bluuebunny/crossref_metadata_2025 huggingface dataset:
INTERGENERATIONAL EMPLOYEE NETWORK AGEISM: COLLABORATIVE INTERVENTION TRAINING CREATES ATTITUDE MODIFICATIONS
Authors: Harllee Heath D , Noah Amanda , Knight Becky P
Published: November 2019

Lack of positive attitudes towards aging has shown to cause challenges within intergenerational networks in employment situations. These can include job satisfaction, intrinsic motivation to work, and ageism subjectivity as underlying determinants and consequences. The collaborative intervention pilot training program goals were two-fold: 1) To expose and understand ageism as a discriminatory action. 2) To create a more positive social dynamic network in a diverse workplace in regard to general expectations of ageism. Two team-based learning intervention programs were created in order to increase collaborative awareness of ageism and were presented to a medium size intergenerational department staff (N=64) as part of a professional development series on equity, diversity and inclusion. Through three multidimensional self-help training activities, learning was done individually, within similar age employee groups, and within intergenerational employee groups. Participants were able to discuss and express general understandings and expectations of aging and learning tools such as intergenerational reactivity and emotion regulation strategies were presented. Within survey responses at the completion of the trainings, key findings showed that respondents had a better understanding of ageism (76%) and felt better equipped to work within an employment team of diverse ages (71%). Additionally, the subject matter of this pilot training program resulted in re-conceptualized positive aging (61%). Future implications and goals for the program include interventions to further increase positive intergenerational understanding and workplace generational inclusiveness.
STUDYING AGING ABROAD: TWO INTENSIVE COURSES AT DREXEL UNIVERSITY
Authors: Mulhorn Kristine A , Ballenger Jesse F , Clark Katherine F , Yoshinaga F
Published: November 2019

The model for short-term study abroad courses---called Intensive Courses Abroad (ICA) is one where various topics can be covered under a single theme over a 10-to-14 day travel timeframe. Students participate in pre-departure assignments, a daily schedule in the host country with meaningful visits followed by group discussions, and a final presentation upon return to the U.S. In both examples presented, the topic is aging. In one, there is a visit to Japan, focusing on aging, technology and culture. Students consider design and lifestyle implications of an aging society. The course includes visits to a geriatric rehabilitation facility and to a residential facility that employs various robots and other technology. Students explore a remote community and its design challenges for an aging society. Participation in a community survey to address a question they plan to pursue for their final project, such as the role of technology in society, how we understand the aging process, and how culture defines aging. In the second course, global aging frames discussions on the way Chile is adopting mechanisms to address chronic conditions associated with aging, including dementia. In the course, students learn about the social and political context. Students observe various ways Chile has adopted innovative approaches to address dementia care and various community-level interventions. Students will reflect in journals regularly and give a presentation about the ways the country is facing the challenges of an aging society where more than 30% of the population is projected to be over 60 by 2050.
KEEPING UP WITH THE JONESES: SOCIOECONOMIC STATUS AND SUBJECTIVE PERCEPTIONS OF AGING
Authors: Bellingtier Jennifer A , English Alaina N , Neupert Shevaun D
Published: November 2019

Money may not buy happiness, but can it buy a more positive outlook on aging? Past research examining the associations between indicators of socioeconomic status (SES) and subjective perceptions of aging have been mixed with some finding greater socio-economic resources predict more positive aging perceptions, whereas others find no connection. We examine objective (i.e., income and education) and subjective social status (i.e., MacAurthur ladder) and their connections to subjective age, attitudes towards aging, and awareness of age-related changes using hierarchical multiple regression analyzes. Participants (n =296, age range 60-90) completed survey measures online. Results indicate minimal connection between income, education, and aging perceptions. However, perceiving oneself to be higher in social standing compared to one’s community was consistently related to more favorable perceptions of aging. Higher community standing may indicate favorable development, fewer stressors, or more resources compared to others, which could contribute to more positive perceptions of aging.
SOCIAL ROLES AND PERSONALITY IN LATER LIFE
Authors: Kornadt Anna E , Kornadt Anna E
Published: November 2019

Despite considerable stability of the Big Five personality traits, there is evidence for personality plasticity and change across the lifespan. In younger years, the investment in social roles, such as entering worklife or starting a family has been shown to drive personality change. With regard to personality in later life, the investigation of social roles has so far been neglected. A questionnaire was developed to assess a large number of social roles that can be assumed in the second half of life. N = 306 participants aged 50 to 86 years reported on their social roles and rated their personality traits. Results show that assuming and investing in certain social roles (e.g. friend, retiree, volunteer) mediated the effects of age on the Big Five, especially for the oldest participants and in the domains openness and extraversion. The findings support the importance of social roles for personality also in later life.
THE EFFECTS OF AGE-BASED EVALUATIONS ON OLDER ADULTS’ GAIT VARIABILITY
Authors: Barber Sarah , Hamel Kate , Ketcham Carl , Lui Kristy
Published: November 2019

Older adults are stereotyped as being slow, weak, and frail. In this study we examined how these stereotypes about age-related physical decline affect older adults’ walking performance. Healthy, community-dwelling older adults were asked to walk at their own comfortable pace along a 24’ temporospatial-measuring walkway 10 times. For some participants this was done with a normal-base of support (i.e., usual gait). However, for other participants this was done with a narrow-base of support (i.e., walking within a path of 15 cm outlined by tape). Walking tasks were done either in the presence or absence of a negative age-based evaluation. Results showed that the negative age-based evaluations were associated with greater stride-to-stride variability, particularly for participants who felt less confident in their abilities. Given that gait variability is a predictor of falling, this raises the possibility that negative age-based evaluations can produce concerns that are an intrinsic risk factor for falls.
NEURONAL FGF-21 SIGNALING: A SENSOR OF DIETARY PROTEIN
Authors: Hill Cristal , Morrison Christopher
Published: November 2019

Our data demonstrates that dietary protein restriction increases energy expenditure and improves glucose homeostasis, and that this effect is largely mediated by the metabolic hormone fibroblast growth factor 21(FGF21). Considering that the central nervous system (CNS) is acknowledged as a major regulator of both energy and glucose homeostasis, we have extended our studies to identify the tissue site mediating these FGF21-dependent effects via dietary protein restriction. In this study, mice with dysfunctional FGF21-signaling in either the CNS or adipose tissue were fed a control or low protein (LP)-diet to assess changes in body weight and metabolic endpoints. Our data show that LP diet increased energy expenditure and reduced body weight in control littermates, but these effects were lost in mice bearing CNS-specific deletion of Klb. These data highlight a liver to brain FGF21-signal as the first known neuroendocrine mechanism to explain the coordinated metabolic changes induced by dietary protein restriction.
MLTSS AND AGING IN PLACE: HOW PERSONAL CARE SERVICES HELP AVOID NURSING FACILITY ADMISSIONS OF OLDER ADULTS
Authors: Neumann Lycia Tramujas Vasconcellos , Documet Patricia I
Published: November 2019

Older adults value community living and prefer to “age in place”, which increased the need for long-term care to be provided at home. Recently, a capitated option for Medicaid beneficiaries, managed long-term services and supports (MLTSS), has become popular. This evaluation research study investigated 1) the effectiveness of attendant care services to avoid long-term institutionalization of older adults when provided as part of an MLTSS program, and 2) the effect of the type of attendant care services on long-term institutionalization. Using enrollment and claims data of 491 community-dwelling older adults enrolled in an MLTSS program for at least six months, multivariate regression models analyzed the association between long-stay nursing facility (LSNF) admissions and the use of attendant care services. Findings confirmed the hypothesis that those receiving attendant care services are less likely to have LSNF admissions and that as the dosage increases, the odds of LSNF decreased. The type of attendant care services also influenced the results. Participants who used only self-directed AC services were 93% less likely to have an LSNF admission than those receiving no AC services, and 23.5% less likely to have this outcome than those who only received agency attendant care services. In addition, the use of other home and community-based services are also significantly associated with LSNF admissions. These findings have important research and practical implications at the program and policy level, as MLTSS programs spread across the country and aim to “rebalance” the LTSS system.
PATTERNS OF UNMET NEEDS AND STRENGTHS AMONG STROKE PATIENTS AND THEIR INFLUENCE ON OUTCOMES
Authors: Woodward Amanda , Hughes Anne K , Reeves Mat , Fritz Michele , Freddolino Paul , Coursaris Constantinos , Swierenga Sarah J
Published: November 2019

The transition home after a stroke is a particularly challenging time for patients and caregivers. There is extensive literature on unmet needs among stroke patients, but there are fewer studies that examine the strengths and resources of stroke patients and how these may influence their subsequent recovery. This study uses data from the Michigan Stroke Transitions Trial (MISTT), a pragmatic 3-arm clinical trial that tested the efficacy of case management against usual care. Two intervention groups (n=160) received up to 90 days of services from a social work case manager. A complete biopsychosocial assessment was conducted approximately 5 days after discharge. Latent class analysis was used to identify different classes based on six indicators of unmet needs and twelve indicators of strengths. Four homogenous classes were identified in the final model. Class 1 (n=56, 35%) included patients with few needs and strong social support, but few other strengths. Class 2 (n=46, 29%) had few needs and a high level of strengths across all indicators. Class 3 (n=39, 24%) has moderate needs related to mental health, non-stroke physical health, and finances, but few strengths. Class 4 (n=19, 12%) has moderate needs related to social support, non-stroke related physical health, and finances, but with moderate strengths related to indicators like coping, cognition, and insight. Class membership was related to short-term quality of life. Understanding the combination of needs and strengths has potential implications for services provided during care transitions as well as the policies and funding mechanisms that support those services.
ACUTE CARE UTILIZATION IN OLDER ADULTS LIVING UNDIAGNOSED OR UNAWARE OF DEMENTIA
Authors: Amjad Halima , Roth David L , Huang Jin , Wolff Jennifer L , Samus Quincy M
Published: November 2019

Most individuals with dementia are undiagnosed or they/their families are unaware of the diagnosis. Implications of dementia diagnosis and awareness are poorly understood. Our objective was to determine whether undiagnosed dementia or unawareness increases risk of hospitalization or emergency department (ED) visits, outcomes with recognized risk in diagnosed dementia. We linked National Health and Aging Trends Study (NHATS) data to fee-for-service Medicare claims for 4,311 community-living participants in the nationally representative cohort. We assessed probable versus no dementia using validated NHATS dementia criteria, undiagnosed versus diagnosed using Medicare claims, and aware versus unaware using NHATS self or proxy report of diagnosis. Cox proportional hazards models evaluated hospitalization and ED visit risk by time-varying dementia diagnosis and awareness status, adjusting for sociodemographic characteristics, functional impairment, medical comorbidities, and prior hospitalization. Compared to no dementia, persons with dementia who were unaware but diagnosed had greater risk of hospitalization (HR 1.66, 95% CI 1.26-2.19) and ED visits (HR 1.63, 95% CI 1.28-2.08). Persons unaware but diagnosed also had greater risk compared to persons aware and diagnosed (hospitalization HR 1.34, 95% CI 0.98-1.82; ED HR 1.38, 95% CI 1.05-1.83). Persons with undiagnosed dementia demonstrated hospitalization risk similar to persons with no dementia (HR 1.02, 95% CI 0.79-1.31) and similar or potentially lower than persons aware and diagnosed (HR 0.82, 95% CI 0.61-1.10); ED visit findings were similar. Results suggest that being unaware of dementia diagnosis may affect healthcare utilization. Strategies to improve communication and understanding of dementia could potentially reduce hospitalizations and ED visits.
HOSPITAL CARE USE IN OLDER ADULTS: THE ROLE OF PSYCHOLOGICAL AND SOCIAL FACTORS
Authors: Straatmann Viviane , Dekhtyar Serhiy , Meinow Bettina , Fratiglioni Laura , Calderon-Larranaga Amaia
Published: November 2019

Although older people’s health status is the main determinant of healthcare use, there has been little research on how psychosocial factors relate to healthcare utilization. We explored the extent to which psychological and social aspects predict the use of hospital care in an older Swedish population. 2867 people ≥60 years from the Swedish National study on Aging and Care in Kungsholmen (SNAC-K) were followed from baseline (2001-2004) for four years. We created standardized indexes of psychological well-being, and social well-being. Binomial negative mixed models were used to estimate the association of psychological and social indexes with hospital care use (i.e. unplanned hospital admissions [UHA], 30-day readmissions [30DR] and length of stay [LOS]). Individuals with a psychological well-being score above the median had less UHA (IRR 0.43, 95%CI 0.20-0.93) and lower LOS (IRR 0.18, 95% 0.06-0.58), even after full adjustment. High levels of social well-being were also protective for UHA and LOS in the minimally adjusted model, but not after adjusting by life style and personally traits. Relative to individuals with poor well-being on both indexes, those with rich psychological and poor social well-being had reduced hospital care use (IRR 0.44 95%CI 0.24-0.84; IRR 0.23, 95%CI 0.08-0.67, respectively), and even further in those with rich psychological and social well-being (IRR 0.33 95%CI 0.14-0.75; IRR 0.10, 95% 0.02-0.45, respectively). No statistically significant association was found with 30DR. Provided the importance of psychosocial aspects in predicting UHA and LOS, targeting the former could be a strategy for reducing healthcare use and, eventually, costs.
AFFECT VARIABILITY AND SLEEP: EMOTIONAL UPS AND DOWNS ARE RELATED TO A POORER NIGHT’S REST
Authors: Leger Kate A , Charles Susan , Fingerman Karen
Published: November 2019

Emotional experience is strongly related to physical health. Yet, fluctuations in daily emotional experience, known as affect variability, have been less examined. It is unknown how affect variability throughout the day is related to sleep, a critical health behavior. The current study examines this relationship in an ecological momentary assessment of 277 older adults. Regression models indicate that greater variability in daily positive affect is associated with fewer hours of sleep (b = -0.648, p = .04) and greater morning tiredness (b = 0.67, p = .006) even after adjusting for mean levels of affect. Although greater negative affect variability is associated with worse sleep quality (b = -0.77, p = .02) and greater morning tiredness (b = 0.91, p = .004), these relationships disappear once mean negative affect is added into the model. Findings support models describing the downside in the fragility of positive affect.
MATTERS OF THE HEART: DAILY SOCIAL INTERACTIONS AND CARDIOVASCULAR REACTIVITY IN MIDDLE AND OLD AGE
Authors: Birditt Kira S , Turkelson Angela , Mones Meaghan , Najarian Kayvan , Gonzalez Richard
Published: November 2019

Social ties are essential for survival but the mechanisms accounting for this link are unclear. This study examined links between daily interpersonal experiences and cardiovascular reactivity. A total of 34 participants (aged 40 to 80) completed ecological momentary assessment surveys every three hours for 4 days and wore a device that assessed heart rate (HR) and heart rate variability (HRV). Multilevel models revealed that a greater number of social interactions and negative social interactions predicted increased HR. Links between social interactions and cardiovascular reactivity varied by gender and race. A greater number of interactions and negative interactions predicted increased HRV among men and not women. A greater number of social interactions predicted increased HR among Black individuals and White women but not White men. Thus, social interactions appear to get under the skin via the cardiovascular system but in unique ways that vary by gender and race.
USING A UNIVERSAL SATISFACTION SCORE IN LONG-TERM CARE SETTINGS
Authors: Castle Nicholas , Schwartz Lindsay , Gifford David
Published: November 2019

The CoreQ (not an acronym) consists of a limited number of satisfaction items (3-4 items, depending on setting) that are used to create an overall satisfaction score for long-term care facilities. This measure has been used in assisted living (AL) and skilled nursing facilities (SNFs) and has been endorsed by the National Quality Forum (NQF). Briefly, the development and psychometric testing of the CoreQ will be described, including the rationale for producing an overall satisfaction score and correlation with important quality indicators like Five-Star. Using data collected over the past 3 years, comprising more than 100,000 respondents, the use of the CoreQ measure will be described. For example, the CoreQ scores are used in MA to allow providers to benchmark their performance. The use of the scores in this way will be discussed including how providers have used the scores for quality improvement. Some states have elected to use CoreQ in pay for performance and other state initiatives. A case study of how New Jersey uses CoreQ with SNFs will be presented, including distribution of scores and addressing data collection challenges. CoreQ can be utilized as a short customer satisfaction measure to allow providers to benchmark their performance, residents and families in decision-making, and states and others to use for accountability.
USING OBSERVATIONAL DATA TO INFORM CANDIDATE PHENOTYPES FOR GEROSCIENCE TRIALS
Authors: Sanders Jason L , Arnold Alice , Boudreau Robert , Kritchevsky Stephen , Newman Anne
Published: November 2019

Geroscience trials will manipulate aging mechanisms which may have pleiotropic effects and alter multiple biologic processes and clinical outcomes. Determining an intervention’s efficacy and safety will require measuring several aspects of aging and intermediate endpoints with less regard to specific diseases. Picking the right measurements will significantly impact a trial’s cost-effectiveness and chance of success. Observational studies are ideal resources to test candidate phenotypes before investing in trials. We present a decade’s worth of results from the Cardiovascular Health Study as examples of using observational data to inform measurement in geroscience trials. Specifically, we illustrate the underlying theory, construction, operational characteristics, and inter-relationships of candidate phenotypes spanning circulating biomarkers, tissue and organ structure, and functional status, all of which can be used in geroscience trials depending on the intervention’s target and predicted outcome.
CHRONIC PAIN SELF-MANAGEMENT PRACTICES AND PREFERENCES AMONG URBAN AFRICAN AMERICAN OLDER ADULTS
Authors: Janevic Mary R , Janevic Mary , Robinson-Lane Sheria , Murphy Susan , Piette John
Published: November 2019

African American older adults experience disproportionate burden from disabling chronic pain. Pain self-management interventions for this group are most effective when they integrate culturally-relevant preferences into intervention design. In the STEPS pilot trial, we collected focus group (n=23) and survey (n=57) data from African Americans age 60+ years about pain-management practices. Participants were recruited from the community and reported pain for 3+ months, with intensity >4 (0 to 10 scale). The most frequently-used pain-management strategies were exercise (75%) and prayer/Bible reading (74%). Also commonly used were healthy eating (61%), OTC medications (65%), and herbal supplements (51%). Focus group themes provided more nuanced information, including reasons for avoiding prescription pain medications, positive experiences with topical treatments, the value of movement, and the role of social support. Findings reveal strong engagement in pain self-care in this population. Interventions can build on existing practices by incorporating spirituality and appealing options for physical activity.
MOBILIZING NETWORKS TO ADDRESS DEMENTIA IN A LATINO COMMUNITY
Authors: Gelman Caroline , Giunta Nancy
Published: November 2019

Many Latino older adults delay seeking help for symptoms of Alzheimer’s Disease or Related Dementia (ADRD) due to substantial barriers to services. Community-based Natural helpers (NHs) can increase health-related knowledge and can serve as full partners in health education and promotion. This paper presents the process and product of the first phase of a community-based participatory research study to develop a culturally-tailored intervention increasing knowledge about ADRD and services in East Harlem, NY. We describe the results of the initial survey and development of El Barrio SHARE, an intervention that recruits and trains community residents to provide information and referrals about dementia, tapping into natural community networks of people (hairdressers, bodega clerks, mail carriers) who interact with and have longstanding relationships with older adults in the course of their work. NHs are well-positioned to observe and detect problems, and can link elders to relevant, culturally-sensitive resources, accessible support, and treatment.
THE RELATIONSHIP BETWEEN PAIN AND STRESS IN OLDER BLACKS
Authors: Taylor Janiece L , Taylor Janiece L , Parker Lauren , Thorpe Jr. Roland J , Whitfield Keith E
Published: November 2019

Older Blacks have higher rates of undermanaged and undertreated pain than other racial/ethnic groups. Pain can lead to disability and poor quality of life. It is essential that we identify modifiable factors related to pain in this population. This study examined if stress was associated with pain among older Blacks. Data were taken from the Baltimore Study on Black Aging, (N=602, mean age 69 [SD= 9.76]). A total of 78% of participants reported bodily pain in the past month. Women had an increased odds of reporting bodily pain (OR 1.89, 95% CI 1.17, 3.07) compared to men. Using logistic regression controlling for age, self-rated health, sex, depressive symptoms, and chronic conditions, higher levels of stress were associated with increased odds of bodily pain (OR 1.04, 95% CI 1.00, 1.07). Identification of effective coping mechanisms to combat stress may lead to pain relief among older Blacks, particularly Black women.
COMMON PURPOSE: NETWORKING INITIATIVES TO FOSTER DEMENTIA-CAPABLE CARE FOR LIFELONG DISABILITIES
Authors: Taylor Catherine , Gadbois Christine , Fournier Sandra L , Clark Phillip G , Helm Faith
Published: November 2019

As individuals with I/DD live longer, Alzheimer’s disease is on the rise, particularly in individuals with Down syndrome. Practitioners have recognized that the I/DD system does not possess the expertise to provide appropriate care for this population as it ages. A series of federally funded initiatives in Rhode Island – supported by the Centers for Medicare and Medicaid Services (CMS), the Administration for Community Living (ACL), and the Health Resources and Services Administration (HRSA) -- have begun to equip health care and direct care professionals to meet the needs of individuals with I/DD and AD. Using a “connector” model, the GWEP at RIGEC has woven together these efforts, aligned program goals from disparate funders, built connections between the Aging Network and the disability system, and worked with the National Task Group on Intellectual Disabilities and Dementia Practices (NTG) to create sustainable resources for the health care and direct care workforces.
THE MAGIC OF MUSIC FOR IMPROVING PSYCHOLOGICAL HEALTH FOR THOSE WITH DEMENTIA AND THEIR CAREGIVERS
Authors: MacDonald Stuart , Sheets Debra J , Smith Andre P , Kennedy Mary , Hundza Sandra
Published: November 2019

Arts-based interventions for person’s with dementia and their caregivers represent an inexpensive, non-invasive, and non-pharmacological intervention with the potential to improve psychological function as well as reduce healthcare costs. The paper presents an overview of Voices in Motion (ViM), and the impact of this social-cognitive intervention on changes in psychological function for those with dementia and their caregivers (current n=26 dyads). Choir rehearsals were held on a weekly basis, and included a social discussion component. A range of outcomes (neuropsychological and physiological function, neural activation) were assessed using an intensive repeated measures design that facilitates both between- and within-person analyses, including nuanced evaluation of whether psychological function improves post intervention relative to an individual’s personal average, yielding a conservative within-person test of the benefits of intervention. Discussion focuses on the promise of such interventions for mitigating dementia symptoms and facilitating the psychological health of caregivers.
SYSTEMATIC CHANGES IN GAIT PURSUANT TO CHOIR PARTICIPATION FOR CAREGIVERS AND PERSONS WITH DEMENTIA
Authors: Hundza Sandra , MacDonald Stuart W , Sheets Debra J , Smith Andre P
Published: November 2019

Choir interventions confer psychological benefits for persons with dementia (PwD) and their caregivers. However, less is known about whether physiological function also exhibits improvements pursuant to such social-cognitive interventions. The present study, based upon a subsample of the Voices in Motion (ViM) project, explored whether participation in an intergenerational choir results in systematic improvements in gait velocity (indexed using a GAITRite computerized walkway) for both informal caregivers (n=14; 71.4% female) and PwD (n=14; 64.3% female). Longitudinal burst data from the first of three cohorts spanning 4 assessments over 3.5 months was analysed using multilevel modeling. Whereas caregivers exhibited significant improvements (p<.05) in gait velocity, PwD showed no improvement. Ongoing analyses are exploring additional cohorts, and whether improvements in gait dynamically covary with reductions in comorbidities (e.g., neuropsychological function, caregiver burden, depressive affect). These results underscore the potential of choir for facilitating both psychosocial and physiological function for caregivers and PwD.
CHURCH RELATIONSHIPS, DISCRIMINATION, AND GENERALIZED ANXIETY DISORDER AMONG OLDER AFRICAN AMERICANS
Authors: Nguyen Ann W
Published: November 2019

The African American church has played a major role in African American communities, and church relationships represent an important stress-coping resource for older African Americans. This study examined 1) the association between everyday discrimination and generalized anxiety disorder (GAD) and 2) whether church-based relationships buffer the negative effects of everyday discrimination on GAD among older African Americans. Logistic regression analyses were conducted using data from 670 African American respondents age 55 and older from the National Survey of American Life: Coping with Stress in the 21st Century. More frequent experiences of everyday discrimination was associated with higher odds of meeting criteria for GAD. Significant interactions indicated that frequent contact with church members and high levels of subjective closeness to church members buffered against the negative effects of discrimination on GAD. Interventions that focus on the use of church members for support capitalize on a major strength among older African Americans.
Comparison of aortic remodelling after conservative treatment or thoracic endovascular repair in type B dissections
Authors: Mustafi Migdat , Andic Mateja , Bartos Oana , Grözinger Gerd , Schlensak Christian , Lescan Mario
Published: November 2019

OBJECTIVES

Our aim was to compare aortic remodelling in type B dissections after thoracic endovascular aortic repair (TEVAR) or conservative treatment.

METHODS

We conducted a retrospective analysis of computed tomography (CT) data sets at dissection onset and at the last follow-up in a group with conservative (group A) and TEVAR treatment (group B). An additional analysis of the preoperative CT images was performed in patients from group A, who were converted to TEVAR during follow-up. Diameters and lengths of all aortic segments were measured and growth rates were calculated.

RESULTS

We included 74 patients: 50 patients in group A (follow-up time: 1625 ± 209 days) and 24 patients in group B (follow-up time: 554 ± 129 days). The mean aortic diameter growth rate was significantly higher in group A than in group B in the mid-descending aorta (A: +7 mm/year; B: −4 mm/year; P = 0.003). Length growth difference was only present in the abdominal aortic segment and was more pronounced in group A (+2 vs ±0 mm/year; P = 0.009). The conversion rate from conservative treatment to TEVAR was 36% (n = 18). A false lumen diameter of >22 mm at baseline was associated with a higher rate of conversion (P = 0.036). After conversion, the mean growth rate in the proximal descending and mid-descending aorta decreased from preoperative +11 and +18 mm/year to postoperative −9 and −14 mm/year, respectively (P < 0.001).

CONCLUSIONS

In acute type B dissections, TEVAR stops aortic enlargement in the thoracic aorta, but promotes distal dilatation compared to the conservative treatment group. After conversion to TEVAR in conservatively pretreated chronic type B dissections, a more pronounced diameter decrease in the descending aorta was observed than in patients treated in the acute phase.
Synergistic effect of IgG4 antibody and CTLs causes tissue inflammation in IgG4-related disease
Authors: Sasaki Takanori , Yajima Taiki , Shimaoka Tatsuro , Ogawa Shuhei , Saito Takashi , Yamaoka Kunihiro , Takeuchi Tsutomu , Kubo Masato
Published: November 2019

IgG4-related disease (IgG4-RD) is characterized by multi-organ irreversible damage resulting from tissue-specific infiltration of IgG4+ plasma cells and cytotoxic T lymphocytes (CTLs). However, whether IgG4 antibody contributes to the inflammation remains unclear. In this study, we established a mouse model that enabled us to evaluate the pathogenic function of IgG4 antibodies in response to a tissue-specific autoantigen using recombinant ovalbumin (OVA)-specific human IgG4 monoclonal antibody (rOVA-hIgG4 mAb) and the mice expressing OVA of the pancreatic islets (RIP-mOVA mice). We found no inflammatory effect of rOVA-hIgG4 mAb transfer alone; however, co-transfer with OVA-specific CD8 CTLs (OT-I T cells) induced tissue damage with dense lymphocytic inflammation in the pancreas of RIP-mOVA mice. rOVA-hIgG4 mAb caused accumulation of conventional DC1 cells (cDC1s) in the lymphoid tissues, and the dendritic cells (DCs) activated the OT-I T cells via cross-presentation. We also revealed that the synergistic effects of CTLs and antibodies were observed in the other subclasses including endogenous antibodies if they recognized the same antigen. The transfer of OVA-specific CD4 helper T cells (OT-II T cells) into RIP-mOVA mice induced the production of anti-OVA antibody, which had a synergistic effect, through acquisition of a T follicular helper (TFH) phenotype. Moreover, using OT-II T cells deficient in Bcl6 caused lower anti-OVA antibody production and inflammation with OT-I T cells. Our results indicated that autoreactive IgG4 antibodies play an important role of the tissue-specific CTL response in IgG4-RD.
Selective suppression of oral allergen-induced anaphylaxis by Allergin-1 on basophils in mice
Authors: Lin Yu-Hsien , Tahara-Hanaoka Satoko , Nagai Kei , Yoshikawa Soichiro , Kubo Masato , Shibayama Shiro , Karasuyama Hajime , Shibuya Akira
Published: November 2019

Mast cells (MCs) play a critical role in oral allergen-induced anaphylaxis. However, the contribution of basophils to the anaphylaxis remains unclear. The inhibitory immunoreceptor Allergin-1 is highly expressed on MCs and basophils and inhibits FcεRI-mediated signaling in MCs. Here, we show that Allergin-1-deficient (Milr1−/−) mice developed more severe hypothermia, a higher mortality rate and a greater incidence of diarrhea than did wild-type (WT) mice in an oral ovalbumin (OVA)-induced food allergy model. MC-deficient Mas–TRECK mice, which had been reconstituted with either WT or Milr1−/− bone marrow-derived cultured MCs, did not develop hypothermia in this food allergy model. On the other hand, depletion of basophils by injection of anti-CD200R3 antibody rescued Milr1−/− mice from lethal hypothermia but not from diarrhea. In vitro analyses demonstrated that Allergin-1 inhibits IgE-dependent activation of both human and mouse basophils. Thus, Allergin-1 on basophils selectively suppresses oral allergen-induced anaphylaxis.
Did a quality improvement intervention improve quality of maternal health care? Implementation evaluation from a cluster-randomized controlled study
Authors: Larson Elysia , Mbaruku Godfrey M , Cohen Jessica , Kruk Margaret E
Published: November 2019

Objective

To test the success of a maternal healthcare quality improvement intervention in actually improving quality.

Design

Cluster-randomized controlled study with implementation evaluation; we randomized 12 primary care facilities to receive a quality improvement intervention, while 12 facilities served as controls.

Setting

Four districts in rural Tanzania.

Participants

Health facilities (24), providers (70 at baseline; 119 at endline) and patients (784 at baseline; 886 at endline).

Interventions

In-service training, mentorship and supportive supervision and infrastructure support.

Main outcome measures

We measured fidelity with indictors of quality and compared quality between intervention and control facilities using difference-in-differences analysis.

Results

Quality of care was low at baseline: the average provider knowledge test score was 46.1% (range: 0–75%) and only 47.9% of women were very satisfied with delivery care. The intervention was associated with an increase in newborn counseling (β: 0.74, 95% CI: 0.13, 1.35) but no evidence of change across 17 additional indicators of quality. On average, facilities reached 39% implementation. Comparing facilities with the highest implementation of the intervention to control facilities again showed improvement on only one of the 18 quality indicators.

Conclusions

A multi-faceted quality improvement intervention resulted in no meaningful improvement in quality. Evidence suggests this is due to both failure to sustain a high-level of implementation and failure in theory: quality improvement interventions targeted at the clinic-level in primary care clinics with weak starting quality, including poor infrastructure and low provider competence, may not be effective.
Isolation of Metrosideros (ʻOhiʻa) Taxa on Oʻahu Increases with Elevation and Extreme Environments
Authors: Stacy Elizabeth A , Sakishima Tomoko , Tharp Heaven , Snow Neil
Published: November 2019

Species radiations should be facilitated by short generation times and limited dispersal among discontinuous populations. Hawaii’s hyper-diverse, landscape-dominant tree, Metrosideros, is unique among the islands’ radiations for its massive populations that occur continuously over space and time within islands, its exceptional capacity for gene flow by both pollen and seed, and its extended life span (ca. >650 years). Metrosideros shows the greatest phenotypic and microsatellite DNA diversity on Oʻahu, where taxa occur in tight sympatry or parapatry in mesic and montane wet forest on 2 volcanoes. We document the nonrandom distributions of 12 taxa (including unnamed morphotypes) along elevation gradients, measure phenotypes of ~6-year-old common-garden plants of 8 taxa to verify heritability of phenotypes, and examine genotypes of 476 wild adults at 9 microsatellite loci to compare the strengths of isolation across taxa, volcanoes, and distance. All 8 taxa retained their diagnostic phenotypes in the common garden. Populations were isolated by taxon to a range of degrees (pairwise FST between taxa: 0.004–0.267), and there was no pattern of isolation by distance or by elevation; however, significant isolation between volcanoes was observed within monotypic species, suggesting limited gene flow between volcanoes. Among the infraspecific taxa of Metrosideros polymorpha, genetic diversity and isolation significantly decreased and increased, respectively, with elevation. Overall, 5 of the 6 most isolated taxa were associated with highest elevations or otherwise extreme environments. These findings suggest a principal role for selection in the origin and maintenance of the exceptional diversity that occurs within continuous Metrosideros stands on Oʻahu.
MC1R and KIT Haplotypes Associate With Pigmentation Phenotypes of North American Yak (Bos grunniens)
Authors: Petersen Jessica L , Kalbfleisch Theodore S , Parris Morgan , Tietze Shauna M , Cruickshank Jenifer
Published: November 2019

Small numbers of domestic yak (Bos grunniens) were imported to North America in the late 19th century indirectly from the Qinghai-Tibetan Plateau. Coat color of yak is of interest for fiber production, aesthetics, and as a potential indicator of recent hybridization with cattle. North American yak are classified into 3 major coat color patterns depending upon the presence and extent of white markings. They are further classified by nose pigmentation (black or gray). The aim of this study was to identify loci involved in white patterning and nose pigmentation of North American yak. Genotyping by mass spectrometry of markers identified through Sanger and whole-genome sequencing revealed a 388 kb haplotype of KIT associated in a semi-dominant manner with white coloration in this population of yak. This KIT haplotype is similar to both a haplotype found in white-faced Chinese yak and to haplotypes found in cattle but is divergent from other Bos species such as bison, gaur, and banteng. Melanocortin 1 receptor (MC1R) was implicated as a dominant determinant of black nose color with a single haplotype containing 2 missense mutations perfectly associated with the phenotype. The MC1R haplotype associated with black nose pigment is also similar to cattle haplotypes. No cattle studied, however, shared either of the 2 haplotypes associated with color in yak, suggesting these alleles were introgressed into yak before they were imported to North America. These results provide molecular insight into the history of North American yak and information from which breeders can determine possible color outcomes of matings.
Chromogranin A pathway: from pathogenic molecule to renal disease
Authors: Mir Saiful A. , Biswas Nilima , Cheung Wai , Wan Ji , Webster Nicholas , Macedo Etienne , O’Connor Daniel T. , Vaingankar Sucheta M.
Published: November 2019

Background:

Chromogranin A (CHGA) is an index granin protein critical for biogenesis and exocytotic release of catecholamine storage granules. It is elevated in plasma of patients with sympathetic over-activity and kidney dysfunction. Several CHGA polymorphisms are associated with hypertensive kidney disease. Previously, we unraveled the molecular mechanism by which CHGA expression is regulated in African Americans carrying a genetic variation associated with hypertensive chronic kidney disease (CKD).

Method:

Experimental CKD mouse model were created by 5/6th nephrectomy (Npx) using wild-type and Chga−/− knockout mouse strains to delineate the role of CHGA in CKD.

Result:

Wild-type-Npx mice expressing Chga developed exacerbated azotemia and fibrosis as compared with their knockout-Npx counterparts. Gene expression profiling revealed downregulation of mitochondrial respiratory complexes genes consistent with maladaptive mitochondria in wild-type-Npx mice, contrasted to knockout-Npx. In healthy individuals, an inverse relationship between circulating CHGA levels and glomerular function was observed. In vitro, mesangial cells treated with CHGA-triggered nitric oxide release by a signaling mechanism involving scavenger receptor SR-A. The CHGA-treated and untreated mesangial cells displayed differential expression of cytokine, chemokine, complement, acute phase inflammatory and apoptotic pathway genes. Thus, build-up of plasma CHGA because of kidney injury served as an insult to the mesangial cells resulting in expression of genes promoting inflammation, fibrosis, and progression of CKD.

Conclusion:

These findings improve understanding of the role of elevated CHGA in the progression of CKD and reveal novel pathways that could be exploited for therapeutic strategies in hypertensive kidney disease.
Depression and Fatigue in Patients With Multiple Sclerosis Have No Influence on the Parameters of Cognitive Evoked Potentials
Authors: Lazarevic Snezana , Azanjac Arsic Ana , Aleksic Dejan , Toncev Gordana , Miletic-Drakulic Svetlana
Published: November 2019

Purpose:

The purpose of this study was to examine if depression and fatigue affect event-related brain potentials (ERPs) in patients with relapsing–remitting multiple sclerosis, and to assess the significance of ERP as an indicator of cognitive impairment.

Methods:

A total of 81 relapsing–remitting multiple sclerosis patients and 32 healthy control subjects participated in the study. Cognitive functions were evaluated using a standard PASAT, the symbol digit modality test, and ERP. The degrees of depressive symptomatology and fatigue were assessed with Beck Depression Inventory, the Fatigue Severity Scale, and the Fatigue Impact Scale.

Results:

Fatigue and depression had a negative effect on the cognitive functions examined by neuropsychological tests. Depression and fatigue did not influence ERP amplitude and latency findings. Depression level was negatively correlated with symbol digit modality test score (r = −0.135, P < 0.05). Fatigue level was negatively correlated with the results for PASAT A (r = −0.225, P < 0.05) and PASAT B (r = −0.342, P < 0.01). Reaction time was positively associated with depression (r = 0.246, P = 0.01) and fatigue (r = 0.281, P = 0.01).

Conclusions:

Depression and fatigue have no effect on ERP amplitude and latency, so they cannot participate in risk assessment for the development of cognitive impairment in patients with relapsing–remitting multiple sclerosis.
Persistent loss of biologically-rich tropical forests in the Indian Eastern Himalaya
Authors: Sheth Chintan , Datta Aparajita , Parashuram Devathi
Published: November 2019

Deforestation is a major cause of biodiversity loss in Asia. Using fine-resolution satellite imagery we assessed the change in forest cover of a state-managed Reserved Forest located in India’s Eastern Himalaya biodiversity hot-spot. Thirty-two square kilometers of forest cover was lost from 2013 and 2017 with a 5% decline in total forest area over four years. Hornbills are a key functionally important species found in the area. We therefore assessed the habitat around 29 hornbill nest trees in this Reserved Forest and estimated that there was a loss of 35% of forest cover from 2011 to 2019. We identify illegal logging (despite a ban by the Supreme Court of India) as the main driver that is depleting forest cover within this important area. Our results highlight the ongoing threats to biologically-rich forests and the need for urgent measures to halt this loss. We suggest that this study has practical implications for the governance of non-PA state-managed forests in Arunachal Pradesh. The ongoing deforestation appears to be due to organized crime, institutional inadequacy from a combination of limited resources, bureaucratic apathy, and/or ambiguity in use and ownership of forest land compared to other community forests which appear to have robust governance systems.
Mapping the growth effect of previously hidden ubiquitin alleles using an overexpression based mutational scan
Authors: Mavor David , Bolon Daniel N. A. , Mishra Parul
Published: November 2019

Deep mutational scanning has emerged as a powerful, high throughput approach to determine the growth effect of thousands of alleles at once in bulk competition. However, to date only the growth effect of mutant alleles in isolation has been determined. Building off previous work, we have created a library of all possible single point mutations in ubiquitin and determined the growth effect of mutants overexpressed in the presence of a wild type allele. Using this scan, we explained over half of the previously missing mutants in the single allele scan by showing that they exhibit deleterious effects when co-expressed with wild type ubiquitin. Additionally, unlike the single allele growth effect, these overexpression growth effects were distributed across the entire protein. This overexpression scan methodology can identify likely dominant mutant effects in any essential gene and is highly complementary with traditional deep mutational scanning approaches.
Poly-Exposure and Poly-Genomic Scores Implicate Prominent Roles of Non-Genetic and Demographic Factors in Four Common Diseases in the UK
Authors: He Yixuan , Lakhani Chirag M , Manrai Arjun K , Patel Chirag J
Published: November 2019

While polygenic risk scores (PRSs) have been shown to identify a small number of individuals with increased clinical risk for several common diseases, non-genetic factors that change during a lifetime, such as lifestyle, employment, diet, and pollution, have a larger role in clinical prediction. We analyzed data from 459,613 participants of the UK Biobank to investigate the independent and combined roles of demographics (e.g., sex and age), 96 environmental exposures, and common genetic variants in atrial fibrillation, coronary artery disease, inflammatory bowel disease, and type 2 diabetes. We develop an additive modelling approach to estimate and validate a poly-exposure score (PXS) that goes beyond consideration of a handful of factors such as smoking and pollution. PXS is able to identify groups with high prevalence of the four common disease comparable to, if not better, than the PRS. Type 2 diabetes has the largest discrepancy in PXS and PRS performance, defined as the maximum area under the receiver-operator curve (AUC) (PXS AUC of 0.828 [0.821-0.836], PRS AUC of 0.711 [0.702-0.720]). Most importantly, we show that PXS identifies individuals that have low genetic risk but high overall risk for disease. While PRS is useful for screening genetically exceptional individuals in a time-invariant way, broader consideration of multiple non-genetic and modifiable factors is required to fully translate risk scores to the bedside for precision medicine. All results and the PXS calculator can be found in our web applicationhttp://apps.chiragjpgroup.org/pxs/.