March 16 Lunch Colloquium

Healthy Brain Aging: Retired Faculty and Their Faculties

It is not often that the Emeritus College members are treated during a Luncheon Colloquium to a talk by an active department chairman. But this was the case when Dr. Allan Levey, MD, PhD, the Betty Gage Holland Professor and Chair, Department of Neurology, and Director, Emory Alzheimer's Disease Research Center, spoke on March 16 on "Healthy Brain Aging: Faculty and their Faculties." And there was a record attendance of at least 54 individuals testifying to his popularity and the timeliness of the topic.

The seriousness of this diagnosis was explained by its being the second most common condition contributing to death, behind heart failure. The incidence in the population is 3% in the age group 65-74, 19% in the 75-84 age group, and a startling 47% in those > 85 years. Currently there are over 5 million individuals with Alzheimer's Disease (AD) in the US, and this is projected to move to 18 million by 2050. And unlike many of the common diseases diagnosed, there has not been any reduction in mortality for people suffering from AD. The cost to our society is over $200 billion in care each year (2014 figures).  

The characteristic pathological features of AD in brains are amyloid plaques and neurofibrillary tangles, and although these were first described 200 years ago, it wasn't until the 1970s that our recognition of AD as a disease entity received attention.

One unfortunate aspect of the disease is the fact that the pathological features begin 15-20 years before the symptoms start in the form of mild cognitive impairment, which can last 3-5 years followed by frank AD/dementia over the next 8-10 years.

Although cholinesterase inhibitors such as donepezil (Aricept), rivastigmine (Exelon) and galantamine (Razadyne) as well as memantine (Namenda) are prescribed, they are not very effective when used in the symptomatic setting. Recent thinking based upon the long asymptomatic period suggests that use of drugs earlier might be more useful.

But how do we diagnose the disease earlier? Positron Emission Tomography (PET) scans using isotope tags for amyloid and tangles are most helpful but expensive and expose patients to radiation risks, especially if used repeatedly. Analysis of the fluid obtained from a lumbar puncture can also be helpful, and investigators are working on blood tests and eye-based examinations to arrive at an early diagnosis.      

Currently research is examining ways to prevent the activation of amyloid formation and tangles. Others are focusing on the macrophages of the central nervous system, the microglial cells, and ways to reduce chronic inflammation, which is believed to lead to AD. Recent research is focusing on repurposing a portion of the brain called the locus ceruleus, which is now considered the master regulator of the brain's immune response to deal with the inflammatory response. Currently attention is being given to a drug used for ADHD, atomoxetine (Strattera), which may interrupt the inflammatory cycle.

The cause of AD is not known; however, it is believed that genes contribute 80% toward susceptibility, while environment plays about a 20% part. One of the first genes found to be important was APOE; however, researchers have now identified at least 20 genes that pose some risk. Also there are dominant genes, APP, PS1, and PS2, which definitely put young people (<60 years) at significant risk (see movie Still Alice).  

Environmental risks that have been identified include head trauma, depression, hypertension, elevated cholesterol, vitamin B-12 or folate deficiency, elevated homocysteine, and diabetes. On the other hand protective factors are education, physical exercise, use of statins (like Lipitor), and anti-inflammatory drugs, and red wine, which contains resveratrol. Dr. Levey was not enthusiastic about on-line cognitive exercises.

He hoped the audience would not respond to his talk with "Oh! My God," but hear his enthusiasm and optimism for steps that can keep our brains healthy and for the new strategies being conceived to understand and treat this disease. Emory is participating in clinical trials on AD and interested individuals should contact Dr. Levey at alevey@emory.edu 

The University in Crisis

SUMMARY REPORT

Emory University Emeritus College

Interdisciplinary Seminar:

The University in Crisis

Fall, 2014

January 8, 2015

PART 3:

THE UNIVERSITY'S CHANGING ROLE IN RELATION TO STUDENTS

The Professional PhD

The seminar shifted its focus from undergraduate liberal arts students to undergraduate and graduate students in professional programs, specifically students in the School of Nursing. The presenter, Jo Ann Dalton, Professor Emerita of Nursing, spoke to issues arising from the movement toward the academic professionalization of schools of nursing, resulting in a requirement that faculty possess a doctoral degree, either the PhD or the DNP (Doctor of Nursing Practice). The burden of her argument was that the increasingly stringent demands that nursing-school faculty shall possess doctoral degrees and that they shall do the sort of scholarship that results in publication in peer-reviewed journals may have enhanced the profession of nursing in the eyes of the academy, but that the advantages of such professionalization in the faculty ranks may or may not translate into the graduation of nurses who are better trained for practice.

Dalton's presentation included some essential historical background. More than a century ago nurses were actually taught by doctors; around the turn of the century formal nurse training programs were established in the United States. About fifty years later some of the training programs transitioned to baccalaureate programs and, within a short period of time, master's and nurse-practitioner (NP) programs followed. Today, the largest proportion of registered nurses (individuals who have taken the RN licensing examination) graduated from baccalaureate programs or have added the baccalaureate degree after graduating from a two- or three-year nursing program. Although a few doctoral programs in nursing are older, many of the programs in were started in the 1990s. Today, however, the number of PhDs in nursing programs remains low and the proportion of nurses with any doctoral degree (PhD, DNP, DSN, EdD) also remains low. Further, many of the nurses who have doctoral degrees have retired or are nearing retirement. By contrast, there has been a marked increase in the number of Doctor of Nursing Practice (DNP) programs in the past decade. At Emory the SON launched a DNP program in 2014. Meanwhile, across the country there is a faculty shortage that is causing schools to limit their enrollment, ultimately limiting the number of faculty prepared to teach the next generation of nursing students.

The School of Nursing at Emory has in recent years increased its requirement that faculty have a doctoral degree, thus enlarging the number of doctorally prepared faculty. It has as an ambition increasing the number of endowed chairs supporting faculty positions. Currently, all tenure-track faculty are expected to apply for and receive grant funding, reflecting a national trend for research in the field. Across the country nursing research has grown significantly in the past thirty years, greatly enhanced by the creation (in 1993) of the National Institute of Nursing Research as a member of the National Institutes of Health.

All of these are salutary developments for the academic profession of nursing and for the Emory School of Nursing in particular. But there are questions as well. One concern is cost: specifically, will the increase in funding needed to support nursing education where most of the faculty have doctoral degrees, teach and do research, also increase tuition costs to students? Faculty with active programs of funded research have reduced teaching loads, while at the same time there is an expectation that individuals whose primary role is teaching will support some of their appointment with complementary positions in practice or service. Faculty are expected to publish regardless of whether they are tenured, tenure-track, or clinical faculty; however, there is variability of expectation in the number of and type of publications.

Faculty supervision of student practice is required by law, with the amount and type of supervision varying with the level of the program in which the student is enrolled. Graduates of Emory's School of Nursing may have greater opportunities and may be more successful in the job market and in industry because of educational experiences, resources, and the prestige-factor of Emory

The last concern - about how well students are trained - remained the "bottom line" in our discussion, and Professor Dalton's description of the state of play in American nursing education helped us understand better how universities constantly need to be reminded of their responsibilities to the young people whose education and development are their principal concern, both for their own good and for the good of society at large.

The University's Failure to Educate Teachers

By contrast, the presentation by Linda Hubert, Professor Emerita of English in Agnes Scott College, drew attention to a crisis that is national in scope and bears directly on the future of the American polity - the failure of universities and colleges to educate the educators of our children. She pointed us to a selection of readings whose titles only hint at the scope of the problem: The Teacher Wars; "Education Degree Programs . . . Take a Nosedive"; "An Industry of Mediocrity: . . . Teacher-Education Programs"; and on a more positive note, Building a Better Teacher.

Public education is in crisis in the United States and has been for decades - for a host of reasons. But our seminar determined to focus on just one of these, what many commentators see as the failure of the system of American higher education to produce good teachers for our elementary and secondary schools. Historically, of course, it was our colleges and universities that were charged with the responsibility of training teachers, even if in the last century the task devolved principally upon "normal schools" or "teachers' colleges." Now, however, the preponderance of teacher-preparation and certification programs fail to deliver competence and quality to the profession, and it is time for the nation's elite universities to mount a concerted campaign - joining with the relatively few which, thankfully, have not lost sight of this mission, like Harvard, Columbia, and UNC Chapel Hill - to improve the quality of American K-12 teaching.

One question arose immediately in regard to such elite institutions, however: Does the prevailing ethos of a Research I university somehow militate against teacher-training and thus prevent it from taking teacher- training seriously? Consider: Such institutions are fully aware that little prestige attaches to elementary and secondary teaching, and, as a consequence, they take no particular pains to promote teaching as a worthy career choice for their undergraduates. Further, and as an added consequence, elite universities seem to admit very few undergraduates who profess a desire to become K-12 teachers. Rather, with no doubt unconscious bias, they concentrate on admitting those who are bound for graduate work in "the professions" - in general parlance, K-12 teaching is not spoken of as one of the professions - or, increasingly, in business school. If they think of careers in teaching at all, faculty and administrators at Research I universities likely feel that there are a plethora of lesser institutions in this country that will train teachers at far less cost. The long and short of it is that most elite institutions in the United States do not think of teacher-training as something they should be doing or want to get involved with. [As a further illustration of this bias, this editor might interject that he received zero training for teaching even at the college level while a graduate student at a premier Research I university.]

But of course there are elite universities that do a very creditable job of teacher training, and inevitably the members of our seminar were led to contrast them with Emory in this respect. As Linda Hubert wrote in her summation of her presentation, "My particular concern for this seminar, the role of well-regarded colleges and universities in the preparation of America's elementary and secondary teachers, has no bearing at all on Emory - or its future - at this point." Her comment was of course pointedly ironic, as she went on to call attention to Emory's recent dissolution of its Department of Education. She said she understood that there were valid quality-control reasons behind the move, but she wondered aloud why there could not have been, instead, a strong administrative push to improve the Department and, indeed, to position Emory College as one where undergraduates might receive nationally recognized training toward the profession of teaching, and why, indeed, at the same time the Graduate School would not also have established in tandem a graduate teachers' college along the lines of Columbia's or Harvard's School of Education.

She concluded her report with the following statement:

My position is that Emory (like its neighbor Agnes Scott) [where Hubert was Professor of English] has abandoned an important responsibility by failing to design and implement innovative programs to prepare the superior teacher-leaders that this state and the nation sorely need. Emory missed an opportunity to improve its graduate education program on the order of the Duke University model, my favorite among the programs that I reviewed. The best education programs for the best teacher - like Duke's - embrace the following criteria:

1. Secondary teachers should prepare for teaching certification only after completing a four-year undergraduate degree with a strong liberal arts foundation (which is the case in the most successful European models). A master's level degree from a creditable institution should be mandated. Education mills should be shut down.
2. Expertise in the subject matter (or matters) for which the candidate is seeking certification should be developed to a high standard. (Note that Georgia plans to raise its standards for subject matter competence by 2017. [See AJC, 22 Nov 2014].)
3. Instruction in the craft of teaching, and particularly the skills involved in the discipline of focus, should benefit from the best research in the field.
4. The usual battery of coursework in adolescent psychology, current issues in education, ethical responses and responsibilities, and other concerns of educational process and policy should be part of a challenging program that directs the student to reflect deeply, to engage in research, and to critique existing structures.
5. Practice teaching under the careful supervision of several different, carefully selected mentors should constitute a substantial percentage of any program - and follow-up resources should be provided through the first several years of teaching.
6. Well-suited teacher candidates should be able to get first-rate degrees without first-rate debt. Harvard, Stanford, Columbia and many other distinguished institutions, like the fine model represented by Duke University, provide for significant scholarships as well as some payment during the teaching practicum.

The members of the seminar concluded that the "Top 21" American universities must come to the rescue of American K-12 education. And, as a national university with preeminent regional standing in the Southeast, Emory can no longer avoid assuming its ethical responsibility for training the teachers of America - and, indeed, of Georgia and of Atlanta, with the goal, for example, of making the Atlanta Public Schools among the best in the nation. Most of us found it ironic that while Emory could disband its Department of Education with apparent nonchalance, the Emory Report regularly trumpets the fact that "Emory University once again ranks among the top 20 medium-sized colleges and universities contributing alumni to Teach For America's teaching corps" (September 18, 2014).

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We say goodbye to Kimberly, contd. 

Some of you may not be aware of this but I am actually a formally trained Human Resources Professional having done graduate work at the ILR School at Cornell. As a mid-career professional, I'm at a juncture where I've decided to leverage my HR background to transition into the area of higher education diversity and inclusion.

I've been finding that transition very challenging, so I've had to get creative and have utilized temporary work at Emory as well as teaching as an Adjunct Professor at Morehouse College to create what I would term an Adult Internship.

This has allowed me the opportunity to explore the industry on both the classroom side as well as the administrative side. It has also allowed time for me to engage in pro bono diversity projects in order to gain this experience.

To my pleasure, I was very excited to have the opportunity to work in the Emeritus College, which adds another dimension to my diversity portfolio. Little did I know that I was going to have the opportunity be a student and you probably did not realize many of you were my sensei.

I found it very rewarding and inspiring to see how truly work and life can marry to create a lifestyle where each informs the other--to see and hear that there are careers that can exist that are not separate and apart from oneself but actually integrated into oneself.  

My intuition told me that this was possible but having been taught by some of the greatest teachers and minds over the past several months (that would be you all) was confirmation.

So with this information and these experiences I've applied for a one year fellowship (http://diversity.harvard.edu/pages/fellowship) to work in the office of Diversity at Harvard in order to learn this higher education discipline.

I'm not sure whether I will get it, but I do know this experience of observing a dynamic group of individuals who have lived and continue to live their dreams with passion has inspired me to continue to pursue and search for my own.

Thank you Emeritus College for being my teachers and part of my journey.

Best,

Kim

Peter Dowell Memorial Service

It is with great sadness that I write to convey the news that Peter Dowell, Professor Emeritus of English, passed away on March 17.  Peter had recently been diagnosed with advanced cancer, and he died at the home of his son and his son's family in Dallas.  A gifted teacher, Peter arrived at Emory in 1963, as Instructor of English, and he played important roles in both English and the ILA for decades.  Many of you will remember Peter from his long period of administrative leadership in Emory College.  He served first as Associate Dean and then as Senior Associate Dean for Undergraduate Education for a period of 15 years, from 1988 to 2003.  During that time, he was a generous, thoughtful leader who approached everyone - faculty, students, staff - with empathy, respect, and good humor.  He was an exemplary colleague for us all, and I was fortunate to have the chance to work with him more closely after he left the College administration to return to the Department of English.  Peter retired from Emory in 2009.

A Memorial Service for Peter Dowell, Professor Emeritus of English, will be held at St. Bartholomew's Episcopal Church, 1790 Lavista Road, Atlanta 30329 on April 11th at 11 am.  In lieu of flowers, the family has requested donations be sent to Special Olympics Georgia, 4000 DeKalb Technology Parkway, Atlanta 30340 or to St. Bartholomew's.

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