Eastern Oklahoma VA Health Care System

Serum concentration of hepatic enzymes are linked to liver dysfunction, metabolic and cardiovascular diseases. We perform genetic analysis on serum levels of alanine transaminase (ALT), alkaline phosphatase (ALP) and gamma-glutamyl transferase (GGT) using data on 437,438 UK Biobank participants. Replication in 315,572 individuals from European descent from the Million Veteran Program, Rotterdam Study and Lifeline study confirms 517 liver enzyme SNPs. Genetic risk score analysis using the identified SNPs is strongly associated with serum activity of liver enzymes in two independent European descent studies (The Airwave Health Monitoring study and the Northern Finland Birth Cohort 1966). Gene-set enrichment analysis using the identified SNPs highlights involvement in liver development and function, lipid metabolism, insulin resistance, and vascular formation. Mendelian randomization analysis shows association of liver enzyme variants with coronary heart disease and ischemic stroke. Genetic risk score for elevated serum activity of liver enzymes is associated with higher fat percentage of body, trunk, and liver and body mass index. Our study highlights the role of molecular pathways regulated by the liver in metabolic disorders and cardiovascular disease.

Neurobiological disturbances associated with reward and/or habit learning are theorized to maintain symptoms of anorexia nervosa (AN). Although research has investigated responses in brain regions associated with reward and habit to disorder-specific cues (e.g., food) and presumed rewards (e.g., money), little is known about the functional organization of the circuits underlying these constructs independent of stimulus. This study aimed to provide initial data on the synchrony of networks associated with reward and habit in AN by comparing resting-state functional connectivity (RSFC) patterns between AN and healthy control (HC) participants in these circuits and delineating how these patterns relate to symptoms. Using theoretically selected seeds in the nucleus accumbens (NAcc), ventral caudate, and dorsal caudate, reflecting a continuum from reward- to habit- oriented regions, RSFC patterns were compared between AN restricting subtype (n = 19) and HC (n = 19) participants (cluster threshold: p < .01). Exploratory correlations between RSFC z-scores and Eating Disorder Examination (EDE) scores, BMI, and illness duration were conducted. The AN group demonstrated lower RSFC between the NAcc and superior frontal gyrus, between the ventral caudate and frontal and posterior regions, and between the dorsal caudate and frontal, temporal, and posterior regions. In the AN group, lower NAcc- superior frontal gyrus RSFC correlated with greater EDE Global scores (r = -.58, CI: -.83, -.13). These resting-state synchrony disruptions of the ventral and dorsal frontostriatal circuits, considered in context of the broader literature, support the utility of further investigating possible reward and habit disturbances supporting symptoms in AN.

Moral injury is a particular response to profoundly distressing life events that manifests in damage to basic human/relational capacities, such as trust, autonomy, initiative, competence, identity, and intimacy. This paper describes and presents preliminary outcomes of "Reclaiming Experiences And Loss," or "REAL," which is an innovative moral injury group therapy that was developed collaboratively by Veterans Affairs mental health and spiritual care providers. Clinical outcome measures collected pre- and post-group indicates that REAL is effective at reducing symptoms of post-traumatic stress disorder and depression. Additionally, a cohort case example demonstrates the impact of REAL as told through individual stories as well as the intersectionality and interactions that comprise a typical REAL cohort and are considered central to care. Implications for ongoing care and future research are discussed.

As of August 2025, the Veterans Health Administration (VHA) Spinal Cord Injuries and Disorders (SCI/D) system of care provides state-of-the-art specialty medical care for 24,560 United States Veterans living with SCI/D and multiple sclerosis and motor neuron disease with spinal cord involvement. This article reviews the history of VHA SCI/D care to show how VHA's early adoption of rehabilitation innovations and lifetime management not only improved Veterans' outcomes but also contributed to its evolution as a world leader in SCI/D research, training, and comprehensive life-long care. This review traces events that shaped the current VHA SCI/D System of Care as it evolved from housing and pensions for disabled Veterans after the US Civil War to the present-day foundational service within one of the largest health care, research, and medical training systems in the world.This history highlights VHA's longstanding commitment to providing comprehensive, world-class services for Veterans and their families and reinforces its leadership and commitment to cutting-edge research on treatments, potential SCI/D cures, and innovations in precision medicine, training, and technology for all people living with SCI/D.

Unlabelled: The translation of big data analytics and artificial intelligence (AI) into clinical decision support systems (CDSSs) has advanced from proof of concept to real-world clinical practice. AI-informed CDSSs show measurable improvements in diagnostic accuracy, risk stratification, resource use, and patient outcomes compared to traditional models, offering the potential to assist clinicians in managing symptom complexity and uncertainty in health care delivery. Despite this potential, access to large amounts of high-quality and granular data remains one of the most significant bottlenecks to AI-enabled CDSSs. We argue that as health care systems increasingly adopt data-driven decision support, addressing the challenges of data accessibility and protection is essential to realizing the full potential of AI in clinical medicine. We use selected case examples of AI-informed CDSSs in oncology, organ transplantation, diabetic retinopathy, epilepsy, spinal cord injury, rare disease diagnosis, and emergency medicine to illustrate opportunities and challenges related to AI's potential to improve patient outcomes. We discuss public and semipublic, medical institutional and commercial, and government and national data sources that are currently available for the development of CDSSs and highlight the practical and ethical constraints associated with these data. We consider alternative data resources and ways in which health care systems can strengthen data ecosystems to increase AI-driven CDSS efficacy and implementation to improve patient outcomes.

Suicide is the second-leading cause of death for United States Military Veterans under age 45, and research suggests that adverse childhood experiences (ACEs) are a major contributor to suicide risk. The present study aimed to better understand the scope of ACEs and connections between ACEs and death ideation and suicide preparatory behaviours among U.S. Veterans who use Veterans Health Administration (VHA) services. Using VHA electronic health records data, the relationship between childhood adversity (i.e., Adverse Childhood Experiences Scale), death ideation and suicide preparatory behaviours (i.e., Columbia Suicide Severity Rating Scale) were examined. Two-stage multivariate logistic regression models evaluated the association between ACEs, death ideation and suicide preparatory behaviours, accounting for age, gender, race, ethnicity, marital status, region of residency in the U.S., and era of military service. Results suggested that standardized ACE screenings were rarely administered across VHA. 32.4% of ACEs screeners were administered at one site. ACEs were significantly related to death ideation in the past 5 years, after factoring in demographics, (OR = 1.128, 95% CI: 1.099-1.159). Similarly, ACEs were significantly related to lifetime reports of suicide preparatory behaviours (OR = 1.179, 95% CI: 1.148-1.211). Findings demonstrate the lack of ACEs screening in VHA. Despite limited screening, results suggest a significant relationship between childhood adversity and both death ideation and suicide preparatory behaviours in adulthood, suggesting individuals who report childhood adversity may be at higher risk for suicide. These findings can inform suicide screening and prevention efforts within and outside VHA.

Abstract The Phenome-Wide Association Study (PheWAS) is increasingly used to broadly screen for potential treatment effects, e.g., IL6R variant as a proxy for IL6R antagonists. This approach offers an opportunity to address the limited power in clinical trials to study differential treatment effects across patient subgroups. However, limited methods exist to efficiently test for differences across subgroups in the thousands of multiple comparisons generated as part of a PheWAS. In this study, we developed an approach that maximizes the power to test for heterogeneous genotype–phenotype associations and applied this approach to an IL6R PheWAS among individuals of African (AFR) and European (EUR) ancestries. We identified 29 traits with differences in IL6R variant-phenotype associations, including a lower risk of type 2 diabetes in AFR (OR 0.96) vs EUR (OR 1.0, p-value for heterogeneity = 8.5 × 10 –3 ), and higher white blood cell count (p-value for heterogeneity = 8.5 × 10 –131 ). These data suggest a more salutary effect of IL6R blockade for T2D among individuals of AFR vs EUR ancestry and provide data to inform ongoing clinical trials targeting IL6 for an expanding number of conditions. Moreover, the method to test for heterogeneity of associations can be applied broadly to other large-scale genotype–phenotype screens in diverse populations.