Age Continuum Research Articles

Socioeconomic Inequities in the Age-Specific Burden of Severe Respiratory Syncytial Virus in Canada, 2016–2019

Abstract Background Limited attention has been given to social inequities in respiratory syncytial virus (RSV), particularly beyond childhood and neighborhood-level measures. This study aimed to quantify the burden of severe RSV disease across the age continuum by individual-level socioeconomic status (SES) indicators. Methods We conducted a longitudinal descriptive study of Canadians (excluding Québec) ≥6 months of age using the 2016 Canadian Census Health and Environment Cohort (2016–2019). International Classification of Diseases, 10th Revision–coded RSV-related hospitalization rates, rate ratios (RRs), and rate differences (RDs) per 100 000 person-years were estimated using Poisson regression. Results Rates of RSV-related hospitalization were greatest among Canadians with lower compared to higher SES, as indicated through income (RD, 11.7 [95% confidence interval {CI}, 10.1–13.3]; RR, 2.8 [95% CI, 2.4–3.2]), education (RD, 18.7 [95% CI, 16.6–20.9]; RR, 3.3 [95% CI, 2.9–3.7]), and measures of poorer housing conditions including unaffordable housing and apartment living. Inequities varied by measure and age group; while rates were highest among 6- to 59-month-olds and ≥80-year-olds overall, some of the greatest relative SES inequities were among other ages. Conclusions Understanding SES factors’ role in RSV-related hospitalization risk is necessary to inform equitable prevention efforts, including delivery of emerging RSV immunizations.

The Role of p16Ink4a as an Early Predictor of Physiological Decline during Natural Aging.

Cellular senescence is a prominent accomplice of aging. The expression of gene p16ink4a has been established as a biomarker of cellular senescence in humans and animal models. However, it has not been extensively studied in clinical settings in the context of natural aging and the development of age-related diseases. Here, we report the results of a natural aging study that provided an assessment of cellular senescence and a battery of measures of clinical status, quality of life (QOL), and physical performance in 250 community-dwelling participants across age continuum. This report focused on analyzing predictive relationships between cellular senescence and different clinical assessments. Our results suggest that clinical labs and QOL assessments produce distinct groupings of participants, yet both have strong predictive associations with p16ink4a. Furthermore, the highest accuracy of p16ink4a prediction requires subsets of measurements representing diverse aspects of each assessment, pointing towards a system-level role of p16ink4a. Our analysis also led to an assessment-based composite indexes that strongly correlate with p16ink4a expression. Our study underscores p16ink4a's association with both earlier signs of physiological decline (based on clinical labs) and the later onset of health issues limiting the quality of life.

Characterizing vaginal stenosis in female cancer survivors.

e13800 Background: Vaginal stenosis is an underreported and undertreated sequelae of cancer treatment that leads to pain with sexual activity and inability to tolerate pelvic exams. We sought to describe a population of female cancer survivors presenting with sexual health concerns and identify factors associated with presence of vaginal stenosis on genitourinary exam (GU). Methods: A retrospective analysis included 134 female cancer survivors presenting to a sexual health after cancer program in South Florida (2020-2023). Sexual function and GU anatomy disruptions were evaluated using the Female Sexual Function Index (FSFI) and Adapted Vulvovaginal Exam Score (AVES), respectively. Vaginal stenosis was defined as presence of vaginal agglutination, shortening, or scarring/adhesions on GU exam. Patients who did and did not present with vaginal stenosis were compared using Chi-squared analysis, while independent t-test analyzed FSFI and AVES scores. Results: Of 134 patients, 116 met criteria for inclusion and underwent a GU examination. Median age was 45 (23-75). Race, ethnicity, menopausal status, cancer type, and treatment type were similar between groups. The rate of vaginal stenosis in patients with breast cancer was 13.4%, gynecologic cancer was 27.2%, and 28.6% with other cancer types (including gastrointestinal, hematologic, sarcoma). Higher median AVES scores, which denote more severe GU exam disruptions, were found in patients with vaginal stenosis compared to those without (13 vs 5; p<.001). While overall FSFI scores were similar between groups, median FSFI pain domain scores were lower in those with vaginal stenosis compared to those without stenosis (7.8 vs 11; p=0.037). Conclusions: Factors associated with the development of vaginal stenosis in female cancer survivors are not well-described. Our analysis reveals that vaginal stenosis develops in women treated for a variety of cancer types across the age continuum. Identifying and treating this severe sequela of treatment is a critical step in improving the sexual health of female cancer survivors. Ongoing work seeks to evaluate the safety and efficacy of treatments to reverse GU exam disruptions after cancer treatment. [Table: see text]

Impact of an Intergenerational Book Club on Cross-Generational Attitudes: A Mixed-Methods Study

ABSTRACT This mixed-methods study explores the impact of an intergenerational book club, Pages Across Ages, on cross-generational attitudes between older adults and college-aged students. Amidst growing concerns over ageism and demographic shifts, the study investigates how structured dialogue around selected literary works can facilitate understanding and empathy across generations. Pages Across Ages comprised weekly in-person and virtual meetings to discuss Kristin Hannah’s The Four Winds, a novel selected for its potential to foster point-driven conversation about relevant issues across the age continuum. Employing a combination of qualitative and quantitative measures, including the Aging Semantic Differential scale, the study reveals significant shifts in attitudes post-participation. Qualitative data from focus groups corroborate these findings, highlighting themes of mutual learning, changing perspectives, and social justice discussions as a result of intergroup contact. This research underscores the potential of book clubs, which have a rich history in America for their ability to act as vehicles for social change, as platforms for fostering intergenerational engagement and addressing age-related prejudices.

Differential Item Functioning Along the Old Age Continuum: Contrasting Chronological Age With Contextual Variables in the Assessment of Gains and Losses Across Advanced Old Age.

The fourth age is considered a life stage with a high likelihood of age-related losses. However, very old age extends over decades, and little is known about how transitions that may happen during this age period (e.g., developing support needs or adopting caregiving roles) or lack thereof might change perceptions of age-related gains or losses. Many subjective age scales assume implicitly that they work across advanced old age, but data to support this assumption are scarce. This study reports findings on (1) diverging, age-specific understandings of age-related change and (2) whether very old adults' functional health, received social support, and caregiving roles, rather than chronological age, account for such differences. Data came from the nationally representative survey "Old Age in Germany D80+" conducted in 2020/2021, comprising 10,578 individuals aged 80-106 years. At equivalent levels of perceived gains and losses, adults in the early fourth age reported more "freedom in daily life," less "dependency on others," and fewer "needs to reduce activities," whereas adults in the late fourth age reported more "appreciation of others." Chronological age, as such, was not the primary source of this response shift. Rather, functional health, social support, and caregiving responsibilities accounted for the differences in how older adults interpreted and reported specific age-related gains and losses. Findings underscore that across the multiple decades of the fourth age, interpretations of aging experiences vary and depend on a person's own late-life health and functioning and on that of significant others.

Comprehensive Standardized Assessment for Information Continuity: What Does the Workforce Need

Introduction: Older adults living with frailty and multimorbidity interact with multiple care providers across different health settings increasing the risk for fragmented care and information discontinuity. Information discontinuity results in workforce inefficiencies and adverse health events, including duplication of assessment and diagnostics, medication errors and increased health service use. Standardized assessments potentiate integrated care by communicating consistent measures of health information between health care sectors and providers. InterRAI assessments facilitate integration through promoting a common language and aligning successive assessments across the care continuum.
 Description: We used a pragmatic case example of a theoretical medically-complex older adult to illustrate effective use of interRAI standardized assessments throughout the health care journey. The interRAI suite of instruments spans across the age continuum, from pediatrics to geriatrics, and is designed to be used across diverse care settings, including community services, primary care, home care, long-term care, acute care, inpatient and community mental health, and palliative services. The case example represents one patient’s assessment findings, derived from standardized assessment instruments, such as the contact assessment, home care assessment and long-term care facility assessment. Automated and embedded risk algorithms are generated as outputs from the assessment, acting as decision support tools to inform care planning for clinical, functional, and social support needs. Process schematics depict potential workflows, where instruments can guide care strategies and facilitate the flow of information between the care team members.
 Discussion: Integrating elements such as using a common language, standardized assessment items, and embedded decision support algorithms, can support effective communication and collaboration in the care of older adults between clinical settings. Risk algorithms and scales support real-time identification of care issues, with standardized assessment items allowing for changes in health status to be easily recognized. Operationalizing a suite of standardized assessment instruments across the health system offers advantages for the individual including improved continuity of care, as well as for organizations and the system through use of a consistent measurement of health metrics between health providers and sectors, and evaluating health system performance. Successful adoption of comprehensive assessment tools to support integration requires training, stakeholder engagement and time to embed work and care processes into practice.
 Conclusion: Standardized language and algorithms used in interRAI comprehensive assessments can increase capacity for integration and continuity of care across the full spectrum of health sectors and settings. Findings from this pragmatic case example demonstrate real-world application and utility of standardized assessments to support an integrated workforce.

Association of maternal age with adverse pregnancy outcomes: A prospective multicenter cohort study in China.

Although maternal age might affect pregnancy outcomes, it remains unclear whether this relationship is linear or curvilinear and if it differs between nulliparous and multiparous women. We aimed to characterize the relationship between maternal age and risks of pregnancy outcomes in a diverse sample of Chinese singleton pregnant women and to evaluate whether the relationship varied by parity. We based this prospective multicenter cohort study on data from 18 495 singleton pregnant women who participated in the University Hospital Advanced Age Pregnant Cohort Study, conducted in eight Chinese public hospitals from 2016 to 2021. We used restricted cubic splines to model nonlinear relationships between maternal age continuum and adverse outcomes, and performed multivariable log-binomial regression to estimate the adjusted relative risk (RR) and 95% confidence interval (CI). Among 18 495 singleton pregnant women (mean age 35.7, standard deviation (SD) = 4.2 years), maternal age was not related to postpartum hemorrhage or small for gestational age, but showed a positive, nonlinear relationship to gestational diabetes mellitus, hypertensive disorders of pregnancy, preeclampsia, placenta accreta spectrum, placenta previa, cesarean delivery, preterm birth, large for gestational age, macrosomia, and fetal congenital anomaly, with inflection points around 35.6-40.4 years. Compared to women younger than 35 years, older women had higher risks of adverse pregnancy outcomes, except for postpartum hemorrhage and small for gestational age. The risks of placenta accreta spectrum, placenta previa, large for gestational age, and macrosomia were highest for women aged 40-44 years, and risks of gestational diabetes mellitus, hypertensive disorders of pregnancy, preeclampsia, cesarean delivery, preterm birth and congenital anomaly were highest for those aged ≥45 years. Most risks were more pronounced in nulliparous than multiparous women (P for interaction <0.02). Delayed childbirth was related to increased risks of adverse pregnancy outcomes, especially for nulliparous women. Appropriate childbearing age, generally before 35 years, is recommended for optimising pregnancy outcomes.

Back to basics: Practical strategies to reduce sensory overstimulation in the emergency department identified by adults and caregivers of children with autism spectrum disorder

IntroductionSensory overstimulation of autistic patients of all ages during an ED visit can ultimately lead to care escalation, but few studies have evaluated patient perspectives on improving the ED sensory experience across the age continuum. The purpose of this study was to explore patient-centered perspectives on reducing adult and pediatric autistic patients’ sensory stimulation during an ED visit. MethodsWe used a qualitative descriptive design to explore how autistic patients experience sensory disruption and recommendations to improve care. Data were analyzed inductively using an overall categorization of 6 senses (visual, auditory, touch, smell, taste, and proprioception). ResultsFourteen adults and 30 caregivers of children provided written responses to open-ended interview questions (n = 44). Participants suggested strategies to minimize the sensory disruption they experienced; however, an overarching recommendation was for clinicians to ask about their or their child’s preferences before delivering care or services. ConclusionBecause people with autism are more likely to visit an ED than their neurotypical counterparts, ED clinicians should be proficient in “sensory-friendly care.” A variety of evidence-based practical strategies and design approaches exist that can be leveraged to reduce the risk of care escalation; however, the most basic may be to prioritize asking patients and their caregivers about their preferences prior to providing care.

Soft Tissue Sarcomas in Adolescents and Young Adults.

Soft tissue sarcomas (STS) represent a heterogeneous group of extraskeletal mesenchymal tumors that affect individuals throughout the entire age continuum. Despite this pervasive influence, key differences exist in the presentation of these sarcomas across varying age groups that have prevented a more uniform approach to management. Notably, rhabdomyosarcoma (RMS) is more common in children, while most nonrhabdomyosarcoma soft tissue sarcoma (NRSTS) subtypes are more prevalent in adults. Older patients with NRSTS appear to have more molecularly complex biology and often present with more advanced disease compared with children. Poorer outcome disparities are observed in older patients with RMS despite receiving similar treatment as younger patients. In this review, we highlight differences in epidemiology, biology, and management paradigms for pediatric and adult patients with STS and explore opportunities for a unified approach to enhance the care and outcomes within the AYA population.

AHOD2131: A Randomized Phase 3 Response-Adapted Trial Comparing Standard Therapy with Immuno-Oncology Therapy for Children and Adults with Newly Diagnosed Stage I and II Classic Hodgkin Lymphoma

Background: Chemotherapy in combination with radiotherapy (RT) is the standard for early-stage (ES) Hodgkin lymphoma (cHL). Despite high cure rates (12-year overall survival (OS) &amp;gt;93%), there is room to improve short and long-term outcomes for children and adults with ES cHL. Incorporation of immunotherapy (IO) into front line treatment of ES cHL is an opportunity to both improve progression-free survival (PFS) and maintain OS, while minimizing long-term morbidity and mortality by reducing exposure to RT and high-dose chemotherapy. Study Design and Methods: HL leaders of the NCTN groups, expert HL researchers and physicians, and representatives from the Cancer Therapy Evaluation Program (CTEP) formed a working group in April 2020 with the goals of harmonizing treatment approaches for ES cHL across pediatric and adult patients and reaching consensus regarding the optimal study design for incorporating IO therapy into frontline treatment. Study champions identified from each of the North American cooperative groups [Children's Oncology Group (COG), SWOG, ECOG-ACRIN, Alliance, NRG] and experts in imaging, radiation oncology, lymphoma biology and patient-reported outcomes (PROs) were included. The resulting COG-led clinical trial, AHOD2131, represents the largest ES cHL trial in the history of North American cooperative groups and the first to enroll patients across the age continuum. AHOD2131 (NCT05675410; Figure) is a randomized, phase 3 trial enrolling patients ages 5 to 60 years with newly diagnosed, previously untreated stage I and II cHL and will investigate the addition of the CD30-antibody drug conjugate brentuximab vedotin (Bv) with PD-1 blockade (nivolumab) compared to standard chemotherapy +/- RT. Since the April 2023 activation, 97 North American sites have activated the trial, and 21 participants have enrolled. Target enrollment is 1875 patients over 5 years of accrual, for an estimated 1782 eligible and evaluable patients. The primary objective is to compare the 3-year PFS of patients with ES cHL treated through a response-adapted, superiority design with either standard therapy or with an IO approach (BV + nivolumab). All patients will be stratified as favorable or unfavorable based on disease risk features at enrollment. Based on initial response assessment by PET/CT (via central review) after 2 cycles of ABVD, patients were classified to PET2 positive (SER, defined as 5 Point Score 4 or 5, ~15% of patients) and PET negative (RER). Those who are PET positive will receive involved site RT (ISRT). The SER and RER patients will be randomized to standard chemotherapy vs. IO therapy respectively. In addition to the primary outcome of PFS, there are 11 secondary and 10 exploratory aims. The secondary aims focus on OS, PFS of subgroups, and event-free survival at 12 years, physician-reported treatment-related adverse event (AE) rates, patient-reported AE using pediatric and adult versions of Patient-Reported Outcomes version of the Common Terminology Criteria for Adverse Events (PRO-CTCAE), and the capture of representation by self-report and the use of electronic PRO data collections. The exploratory aims include the assessment of imaging central review as compared to local institutional review and the use of convolutional neural networks through artificial-intelligence machine learning. The study will examine the effect of therapy on acute and long-term adverse effects including health-related quality of life (HRQoL) and OS for up to 12 years. The study will compare patient self-report and provider AE reports and evaluate the associations of self-reported race/ethnicity and social determinants of health (SDOH)and post-progression/post-relapse OS. AHOD2131 strengthens the effort between the North American cooperative groups to conduct collaborative clinical trials and aims to harmonize an improved standard of care for ES cHL across the age continuum.

The Many Faces of Arrhythmogenic Cardiomyopathy: An Overview.

Arrhythmogenic cardiomyopathy (AC) is a disease that involves electromechanical uncoupling of cardiomyocytes. This leads to characteristic histologic changes that ultimately lead to the arrhythmogenic clinical features of the disease. Initially thought to affect the right ventricle predominantly, more recent data show that it can affect both the ventricles or the left ventricle alone. Throughout the recent era, diagnostic modalities and criteria for AC have continued to evolve and our understanding of its clinical features in different age groups as well as the genotype to the phenotype correlations have improved. In this review, we set out to detail the epidemiology, etiologies, presentations, evaluation, and management of AC across the age continuum.

“Everyone’s got a story”: Nursing and allied health students’ attitudes (interest, desire, and intent) to work with older adults on graduation

Introduction: Our ageing population requires a highly skilled labour force to ensure the increasing needs of older adults within the health sector are responded to appropriately. Working with older adults can be very rewarding. However, for many university students, it is an unpopular career choice. This study aimed at assessing nursing and allied health students’ perceptions and attitudes along with their interests in working with older adults after graduation. Methods: This study was part of a larger study conducted from July to December 2020. Five focus groups were conducted with 17 first-semester undergraduate students aged 19–43 years, two of whom were male. Semi-structured questions were conducted with thematic analysis to gain insight into interest in working with older adults on graduation. Results: Results indicated that older adults were perceived on an age continuum that can be described as “young-old” to “old-old”, with age being “just a number” and that there are variations indicating heterogeneity among older adults. Participants discussed that older adults could be interesting to talk to and be a source of wisdom, using examples from their experiences with older relatives. Challenges of ageing were identified, including physical and cognitive decline, loneliness and financial constraints. A perception of stigma working in aged care along with little financial incentives was identified. Conclusion: This study provides evidence that students require the opportunity to experience working with older adults in placements and given mentorship opportunities to work specifically with older adults. Further research is needed around scholarship of teaching and learning to address attitude- and stereotype-based positive change.

A call for action: Increasing the pediatric rehabilitation medicine workforce.

Pediatric Rehabilitation Medicine (PRM) is a unique blend of traditional medical rehabilitation knowledge and skills primarily focused on temporary and/or permanent disability conditions of childhood onset throughout the age continuum, with an emphasis on promoting function and participation. Although there are two established pathways to enhance knowledge and skills in PRM, one a combined residency with Pediatrics and the other a PRM fellowship, there has been a relative decline in participants in this training, as has been seen across other subspecialties in Physical Medicine and Rehabilitation (PM&R) and other medical specialties. Based on pediatric rehabilitation physician surveys and the increasing prevalence of children with disabilities, there has been a call to consider opening PRM fellowships to physicians not trained in PM&R. This commentary proposes establishing a commission to lead a transparent and inclusive process to assure that all options to address issues related to optimizing PRM care are considered and provide a course of action to address the needs of children and adults with childhood onset disabilities.

Updates in food allergen immunotherapy.

Food allergies are on the rise. Though allergen avoidance and management of acute reactions have been the backbone of therapy, complete avoidance and timely acute care is often not feasible. Food allergen immunotherapy (FAIT) is a novel and evolving treatment option intended to induce desensitization and potential sustained unresponsiveness (SU) to food allergens. This review addresses the methods, mechanisms, efficacy, and adverse effects of oral immunotherapy (OIT), sublingual immunotherapy (SLIT), and epicutaneous immunotherapy (EPIT) for food allergens in the published literature. Single FAIT has been most extensively studied in peanut, milk, and hen's egg allergic patients and has been successful in achieving desensitization in treated individuals through various modalities. Long-term data regarding SU is limited; however, current data suggests subsets of patients may be more likely to achieve SU compared to others. Other studies are actively assessing multifood AIT and novel FAIT protocols with adjunctive therapies. Food allergy constitutes a prevalent problem with far-reaching consequences. The emergence of FAIT may mitigate the burden of food allergy. Current evidence is promising for specific allergens and pediatric patient populations. Future studies are needed to further assess efficacy between different modalities of immunotherapy for food allergens across an age continuum.

Normative Reference Values for FEES and VASES: Preliminary Data From 39 Nondysphagic, Community-Dwelling Adults.

The aim of this study was to establish preliminary reference values for the Visual Analysis of Swallowing Efficiency and Safety (VASES)-a standardized rating methodology used to evaluate swallowing safety and efficiency for flexible endoscopic evaluation of swallowing (FEES). FEES were completed in nondysphagic, community-dwelling adults using a standardized protocol of 15 swallowing trials that varied by bolus size, consistency, contrast agent, and swallowing instructions. FEES were blindly analyzed using VASES. Primary outcome measures included bolus location at swallow onset, Penetration-Aspiration Scale (PAS) scores, and percentage-based residue ratings for six anatomic landmarks. Secondary outcome measures included sip size, bite size, and number of swallows. Thirty-nine healthy adults completed the study, yielding an analysis of 584 swallows. Swallows were initiated with the bolus in the pharynx for 41.8% of trials. PAS 1 was the most common score, accounting for 75.3% of trials, followed by PAS 3, which accounted for 18.8% of trials. When residue was present (> 0%), the amount was relatively small across all anatomic landmarks, with median residue ratings of 2.0% (oropharynx), 1.5% (hypopharynx), 3.0% (epiglottis), 3.0% (laryngeal vestibule), and 3.5% (vocal folds). Five events of aspiration were observed, which were characterized by subglottic residue ratings of 1%, 3%, 10%, 24%, and 90%. The average sip size of self-selected volume cup sips of water was 19.8 ml, and the average bite size of a 3.0-g saltine cracker was 1.33 g. Moreover, 78% of the trials in this study protocol (except 90-ml trials) were completed in a single swallow. The results from this study provide preliminary norms for VASES that could be used as a reference when assessing functional swallowing outcomes during FEES. While this is an important first step in establishing norms for FEES and VASES, clinicians and researchers should be mindful that the normative reference values from this study are from a relatively small study sample (N = 39), with most people below the age of 60 years (n = 30). Future research should expand on these norms by including a greater number of people across the age continuum and with greater racial, ethnic, and gender diversity. Supplemental Material and Open Science Form: https://doi.org/10.23641/asha.23504325.

Evaluating U-Pb accuracy and precision by comparing zircon ages from 12 standards using TIMS and LA-ICP-MS methods

U-Pb geochronological studies based on LA-ICP-MS isotopic measurements often require a profound understanding of the accuracy, precision, and preferred ages derived from this methodology. To enhance such awareness, an approximately 60,000 record U-Pb database is compiled from LA-ICP-MS zircon analyses of 12 standards (reference materials), with the standards having ages ranging from 3500 Ma to 0 Ma. Because the 12 standards are dated with the highly accurate and precise TIMS methods, a means exists for assessing the accuracy and precision of corresponding LA-ICP-MS ages. For each standard, the LA-ICP-MS ages are separated by concordance classes, and then age distributions are calculated for each concordance class using four age models: 206Pb/238U, 207Pb/206Pb, IsoplotR concordia, and non-iterative probability ages. Preferred U-Pb ages are determined by the model from which LA-ICP-MS ages consistently align with TIMS ages across the entire age continuum from 3500 Ma to present. The results favor the non-iterative probability model, which indicate that LA-ICP-MS ages have a mean accuracy of ±1.4 myr when comparing median LA-ICP-MS ages with mean TIMS ages; however, LA-ICP-MS ages have relatively poor 2σ internal precision, which is age-dependent and generally ranges from ±3 myr to ±25 myr, with mean 2σ internal precision of 15 myr. Additionally, the results suggest that U-Pb discordance has at least two primary sources: (a) inherent LA-ICP-MS imprecision due to repeated measurement errors of 206Pb/238U and 207Pb/206Pb ratios, is likely the primary cause of proximal-Wetherill discordance, whereas (b) Pb-loss is likely the primary contributor to distal-Wetherill discordance.

The 2022 Certified Flight Registered Nurse Pulse Survey

ObjectiveThe Certified Flight Registered Nurse (CFRN) credential independently validates a registered nurse's advanced knowledge, skills, and abilities in the unique specialty of flight nursing. Introduced in 1993 and celebrating its 30th anniversary in July 2023, the CFRN is held by over 5,500 registered nurses. The purpose of the 2022 CFRN pulse survey was to better understand the ways CFRN-certified registered nurses value this national flight nursing specialty credential. The CFRN survey is a companion to the 2022 Certified Transport Registered Nurse pulse survey, which focused on the Certified Transport Registered Nurse critical care ground transport nursing credential. MethodsThe Board of Certification for Emergency Nursing e-mailed individuals in its database of CFRN credential holders and asked them to respond to a 14-question online survey between October 17, 2022, and November 8, 2022. Participation in the survey was voluntary. Of the 5,275 verified CFRN holders who received the survey, 992 responded, for a response rate of 18.8%. The survey instrument included discrete field and open-ended questions. Data were deidentified for analysis, and institutional review board exemption was received. Counts and percentages were reported, and descriptive statistics were used. ResultsThe highest percentage of flight nurses who responded have more than 10 years of experience in flight nursing (35.3%) and are employed by a stand-alone transport program (42.7%). Flight nurses reported they spent a mean of 70% of their work hours transporting via rotor wing aircraft, with a predominantly adult patient population. The top perceived benefits of being a CFRN-certified nurse were a sense of accomplishment and pride (90.7%) followed by flight physiology knowledge (85.4%), flight nursing clinical knowledge (83.4%), and confidence as a flight nurse (80.6%). ConclusionThe 2022 CFRN pulse survey identified current CFRN demographics, practice environments including transport percentage by mode and patient population types, and perceived benefits of the CFRN credential. The findings suggest CFRNs are very experienced, provide care for patients across the age continuum, and perceive multiple intrinsic and extrinsic benefits of CFRN certification, all of which are essential to safe, evidence-based advanced nursing practice in the unique, complex, autonomous, and dynamic flight environment.

Resilience and resistance to the accumulation of amyloid plaques and neurofibrillary tangles in centenarians: An age-continuous perspective.

With increasing age, neuropathological substrates associated with Alzheimer's disease (AD) accumulate in brains of cognitively healthy individuals-are they resilient, or resistant to AD-associated neuropathologies? In 85 centenarian brains, we correlated NIA (amyloid) stages, Braak (neurofibrillary tangle) stages, and CERAD (neuritic plaque) scores with cognitive performance close to death as determined by Mini-Mental State Examination (MMSE) scores. We assessed centenarian brains against 2131 brains from AD patients, non-AD demented, and non-demented individuals in an age continuum ranging from 16 to 100+ years. With age, brains from non-demented individuals reached the NIA and Braak stages observed in AD patients, while CERAD scores remained lower. In centenarians, NIA stages varied (22.4% were the highest stage 3), Braak stages rarely exceeded stage IV (5.9% were V), and CERAD scores rarely exceeded 2 (4.7% were 3); within these distributions, we observed no correlation with the MMSE (NIA: P=0.60; Braak: P=0.08; CERAD: P=0.16). Cognitive health can be maintained despite the accumulation of high levels of AD-related neuropathological substrates. Cognitively healthy elderly have AD neuropathology levels similar to AD patients. AD neuropathology loads do not correlate with cognitive performance in centenarians. Some centenarians are resilient to the highest levels of AD neuropathology.

Metamorphic patterns and zircon U–Pb dating of the Xilingol complex in Inner Mongolia, China: Implications for rifting metamorphism and tectonic evolution in eastern Central Asian Orogenic Belt

The Xilingol complex is one of the maximal outcropped metamorphic terranes in the eastern segment of the Central Asian Orogenic Belt. Detailed petrological and geochronological study of the Xilingol complex will provide valuable insights into the orogenic process and closure of the Paleo-Asian Ocean. We present a comprehensive study of petrology, pseudosection modelling, and zircon U-Pb geochronology of representative rocks collected in Daqing Pasture, including two-mica quartz schist, epidote amphibolite, biotite plagioclase gneiss and quartzite. The Xilingol complex in Daqing Pasture can be preliminarily divided into the north and south segments based on field and petrological observations. The north segment comprises two-mica quartz schist, biotite quartz schist, amphibolite and minor epidote amphibolite, whereas the south segment consists mainly of biotite gneiss, amphibolite and quartzite, with varying degrees of migmatization developed. Combined pseudosection modelling and composition isopleths of garnet and biotite constrain a peak P–T condition of ~660 °C, ~5.5 kbar for the garnet-bearing two-mica quartz schist in the north segment, corresponding to low amphibolite facies metamorphism. The garnet-bearing biotite plagioclase gneisses in the south segment are interpreted to experience high amphibolite facies metamorphism at a peak condition of ~750–790 °C, ~5.5–8.0 kbar, followed by nearly isobaric cooling. The variations of peak P–T estimates within Daqing Pasture, coupled with the spatial heterogeneities of lithological associations between different outcropped terranes, reveal an overall northward decreasing metamorphic grade for the Xilingol complex. Metamorphic zircons from three biotite plagioclase gneisses in the south segment yield apparent 206 Pb/ 238 U age spreads of 397–348 Ma, 363–294 Ma and 341–301 Ma, respectively. These partially overlapping zircon ages are an indication of discrete metamorphic events involving localized thermal metamorphism at depth in the Middle Devonian and long-lasting Buchan-type metamorphism in the Carboniferous, with intermediate data probably related to a mixture of multiple growth domains. Five metamorphic zircons with low Th/U ratios from the epidote amphibolite in the north segment yield a concordia age of 284.8 ± 1.9 Ma, reflecting the diachronism of the Late Paleozoic Buchan-type metamorphism. Summarizing all U-Pb data of inherited magmatic zircons and metamorphic zircons, a distinct U-Pb age continuum is retrieved to elucidate a successive process from sedimentary diagenesis of forearc sedimentary formations to deep burial in the Early Devonian, and then to subsequent multi-stage metamorphic overprinting from the Middle Devonian to the Permian. The isograd patterns, P–T–t paths (clockwise paths and long-term duration) and spatial distribution of metamorphic terranes of the Xilingol complex are more compatible with an active continent rift setting rather than paired metamorphic belts in the arc-basin system, revealing post-collisional extension of the Early-Middle Paleozoic orogenic lithosphere of eastern CAOB in the Late Paleozoic. • The Xilingol complex underwent long-lasting Buchan-type metamorphism in the Carboniferous to Permian. • Metamorphic patterns of the Xilingol complex are compatible with continent rift setting. • Zircon U-Pb age continuum reveals a successive process from diagenesis to deep burial to multiple metamorphic episodes.

Inclusion of a core patient-reported outcomes battery in adolescent and young adult cancer clinical trials.

Disparities in care, treatment-related toxicity and health-related quality of life (HRQoL) for adolescents and young adults (AYAs, aged 15-39 years) with cancer are under-addressed partly because of limited collection of patient-reported outcomes (PROs) in cancer clinical trials (CCTs). The AYA years include key developmental milestones distinct from younger and older patients, and cancer interrupts attainment of critical life goals. Lack of consensus on a standardized approach to assess HRQoL and treatment-related toxicity in AYA CCTs has limited the ability to improve patient outcomes. The National Cancer Institute's Clinical Trials Network AYA PRO Task Force was assembled to reach consensus on a core set of PROs and foster its integration into AYA CCTs. Eight key considerations for selecting the core PRO AYA battery components were identified: relevance to AYAs; importance of constructs across the age continuum; prioritization of validated measures; availability of measures without licensing fees; availability in multiple languages; applicability to different cancer types and treatments; ability to measure different HRQoL domains and toxicities; and minimized burden on patients and sites. The Task Force used a modified Delphi approach to identify key components of the PRO battery. The Patient-Reported Outcomes Measurement Information System (PROMIS) and the PRO Common Terminology Criteria for Adverse Events Measurement System met all criteria and were selected to assess HRQoL and treatment toxicity, respectively. Investigators are rapidly incorporating the recommendations of the Task Force into AYA trials. Inclusion of a standardized assessment of HRQoL and treatment toxicities in AYA CCTs is a vital first step to develop interventions to improve health outcomes for AYAs diagnosed with cancer.