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98 The Crosstalk between Mitochondrial Dysfunction and Neurodevelopmental Outcomes in Preterm Infants with Pain/Stress in the NICU
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- Tingting Zhao, Xiaolin Chang, Subrata Biswas, Jeremy Balsbaugh, Jennifer Liddle, Ming-hui Chen, Adam Matson, Xiaomei Cong
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- Journal:
- Journal of Clinical and Translational Science / Volume 8 / Issue s1 / April 2024
- Published online by Cambridge University Press:
- 03 April 2024, p. 27
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OBJECTIVES/GOALS: Early life pain/stress impacts infants’ neurodevelopmental outcomes. Mitochondrial dysfunction may interface between infants’ stress and neurodevelopment. The study aims to investigate the associations between pain/stress, proteins associated with mitochondrial dysfunction, and neurobehavioral responses in preterm infants. METHODS/STUDY POPULATION: A prospective cohort study was conducted with 33 preterm infants enrolled between September 2017 and July 2022 at two affiliated NICUs in Hartford and Farmington, CT. Daily pain/stress experienced during NICU was documented. At 36-38 weeks post-menstrual age (PMA), neurobehavioral outcomes were evaluated using the NICU Network Neurobehavioral Scale (NNNS) and buccal swabs for Mass spectrometry-based proteomics analysis. Lasso statistical methods were conducted to study the association between protein abundance and infants’ NNNS summary scores. Multiple linear regression and Gene Ontology (GO) enrichment analyses were performed to examine how clinical characteristics and neurodevelopmental outcomes may be associated with protein levels and underlying molecular pathways. RESULTS/ANTICIPATED RESULTS: During NICU hospitalization, preterm premature rupture of membrane (PPROM) was negatively associated with neurobehavioral outcomes. The protein functions, including leptin receptor binding activity, glutathione disulfide oxidoreductase activity, and response to oxidative stress, lipid metabolism, phosphate, and proton transmembrane transporter activity, were negatively associated with neurobehavioral outcomes. In contrast, cytoskeletal regulation, epithelial barrier, and protection function were found to be positively associated with neurodevelopmental outcomes. In addition, mitochondrial dysfunction-related proteins (SPRR2A, PAIP1, S100A3, MT-CO2, PiC, GLRX, PHB2, and BNIPL-2, ABLIM1, UNC45A, Keratins, MUC1, and CYB5B) were found to be associated with neurobehavioral outcomes. DISCUSSION/SIGNIFICANCE: Mitochondrial dysfunction-related proteins were observed to be associated with early life pain/stress and neurodevelopmental outcomes in infants. Buccal proteins could be used to predict potential neurobehavioral outcomes. In addition, individualized skin integrity protection should be provided to preterm infants during their NICU stay.
Preventing unnecessary urine cultures at a Veteran’s affairs healthcare system
- Chad D. Nix, William B. Messer, Amy Boda, Kimberly T. MacKay, Jennifer Holmquist, La’Tonzia L. Adams, Eric Gladwin, Christopher D. Pfeiffer
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- Infection Control & Hospital Epidemiology , First View
- Published online by Cambridge University Press:
- 25 March 2024, pp. 1-3
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Estimating minimum dietary diversity for children aged 6–23 months: a comparison of agreement and cost of two recall methods in Cambodia and Zambia
- Laura S Hackl, Lidan Du-Skabrin, Amry Ok, Chiza Kumwenda, Navy Sin, Lukonde Mwelwa-Zgambo, Ramji Dhakal, Bubala Thandie Hamaimbo, Elise C Reynolds, Katherine P Adams, Charles D Arnold, Christine P Stewart, Erin M Milner, Sarah Pedersen, Jennifer Yourkavitch
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- Journal:
- Public Health Nutrition / Volume 27 / Issue 1 / 2024
- Published online by Cambridge University Press:
- 22 January 2024, e79
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Objective:
To compare the agreement and cost of two recall methods for estimating children’s minimum dietary diversity (MDD).
Design:We assessed child’s dietary intake on two consecutive days: an observation on day one, followed by two recall methods (list-based recall and multiple-pass recall) administered in random order by different enumerators at two different times on day two. We compared the estimated MDD prevalence using survey-weighted linear probability models following a two one-sided test equivalence testing approach. We also estimated the cost-effectiveness of the two methods.
Setting:Cambodia (Kampong Thom, Siem Reap, Battambang, and Pursat provinces) and Zambia (Chipata, Katete, Lundazi, Nyimba, and Petauke districts).
Participants:Children aged 6–23 months: 636 in Cambodia and 608 in Zambia.
Results:MDD estimations from both recall methods were equivalent to the observation in Cambodia but not in Zambia. Both methods were equivalent to the observation in capturing most food groups. Both methods were highly sensitive although the multiple-pass method accurately classified a higher proportion of children meeting MDD than the list-based method in both countries. Both methods were highly specific in Cambodia but moderately so in Zambia. Cost-effectiveness was better for the list-based recall method in both countries.
Conclusion:The two recall methods estimated MDD and most other infant and young child feeding indicators equivalently in Cambodia but not in Zambia, compared to the observation. The list-based method produced slightly more accurate estimates of MDD at the population level, took less time to administer and was less costly to implement.
Inspiring diverse researchers in Virginia: Cultivating research excellence through a career-building program
- Lina V. Mata-McMurry, Jennifer V. Phillips, Sandra G. Burks, Adam Greene, Sana Syed, Karen C. Johnston
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- Journal of Clinical and Translational Science / Volume 8 / Issue 1 / 2024
- Published online by Cambridge University Press:
- 22 January 2024, e27
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Historically underrepresented groups in biomedical research have continued to experience low representation despite shifting demographics. Diversity fosters inclusive, higher quality, and innovative team science. One avenue for diversifying research teams is integrating diversity-focused initiatives into Clinical and Translational Science Award (CTSA) Programs, such as the integrated Translational Health Research Institute of Virginia (iTHRIV). In 2020, iTHRIV participated in Building Up, developed by the University of Pittsburgh CTSA, and intended to increase representation and improve career support for underrepresented groups in the biomedical workforce. Drawing lessons from this study, iTHRIV implemented the “inspiring Diverse Researchers in Virginia” (iDRIV) program. This yearlong program provided education, coaching, mentoring, and sponsorship for underrepresented early career investigators in the biomedical workforce. To date, 24 participants have participated in the program across three cohorts. Participants have been predominantly female (92%), with 33% identifying as Hispanic/Latinx, 29% as Black, and 13% as Asian. Notably, 38% of scholars have subsequently achieved at least one accomplishment, such as receiving a local research honor or award and an extramural funding award from a foundation or federal agency. The iTHRIV iDRIV program serves as a model for providing career support to developing investigators from underrepresented backgrounds, with the overall goal of improving patient health.
Invited Symposium 3: Pediatric Neuropsychology Medical Advances and Life Span Outcomes
- Celiane Rey-Casserly, Lana Harder, Adam R. Cassidy, Andrew Heitzer, Jennifer Longoria
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- Journal:
- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, pp. 665-666
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Medical advances continue to improve the outlook for pediatric patients with a variety of acquired and congenital medical conditions. Such critical advances have an impact on lifespan outcomes for affected individuals. Neuropsychology plays a critical role in evaluating outcomes and informing clinical care for pediatric patients, with an increasing role in prevention. Neuropsychologists are essential members of interdisciplinary teams and ongoing medical management. Our symposium will present examples of the latest progress made over the last decade in the areas of sickle cell disease, demyelinating disorders, congenital heart disease, and cancer. Highlights include recent research on neurocognitive surveillance for pediatric patients with sickle cell disease including identification of risk and resilience factors and ways to reduce cognitive decline; discovery of the anti-MOG antibody in patients with demyelinating disorders and associated neuropsychological outcomes; advances in the understanding of congenital heart disease, the latest initiatives in the field, and discussion of neuropsychology’s role in the care of these patients; and advances in targeted therapies for childhood cancer, risks associated with cancer and its treatment into adulthood, and an application of a developmental, lifespan approach in the care of childhood cancer survivors. Following each presentation, there will be an opportunity for discussion and questions. Upon conclusion of this course, learners will be able to:
1. Describe recent advances in medical care for pediatric sickle cell disease, demyelinating disorders, congenital heart disease, and cancer
2. Explain long-term neuropsychological outcomes in pediatric medical disorders
3. Assess the role of neuropsychology in advancing the field across pediatric medical disorders
1 Sex Differences in Associations Between APOE ε2 and Longitudinal Cognitive Decline
- Madeline Wood, Lisa Xiong, Yuen Yan Wong, Rachel F Buckley, Walter Swardfager, Mario Masellis, Andrew Lim, Emma Nichols, Renaud La Joie, Kaitlin Casaletto, Raj Kumar, Kristen Dams-O’Connor, Priya Palta, Kristen George, Claudia Satizabal, Lisa L Barnes, Julie A Schneider, Judy Pa, Adam Brickman, Sandra Black, Jennifer Rabin
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- Journal:
- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, pp. 405-406
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Objective:
Women have a greater lifetime risk of developing Alzheimer’s disease (AD) dementia than men, a sex/gender disparity that cannot be explained by female longevity alone. There is substantial evidence for sex differences in the effects of APOE £4 on risk for AD. While APOE e4 increases AD risk in both sexes, women who carry APOE e4 are disproportionately vulnerable to cognitive impairment and AD compared to their counterpart men. In contrast to APOE e4, APOE £2 is associated with slower cognitive decline and a lower risk of AD. Although a less robust literature, APOE e2 may also have sex-specific effects. Because APOE e2 is the rarest major APOE allele, well-powered studies are needed to examine sex-specific effects. The objective of the present study was to examine sex-specific associations of APOE e2 carriage with longitudinal cognitive decline in a large cohort of clinically unimpaired adults.
Participants and Methods:We used observational data from two sources: the National Alzheimer’s Coordinating Center (NACC) and the Rush Alzheimer’s Disease Center (ROS/MAP/MARS) studies. We included data from clinically unimpaired adults who were >50 years old at baseline who self-identified as non-Hispanic White (NHW) or non-Hispanic Black (NHB). Participants were categorized as APOE £2, £4, or £3/e3 carriers. APOE e2/e4 carriers were excluded. The same battery of neuropsychological tests was used to assess global cognition in participants from both data sources. Linear mixed models examined interactive associations of genotype (£2 or £4 vs. £3/£3), sex, and time on longitudinal cognition in NHW and NHB participants separately. Analyses were first performed in a pooled sample of NACC and ROS/MAP/MARS participants and if significant they were repeated separately in each data source.
Results:Across both data sources, 9,766 NHW (mean (SD) age=73.0(9.00) years, mean (SD) education=16.3(2.83) years, n(%) women=6,344(65.0)) and 2,010 NHB participants (mean(SD) age=71.3(7.59) years, mean(SD) education=14.9(3.10) years, n(%) women=1,583(78.8)) met inclusion criteria. Sex modified the association between APOE £2 and cognitive decline in NHW (ß=0.097, 95% CI: 0.023-0.172, pint=.01) but not NHB participants (ß=-0.011, 95% CI: -0.153-0.131, pint=.9). In sex-stratified analyses of NHW participants, APOE £2 (vs. £3/£3) carriage was associated with attenuated cognitive decline in men (ß=0.096, 95% CI: 0.037-0.155, p=.001), but not women (ß=-0.001, 95% CI: -0.044-0.043, p=.97). In analyses comparing men and women APOE £2 carriers, men exhibited slower cognitive decline than women (ß=0.120, 95% CI: 0.051-0.190, p=.001). Analyses performed separately in NACC and ROS/MAP revealed the same pattern of male-specific APOE £2 protection in NHW participants in both data sources.
Conclusions:In light of the longstanding view that APOE £2 protects against AD and dementia, our results provide evidence that APOE £2 is associated with attenuated cognitive decline in men but not women among NHW adults. This male-specific protection may contribute to sex differences in AD-related cognitive decline. Our findings have important implications for understanding the biological drivers of sex differences in AD risk, which is crucial for developing sex-specific strategies to prevent and treat AD dementia.
3 Does External Locus of Control Moderate the Intergenerational Transmission of Dementia Risk Among Non-Latinx Black and Non-Latinx White Middle-Aged Adults?
- A. Zarina Kraal, Priya Palta, Adam M. Brickman, Jennifer J. Manly
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- Journal:
- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, pp. 785-786
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Objective:
People whose parents had dementia or memory impairment are at higher risk for later-life cognitive impairment themselves. One goal of our research is to identify factors that either increase the risk of or protect against family history of dementia over the life course. External locus of control has been associated with lower cognitive function in middle-aged and older adults. Previous findings have shown that adults racialized as Black have relatively high levels of external locus of control due to inequity and racism. We hypothesized that lower parental memory would be associated with lower offspring memory among Non-Latinx Black and Non-Latinx White (hereafter Black and White, respectively) adults; and associations would be stronger among participants with higher levels of external locus of control.
Participants and Methods:Participants comprised 594 adults racialized as Black or White (60.3% Black; 62% women; aged 56.1 ± 10.4; 15.3 ± 2.7 years of education) from the Offspring Study who are the adult children of participants in the Washington Heights Inwood Columbia Aging Project (WHICAP). Parental memory was residualized for age (74.3 ± 6.0) and education (13.7 ± 3.1). Self-reported external locus of control was assessed using 8 items from the the perceived control questionnaire. Memory was assessed with the Selective Reminding Test, and a composite of total and delayed recall scores were computed. Linear regression quantified the interaction between parental memory and external locus of control on memory in models stratified by race, and adjusted for age, sex/gender, and number of chronic health diseases.
Results:Among Black participants (n=358), there were no main effects of parental memory or locus of control on offspring memory. However, lower parental memory was associated with lower offspring memory among Black participants with high levels of external locus of control (standardized estimate=0.36, p=0.02, 95%CI [0.05, 0.67]). Associations were attenuated and non-significant at lower levels of control. Among White participants (n=236), there was a main effect of parental memory on offspring memory, and this association did not vary by levels of external locus of control.
Conclusions:Poor parental memory, which reflects risk for later-life cognitive impairment and dementia, was associated with lower memory performance among White middle-aged participants. Among Black participants, this association was observed among those with high levels of external locus of control only. Economic and social constraints shape levels of external locus of control and are disproportionately experienced by Black adults. In the face of greater external locus of control, a cascade of psychological and biological stress-related processes may be triggered and make Black adults’ memory function more vulnerable to the detrimental impact of parent-related dementia risk. Longitudinal analyses are needed to clarify temporal associations. Nonetheless, these findings suggest that reducing social and economic inequities disproportionately experienced by Black adults may dampen the effect of intergenerational transmission of dementia risk on cognition.
80 The Association between Periodontal Disease and Self-Reported Cognitive and Functional Decline at Age 60 in a Large, Multicultural Cohort Study
- Jessie Himmelstern, John R Warren, Eric Grodsky, Chandra Muller, Emily Lybbert, Adam Brickman, Jennifer Manly, Ryan Demmer
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- Journal:
- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, pp. 383-384
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Objective:
We assess the association between self-reported history of periodontal disease diagnosis with self-reported cognitive and functional decline at age ∼60. We also investigate (1) the roles of social background, demographic characteristics, education, and adolescent test scores in confounding that association and (2) the role of cardiovascular disease in mediating that association.
Participants and Methods:We use data from a nationally representative sample of 13,525 people who participated in the 2021 wave of the High School & Beyond (HSB) cohort study. HSB began in 1980 with a nationally-representative sample of American 10th and 12th grade students; these students have been followed up on six occasions since 1980, yielding extraordinary and prospectively-collected life course data on all key measures for a large, multicultural sample.
In 2021, HSB sample members were evaluated with neuropsychological tests that evaluated list learning and memory, semantic and letter fluency, and working memory. They were also asked to self-report memory and functional decline using the AD8, using a cutoff of 2 or more items for significant concerns. Mild Cognitive Impairment will be identified using an algorithm validated in a similar sample of middle aged participants.
Sample members were also asked in 2021 whether a medical professional had ever diagnosed them with periodontal disease; those responding affirmatively were then asked the years in which they started and stopped having periodontal disease.
Measures of social and economic background; demographic characteristics; and educational contexts, opportunities, and attainments were measured prospectively—and in great detail—in the surveys administered in the 1980s. Critically, almost all sample members completed a series of cognitive tasks during adolescence, allowing us to address a key set of confounders in the relationship between periodontal disease and MCI. Markers of cardiovascular disease were measured in both 2013 and 2021.
We estimate logistic regression models predicting significant cognitive and functional concerns as a function of periodontal disease history; we also estimate models that account for confounders, including social background, demographic characteristics, education, and cognitive skills during adolescence; finally, we estimate models that account for the mediating role of cardiovascular disease. All models account for the clustered sampling design of HSB and employ sampling weights to account for HSB’s complex sampling design and selective attrition from the panel.
Results:About 15% of the cohort has been diagnosed with periodontal disease, and nearly one in five had significant cognitive and functional concerns.
People with a history of periodontal disease were more likely to report significant cognitive and functional concerns. This association remains substantive and statistically significant after adjusting for confounders. All else equal, the odds of people with a history of periodontal disease having an AD8 score of 2 or higher were about 60% greater than the odds of those not reporting periodontal disease. Very little of this association can be attributed to cardiovascular disease as a mediating pathway.
Conclusions:People with a history of periodontal disease are at greatly elevated risk of self-reported cognitive and functional concerns at age ∼60. This supports evidence— never before collected at this scale in a long-term, representative cohort study—that oral pathogens may contribute to cognitive well-being over the life course.
15 Does Subjective Socioeconomic Status Mediate the Relationship Between Objective Socioeconomic Status and Neuropsychological Test Performance Across Race and Ethnicity?
- Foysal B Uddin, Justina F Avila-Rieger, Dominika Seblova, Adam Brickman, Jennifer J Manly
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- Journal:
- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, pp. 430-431
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Objective:
Socioeconomic disadvantage is a chronic stressor associated with several biological markers of health (e.g., inflammation) as well as early-onset cognitive aging. Studies examining socioeconomic status (SES) and its link with health outcomes exhibit no uniformity in the way in which SES is measured and defined. Also, studies have found that subjective socioeconomic status (SSES), defined by a subjective SES scale, was more consistently and strongly related to psychological functioning and health-related outcomes than objective socioeconomic status (OSES), defined by a composite score of education, household income, and occupation. The goal of the current study was to assess whether SSES mediates the relationship between OSES and neuropsychological test performance similarly across racial and ethnic groups.
Participants and Methods:Participants were 1,912 middle-aged older adults (13% non-Hispanic white, 17% non-Hispanic Black, 69% Hispanic/Latinx) from the Offspring study. Participants are the adult children of participants in the Washington Heights Inwood Columbia Aging Project, a community-based cohort study of aging and dementia representing the ethnic/racial diversity of upper Manhattan. Participants on average were 56.5 years of age and 67% were women. Measures of verbal learning and memory (SRT immediate and delayed recall), verbal fluency (animal and letter fluency), and attention/working memory (digit span forward and backward) were administered. OSES was characterized by years of formal education completed. SSES was measured by the MacArthur Scale of Subjective Social Status. The scale measures perceptions of one’s social standing relative to others. We conducted separate stratified mediation analyses for each neuropsychological outcome across each racial and ethnic group. All models were adjusted for age.
Results:Participants with higher OSES demonstrated higher neuropsychological test scores (effect size associations ranged from .29 to .45) and reported higher SSES (b=.109 95% CI: .08, .14). Lower SSES was associated with lower neuropsychological test scores (effect-size range .06 to .13). In stratified analyses, the relationship between OSES and SSES was strongest for White participants (b=.13 [.01, .24]) compared with Latinx (b=.06 [.02, .11]) and Black (b=.06 [-.03, .16]) participants. Associations between SSES and neuropsychological outcomes were only reliable for White participants on SRT Immediate and Delayed Recall and Animal Fluency and for Black participants on Digit Span Forward. In mediation analyses, SSES mediated the relationship between OSES and Immediate Recall (indirect effect b=.18 [.001, .45]; 39% mediated), Delayed Recall (indirect effect b=.05 [.004, .09]; 44% mediated), and Animal Fluency (indirect effect b=.09 [.01, .20]; 22% mediated) for White participants. There was no evidence of mediation in Black or Latinx participants.
Conclusions:The relationship between OSES and SSES was strongest for White participants compared to Black and Latinx participants. Even though perception of social status predicted lower cognitive test scores among Black and Latinx adults, it is only a part of the indirect pathway linking OSES to cognitive function among White adults. It is likely that mechanisms related to tangible resources that benefit health (as opposed to perceived inequity) are in the pathway linking education to cognition among Black and Latinx, and thus intervening on systems of inequality throughout the life course has the most promise for improving brain health in those communities.
30 Item response theory and differential item functioning of the AD8: The High School & Beyond Study
- Mark Lee, Justina F Avila-Rieger, Rob Warren, Eric Grodsky, Chandra Muller, Adam M Brickman, Jennifer J Manly
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- Journal:
- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, p. 240
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Objective:
The AD8 is a validated screening instrument for functional changes that may be caused by cognitive decline and dementia. It is frequently used in clinics and research studies because it is short and easy to administer, with a cut off score of 2 out of 8 items recommended to maximize sensitivity and specificity. This cutoff assumes that all 8 items provide equivalent “information” about everyday functioning. In this study, we used item response theory (IRT) to test this assumption. To determine the relevance of this measure of everyday functioning in men and women, and across race, ethnicity, and education, we conducted differential item functioning (DIF) analysis to test for item bias.
Participants and Methods:Data came from the 2021 follow up of the High School & Beyond cohort (N=8,690; mean age 57.5 ± 1.2; 55% women), a nationally representative, longitudinal study of Americans who were first surveyed in 1980 when they were in the 10th or 12th grade. Participants were asked AD8 questions about their own functioning via phone or internet survey. First, we estimated a one-parameter (i.e., differing difficulty, equal discrimination across items) and two-parameter IRT model (i.e., differing difficulty and differing discrimination across items). We compared model fit using a likelihood-ratio test. Second, we tested for uniform and non-uniform DIF on AD8 items by sex, race and ethnicity (non-Hispanic White, non-Hispanic Black, Hispanic), education level (high school or less, some college, BA degree or more), and survey mode (phone or internet). We examined DIF salience by comparing the difference between original and DIF-adjusted AD8 scores to the standard error of measurement of the original score.
Results:The two-parameter IRT model fit the data significantly better than the one-parameter model, indicating that some items were more strongly related to underlying everyday functional ability than others. For example, the “problems with judgment” item had higher discrimination (more information) than the “less interest in hobbies/activities” item. There were significant differences in item endorsement by race/ethnicity, education, and survey mode. We found significant uniform and non-uniform DIF on several items across each of these groups. For example, for a given level of functional decline (theta) White participants were more likely to endorse “Daily problems with thinking/memory” than Black and Hispanic participants. The DIF was salient (i.e., caused AD8 scores to change by greater than the standard error of measurement for a large portion of respondents) for those with a college degree and phone respondents.
Conclusions:In a population representative sample of Americans ∼age 57, the items on the AD8 contributed differing levels of discrimination along the range of everyday functioning that is impacted by later life cognitive impairment. This suggests that a simple cut-off or summed score may not be appropriate since some items yield more information about the underlying construct than others. Furthermore, we observed significant and salient DIF on several items by education and survey mode, AD8 scores should not be compared across education groups and assessment modes without adjustment for this measurement bias.
45 The Impact of Loneliness on Amyloid Burden, Cerebrovascular Disease, Neurodegeneration, and Memory Performance in a Community-Based Sample of Older Adults
- Bayardo E Lacayo, Clarissa Morales, Aine Montgomery, Kiana Chan, Stephanie Cosentino, Adam M Brickman, Jennifer Manly, Nicole Schupf, Richard Mayeux, Patrick Lao
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- Journal:
- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, pp. 455-456
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Objective:
The current research framework recommends using biomarkers to further understand Alzheimer’s disease (AD) pathogenesis, including other contributing factors like cerebrovascular disease. In longitudinal studies of people with neuropathological examination after death, baseline loneliness was associated with lower cognition, faster cognitive decline, and future AD risk, independent of AD pathology. Examination of memory impairment along with AD and cerebrovascular biomarkers, could aid risk reduction efforts earlier in the lifecourse and among populations with more exposure to loneliness. We hypothesized that loneliness is associated with amyloid, vascular, and neurodegeneration biomarkers; with worse memory; and that loneliness increases the susceptibility to biomarker-related memory impairment.
Participants and Methods:A subset of cognitively unimpaired older adults with available amyloid PET, vascular MRI (white matter hyperintensity volume, WMH), structural MRI (cortical thickness in AD signature regions), neuropsychological testing (memory factor score), dichotomized loneliness data (one item from CES-D), and relevant medical data were drawn from the community-based Washington Heights-Inwood Columbia Aging Project (WHICAP; n=169; covariates included age=81±6 years; 63% women; 49/31/20% Non-Hispanic Black/Non-Hispanic White/Hispanic; education=13±4 years; 32% APOE-e4 carriers). General linear models in the overall sample and stratified by race and ethnicity tested the association between loneliness and AD and cerebrovascular biomarkers, loneliness and memory, and the interaction of loneliness and biomarkers on memory, adjusting for covariates.
Results:Loneliness was endorsed in 18% of participants, marginally associated with older age (2.1 [-0.2, 4.4], p=0.08), was more likely in those with untreated diabetes (13/0.1% lonely/not lonely, p=0.001), associated with lower cortical thickness (-0.05 [-0.09, -0.02], p=0.01), and associated with lower memory (0.3 [-0.6, -0.001], p=0.05). In Non-Hispanic White participants, loneliness was associated with greater WMH volume (0.5 [0.07, 0.82], p=0.03), while in Hispanic participants, loneliness was associated with lower cortical thickness (-0.16 [-0.24, -0.08], p=0.0006). In Non-Hispanic Black participants, loneliness was associated with lower memory (-13 [-26, -0.5], p=0.05), and the association between lower cortical thickness and lower memory was stronger in those that endorse loneliness (5 [0.2, 10], p=0.05). In Hispanic participants, loneliness was associated with higher memory (13 [4, 22], p=0.009), but the association between higher amyloid burden and lower memory was stronger in those that endorse loneliness (-12 [-20, -4], p=0.006); further, loneliness was marginally associated with lower memory (-0.7 [-1.4, 0.1], p=0.09), independently of WMH.
Conclusions:Associations between loneliness and biomarkers may relate to health seeking behavior, reported as treatment status for diabetes, for cerebrovascular burden and general neurodegeneration, but might be more complex for amyloid. The degree to which loneliness increased the susceptibility to amyloid and neurodegeneration-related, but not cerebrovascular-related, memory impairment, specifically, may suggest that domains beyond memory should be considered. Future work should be longitudinal to disentangle the effects of loneliness from related constructs like depression and anxiety, incorporate other AD biomarkers such as hyperphosphorylated tau, and incorporate biological mechanisms (e.g., stress, inflammation) into models of loneliness and AD pathogenesis. Older adults from all backgrounds may be more susceptible to loneliness, which was associated with lower memory; culturally-humble, social support-based interventions may reduce the risk of cognitive impairment.
6 Racial Discrimination and White Matter Integrity Among Black Older Adults
- Jordan D Palms, Mohamad J. Alshikho, Patrick J. Lao, Clarissa D. Morales, Jennifer J. Manly, Nicole Schupf, Adam M. Brickman, Laura B. Zahodne
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- Journal:
- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, pp. 788-789
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Objective:
Non-Hispanic Black older adults experience a disproportionate burden of Alzheimer’s Disease and related dementias (ADRD) risk compared to non-Hispanic White older adults. It is necessary to identify mechanisms that may be contributing to inequities in cognitive aging. Psychosocial stressors that disproportionately affect Black adults (e.g., discrimination) have the potential to impact brain health through stress pathways. The brain’s white matter, which appears to be particularly important for ADRD risk among Black older adults, may be uniquely vulnerable to stress-related physiological dysfunction. To further understand whether and how discrimination can affect ADRD risk, this study aimed to examine associations between multiple forms of racial discrimination and white matter integrity, operationalized through diffusion tensor imaging.
Participants and Methods:Cross-sectional data were obtained from 190 non-Hispanic Black residents aged 65+ without dementia in northern Manhattan. Racial discrimination was self-reported using the Everyday Discrimination and Major Experiences of Lifetime Discrimination scales. Example items from the Everyday Discrimination Scale include: “You are treated with less respect than other people”; “You are called names or insulted.” Example items from the Major Experiences of Lifetime Discrimination Scale include: “At any time in your life, have you ever been unfairly fired from a job?”; “Have you ever been unfairly denied a bank loan?” Racial discrimination was operationalized as experiences attributed to “race” or “skin color.” White matter integrity was assessed using fractional anisotropy (FA) via diffusion tensor imaging. Multivariable regression models evaluated the unique effects of everyday and major experiences of lifetime racial discrimination on mean FA in the whole brain and specific regions. Initial models controlled for age, sex/gender, intracranial volume, and white matter hyperintensities. Subsequent models additionally controlled for socioeconomic and health factors to consider potential confounders or mediators of the relationship between discrimination and white matter integrity.
Results:Major experiences of lifetime discrimination were negatively associated with mean FA within the left cingulum cingulate gyrus and the right inferior fronto-occipital fasciculus. These associations persisted when controlling for additional covariates (i.e., education, depression, and cardiovascular diseases). In contrast, major experiences of lifetime discrimination were positively associated with mean FA within the right superior longitudinal fasciculus (temporal part). This association was attenuated when controlling for additional covariates. Everyday racial discrimination was not associated with mean FA in any regions.
Conclusions:These results extend prior work linking racial discrimination to brain health and provide evidence for both risk and resilience among Black older adults. Major experiences of lifetime racial discrimination, a proxy for institutional racism, may have a stronger effect on white matter integrity than everyday racial discrimination, a proxy for interpersonal racism. Educational opportunities and cardiovascular risk factors may represent mediators between racial discrimination and white matter integrity. White matter integrity within specific brain regions may be a mechanism through which racially patterned social stressors contribute to racial disparities in ADRD. Future research should characterize within-group heterogeneity in order to identify factors that promote resilience among Black older adults.
81 Occupation Complexity Mediates the Association between Education and Self-Reported Cognitive and Functional Decline in 60-Year-Olds
- Jessie Himmelstern, John R Warren, Eric Grodsky, Chandra Muller, Koit Hung, Adam Brickman, Jennifer Manly
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- Journal:
- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, pp. 384-385
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Objective:
We ask about the degree to which the association between (1) the quantity and quality of people’s education and (2) midlife self-reported concerns about cognition and daily function is mediated by occupational complexity. The overarching hypothesis is that amount and quality of education provides people with access to better jobs, including jobs that are more cognitively complex. Occupational complexity, in turn, may be protective against cognitive impairment. If true, this means that part of the poorly-understood connection between education and cognitive impairment can be attributed to occupational complexity.
Participants and Methods:We use data from a nationally representative sample of 13,525 people who participated in the 2021 wave of the High School & Beyond (HSB) cohort study. HSB began in 1980 with a nationally-representative sample of American 10th and 12th grade students; these students have been followed up on six occasions since 1980, yielding extraordinary and prospectively-collected life course data on all key measures for a large, multicultural sample.
In 2021, HSB sample members were evaluated with neuropsychological tests that evaluated list learning and memory, semantic and letter fluency, and working memory. They were also asked to self-report memory and functional decline using the AD8, using a cutoff of 2 or more items for significant concerns. Mild Cognitive Impairment will be identified using an algorithm validated in a similar sample of middle aged participants.
HSB surveys gathered information about sample members’ labor force activities in every survey between 1980 and 2021, including information sufficient to code verbatim reports of occupations to the standards of the 2010 Standard Occupational Classification. We have linked these codes for sample members’ 2013 and 2021 occupations to the O*Net database, which includes extensive information about the cognitive complexity (and other attributes) of every occupation.
Measures of key confounders—including social and economic background; demographic characteristics; educational contexts, opportunities, and attainments that are associated with labor force outcomes; adolescent achievement test scores; and aspects of midlife occupations besides complexity (e.g., how well they pay)—were measured prospectively and in great detail in the surveys administered between the 1980s and 2021.
We estimate logistic regression models predicting significant cognitive and functional concerns as a function of educational contexts, opportunities, and outcomes; we also estimate models that account for the confounders listed above. Our main focus is on coefficients for education in models that do and do not include occupational complexity as a mediator. All models account for the clustered sampling design of HSB and use sampling weights to account for HSB’s complex sampling design and selective attrition from the panel.
Results:Nearly one in five cohort members had significant cognitive and functional concerns; rates are lower for non-Latinx Whites and for better educated people. Associations between educational contexts, opportunities, and outcomes (including attainment) are robust, even after adjusting for confounders.
Between one quarter and one third of the conditional association between education and self-reported cognitive and functional concerns can be attributed to occupational complexity.
Conclusions:Occupational complexity is an important pathway through which more and better education protects people from concerns about cognitive and functional decline at about age 60.
4 Associations Between Education, Emotional and Instrumental Support, and Cognitive Function in Black, White, and Latinx Older Adults
- Kiara A. Baker, A. Zarina Kraal, Laura B. Zahodne, Nicole Schupf, Adam M. Brickman, Jennifer J. Manly
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- Journal:
- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, pp. 88-89
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Objective:
Higher education is strongly associated with better cognitive function in older adults. Previous research has also showed that positive psychosocial factors, such as selfefficacy and emotional and instrumental support, are beneficial for late-life cognition. There is prior evidence of a buffering effect of self-efficacy on the relationship between educational disadvantage and poor cognition in older adults, however it is not known if other psychosocial factors modify the schooling-cognition relationship. We hypothesized that higher levels of emotional and instrumental support will diminish the association between lower education and lower cognitive test scores among older adults.
Participants and Methods:553 older adults without dementia (42.1% non-Latinx Black, 32.2% non-Latinx White, 25.7% Latinx; 63.2% women; average age 74.4 (SD 4.3)) from the Washington Heights-Inwood Columbia Aging Project. Neuropsychological tests assessed four cognitive domains (language, memory, psychomotor processing speed, and visuospatial function). Self-reported emotional and instrumental support were assessed with measures from NIH Toolbox. Linear regression estimated interactions between education and the two support measures on cognition in models stratified by cognitive domain and racial and ethnic group. Covariates included age, sex/gender, and chronic health conditions (e.g. heart disease, stroke, cancer, etc.).
Results:Education was associated with cognition across racial and ethnic groups. For every one year of schooling, the processing speed z-score composite was 0.33 higher among Latinx participants, 0.10 among non-Latinx Black participants, and 0.03 higher among non-Latinx White participants. The education-cognition relationship was generally similar across cognitive domains with larger effects in non-Latinx Black and Latinx participants than in White participants. Low education was associated with slower processing speed among Black participants with low emotional support (B = 0.224, 95% CI [0.014, 0.096]), but there was no association between low education and processing speed among Black older adults with high levels of emotional support (beta for interaction = -.142, 95% CI [-0.061, -0.001]). A similar pattern of results was observed for instrumental support (beta for interaction = -.207, 95% CI [-0.064, 0.010]). There were no interactions between support and education on other cognitive domains or among Latinx and White participants.
Conclusions:We found that higher levels of emotional and instrumental support attenuate the detrimental effect of educational disadvantages on processing speed in older Black adults. This may occur via benefits of social capital, which provides access to health resources and knowledge, increased social interaction, an emotional outlet allowing the ability to better cope with stress. Longitudinal analyses are needed to examine temporal patterns of associations. In addition, improving equitable access to high quality schools will improve later-life cognitive outcomes for future generations of older adults. However, for the growing number of Black older adults who will not experience the benefits of structural improvements in the education system, emotional and instrumental support may represent a modifiable psychosocial factor to reduce their disproportionate burden of cognitive morbidity.
5 Association of Discrimination to Cognition Among US-Born and Immigrant Latinx
- Shana S. Samuel, Dominika Seblova, Adam M. Brickman, Jennifer J. Manly, Desiree A Byrd
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- Journal:
- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, pp. 89-90
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Objective:
Neuropsychology is in a nascent stage of understanding the mechanisms that link social forces, psychosocial experiences, and brain health. Discrimination is associated with lower quality of life, higher stress, and worse physical health outcomes in Latinx, but contradictory findings in prior research complicate our understanding of its relationship to cognition. These contradictory results may be explained by heterogeneity within the broad category of Latinx, a cultural identity that requires more nuanced conceptualization. Immigration status is a primary social identifier for Latinx people that carries significant stigma. However, prior research found enculturation promotes better physical and mental health outcomes in immigrants compared to their US-born counterparts, which may protect immigrant Latinx from the cognitive costs of discrimination. The current study hypothesized that the effect of discrimination on cognition will be stronger in US-born Latinx compared to immigrant Latinx.
Participants and Methods:We partnered with 1,023 neurologically healthy, community dwelling Latinx adults (M age=56.1(±10.7); M education=12.5(±3.7); 69% women) in a prospective cohort study in NYC investigating risks factors for Alzheimer’s disease. Immigration status was determined by self-report of birthplace. Measures of attention, language, and memory were administered by bilingual examiners in the participants’ self-selected preferred language of English (n = 388) or Spanish (n=635). Discrimination, measured with the Everyday Discrimination Scale and Major Experiences of Discrimination Scale, was chronicity coded to weigh experiences of discrimination according to yearly chronicity. Linear regression models were employed for US-born and immigrant participants to assess the relationship between both discrimination measures and each cognitive measure.
Results:Compared to US-born Latinx (n = 224), immigrant Latinx (n = 799; primarily from the Dominican Republic) were older, had fewer years of school, had lower income, and were much more likely to have chosen to be assessed in Spanish. Immigrants reported experiencing significantly fewer everyday and major experiences of discrimination than nonimmigrants. In unadjusted models, discrimination did not predict cognitive performance among US-born Latinx. Among immigrant Latinx, more major experiences of discrimination across the lifetime predicted better phonemic (F(2,362) = 4.167, p<0.05, R2=0.017) and semantic fluency (F(2,362) = 3.304, p<0.05, R2=0.013) but was not associated with measures of attention or memory.
Conclusions:Discrimination is an important life stressor for Latinx people living in the US, particularly when its impact is summed across intersectional identities. The current study is among the first to explore the potential cognitive impact of discrimination within a group of Latinx adults. The described relationship between discrimination and language performance in this cohort may be confounded by the language in which cognitive tests were administered. Future studies should consider how discrimination measures may be limited in their ability to accurately capture the experiences of US-born and immigrant Latinx groups and expand the measurement of cognition to additional domains.
The Global Dynamics of Inequality (GINI) project: analysing archaeological housing data
- Amy Bogaard, Scott Ortman, Jennifer Birch, Gabriela Cervantes Quequezana, Shadreck Chirikure, Enrico R. Crema, Pablo Cruz, Gary Feinman, Mattia Fochesato, Adam S. Green, Detlef Gronenborn, Helena Hamerow, Guiyun Jin, Tim Kerig, Dan Lawrence, Mark D. McCoy, Jessica Munson, Paul Roscoe, Eva Rosenstock, Amy Thompson, Cameron A. Petrie, Timothy A. Kohler
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The GINI project investigates the dynamics of inequality among populations over the long term by synthesising global archaeological housing data. This project brings archaeologists together from around the world to assess hypotheses concerning the causes and consequences of inequality that are of relevance to contemporary societies globally.
Outcomes after initial heart failure consultation in Fontan patients
- Sharon Chen, Muhammad F. Shezad, Angela Lorts, Amanda D. McCormick, Chad Y. Mao, Kathleen E. Simpson, Matthew J. O’Connor, Aliessa Barnes, Adam M. Lubert, Chesney Castleberry, Julie Schmidt, Katie Schroeder, Anna Joong, David W. Bearl, Ashwin K. Lal, Deepa Mokshagundam, Jennifer Conway, Ari Cedars, Kurt R. Schumacher
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- Cardiology in the Young , First View
- Published online by Cambridge University Press:
- 28 November 2023, pp. 1-8
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Background:
Patients with Fontan failure are high-risk candidates for heart transplantation and other advanced therapies. Understanding the outcomes following initial heart failure consultation can help define appropriate timing of referral for advanced heart failure care.
Methods:This is a survey study of heart failure providers seeing any Fontan patient for initial heart failure care. Part 1 of the survey captured data on clinical characteristics at the time of heart failure consultation, and Part 2, completed 30 days later, captured outcomes (death, transplant evaluation outcome, and other interventions). Patients were classified as “too late” (death or declined for transplant due to being too sick) and/or “care escalation” (ventricular assist device implanted, inotrope initiated, and/or listed for transplant), within 30 days. “Late referral” was defined as those referred too late and/or had care escalation.
Results:Between 7/2020 and 7/2022, 77 Fontan patients (52% inpatient) had an initial heart failure consultation. Ten per cent were referred too late (6 were too sick for heart transplantation with one subsequent death, and two others died without heart transplantation evaluation, within 30 days), and 36% had care escalation (21 listed ± 5 ventricular assist device implanted ± 6 inotrope initiated). Overall, 42% were late referrals. Heart failure consultation < 1 year after Fontan surgery was strongly associated with late referral (OR 6.2, 95% CI 1.8–21.5, p=0.004).
Conclusions:Over 40% of Fontan patients seen for an initial heart failure consultation were late referrals, with 10% dying or being declined for transplant within a month of consultation. Earlier referral, particularly for those with heart failure soon after Fontan surgery, should be encouraged.
Subsurface scientific exploration of extraterrestrial environments (MINAR 5): analogue science, technology and education in the Boulby Mine, UK – CORRIGENDUM
- Charles S. Cockell, John Holt, Jim Campbell, Harrison Groseman, Jean-Luc Josset, Tomaso R. R. Bontognali, Audra Phelps, Lilit Hakobyan, Libby Kuretn, Annalea Beattie, Jen Blank, Rosalba Bonaccorsi, Christopher McKay, Anushree Shirvastava, Carol Stoker, David Willson, Scott McLaughlin, Sam Payler, Adam Stevens, Jennifer Wadsworth, Loredana Bessone, Matthias Maurer, Francesco Sauro, Javier Martin-Torres, Maria-Paz Zorzano, Anshuman Bhardwaj, Alvaro Soria-Salinas, Thasshwin Mathanlal, Miracle Israel Nazarious, Abhilash Vakkada Ramachandran, Parag Vaishampayan, Lisa Guan, Scott M. Perl, Jon Telling, Ian M. Boothroyd, Ollie Tyson, James Realff, Joseph Rowbottom, Boris Laurent, Matt Gunn, Shaily Shah, Srijan Singh, Sean Paling, Tom Edwards, Louise Yeoman, Emma Meehan, Christopher Toth, Paul Scovell, Barbara Suckling
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- International Journal of Astrobiology / Volume 23 / 2024
- Published online by Cambridge University Press:
- 06 November 2023, e2
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Electrifying the case review process for better speed, reach, and impact
- Jennifer Gutowski, Melissa Bronstein, Adam Tatro, Stephany Frey, Emil Lesho
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- Antimicrobial Stewardship & Healthcare Epidemiology / Volume 3 / Issue S2 / June 2023
- Published online by Cambridge University Press:
- 29 September 2023, p. s95
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Background: Prevention of healthcare-associated infections (HAIs) requires timely feedback to and input from all staff involved in patient care to best identify practice gaps and improvement targets. However, multidisciplinary review of HAI events can be challenging to promptly complete given staffing shortages and the excess administrative burden of emailed and printed forms and disjointed analyses, reporting, and visualization tools. Plagued by a lack of feedback from attending and ordering physicians, difficulty transcribing and analyzing nonstandardized data, and challenges in summarizing and distributing actionable findings, we sought to reduce turnaround time (TAT), improve data collection, and broaden communication of HAI contributing factors and proposed solutions. Methods: A secure web application for electronic data capture and reporting, Research Electronic Data Capture (REDCap), was used; the software application is free to nonprofit organizations. The review process is now initiated by an infection preventionist entering HAI information into an initial survey, which automatically cascades information into 4 subsequent surveys, distributed through automated email links, providing an opportunity for individual responses from the nursing unit, the attending provider, an infectious disease physician, and the ordering provider for the positive test that detected the HAI. Survey questions focus on evaluation of adherence to CDC and SHEA HAI prevention strategies. Reminders are automatically generated and continue to be sent to involved staff until their portion is completed. Survey responses are automatically summarized upon completion of all reviews and are shared with several stakeholders, including hospital leadership, the care team, infection prevention staff, and quality-control partners (Fig.). Discrete qualitative and quantitative data are exported in a standard application-programming interface (API) format for immediate analysis and interpretation. Results: After the review process was launched using new electronic technology, the average TAT and completion rate improved from 23 days and 40% to 7 days and 95%, respectively. Input from ordering and attending physicians, once extremely rare, became frequent. Nuanced insight into causative and preventive factors, previously unachievable, occurred during review of all 38 HAIs reported in December 2022. Reviewers believed that 48% of HAIs reviewed could have been prevented. Conclusions: Applying electronic technology to HAI case review improved completion and timeliness of reviews by both providers and nurses. By sharing data and insights with all stakeholders in real time, the new procedure permitted multidirectional communication between the care teams and increased awareness of patient harm as well as ownership of patient safety. Our process is freely and readily generalizable to any nonprofit healthcare facility.
Disclosures: None
Snack frequency, size, and energy density are associated with diet quality among US adolescents
- Gina L Tripicchio, Regan L Bailey, Adam Davey, Christina M Croce, Jennifer Orlet Fisher
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- Public Health Nutrition / Volume 26 / Issue 11 / November 2023
- Published online by Cambridge University Press:
- 07 August 2023, pp. 2374-2382
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Objective:
To evaluate snacking and diet quality among US adolescents.
Design:Cross-sectional analysis examined snack frequency (snacks/day), size (kcal/snack) and energy density (kcal/g/snack) as predictors of diet quality using the mean of two 24-h dietary recalls. Diet quality was assessed using the Healthy Eating Index (HEI-2015, 0–100), a mean adequacy ratio (MAR, 0–100) for under-consumed nutrients (potassium, fibre, Ca, vitamin D) and mean percentage of recommended limits for over-consumed nutrients (added sugar, saturated fat, Na). Linear regression models examined total snacks, food only snacks and beverage only snacks, as predictors of diet quality adjusting for demographic characteristics and estimated energy reporting accuracy.
Setting:2007–2018 National Health and Nutrition Examination Survey.
Participants:Adolescents 12–19 years (n 4985).
Results:Snack frequency was associated with higher HEI-2015 (β = 0·7 (0·3), P < 0·05) but also with higher intake of over-consumed nutrients (β = 3·0 (0·8), P ≤ 0·001). Snack size was associated with lower HEI (β = –0·005 (0·001), P ≤ 0·001) and MAR (β = –0·005 (0·002), P < 0·05) and higher intake of over-consumed nutrients (β = 0·03 (0·005), P ≤ 0·001). Associations differed for food only and beverage only snacks. Food only snack frequency was associated with higher HEI-2015 (β = 1·7 (0·03), P ≤ 0·001), while food only snack size (β = –0·006 (0·0009), P ≤ 0·001) and food only snack energy density (β = –1·1 (0·2), P ≤ 0·001) were associated with lower HEI-2015. Conversely, beverage only snack frequency (β = 4·4 (2·1) P < 0·05) and beverage only snack size (β = 0·03 (0·01), P ≤ 0·001) were associated with higher intake of over-consumed nutrients.
Conclusions:Smaller, frequent, less energy-dense food only snacks are associated with higher diet quality in adolescents; beverages consumed as snacks are associated with greater intake of over-consumed nutrients.