bluuebunny/crossref_metadata_2025 huggingface dataset:
Elevation-Dependent Climate Change in the European Alps
Authors: Kuhn Michael , Olefs Marc
Published: December 2020

Elevation-dependent climate change has been observed in the European Alps in the context of global warming and as a consequence of Alpine orography. It is most obvious in elevation-dependent warming, conveniently defined as the linear regression of the time series of temperatures against elevation, and it reaches values of several tenths of a degree per 1,000 m elevation per decade. Observed changes in temperature have forced changes in atmospheric pressure, water vapor, cloud condensation, fluxes of infrared and solar radiation, snow cover, and evaporation, which have affected the Alpine surface energy and water balance in different ways at different elevations. At the same time, changes in atmospheric aerosol optical depth, in atmospheric circulation, and in the frequency of weather types have contributed to the observed elevation-dependent climate change in the European Alps. To a large extent, these observations have been reproduced by model simulations.
The Facial Aging Process From the “Inside Out”
Authors: Swift Arthur , Liew Steven , Weinkle Susan , Garcia Julie K , Silberberg Michael B
Published: December 2020

The normal course of aging alters the harmonious, symmetrical, and balanced facial features found in youth, not only impacting physical attractiveness but also influencing self-esteem and causing miscommunication of affect based on facial miscues. With this evidence-based paper, the authors aim to provide a comprehensive overview of the latest research on the etiology and progression of facial aging by explaining the aging process from the “inside out,” that is, from the bony platform to the skin envelope. A general overview of the changes occurring within each of the main layers of the facial anatomy is presented, including facial skeleton remodeling, fat pad atrophy or repositioning, changes in muscle tone and thickness, and weakening and thinning of the skin. This is followed by an in-depth analysis of specific aging regions by facial thirds (upper, middle, and lower thirds). This review may help aesthetic physicians in the interpretation of the aging process and in prioritizing and rationalizing treatment decisions to establish harmonious facial balance in younger patients or to restore balance lost with age in older patients.
Phylogeography of the iconic Australian pink cockatoo,Lophochroa leadbeateri
Authors: Ewart Kyle M , Johnson Rebecca N , Joseph Leo , Ogden Rob , Frankham Greta J , Lo Nathan
Published: December 2020

The pink cockatoo (Lophochroa leadbeateri; or Major Mitchell’s cockatoo) is one of Australia’s most iconic bird species. Two subspecies based on morphology are separated by a biogeographical divide, the Eyrean Barrier. Testing the genetic basis for this subspecies delineation, clarifying barriers to gene flow and identifying any cryptic genetic diversity will likely have important implications for conservation and management. Here, we used genome-wide single nucleotide polymorphisms (SNPs) and mitochondrial DNA data to conduct the first range-wide genetic assessment of the species. The aims were to investigate the phylogeography of the pink cockatoo, to characterize conservation units and to reassess subspecies boundaries. We found consistent but weak genetic structure between the two subspecies based on nuclear SNPs. However, phylogenetic analysis of nuclear SNPs and mitochondrial DNA sequence data did not recover reciprocally monophyletic groups, indicating incomplete evolutionary separation between the subspecies. Consequently, we have proposed that the two currently recognized subspecies be treated as separate management units rather than evolutionarily significant units. Given that poaching is suspected to be a threat to this species, we assessed the utility of our data for wildlife forensic applications. We demonstrated that a subspecies identification test could be designed using as few as 20 SNPs.
Epicardial adipose tissue modulates arrhythmogenesis in right ventricle outflow tract cardiomyocytes
Authors: Lu Yen-Yu , Huang Shih-Yu , Lin Yung-Kuo , Chen Yao-Chang , Chen Yi-Ann , Chen Shih-Ann , Chen Yi-Jen
Published: December 2020

Aims

Ventricular arrhythmia (VA) frequently occurs in fatty infiltrative cardiomyopathy or epicardial adipose tissue (EAT) abundant hearts. Right ventricular outflow tract (RVOT), commonly covered with EAT, is vital for VA genesis. This study explored whether EAT contributes to RVOT arrhythmogenesis.

Methods and results

Conventional microelectrodes and whole-cell patch clamp were used to record electrical activity and ionic currents in rabbit RVOT tissue preparation or isolated single cardiomyocytes with or without (control) connected EAT. Epicardial adipose tissue-connected (N = 6) RVOT had more portions of fibrosis than did control (N = 5) RVOT (160.3 ± 23.2 vs. 91.9 ± 13.4 μm2/mm2, P < 0.05). Epicardial adipose tissue-connected RVOT cardiomyocytes (n = 18) had lower negative resting membrane potential (−68 ± 1 vs. −73 ± 2 mV, P < 0.05); smaller action potential (AP) amplitude (108 ± 4 vs. 135 ± 6 mV, P < 0.005); and longer 90%, 50%, and 20% of AP duration repolarization (361 ± 18 vs. 309 ± 9 ms, P < 0.05; 310 ± 17 vs. 256 ± 13 ms, P < 0.05; and 182 ± 19 vs. 114 ± 24 ms, P < 0.05, respectively) than did control (n = 13) RVOT cardiomyocytes. Moreover, compared with control RVOT cardiomyocytes, EAT-connected RVOT cardiomyocytes had larger transient outward potassium currents, similar delayed rectifier potassium currents, smaller L-type calcium currents, and inward rectifier potassium currents. After ajmaline (10 μM, a sodium channel blocker) superfusion, high VA inducibility was observed through rapid pacing in EAT-connected RVOT but not in control RVOT.

Conclusions

Epicardial adipose tissue exerts distinctive electrophysiological effects on RVOT with a propensity towards VA induction, which might play a role in lipotoxicity pathogenesis-related ventricular arrhythmogenesis.
Sexuality in Later Life and Mental Health Among Older Black Gay Men
Authors: Esiaka Darlingtina , Cheng Alice , Nwakasi Candidus
Published: December 2020

Self-acknowledgement and integration of racial and sexual identities are significant to one’s overall sense of identity because of their implications for mental health and wellbeing. These issues are important as one ages because older people experience a wide range of factors that add layers to their ability to (re)integrate subsets of their identity into their overall self-identity such as age and age-related disabilities. This study examined the intersection of race and sexual identities on overall health status in older Black gay men, a demographic group that has historically received less attention. Data from the Social Justice Sexuality (SJS) survey of LGBTQ+ people of color which occurred over a 12-month period in the United States were analyzed. Participants (N=160), 50 years and over, responded to questions about their sexuality, social identity, family dynamics, community connection and engagement, and mental and physical health. Results show an association of mental wellbeing with racial and sexual identities. Further, results show that a strong sense of connection to other sexual minorities is positively associated with mental health in older Black gay men. We discuss the implication of findings for mental health interventions targeting this gendered population.
The Effect of Loneliness on Cognition: A Longitudinal Study
Authors: Maiden Robert , Greil Larry , Hayslip Bert
Published: December 2020

A panel study was conducted among 244 older adults (52-years-old to 92) to explore whether social engagement and loneliness are associated with cognitive ability. Measures of crystallized (Gc) and fluid (Gf) ability were collected at two points in time. Using latent variable SEM with separate models for men and women, Gc and Gf at W2 were regressed on perceived general health, social support, sociability, loneliness and involvement in organizational activities, controlling for Gc and Gf at W1. Fit statistics were adequate. Among women, Gc at W1 was associated with perceived health (B=1.03, p=.000), while Gf at W1 was associated with perceived general health (B=1.28, p=.010) and organizational involvement (B=1.8, p=.019). Gc at W2 was associated with Gc at W1 (B=.61, p=.000), and age (B=-.12, p=.007), while Gf at W2 was associated with Gf at W1 (B=.74, p=.000), age (B=-.08, p=.008), and loneliness (B=-.78, p=.038). Among men, there were no significant associations between either Gc at W1 or Gf at W1 and other variables. Gc at W2 was associated with Gc at W1 (B=.29, p=.031), while Gf at W1 was associated with Gf at W2 (B=7.9, p=.000) and perceived general health (B=2.46, p=.006). These findings suggest that loneliness and organizational involvement are associated with lower Gf scores among women but not among men. Gc was not associated with loneliness or organizational involvement for either women or men. This suggests that interventions targeting the prevention of loneliness and the promotion of organizational involvement may enhance cognitive functioning in later life among women.
Racial or Ethnic and Multimorbidity Differences in Functional Limitation Trajectories Among Older Americans
Authors: Quinones Ana , Elman Miriam , Botoseneanu Anda , Newsom Jason , Dorr David , Nagel Corey , Allore Heather
Published: December 2020

Racial/ethnic minority groups in the U.S. are at risk for greater co-existing chronic disease (multimorbidity) burden and experience greater functional limitations relative to non-Hispanic white peers. To target programs designed to preserve functional independence, this study aims to identify temporal trends of functional limitation among race/ethnic groups and within the context of multimorbidity. Data from the Health & Retirement Study (2000-2014, N=16,959, 65 years of age and older, community-dwelling adults) were used in generalized estimating equation (GEE) models to assess changes in functional limitations over time (combined activities of daily living [ADL] and instrumental activities of daily living [IADL], range 0-11). Models were adjusted for race/ethnicity (non-Hispanic black, Hispanic, non-Hispanic white), self-reported chronic disease categories (no/one, ≥2 somatic, somatic-depression; of arthritis, cancer, diabetes, heart disease, high depressive symptoms [CES-D8≥4], hypertension, lung disease, stroke), age at baseline, sex, body-mass index, education, partnered, net worth, and time. In adjusted GEE models, Hispanic and black respondents experience 1.4 times greater counts of functional limitations, respectively, relative to white respondents (incidence rate ratio [IRR]= 1.4, 95% CI[1.17, 1.66], IRR=1.4, CI[1.26, 1.61]); however, temporal trends were similar. With regard to multimorbidity categories, somatic or somatic-depression multimorbidity were each associated with 2.2 or 3.5 times greater functional limitations, respectively, relative to having no/one condition (IRR=2.2, CI[2.06, 2.39], IRR=3.5, CI[3.18, 3.74]). There are marked differences in functional limitation levels between minority ethnic and white groups, as well as among chronic disease combination groups, suggesting the need to intervene in middle-age to reduce disparities.
Predicting Age From Large-Scale Brain Networks: Evidence From the Cam-CAN Dataset Across the Lifespan
Authors: Caulfield Meghan , Kan Irene , Chrysikou Evangelia
Published: December 2020

Changes in cognition observed in aging (e.g. a shift from prioritization of fluid cognition in young adulthood toward an emphasis on crystalized knowledge and semantic cognition in older adulthood) are believed to reflect alterations in neural connectivity in aging. Recent work specifically highlights how increased connectivity between executive control (EC) regions and default mode network (DMN) may underlie characteristic shifts in cognitive abilities between younger and older adults. However, the contribution of the salience network, which plays a crucial role in mediating the dynamic interplay between EC and DMN, is relatively overlooked. To extend previous work, we used a large cohort (N = 547) of participants from the Cam-CAN database (18-88 years old) to examine whether resting-state functional connectivity between EC and DMN can reliably predict participant age. We further examined how addition of the salience network impacts the hypothesized increased connectivity between EC and DMN as a result of aging. A series of multiple regression analyses using functional connectivity and age as variables revealed that connectivity between EC and DMN regions (specifically between dorsolateral and ventromedial prefrontal cortex and parietal regions, including the precuneus) accounted for a significant portion of age variability and that the inclusion of the salience network improved the models’ explanatory power. Follow-up analyses by age cohort further highlighted that these relationships dynamically change across the lifespan. We will discuss these findings in the context of default-executive coupling hypothesis for aging and propose avenues for future research in refinement of this model.
The Impact of Relationship Satisfaction With Adult Children on Depression Among Older Adults With Abusive Spouses
Authors: Yoon Sukyung
Published: December 2020

Adults (65 and older) comprised about 15% of the 2019 South Korean population (hereafter Korea), but are estimated to be 20% in 2025 and 40% in 2050 (StatisticsKorea, 2019). Good relationships with spouses impact mental health during later life (Santini et al., 2015) but 10.2% of women and 7.6% men 65 and older reported they experienced spousal violence (The Domestic Violence Survey, 2016) Moreover, violent behavior in baby-boomer marriages was significantly higher than their counterparts (Suh, 2015). Previous research investigated how relationships with adult-children impacted older Koreans’ mental health(Kim & Ko, 2013) but few examined the influence on older-adults with abusive spouses. This study investigates depression among older-adults with abusive spouses, and the impact of relationship-satisfaction with their adult-children on depression. This study utilizes the 13th wave of the nationally representative Korea Welfare Panel (2018). The sample consisted of 353 older adults 65 and older with abusive spouses over the past year. The dependent variable was depression, measured using the CES-D-11. The relationship-satisfaction with adult-children was measured on a seven-point Likert scale. Education, health, religion, sex, and age were included, and multiple regression analysis was conducted. The relationship-satisfaction with adult-children and good health status were significantly reduced depression among the population. Health care professionals and practitioners should screen for elder abuse and depression. Additionally, programs are needed to help older - adults develop good relationships with family members are needed.
The Home, Block, and Community Environments and Biomarkers of Aging in the National Health and Aging Trends Study
Authors: Roberts Laken , Samuel Laura , Boyce Danielle , Hladek Melissa , LaFave Sarah , Szanton Sarah
Published: December 2020

Prior studies have linked household and community conditions to the health and functioning of older adults. However, few studies have investigated associations between household, block, and community environmental conditions with biomarkers of aging. This study used NHATS Round 7 (2017) data on 3,283 community-dwelling older adults to test cross-sectional associations between interior and exterior household disorder, block disorder, community social cohesion, and four biomarkers: C-reactive protein, hemoglobin A1c, cytomegalovirus, and interleukin-6. Survey-weighted models adjusted for age, sex, race/ethnicity, income, education, homeownership, housing type, and metropolitan area; HbA1c was stratified by diabetes diagnosis. Greater interior household disorder was associated with higher IL-6 (β=0.06, SE=0.025, p=0.014) and, among diabetics, greater block disorder was associated with higher HbA1c (β=0.11, SE=0.05, p=0.046). These results link home and block environmental characteristics with biomarkers of aging, suggesting that modifiable aspects of older adults’ living environments may be related to disease and disability risk via physiologic dysregulation.
How Does Neighborhood Environment Influence Dementia Onset?: Evidence From the National Health and Aging Trends Study
Authors: Wang Yi , Qin Weidi
Published: December 2020

Existing research has established significant associations between older individuals’ social participation (e.g., visiting friends and family, going out for enjoyment, etc.) and their risk of developing dementia. However, little was known about the role of neighborhood environment (i.e., neighborhood social cohesion, neighborhood physical disorder). This study aims to investigate the moderating effects of neighborhood environment on the relationship between social participation and dementia incidence using data obtained from 8 waves (Rounds 1 through 8) of the National Aging and Trends Study. 7,416 Medicare beneficiaries aged 65 or above who were community-dwelling and free from dementia at Round 1 (2011) were selected. Among them, 1,005 participants developed dementia in the followed-up years from 2012 to 2018. We conducted survival analysis using the accelerated failure time (AFT) models to examine the moderating effects of neighborhood social cohesion and neighborhood physical disorder on the onset of dementia. The unit of time-to-event data was in years. Findings showed that the interaction term of neighborhood physical disorder and individual social participation was significant, indicating neighborhood physical disorder moderates the protective effects of social participation on dementia incidence. Specifically, among older adults who participate in social activities at the same level, the progression to the onset of dementia is 1.06 times faster for those living in neighborhoods with higher level (i.e., one unit increase in the score) of physical disorder. The findings recommend modification of physical environment at the neighborhood level to facilitate social participation for the betterment of cognitive health in later life.
Delivering and Embedding Dementia-Friendly Training in a Healthcare System
Authors: Schneider Ellen , Dale Maureen , Wells Krista , Gotelli John , Julian Carol , Henage Cristine , Busby-Whitehead Jan , Roberts Ellen
Published: December 2020

Alzheimer’s disease is the 4th leading cause of death in North Carolina for people 65 and older. People with dementia are hospitalized more often and have prolonged stays, poorer outcomes, higher costs, and increased readmission rates. Hospital employees have expressed the desire to have specialized training to learn how to more effectively communicate with and provide better care to patients with dementia. To address identified patient and hospital employee needs, the University of North Carolina (UNC) Center for Aging and Health is disseminating hospital-specific dementia-friendly training at five hospitals within the UNC Health System. The training is being delivered via online modules and follow-up didactic sessions over a three-year period to clinical and non-clinical staff who interact with patients. To date, 1,948 employees at three of the five hospitals have launched the online training; 1,102 have completed the training. The pilot training took place at the UNC Hospitals--Hillsborough Campus (“Hillsborough Hospital”) in 2019. Hillsborough Hospital staff (n=195) who participated in the dementia friendly training completed a survey to assess their ability to recognize symptoms and provide appropriate care to dementia patients pre- and post-training. Clinical staff answered 23 Likert scale self-efficacy questions; non-clinical staff answered the first 12 of these questions. Positive change in self-efficacy ratings from pre- to post-training was significant for every question (p < .0001). Additional results will be included in the poster. The dementia-friendly hospital initiative is preparing employees to provide better care for people with dementia and is effective in increasing employee self-efficacy.
Dementia Care Training Regulations and Deficiencies of Care for Inappropriate Psychotropics Use in Nursing Homes
Authors: Yoon Jung Min , Trinkoff Alison , Storr Carla , Galik Elizabeth
Published: December 2020

Psychotropics are often used to manage behavioral and psychological symptoms of dementia (BPSD) in nursing homes (NHs), despite their adverse effects and lack of efficacy. NHs can be flagged for inappropriate psychotropics use as a deficiency of care (F-tag 758). To improve dementia care, 15 states require dementia-specific in-service training for NH nursing staff with specific training content and hours. The study aimed to relate the occurrence of F-758 citations to the presence of dementia-specific in-service training regulations, stratified by nurse staffing levels (<75th vs ≥75th percentile of nurse hours per resident day, HPRD). Certification and Survey Provider Enhanced Reporting data (n=14,548 NHs) from 2017-18 were used, containing 1,872 NHs with F-758 tags related to care of residents with dementia. NHs in states specifying training content and hours had significantly lower odds of receiving F-758 tags (OR=0.75, 95% CI=0.60-0.94). Among NHs with lower registered nurse HPRD, those in states regulating training content and hours had significantly lower odds of receiving F-758 tags (OR=0.66, 95% CI=0.49-0.89), with similar findings among NHs with lower certified nurse assistant HPRD (OR=0.69, 95% CI=0.51 52-0.91 92). This study found that required dementia-specific in-service training may be helpful in facilities with lower staffing. It is recommended that states develop more comprehensive, robust dementia care training regulations for NH nursing staff.
Exploring Leadership, Stress of Conscience, and Person-Centered Care in Nursing Homes
Authors: Backman Annica , Sjögren Karin , Lovheim Hugo , Lindkvist Marie , Edvardsson David
Published: December 2020

On a daily basis, many care situations contain difficult issues and challenges for care providers. Stress of conscience, such as feelings of guilt, can be experienced by staff when not fulfilling ethical obligations to the residents. Although leadership has been advocated as a key component for staff work perceptions as well as for person-centred care, the impact of nursing home managers’ leadership on levels of stress of conscience among staff and the extent to which person-centred care (PCC) is provided is yet to be explored. Thus, the aim was to explore the relationship between leadership, stress of conscience and PCC as perceived by staff. The study was based on a cross-sectional national survey of 3084 staff and their managers in 189 nursing homes throughout Sweden. Descriptive statistics and regression modelling were used to explore associations. The preliminary results showed that leadership was negatively associated to stress of conscience and positively associated to PCC. PCC were negatively associated to stress of conscience. Additional findings will be presented. This indicates that nursing home managers’ leadership seem to beneficially impact staff work situation in terms of stress of conscience and person-centred care provision.
Association of Physical Activity, Muscle Mass, Strength, and Function to Quality of Life in Older Adults
Authors: Taani Murad , Cho Chi , Ellis Julie
Published: December 2020

Physical inactivity and loss of muscle mass, strength, and function are associated with negative outcomes including disability and a decline in health-related quality of life (HRQoL) among older adults. Older adults living in continuing care retirement communities (CCRCs) are at greater risk for declining physical activity and muscle outcomes compared to community-dwelling older adults. Few researchers studying the association of muscle and physical activity have examined the distinction between physical and mental HRQoL. Understanding the differential association of physical and mental HRQoL to physical activity and muscle outcomes can inform the development of useful interventions. The aim of this study was to examine the relationships between physical activity, muscle mass, strength, function and physical and mental HRQoL. Using a descriptive, correlational design, 105 older adults living in CCRCs were recruited. Light physical activity (LPA), moderate physical activity (MPA), sedentary behavior, and steps per day were assessed using ActiGraph GT3X. Appendicular skeletal muscle mass (ASMM) was assessed with bioelectrical impedance spectroscopy, handgrip strength with JAMAR Smart Hand Dynamometer, muscle function with the Short Physical Performance Battery (SPPB) test, and physical and mental HRQoL with the SF-36 questionnaire. The mean age of participants was 83 (SD=7.4). Using multiple regression models adjusted for sex and age, steps per day and SPPB score explained 38.4 % of the variance in physical HRQoL. Handgrip strength explained 8 % of the variance in mental HRQoL. These findings suggest that QoL improvement programs should include components to improve physical activity, muscle strength and function.
Post-Acute Rehabilitation in Persons With Dementia: Does It Make a Difference?
Authors: Flanagan Jane , Boltz Marie , Ji Ming
Published: December 2020

Persons with dementia are about two times more likely to be hospitalized than their peers who are cognitively healthy. These individuals are frequently discharged to skilled nursing facilities or nursing home settings, to receive short-term, post-acute, rehabilitative care. The rehabilitative care, Physical Therapy (PT) and Occupational Therapy (OT), provided in skilled nursing facilities (SNFs) aims to restore the person to their pre-hospitalization functional status and assist the person to return home. This study used MDS assessment data of 6396 people, age 65 years and older with dementia, admitted to SNFs in 2013 from acute care hospitals in Massachusetts to assess the effects of OT and PT on the change in physical function of nursing home residents admitted to the nursing home after hospitalization. Multiple linear regression analyses. The sample was mostly female (64.1%), non-Hispanic (98.86%), and white (93.71%), with a mean age of 85.3 (SD=6.85). After controlling for age, gender, race and comorbidities, and delirium, rehabilitation interventions (OT, PT or OT+PT) did not have any significant effect on changes in physical function among residents with dementia (p for OT = 0.14; p for PT=0.59; p for OT+PT:= 0.32). Additionally, non-white residents had poorer function at three months (β =1.86, 95% CI:-3.57- -0.16). The results indicate for persons with dementia admitted to SNFs, OT, PT or OT+PT did not lead to a significant improvement physical function. More innovative and effective interventions should be developed to improve physical function in persons with dementia post-hospitalization.
Dual Effects of Hearing Loss and Dementia on Functional Limitations in Older Adults
Authors: McKee Michael , Zhou Yunshu , Ehrlich Joshua , Mahmoudi Elham , Deal Jennifer , Reed Nicholas
Published: December 2020

Age-related hearing loss (HL) is both common and associated with elevated risk for cognitive decline and poorer health. To care for an aging population, it is critical to understand the effect of coexisting HL and dementia on functional activities. The effect of co-existing dementia and self-reported HL on daily functioning were assessed. A cross-sectional analysis was performed using nationally-representative data from the 2015 National Health and Aging Trends Study consisting of U.S. adults 65+. The sample included 1,829 adults with HL (22.8%) and 5,338 adults without HL. Multivariable Poisson regression was used to model the independent effects and interaction of self-reported HL and dementia status on three validated functional activity scales (self-care, mobility, and household). All analyses adjusted for sociodemographic and medical factors. HL participants were more likely to be white, older, male, less educated (p <0.01). 8.4% had possible dementia and 6.5% had probable dementia. Respondents with HL or possible or probable dementia had significantly lower mobility, self-care, and household activity scores (p<.001 for all comparisons) compared to their peers. A small yet significant interaction was present in all models, suggesting that HL respondents with co-occurring dementia had lower mobility, self-care, and household activity scores than predicted by the independent effects of dementia and self-reported HL (p<.001 for all comparisons). Older adults with co-occurring dementia and HL are at increased risk for poor functioning and should be screened by healthcare providers. Future work should consider the impact of intervention in this vulnerable/at-risk population.
Development of an Educational Intervention and Patient-Family Facing Materials for Deprescribing in Home Hospice
Authors: Tjia Jennifer , Clayton Mardie , Duodu Vennesa , Puerto Geraldine , Rappaport Lynley , DeSanto-Madeya Susan
Published: December 2020

Deprescribing is emerging as a clinical intervention to optimize quality of life, improve patient safety, and reduce burden for older adults with serious illness and their caregivers. Few resources are available to educate and engage clinicians, older adults and their families in discussions about deprescribing. This presentation describes the development of educational intervention materials, including clinician, patient and family-facing materials, about medication management and deprescribing for seriously ill older adults in home hospice. An environmental scan of the existing deprescribing resources was conducted; a state-of-the-art educational program for hospice deprescribing was located and used as the basis for an innovative clinician-facing educational intervention. A stakeholder panel of 2 hospice administrators, 3 nurses, 2 physicians, 2 pharmacists, and 2 former family caregivers, drawn from 2 geographically diverse hospice agencies, reviewed the content of the educational program and made recommendations for additional content. Iterative rounds of development and feedback resulted in: (1) a 3-part, 1 hour, clinician educational program with CE credits for nurses that presents a standardized deprescribing approach that aligns medication prescribing with the goals of patients and caregivers, and (2) a patient/family caregiver medication management notebook for intervention group participants (addressing management of common symptoms, medications in hospice, and deprescribing) and an adapted version for attention control participants. A professional designer created thematic coherence for all materials that were well received by stakeholder panelists and hospice staff. Ultimately, educational materials will support efforts to standardize deprescribing approaches that aim to optimize end-of-life care outcomes for patients and family caregivers.
Effects of a Multidisciplinary Intervention on Daily-Living Gait Among Older Adults With Parkinson’s Disease
Authors: Hausdorff Jeffrey , Cohen Moriya , Ganz Natalie , Green Yitchak , Badichi Inbal , Curevich Tanya
Published: December 2020

Multidisciplinary interventions can improve gait and balance in patients with Parkinson’s disease (PD). However, it is not yet known if these interventions also positively impact the quality of daily-living walking. We, therefore, examined the effects of a multidisciplinary, intensive out-patient rehabilitation program (MIOR) as delivered by the rehabilitation center of EZRA–LEMARPE organization on gait and balance as measured in the clinic and on every-day walking, as measured during 1-week of continuous measurement. 46 PD patients (age: 70.05±7.71; gender: 31.3% women; disease duration: 8.85±6.27 yrs) were evaluated before and after participating in 8-weeks of physical, occupational, and hydro-therapy, boxing, and dance (3 days/week; 5 hrs/day). After the intervention, clinical measures of balance (MiniBest Test of Balance delta: 1.82±3.30 points, p=0.001), mobility (TUG delta: -1.78±6.15sec; p=0.001), and usual-walking speed (delta 19±16cm/s; p<0.001) improved. Daily-living step counts and daily-living gait quality did not change (p>0.5). In exploratory analyses, subjects were categorized as responders (Rs) and non-responders (NRs) based on changes in their daily-living walking gait speed. Rs increased their daily-living gait speed (delta: 10±14cm/s; p<0.001); NRs did not. Rs (n=21) also improved their daily-living gait quality measures (e.g. stride regularity, step length, stride time variability). At baseline, disease severity (MDS-UPDRSIII) was lower (p=0.02) in Rs (25.33±11.47), compared to the NRs (34.38±14.27). These results demonstrate that improvements in the clinic do not necessarily transfer to improvements in daily-living gait. Further, in select patients, MIOR can ameliorate daily-living walking quality, potentially reducing the risk of falls and other adverse outcomes associated with impaired mobility.
Accuracy of Nurses’ Fall Prevention Interventions in Patients With Cognitive Impairment and Behavioral Symptoms
Authors: Gray-Miceli Deanna , Kris Alison
Published: December 2020

Over 50 percent of older residents in nursing homes (NHs) fall each year. Many falls occur among NH patients with cognitive impairment and behavioral symptoms. Although NH nurses caring for patients who fall intervene to prevent fall recurrence, we know little about nurse’s perceptions of the most effective interventions for management of falls related to behavioral symptoms. The purpose of this qualitative study is to describe and analyze nurse’s perceptions of fall prevention interventions believed to be due to behavioral symptoms. This secondary analysis of existing qualitative data was conducted from a multi-site parent study in three NHs in the northeastern U.S. designed to test nurse’s knowledge of falls prevention and interventions. Forty-seven registered or licensed practical nurses, English speaking who were full or part time employees were recruited to participate. Most were female (n=46; 98.7%) with a median age of 49.5 years and ten years experience. A grounded theory approach was used to explore qualitative data (Glaser & Strauss, 1967) about nurse’s primary and secondary interventions. Qualitative data were collected in the form of responses to open ended questions from 47 nurses. The correctness of nurse interventions were independently evaluated, then validated among two independent experts. Cohen’s κ was used to determine if there was agreement between the experts’ judgement on correctness of the nurses’ intervention. Results indicated a high level agreement between expert evaluations (κ =.727-.760, p<.001). Emergent themes in the nurse interventions included: seeking outside help, confronting behavior, completing additional assessments, and patient reassurance.
Oral Dysphagia and Its Associations With Nutrition, Physical Functions, and Depression for the Elderly in the Community
Authors: Zhao Yinan , Ning Hongting , Liao Lulu , Hu Hengyu , Chen Huijing , Feng Hui
Published: December 2020

Objectives: To explore the occurrence of oral dysphagia problems among elderly in community and to investigate whether the severity of oral dysphagia problems is associated with nutrition, physical functions and mental health. Methods: Trained nurses conducted a rigorous assessment of 679 elderly people living in communities in Zhuzhou. Basic personal information, The Short Form Mini Nutritional Assessment (MNASF), Activities of daily living (ADL), Patient Health Questionnaire-9 (PHQ-9) were used to assess each elderly. Oral dysphagia was assessed by means of a standardized questionnaire including clinically symptoms of oral dysphagia such as coughing and choking. Results: A total of 654 old people was enrolled in this study, including 250 (38.2%) developing the one or more symptoms of oral dysphagia, the most common symptoms were: drinking water choking (30.7%), followed by saliva (9.6%), dysphagia or pain (6.4%),food loss from the corner of the mouth (2.3%), foreign body sensation of the esophagus (1.8%),food residue (1.2%).The severity of oral dysphagia problems was linearly associated with nutrition, physical function, depression, education level and current care status. The higher the burden of oral symptoms, the lower the self-rated health. Conclusions: The occurrence of oral dysphagia symptom was associated in a stepwise fashion with nutrition, physical function, depression, education level and current care status. In the community, the early recognition, diagnosis and treatment of oral dysphagia is an important link of reducing the mortality and improving the rehabilitation outcome. Additionally, the psychological construction in the elderly should be taken seriously by their families and community workers.
Addressing Alzheimer’s Risk in Racially Diverse, Low-Income Older Adults Through Telephone Health Coaching
Authors: Zanjani Faika , Rhodes Annie , Wilkerson Taylor , Inker Jennifer , Richardson Joann
Published: December 2020

Preclinical Alzheimer’s disease (AD) behavioral risk reduction needs to be more fully explored at the community-level. Connecting behavior change to AD can reduce individual-level helplessness for the disease. However, behavior change targeting AD prevention factors (e.g., alcohol, depression, physical inactivity, smoking, isolation, medication management) is extremely challenging for multiple reasons, including failures in connecting AD and health behavior risk, and due to individual-level motivational, self-efficacy, and knowledge barriers. Methods: As part of the Virginia Commonwealth University iCubed Health and Wellness in Aging Population Core, 20 diverse older adults (aged 60+) living in Richmond, VA, with incomes below $12,000/year and managing either diabetes/cardiovascular symptoms, were offered weekly telephone-based health coaching for 12-weeks, providing education, motivations, self-efficacy skills, and referral services, for AD behavioral risk factors. A patient preference health coaching behavioral change strategy was implemented, where the person decides which behavioral practices to target. All study subjects completed a behavioral-psychosocial baseline and 3-month follow-up assessment. Findings: The study demonstrated feasibility for implementing health coaching within low-income racially-diverse older adults. The study sample (n=20, mean age 69 years (range: 61-77 years) was 90% African American (n=18), and 55% males (n=11). Improvement in AD knowledge (F=4.19;p=.0565); cognitive functioning (memory (F=4.19;p=.0556); delayed memory (F=2.85;p=.1086); TrailsA (F=5.60;p=.0294)), alcohol-risk (F=3.33;p=.1108) and social isolation (F=4.11;p=.0569) trends were found at 3-month follow-up. Conclusions: The findings from this study exhibit positive trends in reducing AD risk. This study creates the impetus for future large-scale investigations and dissemination of findings to improve the lives of at-risk low-income aging adults.
Life-Space in a National Cohort of U.S. Older Adults: Normative Data for the UAB Life-Space Assessment
Authors: Lo Alexander , Wadley Virginia , Crowe Michael , Brown Cynthia , Kennedy Richard
Published: December 2020

The University of Alabama at Birmingham Life-Space Assessment (LSA) is a self-reported measure for assessing community mobility. Restricted mobility is correlated with a number of adverse health outcomes, including mortality, frailty, cognitive decline, and nursing home admissions. Thus, it is important for providers to understand how the LSA score of a patient compares to the general population. To facilitate such comparisons, we developed demographically adjusted norms for the LSA and its correlation with other functional measures. Norms were based on 15,390 participants age 45 and older in the National Institutes of Health-funded REasons for Geographic and Racial Differences in Stroke (REGARDS) study, a national, population-based, longitudinal study investigating the causes of excess stroke mortality among African Americans and individuals living in the Southeastern US stroke belt region. LSA scores declined from a median of 100 in the 45-54 age range to a median of 59.7 in the 85 and older age range, with higher median scores in males. LSA scores showed modest but significant positive correlations with SF-12 Physical Component and Mental Component, Center for Epidemiologic Studies Depression Scale, and Six Item Screener cognitive scores, as well as modest but significant negative correlations with AD8 Dementia Screening, Katz Activities of Daily Living, and Timed Walk scores. The LSA is a brief, easily administered measure that offers a valid method of assessing community mobility in the older adult population.
Does the Home-Visit Communicating Service by Postal Workers Improve the Mental Health of Older Persons Living Alone?
Authors: Inagaki Hiroki , Awata Shuichi
Published: December 2020

In Japan, the number of older households living alone or married couples is increasing as society ages. For such households, Japan Post offers “Mimamori Home-visit service” a fee-based service where postal workers visit once a month to check their living and health conditions. We examined whether the use of this service improves the mental health of users. There were 10,592 service users as February 2019. The survey targeted 524 people (356 women) who started using the system in January or February (wave1) and continued using until August 2019 (wave2). The mean age was 79.5 years. Visiting postal workers conducted tablet-based interviews to assess social support networks (LSNS-6) and mental health (WHO-5). Information on gender, age, and family form (living alone or not) was provided by Japan Post. The WHO-5 average score was 16.4 for wave1 and 16.3 for wave2. Changes in mental health (WHO-5 scores) at 2 time points were compared by ANCOVA using family form (living alone or not) and social isolation (12 points or less/13 or more for LSNS-6) as explanatory variables and gender and age as covariates. The results showed a significant interaction between the 3 factors of time, family form, and social isolation. WHO-5 scores increased (14.2 to 15.3) in the group that lived alone and had 12 or less of LSNS-6. In the other group, the score was no change or lowered. It has been shown that mental health improves with the use of monitoring services in elderly people living alone and in social isolation.
Temperature distribution in a permafrost-affected rock ridge from conductivity and induced polarization tomography
Authors: Duvillard P-A , Magnin F , Revil A , Legay A , Ravanel L , Abdulsamad F , Coperey A
Published: December 2020

Knowledge of the thermal state of steep alpine rock faces is crucial to assess potential geohazards associated with the degradation of permafrost. Temperature measurements at the rock surface or in boreholes are however expensive, invasive, and provide spatially limited information. Electrical conductivity and induced polarization tomography can detect permafrost. We test here a recently developed petrophysical model based on the use of an exponential freezing curve applied to both electrical conductivity and normalized chargeability to infer the distribution of temperature below the freezing temperature. We then apply this approach to obtain the temperature distribution from electrical conductivity and normalized chargeability field data obtained across a profile extending from the SE to NW faces of the lower Cosmiques ridge (Mont Blanc massif, Western European Alps, 3613 m a.s.l., France). The geophysical data sets were acquired both in 2016 and 2019. The results indicate that only the NW face of the rock ridge is frozen. To evaluate our results, we model the bedrock temperature across this rock ridge using CryoGRID2, a 1-D MATLAB diffusive transient thermal model and surface temperature time-series. The modelled temperature profile confirms the presence of permafrost in a way that is consistent with that obtained from the geophysical data. Our study offers a promising low-cost approach to monitor temperature distribution in Alpine rock walls and ridges in response to climate change.
The future is now: marine aquaculture in the anthropocene
Authors: Pernet Fabrice , Browman Howard I
Published: December 2020

Aquaculture now produces more seafood than wild capture fisheries and this production is expected to at least double by 2050. Representing almost half of global production, marine aquaculture will contribute to sustainably feeding the growing humanity. However, climate change will undoubtedly challenge the future growth of marine aquaculture. Temperature and sea-level rise, shifts in precipitation, freshening from glacier melt, changing ocean productivity, and circulation patterns, increasing occurrence of extreme climatic events, eutrophication, and ocean acidification are all stressors that will influence marine aquaculture. The objective of this themed article set was to bring together contributions on the broad theme of the potential impacts, adaptation, and mitigation strategies of marine aquaculture to climate change. Here we present 14 papers covering a diverse set of approaches including experimentation, modelling, meta-analysis and review, and disciplines like biology, ecology, economics, and engineering. These articles focus on the impacts of climate change-related stressors on the aquaculture potential itself and on the resulting ecological interactions (e.g. parasitism and predation), on phenotypic plasticity and adaptation potential of species, and on measures to mitigate the effects of climate change on aquaculture and vice versa. Considering this, adaptation of the aquaculture sector relies on anticipating the biogeographical changes in the distribution of species, determining their potential for adaptation and selective breeding for resistance or tolerance to climate-induced stressors, and fostering ecosystem resilience by means of conservation, restoration, or remediation. By will or by force, aquaculture will contribute to the low carbon economy of tomorrow. Aquaculture must move towards a new paradigm where the carbon footprint and the analysis of the life cycle of products are at least as important as economic profitability.
A comparative study between two antifungal agents, Luliconazole and Efinaconazole, of their preventive effects in a Trichophyton-infected guinea pig onychomycosis model
Authors: Nakamura Akihiro , Hirakawa Satoko , Nagai Hiroaki , Inagaki Katsuhiro
Published: December 2020

An efficacious period of two topical antifungal drugs was compared in a Trichophyton mentagrophytes-infected onychomycosis model in guinea pigs treated with antifungal drugs prior to infection. Luliconazole 5% (LLCZ) and efinaconazole 10% (EFCZ) test solutions were applied to the animals’ nails once daily for 2 weeks followed by a nontreatment period of 2, 4, and 8 weeks. After each nontreatment period, the nails were artificially infected by the fungus. Drug efficacy was quantitatively evaluated by qPCR and histopathological examination of the nails collected following a 4-week post-infection period. The fungal infection was confirmed in the untreated group. Both LLCZ and EFCZ prevented fungal infection in the treated groups with the nontreatment period of 2 weeks. After the nontreatment period of 4 weeks, no infection was observed in the LLCZ-treated group; however, infection into the nail surface and fungal invasion into the nail bed were observed in the EFCZ-treated group. After the nontreatment period of 8 weeks, fungi were found in the nail surface and nail bed in some nails treated with EFCZ; however, no infection was observed in the nail bed of the LLCZ-treated group. The results suggest that LLCZ possesses longer-lasting antifungal effect in nails of the guinea pigs than EFCZ, and that this animal model could be useful for translational research between preclinical and clinical studies to evaluate the pharmacological efficacy of antifungal drugs to treat onychomycosis. This experimentally shown longer-lasting preventive effects of LLCZ could also decrease the likelihoods of onychomycosis recurrence clinically.