Berman Center for Outcomes and Clinical Research

The American Heart Association (AHA) recently introduced a new clinical entity; the cardiovascular-kidney-metabolic syndrome (CKMS), to promote a multi-disciplinary approach for chronic disease management. This study aims to investigate the relationship between CKMS and major adverse outcomes in older populations in primary care. This study utilized data from 18,367 community-dwelling individuals aged ≥ 65, free from prior cardiovascular disease (CVD). Participants were classified into four CKMS stages (stage 0-no CKMS risk factor to stage 3-high CKMS risk) at baseline based on the AHA definition. The association with 14 health outcomes was analysed using multivariable cause-specific hazard models. Additional stratifications were performed by social disadvantage, inflammation levels, and number of CKMS components within each stage to refine risk staging. Over a median follow-up of 8.6years, the prevalence of CKMS stages 0 to 3 was 2.8%, 8.2%, 52.6%, and 36.0%, respectively. Compared to stage 0, stage 3 associated with all-cause mortality (HR 1.31, 95%CI 1.01-1.69), CVD mortality (3.11, 1.46-6.60), incident total CVD events (2.78, 1.86-4.15), myocardial infarction (2.37, 1.21-4.62), stroke (2.75, 1.50-5.04), heart failure hospitalization (4.56, 1.45-14.37), atrial fibrillation (2.63, 1.61-4.29), cancer (1.31, 1.04-1.64), depression (1.20, 1.04-1.39), and physical disability (1.92, 1.20-3.08). Social disadvantage, high inflammation, and CKMS component count further amplified these associations. No linear trend was observed for cognitive outcomes and non-CVD cause-specific mortality. This study is the first to establish relationships between CKMS and multiple age-related outcomes in older adults, providing critical insights for developing holistic approaches to primary care in the aged.

A crucial objective within dermatology includes the identification of skin lesions, which can help with highlighting diseases amongst the likes of melanoma early into the heart of the diagnosis process. With time, professionals have depended on manually finding skin lesions on the body – a process which is inefficient for time-management and is openly vulnerable to incorrect results. This paper suggests a deep learning-dependent methodology utilizing You Only Look Once version 8 (DLBA- YOLOv8) in the case of skin lesion detection with a quick and error-less methodology. Using the ISIC dataset, the model was effectively trained with a collection of data of dermoscopic imagery of skin lesions. With state-of-the-art integration and performance in lesion localization and classification, results from experiments have demonstrated YOLOv8’s capability to achieve a mean Average Precision (mAP) of 98.8%, comparatively overcoming the efficiency of YOLOv7 (89.3%) and Faster R-CNN (87.1%). In addition to that, when placing the results of YOLOv5 and Mask R-CNN in terms of Intersection over Union (IoU) scores side by side with YOLOv8, (85.2% and 84.6% respectively), YOLOv8 shows a great outperformance of both with a score of 88.7%. With the utilization of the Ultralytics framework and an assessment through metrics along the likes of mAP and IoU, the system shows a successful implementation. Handing the industry, a greatly developed perk in precision and overall efficiency over current existing methodologies, this paper underscores the potential capabilities of YOLOv8 in real clinical applications for skin lesion detection through an automated process.

Plasma biomarkers of Alzheimer's disease and related dementias (ADRD) are associated with the risk of dementia. However, the extent to which they could reflect cognitive ageing, and whether this is consistent across factors known to influence biomarkers (e.g. sex and chronic kidney disease) and in different populations, is unknown. Data were from a diverse community-dwelling cohort of older individuals without dementia in Australia (n = 11,930) and the US (n = 1,181). Global cognition, verbal fluency, episodic memory and psychomotor speed were assessed repeatedly over more than a decade. Plasma phosphorylated tau181 (p-tau181), glial fibrillary acidic protein (GFAP), neurofilament light chain (NfL) and amyloid beta (Aβ) 42 and 40 were measured using Simoa technology. Higher levels of p-tau181 (β: -0.001 to -0.212), GFAP (β: -0.022 to -0.300) and NfL (β: -0.022 to -0.219), and lower levels of Aβ42/40 ratio (β: 0.015 to 0.126) were associated with greater cognitive decline over time. Associations were strongest for global cognition, episodic memory, and psychomotor speed, and weaker/non-significant for verbal fluency. All associations were consistent across countries. Furthermore, in stratified analyses, the results did not differ by sex or depending on the presence of chronic kidney disease. We found robust associations between plasma ADRD biomarkers and cognitive change in initially healthy older individuals in both Australia and the US, and across both sexes. Despite chronic kidney disease influencing biomarker levels, associations were consistent among individuals with and without chronic kidney disease. This indicates the potential broad utility of these biomarkers.

BackgroundRetinal vessel calibres (RVCs) are non-invasive markers of microvascular health and may serve as accessible indicators of cerebral small vessel disease (CSVD) and future cognitive impairment. This study examines whether RVCs are associated with cognitive decline, and how these associations compare with those observed for white matter hyperintensities (WMH), a known marker of CSVD.MethodsData were analysed from community-dwelling participants aged 70+ in the ASPREE trial and sub-studies, free of dementia and cardiovascular disease at baseline. RVCs were measured from fundus photography and WMH volumes from 3 T magnetic resonance imaging. Covariate-adjusted linear mixed-effects models assessed cognitive trajectories relative to baseline RVCs and WMH volumes. Cross-sectional associations between baseline RVCs and WMHs were examined via linear regression.ResultsThis study included 3540 participants with RVC data and 489 with WMH data (median [IQR] age: 73.2 [71.4-76.3] and 72.5 [71.2-75.4] years; female: 52.9% and 47.6%) over a median follow-up of 7.4 [IQR 5.5–8.5] and 3.8 [IQR 2.9-5.3] years, respectively. Baseline RVCs were not significantly associated with cognitive trajectories nor with baseline WMHs. Larger baseline WMH volumes were associated with greater global (Modified Mini-Mental State Examination) decline (mean 0.40 points/year; 95% CI 0.57, 0.22) and declines in delayed memory (HVLT-r) (−0.13 [−0.22, −0.04]), psychomotor function (Symbol Digit Modalities Test) (−0.29 [−0.52, −0.07]) and to a lesser extent, executive function (Controlled Oral Word Association Test) (−0.09 [95% CI −0.22, 0.03]).ConclusionIn contrast to WMH volumes, RVCs were not associated with cognitive decline. Exploring longitudinal changes in a broader range of retinal and brain biomarkers may provide deeper insights into the relationship between ocular and cerebral biomarkers in CSVD and clinical outcomes.

Professional identity (PI) has been linked to job satisfaction and retention, with research suggesting that fostering a strong PI during nursing education can help mitigate burnout and reduce turnover. However, few studies have explored how various learning experiences contribute to PI development. The purpose of this study was to describe the connections between educational experiences and PI. An open-ended prompt was disseminated to prelicensure nursing students. Participants described an experience that connected them to their PI. Thematic analysis was used to analyze responses and identify key themes. Four main themes emerged as influential in PI development: relationships, confidence, autonomy, and hinge moments. Positive relationships with patients, preceptors, and colleagues were identified as critical in strengthening PI. Clinical and classroom experiences that boosted confidence and autonomy were also essential. Hinge moments, such as meaningful patient interactions or significant clinical events, were pivotal in shaping students' PI. Findings identified key factors that shape PI, emphasizing the need for hands-on learning experiences such as simulations and early clinical exposure.

Poor social connection is considered a risk factor for dementia. Since socializing behaviors may cluster together or act compensatorily, we aimed to investigate social connection patterns and their association with dementia, for men and women separately. A total of 12,896 community-dwelling older adults (mean±SD age: 75.2±4.3 years, 54% women) without major cognitive impairment were included. Latent class analysis was conducted using 24 baseline social connection indicators. Cox proportional hazards regression was used to estimate the association between latent classes and incident dementia over 12 (median: 8.4) years follow-up. Three distinct classes were identified in both genders: strong social connections with an intermediate friend-relative network (Class 1: men, 43.8%; women, 37.9%), weak social connections (Class 2: men, 29.6%; women, 27.4%), and strong social connections with a larger friend-relative network (Class 3: men, 26.6%; women, 34.7%). Compared to Class 1, men in Class 2 (HR: 1.38, 95% CI: 1.08-1.77) and women in Class 3 (HR: 1.27, 95% CI: 1.01-1.60) had an increased risk of dementia. Dementia risk varies with different social connection patterns among older men and women. Three distinct social connection patterns were identified based on 24 indicators. These patterns were related to dementia risk differently in men and women. In men, a weak social connection pattern was associated with a higher dementia risk. In women, a strong social connection with a relatively larger friend-relative network was associated with a greater dementia risk.

The topic of alternatives to incarceration often seems at once forgotten and yet ever-present in the federal sentencing system. U.S. Sentencing Commission data indicate nine out of every ten federal sentences include terms of imprisonment, and yet the offenses and offenders in the federal system ought to permit great use of alternatives. This issue of FSR seeks to bring new attention to these topics, largely though the materials emerging from the Center for Justice and Human Dignity’s October 2023 “Rewriting the Sentence II Summit.” This event at George Washington University aspired to highlight how the full array of practitioners — judges, prosecutors, defense attorneys and other sentencing system actors — could make meaningful commitments to alternative to incarceration practices. This introductory essay provides context and framing for the materials that follow.

It has been suggested that higher triglyceride levels were associated with a lower risk of Alzheimer disease. This study aimed to examine the association of triglycerides with dementia and cognition change in community-dwelling older adults. This prospective longitudinal study used data from the Aspirin in Reducing Events in the Elderly (ASPREE) randomized trial of adults aged 65 years or older without dementia or previous cardiovascular events at enrollment. The main outcome was incident dementia. Other outcomes included changes in composite cognition and domain-specific cognition (global cognition, memory, language and executive function, and psychomotor speed). The association between baseline triglycerides and dementia risk was estimated using Cox proportional hazard models adjusting for relevant risk factors. Linear mixed models were used to investigate cognitive change. The analysis was repeated in a subcohort of participants with available APOE-ε4 genetic data with additional adjustment for APOE-ε4 carrier status and an external cohort (UK Biobank) with similar selection criteria applied. This study included 18,294 ASPREE participants and 68,200 UK Biobank participants (mean age: 75.1 and 66.9 years; female: 56.3% and 52.7%; median [interquartile range] triglyceride: 106 [80-142] mg/dL and 139 [101-193] mg/dL), with dementia recorded in 823 and 2,778 individuals over a median follow-up of 6.4 and 12.5 years, respectively. Higher triglyceride levels were associated with lower dementia risk in the entire ASPREE cohort (hazard ratio [HR] with doubling of triglyceride: 0.82, 95% CI 0.72-0.94). Findings were similar in the subcohort of participants with APOE-ε4 genetic data (n = 13,976) and in the UK Biobank cohort (HR was 0.82 and 0.83, respectively, all p ≤ 0.01). Higher triglycerides were also associated with slower decline in composite cognition and memory over time (p ≤ 0.05). Older adults with higher triglyceride levels within the normal to high-normal range had a lower dementia risk and slower cognitive decline over time compared with individuals with lower triglyceride levels. Higher triglyceride levels may be reflective of better overall health and/or lifestyle behaviors that would protect against dementia development. Future studies are warranted to investigate whether specific components within the total circulating pool of plasma triglycerides may promote better cognitive function, with the hope of informing the development of new preventive strategies.