Prevalence and correlates of cognitive impairment in kidney transplant recipients.

BACKGROUND: There is a high prevalence of cognitive impairment in dialysis patients. The prevalence of cognitive impairment after kidney transplantation is unknown. METHODS: Study Design: Cross-sectional study. SETTING AND PARTICIPANTS: Single center study of prevalent kidney transplant recipients from a transplant clinic in a large academic center. INTERVENTION: Assessment of cognition using the Montreal Cognitive Assessment (MoCA). Demographic and clinical variables associated with cognitive impairment were also examined. Outcomes and Measurements: a) Prevalence of cognitive impairment defined by a MoCA score of <26. b) Multivariable linear and logistic regression to examine the association of demographic and clinical factors with cognitive impairment. RESULTS: Data from 226 patients were analyzed. Mean (SD) age was 54 (13.4) years, 73% were white, 60% were male, 37% had diabetes, 58% had an education level of college or above, and the mean (SD) time since kidney transplant was 3.4 (4.1) years. The prevalence of cognitive impairment was 58.0%. Multivariable linear regression demonstrated that older age, male gender and absence of diabetes were associated with lower MoCA scores (p < 0.01 for all). Estimated glomerular filtration rate (eGFR) was not associated with level of cognition. The logistic regression analysis confirmed the association of older age with cognitive impairment. CONCLUSION: Cognitive impairment is common in prevalent kidney transplant recipients, at a younger age compared to general population, and is associated with certain demographic variables, but not level of eGFR.

Paternal Genetic Structure in Contemporary Mennonite Communities from the American Midwest.

Over the last 35 years, researchers from the Laboratory of Biological Anthropology at the University of Kansas have been working with Mennonite communities to better understand evolutionary patterns of fission-fusion in relationship to their genetic history and population structure. In this study, short tandem repeat (STR) markers from the nonrecombining region of the Y chromosome (NRY) provided increased resolution of the molecular population structure for these groups. NRY is known to be informative for determining paternal genetic ancestral patterns in recently derived human populations. Mennonites represent a branch of the Anabaptist movement that began in northern and central Europe in the 16th century and maintain a well-documented migration and genealogical history. Provided this historical information, we investigated the genetic relationship of 15 NRY STR loci within five Mennonite communities from Kansas (Goessel, Lone Tree, Garden View, and Meridian) and Nebraska (Henderson). We sought to determine if patterns of fission/fusion along familial lines persisted with paternal genetic information as evidenced through other classical genetic polymorphisms and molecular markers. NRY haplotype information was obtained for 94 individuals, and genetic variation was analyzed and compared across the five study populations and comparative Anabaptist and European populations. NRY haplogroups were assigned using a Bayesian allele frequency approach with 14 STR loci. A total of 92 NRY haplotypes were detected, with none shared across these communities. The most prevalent NRY haplogroup was R1b, which occurred in 56% of the entire sample. Eight additional NRY haplogroups (E1b1b, G2a, I1, I2, J2a1, L, Q, and R1a) were detected in smaller frequencies. Principal component analysis of NRY data, in contrast to mitochondrial DNA data, displayed no patterns of population subdivision of these congregations into communities. These NRY genetic profiles provide additional information regarding the recent migratory history of Mennonite communities and additional evidence for fission along paternal lines after migration to the United States.

Prevalence and significance of isolated T wave inversion in 1755 consecutive American collegiate athletes.

BACKGROUND: We evaluated the prevalence of isolated T-wave inversions (TWI) in American athletes using contemporary ECG criteria. Ethnic and gender disparities including the association of isolated TWI with underlying abnormal cardiac structure are evaluated. METHODS: From 2004 to 2014, 1755 collegiate athletes at a single American university underwent prospective collection of medical history, physical examination, 12-lead ECG, and 2-dimensional echocardiography. ECG analysis was performed to evaluate for isolated TWI as per contemporary ECG criteria. RESULTS: The overall prevalence of isolated TWI is 1.3%. Ethnic and gender disparities are not observed in American athletes (black vs. white: 1.7% vs. 1.1%; p=0.41) (women vs. men: 1.5% vs. 1.1; p=0.52). No association was found with underlying cardiomyopathy. CONCLUSION: A lower prevalence of isolated TWI in American athletes than previously reported. Isolated TWI was not associated with an abnormal echocardiogram. No ethnic or gender disparity is seen in American college athletes.

Secondhand tobacco smoke exposure in low-income children and its association with asthma.

Secondhand tobacco smoke (SHS) is a common indoor environmental exposure that is particularly prevalent in low-income families. It has been found to be associated with asthma in some studies; however, across all relevant studies, results have been conflicting. This study aimed to determine the prevalence of SHS exposure in the home environment in a low-income, minority population and to determine the association of exposure with childhood asthma, wheeze, and oral corticosteroids use. This retrospective study analyzed self-reported data collected as part of the Kansas City Safe and Healthy Homes Partnership to determine prevalence of SHS exposure. A logistic regression model was then used to assess the association between exposure and asthma, oral steroid use, and wheeze. Overall, 40% of children lived with at least one smoker and 15% of children lived with at least one smoker who smoked inside the house. No significant association was found between asthma or oral corticosteroid use and SHS exposure. Children who lived with a smoker had a 1.54 increased odds of wheeze in the past year. A large percentage of low-income children in the Kansas City area continue to suffer the adverse effects of SHS. These data support the need for innovative public policy to protect children from such exposure in their home environment.

Homes of low-income minority families with asthmatic children have increased condition issues.

The home is increasingly associated with asthma. It acts both as a reservoir of asthma triggers and as a refuge from seasonal outdoor allergen exposure. Racial/ethnic minority families with low incomes tend to reside in neighborhoods with low housing quality. These families also have higher rates of asthma. This study explores the hypothesis that black and Latino urban households with asthmatic children experienced more home mechanical, structural condition-related areas of concern than white households with asthmatic children. Participant families (n = 140) took part in the Kansas City Safe and Healthy Homes Program, had at least one asthmatic child, and met income qualifications of no more than 80% of local median income; many were below 50%. Families self-identified their race. Homes were assessed by environmental health professionals using a standard set of criteria and a specific set of on-site and laboratory sampling and analyses. Homes were given a score for areas of concern between 0 (best) and 53 (worst). The study population self-identified as black (46%), non-Latino white (26%), Latino (14.3%), and other (12.9%). Mean number of areas of concern were 18.7 in Latino homes, 17.8 in black homes, 13.3 in other homes, and 13.2 in white homes. Latino and black homes had significantly more areas of concern. White families were also more likely to be in the upper portion of the income. In this set of 140 low-income homes with an asthmatic child, households of minority individuals had more areas of condition concerns and generally lower income than other families.

Place attachment among retirees in Greensburg, Kansas.

On 4 May 2007 an ef-5 tornado leveled 95 percent of Greensburg, Kansas. Because city leaders encouraged everyone to use "green" building techniques as they rebuilt their homes and businesses, not only has the return to normalcy been exceedingly slow, but some of the town's older residents feel that officials have overlooked their needs. These minor episodes of discord enabled us to learn what features are most important to people in retirement. The features include identifiable landmarks, a space in which to socialize, and age-specific businesses. We assert that the lessons learned in Greensburg are applicable to other communities with a sizable older population. As baby boomers rapidly enter retirement they will seek places to live that are elder friendly and enable them to effectively bond with place. As previous research attests, people who have a strong attachment to place commonly have a good quality of life.

Milking the Plains: movement of large dairy operations into southwestern Kansas.

Western Kansas has an historical identification with cattle, with a focus on cattle ranching and more specifically since the 1950s, beef-cattle feedlots. Since the mid-1990s large dairy operations have moved into southwestern Kansas. Today more than twenty large dairies house more than 70,000 milk cows. These operate as confined feeding operations similar to beef-cattle feedlots. Regional advantages for the dairy industry include affordable land with wide-open space, local residents' cattle- and dairy-friendly attitudes, and other factors. Regional promoters have actively recruited dairies, and a dairy-business support system has emerged. The prospects for continued expansion of dairies in southwestern Kansas are unclear; despite the locational advantages and the possibility that the industry may continue to relocate here, as did the cattle-feeding industry several decades ago, further moves into the area may depend on continued resources availability and additional infrastructure development.

"In those days the distances were all very different": alienation in Ernest Hemingway's "God Rest You Merry, Gentlemen".

This essay explores the significance of the opening paragraph of Hemingway's "God Rest You Merry, Gentlemen," examining the perplexing but necessary comparison of two seemingly unrelated locales, Kansas City and Constantinople. Early drafts of the story include substantively different introductions. In the published story, however, Hemingway's reliance on a barren physical topography establishes the emotional climate, uniting two distant cities to suggest that the impoverishment of modern urban life is the root cause of the story's tragedy.

An unremembered diversity: mixed husbandry and the American grasslands.

The Green Revolution of the 1960s brought about a dramatic rise in global crop yields. But, as most observers acknowledge, this has come at a considerable cost to biodiversity. Plant breeding, synthetic fertilizers, and mechanization steadily narrowed the number of crop varieties commercially available to farmers and promoted fencerow-to-fencerow monocultures. Many historians trace the origins of this style of industrialized agriculture to the last great plow-up of the Great Plains in the 1920s. In the literature, farms in the plains are often described metaphorically as wheat factories, degrading successive landscapes. While in many ways these farms were a departure from earlier forms of husbandry in the American experience, monocultures were quite rare during the early transformation of the plains. Analysis of a large representative sample, based on manuscript agricultural censuses and involving twenty-five townships across the state of Kansas, demonstrates that diverse production reached even the most challenging of plains landscapes.

Biological aging and Cox hazard analysis of mortality trends in a Mennonite community from south-central Kansas.

This study investigated mortality in 568 individuals from the Goessel Mennonite community in rural central Kansas. There were three main objectives to this research: 1) characterize mortality trends within a biologically well-defined Mennonite community; 2) determine what biochemical, morphological, and physiological risk factors could be related to all-cause mortality, stratified by age and sex; and 3) compare these results to previously described variables that were associated with both biological age and mortality in this population. Mortality data were obtained from three sources: Kansas Vital Records, the Social Security death index, and church records. In total, 221 (39%) individuals were found to have died in this population between January 1980-June 2002. Analogous to the larger US population, the three leading causes of death in this community were heart disease, cancer, and stroke, accounting for 60% of all deaths. Besides advancing age, the greatest biological risk factor in this population was decreased amounts of albumin in men (relative risk, 2.47), potentially indicating underreported cases of either chronic kidney disease or frailty syndrome for males. Cox proportional hazard models demonstrated that increased amounts of total cholesterol may provide a protective effect for elderly individuals. We conclude, based on the previously described heritability of both albumin (h(2) = 0.40) and total cholesterol (h(2) = 0.50) in this population, that underlying genetic factors associated with both chronic degenerative diseases and biological aging may have important implications for understanding mortality patterns in this community.