bluuebunny/crossref_metadata_2025 huggingface dataset:
Caring for Older Adults with Vision Impairment and Dementia: Data from the National Study of Caregiving
Authors: Varadaraj Varshini , Swenor Bonnielin , Chyng Shang-En , Sheehan Orla , Deemer Ashley , Ehrlich Joshua , Wolff Jennifer , Roth David
Published: December 2020

We examined caregiving relationships for individuals with vision impairment (VI) and dementia, using 2011 National Health and Aging Trends Study (NHATS) data, a survey of Medicare beneficiaries, linked to the National Study of Caregiving, a survey of family/unpaid helpers to NHATS participants. VI was defined as self-reported blindness or difficulty recognizing someone across the street, watching television or reading newspaper print. Dementia was defined as probable dementia based on survey-report or AD8 criteria. Caregiving outcomes included: (1) hours of care provided in the last month and (2) number of valued activities affected by caregiving. Among 1,196 caregivers, 617 assisted older adults without dementia or VI (D-/VI-), 298 with dementia but without VI (D+/VI-), 143 without dementia but with VI (D-/VI+), and 138 with dementia and VI (D+/VI+). In fully-adjusted regression models, caregivers of older adults D+/VI+ spent twice as many hours (IRR=2.0; 95%CI: 1.5-2.7) providing care than caregivers of older adults D-/VI-; however, caregivers of adults D+/VI- and those providing to older adults D-/VI+ spent 1.5-times more hours (95% CI=1.2-1.7; 95% CI=1.1-2.0, respectively). Additionally, caregivers of older adults D+/VI+ reported 4 times as many valued activities were affected (95%CI=2.8-5.6) then caregivers of those D-/VI-, while caregivers of those D+/VI- reported 1.9-times (95% CI=1.3-2.8) and D-/VI+ 1.6-times (95% CI=1.1-2.3) more activities were affected. Our results suggest that caring for older adults with VI has similar demands as caring for older adults with dementia, but that these implications may be magnified when caring for older adults with both dementia and VI.
Whole-Person, Whole-Team Approach to Quality Improvement: Why Person-Centered Care Matters
Authors: Engle Ryann , Snow A Lynn , Clark Valerie , Zhao Shibei , Gillespie Christopher , Hartmann Christine
Published: December 2020

The Department of Veterans Affairs (VA) began its culture transformation journey in 2006, supporting its nursing homes in providing high-quality, person-centered care in person-centered environments. We implemented a quality improvement intervention to support frontline staff from low-performing VA nursing homes in providing high-quality care using a whole-person, whole-team approach. The intervention consisted of a bundle with four components: 1) specialized frontline staff huddles that encouraged high-quality frontline staff communication and collaboration, 2) micro-root cause analyses and targeted interventions to promote resident sleep and reduce resident falls through individualized care, 3) in-depth frontline conversations regarding residents’ distress behaviors and mobility, and 4) targeted, team-based, person-centered performance improvement projects. The intervention was implemented at 8 low-performing VA nursing homes (August 2018 - April 2019) via in-person and virtual sessions and facilitated through CLC-based champions and intervention team-based coaches. We monitored the intervention’s impact using pre-post Centers for Medicare and Medicaid Services quality star ratings. We also conducted 17 post-intervention interviews with key informants at 7 participating nursing homes and conducted a content analysis of the data. Pre intervention, all 8 nursing homes had a history of being 1 or 2 stars in overall quality. Post intervention, 3 homes increased 1 star; 1 home increased 2 stars; 2 homes increased 3 stars; 2 homes increased 4 stars. Post intervention, participants perceived improved delivery of person-centered care (e.g., providing individualized sleep hygiene, de-implementing alarms). Our findings suggest a whole-person, whole-team intervention can effectively and efficiently improve both person-centered care and care quality.
Bidirectional Longitudinal Relationships Between Homebound Status and Falls Among Older Adults
Authors: Liu Minhui , Li Yuxiao , Sun Xiaocao , Miyawaki Christina , Hou Tianxue , Tang Siyuan , Szanton Sarah
Published: December 2020

Research has shown an association between homebound status and falls among older adults. However, this association was primarily drawn from cross-sectional studies. Using the National Health and Aging Trends Study, we examined 1) whether prior-wave falls predicted homebound status in a later wave in 2,916 non-homebound participants in Wave 1 and 2) whether prior-wave homebound status predicted falls in 2,512 participants with no falls in Wave 1. Homebound status (non-homebound and homebound) was determined by the frequency, difficulty, and needing help of outdoor mobility. Falls were ascertained by asking participants whether they had a fall in the last year. Generalized estimation equation models were used to examine their bidirectional association, adjusting for demographics, health-related, and behavioral factors. Participants who had fallen in later waves were more likely to be older non-Hispanic black, comorbid, and have more pain, depression, disabilities, worse health status vision impairment, and low physical activities. Participants who were homebound in later waves tended to older, female, non-Hispanic black, less-educated, living alone or with others only, comorbid, obese, and have more pain, depression, disabilities, worse health status, more hospitalizations, vision and hearing problems, and low physical activities. Previous falls significantly predicted later homebound status (adjusted odds ratio [OR]: 1.28, 95% CI: 1.09-1.50). Prior wave homebound status also significantly contributed to falls in the next year (adjusted OR: 1.28, 95% CI: 1.12-1.46). The bidirectional longitudinal association between homebound status and falls suggests a vicious circle between them. Fall prevention programs should particularly target homebound older adults for falls reduction.
Machine Learning in Aging: An Example of Developing Prediction Models for Serious Fall Injury in Older Adults
Authors: Speiser Jaime , Callahan Kathryn , Fanning Jason , Gill Thomas , Newman Anne , Pahor Marco , Rejeski Jack , Houston Denise
Published: December 2020

Advances in computational algorithms and the availability of large datasets with clinically relevant characteristics provide an opportunity to develop machine learning prediction models to aid in diagnosis, prognosis, and treatment of older adults. Some studies have employed machine learning methods for prediction modeling, but skepticism of these methods remains due to lack of reproducibility and difficulty understanding the complex algorithms behind models. We aim to provide an overview of two common machine learning methods: decision tree and random forest. We focus on these methods because they provide a high degree of interpretability. We discuss the underlying algorithms of decision tree and random forest methods and present a tutorial for developing prediction models for serious fall injury using data from the Lifestyle Interventions and Independence for Elders (LIFE) study. Decision tree is a machine learning method that produces a model resembling a flow chart. Random forest consists of a collection of many decision trees whose results are aggregated. In the tutorial example, we discuss evaluation metrics and interpretation for these models. Illustrated in data from the LIFE study, prediction models for serious fall injury were moderate at best (area under the receiver operating curve of 0.54 for decision tree and 0.66 for random forest). Machine learning methods may offer improved performance compared to traditional models for modeling outcomes in aging, but their use should be justified and output should be carefully described. Models should be assessed by clinical experts to ensure compatibility with clinical practice.
Racial and Ethnic Disparities at End of Life Among Persons With Alzheimer’s Disease and Related Dementias
Authors: Rising Morgan , Hair Nicole
Published: December 2020

End-of-life (EOL) care for persons with Alzheimer’s disease and related dementias (ADRD) is heterogeneous and, often, inconsistent with patients’ priorities. While differences in physician-patient communication or the health care decision-making process likely contribute to disparities in EOL care, little is known about the relationships between race, advance care planning (ACP), and quality of care among persons with ADRD. The aim of this study was to (1) characterize trends in both ACP and EOL treatment intensity in persons with ADRD and (2) test whether racial differences in ACP mediate disparities in EOL care. We analyzed a population-based cohort of older adults with cognitive impairment or dementia who participated in the Health and Retirement Study (HRS) and died between 2000 and 2014 (n = 5,316). While participation in ACP among persons with ADRD increased from 2000 to 2014 (66% to 83%, P < 0.05), models stratified by race showed that differences in participation rates across white and nonwhite persons with ADRD persisted over the sample period. Racial disparities in the location of death, a proxy for the intensity of EOL care, narrowed from 2000 to 2014. However, next-of-kin surrogates of nonwhite persons with ADRD were much more likely to report the decedent received “all care possible…in order to prolong life”. Assignment of a durable power of attorney was found to influence location of death, while both creation of a living will and participation in discussions about EOL care preferences were found to influence the likelihood that decedents received all possible life-prolonging treatments.
Reasons for Non-Participation in an Actigraphy Study in an Alzheimer’s Disease Center Registry
Authors: Laffer Alex , Hicks Hilary , Losinski Genna , Watts Amber
Published: December 2020

When recruited individuals decline to participate in research, it can lead to sampling bias, increased costs, and extended duration of data collection. Understanding reasons why eligible participants decline participation may improve study enrollment rates. We aimed to understand barriers to recruitment and data collection in older adults with and without Alzheimer’s disease in the University of Kansas Alzheimer’s Disease Center Registry annual visit. We recruited Registry participants to join an observational sub-study using wrist-worn actigraphy to measure physical activity and sleep. We analyzed reasons for non-enrollment from encounters with non-participating individuals. Of 104 encounters, 37 were never recruited due to appointment cancellation, rescheduling, or no-show. Of the remaining encounters, the most common reasons for non-participation were physical limitations (N = 13), study logistics (e.g., limited supplies; N = 12), participant travel plans (N = 10), and unknown (N = 8). Other categories (N = 6) included disinterest, study partner concerns about pragmatics (e.g., fear that an individual with AD would lose the ActiGraph), problems with the study design (e.g., lack of feedback to participants), and participants’ limited availability or deferment to a later date. These findings offer insight into potential avenues to overcome barriers to participation in older adults already engaged in ongoing research through an Alzheimer’s Disease Center Registry. Researchers could benefit from adapting study procedures to correct for reasons of non-participation. For example, giving more education and reassurance to potential participants about observation and giving feedback regarding activity patterns.
Is Immediate Recall test scores affected by Anxiety in a memory clinic population? A clinical correlation study
Authors: Khachan Hamed , Nair Anil , Andrea Fioralba , Kanjolia Mahak
Published: December 2020

Background: It is unknown if anxiety affects performance on immediate recall testing (IR) in memory clinic patients. Method: We performed a retrospective analysis of memory clinic patients in the south shore of Boston from 2010 to 2019. We correlated anxiety screen data (GAD7) to IR scores. Univariate analyses used Spearman correlation. A multivariate regression model analyzed GAD7 to covariates of IR, age, sex, and race. Hypothesis: We hypothesized a positive correlation between anxiety levels scored by GAD7 and IR. Results: 994 patients in the memory clinic between 2010-2020 had analyzable data. Patients were 58.6% female, 84.6 % White. The mean age was 70.1±14.4, IR 6.62 ± 5.4, GAD7 5.5±5.71. On univariate analysis, IR correlated significantly to age (⍴ = 0.08, p = 0.01), gender (⍴ = 0.06, p = 0.046), and race (⍴= - 0.25, p <0.001), but not to GAD7 (⍴=-0.07, p=0.14). The multivariate model confirmed the lack of association of anxiety scores to (□=-0.05, p=0.41) to GAD7 scores. IR task performance was significantly associated only to age (□= -0.04, p=0.03) and gender (□= -1.18, p=0.04) in the regression model. Conclusions: Immediate recall task performance was not significantly affected by anxiety measured by GAD7 scores in a memory clinic population. However, a negative correlation was shown on immediate recall scores in males and older subjects.
Moderating Effect of Cognitive Reserve on Brain Integrity and Cognitive Performance
Authors: Nelson Monica , Andel Ross , Martinkova Julie , Čechová Kateřina , Marková Hana , Hort Jakub
Published: December 2020

Dementia is arguably the most devastating condition of older adulthood with treatment options still elusive. Alzheimer’s is the most prevalent form of dementia where cognitive deficits relate strongly to underlying brain pathology. However, there exist cases in which cognitive performance does not match the corresponding level of neuropathology. Attempts to explain this phenomenon often include the concept of cognitive reserve (CR), whereby greater CR (e.g., more education or higher occupational position) presumably results in less impairment relative to the extent of pathology early in disease progression but also greater impairment once cognitive symptoms manifest. We examined the influence of CR proxy variables (education and occupation) on the relationship between hippocampal volume and cognitive performance on tests of executive control and memory using data from the Czech Brain Aging Study (CBAS). Participants were cognitively normal/with subjective cognitive decline but without actual impairment (CN; n=115; M(age)=66.43; M(education)=15.90; 37 men) or had amnestic mild cognitive impairment (aMCI; n=165; M(age)=71.37; M(education)=14.92; 85 men). We found that hippocampal volume was significantly related to executive control (b=-.0001, p=.03) and memory (b=.0002, p<.001) for participants with aMCI, but only memory (b=.0002, p=.03) for CN participants. Occupational position moderated the association between memory and hippocampal volume in aMCI, with the result approaching significance (p=.07), whereby a greater link between memory problems and hippocampal atrophy was present in those previously in high occupational positions. No other moderations for occupational position or education emerged (ps>.25). We found evidence for the concept of CR using occupational position as proxy.
Music and Memory in Dementia Care: Comfort With Harmony
Authors: Vinoo Deepa
Published: December 2020

Data show a substantial increase in the number of people with diagnosis of dementia nationally and globally. Behavioral disturbances among persons with dementia including agitation and psychosis form a constellation of symptoms referred to as behavioral and psychological symptoms of dementia (BPSD).BPSD impacts heavily on resident’s quality of life, caregivers stress and management options for the team. FDA do not approve usage of psychotropic for Dementia related Behaviors.This study was conducted in six memory care units ,N-150.Prior to the project Psychotropic usage was 64% ,physical altercations, fallsand staff been out due to work related injury were high in those units. In 2014 a memory care team came together , identified gaps and created structured memory care units with memory care programs which includes , consistent trained staffing, meaningful engagement of residents, psychotropic stewardship program , shift from medical model to palliative model of care,person centered approach, music& memory program, shared governance, staff empowerment. All residents in those units were assessed for Psychotropic usage, falls, pain management. transfer to acute hospitals and 1;1 from 2014 to 2019. Results, Usage of Music& Memory increased from 4% 75%, Anti psychotic usage reduced by 18%, Falls reduced by 12%, Physical altercation decreased from 12 to 0, Improved pain Management .Significant reduction in transfer to acute hospitals. Reduced 1;1 from 6 to 1.Staff verbalized increased satisfaction and decreased stress. Improved family involvement. Increased bonding between residents, staff and families.Decresed work related injury while giving care.
Stress Mediating Genes in Aging, Health, and Longevity Traits: Effects of Multiple Interactions
Authors: Yashin Anatoliy , Wu Dequing , Arbeev Konstantin , Yashkin Arseniy , Gorbunova Galina , Akushevich Igor , Duan Matt , Ukraintseva Svetlana
Published: December 2020

Persistent stress of external or internal origin accelerates aging, increases risk of aging related health disorders, and shortens lifespan. Stressors activate stress response genes, and their products collectively influence traits. The variability of stressors and responses to them contribute to trait heterogeneity, which may cause the failure of clinical trials for drug candidates. The objectives of this paper are: to address the heterogeneity issue; to evaluate collective interaction effects of genetic factors on Alzheimer’s disease (AD) and longevity using HRS data; to identify differences and similarities in patterns of genetic interactions within two genders; and to compare AD related genetic interaction patterns in HRS and LOADFS data. To reach these objectives we: selected candidate genes from stress related pathways affecting AD/longevity; implemented logistic regression model with interaction term to evaluate effects of SNP-pairs on these traits for males and females; constructed the novel interaction polygenic risk scores for SNPs, which showed strong interaction potential, and evaluated effects of these scores on AD/longevity; and compared patterns of genetic interactions within the two genders and within two datasets. We found there were many genes involved in highly significant interactions that were the same and that were different within the two genders. The effects of interaction polygenic risk scores on AD were strong and highly statistically significant. These conclusions were confirmed in analyses of interaction effects on longevity trait using HRS data. Comparison of HRS to LOADFS data showed that many genes had strong interaction effects on AD in both data sets.
Functional Measures Are Severely Under-Captured in Electronic Health Records
Authors: Schiltz Nicholas , Foradori Megan , Reimer Andrew , Dolansky Mary
Published: December 2020

Electronic health records (EHR) data are increasingly used to inform clinical care decisions, assess quality of care, and identify patients at high-risk of poor outcomes (e.g. readmission). Functional measures—including mobility and the ability to perform activities of daily living (ADLs)—are key indicators associated with health-related quality of life and chronic disease management in older adults. The goal of this analysis was to quantify the extent that measures of function are used in a national pool of structured EHR data. We used 2017-2019 data from IBM Watson Health Explorys, representing EHR data from 27 health systems and 360 hospitals nationwide (n=5,224,530 adults age 65 and older). Structured EHR data were mapped to SNOMED-CT codes that identifed six categories of function: mobility, fine motor, gross motor, large muscle, ADLs, and instrumental ADLs. Results indicated that only 3 of the 6 categories were used: ADLs (4.2% of study population), mobility (3.2%), and gross motor skills (2.4%). Fine motor, IADLs, and large muscle function were not recorded in any patients. These results indicate that functional measures appear to be under-reported in structured EHR data when compared to published estimates of the population prevalence. In conclusion, measures of function and mobility remain largely unused in structured EHR data, likely because this information is either not assessed, unavailable for inclusion, or is captured in a non-structured format (e.g. clinical notes). Comprehensive functional measures need to be added to EHRs to assess quality and improve delivery and outcomes in older adult patients.
Diverse Sources of Social Support and Cognitive Functioning by Race, Ethnicity, and Nativity
Authors: Gauthier G Robin , Garcia Marc , García Catherine
Published: December 2020

This study examines the relationship between social support profiles and cognitive functioning by race, ethnicity and nativity in older adults using cross-sectional data drawn from the Health and Retirement Study (2010 and 2012). We employed a hierarchical clustering routine to generate nine support profiles that differentiated three sources of support: children, wider family relationships and friendships. Cognitive functioning was measured as the score on the Telephone Interview for Cognitive Status (TICS-m), a 27 point scale of cognitive function. Our approach explicitly acknowledges the ambivalence and multidimensionality of close relationships and the resources embedded within them. Descriptive analyses revealed significant differences in access to support across demographic groups. White respondents are over-represented in profiles that are characterized by support from friends, and under-represented in family support profiles. The reverse is found among Foreign-born Hispanic respondents who are over-represented in the profiles characterized by high family support and under-represented in those with high friend support. Native-born Hispanic respondents and Black respondents have less clear support patterns, although both are more likely to receive support from family and children compared to friends. Findings from the poisson regression suggest that the relationship between familial support and cognitive decline is stronger among Hispanic respondents, particularly those who are foreign born. These findings are supported even with the inclusion of other relationship quality indicators including negative support and frequency of contact.
Efficacy of Different Types of Exercise on Cognitive Function in People With MCI or Dementia: A Network Meta-Analysis
Authors: Wan Qiaoqin , Huang Xiuxiu , Zhao Xiaoyan , Li Bei , Cai Ying , Zhang Shifang
Published: December 2020

With the accelerating progress of population aging, cognitive dysfunction is becoming increasingly prevalent. Exercise, as a promising non-pharmaceutical therapy, showed favorable effects on cognitive function. But which type is the most effective exercise treatment is still unclear. This study compared the efficacy of different types of exercise interventions based on network meta-analysis and aimed to explore the optimal exercise treatment for cognitive decline. The electronic databases of PubMed, Web of Science, Embase, Cochrane Central Register of Controlled Trials, SPORTDiscus, PsycInfoy, and OpenGrey were searched from inception to September 2019. We only included randomized controlled trials that examined the effectiveness of exercise interventions in people with MCI or dementia. Primary outcomes were global cognition, executive function and memory function. Standard mean difference (SMD) and its 95% confidence interval (CI) were calculated to estimate the effect sizes. Finally, 73 articles with 5748 participants were included. The results showed all kinds of exercise interventions were effective on global cognition and resistance exercise was probably the most effective exercise treatment to prevent the decrease of global cognition (SMD=1.05, 95%CI 0.56-1.54), executive function (SMD=0.85, 95%CI 0.21-1.49) and memory function (SMD=0.32, 95%CI 0.01-0.63) for people with cognitive dysfunction. Subgroup analysis revealed multi-component exercise showed more favorable effects on global cognition (SMD=0.99, 95%CI 0.44-1.54) and executive function (SMD=0.72, 95%CI 0.06-1.38) in people with MCI. In conclusion, resistance exercise tended to be the optimal exercise type for people with cognitive dysfunction, especially for people with dementia. And multi-component exercise also should be recommended for people with MCI.
Awareness of Losses and Not Gains Predicts Moderate-to-Vigorous Physical Activity
Authors: O’Brien Erica , Diehl Manfred , Cerino Eric , Almeida David
Published: December 2020

The current study used data from a nationally representative sample of middle-aged and older adults to examine the synergistic relationship between negative and positive self-perceptions of aging on two types of physical activity (PA) and sedentary behavior. Participants from Wave 3 of the National Study of Daily Experiences reported on their awareness of age-related losses and gains, the frequency, duration, and intensity of their PA, and their sedentary behavior across seven days. We performed separate hierarchical models that regressed moderate-to-vigorous exercise, walking, and sitting on perceived losses and gains. Results revealed a significant main effect of perceived losses on moderate-to-vigorous exercise (p=.005, 95% CI=[-121.79,-22.267]). People who perceived more losses than average also reported engaging in fewer minutes of effortful PA. Results also suggested a marginal trend for more perceived losses to predict less walking (p=.055, 95% CI=[-42.85,0.42]) but to have no impact on sitting time (p=.58). Neither perceived gains nor the interaction between perceived gains and perceived losses emerged as significant predictors (ps>.17). Previous work demonstrates a facilitative role played by positive (self-)perceptions of aging on engagement in preventive health behaviors that have important impacts on long-term developmental outcomes. We explored additive and multiplicative effects associated with gain- and loss-related perceptions on PA and sedentary behavior to improve our understanding of the psychological context that surrounds the views of aging and health link. Initial findings suggest differential consequences of positive and negative self-perceptions of aging on distinct health-related behaviors, with the latter being stronger and contributing to activity inhibition.
Physical Activity Programming and Physical Function of Older Adults in Adult Day Centers: A Mixed-Methods Approach
Authors: Soto Yuliana , Aguinaga Susan , Guzman Jacqueline
Published: December 2020

With increased prevalence of Alzheimer’s disease, there is a need for long-term care services (e.g., Adult Day Centers (ADCs)) to provide physical activity (PA) programs to maintain physical function of older adults. ADCs report offering PA programs; however, information on PA programs and physical function of participants attending ADCs is limited. The study aims to a) explore perspectives of ADC directors on PA programming; b) examine physical function in older adults attending ADCs. A cross-sectional mixed-methods study was conducted among ADC directors and attending participants. Interviews were conducted with ADC directors to assess barriers and facilitators of PA programming. Physical function was assessed among ADC participants via the Short Physical Performance Battery (SPPB) and Timed Up and Go (TUG). Five director interviews were conducted and three major themes emerged; 1) current PA programming limited by fear of falls, 2) staff training and retention, and 3) diversifying PA programming. Twenty-nine ADC participants enrolled in the study, Mage= 74.5±8.2 years; BMI= 29.2 ±7.4 kg/m2; MMSE= 25.6 ±3.3; 51.7% (n=15) African American; 79.3% (n=23) males. ADC participants scored 6.7±3.1 on the SPPB and 15.4±5.3 seconds on the TUG. Directors expressed the importance of PA; however, mentioned current programming was limited due to risk of falls and untrained staff in PA. Findings indicate that older adults attending ADCs have physical function scores indicative of high fall risk. Future PA programming may consider including alternative forms of PA while embedding falls prevention strategies to reduce risk of falls and improve physical function among ADC participants.
The Oklahoma Falls Prevention Program Targeting Rural Community-Dwelling Older Adults
Authors: Kleszynski Keith , Campbell Janis , Henley Omolara , Jennings Lee
Published: December 2020

The Oklahoma Healthy Aging Initiative is a statewide health promotion program for older adults based at the University of Oklahoma. Seven staff educators and 32 volunteers delivered 2 community-based fall prevention programs, Staying Active and Independent for Life (SAIL) and Tai Chi Quan: Moving for Better Balance (TCBB) to 763 older Oklahomans in 71 sites across the state over 9 months. For both programs, twenty-four 60-90 minute classes were delivered over 12 weeks with pre and post assessments completed at the first and last class, respectively. Two hundred ninety eight participants (39%) completed at least 75% of class sessions and to date 140 completed a posttest evaluation and were included in the evaluation. Participants were mostly older (87% ≥60 years), female (86%), college educated (45%), white (87%), and most participated in TCBB (89%). Participants improved in 2 physical performance measures: mean 30-second chair stands increased from 11.5 (SD3.8) to 13.1 (SD3.4) stands (p<0.0001); and mean timed up and go time decreased from 10.0 (SD2.9) to 9.4 (SD2.9) seconds (p=0.004 ). More participants reported vigorous or moderate activity at least 3 times per week after program completion, 134 (96%) vs. 114 (81%), p=0.0001. There was no difference in measures of global health, satisfaction with social roles and activities, or companionship with participant mean scores near the upper range of these scales at baseline. Older Oklahomans participating in community-based exercise report good overall health and report high social connection. Future efforts will focus on more socially isolated older adults and diverse communities.
The Importance of Positive Events When Living With Chronic Pain
Authors: Kircher Julie , Charles Susan , Sin Nancy , Almeida David
Published: December 2020

Chronic pain is a common condition in later life that is related to high levels of anxiety and depression. One reason why chronic pain is related to affective distress is that this condition may prevent people from deriving the same positive emotions from enjoyable activities. Few studies, however, have examined how exposure and reactivity to daily events differ by chronic pain status. We hypothesized that those with chronic pain will have less exposure and less positive affect reactivity to positive daily events compared to those without chronic pain. Participants from the diary substudy of MIDUS (N = 1,733; nChronicPain = 658, nNoPain = 1,075; M = 56 years-old) completed eight interview days. Chronic pain status was unrelated to the frequency of positive events. Multi-level models revealed that although people with chronic pain had lower levels of daily positive affect, they reacted more positively to daily events (γ = -.033, SE = .010, p < .0001). As a result, levels of daily positive affect on days when people experienced a positive event did not vary by pain status (MChronicPain = 2.73, MNoPain = 2.75). People with chronic pain averaged higher levels of daily negative affect compared to people without chronic pain (MChronicPain = .21, M NoPain =.20), but, on days when they experience a positive event, those with chronic pain had a greater decrease in their negative affect. Findings suggest that positive events impact those with chronic pain more than they do individuals without chronic pain.
Entomological and Anthropological Factors Contributing to Persistent Malaria Transmission in Kenya, Ethiopia, and Cameroon
Authors: Bamou Roland , Rono Martin , Degefa Teshome , Midega Janet , Mbogo Charles , Ingosi Prophet , Kamau Alice , Ambelu Argaw , Birhanu Zewdie , Tushune Kora , Kopya Edmond , Awono-Ambene Parfait , Tchuinkam Timoléon , Njiokou Flobert , Yewhalaw Delenasaw , Antonio Nkondjio Christophe , Mwangangi Joseph
Published: December 2020

Introduction

In order to improve our understanding of the fundamental limits of core interventions and guide efforts based on prioritization and identification of effective/novel interventions with great potentials to interrupt persistent malaria transmission in the context of high vector control coverage, the drivers of persistent disease transmission were investigated in three eco-epidemiological settings; forested areas in Cameroon, coastal area in Kenya and highland areas in Ethiopia.

Methods

Mosquitoes were sampled in three eco-epidemiological settings using different entomological sampling techniques and analysed for Plasmodium infection status and blood meal origin in blood-fed specimens. Human behavioural surveys were conducted to assess the knowledge and attitude of the population on malaria and preventive measures, their night activities, and sleeping pattern. The parasitological analysis was conducted to determine the prevalence of Plasmodium infection in the population using rapid diagnostic tests.

Results

Despite the diversity in the mosquito fauna, their biting behaviour was found to be closely associated to human behaviour in the three settings. People in Kenya and Ethiopia were found to be more exposed to mosquito bites during the early hours of the evening (18-21h) while it was in the early morning (4-6 am) in Cameroon. Malaria transmission was high in Cameroon compared to Kenya and Ethiopia with over 50% of the infected bites recorded outdoors. The non-users of LLINs were 2.5 to 3 times more likely to be exposed to the risk of acquiring malaria compared to LLINs users. Malaria prevalence was high (42%) in Cameroon, and more than half of the households visited had at least one individual infected with Plasmodium parasites.

Conclusions

The study suggests high outdoor malaria transmission occurring in the three sites with however different determinants driving residual malaria transmission in these areas.
A Menu of Models
Authors: Van Schaack Beth
Published: December 2020

Given the limited availability of the International Criminal Court (ICC) when it comes to the crimes being committed in Syria, chapter 6 presents an array of legal theories and practical modalities for exercising international jurisdiction that do not involve the ICC or the U.N. Security Council, including a number of innovative paradigms for creating a dedicated ad hoc international tribunal. These options include the potential for a subset of states to pool their respective jurisdictional competencies to create a tribunal reminiscent of the Nuremberg Tribunal. Other available models include additional action at the U.N. General Assembly; a regional tribunal within the League of Arab States; a tribunal created by way of an international agreement among interested states; trials before specialized chambers in liberated areas within Syria or within neighboring states with varying degrees of international involvement; or the building of a shell of a special chamber that could be eventually inserted into the Syrian judicial system post-transition. Any of these models could incorporate various elements of hybridity. The chapter argues that many of these models offer a better option for the situation in Syria than the ICC given the extent and nature of the international crimes being committed (war crimes in a largely non-international armed conflict) and limitations within the ICC’s subject matter and personal jurisdiction. The chapter closes with a pragmatic discussion of steps that the international community could have taken to lay the groundwork for any of the models discussed, even prior to the end of the conflict or a political transition in Syria.
Civil Suits
Authors: Van Schaack Beth
Published: December 2020

Rounding out the matrix of accountability, chapter 8 presents several nonpenal options to bring justice to Syria, including civil suits in domestic courts against responsible individuals and entities and options for exercising jurisdiction over the sovereign state of Syria. Because there is no notion of state criminality under international law, only civil claims seeking money damages can be advanced against sovereign states. Jurisdiction over Syria exists before the International Court of Justice (ICJ) under the Convention against Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment; however, so far no state has been willing to take Syria to task before the ICJ. And so, victims must bear this burden. In this regard, some tort law options exist in domestic courts, especially in the United States with its suite of statutes giving its domestic courts jurisdiction over certain international law violations in certain circumstances. This chapter features a groundbreaking suit against Syria under the United States’ Foreign Sovereign Immunities Act, which resulted in a $300 million judgment for the surviving family members of Marie Colvin, the intrepid war correspondent assassinated by the Syrian regime. The chapter observes that although civil remedies are no substitute for vigorous criminal liability, these suits do extend victims some dignitary benefits that may not accrue with participation in a criminal process, even as a partie civile, including the opportunity to control the litigation process and act where the public authorities may be unable or unwilling to do so.
Epilogue
Authors: Dalle Vacche Angela
Published: December 2020

Bazin’s model of spectatorship is grafted onto the system of the arts, with the sensuality of painting at the bottom. By contrast, the abstractions of literature belong to the top of cinema’s trajectory toward an anti-anthropocentric stance. It is as if cinema could recapitulate the history of technology and Darwinian evolution inside our consciousness so that we may better understand how we overlap with, as well as differ from, animals, plants, objects, and machines. Dialogical with Edgar Morin’s sense that man is not above nature, but only a fact in the cosmos, Bazin is most likely to disagree with Teilhard de Chardin’s anthropocentric noogenesis. Interestingly, Bazin devotes his very last essay to how humble farming weaves itself around the religious ruins of Saintonge, thus emphasizing mankind’s resilience as well as finitude.
Employers as Shapers of Health
Authors: Plough Alonzo L.
Published: December 2020

This chapter assesses the role of employers as Culture of Health mediators. With their significant influence over the lives of their workforce, employers have the authority to make choices that either promote or inhibit a Culture of Health within their organizations. They also may play important roles in building a Culture of Health in the communities in which they are located and where their employees live. The chapter then considers the approaches taken by three types of employers—Fortune 500 companies, a large retail chain, and the military. Two studies of Fortune 500 companies examine corporate transparency in reporting health-promotion policies and efforts to create healthy work environments and strengthen communities. Another study illustrates the feasibility of stabilizing work schedules of low-wage retail workers to benefit workers as well as store sales.
Driving Innovation Through Medicaid
Authors: Plough Alonzo L.
Published: December 2020

This chapter highlights the expanding use of Medicaid to address social determinants of health, particularly housing instability and opioid addiction. Medicaid today is a core component of the nation's health care system, providing health coverage to more than 66 million people. With one in five Americans participating in Medicaid, the program has the reach and influence to play a key role in promoting health and health equity, especially through research and demonstration waivers that allow states to experiment. The chapter then offers examples of innovative programming and service delivery in three states and looks at a major insurer’s commitment to address the root causes of homelessness among its Medicaid beneficiaries. However, the significant infrastructure and start-up costs involved in implementing Medicaid reforms loom as potential barriers. Health care and social service providers will need to develop new information systems, recruit and retrain providers, and establish data-exchange protocols in order to realize the benefits from the federal infusion of new money into Medicaid.
Scripture as External Authority
Authors: Guhin Jeffrey
Published: December 2020

In these schools (and in many other communities) scripture is understood and experienced as an “external authority,” itself making claims and commanding action, even if that authority was understood as that of an “agent of God” rather than a final, ultimate authority. There was a key difference in how the Qur’an and Bible were approached both individually and collectively, with the Qur’an understood as a slightly more difficult text that required more expert interpretation and the Bible understood as democratically available and hermeneutically clear. Scripture gains its authority in a few ways. First, it functions as a powerful boundary from other communities. Second, it is understood and described as an autonomous agent that acts in people’s lives. Third, scripture maintains its power through its role as a practice in people’s day-to-day experience of relating to the text, especially reading and memorizing.
The Only Wonderful Things
Authors: Homestead Melissa J.
Published: December 2020

This book tells for the first time the story of the central relationship of novelist Willa Cather’s life, her nearly forty-year partnership with Edith Lewis. Cather has been described as a distinguished artist who turned her back on the crass commercialism of the early twentieth century and as a deeply private woman who strove to hide her sexuality, and Lewis has often been identified as her secretary. However, Lewis was a successful professional woman who edited popular magazines and wrote advertising copy at a major advertising agency and who, behind the scenes, edited Cather’s fiction. Recognizing Lewis’s role in Cather’s creative process changes how we understand Cather as an artist, while recovering their domestic partnership (which they did not seek to hide) provides a fresh perspective on lesbian life in the early twentieth century. Homestead reconstructs Cather and Lewis’s life together in Greenwich Village and on Park Avenue, their travels to the American Southwest that formed the basis of Cather’s novels The Professor’s House and Death Comes for the Archbishop, their summers as part of an all-woman resort community on Grand Manan Island, and Lewis’s magazine and advertising work as a context for her editorial collaboration with Cather. Homestead tells a human story of two women who chose to live in partnership and also explains how the Cold War panic over homosexuality caused biographers and critics to make Lewis and her central role in Cather’s life vanish even as she lived on alone for twenty-five years after her partner’s death.
Beginnings
Authors: Hefling Charles
Published: December 2020

The 1662 Book of Common Prayer is a revised recension of a liturgical text, first issued in 1549, which was at once an engine and a product of the English Reformation. This chapter situates the original Prayer Book in that context, and offers a detailed examination of its most contested text: the Supper of the Lord and the Holy Communion. This service was heavily revised in 1552, and the revisions shed light on the intentions of the revisers and the meaning of the revised text, which remains largely the same in the final revision of 1662. Among the theological issues involved were justification by faith, the presence of Christ, the nature of a sacrament, and the purpose of the eucharistic liturgy in a reformed church. This chapter also considers, more briefly, the revisions of other services that were made in 1552.
Recessional
Authors: Hefling Charles
Published: December 2020

In the nineteenth century, pressures that strained the boundaries of Anglican Christianity, in so far as the Prayer Book defined them, came largely from the advanced “high-church” movement known as Anglo-catholicism, which sought to recover or re-introduce liturgical practices that had been abolished at the Reformation. An attempt to deal with the nonconformity of Anglo-catholic “ritualists” led to a proposed revision of the Book of Common Prayer that Parliament declined to endorse. Nevertheless, revision gathered momentum, with the result that by the end of the twentieth century the “classical” Prayer Book had been superseded by other, modernized liturgies throughout the Anglican world. While it remains a venerable book, the Book of Common Prayer may be revered for what it once was more than for what it is.
What the Protectors Protect
Authors: Coverage Crime
Published: December 2020

Although a suspect’s name and other identifying details are part of the public record or supplied to reporters by police, news media in the Netherlands, Sweden, and Germany routinely protect suspects and even convicted criminals from public exposure. We group these countries in a Protector model. Journalists said they weigh their obligation to inform the public against (1) protecting the defendants’ families—especially if they have children; (2) respecting the right to the presumption of innocence; and (3) avoiding dissemination of information that could damage the defendant’s reputation and/or chance for reintegration. Protector countries share a faith that many criminals can successfully reintegrate into society. Journalists are most likely to protect the private person accused of a crime in the private sector and least likely to protect a public figure or official accused of a public crime.
Institutioni Scholasticae Minime Accommodata
Authors: Heßbrüggen-Walter Stefan
Published: December 2020

This contribution reconstructs the controversy between Gerard de Neufville (1590-1648) and Johann Clauberg about the comparative merits of Bacon and Descartes in the university classroom. This controversy had a crucial pragmatic dimension, evaluating the question of how Baconian and Cartesian philosophical projects could meet the pedagogical needs of the university as an educational institution. The exchange between de Neufville and Clauberg shows that textbooks of natural philosophy contain important discussions of pedagogical practice. De Neufville fears that a revolution of natural philosophy along Baconian lines may well take centuries. But professors still need something to teach to students. Therefore, he envisions a Baconian philosophia nov-antiqua that reintroduces certain aspects of Aristotelian science into a broadly Baconian empirical investigation of nature. Clauberg’s criticism of his teacher focuses on two perceived weaknesses. First, Baconian doubt renders natural philosophy unteachable; while Cartesian doubt does not, because it can be dissolved comparatively quickly. Second, de Neufville’s evolutionary approach may inadvertently convey false doctrines to students, thereby preventing their epistemic progress. The only defence against unexamined opinions is the suspension of judgment. Besides that, he argues, de Neufville’s pragmatic worries are unfounded: Cartesians are successful professionals in theology, medicine, and in the university itself.