Air Pollution and the Dynamic Association Between Depressive Symptoms and Memory in Oldest-Old Women

BACKGROUND/OBJECTIVES Exposure to air pollution may contribute to both increasing depressive symptoms and decreasing episodic memory in older adulthood, but few studies have examined this hypothesis in a longitudinal context. Accordingly, we examined the association between air pollution and changes in depressive symptoms (DS) and episodic memory (EM) and their interrelationship in oldest-old (aged 80 and older) women. DESIGN Prospective cohort data from the Women\u27s Health Initiative Memory Study-Epidemiology of Cognitive Health Outcomes. SETTING Geographically diverse community-dwelling population. PARTICIPANTS A total of 1,583 dementia-free women aged 80 and older. MEASUREMENTS Women completed up to six annual memory assessments (latent composite of East Boston Memory Test and Telephone Interview for Cognitive Status) and the 15-item Geriatric Depression Scale (GDS-15). We estimated 3-year average exposures to regional particulate matter with aerodynamic diameter below 2.5 μm (PM2.5) (interquartile range [IQR] = 3.35 μg/m3) and gaseous nitrogen dioxide (NO2) (IQR = 9.55 ppb) at baseline and during a remote period 10 years earlier, using regionalized national universal kriging. RESULTS Latent change structural equation models examined whether residing in areas with higher pollutant levels was associated with annual changes in standardized EM and DS while adjusting for potential confounders. Remote NO2 (β = .287 per IQR; P = .002) and PM2.5 (β = .170 per IQR; P = .019) exposure was significantly associated with larger increases in standardized DS, although the magnitude of the difference, less than 1 point on the GDS-15, is of questionable clinical significance. Higher DS were associated with accelerated EM declines (β = −.372; P = .001), with a significant indirect effect of remote NO2 and PM2.5 exposure on EM declines mediated by DS. There were no other significant indirect exposure effects. CONCLUSION These findings in oldest-old women point to potential adverse effects of late-life exposure to air pollution on subsequent interplay between DS and EM, highlighting air pollution as an environmental health risk factor for older women

Outdoor Air Pollution Exposure and Inter-relation of Global Cognitive Performance and Emotional Distress in Older Women

The interrelationships among long-term ambient air pollution exposure, emotional distress and cognitive decline in older adulthood remain unclear. Long-term exposure may impact cognitive performance and subsequently impact emotional health. Conversely, exposure may initially be associated with emotional distress followed by declines in cognitive performance. Here we tested the inter-relationship between global cognitive ability, emotional distress, and exposure to PM2.5 (particulate matter with aerodynamic diameter 2 (nitrogen dioxide) in 6118 older women (aged 70.6 ± 3.8 years) from the Women’s Health Initiative Memory Study. Annual exposure to PM2.5 (interquartile range [IQR] = 3.37 μg/m3) and NO2 (IQR = 9.00 ppb) was estimated at the participant’s residence using regionalized national universal kriging models and averaged over the 3-year period before the baseline assessment. Using structural equation mediation models, a latent factor capturing emotional distress was constructed using item-level data from the 6-item Center for Epidemiological Studies Depression Scale and the Short Form Health Survey Emotional Well-Being scale at baseline and one-year follow-up. Trajectories of global cognitive performance, assessed by the Modified-Mini Mental State Examination (3MS) annually up to 12 years, were estimated. All effects reported were adjusted for important confounders. Increases in PM2.5 (β = -0.144 per IQR; 95% CI = −0.261; −0.028) and NO2 (β = −0.157 per IQR; 95% CI = −0.291; −0.022) were associated with lower initial 3MS performance. Lower 3MS performance was associated with increased emotional distress (β = −0.008; 95% CI = −0.015; −0.002) over the subsequent year. Significant indirect effect of both exposures on increases in emotional distress mediated by exposure effects on worse global cognitive performance were present. No statistically significant indirect associations were found between exposures and 3MS trajectories putatively mediated by baseline emotional distress. Our study findings support cognitive aging processes as a mediator of the association between PM2.5 and NO2 exposure and emotional distress in later-life

Orphan CpG Islands Identify Numerous Conserved Promoters in the Mammalian Genome

CpG islands (CGIs) are vertebrate genomic landmarks that encompass the promoters of most genes and often lack DNA methylation. Querying their apparent importance, the number of CGIs is reported to vary widely in different species and many do not co-localise with annotated promoters. We set out to quantify the number of CGIs in mouse and human genomes using CXXC Affinity Purification plus deep sequencing (CAP-seq). We also asked whether CGIs not associated with annotated transcripts share properties with those at known promoters. We found that, contrary to previous estimates, CGI abundance in humans and mice is very similar and many are at conserved locations relative to genes. In each species CpG density correlates positively with the degree of H3K4 trimethylation, supporting the hypothesis that these two properties are mechanistically interdependent. Approximately half of mammalian CGIs (>10,000) are “orphans” that are not associated with annotated promoters. Many orphan CGIs show evidence of transcriptional initiation and dynamic expression during development. Unlike CGIs at known promoters, orphan CGIs are frequently subject to DNA methylation during development, and this is accompanied by loss of their active promoter features. In colorectal tumors, however, orphan CGIs are not preferentially methylated, suggesting that cancer does not recapitulate a developmental program. Human and mouse genomes have similar numbers of CGIs, over half of which are remote from known promoters. Orphan CGIs nevertheless have the characteristics of functional promoters, though they are much more likely than promoter CGIs to become methylated during development and hence lose these properties. The data indicate that orphan CGIs correspond to previously undetected promoters whose transcriptional activity may play a functional role during development

Diverse pathways to positive and negative affect in adulthood and later life: An integrative approach using recursive partitioning

Recursive partitioning is an analytic technique that is useful for identifying complex combinations of conditions that predict particular outcomes as well as for delineating multiple subgroup differences in how such factors work together. As such, the methodology is well suited to multidisciplinary, life course inquiry in which the goal is to integrate many interacting influences and understand subgroup variation. The authors conducted recursive partitioning analyses on a previously published study (D. K. Mroczek & C. M. Kolarz, 1998) that investigated life course profiles of positive and negative affect and incorporated various top-down (personality traits) and bottom-up (sociodemographic statuses, contextual influences) influences. The new analyses reveal multiway, nonlinear interactions among these variables in predicting affective experience and, importantly, life course differences in how these various factors combine. Included are details of how recursive partitioning trees are generated as well as descriptions of the software packages available for using such techniques. Overall, the methodology offers tractable strategies for discerning meaningful patterns in highly complex data sets

SUPPLEMENTAL_APPENDIX - “Meet Me Where I Am”: Removing Barriers to End-of-Life Care for Homeless Veterans and Veterans Without Stable Housing

<p>SUPPLEMENTAL_APPENDIX for “Meet Me Where I Am”: Removing Barriers to End-of-Life Care for Homeless Veterans and Veterans Without Stable Housing by David A. Gruenewald, Daniel Doan, Anne Poppe, Jacqueline Jones, and Evelyn Hutt in American Journal of Hospice and Palliative Medicine®</p

Diagnostic Value of DECT-Based Collagen Mapping for Assessing the Distal Tibiofibular Syndesmosis in Patients with Acute Trauma

Background: Injury to the distal tibiofibular syndesmosis (DTFS) is common in patients with trauma to the ankle, but diagnostic accuracy of conventional X-ray and CT is insufficient. A novel dual energy CT (DECT) post-processing algorithm enables color-coded mapping of collagenous structures, which can be utilized to assess the integrity of the DTFS. Methods: Patients were included in this retrospective study if they underwent third-generation dual-source DECT followed by 3T-MRI or ankle joint surgery within 14 days between January 2016 and December 2021. Three radiologists blinded to all patient data independently evaluated grayscale images and, after 8 weeks, grayscale and collagen mapping images for the presence of ligamentous injury or avulsion fractures of the DTFS. MRI and surgery provided the reference standard. Diagnostic accuracy parameters were calculated for all ratings, and a comparison of ROC curve analysis was performed to evaluate the incremental diagnostic value of color-coded images over grayscale images. Results: A total of 49 patients (median age 49 years; 32 males) were evaluated. Application of collagen mapping significantly increased sensitivity (25/30 [83%] vs. 20/30 [67%]), specificity (110/118 [93%] vs. 70/118 [60%]), positive predictive value (25/33 [76%] vs. 20/67 [30%]), negative predictive value (110/115 [96%] vs. 70/80 [88%]), and accuracy (134/147 [91%] vs. 90/147 [61%]) for the detection of injury to the DTFS (all parameters, p < 0.001). Collagen mapping achieved higher diagnostic confidence, image quality, and noise scores compared to grayscale CT (all parameters, p < 0.001). Conclusions: Collagen mapping yields substantially higher diagnostic accuracy and confidence for assessing the integrity of the distal tibiofibular syndesmosis compared to grayscale CT in patients with acute trauma. The application of this algorithm can accelerate the adequate diagnosis and treatment of DTFS injury in clinical routine

Dual-Energy CT in Cardiothoracic Imaging: Current Developments

This article describes the technical principles and clinical applications of dual-energy computed tomography (DECT) in the context of cardiothoracic imaging with a focus on current developments and techniques. Since the introduction of DECT, different vendors developed distinct hard and software approaches for generating multi-energy datasets and multiple DECT applications that were developed and clinically investigated for different fields of interest. Benefits for various clinical settings, such as oncology, trauma and emergency radiology, as well as musculoskeletal and cardiovascular imaging, were recently reported in the literature. State-of-the-art applications, such as virtual monoenergetic imaging (VMI), material decomposition, perfused blood volume imaging, virtual non-contrast imaging (VNC), plaque removal, and virtual non-calcium (VNCa) imaging, can significantly improve cardiothoracic CT image workflows and have a high potential for improvement of diagnostic accuracy and patient safety