Digital Commons Network^™

Innovation In Patient-Centered Care: Lessons From A Qualitative Study Of Innovative Health Care Organizations In Washington State, Peter Reed, Douglas A. Conrad, Susan E. Hernandez, Carolyn Watts, Miriam Marcus-Smith

Health Administration Publications

Background

Growing interest in the promise of patient-centered care has led to numerous health care innovations, including the patient-centered medical home, shared decision-making, and payment reforms. How best to vet and adopt innovations is an open question. Washington State has been a leader in health care reform and is a rich laboratory for patient-centered innovations. We sought to understand the process of patient-centered care innovation undertaken by innovative health care organizations – from strategic planning to goal selection to implementation to maintenance.

Methods

We conducted key-informant interviews with executives at five health plans, five provider organizations, and ten primary care …

Genetic Variation In Spag16 Regions Encoding The Wd40 Repeats Is Not Associated With Reduced Sperm Motility And Axonemal Defects In A Population Of Infertile Males, David R. Nagarkatti-Gude, Giulia Collodel, Lori D. Hill, Elena Moretti, Michela Geminiani, Zhibing Zhang, Jerome F. Strauss

Obstetrics and Gynecology Publications

Background SPAG16 is a critical structural component of motile cilia and flagella. In the eukaryotic unicellular algae Chlamydomonas, loss of gene function causes flagellar paralysis and prevents assembly of the “9 + 2” axoneme central pair. In mice, we have previously shown that loss of Spag16 gene function causes male infertility and severe sperm motility defects. We have also reported that a heterozygous mutation of the human SPAG16 gene reduces stability of the sperm axonemal central apparatus.

Methods In the present study, we analyzed DNA samples from 60 infertile male volunteers of Western European (Italian) origin, to search for novel …

Cholesterol Side-Chain Cleavage Gene Expression In Theca Cells: Augmented Transcriptional Regulation And Mrna Stability In Polycystic Ovary Syndrome, Jessica K. Wickenheisser, Jessica M. Biegler, Valen L. Nelson-Degrave, Richard S. Legro, Jerome F. Strauss Iii, Jan M. Mcallister

Obstetrics and Gynecology Publications

Hyperandrogenism is characteristic of women with polycystic ovary syndrome (PCOS). Ovarian theca cells isolated from PCOS follicles and maintained in long-term culture produce elevated levels of progestins and androgens compared to normal theca cells. Augmented steroid production in PCOS theca cells is associated with changes in the expression of genes for several steroidogenic enzymes, including CYP11A1, which encodes cytochrome P450 cholesterol side-chain cleavage. Here, we further examined CYP11A1 gene expression, at both the transcriptional and post-transcriptional level in normal and PCOS theca cells propagated in long-term culture utilizing quantitative RT-PCR, functional promoter analyses, and mRNA degradation studies. The minimal …

Active Hydrophilic Components Of The Medicinal Herb Salvia Miltiorrhiza (Danshen) Potently Inhibit Organic Anion Transporters 1 (Slc22a6) And 3 (Slc22a8), Li Wang, Douglas H. Sweet

Pharmaceutics Publications

Many active components of herbal products are small organic anions, and organic anion transporters were previously demonstrated to be a potential site of drug-drug interactions. In this study, we assessed the inhibitory effects of six hydrophilic components of the herbal medicine Danshen, lithospermic acid, protocatechuic acid, rosmarinic acid, salvianolic acid A, salvianolic acid B, and tanshinol, on the function of the murine organic anion transporters, mOat1 and mOat3. All of Danshen components significantly inhibited mOat1- and mOat3-mediated substrate uptake () with lithospermic acid (LSA), protocatechuic acid, rosmarinic acid (RMA), and salvianolic acid A (SAA) producing virtually complete inhibition under test …

Comparison Of Biomarkers In Blood And Saliva In Healthy Adults, Sarah Williamson, Cindy Munro, Rita Pickler, Mary Jo Grap, R. K. Elswick Jr.

School of Nursing Publications

Researchers measure biomarkers as a reflection of patient health status or intervention outcomes. While blood is generally regarded as the best body fluid for evaluation of systemic processes, substitution of saliva samples for blood would be less invasive and more convenient. The concentration of specific biomarkers may differ between blood and saliva. The objective of this study was to compare multiple biomarkers (27 cytokines) in plasma samples, passive drool saliva samples, and filter paper saliva samples in 50 healthy adults. Demographic data and three samples were obtained from each subject: saliva collected on filter paper over 1 minute, saliva collected …

Toothbrush Contamination: A Review Of The Literature, Michelle R. Frazelle, Cindy L. Munro

School of Nursing Publications

Toothbrushes are commonly used in hospital settings and may harbor potentially harmful microorganisms. A peer-reviewed literature review was conducted to evaluate the cumulative state of knowledge related to toothbrush contamination and its possible role in disease transmission. A systematic review was conducted on adult human subjects through three distinct searches. The review resulted in seven experimental and three descriptive studies which identified multiple concepts related to toothbrush contamination to include contamination, methods for decontamination, storage, design, and environmental factors. The selected studies found that toothbrushes of healthy and oral diseased adults become contaminated with pathogenic bacteria from the dental plaque, …

Care Seeking For Neonatal Illness In Low- And Middle-Income Countries: A Systematic Review, Hadley K. Herbert, Anne C. C. Lee, Aruna Chandran, Igor Rudan, Abdullah H. Baqui

Surgery Publications

Background

Despite recent achievements to reduce child mortality, neonatal deaths continue to remain high, accounting for 41% of all deaths in children under five years of age worldwide, of which over 90% occur in low- and middle-income countries (LMICs). Infections are a leading cause of death and limitations in care seeking for ill neonates contribute to high mortality rates. As estimates for care-seeking behaviors in LMICs have not been studied, this review describes care seeking for neonatal illnesses in LMICs, with particular attention to type of care sought.

Methods and Findings

We conducted a systematic literature review of studies that …

A Program For Sustained Improvement In Preventing Ventilator Associated Pneumonia In An Intensive Care Setting, Raquel A. Caserta, Alexandre R. Marra, Marcelino S. Durão, Cláudia Vallone Silva, Oscar Fernando Pavao Dos Santos, Henrique Sutton De Sousa Neves, Michael B. Edmond, Karina Tavares Timenetsky

Internal Medicine Publications

Background Ventilator-associated pneumonia (VAP) is a common infection in the intensive care unit (ICU) and associated with a high mortality.

Methods A quasi-experimental study was conducted in a medical-surgical ICU. Multiple interventions to optimize VAP prevention were performed from October 2008 to December 2010. All of these processes, including the Institute for Healthcare Improvement’s (IHI) ventilator bundle plus oral decontamination with chlorhexidine and continuous aspiration of subglottic secretions (CASS), were adopted for patients undergoing mechanical ventilation.

Results We evaluated a total of 21,984 patient-days, and a total of 6,052 ventilator-days (ventilator utilization rate of 0.27). We found VAP rates of …

Blockade Of Electron Transport At The Onset Of Reperfusion Decreases Cardiac Injury In Aged Hearts By Protecting The Inner Mitochondrial Membrane, Qun Chen, Thomas Ross, Ying Hu, Edward J. Lesnefsky

Internal Medicine Publications

Myocardial injury is increased in the aged heart following ischemia-reperfusion (ISC-REP) compared to adult hearts. Intervention at REP with ischemic postconditioning decreases injury in the adult heart by attenuating mitochondrial driven cell injury. Unfortunately, postconditioning is ineffective in aged hearts. Blockade of electron transport at the onset of REP with the reversible inhibitor amobarbital (AMO) decreases injury in adult hearts. We tested if AMO treatment at REP protects the aged heart via preservation of mitochondrial integrity. Buffer-perfused elderly Fischer 344 24 mo. rat hearts underwent 25 min global ISC and 30 min REP. AMO (2.5 mM) or vehicle was given …

Interactions Between Bile Acids And Nuclear Receptors And Their Effects On Lipid Metabolism And Liver Diseases, David Q.-H. Wang, Brent A. Neuschwander-Tetri, Piero Portincasa, William M. Pandak

Internal Medicine Publications

In this special issue of Journal of Lipids, we acknowledge the contributions by several experts offering timely perspectives on the complex interactions between bile acids and nuclear receptors (NRs) on lipid metabolism and liver diseases at different levels and contexts in the body.

NRs are found within the interior of cells and are defined as ligand-activated transcriptional regulators of several key aspects of body physiology and pathophysiology. NRs regulate gene transcription through interaction with cellular coactivators and corepressors. In the liver, NRs play a key role in a large variety of metabolic processes such as cholesterol, bile acid, fatty acid, …

Non-Alcoholic Fatty Liver Disease: The Bile Acid-Activated Farnesoid X Receptor As An Emerging Treatment Target, Michael Fuchs

Internal Medicine Publications

Non-alcoholic fatty liver disease (NAFLD) is currently evolving as the most common liver disease worldwide. It may progress to liver cirrhosis and liver cancer and is poised to represent the most common indication for liver transplantation in the near future. The pathogenesis of NAFLD is multifactorial and not fully understood, but it represents an insulin resistance state characterized by a cluster of cardiovascular risk factors including obesity, dyslipidemia, hyperglycemia, and hypertension. Importantly, NAFLD also has evolved as independent risk factor for cardiovascular disease. Unfortunately thus far no established treatment does exist for NAFLD. The bile acid-activated nuclear farnesoid X receptor …

Posttransplant Metabolic Syndrome, M. Shadab Siddiqui, Richard K. Sterling

Internal Medicine Publications

Metabolic syndrome (MS) is a cluster of metabolic derangements associated with insulin resistance and an increased risk of cardiovascular mortality. MS has become a major health concern worldwide and is considered to be the etiology of the current epidemic of diabetes and cardiovascular disease. In addition to cardiovascular disease, the presence of MS is also closely associated with other comorbidities including nonalcoholic fatty liver disease (NAFLD). The prevalence of MS in patients with cirrhosis and end-stage liver disease is not well established and difficult to ascertain. Following liver transplant, the prevalence of MS is estimated to be 44–58%. The main …

Inflammation, Coagulation And Cardiovascular Disease In Hiv-Infected Individuals, Daniel A. Duprez, Jacqueline Neuhaus, Lewis H. Kuller, Russell Tracy, Waldo Belloso, Stephane De Wit, Fraser Drummond, H. Clifford Lane, Bruno Ledergerber, Jens Lundgren, Daniel Nixon, Nicholas I. Paton, Ronald J. Prineas

Internal Medicine Publications

Background

The SMART study was a trial of intermittent use of antiretroviral therapy (ART) (drug conservation [DC]) versus continuous use of ART (viral suppression [VS]) as a strategy to reduce toxicities, including cardiovascular disease (CVD) risk. We studied the predictive value of high sensitivity C-reactive protein (hsCRP), interleukin-6 (IL-6) and D-dimer with CVD morbidity and mortality in HIV-infected patients who were enrolled in SMART beyond other measured CVD risk factors.

Methods

A blood sample was available in 5098 participants who were enrolled in the SMART study for the measurement of IL-6, hsCRP and D-dimer. Hazard ratios (HR) with 95% CI …

Metabolomic Profiling To Identify Predictors Of Response To Vitamin E For Non-Alcoholic Steatohepatitis (Nash), Jianfeng Cheng, Andrew Joyce, Katherine Yates, Bradley Aouizerat, Arun J. Sanyal

Internal Medicine Publications

Vitamin E was recently shown to improve hepatic histology in a randomized controlled trial of pioglitazone or vitamin E for nonalcoholic steatohepatitis (PIVENS). The current study utilized samples collected in the PIVENS trial to identify: (1) baseline metabolomic profiles that could identify who would respond to vitamin E treatment and (2) end of treatment metabolomic profiles reflective of histologic improvement. A comprehensive analysis of metabolomics profiles (n = 547) quantified by mass spectrometry was performed in vitamin E responders (n = 16), vitamin E non-responders (n = 15), and placebo responders (n = 15). At baseline, phenyl-propionic acid (Odds ratio: …

Anti-Inflammatory And Cardioprotective Effects Of Tadalafil In Diabetic Mice, Amit Varma, Anindita Das, Nicholas N. Hoke, David E. Durrant, Fadi N. Salloum, Rakesh C. Kukreja

Internal Medicine Publications

Background

Insulin resistance impairs nitric oxide (NO) bioavailability and obesity promotes a state of chronic inflammation and damages the vascular endothelium. Phosphodiesterase-5 inhibitors restore NO signaling and may reduce circulating inflammatory markers, and improve metabolic parameters through a number of mechanisms. We hypothesized that daily administration of the PDE-5 inhibitor, tadalafil (TAD) will attenuate inflammation, improve fasting plasma glucose and triglyceride levels, body weight, and reduce infarct size after ischemia/reperfusion injury in obese, diabetic mice.

Methods

Twenty leptin receptor null (db/db) mice underwent treatment with TAD (1 mg/Kg) or 10% DMSO for 28 days. Body weight and fasting …

Catheter Related Bloodstream Infection (Cr-Bsi) In Icu Patients: Making The Decision To Remove Or Not To Remove The Central Venous Catheter, Rodrigo O. Deliberato, Alexandre R. Marra, Thiago D. Correa, Marines D. V. Martino, Luci Correa, Oscar Fernando Pavao Dos Santos, Michael B. Edmond

Internal Medicine Publications

Background

Approximately 150 million central venous catheters (CVC) are used each year in the United States. Catheter-related bloodstream infections (CR-BSI) are one of the most important complications of the central venous catheters (CVCs). Our objective was to compare the in-hospital mortality when the catheter is removed or not removed in patients with CR-BSI.

Methods

We reviewed all episodes of CR-BSI that occurred in our intensive care unit (ICU) from January 2000 to December 2008. The standard method was defined as a patient with a CVC and at least one positive blood culture obtained from a peripheral vein and a positive …

Acrolein Induces Endoplasmic Reticulum Stress And Causes Airspace Enlargement, Yoshiaki Kitaguchi, Laimute Taraseviciene-Stewart, Masayuki Hanaoka, Ramesh Natarajan, Donatas Kraskauskas, Norbert F. Voelkel

Internal Medicine Publications

Background

Given the relative abundance and toxic potential of acrolein in inhaled cigarette smoke, it is surprising how little is known about the pulmonary and systemic effects of acrolein. Here we test the hypothesis whether systemic administration of acrolein could cause endoplasmic reticulum (ER) stress, and lung cell apoptosis, leading to the enlargement of the alveolar air spaces in rats.

Methods

Acute and chronic effects of intraperitoneally administered acrolein were tested. Mean alveolar airspace area was measured by using light microscopy and imaging system software. TUNEL staining and immunohistochemistry (IHC) for active caspase 3 and Western blot analysis for active …

Copper Deficiency Induced Emphysema Is Associated With Focal Adhesion Kinase Inactivation, Shiro Mizuno, Masanori Yasuo, Harm J. Bogaard, Donatas Kraskauskas, Aysar A. Alhussini, Jose Gomez-Arroyo, Daniela Farkas, Laszlo Farkas, Norbert F. Voelkel

Internal Medicine Publications

Background

Copper is an important regulator of hypoxia inducible factor 1 alpha (HIF-1α) dependent vascular endothelial growth factor (VEGF) expression, and is also required for the activity of lysyl oxidase (LOX) to effect matrix protein cross-linking. Cell detachment from the extracellular matrix can induce apoptosis (anoikis) via inactivation of focal adhesion kinase (FAK).

Methodology

To examine the molecular mechanisms whereby copper depletion causes the destruction of the normal alveolar architecture via anoikis, Male Sprague-Dawley rats were fed a copper deficient diet for 6 weeks while being treated with the copper chelator, tetrathiomolybdate. Other groups of rats were treated with the …

Bevacizumab Added To Neoadjuvant Chemotherapy For Breast Cancer, Harry D. Bear, Gong Tang, Priya Rastogi, Charles E. Geyer Jr., Andre Robidoux, James N. Atkins, Luis Baez-Diaz, Adam M. Brufsky, Rita S. Mehta, Louis Fehrenbacher, James A. Young, Francis M. Senecal, Rakesh Gaur, Richard G. Margolese, Paul T. Adams, Howard M. Gross, Joseph P. Costantino, Sandra M. Swain, Eleftherios P. Mamounas, Norman Wolmark

Massey Comprehensive Cancer Center Publications

BACKGROUND

Bevacizumab and the antimetabolites capecitabine and gemcitabine have been shown to improve outcomes when added to taxanes in patients with metastatic breast cancer. The primary aims of this trial were to determine whether the addition of capecitabine or gemcitabine to neoadjuvant chemotherapy with docetaxel, followed by doxorubicin plus cyclophosphamide, would increase the rates of pathological complete response in the breast in women with operable, human epidermal growth factor receptor 2 (HER2)–negative breast cancer and whether adding bevacizumab to these chemotherapy regimens would increase the rates of pathological complete response.

METHODS

We randomly assigned 1206 patients to receive neoadjuvant therapy …

Variants Located Upstream Of Chrnb4 On Chromosome 15q25.1 Are Associated With Age At Onset Of Daily Smoking And Habitual Smoking, Manav Kapoor, Jen-Chyong Wang, Sarah Bertelsen, Kathy Bucholz, John P. Budde, Anthony Hinrichs, Arpana Agrawal, Andrew Brooks, David Chorlian, Danielle Dick, Victor Hesselbrock, Tatiana Foroud, John Kramer, Sammuel Kuperman, Niklas Manz, John Numberger Jr, Bernice Porjesz, John Rice, Jay Tischfield, Xiaoling Xuei, Marc Schuckit, Haward J. Edenberg, Laura J. Bierut, Alison M. Goate

Psychiatry Publications

Several genome-wide association and candidate gene studies have linked chromosome 15q24–q25.1 (a region including the CHRNA5-CHRNA3-CHRNB4 gene cluster) with alcohol dependence, nicotine dependence and smoking-related illnesses such as lung cancer and chronic obstructive pulmonary disease. To further examine the impact of these genes on the development of substance use disorders, we tested whether variants within and flanking theCHRNA5-CHRNA3-CHRNB4 gene cluster affect the transition to daily smoking (individuals who smoked cigarettes 4 or more days per week) in a cross sectional sample of adolescents and young adults from the COGA (Collaborative Study of the Genetics of Alcoholism) families. Subjects were …

Adenovirus-36 Is Associated With Obesity In Children And Adults In Sweden As Determined By Rapid Elisa, Malin Almgren, Richard Atkinson, Jia He, Agenta Hilding, Emilia Hagman, Alicia Wolk, Anders Thorell, Claude Marcus, Erik Naslund, Claes-Goren Ostenson, Martin Schalling, Catherina Lavebratt

Pathology Publications

Background

Experimental and natural human adenovirus-36 (Adv36) infection of multiple animal species results in obesity through increasing adipogenesis and lipid accumulation in adipocytes. Presence of Adv36 antibodies detected by serum neutralization assay has previously been associated with obesity in children and adults living in the USA, South Korea and Italy, whereas no association with adult obesity was detected in Belgium/the Netherlands nor among USA military personnel. Adv36 infection has also been shown to reduce blood lipid levels, increase glucose uptake by adipose tissue and skeletal muscle biopsies, and to associate with improved glycemic control in non-diabetic individuals.

Principal Findings

Using …

Non-Linear Dynamical Signal Characterization For Prediction Of Defibrillation Success Through Machine Learning, Sharad Shandilya, Kevin R. Ward, Michael Kurz, Kayvan Najarian

Computer Science Publications

Background

Ventricular Fibrillation (VF) is a common presenting dysrhythmia in the setting of cardiac arrest whose main treatment is defibrillation through direct current countershock to achieve return of spontaneous circulation. However, often defibrillation is unsuccessful and may even lead to the transition of VF to more nefarious rhythms such as asystole or pulseless electrical activity. Multiple methods have been proposed for predicting defibrillation success based on examination of the VF waveform. To date, however, no analytical technique has been widely accepted. We developed a unique approach of computational VF waveform analysis, with and without addition of the signal of end-tidal …

Fracture Detection In Traumatic Pelvic Ct Images, Jie Wu, Pavani Davuluri, Kevin R. Ward, Charles Cockrell, Rosalyn H. Hargraves, Kayvan Najarian

Computer Science Publications

Fracture detection in pelvic bones is vital for patient diagnostic decisions and treatment planning in traumatic pelvic injuries. Manual detection of bone fracture from computed tomography (CT) images is very challenging due to low resolution of the images and the complex pelvic structures. Automated fracture detection from segmented bones can significantly help physicians analyze pelvic CT images and detect the severity of injuries in a very short period. This paper presents an automated hierarchical algorithm for bone fracture detection in pelvic CT scans using adaptive windowing, boundary tracing, and wavelet transform while incorporating anatomical information. Fracture detection is performed on …

An Automated Optimal Engagement And Attention Detection System Using Electrocardiogram, Ashwin Belle, Rosalyn H. Hargraves, Kayvan Najarian

Computer Science Publications

This research proposes to develop a monitoring system which uses Electrocardiograph (ECG) as a fundamental physiological signal, to analyze and predict the presence or lack of cognitive attention in individuals during a task execution. The primary focus of this study is to identify the correlation between fluctuating level of attention and its implications on the cardiac rhythm recorded in the ECG. Furthermore, Electroencephalograph (EEG) signals are also analyzed and classified for use as a benchmark for comparison with ECG analysis. Several advanced signal processing techniques have been implemented and investigated to derive multiple clandestine and informative features from both these …

Antibiotic Prevention Of Acute Exacerbations Of Copd, Richard P. Wenzel, Alpha A. Fowler, Michael B. Edmond

VCU Health Publications

An estimated 24 million persons in the United States have COPD on the basis of lung-function testing.1 Globally, COPD is the fourth leading cause of death,2 and in the United States it is the third most common cause of death and chronic complications.3 The average person with COPD has one to two acute exacerbations each year, with wide variation from patient to patient.4 In 2000 in the United States, 726,000 patients were hospitalized with acute exacerbations of COPD.1 During an acute exacerbation, antibiotics are generally administered for 5 to 10 days,5 creating a national burden of 120 million to 480 …

Cardiorespiratory Fitness, Alcohol Intake, And Metabolic Syndrome Incidence In Men, Kerem Shuval, Carrie E. Finley, Karen G. Chartier, Bijal A. Balasubramanian, Kelley Pettee Gabriel, Carolyn E. Barlow

Social Work Publications

Purpose

To prospectively examine the independent and joint effects of alcohol consumption and cardiorespiratory fitness on the incidence of metabolic syndrome in a cohort of men.

Methods

A prospective examination of 3,411 apparently healthy men at baseline, who came to the Cooper Clinic (Dallas, Texas) for at least 2 preventive visits (1979–2010). Primary exposure variables were cardiorespiratory fitness and alcohol intake; the outcome measure was metabolic syndrome (MetS) and the components thereof. Cox proportional hazard models were computed to assess the relationship between the exposure variables and the incidence of MetS while adjusting for confounders.

Results

Over a mean follow-up …

Lipid Environment Modulates The Development Of Acute Tolerance To Ethanol In Caenorhabditis Elegans, Jill C. Bettinger, Kapo Leung, Mia H. Bolling, Andrew D. Goldsmith, Andrew G. Davies

Pharmacology and Toxicology Publications

The development of tolerance to a drug at the level of the neuron reflects a homeostatic mechanism by which neurons respond to perturbations of their function by external stimuli. Acute functional tolerance (AFT) to ethanol is a fast compensatory response that develops within a single drug session and normalizes neuronal function despite the continued presence of the drug. We performed a genetic screen to identify genes required for the development of acute functional tolerance to ethanol in the nematode C. elegans. We identified mutations affecting multiple genes in a genetic pathway known to regulate levels of triacylglycerols (TAGs) via …

Morphine Decreases Enteric Neuron Excitability Via Inhibition Of Sodium Channels, Tricia H. Smith, John R. Grider, William L. Dewey, Hamid I. Akbarali

Pharmacology and Toxicology Publications

Gastrointestinal peristalsis is significantly dependent on the enteric nervous system. Constipation due to reduced peristalsis is a major side-effect of morphine, which limits the chronic usefulness of this excellent pain reliever in man. The ionic basis for the inhibition of enteric neuron excitability by morphine is not well characterized as previous studies have mainly utilized microelectrode recordings from whole mount myenteric plexus preparations in guinea pigs. Here we have developed a Swiss-Webster mouse myenteric neuron culture and examined their electrophysiological properties by patch-clamp techniques and determined the mechanism for morphine-induced decrease in neuronal excitability. Isolated neurons in culture were confirmed …

Is Aging A Disability?, Edward F. Ansello

Director's Editorials from Age in Action

Growing older is not predictable decline, and the overwhelming majority age without acquiring disabilities. Because age does not equal disability, the Virginia Commission on Government Reform and Restructuring should not fold the Virginia Department of the Aging, the Department of Rehabilitative Services, and the Department for the Deaf and Hard of Hearing into one agency.

All The World's A Stage, Edward F. Ansello

Director's Editorials from Age in Action

Population aging is occurring worldwide because of success in attacking causes of infant mortality, improved public hygiene, and falling fertility rates; health care in later life itself has had only marginal impact in the numbers. Societies should appreciate the differences associated with being older but also deem to later life the value and protections given to other ages.