The VA New York Harbor Healthcare System is a set of hospitals run by the United States Department of Veterans Affairs in the New York City area. It comprises three medical centers, two community outpatient clinics, and five veterans centers. The system is a component of the much larger VA Health Care Network.
Key Points Fibroblast growth factor 23 and 24,25-dihydroxyvitamin D are positively correlated and are significantly lower in Dent disease than in idiopathic calcium kidney stones patients. Dent patients with low 24,25-dihydroxyvitamin D had greater hypercalciuria and proteinuria, and, among adults, higher 1,25-dihydroxyvitamin D concentrations. Moderate phosphate supplementation mitigates hypercalciuria. Background Hypercalciuria is a prominent characteristic in Dent disease type 1 (DD1) and is associated with kidney stones and nephrocalcinosis. The objectives of this study were to assess fibroblast growth factor 23 (FGF23) and 24,25-dihydroxyvitamin D (24,25(OH) 2 D) in DD1 patients and investigate the effects of phosphate supplementation on urinary calcium excretion. Methods Serum and 24-hour urine assessments from adult and pediatric DD1 patients ( N =10 adults; N =9 pediatrics) were compared with adult control subjects with a history of idiopathic calcium kidney stones and hypercalciuria ( N =9). Adult DD1 patients and control participants completed an oral phosphate supplementation intervention (1 g/d×14 days) with reassessment immediately after intervention. Results FGF23 was significantly lower in DD1 than in the control cohort (adults, P = 0.006) and positively correlated with 24,25(OH) 2 D across all study cohorts. The concentrations of 24,25(OH) 2 D were low with conversion ratios (25-hydroxyvitamin D: 24,25(OH) 2 D) exceeding the clinical reference limit for five of 10 adults and six of 9 pediatric DD1 patients. The DD1 cohorts were then stratified by the 24,25(OH) 2 D ratio into “normal” and “low” 24,25(OH) 2 D. Adult DD1 patients with low 24,25(OH) 2 D ( n =5) had lower FGF23, higher 1,25-dihydroxyvitamin D, greater urine calcium, and greater urine protein. Pediatric stratified data mirrored that in adults with the exception of no difference in serum 1,25-dihydroxyvitamin D. Phosphate supplementation was effective in decreasing urine calcium in both adult DD1 and control adult cohorts. Conclusions Clinical measurement of 24,25(OH) 2 D is a novel and useful analysis for evaluating the severity of calcium and protein dysregulation in DD1. In addition, moderate phosphate supplementation effectively mitigates urine calcium excretion in DD1 adult patients. Clinical Trial registry name and registration number: ClinicalTrials.gov, NCT02016235.
BACKGROUND:These recommendations provide guidance on the optimal duration of antibiotics in patients with complicated urinary tract infection (cUTI), especially in presence of associated Gram-negative bacteremia. METHODS:The panel's recommendations are based upon evidence derived from systematic literature reviews which focused on comparative benefits and harms of shorter (5-7 days) vs prolonged (10-14 days) duration of antibiotics, including publications since 2000. These recommendations adhere to a standardized methodology for rating the certainty of evidence and strength of recommendation according to the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) approach. RESULTS:The guidelines panel suggests that patients with cUTI who are improving on effective therapy can be treated with shorter duration of antimicrobials (either 5-7 days of a fluoroquinolone or 7 days of a non-fluoroquinolone) rather than longer courses of antibiotics, regardless of the presence of associated Gram-negative bacteremia. An effective antimicrobial agent achieves therapeutic levels in the urine and relevant tissue and is active against the causative pathogen. However, men with febrile UTI in whom acute bacterial prostatitis is suspected may benefit from a longer treatment duration (10-14 days), and a short courses of oral beta lactams may require higher doses for efficacy. CONCLUSIONS:Shorter durations of antibiotics for cUTI provide similar efficacy as longer courses, except in men with febrile UTI in whom acute bacterial prostatitis is suspected. This recommendation places a high value on antibiotic stewardship considerations as well as reducing the burden of antimicrobial administration from a healthcare perspective and reducing the burden of taking antibiotics from a patient perspective.
Schizophrenia and related psychoses occur in all human populations, with the highest rates of diagnosis among Black individuals and those of mainly African ancestry1. Decades of research have established a highly heritable and polygenic basis for schizophrenia, which is mostly shared across populations2-4. However, a recruitment bias towards European cohorts5 has led to discoveries that are poorly generalizable to African populations. This exclusion of the world's most genetically diverse populations narrows our understanding of disease biology and risks exacerbating health disparities. Here we show that electronic health records linked with genomic data from the Million Veteran Program (MVP)6-a national research programme that looks at the effects of genes, lifestyle, military experiences and exposures on the health and wellness of veterans-enable a comprehensive assessment of schizophrenia genetics in populations of African ancestry in the USA. We identify ancestry-independent associations in African populations and expand the catalogue of implicated regions by more than 100 loci. Through statistical fine-mapping and integrative transcriptomic analyses, we refine disease-associated signals to consensus genes with convergent neurobiological functions. These findings provide a much-needed view of schizophrenia's genetic architecture in populations of African ancestry, and offer biological insights that both extend previous work and broaden its global relevance.
How well the over 200,000 U.S. servicemembers who complete military service each year navigate the transition to civilian life may impact their later-life outcomes, with smoother transitions increasing resilience to later life stressors and leading to better long-term outcomes. The purpose of this study was to examine whether veterans who experience better military-to-civilian transitions are less vulnerable to poor mental health when faced with later stressors. Data were drawn from a population-based sample of U.S. veterans (N = 9,566) who completed six biannual surveys on their health and well-being throughout the first three years following separation from military service (2016–2019), and another a year into the COVID-19 pandemic (2021). We examined veterans’ vocational, financial, and social readjustment patterns using latent growth modeling and impacts on subsequent mental health using logistic regressions. The majority of veterans reported consistently high vocational and social well-being but low financial well-being during the initial transition from service, with approximately 15
OBJECTIVE:This study establishes normative data for the Emory Complex Figure-Loring Scoring (CF-LS) and Recognition task, a streamlined alternative to traditional CF measures designed to improve clinical efficiency and utility. Using a large healthy adult sample, we provide regression-based, demographically adjusted norms to support accurate interpretation in clinical and research settings. METHOD:The sample included 398 cognitively healthy adults from the Emory Healthy Brain Study. Participants completed the Rey CF using the Emory CF-LS system, which scores 10 core elements for accuracy and location across non-recognition conditions. These 10 core elements are included in a 4-choice recognition task. Regression models incorporating age, education, and race were used to generate scaled scores and stanines for each non-copy condition. RESULTS:Copy scores showed ceiling effects, with 72.1% achieving a perfect score, whereas Recall and Recognition scores were more normally distributed. Immediate and Delayed were highly correlated (r = .92), and both were strongly associated with Recognition (r range = .70-.71). Age, education, and race significantly predicted performance, informing the development of demographically adjusted normative data. CONCLUSIONS:This report provides regression-based norms for the Emory CF-LS system and Recognition task, offering both scaled scores and stanines to support flexible interpretation. By quantifying the predicted relationship between recall and recognition, the study introduces a practical formal method for detecting retrieval inefficiency. Although the sample is limited by high educational attainment and a narrow age range, findings support broader use of the Emory CF-LS and recognition in cognitive assessment.
