bluuebunny/crossref_metadata_2025 huggingface dataset:
Quantitative PET in the 2020s: a roadmap
Authors: Meikle Steven R , Sossi Vesna , Roncali Emilie , Cherry Simon R , Banati Richard , Mankoff David , Jones Terry , James Michelle , Sutcliffe Julie , Ouyang Jinsong , Petibon Yoann , Ma Chao , El Fakhri Georges , Surti Suleman , Karp Joel S , Badawi Ramsey D , Yamaya Taiga , Akamatsu Go , Schramm Georg , Rezaei Ahmadreza , Nuyts Johan , Fulton Roger , Kyme André , Lois Cristina , Sari Hasan , Price Julie , Boellaard Ronald , Jeraj Robert , Bailey Dale L , Eslick Enid , Willowson Kathy P , Dutta Joyita
Published: December 2020

Positron emission tomography (PET) plays an increasingly important role in research and clinical applications, catalysed by remarkable technical advances and a growing appreciation of the need for reliable, sensitive biomarkers of human function in health and disease. Over the last 30 years, a large amount of the physics and engineering effort in PET has been motivated by the dominant clinical application during that period, oncology. This has led to important developments such as PET/CT, whole-body PET, 3D PET, accelerated statistical image reconstruction, and time-of-flight PET. Despite impressive improvements in image quality as a result of these advances, the emphasis on static, semi-quantitative ‘hot spot’ imaging for oncologic applications has meant that the capability of PET to quantify biologically relevant parameters based on tracer kinetics has not been fully exploited. More recent advances, such as PET/MR and total-body PET, have opened up the ability to address a vast range of new research questions, from which a future expansion of applications and radiotracers appears highly likely. Many of these new applications and tracers will, at least initially, require quantitative analyses that more fully exploit the exquisite sensitivity of PET and the tracer principle on which it is based. It is also expected that they will require more sophisticated quantitative analysis methods than those that are currently available. At the same time, artificial intelligence is revolutionizing data analysis and impacting the relationship between the statistical quality of the acquired data and the information we can extract from the data. In this roadmap, leaders of the key sub-disciplines of the field identify the challenges and opportunities to be addressed over the next ten years that will enable PET to realise its full quantitative potential, initially in research laboratories and, ultimately, in clinical practice.
Computational schemes between the exact, analytical and numerical solution in present of time—fractional ecological model
Authors: Wu Li , Mousa A A , Lu Dianchen , Khater Mostafa M A
Published: December 2020

This paper investigates the accuracy of three recent computational schemes (the extended simplest method (ESEM), sech—tanh expansion method (STEM), and modified Kudryashov method (MKM)) through calculating the absolute value of error between their solutions and numerical solutions. The computational schemes claim to obtain exact traveling wave solutions of the investigated models; therefore, it supposes the numerical study for any models that have been analytically investigated under any constructed computational solutions that will be matching, but our study shows a different fact. (Khater et al Soft Computing (Submitted)) has studied the computational solutions of the time-fractional Lotka—Volterra (LV) model through the above-mentioned computational schemes. Many solutions have been obtained in different mathematical formulas such as exponential, trigonometric, hyperbolic, etc. These solutions describe the interaction between the high -frequency Langmuir and the low-frequent ion-acoustic waves with many applications in electromagnetic waves, plasma physics, and signal processing through optical fibers, coastal engineering, and fluid dynamics. This manuscript applies the trigonometric quintic B—spline scheme to the fractional LV model along with the Caputo and Fabrizio fractional derivatives and computational obtained solutions for investigating the numerical solutions under each employed analytical scheme. The numerical solutions are simulated in two-dimensional sketches to explain the relation between exact and numerical solutions. This study proves the computational fact hypotheses for obtaining exact solutions, and they all obtain computational solutions.
Ki-67 Proliferation Index Assessment in Gastroenteropancreatic Neuroendocrine Tumors by Digital Image Analysis With Stringent Case and Hotspot Level Concordance Requirements
Authors: Boukhar Sarag A , Gosse Matthew D , Bellizzi Andrew M , Rajan K D Anand
Published: December 2020

Objectives

The Ki-67 proliferation index is integral to gastroenteropancreatic neuroendocrine tumor (GEP-NET) assessment. Automated Ki-67 measurement would aid clinical workflows, but adoption has lagged owing to concerns of nonequivalency. We sought to address this concern by comparing 2 digital image analysis (DIA) platforms to manual counting with same-case/different-hotspot and same-hotspot/different-methodology concordance assessment.

Methods

We assembled a cohort of GEP-NETs (n = 20) from 16 patients. Two sets of Ki-67 hotspots were manually counted by three observers and by two DIA platforms, QuantCenter and HALO. Concordance between methods and observers was assessed using intraclass correlation coefficient (ICC) measures. For each comparison pair, the number of cases within ±0.2xKi-67 of its comparator was assessed.

Results

DIA Ki-67 showed excellent correlation with manual counting, and ICC was excellent in both within-hotspot and case-level assessments. In expert-vs-DIA, DIA-vs-DIA, or expert-vs-expert comparisons, the best-performing was DIA Ki-67 by QuantCenter, which showed 65% cases within ±0.2xKi-67 of manual counting.

Conclusions

Ki-67 measurement by DIA is highly correlated with expert-assessed values. However, close concordance by strict criteria (>80% within ±0.2xKi-67) is not seen with DIA-vs-expert or expert-vs-expert comparisons. The results show analytic noninferiority and support widespread adoption of carefully optimized and validated DIA Ki-67.
Longitudinal Causal Effects of Normalized Protein Catabolic Rate on All-Cause Mortality in Patients With End-Stage Renal Disease: Adjusting for Time-Varying Confounders Using the G-Estimation Method
Authors: Aryaie Mohammad , Sharifi Hamid , Saber Azadeh , Nazemipour Maryam , Mansournia Mohammad Ali
Published: December 2020

In this study, we aimed to estimate the causal effect of normalized protein catabolic rate (nPCR) on mortality among end-stage renal disease (ESRD) patients in the presence of time-varying confounding affected by prior exposure using g-estimation. Information about 553 ESRD patients was retrospectively collected over an 8-year period (2011–2019) from hemodialysis facilities in Kerman, Iran. nPCR was dichotomized as <1.2 g/kg/day versus ≥1.2 g/kg/day. Then a standard time-varying accelerated failure time (AFT) Weibull model was built, and results were compared with those generated by g-estimation. After appropriate adjustment for time-varying confounders, weighted g-estimation yielded 78% shorter survival time (95% confidence interval (95% CI): −81, −73) among patients with a continuous nPCR <1.2 g/kg/day than among those who had nPCR ≥1.2 g/kg/day during follow-up, though it was 18% (95% CI: −57, 54) in the Weibull model. Moreover, hazard ratio estimates of 4.56 (95% CI: 3.69, 5.37) and 1.20 (95% CI: 0.66, 2.17) were obtained via weighted g-estimation and the Weibull model, respectively. G-estimation indicated that inadequate dietary protein intake characterized by nPCR increases all-cause mortality among ESRD patients, but the Weibull model provided an effect estimate that was substantially biased toward the null.
Invited Commentary: The Prevalent New-User Design in Pharmacoepidemiology—Challenges and Opportunities
Authors: Filion Kristian B , Yu Ya-Hui
Published: December 2020

The prevalent new-user design includes a broader study population than the traditional new-user approach that is frequently used in pharmacoepidemiologic research. In an article appearing in this issue (Am J Epidemiol. 2021;190(7):1341–1348), Webster-Clark et al. describe the treatment initiator types included in the prevalent new-user design and contrast the causal questions assessed using a prevalent new-user design versus a new-user design. They further applied a series of simulation studies showing the importance of accounting for treatment history in addition to time since initiation of the comparator in the prevalent new-user design. In this commentary, we put their findings in the broader context with a discussion of the strengths and limitations of the prevalent new-user design and settings where it would be most useful. The prevalent new-user design and new-user design both address unique questions of clinical and public health importance. Real-world evidence generated by pharmacoepidemiologic research is increasingly being used by regulators and other knowledge users to inform their decision-making. Understanding the causal questions addressed by different designs is crucial in this process; the study by Webster-Clark et al. represents an important step in addressing this issue.
Vertical Abdominoplasty Technique and the Impact of Preoperative Comorbidities on Outcomes
Authors: Bunting Haley , Lu Karen B , Shang Zhiguo , Kenkel Jeffrey
Published: December 2020

Background

As the number of patients requiring bariatric surgery has increased, so has the demand for body contouring after massive weight loss. Surgery involving the abdomen in these patients is particularly challenging as both vertical and horizontal laxity if often present, making traditional abdominoplasty techniques less effective.

Objectives

The aim of this study was to review the operative technique and evaluate the preoperative comorbidities and operative decisions that may impact patient outcomes in those undergoing vertical abdominoplasty.

Methods

A review of the authors’ technique is described. A retrospective chart review of patients who underwent vertical abdominoplasty for significant vertical and horizontal laxity after massive weight loss by a single surgeon between June 2007 and July 2019 was performed. Preoperative parameters, operative factors, and minor and major complications were evaluated.

Results

Our complication rate was 81% (13/16), which were all minor. No major complications were encountered. Patients with a history of nicotine use had a 100% complication rate. There was a trend toward higher seroma formation in patients with coronary artery disease and those with a history of smoking. There was also a trend toward higher wound dehiscence in patients with renal disease. The authors found no statistically significant correlation between complications and older age, higher weight of tissue resected, higher body mass index, and medical comorbidities.

Conclusions

This small series helps to elucidate the role of vertical abdominoplasty in the care of patients following massive weight loss and its associated morbidity. Proper patient selection, appropriate preoperative patient counseling, and sound surgical technique help to mitigate the negative outcomes.

Level of Evidence: 4
Separating differential allocation by females from direct effects of male condition in a beetle
Authors: Richardson Jon , Smiseth Per T
Published: December 2020

Differential allocation is the adjustment of reproductive allocation, typically by a female, in response to the quality of her male partner. A recent theoretical model suggests that differential allocation may influence trade-offs between reproductive traits within a breeding attempt. Furthermore, it is often difficult to distinguish differential allocation from direct effects of male condition. We address these gaps using a novel cross-fostering design to exclude direct effects of male condition and to test whether differential allocation affects trade-offs between and within breeding attempts. This design detects differential allocation as effects of a female’s mating partner and direct effects of male condition as effects of the larvae’s sire. We used the burying beetle Nicrophorus vespilloides, a species which adjusts reproductive allocation by culling some larvae after hatching. We used food deprivation to manipulate the nutritional condition of both the female’s mating partner and the larvae’s sire. We find clear evidence for differential allocation as females mating with food-deprived males had fewer larvae than females mating with control males. There was a trade-off between number and size of larvae when females mated with control males, but a positive relationship when females mated with food-deprived males. Thus, differential allocation influenced relationships between reproductive traits within a breeding attempt, but not necessarily through trade-offs. Instead, we suggest that there may be cryptic heterogeneity in quality among females or their mating partners that was only exposed when females mated with a male in poor condition.
An Exploration of the Use of Literature as a Therapeutic Intervention in Social Work
Authors: Murphy Jennifer , Jenkinson Hilary
Published: December 2020

In recent decades, a greater awareness and familiarity has developed in relation to incorporating creative approaches to working with individuals and groups within a social work context. Art therapy, music therapy and even drama therapy have become more commonplace within the range of approaches employed by agencies and practitioners working therapeutically. However, the use of literature as a therapeutic tool is perhaps a less well-known, less developed and under-researched area of practice. This article discusses the potential for literature to be used as a therapeutic tool and explores the power of words to enable us to make sense of our surroundings and experiences. The article also presents findings of a small-scale piece of research undertaken with practitioners currently using literature in their practice. Themes arising from this research are explored such as the potential of literature to facilitate reflection, practitioners’ experiences of applying the approach, the value of engaging with literature in developing expressive language and the potential for this work in promoting inclusion.
Severe oligomeric tau toxicity can be reversed without long-term sequelae
Authors: Martinisi Alfonso , Flach Martin , Sprenger Frederik , Frank Stephan , Tolnay Markus , Winkler David T
Published: December 2020

Tau is a microtubule stabilizing protein that forms abnormal aggregates in many neurodegenerative disorders, including Alzheimer’s disease. We have previously shown that co-expression of fragmented and full-length tau in P301SxTAU62on tau transgenic mice results in the formation of oligomeric tau species and causes severe paralysis. This paralysis is fully reversible once expression of the tau fragment is halted, even though P301S tau expression is maintained. Whereas various strategies to target tau aggregation have been developed, little is known about the long-term consequences of reverted tau toxicity. Therefore, we studied the long-term motor fitness of recovered, formerly paralysed P301SxTAU62on-off mice. To assess the seeding competence of oligomeric toxic tau species, we also inoculated ALZ17 mice with brainstem homogenates from paralysed P301SxTAU62on mice. Counter-intuitively, after recovery from paralysis due to oligomeric tau species expression, ageing P301SxTAU62on-off mice did not develop more motor impairment or tau pathology when compared to heterozygous P301S tau transgenic littermates. Thus, toxic tau species causing extensive neuronal dysfunction can be cleared without inducing seeding effects. Moreover, these toxic tau species also lack long-term tau seeding effects upon intrahippocampal inoculation into ALZ17 mice. In conclusion, tau species can be neurotoxic in the absence of seeding-competent tau aggregates, and mice can clear these tau forms permanently without tau seeding or spreading effects. These observations suggest that early targeting of non-fibrillar tau species may represent a therapeutically effective intervention in tauopathies. On the other hand, the absent seeding competence of early toxic tau species also warrants caution when using seeding-based tests for preclinical tauopathy diagnostics.
Repeated traumatic brain injury and risk of epilepsy: a Danish nationwide cohort study
Authors: Lolk Kasper , Dreier Julie W , Christensen Jakob
Published: December 2020

Traumatic brain injury is associated with increased risk of epilepsy, but the importance of repeated traumatic brain injuries has not yet been established. We performed a nationwide population-based cohort study of 2 476 905 individuals born in Denmark between 1977 and 2016. We estimated hazard ratios (HRs) and the cumulative incidence of epilepsy following traumatic brain injury using Cox and competing risk regression, respectively. To estimate the cumulative incidence of epilepsy in the population without traumatic brain injury, we matched 10 controls for each subject with traumatic brain injury on year of birth, sex, and date of brain insult in the index person. In the cohort, traumatic brain injury was sustained by 167 051 subjects (71 162 females and 95 889 males), and 37 200 individuals developed epilepsy (17 905 females and 19 295 males). Compared with subjects without traumatic brain injury, the relative risk of epilepsy increased after a first traumatic brain injury [HR 2.04, 95% confidence interval (CI) 1.96–2.13] and even more after a second traumatic brain injury (HR 4.45, 95% CI 4.09–4.84). The risk increased with the severity of the first and the second traumatic brain injury, most notably after severe traumatic brain injuries. Females were more likely than males to develop epilepsy after mild traumatic brain injury (HR 2.13, 95% CI 2.00–2.28 versus HR 1.77, 95% CI 1.66–1.88; P < 0.0001); in contrast, males were more likely than females to develop epilepsy after severe traumatic brain injury (HR 5.00, 95% CI 4.31–5.80 versus 3.21, 95% CI 2.56–4.03; P = 0.0012). The risk remained increased for decades after the traumatic brain injury. This knowledge may inform efforts to prevent the development of post-traumatic epilepsy.
Impact of Sex and Metabolic Comorbidities on Coronavirus Disease 2019 (COVID-19) Mortality Risk Across Age Groups: 66 646 Inpatients Across 613 U.S. Hospitals
Authors: Goodman Katherine E , Magder Laurence S , Baghdadi Jonathan D , Pineles Lisa , Levine Andrea R , Perencevich Eli N , Harris Anthony D
Published: December 2020

Background

The relationship between common patient characteristics, such as sex and metabolic comorbidities, and mortality from coronavirus disease 2019 (COVID-19) remains incompletely understood. Emerging evidence suggests that metabolic risk factors may also vary by age. This study aimed to determine the association between common patient characteristics and mortality across age-groups among COVID-19 inpatients.

Methods

We performed a retrospective cohort study of patients discharged from hospitals in the Premier Healthcare Database between April–June 2020. Inpatients were identified using COVID-19 ICD-10-CM diagnosis codes. A priori-defined exposures were sex and present-on-admission hypertension, diabetes, obesity, and interactions between age and these comorbidities. Controlling for additional confounders, we evaluated relationships between these variables and in-hospital mortality in a log-binomial model.

Results

Among 66 646 (6.5%) admissions with a COVID-19 diagnosis, across 613 U.S. hospitals, 12 388 (18.6%) died in-hospital. In multivariable analysis, male sex was independently associated with 30% higher mortality risk (aRR, 1.30, 95% CI: 1.26–1.34). Diabetes without chronic complications was not a risk factor at any age (aRR 1.01, 95% CI: 0.96–1.06), and hypertension without chronic complications was a risk factor only in 20–39 year-olds (aRR, 1.68, 95% CI: 1.17–2.40). Diabetes with chronic complications, hypertension with chronic complications, and obesity were risk factors in most age-groups, with highest relative risks among 20–39 year-olds (respective aRRs 1.79, 2.33, 1.92; P-values ≤ .002).

Conclusions

Hospitalized men with COVID-19 are at increased risk of death across all ages. Hypertension, diabetes with chronic complications, and obesity demonstrated age-dependent effects, with the highest relative risks among adults aged 20–39.
Guidance on Imaging for Invasive Pulmonary Aspergillosis and Mucormycosis: From the Imaging Working Group for the Revision and Update of the Consensus Definitions of Fungal Disease from the EORTC/MSGERC
Authors: Alexander Barbara D , Lamoth Frédéric , Heussel Claus Peter , Prokop Cornelia Schaefer , Desai Sujal R , Morrissey C Orla , Baddley John W
Published: December 2020

Background

Clinical imaging in suspected invasive fungal disease (IFD) has a significant role in early detection of disease and helps direct further testing and treatment. Revised definitions of IFD from the EORTC/MSGERC were recently published and provide clarity on the role of imaging for the definition of IFD. Here, we provide evidence to support these revised diagnostic guidelines.

Methods

We reviewed data on imaging modalities and techniques used to characterize IFDs.

Results

Volumetric high-resolution computed tomography (CT) is the method of choice for lung imaging. Although no CT radiologic pattern is pathognomonic of IFD, the halo sign, in the appropriate clinical setting, is highly suggestive of invasive pulmonary aspergillosis (IPA) and associated with specific stages of the disease. The ACS is not specific for IFD and occurs in the later stages of infection. By contrast, the reversed halo sign and the hypodense sign are typical of pulmonary mucormycosis but occur less frequently. In noncancer populations, both invasive pulmonary aspergillosis and mucormycosis are associated with “atypical” nonnodular presentations, including consolidation and ground-glass opacities.

Conclusions

A uniform definition of IFD could improve the quality of clinical studies and aid in differentiating IFD from other pathology in clinical practice. Radiologic assessment of the lung is an important component of the diagnostic work-up and management of IFD. Periodic review of imaging studies that characterize findings in patients with IFD will inform future diagnostic guidelines.
Active Aging for Undergraduate University Students: Lessons From Student See Me at 70 Course Reflections
Authors: Roberts Emily
Published: December 2020

Demographic factors tell us that the number of adults age 65 and older will nearly double by 2030. A holistic and proactive approach to providing positive outcomes in aging requires integrated strategies focusing on providing organizational structures to support this demographic shift. Active aging is a framework first developed by the World Health Organization optimizing opportunities for health, participation and security in order to enhance quality of life as people age. Active aging allows people to realize their potential for physical, social and mental wellbeing throughout the life course. This presentation shares outcomes from a university honors active aging seminar entitled Active Aging for L.I.F.E. in which students were provided with information on a wide range of topics in order to build their personal understanding of the relationships between Longevity, Independence, Fitness and Engagement. Student were then asked to develop a final paper entitled See Me at 70, in which they were to use the course content to develop a narrative of power and inspiration about their future self at age 70. What tactics would be used through their lifespan to develop a behavior and belief system which would enable them to live their life to the fullest both physically and cognitively? How would they respond to the challenges of aging and turn them in to opportunities? This presentation shares key themes of the student work, including the relationships between independence and interdependence, the connections between physical and cognitive health, maintaining purpose and facing unforeseen challenges with a positive attitude.
Dance and Music in Children’s Literature: A Qualitative Study of Intergenerational Solidarity Themes
Authors: Fogle Stephen
Published: December 2020

Intergenerational Solidarity is consistently recognized by the United Nations as a primary focus for work being undertaken to build a society for all ages. This study utilized a qualitative methodology to examine themes of intergenerational solidarity contained within children’s literature. Specifically, this study explored intergenerational examples of dance and music shared by older adults and children. McGuire’s (2016) Growing Up and Growing Older annotated bibliography for preschool-to-third grade children, which contains over seventy pages of non-ageist children’s literature references (N= 411), served as the sample frame for this study. A sample of six story and picture books was selected after inclusion criteria and availability from two public children’s libraries considerations were met. Inclusiveness of the present sample is manifested through geographic origin of dance and music traditions as well as the age range, gender, primary spoken language, and kin relationships of the older adult and children characters. Results revealed three intergenerational solidarity themes: 1) a humanizing portrayal of an older adult, 2) common cause, 3) continuity of tradition. This study demonstrates the efficacy of the arts, specifically dance and music, for facilitating intergenerational solidarity. This study identifies three themes that primary school teachers and children's librarians can utilize when selecting reading material about intergenerational solidarity. Finally, this study contributes to decades of pioneering educational gerontology literature focused on combating ageism through development of curricula that stimulate discovery of the elder within.
Want to Engage More Physical Therapy Students in Geriatrics? Teach the 4Ms
Authors: Shubert Tiffany , Henage Cristine
Published: December 2020

In 2019, 1.2% of the 209,000 licensed physical therapists in the United States had completed sufficient training to be Geriatric Certified Specialists. The dramatic demographic shift in the population will require all physical therapists to have foundational knowledge of evidence-based management of older adults. Our purpose was to pilot the impact of an 8-week curriculum for physical therapy students that integrated key concepts of rehabilitation for older adults with the Age-Friendly Health System’s 4Ms (Mentation, Mobility, Medications, What Matters). The curriculum included guest speakers from medicine, social work, nutrition, pharmacy, community providers (YMCA) and older adults. Every class modeled how to assess the Ms and integrate information into a plan aligned with what matters to the client. Students completed a pre-post survey to evaluate their understanding of the 4Ms, and self-assess confidence in applying concepts to practice. Results supported the value of integrating the 4Ms into the curriculum. Over 89% of respondents reported assessing medications and mentation was very important to patient care compared to 11% and 33% pre-course, and 78% of students reporting they were highly-likely to advocate for the 4Ms as part of their practice. The 4Ms provided a framework that made geriatric care more appealing. Several students commented they had no interest in geriatrics prior to the course, but were more confident in their abilities and more interested in caring for older adults. Findings from this pilot support the value of the 4Ms as a framework for graduate-level allied health programs curriculum development.
Meeting the Physical and Mental Health Needs of Older Offenders: Does Aging in Place Work in Prison?
Authors: Elmer Eddy , Pope Heather Campbell
Published: December 2020

In many countries, the proportion of older people in prison is growing due to longer sentences, increases in convictions for historical offences, and longevity. Moreover, harsh conditions of confinement coupled with the negative effects of a criminal lifestyle may contribute to 'accelerated aging' in this population. Indeed, many prisoners develop health problems that are more commonly seen among people who are up to ten years older. Correctional institutions are increasingly struggling to meet the complex and expensive healthcare needs of these offenders, especially at end-of-life. Some institutions have taken the position that prisons were never intended to be nursing homes, nor can they be adequately adapted to fulfill this role. As a result, these institutions attempt to place some aging offenders in healthcare institutions within the community, provided that their risk to the public can be adequately managed. Other institutions have argued that the needs of aging offenders can be successfully met behind prison walls and have taken steps to allow prisoners to 'age in place.' After summarizing the research on the physical and mental health needs of aging offenders, this presentation considers the advantages and disadvantages of meeting older offenders' healthcare needs both within and outside the prison setting and provides relevant examples of both. Special attention is paid to the issues of social isolation and loneliness: both may contribute to accelerated aging, and perhaps even the risk for re-offending, raising questions about which correctional settings are most beneficial for minimizing these problems.
Organizational Commitment Among Residential Senior Care Workers
Authors: Kilaberia Tina
Published: December 2020

Despite growing evidence of the increase in the aging population nationally, there continues to be a shortage of health and social care professionals who work with older adults. Some studies examine this phenomenon by looking at motivations that underlie commitment to geriatric careers. Others study commitment among those who are already geriatric professionals. Both the volume and diversity of the aging population challenge organizations to provide care. Drawing on 44 interviews, observations of 62 meetings, and a 5-year immersion, this organizational ethnography looks at commitment factors at a large, urban, faith-based residential senior care organization. Commitment factors are examined on three levels: daily tensions and rewards; value tensions and rewards; and deal breakers and clinchers. Findings show that intrinsic identity-based factors such as affective bonds with older persons and sharing in faith values sustain commitment on the person level. Interprofessional tensions may detract from commitment. Implications pertain to the role of leadership in equity-related and ethical tensions as well as the improved uptake of allied health professional expertises such as social work and chaplaincy. This study extends the extant knowledge by incorporating perspectives of social workers, chaplains, rehabilitation, recreational, diet and environmental services workers in addition to the more commonly examined groups such as nurses and certified nursing assistants, and in a setting that includes Assisted Living in addition to long-term care.
Implications of Exceeding the Age and Interventions to Extend Life Purpose: Perspectives From Asian Centenarians
Authors: Maulod Ad , Manap Normala , Rouse Sasha , Chan Angelique W M
Published: December 2020

Centenarians have often been regarded as living paradigms of exceptional longevity yet little is known from their perspective about the purpose, meaning and quality of living longer lives. In Singapore, the number of centenarians has multiplied 30-fold from 50 in 1990 to about 1500 in 2020. Although centenarians are respected as ‘national treasures’ – having witnessed Singapore’s transformation from British colony to global city state, their needs remain invisible in both the healthcare and social sectors. The tendency to romanticize exceptional longevity neglects a deeper understanding of (i) its consequence on the oldest old (85+ years) who may be impacted by severe functional and sensory deficits and (ii) their experience of social isolation in the family and communities. This paper discusses findings based on interviews with 15 Singapore centenarians (100 to 111 years old) and their family carers. Diverse experiences of longevity are shaped by these factors: health status; personal disposition; strength of family and social networks; exposure to adversity and coping resources; spiritual beliefs; role loss; and changes in the lived environment. Appropriate health and psychosocial interventions could have been delivered earlier in the life trajectory to enable better quality of life and continued social engagement. Learning from the challenges (eg. social withdrawal; extensive functional and sensory losses) of existing centenarians contributes to a more precise understanding of how best to harness the productive capacities of our oldest old.
Mitigating the Impact of Long-Term Construction on the Health of Older Adult Residents in New York City’s Chinatown
Authors: Kwon Simona , Tan Yi-Ling , Wong Jennifer , Pan Janet
Published: December 2020

Introduction: Recent proposed major construction projects in New York City’s Chinatown often last multiple years. Little is known about the health impact of construction on vulnerable populations such as older adults. In Chinatown, approximately 20% of residents are older adults, live below the poverty level (34%), have a disability (47%), and nearly half report limited English proficiency. Objectives: We are conducting a mixed methods study to describe possible health and psychosocial outcomes of construction on older adults in Chinatown. Methods: We used a community-engaged modified Delphi process to identify priority areas related to construction and older adults which included: 1) a scoping review of the health impact of long-term construction; 2) key informant interviews of academic experts; and 3) convened community stakeholder leaders to review key focus areas and evidence-informed, culturally-relevant mitigation strategies. Five priority topics were identified: 1) Construction site emissions; 2) Noise; 3) Outdoor nocturnal lighting; 4) Neighborhood changes; and 5) Relocation. Results: Long-term construction contributes to adverse effects of air pollution, noise, and changes in the environment, with exposure to particulate matter and unwanted noise associated with higher morbidity and mortality. Unsafe sidewalk due to construction increase the risk of falling, the leading cause of death among NYC seniors. Construction-related stressors may isolate older adults from vital services and social networks. Conclusion: Long-term construction poses serious health implications for older adults. Stakeholders should adopt a community-engaged approach and identify meaningful community priorities to inform practical solutions to mitigate the impact of construction on vulnerable Chinatown older adults.
The Association Between Spousal Caregiver Status and Psychological Well-Being Among Older Adults
Authors: Wang Yang
Published: December 2020

Older adults often bear the responsibility of taking care of their spouses who have physical or cognitive impairments. Although previous studies suggested various caregiving-related negative experiences might be related to older spousal caregivers’ mental health status, the components of psychological well-being (PSW) among older spousal caregivers have not been fully explored. This study examined the association between spousal caregiver status and PSW. Data were drawn from wave 2014 of the Health and Retirement Study. The sample consisted of 3,857 adults who were above 50, and 376 of the participants provided care in activities in daily life (ADL) or instrumental activities in daily life (IADL) to their spouses/partners. Three hundred and thirty-one of them had a spouse/partner who needed care, but did not provide the care to their spouse/partner. The majority of participants, 3,150 of them, did not provide care, and their spouse/partner did not need care. Four domains of PSW were assessed: purpose of life, life satisfaction, positive affect, and negative affect. Univariate analyses and multivariable linear regression were used for analyses. Spousal caregivers and non-caregivers with need had a worse PS status, compared to non-caregivers without need. But after adjusting for socio-economic resources, health status, or social support factor, the difference in their four domains of PSW was insignificant. Older spousal caregivers’ PSW could be protected by promoting that population’s socio-economic resources and health status. Future practice needs to address caregivers’ emotional need. Future research need to examine the long-term effect of caregiving on older spousal caregivers’ PSW.
Effects of Paid Leave Policies on Working Caregivers' Labor Supply
Authors: Kim Soohyun
Published: December 2020

Approximately two in three caregivers are in the labor force. However, paid family leave is the only policy support for working caregivers to date, which helps to balance their work and care responsibilities. I analyze the data from the 1998-2014 Health and Retirement Study to examine 1) how paid leave policies affect labor market outcomes for workers in need of caring for a spouse/partner or an older parent/-in-law and 2) how the effects differ by gender. Paid leave policy is distinguished between employer-provided leave and state government-provided leave. Using the first-difference approach, I compare the short-term and long-term changes in the extensive and intensive margins of labor with and without access to paid leave policies when a health deterioration of the older family member occurs. My preliminary results show that, without paid leave policy, the health event of a spouse/partner or an older parent/-in-law affects women’s labor supply but not men’s. Paid leave provided by an employer increases the labor supply for both women and men, with the more noticeable long-term effects for men. State paid family leave increases women’s wage and salary both in the short run and in the long run. My findings underline the importance of paid leave policy for retaining the workers in need of providing care for a family member, particularly for women.
Physical Activity as a Mediator in the Relationship Between Race or Ethnicity and Changes in Multimorbidity
Authors: Newsom Jason , Denning Emily , Quinones Ana , Elman Miriam , Botoseneanu Anda , Allore Heather , Nagel Corey , Dorr David
Published: December 2020

Racial/ethnic disparities in multimorbidity (≥2 chronic conditions) and their rate of accumulation over time have been established. Studies report differences in physical activity across racial/ethnic groups. We investigated whether racial/ethnic differences in accumulation of multimorbidity over a 10-year period (2004-2014) were mediated by physical activity using data from the Health and Retirement Study (N = 10,724, mean age = 63.5 years). Structural equation modeling was used to estimate a latent growth curve model of changes in the number of self-reported chronic conditions (of nine) and investigate whether the relationship of race/ethnicity (non-Hispanic Black, Hispanic, non-Hispanic White) to change in the number of chronic conditions was mediated by physical activity after controlling for age, sex, education, marital status, personal wealth, and insurance coverage. Results indicated that Blacks engaged in significantly lower levels of physical activity than Whites (b = -.171, □ = -.153, p < .001), but there were no differences between Hispanics and Whites (b = -.010, □ = -.008, ns). Physical activity also significantly predicted both lower initial levels of multimorbidity (b = -1.437, □ = -.420, p < .001) and greater decline in multimorbidity (b = -.039, □ = -.075, p < .001). The indirect (mediational) effect for the Black vs. White comparison was significant (b = .007, □ = .011, 95% CI [.004,.010]). These results provide important new information for understanding how modifiable lifestyle factors may help explain disparities in multimorbidity in middle and later life, suggesting greater need to reduce sedentary behavior and increase activity.
Respect Your Elders: The Relation Between Generativity and Life Satisfaction in Custodial Grandparents
Authors: Scott Rachel , Nadorff Danielle , Yancura Loriena , Barnett Melissa
Published: December 2020

In Erikson’s (1950) theory of psychosocial development, generativity is defined as the drive to benefit future generations and leave a legacy. The prototypical individual satisfies this generative desire through parenthood in midlife. This stage has been shown to expand into later life due to grandparenthood (Erikson, 1982). Generativity has been shown to predict life satisfaction, but the amount of generative concern and action can be impacted by factors such as perceived respect from younger generations (Cheng, 2009). The current study examined adults aged 40 and older (M age = 61 yr) using a nationwide sample from Qualtrics Panel Service to assess the extent to which perceived respect moderates the relation between generativity and life satisfaction in custodial grandparents. Results indicated that perceived respect from the grandchild was found to have a moderating effect on the relation between generativity of custodial grandparents and life satisfaction. Results suggest that for those who perceive low levels of respect from their grandchildren, the more generativity they express, the lower their life satisfaction. For those who perceive higher levels of respect from their grandchildren, the more generativity they express, the higher their life satisfaction. These findings suggest that as attempts to be generative increase, life satisfaction fluctuates. This may in turn impact the likelihood of generative actions from the custodial grandparent.
Role Centrality and Shared Activities With Grandchildren: Effects on Grandparent Depression
Authors: Marello Madeline , Patrick Julie
Published: December 2020

Research shows that physical and mental health are closely linked (Ohrnberger, Fichera, & Sutton, 2017). Further, social role theory states that holding and enacting valued roles, such as grandparenting, can buffer the negative effects of health on depression (Reitzes & Mutran, 2004). Using data from 247 grandparents (Mean age = 66.5; range 42 to 90 years; 46.2% grandfathers), we examined the differences between 164 custodial and 83 traditional grandparents on whether grandparent role centrality and engagement with grandchildren altered the effects of physical health on depression. The multigroup moderated moderation model was significant (X2(DF=30, N = 247) = 1610.78, p < .001; R2 = .797). We examined whether the paths were moderated by custodial status. Among custodial grandparents, role centrality (β = -.482**) and shared activities (β = -.493***) were significant predictors of depressive symptomatology. Moreover, the interaction between physical health and activities (β = .488***) and between physical health and role centrality (β = .522**) also accounted for significant variance among custodial grandparents. Custodial grandparents in poorer health who valued the grandparent role and those in poorer health who engaged with their grandchildren experienced fewer depressive symptoms. No such patterns were observed for traditional grandparents. Although we had anticipated that the interaction between role centrality and engagement with grandchildren would predict depressive symptoms, the interaction did not reach significance. Results are discussed in terms of the need to examine the differences of family/social contexts in grandparent populations.
Effects of Treatment Preference on Adherence, Attrition, and Process Measures Among Older Adult Worriers
Authors: Brenes Gretchen , Clary Heidi Munger , Miller Michael , Divers Jasmin , Anderson Andrea , Hargis Gena , Danhauer Suzanne
Published: December 2020

Patient preference may be related to treatment outcomes through decreased rates of attrition and higher rates of adherence and patient satisfaction. We present findings from a 2-stage randomized preference trial of cognitive-behavioral therapy (CBT) and yoga for the treatment of late-life worry. We examine rates of preference for CBT and yoga, as well as the stability of these preferences over time. We also examine the impact of preference on adherence, attrition, and process measures (satisfaction, treatment expectancies, and working alliance). Five hundred participants were randomized to either the randomized controlled trial (RCT; N=250) or the preference trial (participants chose the treatment; N=250). All participants received 10 weeks of an intervention. Among those in the preference trial, 48% chose CBT and 52% chose yoga (p>.05). Strength of preference was similar between the groups; 73.3% and 76.2% reported a strong preference for CBT and yoga, respectively (p>.05). Fourteen percent of those who preferred CBT at baseline preferred yoga upon completion of the intervention, while 12.2% of those who preferred yoga at baseline preferred CBT upon completion of the intervention (p>.05). There were no significant differences between participants in the RCT and preference trial on intervention adherence, attrition, satisfaction, or working alliance (p’s>.05). Treatment expectancies were higher for the preferred intervention (p’s<.0001). Results suggest that older adults prefer CBT and yoga at similar rates, and these preferences are stable. Receiving a preferred treatment had no effect on adherence, attrition, satisfaction, or working alliance.
Grandparenting and Well-Being of Hong Kong Older Adults: The Mediating Role of Intergenerational Relationships
Authors: Lai Daniel W L , Li Jessica J , Lee Vincent
Published: December 2020

Grandparenting and intergenerational relationship play important roles in some older adults‘ later life, especially older people of Chinese culture. This study investigated the relationship between grandparenting activities, intergenerational relationship, and psychosocial well-being of Hong Kong Chinese older adults. A representative sample of 507 grandparents (aged 55+) were telephone surveyed in June to July 2019. Level of involvement in grandparenting activities was measured. Resilience and happiness were measured by Connor-Davidson Resilience Scale and Subjective Happiness Scale. Two single-item instruments were adapted to capture the relationships between older adults and adult children, and between grandparents and grandchildren, respectively. A series of linear regressions and mediation tests with bootstrap approach were performed to examine the relationships between grandparenting activities, intergenerational relationship, and resilience and happiness. After controlling for socio-demographics, the frequency of grandparenting activities correlated positively with resilience and happiness. The relationship was partially mediated by inter-generational relationships including the relationships with adult children and grandchildren. The findings have concluded that grandparenting involvement and satisfactory intergenerational relationship are protective factors of health and wellbeing. Future healthy aging policy-making or programming should expand the scope from focusing on individual older adults to strategies of achieving the family-friendly goal so that intergenerational relationships could be better nurtured, benefiting not just the family as a functional unit but also the older adults’ healthy aging.