A5049631717- Geriatric Care and Nursing Homes
- Dementia and Cognitive Impairment Research
- Health disparities and outcomes
- Frailty in Older Adults
- Chronic Disease Management Strategies
- T-cell and B-cell Immunology
- Palliative Care and End-of-Life Issues
- Health Systems, Economic Evaluations, Quality of Life
- Elder Abuse and Neglect
- Immune Cell Function and Interaction
- Aging, Elder Care, and Social Issues
- Intensive Care Unit Cognitive Disorders
- Ethics in medical practice
- Homelessness and Social Issues
- Technology Use by Older Adults
- Diabetes and associated disorders
- Clinical practice guidelines implementation
- Retirement, Disability, and Employment
- COVID-19 and healthcare impacts
- Aging and Gerontology Research
- Health, psychology, and well-being
- Healthcare Decision-Making and Restraints
- Emergency and Acute Care Studies
- Nursing Diagnosis and Documentation
- Ethics in Clinical Research
University of California, San Francisco
2015-2025
San Francisco General Hospital
2015-2023
Beth Israel Deaconess Medical Center
2022
San Francisco VA Medical Center
2014-2015
San Francisco Department of Public Health
2014
Mass General Brigham
2008
Harvard University
2008
Brigham and Women's Hospital
2008
The failure of CD25+ regulatory T cells (Tregs) to proliferate after cell receptor (TCR) stimulation in vitro has lead their classification as naturally anergic. Here we use Tregs expressing a transgenic TCR show that despite anergy vitro, response immunization vivo. also and accumulate locally transgenically expressed tissue antigen whereas CD25− counterparts are depleted at such sites. Collectively, these data suggest the anergic state characterizes may not accurately reflect...
Few health systems have adopted effective dementia care management programs. The Care Ecosystem is a model for delivering from centralized hubs across broad geographic areas to caregivers and persons with (PWDs) independently of their system affiliations.To determine whether the in improving outcomes important PWDs, caregivers, payers beyond those achieved usual care.A single-blind, randomized clinical trial pragmatic design was conducted among PWDs caregivers. Each PWD-caregiver dyad...
Although the barriers to dementia care in primary are well characterized, practitioner (PCP) perspectives could be used support design of values-aligned pathways that strengthen role care.
Abstract It is well established that CD4+CD25+ regulatory T cells (Tregs) inhibit autoimmune pathology. However, precisely how the behavior of disease-inducing altered by Tregs remains unclear. In this study we use a TCR transgenic model diabetes to pinpoint pathogenic CD4 are modified in vivo. We show although only modestly cell expansion, they potently suppress tissue infiltration. This associated with failure differentiate into effector and up-regulate IFN-γ-dependent chemokine receptor...
Even before the COVID-19 pandemic, older adults with cognitive impairment living alone (an estimated 4.3 million individuals in United States) were at high risk for negative health outcomes. There is an urgent need to learn how this population managing during pandemic. This a qualitative study of 24 aged 55 and from diverse racial/ethnic backgrounds. Participants' lived experiences pandemic elicited via 59 ethnographic interviews conducted over phone either English, Spanish, or Cantonese....
Technology has the potential to increase social connectedness among older adults, but one-third do not use internet. We formed a community partnership, Tech Allies, providing tablets, broadband, and 1:1 training isolated adults. In pragmatic pilot trial, participants were randomized into intervention ( n = 44) waitlist 39) groups. Volunteers provided eight weekly, in-home iPad lessons. Surveys assessed self-reported loneliness, support, technology use, confidence at baseline follow-up. A...
Adoptive transfer of ovalbumin (OVA)-specific T cells from the DO.11 TCR transgenic mouse on a Rag−/− background into mice expressing OVA in pancreatic islet induces acute insulitis and diabetes only if endogenous lymphocytes, including regulatory cells, are removed. When wild-type OVA-specific/Rag−/− which all CD25−, transferred antigen–expressing mice, peripheral immunization with adjuvant is needed to induce diabetes. In contrast, naive CTLA-4−/−/Rag−/− OVA-specific (also CD25−) develop...
Background— Regular recertification is mandatory to maintain board certification status in all specialties. However, the evidence that physicians’ performance decreases with time since initial limited. We therefore carried out a study determine whether frequency of antihypertensive treatment intensification for diabetic patients changes their last certification. Methods and Results— In this retrospective cohort study, we analyzed 8127 hypertensive diabetes mellitus treated by 301 internists...
Our objective was to develop and test a scalable model of dementia specialty care that complements primary with additional caregiver support education, medication consultation, in planning for future medical, financial, legal decisions consistent patient values.Care is delivered via the phone web by unlicensed Care Team Navigators (CTNs), who are trained supervised specialist nurse, social worker, pharmacist.• This "Care Ecosystem" being tested pragmatic randomized controlled trial.The...
Objectives. We examined older jail inmates’ predetainment acute care use (emergency department or hospitalization in the 3 months before arrest) and their plans for using after release. Methods. performed a cross-sectional study of 247 inmates aged 55 years assessing sociodemographic characteristics, health, geriatric conditions associated with anticipated postrelease use. Results. found that 52% reported 47% planned to emergency In modified Poisson regression, homelessness was independently...
Background: Cognitive impairment, including dementia, is frequently under-detected in primary care. The Consortium for Detecting Impairment, Dementia (DetectCID) convenes three multidisciplinary teams that are testing novel paradigms to improve the frequency and quality of patient evaluations detecting cognitive impairment care appropriate follow-up. Objective: Our objective was characterize paradigms, similarities differences, identify common key lessons from implementation. Methods: A...
There is now an unprecedented opportunity to improve the care of over 5 million people who are living with Alzheimer's disease and related dementias many more cognitive impairment due brain injury, systemic diseases, other causes. The introduction a new Medicare planning benefit-long sought openly by advocacy organizations clinicians badly needed patients families-could greatly health quality, but only if widely fully implemented. We describe components this benefit its promise better...
Shelter-in-place orders during the COVID-19 pandemic created unmet health-related and access-related needs among older adults. We sought to understand prevalence of these community-dwelling adults.We performed a retrospective chart review pandemic-related outreach calls adults between March July 2020 at four urban, primary care clinics: home-based practice, safety net adult medicine clinic, an academic geriatrics clinic for living with HIV. Participants included those 60 or three sites, 65...
Abstract CTLA-4 is critical to the regulation of CD4 T cell homeostasis in vivo. However, whether regulates responses both self and foreign proteins not clear. We have directly compared role controlling same protein presented as an endogenous tissue Ag vs a immunizing Ag. show that only modestly reduces administered with adjuvant, but dramatically inhibits expressed transgenically protein. The consequence engagement inhibit accumulation local lymph node draining Ag-bearing tissue, failure...
Objectives: Unbefriended older adults are those who lack the capacity to make medical decisions and do not have a completed advance directive that can guide treatment or surrogate decision maker. Adult orphans retain decision-making but at risk of becoming unbefriended due health care In follow-up 2016 American Geriatrics Society (AGS) position statement on adults, we examined clinicians' experiences in caring for adult orphans.Methods: Clinicians recruited through AGS (N = 122) an online...
The decision‐making process on behalf of unrepresented adults (ie, those who lack capacity to make medical decisions and have no identifiable surrogate) is at risk for not incorporating their interests, raising ethical concerns. We performed semistructured interviews with key stakeholders across multiple sectors in an urban county participate the care or adults. This included a safety net healthcare system, social services, legal services. Participants were healthcare, service, professionals...
Hospitalizations by patients who do not meet acute inpatient criteria are common and overburden healthcare systems. Studies have characterized these alternate levels of care (ALC) but delineated prolonged (pALC) versus short ALC (sALC) stays.To descriptively compare pALC sALC hospitalizations-groups we hypothesize unique needs.A retrospective study hospitalizations from March-April 2018 at an academic safety-net hospital.Levels for (>3 days) (1-3 were determined using InterQual©, industry...
Abstract Background A diagnosis of dementia impacts all other comorbid conditions and areas patient care. Yet, in primary care settings, is often underdiagnosed misdiagnosed due to competing clinical concerns. Delayed can lead more rapid cognitive decline, increased hospitalizations, health costs, mortality. The objective this work was understand the challenges successful approaches among providers working safety net settings when caring for patients with co‐existing chronic conditions....
Abstract In California, the Department of Health Care Services (Medi-Cal) expanded benefits for older beneficiaries to include screening dementia by trained primary providers starting in July 2022. addition, they created a program promote this and provide training called Dementia Aware. The University San Francisco was awarded contract realize through end September 2024 brought together 4 other California campuses statewide Alzheimer’s organizations stand up program. During symposium,...