bluuebunny/crossref_metadata_2025 huggingface dataset:
Isolation and identification of a novel erythromycin-degrading fungus, Curvularia sp. RJJ-5, and its degradation pathway
Authors: Ren Jianjun , Deng Liujie , Niu Dongze , Wang Zhenzhu , Fan Bo , Taoli Huhe , Li Zhijie , Zhang Jin , Li Chunyu
Published: December 2020

Erythromycin pollution is an important risk to the ecosystem and human health worldwide. Thus, it is urgent to develop effective approaches to decontaminate erythromycin. In this study, we successfully isolated a novel erythromycin-degrading fungus from an erythromycin-contaminated site. The erythromycin biodegradation characteristics were investigated in mineral salt medium with erythromycin as the sole carbon and energy source. The metabolites of erythromycin degraded by fungus were identified and used to derive the degradation pathway. Based on morphological and phylogenetic analyses, the isolated strain was named Curvularia sp. RJJ-5 (MN759651). Optimal degradation conditions for strain RJJ-5 were 30°C, and pH 6.0 with 100 mg L−1 erythromycin substrate. The strain could degrade 75.69% erythromycin under this condition. The following metabolites were detected: 3-depyranosyloxy erythromycin A, 7,12-dyhydroxy-6-deoxyerythronolide B, 2,4,6,8,10,12-hexamethyl-3,5,6,11,12,13-hexahydroxy-9-ketopentadecanoic acid and cladinose. It was deduced that the erythromycin A was degraded to 3-depyranosyloxy erythromycin A by glycoside hydrolase in the initial reaction. These results imply that Curvularia sp. RJJ-5 is a novel erythromycin-degrading fungus that can hydrolyze erythromycin using a glycoside hydrolase and has great potential for removing erythromycin from mycelial dreg and the contaminated environment.
My Heart Has Always Been Set on Pediatrics, and Other Insights From First-Year Medical Students
Authors: Inker Jennifer , Marrs Sarah , McIntyre Madeline , Waters Leland , Gendron Tracey
Published: December 2020

Senior mentoring programs provide medical students exposure to a community-dwelling older adult mentor with whom they meet multiple times throughout the program. The goal of these programs is to expose students to healthy older adults, increase their knowledge of topics in geriatrics and aging, and increase the likelihood that students will pursue geriatric specialties. Though research findings show that senior mentoring programs have the potential to increase medical students’ attitudes towards older adults (Samra et al., 2013) and their willingness to consider working with older patients in the future (McManus et al., 2017), a critical shortage of doctors who specialize in geriatrics still exists. Moreover, the demand for geriatrically-trained physicians is expected to continue to increase (American Geriatrics Society, 2018). In order to develop avenues for successfully fostering interest in and pursuit of geriatrics specialties, we need to fully understand students’ perceptions of working with older adults. The purpose of this qualitative content analysis was to explore first-year medical students’ (n = 216) perceptions of working with older adults. We asked students to respond to the following reflection at the beginning and end of their Senior Mentoring program: How do you feel about working with older patients after you complete your training? Our findings suggest that while students feel more comfortable with and open to caring for older adults, they do not feel compelled to pursue geriatrics. Themes and sub-categories emerging from the data provide insight into why students continue to dismiss pursuing geriatrics.
A Scoping Review of Innovative Housing for Older Adults: Focus on Homesharing, Cohousing, NORC-SSPs, and Villages
Authors: Seetharaman Kishore , Mahmood Atiya , Chaudhury Habib
Published: December 2020

This scoping review explores the benefits, and challenges of major innovative housing and service models for older adults. Several countries are prioritizing housing and service innovation for older adults to address the limitations of traditional market housing in meeting their housing needs and challenges. This study contributes to this issue by reviewing peer-reviewed and grey literature on four well-established innovative housing and service models: cohousing, homesharing, Naturally Occurring Retirement Community Supportive Services Programs (NORC-SSPs), and Villages. Based on the findings synthesized from 65 sources, a pair-wise comparison of (i) cohousing and homesharing; and (ii) NORC-SSPs and Villages was conducted on the basis of: (a) financial aspects (e.g., affordability); and (b) psychosocial aspects (e.g., social interaction and engagement, intergenerationality, autonomy and interdependence, safety, diversity and inclusivity); and (c) long-term sustainability. While there were several financial and psychosocial benefits related to each model, the following challenges were identified that need to be addressed to further improve the relevance and effectiveness of these models: (i) lack of funding and resources to support NORC-SSPs and Villages; (ii) inter-resident conflict in homesharing and cohousing; (iii) limitations of informal support provided by fellow-residents in meeting the needs of older adults with complex needs in all four models; and (iv) lack of inclusivity and sociocultural diversity in cohousing and Villages. By integrating research on older adults’ housing needs and innovative solutions, the findings of this study could guide future housing initiatives that seek to adopt these innovative models by highlighting their strengths, while recognizing areas for improvement.
National Hospitalization Trends Among Centenarians in the United States
Authors: Twersky Sylvia , Davey Adam
Published: December 2020

Continued increases in life expectancy mean than an unprecedented number of individuals are reaching centenarian status, often with complex health concerns. Little research has addressed acute care experiences of centenarians. To address this knowledge gap, we analyzed 10 years of hospital admissions data from a total of 52618 centenarians (aged 100 to 115 years) in the nationally representative National Inpatient Study (NIS) with the aim of characterizing centenarian (mean age 101.4 years, 80% women, 24.2% non-White, 91.3% Medicare, 72.2% emergencies, 18.6% urgent) hospitalizations. Mean length of stay (LOS) decreased from 6.1 to 5.1 days (2000-2009). Over the same period, mean total charges rose from $13373 to $25026; they were $4478 lower for women than men and $4032 more for centenarians age 105 years and older than ages 100 to 104, despite comparable LOSs. Mean LOS was approximately 0.7 days longer for non-Whites than Whites, and mean total charges were approximately $6531 higher for non-Whites than Whites. The 10 most common admission diagnoses were consistent with frailty and end stage cognitive impairment including pneumonia, congestive heart failure, urinary tract infections, fracture of neck of femur, septicemia, fluid and electrolyte disorders, aspiration pneumonitis, acute cerebrovascular disease, acute myocardial infarction, and gastrointestinal hemorrhage, and 10.0% of centenarians died in hospital. We link individual-level data with hospital and state characteristics over the same time period in order to provide a more detailed analysis of individual and system-level characteristics that contribute toward health disparities in hospitalizations and health outcomes among centenarians.
Influence of Context as a Key Ingredient for High Performance on Skilled Nursing Facility Readmissions
Authors: Ayele Roman , Manges Kirstin , Leonard Chelsea , Lee Marcie , Galenbeck Emily , Molla Mithu , Levy Cari , Burke Robert
Published: December 2020

Improving hospital discharge processes and reducing adverse outcomes post discharge has become a topic of national importance, especially for older patients transitioning to skilled nursing facilities (SNFs). The substantial variation in rehospitalization outcomes suggests contextual factors may play a role in performance. We conducted rapid ethnography with opportunistic interviews (148 hours of observations, 30 clinicians) at hospitals that were high (n=2) or low (n=2)- performing in terms of their readmission rates from SNF, as well as 5 associated SNFs, to understand how contextual differences influenced performance variation. We used thematic analysis to categorize contextual factors and compare differences across high and low perfoming sites. We found three main contextual factors that differed across high- and low-performing hospitals and SNFs: team dynamics, patient characteristics, and organizational context. First, we observed high-quality communication, situational awareness, and shared mental models among team members in high-performing sites. Second, patients at high-performing hospitals had better insurance coverage that made it feasible for clinicians to place patients in SNFs based on their needs instead of financial abilities. Third, staff at high-performing hospitals were more engaged in the transitions process and rapport building with SNFs thereby facilitating smooth transitions of care from hospitals to SNFs. For example, clinicians at high- performing sites were actively engaged in directing the discharge process, but this was not observed in low-performing sites where a lack of clinician engagement lead to delays. Understanding how context affects transitions could be used to target organizational, policy, and staff level interventions to reduce adverse outcomes.
Using Latent Class Analysis to Identify Types of Elder Abuse: Multidisciplinary Team Interventions
Authors: Galdamez Gerson , Gassoumis Zachary , Wilber Kathleen
Published: December 2020

Elder abuse is a complex, multifaceted problem that can devastate the lives of older adults, and overwhelm medical, legal, and social service providers. To address this problem, the Elder Abuse Multidisciplinary Team (MDT) is an oft-utilized intervention that brings individuals from various professional disciplines together to address elder abuse. With the passage of the Elder Justice Act of 2010, the Federal Government included budgetary provisions in support of a particularly promising model of MDT: The Elder Abuse Forensic Center (EAFC). Although the EAFC model has been implemented at four sites in California with promising outcomes, the specific structures, processes, and practices that currently define this model have not been validated with rigorous research of other MDTs in the United States. In this study, we surveyed 81 elder abuse MDT key informants across the country, using instruments guided by the most current EAFC model (Yonashiro-Cho et al., 2019). We then used Latent Class Analysis (LCA) to group these teams based on EAFC model characteristics. We hypothesized that elder abuse MDTs would fall on a spectrum: those that were identical or nearly identical to the EAFC model, those that had some EAFC qualities, and those that were not identical. Results of the LCA supported our hypothesis and revealed three types of elder abuse MDTs: EAFCs (n=26), Semi-EAFCs (n=24), and Non-EAFCs (n=31). Policy makers, advocates, and professionals seeking to form new teams or support existing teams can draw on these findings to make decisions about MDT creation and sustainability.
Prescription Pain Reliever Use and Misuse Among Marijuana Users Age 50+ Years
Authors: Choi Namkee , DiNitto Diana
Published: December 2020

Marijuana use among individuals aged 50+ has steadily increased over the past decade, with 8% reporting past-year use in 2018. National epidemiologic data also showed a 36% rate of past-year prescription pain reliever (PPNR) use in the 50+ age group in 2018, a decrease from 40% in 2015, but still significantly higher than for younger age groups. Little research has, however, focused on older adults’ dual recreational and/or medical marijuana and PPNR use. This study, based on the 2015-2018 National Survey of Drug Use and Health, examined rates and correlates of dual marijuana and PPNR use and misuse among those aged 50+ who reported past-year marijuana use (N=2,632). Our findings showed that 43.6% of past-year marijuana users did not use any PPNR, 47.1% used PPNR but did not misuse, and 9.4% misused PPNR in the past year, showing that one in six dual marijuana and PPNR users reported misusing PPNR. The risks of PPNR use/no misuse and PPNR misuse were higher among those who had more chronic medical conditions and major depressive episode. Additionally, the risk of PPNR use/no misuse was associated with high frequency and medical marijuana use; and the risk of PPNR misuse was associated with younger marijuana initiation age and marijuana and other illicit drug use disorders. Thus, correlates of dual marijuana and PPNR use/misuse among older adults are poor physical and mental health problems and problematic marijuana use. Older adults with marijuana and PPNR misuse need access to evidence-based treatments for pain management and substance misuse.
Work of Art, Art of Work: Artistic Literacy and Quality in Long-Term Dementia Care
Authors: Aubrecht Katie
Published: December 2020

This paper shares results from a thematic analysis (Braun & Clarke, 2006) of semi-structured interviews with a purposive snowball sample of 15 leaders in dementia arts education and praxis from Canada, the United States and United Kingdom. Interviews were conducted as part of a multi-phased collaborative, interdisciplinary arts-informed research project that aimed to operationalize quality mental health and dementia care in long-term care (LTC) from a relational perspective, with a focus on LTC staff literacy. Artistic literacy that is cultivated through creative arts-making and public exhibiting was described by participants as crucial to supporting and promoting quality within long-term care. Quality was imagined as a work of art and operationalized in terms of artist competencies, capacities and conditions. Artists included LTC staff, residents and their family and friends. Our analysis identified five themes related to artistic literacy: space-making, validation, fostering community, means of engagement, vulnerability and resilience. Drawing on cultural sociology (Bourdieu, 1993, 1984) and aging studies theory (Basting, 2018), we consider and discuss the role of the arts in disrupting unexamined assumptions about quality in LTC and advancing innovation in LTC staff mental health and dementia care.
How do Senior Center Attendees Rate the Importance of Programs and Services Compared to Non-Attendees?
Authors: Somerville Ceara , Collins Saralyn , Gleason Shayna , Coyle Caitlin
Published: December 2020

Senior centers provide a wide range of programs and services to meet the needs of the growing aging population. As senior centers aim to serve all older community-members, it is important to assess the value of these services through the lens of both attendees and non-attendees of senior centers. Using a sample of 4,750 community-dwelling adults age 60 or older from Massachusetts, this project aims to analyze perceptions of program importance by center attendees versus non-attendees. Almost 60% of the sample never attend a senior center. Nearly a third of center attendees ranked exercise classes and education opportunities as important, compared to about 20% of non-attendees. Almost half of attendees rated application assistance and nutrition programs as not important, compared to 38% and 40% of non-attendees, respectively. Conversely, for all programs listed, non-users more frequently checked “unsure” of program/service importance. This was especially true for exercise classes, professional services, social or recreational activities, educational opportunities, and trips, for which 18% of non-attendees selected unsure. Center attendees more frequently view the programs/services offered at the senior center as important or very important, likely because they have greater awareness. Results highlight that that non-attendees are unsure of the value of programs or have no interest the programs and services provided. Not only do these results provide an opportunity to senior centers to assess how valuable certain programs and services are, they also emphasize the need for continued information streams regarding programs and services offered at senior centers to those who are unfamiliar.
Associations Between Smoking and Cognitive Function Among Community-Dwelling U.S. Chinese Older Adults in Chicago
Authors: Sun Shengxi , Zhang Nannan , Li Mengting , Dong XinQi
Published: December 2020

Previous studies on smoking and cognition reported mixed findings. The inconsistent results are partially explained by the fact that they were limited to specific populations and using different cognitive function measurements. This association between smoking and cognition has rarely been studied in the rapidly increasing U.S. Chinese older adults. This study aims to determine if smoking status and smoking amount are associated with global cognition and cognitive domains in U.S. Chinese older adults. Data was extracted PINE. Five cognitive function tests (East Boston Memory Test, East Boston Memory Delayed Recall, Digital Backward test, Symbol digit Modality Test, and MMSE) were used to measure cognitive domains including episodic memory, working memory, and processing speed. Five cognitive tests were converted to z scores and averaged to generate global cognition. Self-reported smoking status was used for generating smoking status and smoking amount (pack-years). Linear regression was used. The results showed that former smokers had lower global cognition (b=-0.111, SE=0.053, p<.05) and perceptual speed (b=-0.185, SE=0.066, p<.01) than never smokers; current smokers had lower global cognition (b=-0.240, SE=0.060, p<.001), working memory (b=-0.340, SE=0.083, p<.001) and perceptual speed (b=-0.370, SE=0.075, p<.001) compared with never smokers. Smoking pack-years is negatively associated with global cognition (b=-0.003, SE=0.001,p<.001), episodic memory (b=-0.005, SE=0.001, p<.001), and perceptual speed (b=-0.004, SE=0.001, p<.001). Findings revealed that among all smokers, current smokers had the worst cognition and heavier smoking was associated with worse cognition. Policymakers could take measures in lowering smoking amount among U.S. Chinese older adults to protect their cognition.
Factors Associated With Depressive Symptoms Among U.S. Older Chinese Immigrants
Authors: Chao Ying-Yu , Seo Jin Young , Chen Mei-Lan , Zha Peijia
Published: December 2020

Purpose: Chinese Americans represent the largest Asian ethnic subgroup in the United States. Depression is the most common mental health problem among older adults. However, we have a limited understanding of depressive symptoms among older Chinese immigrants. The study aimed to examine the potential factors associated with depressive symptoms among older Chinese immigrants in U.S. Methods: We recruited participants from psychiatric clinics who sought professional help in New York City. Inclusion criteria were Chinese immigrants from Asian countries 50 years or older; able to speak and understand either Mandarin or Cantonese; and had a diagnosis with major depressive disorder. Depressive symptoms were measured with Quick Inventory of Depressive Symptomatology; cognitive function was measured with Montreal cognitive assessment; sleep quality was measured with Pittsburgh Sleep Quality Index, and physical activity was measured with International Physical Activity Questionnaire. Descriptive statistics and multiple regression were performed. Results: Participants were ninety-nine Chinese older immigrants (mean age: 60.69 ± 7.62 years). Participants who had more children (p < .05), poor health status (p < .01), poor quality of life (p < .01), less social support (p < .01), and need help with activities of daily living (p < .05) had more depressive symptoms. Cognitive function, sleep quality, and physical activity were significantly associated with depressive symptoms. Conclusions & Implications: Poor cognitive function, poor sleep quality, and less physical activity were associated with depressive symptoms. Our results provide knowledge for developing culturally tailored self-management interventions for older Chinese immigrants with depressive disorder in managed care settings.
The Prevalence of Prior Mental Health and Substance Use Problems in Older Persons and Their Families
Authors: Becker Todd , Cagle John , Sacco Paul
Published: December 2020

Although research has shown mental health and substance use problems (MHSUPs) are fairly prevalent in older adults (OAs), less research has considered MHSUPs in hospice beneficiaries and their families. This secondary analysis filled this gap using the Health and Retirement Study’s Core survey wave from 2014 and Exit wave data from 2016. These data are nationally-representative of OAs aged 50+. Each biennial wave introduces an experimental module to a random 10% of Core survey participants. One Core 2014 experimental module included self-report indicators assessing past MHSUPs, like depression and anxiety, using single items. Exit 2016 proxy-reported information about respondent deaths was used to create a decedent subsample. Descriptive statistics established MHSUP prevalence rates in OAs and their family. The self-report depression indicator was validated against the 8-item Center for Epidemiological Studies Depression Scale (CESD-8) at the ≥3, ≥4, and ≥5 cut points using χ2 analyses. The full sample’s (N=1,461) average age was 68 years. Participants were mostly non-Hispanic (87.5%), White (72.8%), and female (59.7%). The decedent subsample (n=64) was bifurcated by hospice (54.7%) versus nonhospice (45.3%) utilization. Most participants in the full sample (63.9%), hospice decedent subsample (77.1%), and nonhospice decedent subsample (75.9%) endorsed at least one MHSUP. Depression and anxiety were the most common MHSUPs in each study sample. The CESD-8 was associated with the self-report depression indicator across all cut points (p<.001). Practitioners, policymakers, and researchers should consider the high prevalence rates of MHSUPs found in OAs and their families when designing programs, policies, and research.
Relationship Between Perceived Physical and Mental Fatigability and Physical Performance in Very Old Adults
Authors: Hu Yixin , Zhang Zhuangzhuang , Bair Woei-Nan , Bai Anying , Fan Li
Published: December 2020

To investigate the relationship between perceived physical and mental fatigability and physical performance in community-dwelling very old adults (≥80 years). We examined the association in one retired community in Beijing including 404 very old adults. Pittsburgh Fatigability Scale (PFS), Chinese version, was used to assess perceived fatigability in physical domain (PFS-P) and mental domain (PFS-M). High fatigability is defined as PFS-P ≥ 15, and PFS-M ≥ 13. Physical performance measures include grip strength, usual gait speed, chair stand and Short Physical Performance Battery (SPPB) test. Women have higher PFS scores (both PFS-P & PFS-M) and higher prevalence of high fatigability than men. After adjusting for sex, usual gait speed and SPPB scores were significantly associated with PFS-P & PFS-M, while grip strength and chair stand performance were significantly associated with PFS-P only. After multivariable adjustment, usual gait speed (B=-3.745, P=0.021) and chair stand performance (B=0.335, P=0.005) were significantly associated with PFS-P, while usual gait speed (B=-2.656, P=0.006) and SPPB scores (B=-0.214, P=0.029) were significantly associated with PFS-M. Perceived physical and mental fatigability is highly prevalent in very older adults and they differ by sex. The significant associations between PFS scores and performance measures suggest that PFS is of potential clinical importance, especially when testing performance measures are not feasible. Utilization of PFS score can assist in identifying target populations who are at risk of reduced physical functions, such as older with depression, older women. Interventions to improve usual gait speed are likely to reduce both perceived physical and mental fatigability.
Prefrontal Cortex Hemodynamics During Exercise in Older Adults With Motoric Cognitive Risk Syndrome
Authors: Costa Kell Grandjean da , Fontes Eduardo , Menta Alekya , White Sarah , Fielding Roger , Kowaleski Christopher , Ward Nathan , Reid Kieran
Published: December 2020

The motoric cognitive risk syndrome (MCR) is a recently described pre-dementia syndrome in older adults characterized by slow gait coupled with subjective cognitive complaints. While previous studies have demonstrated the benefits of exercise on cerebral hemodynamics in healthy older adults, to date, no study has characterized the effects of exercise on these parameters among more vulnerable older persons with MCR. To address this knowledge gap, we investigated how the brain area responsible for high-order cognitive function (i.e., prefrontal cortex) is affected during acute cycling exercise in 19 older adults with MCR (Age (mean ± SD): 73.7 ± 7.1 years; BMI: 32.1 ± 5.5 kg/m2; gait speed: 0.55 ± 0.1 m/s; Modified Mini-Mental score: 91.8 ± 6.8; 74% female). Participants performed an incremental submaximal cycling test and we used functional near-infrared spectroscopy to assess changes in concentrations of Oxyhemoglobin (O2Hb), Deoxyhemoglobin (dHb) and total hemoglobin (Hbt) during exercise. Results showed that participants cycled for 4.9 ± 0.5 minutes, achieved a submaximal load of 54.7 ± 17.3 watts, a peak exercise heart rate of 95.7 ± 14.7 beats/min and a rate of perceived exertion (13.8 ± 2.0). Compared to baseline, there was an increase of 97.3 % in the O2Hb, 86 % on the Hbt and an 87.9 decrease of dHb while exercising. Our findings suggest that acute exercise at light through moderate intensity increases prefrontal cortex oxygenation in older adults with MCR. Additional studies are also warranted to characterize the effects of chronic exercise on cerebral hemodynamics in at-risk older adults.
Exploring Technology Perceptions and Intentions to Use in Older Adults
Authors: Williams Stephanie , Orsega-Smith Elizabeth , Ruggiero Laurie
Published: December 2020

By the year 2035, the older adult population is expected to expand to 78 million in the United States. Advancing technology has made aging in place a more accessible possibility; however, understanding what is preventing this population from adopting the advancing devices remains to be a challenge as the presence of a digital divide continues to exist. A 34-question survey adapted from the Technology Proficiency Self-Assessment Questionnaire, and the National Technology Readiness survey was administered to 101 participants over the age of 50 across five local senior centers. The average age range was 70-79 and most were female (79.2%), white (69%), and owned or had access to technology such as a computer or cell phone (93%). Examples of findings include 86% felt technology limited human interaction and 69% felt the use of technology could lead to security risk and a breach of privacy, while 79% felt technology could improve their quality of life. Results found 60-69-year-olds were significantly more likely (p<.05) to have or use technology versus 80-89-year-olds. Correlation between perception and intent to use technology among older adults was positive with a coefficient value of .59(p<.01). Showing a relationship between perceptions and behavioral intentions to use technology, specifically in 60-69-year-olds. This study found access to technology (i.e. computers, cell phones, internet) was not a driving factor of usage among the older population attending a senior center. To increase understanding further exploration of perceptions and intentions to use technology is warranted in the older adult population.
You Have One Reminder: Self-Manage Your Pain
Authors: Shade Marcia , Rector Kyle , Soumana Rasila , Kupzyk Kevin
Published: December 2020

Pain has a significant impact in the lives of aging adults. As the population of America grows older, they need to be encouraged to use pain self-management strategies. Technology is an option, but current pain management applications have usability limitations in older adults. This feasibility study describes the usability of voice assistant reminders for pain self-management. We enrolled 15 community-dwelling aging adults with chronic pain. Participants created two pre-determined voice assistant reminder tasks: 1) to take scheduled pain medication, and 2) to write in a pain diary. We collected data on demographics, pain, confidence of managing symptoms, and objective ease of use. After four weeks, we collected information about subjective ease of use and usefulness of the voice assistant. Participants were mostly female, average age 65 years; reporting moderate pain severity 4.58 (SD 2.29) and pain interference 3.94 (SD 2.62). The mean PROMIS self-efficacy for managing symptoms score was 50.8 (SD 8.2). Voice assistant usability was above average (78 out of 100). The median time to make a voice assistant profile was five minutes (SD 7.5), with a median of seeking help two times. No significant relationships were found between pain and usability. Three participants made physical activity and distraction reminders to self-manage pain. Voice assistant reminders were perceived as consistent, easy to set up and helpful for accountability. Older users may provide helpful feedback for development and testing of voice assistant software for pain self-management. Voice assistants may provide helpful reminders that encourage the completion of pain self-management strategies.
Association Between Frailty and Gut Microbiota Metabolite TMAO in Older People With Cardiovascular Disease
Authors: He Wei , Wang Hua , Yang Jiefu
Published: December 2020

The potential for the gut microbiota to affect health has particular relevance for older adults. Recent evidence suggests that microbiota-derived metabolites may modulate aging-related changes in immunity, sarcopenia, and cognitive function, all of which are elements of frailty. Trimethylamine N-oxide (TMAO) produced by the metaorganismal metabolism of choline, has been implicated in disease pathogenesis. However, relatively little geroscience research has been carried out on TMAO，and even less on other gut microbiota metabolites. The purpose of this study was to explore the relationship between frailty and circulating TMAO concentration. Data and fasting blood samples came from a prospective comprehensive geriatric assessment cohort of older adults (age≥65, n=451) with cardiovascular diseases. The frailty index based on the accumulated deficits model (48 variables) was used for evaluating the status of frailty. TMAO levels differed between groups with a significant increase for people with frailty (p＜0.001). Compared with the lowest quartile of TMAO levels, patients in the highest quartile had increased 3.07-fold risk of frailty (OR=3.07, 95%CI, 1.69-2.97). After adjusting for age, gender, BMI, history of diseases, hsCRP, LDLc, TMAO levels remained associated with frailty (OR=2.11, 95%CI, 1.01-4.38). Similarly, a cubic spline curve showed a dose-dependent relationship between the odds ratio for the risk of frailty and circulating TMAO in a linear trend (p = 0.006). This study suggests that circulating TMAO are independently associated with frailty in older adult with cardiovascular diseases. Efforts to further characterize the relationship between gut microbiota metabolite and frailty should be further pursued.
Relationships of Severe Pain and Cognitive Impairment With Acute Care Use in Home Health Patients
Authors: Wang Jinjiao , Monroe Todd , Simning Adam , Cai Xueya , Temkin-Greener Helena , Yu Fang , Caprio Thomas , Li Yue
Published: December 2020

Pain assessment is challenging in patients with cognitive impairment that can lead to inappropriate pain management and unfavorable health outcomes. Using a 10% random sample of Medicare home health (HH) patients ≥ 65 years old from the 2017 Outcome and Assessment Information Set (OASIS) national dataset (N=646,109), we tested the relationships of cognitive impairment and constant, severe pain that interfered with daily living activities with acute care utilization (i.e., hospitalization and emergency department [ED] admission without hospitalization). Patients who had constant, severe, interfering pain (32.57%, N=210,444) were younger, more likely to be female, white, Medicare-Medicaid dually eligible, living alone, and having functional limitations and depressive symptoms, but less likely to have moderate-to-severe cognitive impairment (25.0% versus 31.5%, p<0.001) than others. In multivariable logistic regression models adjusting for the above covariates, when compared with patients with neither cognitive impairment nor severe, constant, interfering pain, those with both conditions were 17% more likely to have hospitalization (Odds Ratio [OR]=1.17, p<0.001) and 13% more likely to have an ED admission without hospitalization (OR=1.13, p<0.001). This was the first study that examined co-occurring pain and cognitive impairment in HH recipients using national OASIS data. Findings suggest that: 1) older HH patients with moderate-to-severe cognitive impairment have lower rates of reported pain that suggests under-recognition; and 2) having severe, interfering pain among cognitively impaired patients significantly increased their risk of acute care utilization. Therefore, systematic protocols and guidelines should be in place to facilitate pain assessment for improved outcomes among HH patients with cognitive impairment.
Moving Together: Livestream Virtual Group Movement Classes for Persons With Dementia and Caregivers
Authors: Barnes Deborah , Benjamin Cynthia , Lee Amanda , Lee Jennifer , Mehling Wolf , Chesney Margaret , Sudore Rebecca
Published: December 2020

MOVING TOGETHER classes deliver an online live-streaming version of the evidence-based Paired PLIÉ (Preventing Loss of Independence through Exercise) group movement program for people living with dementia (PLWD) and caregivers (CGs) that targets physical movements, mindful body awareness, and social engagement. Paired PLIÉ has been found to be associated with improvements in physical, cognitive, social/emotional function, and relationship quality. However, CGs also reported logistical challenges related to attending in-person classes. Our goal was to assess feasibility and satisfaction with an online version of the program developed by Together Senior Health, Inc. Fifteen of twenty-one participants (70%; 8 PLWD, 7 CGs) successfully completed the 12-week program, of whom all (100%) reported being highly satisfied with online delivery. Participants described physical, social and emotional benefits of participating: “I liked the activities with partner and that I could feel various parts of my body getting massage and movement (PLWD);” and “Really enjoyed this class, so did my body, brain and my spirit (CG).” Participants strongly supported the online format: “[I liked] BEING AT HOME! …Getting ready to go out, going out and coming home takes a lot of energy and we are not sure we would participate if it were not online (PLWD).” In conclusion, we found that online delivery of Moving Together is feasible and acceptable to PLWD and CGs. Offering livestream virtual group movement classes such as Moving Together could enhance accessibility to evidenced-based programs for PLWD and CGs.
Parallel Process Latent Growth Modeling of the Relationships Between Social Cohesion and Mental Health in Later Life
Authors: An Sok , Kim Kyeongmo , Lee Minhong
Published: December 2020

Previous literature suggests that social factors (e.g., social cohesion, social support) are protective predictors of mental health problems. However, there might be a reciprocal relationship between social factors and mental health and the relationship changes over time. Therefore, this study examined the longitudinal relationship between community social cohesion and mental health using a latent growth curve model with 8 waves of the National Health and Aging Trends Study (NHATS; 2011-2018), a nationally representative panel study of Medicare beneficiaries in the United States. Social cohesion measured the perceived level of mutual trust by three items (score range: 0-6) and mental health was measured by PHQ-4 (score range: 0-12). The final model including covariates (age, gender, functional disabilities) fit the data well: χ2=1036.383, p<.001; RMSEA=.037; CFI=.960; and SRMR=.070. Initial level of social cohesion was negatively associated with initial level of mental health problem (β=−.23, p< .001), suggesting that higher levels of social cohesion was associated with lower levels of mental health problems. The covariance between social cohesion slope and mental health slope was significant (β=−.16, p< .01), suggesting an increase in social cohesion was associated with a decrease in mental health problems over time. Functional disabilities significantly influenced mental health over time, while functional disabilities did not influence social cohesion consistently. This study adds to the growing literature on the ways mental health status and social connection have reciprocal relationships over time. Therefore, mental health status in later life could be decreased by improving social cohesion and connectedness with the community.
Current status of PD-1/PD-L1 blockade immunotherapy in breast cancer
Authors: Noguchi Emi , Shien Tadahiko , Iwata Hiroji
Published: December 2020

Over the past 10 years, immunotherapy with immune checkpoint inhibitors has revolutionized the management of various cancers. However, immunotherapy in breast cancer has not been successful. Breast cancer has long been recognized as an immunologically ‘cold’ tumor, although a higher frequency of tumor-infiltrating lymphocytes present in certain subtypes and an association between tumor-infiltrating lymphocytes and favorable prognosis have been reported. In March 2019, the combination of atezolizumab and nanoparticle albumin-bound paclitaxel was granted accelerated approval in the United States for the treatment of programmed death-ligand 1-positive advanced or metastatic triple-negative breast cancer. This finally opened the door for immune checkpoint blockade therapy for breast cancer. Several clinical trials have been conducted using different combinations of immune checkpoint inhibitors and chemotherapy or targeted agents in various treatment settings for metastatic breast cancer and early-stage breast cancer. In this review, we summarize recent advances in immune checkpoint blockade therapy and predictive biomarkers in breast cancer.
Tomato protein phosphatase 2C influences the onset of fruit ripening and fruit glossiness
Authors: Liang Bin , Sun Yufei , Wang Juan , Zheng Yu , Zhang Wenbo , Xu Yandan , Li Qian , Leng Ping
Published: December 2020

Abscisic acid (ABA) plays a vital role in coordinating physiological processes during fresh fruit ripening. Binding of ABA to receptors facilitates the interaction and inhibition of type 2C phosphatase (PP2C) co-receptors. However, the exact mechanism of PP2C during fruit ripening is unclear. In this study, we determined the role of the tomato ABA co-receptor type 2C phosphatase SlPP2C3, a negative regulator of ABA signaling and fruit ripening. SlPP2C3 selectively interacted with monomeric ABA receptors and SlSnRK2.8 kinase in both yeast and tobacco epidermal cells. Expression of SlPP2C3 was ABA-inducible, which was negatively correlated with fruit ripening. Tomato plants with suppressed SlPP2C3 expression exhibited enhanced sensitivity to ABA, while plants overexpressing SlPP2C3 were less sensitive to ABA. Importantly, lack of SlPP2C3 expression accelerated the onset of fruit ripening and affected fruit glossiness by altering the outer epidermis structure. There was a significant difference in the expression of cuticle-related genes in the pericarp between wild-type and SlPP2C3-suppressed lines based on RNA sequencing (RNA-seq) analysis. Taken together, our findings demonstrate that SlPP2C3 plays an important role in the regulation of fruit ripening and fruit glossiness in tomato.
Conformational constraints of cyclopentane peptide nucleic acids facilitate tunable binding to DNA
Authors: Zheng Hongchao , Botos Istvan , Clausse Victor , Nikolayevskiy Herman , Rastede Elizabeth E , Fouz Munira F , Mazur Sharlyn J , Appella Daniel H
Published: December 2020

We report a series of synthetic, nucleic acid mimics with highly customizable thermodynamic binding to DNA. Incorporation of helix-promoting cyclopentanes into peptide nucleic acids (PNAs) increases the melting temperatures (Tm) of PNA+DNA duplexes by approximately +5°C per cyclopentane. Sequential addition of cyclopentanes allows the Tm of PNA + DNA duplexes to be systematically fine-tuned from +5 to +50°C compared with the unmodified PNA. Containing only nine nucleobases and an equal number of cyclopentanes, cpPNA-9 binds to complementary DNA with a Tm around 90°C. Additional experiments reveal that the cpPNA-9 sequence specifically binds to DNA duplexes containing its complementary sequence and functions as a PCR clamp. An X-ray crystal structure of the cpPNA-9–DNA duplex revealed that cyclopentanes likely induce a right-handed helix in the PNA with conformations that promote DNA binding.
Determining the optimal cholecalciferol dosing regimen in children with CKD: a randomized controlled trial
Authors: Iyengar Arpana , Kamath Nivedita , Reddy Hamsa V , Sharma Jyoti , Singhal Jyoti , Uthup Susan , Ekambaram Sudha , Selvam Sumithra , Rahn Anja , Fischer Dagmar-C , Wan Mandy , Shroff Rukshana
Published: December 2020

Background

The optimal treatment regimen for correcting 25-hydroxyvitamin D (25OHD) deficiency in children with chronic kidney disease (CKD) is not known. We compared cholecalciferol dosing regimens for achieving and maintaining 25OHD concentrations ≥30 ng/mL in children with CKD stages 2–4.

Methods

An open-label, multicentre randomized controlled trial randomized children with 25OHD concentrations <30 ng/mL in 1:1:1 to oral cholecalciferol 3000 IU daily, 25 000 IU weekly or 100 000 IU monthly for 3 months (maximum three intensive courses). In those with 25OHD ≥30 ng/mL, 1000 IU cholecalciferol daily (maintenance course) was given for up to 9 months. Primary outcome was achieving 25OHD ≥30 ng/mL at the end of intensive phase treatment.

Results

Ninety children were randomized to daily (n = 30), weekly (n = 29) or monthly (n = 31) treatment groups. At the end of intensive phase, 70/90 (77.8%) achieved 25OHD ≥30 ng/mL; 25OHD concentrations were comparable between groups (median 44.3, 39.4 and 39.3 ng/mL for daily, weekly and monthly groups, respectively; P = 0.24) with no difference between groups for time to achieve 25OHD ≥30 ng/mL (P = 0.28). There was no change in calcium, phosphorus and parathyroid hormone, but fibroblast growth factor 23 (P = 0.002) and klotho (P = 0.001) concentrations significantly increased and were comparable in all treatment groups. Irrespective of dosing regimen, children with glomerular disease had 25OHD concentrations lower than non-glomerular disease (25.8 versus 41.8 ng/mL; P = 0.007). One child had a 25OHD concentration of 134 ng/mL, and 5.5% had hypercalcemia without symptoms of toxicity.

Conclusion

Intensive treatment with oral cholecalciferol as daily, weekly or monthly regimens achieved similar 25OHD concentrations between treatment groups, without toxicity. Children with glomerular disease required higher doses of cholecalciferol compared with those with non-glomerular disease.
Pasteurized and unpasteurized donor human milk
Authors: Pound Catherine , Unger Sharon , Blair Becky
Published: December 2020

It is universally accepted that human milk is the optimal, exclusive source of nutrition for infants 0 to 6 months of age, and may remain part of the healthy infant diet for the first 2 years of age and beyond. Despite advances in infant formulas, human milk provides a wide range of benefits, due in part to its bioactive matrix that cannot be replicated by any other source of nutrition. When there is an insufficient volume of mother’s milk for the vulnerable newborn, pasteurized donor human milk should be made available, as a bridge to mother’s milk and as the first alternative feeding choice, followed by commercial formula. There is a limited supply of donor milk in Canada and distribution is prioritized for sick, hospitalized neonates. Informal milk sharing is the practice of donating and receiving expressed human milk without going through a human milk bank. Informal milk sharing carries risk for bacterial and viral transmission as well as inconsistency and uncertainty regarding donor screening. Paediatricians and other health care providers need to be aware of the risks of informal milk sharing and be able to counsel families appropriately on safer alternatives.
Comprehensive sexual health assessments for adolescents
Authors: Johnson Natasha
Published: December 2020

Sexual activity and experimentation are normative parts of adolescent development that may, at the same time, be associated with adverse health outcomes, including the acquisition of sexually transmitted infections, unplanned pregnancy, and teen dating violence. Anticipatory guidance regarding sexual and reproductive health for teens should address normal sexual development issues, such as identity and attractions, safe relationships, safer sex, and contraception. Health care providers can enhance the sexual education of the youth they see and help mitigate negative health outcomes. This practice point offers a ‘7-P’ approach to ensure that health care providers obtain comprehensive sexual health assessments for adolescents. Teen issues such as identity, confidentiality, and consent, and dating violence are discussed, and Canadian Paediatric Society resources are cited to provide more detailed care pathways on related issues: contraception, pregnancy, and sexually transmitted infections.
A Novel Signaling Pathway Required for Arabidopsis Endodermal Root Organization Shapes the Rhizosphere Microbiome
Authors: Durr Julius , Reyt Guilhem , Spaepen Stijn , Hilton Sally , Meehan Cathal , Qi Wu , Kamiya Takehiro , Flis Paulina , Dickinson Hugh G , Feher Attila , Shivshankar Umashankar , Pavagadhi Shruti , Swarup Sanjay , Salt David , Bending Gary D , Gutierrez-Marcos Jose
Published: December 2020

The Casparian strip (CS) constitutes a physical diffusion barrier to water and nutrients in plant roots, which is formed by the polar deposition of lignin polymer in the endodermis tissue. The precise pattern of lignin deposition is determined by the scaffolding activity of membrane-bound Casparian Strip domain proteins (CASPs), but little is known of the mechanism(s) directing this process. Here, we demonstrate that Endodermis-specific Receptor-like Kinase 1 (ERK1) and, to a lesser extent, ROP Binding Kinase1 (RBK1) are also involved in regulating CS formation, with the former playing an essential role in lignin deposition as well as in the localization of CASP1. We show that ERK1 is localized to the cytoplasm and nucleus of the endodermis and that together with the circadian clock regulator, Time for Coffee (TIC), forms part of a novel signaling pathway necessary for correct CS organization and suberization of the endodermis, with their single or combined loss of function resulting in altered root microbiome composition. In addition, we found that other mutants displaying defects in suberin deposition at the CS also display altered root exudates and microbiome composition. Thus, our work reveals a complex network of signaling factors operating within the root endodermis that establish both the CS diffusion barrier and influence the microbial composition of the rhizosphere.
Give what is due: the need to prioritize healthcare workers in response to COVID-19 pandemic
Authors: Punsalan Mairre Louie D
Published: December 2020

In a recent correspondence published in this journal, the need to prioritize healthcare workers by the government must be considered. Various negative effects were seen from non-prioritization of healthcare workers. With this, healthcare workers heed distress calls affecting their physical and mental well-being. If prioritization is given and initiatives are done, the needs of healthcare workers will be sufficed so that they will be working at maximum to mitigate the spread of COVID-19.