Background: Pediatric acute respiratory distress syndrome (pARDS) has high mortality despite research advancements. Studies have identified inflammatory subphenotypes of ARDS with different outcomes and treatments. Dysregulation of the renin-angiotensin-aldosterone system (RAAS), characterized by elevated renin, is associated with worse outcomes in adults with ARDS. The role of the RAAS has not been evaluated in the pARDS population, especially in the context of these inflammatory subphenotypes. Methods: Plasma samples from the Coagulation and Fibrinolysis in Pediatric Insulin Titration Trial (CAF-PINT) cohort (NCT01892969) were used. ARDS severity was determined by the highest oxygenation or oxygen-saturation index during admission. Renin concentration was measured on day 0 of enrollment via ELISA in both hyperinflammatory (n=39) and hypoinflammatory (n=40) subphenotypes. Results: Median day 0 renin concentration was higher in severe ARDS compared to mild ARDS (6780 vs 4369 pg/mL, p = 0.011) and higher in the hyperinflammatory subphenotype of severe ARDS compared to the hypoinflammatory subphenotype (8746 vs 4043 pg/mL, p = 0.02) Conclusions: Day 0 renin level is associated with maximum ARDS severity during admission suggesting early RAAS dysregulation in more severe illness. Further study of the entire RAAS pathway in children with ARDS is needed, especially within the context of known inflammatory subphenotypes. Further study will focus on identifying RAAS-defined subphenotypes and transcriptomics.

Introduction: The Adolescent HIV Medicine Trials Network (ATN) Protocol 149 (CARES) aimed to reduce youth HIV risk using 3 modalities: Automated Text Messaging and Monitoring (AMMI), Online Peer Support (PS), and Strengths-Based Coaching. We conducted a mixed methods study with stakeholders to inform implementation. Methods: We conducted semi-structured interviews and administered surveys with 28 youth-serving HIV prevention staff in Los Angeles, focusing on feasibility, acceptability, and appropriateness. Interviews were coded based on intervention modality and feedback type. Summary statistics were calculated and random intercept models estimated score differences across modalities. Results: Coaching had the highest mean score of 4.39/5, followed by PS (4.25) and AMMI (4.14). Coaching had significantly higher appropriateness than AMMI (coefficient estimate=0.35, 95% CI: [0.05-0.64]). Coaching was valued for flexibility and a holistic strength-based approach, but barriers included staffing costs and burnout. PS reduced logistical barriers and fostered anonymous dialogue, but posed technology access and organizational policy challenges. AMMI was considered accessible and efficient with automation, though privacy, costs, and phone access were concerns. Conclusion: Higher coaching and PS scores indicate the value of human connection alongside automation. Reported barriers indicate implementation must be flexible and context-specific to organizations. Findings will inform refinement and implementation of the ATN CARES package.

Schizophrenia is a debilitating psychiatric disorder affecting ~24 million individuals globally. Social functioning deficits are a core feature of the illness; affected individuals often maintain smaller social networks, which in turn is associated with greater psychiatric symptom severity. These challenges are especially pronounced in veterans, who experience higher rates of schizophrenia and related psychosocial impairments due to factors such as trauma and comorbid conditions. This study used egocentric social network analysis (SNA) to examine the role of negatively influential social connections in veterans with schizophrenia (SZ; n = 54) compared to healthy controls (HC; n = 41). Participants were compared on measures of network composition, including the number of social connections (alters) perceived as causing stress or difficulty to the individual. Contrary to expectations, the SZ and HC groups did not differ significantly on mean alter difficulty or proportion of difficult alters. Within the SZ group, however, greater depressive symptom severity, as measured by the Brief Psychiatric Rating Scale (BPRS), was associated with a higher proportion of difficult alters and greater mean alter difficulty. No associations were found between alter difficulty and social functioning measures. While the overall prevalence of difficult social connections may not differ significantly from controls in veterans with schizophrenia, our findings suggest that perceived quality of social relationships is linked with symptom burden.

Caretaking is highly prevalent in the Asian-Pacific Islander (API) population in the United States, with API individuals being nearly twice as likely to be caretakers compared to the general population. Caretaking can lead to poor physical health outcomes and increased mental strain, but the API community remains underrepresented in caretaking research. Thus, this study aims to investigate the association between caregiving and mental and physical health within the API community. Data was collected at health fairs hosted by Asian Pacific Health Corps at the University of California, Los Angeles, where attendees in the greater Los Angeles Area were surveyed on their demographics, whether or not they considered themselves caretakers, and details on their current living arrangements. Caretakers were categorized by hours spent caregiving to give insight into the level of burden. Physical health measurements such as blood pressure and body fat percentage, along with modified versions of existing stress and loneliness scales, were paired with each participant’s details. Both physical and mental health are incorporated into a caregiver’s health status. Data will be analyzed using SAS to determine if there is a significant association between being a caregiver and poor health status. We expect to see a strong association between caregiving and poor health status. By exploring the health outcomes for caregivers, we aim to create more targeted interventions to support caregivers in the API community.

Spinal dural arteriovenous fistulas (SDAVFs) are abnormal artery-vein connections and represent the most common subtype within the Toronto classification system, with an estimated incidence of approximately 10 cases per million people. Associated symptoms include lower extremity weakness and numbness, back pain, and urinary incontinence, but often result in misdiagnoses, which may delay treatment. Treatment options for SDAVFs include endovascular embolization to occlude or neurosurgical operation to disconnect the fistula. This single-center analysis of 64 SDAVF cases identified through the UCLA medical system from 1993 to 2023 found a mean patient age of 65.4 years, with 71.2% of patients being male. Two-thirds of cases were in the thoracic region, and three-quarters of all cases resulted in complete obliteration after initial treatment. The Modified Aminoff-Logue disability scale was utilized with a paired t-test, yielding significant improvements for both bladder (p = 0.002) and gait (p = 0.006) disabilities when comparing pre- and post-operation functionality. Considering patients with initial pain, motor, and sensory symptoms at diagnosis, 50%, 57.4%, and 53.2% achieved partial or complete improvement of their symptoms, respectively. While SDAVFs can affect patients in their daily activities, this cohort further reinforces the capacity of various modalities for providing symptom relief, particularly for those with bladder and/or gait disabilities.