Publications by authors named "Susan Bell"

132 Publications

The case for refugee physicians: Forced migration of International Medical Graduates in the 21st century.

Soc Sci Med 2021 May 4;277:113903. Epub 2021 Apr 4.

Department of Communication and Global Health Program, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, United States. Electronic address:

In this paper we propose a new category of International Medical Graduates (IMGs) who are forced to leave their home countries: "refugee physicians." In US social science scholarship, IMGs are divided into US citizen IMG (USIMG) and non-US citizen IMG (non-USIMG). For purposes of US medical licensure qualifications and recordkeeping, US- and non-USIMGs are lumped together. These categorizations are too blunt to demonstrate important differences among non-USIMGs. The category of "refugee physicians" distinguishes non-USIMGs who are forced to flee their homelands from other IMGs. We define and develop this category based on qualitative in-depth interviews conducted in 2019 with 28 non-USIMGs who fled to the US within the past 15 years. Using narrative analysis, we constructed "flight biographies," storied chronological events and experiences, for each physician. The flight biographies highlight the medical and political contexts in which they were forced to flee and are situated in the US. Two representative cases demonstrate how and why lumping refugee physicians together with other IMGs obscures the constraints and challenges that set them apart from the other IMG categories. First, the term refugee physician focuses attention on how physicians are located among forcibly displaced people worldwide, including their distinct relationships to their home countries, transit countries in which some of them seek sanctuary, and the US, where some requested asylum and others have been resettled. Second, because refugee is an umbrella term that blends categories of law, policy, social science, and everyday usage it encompasses a wide variety of lived experiences along a continuum of compulsion to leave. Finally, refugee physician illuminates the group's distinct relationship to medical licensure and brings into focus structural barriers that impede their goal of gaining a US medical license.
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http://dx.doi.org/10.1016/j.socscimed.2021.113903DOI Listing
May 2021

Natural recovery of a marine foundation species emerges decades after landscape-scale mortality.

Sci Rep 2021 Mar 26;11(1):6973. Epub 2021 Mar 26.

Center for Marine Science, University of North Carolina at Wilmington, Wilmington, NC, 28403, USA.

Globally, the conditions and time scales underlying coastal ecosystem recovery following disturbance remain poorly understood, and post-disturbance examples of resilience based on long-term studies are particularly rare. Here, we documented the recovery of a marine foundation species (turtlegrass) following a hypersalinity-associated die-off in Florida Bay, USA, one of the most spatially extensive mortality events for seagrass ecosystems on record. Based upon annual sampling over two decades, foundation species recovery across the landscape was demonstrated by two ecosystem responses: the range of turtlegrass biomass met or exceeded levels present prior to the die-off, and turtlegrass regained dominance of seagrass community structure. Unlike reports for most marine taxa, recovery followed without human intervention or reduction to anthropogenic impacts. Our long-term study revealed previously uncharted resilience in subtropical seagrass landscapes but warns that future persistence of the foundation species in this iconic ecosystem will depend upon the frequency and severity of drought-associated perturbation.
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http://dx.doi.org/10.1038/s41598-021-86160-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7997892PMC
March 2021

Step 0: The Spirit of Inquiry.

Neonatal Netw 2021 Jan;40(1):38-39

It stands to reason that competency in every area of practice, including the evidence-based practice process, improves through participation in the practice. But before engagement in the evidence-based practice process can occur, Melnyk and Fineout-Overholt assert, there must be a "spirit of inquiry." This column describes strategies to spark and cultivate a spirit of inquiry for evidence-based practice and barriers that can dampen the spirit.
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http://dx.doi.org/10.1891/0730-0832/11-T-686DOI Listing
January 2021

Modification of ventriculo-arterial coupling by spironolactone in nonischemic dilated cardiomyopathy.

ESC Heart Fail 2021 Apr 5;8(2):1156-1166. Epub 2021 Jan 5.

VA Tennessee Valley Health Care System, Vanderbilt University Medical Center, Nashville, TN, 37232, USA.

Aims: We sought to clarify the role of ventriculo-arterial (V-A) coupling in the treatment of nonischemic dilated cardiomyopathy (NIDCM) by adding a mineralocorticoid receptor antagonist (MRA) to conventional anti-failure therapy.

Methods And Results: We employed cardiac magnetic resonance imaging to quantify left ventricular (LV) contractility and V-A coupling in normal subjects at rest (n = 11) and in patients with NIDCM (n = 12) before and after long term anti-failure therapy, in which MRA was added to conventional anti-failure therapy. After ≥6 months' treatment in NIDCM patients, LV volumes and mass decreased, and the LV ejection fraction increased from a median of 24% (17, 27) (interquartile range IQR) to 47 (42, 52) (P < 0.002), with a marked reduction in arterial elastance (Ea) from 2.89 mmHg/mL (2.34, 4.0) to 1.50 (1.29, 1.95) (P < 0.002), similar to Ea of normal subjects, 1.53 (1.34, 1.67) (P > 0.05). The V-A coupling ratio, Ea/end-systolic elastance (single-beat method), decreased by -1.08 (-1.96, -0.55), (P = 0.003), as did Ea/end-systolic pressure/end-systolic pressure ratio, -0.54 (0.35, 0.87), (P = 0.002). The preload recruitable stroke work (PRSW) increased as did PRSW indexed for Ea (both P = 0.002), which reflected 'total circulatory performance'.

Conclusions: In NIDCM, adding MRA to conventional anti-failure therapy markedly improved LV ejection fraction and reduced peripheral vascular resistance, due to both improved LV contractility and especially to enhanced V-A coupling, as Ea decreased to normal. Total circulatory performance was a sensitive indicator of both LV pump performance and the arterial loading conditions.
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http://dx.doi.org/10.1002/ehf2.13161DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8006677PMC
April 2021

Evidence-Based Practice Competencies for RNs and APNs: How Are We Doing?

Neonatal Netw 2020 Aug;39(5):299-302

As we approach the end of 2020, the Year of the Nurse and Nurse Midwife, it is a good time to reflect on our evidence-based practice (EBP) competencies through a review of a recent study by Melnyk and colleagues. Before describing these competencies, our progress in achieving EBP competency, and the effect competency status has on health care quality, safety, and patient outcomes, this column reviews the definition of EBP and provides a high-level overview of the steps of EBP as defined in Melnyk and Fineout-Overholt.
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http://dx.doi.org/10.1891/0730-0832.39.5.299DOI Listing
August 2020

Supporting Advanced Practice Providers' Professional Advancement: The Implementation of a Professional Advancement Model at an Academic Medical Center.

J Nurse Pract 2020 Jul-Aug;16(7):504-508. Epub 2020 May 23.

The Ohio State University Comprehensive Cancer Center - Arthur G. James Cancer Hospital and Richard. J. Solove Research Institute, 460 W 10 Ave., Room B160, Columbus, OH 43210.

Organizational commitment to a structured professional advancement model (PAM) is critical for advanced practice provider (APP) development in order to promote and reward excellence, enhance job satisfaction and improve retention and recruitment. A PAM may also serve as a motivational tool for personal and professional growth by developing and promoting a professional, evidence-based collaborative practice environment. A voluntary PAM was implemented at a large Midwestern academic medical center to recognize experienced APPs including certified nurse practitioners, certified nurse-midwives and physician assistants. This manuscript describes the case for creating a PAM, implementation and evaluation.
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http://dx.doi.org/10.1016/j.nurpra.2020.04.012DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7455010PMC
May 2020

Mild Cognitive Impairment Staging Yields Genetic Susceptibility, Biomarker, and Neuroimaging Differences.

Front Aging Neurosci 2020 5;12:139. Epub 2020 Jun 5.

Vanderbilt Memory & Alzheimer's Center, Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, United States.

Introduction: While Alzheimer's disease (AD) is divided into severity stages, mild cognitive impairment (MCI) remains a solitary construct despite clinical and prognostic heterogeneity. This study aimed to characterize differences in genetic, cerebrospinal fluid (CSF), neuroimaging, and neuropsychological markers across clinician-derived MCI stages.

Methods: Vanderbilt Memory & Aging Project participants with MCI were categorized into 3 severity subtypes at screening based on neuropsychological assessment, functional assessment, and Clinical Dementia Rating interview, including mild ( = 18, 75 ± 8 years), moderate ( = 89 72 ± 7 years), and severe subtypes ( = 18, 78 ± 8 years). At enrollment, participants underwent neuropsychological testing, 3T brain magnetic resonance imaging (MRI), and optional fasting lumbar puncture to obtain CSF. Neuropsychological testing and MRI were repeated at 18-months, 3-years, and 5-years with a mean follow-up time of 3.3 years. Ordinary least square regressions examined cross-sectional associations between MCI severity and apolipoprotein E ()-ε4 status, CSF biomarkers of amyloid beta (Aβ), phosphorylated tau, total tau, and synaptic dysfunction (neurogranin), baseline neuroimaging biomarkers, and baseline neuropsychological performance. Longitudinal associations between baseline MCI severity and neuroimaging and neuropsychological trajectory were assessed using linear mixed effects models with random intercepts and slopes and a follow-up time interaction. Analyses adjusted for baseline age, sex, race/ethnicity, education, and intracranial volume for MRI models.

Results: Stages differed at baseline on -ε4 status (early < middle = late; -values < 0.03) and CSF Aβ (early > middle = late), phosphorylated and total tau (early = middle < late; -values < 0.05), and neurogranin concentrations (early = middle < late; -values < 0.05). MCI stage related to greater longitudinal cognitive decline, hippocampal atrophy, and inferior lateral ventricle dilation (early < late; -values < 0.03).

Discussion: Clinician staging of MCI severity yielded longitudinal cognitive trajectory and structural neuroimaging differences in regions susceptible to AD neuropathology and neurodegeneration. As expected, participants with more severe MCI symptoms at study entry had greater cognitive decline and gray matter atrophy over time. Differences are likely attributable to baseline differences in amyloidosis, tau, and synaptic dysfunction. MCI staging may provide insight into underlying pathology, prognosis, and therapeutic targets.
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http://dx.doi.org/10.3389/fnagi.2020.00139DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7289958PMC
June 2020

Cerebrospinal fluid biomarkers of neurodegeneration, synaptic dysfunction, and axonal injury relate to atrophy in structural brain regions specific to Alzheimer's disease.

Alzheimers Dement 2020 06 6;16(6):883-895. Epub 2020 May 6.

Department of Neurology, Vanderbilt Memory & Alzheimer's Center, Vanderbilt University Medical Center, Nashville, Tennessee.

Introduction: Patterns of atrophy can distinguish normal cognition from Alzheimer's disease (AD), but neuropathological drivers of this pattern are unknown. This study examined associations between cerebrospinal fluid biomarkers of AD pathology, synaptic dysfunction, and neuroaxonal injury with two AD imaging signatures.

Methods: Signatures were calculated using published guidelines. Linear regressions related each biomarker to both signatures, adjusting for demographic factors. Bootstrapped analyses tested if associations were stronger with one signature versus the other.

Results: Increased phosphorylated tau (p-tau), total tau, and neurofilament light (P-values <.045) related to smaller signatures (indicating greater atrophy). Diagnosis and sex modified associations between p-tau and neurogranin (P-values<.05) and signatures, such that associations were stronger among participants with mild cognitive impairment and female participants. The strength of associations did not differ between signatures.

Discussion: Increased evidence of neurodegeneration, axonopathy, and tau phosphorylation relate to greater AD-related atrophy. Tau phosphorylation and synaptic dysfunction may be more prominent in AD-affected regions in females.
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http://dx.doi.org/10.1002/alz.12087DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7781154PMC
June 2020

Lower Left Ventricular Ejection Fraction Relates to Cerebrospinal Fluid Biomarker Evidence of Neurodegeneration in Older Adults.

J Alzheimers Dis 2020 ;74(3):965-974

Vanderbilt Memory & Alzheimer's Center, Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA.

Background: Subclinical cardiac dysfunction is associated with decreased cerebral blood flow, placing the aging brain at risk for Alzheimer's disease (AD) pathology and neurodegeneration.

Objective: This study investigates the association between subclinical cardiac dysfunction, measured by left ventricular ejection fraction (LVEF), and cerebrospinal fluid (CSF) biomarkers of AD and neurodegeneration.

Methods: Vanderbilt Memory & Aging Project participants free of dementia, stroke, and heart failure (n = 152, 72±6 years, 68% male) underwent echocardiogram to quantify LVEF and lumbar puncture to measure CSF levels of amyloid-β42 (Aβ42), phosphorylated tau (p-tau), and total tau (t-tau). Linear regressions related LVEF to CSF biomarkers, adjusting for age, sex, race/ethnicity, education, Framingham Stroke Risk Profile, cognitive diagnosis, and apolipoprotein E ɛ4 status. Secondary models tested an LVEF x cognitive diagnosis interaction and then stratified by diagnosis (normal cognition (NC), mild cognitive impairment (MCI)).

Results: Higher LVEF related to decreased CSF Aβ42 levels (β= -6.50, p = 0.04) reflecting greater cerebral amyloid accumulation, but this counterintuitive result was attenuated after excluding participants with cardiovascular disease and atrial fibrillation (p = 0.07). We observed an interaction between LVEF and cognitive diagnosis on CSF t-tau (p = 0.004) and p-tau levels (p = 0.002), whereas lower LVEF was associated with increased CSF t-tau (β= -9.74, p = 0.01) and p-tau in the NC (β= -1.41, p = 0.003) but not MCI participants (p-values>0.13).

Conclusions: Among cognitively normal older adults, subclinically lower LVEF relates to greater molecular evidence of tau phosphorylation and neurodegeneration. Modest age-related changes in cardiovascular function may have implications for pathophysiological changes in the brain later in life.
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http://dx.doi.org/10.3233/JAD-190813DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7278528PMC
April 2021

Cerebrospinal fluid and plasma neurofilament light relate to abnormal cognition.

Alzheimers Dement (Amst) 2019 Dec 22;11:700-709. Epub 2019 Oct 22.

Vanderbilt Memory and Alzheimer's Center, Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA.

Introduction: Neuroaxonal damage may contribute to cognitive changes preceding clinical dementia. Accessible biomarkers are critical for detecting such damage.

Methods: Plasma and cerebrospinal fluid (CSF) neurofilament light (NFL) were related to neuropsychological performance among Vanderbilt Memory & Aging Project participants (plasma n = 333, 73 ± 7 years; CSF n = 149, 72 ± 6 years) ranging from normal cognition (NC) to mild cognitive impairment (MCI). Models adjusted for age, sex, race/ethnicity, education, apolipoprotein E ε4 carriership, and Framingham Stroke Risk Profile.

Results: Plasma NFL was related to all domains ( values ≤ .008) except processing speed ( values ≥ .09). CSF NFL was related to memory and language ( values ≤ .04). Interactions with cognitive diagnosis revealed widespread plasma associations, particularly in MCI participants, which were further supported in head-to-head comparison models.

Discussion: Plasma and CSF NFL (reflecting neuroaxonal injury) relate to cognition among non-demented older adults albeit with small to medium effects. Plasma NFL shows particular promise as an accessible biomarker with relevance to cognition in MCI.
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http://dx.doi.org/10.1016/j.dadm.2019.08.008DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6827361PMC
December 2019

Long-term performance of seagrass restoration projects in Florida, USA.

Sci Rep 2019 10 29;9(1):15514. Epub 2019 Oct 29.

Department of Integrative Biology, University of South Florida, 4202 E Fowler Ave, Tampa, FL, 33620, USA.

Seagrass restoration is a common tool for ecosystem service enhancement and compensatory mitigation for habitat loss. However, little is known about the long-term performance of these projects. We identified seagrass restoration projects by reviewing historic permitting documents, monitoring reports, and studies conducted in Florida, USA, most of which have not been cited previously in peer-reviewed literature. We then revisited 33 seagrass restorations ranging in age from 3 to 32 years to compare seagrass percent cover, species diversity, and community structure in restored and contemporary reference seagrass beds. We found that 88% of restoration projects continued to support seagrass and, overall, restored percent cover values were 37% lower than references. Community composition and seagrass percent cover differed from references in projects categorized as sediment modification and transplant restorations, whereas all vessel damage repair projects achieved reference condition. Seagrass diversity was similar between restored and reference beds, except for sediment modification projects, for which diversity was significantly lower than in reference beds. Results indicate that restored seagrass beds in Florida, once established, often exhibit long-term persistence. Our study highlights the benefit of identifying and surveying historic restorations to address knowledge gaps related to the performance and long-term fate of restored seagrass beds.
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http://dx.doi.org/10.1038/s41598-019-51856-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6820728PMC
October 2019

Frailty Is Related to Subjective Cognitive Decline in Older Women without Dementia.

J Am Geriatr Soc 2019 09 16;67(9):1803-1811. Epub 2019 May 16.

Vanderbilt Memory & Alzheimer's Center, Department of Neurology, Vanderbilt University Medical Center, Nashville, Tennessee.

Objectives: Physical frailty (or loss of physiologic reserve) is associated with cognitive impairment and dementia. Subjective cognitive decline (SCD) may represent early pathologic changes of dementia. The association between these disease markers is unclear.

Design: Cross-sectional analysis.

Setting: Community-based participants from the Vanderbilt Memory & Aging Project.

Participants: A total of 306 older adults with normal cognition (NC; n = 174) or mild cognitive impairment (MCI; n = 132).

Measurements: Frailty was measured using standard methods, and a composite frailty score was calculated. SCD was quantified using the Everyday Cognition Scale (ECog; total score and four domain scores). Objective cognition was assessed with the Montreal Cognitive Assessment (MoCA). Proportional odds models, stratified by sex, related the frailty composite to MoCA and total ECog score adjusting for age, education, body mass index, cognitive diagnosis, depressed mood, Framingham Stroke Risk Profile, apolipoprotein E (APOE ε4) carrier status, and height (for gait speed models). Secondary models related individual frailty components to SCD domains and explored associations in NC only.

Results: In women, frailty composite was related to MoCA (odds ratio [OR] = .56; P = .04), a finding attenuated in sensitivity analysis (OR = .59; P = .08). Frailty composite related to ECog total (OR = 2.27; P = .02), planning (OR = 2.63; P = .02), and organization scores (OR = 2.39; P = .03). Increasing gait speed related to lower ECog total (OR = .06; P = .003) and memory scores (OR = .03; P < .001). Grip strength related to lower ECog planning score (OR = .91; P = .04). In men, frailty was unrelated to objective and subjective cognition (P values >.07). Findings were consistent in the NC group.

Conclusion: Frailty component and composite scores are related to SCD before the presence of overt dementia. Results suggest that this association is present before overt cognitive impairment. Results suggest a possible sex difference in the clinical manifestation of frailty, with primary associations noted in women. Further studies should investigate mechanisms linking early changes among frailty, SCD, and cognition. J Am Geriatr Soc, 1-9, 2019. J Am Geriatr Soc 67:1803-1811, 2019.
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http://dx.doi.org/10.1111/jgs.15972DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6781867PMC
September 2019

A patient-centered deprescribing intervention for hospitalized older patients with polypharmacy: rationale and design of the Shed-MEDS randomized controlled trial.

BMC Health Serv Res 2019 Mar 14;19(1):165. Epub 2019 Mar 14.

Vanderbilt University Medical Center, Center for Quality Aging, Nashville, TN, USA.

Background: Polypharmacy is prevalent among hospitalized older adults, particularly those being discharged to a post-care care facility (PAC). The aim of this randomized controlled trial is to determine if a patient-centered deprescribing intervention initiated in the hospital and continued in the PAC setting reduces the total number of medications among older patients.

Methods: The Shed-MEDS study is a 5-year, randomized controlled clinical intervention trial comparing a patient-centered describing intervention with usual care among older (≥50 years) hospitalized patients discharged to PAC, either a skilled nursing facility (SNF) or an inpatient rehabilitation facility (IPR). Patient measurements occur at hospital enrollment, hospital discharge, within 7 days of PAC discharge, and at 60 and 90 days following PAC discharge. Patients are randomized in a permuted block fashion, with block sizes of two to four. The overall effectiveness of the intervention will be evaluated using total medication count as the primary outcome measure. We estimate that 576 patients will enroll in the study. Following attrition due to death or loss to follow-up, 420 patients will contribute measurements at 90 days, which provides 90% power to detect a 30% versus 25% reduction in total medications with an alpha error of 0.05. Secondary outcomes include the number of medications associated with geriatric syndromes, drug burden index, medication adherence, the prevalence and severity of geriatric syndromes and functional health status.

Discussion: The Shed-MEDS trial aims to test the hypothesis that a patient-centered deprescribing intervention initiated in the hospital and continuing through the PAC stay will reduce the total number of medications 90 days following PAC discharge and result in improvements in geriatric syndromes and functional health status. The results of this trial will quantify the health outcomes associated with reducing medications for hospitalized older adults with polypharmacy who are discharged to post-acute care facilities.

Trial Registration: This trial was prospectively registered at clinicaltrials.gov ( NCT02979353 ). The trial was first registered on 12/1/2016, with an update on 09/28/17 and 10/12/2018.
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http://dx.doi.org/10.1186/s12913-019-3995-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6416929PMC
March 2019

Interpreter assemblages: Caring for immigrant and refugee patients in US hospitals.

Authors:
Susan E Bell

Soc Sci Med 2019 04 26;226:29-36. Epub 2019 Feb 26.

Department of Sociology, Drexel University, USA. Electronic address:

US hospitals have developed a variety of strategies to meet federal requirements and provide culturally and linguistically appropriate health care for people who report limited English proficiency. A key strategy is the use of healthcare interpreters who may be physically present in the room or in the room via telephone or video conference. This paper analyzes the contingent and unstable combinations of heterogeneous human and nonhuman elements that form and disperse during visits to the hospital when healthcare interpreters are used. It draws its analysis from 9 months of fieldwork in 2012 that included following 69 adult immigrant and refugee patients in one hospital in Maine and observing encounters with interpreters and clinic staff. It introduces the concept of interpreter assemblage to make sense of the transnational mixes of people, technologies, and ideas that bring multilingual hospital care to life and give it a character of its own.
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http://dx.doi.org/10.1016/j.socscimed.2019.02.031DOI Listing
April 2019

Resource use by and trophic variability of Armases cinereum (Crustacea, Brachyura) across human-impacted mangrove transition zones.

PLoS One 2019 15;14(2):e0212448. Epub 2019 Feb 15.

Department of Integrative Biology, University of South Florida, Tampa, FL, United States of America.

In Florida, resource use patterns by Armases cinereum (Armases), a highly abundant crab in coastal habitats, may serve as important indicators of habitat condition. Here we investigated feeding patterns of Armases in coastal palm scrub forest to intertidal mangrove forest transition zones (transitions) as well as the relationship between habitat disturbance and Armases' trophic position across three pairs of geographically separated populations in Tampa FL, USA. Each pair of sites represented an unmodified "natural" location as well as a "disturbed" location lacking upland terrestrial palm scrub forested habitat. Laboratory experiments established a baseline understanding of feeding preference of Armases offered strictly mangrove material as well as sources abundant at the transition. In-situ feeding behavior was examined using MixSIAR mixing models with δ13C and δ15N stable isotope tracers. Armases showed a strong preference for consuming partially-decomposed mangrove material from Avicennia germinans and an equally strong preference for Iva frutescens. Armases also displayed predatory behavior under laboratory conditions, confirming omnivory in the presence of mangrove material. Stable isotopes revealed a pattern of elevated trophic position of Armases in disturbed habitats over paired natural locations. Diet reconstruction provided coarse resolution of in-situ feeding and results show high spatial variation: in natural habitats, Armases appears to rely heavily upon upland plant material compared to disturbed habitats where it may consume more animal prey. Combined, these findings support that Armases trophic position and diet may indicate habitat quality in mangrove transitions in the southeastern United States.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0212448PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6377144PMC
November 2019

Changes in vulnerability among older patients with cardiovascular disease in the first 90 days after hospital discharge: A secondary analysis of a cohort study.

BMJ Open 2019 01 29;9(1):e024766. Epub 2019 Jan 29.

Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA.

Objectives: (1) To compare changes in vulnerability after hospital discharge among older patients with cardiovascular disease who were discharged home with self-care versus a home healthcare (HHC) referral and (2) to examine factors associated with changes in vulnerability in this period.

Design: Secondary analysis of longitudinal data from a cohort study.

Participants And Setting: 834 older (≥65 years) patients hospitalised for acute coronary syndromes and/or acute decompensated heart failure who were discharged home with self-care (n=713) or an HHC referral (n=121).

Outcome: Vulnerability was measured using Vulnerable Elders Survey 13 (VES-13) at baseline (prior to hospital admission) and 30 days and/or 90 days after hospital discharge. Effects of HHC referral on postdischarge change in vulnerability were examined using three linear regression approaches, with potential confounding on HHC referral adjusted by propensity score matching.

Results: Overall, 44.4% of the participants were vulnerable at prehospitalisation baseline and 34.4% were vulnerable at 90 days after hospital discharge. Compared with self-care patients, HHC-referred patients were more vulnerable at baseline (66.9% vs 40.3%), had more increase (worsening) in VES-13 score change (B=-1.34(-2.07, -0.61), p<0.001) in the initial 30 days and more decrease (improvement) in VES-13 score change (B=0.83(0.20, 1.45), p=0.01) from 30 to 90 days after hospital discharge. Baseline vulnerability and the HHC referral attributed to 14%-16% of the variance in vulnerability change during the 90 postdischarge days, and 6% was attributed by patient age, race (African-American), depressive symptoms, and outpatient visits and hospitalisations in the past year.

Conclusion: After adjusting for preceding vulnerability and covariates, older hospitalised patients with cardiovascular disease referred to HHC had delayed recovery in vulnerability in first initial 30 days after hospital discharge and greater improvement in vulnerability from 30 to 90 days after hospital discharge. HHC seemed to facilitate improvement in vulnerability among older patients with cardiovascular disease from 30 to 90 days after hospital discharge.
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http://dx.doi.org/10.1136/bmjopen-2018-024766DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6352778PMC
January 2019

The 12-Word Philadelphia Verbal Learning Test Performances in Older Adults: Brain MRI and Cerebrospinal Fluid Correlates and Regression-Based Normative Data.

Dement Geriatr Cogn Dis Extra 2018 Sep-Dec;8(3):476-491. Epub 2018 Dec 6.

Vanderbilt Memory and Alzheimer's Center, Department of Neurology, Vanderbilt University Medical Center, Nashville, Tennessee, USA.

Background/aims: This study evaluated neuroimaging and biological correlates, psychometric properties, and regression-based normative data of the 12-word Philadelphia Verbal Learning Test (PVLT), a list-learning test.

Methods: Vanderbilt Memory and Aging Project participants free of clinical dementia and stroke ( = 230, aged 73 ± 7 years) completed a neuropsychological protocol and brain MRI. A subset ( = 111) underwent lumbar puncture for analysis of Alzheimer's disease (AD) and axonal integrity cerebrospinal fluid (CSF) biomarkers. Regression models related PVLT indices to MRI and CSF biomarkers adjusting for age, sex, race/ethnicity, education, -ε4 carrier status, cognitive status, and intracranial volume (MRI models). Secondary analyses were restricted to participants with normal cognition (NC; = 127), from which regression-based normative data were generated.

Results: Lower PVLT performances were associated with smaller medial temporal lobe volumes ( < 0.05) and higher CSF tau concentrations ( < 0.04). Among NC, PVLT indices were associated with white matter hyperintensities on MRI and an axonal injury biomarker (CSF neurofilament light; < 0.03).

Conclusion: The PVLT appears sensitive to markers of neurodegeneration, including temporal regions affected by AD. Conversely, in cognitively normal older adults, PVLT performance seems to relate to white matter disease and axonal injury, perhaps reflecting non-AD pathways to cognitive change. Enhanced normative data enrich the clinical utility of this tool.
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http://dx.doi.org/10.1159/000494209DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6323369PMC
December 2018

Timing of Left Ventricular Remodeling in Nonischemic Dilated Cardiomyopathy.

Am J Med Sci 2018 09 8;356(3):262-267. Epub 2018 Jun 8.

Division of Cardiovascular Medicine and. Electronic address:

Background: Mineralocorticoid receptor antagonist (MRA) treatment produces beneficial left ventricular (LV) remodeling in nonischemic dilated cardiomyopathy (NIDCM). This study addressed the timing of maximal beneficial LV remodeling in NIDCM when adding MRA.

Materials And Methods: We studied 12 patients with NIDCM on stable β-blocker and angiotensin-converting enzyme inhibitor/angiotensin receptor-blocking therapy who underwent cardiac magnetic resonance imaging before and after 6-31 months of continuous MRA therapy.

Results: At baseline, the LV ejection fraction (LVEF) was 24% (19-27); median [interquartile range]. The LV end-systolic volume index (LVESVI) was 63 ml (57-76) and the LV stroke volume index (LVSVI) was 19 ml (14-21), all depressed. After adding MRA to the HF regimen, the LVEF increased to 47% (42-52), with a decrease in LVESVI to 36 ml (33-45) and increase in LVSVI to 36 ml (28-39) (for each, P  < 0 .0001). Using generalized least squares analysis, the maximal beneficial remodeling (defined by maximal increase in LVEF, the maximal decrease in LVESVI and maximal increase in LVSVI) was achieved after approximately 12-16 months of MRA treatment.

Conclusions: Adding MRA to a standard medical regimen for NIDCM resulted in beneficial LV remodeling. The maximal beneficial remodeling was achieved with 12-16 months of MRA therapy. These results have implications for the timing of other advanced therapies, such as placing internal cardioverter-defibrillators.
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http://dx.doi.org/10.1016/j.amjms.2018.06.003DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7388723PMC
September 2018

Shed-MEDS: pilot of a patient-centered deprescribing framework reduces medications in hospitalized older adults being transferred to inpatient postacute care.

Ther Adv Drug Saf 2018 Sep 15;9(9):523-533. Epub 2018 Jun 15.

Vanderbilt Center for Health Services Research, Center for Quality Aging, Division of General Internal Medicine and Public Health, Geriatric Research Education and Clinical Center, VA Tennessee Valley, 2525 West End Ave, Suite 450, Nashville, TN 37203, USA.

Background: Polypharmacy is common in hospitalized older adults. Deprescribing interventions are not well described in the acute-care setting. The objective of this study was to describe a hospital-based, patient-centered deprescribing protocol (Shed-MEDS) and report pilot results.

Methods: This was a pilot study set in one academic medical center in the United States. Participants consisted of a convenience sample of 40 Medicare-eligible, hospitalized patients with at least five prescribed medications. A deprescribing protocol (Shed-MEDS) was implemented among 20 intervention and 20 usual care control patients during their hospital stay. The primary outcome was the total number of medications deprescribed from hospital enrollment. Deprescribed was defined as medication termination or dose reduction. Enrollment medications reflected all prehospital medications and active in-hospital medications. Baseline characteristics and outcomes were compared between the intervention and usual care groups using simple logistic or linear regression for categorical and continuous measures, respectively.

Results: There was no significant difference between groups in mean age, sex or Charlson comorbidity index. The intervention and control groups had a comparable number of medications at enrollment, 25.2 (±6.3) and 23.4 (±3.8), respectively. The number of prehospital medications in each group was 13.3 (±4.6) and 15.3 (±4.6), respectively. The Shed-MEDS protocol compared with usual care significantly increased the mean number of deprescribed medications at hospital discharge and reduced the total medication burden by 11.6 9.1 ( 0.032) medications. The deprescribing intervention was associated with a difference of 4.6 [95% confidence interval (CI) 2.5-6.7, < 0.001] in deprescribed medications and a 0.5 point reduction (95% CI -0.01 to 1.1) in the drug burden index.

Conclusions: A hospital-based, patient-centered deprescribing intervention is feasible and may reduce the medication burden in older adults.
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http://dx.doi.org/10.1177/2042098618781524DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6116773PMC
September 2018

Neurofilament relates to white matter microstructure in older adults.

Neurobiol Aging 2018 10 28;70:233-241. Epub 2018 Jun 28.

Department of Neurology, Vanderbilt Memory & Alzheimer's Center, Vanderbilt University Medical Center, Nashville, TN, USA. Electronic address:

Cerebrospinal fluid (CSF) neurofilament light (NFL) is a protein biomarker of axonal injury. To study whether NFL is associated with diffusion tensor imaging (DTI) measurements of white matter (WM) microstructure, Vanderbilt Memory & Aging Project participants with normal cognition (n = 77), early mild cognitive impairment (n = 15), and MCI (n = 55) underwent lumbar puncture to obtain CSF and 3T brain MRI. Voxel-wise analyses cross-sectionally related NFL to DTI metrics, adjusting for demographic and vascular risk factors. Increased NFL correlated with multiple DTI metrics (p-values < 0.05). An NFL × diagnosis interaction (excluding early mild cognitive impairment) on WM microstructure (p-values < 0.05) was detected, with associations strongest among MCI. Multiple NFL × CSF biomarker interactions were detected. Associations between NFL and worse WM metrics were strongest among amyloid-β-negative, tau-positive, and suspected nonamyloid pathology participants. Findings suggest increased NFL, a biomarker of axonal injury, is correlated with compromised WM microstructure. Results highlight the role of elevated NFL in predicting WM damage in cognitively impaired older adults who are amyloid-negative, tau-positive, or meet suspected nonamyloid pathology criteria.
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http://dx.doi.org/10.1016/j.neurobiolaging.2018.06.023DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6119102PMC
October 2018

Higher Aortic Stiffness Is Related to Lower Cerebral Blood Flow and Preserved Cerebrovascular Reactivity in Older Adults.

Circulation 2018 10;138(18):1951-1962

Radiology and Radiological Sciences (J.G.T., S.N., L.T.D., J.J.C.), Vanderbilt University Medical Center, Nashville, TN.

Background: Mechanisms underlying the association between age-related arterial stiffening and poor brain health remain elusive. Cerebral blood flow (CBF) homeostasis may be implicated. This study evaluates how aortic stiffening relates to resting CBF and cerebrovascular reactivity (CVR) in older adults.

Methods: Vanderbilt Memory & Aging Project participants free of clinical dementia, stroke, and heart failure were studied, including older adults with normal cognition (n=155; age, 72±7 years; 59% male) or mild cognitive impairment (n=115; age, 73±7 years; 57% male). Aortic pulse wave velocity (PWV; meters per second) was quantified from cardiac magnetic resonance. Resting CBF (milliliters per 100 g per minute) and CVR (CBF response to hypercapnic normoxia stimulus) were quantified from pseudocontinuous arterial spin labeling magnetic resonance imaging. Linear regression models related aortic PWV to regional CBF, adjusting for age, race/ethnicity, education, Framingham Stroke Risk Profile (diabetes mellitus, smoking, left ventricular hypertrophy, prevalent cardiovascular disease, atrial fibrillation), hypertension, body mass index, apolipoprotein E4 ( APOE ε4) status, and regional tissue volume. Models were repeated testing PWV× APOE ε4 interactions. Sensitivity analyses excluded participants with prevalent cardiovascular disease and atrial fibrillation.

Results: Among participants with normal cognition, higher aortic PWV related to lower frontal lobe CBF (β=-0.43; P=0.04) and higher CVR in the whole brain (β=0.11; P=0.02), frontal lobes (β=0.12; P<0.05), temporal lobes (β=0.11; P=0.02), and occipital lobes (β=0.14; P=0.01). Among APOE ε4 carriers with normal cognition, findings were more pronounced with higher PWV relating to lower whole-brain CBF (β=-1.16; P=0.047), lower temporal lobe CBF (β=-1.81; P=0.004), and higher temporal lobe CVR (β=0.26; P=0.08), although the last result did not meet the a priori significance threshold. Results were similar in sensitivity models. Among participants with mild cognitive impairment, higher aortic PWV related to lower CBF in the occipital lobe (β=-0.70; P=0.02), but this finding was attenuated when participants with prevalent cardiovascular disease and atrial fibrillation were excluded. Among APOE ε4 carriers with mild cognitive impairment, findings were more pronounced with higher PWV relating to lower temporal lobe CBF (β=-1.20; P=0.02).

Conclusions: Greater aortic stiffening relates to lower regional CBF and higher CVR in cognitively normal older adults, especially among individuals with increased genetic predisposition for Alzheimer's disease. Central arterial stiffening may contribute to reductions in regional CBF despite preserved cerebrovascular reserve capacity.
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http://dx.doi.org/10.1161/CIRCULATIONAHA.118.032410DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6394409PMC
October 2018

Increased Left Ventricular Mass Index Is Associated With Compromised White Matter Microstructure Among Older Adults.

J Am Heart Assoc 2018 06 26;7(13). Epub 2018 Jun 26.

Department of Neurology, Vanderbilt Memory & Alzheimer's Center, Vanderbilt University Medical Center, Nashville, TN

Background: Left ventricular (LV) hypertrophy is associated with cerebrovascular disease and cognitive decline. Increased LV mass index is a subclinical imaging marker that precedes overt LV hypertrophy. This study relates LV mass index to white matter microstructure and cognition among older adults with normal cognition and mild cognitive impairment.

Methods And Results: Vanderbilt Memory & Aging Project participants free of clinical stroke, dementia, and heart failure (n=318, 73±7 years, 58% male, 39% mild cognitive impairment) underwent brain magnetic resonance imaging, cardiac magnetic resonance, and neuropsychological assessment. Voxelwise analyses related LV mass index (g/m) to diffusion tensor imaging metrics. Models adjusted for age, sex, education, race/ethnicity, Framingham Stroke Risk Profile, cognitive diagnosis, and apolipoprotein E-ε4 status. Secondary analyses included a LV mass index×diagnosis interaction term with follow-up models stratified by diagnosis. With identical covariates, linear regression models related LV mass index to neuropsychological performances. Increased LV mass index related to altered white matter microstructure (<0.05). In models stratified by diagnosis, associations between LV mass index and diffusion tensor imaging were present among mild cognitive impairment participants only (<0.05). LV mass index was related only to worse visuospatial memory performance (β=-0.003, =0.036), an observation that would not withstand correction for multiple testing.

Conclusions: In the absence of prevalent heart failure and clinical stroke, increased LV mass index corresponds to altered white matter microstructure, particularly among older adults with clinical symptoms of prodromal dementia. Findings highlight the potential link between subclinical LV remodeling and cerebral white matter microstructure vulnerability.
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http://dx.doi.org/10.1161/JAHA.118.009041DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6064880PMC
June 2018

Validity and Normative Data for the Biber Figure Learning Test: A Visual Supraspan Memory Measure.

Assessment 2020 09 29;27(6):1320-1334. Epub 2018 May 29.

Vanderbilt University Medical Center, Nashville, TN, USA.

The Biber Figure Learning Test (BFLT), a visuospatial serial figure learning test, was evaluated for biological correlates and psychometric properties, and normative data were generated. Nondemented individuals ( = 332, 73 ± 7, 41% female) from the Vanderbilt Memory & Aging Project completed a comprehensive neuropsychological protocol. Adjusted regression models related BFLT indices to structural brain magnetic resonance imaging and cerebrospinal fluid (CSF) markers of brain health. Regression-based normative data were generated. Lower BFLT performances (Total Learning, Delayed Recall, Recognition) related to smaller medial temporal lobe volumes and higher CSF tau concentrations but not CSF amyloid. BFLT indices were most strongly correlated with other measures of verbal and nonverbal memory and visuospatial skills. The BFLT provides a comprehensive assessment of all aspects of visuospatial learning and memory and is sensitive to biomarkers of unhealthy brain aging. Enhanced normative data enriches the clinical utility of this visual serial figure learning test for use with older adults.
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http://dx.doi.org/10.1177/1073191118773870DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6212325PMC
September 2020

Multimorbidity in Older Adults With Cardiovascular Disease.

J Am Coll Cardiol 2018 05;71(19):2149-2161

Division of Cardiology, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri.

Multimorbidity occurs in adults of all ages, but the number and complexity of comorbid conditions commonly increase with advancing age such that cardiovascular disease (CVD) in older adults typically occurs in a context of multimorbidity. Current clinical practice and research mainly target single disease-specific care that does not embrace the complexities imposed by concurrent conditions. In this paper, emerging concepts regarding CVD in combination with multimorbidity are reviewed, including recommendations for incorporating multimorbidity into clinical decision making, critical knowledge gaps, and research priorities to optimize care of complex older patients.
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http://dx.doi.org/10.1016/j.jacc.2018.03.022DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6028235PMC
May 2018

Cerebrospinal fluid β-amyloid and neurofilament light relate to white matter hyperintensities.

Neurobiol Aging 2018 08 3;68:18-25. Epub 2018 Apr 3.

Vanderbilt Memory & Alzheimer's Center, Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA. Electronic address:

White matter hyperintensities (WMHs) are associated with poorer brain health, but their pathophysiological substrates remain elusive. To better understand the mechanistic underpinnings of WMHs among older adults, this study examined in vivo cerebrospinal fluid biomarkers of β-amyloid deposition (Aβ), hyperphosphorylated tau pathology, neurodegeneration (total tau), and axonal injury (neurofilament light [NFL]) in relation to log-transformed WMHs volume. Participants free of clinical stroke and dementia were drawn from the Vanderbilt Memory & Aging Project (n = 148, 72 ± 6 years). Linear regression models adjusted for age, sex, race/ethnicity, education, intracranial volume, modified Framingham Stroke Risk Profile (excluding points assigned for age), cognitive diagnosis, and APOE-ε4 carrier status. Aβ (β = -0.001, p = 0.007) and NFL (β = 0.0003, p = 0.01) concentrations related to WMHs but neither hyperphosphorylated tau nor total tau associations with WMHs reached statistical significance (p-values > 0.21). In a combined model, NFL accounted for 3.2% of unique variance in WMHs and Aβ accounted for an additional 4.3% beyond NFL, providing novel evidence of the co-occurrence of at least 2 distinct pathways for WMHs among older adults, including amyloid deposition and axonal injury.
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http://dx.doi.org/10.1016/j.neurobiolaging.2018.03.028DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6085839PMC
August 2018

APOE genotype modifies the association between central arterial stiffening and cognition in older adults.

Neurobiol Aging 2018 07 20;67:120-127. Epub 2018 Feb 20.

Vanderbilt Memory & Alzheimer's Center, Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA. Electronic address:

Arterial stiffening is associated with cognitive impairment and prodromal Alzheimer's disease. This study tested the interaction between arterial stiffening and an Alzheimer's disease genetic risk factor (apolipoprotein E [APOE] genotype) on cognition among older adults. Vanderbilt Memory & Aging Project participants with normal cognition (n = 162, 72 ± 7 years, 29% APOE-ε4 carrier) and mild cognitive impairment (n = 121, 73 ± 8 years, 42% APOE-ε4 carrier) completed neuropsychological assessment and cardiac MRI to assess aortic stiffening using pulse wave velocity (PWV, m/s). Linear regression models stratified by cognitive diagnosis related aortic PWV × APOE-ε4 status to neuropsychological performances, adjusting for demographic and vascular risk factors. PWV × APOE-ε4 related to poorer performance on measures of lexical retrieval (β = -0.29, p = 0.01), executive function (β = -0.44, p = 0.02), and episodic memory (β = -3.07, p = 0.02). Among participants with higher aortic PWV, APOE-ε4 modified the association between central arterial stiffening and cognition, such that carriers had worse performances than noncarriers. Findings add to a growing body of evidence for APOE-vascular interactions on cognition in older adults and warrant further research into less heart-healthy cohorts where the association between PWV and cognition among older adults might be stronger.
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http://dx.doi.org/10.1016/j.neurobiolaging.2018.02.009DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5985659PMC
July 2018

Survivorship care planning in neuro-oncology.

Neurooncol Pract 2018 Mar 11;5(1):3-9. Epub 2018 Jan 11.

National Institutes of Health, Bethesda, MD.

Cancer patient survivorship has become a significant topic within oncology care for both adult and pediatric patients. Starting in 2005, the Institute of Medicine recommended the use of survivorship care plans to assist patients transitioning from active treatment to the posttreatment phase of their cancer care, a critical time for many patients. Since 2014 there has been a mandate within the United States for adult cancer patients treated with curative intent to receive survivorship care plans comprised of a treatment summary and a follow-up plan to facilitate a better understanding among patients of what to expect after treatment. In addition to a general oncology survivorship care plan, specific care plans have been created for breast, lung, prostate, and colon cancers, as well as lymphoma. A survivorship care plan specific to adult neuro-oncology has been developed by a multidisciplinary and interprofessional committee, with approval from the Society for Neuro-Oncology Guidelines Committee. It has been published in compendium with this review of survivorship care planning and available as a fillable PDF on the Society of Neuro-Oncology Guidelines Endorsement web page (https://www.soc-neuro-onc.org/SNO/Resources/Survivorship_Care_Plan.aspx). Implementation of this survivorship care plan provides a unique opportunity to begin addressing the range of survivorship issues our neuro-oncology patients navigate from diagnosis to end of life.
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http://dx.doi.org/10.1093/nop/npx034DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6655526PMC
March 2018

Placing care: embodying architecture in hospital clinics for immigrant and refugee patients.

Authors:
Susan E Bell

Sociol Health Illn 2018 02;40(2):314-326

Department of Sociology, Drexel University, USA.

This article is part of a hospital ethnography that investigates healthcare architecture as an aspect of an increasingly large, complex, and urgent global health issue: caring for refugees and other immigrants. It argues that hospitals are nodes in transnational social networks of immigrant and refugee patients that form assemblages of human and non-human objects. These assemblages co-produce place-specific hospital care in different hospital spaces. Place-specific tensions and power dynamics arise when refugees and immigrants come into contact with these biomedical spaces. The argument is developed by analysing waiting rooms and exam rooms in two outpatient clinics in one US hospital. The article draws its analysis from 9 months of fieldwork in 2012 that included following 69 adult immigrant and refugee patients and observing their encounters with interpreters and clinic staff. Its inclusion of a transnational dimension for understanding place-specific hospital care adds conceptual and empirical depth to the study of how place matters in 21st century hospitals.
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http://dx.doi.org/10.1111/1467-9566.12604DOI Listing
February 2018

Subclinical Compromise in Cardiac Strain Relates to Lower Cognitive Performances in Older Adults.

J Am Heart Assoc 2018 02 13;7(4). Epub 2018 Feb 13.

Department of Neurology, Vanderbilt Memory & Alzheimer's Center Vanderbilt University Medical Center, Nashville, TN

Background: Global longitudinal strain (GLS), reflecting total shortening of the myocardium during the cardiac cycle, has emerged as a more precise myocardial function measure than left ventricular ejection fraction (LVEF). Longitudinal strain may be selectively affected in subclinical heart disease, even in the presence of normal LVEF. This study examines subclinical cardiac dysfunction, assessed by GLS and LVEF, and cognition among older adults.

Methods And Results: Vanderbilt Memory and Aging Project participants who were free of clinical dementia, stroke, and heart failure (n=318, 73±7 years, 58% male) completed neuropsychological assessment and cardiac magnetic resonance to quantify GLS and LVEF. Linear regression models related GLS and LVEF to neuropsychological performances, adjusting for age, sex, race/ethnicity, education, Framingham Stroke Risk Profile, cognitive diagnosis, and *ε4 status. Models were repeated with a cardiac×cognitive diagnosis interaction term. Compromised GLS (reflected by higher values) related to worse naming (β=-0.07, =0.04), visuospatial immediate recall (β=-0.83, =0.03), visuospatial delayed recall (β=-0.22, =0.03), and verbal delayed recall (β=-0.11, =0.007). LVEF did not relate to worse performance on any measure (>0.18). No diagnostic interactions were observed.

Conclusions: Our study results are among the first to suggest that compromised GLS relates to worse episodic memory and language performance among older adults who are free of clinical dementia, stroke, and heart failure. Subclinical cardiac dysfunction may correlate with cognitive health in late life, even when LVEF remains normal. The results add to growing evidence that GLS may be a more sensitive and preferred method for quantifying subclinical changes in cardiac function.
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http://dx.doi.org/10.1161/JAHA.117.007562DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5850190PMC
February 2018

Ethical Implications of Rapid Whole-Genome Sequencing in Neonates.

Neonatal Netw 2018 Jan;37(1):42-44

Asante Rogue Regional Medical Center, Medford, OR 97504, USA, Email:

Using rapid whole-genome sequencing (WGS), an infant's genome can now be sequenced in as little as 26 hours allowing for rapid diagnosis and precise, individualized management of monogenetic causes of disease. The potential for decreasing cost and valuable time to diagnosis along with pain and suffering is becoming a reality in the NICU. Coupled with rapidly developing technology is a need to explore the associated ethical implication.
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http://dx.doi.org/10.1891/0730-0832.37.1.42DOI Listing
January 2018