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Medical School Watercooler Newsletter - March 21, 2025, Lindsay Hughes

Watercooler Newsletter

This is the Friday, March 21, 2025 edition of the Frederick P. Whiddon College of Medicine's newsletter -- Watercooler.

Contents include:

• Match Day 2025: Senior medical students match in residency programs -- and love
• Integrative Health and Wellness Program gaining state and national recognition
• 14th Gulf Coast Trauma Symposium set for March 26-28
• Children's & Women's Hospital receives grant for neonatal abstinence syndrome
• Cancer researcher awarded $300,000 NSF grant to study mitochondria

Be(D) Fast For Faster Screening, Allison Goshorn, Alaine Schauer

Articles, Abstracts, and Reports

No abstract provided.

The Importance Of Recruitment Of Low-Income Pregnant Persons In Interdisciplinary Research To Understand The Impact Of Social And Environmental Determinants: Lessons Learned About Implementation And Recruitment, Erika R. Marquez, Amanda Haboush-Deloye, Elizabeth M. Lawrence, Selam Ayele, Courtney Coughenour, Nora Doyle, Wynona Dizon, Lizbeth Perez Rodriguez, Chloe Bombara

Environmental & Global Health Faculty Research

Background: Prior research indicates that enrolling underrepresented populations in clinical research is challenging. Although research has identified some barriers to participation and strategies to overcome them, studies have made little progress in being inclusive and representative. There remains a great need for including racial/ethnic minorities, low-income families, and pregnant women in research. The purpose of this article is to describe the implementation of enrollment strategies used in our study to understand the feasibility of building a maternal cohort and better understand the relationship between environmental and social impacts on maternal exposure and child outcomes.

Methods: Working across multiple academic units, …

Rare Damaging Ccr2 Variants Are Associated With Lower Lifetime Cardiovascular Risk, Marios K. Georgakis, Rainer Malik, Omar El Bounkari, Natalie R. Hasbani, Jiang Li, Jennifer E. Huffman, Gabrielle Shakt, Michael C. Mahaney, Joanne E. Curran, John Blangero

School of Medicine Publications

Background

Previous work has shown a role of CCL2, a key chemokine governing monocyte trafficking, in atherosclerosis. However, it remains unknown whether targeting CCR2, the cognate receptor of CCL2, provides protection against human atherosclerotic cardiovascular disease.

Methods

Computationally predicted damaging or loss-of-function (REVEL > 0.5) variants within CCR2 were detected in whole-exome-sequencing data from 454,775 UK Biobank participants and tested for association with cardiovascular endpoints in gene-burden tests. Given the key role of CCR2 in monocyte mobilization, variants associated with lower monocyte count were prioritized for experimental validation. The response to CCL2 of human cells transfected with these variants was tested …

Compositional Variation In Eye-Infiltrating Immune Cells Distinguishes Human Uveitis Subtypes, Christian Concepcion, Yu Xia, Yulia Korshunova, Gregory W Bligard, Amal Taylor, Michael A Paley, Philip A Ruzycki, Lynn M Hassman

2020-Current year OA Pubs

Uveitis is a heterogeneous group of ocular inflammatory diseases that respond inadequately to empiric therapy, underscoring the need to define pathophysiologic subtypes. Toward this goal, we applied single-cell transcriptional and immune receptor profiling to ocular fluid biopsies from 23 patients with diverse clinical features. We found that a subset of ocular T cells undergoes local clonal expansion, indicating that antigens trigger uveitis in some patients. Infiltrates from HLA-B27 associated acute anterior uveitis (HLA-B27 AAU) were enriched in myeloid cells and innate immune signaling pathways, while chronic uveitis featured prominent adaptive immune cells and transcriptional programs, indicating that immunologic features distinguish …

M3netflow: A Multi-Scale Multi-Hop Graph Ai Model For Integrative Multi-Omic Data Analysis, Heming Zhang, S Peter Goedegebuure, Li Ding, David Denardo, Ryan C Fields, Michael Province, Yixin Chen, Philip Payne, Fuhai Li

2020-Current year OA Pubs

Multi-omic data-driven studies are at the forefront of precision medicine by characterizing complex disease signaling systems across multiple views and levels. The integration and interpretation of multi-omic data are critical for identifying disease targets and deciphering disease signaling pathways. However, it remains an open problem due to the complex signaling interactions among many proteins. Herein, we propose a multi-scale multi-hop multi-omic network flow model, M3NetFlow, to facilitate both hypothesis-guided and generic multi-omic data analysis tasks. We evaluated M3NetFlow using two independent case studies: (1) uncovering mechanisms of synergy of drug combinations (hypothesis/anchor-target guided multi-omic analysis) and (2) identifying biomarkers of …

Resiliency In Child-Caregiver Dyads And The Impact On Health Outcomes In Sickle Cell Disease, Jessica A Zavadil, Melissa Azul, Brian D Carpenter, Cecelia Calhoun

2020-Current year OA Pubs

No abstract provided.

Distinct Attentional Characteristics Of Neurons With Visual Feature Coding In The Primate Brain, Jie Zhang, Runnan Cao, Xiaocang Zhu, Huihui Zhou, Shuo Wang

2020-Current year OA Pubs

Visual attention and object recognition are two critical cognitive functions that shape our perception of the world. While these neural processes converge in the temporal cortex, the nature of their interactions remains largely unclear. Here, we systematically investigated the interplay between visual attention and stimulus feature coding by training macaques to perform a free-gaze visual search task with natural stimuli. Recording from a large number of units across multiple brain areas, we found that units exhibiting visual feature coding showed stronger attentional modulation of responses and spike-local field potential coherence than units without feature coding. Across brain areas, attention directed …

Delivering Guideline-Directed Medical Therapy For Heart Failure With Reduced Ejection Fraction As An Over-Encapsulated Polypill: Rationale And Protocol For The Combo-Hf-X Pilot Crossover Randomised Clinical Trial, Colette Dejong, Mark D Huffman, Anubha Agarwal, Et Al.

2020-Current year OA Pubs

INTRODUCTION: A four-drug regimen of guideline-directed medical therapy (GDMT) for heart failure with reduced ejection fraction (HFrEF) is underused, in part due to prescriber inertia and low patient adherence. Although fixed-dose combination pills ('polypills') have improved adherence and clinical outcomes for other conditions, there are no polypills available that combine multiple classes of GDMT for HFrEF. Pharmacy-level over-encapsulation, in which several tablets are combined into one capsule, offers an opportunity to create customised HFrEF polypills with the goal of improving delivery of HFrEF therapies.

METHODS AND ANALYSIS: In the COMBO-HF-X pilot crossover randomised clinical trial, we will enrol 30-40 patients …

Protocol To Study Inter-Tissue Communication Between The Hypothalamus And White Adipose Tissue And Lifespan Using A Chemogenetic Approach In Aged Mice, Kyohei Tokizane, Shin-Ichiro Imai

2020-Current year OA Pubs

Here, we present a protocol for assessing the impact of a chemogenetic manipulation in a subpopulation of the hypothalamic neurons on aging and lifespan control using a mouse model developed specifically for this purpose. We describe steps for stereotaxic viral injection and assess inter-tissue communication between protein phosphatase 1 regulatory subunit 17 (Ppp1r17)-expressing neurons in the dorsomedial hypothalamus and white adipose tissue. We then detail procedures for lifespan measurements following chemogenetic manipulation in aged mice. For complete details on the use and execution of this protocol, please refer to Tokizane et al.

Evaluation Of The Distress Thermometer In Older Patients With Cancer, Charlotte Zuber, Kristine Swartz, Andrew Chapman, Lora Rhodes, Tingting Zhan, Kuang-Yi Wen

Kimmel Cancer Center Faculty Papers

INTRODUCTION: The Geriatric Depression Scale is a useful tool in screening for depression in older adults, a particularly vulnerable population in oncology. The National Comprehensive Cancer Network (NCCN) Distress Thermometer (DT) has been validated as a fast and effective screening tool for psychological distress in general oncology populations, and it could possibly be used as a surrogate for the longer Geriatric Depression Scale (GDS) test in older adults with cancer.

MATERIALS AND METHODS: In this retrospective cross-sectional study in older adults prior to starting cancer treatment, we evaluated the relationship between the DT and GDS by comparing 242 older adults …

Gene Expression Profiling Of Pancreatic Ductal Adenocarcinoma Cells In Hypercapnia Identifies Siah3 As A Novel Prognostic Biomarker, Nitzan Zohar, Ryan Maguire, Saed Khalilieh, Aditi Jain, Dmitriy Bosykh, Wilbur B. Bowne, Harish Lavu, Charles J. Yeo, Avinoam Nevler

Department of Surgery Faculty Papers

Hypercapnia is a key feature of the respiratory microenvironment in many pathologic conditions. It occurs both as a regional and as a systemic process, and it is associated with multiple metabolic changes such as mitochondrial dysfunction, decreased ATP production, and metabolic shift from glycolytic energy production to fatty acid metabolism. In the cancer tumor microenvironment, hypercapnia has been linked at times to enhanced cell migration, invasion, and chemoresistance. Our previous work has shown that hypercapnia-associated gene signatures can be used as prognostic biomarkers. However, unlike the hypoxia-inducible factor pathway, there are no validated targets to quantify hypercapnia. In this study, …

Examining The Impact Of Depression And Anxiety On The Trajectory Of Executive Functioning And Processing Speed In Mild Cognitive Impairment (Mci), Luke Vaartstra

Clinical Psychology Dissertations

Mild cognitive impairment (MCI) is an intermediary state between normal aging and dementia which is growing in prevalence in the older adult population. Trajectories for MCI are variable and can result in a variety of outcomes including a rescinding of the MCI diagnosis, progression to dementia, or a new state of cognition. The current study examined the impact of depression and anxiety on the cognitive domains of executive functioning and processing speed in MCI trajectories. Data was used from the National Alzheimer’s Coordinating Center’s Uniform Data Set and included a sample of 2886 participants with and MCI diagnosis. Hierarchical linear …

Staff Education On Evidence-Based Educational Content For Patient Fall Prevention Measures, Ogochukwu Vera Nnakwe

Walden Dissertations and Doctoral Studies

Patient falls continue to be a challenge due to the injury associated with them. They can be disabling, costly, and most often lead to increased morbidity and mortality. Falls at home lead to hospitalization of the patient and complication of other health issues and/or aggravation of preexisting health problems. The practice problem was that the clinic did not have patient education content in place for fall prevention measures to discuss with patient at discharge. The practice-focused question was, Will a staff education on evidence-based falls prevention measures result in an increase in staff knowledge on fall prevention? The purpose of …

Racial And Ethnic Inequalities In Actual Vs Nearest Delivery Hospitals, Nansi S. Boghossian, Lucy T. Greenberg, Jeffrey S. Buzas, Joshua Radack, Molly Passarella, Jeannette Rogowski, George R. Saade, Ciaran S. Phibbs, Scott A. Lorch

Faculty Publications

IMPORTANCE Minoritized racial and ethnic groups, such as American Indian and Black individuals, often receive lower quality health care compared with White individuals. There is limited understanding of how these disparities extend to obstetric care, particularly when comparing the quality of care at the actual delivery hospital vs the nearest obstetric hospital based on the birthing individual’s residence. OBJECTIVE To examine inequality in care based on the actual delivery hospital and the closest delivery hospital to the birthing individual’s residential zip code centroid. DESIGN, SETTING, AND PARTICIPANTS This population-based retrospective cohort study used data from 5 states (2008 to 2020 …

Connections Between Co-Occurring Symptoms Of Eating Disorders, Gut Dysbiosis, Anxiety, And Depression, Erin L. Thomas

Doctoral Dissertations and Projects

Eating disorders (ED) are a pervasive mental health condition that puts individuals at risk for long-term physical consequences or even death, and current treatment methods typically do not offer long-term efficacy. The current study aims to examine relationships between co-occurring symptoms of EDs, gastrointestinal distress, anxiety, and depression to add to the scientific literature and point towards directions that may increase the benefits of treatment efforts. A total of 72 participants were asked to complete an online survey that consisted of measures from each variable and took about 20 minutes to finish. Participating individuals had to be at least 18 …

Effect Of Prehabilitation On Functional Outcomes And Hospital Length Of Stay Following Total Joint Arthroplasty, Kristin Nicole Kaplewicz

Doctoral Dissertations and Projects

The purpose of this study was to determine how prehabilitation effects functional outcomes and length of stay in patients that have undergone total joint arthroplasties. Patients have continued to report being unhappy with their results of surgery and a large majority of the time is secondary to patients not being appropriately prepared for what to expect during their surgical recovery period. This information is important because occupational therapists and physical therapists continue to strive to improve patient satisfaction and outcomes. One of the ethical principles that healthcare providers commit to achieving is that of beneficence which means the clinicians must …

Improving Management Of Suicidality Within An Outpatient Eating Disorder Treatment Program Through Standardization Of A Suicide Rating Scale Among Clinical Staff Members: An Evidenced-Based Practice Project, Nicole Neale

Doctoral Dissertations and Projects

Standardization of suicide assessment protocols is essential for maintaining standards of care and optimizing patient safety. However, many healthcare organizations lack a universal protocol for suicide assessment, likely due to the absence of a gold-standard method or tool. This evidence- based practice project aims to enhance the accuracy and consistency of suicide assessments for individuals diagnosed with eating disorders as well as other mental health disorders, ultimately improving patient safety measures and outcomes within an eating disorder treatment center. This project includes a thorough literature review of suicide risk factors, assessment methods, and available tools, followed by the education and …

Standardized Transitional Process In Adolescent Behavioral Health: Evidence-Based Practice Project, Tiffani L. Cotton

Doctoral Dissertations and Projects

Hospital admissions and readmissions significantly impact the quality of care provided to adolescent psychiatric patients. This evidenced-based project aims to review a standardized transition process in support of reducing hospital readmissions. Nurse practitioners, nurse care managers, and social workers collaboratively collaborate with adolescent patients and their families admitted to inpatient behavioral health units to establish discharge plans. Establishing a standardized process for patients transitioning from the behavioral health unit addresses critical areas in the discharge process to ensure that the adolescent patient has the necessary tools for success. The project leader used the IDEAL Transition Strategy (ITS) developed by the …

Rare Damaging Ccr2 Variants Are Associated With Lower Lifetime Cardiovascular Risk, Marios K Georgakis, Rainer Malik, Omar El Bounkari, Natalie R Hasbani, Jiang Li, Jennifer E Huffman, Gabrielle Shakt, Reinier W P Tack, Tamara N Kimball, Yaw Asare, Alanna C Morrison, Noah L Tsao, Renae Judy, Braxton D Mitchell, Huichun Xu, May E Montasser, Ron Do, Eimear E Kenny, Ruth J F Loos, James G Terry, John Jeffrey Carr, Joshua C Bis, Bruce M Psaty, W T Longstreth, Kendra A Young, Sharon M Lutz, Michael H Cho, Jai Broome, Alyna T Khan, Fei Fei Wang, Nancy Heard-Costa, Sudha Seshadri, Ramachandran S Vasan, Nicholette D Palmer, Barry I Freedman, Donald W Bowden, Lisa R Yanek, Brian G Kral, Lewis C Becker, Patricia A Peyser, Lawrence F Bielak, Farah Ammous, April P Carson, Michael E Hall, Laura M Raffield, Stephen S Rich, Wendy S Post, Russel P Tracy, Kent D Taylor, Xiuqing Guo, Michael C Mahaney, Joanne E Curran, John Blangero, Shoa L Clarke, Jeffrey W Haessler, Yao Hu, Themistocles L Assimes, Charles Kooperberg, Jürgen Bernhagen, Christopher D Anderson, Scott M Damrauer, Ramin Zand, Jerome I Rotter, Paul S De Vries, Martin Dichgans

Faculty, Staff and Student Publications

BACKGROUND: Previous work has shown a role of CCL2, a key chemokine governing monocyte trafficking, in atherosclerosis. However, it remains unknown whether targeting CCR2, the cognate receptor of CCL2, provides protection against human atherosclerotic cardiovascular disease.

METHODS: Computationally predicted damaging or loss-of-function (REVEL > 0.5) variants within CCR2 were detected in whole-exome-sequencing data from 454,775 UK Biobank participants and tested for association with cardiovascular endpoints in gene-burden tests. Given the key role of CCR2 in monocyte mobilization, variants associated with lower monocyte count were prioritized for experimental validation. The response to CCL2 of human cells transfected with these variants was tested …

Non-Canonical Splice Variants In Thoracic Aortic Dissection Cases And Marfan Syndrome With Negative Genetic Testing, David R Murdock, Dong-Chuan Guo, John S Depaolo, Ulrike Schwarze, Xue-Yan Duan, Alana C Cecchi, Isabella C Marin, Yingying Tang, Jessica X Chong, Michael J Bamshad, Kathleen A Leppig, Peter H Byers, Scott M Damrauer, Dianna M Milewicz

Faculty, Staff and Student Publications

Individuals with heritable thoracic aortic disease (HTAD) face a high risk of deadly aortic dissections, but genetic testing identifies causative variants in only a minority of cases. We explored the contribution of non-canonical splice variants (NCVAS) to thoracic aortic disease (TAD) using SpliceAI and sequencing data from diverse cohorts, including 551 early-onset sporadic dissection cases and 437 HTAD probands with exome sequencing, 57 HTAD pedigrees with whole genome sequencing, and select sporadic cases with clinical panel testing. NCVAS were identified in syndromic HTAD genes such as FBN1, SMAD3, and COL3A1, including intronic variants in FBN1 in two Marfan syndrome (MFS) …

Fabrication Of Polyvinylpyrrolidone Capped Nickel Nanoclusters As Sensing Material For Enhanced Electrocatalytic Oxidation Of 2-Amino-4-Chlorophenol, Saba Ali Memon, Amber R Solangi, Saima Q Memon, Huma Shaikh, Jamil A Buledi, Sidra Ameen

Faculty, Staff and Student Publications

2-Amino-4-chlorophenol (2A-4CP) is a chemical compound with a chlorine-substituted aromatic ring and an amino group; it is a persistent environmental pollutant that poses serious threat to human health. Therefore, its quantification in environmental samples is the need of the hour. This research is focused on the synthesis of polyvinyl pyrrolidone-capped nickel nanoclusters (PVP/Ni-NCs) through a chemical reduction method. The successfully synthesized PVP/Ni-NCs were characterized using advanced analytical techniques, such as scanning electron microscopy (SEM), atomic force microscopy (AFM), X-ray diffraction (XRD) and zeta sizer analyses. SEM and AFM analyses were conducted to evaluate the surface morphology and 3D texture of …

Dna-Pk Inhibition Sustains The Antitumor Innate Immune Response In Small Cell Lung Cancer, Caterina De Rosa, Floriana Morgillo, Luisa Amato, Francesca Iommelli, Viviana De Rosa, Virginia Tirino, Federica Papaccio, Concetta Tuccillo, Gaetano Di Guida, Domenico Michele D'Angiolella, Alessandra Di Liello, Silvia Zappavigna, Michele Caraglia, Antonio Gambardella, Valerio Nardone, Kavya Ramkumar, Qi Wang, Jing Wang, Ferdinando De Vita, Davide Ciardiello, Erika Martinelli, Teresa Troiani, Stefania Napolitano, Giulia Martini, Alberto Servetto, Lauren Averett Byers, Fortunato Ciardiello, Carminia Maria Della Corte

Faculty, Staff and Student Publications

Small cell lung cancer (SCLC) is a highly aggressive form of lung cancer with limited treatment options. Patients often respond well to initial chemo-immunotherapy but relapse quickly, necessitating new strategies to enhance immune responsiveness. Recent research explores combining DNA-damaging therapies with immunotherapy to activate the STING pathway and improve the antitumor immune response. The addition of DNA Damage Repair (DDR) inhibitors, such as DNA-PKcs inhibitors, after chemotherapy has shown promise in activating innate immune sensors and enhancing CD8

Identification And Catalog Of Viral Transcriptional Regulators In Human Diseases, Citu Citu, Le Chang, Astrid M Manuel, Nitesh Enduru, Zhongming Zhao

Faculty, Staff and Student Publications

Viral genomes encode viral transcriptional regulators (vTRs) that manipulate host gene expression to facilitate replication and evade immune detection. Nevertheless, their role in non-cancerous diseases remains largely underexplored. Here, we unveiled 268 new candidate vTRs from 14 of the 20 viral families we investigated. We mapped vTRs' genome-wide binding profiles and identified their potential human targets, which were enriched in immune-mediated pathways, neurodegenerative disorders, and cancers. Through vTR DNA-binding preference analysis, 283 virus-specific and human-like motifs were identified. Prioritized Epstein-Barr virus (EBV) vTR target genes were associated with multiple sclerosis (MS), rheumatoid arthritis, and systemic lupus erythematosus. The partitioned heritability …

Trajectories Of Forced Vital Capacity In Patients With Systemic Sclerosis-Associated Interstitial Lung Disease, Oliver Distler, Madelon C Vonk, Arata Azuma, Maureen D Mayes, Dinesh Khanna, Kristin B Highland, Gerrit Toenges, Margarida Alves, Yannick Allanore

Faculty, Staff and Student Publications

We used data from the SENSCIS and SENSCIS-ON trials to assess decline in forced vital capacity (FVC) in patients with systemic sclerosis-associated interstitial lung disease (SSc-ILD) who received long-term treatment with nintedanib and the effect of switching patients from placebo to nintedanib. In the SENSCIS trial, patients were randomised to receive nintedanib or placebo until the last patient reached week 52 but for ≤ 100 weeks. In SENSCIS-ON, the extension to SENSCIS, all patients received open-label nintedanib. Per protocol, the off-treatment period between these trials was ≤ 12 weeks. We assessed the trajectory of FVC in patients who received nintedanib …

Lived Experiences Of Adults Who Were Removed From Primary Caregiver And Placed In Foster Care Before Age Three, Jillian Eve Young

Doctoral Dissertations and Projects

The capacity to form attachments early in life with important and primary caregivers can significantly influence a child’s psychological development in numerous areas across the life span. Healthy attachments early in life have been shown to be essential; however, due to various situations, many children have trouble developing healthy attachments or experience disruptions with primary/important caregivers. This transcendental phenomenological study focused specifically on the lived experiences of adults ages 18-64 (born between 1960 and 2004) who were removed from their primary/important caregiver during the first three years (even temporarily) and placed into foster care. In these circumstances, it could be …

The Health Status Of Black Asian American Communities: A Qualitative Study On Black Asian Americans Under Structural Racism, Regina Lee Bryant

Doctoral Dissertations and Projects

The purpose of this ethnographic study was to describe various disparities and obstacles related to health justice, culture, community, identity, resilience, resistance, and well-being of the Black Asian American populations under structural racism within the United States. Data was collected through in-depth interviews, participant observation, and thematic analysis in community settings, including online spaces like the Korean Black Club and the Blasian Facebook groups. These platforms provided insight into shared cultural dynamics and the challenges of navigating dual identities amidst systemic racism. The findings illuminated how structural racism impacted social determinants of health, including economic stability and cultural validation. The …

Lived Experiences Of Ukrainian Nursing Students In The Us: A Transcendental Phenomenological Study, Katherine E. Ferrell

Doctoral Dissertations and Projects

The purpose of this transcendental phenomenological was to explore the lived experiences of Ukrainian prelicensure nursing students at a midwestern nursing program. The theory guiding this study was Albert Bandura’s social learning theory as it explains how people learn through observing, imitating, and modeling. The second theory guiding this study was Madeleine Leininger’s transcultural nursing theory as it identifies that nursing faculty must understand and have knowledge of different cultures to provide meaningful care and education to their students. This study obtained IRB approval before beginning recruitment of 10 Ukrainian nursing students from a private, faith-based university in the midwestern …

An Exploration Of Potential Gaps Between The Expectations Formed In Local Nursing Programs And The Lived Work Experience Of Newly Licensed Nurses, Melissa Low

Doctoral Dissertations and Projects

Understanding how expectations formed while in nursing school affect one's successful transition as a newly licensed nurse allows educators to identify curriculum changes to align expectations between academic and healthcare settings to improve the transition to professional nursing. A descriptive-hermeneutic phenomenological study utilized interviews, observations, and journal activities to identify variances between student nurses' expectations and the professional nurse work environment. A purposeful, criterion-based sampling of newly licensed nurses within four and 12 months of orientation identified 11 individuals to interview, observe, and gather journal entries to detail specific gaps between their expectations formed in nursing school and their lived …

Early-Stage Major Neurocognitive Disorder: A Case Study Of The Experiences Of Elder Men Who Attended A Peer-Led Support Group, Laurie Knight Kjoller

Doctoral Dissertations and Projects

The purpose of this qualitative exploratory case study was to understand how elder men ages 65 and older with a diagnosis of early-stage major neurocognitive disorder experienced their participation in a peer-led support group series held at a neurology clinic in Barnstable, Massachusetts. The theory guiding this study asserts elder individuals contending with a chronic and debilitating illness like major neurocognitive disorder need to experience a sense of belonging and psycho-emotional support to attain resilience and quality of life and is found in the works of Hassani, Izadi-Avanji, Rakhshan, & Majd (2017) as it relates to the experience of elder …