Digital Commons Network^™

Designing Systems For The Care We Need: A Transformation Journey In Southwestern Ontario., Shannon L. Sibbald, Jacobi Elliott, Alexander Smith, Mulugeta B. Chala, Nancy Dool Kontio, Amber Alpaugh-Bishop, Sarah Jarmain, Atharv Joshi, Mike Mcmahon, Matthew Meyer

Health Studies Publications

Primary care is considered the foundation of any health system. In Ontario, Canada Bills 41 and 74 introduced in 2016 and 2019, respectively, aimed to move towards a primary care-focused and sustainable integrated care approach designed around the needs of local populations. These bills collectively set the stage for integrated care and population health management in Ontario, with Ontario Health Teams (OHTs) introduced as a model of integrated care delivery systems. OHTs aim to streamline patient connectivity through the healthcare system and improve outcomes aligned with the Quadruple Aim. When Ontario released a call for health system partners to apply …

Patient And Physician Factors Associated With First Diagnosis Of Non-Affective Psychotic Disorder In Primary Care, Joshua C. Wiener, Rebecca Rodrigues, Jennifer N S Reid, Suzanne Archie, Richard G Booth, Chiachen Cheng, Saadia Hameed Jan, Paul Kurdyak, Arlene G Macdougall, Lena Palaniyappan, Bridget L Ryan, Kelly K. Anderson

Epidemiology and Biostatistics Publications

Primary care physicians play a central role in pathways to care for first-episode psychosis, and their increased involvement in early detection could improve service-related outcomes. The aim of this study was to estimate the proportion of psychosis first diagnosed in primary care, and identify associated patient and physician factors. We used linked health administrative data to construct a retrospective cohort of people aged 14-35 years with a first diagnosis of non-affective psychosis in Ontario, Canada between 2005-2015. We restricted the sample to patients with help-seeking contacts for mental health reasons in primary care in the six months prior to first …

Cancer Incidence And Stage At Diagnosis Among People With Recent-Onset Psychotic Disorders: A Retrospective Cohort Study Using Health Administrative Data From Ontario, Canada., Jared C Wootten, Lucie Richard, Phillip S Blanchette, Joshua C. Wiener, Kelly K. Anderson

Epidemiology and Biostatistics Publications

OBJECTIVE: Prior evidence on the relative risk of cancer among people with psychotic disorders is equivocal. The objective of this study was to compare incidence and stage at diagnosis of cancer for people with psychotic disorders relative to the general population.

METHOD: We constructed a retrospective cohort of people with a first diagnosis of non-affective psychotic disorder and a comparison group from the general population using linked health administrative databases in Ontario, Canada. The cohort was followed for incident diagnoses of cancer over a 25-year period. We used Poisson and logistic regression models to compare cancer incidence and stage at …

Mental Health Services Provision In Primary Care And Emergency Department Settings: Analysis Of Blended Fee-For-Service And Blended Capitation Models In Ontario, Canada., Thyna Vu, Kelly K Anderson, Nibene H Somé, Amardeep Thind, Sisira Sarma

Epidemiology and Biostatistics Publications

Treating mental illnesses in primary care is increasingly emphasized to improve access to mental health services. Although family physicians (FPs) or general practitioners are in an ideal position to provide the bulk of mental health care, it is unclear how best to remunerate FPs for the adequate provision of mental health services. We examined the quantity of mental health services provided in Ontario's blended fee-for-service and blended capitation models. We evaluated the impact of FPs switching from blended fee-for-service to blended capitation on the provision of mental health services in primary care and emergency department using longitudinal health administrative data …

Quality Of Diabetes Care In Blended Fee-For-Service And Blended Capitation Payment Systems., Mary Aderayo Bamimore, Rose Anne Devlin, Gregory S Zaric, Amit X Garg, Sisira Sarma

Epidemiology and Biostatistics Publications

OBJECTIVES: In the middle to late 2000s, many family physicians switched from a Family Health Group (FHG; a blended fee-for-service model) to a Family Health Organization (FHO; a blended capitation model) in Ontario, Canada. The evidence on the link between physician remuneration schemes and quality of diabetes care is mixed in the literature. We examined whether physicians who switched from the FHG to FHO model provided better care for individuals living with diabetes relative to those who remained in the FHG model.

METHODS: Using longitudinal health administrative data from 2006 to 2016, we investigated the impact of physicians switching from …

Emergency Department Use Following Incentives To Provide After-Hours Primary Care: A Retrospective Cohort Study., Michael Hong, Amardeep Thind, Gregory S Zaric, Sisira Sarma

Epidemiology and Biostatistics Publications

BACKGROUND: Access to primary care outside of regular working hours is limited in many countries. This study investigates the relation between the after-hours premium, an incentive for primary care physicians to provide services after hours, and less-urgent visits to the emergency department in Ontario, Canada.

METHODS: We analyzed a retrospective cohort of a random sample of Ontario residents from April 2002 to March 2006, and a subcohort of patients followed from April 2005 to March 2016. We linked patient and primary care physician data with emergency department visit data. We used fixed-effects regression models to analyze the association between the …

Physician Remuneration Schemes, Psychiatric Hospitalizations And Follow-Up Care: Evidence From Blended Fee-For-Service And Capitation Models., Thyna Vu, Kelly K Anderson, Rose Anne Devlin, Nibene H Somé, Sisira Sarma

Epidemiology and Biostatistics Publications

Psychiatric hospitalizations could be reduced if mental illnesses were detected and treated earlier in the primary care setting, leading to the World Health Organization recommendation that mental health services be integrated into primary care. The mental health services provided in primary care settings may vary based on how physicians are incentivized. Little is known about the link between physician remuneration and psychiatric hospitalizations. We contribute to this literature by studying the relationship between physician remuneration and psychiatric hospitalizations in Canada's most populous province, Ontario. Specifically, we study family physicians (FPs) who switched from blended fee-for-service (FFS) to blended capitation remuneration …

Population-Based Studies On Medications And Fall-Related Injury In Older Adults, Yu Ming

Electronic Thesis and Dissertation Repository

Background: Fall-related injuries in older adults result in serious consequences to individuals and health care system, especially with the increasing aging population. The purpose of this study was to (1) describe medication prescription patterns within one year prior to fall-related injuries; (2) identify medication classes prescribed within 30 days prior to the injury that were associated to fall-related injury; and (3) examine the association between fall-related injuries and continuous use or new initiation of most commonly prescribed medications.

Methods: Studies used administrative health care data in Ontario. Study 1 described the frequency of medications prescribed to older adults within one …

The Impact Of The Diabetes Management Incentive On Diabetes-Related Services: Evidence From Ontario, Canada., Thaksha Thavam, Rose Anne Devlin, Amardeep Thind, Gregory S Zaric, Sisira Sarma

Epidemiology and Biostatistics Publications

Financial incentives have been introduced in several countries to improve diabetes management. In Ontario, the most populous province in Canada, a Diabetes Management Incentive (DMI) was introduced to family physicians practicing in patient enrollment models in 2006. This paper examines the impact of the DMI on diabetes-related services provided to individuals with diabetes in Ontario. Longitudinal health administrative data were obtained for adults diagnosed with diabetes and their family physicians. The study population consisted of two groups: DMI group (patients enrolled with a family physician exposed to DMI for 3 years), and comparison group (patients affiliated with a family physician …

Labour Progression In Obese Women: Are Women With Increased Body Mass Index Having Unnecessary Cesarean Sections?, Caroline Shenouda, Aloka Wijesooriya, Amanda Toufeili, Michael R Miller, Debbie Penava, Barbra De Vrijer

Obstetrics & Gynaecology Publications

OBJECTIVE: This study sought to determine whether obese pregnant women undergo cesarean sections without an adequate trial of labour. This may affect future birth and pregnancy outcomes.

METHODS: A retrospective analysis was done on 526 parturients at Victoria Hospital in London, Ontario. Women were categorized according to parity and pre-pregnancy body mass index (BMI; normal weight, BMI 18.5-24.9 kg/m

RESULTS: Obese class II and III primiparous women required an additional 1.62 and 2.67 hours (P = 0.012), respectively, to reach a dilation of 10 cm compared with their normal weight counterparts; obese class II and III multiparous women required an …

Analysis Of Billings Data To Evaluate Patterns Of Mental Health Services In Primary Care And Emergency Departments By Blended Fee-For-Service And Blended Capitation Models In Ontario, Canada, Thy H. Vu

Electronic Thesis and Dissertation Repository

Treating mental illness in primary care improves access to care, but it is unclear how to encourage family physicians to provide adequate mental health services. One approach may be changing how they are remunerated. The objectives of this thesis were to: 1) review the literature on the association between physician remuneration and provision of mental health services, and 2) assess the impact of blended capitation, compared to blended fee-for-service (FFS), on mental health services provision in Ontario. The review found that capitation appears to be associated with fewer services compared to FFS; however, studies of ED visits for mental health …

Production Of Physician Services Under Fee-For-Service And Blended Fee-For-Service: Evidence From Ontario, Canada., Nibene H Somé, Rose Anne Devlin, Nirav Mehta, Greg Zaric, Lihua Li, Salimah Shariff, Bachir Belhadji, Amardeep Thind, Amit Garg, Sisira Sarma

Epidemiology and Biostatistics Publications

We examine family physicians' responses to financial incentives for medical services in Ontario, Canada. We use administrative data covering 2003-2008, a period during which family physicians could choose between the traditional fee for service (FFS) and blended FFS known as the Family Health Group (FHG) model. Under FHG, FFS physicians are incentivized to provide comprehensive care and after-hours services. A two-stage estimation strategy teases out the impact of switching from FFS to FHG on service production. We account for the selection into FHG using a propensity score matching model, and then we use panel-data regression models to account for observed …

Healthcare Utilization Costs Of Emerging Adults With Mood And Anxiety Disorders In An Early Intervention Treatment Program Compared To A Matched Cohort, Ava A. John-Baptiste, Lihua Li, Wanrudee Isaranuwatchai, Elizabeth Osuch, Kelly K. Anderson

Epidemiology and Biostatistics Publications

AIM: The First Episode Mood and Anxiety Disorder Program (FEMAP) provides treatment to emerging adults with mood and anxiety disorders in an accessible, youth-friendly environment. We sought to investigate FEMAP's impact on the costs of care.

METHODS: We conducted a retrospective observational study of one-year health service costs using linked administrative datasets to compare emerging adults treated at FEMAP (FEMAP users) to propensity-score matched controls (non-users). Costs from the perspective of the Ontario Ministry of Health and Long-Term Care, included drug benefit claims, inpatient, physician and ambulatory care services. We used bootstrapping to perform unadjusted comparisons between FEMAP users and …

The 2014 Ontario Child Health Study—Methodology, Michael H. Boyle, Katholiki Georgiades, Laura Duncan, Laura Duncan, Jinette Comeau, Jinette Comeau, Li Wang, Tracie O. Afifi, William R. Avison, Graham Reid, Kathryn Bennett, Terry Bennett, Khrista Boylan, Michelle Butt, Charles Cunningham, Eric Duku, Jim Dunn, Katholiki Georgiades, Stelios Georgiades, Andrea Gonzalez, Geoffrey Hall, Magdalena Janus, Melissa Kimber, Ellen Lipman, Harriet Macmillan, Peter Rosenbaum, Roberto Sassi, Louis Schmidt, Noam Soreni

Paediatrics Publications

Objective: To describe the methodology of the 2014 Ontario Child Health Study (OCHS): a province-wide, cross-sectional, epidemiologic study of child health and mental disorder among 4- to 17-year-olds living in household dwellings. Method: Implemented by Statistics Canada, the 2014 OCHS was led by academic researchers at the Offord Centre for Child Studies (McMaster University). Eligible households included families with children aged 4 to 17 years, who were listed on the 2014 Canadian Child Tax Benefit File. The survey design included area and household stratification by income and 3-stage cluster sampling of areas and households to yield a probability sample of …

Poverty, Neighbourhood Antisocial Behaviour, And Children’S Mental Health Problems: Findings From The 2014 Ontario Child Health Study, Michael H. Boyle, Katholiki Georgiades, Laura Duncan, Laura Duncan, Li Wang, Jinette Comeau, Jinette Comeau, Tracie O. Afifi, William R. Avison, Graham Reid, Kathryn Bennett, Terry Bennett, Khrista Boylan, Michelle Butt, Charles Cunningham, Eric Duku, Jim Dunn, Katholiki Georgiades, Stelios Georgiades, Andrea Gonzalez, Geoffrey Hall, Magdalena Janus, Melissa Kimber, Ellen Lipman, Harriet Macmillan, Peter Rosenbaum, Roberto Sassi, Louis Schmidt, Noam Soreni

Paediatrics Publications

Objectives: To determine if levels of neighbourhood poverty and neighbourhood antisocial behaviour modify associations between household poverty and child and youth mental health problems. Methods: Data come from the 2014 Ontario Child Health Study—a provincially representative survey of 6537 families with 10,802 four- to 17-year-olds. Multivariate multilevel modelling was used to test if neighbourhood poverty and antisocial behaviour interact with household poverty to modify associations with children’s externalizing and internalizing problems based on parent assessments of children (4- to 17-year-olds) and self-assessments of youth (12- to 17-year-olds). Results: Based on parent assessments, neighbourhood poverty, and antisocial behaviour modified associations between …

Family Physician Remuneration Schemes And Specialist Referrals: Quasi-Experimental Evidence From Ontario, Canada., Sisira Sarma, Nirav Mehta, Rose Anne Devlin, Koffi Ahoto Kpelitse, Lihua Li

Epidemiology and Biostatistics Publications

Understanding how family physicians respond to incentives from remuneration schemes is a central theme in the literature. One understudied aspect is referrals to specialists. Although the theoretical literature has suggested that capitation increases referrals to specialists, the empirical evidence is mixed. We push forward the empirical research on this question by studying family physicians who switched from blended fee-for-service to blended capitation in Ontario, Canada. Using several health administrative databases from 2005 to 2013, we rely on inverse probability weighting with fixed-effects regression models to account for observed and unobserved differences between the switchers and nonswitchers. Switching from blended fee-for-service …

Rural Ontario Youth And Mental Wellness, Brad Ross

Electronic Thesis and Dissertation Repository

Currently, there is a significant lack of knowledge regarding rural Ontario youth and their mental wellness. This study addresses the following research questions: 1) How do rural youth maintain mental wellness? and 2) What factors facilitate or hinder the mental wellness of rural youth from their perspective? Eight rural participants, four male and four female, aged 16-23 provided data via one on one interviews. It was found that many rural youth have adapted to utilize their rural environment, social support, and intrapersonal techniques to maintain their mental wellness. Furthermore, four main themes act as both facilitators and hindrances to their …

Higher And Lower Order Factor Analyses Of The Temperament In Middle Childhood Questionnaire., Yuliya Kotelnikova, Thomas M Olino, Daniel N Klein, Sarah V M Mackrell, Elizabeth P Hayden

Brain and Mind Institute Researchers' Publications

The Temperament in Middle Childhood Questionnaire (TMCQ) is a widely used parent-report measure of temperament. However, neither its lower nor higher order structures has been tested via a bottom-up, empirically based approach. We conducted higher and lower order exploratory factor analyses (EFAs) of the TMCQ in a large ( N = 654) sample of 9-year-olds. Item-level EFAs identified 92 items as suitable (i.e., with loadings ≥.40) for constructing lower order factors, only half of which resembled a TMCQ scale posited by the measure's authors. Higher order EFAs of the lower order factors showed that a three-factor structure (Impulsivity/Negative Affectivity, Negative …

Swahn Southwestern Academic Health Network Conference 2017 : The Patient Voice & Experience In Southwestern Ontario, Schulich School Of Medicine & Dentistry

Department of Medicine Publications

The conference, held at Western University in London, Ontario, was a full-day event that included presentations based on its theme: The Patient Voice and Experience in Southwestern Ontario. The day began with a two-part presentation featuring Health Quality Ontario’s patient partnership framework, delivered by Jennifer Schipper, Health Quality Ontario’s Chief of Communication and Patient Engagement. Dr. Gillian Kernaghan, President and CEO of St. Joseph’s Health Care London (and Co-Chair of SWAHN) then shared her organization’s care partnership that has involved the contributions of patients, residents, families, and caregivers.

Other presentations included a personal story shared by Mr. Wayne Kristoff who …

Transitioning From Children's Mental Health To Adult Care: Stakeholder Perspectives And Tracking Service Use Into Adulthood, Kyleigh E. Schraeder

Electronic Thesis and Dissertation Repository

Transitioning youth from Children’s Mental Health (CMH) services to adult care poses a major challenge for our mental health and health care systems. This dissertation used a mixed-methods approach to explore the challenges of caring for youth with ongoing mental health problems into young adulthood. A Grounded Theory qualitative study consisted of interviews with youth (i.e., ages 12 to 15) treated in CMH, their parents, CMH providers, and family physicians. Using administrative health record and CMH data in the province of Ontario, a complementary quantitative study examined the likelihood of receiving mental health services within the medical sector after the …

Implementation Of Clinical Research Trials Using Web-Based And Mobile Devices: Challenges And Solutions., Roy Eagleson, Luis Altamirano-Diaz, Alex Mcinnis, Eva Welisch, Stefanie De Jesus, Harry Prapavessis, Meghan Rombeek, Jamie A Seabrook, Teresa Park, Kambiz Norozi

Paediatrics Publications

BACKGROUND: With the increasing implementation of web-based, mobile health interventions in clinical trials, it is crucial for researchers to address the security and privacy concerns of patient information according to high ethical standards. The full process of meeting these standards is often made more complicated due to the use of internet-based technology and smartphones for treatment, telecommunication, and data collection; however, this process is not well-documented in the literature.

RESULTS: The Smart Heart Trial is a single-arm feasibility study that is currently assessing the effects of a web-based, mobile lifestyle intervention for overweight and obese children and youth with congenital …

Evaluation Of Treatment-Related Mortality Among Paediatric Cancer Deaths: A Population Based Analysis., Jason D Pole, Paul Gibson, Marie-Chantal Ethier, Tanya Lazor, Donna L Johnston, Carol Portwine, Mariana Silva, Sarah Alexander, Lillian Sung

Paediatrics Publications

BACKGROUND: Objectives were to describe the proportion of deaths due to treatment-related mortality (TRM) and to identify risk factors and probable causes of TRM among paediatric cancer deaths in a population-based cohort.

METHODS: We included children with cancer ⩽18 years diagnosed and treated in Ontario who died between January 2003 and December 2012. Deaths were identified using a provincial registry, the Pediatric Oncology Group of Ontario Networked Information System. Probable causes of TRM were described.

RESULTS: Among the 964 deaths identified, 821 were included. The median age at diagnosis was 6.6 years (range 0-18.8) and 51.8% had at least one …

Understanding Views Of Evidence In Public Health Practice And Decision Making In Ontario, Sara Masood

Electronic Thesis and Dissertation Repository

Background: Perceptions of evidence by public health managers, practitioners and policy makers is one of the key determinants of evidence uptake. Therefore, understanding views of evidence in both practice and policy decision making is important to bridge the evidence-practice and policy gap in public health. Objectives & Methods: Two studies are presented in this thesis. The first is a systematic review synthesizing studies exploring the use of research evidence in public health decision making between 2010-2016. The second study is a qualitative descriptive study examining understandings about evidence in Ontario public health units by comparing perspectives from managers and frontline …

Trends In Psychotropic Dispensing Among Older Adults With Dementia Living In Long-Term Care Facilities: 2004-2013., Akshya Vasudev, Salimah Z Shariff, Kuan Liu, Amer M Burhan, Nathan Herrmann, Sean Leonard, Muhammad Mamdani

Psychiatry Publications

OBJECTIVE: Guidelines worldwide have cautioned against the use of antipsychotics as first-line agents to treat neuropsychiatric symptoms of dementia. We aimed to investigate the changes over time in the dispensing of antipsychotics and other psychotropics among older adults with dementia living in long-term care facilities.

METHODS: We used drug claims data from Ontario, Canada, to calculate quarterly rates of prescription dispensing of six psychotropic drug classes among all elderly (≥65 years of age) long-term care residents with dementia from January 1, 2004, to March 31, 2013. Psychotropic drugs were classified into the following categories: atypical and conventional antipsychotics, non-sedative and …

Identification And Survival Outcomes Of A Cohort Of Patients With Cancer Of Unknown Primary In Ontario, Canada., Chong S Kim, Malek B Hannouf, Sisira Sarma, George B Rodrigues, Peter K Rogan, Salaheddin M Mahmud, Eric Winquist, Muriel Brackstone, Gregory S Zaric

Epidemiology and Biostatistics Publications

BACKGROUND: Cancer of unknown primary origin (CUP) is defined by the presence of pathologically identified metastatic disease without clinical or radiological evidence of a primary tumour. Our objective was to identify incident cases of CUP in Ontario, Canada, and determine the influence of histology and sites of metastases on overall survival (OS).

MATERIAL AND METHODS: We used the Ontario Cancer Registry (OCR) and the Same-Day Surgery and Discharge Abstract Database (SDS/DAD) to identify patients diagnosed with CUP in Ontario between 1 January 2000, and 31 December 2005. Patient diagnostic information, including histology and survival data, was obtained from the OCR. …

Primary Health Service Use By Mothers And Children From London-Middlesex, Ontario, Catherine Holtz

Electronic Thesis and Dissertation Repository

Primary health service use (P-HSU) may be influenced by predisposing and enabling factors measured at individual- and contextual-levels but is equitable when driven by need factors. Objectives: 1) Estimate the effect of residential location on maternal and child P-HSU; 2) Assess P-HSU inequity by determining whether the effects of need factors on P-HSU are dependent on predisposing and enabling factors; 3) Describe perceived unmet healthcare needs in the maternal-child population observed to have inequitable P-HSU. Methodology: The sample of 1451 mother-child pairs was from a prenatal cohort recruited from London, Ontario between 2002 and 2004, with follow-up until children were …

Volume Of Carotid Artery Ulceration As A Predictor Of Cardiovascular Events, Mariya Kuk, Thapat Wannarong, Vadim Beletsky, Grace Parraga, Aaron Fenster, J David Spence

Medical Biophysics Publications

BACKGROUND AND PURPOSE: Previous studies have shown the presence of ulceration in atherosclerotic plaque either by categorizing the plaque as complex (irregular morphology with ulcers) or smooth or by quantifying the number of ulcers observed in a specific region of interest. The aim of this study was to quantify carotid total ulcer volume by 3-dimensional ultrasound to investigate the relationship of total ulcer volume to vascular events (strokes, transient ischemic attack, myocardial infarction, revascularization, or death because of cardiovascular reasons).

METHODS: In total, 349 at-risk subjects provided written informed consent to carotid 3-dimensional ultrasound and were analyzed for ulcerations. Ulcer …

Expanding The Basic Science Debate: The Role Of Physics Knowledge In Interpreting Clinical Findings., Mark Goldszmidt, John Paul Minda, Sarah L Devantier, Aimee L Skye, Nicole N Woods

Brain and Mind Institute Researchers' Publications

Current research suggests a role for biomedical knowledge in learning and retaining concepts related to medical diagnosis. However, learning may be influenced by other, non-biomedical knowledge. We explored this idea using an experimental design and examined the effects of causal knowledge on the learning, retention, and interpretation of medical information. Participants studied a handout about several respiratory disorders and how to interpret respiratory exam findings. The control group received the information in standard "textbook" format and the experimental group was presented with the same information as well as a causal explanation about how sound travels through lungs in both the …

Medical Physics Staffing For Radiation Oncology: A Decade Of Experience In Ontario, Canada., Jerry J. Battista Dr., Brenda G Clark, Michael S Patterson, Luc Beaulieu, Michael B Sharpe, L John Schreiner, Miller S Macpherson, Jacob Van Dyk

Oncology Publications

The January 2010 articles in The New York Times generated intense focus on patient safety in radiation treatment, with physics staffing identified frequently as a critical factor for consistent quality assurance. The purpose of this work is to review our experience with medical physics staffing, and to propose a transparent and flexible staffing algorithm for general use. Guided by documented times required per routine procedure, we have developed a robust algorithm to estimate physics staffing needs according to center-specific workload for medical physicists and associated support staff, in a manner we believe is adaptable to an evolving radiotherapy practice. We …

Hyperpolarized (3)He Magnetic Resonance Imaging-Derived Pulmonary Pressure-Volume Curves, Stephen Choy, Andrew Wheatley, David G Mccormack, Grace Parraga

Medical Biophysics Publications

We aimed to evaluate the potential for the use of hyperpolarized helium-3 magnetic resonance imaging (MRI) apparent diffusion coefficient (ADC) surrogates of alveolar size, together with literature-based morphological parameters in a theoretical model of lung mechanics to simulate noninvasive transpulmonary pressure-volume curves. Fourteen ex-smokers with chronic obstructive pulmonary disease (COPD) (n = 8 stage II, n = 6 stage III/IV COPD) and five age-matched never-smokers, provided written, informed consent and were evaluated at baseline and 26 + or - 2 mo later (n = 15 subjects) using plethysmography, spirometry, and (3)He MRI at 3.0 T. Total lung capacity, residual volume, …