The COVID‐19 pandemic has exposed fragilities and reinforced the resiliency of different elements of our manufacturing and processing systems. Food processing, in particular meat packing, currently a very labor‐intensive operation, experienced significant disruption and the car industry implemented shutdowns which will ripple through supply chains in the coming months. It became clear that packaging supply chains are bottlenecks as producers tried to divert food stuffs from restaurants to consumer stores, and shifts in demand for paper products caused persistent consumer outages. The basic chemicals and fuels industry did not see significant disruption, but wild price fluctuations did occur as reduced demands and an unfortunately timed production increase caused available storage capacity to be strained. Recycling industries saw, and will continue to experience, both ends of the disruption as their consuming industries reduced demand and their providers stockpiled material or diverted it to trash. The beverage industry has significant inventory in public venues that has expired. Boutique level hand sanitizer production has resulted as these beverage production systems have been reconfigured and the rules surrounding the grade of alcohol relaxed.1 and we would like to encourage you to consider other ways in which our manufacturing systems will change in response to the pandemic. However, much as there is a need to address the short‐term disruptions caused by a pandemic, and to understand how research can respond to create advanced manufacturing and processing systems with flexibility and resilience in the future, we also need to continue to push forward with efforts that provide new foundations for those features and we have curated articles that we hope fulfill that goal.We are sure there are many of you who have worked long hours to innovate your manufacturing and processing systems to cope with the challenges of COVID‐19 and we would welcome articles and commentaries on how advanced manufacturing can play a role in our collective response. In this issue of JAMP we share a commentary on the rapid manufacturing of vaccines as our contribution to understanding how our community might respond to COVID‐19,2 and Process intensification remains a key approach to advanced manufacturing enabling more nimble and responsive systems. This issue provides two examples tackling a variety of processes: the epoxidation of vegetable oils and the manufacturing of butyl acrylate. show that by using a mesoscale oscillating baffled reactor the process can be converted from a batch operation to a continuous one and in the process they estimate that the new reactor is approximately 144 times smaller than the batch reactor operating at the same production rate.Rahim et al.3 show have combined this technology with membrane pervaporation creating a Simulated Moving Bed Membrane Reactor which reduces the number of operation sections for the manufacturing of butyl acrylate while reducing the eluent consumption and improving the productivity. A complete analysis of all process metrics is given in this paper.The Simulated Moving Bed Reactor (SMBR) technology has been an example for process intensification for a couple of decades. Constantino et al.4 have discusses the importance of protecting data as critical intellectual capital and how many in the AI vendor community do not understand the value of data to the process industry. The commentary offers insight on the need for chemical engineers and data scientists to work closely together to solve technical and operational problems that require analysis of data that is broader than process data and where fundamental models break down. This commentary takes on additional importance for resiliency in light of the social and economic impact of COVID‐19.The use of Artificial Intelligence (AI) in the chemical process industry is being used in new ways that are challenging the way this industry should consider the adoption and deployment of Industry 4.0 that has become ubiquitous in other business sectors. Colegrove5 disc


Iran has witnessed one the fastest decline in the road traffic mortality in past decade. Despite this great achievement, the number of death toll has increased in past two years although in a small manner. The global situation is similarly alarming and recent figures show an increase in the number of fatalities and injuries despite the proclaimed goals for decade of action by the united nation. The current situation does not mean that there were negligence but it indicates more importantly the urgent need to combine the current engineering approach to more humanistic approach to this modern world preventable disaster. Risk perception insufficiency has been found to be a major driver of fatal events especially in younger victims. Although law enforcement and environmental support could initiate the change in behavior but there is need for a humanistic approach for persistent change in behavior.Humanistic Approach, Traffic Accidents


The steady rise of antimicrobial resistance is one challenge where the current research and development system does not provide the needed solutions. Two new World Health Organization (WHO) reports show that too few new antibacterial treatments are in development and that more interventions are needed.Clostridioides difficile. The 10 biological treatments in clinical development target Staphylococcus aureus (six treatments), Pseudomonas aeruginosa (two treatments) and Clostridioides difficile (two treatments).The 2019 WHO clinical antibacterial pipeline analysis describes all antibiotics and biological treatments that are currently in development against the WHO priority pathogens list.WHO also assessed the novelty of the antibacterials using four criteria: absence of known cross resistance, new class, new target and new mode of action as defined by the WHO expert group. Only six of the agents that target the WHO priority pathogens fulfil at least one of the four criteria.New derivatives of the same class can be superior than the first in class treatment by having a better safety profile, better efficacy or activity against resistant bacteria. However, resistance is likely to develop quicker against derivatives of the same class that share the same mode of action and target. Clinicians are reluctant to switch to new, more expensive treatments that are based on non-inferiority trials that only show that the new treatments are not worse than the standard of care. This reluctance and the conservative approach required towards using new antibiotics under stewardship programmes is translating into serious economic challenges. The recent bankruptcy of some of the small antibiotic research and development companies and the fact that most major pharmaceutical companies have left the antibiotic research and development space illustrates these economic difficulties.,How to tackle the lack of private investment in the research and development of new antibacterial treatments has been discussed in the G7, G20 and other international fora.Mycobacterium tuberculosis and Clostridioides difficile.WHO’s first report and publicly accessible database on the preclinical antibacterial pipeline published in January 2020 captures 252 antibacterial agents being developed by 145 individual institutions against the WHO priority pathogens, More public investment is needed to ensure a viable economic environment for antibacterial treatments that are innovative and add significant clinical value. Major pharmaceutical companies also have to make a more sustainable financial contribution. Antibiotic developers together with regulatory agencies must find ways to better demonstrate the clinical advantages of new antibiotics over standard of care through clinical data. Maintaining the antibiotic research and development crisis high on the international political agenda is essential to push for further reforms and to ensure that bacterial infections do not become another field of neglected diseases.In line with WHO’s mandate to promote and conduct research in the field of health,


Medical innovation awards stand out as an important means to focus public attention on what matters in medical advancement. Traditional awards typically focus on celebrating medical innovators with either a track record of proven successes in new treatments or promising basic science breakthroughs still years away from reaching patients. Perhaps one of the greatest challenges for medical innovation that is not sufficiently addressed by these traditional awards is celebrating translational research efforts on the cusp of major advancements where medical innovators are demonstrating success in bringing emerging transformative medical innovations to patients. As a part of its award process, the Sanford Lorraine Cross Award has developed a unique method to fill this gap in the landscape of medical innovation awards for ongoing translational research efforts by identifying promising medical innovations within a narrow spectrum of the research pipeline on the verge of having transformative impact for patients in the near term. The Sanford Lorraine Cross Award addresses the challenges of identifying emerging transformative medical innovations making their way through development by deploying a rigorous, analytically-based “early signals analysis” to identify emerging transformative medical innovations in its selection process independent of the medical innovators who are succeeding in bringing them forward. It also stands apart from traditional medical innovation awards in focusing on identifying award candidates that have significant roles in bringing the emerging transformative medical innovation across the finish line to patients, and their efforts in overcoming challenges, forging collaborations, and ensuring a successful outcome. The data-driven award selection process used for the Lorraine Cross award ultimately inverts the standard medical award selection paradigm – truly innovative areas of discovery and breakthrough science are identified independently of candidates and used to then focus candidate selection on the areas with the most promising transformative potential for patients. This article sets out the details of how the Sanford Award makes use of leading tools and methods in identifying transformative innovations currently in translational research to provide another important focus of what matters in medical innovation.The Sanford Lorraine Cross Award identifies the most successful application of translational research that ultimately expedited the development of a treatment or cure of a disease. Medical research awards garner significant attention and prestige in recognizing research excellence and contributions to making a difference in advancing medical innovation. For instance, the NIH Almanac touts that “The National Institutes of Health (NIH) has a long, rich tradition of support for award-winning, cutting-edge research. Many of the world’s most distinguished investigators have been honored with medicine’s top prizes, including the Nobel Prize and awards from the Albert and Mary Lasker Foundation – ‘America’s Nobels’ – honoring groundbreaking contributions to our understanding of the human disease” . This paThese traditional medical innovation awards either celebrate those medical researchers and innovators with proven successes or transformative basic science breakthroughs still years away from reaching patients. Among the examples of major awards for proven successes are the Nobel Prize in Physiology or Medicine with an emphasis on “discoveries that have changed the scientific paradigm and are of great benefit for mankind”  and the While these traditional medical research awards are a critical component of celebrating foundational scientific research, there is not currently a focus on celebrating those medical researchers and innovators closing the translational research gap for emerging transformative medical innovations today as opposed to the past or in a distant future. Advancing current translational research is perhaps the most pressing challenge of today’s age in medical research in terms of providing new health-care solutions to patient populations. As the groundbreaking Food and Drug Administration (FDA) report on the Challenges and Opportunity on the Critical Path to New Medical Products  brought to public attention that “at a time when basic biomedical knowledge is increasing exponentially, the gap between bench discovery and bedside application appears to be expanding” .The need to recognize and incentivize medical researchers and innovators having success in addressing today’s translational research challenges calls for a new type of medical innovation award backed by an analytical process that leverages the holistic body of highly descriptive but unstructured data on medical research activities. The importance of translational research requires a new paradigm that incorporates means to assess the emerging transformative medical innovations that are making their way through the development process to reach patients. A medical innovation award process that embraces the context of translational research also needs to be able to identify the medical researchers and innovators making significant contributions in advancing these emerging transformative medical innovations by demonstrating ingenuity, perseverance, and commitment to its success in reaching patients.Developing a rigorous and repeatable method for creating an award for translational research is the vision and focus of the Sanford Lorraine Cross Award, which celebrated its inaugural award in emerging transformative medical innovations in December 2018 and is now preparing for its second award process for December 2020.This award is agnostic to individuals at outset. As depicted in Another unique aspect of the Sanford Lorraine Cross Award is the criteria used to select the award winners. Rather than primarily focusing on the significance of the contribution of a researcher or clinician, the Sanford Lorraine Cross Award is concerned about the role that the award candidate has played in bringing a new emerging transformative medical innovation across the finish line to patients, and their efforts in overcoming challenges, forging collaborations, and ensuring a successful outcome.A final distinguishing aspect of the Sanford Lorrain Cross Award is the “rigor” it brings in focusing on emerging transformative medical innovations in its selection process independently of the pioneers who are succeeding in bringing them forward. In particular, the Sanford Lorraine Cross Award stands out in the development of an “early signals analysis,” which applies a data-driven approach using advanced analytical techniques to capture the vision of the Sanford Lorraine Cross Award in targeting emerging transformative medical innovations. As explained in further detail below, the early signals analysis relies on machine learning approaches to enable Sanford to cast a wide net across an expansive portfolio of high-impact translational research activity indicators and identify those innovations that are on the cusp of realizing transformative impacts in bringing new treatments to patients.The early signal analysis functions as the first step in a four-step selection process for the Sanford Lorraine Cross Award, as depicted in Following the selection of the most promising emerging transformative medical innovation areas, the focus then shifted to identifying specific candidates who are advancing science in those areas and embody the spirit of the Sanford Lorraine Cross Award. Potential candidates were identified based on peer-reviewed sources detailing the research history and current status of those selected emerging transformative medical innovation areas, and data mining of recent online activity in medical innovation news and press releases related to those areas. Further, due diligence was carried out by Sanford Health, including discussions and in-depth background analysis of candidates to identify the top three candidates for consideration.The ultimate selection among the three final candidates, each of which was well-qualified, is the responsibility of the Sanford International Board to ensure the focus on a medical pioneer who has demonstrated ingenuity, perseverance, and commitment to bringing an emerging transformative medical innovation to fruition. The Sanford International Board offers both a strong patient-orientation along with a passion for supporting the improvement of the human condition through transformative medical treatments and care, and brings their expertise and life experiences as entrepreneurs, health-care leaders, business executives, and world-class competitive athletes to bear. This advisory group helps oversee Sanford’s World Clinics, with current locations in Canada, China, Germany, Ghana, and the U.S. These Sanford World Clinics provide care to children, families, and underserved populations along with offering innovative approaches in areas as primary care services, regenerative medicine and diabetes, to improve the health and well-being tailored to the needs of each community it serves, using methods that surpass current practices of health-care delivery.This rigorous early signals analysis stands in contrast to other major medical innovation awards, which generally rely on the subjective vetting of a small set of highly accomplished and recognized scientific leaders  and reflet al. explained that when disruptive innovation occurs in this cascade of innovative development, it disrupts the existing paradigm and begins a new innovative cascade of ideas generated by the disruptive idea [The approach of using early signals to identify trends in innovation is rooted in the scientific literature of how innovations evolve over time and the “bursts” in innovative activity that typify emerging innovations. One way of describing trends in innovation is using the analogy of a cascade, shown visually in ive idea . These dAnalyses of this type of disruption rely on the linkages between ideas, and for this reason, the forward citation patterns, or citing of past work by future work, of research publications, and patents are often used to study shifts in patterns that indicate the onset of a disruptive idea. Other work on identifying and characterizing high-impact and transformative science metrics also relies on the idea that transformative ideas will rapidly generate various types of measurable recognition and forward citation activity as radical and high-impact ideas disrupt previously established citation patterns and generate new concepts .The concept of using the patterns related to short-term bursts of innovation activity that occurs just after a transformative or disruptive idea is introduced to characterize high impact areas through forward citation analysis is reflected in various ways using several different approaches and metrics through the work of a number of other researchers, and is particularly applicable to the biomedical innovation space -10.Since the Sanford Lorraine Cross Award is intended to recognize emerging transformative medical innovations making their way through development with a clear path to reaching patients, only signals that occur at the later stages of basic research up until just before product introduction to market are included to spotlight developing areas where the award can help propel emerging ideas to completion.The identification of early signals consistent with the focus of the Sanford Lorraine Cross Award requires tracking activities that take place across translational research. Translational research is the pathway in which basic research discoveries are advanced and developed into new innovative medical products to serve patients, and it reflects the critical interface of “bench and bedside” relationships which drives medical innovations forward. The U.S. NIH explains that: “Information flow at this interface is bi-directional, requiring close interaction between clinical and bench scientists” . TranslaThe nature of translational research and the many steps involved in advancing bioscience innovation makes it difficult to establish a single metric intrinsically tied to its development. The early signals data sources considered in an analysis of innovative potential should represent a variety of milestones on the timeline of translational research as medical innovations go from initial discovery to market delivery to ensure maximum coverage, as transformative applications can occur at various points in the process of developing an initial breakthrough discovery into a market-ready product.For this reason, a mix of seven early signals was identified for the Sanford Lorraine Cross Award to consider, including:NIH transformative research grantsHigh impact scholarly activitiesHigh impact patent activitiesHigh potential venture-backed companiesHigh potential NIH small business innovation research grantsFDA expedited reviewTrending social media topics in medical innovationFrom the scientific literature, a critical way to identify those high impact innovations reflecting a “burst” of activity is through various measures of forward citation patterns. To the extent possible, this focus on forward citations patterns as an early signal of high volume, compressed innovation activity is used to process signals data (such as for publications and patents). However, this is not possible for all measures due to limitations in the underlying data. When forward citations are not available for identifying high potential innovation activities taking place in specific early signal measures, then the early signal measure itself is defined in a manner that reflects only highly innovative activities, such as only selecting innovations going through clinical trials approved for expedited reviews.Once filtered, the unstructured text content present in the early signals data describing the applications of each innovation is pooled for further analysis of the innovative technology platform themes present across the breadth of the various early signals measures. This unstructured text data takes the form of descriptive metadata attached to each record documenting an innovation and includes information such as patent and publication abstracts, grant award descriptions, early stage company descriptions, and social media posts describing innovative discoveries. The various early signals records are pooled without any weighting attached to individual records since later steps in the early signals validation process incorporate subject matter expert judgment and feedback in weighting the validity of different concepts. The complete process of selecting, filtering, and combining the early signals data for use in subsequent analysis phases .et al. of quantitative methodologies for identifying emerging technologies indicates that the two most commonly used types of analysis for characterizing the information structure of data rely on patterns formed by either keywords or citations [There are a wide variety of different quantitative approaches that are possible for analyzing the thematic makeup of early signals data, each of them with advantages and limitations. A comprehensive review by Cozzens itations . The metTo analyze the overarching themes present in the refined pool of early signals innovation data, a machine learning technique known as unsupervised latent topic modeling analysis is used to build out “vocabularies” based on the unstructured text content and then use them to identify distinct topics present across the data present in the descriptions. A text processing algorithm is used to clean the text data and then identify frequently appearing terms and multiword phrases through techniques such as word stemming and stop-word removal which are commonly used in natural language processing methods, which turn text content into data for analysis. Once key terms are identified for each record, weighted term frequency methods are used to assess the importance of each term or keyword phrase in describing the content held within an individual text record. The key terms identified for each body of unstructured text are then used as inputs to an unsupervised clustering technique known as latent topic modeling to identify key underlying concepts present in the text data based on the process of building out “vocabularies” of terms that are identified by the algorithm and evaluating their presence across the data. As opposed to more basic clustering algorithms which evaluate text content at the overall record level and then assign a unique theme to a data record, latent topic modeling estimates the mixture of topics present in an individual record to better approximate the structure of real-life text content which often contains multiple themes within a single record. In addition to identifying the underlying topic structure present across the body of text data, the algorithm also enables calculation of a measure of similarity, or “distance,” between different text records documenting innovations so that all records in the refined pool of early signals data can be compared to one another to identify records that contain similar ideas and concepts. The steps for processing the early signals data for the next stage of review by scientific expert panels are shown in Even after identification of an initial set of topic clusters by the clustering algorithm, it is still necessary to evaluate the cluster groupings to determine cohesiveness and critical mass around a single relevant subject based on analysis of key terms appearing in cluster records. These validation steps filter out clusters that are not focused or are not relevant to the innovation areas that the Sanford Lorraine Cross Award process is designed to target.A total of 20,290 records were generated from the sources for the early signal analysis. This included 9218 records from standardized databases that document more formal stages of innovation involving: Publications, NIH grants, patents, early stage venture capital, SBIR Phase 2 awards, and FDA special approvals. Another 11,072 records came from web surveillance data across medical innovation and research news aggregators that offer insights on informally recognized areas of medical innovation that has new and exciting developments.The latent topic model identified approximately 100 underlying topics present in the body of early signals data. These initial topics were then interpreted through expert review validation and categorized as relevant or “artifact” topics based on how highly focused their themes were on biomedical innovation topics versus other subjects. This step identified 72 highly focused biomedical innovation topics for review by Sanford stakeholders to assess their relevance to the specific vision of the Lorraine Cross Award with respect to the maturity and ongoing research activity in the innovation area. From this grouping, a total of 57 medical innovation topics from the text records were identified and then underwent subsequent review steps with a group of internal Sanford scientific experts who identified a final set of 14 medical innovations to consider in the validation exercise with the external scientific expert panel.et al. note in their work outlining processes by which transformative research can be identified that there are many cultural and cognitive biases that can need to be considered. Further complicating the identification of medical innovations is a wide range of different attributes to innovations that must be considered and weighed, such as potential for impacts on scientific discovery, patients, clinical practice, and public health.In selecting among potential emerging medical innovations for those that stand out as having the highest transformative potential, there is no substitute for the inclusion of expert judgment in evaluating the transformative potential of medical innovation. As Huang et al. [There is an existing literature on retrospective analyses of transformative innovations in the medical space, which includes a variety of techniques that utilize subject matter experts to either critique or rank order sets of medical innovations based on present-day recognition of the innovative value of a set of innovations. For example, Kesselheim et al.  use a meet al.  ask a grFor the Sanford Lorraine Cross Award, the difference from retrospective studies is providing a rigorous approach to conducting the due diligence on emerging innovations identified through the early signals analysis that accounts for the role of uncertainty and the implied preferences of respondents in a forward-looking way. One way to do this is to use a decision theory framework known as multi-attribute utility modeling to capture expert opinions across the various defining characteristics of a particular innovation. Utility modeling techniques are used to assign preference rankings to choices across a set of uncertain outcomes, in this case, represented by the uncertain outcome of the ultimate future transformative impact for a group of candidate medical innovation applications areas.Multi-attribute modeling relies on two key pieces of information gathered from a survey process and a utility function to determine the “utility” of each medical innovation in the eyes of scientific expert evaluators with respect to its ability to cause transformative impacts. The information provided by expert survey respondents is comprised attributes or descriptive properties or characteristics of medical innovations that are measured or scored, and weights, or the importance of each attribute to the respondent in determining the transformative potential of a medical innovation. The combination of attribute scores and weights using a utility function produces a measure of the transformative potential of a given medical innovation, which can then be used to comparatively rank medical innovations on a consistent basis to determine the top candidate innovation areas to consider in identifying candidate inventors for award consideration. For this analysis, the utility function used to combine attributes and weights takes the form of a simple weighted average:whereU = the overall utility measure for a particular candidate medical innovationn = the number of attributes used to describe medical innovationsw = the importance weights of different attributesA = the scores for different attributesWhile other utility function forms are possible, this particular form of multi-attribute analysis is commonly used across a variety of technology areas to assess the market potential for products and services.A review of the literature describing the profiles of the past transformative medical innovations was used to outline a set of attributes describing a set of characteristics of transformative medical innovations. Attributes were identified within the context of four broad areas that describe the transformative impact of innovations on applications of medical science and refined with guidance from a scientific expert group composed of Sanford researchers and clinicians to validate their effectiveness in capturing the dimensions of what it means to have transformative effects. The final listing of broad impact areas that contain detailed attributes across which survey respondents were asked to evaluate candidate medical innovations is shown in An accomplished and broad-based panel of scientific leaders was organized by Sanford Health to participate in the multi-attribute survey process and came together as a group to consider the results and to help guide the focus of what emerging medical innovation areas held the highest transformative potential from which to consider candidates. The members of the Sanford Lorraine Cross Scientific Advisory Board are shown in Since transformative medical innovations identified in early signals data do not necessarily yet have a track record of creating impacts, the attribute evaluations relied on the expert judgment of transformative potential through relative scoring rather than measured outcomes criteria. A survey instrument was created and tested to validate this approach using the following process in two sequential steps:Scientific experts were first asked to weight their preferences toward the attributes shown above with respect to their relative importance in determining the transformative potential of any new medical innovation in the marketplace. To accomplish this, a “budgeting” survey design was used to elicit implied preferences for the importance of certain areas through having respondents assign point values across the entire set of attributes shown above from a limited budget of total points. For this evaluation, a 100-point budget across the 13 attributes was used to determine importance weightings.Scientific experts were then asked to review a refined list of medical innovations identified from the early signals analysis using a Likert scale survey design to elicit measures for how they viewed the potential transformative impact of a given innovation in each attribute area. This took the form of a 0-5 rating system, where a score of 0 represents a predicted outcome of no transformative change relative to the current state of medical science and treatment, a score of 1 indicates a very insignificant transformative impact relative to current conditions in medical science and treatment, and a score of 5 indicates a very significant transformative impact relative to current conditions in medical science and treatment. In the survey, respondents are given the opportunity to include any additional attribute areas they feel are important to transformative impact in the medical space that is not present in the evaluation set provided as well as the opportunity to score the medical innovations along with those attributes.The results from the assessment of the early signal analysis by the Scientific Advisory Committee on which of the emerging medical innovations held the highest potential for transformative impacts set the stage for considering candidates for the Sanford Lorraine Cross Award. In doing so, we now have an award focused on the key issues of our time – celebrating transformative medical innovations of today and the researchers and clinicians playing a key role in overcoming scientific challenges, forging collaborations and ensuring that the emerging transformative medical innovation crosses the finish line to improving the lives of patients.To address the need for a new type of medical innovation award that celebrates those medical researchers and innovators demonstrating the determination and success in advancing translational research for emerging transformative medical innovations, the Sanford Lorraine Cross Award has developed a unique data-driven methodology that inverts the traditional medical award selection paradigm – truly innovative areas of discovery and breakthrough science are identified independently of candidates and used to then focus candidate selection on the areas with the most promising transformative potential for patients. This unique approach allows identification of medical innovations on the cusp of achieving breakthrough outcomes for patients and allows the award to target individuals leading those emerging transformative development efforts.For the inaugural award process, a robust set of different medical innovation areas were identified that are actively contributing to cutting edge science across a variety of medical disciplines. The area of emerging transformative medical innovation ultimately selected for the inaugural award from this grouping that had the highest potential for near term breakthroughs was centered around gene therapy applications. Alongside key advancements in the development of modified viral delivery vectors such as tailored adeno-associated viruses, recent activity in this space has addressed issues with the delivery of fragile DNA molecules without degradation or potentially dangerous immune responses.The pioneering innovators identified within this space leading activities that are having clinical impacts today that was considered as finalists for the Lorraine Cross award were as follows:Jean Bennett, M.D., Ph.D., and Katherine A. High, M.D., whose work with the RPE65 mutation has reversed an inherited form of blindness. Bennett and High pioneered gene therapy, took it to clinical trials, and then received FDA-approval for the treatment, the first FDA approval of a gene therapy for a genetic disease. High also cofounded Spark Therapeutics, a fully integrated, commercial gene therapy company working to accelerate the timeline for bringing new gene therapies to market. Bennett is a professor of ophthalmology at the University of Pennsylvania, and high is president and head of research and development at Spark Therapeutics.Brian Kaspar, Ph.D., whose lab discovered a gene replacement therapy approach that seeks to change the course of spinal muscular atrophy (SMA) by addressing its genetic cause. SMA is a devastating disease that robs babies of basic muscle functions, like breathing and swallowing, and in its most severe form (Type 1), usually leads to death by age 2 years. An initial clinical trial using the AAV9 vector to treat SMA Type 1 demonstrated a dramatic survival benefit and rapid improvement in motor milestones. Kaspar is the scientific founder and chief scientific officer of AveXis, a gene therapy company that was acquired by Novartis in 2018.James M. Wilson, M.D., Ph.D., whose work helped define the scientific and ethical standards for advancing gene therapies through FDA-approved clinical trials. He is the director of the Gene Therapy Program, the Rose H. Weiss Professor and Director of the Orphan Disease Center, and a professor of Medicine and Pediatrics in the Perelman School of Medicine at the University of Pennsylvania. In 2008, Wilson and the University of Pennsylvania cofounded REGENXBIO, Inc., a clinical-stage biotech company designing gene therapy products.After intensive consultation, the winner selected by the Sanford International Board of the first Sanford Lorraine Cross Award was Jean Bennett and Katherine High. The inaugural winner and other finalists exemplify the criteria outlined in the vision of the award and help to validate the methodology used to identify areas of innovation activity that is well-positioned within the translational research pipeline to have significant near-term patient impacts.Additional areas of potentially transformative medical innovation identified by the early signals process will be monitored for ongoing developments and can be included alongside an updated set of early signals data at later times to re-evaluate transformative potential relative to future activities. In addition to allowing the most relevant areas and individuals to be selected dynamically as research focuses and the state of medical science changes, this approach helps control for any bias toward certain areas of established science over time within the selection process.


Joint mSocio-affective components of joint musical engagement have been postulated following empirical investigation of joint music-making and group music-listening  and practical  considerations for using computational techniques in social science research is covered in a review paper by Martinez . ConcernThis article has summarized recent developments in music psychology and related fields that may be applied to detecting emotional contagion in music. We have discussed this research in terms of how it may be incorporated into existing experimental paradigms in scientific studies of music. We hope to encourage further findings regarding the means by which various forms of musical engagement can result in positive prosocial consequences for a broader population.IH conducted literature reviews in order to gather necessary evidence and to generate initial drafts. MBK assisted argument development and expanded source material. Both authors approved the final version of the manuscript.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.


The standard treatment for locally advanced rectal cancer (LARC) includes neoadjuvant chemoradiotherapy (nCRT) followed by total mesorectal excision (TME) and adjuvant chemotherapy.P < 0.01). The authors’ proposed radiopathomics strategy and signature escaped the limitation of using only medical imaging to depict the whole tumor and decreased the potential risk of overlooking tumor heterogeneity by adding micro-scale pathologic information.In this study,This study provided evidence that the radiopathomics strategy of combing the images of both radiology and pathology is a potential strategy for predicting the variation in pathologic response before nCRT. More quantitative and multi-scale tumor information powered by the information fusion method was able to improve the heterogeneous description of tumors and enhance the performance of the model for restaging patients. As such, future studies should focus on the integration of gene and protein information to construct a more comprehensive tumor prediction model from the macro radiological information of tumor to the micro pathological information of tumor. The biologic interpretation between radiomic and pathomic features also should be central to future studies.


Previous literature has analysed the effects of establishment regressors on different measures of restaurant financial performance  Specifications table•This data set can be beneficial to analyze the factors that determine the profitability of corporations in the restaurant industry.•This dataset can be used to conduct different studies on the heterogeneous pattern that profitability of European restaurant corporations presents at country level. These studies would benefit from the creation of company profiles within each country based on financial determinants of profitability.•The data can be useful for business managers and public institutions with an interest in tourism. Understanding the causes of heterogeneity among countries provides useful insights for companies´ business growth and location strategies.•The analysis is useful when discovering new and innovative sources of strategic competitive advantages.1Data were collected by using a multi-step approach to address their objectives with solvency. The first dataset was obtained through a sample consisting of 860 restaurant corporations selected from the total population of active restaurants in Europe in 2018. A random sampling technique was applied to stratify 18 European countries with a sample error of less than 1%. This dataset includes financial indicators obtained from the corporate financial statements from Amadeus Database by Bureau Van Dijk. The second dataset concerned contextual variables and shows macroeconomic and tourism indicators related to the countries in which the restaurant corporations in the sample are active.The data file spreadsheet accompanying this article consists of 860 rows and 20 columns of data. The first four columns collect the identification code of the company and the country where the company operates. The rest of the columns include financial indicators and contextual variables. In the group of financial indicators, two measures of corporate profitability are considered: Return on equity (ROE) is calculated as profits available to equity shareholders/equity shareholders’ funds of corporate and Return of assets (ROA) is calculated as earnings before interest and tax/total assets. In addition, information is also included on other financial indicators such as Fixed assets ratio  2In general, the transnational analysis of the financial performance of restaurant corporations exhibits a hierarchical data structure, which does not match the statistical properties of a random sample. Specifically, companies from the same country share common economic and tourism environment conditions. Some of these characteristics are included in the dataset. However, other contextual variables may be unobservable and, although the coefficients estimated by standard regression remain consistent, standard errors may be biased The figures above demonstrate that country effects vary randomly but also that significant variance exists in the level of financial performance within and between countries. We can explain the causes of such heterogeneity between countries, adding contextual regressors, which could help to understand the impacts of economic conditions and the tourism environment on corporate profitability. For instance, Therefore, the dataset associated to this paper sheds light on an important issue still inadequately explored in the literature on companies’ financial performance. Although traditionally, stakeholders have managed companies’ financial performance based on their economic and financial indicators, the dataset shows additional indicators related to the country in which a company operates, which allows us to understand the causes of heterogeneity among countries in a context of internationalised companies and globalised markets. Future research using hierarchical linear models could facilitate the creation of company profiles based on both their financial variables and each country's specific economic and tourism environment. Moreover, the data included in this paper is also relevant to guide further research to improve knowledge of the determinants of corporates’ profitability in the restaurant industry.The authors declare that they have no known competing financial interests or personal relationships that could have influenced the work reported in this paper.


Thymus regenerative therapy implementation is severely obstructed by the limited number and expansion capacity in vitro of tissue-specific thymic epithelial stem cells (TESC). Current solutions are mostly based on growth factors that can drive differentiation of pluripotent stem cells toward tissue-specific TESC. Target-specific small chemical compounds represent an alternative solution that could induce and support the clonal expansion of TESC and reversibly block their differentiation into mature cells. These compounds could be used both in the composition of culture media designed for TESC expansion in vitro, and in drugs development for thymic regeneration in vivo. It should allow reaching the ultimate objective - autologous thymic tissue regeneration in paediatric patients who had their thymus removed in the course of cardiac surgery. Thymus is an essential organ of the immune system since it is the main site of T lymphocyte production and the place of adaptive immunity regulation. The thymus significance for development and function of the immune system is the centre of hot discussions since the 1961, when thymus function was first discovered by Jacques Miller –7. AccorCurrent epidemiological data indicate that almost 1 in 100 children is born with a congenital heart defect , and theFoxn1 expression could be used to identify the human TEPC/TESC population(s)  for 2013–2017, the Scientific Centre of Excellence for Reproductive and Regenerative Medicine , Terry Fox Foundation and InnovaTRT project that was submitted for funding to the European Union’s Horizon 2020 Programme for 2019–2024 . The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.


The TeleDementia Clinic is an interdisciplinary longitudinal telehealth dementia clinic providing care to rural Veterans in Western Pennsylvania with cognitive decline. The TeleDementia Caregiver Support group uses telehealth to provide caregiver support and education to those caregivers with the highest levels of caregiver burden in this population. The support group has caregivers participating in the session at different rural clinics while a multidisciplinary team of professional  are located at an urban VA medical center. All can interact via video telehealth connection. Each session provides a short educational session on caregiving topics that then provides a springboard for caregiver discussion about their own experiences. The multidisciplinary clinician team lend their expertise to the education and support of caregivers. Both quantitative and qualitative analysis of effectiveness of this model will be discussed.


The authors wish to make the following corrections to this paper :In the Materials and Methods Section 2.2.1, part of the method was incorrect and instead ofEscherichia coli. After confirmation of the integration plasmid by restriction analysis and sequencing, purified plasmids were electroporated into the fusobacterial strains used in this study to generate the respective derivatives lacking target genes according to previously described protocols [29]”.“The plasmid DNA of the recombinants were isolated with the Qiagen Mini prep kit  and the presence of construct was confirmed by restriction digestion and sequencing. The construct was further subcloned in the suicide vector pHS31 as follows: both the fusion construct and pHS31 were digested with EcoRI/BamHI and purified prior to ligation  and transformation into The method should be:“The plasmid DNA of the recombinants were isolated with the Qiagen Mini prep kit  and the presence of the construct was confirmed by restriction digestion and sequencing. Further, purified plasmids were electroporated into the fusobacterial strains used in this study to generate the respective derivatives lacking target genes according to previously described protocols  [29]”.The authors would like to apologize for any inconvenience caused to the readers by these changes.


The fastest growth of population living with cognitive impairment takes place in China. The estimated prevalence of cognitive impairment among older adults in China is between 13% and 20%. This study focused on persons with cognitive impairment (PWCI) and their spousal care partners to explore how spousal relationships impact dyadic experiences of living with cognitive impairment through a person-centered care lens. We conducted a longitudinal qualitative study of 10 dyads of PWCI and their care partners over three years with three data collection time points. Our findings suggest that the complexity of changing experience of living with cognitive impairment is interpreted in the dynamic nature of their spousal relationship and relationship with others, patterns of communication, daily activities and care during the extended period of cognitive decline. It is crucial to help them nurture the belief that there is a significant meaning in the journey of living with cognitive impairment.


NIHR GOSH BRC. The corrected Funding Statement appears below.In the original article, we neglected to include the funder This work was supported by an Action Medical Research project grant (SN4051). Financial support for LH was provided through the regional agreement on medical training and clinical research (ALF) between Stockholm City Council and Karolinska Institute. TB was supported by the NIHR GOSH BRC.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.


This presentation will focus on two projects that aim to inform and educate communities through community based intergenerational programs. An additional link is collaborating with community partner staff on the potential to improve health outcomes with the integration of generations in programming. Through inter-professional collaborations, these projects focus on two areas: reducing social isolation and loneliness among rural older adults through an intergenerational technology program with university students and modifying the implementation of an evidence-based preschool nutrition program for an intergenerational setting. This presentation will focus on the benefits of using community based intergenerational programs and experiential learning opportunities. Aims of this presentation are to highlight how issues related to social isolation and loneliness can be mitigated by incorporating experiential opportunities for university students while simultaneously supporting university students’ preparation for engaging in an intergenerational workforce.


The aim of this Special Issue on the deregulation of cell death in cancer is to bring together recent perspectives on the relationship between tumorigenesis and programmed cell death (PCD). According to the World Health Organization, cancer is the second leading cause of death worldwide, and in 2018 it was responsible for an estimated 9.6 million deaths. The human genome is exposed to mutations during the course of life, and while many have no impact on individual health, others (heritable or acquired) are responsible for carcinogenesis. It is becoming ever clearer that defects in intracellular signaling pathways lead to altered gene functions and malignant cellular transformation . The altThe reactivation of altered or silenced cell death pathways may improve outcomes in cancer. The development of new drugs able to modulate specific molecular targets involved in cell death mechanisms may provide more efficient therapeutic strategies for cancer treatment.


Dear Editor, We would like to congratulate the authors for documenting this interesting phenomenon.We are writing to share our observations regarding the article “Multiple pit defects of unknown etiology in a foldable hydrophobic intraocular lens” by Thabit et al. Factors such as ocular inflammation and systemic comorbidities that affect ocular metabolism may contribute to the opacification of IOLs. Surgical interventions with the injection of different materials into the anterior chamber such as air or gas seem to increase the risk of IOL opacification, particularly in hydrophilic IOLs. The pits are limited to a more or less circular area of the anterior optical surface of the IOL corresponding to the zone of contact with the instilled air or gas.The authors mentioned no obvious reason for the formation of pit-like deposits on the anterior surface of the intraocular lens (IOL). We want to disagree with this statement in that IOL pit formation is a well-established phenomenon where opacification of hydrophilic acrylic IOLs occurs after corneal transplantations such as penetrating keratoplasty and Descemet's stripping endothelial keratoplasty (DSEK). It is our observation that opacification of hydrophilic IOLs develop in eyes that undergo DSEK and receive an air tamponade intraoperatively [Figures 1 and 2].Prolonged breakdown of the blood-aqueous barrier has been suggested as a contributory factor in IOL pit formation. The air in the anterior chamber causes dehydration of the anterior surface of the hydrophilic IOLs, and postoperative inflammation induces a metabolic change in the anterior chamber leading to an increase in aqueous proteins and calcium content that causes subsequent crystallization of the lens.


The main objective of this article was to present some of the engineering noise control methods that are currently being used across the world in the mining industry, while at the same time interrogating noise control measures that could be applied to effectively reduce noise emissions from the equipment utilised within South African mines.A brief summary of the hearing conservation programmes used in South Africa is presented. Summarised research on the use of engineering noise control in South Africa is also presented, with an overview of the various engineering noise control methods applied across the world in dealing with occupational noise.For illustrative purposes, case studies were used to show how engineering noise controls could be used to reduce the noise levels and risks within this context.Some of the case studies used have cited a reduction in the noise intensity emitted by machinery from a range of 93 dBA – 104 dBA to a range of 90 dBA – 94 dBA, demonstrating quite a significant reduction in the noise emission of the equipment. This article further provides recommendations on how South African mines could contextualise these methods.One of the key recommendations is encouraging the South African mining industry towards the documenting and publishing of those engineering noise control methodologies that have proven to be effective for shared best practice. A need was identified for extensive research to be conducted and documented evidence to be made available to assist the South African mining industry with locating and assessing current engineering controls available in South Africa. Machines and processes that require noise control should be identified and, lastly, the current barriers to the use of engineering noise control methodologies should be identified, with the main goals of finding ways to overcome the noise challenges in the mines. Noise may be defined as an undesirable sound lacking musical quality  pillarsOverview of engineering noise control methodsSummarised research on the use of engineering noise control in South AfricaFor illustrative purposes, Case studies of engineering noise control methods currently being used across the world are used to show how engineering noise controls can be used to reduce noise levels in this context.Recommendations on how South African mines can contextualize the noise control methods used by the rest of the world.The engineering noise control methods can be divided into: Control of noise at source, control of noise propagation and receiver control as shown in Gumede, Blomerus, Coutts and De Beer  conducteSensogut  documentCase studies show how engineering noise controls can be used to reduce noise levels in this context. Nikola, Aleksandar, Dinko, Vladimir and Uros  proposedThe research by Sensogut , using aThe Peterson  proposedPeterson, Miller and Yantek (2014), working with the National Institute for Occupational Safety and Health (NIOSH), visited a collaborating mine and investigated a haul truck underground in a shop area using Source Path Contribution (SPC) techniques for Noise Source Identification (NSID) . Further studies were conducted in 2018, using dosimetry and time motion to determine when an operator accumulates the most noise dose (Peterson, Engineering noise controls that have been discussed may be implemented in the South African mines, for example, by enclosing noisy places, using correct sound barriers and using curtains and retrofitted noise control packages. There is limited published evidence from the South African mines that document how engineering noise controls have contributed towards a reduction in noise emission from equipment. Mining companies and research centres in South Africa should consider partnering with NIOSH because of their extensive documented research work on ONIHL in the mines, to extend and contextualise their research to South African mines. The South African mines should thereafter consider conducting research and the documented evidence should be made available to assist with locating and assessing current engineering controls in South African mines. This research work should also include identification of machines and processes that require noise control. Current barriers to the use of noise control should be identified with the main goals of finding ways to mitigate them.This article is not a systematic review paper; hence, not all engineering noise control methods currently have been applied. The engineering noise control method as a technique to mitigating noise in the mines has been presented. Case studies from around the world and how they can be contextualised to the South African mining industry have also been presented. A follow-up to this work would include the documentation of a strategic plan that would encourage the mining industry to publish the noise control interventions that have currently worked for them.


Phytophthora cactorum) was duplicated in Phytophthora cambivora) and two representative images for cucumber damping-off symptom were overlapped in In the original article, there were mistakes in 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.


Following publication of the original article , the autPlease be advised that the Acknowledgements are as follows:“We would like to thank Jacob Kroeker, Katie McKearney, Arthur MacDonald and funding support from the Atlantic Canada Opportunities Agency (Atlantic Innovation Fund) for the development of the working memory training protocol. RH is supported by a Guangzhou Planned Project of Science and Technology grant (2016201604030018).”The original article has now been corrected to include this declaration.The publisher apologizes for any inconvenience caused.


Behavioral health and substance use disorders are significant problems among older adults who are experiencing homelessness. This presentation describes the components of a social work field education model for preparing practitioners to work effectively in community-based agencies using the Hartford Practicum Partnership in Aging Educational (HPPAE) model. A planned and systematic transition from one field setting to another with the goal of giving students a range of practice experiences with various service delivery systems to address social isolation and other social determinants of health. This exploration of demographic and social action factors that may impede or foster success among community-dwelling older adults offer insight and guidance for constructing a conceptual and theoretical model a social justice framework in geriatric social work practice and research.


The authors report on results of a randomized prospective trial in comparable groups of patients with intrarenal stones treated by flexible ureteroscopy and laser lithotripsy   . PatienThey find no significant difference in OR times, hospital stay, postoperative pain, fluoroscopy times or stone free rates defined as 2mm or smaller fragments on non contrast CT one month post treatment.The sentinel finding in this study was an increased complication rate in the regional anesthesia group comprising patients with either bradycardia, mucosal tear or hemorrhage. They attribute the mucosal injuries and bleeding to a lack of good control of laser energy secondary to respiratory excursion of the kidney in patients under regional anesthesia. Moreover “surgeon comfort” which was subjectively measured during the procedure was also significantly less in procedures performed under regional anesthesia.While the numbers are small these results are interesting and emphasize the point that intrarenal surgery with a flexible ureteroscope and laser is an operation of millimeters. Both as regards the stone fragmentation and in avoiding tissue injury. Stones in the mid to distal ureter are relatively unaffected by significant respiratory excursion while those in the kidney can be subject to substantive movement especially in the awake patient. It would have been desirable to have more information on the detailed questions in the surgeon comfort questionnaire and whether this is a validated tool. Nonetheless this study does inform us of some of the pros and cons of differing anesthesia methods for retrograde intrarenal surgery and thus discussions with patients and our anesthesia colleagues.


Through the theoretical framework of the Social Comparison Theory, the current study will examine general attitudes and perceptions of body image in senior adults who are currently participating in organized recreational activities. Participants between the ages of 50 years of age and older participating in organized recreational programs in the Southeast will be administered the Sociocultural Attitudes Toward Appearance Scale (SATAQ) to measure participants’ body image as influenced by general media, athletic and sport figures, as well as pressure to conform to the media ideal. The Figure Rating Scale will be administered, and is composed of nine drawings of bodies that progressively increase in size from very thin to overweight. Pearson product moment coefficient of correlation will be used to determine the association of scores between the SATAQ and Figure Rating Scale.


Middle East Respiratory Syndrome Coronavirus (MERS-CoV) is a disease first reported inSaudi Arabia in 2012 and it can be transmitted from human to human. This disease hasspread to several other countries, most confirmed cases have displayed symptoms of severeacute respiratory illness and many of these patients have died. This research is aimed toconstruct a mathematical model for the transmission of MERS-CoV in two areas by separatingthe human population into two groups; susceptible and infectious groups. The dynamics ofthe disease is studied by a compartmental model involving ordinary differrentialequations. The basic reproductive number of this disease is discussed to control theoutbreak of this disease. Sensitivity analysis of this model is performed to determine therelative importance of the model parameters to the MERS-CoV transmission.


Economic inequality has grown rapidly in all age groups in the past several decades. In each successive cohort, the wealth gap grows for young people and seems to accelerate faster over the life course. While rising inequality has taken its toll on Baby Boomers, we have become acutely aware of the increasing economic pressures across the entire life course  that will manifest in the greatest degree of inequality in older adulthood seen to date. This session explores the forces that have shaped the degree of inequality among current older adults and are setting the stage for future cohorts of older adults. Presenters will explore several aspects of this issue: the growing state of the “risk retirement,” the impact of income inequality on later-life wealth and health, the structural racism written into economic policies intended to help Americans accumulate wealth and maintain health, and the market disadvantage for GED recipients compared to high school diploma recipients.


GSA's Public Policy Advisor will lead a discussion of legislative activities related to elder abuse, neglect, and exploitation during the past year. The panel will examine successes and failures and what may still be possible in the lame duck session and the next Congress.


Fear extinction learning is considered a key process for a successful treatment of anxiety disorders and the post-traumatic stress disorder (PTSD) A recent review The scientific literature has also shown that in the context of reward and aversion processing both chemical messengers work in antagonistic way Worthy of mention is also the necessity to clarify whether the role played by dopaminergic and serotoninergic systems in fear extinction learning is inexorably interdependent, or it is possible to identify a degree of autonomy in each system with regard to the process of fear extinction learning. A closer look at the process of fear extinction could add some timely insights in this regard.When speaking about fear extinction it is important to distinguish between learning and consolidation In conclusion, the current research leaves open the hypothesis that the effect of dopaminergic system on learning of fear extinction memories could reflects, at least in part, some interaction with serotonergic system. Therefore, both monoamine should be simultaneously considered when speaking about fear extinction. This is supported also at the neural level, as the serotonergic system of the dorsal raphe nucleus


The 2019 Minnesota Legislature requested the Department of Human Services (DHS) and Minnesota Board on Aging to develop and administer a report card for assisted living (AL), including conducting annual resident and family surveys in Minnesota AL settings. This presentation includes the perspectives of representatives from MN DHS and Vital Research, as well as the University of Minnesota team who worked together to develop survey items, carry out the cognitive testing, and conduct analyses. Survey items were developed from published literature and existing tools on assisted living quality and underwent testing with MN stakeholders and cognitive testing with MN AL residents. Pilot testing assessed any further changes that needed to take place for resident and family satisfaction with AL quality (n=400). Presenters will share lessons learned with implementing the new tools and different aspects of the of the report card development and implementation process as well as the survey findings.


The study of gerontology across different generational cohorts is not static but rather dynamic. As we consider teaching gerontology to different age cohorts, what similarities and differences do exist? How do the educational needs within higher education differ across the different cohorts of the workforce? This presentation aims to identify and present specific learning needs and styles of the millennial cohort, as compared to other generational cohorts with the effort of building educational strategies for this workforce cohort. The presentation will also address the unique needs that a rural workforce faces and how to address these within the millennial cohort. Strategies such as online learning, flip classroom, experiential strategies and research projects/practicum will be addressed with a specific focus on the engagement of the millennial student. These strategies are all described within the context of teaching gerontology through a specific Certificate in Gerontology program located on a rural campus setting, but meeting the educational needs of people across the country.


Increased survivorship and longevity have resulted in dramatic improvements in life quality for people with significant disabilities and impairments. However, the fields of rehabilitation and gerontology have tended to divide this phenomenon into people aged under 65 aging with lifelong and early onset disabilities, and those aged 65 plus who are aging into late onset disability. But for both groups, increased survivorship also translates into more years living with comorbidities associated with the underlying condition and increased risk for premature onset and higher rates of age-related chronic conditions. Despite these widely acknowledged trends, we have no national data systems that estimate the overall prevalence of the ‘aging with long-term disability’ population and monitor its status. Acknowledged is that the lack of national data and reliance on chronological age undermines our knowledge of the disablement experience across the life course and the needs for services and supports associated with diverse trajectories. Part of a symposium sponsored by the Lifelong Disabilities Interest Group.


Loneliness is a risk factor for poor quality of life among older adults. Social media use provides a new dimension of communication for older adults to connect with people and to maintain social relationships. However, research has been inconclusive about whether social media use reduces loneliness among older adults, which is due in part to a lack of appropriate measures for capturing different types of social media use. Furthermore, little is known about the underlying mechanisms through which social media use is associated with loneliness. This study investigates the association between social media communication with close social ties and loneliness among community-dwelling older adults (65+), and further examines the mediating role of social contact and social support in the association. Data from the 2014 wave of the Health and Retirement Study (HRS) are analyzed to address our research questions . Path analyses are employed to examine the relationships among social media communication with close social ties , frequency of contact with social ties , perceived social support from social ties, and loneliness . The results show that a higher level of social media communication is associated with lower levels of loneliness through social contact and perceived social support. Moreover, the relationship between social media communication and perceived social support is partially mediated by social contact. These findings suggest that social media communication may be considered an intervention that may reduce loneliness among older people.


Dear Editor,JournalRacial disparity in prevalence and incidence of atrial fibrillation (AF) are known to exist While the reported increase in AF prevalence in Thailand is in concordance with the previous projection in Asian countries Notwithstanding, epidemiological data of AF in Asian Pacific region is scare, high quality data similar to that from Suwanwela and colleagues is urgently needed to inform policymakers and clinicians in the allocation of limited health care resources.The 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.


While the use of photographs is an emerging data generation method within phenomenology , research that incorporates photo elicitation to inform the understanding of the lived experience is limited. This presentation will describe the use of photo elicitation within a phenomenological approach to explore the lived experience of older learners in higher education. After an initial interview, six participants aged 50 years and older shared photographs that that they chose to depict experiences of being student at a regional comprehensive university in the Midwest. Photographs served as mode for participant reflection of their experiences and guided a second interview. Interpretative Phenomenological Analysis  with photographs and verbatim transcripts ensued and resulting findings included: complicated sense of belonging and community development and access. Implications for use and analysis of photographs within qualitative research will be discussed.


Globally, people are living longer with the Human Immunodeficiency Virus (HIV) and older individuals are becoming infected. Menopause symptoms affect women’s health and are associated with perceived declines in wellbeing. This study assessed and compared the menopause symptom experience and perceived wellbeing among HIV positive and negative older women in Ibadan Nigeria Focus group discussions were conducted among menopausal women attending the ARV and GOP clinics at the University College Hospital Ibadan. Opinions of discussants on knowledge and experience of menopausal symptoms, perceptions about the menopause and perceived health status were explored. A total of 90 HIV positive and 92 HIV negative women aged between 40 to 60 years were sampled. Knowledge of the cause of menopause was poor, with more HIV positive women opining that sexual promiscuity causes menopause. The majority of the discussants had adequate knowledge of menopausal symptoms with most of them reporting vasomotor and musculoskeletal symptoms. In both groups, perceptions about the menopause were generally positive as most of them opined that the menopause means freedom from sexual activity and child birth. More HIV negative women perceived themselves to be in good health compared to HIV positive women. Menopause induces many of the same metabolic changes that are being observed with HIV infection, and this may affect the health and quality of life of aging women with HIV infection. There’s a need for health education and health promoting interventions that will help these women in coping with the double burden of HIV infection and menopause.


The demographic bulge created by the baby boom generation has shaped American politics since they came of age in the 1960s. Over the next decade, aging issues will become more relevant as the oldest boomers reach 84 and the youngest boomers will be eligible for Medicare. This paper highlights three converging trends that will shape United States politics; including increased spending on “entitlement” programs like Social Security and Medicare, growing mismatch in caregiving need and supply, and the heightened concentration of older adults in certain geographic areas. The next decade will see not only extraordinary demographic change but also unprecedented advances in technology and medicine, and cultural and societal shifts that were once unimaginable.


Studies examining communication during clinical handovers involving paramedics are rare. A recent National Institute of Health Research (NIHR) report has noted a significant gap in our knowledge and understanding of what happens during clinical handovers between ambulance services and emergency departments. This PhD study has used a video analysis to understand issues in communication and teamwork during these clinical handovers by examining cases of good practice.24 Hours in A&E and The Real A&E, was conducted. This methodology emphasised the capturing of real-world practice, without the limitation of semi-structured interviews which are reliant on recall of events. These examples highlighted how interprofessional teamworking and communication were conducted during these high pressured and complex situations. The videos were transcribed verbatim and idiosyncratically to show variances in the style of communication as well as the non-verbal actions used by the staff during the exchange of patient information.A video analysis of 100 examples of handovers from different TV programmes, including The emergent findings demonstrate a variety of interactional strategies that paramedics use when conducting handovers. These strategies often involved a paramedic team member drawing attention to themselves by stating they were ready to do the handover or loudly introducing the patient’s name. This was typically followed by an account of the treatment the paramedic team provided and ended with questions from those receiving the handover. The questions asked by the receiving team would be about the treatment provided and during this exchange the paramedic team would justify the methods used in assisting the patient. When handovers were being taken for high-risk patients, for example ‘haemorrhaging of a femoral artery’, the structure of the handover changed. In such examples, the paramedic team were found to dictate how the receiving team handled continuation of treatment for the patient.The variations in handover examples that have been captured and analysed have been beneficial in understanding the interactions between paramedics and the emergency care team. Initial findings have shown how the structure of communication during handovers can be altered due to situational or contextual factors. These results have highlighted where potential improvements in communication can be made during handovers, which would subsequently increase patient safety and experience.


Journal of Cachexia Sarcopenia and Muscle, we read with great interest the article by Veltkamp et al. “Experimental ischaemic stroke induces transient cardiac atrophy”In the recent issue of the In the present study, the authors investigated cardiac function in mice with experimentally induced acute cerebral ischaemia by middle cerebral artery occlusion (MCAO). Animal models have been well‐established to study pathophysiology of wide range of medical conditions including ischaemic stroke, cancer, cachexia and heart failure.The authors declare that they have no conflict of interests and certify that they comply with the ethical guidelines for authorship and publishing in the Journal of Cachexia, Sarcopenia and Muscle.


Of the many changes to the OAA, the Modernizing Allotments for Vulnerable Elder Rights Protection Activities and Other Programs section included notable changes. This bill specifies that Title VII programs will receive a 7% increase in 2020 and a 6% increase in the following four fiscal years. It extends the Supporting Grandparents Raising Grandchildren Act for an additional year. The reauthorization ensures that ombudsman representatives can be reimbursed for costs incurred through their services. The Act requires that the Government Accountability Office study federal programs for home modification assistance for older adults and individuals with disabilities. The Act directs the Administrator of the Administration for Community Living to continue the 2017 requirement of disseminating and soliciting feedback on the Principles for Person-directed Services and Supports during Serious Illness. This reauthorization updates home and community-based best practices; and elder justice activities, including community outreach and education to bolster community partnerships.


In the appropriate clinical context, bland urine sediment with little cellular activity and primarily hyaline or few finely granular casts suggests AKI is due to a functional decline in GFR from renal hypoperfusionThe utility of a urine sediment score based on RTECs and granular casts was demonstrated in 231 patients with hospital-acquired AKI from either prerenal azotemia or ATI--Urine microscopy can also predict important clinical end points. In the studies described in In this issue of the Brazilian Journal of Nephrology, Goldani and colleagues examine the utility of urine microscopy (urine sediment score based on RTE cells and granular casts) in identifying AKI in patients undergoing cardiac surgeryOne of the major negatives of this study is the low sensitivity of urine microscopy in identifying AKI, a finding noted in other studies. It is likely that a number of AKI patients in this study had prerenal azotemia as the majority of AKI was stage I, which recovered back to baseline in 24 hours. One would expect the urine sediment in these patients to be bland. Identifying these patients and separating those from patients with higher stage or persistent AKI (>48 hours) would have likely improved the sensitivity of the test, but may have reduced specificity.In summary, the authors are to be applauded for performing this study and adding to the literature supporting the continued use of rigorous examination of the spun urine sediment in the evaluation of patient with or at risk for AKI.


This international symposium brings together leading occupational therapy researchers from around the world with a shared focus is on evaluating and improving the driving performance of older adults to decrease their crash risk and facilitate their community participation. In this session, five groups of international scholars will share their collective and individual research outcomes for driving as a means of community mobility. The first presentation will outline their collective international, cross-sectional study of 247 older adults from seven countries where the impact of driving on out-of-home mobility was compared. Each presentation that follows will then present results from innovative studies of ways in which to assess and address fitness to drive in older adulthood. Our discussant will summarize the potential expansion of the current work and engage the audience through interactive questions. Transportation and Aging Interest Group Sponsored Symposium.


Children with intellectual disability are susceptible to poor experiences of care and treatment outcomes, and this may compound existing health inequities. Evidence to date indicates three priority areas that must be addressed in order to reduce these inequities in the safety and quality of care for children with intellectual disability. Firstly, we need reliable methods to identify children with intellectual disability so that healthcare organizations understand their needs. Secondly, we need to develop quality metrics that can assess care quality and unwarranted care variation for children with intellectual disability in hospital. Finally, for a comprehensive understanding of the safety and quality of care for these children, and how to improve, it is critical that healthcare organizations partner with parents/carers and enable children with intellectual disability to voice their experiences of care. Children with intellectual disability have higher healthcare utilization than their peers; yet, their voice is rarely sought to optimize the safety and quality of their healthcare experience. Patient experience narratives enhance our understanding of the genesis of adverse events. By addressing these priorities, children with intellectual disability will be identified, and health services will measure and understand the problematic and beneficial variations in care delivery and can then effectively partner with children and their parents/carers to address the inequities in care quality and create safer healthcare. Children with intellectual disability are susceptible to poorer quality of care than their peers when they are admitted to hospital, and this may compound existing health inequities for this group. To address this, we must identify these children when they access tertiary healthcare, meaningfully measure their quality of care and enable the patient voice to help optimize their healthcare experience.ICD‐10 codes are not reliable for identifying children with intellectual disability when they are admitted to hospital; reliable identification of children with intellectual disability is the first step in understanding where and how clinical variation occurs.Understanding of the patient and system factors underlying unwarranted clinical variation for children with intellectual disability can enable healthcare organizations to adapt care delivery to ensure high‐quality services to meet the needs of the child with intellectual disability.Partnering with these children and their carers to hear their experiences of care will enable healthcare organizations to call attention to and emulate examples of good care quality experiences for these children.1People with intellectual disability have higher rates of health care utilization   with intellectual disability:‘Furthermore, the CYP PREMs are not suitable for CYP with moderate or severe learning disability, and further work is required to develop a PREM that is appropriate for their use in terms of both engaging them and eliciting their views.’  Translational Research Fellowship Scheme [2019–2021] awarded to LM.


There is a growing emphasis on diversity and its impact on health care. Our research has focused on migrants who are Mandarin speaking Chinese and Puerto Rican. Through a series of focus groups conducted in their native languages we discovered that barriers to service access differ across the two groups. In addition, many of these services are administered by individual states rather than the federal government. The diversity across migrant groups and state policies creates a challenge in using findings to establish national or international standards for best practices with older migrants. How then can we apply lessons about diversity and the impact of programs on a national and international scale? We propose the use of Social Interaction Modeling as a method for understanding patterns of behavior at both national and international levels, while preserving the unique character of each migrant group and the context within which they live.


This multi-authored book is the real stimulus for interest in primary care and research. It starts with compelling discussions highlighting the merits and gaps to be addressed only via primary care research. It convinces one of the importance of contextually appropriate evidence for primary care. It further highlights epistemological position that may be unique for this setting, which may allow different methodologies that could have otherwise been applied individually in a different setting to be used to enrich findings.The Matrix cleverly sheds light on different lenses  that researchers can take whilst tackling primary care issues through research. The story also compels one to think harder not to disregard these positions before embarking on primary care research. This is the clever way of capturing graphically the readers into these concepts and I find them difficult to forget.The thoughtful weaving of the storyline in the film The book also dispels wrong assumptions and puts into perspective terminologies that are otherwise used loosely in research. The clear example of this is in chapters 4 and 5 where interdisciplinary approach is differentiated from mixed-methods approach. The examples used in these chapters are compelling and successfully drive the idea of interdisciplinary research home.The book is reader-friendly and practical whilst ensuring important themes of research in primary care are thoroughly explained. Multiple author nature allows the readers to see primary care research from different primary care contextual positions, even so through examples provided to discuss each subject. Although research terminology is used throughout the book, the key is application in the complexity of primary care setting.Another important subject described in this book is quality improvement in primary care, how it contrasts with traditional research and important gaps to be addressed through development of this field. This is an important area for African primary care practitioners whose systems are bugged with challenges requiring leadership in the area of clinical governance.It is also the strength of this book that the chapters are precise and not lengthy to guide individuals through important steps in primary care research. The resource boxes in each chapter are also very useful for individuals who want to learn deeper into certain aspects of their research that needs further reading.I find this book useful, practical and user-friendly. I recommend it as a resource for individuals who are starting their journey in research, especially young primary care researchers, residents and teachers of family medicine.


In the Author Contributions, Catherine Longo should be listed as one of the persons who contributed to Conceptualization and Funding acquisition.The following information is missing from the Funding statement: CL received financial support from the Walton Family Foundation.


This data article presents on the ectoparasites infestation on small mammals in Peninsular Malaysia. The dataset on ectoparasites infestation is important because it raises a major medical concern regarding the spread of potentially zoonotic disease from wildlife to human. Tick and chigger are the primary ectoparasites as reservoirs of vector-borne diseases found on small mammals in Malaysia. These small mammals that are infested with ectoparasites occupy various types of habitats, including human settlements, could be of community health risks as the carriers of potentially zoonotic diseases. Field samplings were conducted from February 2015 to February 2016 in three different ecological habitats of mixed dipterocarp forest, coastal forest and insular forest, in Terengganu, Malaysia. A total of 35 and 22 species of bats and rodents respectively were captured and examined for ectoparasites. Twenty-three species of bats and 16 species of small mammal were recorded as hosts for at least one species of ectoparasites. These findings show that the highest ectoparasite infestation occurred on bat community. Specification Table•The data is useful in providing the information regarding the ectoparasite species composition and the relationship among the ectoparasites with their small mammal hosts.•The data is valuable for further research to determine whether there are any spatial and temporal changes in ectoparasites composition due to ecological disturbances or climate change.•The data on the occurrence of the ectoparasite-vector are useful in epidemiology study to predict the potential of presence of the zoonotic disease in the studied area.•The data also provide information on the interaction of ectoparasites and small mammal hosts in term of the degree of the specificity and distribution of each ectoparasites species.•The data is vital for the community health and wildlife authorities to monitor the host populations near rural villages and forest edges that maybe the cause of zoonotic diseases spillover.1Systematic field samplings were conducted in three different habitats that are mixed dipterocarp forest, coastal forest and insular forest of Terengganu from February 2015 to February 2016. 2Field samplings on small mammals were conducted in three different habitats in Terengganu including the mixed dipterocarp forest, coastal forest and insular forest off coast islands from February 2015 until February 2016. The description of these habitats has been described by A fine tooth-comb was used to remove all the ectoparasite that attached on the host animal coat. Ectoparasite dropped during combing were collected by using the wet sharpen applicator stick and preserved in the collecting vials containing 70 % ethanol separately for each host small mammals. The vials were labelled with sufficient information and brought back to the laboratory for species identification. The ectoparasites were prepared for mounting on slide and identified according to their taxonomic groups which are mesotigmatid mite ,10, chig


A specific feature in the Finnish pension system is rule-based preparation for mortality change. The earned pension capital is adjusted to life expectancy and the lowest age limit of the flexible retirement age will be adapted so that the ratio of expected years in employment and retirement is fixed after year 2030.


Increases in the numbers of older adults with mental health and substance use concerns compel us to identify best practices in training to address these issues. Senior Centers are an ideal location for behavioral health education programs as they are the go-to place for many older adults. This session will describe a program funded by The Retirement Research Foundation and offered in collaboration with Center for Aging and Disability Education and Research at Boston University and NCOA to increase senior center staff knowledge and skills. Approximately 250 senior center staff in Illinois, Florida, and Wisconsin completed an online certificate in Behavioral Health and Aging. Results show that 100% of respondents felt that the training was useful for their job; 93% felt that they will be a more effective worker as a result of the training; and 97% felt that the information they learned in the training will make a difference with the people they serve. We held key informant interviews to assess the impact of training and participants stated that their knowledge, skills, and behaviors were influenced by the program. At the organizational level, leaders reported new programming related to behavioral health and revised practices and protocols. This presentation will cover: (1) the extent to which training participants mastered the competencies needed for effective practice; (2) knowledge and skills gained from the training program; (3) Senior Centers’ capacity to identify and refer older adults to mental health services; and (4) organizational changes related to behavioral health programming with older adults.


Biological membranes consist of lipid bilayer matrices enriched with integral membrane proteins and membrane-associated proteins. They not only define cells and cell organelles but also represent the main contact area for intercellular communication, for which membrane transport and signaling are indispensable. Because of their high physiological importance and unique physical and chemical properties, biological membranes have been intensively studied for over 100 years, and membrane physiology remains a flourishing and lively research field. Recent years have witnessed great progress in our understanding of the biophysical basis of membrane transport and its role in generating biological electricity and controlling the intracellular milieu. The workings of ion channels and transporters are understood in a degree of detail that was unimaginable when many of us started our scientific careers. Protein sequences and three-dimensional structures are now available for almost every major ion channel and transporter family  allow us to define protein ecosystems  for each membrane channel/transporter. Advanced cell culture methodologies also allow us to observe ion transport in intracellular organelles, and techniques are available to study signaling in almost every living cell or organ. Moreover, animal models permit studying the impact of changes in transport protein function or expression on cells and organs, and on the coordinated functions of an intact body.Frontiers in Physiology – Membrane Physiology and Membrane Biophysics will assist in these development by provide a platform for reporting and discussing novel results  with the ultimate aim of correcting membrane transport and organ function and developing hybrid devices that utilize membrane transport protein to link living cells with technical devices.The collaboration between scientists using different approaches and experimental systems will lead to a comprehensive and quantitative description of membrane function at the molecular, cellular, and systemic level in both health and disease in the near future. 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.


Dear Editor,Colonoscopy is a technically difficult procedure due to mobility and tortuous anatomy of the colon. It becomes more challenging in women because of deeper transverse colon and a broad pelvis. This challenge further deepens in patients with prior history of a hysterectomy because of multiple adhesions formation leading to acute angulation of sigmoid colon as well as the bowel dipping deeper into the pelvis.2The rate of moderate or severe discomfort varies significantly between women who had undergone a hysterectomy and those who had not. Mild discomfort was noticed in women without a hysterectomy and moderate to severe discomfort was noticed in women with a hysterectomy.3A meta-analysis by Clancy et al highlighted that colonoscopy completion rate appeared to be decreased in women with a history of hysterectomy in comparison to women without it.However, despite these maneuvers if endoscopists still find difficulty in negotiating the scope further in lumen together with increased patient discomfort, the procedure should be abandoned and the patient must get referred to a more experienced colonoscopist at a high volume center. Pre-procedure counselling with the patient explaining the above points is imperative.LK: Conceived the idea and did final editing and review of manuscript and approval.NB: Review of literature and revision of manuscriptHK: Writing of first draft of manuscript and review of literature