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1. Spectral theory of effective transport for discrete uniaxial polycrystalline materials

Author

Murphy, N. Benjamin, Hallman, Daniel, Cherkaev, Elena, and Golden, Kenneth M.

Subjects
Mathematical Physics, Condensed Matter - Materials Science, Mathematics - Functional Analysis, Mathematics - Numerical Analysis, Physics - Applied Physics
Abstract

We previously demonstrated that the bulk transport coefficients of uniaxial polycrystalline materials, including electrical and thermal conductivity, diffusivity, complex permittivity, and magnetic permeability, have Stieltjes integral representations involving spectral measures of self-adjoint random operators. The integral representations follow from resolvent representations of physical fields involving these self-adjoint operators, such as the electric field $\boldsymbol{E}$ and current density $\boldsymbol{J}$ associated with conductive media with local conductivity $\boldsymbol{\sigma}$ and resistivity $\boldsymbol{\rho}$ matrices. In this article, we provide a discrete matrix analysis of this mathematical framework which parallels the continuum theory. We show that discretizations of the operators yield real-symmetric random matrices which are composed of projection matrices. We derive discrete resolvent representations for $\boldsymbol{E}$ and $\boldsymbol{J}$ involving the matrices which lead to eigenvector expansions of $\boldsymbol{E}$ and $\boldsymbol{J}$. We derive discrete Stieltjes integral representations for the components of the effective conductivity and resistivity matrices, $\boldsymbol{\sigma}^*$ and $\boldsymbol{\rho}^*$, involving spectral measures for the real-symmetric random matrices, which are given explicitly in terms of their real eigenvalues and orthonormal eigenvectors. We provide a projection method that uses properties of the projection matrices to show that the spectral measure can be computed by much smaller matrices, which leads to a more efficient and stable numerical algorithm for the computation of bulk transport coefficients and physical fields. We demonstrate this algorithm by numerically computing the spectral measure and current density for model 2D and 3D isotropic polycrystalline media with checkerboard microgeometry.

Published
2024

2. Spectral theory of effective transport for continuous uniaxial polycrystalline materials

Author

Murphy, N. Benjamin, Hallman, Daniel, Cherkaev, Elena, and Golden, Kenneth M.

Subjects
Mathematical Physics, Condensed Matter - Materials Science, Mathematics - Analysis of PDEs, Mathematics - Functional Analysis, Physics - Applied Physics
Abstract

Following seminal work in the early 1980s that established the existence and representations of the homogenized transport coefficients for two phase random media, we develop a mathematical framework that provides Stieltjes integral representations for the bulk transport coefficients for uniaxial polycrystalline materials, involving spectral measures of self-adjoint random operators, which are compositions of non-random and random projection operators. We demonstrate the same mathematical framework also describes two-component composites, with a simple substitution of the random projection operator, making the mathematical descriptions of these two distinct physical systems directly analogous to one another. A detailed analysis establishes the operators arising in each setting are indeed self-adjoint on an $L^2$-type Hilbert space, providing a rigorous foundation to the formal spectral theoretic framework established by Golden and Papanicolaou in 1983. An abstract extension of the Helmholtz theorem also leads to integral representations for the inverses of effective parameters, e.g., effective conductivity and resistivity. An alternate formulation of the effective parameter problem in terms of a Sobolev-type Hilbert space provides a rigorous foundation for an approach first established by Bergman and Milton. We show that the correspondence between the two formulations is a one-to-one isometry. Rigorous bounds that follow from such Stieltjes integrals and partial knowledge about the material geometry are reviewed and validated by numerical calculations of the effective parameters for polycrystalline media.

Published
2024

3. Emoji Attack: A Method for Misleading Judge LLMs in Safety Risk Detection

Author

Wei, Zhipeng, Liu, Yuqi, and Erichson, N. Benjamin

Subjects
Computer Science - Computation and Language, Computer Science - Machine Learning
Abstract

Jailbreaking attacks show how Large Language Models (LLMs) can be tricked into generating harmful outputs using malicious prompts. To prevent these attacks, other LLMs are often used as judges to evaluate the harmfulness of the generated content. However, relying on LLMs as judges can introduce biases into the detection process, which in turn compromises the effectiveness of the evaluation. In this paper, we show that Judge LLMs, like other LLMs, are also affected by token segmentation bias. This bias occurs when tokens are split into smaller sub-tokens, altering their embeddings. This makes it harder for the model to detect harmful content. Specifically, this bias can cause sub-tokens to differ significantly from the original token in the embedding space, leading to incorrect "safe" predictions for harmful content. To exploit this bias in Judge LLMs, we introduce the Emoji Attack -- a method that places emojis within tokens to increase the embedding differences between sub-tokens and their originals. These emojis create new tokens that further distort the token embeddings, exacerbating the bias. To counter the Emoji Attack, we design prompts that help LLMs filter out unusual characters. However, this defense can still be bypassed by using a mix of emojis and other characters. The Emoji Attack can also be combined with existing jailbreaking prompts using few-shot learning, which enables LLMs to generate harmful responses with emojis. These responses are often mistakenly labeled as "safe" by Judge LLMs, allowing the attack to slip through. Our experiments with six state-of-the-art Judge LLMs show that the Emoji Attack allows 25\% of harmful responses to bypass detection by Llama Guard and Llama Guard 2, and up to 75\% by ShieldLM. These results highlight the need for stronger Judge LLMs to address this vulnerability.

Published
2024

4. Elucidating the Design Choice of Probability Paths in Flow Matching for Forecasting

Author

Lim, Soon Hoe, Wang, Yijin, Yu, Annan, Hart, Emma, Mahoney, Michael W., Li, Xiaoye S., and Erichson, N. Benjamin

Subjects
Statistics - Machine Learning, Computer Science - Machine Learning
Abstract

Flow matching has recently emerged as a powerful paradigm for generative modeling and has been extended to probabilistic time series forecasting in latent spaces. However, the impact of the specific choice of probability path model on forecasting performance remains under-explored. In this work, we demonstrate that forecasting spatio-temporal data with flow matching is highly sensitive to the selection of the probability path model. Motivated by this insight, we propose a novel probability path model designed to improve forecasting performance. Our empirical results across various dynamical system benchmarks show that our model achieves faster convergence during training and improved predictive performance compared to existing probability path models. Importantly, our approach is efficient during inference, requiring only a few sampling steps. This makes our proposed model practical for real-world applications and opens new avenues for probabilistic forecasting., Comment: 30 pages

Published
2024

5. Tuning Frequency Bias of State Space Models

Author

Yu, Annan, Lyu, Dongwei, Lim, Soon Hoe, Mahoney, Michael W., and Erichson, N. Benjamin

Subjects
Computer Science - Machine Learning, Statistics - Machine Learning
Abstract

State space models (SSMs) leverage linear, time-invariant (LTI) systems to effectively learn sequences with long-range dependencies. By analyzing the transfer functions of LTI systems, we find that SSMs exhibit an implicit bias toward capturing low-frequency components more effectively than high-frequency ones. This behavior aligns with the broader notion of frequency bias in deep learning model training. We show that the initialization of an SSM assigns it an innate frequency bias and that training the model in a conventional way does not alter this bias. Based on our theory, we propose two mechanisms to tune frequency bias: either by scaling the initialization to tune the inborn frequency bias; or by applying a Sobolev-norm-based filter to adjust the sensitivity of the gradients to high-frequency inputs, which allows us to change the frequency bias via training. Using an image-denoising task, we empirically show that we can strengthen, weaken, or even reverse the frequency bias using both mechanisms. By tuning the frequency bias, we can also improve SSMs' performance on learning long-range sequences, averaging an 88.26% accuracy on the Long-Range Arena (LRA) benchmark tasks.

Published
2024

6. Learning Physics for Unveiling Hidden Earthquake Ground Motions via Conditional Generative Modeling

Author

Ren, Pu, Nakata, Rie, Lacour, Maxime, Naiman, Ilan, Nakata, Nori, Song, Jialin, Bi, Zhengfa, Malik, Osman Asif, Morozov, Dmitriy, Azencot, Omri, Erichson, N. Benjamin, and Mahoney, Michael W.

Subjects
Physics - Geophysics, Computer Science - Artificial Intelligence, Computer Science - Machine Learning
Abstract

Predicting high-fidelity ground motions for future earthquakes is crucial for seismic hazard assessment and infrastructure resilience. Conventional empirical simulations suffer from sparse sensor distribution and geographically localized earthquake locations, while physics-based methods are computationally intensive and require accurate representations of Earth structures and earthquake sources. We propose a novel artificial intelligence (AI) simulator, Conditional Generative Modeling for Ground Motion (CGM-GM), to synthesize high-frequency and spatially continuous earthquake ground motion waveforms. CGM-GM leverages earthquake magnitudes and geographic coordinates of earthquakes and sensors as inputs, learning complex wave physics and Earth heterogeneities, without explicit physics constraints. This is achieved through a probabilistic autoencoder that captures latent distributions in the time-frequency domain and variational sequential models for prior and posterior distributions. We evaluate the performance of CGM-GM using small-magnitude earthquake records from the San Francisco Bay Area, a region with high seismic risks. CGM-GM demonstrates a strong potential for outperforming a state-of-the-art non-ergodic empirical ground motion model and shows great promise in seismology and beyond.

Published
2024

7. WaveCastNet: An AI-enabled Wavefield Forecasting Framework for Earthquake Early Warning

Author

Lyu, Dongwei, Nakata, Rie, Ren, Pu, Mahoney, Michael W., Pitarka, Arben, Nakata, Nori, and Erichson, N. Benjamin

Subjects
Computer Science - Machine Learning, Physics - Geophysics
Abstract

Large earthquakes can be destructive and quickly wreak havoc on a landscape. To mitigate immediate threats, early warning systems have been developed to alert residents, emergency responders, and critical infrastructure operators seconds to a minute before seismic waves arrive. These warnings provide time to take precautions and prevent damage. The success of these systems relies on fast, accurate predictions of ground motion intensities, which is challenging due to the complex physics of earthquakes, wave propagation, and their intricate spatial and temporal interactions. To improve early warning, we propose a novel AI-enabled framework, WaveCastNet, for forecasting ground motions from large earthquakes. WaveCastNet integrates a novel convolutional Long Expressive Memory (ConvLEM) model into a sequence to sequence (seq2seq) forecasting framework to model long-term dependencies and multi-scale patterns in both space and time. WaveCastNet, which shares weights across spatial and temporal dimensions, requires fewer parameters compared to more resource-intensive models like transformers and thus, in turn, reduces inference times. Importantly, WaveCastNet also generalizes better than transformer-based models to different seismic scenarios, including to more rare and critical situations with higher magnitude earthquakes. Our results using simulated data from the San Francisco Bay Area demonstrate the capability to rapidly predict the intensity and timing of destructive ground motions. Importantly, our proposed approach does not require estimating earthquake magnitudes and epicenters, which are prone to errors using conventional approaches; nor does it require empirical ground motion models, which fail to capture strongly heterogeneous wave propagation effects.

Published
2024

8. HOPE for a Robust Parameterization of Long-memory State Space Models

Author

Yu, Annan, Mahoney, Michael W., and Erichson, N. Benjamin

Subjects
Computer Science - Machine Learning, Statistics - Machine Learning
Abstract

State-space models (SSMs) that utilize linear, time-invariant (LTI) systems are known for their effectiveness in learning long sequences. To achieve state-of-the-art performance, an SSM often needs a specifically designed initialization, and the training of state matrices is on a logarithmic scale with a very small learning rate. To understand these choices from a unified perspective, we view SSMs through the lens of Hankel operator theory. Building upon it, we develop a new parameterization scheme, called HOPE, for LTI systems that utilizes Markov parameters within Hankel operators. Our approach helps improve the initialization and training stability, leading to a more robust parameterization. We efficiently implement these innovations by nonuniformly sampling the transfer functions of LTI systems, and they require fewer parameters compared to canonical SSMs. When benchmarked against HiPPO-initialized models such as S4 and S4D, an SSM parameterized by Hankel operators demonstrates improved performance on Long-Range Arena (LRA) tasks. Moreover, our new parameterization endows the SSM with non-decaying memory within a fixed time window, which is empirically corroborated by a sequential CIFAR-10 task with padded noise.

Published
2024

9. Sex 101: A Rapid Review of Research in the United States on the Impacts of College Sexual Health Curricula

Author

Shoshana N. Benjamin, Amy L. Crandall, and Jennifer S. Hirsch

Abstract

Comprehensive sexuality education (CSE) has been shown to have a wide range of positive impacts for K-12 students. Despite its demonstrated benefits, many K-12 students in the USA do not receive CSE. Because of this, college may be an opportune time to teach this information. However, little is known about the impact of CSE in institutions of higher education. To synthesise knowledge about the impacts of college-level sexual health courses in the USA, a review of the topic was conducted. A review searching Ebscohost, ProQuest, PubMed, and Google Scholar was undertaken. Following the search, a second coder reviewed the articles to confirm eligibility. 13 articles, published between 2001 and 2020, met the inclusion criteria and were included in the review. A wide range of outcomes were reported. These included increased health promoting behaviours, less homophobic and judgemental attitudes around sexuality, improved communication and relationships, and increased understanding of sexual violence. College sexual health courses have high potential efficacy to provide CSE and fill gaps in US students' sexual health knowledge. Future research should corroborate the existing outcomes using randomisation and more diverse samples, and examine whether these courses are effective in preventing sexual assault.

Published
2024
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17. Stigma and efficacy beliefs regarding opioid use disorder treatment and naloxone in communities participating in the HEALing Communities Study intervention.

Author

Nicky Lewis, Barry Eggleston, Redonna K Chandler, Dawn Goddard-Eckrich, Jamie E Luster, Dacia D Beard, Emma Rodgers, Rouba Chahine, Philip M Westgate, Shoshana N Benjamin, JaNae Holloway, Thomas Clarke, R Craig Lefebvre, Michael D Stein, Donald W Helme, Jennifer Reynolds, Sharon L Walsh, Darcy Freedman, Nabila El-Bassel, Kara Stephens, Anita Silwal, Michelle Lofwall, Janet E Childerhose, Hilary L Surratt, Brooke N Crockett, Amy L Farmer, James L David, Laura Fanucchi, Judy Harness, Ben Wilburn, Kelli Bursey, Kristin Mattson, Sarah Mann, Rebecca D Jackson, Aimee Shadwick, Katherine Calver, Deborah Chassler, Jennifer Kimball, Nancy Regan, Jeffrey H Samet, Rachel Sword-Cruz, and Michael D Slater

Subjects
Medicine, Science
Abstract

BackgroundThe HEALing Communities Study (HCS) included health campaigns as part of a community-engaged intervention to reduce opioid-related overdose deaths in 67 highly impacted communities across Kentucky, Massachusetts, New York, and Ohio. Five campaigns were developed with community input to provide information on opioid use disorder (OUD) and overdose prevention, reduce stigma, and build demand for evidence-based practices (EBPs). An evaluation examined the recognition of campaign messages about naloxone and whether stigma and efficacy beliefs regarding OUD treatment and naloxone changed in HCS intervention communities.MethodsData were collected through surveys offered on Facebook/Instagram to members of communities participating in the HCS intervention and wait-list control communities.ResultsParticipants in HCS intervention communities reported a reduction in stigma regarding OUD and increased efficacy beliefs regarding naloxone associated with recognition of campaign messages. However, this finding is cautiously interpreted as there was no clear evidence for recognition differences between the treatment/control conditions.ConclusionStudy findings indicate associations between campaign message recognition and positive outcomes. Results also highlight possible challenges concerning evaluations of social media campaigns using conventional evaluation techniques.Trial registrationClinicalTrials.gov NCT04111939.

Published
2024
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18. NoisyMix: Boosting Model Robustness to Common Corruptions

Author

Erichson, N. Benjamin, Lim, Soon Hoe, Xu, Winnie, Utera, Francisco, Cao, Ziang, Mahoney, Michael W., Erichson, N. Benjamin, Lim, Soon Hoe, Xu, Winnie, Utera, Francisco, Cao, Ziang, and Mahoney, Michael W.

Abstract

The robustness of neural networks has become increasingly important in real-world applications where stable and reliable performance is valued over simply achieving high predictive accuracy. To address this, data augmentation techniques have been shown to improve robustness against input perturbations and domain shifts. In this paper, we propose a new training scheme called NoisyMix that leverages noisy augmentations in both input and feature space to improve model robustness and in-domain accuracy. We demonstrate the effectiveness of NoisyMix on several benchmark datasets, including ImageNet-C, ImageNet-R, and ImageNet-P. Additionally, we provide theoretical analysis to better understand the implicit regularization and robustness properties of NoisyMix., QC 20240612

Published
2024

19. There is HOPE to Avoid HiPPOs for Long-memory State Space Models

Author

Yu, Annan, Mahoney, Michael W., Erichson, N. Benjamin, Yu, Annan, Mahoney, Michael W., and Erichson, N. Benjamin

Abstract

State-space models (SSMs) that utilize linear, time-invariant (LTI) systems are known for their effectiveness in learning long sequences. However, these models typically face several challenges: (i) they require specifically designed initializations of the system matrices to achieve state-of-the-art performance, (ii) they require training of state matrices on a logarithmic scale with very small learning rates to prevent instabilities, and (iii) they require the model to have exponentially decaying memory in order to ensure an asymptotically stable LTI system. To address these issues, we view SSMs through the lens of Hankel operator theory, which provides us with a unified theory for the initialization and training of SSMs. Building on this theory, we develop a new parameterization scheme, called HOPE, for LTI systems that utilizes Markov parameters within Hankel operators. This approach allows for random initializations of the LTI systems and helps to improve training stability, while also provides the SSMs with non-decaying memory capabilities. Our model efficiently implements these innovations by nonuniformly sampling the transfer functions of LTI systems, and it requires fewer parameters compared to canonical SSMs. When benchmarked against HiPPO-initialized models such as S4 and S4D, an SSM parameterized by Hankel operators demonstrates improved performance on Long-Range Arena (LRA) tasks. Moreover, we use a sequential CIFAR-10 task with padded noise to empirically corroborate our SSM's long memory capacity.

Published
2024

20. Homogenization for convection-enhanced thermal transport in sea ice.

Author

Kraitzman, Noa, Hardenbrook, Rebecca, Dinh, Huy, Murphy, N. Benjamin, Cherkaev, Elena, Zhu, Jingyi, and Golden, Kenneth M.

Subjects
CLIMATE change models, STIELTJES integrals, CONVECTIVE flow, THERMAL conductivity, FLUID flow
Abstract

Sea ice regulates heat exchange between the ocean and atmosphere in Earth's polar regions. The thermal conductivity of sea ice governs this exchange, and is a key parameter in climate modelling. However, it is challenging to measure and predict due to its sensitive dependence on temperature, salinity and brine microstructure. Moreover, as temperature increases, sea ice becomes permeable, and fluid can flow through the porous microstructure. While models for thermal diffusion through sea ice have been obtained, advective contributions to transport have not been considered theoretically. Here, we homogenize a multiscale advection–diffusion equation that models thermal transport through porous sea ice when fluid flow is present. We consider two-dimensional models of convective flow and use an integral representation to derive bounds on the thermal conductivity as a function of the Péclet number. These bounds guarantee enhancement in the thermal conductivity due to the added flow. Further, we relate the Péclet number to temperature, making these bounds useful for global climate models. Our analytic approach offers a mathematical theory which can not only improve predictions of atmosphere–ice–ocean heat exchanges in climate models, but can provide a theoretical framework for a range of problems involving advection–diffusion processes in various fields of application. [ABSTRACT FROM AUTHOR]

Published
2024
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21. The Home : Words, Interpretations, Meanings and Environments

Author

David N. Benjamin and David N. Benjamin

Subjects
HQ639
Abstract

Originally published in 1995, as part of the Ethnoscapes: Current Challenges in the Environmental Social Sciences series, reissued now with a new series introduction, The Home: Words, Interpretations, Meanings and Environments, written by by leading theorists and empirical researchers offers an interdisciplinary and multi-cultural spectrum of viewpoints on the study of the home concept. Among the disciplines covered are environment-behaviour research, anthropology, geography, archaeology, architecture, political science, and linguistics-place name research.The authors in this volume focus on refining our concepts of home, our knowledge of the uses of home, and the relationship of home to the study of cultural interpretation. In so doing, they inspire our thinking on the following themes: the struggle to maintain cultural continuity in the face of socio-political change, and the attempts to humanize the present and future built environment.This volume will be interesting to all scholars of cultural interpretation, geographers, and architects, and at the same time useful in graduate studies courses in environmental social sciences and environmental design as reference and source of cutting-edge case studies.

Published
2024

22. Genome-wide transcription response of Staphylococcus epidermidis to heat shock and medically relevant glucose levels

Author

Kaisha N. Benjamin, Aditi Goyal, Ramesh V. Nair, and Drew Endy

Subjects
Staphylococcus epidermidis, skin, transcriptomics, glucose, diabetes, heat-shock, Microbiology, QR1-502
Abstract

Skin serves as both barrier and interface between body and environment. Skin microbes are intermediaries evolved to respond, transduce, or act in response to changing environmental or physiological conditions. We quantified genome-wide changes in gene expression levels for one abundant skin commensal, Staphylococcus epidermidis, in response to an internal physiological signal, glucose levels, and an external environmental signal, temperature. We found 85 of 2,354 genes change up to ~34-fold in response to medically relevant changes in glucose concentration (0–17 mM; adj p ≤0.05). We observed carbon catabolite repression in response to a range of glucose spikes, as well as upregulation of genes involved in glucose utilization in response to persistent glucose. We observed 366 differentially expressed genes in response to a physiologically relevant change in temperature (37–45°C; adj p ≤ 0.05) and an S. epidermidis heat-shock response that mostly resembles the heat-shock response of related staphylococcal species. DNA motif analysis revealed CtsR and CIRCE operator sequences arranged in tandem upstream of dnaK and groESL operons. We identified and curated 38 glucose-responsive genes as candidate ON or OFF switches for use in controlling synthetic genetic systems. Such systems might be used to instrument the in-situ skin microbiome or help control microbes bioengineered to serve as embedded diagnostics, monitoring, or treatment platforms.

Published
2024
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23. Association between right heart size and right ventricular output reserve in patients with pulmonary arterial hypertension.

Author

Egenlauf B, Weinstock KF, Marra AM, Eichstaedt CA, Harutyunova S, Grünig E, Xanthouli P, and Benjamin N

Subjects
Humans, Female, Male, Middle Aged, Retrospective Studies, Aged, Cross-Sectional Studies, Adult, Heart Ventricles diagnostic imaging, Heart Ventricles physiopathology, Echocardiography methods, Cardiac Catheterization, Organ Size, Hypertension, Pulmonary physiopathology, Hypertension, Pulmonary diagnostic imaging, Exercise Test methods, Cardiac Output physiology, Pulmonary Arterial Hypertension physiopathology, Pulmonary Arterial Hypertension diagnostic imaging, Ventricular Function, Right physiology
Abstract

Objectives: Right ventricular (RV) output reserve, defined as increase of cardiac output during exercise, is reduced in patients with pulmonary arterial hypertension (PAH). Aim of this study was to evaluate the association of right heart size measured by echocardiography and invasively measured RV function at rest and during exercise in PAH patients., Methods: Adult PAH-patients who received routine haemodynamic assessment at rest and during exercise by right heart catheterisation and echocardiographic measurement of right heart size (right atrial (RA) and RV area) were included in this study. Clinical, echocardiographic, laboratory, exercise and invasive haemodynamic parameters were retrospectively analysed. The primary endpoint was to assess the association between right heart size and right ventricular function., Results: Data from 215 PAH patients (age 58.9 ± 15.9 years, 63.3% female, 62.2% double or triple combination treatment) were analysed in this cross-sectional study. Cardiac index was significantly lower for patients with enlarged RA-area > 18 cm 2 at rest, and at 25 and 50 W (all p < 0.001) and for patients with enlarged RV area > 20 cm 2 at rest, 25, 50 and 75 W (all p < 0.001). Furthermore, pulmonary vascular resistance and mPAP/CO slope (all p < 0.001) were significantly higher and pulmonary arterial compliance (all p < 0.05) was significantly lower in patients with enlarged RA or RV area. RA and RV area correlated with TAPSE/sPAP (both p < 0.001, R - 0.570 and - 0.530)., Conclusion: This study could underline that an enlargement of RA- and RV-area is associated with an impaired RV function at rest and during exercise in patients with PAH., Competing Interests: Declaration of competing interest BE: received travel fees, consulting fees, speaking fees, and/or honoraria from Janssen, MSD, Bayer and OMT, outside the submitted work. KFW, AMM: nothing to declare. CAE: received speaking fees from MSD outside the submitted work. SH: received honoraria for lectures, consultancy, or both from Actelion, AOP, Bayer/MSD, GSK, Novartis, OMT, Pfizer, and United Therapeutics out-side the submitted work. EG: has received grants and personal fees from Actelion, Bayer AG, and MSD; grants from GSK, Novartis, and United Therapeutics and personal fees from SCOPE, OrPha Swiss GmbH, and Zurich Heart House, outside the submitted work. PX: has received personal fees from MSD and OMT outside the submitted work. NB: received speaker fees from University Hospital Zurich and AOP., (Copyright © 2024. Published by Elsevier B.V.)

Published
2024
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24. Service guidelines, models, and protocols for integrating rehabilitation services in primary healthcare in Brazil, Russia, India, China, and South Africa: a scoping review.

Author

Maseko L, Myezwa H, Benjamin-Damons N, Franzsen D, and Adams F

Subjects
Humans, South Africa, China, Russia, India, Brazil, Rehabilitation, Practice Guidelines as Topic, Primary Health Care, Delivery of Health Care, Integrated
Abstract

Purpose: The WHO emphasises that rehabilitation services must be integrated into primary healthcare as an inherent part of universal health coverage. However, there is limited research on the integration of rehabilitation services in primary healthcare in low- and middle-income countries. The purpose of this paper is to identify and describe the literature on service guidelines, models, and protocols that support the integration of rehabilitation services in primary healthcare in the BRICS countries (Brazil, Russia, India, China, and South Africa)., Methods: A scoping review guided by Arksey and O'Malley's framework was conducted. Structured database and website searches identified published and unpublished records from 2010, which were subjected to eligibility criteria. Mendeley, JBI SUMARI, and Microsoft Excel were used to extract and synthesise the data., Results: The search strategy identified 542 records. Thirty-two records met the inclusion criteria. Shared care and community-based rehabilitation were the most reported practice models, and the implementation of the models, guidelines, and protocols was mostly described in mental health services., Conclusion: This review discusses BRICS countries' rehabilitation service guidelines, models, and protocols for primary healthcare integration and implementation challenges. Rehabilitation professionals should rethink, realign, and apply existing models because of the lack of primary healthcare integration directives.

Published
2024
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25. Long-term oxygen therapy in precapillary pulmonary hypertension - SOPHA study.

Author

Benjamin N, Echampati I, Harutyunova S, Eichstaedt CA, Egenlauf B, Ulrich S, Grünig E, and Xanthouli P

Subjects
Humans, Female, Male, Aged, Middle Aged, Prospective Studies, Oxygen, Hemodynamics, Treatment Outcome, Exercise Tolerance, Walk Test, Hypertension, Pulmonary therapy, Hypertension, Pulmonary physiopathology, Oxygen Inhalation Therapy methods
Abstract

Current guidelines recommend oxygen (O 2 ) supplementation in patients with pulmonary hypertension (PH), despite scarce data on long-term O 2 therapy (LTOT). The aim of this prospective, randomized, controlled trial was to investigate the effect of LTOT in patients with precapillary PH on exercise capacity, clinical parameters and hemodynamics. Patients with precapillary PH under stable therapy and O 2 desaturations at rest and/or during exercise were randomized to receive LTOT (≥ 16 h/day) or no O 2 (control group) for 12 weeks. The control group was offered LTOT after 12 weeks. The primary endpoint changes of 6-minute walking distance (6MWD) from baseline to 12 weeks was hierarchically tested: (1) pre-post primary and secondary intervention (2) intervention vs. control group. Secondary endpoints included changes in clinical parameters. Twenty patients were randomized (women n = 14, age 67 ± 11.4 years, mean pulmonary arterial pressure 39.7 ± 12.5 mmHg, 70% functional class III). 6MWD significantly improved by 42.2 ± 34.20 m (p = 0.003) within 12 weeks LTOT. The intervention group significantly improved in 6MWD (38.9 ± 33.87 m) compared to the control group (- 12.3 ± 21.83 m, p = 0.015). No consistent between-group differences in other parameters were found. LTOT was well tolerated and led to significant improvement of 6MWD. The effect of LTOT should be investigated in larger controlled-trials., (© 2024. The Author(s).)

Published
2024
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26. An uncommon cause of a common disease: a case report of a rare cause of hypertension.

Author

Rao S, Rao R, Kumar A, Benjamin N, and Pandey A

Abstract

Background: Severe hypertension in young patients presents a significant diagnostic dilemma, and treatment can often be codified. Therefore, it is crucial to diagnose these cases for probable secondary hypertension. Common causes of secondary hypertension include large vessel vasculitis, renal artery stenosis, coarctation of the aorta, and endocrine disorders., Case Summary: A 23-year-old Asian male, who was previously in good health, presented with symptoms of chest pain, shortness of breath on exertion grade II, and generalized weakness. On examination, his blood pressure was markedly elevated at 200/110 mmHg. Diagnostic investigations revealed significant vascular involvement, including bilateral renal artery stenosis accompanied by aneurysm formation, celiac trunk disease, and osteal stenosis of the superior mesenteric artery. The patient underwent successful interventional procedure, including renal angioplasty, stenting, and aneurysm coiling. This was followed by tailoring of medical management along with anti-inflammatory and disease-modifying drugs., Discussion: The diagnosis of Takayasu arteritis (TAK) in this case is supported by the patients' age, presentation, and imaging according to the new TAK classification criteria by the American College of Rheumatology/European League Against Rheumatism (EULAR) and emphasizes the potential benefits of a pharmaco-invasive approach for optimal outcomes., Competing Interests: Conflict of interest: None declared., (© The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology.)

Published
2024
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27. Effect of ambrisentan in patients with systemic sclerosis and mild pulmonary arterial hypertension: long-term follow-up data from EDITA study.

Author

Xanthouli P, Uesbeck P, Lorenz HM, Blank N, Eichstaedt CA, Harutyunova S, Egenlauf B, Coghlan JG, Denton CP, Grünig E, and Benjamin N

Subjects
Humans, Female, Male, Middle Aged, Follow-Up Studies, Adult, Aged, Treatment Outcome, Pulmonary Arterial Hypertension drug therapy, Pulmonary Arterial Hypertension physiopathology, Hypertension, Pulmonary drug therapy, Hypertension, Pulmonary physiopathology, Scleroderma, Systemic drug therapy, Scleroderma, Systemic complications, Phenylpropionates therapeutic use, Pyridazines therapeutic use, Antihypertensive Agents therapeutic use
Abstract

Background: In the EDITA trial, patients with systemic sclerosis (SSc) and mild pulmonary vascular disease (PVD) treated with ambrisentan had a significant decline of pulmonary vascular resistance (PVR) but not of mean pulmonary arterial pressure (mPAP) vs. placebo after six months. The EDITA-ON study aimed to assess long-term effects of open label therapy with ambrisentan vs. no pulmonary arterial hypertension (PAH) therapy., Methods: Patients who participated in the EDITA study and received regular follow-up were included in EDITA-ON. Clinical, echocardiographic, laboratory, exercise and hemodynamic parameters during follow-up were analysed. The primary endpoint was to assess whether continued treatment with ambrisentan vs. no treatment prevented the development of PAH according to the new definition., Results: Of 38 SSc patients included in the EDITA study four were lost to follow-up. Of the 34 remaining patients (age 55 ± 11 years, 82.1% female subjects), 19 received ambrisentan after termination of the blinded phase, 15 received no PAH medication. The mean follow-up time was 2.59 ± 1.47 years, during which 29 patients underwent right heart catheterization. There was a significant improvement of mPAP in catheterised patients receiving ambrisentan vs. no PAH treatment (-1.53 ± 2.53 vs. 1.91 ± 2.98 mmHg, p = 0.003). In patients without PAH treatment 6/12 patients had PAH vs. 1/17 of patients receiving ambrisentan (p < 0.0001)., Conclusion: In SSc patients with early PVD, the development of PAH and/or deterioration was less frequent among patients receiving ambrisentan, indicating that early treatment and close follow-up could be beneficial in this high-risk group. Future trials in this field are needed to confirm these results., (© 2024. The Author(s).)

Published
2024
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28. Oral Health Status, Dietary Intake, and Oral Health-related Quality of Life among Institutionalized Elderly in Bangalore.

Author

Rani V, Benjamin N, Abhilash A, Bhasin M, Bhamare R, and Sinha S

Abstract

Objective: The study aimed to evaluate the association between dietary intake and oral health status and how oral health-related quality of life (OHQoL) influences the institutionalized elderly population of Bangalore., Methods and Materials: A cross-sectional study was conducted to appraise the oral health and dietary intake of institutionalized elderly. Patients completed a validated questionnaire and a clinical evaluation. CPI index, loss of attachment (LoA), DMFT, prosthetic status, and prosthetic necessity were utilized to contrast OHQoL using the Chi-square test. The diet and OHQoL were compared using ANOVA., Results: This study surveyed 400 institutionalized elderly populations. The average age of the sample was 70.02 ± 8.149 years. LoA and DMFT were significantly associated with GOHAI's functional domain ( P = 0.000). CPI ( P = 0.049) and DMFT index ( P = 0.003) were associated with GOHAI pain/discomfort and psycho-social domains. The psycho-social domain was associated with an upper arch prosthesis status ( P = 0.010). Subjects with good OHQoL consumed 1961.19 ± 479.33 calories, while those with poor OHQoL consumed 1814 ± 432.41 calories ( P = 0.002)., Conclusion: According to the study findings, periodontal disease, decay, and missing teeth impaired OHQoL. The OHQoL was significantly declined with dietary intake., Competing Interests: There are no conflicts of interest., (Copyright: © 2024 Journal of Pharmacy and Bioallied Sciences.)

Published
2024
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29. Comparative Evaluation of Fracture Resistance of Composite Core Buildup Materials: An In Vitro Study.

Author

Pande D, Benjamin N, Rani V, Hina M, Haldar S, Nirmal H, Gole S, and Ali MS

Abstract

Aim This study aimed to compare the fracture resistance of different materials used in composite core buildups, including conventional filler composite, nanofiller composite, and short fiber-reinforced composite (SFRC). Methods This in vitro study was conducted on 30 freshly extracted premolars. The teeth were treated using a uniform endodontic procedure, and Fiber Posts (REFORPOST, Angelus) were placed. The teeth were then divided into three groups and restored using different materials. Group 1 was restored using SFRC (everX Posterior, GC, Europe), Group 2 using microfiller composite (Te-Econom Flow, Ivoclar Vivadent), and Group 3 using nanofiller composite (Tetric N-Flow, Ivoclar Vivadent). The restoration materials were then light-cured for 40 seconds. The teeth were placed in a Universal Testing Machine (Instron) and a load was applied with a stainless-steel ball (4 mm diameter) until the tooth fractured. The fracture load for each tooth was recorded, and after the mechanical test, the experimental groups were examined for failure modes. Statistical analysis was performed using SPSS version 21.0 software. A one-way ANOVA test was conducted to compare more than two groups, followed by Tukey's test for post hoc pairwise comparison. Results The mean fracture resistance of the microfiller composite (346.94±44.63) was the lowest among the three groups. When analyzed using Tukey's test at p<0.05, fracture resistance was significantly higher in the SFRC, followed by nanofillers and microfiller composites. Conclusion Due to the increasing demand for aesthetic restorations in recent years, composites have become important in modern restorative dentistry. The development and implementation of composite dental restorative materials rely on a comprehensive understanding of each composite component and consideration of methods for modifying each component. As a result, the findings of this study will be beneficial in determining which material to use based on specific cases., Competing Interests: Human subjects: All authors have confirmed that this study did not involve human participants or tissue. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Pande et al.)

Published
2024
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30. Positive Vasoreactivity Testing in Pulmonary Arterial Hypertension: Therapeutic Consequences, Treatment Patterns, and Outcomes in the Modern Management Era.

Author

Gerhardt F, Fiessler E, Olsson KM, Kayser MZ, Kovacs G, Gall H, Ghofrani HA, Badr Eslam R, Lang IM, Benjamin N, Grünig E, Halank M, Lange TJ, Ulrich S, Leuchte H, Held M, Klose H, Ewert R, Wilkens H, Pizarro C, Skowasch D, Wissmüller M, Hellmich M, Olschewski H, Hoeper MM, and Rosenkranz S

Subjects
Humans, Female, Male, Middle Aged, Retrospective Studies, Treatment Outcome, Pulmonary Artery physiopathology, Pulmonary Artery drug effects, Adult, Aged, Antihypertensive Agents therapeutic use, Cardiac Catheterization, Pulmonary Arterial Hypertension drug therapy, Pulmonary Arterial Hypertension physiopathology, Pulmonary Arterial Hypertension diagnosis, Pulmonary Arterial Hypertension mortality, Calcium Channel Blockers therapeutic use
Abstract

Background: Among patients with pulmonary arterial hypertension (PAH), acute vasoreactivity testing during right heart catheterization may identify acute vasoresponders, for whom treatment with high-dose calcium channel blockers (CCBs) is recommended. However, long-term outcomes in the current era remain largely unknown. We sought to evaluate the implications of acute vasoreactivity response for long-term response to CCBs and other outcomes., Methods: Patients diagnosed with PAH between January 1999 and December 2018 at 15 pulmonary hypertension centers were included and analyzed retrospectively. In accordance with current guidelines, acute vasoreactivity response was defined by a decrease of mean pulmonary artery pressure by ≥10 mm Hg to reach <40 mm Hg, without a decrease in cardiac output. Long-term response to CCBs was defined as alive with unchanged initial CCB therapy with or without other initial PAH therapy and World Health Organization functional class I/II and/or low European Society of Cardiology/European Respiratory Society risk status at 12 months after initiation of CCBs. Patients were followed for up to 5 years; clinical measures, outcome, and subsequent treatment patterns were captured., Results: Of 3702 patients undergoing right heart catheterization for PAH diagnosis, 2051 had idiopathic, heritable, or drug-induced PAH, of whom 1904 (92.8%) underwent acute vasoreactivity testing. A total of 162 patients fulfilled acute vasoreactivity response criteria and received an initial CCB alone (n=123) or in combination with another PAH therapy (n=39). The median follow-up time was 60.0 months (interquartile range, 30.8-60.0), during which overall survival was 86.7%. At 12 months, 53.2% remained on CCB monotherapy, 14.7% on initial CCB plus another initial PAH therapy, and the remaining patients had the CCB withdrawn and/or PAH therapy added. CCB long-term response was found in 54.3% of patients. Five-year survival was 98.5% in long-term responders versus 73.0% in nonresponders. In addition to established vasodilator responder criteria, pulmonary artery compliance at acute vasoreactivity testing, low risk status and NT-proBNP (N-terminal pro-B-type natriuretic peptide) levels at early follow-up correlated with long-term response and predicted survival., Conclusions: Our data display heterogeneity within the group of vasoresponders, with a large subset failing to show a sustained satisfactory clinical response to CCBs. This highlights the necessity for comprehensive reassessment during early follow-up. The use of pulmonary artery compliance in addition to current measures may better identify those likely to have a good long-term response., Competing Interests: Disclosures Dr Gerhardt reports remuneration for lectures from Actelion, Bayer, Janssen, and MSD, and grants to the institution from Actelion, Bayer, and Janssen. E. Fiessler reports no disclosures. Dr Olsson reports fees for lectures or consultations from Acceleron, Actelion, Bayer, Janssen, United Therapeutics, MSD, GSK, and Pfizer. Dr Kayser reports no disclosures. Dr Kovacs reports personal fees for lectures or consultancy from Actelion, Bayer, GSK, MSD, Novartis, Pfizer, Chiesi, and Boehringer-Ingelheim. Dr Gall reports fees for lectures or consultancy from Actelion, AstraZeneca, Bayer, BMS, GSK, Janssen-Cilag, Lilly, MSD, Novartis, OMT, Pfizer, and United Therapeutics. Dr Ghofrani reports personal fees and consultancy fees from Actelion, Bayer, GlaxoSmithKline, Novartis, and Pfizer; other from Bellerophon Pulse Technologies; and consultancy fees from MSD. Dr Eslam reports no disclosures. Dr Lang reports remuneration for lectures or consultancy from Actelion, AOP Orphan, AstraZeneca, Bayer-Schering, Cordis, Daiichi-Sankyo, Ferrer, Neutrolis, Janssen, and United Therapeutics. N. Benjamin reports fees for lectures from Actelion, Bayer, MSD, and Janssen. Dr Grünig reports fees for lectures or consultations from Actelion, Bayer, GSK, Janssen, MSD, Pfizer, and United Therapeutics. Dr Halank reports remuneration for consultancy or lectures from Acceleron, Actelion, AstraZeneca, Bayer, BerlinChemie, GSK, Janssen, MSD, and Novartis. Dr Lange reports personal fees for lectures or consultancy from Acceleron Pharma, Actelion, Bayer, GSK, Janssen-Cilag, MSD, Pfizer, and United Therapeutics; and grants to the institution from Acceleron Pharma, Actelion, Bayer, Bellerophon, Gilead, Janssen-Cilag, Pfizer, and United Therapeutics. Dr Ulrich reports grants from Swiss National Science Foundation, Zurich Lung, Swiss Lung, and Orpha Swiss; and grants and personal fees from Actelion, Johnson & Johnson, and MSD. Dr Leuchte reports fees for lectures or consultancy from Actelion, Bayer, GSK, Merck, and Pfizer. Dr Held reports personal fees for lectures or consultancy from Actelion, AstraZeneca, Bayer, Berlin Chemie, Boehringer, GSK, Janssen, MSD, Novartis, OMT, Pfizer, and United Therapeutics. Dr Klose reports speaker or consultancy fees from Actelion, Bayer, Berlin Chemie, GSK, MSD, Novartis, Pfizer, and United Therapeutics. Dr Ewert reports lecture fees from Actelion, AstraZeneca, Bayer, and OMT; and industry-sponsored grants from Actelion and OMT. Dr Wilkens reports personal fees from Actelion, Bayer, Biotest, Boehringer, GSK, Pfizer, and Roche. Dr Pizarro reports honoraria for lectures from Actelion and Janssen. Dr Skowasch reports honoraria for lectures and consultancy from Actelion and Janssen. Dr Wissmüller reports remunerations for lectures from Janssen. Dr Hellmich reports no disclosures. Dr Olschewski reports remuneration for lectures or consultancy or grants to the institution from Actelion, Bayer, Belerophon, Boehringer, GSK, Inventiva, Janssen, Menarini, MSD, Novartis, Pfizer, and Roche. Dr Hoeper reports fees for consultations or lectures from Acceleron, Actelion, Bayer, Janssen, MSD, and Pfizer. Dr Rosenkranz reports remuneration for lectures or consultancy from Abbott, Acceleron, Actelion, Aerovate, Altavant, AOP, AstraZeneca, Bayer, BMS, Boehringer-Ingelheim, Edwards, Ferrer, Gossamer, Janssen, MSD, OMT, Pfizer, United Therapeutics, and Vifor; and grants to the institution from Actelion, AstraZeneca, Bayer, and Janssen.

Published
2024
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31. GAD2 Is a Highly Specific Marker for Neuroendocrine Neoplasms of the Pancreas.

Author

Lennartz M, Benjamin Dünnebier N, Höflmayer D, Dwertmann Rico S, Kind S, Reiswich V, Viehweger F, Lutz F, Fraune C, Gorbokon N, Luebke AM, Hube-Magg C, Büscheck F, Menz A, Uhlig R, Krech T, Hinsch A, Burandt E, Sauter G, Simon R, Kluth M, Steurer S, Marx AH, Lebok P, Dum D, Minner S, Jacobsen F, Clauditz TS, and Bernreuther C

Subjects
Humans, Biomarkers, Tumor metabolism, Pancreas pathology, Pancreatic Neoplasms diagnosis, Pancreatic Neoplasms pathology, Neuroendocrine Tumors diagnosis, Neuroendocrine Tumors pathology, Carcinoma, Neuroendocrine, Glutamate Decarboxylase
Abstract

Glutamate decarboxylase 2 (GAD2) is the most important inhibitory neurotransmitter and plays a role in insulin-producing β cells of pancreatic islets. The limitation of GAD2 expression to a few normal cell types makes GAD2 a potential immunohistochemical diagnostic marker. To evaluate the diagnostic utility of GAD2 immunohistochemistry, a tissue microarray containing 19,202 samples from 152 different tumor entities and 608 samples of 76 different normal tissue types was analyzed. In normal tissues, GAD2 staining was restricted to brain and pancreatic islet cells. GAD2 staining was seen in 20 (13.2%) of 152 tumor categories, including 5 (3.3%) tumor categories containing at least 1 strongly positive case. GAD2 immunostaining was most commonly seen in neuroendocrine carcinomas (58.3%) and neuroendocrine tumors (63.2%) of the pancreas, followed by granular cell tumors (37.0%) and neuroendocrine tumors of the lung (11.1%). GAD2 was only occasionally (<10% of cases) seen in 16 other tumor entities including paraganglioma, medullary thyroid carcinoma, and small cell neuroendocrine carcinoma of the urinary bladder. Data on GAD2 and progesterone receptor (PR) expression (from a previous study) were available for 95 pancreatic and 380 extrapancreatic neuroendocrine neoplasms. For determining a pancreatic origin of a neuroendocrine neoplasm, the sensitivity of GAD2 was 64.2% and specificity 96.3%, while the sensitivity of PR was 56.8% and specificity 92.6%. The combination of PR and GAD2 increased both sensitivity and specificity. GAD2 immunohistochemistry is a highly useful diagnostic tool for the identification of pancreatic origin in case of neuroendocrine neoplasms with unknown site of origin., Competing Interests: Conflicts of Interest and Source of Funding: The antibodies against GAD2 (MSVA-602M), insulin (HMV-308), and c-peptide (HMV-363) were provided by MS Validated Antibodies GmbH (owned by a family member of G.S.). For the remaining authors none were declared., (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc.)

Published
2024
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32. Oral Healthcare Utilization Factors Shaping the Perceived Oral Health Outcome Among Gond Tribes of Chhattisgarh: A Cross-Sectional Study Based on Andersen's Behavioral Model.

Author

Benjamin N, Rani V, Sushma B, Sharma R, Purushottam Burile A, and Chatterjee E

Abstract

Introduction: The Gonds are a highly ancient and expansive tribal community, ranking among the largest in the world. A review of the literature has suggested that they are more vulnerable to oral diseases and are less inclined to utilize oral health services due to the comprehensive approach that considers the socioeconomic, cultural, and structural factors affecting the Gond community's access to oral health services. Tribal health requires action in the health sector. Utilization is an essential marker of the health status of any population and is necessary to bridge the gap between tribes and the wider portion of the community. Hence, this study was conducted among the Gond tribes of Chhattisgarh to evaluate the oral healthcare utilization factors shaping the perceived oral health outcome using Andersen's behavior model., Materials and Methods: This cross-sectional study was carried out among 400 Gond tribes residing in villages of Chhattisgarh. Data was collected through a standardized questionnaire, adapted from Andersen's behavioral model of healthcare utilization during house-to-house survey. The questionnaire included predisposing, enabling, perceived, and evaluated need factors. Oral health status for evaluated need was assessed using the World Health Organization (WHO) Oral Health Assessment form (1997), and the perceived oral health outcome was measured using Oral Health Impact Profile-14 (OHIP-14). Results were computed using descriptive statistics, chi-square test, and one-way analysis of variance (ANOVA). Multivariate analysis was done using binomial logistic regression., Results: The dental visit in the past one year was only 14%. The findings of logistic regression revealed that the perceived oral health outcome was significantly associated with age, occupation, and positive belief in the efficacy of dentist, perceived need, and presence of dental caries., Conclusion: The findings of the present study support Andersen's behavioral model and suggest that there is an interrelationship of predisposing characters, predisposing health beliefs, and enabling need factors that determine the likelihood of use of services, which in turn determines the good or bad oral health outcome., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Benjamin et al.)

Published
2024
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33. Respiratory involvement in connective tissue diseases.

Author

Xanthouli P, Echampati I, Lorenz HM, Heussel CP, and Benjamin N

Subjects
Humans, Lung, Connective Tissue Diseases complications, Lung Diseases, Interstitial etiology, Hypertension, Pulmonary complications, Autoimmune Diseases complications, Rheumatic Diseases complications
Abstract

Pulmonary involvement is doubtless one the most fatal organ manifestations of the autoimmune rheumatic diseases (ARD) and involves the parenchyma, the vessels, the respiratory system itself, but also the muscles and the pleura. Close and regular screening assessments, identification of risk factors, clinical signs associated with the existence of lung disease should alarm the involved physicians treating these patients. The accurate classification is essential, as different treatment options are nowadays available. Pulmonary manifestations of ARD will be analyzed in this review article with special emphasis on interstitial lung disease and pulmonary hypertension., Competing Interests: Declaration of Competing Interest PX has received personal fees from MSD, Astra Zeneca and Boehringer Ingelheim outside the submitted work. CPH has received personal fees from Schering Plough, Pfizer, Basilea, Boehringer Ingelheim, Novartis, Roche, Astellas, Gilead, MSD, Lilly, Intermune, Fresenius; research funding from Siemens, Pfizer, MeVis, Boehringer Ingelheim, German Center for Lung Research; Lecture fees from Gilead, Essex, Schering-Plough, Astra Zeneca, Lilly, Roche, MSD, Pfizer, Bracco, MEDA Pharma, Intermune, Chiesi, Siemens, Covidien, Pierre Fabre, Boehringer Ingelheim, Grifols, Novartis, Basilea and Bayer outside the submitted work. IE and NB declare they have no conflict of interest. HML: has received consulting fees, speaking fees and/or honoraria and unallocated funds for scientific talks and consultations from Abbvie, Astra-Zeneca, Actelion, Alexion, Amgen, Bayer Vital, Baxter, Biogen, Boehringer Ingelheim, BMS, Celgene, Fresenius, Genzyme, GSK, Gilead/Galapagos, Hexal, Janssen-Cilag, Lilly, Medac, MSD, Mundipharm, Mylan, Novartis, octapharm, Pfizer, Roche/Chugai, Sandoz, Sanofi, Shire, SOBI, Thermo Fisher, UCB outside the submitted work., (Copyright © 2023 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.)

Published
2024
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