Faculty Bibliography

OBJECTIVE:Chronic social isolation is a risk factor for all-cause mortality and disease progression, but is not routinely screened for in clinical settings. This study analyzed provider-patient communication patterns about social influences during primary care encounters, to identify opportunities to screen for objective or perceived social isolation. METHODS:Content analysis was conducted on transcripts of 97 audiotaped, English-speaking patient encounters with 27 primary care providers at 3 safety-net primary care centers in New York City. Conversations were first coded for specific social isolation screening, then more broadly to quantify and qualify how social influences were discussed in relation to health. RESULTS:Transcripts included no explicit examples of social isolation screening. Social influences on health were discussed meaningfully in only 28 % of transcripts, compared to medication adherence (93 %) and diet (64 %). Patients initiated conversations about social influences on health twice as often as providers, however providers did not acknowledge 67% of these prompts. CONCLUSION:Social influences on health, including social isolation, were uncommonly discussed in this sample of primary care visits. When social influences were discussed meaningfully, providers utilized relationship-centered communication strategies. PRACTICE IMPLICATIONS:Strategic conversations about social influences, even when brief and informal, can effectively screen patients for social isolation.

In isolation, we are physically apart; in solidarity, we are together. The COVID-19 pandemic emphasizes our social responsibility to maintain physical distance from one another. In doing so, we solidify our collective strength.

During spaceflight, the human cardiovascular system undergoes major changes primarily related to the effects of decreased gravitational force, or microgravity, on the human body. These changes present challenges to human adaptation and operation in space. This article reviews the knowledge gained in human experiments in the past half century of spaceflight, and summarizes our knowledge on the effects of short- and long-duration microgravity exposure on cardiovascular physiology and functioning, including fluid redistribution, autonomic reflexes, cardiac parameters, orthostatic intolerance, arrhythmias, aerobic capacity, and cardiac atrophy. This review also discusses current countermeasures for risk reduction during spaceflight, as well as future directions in cardiovascular research in space.

BackgroundLow birth weight (LBW) neonates have impaired kidney development that leaves them susceptible to kidney disease and hypertension during adulthood. The study here identifies events that blunt nephrogenesis and kidney development in the murine LBW neonate.MethodsWe examined survival, kidney development, GFR, gene expression, and cyto-/chemokines in the LBW offspring of malnourished (caloric and protein-restricted) pregnant mice.ResultsMalnourished pregnant mothers gave birth to LBW neonates that had 40% reduced body weight and 54% decreased survival. Renal blood perfusion was reduced by 37%, whereas kidney volume and GFR were diminished in the LBW neonate. During gestation, the LBW neonatal kidney had 2.2-fold increased apoptosis, 76% decreased SIX2+ progenitor cells, downregulation of mesenchymal-to-epithelial signaling factors Wnt9b and Fgf8, 64% less renal vesicle formation, and 32% fewer nephrons than controls. At birth, increased plasma levels of IL-1β, IL-6, IL-12(p70), and granulocyte-macrophage colony-stimulating factor in the LBW neonate reduced SIX2+ progenitor cells.ConclusionIncreased pro-inflammatory cytokines in the LBW neonate decrease SIX2+ stem cells in the developing kidney. Reduced renal stem cells (along with the decreased mesenchymal-to-epithelial signaling) blunt renal vesicle generation, nephron formation, and kidney development. Subsequently, the mouse LBW neonate has reduced glomeruli volume, renal perfusion, and GFR.