Radical Resection Compared to Local Excision for Very Old Patients With Stage 1 Rectal Cancer: An Exact‐Match Analysis of the SEER Database

ABSTRACT Background We assessed overall survival (OS) and cancer‐specific‐survival (CSS) of radical resection compared to local excision for stage 1 rectal cancer in very old patients (≥ 80 years). Methods This retrospective cohort study included patients aged ≥ 80 years who underwent surgery for stage 1 rectal cancer from the SEER database from 2000–2020. Patients were divided into radical resection and local excision groups, and were exact matched for T stage, tumor grade, and tumor size. The main outcome measures were OS and CSS. Results 6379 patients ≥ 80 years underwent local or radical resection of stage 1 rectal cancer; 51.9% were female and 47% had T1 tumors. After matching, 1125 patients were included in each group. The median OS was longer in patients who underwent radical resection (60 months vs. 51 months, p  = 0.009), yet there were no significant differences in CSS between the two groups. When stratified by the T stage, there was no benefit for radical resection in T1 tumors ( p  = 0.33). In multivariate analysis, radical resection and local excision had similar hazard of mortality (HR 1.03, 95%CI 0.76–1.38). Conclusion Radical resection and local excision had similar CSS in very old patients with stage 1 rectal cancer. A personalized approach considering patient status and treatment goals should be used for each patient.

Treatment outcomes for military‐affiliated clients with posttraumatic stress disorder in a community mental health network

Abstract Treating posttraumatic stress disorder (PTSD) in military‐affiliated populations, including veterans, active duty service members, and their families, remains a significant challenge in the mental health field. Most research on PTSD treatment outcomes has been conducted in controlled trials or within VA and military settings, limiting its generalizability to other clinical environments. This study examined treatment outcomes for 2,717 military‐affiliated clients receiving treatment for PTSD within a community mental health network. Treatments included cognitive processing therapy (CPT), eye movement desensitization and reprocessing (EMDR), or prolonged exposure (PE), with outcomes measured using the PTSD Checklist for DSM‐5 (PCL‐5) throughout treatment. Clients who attended at least four sessions showed substantial symptom reductions for CPT (Δ M = 19.3), d = 0.98; EMDR (Δ M = 16.6), d = 0.86; and PE (Δ M = 17.4), d = 0.87, all of which exceeded improvements seen with other treatments (Δ M = 12.6), d = 0.71. Analyses of clinically meaningful change thresholds showed similar results across treatments, with 51.9% of CPT, 47.8% of EMDR, and 53.1% of PE clients experiencing a PCL‐5 score reduction of at least 18 points after four or more sessions. Dropout prior to four sessions was notable, with 27.5%–40.1% of clients across treatment groups discontinuing treatment before reaching this threshold. Overall, the findings provide real‐world evidence supporting the effectiveness of CPT, EMDR, and PE in military‐affiliated populations and validate their continued use in community mental health settings.

Use of whole health care is associated with increased completion of evidence‐based psychotherapy for posttraumatic stress disorder among veterans receiving care within the Veterans Health Administration

Abstract Trauma‐focused psychotherapy is the front‐line treatment option for posttraumatic stress disorder (PTSD); however, approximately two thirds of veterans who initiate such evidence‐based psychotherapy (EBP) for PTSD discontinue treatment before completing an adequate number of therapy sessions. We examined the association between whole health (WH) care, comprising WH services (e.g., health and wellness coaching, wellness groups) and complementary and integrative health (CIH) therapies, and EBP completion for PTSD. We completed a national retrospective database analysis of Veterans Health Administration administrative records for veterans with PTSD who initiated an EBP in Fiscal Years 2018–2022 and estimated multiple logistic regression models assessing the association between WH care use and EBP completion (i.e., completing eight EBP sessions within 14 weeks). We identified 100,177 veterans with PTSD who initiated EBP (34.8% completed EBP). Of these veterans, 9,824 (9.8%) had used WH services, and 3,396 (3.6%) had used CIH therapies. When controlling for demographic and health‐related variables, WH care use was associated with increased odds of EBP completion. The strongest associations were between the use of WH services both before EBP initiation and concurrent with EBP use, OR = 1.39, 95% CI [1.28, 1.51], and the use of CIH therapies concurrent with EBP use, OR = 1.38, 95% CI [1.20, 1.60], or both before EBP initiation and concurrent with EBP use, OR = 1.30, 95% CI [1.17, 1.45]. The results suggest that parallel use of WH care may bolster patient completion of EBP for PTSD, a critical component of the effectiveness of these psychotherapies.

Response to Litz (2025): Advancing standards for system‐level learning from clinical data (Lancaster et al., 2025)

Abstract We thank Litz (2025) for his thoughtful commentary and shared commitment to improving posttraumatic stress disorder care through the transparent use of observational outcome data. The proposed reporting checklist offers a timely framework for enhancing interpretive clarity and hypothesis generation. Our study incorporated many of these elements and was designed as a descriptive, noncomparative analysis aligned with learning health system goals. We acknowledge the importance of careful framing to avoid overinterpretation and support the broader call for standardized reporting practices. Measurement‐based care remains central to Cohen Veterans Network's approach, and we welcome continued dialogue to advance responsible data use and iterative quality improvement across systems.

Muscle Ultrasound Echo Intensity Detects Insulin Resistance Before Changes in HbA 1c or Fasting Glucose, Independent of BMI

Objectives To quantify the association between skeletal muscle echo intensity (MEI), measured by ultrasound, and clinical markers of insulin resistance and glycemic control, and evaluate MEI's diagnostic accuracy in identifying insulin resistance. Methods In this cross‐sectional study, 20 adults with obesity (mean body mass index [BMI] 34.4 ± 2.6 kg/m 2 , mean age 33 years, 40% female) and 8 healthy, lean adults (mean BMI 22.5 ± 1.4 kg/m 2 , mean age 25 years, 75% female), all without diabetes or metabolic disease, underwent laboratory testing (HbA 1c , 2‐hour oral glucose tolerance testing with insulin for Matsuda Index), muscle ultrasound (deltoid, vastus lateralis), and DEXA for sarcopenia indices. Two blinded research assistants independently analyzed 336 ultrasound images to quantify MEI. Results Increased MEI was significantly associated with greater insulin resistance (lower Matsuda Index; r  = −.47, p  = .011), particularly in women ( r  = −.56, p  = .039). MEI z‐scores identified insulin resistance with an AUROC of 0.872 (95% CI 0.742–1.000). At the optimal threshold of z = 1.96, sensitivity was 94.4%, specificity 80%, accuracy 89.3%, and Youden's index 0.744. MEI accurately identified insulin resistance despite normal HbA 1c and fasting glucose. Increased MEI in both muscles suggested global skeletal muscle changes. Among participants with obesity, MEI did not correlate with BMI but was negatively correlated with sarcopenia indices ( r  = −.56, p  = .0096) and body weight ( r  = −.50, p  = .0233). Conclusions MEI is an accurate, noninvasive biomarker for insulin resistance and may detect muscle alterations before conventional markers emerge. Its independence from BMI and conventional markers supports MEI's use in early risk stratification and identification of individuals at risk for metabolic dysfunction who might otherwise go undetected.

Utilization of the Inpatient Dermatology Service at a Large Academic Medical Centre

Clinical Features in the Diagnosis of Drug Reaction With Eosinophilia and Systemic Symptoms: A Retrospective Cohort Study

A hierarchical analysis of lek counts: environmental drivers of abundance for an endangered grassland bird

Abstract Populations of Attwater's prairie‐chicken ( Tympanuchus cupido attwateri ), once widespread across the Gulf Coastal Prairies of North America, remain critically endangered. Lek counts of displaying males provide the primary basis for population monitoring, yet these counts are vulnerable to detection error and fail to capture underlying demographic processes. We applied hierarchical Bayesian N‐mixture and Dail–Madsen models to 23 years of lek count data (2002–2024) from Attwater Prairie Chicken National Wildlife Refuge to estimate detection‐adjusted abundance and population trend, and assess relationships between abundance, demographic rates, and responses to environmental drivers. The top‐performing N‐mixture model estimated a mean annual population growth rate of 3% (95% CRI: 1%, 5%), providing statistically supported evidence of a positive trend, whereas the naïve count‐based estimate showed no significant change over time. Dail–Madsen models indicated recruitment, rather than survival, as the primary demographic constraint. Environmental covariates revealed that abundance peaked at intermediate levels of perennial forb and grass cover and under moderate drought conditions, with declines observed under vegetative overgrowth and excessive moisture. The interaction between precipitation and the median time since fire revealed that short median time since fire intervals were associated with greater abundance during normal to wet years, underscoring the importance of frequent prescribed fires (median 2‐ to 3‐year intervals). These results provide the first detection‐corrected trend estimates for this species and offer a model‐based framework for linking weather, vegetation, and fire history with population dynamics. Our findings directly inform adaptive management strategies contributing to recovery for this species and demonstrate how robust analyses of long‐term lek data enhance conservation decision‐making for endangered grassland birds.

Greater white‐fronted goose habitat use in Louisiana provides water depth management insights

Abstract Numerous waterfowl species have altered their geographic distribution in recent decades. The greater white‐fronted goose ( Anser albifrons ) has shifted its wintering distribution from coastal marshes in Texas and Louisiana, USA, to interior landscapes, creating challenges for conservation managers. Although the range shift has been primarily attributed to landscape‐scale changes in rice production, effects of fine‐scale habitat conditions on greater white‐fronted goose habitat use are unknown. Thus, information on fine‐scale environmental conditions could provide information to managers working to mitigate effects of the shift. We used global positioning system neck collars to monitor 78 greater white‐fronted geese in Louisiana each winter during 2016–2019 and visited all used locations to record vegetation height, water depth, and land cover. We modeled greater white‐fronted goose habitat use in 4 regions across Louisiana (central, coastal, north, southwest), and evaluated effects of vegetation height, water depth, land cover, and interactions. In our candidate model set, we included a sampling null, which accounted for differences in sampling frequencies among hunt seasons and diel periods. The top model in the central, coastal, and north regions included water depth, whereas the top model in the southwest region included water depth, vegetation height, and land cover. Parameter estimates and confidence intervals indicated that goose habitat use was higher at sites with >5.1 cm of water compared to dry sites or sites with <5.1 cm of water. In the southwest region, goose habitat use was highest in areas identified as other land cover (e.g., corn, cotton, rye, sugarcane) and lowest in open water. Although Louisiana has substantial anthropogenic food resources in the form of rice agriculture and abundant grazing opportunities afforded by mild winters, our results indicate that wet areas provide better habitat to greater white‐fronted geese than dry areas. New agricultural flooding regimes in Louisiana could improve habitat quality and potentially mitigate some effects of the winter distribution shift.

Anuran occupancy of created wetlands within reforested legacy surface mines in Kentucky and West Virginia

Abstract Restoration of habitat is an important component of wildlife management. Surface coal mining has altered forest cover in the Central Appalachians, and most reclamation activities on previously mined lands result in non‐native grasslands or shrub lands. The Forestry Reclamation Approach (FRA), which emphasizes non‐native vegetation removal, soil decompaction, planting of native trees and shrubs, and, in some cases, wetland creation represents an alternative to grassland‐based reclamation that may promote forest‐associated wildlife on legacy surface mines. We used automated recording units to evaluate the response of anurans to created wetlands and the FRA in Kentucky and West Virginia, USA. We used a Bayesian community occupancy model to compare species occupancy and richness across a range of wetland sizes (6.6–252 m 2 ) and 3 site types: 1) younger FRA (1–6 yr), 2) older FRA (7–23 yr), and 3) unmined, mature forests (>100 yr). In addition, we evaluated factors influencing anuran detection probabilities. Mean occupancy and species richness in both states were highest in the younger FRA, suggesting anurans may rapidly colonize wetlands created on restored mines. In Kentucky, occupancy of several species (green frog [ Lithobates clamitans ], pickerel frog [ L. palustris ], and wood frog [ L. sylvaticus ]) was higher in larger created wetlands, but wetland size was not important in West Virginia. Daily minimum temperature positively influenced detection of anurans in both states, and time of day was also important for detection in West Virginia. Wetland creation and implementation of the FRA may be an important tool for wildlife managers aiming to improve anuran populations and diversity on legacy surface mines in the Central Appalachians.