A Case Study on A University-Community Partnership to Eliminate Racial Disparities in Infant Mortality: Effective Strategies and Lessons Learned.

This case study discusses the implementation framework, effective strategies, and lessons learned of a university-community partnership addressing racial disparities in infant mortality. The partnership was successful at enhancing coordination within service delivery systems for maternal and child health programs. Results: the elimination of waiting list for services, maximizing federal and state reimbursement, the adoption of culturally-appropriate intervention practices, increasing racial diversity in the workforce, diffusing silos, and facilitating healthier relationships among service providers.

Academic Detailing to Reduce Sedative-Hypnotic Prescribing in Older Veterans.

Background: Sedative-hypnotics, including benzodiazepines (BZDs) and benzodiazepine receptor agonists (BZD-RA), are considered potentially inappropriate medications (PIMs) in older adults. Academic detailing, an educational outreach delivered by trained clinicians to other clinicians to encourage evidence-based care, can promote deprescribing of PIMs.

Objective: To evaluate the impact of academic detailing on sedative-hypnotic prescribing to older veterans.

Antiaging Therapies, Cognitive Impairment, and Dementia.

Aging is a powerful risk factor for the development of many chronic diseases including dementia. Research based on disease models of dementia have yet to yield effective treatments, therefore it is opportune to consider whether the aging process itself might be a potential therapeutic target for the treatment and prevention of dementia. Numerous cellular and molecular pathways have been implicated in the aging process and compounds that target these processes are being developed to slow aging and delay the onset of age-associated conditions.

What features of the built environment matter most for mobility? Using wearable sensors to capture real-time outdoor environment demand on gait performance.

Background: A growing body of research has demonstrated relationships between built environment characteristics and outdoor mobility. However, most of this work has relied on composite scores of the built environment.

Research Question: Which properties of the outdoor built environment are associated with the greatest change in gait metrics in a real-world setting?

Methods: 25 community-dwelling adults from Southeast Michigan were equipped with mobile inertial measurement units and walked a 1300-meter outdoor course with varying environmental demands.

How Gender Stereotypes May Limit Female Faculty Advancement in Communication Sciences and Disorders.

Purpose: The field of communication sciences and disorders (CSD) faces a critical shortage of the faculty essential to train the future workforce of speech-language pathologists and audiologists. Despite a predominance of women in the field, men receive doctoral degrees, tenure status, academic leadership positions, and American Speech-Language-Hearing Association awards at disproportionately higher rates than women. The purpose of this review is to explore how implicit gender bias may contribute to female faculty advancement, including current and projected faculty workforce shortages, and to propose tangible solutions.

Geographic and Racial Disparities in Infant Hearing Loss.

Objective: Approximately 1 to 2 of every 1000 American newborns has hearing loss identified by newborn screening. This study was designed to determine if infant hearing loss is more common in socioeconomically disadvantaged communities.

Study Design: In this retrospective study, we analyzed electronic medical record data using geostatistical models.

Spectral-Domain OCT Measurements in Alzheimer's Disease: A Systematic Review and Meta-analysis.

Topic: OCT is a noninvasive tool to measure specific retinal layers in the eye. The relationship of retinal spectral-domain (SD) OCT measurements with Alzheimer's disease (AD) and mild cognitive impairment (MCI) remains unclear. Hence, we conducted a systematic review and meta-analysis to examine the SD OCT measurements in AD and MCI.

Dual-Task Gait and Alzheimer's Disease Genetic Risk in Cognitively Normal Adults: A Pilot Study.

Background: Dual-task paradigms, in which an individual performs tasks separately and then concurrently, often demonstrate that people with neurodegenerative disorders experience more dual-task interference, defined as worse performance in the dual-task condition compared to the single-task condition.

Objective: To examine how gait-cognition dual-task performance differs between cognitively normal older adults with and without an APOE ɛ4 allele.

Methods: Twenty-nine individuals ages 60 to 72 with normal cognition completed a dual-task protocol in which walking and cognitive tasks (executive function, memory) were performed separately and concurrently.

The Effect of Neighborhood Disadvantage on Diabetes Prevalence.

Patient socioeconomic data is not usually included in medical records nor easily accessible to clinicians, yet socioeconomic disadvantage can be an important guide to disease management. This study evaluated the neighborhood-level Area Deprivation Index (ADI), a measure of neighborhood socioeconomic disadvantage, as a factor in diabetes mellitus prevalence. Electronic health records at an academic hospital system identified 4,770 Medicare beneficiaries.

Arterial spin labeling reveals relationships between resting cerebral perfusion and motor learning in Parkinson's disease.

Parkinson's disease (PD) is an age-related neurodegenerative disease that produces changes in movement, cognition, sleep, and autonomic function. Motor learning involves acquisition of new motor skills through practice, and is affected by PD. The purpose of the present study was to evaluate regional differences in resting cerebral blood flow (rCBF), measured using arterial spin labeling (ASL) MRI, during a finger-typing task of motor skill acquisition in PD patients compared to age- and gender-matched controls.

Language processing in age-related macular degeneration associated with unique functional connectivity signatures in the right hemisphere.

Age-related macular degeneration (AMD) is a retinal disease associated with significant vision loss among older adults. Previous large-scale behavioral studies indicate that people with AMD are at increased risk of cognitive deficits in language processing, particularly in verbal fluency tasks. The neural underpinnings of any relationship between AMD and higher cognitive functions, such as language processing, remain unclear.

Outcomes That Define Successful Advance Care Planning: A Delphi Panel Consensus.

Context: Standardized outcomes that define successful advance care planning (ACP) are lacking.

Objective: The objective of this study was to create an Organizing Framework of ACP outcome constructs and rate the importance of these outcomes.

Methods: This study convened a Delphi panel consisting of 52 multidisciplinary, international ACP experts including clinicians, researchers, and policy leaders from four countries.

A Scoping Review of Health Disparities in Autism Spectrum Disorder.

Individuals with autism spectrum disorder (ASD) experience increased morbidity and decreased life expectancy compared to the general population, and these disparities are likely exacerbated for those individuals who are otherwise disadvantaged. We conducted a review to ascertain what is known about health and health system quality (e.g.

Individualized Estimation of Physical Activity in Older Adults with Type 2 Diabetes.

Purpose: Compare physical activity intensity in older adults with type 2 diabetes mellitus (T2DM) using individualized, relative cutpoints with standard, absolute cutpoints.

Methods: One hundred older adults with T2DM (68.9 ± 5.

Assessing the cost burden of United States FDA-mandated post-approval studies for medical devices.

Approved medical devices frequently undergo FDA mandated post-approval studies (PAS). However, there is uncertainty as to the value of PAS in assessing the safety of medical devices and the cost of these studies to the healthcare system is unknown. Since PAS costs are funded through device manufacturers who do not share the costs with regulators, we sought to estimate the total PAS costs through interviews with a panel of experts in medical device clinical trial design in order to design a general cost model for PAS which was then applied to the FDA PAS.

Defining Advance Care Planning for Adults: A Consensus Definition From a Multidisciplinary Delphi Panel.

Context: Despite increasing interest in advance care planning (ACP) and previous ACP descriptions, a consensus definition does not yet exist to guide clinical, research, and policy initiatives.

Objective: The aim of this study was to develop a consensus definition of ACP for adults.

Methods: We convened a Delphi panel of multidisciplinary, international ACP experts consisting of 52 clinicians, researchers, and policy leaders from four countries and a patient/surrogate advisory committee.

Frailty Assessment in Hospitalized Older Adults Using the Electronic Health Record.

Introduction: Frailty, a clinical syndrome of decreased physiologic reserve and dysregulation in multiple physiologic systems, is associated with increased risk for adverse outcomes.

Purpose: The aim of this retrospective, cross-sectional, correlational study was to characterize frailty in older adults admitted to a tertiary-care hospital using a biopsychosocial frailty assessment and to determine associations between frailty and time to in-hospital mortality and 30-day rehospitalization.

Methods: The sample included 278 patients ≥55 years old admitted to medicine units.

Test Case Selection in Pre-Deployment Testing of Complex Clinical Decision Support Systems.

Clinical decision support (CDS) systems with complex logic are being developed. Ensuring the quality of CDS is imperative, but there is no consensus on testing standards. We tested ATHENA-HTN CDS after encoding updated hypertension guidelines into the system.

Development of the Tool to Reduce Inappropriate Medications (TRIM): A Clinical Decision Support System to Improve Medication Prescribing for Older Adults.

Study Objective: To create a clinical decision support system (CDSS) for evaluating problems with medications among older outpatients based on a broad set of criteria.

Design: Web-based CDSS development.

Setting: Primary care clinics at a Veterans Affairs medical center.

A Delphi process to address medication appropriateness for older persons with multiple chronic conditions.

Background: Frameworks exist to evaluate the appropriateness of medication regimens for older patients with multiple medical conditions (MCCs). Less is known about how to translate the concepts of the frameworks into specific strategies to identify and remediate inappropriate regimens.

Methods: Modified Delphi method involving iterative rounds of input from panel members.