A5084606721- Heart Rate Variability and Autonomic Control
- Geriatric Care and Nursing Homes
- Blood Pressure and Hypertension Studies
- Palliative Care and End-of-Life Issues
- Frailty in Older Adults
- Stroke Rehabilitation and Recovery
- Family and Patient Care in Intensive Care Units
- Health Policy Implementation Science
- Hemodynamic Monitoring and Therapy
- Primary Care and Health Outcomes
- Cardiovascular and exercise physiology
- Intensive Care Unit Cognitive Disorders
- Cardiovascular Function and Risk Factors
- Telemedicine and Telehealth Implementation
- Cardiovascular Health and Disease Prevention
- Adipose Tissue and Metabolism
- Sodium Intake and Health
- Cardiovascular Disease and Adiposity
- Musculoskeletal pain and rehabilitation
- Heart Failure Treatment and Management
- Pharmaceutical Practices and Patient Outcomes
- Cardiac pacing and defibrillation studies
- Hormonal Regulation and Hypertension
- Nutritional Studies and Diet
- Diabetes and associated disorders
Geriatric Research Education and Clinical Center
2000-2025
Ann Arbor VA Medical Center
1993-2024
University of Michigan
1999-2024
VA Ann Arbor Healthcare System
2000-2023
Mental Health Services
2021
Michigan Medicine
2000-2017
Biology of Infection
2017
Engineering Associates (United States)
2017
University of Maryland, College Park
2002
Foundation for the National Institutes of Health
1998
We tested the hypotheses that 1) there is an age-associated decrease in arterial alpha-adrenergic responsiveness and 2) upregulation of this response during suppression sympathetic nervous system (SNS) activity. measured forearm blood flow (FABF) by plethysmography brachial artery infusions agonist norepinephrine (NE) nonadrenergic angiotensin II (ANG II) 15 young 14 older healthy human subjects. Among old (O) relative to (Y) we identified greater plasma NE levels (Y: 1.29 +/- 0.07 nM vs. O:...
In subjects with type 2 diabetes in whom an impaired response to endothelial-dependent vasodilator has been characterized, the populations have also at least moderately obese. Obesity characterized as independent predictor of endothelial dysfunction nondiabetic subjects. We hypothesized that normotensive compared age-matched control subjects, 1) endothelium-dependent vasodilation, demonstrated by forearm blood flow (FABF) intraarterial acetylcholine, would be decreased; 2)...
The program "Implementing Goals of Care Conversations with Veterans in VA LTC Settings" is proposed partnership the US Health Administration (VA) National Center for Ethics and Geriatrics Extended Program Offices, together Office Nursing Services. three projects this are designed to support a new system-wide mandate requiring providers conduct systematically record conversations veterans about their preferences care, particularly life-sustaining treatments. These treatments include cardiac...
User-centered design (UCD) methods are well-established techniques for creating useful artifacts, but few studies illustrate their application to clinical feedback reports. When used as an implementation strategy, the content of reports depends on a foundational audit process involving performance measures and data, these important relationships have not been adequately described. Better guidance UCD designing is needed. Our objective describe report method refining prototype We propose...
Older adults with cognitive impairment (CI) in postacute care (PAC) are at risk for an increased level of (LOC) postdischarge. Rehabilitation engagement may impact the relationship between CI and LOC. Ninety-two older veterans (> 50 years) were assessed by physical therapists or assistants Hopkins Engagement Rating Scale (HRERS) while participating Veterans Affairs PAC. Hierarchical logistic regression examined whether rehabilitation predicted LOC controlling cognition as Montreal Cognitive...
To test whether changes in sympathetic nervous system (SNS) activity or insulin sensitivity contribute to the heterogeneous blood pressure response aerobic exercise training, we used compartmental analysis of [ 3 H]norepinephrine kinetics determine extravascular norepinephrine release rate (NE 2 ) as an index systemic SNS and determined (S I by intravenous glucose tolerance test, before after 6 mo 30 (63 ± 7 yr) hypertensive subjects. Maximal O consumption increased from 18.4 0.7 20.8 ml ·...
Process mapping is often used in quality improvement work to examine current processes and workflow identify areas intervene improve quality. Our objective this paper describe process maps as a visual means of understanding modifiable behaviors activities, case example ensure that goals care conversations are part admitting veteran long-term settings.We completed site visits 6 VA nursing homes reviewed their admission processes. We conducted interviews document activities occur when referred...
Abstract Objective To evaluate the effectiveness of feedback reports and + external facilitation on completion life‐sustaining treatment (LST) note template durable medical orders. This quality improvement program supported national roll‐out Veterans Health Administration (VA) LST Decisions Initiative (LSTDI), which aims to ensure that seriously‐ill veterans have care goals decisions elicited documented. Data Sources Primary data from databases for VA nursing homes (called Community Living...
We have previously demonstrated in normotensive humans an age-associated increase sympathetic nervous system (SNS) activity combined with appropriate downregulation of α-adrenergic responsiveness. Impaired responsiveness, despite a comparable level SNS activity, could contribute to higher blood pressure older hypertensive humans. measured arterial plasma norepinephrine (NE) levels and the extravascular NE release rate (NE 2 ) derived from [ 3 H]NE kinetics (to assess systemic activity),...
The purpose of this study was to determine whether age is a predictor sensitivity the peripheral effects insulin on carbohydrate metabolism independent potential influences level sympathetic nervous system (SNS) activity and blood pressure (BP).In 60 human subjects (age range 19-78 years), sensitivity, SI, determined from glucose levels obtained during an intravenous tolerance test, plasma norepinephrine (NE) were measured estimate SNS activity.There age-associated increases in NE (r = .585;...
The purpose of this study was to determine whether sodium-resistant hypertensives are more insulin resistant and dietary sodium restriction improves sensitivity in older hypertensives. Insulin assessed by a frequently sampled intravenous glucose tolerance test the index (S I ) after 1 wk each low- (20 mmol ⋅ l −1 day high- (200 diets 21 (63 ± 2 yr) Subjects were grouped on difference mean arterial blood pressure (MABP) between [sodium sensitive (SS): ≥5-mmHg increase MABP high-sodium diet (...
Beta-Adrenergic blockade with propranolol (PRP) has been reported to cause an increase in plasma norepinephrine (NE) levels humans, which suggests that a reflex sympathetic nervous system (SNS) vasoconstrictor tone compensates for the hypotensive effect of beta-adrenergic blockade. However, NE are indirect measure SNS activity. We have developed two-compartment model kinetics estimate release into extravascular compartment as more comprehensive systemic To determine whether alters release,...
OBJECTIVE The impact of healthcare system integration on infection prevention programs is unknown. Using catheter-associated urinary tract (CAUTI) as an example, we hypothesize that US Department Veterans Affairs (VA) nursing homes have a more robust infrastructure due to and centralization compared with non–VA homes. SETTING VA non-VA participating in the AHRQ Safety Program for Long-Term Care collaborative. METHODS Nursing provided baseline information about their assess strengths gaps...
The purpose of this study was to test the hypothesis that heightened sympathetic nervous system (SNS) activity contributes mechanism by which hypertension is associated with insulin resistance in humans. We performed frequently sampled intravenous glucose tolerance tests determine tissue sensitivity metabolic effects (SI) and measured plasma norepinephrine (NE) levels 21 normotensive 14 hypertensive Caucasian subjects. Compared subjects, subjects had decreased SI (5.4 +/- 0.5 vs. 4.0 0.7 x...
The purpose of this study was to test the hypothesis that there is homologous upregulation arterial alpha-adrenergic responsiveness during suppression sympathetic nervous system (SNS) activity in humans. 10 subjects (19-28 yr) were studied placebo and when SNS suppressed by guanadrel. Changes forearm blood flow (FABF) mediated intraarterial infusion norepinephrine (NE), angiotensin II (AII), phentolamine measured plethysmography. During guanadrel compared with placebo, plasma NE levels (1.28...
Abstract Background Telehealth is increasingly used for rehabilitation and exercise but few studies include older adult participants with comorbidities impairment, particularly cognitive. Using Veterans Administration Video Connect (VVC), the aim of present study to screening, recruitment, baseline assessment, initial telehealth utilization post-hospital discharge in a VVC home-telehealth based program enhance mobility physical activity. Methods Older ( n = 45, mean age 73), recently...
Decreased adrenergic responsiveness in human aging could be a result of downregulation mediated by the age-related increase sympathetic nervous system (SNS) tone. If so, suppression SNS tone elderly subjects should upregulate into range observed for younger subjects. To test this hypothesis, we examined alpha 1 (phenylephrine)- and 2 (clonidine)-adrenergic agonist-mediated venoconstriction group 15 older healthy (age 59-73 yr) during placebo when was suppressed guanadrel (15 mg twice daily 3...