Faculty Bibliography

INTRODUCTION/BACKGROUND:Phospholipids are altered in brains of patients with dementia and some studies suggest their plasma levels may be useful in the detection of mild cognitive impairment (MCI) and dementia. METHODS:We measured 188 plasma metabolites in participants who underwent a detailed neuropsychological assessment and classified as normal (n = 153), MCI (n = 145), or dementia (n = 143) by expert adjudication. RESULTS:Among 10 phospholipids recently implicated as altered in dementia, higher concentration of PC aa C36:6 was significantly associated with decreased prevalence of dementia (odds ratio = 0.71, 95% confidence interval = 0.50-1.00 per 1-SD increase). Adding these phospholipids to a model including multiple predictors of dementia led to only minimal improvement in detection (C statistic changed from 0.702 to 0.71). DISCUSSION/CONCLUSIONS:Some phospholipids and metabolites were altered in MCI and dementia but cross-sectional association was relatively weak and did not improve detection of MCI and dementia beyond information provided by clinical variables.

INTRODUCTION/BACKGROUND:We examined prevalence of mild cognitive impairment (MCI) and dementia in the Atherosclerosis Risk in Communities (ARIC) Neurocognitive Study. METHODS:Beginning in June, 2011, we invited all surviving ARIC participants to undergo cognitive, neurological and brain imaging assessments to diagnose MCI or dementia and assign an etiology for the cognitive disorder. RESULTS:Of 10713 surviving ARIC participants (age range 69-88 yrs), we ascertained cognitive diagnoses in 6471 in-person, 1966 by telephone interviews (participant or informant) and the remainder by medical record review. The prevalence of dementia was 9.0% and MCI 21%. Alzheimer's disease was the primary or secondary etiology in 76% of dementia and 75% of MCI participants. Cerebrovascular disease was the primary or secondary etiology in 46% of dementia and 32% of MCI participants. DISCUSSION/CONCLUSIONS:MCI and dementia were common among survivors from the original ARIC cohort. Nearly 30% of the ARIC cohort received diagnoses of either dementia or MCI, and for the majority of these individuals (about 75%) the etiologic basis was attributed to Alzheimer's disease.

We conducted individual and ecologic analyses of prospectively collected data from 839 injured bicyclists who collided with motorized vehicles and presented to Bellevue Hospital, an urban Level-1 trauma center in New York City, from December 2008 to August 2014. Variables included demographics, scene information, rider behaviors, bicycle route availability, and whether the collision occurred before the road segment was converted to a bicycle route. We used negative binomial modeling to assess the risk of injury occurrence following bicycle path or lane implementation. We dichotomized U.S. National Trauma Data Bank Injury Severity Scores (ISS) into none/mild (0-8) versus moderate, severe, or critical (>8) and used adjusted multivariable logistic regression to model the association of ISS with collision proximity to sharrows (i.e., bicycle lanes designated for sharing with cars), painted bicycle lanes, or physically protected paths. Negative binomial modeling of monthly counts, while adjusting for pedestrian activity, revealed that physically protected paths were associated with 23% fewer injuries. Painted bicycle lanes reduced injury risk by nearly 90% (IDR 0.09, 95% CI 0.02-0.33). Holding all else equal, compared to no bicycle route, a bicycle injury nearby sharrows was nearly twice as likely to be moderate, severe, or critical (adjusted odds ratio 1.94; 95% confidence interval (CI) 0.91-4.15). Painted bicycle lanes and physically protected paths were 1.52 (95% CI 0.85-2.71) and 1.66 (95% CI 0.85-3.22) times as likely to be associated with more than mild injury respectively.

BACKGROUND:Apolipoprotein L1 gene (APOL1) G1 and G2 renal-risk variants, common in populations with recent African ancestry, are strongly associated with non-diabetic nephropathy, end-stage kidney disease, and shorter allograft survival in deceased-donor kidneys (autosomal recessive inheritance). Circulating APOL1 protein is synthesized primarily in the liver and hydrodynamic gene delivery of APOL1 G1 and G2 risk variants has caused hepatic necrosis in a murine model. METHODS:To evaluate the impact of these variants in liver transplantation, this multicenter study investigated the association of APOL1 G1 and G2 alleles in deceased African American liver donors with allograft survival. Transplant recipients were followed for liver allograft survival using data from the Scientific Registry of Transplant Recipients. RESULTS:Of the 639 liver donors evaluated, 247 had no APOL1 risk allele, 300 had 1 risk allele, and 92 had 2 risk alleles. Graft failure assessed at 15 days, 6 months, 1 year and total was not significantly associated with donor APOL1 genotype (p-values = 0.25, 0.19, 0.67 and 0.89, respectively). CONCLUSIONS:In contrast to kidney transplantation, deceased-donor APOL1 G1 and G2 risk variants do not significantly impact outcomes in liver transplantation.

BACKGROUND: No global positioning system (GPS) technology study has been conducted among a sample of young gay, bisexual, and other men who have sex with men (YMSM). As such, the purpose of this study was to evaluate the feasibility and acceptability of using GPS methods to understand the spatial context of substance use and sexual risk behaviors among a sample of YMSM in New York City, a high-risk population. METHODS: Data came from a subsample of the ongoing P18 Cohort Study (n = 75). GPS feasibility and acceptability among participants was measured with: 1) a pre- and post-survey and 2) adherence to the GPS protocol which included returning the GPS device, self-report of charging and carrying the GPS device as well as objective data analyzed from the GPS devices. Analyses of the feasibility surveys were treated as repeated measures as each participant had a pre- and post-feasibility survey. When comparing the similar GPS survey items asked at baseline and at follow-up, we present percentages and associated p-values based on chi-square statistics. RESULTS: Participants reported high ratings of pre-GPS acceptability, ease of use, and low levels of wear-related concerns in addition to few concerns related to safety, loss, or appearance, which were maintained after baseline GPS feasibility data collection. The GPS return rate was 100%. Most participants charged and carried the GPS device on most days. Of the total of 75 participants with GPS data, 75 (100%) have at least one hour of GPS data for one day and 63 (84%) had at least one hour on all 7 days. CONCLUSIONS: Results from this pilot study demonstrate that utilizing GPS methods among YMSM is feasible and acceptable. GPS devices may be used in spatial epidemiology research in YMSM populations to understand place-based determinants of health such as substance use and sexual risk behaviors.

Multi-day GPS data is increasingly being used in research-including in the field of spatial epidemiology. We present several maps as ways to present multi-day GPS data. Data come from the NYC Low-Income Housing, Neighborhoods and Health Study (n=120). Participants wore a QStarz BT-Q1000XT GPS device for about a week (mean: 7.44, SD= 2.15). Our maps show various ways to visualize multi-day GPS data; these data are presented by overall GPS data, by weekday/weekend and by day of the week. We discuss implications for each of the maps.

A common policy approach to reducing childhood obesity aims to shape the environment in which children spend most of their time: neighborhoods and schools. This paper uses richly detailed data on the body mass index (BMI) of all New York City public school students in grades K-8 to assess the potential for place-based approaches to reduce child obesity. We document variation in the prevalence of obesity across NYC public schools and census tracts, and then estimate the extent to which this variation can be explained by differences in individual-level predictors (such as race and household income). Both unadjusted and adjusted variability across neighborhoods and schools suggest place-based policies have the potential to meaningfully reduce child obesity, but under most realistic scenarios the improvement would be modest.

Participation in the federally subsidized school breakfast program often falls well below its lunchtime counterpart. To increase take-up, many districts have implemented Breakfast in the Classroom (BIC), offering breakfast directly to students at the start of the school day. Beyond increasing participation, advocates claim BIC improves academic performance, attendance, and engagement. Others caution BIC has deleterious effects on child weight. We use the implementation of BIC in New York City (NYC) to estimate its impact on meals program participation, body mass index (BMI), achievement, and attendance. While we find large effects on participation, our findings provide no evidence of hoped-for gains in academic performance, or of feared increases in obesity. The policy case for BIC will depend upon reductions in hunger and food insecurity for disadvantaged children, or its longer-term effects.