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Incident frailty and cognitive impairment by heart failure status in older patients with atrial fibrillation: the SAGE-AF study

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journal of Geriatric Cardiology 2020年第11期17卷 653-658页

作者： Wei-jia WANG Darleen Lessard jane Saczynski robert j goldberg Alan S.Go Tenes Paul Ely Gracia David D McManus Department of Medicine University of Massachusetts Medical SchoolWorcesterMAUSA Department of Population and Quantitative Health Sciences University of Massachusetts Medical SchoolWorcesterMAUSA Department of Pharmacy and Health System Sciences Northeastern UniversityBostonMAUSA Division of Research Kaiser Permanente Northern CaliforniaOaklandCAUSA

Background Atrial fibrillation(AF) and heart failure(HF) frequently co-occur in older individuals. Among patients with AF, HF increases risks for stroke and death, but the associations between HF and incident cognition and physical impairment remain unknown. We aimed to examine the cross-sectional and prospective associations between HF, cognition, and frailty among older patients with AF. Methods The SAGE-AF(Systematic Assessment of Geriatric Elements in AF) study enrolled 1244 patients with AF(mean age 76 years, 48% women) from five practices in Massachusetts and Georgia. HF at baseline was identified from electronic health records using ICD-9/10 codes. At baseline and 1-year, frailty was assessed by Cardiovascular Health Survey score and cognition was assessed by the Montreal Cognitive Assessment. Results Patients with prevalent HF(n = 463, 37.2%) were older, less likely to be non-Hispanic white, had less education, and had greater cardiovascular comorbidity burden and higher CHA2 DS2 VASC and HAS-BLED scores than patients without HF(all P's justed regression models, HF(present vs. absent) was associated with both prevalent frailty(adjusted odds ratio [a OR]: 2.38, 95% confidence interval [CI]: 1.64-3.46) and incident frailty at 1 year(a OR: 2.48, 95% CI: 1.37-4.51). HF was also independently associated with baseline cognitive impairment(a OR: 1.60, 95% CI: 1.22-2.11), but not with developing cognitive impairment at 1 year(a OR 1.04, 95%CI: 0.64-1.70). Conclusions Among ambulatory older patients with AF, the co-existence of HF identifies individuals with physical and cognitive impairments who are at higher short-term risk for becoming frail. Preventive strategies to this vulnerable subgroup merit consideration.

关键词： Atrial fibrillation Cognitive impairment Heart failure Frailty

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Hearing loss and cognitive decline among older adults with atrial fibrillation:the SAGE-AF study

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journal of Geriatric Cardiology 2020年第4期17卷 177-183页

作者： Wei-jia WANG Darleen Lessard Hawa Abu David D.McManus Tanya Mailhot jerry H.Gurwitz robert j.goldberg jane Saczynski Division of Cardiovascular Medicine Department of MedicineUniversity of Massachusetts Medical SchoolWorcesterMAUSA Department of Population and Quantitative Health Sciences University of Massachusetts Medical SchoolWorcesterMAUSA Department of Pharmacy and Health System Sciences Northeastern UniversityBostonMAUSA Meyers Primary Care Institute University of Massachusetts Medical SchoolWorcesterMAUSA

Objective To examine the association between hearing loss and cognitive function cross-sectionally and prospectively among older adults with atrial fibrillation(AF).Methods Patients with AF≥65-year-old(n=1244)in the SAGE(Systematic Assessment of Geriatric Elements)-AF study were recruited from five internal medicine or cardiology clinics in Massachusetts and *** was assessed by a structured questionnaire at *** function was assessed by Montreal Cognitive Assessment(MoCA)at baseline and one *** impairment was defined as score≤23 on the *** associations between hearing loss and cognitive function were examined by multivariable adjusted logistic *** Participants with hearing loss(n=451,36%)were older,more likely to be male,and have depressive symptoms than patients without hearing *** baseline,528(42%)participants were cognitively *** with hearing loss were significantly more likely to have cognitive impairment at baseline[adjusted odds ratio(OR)=1.37,95%confidence interval(CI):1.05–1.81].Among the 662 participants who did not have cognitive impairment at baseline and attended the one-year follow-up visit,106(16%)developed incident cognitive *** with,versus those without,hearing loss were significantly more likely to develop incident cognitive impairment at one year(adjusted OR=1.68,95%CI:1.07–2.64).Conclusions Hearing loss is a prevalent but under-recognized factor associated with cognitive impairment in patients with *** for hearing loss may be indicated among these patients to identify individuals at high-risk for adverse outcomes.

关键词： Atrial fibrillation Cognitive function Hearing

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Self-reported risk of stroke and factors associated with underestimation of stroke risk among older adults with atrial fibrillation: the SAGE-AF study

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journal of Geriatric Cardiology 2020年第8期17卷 502-509页

作者： jordy Mehawej jane Saczynski jerry H.Gurwitz Hawa O.Abu Benita A.Bamgbade Wei-jia WANG Tenes Paul Katherine Trymbulak Connor Saleeba Zi-Yue WANG Catarina I.Kiefe robert j.goldberg David D.Mc Manus Division of Cardiovascular Medicine Department of MedicineUniversity of Massachusetts Medical SchoolWorcesterMAUSA Department of Pharmacy and Health Systems Sciences School of PharmacyNortheastern UniversityBostonMAUSA Department of Population and Quantitative Health Sciences University of Massachusetts Medical SchoolWorcesterMAUSA Division of Geriatric Medicine and Meyers Primary Care Institute University of Massachusetts Medical SchoolWorcesterMAUSA

Background Though engaging patients with atrial fibrillation(AF) in understanding their stroke risk is encouraged by guidelines, little is known regarding AF patients' perceived stroke risk or its relationship with oral anticoagulation(OAC) use. We aim to identify factors associated with underestimation of stroke risk among older patients with AF and relate this to OAC use. Methods Data are from the ongoing SAGE(Systematic Assessment of Geriatric Elements)-AF study, which included older patients(> 65 years) with non-valvular AF and a CHA2 DS2-VASc score of ≥ 2. Participants reported their perceived risk of having a stroke without OAC. We compared the perceived risk to CHA2 DS2-VASc predicted stroke risk and classified participants as "over" or "under" estimators, and identified factors associated with underestimation of risk using multiple logistic regression. Results The average CHA2 DS2-VASc score of 915 participants(average age: 75 years, 47% female, 86% white) was 4.3 ± 1.6, 43% of participants had discordant predicted and self-reported stroke risks. Among the 376 participants at highest risk(CHA2 DS2-VASc score ≥ 5), 46% of participants underestimated their risk. Older participants(≥ 85 years) were more likely and OAC treated patients less likely to underestimate their risk of developing a future stroke than respective comparison groups. Conclusions A significant proportion of study participants misperceived their stroke risk, mostly by overestimating. Almost half of participants at high risk of stroke underestimated their risk, with older patients more likely to do so. Patients on OAC were less likely to underestimate their risk, suggesting that successful efforts to educate patients about their stroke risk may influence treatment choices.

关键词： Anticoagulation Atrial fibrillation Stroke

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Sleep as a window to understand and regulate Alzheimer's disease:emerging roles of thalamic reticular nucleus

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Neural Regeneration Research 2025年第6期20卷 1711-1712页

作者： Haoqi Sun Shiqian Shen robert j.Thomas M.Brandon Westover Can Zhang Department of Neurology Beth Israel Deaconess Medical CenterHarvard Medical SchoolBostonMAUSA Center for Translational Pain Research Department of AnesthesiaCritical Care and Pain MedicineMassachusetis General HospitalHarvard Medical SchoolBostonMAUSA Division of Pulmonary Critical Care and Sleep MedicineDepartment of MedicineBeth Israel Deaconess Medical CenterHarvard Medical SchoolBostonMAUSA Genetics and Aging Research Unit McCance Center for Brain HealthMass General Institute for Neurodegenerative DiseaseDepartment of NeurologyMassachusetts General HospitalHarvard Medical SchoolBostonMAUSA

Introduction:Alzheimer 's disease(AD) is a common neurodegenerative disorder and the primary cause of dementia. Considerable evidence supports the “amyloid hypothesis,” stating that the pathogenesis of AD is primarily caused by the deposition of amyloid-β(Aβ), which drives tau phosphorylation, neuroinflammation, and neurodegeneration in the brain. The amyloid hypothesis is strengthened by the significant and moderate benefit of lecanemab, a humanized antibody through an anti-amyloid mechanism,showing slowed clinical decline(van Dyck et al.,2023). The recent positive results of anti-amyloid trials have brought back focus on the amyloid hypothesis through biochemical, genetic, and pharmacological approaches(Zhang, 2023).

关键词： Alzheimer inflammation hypothesis

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Ultrasonographic visualization of lower eyelid structures and dynamic motion analysis

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International journal of Ophthalmology(English edition) 2013年第5期6卷 592-595页

作者： Mohammad Taher Rajabi Konstantinos Papageorgiou Shu-Hong Chang Imran jarullazada Mehryar Taban Catherine j.Hwang robert Alan goldberg Division of Orbital and Ophthalmic Plastic Surgery Jules Stein Eye InstituteUniversity of California-Los Angeles Eye Research Center Farabi Eye HospitalTehran University of Medical Sciences

AIMTo define the ultrasonographic structure of normal lower eyelid anatomic compartments and their spacial relationship in dynamic motion.

关键词： lower eyelid ultrasonography dynamic motion analysis

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Hotspot of Adult Cuban Treefrog and Cane Toad Multi-organ Abnormality in Suburban South-west Florida

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Asian Herpetological Research 2020年第2期11卷 139-154页

作者： Sharon Pratt ANZALDUA javier goldberg Private University 27427 Horne Ave Bonita SpringsFlorida 34135USA Instituto de Bio y Geociencias del NOA(IBIGEO-CONICET) CCT-Salta9 de Julio 14Rosario de LermaSalta 4405Argentina

This study represents a continuation of the Florida hotspot of tadpole abnormality found in the Southwest Florida suburban roadside drainage ditches in 2012 to determine if the adult frogs and toads frequenting the study sites were anatomically *** gross examination of all organs included 397 adult anurans and 40 metamorphs representing five anuran species:Osteopilus septentrionalis(N=364),Rhinella marina(N=60),Lithobates sphenocephala(N=7),Anaxyrus terrestris(N=5)and Anaxyrus americanus(N=1).The gonads,liver,kidney and intestines were abnormal at a frequency of 87.4%.The few normal anurans(12.6%)were females and young male *** found a significant difference in organ abnormality type and f requency between *** all f rog and toad males had testicular abnormality(92%)with only 6%with normal testes,whereas the female gonad abnormality was lower,at 41.6%.Hermaphroditism was found in both sexes at a frequency of 26.2%.The toads had a significantly higher frequency of hermaphroditism than the *** toad hermaphroditism frequency was found to be 40%,whereas the frog hermaphroditism 23.3%.A hermaphrodite Cane toad male with a female phenotype coexisted with the normal male phenotype *** fertility of 27 in situ pairs was *** fertile testicular abnormal male and hermaphrodite pairs produced offspring with abnormal larval *** information adds new evidence of the effect of chemicals on wild populations and the effect on non-target species which has always been underestimated.

关键词： gonad hermaphrodite malformation Osteopilus septentrionalis Rhinella marina

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Necrotic enteritis and antibiotic-free production of broiler chickens:Challenges in testing and using alternative products

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Animal Nutrition 2024年第1期16卷 288-298页

作者： robert j.Moore School of Science RMIT UniversityBundooraVictoria 3083Australia

The global trend towards raising broiler chickens without the use of in-feed antibiotics(IFAs)means that there is an ongoing need to develop alternative treatments capable of delivering the benefits that IFAs previously *** supported the productivity performance of chickens and played a key role in maintaining their *** enteritis(NE)is an important disease of broilers that affects health,productivity,and welfare,and was previously well controlled by ***,with the reduction in IFA use,NE is resurgent in some *** and various feed additives,including pre-,pro-,and postbiotics,phytobiotics,fatty acids,and phage therapies have been introduced as alternative methods of NE *** some of these feed additives have specific activity against the NE pathogen,Clostridium perfringens,most have the more general goal of reinforcing gut *** reviews of the effects of many of these feed additives on gut health have been published ***,rather than cover previously well reviewed areas of research this review focuses on the challenges and pitfalls in undertaking experimental assessment of alternative NE treatments and translating laboratory research to real world commercial production *** review is based on the author's particular experience,reading,thoughts,and analysis of the available information and inevitably presents a particular understanding that is likely to be at odds with others thinking on these *** is put forward to stimulate thinking and discussion on the issues covered.

关键词： Necrotic enteritis Clostridium perfringens Vaccines Feed additive Farm management

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The Orosirian(1800–2050 Ma)plate tectonic episode:Key for reconstructing the Proterozoic tectonic record

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Geoscience Frontiers 2023年第3期14卷 1-9页

作者： robert j.Stern Geosciences Dept. U Texas at DallasRichardsonTX 75083-0688United States

Eight lines of evidence indicate that the Orosirian Period in mid-Paleoproterozoic time was characterized by plate tectonics:ophiolites,low T/P metamorphism including eclogites,passive margin formation,tall mountains,paleomagnetic constraints,ore deposits,abundant S-type granites,and seismic images of paleo-subduction *** plate tectonic episode occurred about 1 billion years earlier than the present plate tectonic episode began in Neoproterozoic *** two plate tectonic episodes bracket the‘Boring Billion’,which may have been a protracted single lid tectonic episode that began when the supercontinent Nuna or Columbia *** of multiple lines of evidence for Orosirian plate tectonics demonstrates that Earth’s tectonic style can be reconstructed with some confidence back to at least Early Paleoproterozoic time,and thus the absence of compelling evidence for Mesoproterozoic plate tectonics is not obvious due to poor preservation.A tectono-magmatic lull2.3 Ga suggests an earlier episode of single lid *** for two episodes of plate tectonics and two episodes of single lid tectonics indicates that Earth switched between single lid and plate tectonics multiple times during the last 2.4 Ga.

关键词： Plate tectonics Single lid tectonics Urey ratio Paleoproterozoic

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Weight measurement using image-based pose analysis

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Progress in Natural Science:Materials International 2008年第12期18卷 1507-1512页

作者： robert j.Sclabassi Laboratory for Computational Neuroseience Departments of NeurosurgeryElectrical & Computer Engineeringand BioengineeringUniversity of PittsburghPittsburgh 15213USA

Image-based gait analysis as a means of biometric identification has attracted much research *** of the existing methods focus on human identification,posture analysis and movement *** have been few investigations on measuring the carried load based on the carrier’s gait characteristics by automatic image ***,this measurement is very useful in a number of applications,such as the study of the carried load on the postural development of children and *** this paper,we inves- tigate how to automatically estimate the carried weight from a sequence of *** present a method to extract human gait silhouette based on an observation that humans tend to minimize the energy during *** compute several angles of body leaning and deter- mine the relationship of the carried weight,the leaning angles and the centroid location according to a human kinetic *** weight determination method has been verified successfully by experiments.

关键词： Image-based pose analysis Energy minimization Pattern recognition Load carrying measurement

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Is plate tectonics needed to evolve technological species on exoplanets?

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Geoscience Frontiers 2016年第4期7卷 573-580页

作者： robert j.Stern Geoscience Department University of Texas at Dallas

As we continue searching for exoplanets, we wonder if life and technological species capable of communicating with us exists on any of them. As geoscientists, we can also wonder how important is the presence or absence of plate tectonics for the evolution of technological species. This essay considers this question, focusing on tectonically active roclw （silicate） planets, like Earth, Venus, and Mars. The development of technological species on Earth provides key insights for understanding evolution on exoplanets, including the likely role that plate tectonics may play. An Earth-sized silicate planet is likely to experience several tectonic styles over its lifetime, as it cools and its lithosphere thickens, strengthens, and becomes denser. These include magma ocean, various styles of stagnant lid, and perhaps plate tectonics. Abundant liquid water favors both life and plate tectonics. Ocean is required for early evolution of diverse single-celled organisms, then colonies of cells which specialized further to form guts, ap- pendages, and sensory organisms up to the complexity of fish （central nervous system, appendages, eyes）. Large expanses of dry land also begin in the ocean, today produced above subduction zones in juvenile arcs and by their coalescence to form continents, although it is not clear that plate tectonics was required to create continental crust on Earth. Dry land of continents is required for further evolution of technological species, where modification of appendages for grasping and manipulating, and improve- ment of eyes and central nervous system could be perfected. These bioassets allowed intelligent crea- tures to examine the night sky and wonder, the beginning of abstract thinking, including religion and science. Technology arises from the exigencies of daily living such as tool-making, agriculture, clothing, and weapons, but the pace of innovation accelerates once it is allied with science. Finally, the importance of plate tectonics for devel

关键词： Plate tectonics Exoplanets Planetary science Intelligent life

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