bluuebunny/crossref_metadata_2025 huggingface dataset:
Self-Reported Fears by Hospice Patients at the End of Life
Authors: Kates Jeannette
Published: December 2020

Fear is a common emotion that involves the intense anticipation of threat to a person. At end of life, this fear is often conceptualized as existential distress, which suggests a connection to spirituality. Processing impending death is essential to end-of-life closure and acceptance. Existing evidence suggests that spirituality is associated with greater coping, better psychosocial well-being, and dignified dying; however, the relationship between fear and spirituality at end of life, as well as the specific fears experienced, are not known. The purpose of this study was to explore the relationship between fear and spirituality in patients upon hospice admission. In this retrospective study, admission records from 154 hospice patients were reviewed. Hospice admission data from the psychosocial and spiritual assessments were analyzed using descriptive statistics, inferential statistics, and logistic regression. The average patient age was 81 years of age. A slight majority (51.3%) of patients admitted to fears upon hospice admission. Patients reported a range of one to six fears, with the most common fear being “pain and/or suffering.” Forty-seven percent of the patients identified as being “spiritually active.” Correlation analysis revealed no statistically significant relationship between fear and spiritually. Logistic regression analysis revealed some significant relationships between age and certain fears. Fear is a common symptom at the end of life, and appropriate emotional and psychological support should be provided to mitigate the fears. This study suggests that fears may be different for older adults.
Using the Conversation Starter Kit in Canada to Promote Resident Care Planning Discussions in Long-Term Care
Authors: Kaasalainen Sharon , Sussman Tamara
Published: December 2020

Advance care planning (ACP) is still rare in Canadian long-term care (LTC) homes. Residents and their families view ACP as uncomfortable and difficult to implement, leading them to avoid these discussions. The purpose of this study was to explore the perceptions of LTC residents and their families about using an ACP tool called The Conversation Starter Kit. This study utilized a mixed methods approach. Data was collected in four LTC homes in Ontario, Canada from 78 residents and family members. Data was analyzed using thematic analysis and descriptive statistics. All participants read all sections but only 73% completed all sections of the toolkit. Participants spent an average of 52.3 minutes completing the toolkit and 36.4 minutes discussing it with their family members and/or LTC staff. Participants reported: a better understanding of ACP after using the tool (80%), that the tool helped clarify the available resources and/or choices (53%), and that they felt less apprehensive about ACP after using the tool (60%). Qualitative findings revealed many strengths (e.g., usefulness, ability to start difficult conversations, content and clarification), and weaknesses of the tool (e.g., redundant information, difficulty understanding the content and lack of information regarding medically assisted dying). Family members noted that the toolkit would have been helpful to receive earlier on in their family members’ disease trajectory, perhaps before being admitted into LTC. These study findings support the feasibility and acceptability of the tool to engage residents and family members in/; ACP discussions in LTC.
Helping Fill That Gap: Aging in Place After Disaster Through the Lens of Home-Based Care
Authors: Bell Sue Anne , Krienke Lydia , DeVries Raymond , Iwashyna Theodore J
Published: December 2020

During a disaster, home-based care is intended to continue to function using existing care delivery models. Home-based care providers (HBCP) are often the closest contact with their clients—even during a disaster, seeing them in non-traditional care settings including shelters and hotels. This closeness and commitment to clients, gives HBCP unique insights into strategies to promote aging in place. The purpose of this study was to identify the individual and community-level support needs of older adults after a disaster through the lens of home-based care. Five focus groups were conducted with HBCP (n=27) in two disaster-affected settings: 2017’s Hurricane Irma in Florida and Hurricane Harvey in Texas. Participants were identified by contacting home health agencies listed in an open-source database of agencies receiving Centers for Medicare and Medicaid Services funding. Data was manually coded using an inductive approach and themes were iteratively identified. Forty-nine codes were identified in the preliminary analysis, which were distilled into ten themes describing factors that influence care provision during and after disasters: patient autonomy/dependence, disaster-induced trauma, reluctance to evacuate, chronic disease exacerbation, unpreparedness, systemic inequality, provider preparedness actions, strong sense of community, mistrust of governmental authority, and the uniqueness of the patient and home-based care provider relationship. The perspective offered by HBCP illustrates the complexities of community-level preparedness and informal community support for chronically ill older adults surrounding disasters. Diverse groups involved in aging and disaster response can learn from strategies employed by HBCP during disasters to improve aging in place.
Multimorbidity Accumulation by Race or Ethnicity and Body-Weight Status Among Middle-Aged and Older Americans
Authors: Botoseneanu Anda , Markwardt Sheila , Allore Heather , Nagel Corey , Newsom Jason , Dorr David , Quinones Ana
Published: December 2020

Obesity and multimorbidity are more prevalent among U.S. racial/ethnic minority groups. Evaluating racial/ethnic disparities in multimorbidity accumulation according to body-mass index (BMI) may guide interventions to reduce multimorbidity burden in vulnerable racial/ethnic groups. Data from the 1998-2016 Health & Retirement Study (N=8,106, 51-55 years at baseline) and generalized estimating equations models with inverse probability weights estimated the accumulation of seven chronic diseases (arthritis, cancer, diabetes, heart disease, hypertension, lung disease, and stroke) between racial/ethnic groups [Non-Hispanic White (reference; 64.2%), Non-Hispanic Black (21.6%), Hispanic (14.2%)]. Overweight and obesity were more prevalent in Black (82.3%) and Hispanic (78.9%) than White (70.9 %) participants at baseline. Initial burden of morbidity was higher among Black participants [risk ratio (RR) =1.3, p<0.001] but similar among Hispanic compared with White participants; and higher in overweight or greater BMI categories compared with normal BMI (RR=1.07, 1.15, 1.22, p<0.001, for overweight, obese 1, and obese 2/3 BMI, respectively). Disease accumulation did not differ among racial/ethnic groups. Higher BMI was associated with less disease accumulation compared with the normal BMI category (RR=0.99, 0.98, 0.97, all p<0.001, for overweight, obese 1, and obese 2/3 BMI, respectively, per two-year interval). Black participants crossed the threshold of multimorbidity (≥2 diseases) 4-6 years earlier than White and Hispanic participants. There are substantial differences in initial disease burden between Black and White middle-aged/older adults, but not in the accumulation of disease, suggesting the need to intervene prior to entering middle age to reduce disparities in the burden of multimorbidity among vulnerable racial minorities.
Recruitment of a Diverse Research Cohort in a Large Metropolitan Area for Dementia Intervention Studies
Authors: Reuland Melissa , Johnston Deirdre , Antonsdottir Inga , Bunting Morgan , Samus Quincy
Published: December 2020

In the near future, the costs, both human and financial, of dementia care will grow exponentially. Over five and a half million older Americans are estimated to be living with Alzheimer’s disease and related dementia (ADRD). By 2050, this is expected to increase to over 13 million, with persons of color being at the highest risk for developing dementia. Considerable federal, state and private funds have been committed to research to prevent, treat, and care for persons at risk for ADRD. However, enrollment of research participants, particularly those coming from diverse backgrounds into studies, is a perennial challenge and has serious implications. Between 2014 and 2019, a Johns Hopkins study team implemented a wide ranging research recruitment effort in the Baltimore-Washington DC area to enroll participants into two large federally funded dementia care coordination trials. A total of 2,063 study participants were self- or caregiver referred to these projects via referrals from organizations (e.g. religious, health, social service, aging, Medicaid clams) and targeted community outreach (e.g. events, media). Ultimately, 647 ADRD/study partner dyads were enrolled (31%). Outreach and recruitment challenges included stigma, lack of confirmed diagnosis, mistrust of research, and situational crises. The study team adapted enrollment criteria as challenges emerged, and ultimately spent $101,058 on outreach and recruitment to enroll 647 participant dyads. This represents a cost of $156.19 per dyad. This poster will provide background on the research program, detail the comprehensive outreach and recruitment strategies employed and their costs, and discuss best practices for recruiting this population.
Stigmatization and the Experience of Informal Dementia Caregivers in Nigeria
Authors: Nwakasi Candidus , de Medeiros Kate , Esiaka Darlingtina
Published: December 2020

There is no formal word for dementia in Nigeria. Instead, some Nigerians, in their effort to make sense of dementia symptoms, use descriptions that may result in stigmatization of people living with dementia and their families. With Nigeria’s rapid aging, increased risk of dementia, and lack of formal long-term care, this study focused on the impact of stigma on the caregiving experiences of Nigerian women. This exploration is significant as adult females in Nigeria are the pillar of informal caregiving in the country. The study employed a qualitative descriptive method. Semi-structured interviews were conducted with a purposive sample of 12 adult informal female caregivers in Anambra, Nigeria. Data were then transcribed, coded and analyzed for themes. Afterwards, focus groups of 21 adult Nigerians residing in Ohio, US, were conducted to offer more contextual insight on the findings. The three major themes identified were: 1) negative views of dementia symptoms (e.g., witchcraft, madness), 2) caregiving protects against stigmatization (e.g., by keeping family members out of sight), and 3) stigma and caregiving support such as adult children abandoning parents with dementia because of the stigma associated with dementia. Given the overwhelming presence of stigma in all aspects of dementia to include dementia caregiving, results point to the critical need for better strategies to help strengthen informal caregiving in Nigeria. This includes culturally appropriate dementia education for families and caregivers, and formal long-term care policies that include care support in a rapidly aging Nigeria.
Coping Capacity and Episodic Memory in Older Adults With SMCs: The Mediating Role of Healthy Lifestyle
Authors: Wang Feilong , Li Shijie , Wang Kaifa , Yang Yanni
Published: December 2020

Older adults with subjective memory complaints (SMCs) are at increased risk for episodic memory decline. Episodic memory decline is an important predictor of objective memory impairment (one of the earliest symptoms of Alzheimer’s disease) and an often-suggested criterion of successful memory aging. Therefore, it is important to explore the determinant factors that influence episodic memory in older adults with SMCs. Roy adaptation model and preliminary evidence suggest that older adults with SMCs undergo a coping and adaptation process, a process influenced by many health-related risks and protective factors. This study aimed to explore the relationship between coping capacity and episodic memory, and the mediating role of healthy lifestyle between coping capacity and episodic memory in a sample of 309 community-dwelling older adults with SMCs. Results from the structural equation modeling showed that coping capacity directly affects episodic memory (r=0.629, p＜0.001), and there is a partial mediating effect (60.5%) of healthy lifestyle among this sample of older adults with SMCs. This study demonstrates that coping capacity and adaptation positively correlate with episodic memory in older adults with SMCs, and that these correlations are mediated by healthy lifestyle. The results suggest that older adults with poor coping capacity should be assessed and monitored regularly, and clear lifestyle-related interventions initiated by healthcare providers that promote healthy lifestyles may effectively improve coping capacity and episodic memory in this population group. Note: First author: Feilong Wang, Co-first author: Shijie li, Corresponding author: Yanni Yang
Environmental Influences of Extreme Heat on the Health of Older Adults: A Retrospective Study
Authors: Liu Mei , Buller Carol , Polivka Barbara , Woodburn Terri , Jakubauskas Mark , Wolfe Benjamin
Published: December 2020

Studies have suggested that extreme weather events have differential effects by age. By leveraging electronic medical records, we aim to analyze the environmental influence of extreme heat on the health of older adults. From our healthcare system’s de-identified data warehouse, we extracted a retrospective cohort of 108,192 patients who were ≥65 years of age as of 1/1/2018 with pre-existing chronic conditions including diabetes, COPD, cardiovascular disease, or kidney disease. Extreme heat event period was defined as 5/1/2018 to 9/1/2018 (79 days with temperature ≥90o; 15 days of moderately poor/poor air quality index (AQI) [≥75] values) and the comparison period was defined as 5/1/2019 to 9/1/2019 (51 days with temperature ≥90o; 0 days with moderately poor/poor AQI values) in the Kansas City area. We randomly partitioned the study cohort into two sets and demonstrated the two patient sets were statistically similar (p>0.05) with respect to their demographic and underlying health conditions. Finally, we compared the respiratory, cardiovascular, and renal health outcomes between the 2018 and the 2019 cohorts. Most patients were Caucasians, female and had comorbid conditions. Results showed significantly higher number of all-cause emergency department visits (p=0.04) and outpatient visits (p=<.001) during the extreme heat event period in 2018. Analyses also showed significantly higher number of outpatient visits due to upper respiratory diseases (p=0.008) and acute renal failure (p=0.01) in 2018. In conclusion, extreme heat increased use of healthcare services in older adults with chronic conditions.
Psychiatric Disorders and Mild Cognitive Impairment in Older Veterans With Subjective Memory Complaints
Authors: Delgadillo Mia , Frank Megan , Boese Aidan , Schulte Tilman , Fairchild J Kaci
Published: December 2020

Psychiatric disorders pose a unique risk for Alzheimer’s disease (AD). Prior research indicates psychiatric disorders in MCI increase AD vulnerability. Less research has been done to understand how psychiatric disorders may affect the development of MCI. Understanding these potentially modifiable risk factors is important as they may represent a potential target of intervention for secondary prevention of AD. The present study examines the relationship between psychiatric disorders and amnestic MCI (aMCI) in a sample of Veterans with subjective memory complaints. The sample included 150 older adults with subjective memory complaints (90% male, age = 70.6±8.2). aMCI diagnosis was based upon performance on the delayed recall trials of the Rey Auditory Verbal Learning Test and Logical Memory II of the Wechsler Memory Scale-4th edition. Psychiatric disorders (e.g., Mood Disorders, Anxiety Disorders, and Substance Use Disorders) were assessed using the Mini Neuropsychiatric Interview for DSM-IV. Logistic regression modeling demonstrated that diagnosis of anxiety disorders, but not mood or substance use disorders, was significantly associated with aMCI status. Specifically, older adults with an anxiety disorder were less likely to have aMCI than those older adults without an anxiety disorder. Additional analyses revealed that within those with aMCI (n=107), persons with a psychiatric disorder were significantly younger than those without a psychiatric disorder by an average of 6 years. These findings support prior research on the complex relationship of anxiety and cognitive impairment as well as suggest that those with psychiatric disorders may be at risk for developing aMCI at younger ages.
The Role of Functional Risk and Fear of Falling in Older Adults’ Everyday Walking Activity
Authors: Jansen Carl-Philipp , Klenk Jochen , Nerz Corinna , Labudek Sarah , Kramer Franziska , Becker Clemens , Schwenk Michael
Published: December 2020

Some persons have low functional risk (FR) but also high levels of fear of falling (FOF), in some it may be the exact opposite; in others, FOF matches actual functional risk. In order to characterise older persons in this respect, Delbaere et al. (2010) defined four groups: ‘vigorous’ (low FR/FOF), ‘anxious’ (low FR/high FOF), ‘stoic’ (high FR/low FOF), and ‘aware’ (high FR/FOF). We examined how the proposed group model translates into actual walking behaviour and explored whether group differences in walking occur due to FR level rather than the amount of FOF. Group allocation of N=294 participants was determined based on previously published cut-offs for FR (high vs. low Timed Up-and-Go) and FOF (high vs. low Short Falls-Efficacy Scale International). Walking activity was operationalised as mean number of steps per day over one week, assessed using ‘activPAL4™ micro’ accelerometers. Number of steps in the four groups were 6,335 (‘vigorous’), 5,782 (‘anxious’), 4,851 (‘stoic’), and 4,627 (‘aware’). Linear regression results showed that in the two low FR groups, those with high FOF did not differ significantly from the reference group with low FOF (anxious - vigorous: B=-645.3 steps, p=.157); however, the two groups with high FR showed a significantly different number of steps than the ‘vigorous’ group, irrespective of their FOF (aware-vigorous: B=-1536.1 steps, p=.002; stoic-vigorous: B=-1314.8 steps, p=.005). This means that FR outperformed FOF in their association with walking behaviour, i.e., participants can be better separated in their daily walking behaviour by FR than by FOF.
Use of Sitters for Patient Safety in a Veteran Population
Authors: Kresevic Denise , Burant Christopher
Published: December 2020

Patient safety including falls risk, is a high priority and an increasing challenge for all health care facilities. Safety risk factors include both physical factors and psychological factors. One common strategy to increase safety has been the use of “sitters.”. Studies on functions and outcomes are conflicting some have reported no differences in falls, decreases in falls and restraints, and increases in falls. A total survey sample of 22 “sitters” and 56 registered nurses conducted at a large midwestern VA facility to assess perceptions of sitters. Groups were similar in ages (41-50 years) with sitters having slightly more experience (11-20 years) versus nurses (6-10 years). Safety conditions most likely to be identified with sitter usage were delirium, elopement, and being a hospice patient. Sitters were more likely to identify falls risk, sitters 63% of time versus RN perception 30.9% (Chi Square=7.0, df=l, p=.008); dementia 59% vs 13% (Chi square=17.15, df=1, p=.001); and weakness 66.7% vs 18.2% (Chi square=16.54, df=1, p=.001). Sitters were more likely to have training in delirium 55% vs nurses, 34% (Chi sq=2.557, df=1 p=.11). Nurses identified that the use of sitters were very likely to prevent falls 29.8%, calm patients 25.2%, maintain lines 25.2%, prevent elopement 30.5% and redirect patients 29.7%. Nurses identified the following available safety strategies: alarms (67.2%), adjusting assignment (47.2%), music therapy (5.4%), use of restraints (<2%), pet therapy (<2%), and video monitoring (<1%). Implementation of safety programs must address availability of multiple strategies including: matching sitter competencies with patient populations served.
Affective Response During a Sorting Task for Geriatric Hoarding
Authors: Dozier Mary , Young Amy , Camilleri Scott
Published: December 2020

Previous research suggests older adults with hoarding disorder are more likely to express non-fear-based emotions when sorting. The purpose of this study was to examine the emotions expressed by eight rural-dwelling older adults with hoarding disorder when sorting and discarding possessions. The study took place in participants’ homes and involved a 15-minute behavioral sorting task where participants were asked to sort through personal items and make a decision to either keep or discard each item. Participants were asked to rate their Subjective Units of Distress (SUDs) and to state their emotional state prior to the sorting task, every 5 minutes throughout the test, and after completing the task. Four participants did not complete the sorting task due to a lack of a desire to discard objects (e.g., “I want to keep it all”). For the four participants who did complete the task, an average of 53 items were sorted and an average of 24 items were discarded. The average decrease in SUDs from pre-task to post-task was 40. Overall, most participants reported feeling positive emotions before, during, and following the task, with the most commonly reported emotion being joy. This study supports prior research suggesting that not all hoarding is fear based and that older adults may be more motivated by increasing positive associations with sorting and discarding. A focus on increasing patients’ insight and sense of self-efficacy may lead to increased treatment gains for older adults with hoarding disorder.
An extended ice-age sea-level equation: incorporating water flux across sills
Authors: Coulson Sophie , Al-Attar David , Mitrovica Jerry
Published: December 2020

We present a generalized theory governing gravitationally self-consistent, spatio-temporal sea-level changes within an ocean-plus-lake system that is intermittently connected by water mass flux across a sill. Our expressions for the change in sea level (defined as the difference in height of the sea surface equipotential relative to the solid surface) hold for any Earth model, and easily incorporate effects of viscoelastic deformation of the solid Earth and perturbations in both the gravitational field and rotation vector (as is now standard in ice-age sea-level calculations). In its most general form, the theory also includes an exact treatment of the evolving shoreline position in both water bodies. Our formalism involves three cases: (1) one global ocean, in which mass transfer may occur between ice sheets and the global ocean; (2) an ocean and lake separated by an exposed sill, in which mass transfer may occur between ice sheets and the global ocean, and between the ocean and lake via evaporative flux; and (3) transitional phases between these two states, when the ocean surface reaches the height of the sill from below (i.e., the sill is breached) or above (the sill is exposed). We illustrate the new theory using examples from the Black Sea flooding during the last deglacial phase (∼10 ka) and sea-level fall in the Mediterranean Sea during the Messinian Salinity Crisis (5.96-5.33 Ma). These examples demonstrate the importance of including the geophysical feedbacks associated with sea-level change in an isolated basin in the dynamics of flooding and desiccation.
Laterally varying scattering properties in the North Anatolian Fault Zone from ambient noise cross-correlations
Authors: van Dinther Chantal , Margerin Ludovic , Campillo Michel
Published: December 2020

Intrinsic absorption and scattering properties provide us with information about the physical state and heterogeneity of the Earth’s crust. These properties are usually obtained by observing the energy decay of naturally occurring earthquakes, leading to sparse spatial sampling and therefore average scattering values over a large region. This study uses ambient noise cross-correlations to analyse the energy decay and scattering properties over a part of the North Anatolian Fault (NAF; Turkey) from the continuous records of the 73 stations of the DANA temporary array in the frequency band 0.1–0.5 Hz. The region covered by the stations has rapidly varying geological characteristics and is highly faulted around the northern strand of the NAF. We measured in the noise correlations the space–time evolution of the energy of the coda waves. We first perform measurements in separate subregions. The local scattering and attenuation properties are obtained by global optimization of a 2-D solution of the radiative transfer equation for surface waves. We found that the mean free path and attenuation coefficient are considerably varying laterally with strong scattering observed in the region lying along the northern strand of NAF. The optimization provides well-constrained values for the scattering mean free path on the order of 10 km in the fault region. The mean free path is much larger (>100 km) in the neighbouring regions. We compare our global observations with a phonon based Monte Carlo simulation of scattered energy in a laterally variable scattering model. These simulations confirm the large contrast of heterogeneity between NAF and the surrounding crust and provide further constraints on the lateral extent of NAF. When sources are located inside the fault zone, we find a signature of the actual non-uniform scattering properties, observed as a concentration of energy in the fault zone for a limited amount of time. This in turn suggests that lateral variations of scattering properties should be taken into account in future monitoring studies.
Anti-HA antibody does not detect hyaluronan
Authors: Šínová Romana , Žádníková Petra , Šafránková Barbora , Nešporová Kristina
Published: December 2020

It is generally known that hyaluronic acid (HA) is a biocompatible and biodegradable glycosaminoglycan distributed widely throughout epithelial, connective and neural tissues. HA is one of the chief components of the extracellular matrix. Lack of immunogenicity is one of the biggest advantages of the therapeutic use of HA, but it also prevents the production of specific anti-HA antibodies. Contrary to this, there are still several studies performing HA detection by immunohistochemical or immunohistofluorescent method using an anti-HA antibody. Therefore, this short study discusses whether the anti-HA antibody is specific for HA. To verify the specificity of the HA staining the hyaluronidase treatment of histological samples was performed and the ability of anti-HA antibody and biotinylated HA binding protein (bHABP)-based probe to bind to their targets was evaluated. Additionally, the competitive binding assay with short HA oligosaccharides and subsequent histological staining was performed. Both assays showed that the anti-HA antibody is not sufficiently specific for HA and that the bHABP probe is a reliable method for HA detection in histological samples. The conclusion made by previous investigators based on using HA antibodies should be reevaluated and future use of anti-HA antibody should be avoided.
Testing risk and protective factor assumptions in the Icelandic model of adolescent substance use prevention
Authors: Kristjansson Alfgeir L , Lilly Christa L , Thorisdottir Ingibjorg E , Allegrante John P , Mann Michael J , Sigfusson Jon , Soriano Humberto E , Sigfusdottir Inga Dora
Published: December 2020

Iceland has witnessed a dramatic decline in adolescent substance use that may be partly the result of efforts related to the Icelandic prevention model (IPM). We sought to test risk and protective factor assumptions of the IPM using a prospective cohort study with 12 months separating baseline from follow-up. Participants were students in grades 8 and 9 in the national Icelandic school system enrolled in the spring of 2018 and 2019 (N=2165). Participants self-reported their experiences of cigarette smoking, alcohol consumption, and cannabis use and seven risk and protective factors. Analyses were conducted with generalized linear modeling with extension to general estimating equations with correlated outcomes data. Both individual main-effects models and collective models including all main-effects were tested. Out of 28 individual main-effects models, 23 produced findings consistent with study premises (P<0.05). Multiple main-effects models largely sustained the findings of the individual main-effects models. Findings support the assumption that the risk and protective factors commonly emphasized in the IPM are associated with the four different substance use outcomes in the hypothesized direction. Communities that plan to implement the IPM among adolescents might consider these factors in their work.
Machine learning approach to extract building footprint from high-resolution images: the case study of Makkah, Saudi Arabia
Authors: Faisal Kamil , Imam Ayman , Majrashi Abdulrahman , Hegazy Ibrahim
Published: December 2020

Extracting and identifying building boundaries from high-resolution images have been a hot topic in the field of remote sensing for years. Various methods including geometric, radiometric, object based and edge detection were previously deliberated and implemented in different studies in the context of building extraction. Nevertheless, the reliability of extraction process is mainly subject to user intervention. The current study proposes a new automatic morphology-based approach for extracting buildings using high-resolution satellite images of Al-Hudaybiyah region in the city of Makkah as a case study. The proposed technique integrates the support vector machine for extracting buildings that have bright and dark roofs. The appropriateness of this method has been examined by means of various indicators for example completeness, correctness and quality. Preliminary findings will illustrate the precision and accuracy of the used machine learning algorithm. Research results can provide a generic indicator to assist the planning authorities in achieving better urban planning processes taking into account all potential environmental, social and urban demands and requirements.
Respiratory Syncytial Virus–Associated Hospitalization Rates among US Infants: A Systematic Review and Meta-Analysis
Authors: McLaughlin John M , Khan Farid , Schmitt Heinz-Josef , Agosti Yasmeen , Jodar Luis , Simões Eric A F , Swerdlow David L
Published: December 2020

Background

Although global reviews of infant respiratory syncytial virus (RSV) burden exist, none have summarized data from the United States or evaluated how RSV burden estimates are influenced by variations in study design.

Methods

We performed a systematic literature review and meta-analysis of studies describing RSV-associated hospitalization rates among US infants and examined the impact of key study characteristics on these estimates.

Results

We reviewed 3328 articles through 14 August 2020 and identified 25 studies with 31 unique estimates of RSV-associated hospitalization rates. Among US infants <1 year of age, annual rates ranged from 8.4 to 40.8 per 1000 with a pooled rate of 19.4 (95% confidence interval [CI], 17.9–20.9). Study type influenced RSV-associated hospitalization rates (P = .003), with active surveillance studies having pooled rates (11.0; 95% CI, 9.8–12.2) that were half that of studies based on administrative claims (21.4; 19.5–23.3) or modeling approaches (23.2; 20.2–26.2).

Conclusions

Applying our pooled rates to the 2020 US birth cohort suggests that 79 850 (95% CI, 73 680–86 020) RSV-associated infant hospitalizations occur each year. The full range of RSV-associated hospitalization rates identified in our review can better inform future evaluations of RSV prevention strategies. More research is needed to better understand differences in estimated RSV burden across study design.
Opinion: Genetic Conflict With Mobile Elements Drives Eukaryotic Genome Evolution, and Perhaps Also Eukaryogenesis
Authors: Collens Adena B , Katz Laura A
Published: December 2020

Through analyses of diverse microeukaryotes, we have previously argued that eukaryotic genomes are dynamic systems that rely on epigenetic mechanisms to distinguish germline (i.e., DNA to be inherited) from soma (i.e., DNA that undergoes polyploidization, genome rearrangement, etc.), even in the context of a single nucleus. Here, we extend these arguments by including two well-documented observations: (1) eukaryotic genomes interact frequently with mobile genetic elements (MGEs) like viruses and transposable elements (TEs), creating genetic conflict, and (2) epigenetic mechanisms regulate MGEs. Synthesis of these ideas leads to the hypothesis that genetic conflict with MGEs contributed to the evolution of a dynamic eukaryotic genome in the last eukaryotic common ancestor (LECA), and may have contributed to eukaryogenesis (i.e., may have been a driver in the evolution of FECA, the first eukaryotic common ancestor). Sex (i.e., meiosis) may have evolved within the context of the development of germline–soma distinctions in LECA, as this process resets the germline genome by regulating/eliminating somatic (i.e., polyploid, rearranged) genetic material. Our synthesis of these ideas expands on hypotheses of the origin of eukaryotes by integrating the roles of MGEs and epigenetics.
The Combined Effect of Haplodiplonty and Partial Clonality on Genotypic and Genetic Diversity in a Finite Mutating Population
Authors: Stoeckel Solenn , Arnaud-Haond Sophie , Krueger-Hadfield Stacy A
Published: December 2020

Partial clonality is known to affect the genetic composition and evolutionary trajectory of diplontic (single, free-living diploid stage) populations. However, many partially clonal eukaryotes exhibit life cycles in which somatic development occurs in both haploid and diploid individuals (haplodiplontic life cycles). Here, we studied how haplodiplontic life cycles and partial clonality structurally constrain, as immutable parameters, the reshuffling of genetic diversity and its dynamics in populations over generations. We assessed the distribution of common population genetic indices at different proportions of haploids, rates of clonality, mutation rates, and sampling efforts. Our results showed that haplodiplontic life cycles alone in finite populations affect effective population sizes and the ranges of distributions of population genetic indices. With nonoverlapping generations, haplodiplonty allowed the evolution of 2 temporal genetic pools that may diverge in sympatry due to genetic drift under full sexuality and clonality. Partial clonality in these life cycles acted as a homogenizing force between those 2 pools. Moreover, the combined effects of proportion of haploids, rate of clonality, and the relative strength of mutation versus genetic drift impacts the distributions of population genetics indices, rendering it difficult to transpose and use knowledge accumulated from diplontic or haplontic species. Finally, we conclude by providing recommendations for sampling and analyzing the population genetics of partially clonal haplodiplontic taxa.
Short-term safety of adjuvant chemoradiotherapy after local resection for patients with high-risk submucosal invasive rectal cancer: a single-arm, multicenter phase II trial
Authors: Noguchi Masaaki , Shitara Kohei , Kawazoe Akihito , Yamamoto Daisuke , Takii Yasumasa , Saito Yutaka , Sato Toshihiko , Horimatsu Takahiro , Ishikawa Hideki , Ito Yoshinori , Ito Masaaki , Ikematsu Hiroaki
Published: December 2020

Background

Surgery is recommended for patients with high-risk submucosal invasive rectal cancer (SM-RC) after local resection but affects the quality of life due to stoma placement or impaired anal function; therefore, alternative treatment approaches are needed to prevent local metastasis. The purpose of this study was to assess the short-term safety of adjuvant chemoradiotherapy with capecitabine in patients with high-risk submucosal invasive rectal cancer after local resection.

Methods

This single-arm, multicenter, phase II trial included patients undergoing local resection for high-risk submucosal invasive rectal cancer within 12 weeks prior to enrollment. High-risk submucosal invasive rectal cancer was defined as the presence of at least one of the following factors: poor differentiation of adenocarcinoma, submucosal invasion depth > 1 mm, presence of lymphovascular invasion and grade-2 or -3 tumour budding. Protocol treatment comprised 45.0 Gy radiotherapy with conventional fractionation and 1650 mg/m2 capecitabine given twice daily until radiotherapy completion. The primary endpoint was treatment completion rate with an expected rate of 95% and a threshold of 80%.

Results

Twenty-nine patients from six institutions were enrolled between May 2015 and February 2018. One patient was ineligible. Twenty-three patients completed treatment, with a completion rate of 82% (80% confidence interval, 69–91%); the remaining five patients completed treatment with protocol deviation. The median relative dose intensity of capecitabine was 100% (range, 58–100%). Common adverse events included radiation dermatitis (54%), anal pain (39%) and anal mucositis (29%). No grade-3 or higher adverse events were reported.

Conclusions

Adjuvant chemoradiotherapy using capecitabine demonstrated acceptable short-term safety profiles in patients with high-risk submucosal invasive rectal cancer after local resection.
The effect of pollen source on seed traits and dispersability in the heterocarpic annualCrepis sancta
Authors: Dener Efrat , Shemesh Hagai , Giladi Itamar
Published: December 2020

Aims

The evolution and expression of dispersal-related traits are intertwined with those of other life-history functions and are manifested within various physiological constraints. Such a relationship is predicted between inbreeding levels and dispersability, which may be anatomically and ontogenetically linked so that the selection pressures on one may affect the other. While both the effect of inbreeding on reproductive success and on dispersal strategies received much attention, only a few studies considered both simultaneously. Furthermore, such studies often rely on two dichotomic representations of breeding and dispersal: using selfing versus outcrossing as a representation of breeding level, and dispersal ratio as the sole representation of dispersal strategy.

Methods

Here, we used pollination experiments in the heterocarpic Crepis sancta (Asteraceae) to expand in two different manners on the common practice of using dichotomic representations of breeding and dispersal. First, we used pollination treatments that represent a continuum from selfing through pollination by kin to pollination by a distant neighbor. Second, we measured a whole set of continuous morphological and dispersal-related traits, in addition to measurements of reproductive success and dispersal ratio.

Important Findings

The proportion of developed capitula and the number of both dispersed and non-dispersed achenes were significantly lower in the self-pollination treatment in comparison to the outcrossed treatments. The effect of pollen sources on dispersal ratio was not statistically significant, though self-pollinated plants rarely produced non-dispersing seeds. Achene’s biomass increased with distance between parent plants, but pappus width did not, leading to a nonsignificant effect of pollination on falling velocity. Overall, pollen source affected mainly traits that were associated with reproductive output, but it had no clear effect on predominately dispersal-related traits. Such differences in the response of reproduction and dispersal traits to variation in pollen source suggest that dispersal-related selection is probably weak and/or masked by other forces.
Trends in Surgical Volume in the Military Health System—A Potential Threat to Mission Readiness
Authors: Haag Austin , Cone Eugene B , Wun Jolene , Herzog Peter , Lyon Samuel , Nabi Junaid , Marchese Maya , Friedlander David F , Trinh Quoc-Dien
Published: December 2020

Introduction

The Military Health System (MHS) is tasked with a dual mission both to provide medical services for covered patients and to ensure that its active duty medical personnel maintain readiness for deployment. Knowledge, skills, and attitudes (KSA) is a metric evaluating the transferrable skills incorporated into a given surgery or medical procedure that are most relevant for surgeons deployed to a theatre of war. Procedures carrying a high KSA value are those utilizing skills with high relevance for maintaining deployment readiness. Given ongoing concerns regarding surgical volumes at MTFs and the potential adverse impact on military surgeon mission readiness were high-value surgeries to be lost to the civilian sector, we evaluated trends in the setting of high-value surgeries for beneficiaries within the MHS.

Methods

We retrospectively analyzed inpatient admissions data from MTFs and TRICARE claims data from civilian hospitals, 2005-2019, to identify TRICARE-covered patients covered under “purchased care” (referred to civilian facilities) or receiving “direct care” (undergoing treatment at MTFs) and undergoing seven high-value/high-KSA surgeries: colectomy, pancreatectomy, hepatectomy, open carotid endarterectomy, abdominal aortic aneurysm (AAA) repair, esophagectomy, and coronary artery bypass grafting (CABG). Overall and procedure-specific counts were captured, MTFs were categorized into quartiles by volume, and independence between trends was tested with a Cochran–Armitage test, hypothesizing that the proportion of cases referred for purchased care was increasing.

Results

We captured 292,411 cases, including 7,653 pancreatectomies, 4,177 hepatectomies, 3,815 esophagectomies, 112,684 colectomies, 92,161 CABGs, 26,893 AAA repairs, and 45,028 carotid endarterectomies. The majority of cases included were referred for purchased care (90.3%), with the proportion of cases referred increasing over the study period (P < .01). By procedure, all cases except AAA repairs were increasingly referred for treatment over the study period (all P < .01, except esophagectomy P = .04). On examining volume, we found that even the highest-volume-quartile MTFs performed a median of less than one esophagectomy, hepatectomy, or pancreatectomy per month. The only included procedure performed once a month or more at the majority of MTFs was CABG.

Conclusion

On examining volume and referral trends for high-value surgeries within the MHS, we found low surgical volumes at the vast majority of included MTFs and an increasing proportion of cases referred to civilian hospitals over the last 15 years. Our findings illustrate missed opportunities for maintaining the mission readiness of military surgical personnel. Prioritizing the recapture of lost surgical volume may improve the surgical teams’ mission readiness.
Emergency Department Utilization in the U.S. Military Health System
Authors: Dalton Michael K , Andriotti Tomas , Matsas Bridget , Chaudhary Muhammad Ali , Tilley Laura , Lipsitz Stuart , Learn Peter A , Schoenfeld Andrew J , Jarman Molly P , Goralnick Eric
Published: December 2020

Introduction

Emergency department (ED) utilization represents an expensive and growing means of accessing care for a variety of conditions. Prior studies have characterized ED utilization in the general population. We aim to identify the clinical conditions that drive ED utilization in a universally insured population and the impacts of care setting on ED use and admissions in the U.S. Military Health System.

Methods

We queried TRICARE claims data from October 1, 2012, to September 30, 2015, to identify all ED visits for adult patients (age 18-64). The primary presenting diagnoses of all ED visits and those leading to admission are presented with descriptive statistics. Logistic regression was used to identify clinical and sociodemographic factors associated with admission from the ED.

Results

A total of 4,687,205 ED visits were identified, of which 46% took place in the DoD healthcare facilities (direct care). The most common diagnoses across all ED visits were abdominal pain, chest pain, headache, nausea and vomiting, and urinary tract infection. A total of 270,127 (5.8%) ED visits led to inpatient admission. The most common diagnoses leading to admission were chest pain, abdominal pain, depression, conditions relating to acute psychological stress, and pneumonia. For patients presenting with 1 of the 10 most common ED diagnoses, those who were seen at a civilian ED were significantly less likely to be admitted (3.4%) compared to direct care facilities (4.1%) in an adjusted logistic regression model (Adjusted Odds Ratio 0.40 [95% CI: 0.40-0.41], P < .001).

Conclusions

Ultimately, we show that abdominal pain and chest pain are the most common reasons for presentation to the ED in the Military Health System and the most common presenting diagnoses for admission from the ED. Among patients presenting with the most common ED conditions, direct care EDs were significantly more likely to admit patients than civilian facilities.
The 2017 May 20 stellar occultation by the elongated centaur (95626) 2002 GZ32
Authors: Santos-Sanz P , Ortiz J L , Sicardy B , Benedetti-Rossi G , Morales N , Fernández-Valenzuela E , Duffard R , Iglesias-Marzoa R , Lamadrid J L , Maícas N , Pérez L , Gazeas K , Guirado J C , Peris V , Ballesteros F J , Organero F , Ana-Hernández L , Fonseca F , Alvarez-Candal A , Jiménez-Teja Y , Vara-Lubiano M , Braga-Ribas F , Camargo J I B , Desmars J , Assafin M , Vieira-Martins R , Alikakos J , Boutet M , Bretton M , Carbognani A , Charmandaris V , Ciabattari F , Delincak P , Fuambuena Leiva A , González H , Haymes T , Hellmich S , Horbowicz J , Jennings M , Kattentidt B , Kiss Cs , Komžík R , Lecacheux J , Marciniak A , Moindrot S , Mottola S , Pal A , Paschalis N , Pastor S , Perello C , Pribulla T , Ratinaud C , Reyes J A , Sanchez J , Schnabel C , Selva A , Signoret F , Sonbas E , Alí-Lagoa V
Published: December 2020

We predicted a stellar occultation of the bright star Gaia DR1 4332852996360346368 (UCAC4 385-75921) (mV = 14.0 mag) by the centaur 2002 GZ32 for 2017 May 20. Our latest shadow path prediction was favourable to a large region in Europe. Observations were arranged in a broad region inside the nominal shadow path. Series of images were obtained with 29 telescopes throughout Europe and from six of them (five in Spain and one in Greece) we detected the occultation. This is the fourth centaur, besides Chariklo, Chiron, and Bienor, for which a multichord stellar occultation is reported. By means of an elliptical fit to the occultation chords, we obtained the limb of 2002 GZ32 during the occultation, resulting in an ellipse with axes of 305 ± 17 km × 146 ± 8 km. From this limb, thanks to a rotational light curve obtained shortly after the occultation, we derived the geometric albedo of 2002 GZ32 (pV = 0.043 ± 0.007) and a 3D ellipsoidal shape with axes 366 km × 306 km × 120 km. This shape is not fully consistent with a homogeneous body in hydrostatic equilibrium for the known rotation period of 2002 GZ32. The size (albedo) obtained from the occultation is respectively smaller (greater) than that derived from the radiometric technique but compatible within error bars. No rings or debris around 2002 GZ32 were detected from the occultation, but narrow and thin rings cannot be discarded.