage 2 splenic hemangiosarcoma.Plasma from 19 dogs was analyzed for propranolol pharmacokinetics and RNA was extracted from tumors from 13 of the dogs for transcriptional profiling. Results Although propranolol did not appear to influence treatment outcomes, our results revealed long-term survival in young adult dogs (less than 6 years of age), suggesting the possibility of a better response to doxorubicin. Faster clearance of 4-OH propranolol also correlated with long-term survival in younger dogs, but this appeared to be associated with drug metabolism due to age rather than effects of the drug on survival outcomes. Gene expression analysis identified distinct age-associated tumor signatures, with young dogs exhibiting increased immune-related gene expression and older dogs showing elevated expression of genes associated with the cell cycle and the DNA damage response and repair. Conclusions These findings highlight several hallmarks of cellular aging in hemangiosarcoma that may influence treatment responses and long-term survival. Our findings suggest that young adult dogs with splenic hemangiosarcoma treated with doxorubicin have a better prognosis and underscore the need for further research into age-related molecular mechanisms of disease. These insights could refine therapeutic strategies and clinical decision-making in hemangiosarcoma management.

Background/Objectives: Falls are a leading cause of hospitalization, injury, and healthcare spending among older adults. Surveillance data on local falls, especially for those associated with Alzheimer’s disease and related dementias (ADRD), are limited. We conducted a surveillance analysis to describe fall-related hospitalizations and their associations with ADRD in Los Angeles County (LAC). Methods: We analyzed countywide hospital discharge data for LAC residents aged 50+ from 2016–2022 (n = 3,520,927) to assess differences in fall-related hospitalizations by ADRD status and demographic characteristics. We used multivariable logistic regression to identify predictors of fall status and multinomial regression to examine associations between ADRD status and discharge disposition. Results: Of all hospitalizations, 6.8% were fall-related. Individuals hospitalized for falls had longer stays, higher charges, and were more frequently female, older, and White. Fall frequency peaks consistently occurred during winter months, with higher seasonal variation among those without ADRD. After adjustment, ADRD diagnosis was associated with increased odds of fall-related hospitalization (AOR = 1.14) and non-routine discharge, including transfer to a short-term hospital (AOR = 1.35), skilled nursing or other care facilities (AOR = 1.88), and home health care (AOR = 1.23). Conclusions: This study provides one of the most comprehensive local assessments of fall-related hospitalization among older adults in the United States. The findings highlight the increased risk and care complexity among patients with ADRD. As results are descriptive and reflect cross-sectional surveillance, temporality and causality cannot be inferred. Nevertheless, the findings underscore the need for better surveillance and integrated fall prevention, discharge planning, and post-hospital support strategies tailored to individuals with ADRD.