bluuebunny/crossref_metadata_2025_split huggingface dataset:
INNOVATING THE DETECTION OF CARE PRIORITIES IN HEART FAILURE USING LARGE LANGUAGE MODELS
Authors: Albashayreh Alaa , Zeinali Nahid , White Stephanie 
Published: January 2025

Abstract
Engaging older adults with advanced chronic conditions, such as heart failure, in discussions about their care priorities is crucial for ensuring treatments align with their preferences, especially at the end of life. Despite the abundance of data in electronic health records (EHRs), documentation of care priorities is often inconsistent and underutilized. This study utilizes natural language processing (NLP) to detect and characterize care priorities in the EHRs of older adults with heart failure, aiming to enhance patient-centered care. We retrained Bio-Clinical-BERT, a Bidirectional Encoder Representations from Transformers (BERT) large language model, using EHR data from a Midwestern U.S. hospital to create Care-BERT, a novel model for predicting care priorities in clinical narratives. We developed a gold-standard corpus of 1,068 notes, focusing on comfort measures only and life-sustaining treatments, with the dataset divided into training (80%) and testing (20%) sets. Care-BERT outperformed BERT-base, Bio-Clinical-BERT, and PubMed-BERT, achieving the highest performance in predicting care priorities (internal validation: F1-score = 0.941, AUC = 0.978; external validation with 200 GPT-based synthetic notes: F1-score = 0.876, AUC = 0.966). Applied to 2,218,251 EHR notes for 7,984 older adults with heart failure (mean age = 76.9 years), Care-BERT revealed that 2.8% had comfort measures only and 17.3% had life-sustaining treatments documented. This study highlights the potential of Transformer-based NLP models like Care-BERT to improve the documentation of care priorities in EHRs and enhance patient-centered care. Future research will explore documentation variations across patient groups using NLP-based labels, providing further insights into care preferences.
TRANSRURAL LIVES: LESSONS FROM AN INTERDISCIPLINARY COMMUNITY-BASED DIGITAL STORYTELLING PROJECT
Authors: Tester Griff , Eliatamby-O’Brien M 
Published: January 2025

Abstract
TransRural Lives is an interdisciplinary, community-based digital storytelling project focused on transgender older adults (50+) living in non-metropolitan areas of the Pacific Northwest. Through unstructured interviews, we create audio vignettes that capture their unique experiences, which are featured on our website. While social science research often groups lesbian, gay, and transgender older adults together, older transgender individuals face distinct health and community-building challenges. Additionally, much of the scholarship overlooks the urban-rural divide, often portraying transgender people as primarily urban subjects. However, rural areas offer alternative sites for transgender identity formation that are equally significant. TransRural Lives provides a platform for non-linear and metaphorical storytelling, allowing participants to express joy, repression, and gender knowledge on their terms, without the constraints of linear, medicalized narratives. Our project highlights the socio-cultural, geographic, and historical factors that have shaped transgender experiences in rural areas, revealing the complexity of their lives. This paper reflects on the first two years of our work, including the relationships we’ve developed with community partners and the challenges of navigating university policies that often do not accommodate community engagement – such as debates over the use of incentives and disputes about “ownership” of stories. This issue is particularly relevant for partners like the Northwest Portland Area Indian Health Board’s Paths (Re)Membered Project, which empowers the Two Spirit and Indigenous LGBTQ+ community by emphasizing their strengths, resilience, and histories in the pursuit of health equity, and actively challenges research procedures rooted in colonial practices.
CLINICIAN TYPE AND SETTING OF CARE DELIVERED TO MEDICARE BENEFICIARIES WITH DEMENTIA IN THE U.S
Authors: Maust Donovan , Davis Rachel , Muench Ulrike , Marcus Steven , Spetz Joanne 
Published: January 2025

Abstract
Improving care coordination for persons living with dementia (PLWD) requires understanding of the types of clinicians delivering care and the settings in which they practice. We identified all beneficiaries with dementia in traditional Medicare in 2019. We used the Medicare Carrier file—i.e., where bills for care provided by individual clinicians are recorded—to identify clinicians providing care to PLWD, which we then linked to the National Plan & Provider Enumeration System (NPPES). Using the Carrier and NPPES files, we characterized the workforce providing care to PLWD, including specialty and licensure (e.g., primary care physician, neurologist, nurse practitioner), setting of care delivery, and whether the clinician included a dementia diagnosis in the billing information. Overall, 1,934,318 PLWD received care from 783,225 unique clinicians. The most common settings of care were office (74.8% of PLWD), emergency room (63.9%), inpatient hospital (52.1%), and skilled nursing facility (37.1%). 87.0% of PLWD received care from a primary care physician, 62.9% from a nurse practitioner, and 33.1% from a physician assistant. Among all the clinicians that care for PLWD, 20.3% are primary care physicians, 15.3% nurse practitioners, and 9.0% physician assistants. 2.4% are psychiatrists, 1.7% neurologist, and just 0.5% are geriatric subspecialist physicians. For clinicians providing care to PLWD, the majority provide care in the outpatient setting, followed by hospital-based care. Programs to improve care coordination for PLWD, such as GUIDE Model programs, must account for delivery across multiple health care settings, recognizing that geriatric subspecialists comprise an extremely small proportion of the PLWD-serving workforce.
TEN-YEAR ANALYSIS OF ADVERSE DRUG REACTIONS IN PEOPLE WITH DEMENTIA USING FDA ADVERSE EVENT REPORTING SYSTEM DATA
Authors: Mao Jieyu , Yamakawa Miyae , Takeya Yasushi 
Published: January 2025

Abstract
Dementia often leads to polypharmacy and increased ADR risk, making ADR recognition vital since People with Dementia (PwD) struggle to communicate discomfort. This study used the FDA Adverse Event Reporting System (FAERS) database from 2013 to 2024 to extract dementia-related ADR reports. A total of 23,519 ADR reports were analyzed after data cleansing. Missing data was addressed using the MissForest algorithm and refined with KNN imputation. Signal detection calculated PRR (Proportional Reporting Ratio) for frequently reported drugs and ADRs. Over the ten years, the number of dementia-related ADR reports fluctuated significantly, while showing a sharp peak around 2023. Consumers are the most common reporters of ADRs, accounting for 33.4% of the reports, followed by medical doctors at 30.1%. The median time from treatment initiation to the occurrence of ADR was 20 days. Regarding patient outcomes, 38.2% reported hospitalization, and 12.4% reported death. The most reported ADRs were death (706 cases), drug ineffective (527 cases), off label use (502 cases) and aggression (458 cases). Approximately 48.8% of the top 100 ADR reports can be observed and reported by nurses. Exelon Patch was the drug most frequently reported to cause ADRs, strongly associated with death, while Epidiolex showed significant signals for seizure. Cholinesterase inhibitors and antipsychotics/anticonvulsants had high ADR report counts across multiple system organ classes, especially nervous system. Due to cognitive impairments, PwD often face challenges in reporting symptoms, highlighting the importance of objective observation and monitoring by healthcare professionals to ensure accurate ADR identification and improve PwD outcomes.
FASTER EPIGENETIC AGING AND INCREASED RISK OF PROSPECTIVE MORBIDITY AND MORTALITY FOR U.S. VETERANS
Authors: Bourassa Kyle 
Published: January 2025

Abstract
Epigenetic measures of aging have promise as biomarkers of future morbidity and mortality, but require validation in real-world medical settings. To provide evidence of this validation, we investigated whether an epigenetic measure of aging—DunedinPACE—was associated with prospective health for 2,216 post-9/11 U.S. military veterans enrolled in the Post-Deployment Mental Health Study (472 women, 1,744 men; 1,077 non-Hispanic Black veterans, 1,139 non-Hispanic White veterans). Prospective health outcomes included chronic disease burden (Charlson comorbidity index), predicted annual VA healthcare costs (Nosos scores), chronic disease incidence, and mortality—all assessed using VA electronic health records (EHR). Veterans averaged 37.4 years old at enrollment and with an average of 13.1 years of EHR follow-up. Veterans with faster DunedinPACE aging scores developed greater chronic disease burden and greater predicted healthcare costs over the subsequent 5, 10 year, and 15 years. Faster aging scores were associated with increased risk for incident myocardial infarction, stroke, diabetes, cancer, liver disease, and renal disease, as well as greater risk of mortality due to all-causes and death due to chronic disease. Results remained when controlling for demographic and technical covariates, as well as self-reported smoking and smoking methylations scores, replicated when stratifying by sex and race/ethnicity, and replicated when using an alternative measure of epigenetic aging (PC-GrimAge). These findings suggest DunedinPACE is a biomarker of accelerated aging that associated with prospective morbidity and mortality across multiple chronic diseases and organ systems. With further refinement, epigenetic aging scores have the potential to be useful clinical biomarkers of future health.
AN ASSESSMENT OF STATE EMPLOYEE BACKGROUND CHECK POLICIES FOR IMPROVING QUALITY IN NURSING FACILITIES
Authors: Mehboob Gul Rukh , Kaskie Brian , Sharma Hari 
Published: January 2025

Abstract
Employee background checks are important measures for ensuring the safety of older adults in nursing homes. Programs like the National Background Check Program (NBCP) provide federal grants to help states enhance their background check systems for long-term care receivers. While these checks require resources, their effectiveness in reducing abuse, neglect, and exploitation remains uncertain. We aim to compare NBCP grant-receiving states (N=27) with non-receiving states (N=23) to identify regulatory changes and adaptation of specific policy measures over time to improve employee background check systems. We used a policy scan approach to compare and rank states by thoroughly analyzing regulations, bills, documents and reports from 2005 to 2024. We evaluated states based on three policy domains: types of LTC providers required to conduct employee background checks, the disqualifying offenses considered by the states, and the processes used to implement and administer these checks. We also analyzed temporal changes in states’ background check systems over time. We found notable differences in regulations concerning the types of LTC providers involved and disqualifying offenses between NBCP and non-NBCP states. However, we found little difference in the processes between these two groups. Overall, the NBCP states show better adaptation and temporal changes due to advanced technical systems and improved regulations. To our knowledge, this is the first study to comprehensively assess the regulatory framework of state employee background check systems. Our study has direct policy implications for state and national policymakers debating the effectiveness of NBCP in improving nursing home quality.
THE PERCEIVED LIFE EXPERIENCES OF AFRICAN METHODIST EPISCOPAL (AME) MEMBERS
Authors: Lane-Nelson Nia 
Published: January 2025

Abstract
The African American (AA) church has played an essential role in the AA community. Using the Life Course Theory (LCT) as a sensitizing framework, this qualitative descriptive study described how AA members of one AME church perceived their life experiences as influencing their current health status. LCT key concepts (pathways or trajectories, early life experiences, critical or sensitive periods, cumulative impacts, and risk and protective factors) concentrate on the socioeconomic and environmental contexts within the life of an individual. Individual interview questions were developed based on the LCT key concepts. Seventeen in-depth interviews were conducted. Qualitative content analysis was used to identify categories and subcategories. Within the key concept of early life experiences 3 categories (Economic hardships, Personal hardships, and Protective influences in early childhood) were identified. Within the category of Economic hardships 3 subcategories were identified; not having food, living was tight, and neglect in early childhood due to economic hardships. Within Personal hardships the subcategories were parental responsibilities in early childhood, separation in family, family trauma, and experiences with racism at an early age. Within Protective influences in early childhood the subcategories were receiving love and support, feeling safe and protected, learning from parents and others, dealing with racism, and active in childhood activities. Through using the LCT, participants were able to highlight the social, economic, and environmental issues experienced throughout their lives and the impact on their health. Participants shared narratives spanning from early childhood to the present, with a common stressor being experiences with racial discrimination.
UNDERSTANDING RACIAL BIAS AWARENESS ACROSS ADULTHOOD: THEMES OF BIAS, JUSTIFICATIONS, AND EMOTIONS
Authors: Beatty Jennifer , Hill Patrick , Doriscar Jonathan E , Leath Seanna 
Published: January 2025

Abstract
This project employed a mixed-methods approach to analyze how age-diverse White Americans (N = 345; age range: 19 to 85) make meaning of specific instances of personal racial bias. Across three data collections, that targeted younger, middle-aged, and older adults, we asked participants to write about a time when they were racially biased. In the samples, 98% of younger adults, 91% of middle-aged adults, and 86% of older adults indicated specific instances of racial bias, and many indicated antiblack bias. Age-diverse adults frequently assumed that racial out-group members were criminal or deviant or assumed that those individuals had an undesirable culture. The participants also often indicated numerous justifications and emotions about their bias. For example, common justifications across all ages included perceived threat or the ambiguity of the situation. Specific emotions and justifications only differed moderately by age. Our findings indicate that while age-diverse White adults may make meaning of their bias in different ways, they tend to do so with self-conscious emotions and bias justifications that do not mitigate bias. Critically, middle-aged and older adults were less likely to indicate emotions at all in their reports. These findings may reflect a positivity bias among older adults who are less willing to highlight or remember their negative emotions or it may speak to the possibility that they may feel less fear in intergroup settings. The current work offers insights into more personalized approaches to bias regulation by integrating specific bias contexts with bias justifications and emotional awareness.
ADVERSE CHILDHOOD EXPERIENCES AND SOCIAL PARTICIPATION ON FRAILTY STATE TRANSITIONS: A 10-YEAR PROSPECTIVE COHORT
Authors: Li Jiajia , Pei Heming , Kang Ning , Chen Gong , Pei Lijun 
Published: January 2025

Abstract

Background
Adverse childhood experiences (ACEs) is associated with frailty, while the association with frailty state transitions and the role of social participation remain unclear. This study aimed to investigate the association between ACEs and frailty state transition, alongside the moderation effect of social participation

methods
Data from 9,621 adults aged 45+ from the CHARLS (2011-2020) were analyzed. Frailty was measured with the frailty index, while ACEs and social participation were measured with a validated questionnaire. The association between ACEs and frailty state transitions was estimated with multi-state models. Interaction analysis was used to examine the moderation effects of social participation.

Results
Participants exposed to higher ACEs levels (≥ 4) were associated with an increased risk of forward transition (robust to pre-frail, HR=1.36, 95%CI: 1.21-1.53; prefrail to frail, HR=1.38, 95%CI: 1.17 - 1.62) and decreased risk of backward transition (pre-frail to robust, HR = 0.64, 95%CI: 0.54 – 0.76). Additionally, participants with social participation were associated with increased risk of backward transition (frail to pre-frail, HR = 1.14, 95%CI: 1.02 – 1.27). Social participation moderated the association between ACEs exposure and frailty (P for interaction &lt; 0.05), while participants with lower ACEs exposure levels and social participation were associated with an increased risk of transition from frail to pre-frail (ACEs levels =1, HR = 1.57, 95%CI: 1.06 – 2.32; ACEs levels =2, HR = 1.49, 95%CI: 1.02 – 2.17).

Conclusion
High levels of ACEs exposure were associated with a greater likelihood of adverse frailty development. Older adults with ACEs exposure might benefit from intervention strategies to improve social participation.
CREATING A SUCCESSFUL DATA PLAN: NIA BEHAVIORAL AND SOCIAL AGING RESEARCH DMS REVIEW EXPERIENCE
Authors: McNally James , Jain Paavani 
Published: January 2025

Abstract
The revised NIH Data Management and Sharing (DMS) Policy took effect in January 2023, requiring all researchers applying for NIH funding to develop a detailed DMS plan as part of the application. In turn, NIH became responsible for reviewing and approving the submitted plan before issuing an award and monitoring compliance. Having recently completed our first year of DMS reviews, this presentation will report lessons learned by the NIA Division of Behavioral and Social Research (DBSR). One of the critical changes was the requirement for a six-element document addressing Data Type; Related Tools, Software, and Code; Standards; Data Preservation, Access, and Associated Timelines; Access, Distribution, or Reuse Considerations; and Oversight of Data Management and Sharing study. Despite efforts to educate and prepare all parties for this transition, researchers had questions about the best way to prepare a DMS plan and from NIA staff on reviewing the submitted requests. Within DBSR, the Office of Data Resources and Analytics (ODRA) established a review team to examine DMS plans, develop necessary resources, and coach grantees. The presentation will present lessons learned for best practices in DMS development. We will discuss handling primary versus secondary data, metadata, and source code, selecting an appropriate repository for socio-behavioral and interdisciplinary aging data, data restrictions, and navigating various grant mechanisms and their data prospects. A non-compliant DMS plan can delay or reverse funding decisions; NIA seeks to ensure all researchers understand this plan’s importance and how to successfully create one that supports ongoing scientific discovery.
FUNCTIONAL LIMITATIONS AND MORTALITY AMONG PERSONS AGING WITH HIV INFECTION AND SUBSTANCE USE
Authors: Ramamurthi Hema , Gruber-Baldini Ann , Orwig Denise 
Published: January 2025

Abstract
Aging individuals living with HIV experience earlier onset of adverse health outcomes, increased hospitalization rates, and mortality. However, there is limited research demonstrating the impact of HIV, substance use and functional limitations on survival. We analyzed self-reported longitudinal data collected during biannual visits from 2005 to 2020 among 2,633 participants contributing 120527 study visits in the community-engaged, AIDS Linked to the Intravenous Experience (ALIVE) cohort. Functional limitation was defined as having reported “limited a lot” in one of the 4 items of the physical activity section of Medical Outcomes Study-HIV scale. Scores from each visit were summed and categorized into: No Limitation = 0, Moderate Level of Limitation = 1-2 and Severe Limitation &gt; 3. The sample included 751 (28.52%) People Living with HIV (PLWH), who were slightly older than HIV-negative counterparts (47.97 years vs. 44.89 years, p&lt; 0.001). PLWH had a higher prevalence of functional limitations compared to HIV-negative individuals (44.1% vs. 38.3%, p&lt; 0.05). In Cox Proportional Hazards models adjusted for socio-demographic, lifestyle factors and comorbidities, detectable viral load (HR=2.49, CI=2.08-2.97), and having 1-2 or &gt;3 functional limitations (HR=1.27, CI =1.07-1.50 & HR=1.78, CI=1.51-2.10) respectively were predictive of mortality. This analysis highlights the importance of self-reported functional limitations and other potentially modifiable risk factors as important correlates of mortality among PLWH. These factors should be of key focus in the development of future interventions to effectively reduce adverse outcomes among PLWH.
BEING A SUPERWOMAN, THE EXPLORATION OF AFRICAN AMERICAN WOMEN DEMENTIA CAREGIVERS AND THEIR MENTAL HEALTH
Authors: Rhodes Shanae 
Published: January 2025

Abstract
Existing literature presents evidence that African American caregivers experience a health paradox where they have commonly reported having worse physical health but better mental health related to caregiver burden when compared to other racial groups. However, there are inconsistencies across the research literature regarding mental health outcomes for this population. Guided by Pearlin’s Stress Process Model and the Superwoman Schema, the purpose of this study was to explore the influence of the Superwoman Schema characteristics and caregiver burden on the psychological health (anxiety and depressive symptoms) of African American female caregivers. A mixed methods design was used for this study. This presentation will focus on the quantitative segment. Cross-sectional correlations and regression analyses were conducted using data collected from 127 participants to investigate the relationship between caregiver burden, the five Superwoman characteristics, and psychological health for African American female caregivers. Results showed that caregivers who reported a higher endorsement of any of the Superwoman characteristics were more likely to report higher caregiver burden, anxiety, and depressive symptoms. Endorsement of some of the Superwoman characteristics (i.e., obligation to present an image of strength and obligation to help) partially mediated the relationship between caregiver burden and anxiety and caregiver burden and depressive symptoms. Future research should continue to examine the mediation of Superwoman characteristics on the relationship between caregiver burden and psychological health outcomes. These partial mediators can inform intervention development to mitigate the negative impact of caregiver burden on mental health.