Enhancing Dementia Knowledge and Self-Efficacy of In-Home Supportive Services Caregivers Through Online Training

California's In-Home Supportive Services (IHSS) program provides vital home care to low-income consumers, some of whom live with Alzheimer's disease or related dementias (ADRD). Yet, most IHSS caregivers receive little or no training in dementia care. We present preliminary descriptive results of the IHSS + ADRD Training Project, a 10-week, competency-based, dementia training program, delivered online, for IHSS caregivers, in Alameda County. Increase in dementia knowledge and self-efficacy at training completion supports the importance of continuing and expanding this work.

THE IHSS+ ADRD TRAINING PROJECT: BOLSTERING THE DEMENTIA CARE WORKFORCE IN CALIFORNIA

California’s In-Home Supportive Services (IHSS) program provides vital home care to low-income consumers, some of whom live with Alzheimer’s disease or related dementias (ADRD). Yet, most IHSS caregivers receive little or no training in dementia care. With the prevalence of ADRD among Californians age 55+ projected to increase 127% by 2040, reaching over 1.5 million people, the IHSS consumer population living with ADRD will likely increase at a similar rate, exacerbating the need for dementia-trained home care workers. This poster describes preliminary outcomes of the IHSS+ ADRD Training Project, a 10-week, competency-based training program, aiming to reach 600 IHSS caregivers in Alameda County, California, by 2024. All planned in-person activities switched to virtual strategies due to the COVID-19 pandemic. To date, 348 IHSS caregivers have been trained through 16 classes, with 9 classes offered in English, 3 classes in Spanish, and 4 classes in Cantonese. A quasi-experimental, longitudinal design was used to evaluate the project’s impact through pre, post, and 3-month follow-up surveys. Caregiver outcome measures included the: 1) Dementia Knowledge Assessment Tool 2, 2) Fortinsky self-efficacy scale, 3) Caregiver Self-Assessment Questionnaire, and 4) Patient Health Questionnaire-2. Preliminary outcomes trend toward significant increases in caregivers’ knowledge about ADRD and self-efficacy to maximize care they provide to consumers. While caregivers also reported slight increases in stress and depression, they expressed high levels of satisfaction with the training. Future analysis will include comparing IHSS caregiver outcomes to healthcare utilization patterns of IHSS consumers before and after their caregiver’s participation in the training.

Implementing a Community-Based Collaborative Project During the COVID-19 Pandemic: A Process Evaluation

In-Home Supportive Services (IHSS) caregivers are critical linchpins in our long-term care system, but little research exists to examine the strategies for enhancing their role working in the homes of persons living with dementia (PLWD). The aim of the IHSS+ Alzheimer’s Disease and Related Dementias Training Project (IHSS+ ADRD Training Project) is to implement a competency-based dementia training program for 600 IHSS caregivers and their consumers; and evaluate the training program’s impact on caregiving, long-term services and supports, and health systems. This project is a partnership between the University of California, San Francisco, Institute for Health & Aging; Center for Caregiver Advancement, a nonprofit organization founded by home care workers; and Alameda Alliance for Health, a non-profit managed care plan created by and for residents of Alameda County, California. The research design and funding of the project was established just prior to the COVID-19 pandemic. As the pandemic evolved, the IHSS+ ADRD Training Project underwent many revisions and pivoted to remote strategies to ensure progress could be made toward the aims. This poster describes a process evaluation of how various challenges were addressed and subsequent changes were made to the methodology. Using a community-based participatory research and program evaluation hybrid model, this project remained nimble, configuring an online dementia training program and evaluation methods that accommodated safety needs of community partners. Benefits and limitations of implementing the IHSS+ ADRD Training Project, using remote strategies, to ensure IHSS caregivers and their consumers could continue receiving education and support, are highlighted.

Competency-based training for in-home supportive services providers of consumers with ADRD

The In-Home Supportive Services (IHSS) program in California provides direct care for low-income seniors and people with disabilities. Yet, the vast majority of these workers receive little to no training in caring for consumers, especially those with Alzheimer's disease and related dementias (ADRD). We developed and implemented a competency-based training program for IHSS caregivers who provide care for persons with ADRD. The 10-week, 35-hour program consisted of training modules with topics ranging from roles and rights of the care recipient to assisting with personal hygiene, with a focus on managing ADRD-related behaviors. The in-person training was delivered in English and Spanish to two cohorts of 30 IHSS workers each. Fifty-seven participants completed the training program; the majority in both trainings were female (79%) and self-identified as Latina (70%). There were statistically significant gains post-intervention in overall confidence in caregiving skills and knowledge among all participants.

Mixed glioneuronal tumour of the fourth ventricle with prominent rosette formation

We describe three unusual tumours characterized by a mixture of glial and neuronal differentiation, involvement of the posterior fossa and formation of rosettes. Mixed glial-neuronal tumours of the posterior fossa are rare and poorly described neoplasms. However, several distinctive entities have appeared in the literature over recent years under a variety of different names. Our cases demonstrate the morphological features of the 'rosette-forming glioneuronal tumour of the fourth ventricle', a recently identified tumour characterised by its unique location, neurocytic pseudo-rosette formation and the presence of a low grade astrocytoma component. The long term prognosis of these tumours remains unclear. However, the clinical data available including the cases presented here, along with the histological features, suggest that these are low grade tumours with a good prognosis after surgical resection.

Reversal of donor myocardial dysfunction by triiodothyronine replacement therapy

Triiodothyronine deficiency after brain death can result in progressive deterioration of cardiac function in potential organ donors. We report on the use of triiodothyronine replacement in improving myocardial function, allowing the use of donor hearts that might have been considered unsuitable for transplantation. From July to September 1992, of 24 organ procurements and transplantations, six donors were receiving high doses of inotropes with elevated left-sided filling pressures. Donor characteristics were as follows: five were male donors and one was a female donor, with mean age 16.50 +/- 7.50 years (8 to 30 years), mean weight 49.17 +/- 13.64 kg (25 to 63 kg), average time from clinical brain death to procurement 94.50 +/- 73.53 hours (49 to 240 hours), and two donors had arrest periods of up to 10 minutes. Despite large inotrope infusions, echocardiograms showed depressed left ventricular function (mean ejection fraction 39.17 +/- 5.85) and hemodynamic instability was present with elevated ventricular filling pressures. Triiodothyronine replacement (maximal dose 0.6 microgram/kg) was initiated an average of 139.17 +/- 32.00 minutes (115 to 185 minutes) before procurement. At the time of procurement, ventricular filling pressures were lower, hemodynamic condition stabilized, and pressor requirements decreased. Hearts were preserved in University of Wisconsin solution with a mean ischemic time of 188.83 +/- 36.86 minutes (149 to 237 minutes).(ABSTRACT TRUNCATED AT 250 WORDS)

Studies of the initiation of myelination by Schwann cells

The rapid morphologic changes in Schwann cells and in their relationships to axons during the transition from the premyelinating to the myelinating state have been known for more than 15 years. The sorting of axons by dividing Schwann cells, the establishment of a 1:1 relationship between a postmitotic Schwann cell, and the onset of myelin sheath formation have all been described in detail. However, the chain of molecular events and mechanisms by which these morphologic changes are regulated has not been elucidated. In this chapter we have reviewed results that strongly suggest that the adhesion molecule L1 is one of the important determinants that mediate the elongation of the Schwann cell along the axon, and the extension of Schwann processes to engulf axons. Thus, L1 functions to promote the spreading of the Schwann cell process over the surface of the axon. L1 does not appear to be exclusively involved in the adhesion of Schwann cells to axons, in the activation of Schwann cell proliferation by axons, or in the induction of synthesis of extracellular matrix proteins. The results from the anti-L1 blocking experiments further provided clues for an understanding of how the expression of GalC and MAG, which are both likely to be involved in the initiation of myelination, are regulated. These results imply that the overall regulation of expression of these early myelin components could require controls other than a single signaling mechanism derived from contact with axons. We propose that the deposition of basal lamina or one of its components could also be involved. Finally, the results from anti-GalC-blocking experiments indicated that GalC is involved in the mechanism of early growth of the myelin spiral.

Production of parathyroid hormone-related protein by a rat parathyroid cell line

Parathyroid hormone-related protein (PTHrP), the peptide associated with humoral hypercalcemia of malignancy, has been identified in fetal and adult parathyroid glands. We here report a sub-clone of a rat parathyroid cell line which secretes a single peptide species corresponding in size to PTHrP(1-84). Biological activity of the secretion product was blocked by a specific antiserum against PTHrP, but not by parathyroid hormone (PTH) antiserum. Secretion of PTHrP by these cells was regulated by extracellular calcium in the physiological range. A single messenger RNA species for PTHrP was identified, though PTH mRNA could not be shown in these cells. Hybrid CAT genes containing 700-1000 bp of 5'-flanking DNA from the human PTH or PTHrP genes were transfected into these cells, and the PTHrP gene was expressed at 10-fold higher levels than the PTH gene. These cells thus provide a valuable model system for investigation expression of PTHrP in a non-transformed cell line.

Thought for Food: Suggestions for a systematised approach to emergency food distribution operations

The following paper is a synopsis of a longer report, under the same name, aimed at the people responsible for implementing relief food operations. The report attempts to fill a perceived need for a manual covering the organisation of relief operations from planning to evaluation stages. Following the initial planning phase, the distribution of relief food can be viewed as a logistics operation sandwiched between two phases of data acquisition - one before the distribution of relief to targetted destinations, and the other after the distribution, to assess its efficacy and to identify problems.

Antithymocyte gamma globulin, low-dosage cyclosporine, and tapering steroids as an immunosuppressive regimen to avoid early kidney failure in heart transplantation

Cyclosporine is a powerful immunosuppressive agent that unfortunately has significant renal toxicity. Two risk factors associated with a high incidence of kidney failure in patients receiving cyclosporine have been described in the literature. In an effort to decrease the possibility of renal toxicity with the use of cyclosporine, we use low-dosage cyclosporine, antithymocyte gamma globulin, and tapering dosages of steroids as an immunosuppressive regimen. Twenty-one patients had orthotopic heart transplants from January 1985 to January 1986. Sixteen of 21 patients or 70% had at least one high risk factor for kidney failure. There were no episodes of acute kidney failure, and the blood urea nitrogen and creatinine levels that were recorded over an average of 8.5 months per patient did not increase significantly from preoperative values. Seventeen of 21 or 81% of the patients are alive and functioning fully. The incidence of rejection per patient was 0.9, and there were no biopsy-proven severe rejections. One patient died at 5 months; the autopsy showed generalized moderate rejection. There were 0.24 episodes of infection per patient, with one patient who died from Pneumocystis pneumonia. With this immunosuppression protocol, early postoperative kidney dysfunction was avoided. The incidences of rejection and infection were within acceptable range, and the quality of life in the 17 survivors is excellent.

Influence of anti-oestrogens on gonadotrophin secretion in control and ACTH-infused immature rats

The objective of this study was to determine whether anti-oestrogens (nafoxidine, MER-25) would block the suppressive effects of ACTH on gonadotrophin secretion in immature rats. Female rats were castrated at 25-26 days of age, and an Alzet osmotic minipump containing ACTH (1-24) or saline was implanted in each animal. ACTH was administered at a rate of 1 IU/day by constant infusion. Beginning on the day of surgery, animals were injected daily for 5 days with 0.25, 5 or 25 micrograms/100 g body weight of nafoxidine or 5 mg MER-25 and sacrificed on the sixth day following castration. ACTH lowered serum LH concentrations and increased pituitary LH levels. Serum androstenedione concentrations were more than two times greater in ACTH-infused than in control rats, but serum oestrone levels were not affected. Serum testosterone and oestradiol concentrations in ACTH-infused rats remained below levels of detection. Administration of 0.25 micrograms of nafoxidine prevented the suppressive effects of ACTH on serum LH. Serum levels of LH in these animals were comparable to saline-treated controls (418 +/- 94 vs 443 +/- 73 ng/ml). The two higher doses of nafoxidine and MER-25 were ineffective in suppressing the actions of ACTH on serum LH. MER-25 reduced serum LH values in both controls and ACTH-infused rats. Serum FSH concentrations were not altered by ACTH or nafoxidine treatment. MER-25 elevated pituitary FSH concentrations in both control and ACTH-infused rats.(ABSTRACT TRUNCATED AT 250 WORDS)

Characteristics of pectate lyase formation by Hypomyces solani f. sp. cucurbitae

Pectate lyase, produced by Hypomyces (Fusarium) solani f. sp. cucurbitae, is considered a normal extracellular enzyme in that most of the enzyme was found in the culture medium during early stages of enzyme production and before extensive lysis. This enzyme was produced during active growth in the presence of citrus pectate but not citrus pectin. Enzyme yield was highest when the initial pH of the medium was between 5.5 and 7.5 and the temperature was between 25 and 29 C. Production of the enzyme was reduced when individual amino acids or inorganic N-sources were substituted for casein hydrolyzates. Glucose repressed enzyme formation when it exceeded 0.025%, while arabinose and xylose had little effect or stimulated greater production at 0.1%. Pectate lyase yield varied considerably, depending on fungus strain and inoculum level used. A delay in enzyme formation was reduced substantially when small amounts of agar were present in the liquid medium or the medium was solidified with agar.