Increasing Older Adults' Social Connectedness: Development and Implementation of a Web-Assisted Acceptance and Commitment Therapy-Based Intervention

In this article, we will provide a rationale for a web-assisted acceptance and commitment therapy (ACT) approach to loneliness among older adults, drawing upon theories from the literature on adult development and aging, emotion regulation, and loneliness. The intervention program was developed using the principles of ACT, which is a cognitive behavioral approach and unified model of human behavior change and psychological growth. The ACT intervention focuses on developing nonjudgmental present-focused awareness of internal experiences (thoughts, emotions, and memories) through strategies such as acceptance and mindfulness rather than directly modifying or removing them per se. The ACT intervention appears well-suited to assist older adults in coping with the challenges of aging, as the focus is on an individual’s willingness to sit with internal experiences out of one’s control (ie, acceptance), stepping back from negative or critical thoughts and developing greater kindness toward oneself (ie, defusion), discerning what is most important to one’s true self (ie, values), and building larger patterns of effective action based on such values (ie, committed action). The ACT intervention was developed as a resource for older adults who are socially isolated or having difficulty with social connectedness. Eight modules comprise the web-assisted ACT intervention program, which includes reading materials, video clips, and activities. Each module is followed by a summary, a homework assignment, a short quiz to assess learning, and a moderated discussion with a coach. The intervention program begins with reconnecting participants with their values. The goal of the ACT intervention program is to foster flexibility in a participant’s behavior so they can behave consistently with their chosen values, rather than becoming locked into a pattern of behavior that is driven by avoiding distress or discomfort. The ACT intervention approach is both novel and innovative, as it is based on ACT and leverages a behavioral health web platform that is flexible and inclusive in its design. The ACT intervention aims to help older adults become more socially connected, less lonely, and more satisfied with their relationships with other people. The emphasis that ACT places on values and living life in accordance with one’s values renders it an approach ideally suited to older adults. Finally, recommendations for future research regarding this approach to addressing loneliness among older adults is addressed.

Spin polarized electron dynamics enhance water splitting efficiency by yttrium iron garnet photoanodes: a new platform for spin selective photocatalysis

This work presents a spectroscopic and photocatalytic comparison of water splitting using yttrium iron garnet (Y3Fe5O12, YIG) and hematite (α-Fe2O3) photoanodes. Despite similar electronic structures, YIG significantly outperforms widely studied hematite, displaying more than an order of magnitude increase in photocurrent density. Probing the charge and spin dynamics by ultrafast, surface-sensitive XUV spectroscopy reveals that the enhanced performance arises from (1) reduced polaron formation in YIG compared to hematite and (2) an intrinsic spin polarization of catalytic photocurrents in YIG. Ultrafast XUV measurements show a reduction in the formation of surface electron polarons compared to hematite due to site-dependent electron-phonon coupling. This leads to spin polarized photocurrents in YIG where efficient charge separation occurs on the Td sub-lattice compared to fast trapping and electron/hole pair recombination on the Oh sub-lattice. These lattice-dependent dynamics result in a long-lived spin aligned hole population at the YIG surface, which is directly observed using XUV magnetic circular dichroism. Comparison of the Fe M2,3 and O L1-edges show that spin aligned holes are hybridized between O 2p and Fe 3d valence band states, and these holes are responsible for highly efficient, spin selective water oxidation by YIG. Together, these results point to YIG as a new platform for highly efficient, spin selective photocatalysis.

Structural degeneracy and formation of crystallographic domains in epitaxial LaFeO3 films revealed by machine-learning assisted 4D-STEM

Structural domains and domain walls, inherent in single crystalline perovskite oxides, can significantly influence the properties of the material and therefore must be considered as a vital part of the design of the epitaxial oxide thin films. We employ 4D-STEM combined with machine learning (ML) to comprehensively characterize domain structures at both high spatial resolution and over a significant spatial extent. Using orthorhombic LaFeO3 as a model system, we explore the application of unsupervised and supervised ML in domain mapping, which demonstrates robustness against experiment uncertainties. The results reveal the consequential formation of multiple domains due to the structural degeneracy when LaFeO3 film is grown on cubic SrTiO3. In situ annealing of the film shows the mechanism of domain coarsening that potentially links to phase transition of LaFeO3 at high temperatures. Moreover, synthesis of LaFeO3 on DyScO3 illustrates that a less symmetric orthorhombic substrate inhibits the formation of domain walls, thereby contributing to the mitigation of structural degeneracy. High fidelity of our approach also highlights the potential for the domain mapping of other complicated materials and thin films.

The intergenerational transmission of economic adversity, BMI, and emotional distress from adolescence to middle adulthood

The present study examined the intergenerational transmission of economic adversity, as well as physical and mental health across generations. Specifically, we examined the effects of parental economic adversity, body mass index (BMI), and emotional distress during the child's adolescence on their economic adversity, BMI, and emotional distress in middle adulthood. The study included 366 Generation 1 (G1) mothers and fathers and their adolescents (Generation 2; G2) in middle adulthood. G1 behavior was examined when G2 was 16 years old and G2 behavior was assessed at Age 42. In line with aspects of the family stress model, economic hardship was related to economic pressure, which in turn was related to emotional distress for both G1 and G2. For each generation, economic pressure was also associated with BMI. There was also evidence of the intergenerational transmission of economic hardship, BMI, and emotional distress from G1 to G2. Finally, the intergenerational transmission of economic adversity in the family of origin to adult health outcomes was explained by these same health behaviors of the first generation. Results suggest that economic adversity and parental health behaviors as experienced in adolescence have long-term economic and health consequences into middle adulthood. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

The effects of dental hygiene instrument handles on muscle activity production

OBJECTIVE

The objective of this study was to compare the effects of 10 commercially available instrument handle designs' mass and diameter on forearm muscle activity during a simulated periodontal scaling experience.

METHODS

A convenience sample of 25 registered dental hygienists was recruited for this IRB-approved study. Ten commercially available instruments were categorized into four groups based on their masses and diameters: large diameter/light mass, small diameter/light mass, large diameter/heavy mass and small diameter/heavy mass. Participants were randomized to four instruments, one from each group. Participants scaled with each instrument in a simulated oral environment while muscle activity was collected using surface electromyography. Muscle activity was compared among the four instrument group types.

RESULTS

Muscle activity of the flexor digitorum superficialis was not significantly influenced by instrument mass (p = 0.60) or diameter (p = 0.15). Flexor pollicis longus muscle activity was not significantly influenced by instrument mass (p = 0.81); diameter had a significant effect (p = 0.001), with smaller diameter instruments producing more muscle activity. For the extensor digitorum communis and extensor carpi radialis brevis, instrument mass did not significantly affect muscle activity (p = 0.64, p = 0.43), while diameter narrowly failed to reach significance for both muscles (p = 0.08, p = 0.08); muscle activity for both muscles increased with smaller diameter instruments.

CONCLUSION

Results from this study indicate instrument diameter is more influential than mass on muscle activity generation; small diameter instruments increased muscle activity generation when compared to large diameter instruments. Future research in real-world settings is needed to determine the clinical impact of these findings.

Effects of a brief self-compassion intervention for college students with impostor phenomenon

The present study used a latent growth curve modeling approach to (a) examine the effectiveness of a brief self-compassion intervention on reducing impostor phenomenon, maladaptive perfectionism, and psychological distress and (b) explore who would benefit more from this intervention. A total of 227 college students at a large Midwest university were randomly assigned to participate in either a 4-week brief self-compassion intervention group or a nonintervention control group. Analyses of the effectiveness of the intervention suggested the brief self-compassion intervention had significant treatment effects for reducing impostor phenomenon and maladaptive perfectionism. Moreover, this study also examined whether participants with different levels of fear of self-compassion and core self-evaluation would report different levels of treatment effectiveness. Fear of self-compassion was found to be a significant moderator of the intervention effects in reducing maladaptive perfectionism and psychological distress. Specifically, participants in the intervention group with higher levels of fear of self-compassion reported a greater decline in both maladaptive perfectionism and psychological distress over time when compared to those with lower levels of fear of self-compassion. Core self-evaluation significantly moderated the effectiveness of this intervention in reducing participants' levels of impostor phenomenon and maladaptive perfectionism. Specifically, participants in the intervention group with lower core self-evaluation reported a greater reduction in maladaptive perfectionism over time when compared to those with higher core self-evaluation. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Complete genome sequence of phi29-like Microbacterium foliorum podovirus phage PineapplePizza

Bacteriophage PineapplePizza is a podovirus infecting Microbacterium foliorum NRRL B-24224. The genome is 16,662 bp long and contains 23 predicted protein-coding genes. Interestingly, PineapplePizza shows amino acid similarities to well-studied Bacillus subtilis phage phi29.

The Effects of Dental Hygiene Instrument Handles on Muscle Activity Production

Purpose The objective of this study was to compare the effects of ten commercially available instrument handle designs' mass and diameter on forearm muscle activity during a simulated periodontal scaling experience.Methods A convenience sample of 25 registered dental hygienists were recruited for this IRB-approved study. Ten commercially available instruments were categorized into four groups based on their masses and diameters: large diameter/light mass, small diameter/light mass, large diameter/heavy mass, and small diameter/heavy mass. Participants were randomized to four instruments with one from each group. Participants scaled with each instrument in a simulated oral environment while muscle activity was collected using surface electromyography. Muscle activity was compared among the four instrument group types.Results Muscle activity of the flexor digitorum superficialis was not significantly influenced by instrument mass (p=0.60) or diameter (p=0.15). Flexor pollicis longus muscle activity was not significantly influenced by instrument mass (p=0.81); diameter had a significant effect (p=0.001) with smaller diameter instruments producing more muscle activity. For the extensor digitorum communis and extensor carpi radialis brevis, instrument mass did not significantly affect muscle activity (p=0.64, p=0.43), while diameter narrowly failed to reach significance for both muscles (p=0.08, p=0.08); muscle activity for both muscles increased with smaller diameter instruments.Conclusion Results from this study indicate instrument diameter is more influential than mass on muscle activity generation; small diameter instruments increased muscle activity generation when compared to large diameter instruments. Future research in real-world settings is needed to determine the clinical impact of these findings.

Strong on-Chip Microwave Photon-Magnon Coupling Using Ultralow-Damping Epitaxial Y3Fe5O12 Films at 2 K

Y₃Fe₅O₁₂ is arguably the best magnetic material for magnonic quantum information science (QIS) because of its extremely low damping. We report ultralow damping at 2 K in epitaxial Y₃Fe₅O₁₂ thin films grown on a diamagnetic Y₃Sc₂Ga₃O₁₂ substrate that contains no rare-earth elements. Using these ultralow damping YIG films, we demonstrate for the first time strong coupling between magnons in patterned YIG thin films and microwave photons in a superconducting Nb resonator. This result paves the road toward scalable hybrid quantum systems that integrate superconducting microwave resonators, YIG film magnon conduits, and superconducting qubits into on-chip QIS devices.

Older Adults’ Experiences in a Web-Based Intervention for Loneliness

Background: Older adults may be vulnerable to loneliness due to natural and age-related transitions. Lonely older adults are at an increased risk of adverse health outcomes due to their loneliness, including cognitive decline, cardiovascular disease, and mortality. Objective: The purpose of this study was to explore the experiences of vulnerable older adults in a web-based loneliness intervention. Methods: Older adult participants in a web-based loneliness intervention (n = 24) participated in semi-structured interviews eliciting feedback about their experience in the program and perceived outcomes. Participants’ responses were analyzed using qualitative content analysis. Results: Participants reported fewer negative perceptions of their social skills and future social interactions, gaining new social skills, improved relationships, and increased confidence to initiate and maintain social contact. Conclusions: Findings suggest the efficacy of combining a web-based loneliness intervention with cognitive behavioral therapy, and provide implications for future web-based interventions for older adult populations.

Diversity in Social Communication and Support: Implications for Loneliness Among LGB Adults

BACKGROUND AND OBJECTIVES

Current research indicates that structural and functional social network attributes influence older adults' well-being. However, these linkages may vary by sexual orientation. This study examines how social communication diversity and support diversity are related to loneliness and differ between lesbian, gay, and bisexual (LGB) and heterosexual adults.

RESEARCH DESIGN AND METHODS

Using data from the American Association of Retired Persons Foundation's Loneliness and Social Connection Survey of adults 45+ (N = 3,009), including 10% who identified as LGB, we derive entropy scores, which capture the extent to which network size and quality of relationships are evenly distributed. A series of linear regressions were conducted to examine sexual orientation, social network indicators, and their interactions in predicting loneliness.

RESULTS

We found a positive association between social communication diversity and loneliness. This finding was qualified by the interaction with sexual orientation. In addition, we found a negative association between support diversity and loneliness, an effect that was stronger for LGB participants than for heterosexual participants. The effect of support diversity on loneliness was much stronger for LGB adults than heterosexual adults.

DISCUSSION AND IMPLICATIONS

While LGB adults tend to score higher on the loneliness scale overall, the findings suggest that communication and support diversity have uniquely different patterns of associations for sexual minority groups. This study highlights the importance of considering multiple dimensions of social networks and has implications for addressing loneliness for heterosexual and LGB adults.

Detection of atrial fibrillation in patients with cryptogenic stroke: The Nordic Atrial Fibrillation and Stroke (NOR-FIB) study - topline results

Funding Acknowledgements

Type of funding sources: Other. Main funding source(s): NOR-FIB is an investigator driven academic study. 100 of 259 devices are supported by Medtronic.

BRT and ATL are recipients of a PhD grants from the South-Eastern Norway Regional Health Authority.

The study is supported by the research infrastructure of the European Cerebrovascular Research Infrastructure (ECRI).

Background

Cardioembolism due to occult atrial fibrillation (AF) is one of the common causes often identified by additional investigations in patients with cryptogenic stroke (CS). A large proportion of recurrent cerebral infarctions caused by AF can probably be prevented if more patients receive optimal cardiac monitoring after CS and TIA.

Purpose

The aim of the prospective observational multi-center NOR-FIB study was to detect and quantify AF in patients with cryptogenic stroke or TIA under continuous 12 months cardiac rhythm monitoring with an implantable cardiac monitor (ICM) and to possibly identify biomarkers predicting incident AF.

Methods

Patients with cryptogenic stroke and TIA diagnosed after state-of-the-art work-up had their ICM implanted by a stroke physician within 14 days after symptom onset. All patients were followed clinically and by rhythm monitoring for 12 months. AF was defined by detected atrial arrhythmia episodes ≥ 2 min, and these patients were considered for a change of their secondary prevention from antiplatelet drugs to oral anticoagulants (OAC).

Results

A total of 259 patients with cryptogenic stroke or TIA from 18 hospitals in Norway, Sweden and Denmark were included. After 12 months follow-up 74 (28.6 %) patients were diagnosed with paroxysmal AF, of which 91.9% were asymptomatic. Patients with AF had significantly higher mean age (72.6 vs 62.2, p<0.001), more severe stroke (median National Institute Stroke Scale Score on admission 2 vs 1, p 0.002) and higher pre-stroke median CHA2DS2-VASc score (3 vs 2, p<0.001) than patients without AF. Both hypertension and hyperlipidemia was more common in patients with AF. In 64 (86.5%) cases AF was detected early after index stroke, i.e., within the first two months of monitoring (mean 47.7 days + 52,1). Recurrent AF episodes were detected in 68 (91.9%) cases. Of the 74 AF patients, 72 (97.3%) were switched to OAC. Recurrent strokes during follow-up occurred in 2 AF patients (2.7 %) and in 9 non-AF patients (4.9 %).

Conclusion

AF was detected in 29% of all cryptogenic stroke/TIA patients. Most of the patients were asymptomatic for their arrhythmia, and would have gone undiagnosed without a continuous monitoring approach. Since most of the patients with detected AF were switched to OAC, the 12 months risk of recurrent stroke in this group was low. Prolonged cardiac rhythm monitoring with ICMs is an effective tool for diagnosing underlying asymptomatic AF in a patient population typically confined to a stroke unit.

652 Fate of The Contralateral Limb Following Major Lower Limb Amputation in Patients with Peripheral Arterial Disease And/Or Diabetes: Case Series from Two Regional Vascular Centres

Introduction

This is the first clinical case series to report time to ulceration, minor and major amputation of the contralateral limb (CLL) in the first 12 months following major lower limb amputation (LLA) in patients with peripheral arterial disease (PAD) and/or diabetes.

Method

Consecutive patient samples at two regional UK vascular centres were included; from 2010 to 2017 (site 1) and 2014 to 2016 (site 2). Data were extracted from electronic records for 12 months following index major LLA. Survival analyses are presented for the event of mortality in the total study population, plus major amputation-free survival, and complication-free survival in site 1 only; results are stratified by diabetes status.

Results

Of 381 patients reviewed (n = 197 site 1; n = 184 site 2), 208 (54.6%) were diagnosed with diabetes at the time of their index major LLA. The mean survival time of patients was lower in those without diabetes (HR: 0.64 [95% CI, 0.43 to 0.95], p=.03). The mean time to major amputation of the CLL or death in patients was lower in those without diabetes (HR: 0.65 [95% CI, 224 0.40 to 1.06]; p=.08). The median time to any complication of the CLL or death was greater in those without diabetes (HR: 1.25 [95% CI, 227 0.88 to 1.78]; p=.21).

Conclusions

Death rates were higher in patients without diabetes, whilst those with diabetes had high levels of CLL complications. Optimisation of care to protect the CLL following major LLA and guidance for carers, patients, and clinicians is required.

Reducing loneliness and improving well-being among older adults with animatronic pets

BACKGROUND

Studies consistently demonstrate that older adults who are lonely have higher rates of depression and increased mortality risk. Pet ownership may be a solution for loneliness; however, challenges related to pet ownership exist for older adults. Therefore, researchers and practitioners are examining the use of animatronic pets to reduce loneliness.

OBJECTIVE

To determine the feasibility of an animatronic pet program, and whether ownership of animatronic pets would decrease loneliness and improve well-being among lonely older adults.

METHODS

Eligible individuals were identified as lonely through a prior survey. Participants were provided with the choice of an animatronic pet and completed T1/T2/T3 surveys.

RESULTS

Attrition was high; 168 (63%) participants completed T1/T2 surveys, and 125 (48%) also completed a T3 survey. Post survey data indicated that loneliness decreased, while mental well-being, resilience, and purpose in life improved. Frequent interactions with the pets were associated with greater improvement in mental well-being and optimism.

CONCLUSIONS

Animatronic pets appear to provide benefits for the well-being of lonely older adults. Future studies should employ randomized controlled designs examining the impact of animatronic pets.

Mixed methods process evaluation of my breathing matters, a digital intervention to support self-management of asthma

This study aimed to explore user engagement with 'My Breathing Matters', a digital self-management intervention for asthma, and identify factors that may influence engagement. In a mixed methods design, adults with asthma allocated to the intervention arm of a feasibility trial (n = 44) participated in semi-structured interviews (n = 18) and a satisfaction questionnaire (n = 36) to explore their views and experiences of the intervention. Usage data highlighted that key intervention content was delivered to most users. The majority of questionnaire respondents (78%; n = 28) reported they would recommend the intervention to friends and family. Interviewees expressed positive views of the intervention and experienced several benefits, mainly improved asthma control, medication use, and breathing technique. Factors that may influence user engagement were identified, including perceptions of asthma control, current self-management practices, and appeal of the target behaviours and behaviour change techniques. Findings suggested My Breathing Matters was acceptable and engaging to participants, and it was used as intended.

Relationship Between Coronavirus-Related eHealth Literacy and COVID-19 Knowledge, Attitudes, and Practices among US Adults: Web-Based Survey Study

Background

During a global pandemic, it is critical that the public is able to rapidly acquire new and accurate health information. The internet is a major source of health information. eHealth literacy is the ability of individuals to find, assess, and use health information available on the internet.

Objective

The goals of this study were to assess coronavirus-related eHealth literacy and examine the relationship between eHealth literacy and COVID-19−related knowledge, attitudes, and practices (KAPs).

Methods

We conducted a web-based survey of a representative sample of 1074 US adults. We adapted the 8-item eHealth Literacy Scale to develop the Coronavirus-Related eHealth Literacy Scale (CoV-eHEALS) to measure COVID-19−related knowledge, conspiracy beliefs, and adherence to protective behaviors (eg, wearing facial masks and social distancing). Our analyses identified sociodemographic associations with the participants’ CoV-eHEALS scores and an association between the CoV-eHEALS measure and COVID-19 KAPs.

Results

The internal consistency of the adapted CoV-eHEALS measure was high (Cronbach α=.92). The mean score for the CoV-eHEALS was 29.0 (SD 6.1). A total of 29% (306/1074) of the survey participants were classified as having low coronavirus-related eHealth literacy (CoV-eHEALS score <26). Independent associations were found between CoV-eHEALS scores and ethnicity (standardized β=–.083, P=.016 for Black participants) and education level (standardized β=–.151, P=.001 for participants with high-school education or lower). Controlling for demographic characteristics, CoV-eHEALS scores demonstrated positive independent associations with knowledge (standardized β=.168, P<.001) and adherence to protective behaviors (standardized β=.241, P<.001) and a negative association with conspiracy beliefs (standardized β=–.082, P=.009).

Conclusions

This study provides an estimate of coronavirus-related eHealth literacy among US adults. Our findings suggest that a substantial proportion of US adults have low coronavirus-related eHealth literacy and are thus at a greater risk of lower and less-protective COVID-19 KAPs. These findings highlight the need to assess and address eHealth literacy as part of COVID-19 control efforts. Potential strategies include improving the quality of health information about COVID-19 available on the internet, assisting or simplifying web-based search for information about COVID-19, and training to improve general or coronavirus-specific search skills.

Dealing With Loneliness Among LGBT Older Adults: Different Coping Strategies

Older lesbian, gay, bisexual, transgender (LGBT) adults may be at risk for high levels of loneliness—a risk factor for worse health behaviors—as a result of historical and social discrimination. Some LGBT older adults may have estranged relationships with family members or have toxic relationships, consequently leaving them without adequate social support. The 2018 Loneliness and Social Connections survey by the AARP Foundation consists of a national sample of non-institutionalized individuals 45 and older, including 2905 individuals who identify as heterosexual and 318 who identify as LGBT. The study indicated individuals had similar levels of loneliness regardless of sexual orientation. However, significant differences between heterosexuals and LGBT participants were found in their communication and time usage when they are lonely. For example, heterosexual individuals socialize with friends in person more than homosexuals (t=-2.393, p<.05), whereas LGBT older adults use technology more to socialize with friends (t=3.749), p<.001. Further, findings revealed that older LGBT adults tend to engage in more risky or unhealthy behaviors when lonely than do heterosexual older adults (t=3.907, p<.001). Overall, the results indicate that while LGBT older adults may spend more time alone (t=7.350, p<.001), they are engaging in different types of activities, particularly involving technology to communicate with friends, suggesting compensation for their lack of in-person contact. By understanding how LGBT older adults cope with loneliness along with the risks and resources that have influences on their health disparities can be useful for developing interventions to improve the health and well-being in these communities.

Magnification loupes influence on neck and trunk flexion of dental hygienists while scaling-A pilot study

OBJECTIVE

Work-related musculoskeletal disorders (MSDs) are common in the dental hygiene profession. Awkward postures contribute to MSDs and magnification loupes have been suggested to reduce this risk factor and minimize MSDs.

METHODS

After IRB approval, 24 hygienists were enrolled in the study: twelve hygienists wearing loupes with a standard manufacturer determined declination angle (control) and 12 hygienists wearing loupes with a custom measured declination angle (experimental). To measure changes in neck and trunk flexion, accelerometers were placed on the occipital region of head, cervical vertebrae C5, and thoracic vertebrae T5 and baseline posture was recorded. Typodonts with artificial calculus simulated the oral environment. Participants were randomly assigned to wear their designated loupes during the first or second trial of the experiment and scaled in each quadrant (UR, LR, UL, LL) of the mouth for two minutes. Participants completed the scaling task twice: in the loupes and no loupes condition in a counterbalanced order. Three-way mixed design ANOVA was used to determine posture differences in neck and trunk posture.

RESULTS

Those wearing custom loupes (M = 16.52, SD = 6.40) had significantly less trunk flexion while scaling compared to hygienists wearing standard loupes (M = 22.27, SD = 6.40), F(1, 22) = 7.14, P = .01. Neck flexion was not significantly affected while scaling between loupes vs no loupes or loupes type condition, (P's > .05).

CONCLUSION

Posture was partially impacted by loupes type. Custom loupes resulted in less trunk flexion. Neck flexion was not affected by either loupes type.

Walking in the Light: How History of Physical Activity, Sunlight, and Vitamin D Account for Body Fat-A UK Biobank Study

OBJECTIVE

The high prevalence of vitamin D deficiency and obesity drives the need for successful strategies that elevate vitamin D levels, prevent adipogenesis, and stimulate lipolysis. This study provides a theoretical model to evaluate how physical activity (PA) and sunlight exposure influence serum vitamin D levels and regional adiposity. This study hypothesized a posteriori that sunlight is associated with undifferentiated visceral adiposity by increasing the ratio of brown to white adipose tissue.

METHODS

Using 10-year longitudinal data, accelerometry, a sun-exposure questionnaire, and regional adiposity quantified by dual-energy x-ray absorptiometry imaging, a structural-equation mediation model of growth curves was constructed with a data-driven methodology.

RESULTS

Sunlight and PA conjointly increased serum vitamin D. Changes in vitamin D levels partially mediated how sunlight and PA impacted adiposity in visceral and subcutaneous regions within a subjective PA model. In an objective PA model, vitamin D was a mediator for subcutaneous regions only. Interestingly, sunlight was associated with less adiposity in subcutaneous regions but greater adiposity in visceral regions.

CONCLUSIONS

Sunlight and PA may increase vitamin D levels. For the first time, this study characterizes a positive association between sunlight and visceral adiposity. Further investigation and experimentation are necessary to clarify the physiological role of sunlight exposure on adipose tissue.

The development of a brief measure of health personality

The purpose of this research was to develop a brief assessment of health personality, defined as a set of individual dispositions that are directly related to health. In Study 1, an initial pool of items was developed with 615 older adults, 65 years of age and older. The scale was reduced to a 15-item version for use in applied health care settings. Results indicated that the 'Health Personality Assessment scale' has good internal consistency, and the five-factors correlated significantly with self-reported measures of physical health and well-being. In Study 2, the scale was cross-validated with 254 older adults from the Health Literacy and Cognitive Function among Older Adults Study. The scale was refined and a third study consisted of 3,907 older adults. Reliability and validity of the scale were confirmed. Future research should evaluate the usefulness of this scale in applied healthcare settings.

A Cultural Comparison of Personality Profiles of U.S. and Japanese Centenarians

The purpose of this study was a cross-cultural examination of centenarians' personality through a person-centered approach to examine if there is a "resilient" personality profile consistent across cultures. Proxy reports information was obtained from family and close friends of 239 U.S. centenarians from the Georgia Centenarians Study and 272 Japanese centenarians from the Tokyo Centenarian Study. Latent profile analyses were conducted to identify personality profiles in centenarians from the United States and Japan. Two personality profiles were identified in both samples: a "resilient" personality profile and "nonresilient" personality profile. The "resilient" group had higher levels of positive personality traits with higher scores on agreeableness and extraversion and lower scores on neuroticism, conscientiousness, and openness. The "nonresilient" group had higher scores on neuroticism and lower scores on extraversion, openness, agreeableness, and conscientiousness. Fifty percent of U.S. centenarians and 65% of Japanese centenarians were in the "resilient" group.

Preventing child sexual abuse: A systematic review of interventions and their efficacy in developing countries

BACKGROUND

Research on prevalence, risk factors, and prevention interventions for child sexual abuse has continued to focus on western and developed countries. Where country-level prevalence data or large-scale research exists, rates of child sexual abuse are consistently higher in developing and non-western countries than their western and developed counterparts.

OBJECTIVE

We systematically reviewed research on the nature of child sexual abuse interventions in developing countries, the settings and populations included to identify types of child sexual abuse prevention initiatives being implemented in developing countries and their effectiveness.

METHODS

Following PRISMA guidelines, we conducted a systematic search of six databases and identified eight studies to include in our analysis.

RESULTS

Most empirically evaluated interventions in developing countries have focused on preschool and primary school-aged children. Most have focused on interventions delivered in educational settings, with a lack of focus on population-level interventions to prevent child sexual abuse. Researchers have used outcomes measuring knowledge or skills for young people in self-protection and help-seeking, not deployment of those skills, actual reduction in prevalence of CSA, or improvements in conditions of safety in organizational contexts.

CONCLUSIONS

If the focus on school-based strategies to prevent child sexual abuse continues in developing countries, a significant gap in knowledge of the efficacy of population-level interventions outside of school contexts, and consistency across the application of interventions will remain. Evaluations are needed that address the efficacy of broader government-led or whole-of-community prevention interventions to reduce actual prevalence of child sexual abuse, or that can link increased knowledge and skill with reduced victimization.

USA Department of Defense audit of surgical antibiotic prophylaxis prescribing patterns in inguinal hernia repair

PURPOSE

Antibiotic prophylaxis in inguinal hernia repair (IHR) is contentious in literature and practice. In low-risk patients, for whom evidence suggests antibiotic prophylaxis is unnecessary, many surgeons still advocate for its routine use. This study surveys prescription patterns of Department of Defense (DoD) general surgeons.

METHODS

An anonymous survey was sent electronically to approximately 350 DoD general surgeons. The survey asked multiple-choice and free text answers about prescribing patterns and knowledge of current evidence for low-risk patients undergoing elective open inguinal hernia repair without mesh (OIHRWOM), open inguinal hernia repair with mesh (OIHRWM), or laparoscopic inguinal hernia repair (LIHR).

RESULTS

110 DoD general surgeons consented to participate. 58.6, 95 and 84.2% of surgeons always administer antibiotic prophylaxis in OIHRWOM, OIHRWM, and LIHR, respectively. 37.9, 70.9, and 63.2% of surgeons believe that it reduces rates of surgical site infection in OIHRWOM, OIHRWM, and LIHR, respectively. The most common reasons for empirically prescribing antibiotic prophylaxis include "I think the evidence supports it" (27 of 72 responses), "I would rather be conservative and safe" (15 of 72 responses), and "I am following my hospital/department guidelines" (9 of 72 responses). 11.8, 40.8, and 32.9% of surgeons believe current evidence supports antibiotic prophylaxis use in OIHRWM, OIHRWOM, and LIHR, respectively. 50, 18.4, and 22.4% of surgeons believe current evidence refutes antibiotic prophylaxis use in OIHRWM, OIHRWOM, and LIHR, respectively.

CONCLUSION

The survey results indicate that the majority of practicing DoD general surgeons still empirically prescribe surgical antibiotic prophylaxis in IHR despite more conflicting opinions that it has no meaningful effect or that current evidence does not supports its use.

Advanced ultrasound methods in assessment of carotid plaque instability: a prospective multimodal study

Background

A significant proportion of ischemic strokes are caused by emboli from atherosclerotic, unstable carotid artery plaques. The selection of patients for endarterectomy in current clinical practice is primarily based on the degree of carotid artery stenosis and clinical symptoms. However, the content of the plaque is known to be more important for stroke risk. Intraplaque neovascularization (IPN) has recently emerged as a possible surrogate marker for plaque instability. Neo-microvessels from the adventitial vasa vasorum grow into the full thickness of the vessel wall in an adaptive response to hypoxia, causing subsequent intraplaque haemorrhage and plaque rupture. Conventional ultrasound cannot detect IPN. Contrast-enhanced ultrasound and Superb Microvascular Imaging (SMI), have, however, shown promise in IPN assessment. Recent research using Shear Wave Elastography (SWE) has also reported reduced tissue stiffness in the artery wall (reduced mean Young’s modulus) in unstable compared to stable plaques. The purpose of this study is to identify unstable carotid artery plaques at risk of rupture and future ischemic stroke risk using multimodal assessments.

Methods

Forty five symptomatic and 45 asymptomatic patients > 18 years, with > 50% carotid stenosis referred to Oslo University Hospital ultrasound lab will be included in this on-going project. Patients will undergo contrast enhanced ultrasound, SMI, carotid-MRI and PET-(¹⁸F-FDG). Contrast enhanced ultrasound will be analyzed semi-quantitatively (5-levels visual classification) and quantitatively by plotting time-intensity curve analyses to obtain plaque peak contrast enhancement intensity. Plaques removed at carotid endarterectomy will be assessed histologically and the number of microvessels, areas of inflammation, granulation, calcification, lipid and fibrosis will be measured.

Discussion

This multimodality study will primarily provide information on the clinical value of advanced ultrasound methods (SMI, SWE) for the detection of unstable carotid artery plaque in comparison with other methods including contrast-enhanced ultrasound, carotid-MRI and PET-(¹⁸F-FDG) using histology as the gold standard. Secondly, findings from the methods mentioned above will be related to cerebrovascular symptoms, blood tests (leukocytes, CRP, ESR, lipoproteins and inflammatory markers) and cardiovascular risk factors at inclusion and at 1-year follow-up. The overall aim is to optimize detection of plaque instability which can lead to better preventive decisions and reduced stroke rate.

AGING STRONG 2020: INTERVENTIONS TO IMPROVE LONELINESS AMONG OLDER ADULTS

Research confirms serious and concerning health implications for lonely and socially isolated older adults. Studies consistently demonstrate that older adults who are lonely or socially isolated have higher rates of depression, more health conditions, and greater mortality. AARP Services, Inc. (ASI) and UnitedHealthcare (UHC) are committed to the health and well-being of insureds in AARP® Medicare Supplement Plans insured by UnitedHealthcare Insurance Company (for New York certificate holders, UnitedHealthcare of New York), recognizing that health and wellness should be promoted on a holistic level to ensure successful aging. As part of this commitment, a research initiative entitled Aging Strong 2020 has been developed. Its purpose is to impact insureds’ personal and social investments in their well-being Thus a related series of interventions are aiming to increase resilience by focusing on enhanced purpose in life, social connectedness, and optimism. This symposium will specifically discuss these efforts related to social connectedness and how they have improved well-being among lonely older adults. First discussed is the prevalence and outcomes of loneliness in a large national survey. Interventions include use of animatronic pets, a telephonic reminiscent memory program, and an online self-compassion mindfulness program. Findings from these initiatives demonstrate that interventions designed to improve loneliness and well-being among lonely older adults can contribute to the holistic model of health.

Health experiences of asylum seekers and refugees in Wales

Key messages

Improving health equity is key to realising Wales’ ambition to become a Nation of Sanctuary. Peer Researchers enabled participation by sanctuary seekers and revealed useful findings to steer future policy and practice.

Multi-pathogen serological survey of migratory caribou herds: A snapshot in time

Pathogens can impact host survival, fecundity, and population dynamics even when no obvious disease is observed. Few baseline data on pathogen prevalence and diversity of caribou are available, which hampers our ability to track changes over time and evaluate impacts on caribou health. Archived blood samples collected from ten migratory caribou herds in Canada and two in Greenland were used to test for exposure to pathogens that have the potential to effect population productivity, are zoonotic or are emerging. Relationships between seroprevalence and individual, population, and other health parameters were also examined. For adult caribou, the highest overall seroprevalence was for alphaherpesvirus (49%, n = 722), pestivirus (49%, n = 572) and Neospora caninum (27%, n = 452). Lower seroprevalence was found for parainfluenza virus type 3 (9%, n = 708), Brucella suis (2%, n = 758), and Toxoplasma gondii (2%, n = 706). No animal tested positive for antibodies against West Nile virus (n = 418) or bovine respiratory syncytial virus (n = 417). This extensive multi-pathogen survey of migratory caribou herds provides evidence that caribou are exposed to pathogens that may have impacts on herd health and revealed potential interactions between pathogens as well as geographical differences in pathogen exposure that could be linked to the bio-geographical history of caribou. Caribou are a keystone species and the socio-economic cornerstone of many indigenous cultures across the North. The results from this study highlight the urgent need for a better understanding of pathogen diversity and the impact of pathogens on caribou health.

The barriers to linkage and retention in care for women living with HIV in an high income setting where they comprise a minority group

Women comprise a minority population of individuals living with HIV in Australia, and are often poorly represented in research and clinical trials so their needs remain largely unknown. Data suggests that they are diagnosed later than men and start antiretroviral therapy at a lower CD4 cell count. This raises the question whether there are sex specific barriers to linkage and retention in care. This study analyzed 484 surveys received from clinicians collecting demographic, virological, and reproductive health data along with perceived barriers to linkage and retention in care. Most women (67%) were estimated to have been linked into care within 28 days of diagnosis. For women who were not linked into care for more than 28 days, the most commonly reason cited was fear of disclosure to others, followed by fear of disclosure to their partner. The main reasons given for non-retention in care were related to transport, carer responsibilities, financial pressure, health beliefs and concern about stigma or disclosure.

Video Review of Baseline Performance on Global Ratings in a Double-Blind Placebo Surgery Trial

Background

A randomized controlled double-blind sham surgery trial was conducted to determine the effectiveness of implantation of human embryonic dopamine neurons into the putamen of patients with advanced Parkinson's disease (PD). The present analyses determined whether patients viewing a video of them performing motor activities off medications at baseline would affect self-ratings 12 months later on the Global Rating Scale (GRS).

Objectives

To examine changes in GRS scores pre- and post-video review for the total sample; to examine differences in scores between actual implant and sham groups, as well as perceived groups pre- and post-video review; to examine differences among four subgroups of patients based on actual and perceived treatment (i.e., actual implant/perceived implant).

Methods

Forty participants were recruited and randomly assigned to receive either neural implantation or sham surgery. The primary outcome variable was a one-item GRS ranging from -3 (much worse since surgery) to +3 (much improved since surgery). At 12 months (before the blind was lifted) patients rated themselves on the GRS before and after viewing the baseline video.

Results

Total sample GRS scores improved after the video (P = .001). There were no differences between the actual implant and sham groups before or after the video, but there were differences between perceived groups at both times (P < .001). Among subgroups, improvement after the video was found only in the group receiving the implant but who thought sham (P = .011).

Conclusions

When self-ratings are an outcome variable, review of baseline videos is recommended before making comparative ratings.

Cardiovascular disease and diabetes in HIV-positive and HIV-negative gay and bisexual men over the age of 55 years in Australia: insights from the Australian Positive & Peers Longevity Evaluation Study

OBJECTIVES

As HIV-positive people age, diagnosis and management of comorbidities associated with ageing are of increasing concern. In this study, we aimed to compare the self-reported prevalences of heart disease, stroke, thrombosis and diabetes in older Australian HIV-positive and HIV-negative gay and bisexual men (GBM).

METHODS

We analysed data from the Australian Positive & Peers Longevity Evaluation Study (APPLES), a study of a prospectively recruited cross-sectional sample of 228 (51.1%) HIV-positive and 218 (48.9%) HIV-negative GBM, aged ≥ 55 years. Regression methods were used to assess the association of HIV status with self-reported comorbidities.

RESULTS

Of 446 patients, 389 [200 (51.4%) HIV-positive] reported their disease history. The reported prevalence of comorbidities was higher in the HIV-positive group than in the HIV-negative group: heart disease, 19.5 versus 12.2%; stroke, 7.5 versus 4.2%; thrombosis, 10.5 versus 4.2%; and diabetes, 15.0 versus 9.0%, respectively. In adjusted analyses, HIV-positive GBM had significantly increased odds of reporting heart disease [adjusted odds ratio (aOR) 1.99; P = 0.03] and thrombosis (aOR 2.87; P = 0.01). In our analysis, HIV status was not significantly associated with either age at diagnosis of heart disease (median 53 years for HIV-positive GBM versus 55 years for HIV-negative GBM; P = 0.64) or 5-year cardiovascular disease (CVD) risk estimated using the Framingham risk score.

CONCLUSIONS

HIV-positive GBM more commonly reported heart disease and thrombosis compared with their HIV-negative peers. These results further highlight the need to understand the impact of HIV on age-related comorbidities in GBM, to guide optimal screening and treatment strategies to reduce the risk of these comorbidities among the HIV-positive population.

The Association between Household Food Insecurity and Body Mass Index: A Prospective Growth Curve Analysis

OBJECTIVE

To examine the association between food insecurity and body mass index (BMI) from early adolescence to adulthood.

STUDY DESIGN

Growth curve analyses were performed. Sex differences were examined by conducting the analyses separately by sex. Ten data points were examined over a 16-year period from age 15 to 31 years. Data were obtained from the Family Transitions Project, a longitudinal study of 559 adolescents and their families that was initiated in 1989 in the Midwest. Primarily rural, non-Hispanic whites were selected based on the economic farm crisis. We examined participants from adolescence to adulthood from 1991 through 2007. Measures included a 2-item food insecurity construct and BMI as indicated by self-reported height and weight from adolescence through middle adulthood. These associations were analyzed using prospective growth curve modeling.

RESULTS

Our analyses indicated a general increase in BMI with age, whereas food insecurity declined over time. Higher levels of food insecurity at age 15 years led to a more rapid increase in BMI. Finally, a positive relationship was found between the changes in food insecurity and BMI over time. These associations held only for females.

CONCLUSION

Our results argue for increasing access to food during key developmental periods such as early adolescence, which could help reduce the long-term implications for health, particularly BMI in girls.

Phylogeny of Hepatocystis parasites of Australian flying foxes reveals distinct parasite clade

Hepatocystis parasites are close relatives of mammalian Plasmodium species and infect a range of primates and bats. Here, we present the phylogenetic relationships of Hepatocystis parasites of three Australian flying fox species. Multilocus phylogenetic analysis revealed that Hepatocystis parasites of Pteropus species from Australia and Asia form a distinct clade that is sister to all other Hepatocystis parasites of primates and bats from Africa and Asia. No patterns of host specificity were recovered within the Pteropus-specific parasite clade and the Hepatocystis sequences from all three Australian host species sampled fell into two divergent clades.

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First molecular phylogeny of Hepatocystis parasites in Australian flying foxes.

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Hepatocystis parasites of Pteropus form a distinct clade.

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Lack of host species specificity as distinct hallmark of Hepatocystis parasites.

Acquired Bilateral Superior Oblique Palsy: A Localising Sign in the Dorsal Midbrain

Bilateral superior oblique palsy is an uncommon ocular motility problem, the commonest cause being closed head trauma. Two cases, both adults, are presented in whom bilateral superior oblique palsy occurred as a result of neoplastic infiltration of the dorsal midbrain in the region of the anterior medullary velum. In the absence of a history of head trauma, the presence of an acquired bilateral superior oblique palsy is a definite sign of a single lesion in the region of the decussation of the trochlear nerves and appropriate imaging is indicated.

Gravitational Wave Speed: Undefined. Experiments Proposed

Since changes in all 4 dimensions of spacetime are components of displacement for gravitational waves, a theoretical result is presented that their speed is undefined, and that the Theory of Relativity is not reliable to predict their speed. Astrophysical experiments are proposed with objectives to directly measure gravitational wave speed, and to verify these theoretical results. From the circumference of two merging black hole's final orbit, it is proposed to make an estimate of a total duration of the last ten orbits, before gravitational collapse, for comparison with durations of reported gravitational wave signals. It is proposed to open a new field of engineering of spacetime wave modulation with an objective of faster and better data transmission and communication through the Earth, the Sun, and deep space. If experiments verify that gravitational waves have infinite speed, it is concluded that a catastrophic gravitational collapse, such as a merger of quasars, today, would re-define the geometry and curvature of spacetime on Earth, instantly, without optical observations of this merger visible, until billions of years in the future.

European Academy of Neurology and European Stroke Organization consensus statement and practical guidance for pre-hospital management of stroke

BACKGROUND AND PURPOSE

The reduction of delay between onset and hospital arrival and adequate pre-hospital care of persons with acute stroke are important for improving the chances of a favourable outcome. The objective is to recommend evidence-based practices for the management of patients with suspected stroke in the pre-hospital setting.

METHODS

The GRADE (Grading of Recommendations Assessment, Development and Evaluation) methodology was used to define the key clinical questions. An expert panel then reviewed the literature, established the quality of the evidence, and made recommendations.

RESULTS

Despite very low quality of evidence educational campaigns to increase the awareness of immediately calling emergency medical services are strongly recommended. Moderate quality evidence was found to support strong recommendations for the training of emergency medical personnel in recognizing the symptoms of a stroke and in implementation of a pre-hospital 'code stroke' including highest priority dispatch, pre-hospital notification and rapid transfer to the closest 'stroke-ready' centre. Insufficient evidence was found to recommend a pre-hospital stroke scale to predict large vessel occlusion. Despite the very low quality of evidence, restoring normoxia in patients with hypoxia is recommended, and blood pressure lowering drugs and treating hyperglycaemia with insulin should be avoided. There is insufficient evidence to recommend the routine use of mobile stroke units delivering intravenous thrombolysis at the scene. Because only feasibility studies have been reported, no recommendations can be provided for pre-hospital telemedicine during ambulance transport.

CONCLUSIONS

These guidelines inform on the contemporary approach to patients with suspected stroke in the pre-hospital setting. Further studies, preferably randomized controlled trials, are required to examine the impact of particular interventions on quality parameters and outcome.

Comparison of Kaposi Sarcoma Risk in Human Immunodeficiency Virus-Positive Adults Across 5 Continents: A Multiregional Multicohort Study

BACKGROUND

We compared Kaposi sarcoma (KS) risk in adults who started antiretroviral therapy (ART) across the Asia-Pacific, South Africa, Europe, Latin, and North America.

METHODS

We included cohort data of human immunodeficiency virus (HIV)-positive adults who started ART after 1995 within the framework of 2 large collaborations of observational HIV cohorts. We present incidence rates and adjusted hazard ratios (aHRs).

RESULTS

We included 208140 patients from 57 countries. Over a period of 1066572 person-years, 2046 KS cases were diagnosed. KS incidence rates per 100000 person-years were 52 in the Asia-Pacific and ranged between 180 and 280 in the other regions. KS risk was 5 times higher in South African women (aHR, 4.56; 95% confidence intervals [CI], 2.73-7.62) than in their European counterparts, and 2 times higher in South African men (2.21; 1.34-3.63). In Europe, Latin, and North America KS risk was 6 times higher in men who have sex with men (aHR, 5.95; 95% CI, 5.09-6.96) than in women. Comparing patients with current CD4 cell counts ≥700 cells/µL with those whose counts were <50 cells/µL, the KS risk was halved in South Africa (aHR, 0.53; 95% CI, .17-1.63) but reduced by ≥95% in other regions.

CONCLUSIONS

Despite important ART-related declines in KS incidence, men and women in South Africa and men who have sex with men remain at increased KS risk, likely due to high human herpesvirus 8 coinfection rates. Early ART initiation and maintenance of high CD4 cell counts are essential to further reducing KS incidence worldwide, but additional measures might be needed, especially in Southern Africa.

Outcomes of exertional rhabdomyolysis following high-intensity resistance training

BACKGROUND

High-intensity resistance training (HIRT) programmes are increasingly popular amongst personal trainers and those attending gymnasiums. We report the experience of exertional rhabdomyolysis (ER) at two tertiary hospitals in Melbourne, Australia.

AIMS

To compare the clinical outcomes of ER with other causes of rhabdomyolysis.

METHODS

Retrospective cross-sectional study of patients presenting with a serum creatine kinase (CK) of greater than 25 000 units/L from 1 September 2013 to 31 August 2014 at two tertiary referral hospitals in Melbourne, Australia. Records were examined to identify care measures implemented during hospital stay, clinical outcomes during admission and on subsequent follow up.

RESULTS

Thirty four cases of rhabdomyolysis with a CK of greater than 25 000 units/L (normal range: 20-180 units/L) were identified during the 12-month study period. Twelve of the 34 cases (35%) had ER with 10 of 12 related to HIRT. No acute kidney injury, intensive care admission or death were seen among those with ER. All cases were managed conservatively, with 11 admitted and 9 receiving intravenous fluids only. In contrast, patients with rhabdomyolysis from other causes experienced significantly higher rates of intensive care admission (64%, P = 0.0002), acute kidney injury (82%, P = 0.0001) and death (27%, P = 0.069).

CONCLUSION

ER resulting from HIRT appears to have a benign course compared with rhabdomyolysis of other aetiologies in patients with a serum CK greater than 25 000 units/L. Conservative management of ER appears to be adequate, although this requires confirmation in future prospective studies.