A majority of healthcare today occurs in private homes and is performed by older adults and their informal caregivers. However, only recently have we begun to understand more about the healthcare work of older adults and their caregivers and the home as a healthcare delivery system. Work science allows us to conceptualize the healthcare activities of older adults and their caregivers as a type of health-related work that has been conceptualized under the broad term, patient work. Applying a patient work lens can offer a unique perspective to addressing the persistent and pervasive challenges faced by older adults and their caregivers as they manage their healthcare at home and across healthcare settings. I will describe the historical development of the patient work approach and highlight recent efforts to use a patient work approach to understand and support the work of older adults and their caregivers providing care in the home.


Innovative technology can improve the lives of older adults, including those diagnosed with dementia, and their caregivers. Yet a lack of careful attention to preferences and needs of end-users and continuous updates to resources could leave consumers without a valuable user experience. This symposium will cover exemplar cases of innovative technologies, available resources, and current research. The first presentation will discuss virtual reality used among older adults with dementia and the opportunities to further explore it’s use as an intervention. The second presentation will share the process of seeking stakeholders’ preferences in the design specifications for a socially assistive robot and how the perspectives shaped the development of the Quori robot. The third presentation will focus on detailing the Information Quality Framework for Online Dementia Care Resources. The fourth presentation will discuss the implications of a systematic review that revealed researchers are reporting on all older adults within a category of 65 and older, thus failing to present variance among different older age cohorts. These presentations will all conclude with a discussion on opportunities for improvement in the respective areas.


We present an algorithm for recovering the PRS behind a sequence of such automata, and apply it to the sequences of automata extracted from trained RNNs using the We present an algorithm for extracting a subclass of the context free grammars (CFGs) from a trained recurrent neural network (RNN). We develop a new framework, Extracting the learned language of an RNN is important to facilitate understanding of the RNN and to verify its correctness. Furthermore, the extracted CFG can augment the RNN in classifying correct sentences, as the RNN’s predictive accuracy decreases when the recursion depth and distance between matching delimiters of its input sequences increases.


The brain anxiety network is composed of a number of interconnected cortical regions that detect threats and execute appropriate defensive responses via projections to the shell of the nucleus accumbens (NAcSh), dorsolateral region of the bed nucleus of the stria terminalis (BSTDL) and lateral region of the central nucleus of the amygdala (CeL). The paraventricular nucleus of the thalamus (PVT) is anatomically positioned to integrate threat- and arousal-related signals from cortex and hypothalamus and then relay these signals to neural circuits in the NAcSh, BSTDL, and CeL that mediate defensive responses. This review describes the anatomical connections of the PVT that support the view that the PVT may be a critical node in the brain anxiety network. Experimental findings are reviewed showing that the arousal peptides orexins (hypocretins) act at the PVT to promote avoidance of potential threats especially following exposure of rats to a single episode of footshocks. Recent anatomical and experimental findings are discussed which show that neurons in the PVT provide divergent projections to subcortical regions that mediate defensive behaviors and that the projection to the NAcSh is critical for the enhanced social avoidance displayed in rats exposed to footshocks. A theoretical model is proposed for how the PVT integrates cortical and hypothalamic signals to modulate the behavioral responses associated with anxiety and other challenging situations. Anxiety is an ethologically advantageous emotion that maximizes survival because it promotes avoidance of potential harm in situations where dangers can emerge quickly . It is cThe present review presents evidence that the paraventricular nucleus of the thalamus (PVT) may be a critical node in the brain anxiety network. Anatomical details of how the PVT is connected with many components of the brain’s anxiety network are presented as well as recent evidence showing that neurotransmission to the PVT from orexin neurons in the hypothalamus contributes to stress-induced anxiety. The review also discusses recent anatomical evidence that shows that neurons in the PVT provide divergent projections to key striatal-like subcortical regions involved in the various defensive responses. Finally, a model is described that postulates that the PVT integrates and amplifies cortical signals related to threats and relays these signals to activate subcortical circuits that modulate defensive responses including avoidance of potential threats.impending threat and is often experimentally defined in rodents as freezing to conditioned cues or contexts. In contrast, anxiety is a response to potential threats and is operationally defined as avoidance of potential risks involving open spaces, bright lights, and novel conspecifics  peptides are exclusively found in neurons of the lateral and perifornical region of the posterior hypothalamus . The bio2-panic provocation model of panic anxiety (Experimental evidence indicates that orexins are involved in fear and anxiety. For instance, systemic administration of a non-specific orexin receptor antagonist reduces fear potentiated startle and the increases in heart rate and blood pressure that are produced when rats are placed in the context previously associated with footshocks . Researc anxiety . Another anxiety . There i anxiety .The areas of the brain where the orexin peptides or antagonists act to modulate anxiety and fear remained largely unexplored until recently. Orexin fibers and receptors are found in many of the regions of the anxiety network including the BSTDL and CeL  and admiIn summary, stress and anxiety are complementary states that engage many of the same neural circuits . Orexin There is experimental evidence that the PVT mediates freezing to conditioned tones as well as the immediate anxiogenic effects of footshocks  via a prNeurons in the NAcSh and cEA integrate signals from a number of sources including the thalamus, cortex and other areas of the brain resulting in the selection and expression of appropriate behavioral responses via activation of multisynaptic descending pathways . This caThe model emphasizes the hypothesis that the PVT integrates top-down signals related to potential threats with bottom-up signals related to emotional and behavioral states to energize defensive responses by activating descending pathways in the NAcSh and cEA. Cortical areas where the memory of aversive experience is processed and stored would provide the key signals that trigger striatal neurons to generate defensive response. The model advances the view that the PVT receives and integrates threat-related signals from the cortex along with behavioral or emotional state signals from the hypothalamus and brainstem. In this model, the PVT serves to integrate threat and situational information in a way that promotes appropriate defensive responses via its divergent projections to the NAcSh and cEA. The model also proposes that the PVT serves to promote or amplify the influence of the cortex on subcortical regions. The proposed model is focused on how the PVT regulates defensive behaviors. Nonetheless, the model is also pertinent for understanding how the PVT mediates appetitive behaviors. For example, recent evidence shows that signals from orexin and prelimbic cortical neurons converge and act at the PVT to modulate reward seeking responses to cues in a manner similar to what is predicted by the model .Going forward it will be important to design experiments in which the contribution of the PVT on complex behavior can be examined in experimental situations where both appetitive and aversive outcomes are possible as recently done by some research groups . It woulThe author confirms being the sole contributor of this work and has approved it for publication.The author declares that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.


Engineering genetic material for treatment of disease is a promising method which has been used for the treatment of different human pathologies for several decades  contains atypical microRNA2911. This Chinese herb is used for treating influenza infection and the authors have provided evidence to show that this microRNA directly targets influenza virus and is the active ingredient of honeysuckle herb for the treatment of flu . The exact biological manifestation of many of these ncRNAs are yet to be discovered  is another possibility.D. discoideum needs to go through cycles of multicellular development is a speculation that during the multicellular phase in which cyclic AMP signals, some novel ncRNAs might develop. The behavior of prestalk and prespore cells are different and novel genetic material might be eliminated in the cycle through sloughing off of the stalk cells. In summary D. discoideum is a promising model to examine how the symbiont fends off a novel pathogen (mainly a virus) for which the amoeba does not have a well-established defense mechanism.This suggestion that The efforts of using CRISPR-Cas9 technology for human gene editing and treatment of viruses is opening a new horizon for novel treatment methods. However, still there are several steps to take before we can safely and effectively use this technology for a viral infection treatment. Here I suggested a theoretical framework of using symbiotic relation between prokaryotes and eukaryotes for generating RNA-based therapeutics which might be used in human as well. This approach entails exposing the symbiont to a bacteriophage and searching for new genetic materials which are produced to eliminate the infection in the whole symbiont.The author confirms being the sole contributor of this work and has approved it for publication.The author declares that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.


The authors recently reported on the potential of targeting SRC kinase signaling in pancreatic cancer stem cells . During This error does not affect any of the data or conclusions in the article, and all densitometric analyses remain the same. The authors apologize for any confusion this error may have caused to the readers.


After this article  was publPLOS ONE’s Editorial Board confirmed that the replacement blot images support the results and conclusions as reported in the article.The authors commented that these experiments were repeated about three times at the time of the original experiments, and this duplication in the published figure may have arisen due to errors in preparing the figure. The authors have provided replacement data from a different replicate of the Mitochondrial fraction CytC and VDAC blot experiments, along with an updated version of the graph in In addition, the authors clarified that in preparing Figs The raw blot images for the S1 File(TIF)Click here for additional data file.S2 File(DOCX)Click here for additional data file.


In this first stage of an 8 state initiative designed to assist nursing homes in reducing unnecessary hospital readmissions, 16 nursing homes were identified and invited by CMS and state agency advisors to participate in the pilot study of the effects of intervention (use of the Guide). Selected facilities received an online orientation to the project and onsite visit from project team leadership prior to launch. Pre and post implementation data were uploaded to a secure section of the project website by the facilities. Three facilities withdrew due to change in top management and a fourth facility provided incomplete data resulting in data for analysis from 12 pilot facilities. Results show the average reduction in readmissions was 31.2% for the project period as compared with the 3-month pre-project period. This presentation will include facility reports of the effect of Guide use on resident and family decision making.


The elucidation of better treatments for solid tumors and especially malignant glial tumors is a priority. Better understanding of the molecular underpinnings of treatment response and resistance are critical determinants in the success for this endeavor. Recently, a battery of novel tools have surfaced that allow to interrogate tumor cell metabolism to more precise extent than this was possible in the earlier days. At the forefront of these developments are the extracellular flux and carbon tracing analyses. Through utilization of these techniques our group made the recent observation that acute and chronic c-MET inhibition drives fatty acid oxidation that in turn can be therapeutically targeted for drug combination therapies. Herein, we summarize and comment on some of our key findings related to this study. In the 1920s of the last century biochemist Otto Warburg made the remarkable and astonishing discovery that malignant cells heavily utilize glucose and metabolize it to lactic acid despite the presence of sufficient oxygen , 4. In t


MyCovenant. The data deals with the Monitoring Emission Inventories submitted by local authorities by 2016. Data has been processed and elaborated to highlights specific features of signatories and the policies they have adopted in the development of their Sustainable Energy Action Plans (SEAP). Available data relates to the mitigation policies in the SEAPs and includes their carbon reduction potential, the status of implementation and the class of governance. The CoM gathers together thousands of local authorities who voluntary committed to decarbonisation and increase resilience in their territory. Therefore, this data can be of interest for local policy makers and urban planners to identify successful examples in cities with comparable contexts and to identify possible measures in several sectors for climate change mitigation.This data article relates to and complement the research paper: "Assessment of climate change mitigation policies in 315 cities in the Covenant of Mayors initiative"  Specifications TableValue of the DataThe data gives quantitative and qualitative information on the local mitigation policies implemented to achieve the 20% carbon reduction target by local authorities which are part of the Covenant of Mayors up to 2016Climate change research, local government, policy makers, urban science are the fields where this data provides valuable information.Data can be used for comparisons with other data on local policies, for investigation on climate change mitigation and adaptation, for further analysis. Urban planners and local policy makers can benefit from the dataThe data supports regular evaluation of the carbon reduction target within the CoM initiative and the sharing of successful approaches and methodologies.The data gives insight on mitigation policies in different sectors adopted in local authorities across Europe.11-“Signatories”: the information on local authorities 2-2), the responsible local organisation for the implementation and the status of implementation.“Policies” the mitigation policies included in the MEIs submitted by local authorities, with specification on sectors , mode of governance, the corresponding carbon reduction potential (tCOCities play a key role in the climate challenge and are the place where local experimental governance aiming at meeting low carbon objectives can be tested In particular, the variables included in the dataset are:2The experimental design of the study is to relate the local authorities’ characteristics with their planned mitigation policies and the governance approach. Detailed studies and investigation on multi-level governance and policies were previously developed and investigated to base the structure of the analysis ,6. The dThe authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.


The recruitment of participants for chronic disease clinical trial research is often challenging. Further complicating participant recruitment occurs when the intervention is dyadic . Despite the strong support in favor of dyadic interventions for certain chronic diseases , researchers have not systematically shared challenges and opportunities for dyadic recruitment. During the recruitment for a yoga and self-management education intervention for people with chronic pain and their caregivers, several steps were taken to recruit and screen potential participants for the study. In this presentation, we will provide an overview of common recruitment challenges for physical activity and chronic disease self-management studies as well as the actual challenges encountered and our procedures for overcoming these obstacles. We will present our consort figure with attention toward inclusion and exclusion criteria of both care receivers and caregivers. Additional discussion will include specific challenges encountered when recruiting and screening caregivers . The need for innovative clinical trial research with caregivers and care recipient dyads is essential as new care practices continue to evolve and demands on health care utilization increase. Lessons learned from this study may prove useful for future researchers as they embark on developing and testing dyadic interventions among adults with chronic disease and their caregivers.


Employers are facing significant demographic changes in their workforce as the US population continues to age and older workers seek to delay retirement until later ages. The challenges associated with workforce aging vary substantially across the economy and vary by industry, occupation, and size of the organization. This analysis highlights the findings from employer surveys and workshops of senior HR leaders. The article summarizes the findings from our three-year research project including whether employers perceive that workforce aging is a challenge to their organization and if so, what changes in compensation and working conditions are being made to accommodate the changes in age structure


With this notice, Frontiers states its awareness of concerns regarding the validity of the participant data in this study. An investigation is currently being conducted by Kashan University of Medical Sciences research ethics committee. This expression of concern has been posted while Frontiers awaits the outcome of that investigation and will then be updated accordingly.


Has American society become more socially disconnected as Robert Putnam argues in Bowling Alone? Claude Fischer disputes this contention with evidence that Americans remain about as connected to friends and family as in the past. We address this debate with data for older adults from the National Social Life, Health and Aging Study, collected in 2005, 2010, and 2015. We compare social participation as reported at ages 57 to 68 for members of the Silent Generation cohort vs the Baby Boom cohort. We find that the gender gap in social participation evident for the Silent Generation does not exist at all for younger Baby Boomers, only appearing after age 62. These same cohort differences appear for participation in religious services and organized groups. This suggest that the gendered separation of social roles that characterized older generations is becoming less pronounced, with implications for social support and social isolation.


Asking older adults What Matters to them and assuring that care plans are aligned with these preferences is the cornerstone of an Age-Friendly Health System (AFHS). Health systems have struggled to identify clear ways to ask this question and meaningfully utilize the responses. Both simple and complex options for addressing this challenge have been developed at Rush University Medical Center. At Rush, nurses began asking every inpatient What Matters and placing the response on the white board in the patient’s room. Results of this practice include increased awareness of staff and significant increases in patient satisfaction. Qualitative analysis of responses yields increased awareness of patterns that the hospital can more systematically address. The Rush Center for Excellence in Aging hosts Schaalman Senior Voices, in which older adults from diverse backgrounds are given the unique opportunity to offer their perspectives on life, health and aging related to “What Matters” to them. The films have been used effectively to stimulate conversations among older adults and families in the community and in health professions courses, and with health systems executives. The Rush College of Medicine has integrated AFHS training into communication skills for medical students. Faculty introduce the 4Ms and demonstrate methods for having What Matters (WM) conversations. Students then practice WM conversations with simulated patients; some have had the opportunity to practice with real patients in preceptorships. Implications for the health system and community will be discussed as Rush builds an Age-Friendly Health Community.


This data article presents supplementary material for our report “Role of obstetricians in promoting pregnancy-related knowledge among women with epilepsy in Japan” . To provide more effective preconception counseling and perinatal care, we surveyed the attitude of epileptologists and obstetricians about pregnancy-related issues in women with epilepsy (WWE). Obstetricians said they needed information from epileptologists about seizure for management of WWE. Half of epileptologists did not feel the need to communicate with obstetricians before their patients’ pregnancy; they only contacted obstetricians after their patients became pregnant, and they only referred patients to an obstetrician if requested by the patient. Specifications TableValue of the Data•This dataset provides the viewpoints of epileptologists and obstetricians toward pregnancy-related issues of WWE.•These data help readers to understand present issues and the need to build a system of coordination between epileptologists and obstetricians.•These data, obtained from epileptologists and obstetricians, provide additional insight to the accompanying article 1The data in this article consist of additional figures and tables provided in a report 2We mailed questionnaires and consent forms. In total, 115 epileptologists returned the questionnaires  and 187 obstetricians returned the survey . Data were collected from May to June 2019.3Informed consent was obtained from respondents, and all procedures performed in the study were in accordance with the principals of the Declaration of Helsinki. This study was approved by the Medical Research Ethics Committee of Tokyo Medical and Dental University (M2018–290).The authors declare that they have no known competing financial interests or personal relationships which have, or could be perceived to have, influenced the work reported in this article.


Many Chinese older adults suffer from oral health diseases and problems due to low oral health literacy, limited dental coverage and lack of dental care services for this segment of the population in China. However, so few studies have been conducted to examine social and behavior factors related to oral health among Chinese older adults. This symposium examines how socioeconomic status (SES) and health behaviors are associated with oral health among Chinese older adults. The first paper used the Nanjing Centenarians Study to examine the association between health behaviors and oral health among Chinese centenarians. The results showed that health behaviors were associated with self-rated oral health and edentulism. Using the Chinese Longitudinal Healthy Longevity Survey, the second one employed an ‘after death’ approach to examine risk factors for orofacial pain symptoms at the end of life among Chinese older adults. The third paper investigated the association between SES and tooth loss among middle-aged and older adults in ten cities of China. SES played a stronger role in tooth retention for non-migrants and migrants with high education vs those migrants with low education. The last paper examined the association between health behaviors and retention of teeth among Chinese older adults using data from the Chinese 4th National Oral health Survey. This symposium provides empirical evidence on the current status of oral health and health behaviors at the national level, and also suggests that is critical to improve oral health education and access to dental care.


In the original article, we neglected to acknowledge the HRSM project NANOBILD for infrastructure support. The corrected acknowledgment statement appears below:The authors thank Dietmar Pum  for technical advice and acknowledge the HRSM project NANOBILD for infrastructure support.The authors apologize for this error and state that this does not change the scientific conclusions of the article in any way. The original article has been updated.


Home and Community Based Services has grown as an alternative to nursing homes over the past 30 years. While there are extensive data on nursing home staffing, there is a dearth of similar information about Medicaid financed home care. We use data from 2014-2016 Pennsylvania Medicaid to examine personal care for elderly with and without dementia across the range of physical disability. One challenge is that even though physical function can be measured in terms of discrete tasks , analysis of the amount of care people receive has to take into account the combination of dementia and combinations of ADL limitations. We found that older adults with dementia receive one hour more of personal care per day at the lowest level of disability and 1.5 hours at the highest level. The increased need for caregiving hours should be incorporated into policies that guide HCBS programs.


Major causes of brachial plexopathy in patients with breast cancer are metastatic invasion or radiation damage to the plexus. Differentiation between the two pathologies is important for appropriate treatment planning. The complicated anatomy of the plexus makes this a difficult area to image accurately. Magnetic resonance imaging (MRI) is the imaging modality of choice for diagnostic evaluation of these cases. We presented a case to demonstrate the role of


With the passage of the new “Supporting Older Americans Act of 2020,” Congress acknowledged and address several under appreciated issues -the growing social isolation and loneliness of older adults, and the significant role that the aging network does and can play in providing supportive services to older adults with advanced illness . This presentation will provide information on these and other pieces of the OAA puzzle.


Immunosenescence is described as a decline in the normal functioning of the immune system associated with physiologic ageing. Immunosenescence contributes to reduced efficacy to vaccination and increased susceptibility to infectious diseases in the elderly. Extensive studies of laboratory animal models of ageing or donor lymphocyte analysis have identified changes in immunity caused by the ageing process. Most of these studies have identified phenotypic and functional changes in innate and adaptive immunity. However, it is unclear which of these defects are critical for impaired immune defense against infection. This review describes the changes that occur in innate and adaptive immunity with ageing and some age-related viral diseases where defects in a key component of immunity contribute to the high mortality rate in mouse models of ageing.


From the grassroots development of creative aging research to broad base community collaborations that address the issues of today and tomorrow, this presentation will illustrate how state departments of aging and state arts agencies can combine to partnership with research universities to demonstrate the efficacy of the arts to mediate problems of loneliness, isolation and caregiver stress. This case study will show how resources can be expanded and effective practices established through community based research to find ways to build healthy and engaging communities that serve to break down the barriers of isolation and promote social networks.


It is important to predict the environment around the breathing human because inhalationof virus  is recently severe worldwide problem, and air pollutioncaused by diesel emission particle (DEP) and asbestos attract a great deal of attention.In the present study, three‐dimensional numerical simulation was carried out to predictunsteady flows around a breathing human and how suspended particulate matter  reaches the human nose in inhalation and exhalation. In the calculation, wefind out smaller breathing angle and the closer distance between the human nose andpollutant region are effective in the inhalation of SPM.


Arts programming can address chronic conditions prevalent among older adults. An overview of an implementation of the revised nationwide Opening Minds through Arts (OMA) program anchors the symposium. The paper reports an implementation by an area university and an eldercare facility to recruit and train student volunteers to collaborate with persons living with dementia, and create paintings for a public exhibition. The Arts for a Lifetime Program used bi-weekly student led programming in a long-term care community; the paper includes an overview of materials used throughout the program and reports resident preferences for materials. A report of results of an ethnographic investigation of the impact of creative aging fine arts programs on older adults adds information about how participation might influence the older person’s self-esteem or perceptions of aging. The presentation about creation of music modules investigates the potential of music therapy for the promotion of healing for older adults managing pain. The final paper describes the methodology lessons learned from ARTmail, a community engaged study of the benefits of a structured participatory arts program for older adults with memory symptoms or cognitive impairment. Presentations in this symposium inform identification and development of opportunities to create and engage in meaningful experiences with older adults.


Communication models describe the flow of signals among nodes of a network. In neural systems, communication models are increasingly applied to investigate network dynamics across the whole brain, with the ultimate aim to understand how signal flow gives rise to brain function. Communication models range from diffusion-like processes to those related to infectious disease transmission and those inspired by engineered communication systems like the internet. This Focus Feature brings together novel investigations of a diverse range of mechanisms and strategies that could shape communication in mammal whole-brain networks. How does a massive network of neurons give rise to intercommunication across the entire brain? As advances are made in understanding mammalian brain network structure . However, this does not mean that a subset of nodes cannot exert strong influence on the entire network. The Focus Feature concludes with two papers that consider the role of controllability, a notion borrowed from the study of dynamical systems in physics. Controllability in networks captures the degree to which network dynamics can be driven by a small subset of nodes.Patankar et al.  examine Finally, Srivastava et al.  provide This collection of studies broadens the range of communication models in brain networks and highlights novel structural and functional demands that are likely at play. One can expect that this work will lead to further blossoming in this area of investigation and a deeper consideration of network communication in other areas of brain science.


Background: Children and adolescents are especially vulnerable to mental, neurological and substance use disorders during various stages of their growth and development. They often require specialized personnel whose training is time consuming and costly. Consequently many children and adolescents remain untreated in developing countries. This paper describes steps Uganda is taking to develop local capacity for child and adolescent mental health services through training of multi-disciplinary teams.Methods: A 2 year training programme was introduced in accordance with the Ugandan Ministry of Health Child and Adolescent Mental Health Strategy. This had been jointly developed in 2008 by Mbarara University of Science and Technology, Makerere University, the Uganda Ministry of Health and East London Foundation NHS Trust, United Kingdom (UK). The initial funding for the programme focused on monitoring and evaluation of the training, quality of clinical practice and clinical activity data.Results: Fifty health workers have been trained and are now working at regional referral hospitals and non-governmental organizations. Monitoring and evaluation demonstrated major increases in the range of disorders and client numbers  over 6 years. There was increased confidence, knowledge and skills in assessment. Learning in a multidisciplinary environment was interesting and helpful. Assessments were more thorough and child centred and more psychological treatments were being used. Programme graduates are now contributing as trainers.Conclusion: The clinically focused multidisciplinary training has yielded rewarding outcomes across Uganda. Ongoing support and collaborative work can expand service capacity in child and adolescent mental health for Uganda and other developing countries. Children and adolescents are vulnerable to certain specific mental, neurological and substance use disorders (MNS) due to their incomplete physical, mental and social growth and development –3. The mChildhood MNS disorders have unique presentations and their treatment differs significantly from those disorders first presenting in older adolescents and adults –14. ThesIn Uganda many children suffer psychological trauma from war, abuse and bereavement but in common with other LMICs , few chiStigma is one of the challenges facing children and adolescents with mental disorders , especiaThis paper describes steps Uganda is taking to develop local capacity for child and adolescent mental health services through training of multi-disciplinary teams with the introduction of a university accredited Advanced Diploma in CAMH for public health workers and national CAMH policy guidelines. The process, achievements and results of UK project monitoring and evaluation are described with discussion of challenges faced and relevance to other LMICs.In 2008 a national strategy for child and adolescent mental health in Uganda was developed by a partnership of the Faculties of Medicine of Mbarara University of Science and Technology, Makerere University, Ugandan Ministry of Health and the Butabika East London Link . The aims of the strategy were to develop a specialist child and adolescent mental health service for Uganda by providing dedicated out-patient and in-patient care with trained specialists at regional level and developing a multi-disciplinary workforce that can train professionals in health and education at district level to recognize child mental health problems and educate the population in prevention. The core requirement of the strategy was specialist training. In order to introduce a national training programme four Ugandan professionals were trained in the UK on Commonwealth Scholarships when a draft curriculum was jointly drafted.The Butabika Link East London Link obtained funding for two projects (2012–2017) from the Health Partnership Scheme of the Department for International Development, UK government, to develop and implement a multi-disciplinary training programme in CAMH for mental health and child health professionals in Uganda. The majority of the training in the initial course was provided by UK CAMH professionals but the second project evaluated the delivery of the course by the new cohort of trained Ugandan professionals and secured university accreditation from Mbarara University of Science and Technology as the Advanced Diploma in CAMH. The initial training programme was preceded by a training the trainers course and further training of trainers took place in preparation for the Ugandan led course. Exercises, focus groups and discussion allowed for anxieties about the heterogeneous nature of the multidisciplinary participants to be considered and managed during the training programme.The Butabika Link East London Link obtained additional UK government funding for two smaller projects (2016–18) to assist the Ugandan Ministry of Health and CAMH professionals to develop, launch and implement a national CAMH Policy.The diploma is a 2 year modular programme with the six first year courses providing basic training that focus on practical skills in child and family assessments, and recognition and management of mental disorders in children and adolescents. The first year of the training serves as a foundation for the second year courses which focus on psychological therapies, clinical supervision, training, service development and research. Each module consists of 5 days of classroom teaching at the Butabika School for Psychiatric Officers followed by 5 days of clinical experience in the specialist children's ward at Butabika Hospital. The trainees are expected to focus on assessing and treating children and adolescents in their workplace between modules and to complete case studies, a logbook and a research or audit project. As well as written examinations for each course, clinical and teaching skills are examined. The programme provides training that equips trainees with the knowledge, clinical, teaching and managerial skills to provide care, develop child mental health services and to train others. The criteria for admission to the programme include commitment, professional mix and regional representation, and ability to teach others. Previous training/expertise and interest in child and adolescent mental health are key.Apart from assessment of the trainees' academic and clinical performance, M&E for the training projects consisted of evaluation of the quality of the course by trainees  together with evaluation of the impact of the training on service delivery and quality of clinical work over 6 years. Baseline activity data was collected at the four teaching hospitals at the start of the first project and as trainees joined the course from other locations an M&E coordinator collected the number of child attendances per month from a professional at each site by age group for out-patient attendances and admissions. This included a record of children seen by both CAMH and non CAMH staff. The number of dedicated clinics for children and of CAMH trained staff at each location was recorded.The quality of clinical work was assessed on an individual basis during clinical training and examined twice. A sample of the twenty most recent case notes for outpatient attendances or admissions were assessed annually at each of four main sites using a case note monitoring form. This recorded patient demographics, diagnosis, assessing professional (CAMH trained or not), indicators of quality of assessment , management and appropriate use of medication (no prescription when not indicated). For follow ups it recorded use of psychological treatments, reviews of diagnosis and management including medication side effects.The first two diploma cohorts funded by the projects completed their training in 2015 and 2017. Since then the first and second year courses have been running simultaneously allowing a new cohort to graduate each year with more efficient use of teaching resources. Fifty health workers from various medical backgrounds have been trained since 2012 and are working with children at various regional referral hospitals. These comprise two psychiatrists, one medical officer, ten psychologists, sixteen psychiatric clinical officers, twelve nurses, two occupational therapists, five social workers/counselors, one public health officer and one human resource officer . These new cohorts of trained CAMH professionals have been able to contribute to the training programme, provide peer – peer mentoring and supervision as well as providing clinical assessments and management of children with mental health and developmental disorders at their work places .Monitoring and evaluation of the training programme showed that following the training, the trainees developed increased confidence, knowledge and skills in assessment and management of mental health problems in children and adolescents and in teaching and presentation skills. All the trainees study together but different professional groups have varied levels of experience related to topics in the programme and share their knowledge and experience. The roles of specific professions are discussed in depth at the end of the programme (for example psychometric assessment for psychologists). Initially the professionals found learning in a multi-disciplinary group unfamiliar and some were uneasy about different educational levels, for example between doctors and nurses. The training groups quickly became cohesive and mutually supportive which was crucial for trainees working in isolation around the country. Individuals spontaneously commented how valuable it was to train with and learn from other professionals from social work, psychology, occupational therapy, counseling, and child health. This enriched trainees' knowledge and skills through shared experiences and they came to see the importance of developing a multidisciplinary and inter-professional environment in child mental health services.Some quotes from trainees following clinical placements includedI am building more relationship with my clients and they keep the appointments. I have noticed that the way we ask questions is indeed very important and that when you begin the interaction with your clients with a smile and have a smile during and at the end of the session it becomes more therapeutic. Please members let us try it!!!” (CAMH Trainee)“I did receive a child aged 13 yrs with history of shaking the right arm for about a month. I applied the skills that I had learnt including questioning skills, history taking, and genogram. I was amazed when the mother commented that she had never met a doctor who could ask her such questions. She was impressed and interestingly the girl left my clinical room when the shaking had stopped. The mother telephoned me yesterday thanking me and saying that the girl has been free from shaking for the last five days.” (CAMH Trainee)“I would like to thank you for all the efforts, work and time that you have dedicated to our training. Surely there is no enough thank you or reward that I can give, except results of the practice of the skills that I have learnt over this period of time. At my new workplace, all my colleagues know that I have speciality in CAMHS and have been booking patients for me which is a great start in a new place.” “The course in child and adolescent mental health provided a deserving opportunity for the first trainees in Uganda to acquire knowledge and skills in this field so as to provide a service that was previously non-existent in most hospitals in this country. The course content effectively addressed the common mental health problems in children and adolescents in our community. In future trainings more emphasis should be placed on psychotherapies, family therapy and child protection. There is however, a huge need for child and adolescent mental health service in this country and therefore the need to train more child and adolescent mental health specialists.” .“The final project was completed in 2019 and monitoring and evaluation for the projects demonstrated that, since the start of the Diploma course in 2012, the number of sites with a trained CAMH professional increased from 4 to 24 with all regions of the country represented. The number of children seen in their services increased from 2,184 to 31,034 .The development of multidisciplinary teams has so far been confined to the university hospitals while CAMH trained mental health and child health professionals provide much of the service to children in regional hospitals and health centres around the country as well as continuing to see adults. Despite there being just one or two CAMH staff at these units, most were able to set up specialist CAMH clinics by dedicating specific clinic days for children. The specialist multidisciplinary teams at the national referral hospitals in Kampala, Butabika, and Mulago, have been able to provide daily specialist CAMH outpatient services and a large children's inpatient service at Butabika, A few CAMH Diploma graduates have been employed by NGOs to work with refugee children mainly in Northern Uganda where their skills have also been utilized extensively in staff training.In addition to the substantial increase in children attending services, examination of clinical records showed more children were having thorough child centred assessments, and there were increased numbers and range of non-epilepsy diagnoses compared to baseline findings. The improved quality of assessments by CAMH trained staff compared with assessments by other mental health professionals included the recognition of co morbidity in epilepsy cases, less medication used, more appropriate medication used, increased use of psychological treatments and more revisions of diagnosis and management for cases seen by non CAMH professionals. For example, assessments now included observation of the child, child's views, their drawings, and observations of family relationships accompanied by a drawing of the family genogram. Less medication was being prescribed whereas before the training, most children with mental health problems were given psychotropic medication due to lack of adequate knowledge of psychological treatments. All pioneer graduates of the programme have been equipped with training skills through training the trainers courses and have been providing training for large numbers of health and primary care workers, teachers and community groups in their local areas.Peer support supervision has been piloted over 2 years around the country and has worked well to support CAMH workers in the regions and provide continued professional development for local health professionals. There has been great enthusiasm for continuing the 2 day events but sustaining them without funding for transport is a problem. Butabika Hospital already has a professional supervision system for PCOs working in the regional hospitals and funding has been sought from the Ministry of Health for a separate specialist supervision system for CAMH workers.In 2017 the Ministry of Health launched the Ugandan Policy for Child and Adolescent Mental Health . Other aThis training is timely, not just being academic but responding to one of Uganda's biggest public health problems. It is a speciality that needs to be recognised and embraced at all levels” .“Research interest in the subspecialty has been generated and the development and launch of CAMH policy was a great achievement...... I hope that people will come from neighbouring countries as this training programme is the first of its kind in the region” .“An independent value for money assessment of the first training project was commissioned by the Tropical Health Education Trust . It concDevelopment of the CAMH training programme in Uganda and a multidisciplinary service for most regions of Uganda has had a major impact on the numbers of specialist CAMH staff, attendances by children with mental health problems and the quality of treatment received but has not been without challenges. The extensive preparatory work, need for external funding, achievement of university accreditation and current challenges in relation to workload and sustainability are relevant to the development of specialist clinical training programmes in other LMICs , 22, 25.Following the strategic work that took place with the Ministry of Health in 2008, before the training programme could start in 2012, it was necessary to train four key staff in the UK on Commonwealth Fellowships, develop a curriculum to meet university regulations and secure funding for the first UK funded training project. The first two fully funded groups graduated in 2015 and 2017 but university accreditation for the Advanced Diploma in CAMH was not achieved until 2017.The Ministry of Health has recognized the diploma as the specialist qualification for child mental health posts in Uganda and this has been supported by the introduction of the MOH Policy for CAMH  and its Prior to the training programme very few children attended mental health services and those who did mainly suffered from epilepsy and intellectual disability. Training of local hospital and community health staff by CAMH professionals and public education through the media and community groups has resulted in increased recognition and referral of a range of mental health problems. This presented anticipated challenges , 28, witIn such overstretched services with few staff almost half of child cases were still seen by non CAMH staff although we found that younger children and new cases were more likely to be seen by CAMH staff. It has been important to prioritize new cases and young children for specialist CAMH assessment. Adult trained staff are familiar with the management of older adolescents with psychosis, affective disorders or substance misuse.Because of the large and growing child population in Uganda including many refugees with high levels of need, it is important to train more child and adolescent psychiatrists, accessible in rural areas, to support CAMH professionals working in isolation as well as pediatricians and child health workers who see many children with mental health problems. They can be recruited from both psychiatry and child health.General adult psychiatrists are eligible to undertake the training to become child and adolescent psychiatrists and we continue to lobby the MOH to support posting of medical officer special grade (psychiatry) to the regional and district hospitals. Those interested in providing CAMH services may then access the MOH scholarships for the Advanced Diploma in CAMH. Since the training programme was opened to child health professionals a medical officer and a clinical officer in child health have graduated. Pediatricians and medical officers in Uganda and sub Saharan Africa have shown interest in the training and some of these may then undertake psychiatric training in order to be eligible for consultant posts. To this end it will be important to publicize the training to attract international applicants from countries with few trained CAMH staff.In addition to trained doctors, a sustained increase in the capacity of the multidisciplinary CAMH workforce will be essential because of the growing volume of work and the unmet need for access to specialist CAMH services in all regions of Uganda. Priority for training and scholarships will need to be given to individuals from different professional backgrounds and from poorly served parts of Uganda. The provision of scholarships and the development of specialist CAMH posts will be essential for public health workers who so far have shown tremendous commitment to the specialty and have been very active in training their colleagues and community workers.The continued implementation of the national CAMH policy is crucial and, as part of this, CAMH professionals have provided training and held meetings with local directors of regional hospitals. Mental health services in the regions have many unfilled posts and the local promotion of child mental health awareness is vital to convince hospital directors of the need to appoint CAMH staff and to designate vacant posts for CAMH.Financial sustainability of the course has been a major challenge since the two UK funded training projects ended because public health workers for whom the course was designed, have low salaries and cannot afford the modest university fees, internet and travel costs. Provision of free residential accommodation at Butabika Hospital during the teaching modules has been invaluable for trainees outside Kampala. There were delays in securing scholarships for university fees through the Ministry of Health and in the transference of funds to the teaching institution affecting payment of course expenses and teaching fees. CAMH trainers experienced financial stress while balancing their teaching contribution with demanding service responsibilities. Long term reliable sponsorship for university fees is required otherwise the number of public health workers who can be trained will be limited.Like Uganda many LMICs have a young population with high percentages of children in need of specialist child and adolescent mental health services –17, 19. For LMICs planning to develop child mental health services through their own training programme we can make some recommendations drawn from our experiences over 12 years. It would be important to train a few key individuals in CAMH in advance to take both a training and strategic lead in order to develop a countrywide initiative, with support from and involvement of the ministry of health at an early stage. A teaching site ideally in proximity to a clinical training base where large numbers of children can be seen needs to be identified. Rather than a pure academic focus, the training programme needs to aim to develop a high level of clinical skills with associated knowledge and understanding for professionals working in public health services. Ideally it should be linked to a university as soon as possible as obtaining academic approval for such a specialist course was in our experience a long drawn out process. While the programme's demands meant that it could have been offered as a postgraduate master's degree, it was important to be able to recruit a multidisciplinary group including nurses from services throughout the country hence its designation as an advanced diploma. The modular design works well but thought needs to be given to the provision of accommodation and food with the possibility of scholarships to enable low paid health workers to attend. At the outset some seed funding and sponsorship would be likely to be required. We were fortunate to have UK government funding with UK volunteers to develop and evaluate the programme and associated government policy but we hope that other countries will be able to make use of our resources and experience to develop child mental health services themselves .The ongoing partnership with East London provided continued opportunities for long term volunteers from UK and other -high income countries to come to Uganda to support the CAMH programme contribute to training the trainers, deepen skills in psychological therapies and to further develop Butabika as a centre for clinical training. They have benefited from the opportunity to develop new skills in cross cultural working and project management and also to conduct research programmes. The relationships established have proved mutually beneficial with continued electronic and telephone communication to support the training programme.Initial steps to train a cohort of CAMH professionals in Uganda have yielded rewarding outcomes. With collaborative effort over time, it proved possible to develop multidisciplinary teams for both urban centres and rural areas through the national and regional referral hospital system. These multi-disciplinary professionals have been able to improve both access to and the quality of mental health services for children and to train others in their local hospital and community services even when working in isolation. The multidisciplinary nature of the programme implies that different categories of staff can be trained; and recently this has included some professionals providing general health care in rural health centres where they can easily be accessed by the rural communities. This means that communities can be trained to identify children with mental health problems as early as possible and refer to appropriate services within their communities or regional centres.grukundo@must.ac.ug.The data analyzed in this study is subject to the following licenses/restrictions: The raw data from which the article has been written will be available on request to the authors. Requests to access these datasets should be directed to Godfrey Zari Rukundo, Ethical review and approval was not required for the study on human participants in accordance with the local legislation and institutional requirements. Written informed consent from the participants' legal guardian/next of kin was not required to participate in this study in accordance with the national legislation and the institutional requirements.GR wrote the first draft of the article. The rest of the authors JN, PO, and AH contributed significantly to the writing of the final paper, improving on the draft. All authors contributed to the article and approved the submitted version.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.


Following publication of the original article , the autThis has since been corrected in the published article and the corrected names may be found in this correction.The publisher apologizes for any inconvenience caused.


Ongoing innovative preclinical research and development provide a rationale for studying new diagnostic and treatment approaches in inflammatory and autoimmune diseases, diabetes, paralysis and other disorders. Bioelectronic Medicine, on the Springer/Nature BMC platform reflects the commitment to a necessary forum for publishing cutting edge primary research, timely reviews and other relevant publications. Here we comment on the recent content of Bioelectronic Medicine (published in 2018) that captured many important aspects of the current state of the field. Our aims are to trigger multidisciplinary discussions and to inspire future research efforts that will contribute to advancing the field.It is an exciting time for the expanding field of Bioelectronic MedicineBioelectronic Medicine by Giagka and Serdijn  Zhang et al. provided insight into the utility of wavelet decomposition as a method to extract neural features obtained from a microelectrode array implanted in the motor cortex of a human with tetraplegia (Zhang et al., Studies providing mechanistic insight into the CNS in health and disease are extremely important for Bioelectronic Medicine (Pavlov et al., Obesity and diabetes are pandemic and present significant challenges to modern society (Mokdad et al., Visual prostheses are medical devices designed to provide some degree of vision to individuals with blindness as a result of severe degeneration or damage to the retina, the optic nerve, or brain damage (Fernandez, It was estimated that in 2015, 36 million people were blind, and 217 million had moderate or severe vision impairment (Bourne et al., Bioelectronic Medicine will be the platform for innovative research and conceptual developments reflecting the progress in the field.A growing knowledge of mechanisms of neural regulation in disease pathogenesis will be instrumental for developing new bioelectronic technologies.


In response to the protracted Ebola virus outbreak in the Democratic Republic of Congo, the international public health community called for increased attention, coordination, and resources to support the response. The use of real-time modeling and analytics to support public health decision-making  has been an important capability that has grown during previous outbreaks –3. DespiTo improve communication and create awareness of the efforts of modeling groups already studying the DRC Ebola outbreak, we—an existing outbreak science working group—convened an informal modeling research coordination group to align efforts around infectious disease modeling of the outbreak . Each moThe presentations throughout the seven months of this modeling coordination group meetings highlighted some of the ways this DRC outbreak differed to the prior 2014 West African outbreak. The impact of violence itself on epidemic growth and effective response was also a major focus of modeling efforts . Shifts This working group was not formally endorsed by any agency or formally tasked with supporting any specific public health activity in the DRC. It was not intended to replace formal modeling groups who had already been tasked to support the Ebola response and is distinctly different from epidemic surveillance sharing platforms such as the Global Public Health Intelligence Network or the Epidemic Intelligence Information System ,14. HoweThe Ebola modeling coordination group also highlighted the pervasive complexities of conducting research during epidemics. For example, there is a need to balance broad participation of scientists to study and help resolve the crisis while also deferring to the more urgent priorities of health authorities who are engaged in the critical public health response as well as respecting existing local and international research efforts already formally tasked with supporting the outbreak. It is also a priority to conduct equitable research by collaborating with locally-based scientists so that they are properly involved in and credited with the international scientific response, including data collection efforts. We propose that coordination groups, like the one described here, could help with that. Moreover, we have demonstrated how this model coordination framework could readily be adopted by other groups for future epidemics and indeed has been so in the current COVID-19 outbreak .


Physical conditions of living environments can impact risk of falls, however, prior work has focused typically on one domain at a time—either neighborhood or home, capturing limited environmental boundaries of older adults. We extend prior work by considering both neighborhood and home as important residential contexts and examine their impact on the onset of falls over time. Data are drawn from two waves of the Health and Retirement Study . We used interviewers’ report on outdoor and indoor dwelling conditions to assess environmental risk factors. One-third of respondents reported at least one fall years later. The presence of green space such as a park near the housing unit and clutter in the home appears to increase the risk of falls over a four-year period. This finding suggests that falls in old age may be determined by a combination of outdoor and indoor risk factors.


HIV/AIDS is an infectious disease that has claimed the lives of millions of people worldwide. Currently, there is no vaccine that has been developed in a bid to fight this deadly infection, however, antiretrovirals (ARVs), which are drugs used in the treatment of HIV infection are routinely prescribed to infected persons. They act via several mechanisms of action to reduce the severity of infection and rate of infectivity of the virus by decreasing the viral load while increasing CD4 counts. COVID-19 pandemic has resulted in unprecedented events affecting almost all areas of humans' life including availability of medicines and other consumables. This paper analyses the availability of ARVs during COVID-19 era and offered recommendations to be adopted in order to prevent shortages. It was discovered in 2019 and has since become a global health crisis and was declared a pandemic on 11on (WHO) . Antireton (WHO) . Analysion (WHO) . The ripFactors responsible for the low availability of ARV medicines across borders include: inadequate human resources in manufacturing facilities due to physical distancing and lockdown; curtailing of sea and air transport dents the manufacture and distribution of raw materials and other products such as packaging materials pharmaceutical companies needs to in order to manufacture these medicines. Other factors include: increased overhead and transport costs, the need for an alternative source of key starting materials and active pharmaceutical ingredients coupled with fluctuation and weakened national currency caused by envisaged economic shock apparently pushed up the cost of some antiretroviral regimens . AdditioFirstly, HIV therapy should be promptly integrated into social health insurance scheme if not in totality at least to a greater percentage at all tiers of government such that a pool of funds is created thus, enhancing domestic resource mobilization without further pushing people into poverty. A coordinated action by government and private organizations is necessary for even distribution of ARVs to persons who need HIV treatment . Secondlit is vital that countries urgently make plans now to mitigate the possibility and impact of higher cost and reduced availability of antiretroviral medicines'. It is a call for global action by both suppliers and buyers to ensure smooth delivery and accessibility of ARV medicine for continue treatment by person living with HIV. Government should also pull concerted efforts and create policies that will enable this set of people gain uninterrupted access to antiretroviral in the midst of the current pandemic and beyond this global health crisis.The economic impact of COVID-19 pandemic indicates a possible shortfall in the availability and a rise in the cost of ARVs. We cannot let the COVID-19 pandemic undo the hard-won gain in the global response to this disease. In different occasion the executive director UNAIDS Winnie Byanyama said: '


In order to address the geropsychology workforce shortage, educators are trying to better understand the attitudes, interests, and needs of prospective students as well as expand educational opportunities and specialty competence. This symposium reports on several recent and ongoing research projects and educational initiatives which can together inform future efforts to recruit students into the field. King et al. discuss how concerns about adultist oppression might keep young adults from entering the field. This study describes a new adultism measure which positively correlates with ageism and negatively correlates with both experience and interest in working with older adults. Together with Strong and Graham’s study looking at ageism among North American and non-North American students, these studies remind us of the continued effort needed to better understand and combat age-related oppression of individuals at both ends of the lifespan. Two studies share specific educational initiatives addressing areas of essential but undervalues areas of training for geropsychologists. O’Malley and Graham report on the integration of health policy training into undergraduate education, while Jacobs et al. describing a new performance-based evaluation tool for training in the assessment of decision-making capacity. Postgraduate specialization continues to be crucial in establishing and growing the discipline of geropsychology. Mlinac and Smith report on the development of a mentorship program for professionals on the path to board certification.


There are 5.8 million Americans living with Alzheimer’s disease and more than 16 million Americans providing unpaid care for people with AD and related dementias. Since a treatment that can slow or stop progression of this disease has yet to be discovered, novel interventions are sorely needed to maintain cognitive function and quality of life among individuals with dementia, improve the health and well-being of caregivers, and provide assistance in caregiving duties. This symposium addresses novel interventions in the dementia care continuum ranging from social and leisure activities for improving cognition to incorporation of emerging technologies to assist with caregiving and provides recommendations and priorities for future studies. The first presentation introduces evidence that participation in an intergenerational choir can improve cognition, social connectedness, and quality of life among people with dementia and their caregivers. The second presentation systematically assesses recent randomized controlled trials of computerized cognitive training  aimed at improving cognitive function among individuals with cognitive impairment or dementia. The third presentation examines the evidence that interventions employing artificial intelligence such as robots may improve care for persons with Alzheimer’s disease and caregivers’ quality of life and provides suggestions for future studies to better assess the efficacy of these interventions. The session concludes with a presentation on a survey method used to build consensus among a panel of experts across academia and industry which identified the emerging technologies that are expected to become the most prevalent in dementia care and provides recommendations for limiting associated risks.


Beckett et al  performeHowever, we are concerned that the authors excluded all scientific articles regarding the outcomes of human trials using the proposed dietary strategies due to fees for obtaining these articles and the assumed lack of ability of people with MS to interpret these types of articles. In our experience, people with MS who desire to incorporate diet into their personal treatment plans are often highly informed of the scientific literature regarding dietary strategies for MS. In addition, scientific journals often are open access and/or provide lay language summaries of the article; for these reasons, we disagree with the authors' justification for excluding these articles. Furthermore, the authors conclude that online dietary advice is often the result of an individual’s experiences and has not been scientifically evaluated. However, at the time of the internet search November 2016) performed by Beckett et al 016 perfo and assoWe agree with Beckett et al  that theWe would like to thank the journal editors for allowing us to reply to Beckett et al , who con


The wide range of services needed to support a safe and quality life among people living with dementia at home is growing and extends beyond the bounds of traditional reimbursement models. Within the context of a health care system that is not designed to reimburse for these types of services, federal grants from the Alzheimer’s Disease Programs Initiative (ADPI) funded by the Administration for Community Living (ACL) have supported the delivery of home- and community-based services (HCBS) for people with dementia and their care partners with a pragmatic emphasis on sustainability, such as establishing successful reimbursement pathways. Drawing lessons from ACL’s ADPI program and from the Health Resources & Services Administration Geriatric Workforce Enhancement Program and Geriatrics Academic Career Award program, this symposium examines opportunities and strategies for providing services to people living with dementia in the community and highlights occupational therapy as a valuable dementia care service that has potential for sustainable delivery and opportunities for professional expansion. Papers address needed workforce development for delivering HCBS to diverse populations living with dementia and examine occupational therapy roles in delivering HCBS to persons with dementia and their care partners. Additionally, papers examine the implementation and outcomes of evidence-based occupational therapy and interprofessional interventions for persons living with dementia in the community. Reimbursement mechanisms for occupational therapy services delivered to people with dementia in the community are described. Discussion addresses how these innovative interventions and reimbursement mechanisms align with the recent surge of National Institute on Aging funding for pragmatic trials.


The COVID-19 pandemic has in a matter of weeks fundamentally crippled health systems in many countries and is now threatening to cause a global economic depression [We wish to highlight two key natural experiments that it is important to focus attention on. The first is countries’ responses to dealing with and mitigating the effects of the pandemic. There is considerable global variation in national responses ranging from immediate attempts to suppress the outbreak  to containment approaches aiming to promote the development of herd immunity  . These aA second major net of natural experiments that need to be undertaken is to establish on a global scale the impact of improvements in air quality on human and planetary health. The pandemic has resulted in the greatest restrictions in travel in human history, which have already led to very substantial reductions in ambient air nitrogen dioxide and particulate matter levels . Given tWhile still in the midst of the global turbulence caused by COVID-19, it is difficult to see any silver lining. We do however need to make the most of this adversity. We argue that mounting major international natural experiments to understand optimal approaches to national pandemic responses, and the effects of air quality improvements on human health represent very major opportunities to advance population health. Since such evaluations typically make use of routinely collected health care data -6, theseWe must collectively seize these opportunities to help achieve a lasting benefit of the global tragedy now unfolding.


Refactoring is often needed to ensure that software systems meet their performance requirements in deployments with different operational profiles, or when these operational profiles are not fully known or change over time. This is a complex activity in which software engineers have to choose from numerous combinations of refactoring actions. Our paper introduces a novel approach that uses performance antipatterns and stochastic modelling to support this activity. The new approach computes the performance antipatterns present across the operational profile space of a software system under development, enabling engineers to identify operational profiles likely to be problematic for the analysed design, and supporting the selection of refactoring actions when performance requirements are violated for an operational profile region of interest. We demonstrate the application of our approach for a software system comprising a combination of internal  components and external third-party services.


Humans combine incoming sensory and past information to deal with ambiguous and uncertain information  that uncertainty from the encoded stimulus is stored in short-term memory and (2) that knowledge about different statistical environmental regularities might affect how the brain integrate past information with current decisions. While the first should inform the development of models of short-term memory storage, specially those concerning short-term synaptic plasticity, a candidate mechanism to explain serial dependence (Barbosa et al., For downstream areas to have access to previous trial probability distribution of stimulus values, the brain must keep it in short-term memory. van Bergen and Jehee's  results If serial dependence relied only on averaging of previous and current information, one would expect response biases to increase as the difference between consecutive stimuli increase. However, as first shown by Fischer and Whitney , van BerInteresting predictions for future investigations of serial dependence can be generated by assuming that participants have at least an approximate knowledge of the natural temporal dynamics of the environment. For example, by having participants learn a new internal model of stimuli sequence (Chalk et al., Evidence that the brain uses past information and weight current and previous information based on uncertainty has been out there for a while. van Bergen and Jehee's  work proThe author confirms being the sole contributor of this work and has approved it for publication.The author declares that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.


As the caregiver ratio declines, technology will play an increasingly important role in supporting formal and informal caregivers. This presentation will report on the particular effects that frontier technologies may have on various tasks associated with caregiving, including assisting with basic Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs). The expert panel predicted that different technologies and new products will have varied effects on caregiving tasks, and that some tasks may be more impacted than others. Some of the key opportunities and barriers to integrating technologies into various tasks of caregiving will be discussed.


Careful fidelity monitoring is critical to implementing evidence-based interventions in dementia care settings to ensure that the intervention is delivered consistently and as intended. Most approaches to fidelity monitoring rely on human coding of content that has been covered during a session or of stylistic aspects of the intervention, including rapport, empathy, enthusiasm and are unrealistic to implement on a large scale in real world settings. Technological advances in automatic speech recognition and language and speech processing offers potential solutions to overcome these barriers. We compare three commercial automatic speech recognition tools on spoken content drawn from dementia care interactions to determine the accuracy of recognition and the guarantees for privacy offered by each provider. Data were obtained from recorded sessions of the Dementia Behavior Study intervention trial (NCT01892579). We find that despite their impressive performance in general applications, automatic speech recognition systems work less well for older adults and people of color. We outline a plan for automating fidelity in interaction style and content which would be integrated in an online program for training dementia care providers.


Older adults are often relying on a family member or other informal caregiver (friend or other) to jointly navigate the health care system and cope with the ramifications of serious illness; thus, the patient-caregiver dyad becomes the unit of care. The caregiving role becomes crucial in cases where patients are facing a condition that limits their cognitive and functional abilities and caregivers are called to act as proxy decision makers for significant treatment and symptom management decisions. Caregivers often report that they feel isolated and overwhelmed, and in some cases experience significant barriers in communicating with health care providers. It is important that clinicians communicate in a way that acknowledges and addresses caregivers’ preferences, needs and perspectives. Caregiver centered communication can facilitate a more effective adaptation throughout the illness course with better adherence to recommended treatment plans and greater satisfaction with care for both patients and families, as well as a more comprehensive response to their psychosocial needs. While health care organizations often aim to increase caregiver engagement and involvement in care processes, there is a lack of tools or strategies not only to more actively engage caregivers but also to assess how ongoing approaches perform in terms of facilitating meaningful and inclusive communication. This symposium will review existing tools and a new instrument to measure caregiver centered communication, challenges and opportunities in measuring the quality of communication with caregivers and highlight empirical data of communication quality in various health care settings including home care and hospice.


L-arginine by means of nitric oxide synthase enzymes. Recently, a novel pathway for the reduction of dietary inorganic nitrate to nitrite by the bacteria in the oral cavity and subsequently to vasodilatory nitric oxide within the body has been uncovered. Dietary nitrate is abundant in green leafy vegetables, including beetroot and spinach, and reduction of exogenous nitrate to nitrite by oral bacteria can increase nitric oxide in the vasculature, lessening hypertension. Supplements rich in nitrate may be an attractive choice for treatment due to fewer side effects than drugs that are currently used to treat hypertensive pregnancy disorders. Additionally, manipulation of the composition of the oral microbiota using pro- and prebiotics in tandem with additional dietary interventions to promote cardiovascular health during gestation may offer a safe and effective means of treating hypertensive pregnancy disorders including gestational hypertension and pre-eclampsia. The use of dietary inorganic nitrate as a supplement during pregnancy requires further exploration and large scale studies before it may be considered as part of a treatment regime. The aim of this article is to review the current evidence that oral microbiota plays a role in hypertensive pregnancies and whether it could be manipulated to improve patient outcomes.Chronic hypertension during gestation is associated with an increased risk of adverse pregnancy outcomes including pre-eclampsia, fetal growth restriction and preterm birth. Research into new chemotherapeutic regimes for the treatment of hypertension in pregnancy is limited due to concerns about fetal toxicity and teratogenicity, and new therapeutic avenues are being sought in alternative physiological pathways. Historically, generation of the vasodilator nitric oxide was believed to be solely from  Hypertension is a modern medical crisis in all nations across the globe due to its correlation with a poor, high calorie diet and minimal exercise, all of which are risk factors for cardiovascular disease and death  is crucial in maintaining vascular homeostasis within the host  is a vital signaling molecule in the cardiovascular system and has been implicated in numerous vascular processes including vasodilation and tissue protection .in vivo both in animal models  per oral administration; a high pharmacological dose] led to methemoglobinemia in a pregnant rat model  toward higher relative abundances of Neisseria and Veillonella following nitrate supplementation (Koopman et al., Research interest in the oral microbiota and its relationship with BP responses has become more prominent within the last few years (Bryan et al., Given the positive effects of nitrate supplementation in non-pregnant populations, and our preliminary findings in pregnant women, it remains possible that dietary interventions targeting the nitrate-nitrite-NO pathway could be used in future to improve outcomes in HPDs. Investigating whether differences in the oral microbiome are associated with HPDs, and determining the efficacy of BP responses to dietary nitrate supplementation amongst different groups of pregnant women, is the focus of our current studies. Future trials should explore and evaluate whether nitrate supplementation and/or probiotic supplementation can improve pregnancy outcomes in hypertensive pregnant women. Research should also be expanded to other maternal microbiotas which are known to be dramatically altered during gestation, such as the gut (Koren et al., All authors contributed to the writing of the manuscript and approved the final submitted version.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.


In the past decade, remote home monitoring has emerged to monitor surgical patients in the vulnerable period after hospital discharge.In this observational feasibility study,The results of this study provide a valuable contribution to the discussion on the feasibility of monitoring systems for older and vulnerable populations. Future home monitoring systems should measure a various range of parameters, yet remain usable and acceptable for older and vulnerable patients. This is necessary to ensure high compliance and completion rates of the population with the perceived greatest benefit of monitoring. Finally, the integration of monitoring systems into existing health care systems should be well explored to secure feasibility for health care professionals.


With this notice, Frontiers states its awareness of concerns regarding the validity of the participant data in this study. An investigation is currently being conducted by Kashan University of Medical Sciences research ethics committee. This expression of concern has been posted while Frontiers awaits the outcome of that investigation and will then be updated accordingly.


Oxford Medical Case Reports will contribute to increasing the available knowledge base through the submission of papers by medical staff in humanitarian settings sharing their experiences and challenges with the provision care for people living with complex medical conditions in similar resource-limited settings.As discussed by our colleague Wind , in a prNone declared.


Following publication of the original article , the autResults for matched tests performed by BioFire and qPCR or rapid test and qPCR.The publisher apologizes for any inconvenience.The original article has been corrected.


Cellular processes often decline with age and cells lose their ability to function optimally, which may lead to organ-specific dysfunction and the development of systemic age-related diseases. The cellular hallmarks of aging are associated with clinical signs and symptoms and can be termed Age Associated Cellular Decline. An expert consensus study group was convened to provide an initial framework for the development of a tool for adults over 50 years old, which identifies self-reported symptoms and observable signs likely to be early and/or surrogate markers of age associated cellular decline. A total of 16 potential early signs and symptoms of age associated cellular decline were identified and need to be validated in further research.


The goal of ending preventable maternal and newborn mortality is achievable. Many maternal and newborn deaths can be averted through family planning services, and the timely provision of high quality care throughout pregnancy, childbirth, and the postnatal period. Yet, progress in increasing universal access to these life-saving interventions has been uneven and slower than we hoped. There are still approximately 2.5 million newborn deaths and 300 000 maternal deaths per year, most occurring in countries with the highest resource constraints and weakest health care infrastructures ,2.The positive news is that these stark numbers have not gone unnoticed, and great strides have been made in identifying essential packages of care for saving the lives of mothers and their newborn babies. Global consensus has also been reached on a core set of indicators for assessing progress in scaling-up these essential packages. Targets for reducing maternal and newborn mortality are in the Sustainable Development Goal (SDG) Framework, and many of these core indicators are embedded within other global accountability frameworks such as the Global Strategy for Women’s, Children’s and Adolescents’ Health (2016-2030), Countdown to 2030, Every Newborn Action Plan, and Ending Preventable Maternal Mortality.But, why does it matter if maternal and newborn health related indicators feature prominently in global accountability frameworks? The simple answer is the maxim we know so well: What gets measured gets done. And this translates into all of us doing our part to make it possible for every woman to have a healthy pregnancy and positive birth outcome for herself and her newborn baby.The inclusion of maternal and newborn health indicators in global accountability frameworks has spurred a surge of data collection efforts in recent years – new questions and modules have been added, for example, to large-scale population-based surveys such as the UNICEF supported Multiple Indicator Cluster Surveys (MICS) and the USAID supported Demographic and Health Surveys (DHS), and to health facility assessments such as MEASURE’s Service Provision Assessment, and WHO’s Service Availability and Readiness Assessment. There are also ongoing efforts to provide guidance to countries, through a set of modules (DHIS2 modules) produced under the umbrella of the Health Data Collaborative, on a standard set of indicators to collect through their routine health information systems.All these data collection efforts have greatly increased the availability of data on essential maternal and newborn health interventions. The aim of this supplement is to take stock of where we are now: Are these efforts enough to meet global and national monitoring needs for maternal and newborn health? What else needs to be done to improve the measurement of maternal and newborn health indicators so that we all can be held to account for achieving the ambitious SDG targets? This supplement is organized into three sections. The first provides an overview of the data landscape for essential maternal and newborn health interventions. The second section includes papers that focus on the policy and programmatic implications of accurately measuring and regularly monitoring key maternal and newborn health indicators. These studies demonstrate what can be learned from analyses of available data about progress in individual and in groups of countries. They highlight where improvements are being made, where more work is needed, and context specific opportunities for increasing both the supply of and demand for essential maternal and newborn care. The set of papers in the third section highlights methodological work completed or under way on improving the measurement of maternal and newborn interventions and how this work helps address existing data gaps.Several actionable messages emerge from the collection. These include a recommendation to increase data collection approaches that capture information about effective coverage and the quality of care. The study by Carvajal-Aguire et al., for example, revealed large data gaps in 20 countries in sub-Saharan Africa on the content of health services provided . One sucAlthough the escalation in data availability on maternal and newborn health interventions is a laudable achievement, studies in this collection show that further work is needed on harmonizing data collection efforts to improve comparability across them. The study by Amouzou et al., for example, found that the MICS and DHS use different questions and methodologies for capturing information on postnatal care which reduces comparability across the two survey programs and the ability to develop time trends . Other aThis supplement is timely given the ambitious global development agenda and the growing awareness of maternal and newborn survival as essential to its achievement. It shows the power of data to: 1) inform us about how well we are doing in improving coverage of essential maternal and newborn interventions within and across countries, and 2) why investments in the measurement agenda are critical for increasing our ability to know what we need to know about the success of policies and programs in saving maternal and newborn lives.


Growing evidence indicates that residential contexts are implicated in the health and well-being of older adults. Operationalization of these contexts varies and includes psychosocial, physical and socioeconomic neighborhoods, and more proximal contexts . We aim to bring together a diverse set of papers focused on the living environment to understand how contextual factors are associated with individual outcomes. Muñoz and colleagues applied a lifespan perspective by evaluating associations between current and childhood neighborhood perceptions on cognitive health. Their results indicated that the association between perceived neighborhoods and cognition in adulthood was moderated by childhood neighborhoods. García and Ailshire contextualized the types of neighborhoods in which older Latinos live and how these influenced diabetes risk. They identified neighborhood clusters characterized by racial/ethnic and socioeconomic compositions and found that predominantly Latino neighborhoods with low SES were more likely to have diabetes compared to other neighborhood clusters. This symposium will also focus on the more proximal environment. Lee and Ailshire examined the neighborhood and home environment and found that the home’s proximity to green space and level of clutter within the home was associated with increased fall risks in older adults. Fingerman and colleagues coded older adults’ living spaces and found that personality type was associated with room conditions. Altogether, the presentations highlight the relevance of context measured across multiple levels of analyses and dimensions of well-being outcomes in aging individuals. Dr. Markus Schafer will provide a discussion of these findings and address the challenges and opportunities for future research.


Surface modified bioactive virus-mimicking organic nanovesicles represent themselves as complex biomimetic structures that have abilities to dissect the functions of individual entities in a complex biochemical system. The customized surface of nanovesicles from (glyco)dendrimersomes has structural modifications that contribute to manifest the SARS-CoV-2 and host pathogenic molecular interactions that help the virus to evade the human immune system. Nanovesicles also have a potential role in dynamic biomedical applications such as designing galectin targeting drugs, evaluation of antibodies to design antiviral therapeutics or vaccines and targeted delivery of drugs.in vitro, biocompatibility and customized design that provides a better understanding of a particular function with safe handling. Designing spike-like oligomannoses of SARS-CoV-2 on the surface of (glyco)dendrimersomes play a significant role to translate host-pathogenic molecular mechanisms dendrimersomes with glycans and glycoproteins (oligomannoses) found on the surface of viruses including SARS-CoV-2 and other living cells or bacterial pathogens provide an opportunity to understand molecular interaction patterns between host and pathogen. This customized system helps to better understand the effects of one single molecular function at a time rather than to attain a synergistic response which becomes difficult to explain  receptor on the surface of the host cells and mediates entry inside cells dendrimersomes that have customized sequence of sugars or proteins and allow scientists to understand how host and pathogens interact? and How intercellular signaling changes during the process of disease? dendrimersomes also have abilities to act as an epitope of an antigen and to be recognized by the antibodies secreted by immune cells to generate an immune response and neutralize the future pathogenic attacks. These (glyco)dendrimersomes also act as a functional platform to screen antibodies to design and select vaccines. Empty lumen or pocket of the (glyco)dendrimersomes provide an advantage to use them as a carrier of antiviral therapeutics that can target specific virus particles because of their surface modifications and release drugs upon exposure to a particular physicochemical stimulus such as ultra-violet light. Surface targeting and controlled release of drugs have advantages to better manage patients' health and have profound treatment success rates dendrimersomes as nearly safe against human umbilical vein endothelial cells (HUVEC) and they were observed viable upon exposure to nanovesicles that require further toxicological investigations to use them as drug carriers dendrimersomes provide a multi-dynamic platform to understand host-pathogen interactions that help SARS-CoV-2 to evade the human immune system. Nanovesicles have the potential to be used as a vaccine having customized oligomannoses as terminal groups on their surface that represent the blueprints of spike S proteins. The empty lumen of organic supramolecular vesicles has abilities to carriage antiviral drugs or therapeutics to their targeted sites or pathogens and release drugs in response to a particular stimulus.BJ designed the study and wrote the manuscript.The author declares that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.


Pediatric Reports was launched in 2009 and it has been published over the past eleven years by PAGEPress Publications [ications . ProfessPediatric Reports from PAGEPress and perpetuate the legacy of this journal, and ensure that we serve well the pediatrician community. Pediatric Reports complements very well the MDPI portfolio of medical journals [Children [International Journal of Neonatal Screening [We are delighted to take over the publication of journals , especiaChildren  and the creening .MDPI will publish the fourth quarterly issue of 2020 and will thereafter publish four quarterly issues as of 2021. Pediatric Reports [Enjoy publishing your work in  Reports !