Faculty Bibliography

We assessed community residents' perceptions of corner stores to better understand what facilitates and deters patronage at these food outlets. Data came from 978 household interviews in 2 Latino communities undergoing corner store interventions. Chi-square tests, an independent sample t test, and a multivariate logistic regression were conducted to assess the relationship between residents' perceptions about corner stores and their reported patronage at these food outlets. Residents reported that corner stores do not sell a variety of fruits and vegetables and are not places where one can get information about healthy eating. Convenience, cleanliness, positive customer service, availability of culturally appropriate items, and availability of quality fresh fruit increased the odds of store patronage. Simply providing healthy foods will not incentivize patrons to purchase them. Corner store interventions can be more effective if they address the characteristics that community residents prioritize.

The number of individuals with prediabetes is expected to grow substantially and estimated to globally affect 482 million people by 2040. Therefore, effective methods for diagnosing prediabetes will be required to reduce the risk of progressing to diabetes and its complications. The current biomarkers, glycated hemoglobin (HbA1c), fructosamine, and glycated albumin have limitations including moderate sensitivity and specificity and are inaccurate in certain clinical conditions. Therefore, identification of additional biomarkers is being explored recognizing that any single biomarker will also likely have inherent limitations. Therefore, combining several biomarkers may more precisely identify those at high risk for developing prediabetes and subsequent progression to diabetes. This review describes recently identified biomarkers and their potential utility for addressing the burgeoning epidemic of dysglycemic disorders.

As of 2015, only 12 countries in the World Health Organization's AFRO region had met Millennium Development Goal #4 (MDG#4) to reduce under-five mortality by two-thirds by 2015. Given the variability across the African region, a four-country study was undertaken to examine barriers and facilitators of child survival prior to 2015. Kenya was one of the countries selected for an in-depth case study due to its insufficient progress in reducing under-five mortality, with only a 28% reduction between 1990 and 2013. This paper presents indicators, national documents, and qualitative data describing the factors that have both facilitated and hindered Kenya's efforts in reducing child mortality. Key barriers identified in the data were widespread socioeconomic and geographic inequities in access and utilization of maternal, neonatal, and child health (MNCH) care. To reduce these inequities, Kenya implemented three major policies/strategies during the study period: removal of user fees, the Kenya Essential Package for Health, and the Community Health Strategy. This paper uses qualitative data and a policy review to explore the early impacts of these efforts. The removal of user fees has been unevenly implemented as patients still face hidden expenses. The Kenya Essential Package for Health has enabled construction and/or expansion of healthcare facilities in many areas, but facilities struggle to provide Emergency Obstetric and Neonatal Care (EmONC), neonatal care, and many essential medicines and commodities. The Community Health Strategy appears to have had the most impact, improving referrals from the community and provision of immunizations, malaria prevention, and Prevention of Mother-to-Child Transmission of HIV. However, the Community Health Strategy is limited by resources and thus also unevenly implemented in many areas. Although insufficient progress was made pre-2015, with additional resources and further scale-up of new policies and strategies Kenya can make further progress in child survival.

Introduction: Sleep may play a role in AD pathogenesis, but the timing, role, and extent to which sleep disturbances in late-life are associated with increasing burden of AD neuropathology remains unclear. Sleep spindles have been implicated in sleep quality. Wakefulness is mediated by an arousal system beginning in the brainstem and continuing on to the diencephalon and innervating the thalamus, the region where sleep spindle oscillations are generated. In AD pathology, hyperphosphorylated tau (P-Tau) protein accumulates in the brainstem, from where it spreads to the entorhinal cortices, hippocampi and other brain regions. These tau aggregates may interfere with the sleep-wake cycle resulting in down-regulation of sleep spindles and associated sleep disruption. Increased CSF P-tau and T-tau levels are likely related to the formation of neurofibrillary tangles in the brainstem and limbic system (Braak stages I-IV). Methods: 49 cognitively normal (CDR=0) elderly (66.95 +/- 7.76 years) subjects completed a structural MRI, lumbar puncture (LP) and nocturnal polysomnography (NPSG) within 4.65 +/- 6.81 months of the LP. From the NPSG, spindle frequency and density were analyzed for stages NREM1, NREM2 and NREM3, using an automated optimization algorithm which decomposes the EEG as a sum of transient and oscillatory components. This was used to detect the spindles and a Fourier analysis was performed to evaluate the spindle frequency in Hz. Results: Spindle frequency and density in NREM2 sleep were inversely associated with CSF P-tau (r= -0.355, p<0.05; r=-0.476, p<0.05) and CSF T-tau (r=-0.405, p<.05; r=-0.542, p<.05) using partial correlation controlling for age and ApoE4 allele. There were no associations between spindle frequency or density and CSF P-tau or CSF T-tau in stages NREM1, NREM3. Conclusion: The association of spindle frequency and density in NREM2 to CSF P-tau and CSF T-tau in cognitively normal elderly suggest either that tau pathology may produce an early downstream effect on sleep spindles, or that changes in sleep spindles can identify a process relating to tau pathology. Whether the association of tau to spindles is a non-specific effect of tau on increasing sleep fragmentation in general remains an area of active investigation

Introduction: Racial and socioeconomic disparities are known to negatively affect sleep duration in school-aged children and adults. Little is known about how very young African American (AA) and Caucasian (C) children (1-year-olds) differ in nocturnal and daytime sleep duration and how this may affect daytime behavioral patterns. The purpose of this study was to determine differences in total sleep duration between AA and C 1-year-olds and how nighttime and daytime total sleep hours and number of minutes awake during the night relates to objective behavioral performance measures. Methods: We analyzed data from the first-year clinic visits (N=1056) (mean SD) (1.08 years 0.12) of predominantly AA (n=663) and C (n=393) children living in Shelby County, TN enrolled in the Conditions Affecting Neurocognitive Development and Learning in Early Childhood (CANDLE) study. T-tests for differences between total nocturnal and daytime sleep hours and number of minutes awake during the night (all reported by parent) between races and bivariate correlations determined if sleep periods were associated with Brief Infant Toddler Social Emotional Assessment (BITSEA) total and subscale scores for externalizing and internalizing behavior problems. Results: AA children slept significantly fewer hours than C children during daytime (7am-7pm) (2.6 1.5 v 2.9 1.1, p<0.001) and nighttime (7pm - 7am) hours (9.2 1.4 v 10.4 1.1) respectively. AA were awake more minutes during the night (18.7 40.9) than C (8.9 25.3, p <0.001). Total nighttime sleep hours were significantly correlated with Externalizing (r= -.20, p < 0.001) and Internalizing BITSEA subscales (r= -.20, p < 0.001) as were nighttime wake minutes (r= .14, p<0.001 and r= .11, p<0.001, respectively). Daytime hours of sleep were non-significantly correlated to the BITSEA scores. Conclusion: Urban 1-year-old AA children sleep significantly less during nighttime and daytime hours than their C counterparts. Fewer total night minutes of sleep corresponded with higher (i.e, more impaired) scores for externalizing and internalizing behaviors while more minutes of wake during the night resulted in similar behavior patterns. More focus must be given to alerting urban communities of the importance of adequate nighttime sleep for their very young children

Extensive evidence has suggested that early academic skills are a robust indicator of later academic achievement; however, there is mixed evidence of the effectiveness of intervention on academic skills in early years to improve later outcomes. As such, it is clear there are other contributing factors to the development of academic skills. The present study tests the role of executive function (EF) (a construct made up of skills complicit in the achievement of goal-directed tasks) in predicting 5th grade math and reading ability above and beyond math and reading ability prior to school entry, and net of other cognitive covariates including processing speed, vocabulary, and IQ. Using a longitudinal dataset of N = 1292 participants representative of rural areas in two distinctive geographical parts of the United States, the present investigation finds EF at age 5 strongly predicts 5th grade academic skills, as do cognitive covariates. Additionally, investigation of an interaction between early math ability and EF reveals the magnitude of the association between early math and later math varies as a function of early EF, such that participants who have high levels of EF can "catch up" to peers who perform better on assessments of early math ability. These results suggest EF is pivotal to the development of academic skills throughout elementary school. Implications for further research and practice are discussed.