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Objective: The Automated Neuropsychological Assessment Metrics (ANAM) is a computerized cognitive test system used extensively with military service members. The aim of this study was to develop a nationally representative normative dataset of Army National Guard (ARNG) personnel and to explore potential relationships between ANAM performances and select military service, demographic, and health factors., Methods: ANAM performance data were collected using standardized procedures from a representative sample of ARNG service members in six U.S. states. Normative performance values, stratified by age, sex, and military occupational category, were calculated for each ANAM subtest and descriptive measures were computed, along with base rates of below-average performance. The effect of demographic (e.g., age, sex, education, race) and military service and health factors (e.g., deployment, job category, history of head injury) was examined., Results: Data from 1,436 ARNG service members (14.3% female) were analyzed, and normative values calculated. Overall, differences in ANAM performance based on demographic, military service, and health factors were small. A total of 8.9% of the sample had scores on two or more subtests that were ≥ 1.3 SD below the mean; this dropped to 1.9% using a more stringent cut point (≥2 SD below the mean)., Conclusion: The ANAM normative data reported herein ensure that healthcare providers and researchers have access to reference data that more accurately reflect the larger population of ARNG service members. These data support the assessment and management of ARNG service members' health, as well as future ANAM research involving ARNG service members., (Published by Oxford University Press 2024.)

Background: Personal Protective Equipment (PPE) Portraits is a hybridized art and medical intervention that lessens the alienating appearance of PPE through wearable, smiling headshot pictures. During the pandemic, the use of these portraits was expanded, but Canadian initiatives offered portraits only to immediate stakeholders. PPE Portraits Canada (PPC) aimed to provide PPE portraits to any Canadian healthcare institution and surveyed healthcare workers (HCW) regarding these portraits' impact., Methods: University student volunteers founded PPC via online platforms and coast-to-coast collaborations that allowed any HCW nationwide to request a free portrait via an accessible online form. PPC has gathered feedback from participating HCWs directly via an anonymous and bilingual survey., Results: 70% of HCWs wore their portraits "always" or "usually", 69% of HCWs "definitely would" recommend their portrait, 89.5% of HCWs found that the PPE portraits made a difference in their experiences with patients and 74% found the same for their colleagues. The pre- and post-effect of the portraits, led to a 37.5% greater likelihood that HCWs felt "connected" or "very connected" to patients/residents. For the thematic analysis, 70% or more of the comments were rated as positive, with less than 5% of comments being rated as negative., Conclusion: This model's logistical framework can be expanded beyond PPE portraits to other initiatives with limited resources, allowing them to reach and positively impact diverse populations. HCW feedback was predominantly positive. The optimal design and impact of PPE portraits on patients and HCWs should be studied further to improve portrait adoption., Competing Interests: This paper mentions several softwares and programs utilized by the authors and the PPE Portraits Canada organizing team. Both parties have benefitted from non-profit or COVID-19 response discounts and/or free premium subscriptions to use these programs at scale. However, these are non-exclusive and none of the authors have received any monetary compensation nor are they affiliated in any other way with the companies behind these products. Exceptionally, PPC received an exclusive sponsorship from a local printing sponsor in Montréal (The Business Box) that is mentioned in the article to receive PPE Portraits at cost. The authors are in no way obligated to mention these programs but are doing so to inspire others and facilitate the scaling of other initiatives. This does not alter our adherence to PLOS ONE policies on sharing data and materials., (Copyright: © 2024 Rendon et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Competing Interests: AAD is founder of Personal Protective Equipment (PPE) Portraits Canada and LR and CRV are both volunteers and members of the initiative.

Background: Computed tomography (CT) is increasingly used for assessing skeletal muscle characteristics. In cystic fibrosis (CF) and chronic obstructive pulmonary disease (COPD), reduced limb muscle mass predicts poor clinical outcomes. However, the degree to which quantity or quality of respiratory and nonrespiratory muscles is affected by these diseases remains controversial., Methods: Thoracic CT images of 29 CF, 21 COPD and 20 normal spirometry control subjects were analysed to measure indices of muscle quantity (volume or cross-sectional area) and quality (radiodensity) in respiratory (diaphragm, abdominal) and nonrespiratory (pectoralis, lumbar paraspinal) muscles. Multivariable linear regression assessed relationships of CT measurements with body mass index (BMI), forced expiratory volume in 1 s (FEV 1 ) % pred, inflammation and infection biomarkers, nutritional status and CF genotype., Results: Diaphragm volume in CF was significantly higher than in COPD (by 154%) or controls (by 140%). Abdominal muscle area in CF was also greater than in COPD (by 130%). Nonrespiratory muscles in COPD had more low radiodensity muscle (marker of lipid content) compared to CF and controls. In CF but not COPD, higher BMI and FEV 1 % pred were independently associated with higher diaphragm and/or abdominal muscle quantity indices. Serum creatinine also predicted respiratory and nonrespiratory muscle quantity in CF, whereas other biomarkers including genotype correlated poorly with muscle CT parameters., Conclusions: Our data suggest that the CF diaphragm undergoes hypertrophic remodelling, whereas in COPD the nonrespiratory muscles show altered muscle quality consistent with greater lipid content. Thoracic CT can thus identify distinctive respiratory and nonrespiratory muscle remodelling signatures associated with different chronic lung diseases., Competing Interests: Conflict of interest: B.J. Petrof is an associate editor of this journal. The remaining authors have nothing to disclose., (Copyright ©The authors 2023.)

Organizational backends and logistics are often complex and many institutions set-up their workflows based on manual and tedious processes that negatively shape their interactions with stakeholders. Incorporating new technologies can be intimidating. However, a plethora of financially and technically accessible resources that do not require any coding knowledge, can be utilized by institutions to enhance their organizational workflow and stakeholder experience. Guided by our own learning experiences in optimal logistical set-up and user design, we wish to highlight five effective and easily implementable tricks to aid higher institutions and student groups in healthcare to accomplish their administrative duties., Competing Interests: The authors have no conflicts of interest or sources of funding to disclose., (© 2022 Ventrella, Taifour, Rendon, Donovan; licensee Synergies Partners.)

Background: The intensive care unit (ICU) is an emotionally taxing environment. Patients and family members are at an increased risk of long-term physical and psychological consequences of critical illness, known collectively as post-intensive care syndrome (PICS). These environmental strains can lead to a high incidence of staff turnover and burnout., Aim: The ICU Bridge Program (ICUBP) is a student-led organization that attempts to mitigate these stressors on patients, family, and staff, by assigning university volunteers to ICUs across Montreal., Setting: ICU., Participants: ICU volunteers, staff, patients, and families., Program Description: The ICUBP volunteers support staff by orienting patients and families, while using effective communication strategies to provide comfort and promote a calm environment. The presence of volunteer visitors is helpful to patients who do not have the support of family members and/or friends. The program provides students with profound learning experiences by allowing them to shadow multidisciplinary teams, gaining a privileged and varied exposure to an acute medical environment, while developing their communications skills., Program Evaluation: The program reassesses its methods and impact via internal student-designed surveys distributed on a yearly basis to staff and volunteers., Discussion: Research is warranted to assess the impact of the program on ICU patients, visitors, staff, and volunteers., (© 2022. The Author(s).)

Rationale: Chronic obstructive pulmonary disease (COPD) is associated with abnormal skeletal muscle morphology and function. Objectives: To test the hypothesis that in vivo diaphragm muscle morphology assessed by computed tomography (CT) imaging would be associated with COPD severity, exacerbations, health status, and exercise capacity. Methods: The COPD Morphometry Study is a cross-sectional study that enrolled a clinical sample of smokers with COPD. Spirometry was performed and COPD severity was defined according to guidelines. Three-dimensional left hemidiaphragm morphology was segmented from contiguous axial CT images acquired at maximal inspiration, yielding quantitative measures of diaphragm CT density in Hounsfield units, dome height, and muscle volume. Exacerbations prompting pharmacotherapy or hospitalization in the preceding 12 months and St. George's Respiratory Questionnaire for COPD were assessed. Incremental symptom-limited cycle ergometry quantified peak oxygen uptake ([Formula: see text]o 2Peak ). Associations were adjusted for age, sex, body height, body mass index, and smoking status. Results: Among 65 smokers with COPD (75% male; [mean ± standard deviation (SD)] 56 ± 26 pack-years; forced expiratory volume in 1 second [FEV 1 ] percentage predicted 55 ± 23%), mean diaphragm CT density was 3.1 ± 10 Hounsfield units, dome height was 5.2 ± 1.3 cm, and muscle volume was 57 ± 24 cm 3 . A 1-SD decrement in the diaphragm CT density was associated with 8.3% lower FEV 1 , 3.27-fold higher odds of exacerbation history, 9.7-point higher score on the St. George's Respiratory Questionnaire for COPD, and 2.5 ml/kg/min lower [Formula: see text]o 2Peak . A 1-SD decrement in dome height was associated with 11% lower FEV 1 and 1.3 ml/kg/min lower [Formula: see text]o 2Peak . There were no associations with diaphragm volume observed. Conclusions: CT-assessed diaphragm morphology was associated with COPD severity, exacerbations, impaired health status, and exercise intolerance. The mechanisms and functional impact of lower diaphragm CT density merit investigation.