BACKGROUND & AIMS The rate of readmission to the hospital 30 days after discharge (30-day readmission rate) is used as a quality measure for hospitalized patients, but it has not been studied adequately for patients with advanced liver disease. We investigated the incidence and factors that predict this rate and its relationship with mortality at 90 days. METHODS We analyzed data from patients with advanced liver disease who were hospitalized to an inpatient hepatology service at 2 large academic medical centers in 2008. Patients with elective admission and recipients of liver transplants were not included. During the study period, there were 447 patients and a total of 554 eligible admissions. Multivariate analyses were performed to identify variables associated with 30-day readmission and to examine its relationship with mortality at 90 days. RESULTS The 30-day readmission rate was 20%. After adjusting for multiple covariates, readmission within 30 days was associated independently with model for end-stage liver disease scores at discharge (odds ratio [OR], 1.06; 95% confidence interval [CI], 1.02–1.09; P = .002), the presence of diabetes (OR, 1.78; 95% CI, 1.07–2.95; P = .027), and male sex (OR, 1.73; 95% CI, 1.03–2.89; P = .038). After adjusting for age, sex, and model for end-stage liver disease score at discharge, the 90-day mortality rate was significantly higher among patients who were readmitted to the hospital within 30 days than those who were not (26.8% vs 9.8%; OR, 2.6; 95% CI, 1.36 –5.02; P = .004). CONCLUSIONS Patients with advanced liver disease frequently are readmitted to the hospital within 30 days after discharge; these patients have a higher 90-day mortality rate than those who are not readmitted in 30 days. These data might be used to develop strategies to reduce early readmission of hospitalized patients with cirrhosis.

Rationale:The clinical pathology describing infants with chronic lung disease of infancy (CLDI) has been limited and obtained primarily from infants with severe lung disease, who either died or required lung biopsy. As lung tissue from clinically stable outpatients is not available, physiological measurements offer the potential to increase our understanding of the pulmonary pathophysiology of this disease. Objectives: We hypothesized that if premature birth and the development of CLDI result in disruption of alveolar development, then infants and toddlers with CLDI would have a lower pulmonary diffusing capacity relative to their alveolar volume compared with full-term control subjects. Methods: We measured pulmonary diffusing capacity and alveolar volume, using a single breath-hold maneuver at elevated lung volume. Subjects with chronic lung disease of infancy (23-29 wk of gestation; n 5 39) were compared with full-term control subjects (n 5 61) at corrected ages of 11.6 (4.8-17.0) and 13.6 (3.2-33) months, respectively. Measurements and Main Results: Alveolar volume and pulmonary diffusing capacity increased with increasing body length for both groups. After adjusting for body length, subjects with CLDI had significantly lower pulmonary diffusing capacity (2.88 vs. 3.23 ml/ min/mm Hg; P 5 0.0004), but no difference in volume (545 vs. 555 ml; P 5 0.58). Conclusions: Infants and toddlers with CLDI have decreased pulmonary diffusing capacity, but normal alveolar volume. These physiological findings are consistent with the morphometric data obtained from subjects with severe lung disease, which suggests an impairment of alveolar development after very premature birth.

Even though acute anxiety has received substantial rhetorical attention during the COVID-19 pandemic, to our knowledge it has not been subject to scientific inquiry until now. Although this study cannot confirm that any search was linked to a specific acute anxiety event or panic attack, it provides evidence of the collateral psychological effects stemming from COVID-19, and motivates several data-driven recommendations.First, surveillance should continue as changes during the pandemic may spark new increases in acute anxiety that necessitate a response. Second, in light of the pandemic, resource providers should better address acute anxiety. For instance, Illinois launched "Call4Calm," a hotline to help people cope with acute COVID-19 anxiety, and such programs could be expanded nationally. Third, more must be done to link those needing help with help. A "panic attack" Google query does not return any links to helplines, even though Google has pioneered the "OneBox" approach to mental health queries, highlighting life-saving results at the top of a user's search results (including suicide and addiction hotlines) rather than hoping searchers find actionable information by chance alone. The Google OneBox should be expanded to promote resources for acute anxiety, like SAMHSA's Disaster Distress Helpline, to meet potential increased demand during COVID-19 now and in the future.Time-sensitive decision-making during a pandemic underscores the importance of fostering an agile empirical approach that can continually monitor health threats, 6 including the ability to study an outcome without a priori anticipatory data collection. Mining internet searches may improve strategies to discover and subsequently address the collateral mental health consequences of COVID-19.

OBJECTIVES-To examine the association between changes in body mass index (BMI), dementia, and mild cognitive impairment (MCI). DESIGN-Prospective observational study.SETTING-Urban community in Indianapolis, Indiana. PARTICIPANTS-Participantswere African Americans aged 65 and older enrolled in the Indianapolis Dementia Project and followed through 2007. This analysis included 1,331 participants who did not have dementia at their first BMI measurement. MEASUREMENTS-Cognitive assessment and clinical evaluations were conducted every other year to identify participants with dementia or MCI during 12 years of follow-up (mean follow-up 6.4 years). BMI measures; alcohol and smoking history; and medical conditions including history of cancer, hypertension, diabetes mellitus, heart attack, stroke; and depression were collected at each follow-up evaluation. Mixed-effect models were used to examine the differences in BMI between participants who developed dementia or MCI and those who did not, adjusting for covariates.RESULTS-Mean BMI at baseline was 29.8 ± 5.7 for women and 28.3 ± 4.8 for men. Participants with incident dementia or MCI had greater decline in BMI than those without (P=.02 for dementia, P=.04 for MCI). BMI in participants with incident dementia, MCI, and normal © 2010, The American Geriatrics Society Address correspondence to Sujuan Gao, Department of Medicine, Indiana University School of Medicine, 410 West 10th Street, Suite 3000, Indianapolis, IN 46202. sgao@iupui.edu. Author Contributions: Study design: Gao, Hendrie, Unverzagt, Hall. Data acquisition: Hendrie, Unverzagt, Hake, Smith-Gambel, Hall. Data analysis and interpretation: Gao, Nguyen, Hendrie. Preparation of manuscript: Gao, Nguyen, Hendrie, Unverzagt, Hake, Smith-Gambel, Hall. Conflict of Interest:The editor in chief has reviewed the conflict of interest checklist provided by the authors and has determined that the authors have no financial or any other kind of personal conflicts with this paper. Sponsor's Role:The data used in this manuscript are from a NIH-funded study "Indianapolis-Ibadan Dementia Project." The sponsor played no role in the design, method, analysis, or preparation of the manuscript. NIH Public AccessAuthor Manuscript J Am Geriatr Soc. Author manuscript; available in PMC 2012 January 1. NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript cognition did not differ 12 or 9 years before diagnosis, but 6 years before diagnosis, participants with incident dementia had significantly lower BMI than participants with normal cognition (P=. 03), as did participants with MCI (P=.006).CONCLUSION-Decline in BMI appears to be an early marker for dementia. There is a need for the close monitoring of weight loss in older adults. Keywordsbody mass index; dementia; mild cognitive impairment; African AmericansObesity is associated with risk of diabetes mellitus, hypertension, and cardiovascular disease, conditions related to risk of dementia. There are studies confirming that midlife obesity is a risk factor for dem...

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Background-Childhood asthma is most often characterized by recurrent wheezing, airway hyperreactivity, and atopy; however, our understanding of these relationships from early in life remains unclear. Respiratory illnesses and atopic sensitization early in life may produce an interaction between innate and acquired immune responses leading to airway inflammation and heightened airway reactivity.

Increasing use of the botanical kratom to self-manage opioid withdrawal and pain has led to increased kratom-linked overdose deaths. Despite these serious safety concerns, rigorous fundamental pharmacokinetic knowledge of kratom in humans remains lacking. We assessed the pharmacokinetics of a single low dose (2 g) of a well-characterized kratom product administered orally to six healthy participants. Median concentration-time profiles for the kratom alkaloids examined were best described by a two-compartment model with central elimination. Pronounced pharmacokinetic differences between alkaloids with the 3S configuration (mitragynine, speciogynine, paynantheine) and alkaloids with the 3R configuration (mitraciliatine, speciociliatine, isopaynantheine) were attributed to differences in apparent intercompartmental distribution clearance, volumes of distribution, and clearance. Based on noncompartmental analysis of individual concentration-time profiles, the 3S alkaloids exhibited a shorter median time to maximum concentration (1–2 vs. 2.5–4.5 h), lower area under the plasma concentration-time curve (430–490 vs. 794–5120 nM × h), longer terminal half-life (24–45 vs. ~12–18 h), and higher apparent volume of distribution during the terminal phase (960–12,700 vs. ~46–130 L) compared to the 3R alkaloids. Follow-up mechanistic in vitro studies suggested differential hepatic/intestinal metabolism, plasma protein binding, blood-to-plasma partitioning, and/or distribution coefficients may explain the pharmacokinetic differences between the two alkaloid types. This first comprehensive pharmacokinetic characterization of kratom alkaloids in humans provides the foundation for further research to establish safety and effectiveness of this emerging botanical product.

The botanical natural product goldenseal can precipitate clinical drug interactions by inhibiting cytochrome P450 (CYP) 3A and CYP2D6. Besides P‐glycoprotein, effects of goldenseal on other clinically relevant transporters remain unknown. Established transporter‐expressing cell systems were used to determine the inhibitory effects of a goldenseal extract, standardized to the major alkaloid berberine, on transporter activity. Using recommended basic models, the extract was predicted to inhibit the efflux transporter BCRP and uptake transporters OATP1B1/3. Using a cocktail approach, effects of the goldenseal product on BCRP, OATP1B1/3, OATs, OCTs, MATEs, and CYP3A were next evaluated in 16 healthy volunteers. As expected, goldenseal increased the area under the plasma concentration‐time curve (AUC0–inf) of midazolam (CYP3A; positive control), with a geometric mean ratio (GMR) (90% confidence interval (CI)) of 1.43 (1.35–1.53). However, goldenseal had no effects on the pharmacokinetics of rosuvastatin (BCRP and OATP1B1/3) and furosemide (OAT1/3); decreased metformin (OCT1/2, MATE1/2‐K) AUC0–inf (GMR, 0.77 (0.71–0.83)); and had no effect on metformin half‐life and renal clearance. Results indicated that goldenseal altered intestinal permeability, transport, and/or other processes involved in metformin absorption, which may have unfavorable effects on glucose control. Inconsistencies between model predictions and pharmacokinetic outcomes prompt further refinement of current basic models to include differential transporter expression in relevant organs and intestinal degradation/metabolism of the precipitant(s). Such refinement should improve in vitro‐in vivo prediction accuracy, contributing to a standard approach for studying transporter‐mediated natural product‐drug interactions.