Faculty Bibliography

OBJECTIVE/UNASSIGNED:Denture use has been shown to improve nutritional intake and diet quality in people with tooth loss. Despite evidence linking tooth loss and dementia, few studies have examined the association between denture use and cognitive decline. We investigated the relationship between denture use and cognitive decline among Chinese older adults with tooth loss. METHODS/UNASSIGNED:We analyzed data from the Chinese Longitudinal Healthy Longevity Survey 2008-2018, including 27,708 community-dwelling dentate and edentulous (i.e., who have lost all natural teeth) older adults aged 65 and older. Cognitive function was assessed using the Mini-Mental State Examination from 2008 to 2018. Linear mixed-effect models were employed to assess the association of denture use with baseline cognitive function and rate of cognitive decline, adjusting for sociodemographic characteristics, health-related behavior, and health status. Subgroup analyses evaluated differences in associations among dentate participants with varying degrees of tooth loss (1-9, 10-19, 20-31). RESULTS/UNASSIGNED: = 0.818). Results remained consistent across subgroups of dentate participants with various degrees of missing teeth. CONCLUSIONS/UNASSIGNED:Denture use may help protect against cognitive decline in older adults with partial tooth loss. This study highlights the potential importance of prosthodontic rehabilitation in preserving cognitive health. Further research is needed to establish a causal relationship between denture use and cognitive function.

While a broad consensus about the first successful migration modern humans out of Africa seems established, the peopling of Arabia remains somewhat enigmatic. Identifying the ancestral populations that contributed to the gene pool of the current populations inhabiting Arabia and the impact of their contributions remains a challenging task. We investigate the genetic makeup of the current Yemeni population using 46 whole genomes and 169 genotype arrays derived from Yemeni individuals from all geographic regions across Yemen and 351 genotype arrays derived from neighboring populations providing regional context. Principal Component Analysis shows stratification between Yemen districts but also with respect to nearby populations: Yemeni, other Arabian and Bedouin samples form a continuum towards the populations of the Levant, whereas East Africa and India appear strongly differentiated. This finding is further supported by higher Principal Components, admixture and haplogroup analyses, and F-statistics. Moreover, two-reference linkage disequilibrium decay estimates are most significant for Yemeni admixture from an ancient northern influx (up to 5220BP from Palestine) and East Africa (750BP). We show that the initial gene flow into the Yemeni populations of today came from the rest of Arabia and the Levant, and a less substantial and more recent genetic impact into coastal Yemen from East Africa, particularly.

A "barium chemobezoar" or "barolith" is a rare but serious cause of intestinal obstruction. We present two cases, a 70-year-old female patient and a 61-year-old male patient, both requiring urgent surgery for barolith-induced bowel obstruction. Diagnostic challenges were encountered in both cases, with imaging raising suspicion for barolith formation after prior barium use. Surgical intervention, including colotomy and enterotomy, was necessary due to the risk of perforation and ischemia. These cases highlight the variability in presentation and the lack of standardized guidelines for diagnosis and management, emphasizing the need for heightened clinical awareness and timely imaging.

BACKGROUND:Ketamine's potential for treating depression has drawn increased clinical interest in recent years. However, despite growing therapeutic use, recreational use among individuals with depression remain underexplored. METHODS:We analyzed data from the 2015-2022 National Survey on Drug Use and Health focusing on adults in the US. Trends in past-year ketamine use, overall and by depression status, were estimated separately for 2015-2019 and 2021-2022 due to methodological changes in the survey. We also delineated correlates of ketamine use in each period, focusing on depression, sociodemographic characteristics, and other past-year drug use. RESULTS:Overall ketamine use prevalence increased from 2015 to 2019 (from 0.11 % to 0.20 %, an 81.8 % increase, p < 0.01) and from 2021 to 2022 (from 0.20 % to 0.28 %, a 40.0 % increase, p < 0.05). From 2015 to 2019, use increased among adults with and without depression (by 139.3 % [p < 0.05] and 66.7 % [p < 0.05], respectively), while from 2021 to 2022, an increase occurred only among those without depression (by 38.9 %, p < 0.05). Multivariable models revealed that depression was associated with increased odds of ketamine use in 2015-2019 (aOR = 1.80, 95 % CI: 1.12-2.89) but not in later years. New sociodemographic correlates emerged in 2021-2022, including adults aged 26-34 and those with a college degree being at higher odds for use. Various drugs (especially ecstasy/MDMA and gamma-hydroxybutyrate) were consistently associated with higher odds of use. CONCLUSION/CONCLUSIONS:We identified differential patterns and correlates of ketamine use over time. Shifts may be related to the evolving ketamine landscape and/or changing survey methodology. Monitoring of use patterns is crucial to inform prevention and harm reduction strategies.

Black Americans (AA) face a confluence of challenges when seeking care including unaffordable costs, negative experiences with providers, racism, and distrust in the healthcare system. This study utilized linear regressions and mediation analysis to explore the interconnectedness of these challenges within a community-based sample of 313 AA women aged 45 and older. Approximately 23% of participants reported affordability problems, while 44% had a negative experience with a provider. In the initial linear regression model excluding perceived racism, higher levels of distrust were observed among women reporting affordability problems (β = 2.66; p = 0.003) or negative experiences with a healthcare provider (β = 3.02; p = <0.001). However, upon including perceived racism in the model, it emerged as a significant predictor of distrust (β = 0.81; p = < 0.001), attenuating the relationships between affordability and distrust (β = 1.74; p = 0.030) and negative experience with a provider and distrust (β = 1.79; p = 0.009). Mediation analysis indicated that perceived racism mediated approximately 35% and 41% of the relationships between affordability and distrust and negative experience with a provider and distrust, respectively. These findings underscore the critical imperative of addressing racism in the efforts to mitigate racial disparities in healthcare. Future research should explore the applicability of these findings to other marginalized populations.

BACKGROUND/UNASSIGNED:Older adults treated in emergency departments (EDs) are at higher risk for adverse outcomes. Using multiple facilities can worsen this issue through service duplication and poor care transitions. Veterans with dual insurance coverage can access both Veterans Health Administration (VHA) and non-VHA EDs. This study aimed to identify factors associated with non-VHA ED use among veterans. METHODS/UNASSIGNED:We conducted a retrospective observational study of patients aged ≥ 65 who had primary care at the James J Peters VA Medical Center and at least one VHA or non-VHA ED visit between October 2017 and February 2020. Data were collected from the Veterans Affairs Corporate Data Warehouse and the Bronx Regional Health Information Exchange Organization. Generalized linear mixed models were used to examine factors influencing non-VHA ED use. RESULTS/UNASSIGNED:The study sample consisted of 3,897 veterans and a total of 13,312 ED visits. Compared to VHA-exclusive ED users, non-VHA ED users were more likely to live farther away (OR 1.04, CI 1.02 - 1.06) and seek care outside regular hours, including mornings (OR 1.61, CI 1.39 - 1.87), nights (OR 1.49, CI 1.33 - 1.66), weekends (OR 1.28, CI 1.16 - 1.42), and holidays (OR 1.32, CI 1.04 - 1.68). They were also more likely to present with emergency care sensitive conditions (OR 2.13, CI 1.90 - 2.37) and recent inpatient hospitalizations (OR 1.22, CI 1.05 - 1.41). CONCLUSION/UNASSIGNED:These findings suggested that distance and acuity are important predictors of non-VHA ED use in urban areas such as the Bronx, NY. Identifying veterans with key risk factors could improve care coordination and potentially reduce non-VHA ED use.

Countertransferential and other types of personal responses to candidates are inevitable among psychoanalytic educators, whether they be supervisors, progression advisors, the progression committee as a whole, or course instructors. Nonetheless many educators remain unaware of these phenomena - despite the robust literature on this subject in supervisors - perhaps because we do not like to think of ourselves as having potentially deleterious personal reactions to younger colleagues with whom we have significant and highly valued relationships. This paper emphasizes the role of such phenomena in progression advisors' deliberations about candidates' development, as well as in the committee as a whole - a subject not addressed in the literature. Especially when unrecognized such responses can compromise the checks and balances function of the progression committee and significantly diminish rich and effective dialogue with candidates about their development. Examples of the potential impact and more or less effective mitigation of such responses are presented. Ensuring that faculty members and candidates alike are familiar with the inevitability of these reactions, their multiple sources and manifestations in those involved in the work of progression enhances the possibility of developing strategies to address these reactions and reduce their effect.

While the emergency department (ED) is an important setting for identifying youth with psychiatric symptoms and connecting them to services, the demands of the ED make efficient and accurate measurement essential in the implementation of mental health screening. The Kiddie-Computerized Adaptive Test (K-CAT) scales, a new electronically administered measure that offers quick and comprehensive assessment across several mental health domains, may be particularly useful in this setting. Given current recommendations for youth suicide risk screening in EDs, this study compared the K-CAT-Suicide Scale (K-CAT-SS) and the Ask Suicide-screening Questions (ASQ), a widely used measure in EDs, in a sample of participants presenting to a pediatric, psychiatric emergency setting. The measures agreed on the presence of suicide risk in over 85% of cases (κ=0.59), and the characteristics of youth who screened at risk on both were similar. Cases of disagreement were more often male and more often had educational accommodations. They had lower symptom levels of and were less often diagnosed with internalizing disorders and were less often identified as high risk by ED psychiatrists and psychologists. Examination of item endorsement patterns in cases of disagreement revealed important areas of future study, including the role of caregiver report in suicide risk screening, item comprehension concerns, and the validity of assessing youth with neurodevelopmental disabilities. While additional research would be beneficial into its psychometrics when deployed in real-world settings, the K-CAT-SS should be considered a viable alternative for suicide risk screening in EDs.