Clustering-based COPD Subtypes Have Distinct Longitudinal Outcomes and Multi-omics Biomarkers

Introduction: Chronic obstructive pulmonary disease (COPD) can progress across several domains, complicating the identification of the determinants of disease progression. In our previous work, we applied k-means clustering to spirometric and chest radiologic measures to identify four COPD-related subtypes: "Relatively resistant smokers (RRS)", "mild upper lobe predominant emphysema (ULE)", "airway-predominant disease (AD)", and "severe emphysema (SE)". In the current study, we examined longitudinal spirometric and radiologic emphysema changes and prospective risks of COPD exacerbations, incident comorbidities, and mortality of these clusters. We also compared their associations to protein and transcriptomic biomarkers. Methods: We included 8,266 non-Hispanic white and African-American smokers from the COPDGene study. We used linear regression to investigate associations to five-year prospective changes in spirometric and radiologic measures and to plasma protein and blood gene expression levels. We used Cox-proportional hazard modeling to test for associations to prospective exacerbations, comorbidities, and mortality. Results: The RRS, ULE, AD, and SE clusters represented 39%, 15%, 26%, and 20% of the studied cohort at baseline, respectively. The SE cluster had the greatest 5-year FEV1 and emphysema progression, and the highest risks of exacerbations, cardiovascular disease (CVD), and mortality. The AD cluster had the highest diabetes risk. After adjustments, only the ULE and AD clusters had elevated CVD mortality risks, while only the ULE cluster had the highest cancer-related mortality risk. These clusters also demonstrated differential protein and gene expression biomarker associations. Conclusion: COPD k-means subtypes demonstrate varying rates of disease progression, prospective comorbidities, mortality, and associations to proteomic and transcriptomic biomarkers.

Staying Calm and Well in the Midst of the COVID-19 Storm: One University's Longitudinal Outcomes Evaluation of a Mental Health and Well-Being Webinar Series

Background: As the COVID-19 pandemic began, wellness leadership at a large Mid-west public university anticipated an increase in mental health problems among faculty and staff. A two-part weekly webinar series entitled "Staying Calm and Well in the Midst of the COVID-19 Storm" was launched to assist faculty and staff in coping with stressful issues related to the pandemic and enhancing their well-being. This series provided the university community with evidence-based knowledge, skills, and resources to enhance their ability in taking good self-care.Aim: To assess participant mental health outcomes during the two-part mental health and well-being educational webinar series over time.Methods: A longitudinal outcomes evaluation was conducted. Evaluation data was obtained from the participants via an anonymous post-webinar survey, which included questions from the Patient-Health Questionnaire-4 (PHQ-4) to assess symptoms of anxiety and depression. The first series was conducted over the course of 8 weeks and the second series took place over 7 weeks. Descriptive statistics were used to assess responses to the PHQ-4 over time to evaluate outcomes of the webinar series. An open-ended question also asked participants about the 2 to 3 biggest concerns and worries they had at that moment. Results: The average amount of survey responses received were 1,470.25 (SD = ± 240.3) for Series One and 926.4 (SD = ± 164.3) for Series Two. Ninety-five percent of participants put the skills they learned during both series into practice. When participants reported experiencing anxiety or depressive symptoms, they most frequently reported experiencing them several days a week. The number of participants reporting no depressive or anxiety symptoms increased as the webinar series progressed over time. The types of concerns and worries reported varied across time.Conclusion: The Staying Calm and Well During the COVID-19 Pandemic webinar participants had a reduction in symptoms associated with anxiety and depression after completing the series.

Longitudinal Outcomes of Gender Identity in Children (LOGIC): study protocol for a retrospective analysis of the characteristics and outcomes of children referred to specialist gender services in the UK and the Netherlands

IntroductionSpecialist gender services for children and young people (CYP) worldwide have experienced a significant increase in referrals in recent years. As rates of referrals increase, it is important to understand the characteristics and profile of CYP attending these services in order to inform treatment pathways and to ensure optimal outcomes.Methods and analysisA retrospective observational study of clinical health records from specialist gender services for CYP in the UK and the Netherlands. The retrospective analysis will examine routinely collected clinical and outcome measures data including demographic, clinical, gender identity-related and healthcare resource use information. Data will be reported for each service and also compared between services. This study forms part of a wider programme of research investigating outcomes of gender identity in children (the Longitudinal Outcomes of Gender Identity in Children study).Ethics and disseminationThe proposed study has been approved by the Health Research Authority and London—Hampstead Research Ethics Committee as application 19/LO/0181. The study findings will be published in peer-reviewed journals and presented at both conferences and stakeholder events.

Contactless In-Home Monitoring of the Long-Term Respiratory and Behavioral Phenotypes in Older Adults With COVID-19: A Case Series

Currently, there is a limited understanding of long-term outcomes of COVID-19, and a need for in-home measurements of patients through the whole course of their disease. We study a novel approach for monitoring the long-term trajectories of respiratory and behavioral symptoms of COVID-19 patients at home. We use a sensor that analyzes the radio signals in the room to infer patients' respiration, sleep and activities in a passive and contactless manner. We report the results of continuous monitoring of three residents of an assisted living facility for 3 months, through the course of their disease and subsequent recovery. In total, we collected 4,358 measurements of gait speed, 294 nights of sleep, and 3,056 h of respiration. The data shows differences in the respiration signals between asymptomatic and symptomatic patients. Longitudinally, we note sleep and motor abnormalities that persisted for months after becoming COVID negative. Our study represents a novel phenotyping of the respiratory and behavioral trajectories of COVID recovery, and suggests that the two may be integral components of the COVID-19 syndrome. It further provides a proof-of-concept that contactless passive sensors may uniquely facilitate studying detailed longitudinal outcomes of COVID-19, particularly among older adults.