American Resources Research Articles

Predictors of Hospital Readmission, Institutionalization, and Mortality in Geriatric Rehabilitation Following Hospitalization According to Admission Reason.

Older adults following an inpatient geriatric rehabilitation (GR) program commonly experience adverse health outcomes such as hospital readmission, institutionalization, and mortality. Although several studies have explored factors related to these outcomes, the influence of admission reason on the predictive factors of adverse health outcomes in the rehabilitation process remains unclear. Therefore, this study aimed to identify predictive factors for adverse health outcomes in inpatients attending GR according to their admission reason. This retrospective study included patients with orthogeriatric (OG) conditions and patients with hospital-associated deconditioning (HAD) admitted to GR after an acute hospitalization between 2016 and 2020. Patients were evaluated by a comprehensive geriatric assessment at admission, including sociodemographic data, social resources, clinical data, cognitive, functional and nutritional status, and physical performance measurements. Adverse health outcomes were collected (hospital readmission, institutionalization, and mortality). Univariate analyses and multivariate backward binary logistic regressions were used to determine predictive factors. In this study, 290 patients were admitted for OG conditions, and 122 patients were admitted due to HAD. In patients with OG conditions, lower Mini-Mental State Examination (MMSE) predicted institutionalization and mortality. Lower Mini Nutritional Assessment-Short Form predicted institutionalization, whereas lower Barthel Index and lower Tinetti-Performance-Oriented Mobility Assessment scores were associated with higher mortality. In patients with HAD, higher age-adjusted comorbidity index predicted hospital readmission and mortality, and lower Short Physical Performance Battery scores predicted institutionalization and mortality. Finally, lower MMSE scores, worse values in Older Americans Resources and Services Scale and male gender were associated with a higher risk of institutionalization. Predictive factors for hospital readmission, institutionalization, and mortality in patients with OG conditions and HAD during GR were different. Some of those predictors, such as nutritional status and physical performance, are modifiable. Understanding predictive factors for adverse outcomes, and how these factors differ by admission diagnosis, improves our ability to identify patients most at risk. Early identification of these patients could assist with prevention efforts and lead to a reduction of negative outcomes.

Arthritis is associated with high nutritional risk among older Canadian adults from the Canadian Longitudinal Study on Aging

This study assessed the association between arthritis, functional impairment, and nutritional risk (NR). Cross-sectional data were from the Canadian Longitudinal Study on Aging, a nationally representative sample of 45–85-year-old community-dwelling Canadians (n = 41,153). The abbreviated Seniors in the Community: Risk Evaluating for Eating and Nutrition II (SCREEN II-AB) Questionnaire determined NR scores (continuous), and high NR (score < 38); the Older American Resources and Services scale measured functional impairment. NR scores and status (low/high) were modelled using multiple linear and logistic regressions, respectively. Analyses adjusted for demographic characteristics, functional impairment, and health (body mass index, self-rated general and mental health). Additional analyses stratified the models by functional impairment. People with arthritis had poorer NR scores (B: − 0.35, CI − 0.48, − 0.22; p < 0.05) and increased risks of high NR (OR 1.11, 95% CI 1.06, 1.17). Among those with functional impairment, the likelihood of high NR was 31% higher in people with arthritis compared to those without arthritis (95% CI 1.12, 1.53). Among those with no functional impairment, the likelihood of high NR was 10% higher in people with arthritis compared to those without (95% CI 1.04, 1.16). These relationships differed based on the type of arthritis. Arthritis is associated with high NR in community-dwelling older adults, both with and without functional impairment. Findings highlight the need for further research on these relationships to inform interventions and improve clinical practices.

Prevalence and risk factors for impaired activities of daily living in patients with neo-vascular age-related macular degeneration who present for anti-VEGF treatment

Background/ObjectivesTo assess the prevalence and correlates of impaired activities of daily living (ADLs) in patients with neovascular age-related macular degeneration (nAMD) who present for anti-vascular endothelial growth factor (VEGF) therapy.MethodsIn a clinic-based cohort of 437 patients with nAMD who presented for anti-VEGF therapy, the Older American Resources and Services Scale (OARS) was administered to assess for impairments in basic, instrumental and total ADL. Logistic regression analyses were conducted to determine odds ratios (OR) and 95% confidence intervals (CI) for factors associated with ADL impairment.ResultsThe prevalence of impaired basic, instrumental and total ADL was 37.76%, 67.82% and 39.59%, respectively. In multivariate-adjusted models, moderate visual impairment [OR 5.65, 95% CI (2.31–13.83) and blindness [OR 5.43, 95% CI (2.09–14.12)] were associated with greater odds of impaired total ADL. Depressive symptoms [OR 2.08, 95% CI (1.08–4.00)], the presence of any disability [OR 3.16, 95% CI (1.64–0.07)] and never driving [OR 4.00, 95% CI (1.60–10.00)] were also positively associated with total ADL impairment. Better vision-related quality of life (QoL) was inversely associated with impaired instrumental ADL whilst higher health-related QoL scores were associated with decreased odds of total ADL impairment.ConclusionsThere is a high prevalence rate of ADL impairment among nAMD patients presenting for therapy. Visual impairment, never driving, poor physical and mental health increased the odds of experiencing ADL impairment whilst better VRQoL and HRQoL reduced the odds of impairment.

Efficacy of the Pedagogical, Cultural, and Advocacy Programming at Purdue University Asian American and Asian Resource and Cultural Center

Efficacy of the Pedagogical, Cultural, and Advocacy Programming at Purdue University Asian American and Asian Resource and Cultural Center

“So, Do Not Fear”: Religion and the prevalence, persistence, and severity of anxiety disorders among Black Americans

BackgroundThere is a dearth of scholarship that explicates the effects of religious participation on anxiety disorders among Black Americans. A better understanding of the links between religious participation, a coping resource, and anxiety disorders among Black Americans remains essential, given Black Americans are less likely than their white counterparts to seek professional treatment for mental health problems, leading to greater unmet mental health needs. The aim of this study was to investigate whether religious participation is associated with the prevalence, persistence, and severity of anxiety disorders among Black adults. MethodsWe used a national sample of Black adults (N = 4999) from the National Survey of American Life, a cross-sectional study conducted from 2001 to 2003. Five anxiety disorders were assessed: posttraumatic stress disorder, generalized anxiety disorder, panic disorder, social anxiety disorder, and agoraphobia. Three dimensions of religious participation were assessed: organizational, non-organizational, and subjective religious participation. Weighted logistic and linear regressions were estimated to examine the associations between religious participation and anxiety disorders. ResultsFindings indicate that organizational religious participation and subjective religiosity were associated with lower odds of anxiety disorders and decreased severity. Findings for non-organizational religious participation in relation to the prevalence, persistence, and severity of anxiety disorders were mixed. LimitationsThe study limitations include the utilization of self-reported measures, cross-sectional study design, and age of the data set. ConclusionsDifferent dimensions of religious participation have differing effects on anxiety disorders. Religious participation may be an important resource for Black Americans in coping and preventing anxiety disorders.

The American political and academic elite on the end of the conflict in Ukraine

By the end of 2023, the American ruling circles got rid of illusions about the possibility of inflicting a decisive defeat on Russia during the Russian-Ukrainian conflict. From the point of view of the American political and academic elite, this conflict is clearly dragging on, diverting American resources from other US foreign policy priorities. According to many American experts and practical politicians, the United States has managed to extract serious benefits from the events in Ukraine, and it is time to limit its participation in this conflict before it becomes another &amp;quot;endless war&amp;quot; for the United States.

Linguapragmatic characteristics of educational media discourse: American, British, and Russian visual presentations

The article is devoted to the study of current problems of educational media communication in the linguapragmatic aspect. The paper discusses the main linguapragmatic characteristics of educational media. The role of the implementation of the presentation strategy of the language personality in the educational media resource is established. The main presentations implementing the presentation strategy in the educational media resource are identified. The purpose of this work is to identify and describe American, British, and Russian visual presentations within the framework of the presentation strategy of the educational media presentation. As a research material, media texts on electronic learning of a foreign language in the educational media resource of the first quarter of the 21st century in English and Russian are used. To achieve the goal, the following methods are used: lexical, grammatical, stylistic analysis, linguasemiotic and linguapragmatic analysis, elements of content analysis and discursive analysis, interpretive and quantitative analysis. American, British, and Russian visual presentations of educational media are described and illustrated by examples. It is established that the visual presentations of online learning of a foreign language in the American, British, and Russian educational media resource are aimed at the media recipient’s perception of the shape, color, position, and movement of the object. The undoubted novelty is represented by the identified subtypes of visual presentations in the American, British, and Russian educational media history: graphemes, coloremes, proxemes, kinestems. It was established that the presentation strategy of the educational media resource on the problems of online learning of a foreign language, implemented in educational media texts on sites on the Internet in the studied linguistic cultures, has similar features, since it is aimed at informing and influencing the addressee. Information contains tools and techniques that convey the content of online courses, the online learning process, the methods, and techniques that are used in this process. The impact is implemented to attract the attention of potential students to the course and educational institution, as well as incentives to study in this educational institution. It seems promising to distinguish between conflict and cooperative strategies in the educational media discourse in different linguocultures.

The Effects of Cognitive Ability, Mental Health, and Self-Quarantining on Functional Ability of Older Adults During the COVID-19 Pandemic: Results From the Canadian Longitudinal Study on Aging.

Determine whether levels of anxiety and depression, cognitive ability, and self-quarantining during and prior to the pandemic predict decreases in perceived functional ability. Longitudinal data collected from the Canadian Longitudinal Study on Aging (CLSA) COVID-19 Questionnaire Study (2020) and core CLSA study (Follow-Up 1; 2014-2018). 17541 CLSA participants. Self-quarantining behaviours from questionnaires administered at Baseline (April 2020), Monthly, and Exit (December 2020) time points of the CLSA COVID-19 Questionnaire Study, levels of anxiety and depression at Baseline, perceived change in functional ability at Exit, and performance on neuropsychological tests (Rey Auditory Verbal Learning Task, Mental Alternation Task, Animal Fluency Test) and functional ability (Older Americans Resources and Services [OARS] Multidimensional Assessment Questionnaire) from the core CLSA study. Greater cognitive ability pre-pandemic (B = -.003, P < .01), higher levels of anxiety (B = -.024, P < .01) and depressive symptoms (B = -.110, P < .01) at Baseline, and higher frequency of engaging in self-quarantining throughout the COVID-19 survey period (B = -.098, P < .01) were associated with perceived loss in functional ability at Exit. Self-quarantining behaviour was associated with perceived loss in functional ability only at average and high levels of depressive symptoms (B = -.013, P < .01). Older adults with higher cognitive and lower functional ability prior to the pandemic were at greater risk of decreased perceived functional ability during the first year of the pandemic, as were those who experienced greater levels of anxiety and depressive symptoms during the pandemic. Strategies/interventions to preserve functional ability in older adults with cognitive independence prior to future pandemics are warranted.

Abstract A075: Using social marketing principles to address lung cancer screening among Chinese Americans

Abstract Background: Lung cancer is the second and fourth most common cancer diagnosed among Chinese American men and women respectively. Screening can detect lung cancer in its early, most treatable stages. In 2022, the US Preventive Services Task Force (USPSTF) expanded their annual lung cancer eligibility criteria. Despite the disproportionately high rates of lung cancer among Chinese Americans, prior research suggest that screening rates in Chinese Americans remain low due to complex and systemic barriers. Objective: We seek to describe the development of a culturally and linguistically relevant project to provide education and outreach on lung cancer screening for Chinese Americans. Methods: The project was guided by the principles of participatory cultural adaptation and social marketing to develop sustainable education and outreach efforts and identify appropriate messaging and channels. This included a scoping review focusing on barriers to lung cancer screening in Chinese Americans and a survey of Chinese-serving physicians. A transdisciplinary advisory group guided the development and implementation of the project and design of the multi-media materials. We leveraged existing regional and national networks to maximize the outreach to Chinese American communities across the US. Results: Using social marketing principles, we developed culturally tailored multi-media materials to raise awareness of the eligibility criteria for lung cancer screening and address barriers toward screening in Chinese Americans. This included the following: 1) a bilingual website with information and resources for Chinese Americans, including an eligibility quiz; 2) digital stories featuring patient stories which directly address perceived barriers toward lung screening; and 3) materials for physicians. We will share the cultural adaptation process and present data on the reach of the social media outreach. Conclusion: There is a need to develop culturally and linguistically relevant education and outreach efforts to actively promote lung cancer screening and address barriers to screening among high-risk Chinese Americans, in order to reduce lung cancer disparities. Citation Format: Simona Kwon, Yi-Ling Tan, Stella Chong, Binh Luu, William Tsai, Judy Ah-Yune, Jamie Love, Suzanne Vang. Using social marketing principles to address lung cancer screening among Chinese Americans [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr A075.

Frailty prevalence among older decompensated heart failure patients

Abstract Background Frailty is a clinical syndrome characterized by diminished strenght, endurance and reduced physiologic function that increases an individual’s vulnerability. This syndrome often coexists in elderly patients with heart failure and can have a negative impact on their health and well-being. In the last few years four domains of frailty had been described: clinical, functional, psyco-cognitive and social. Purpose To determine the prevalence of frailty in each domain in patients 65 years of age and older with decompensated heart failure (DHF). Methods Prospective and observational study carried out in consecutive patients admitted to hospital due to DHF. Different validated scales were used. Clinical Domain: Charlson Comorbidity Index (CCI), MiniNutritional Assessment (MNA), Clinical Frailty scale CFS), New York Heart Association classification (NYHA); Functional Domain: Timed Up and Go (Up&amp;Go), Short Physical Performance Battery, Fried phenotype (SPPB), Activities of Daily Living (ADL), Instrumental Activities of Daily Living (IADL); Psyco-cognitive Domain: Minimental State Examination (MMSE), Yesevage Geriatric Depression Scale (YGDS); Social Domain: Old American Resources and Services (OARS). All patients signed the informed consent and were evaluated when they were clinically stable. Results 200 consecutive patients were included, aged 81.1 (SD 7.7),108 (54%) were female. Diabetes was present in 89 (44.7%) patients, arterial hypertension in 182 (91.5%), dyslipidemia in 138 (69.3%), active smoking in 8 (4.1 %), chronic obstructive pulmonary disease in 66 (33.5%), apnea 44 (22.4%), neoplasms in 36 (18.3%), chronic renal failure in 48 (24.4%), previous myocardial infarction in 42 (21.3%), stroke in 245 (12.2%), previous heart failure in 145 (73.6%), atrial fibrillation in 132 (66.7%). 10 (5%) lived in a nursing home. The in-hospital all-cause mortality rate was 7 (3.5%). Clinical domain: 125 (65.1%) had high comorbidity (CCI). 60 (43.1%) were malnourished (MNA) and 129 (70.9 %) considered as frail (CFS). 151 (77%) were in NYHA Functional Class III-IV. Functional domain: 165 (99.4 %) (Up&amp;Go) and 170 (97.1 %) (SPPB) were considered at fall risk. 147 (83.5%), frail by the Fried Phenotype. 188 (97.4 %) (ADL) and 173 (89.6 %) (IADL) had some degree of dependence. Psyco-cognitive: 82 (44.8%) had cognitive impairment (MMSE) and 70 (38%) some depression degree (YGDS). Social: 28 (15.4%) considered not to have a good social support (OARS). (See Table for details) Conclusions Patients with DHF are a complex and frail population that needs a holistic approach. The prevalence of frailty is high. In order to know how reversible frailty could be in older patients suffering DHF, clinical, functional, psyco-cognitive and social interventional trials are needed.

Molecular Biomarkers of Aging to Predict Clinical Frailty in Newly Diagnosed Hematologic Malignancy

Introduction: Older adults with hematologic malignancy (HM) are a growing demographic with wide-ranging therapeutic options. With aging, patient health and treatment decision-making are heterogenous. Treatment decisions are impacted by chronological age, performance status, and comorbidities. An approach to treating older adults based on objective measures of health may better personalize therapy by focusing on physiologic parameters. Here we examined the relationship of a blood-based aging biomarker, p16 INK4a (p16), with clinical frailty. Methods: Newly diagnosed patients with HM were enrolled in a prospective study capturing fitness measures and peripheral blood T lymphocyte (PBTL) p16 levels pre-treatment. Clinical phenotypes of fitness included 11 measures: ECOG performance status, Patient-Reported Outcome Measurement Information System (PROMIS) Global Health Scale Short Form v1, Older Americans Resources and Services (OARS) instrumental activities of daily living (IADL), Medical Outcomes Study (MOS) physical function, patient-reported Karnofsky Performance Status (KPS), social activity and social support (MOS) scores, Mental Health Index (MHI), and cognition (Blessed Orientation-Memory-Concentration). Physical function was measured using the Short Physical Performance Battery (SPPB). PBTL p16 was measured using the OSU_Senescence Nanostring CodeSet, which includes 74 additional T cell markers and five controls. PBTL were also examined for DNA methylation. PBTL were extracted, bisulfite converted, and methylation was quantified using the Illumina 850K EPIC methylation array at the TruDiagnostic core laboratory. Raw data was processed using the minfi pipeline, followed by normalization, batch correction, and KNN-based imputation using the GMQN and impute R packages. Principal-component (PC) PhenoAge measures were calculated using the processed methylation values. Results: Patients newly diagnosed with HM (n=33) (acute leukemia n=13, 39.5%, plasma cell dyscrasia n=13, 39.5%, lymphoma n=4, 12.1%, chronic lymphocytic leukemia=3, 9.1%) and complete p16 analysis with geriatric deficits were included. The mean p16 score was 32.6 (range 1.7-259.7). We quantified a composite deficit index defined as a frailty score higher than the third quartile using the aggregate score of the above fitness measures (range 0 to 11). Using a threshold for p16 ≥31.9, the model had 80% sensitivity and 79% specificity to identify frailty. The positive predictive value was 0.40, the negative predictive value was 0.96, and the accuracy was 0.76. The area under the ROC curve (AUC) for frailty versus p16 was 0.725. PBTL p16 was also explored in relation to other biomarkers of interest including epigenetic age (n=50). PBTL p16 correlated with PhenoAge r=0.38, p=0.0067. Conclusion: Aging biomarkers provide a novel means to quantify physiologic age in newly diagnosed HM. PBTL p16 levels showed a significant relationship with a composite metric of clinical fitness and accelerated aging in patients with different HM. PBTL p16 was both a sensitive and specific blood-based biomarker to identify clinical frailty in this preliminary analysis.

Associations between Osteosarcopenia and Falls, Fractures, and Frailty in Older Adults: Results From the Canadian Longitudinal Study on Aging (CLSA)

ObjectiveTo explore if older adults with osteosarcopenia are at a greater risk of falls, fractures, frailty, and worsening life satisfaction and activities of daily living (ADL) compared to those with normal bone mineral density (BMD) and without sarcopenia. DesignThe baseline and 3-year follow-up of a longitudinal study. Setting and ParticipantsCommunity-dwelling people aged 65 years or older in Canada. MethodsCaucasian participants 65 years or older that completed the Canadian Longitudinal Study on Aging (CLSA) 2015 baseline interview, physical measurements and 3-year follow-up were included. Osteopenia/osteoporosis was defined as BMD T score below −1 SD according to the World Health Organization, and sarcopenia was defined as low grip strength and/or low gait speed according to the Sarcopenia Definition Outcomes Consortium. Osteosarcopenia was defined as the coexistence of osteopenia/osteoporosis and sarcopenia. Self-reported incident falls and fractures in the last 12 months before the 3-year follow-up were measured. Frailty was assessed through the Rockwood Frailty Index (FI); life satisfaction through the Satisfaction With Life Scale (SWLS); and ADL through the Older American Resources and Services modules. Multivariable logistic and linear regression, including subgroup analyses by sex, were conducted. ResultsThe sample of 8888 participants (49.1% females) had a mean age (SD) of 72.7 (5.6) years. At baseline, neither osteopenia/osteoporosis nor sarcopenia (reference group) was present in 30.1%, sarcopenia only in 18.4%, osteopenia/osteoporosis only in 29.2%, and osteosarcopenia in 22.3%. Osteosarcopenia was significantly associated with incident falls and fractures in males [adjusted odds ratio (aOR), 1.90, 95% CI 1.15, 3.14, and aOR 2.60, 95% CI 1.14, 5.91, respectively] compared to males without osteopenia/osteoporosis or sarcopenia. Participants with osteosarcopenia had worsening ADL of 0.110 (estimated β coefficient 0.110, 95% CI 0.029, 0.192) and a decrease in their SWLS by 0.660 (estimated β coefficient −0.660, 95% CI −1.133, −0.187), compared to those without. Osteosarcopenia was not associated with frailty for both males and females. Conclusions and ImplicationsOsteosarcopenia was associated with self-reported incident falls and fractures in males and worse life satisfaction and ADL for all participants. Assessing and identifying osteosarcopenia is essential for preventing falls and fractures. Furthermore, it improves life satisfaction and ADL.

Feasibility of the geriatric assessment in older caregivers of older adults with cancer to guide supportive care.

224 Background: Older caregivers of older patients with cancer are at high risk for adverse physical and psychological outcomes. Performing a caregiver geriatric assessment (GA) may help identify caregivers at increased risk of adverse outcomes and guide supportive care strategies. In this study, we aimed to determine the feasibility of a GA to evaluate age-related conditions, and physical and emotional health of both patients and caregivers. Methods: Caregivers aged 65+ and patients aged 65+ with diagnosis of cancer receiving a new line of cancer treatment and caregivers aged 65+ were recruited (Goal 60 dyads; current N=40). Patient and caregiver physical and emotional health was captured using the GA which included assessment of physical function (activities of daily living [ADLs], instrumental activities of daily living [IADLs], Short Physical Performance Battery [SPPB], fall history), comorbidity, psychological health (Geriatric Depression Scale [GDS], General Anxiety Disorder-7 [GAD-7]), cognition (Montreal Cognitive Assessment [MOCA] or Blessed Orientation Memory Concentration [BOMC]), Social Support (Older Americans Resources and Services [OARS] Social Support), polypharmacy, nutrition, caregiver Environmental Mastery, and Modified Caregiver Strain Index. Results: Of 40 dyads who have consented, 17 dyads (42%) completed the GA, 14 dyad GAs are pending (35%), eight have withdrawn (20%), and one was lost to follow-up (2.5%). Mean time for caregivers to complete self-reported GA assessment was 47 minutes (range 20-120 minutes) and return to study staff was 5 days (range 0-22 days). Caregivers had mean age 78 years (range 65-85), 100% white, 94% female, and 94% spouses. Caregivers had high prevalence of age-related conditions, including comorbidities (mean 3.7), impairments in ADLs (24%), IADLs (31%), and physical function (55%). More patients than caregivers screened positive for depression (29% vs 12%) and anxiety (17% vs 6%). Caregivers reported high mastery (Ryff subscale, mean 38, range 26-49) and low strain (4.4, range 0-16). Conclusions: The GA is feasible to use in older cancer caregivers to help identify aging related conditions that may influence caregiving ability. Future work should identify how GA in older cancer caregivers can be used to identify intervention strategies to optimize caregiving abilities and improve outcomes in both older adults with cancer and their caregivers. Clinical trial information: NCT05244915 .[Table: see text]

Dual Sensory Impairment and Functional Status in a Prospective Cohort Study.

To examine the impact of visual impairment, hearing impairment, and dual sensory impairment (DSI) on functional status in older adults. Secondary analysis of the Manitoba Health and Aging Study, a population-based cohort study of 1751 adults age 65+. Data were collected from 1991 to 1992 (Time 1), with follow-up five years later (Time 2). Vision and hearing were self-reported. Functional status was measured using the Older Americans Resource and Services (OARS). Logistic regression models were constructed to assess functional status at both Time 1 and Time 2. Dual sensory impairment (DSI) at Time 1 predicted poor functional status at both Time 1 and Time 2. The adjusted odds ratios (OR; 95% confidence interval [CI]) for poor functional status at Time 1 for those with only hearing impairment was 1.74 (1.25, 2.44) for visual impairment was 2.95 (2.19, 3.98), and for DSI was 3.58 (2.58, 4.95). At Time 2, the adjusted ORs for poor functional status for those with only hearing impairment was 1.32 (0.86, 2.03), for visual impairment was 1.63 (1.05, 2.52), and for DSI was 2.61 (1.54, 4.40). DSI is associated with lower functional status, but the effect of visual impairment is more pronounced than hearing impairment.

Physiotherapy Can Help Recover Functional Status in Community-dwelling Seniors Assessed in Emergency Departments for Minor Injuries

Background: Around 75% of seniors seeking treatment for injuries in Emergency Departments (ED) are discharged home with minor injuries that put them at risk of functional decline in the following months. Objectives: To 1) describe seniors’ characteristics using or not physiotherapy services following ED visits for minor injuries and 2) examine their functional status according to physiotherapy use. Methods: Secondary data analyses of the Canadian Emergency Team Initiative cohort study. Participants were 65 years and older, discharged home after consulting EDs for minor injuries and assessed three times: ED, 3- and 6-months. Physiotherapy use was recorded as yes/no. Functional status was measured using the Older American Resources Scale (OARS). Multivariate linear regressions were used to examine change in OARS scores over time, accounting for confounders. Results: Among the 2169 participants, 565 (26%) received physiotherapy, and 1604 (74%) did not. Physiotherapy users were more likely females (71% vs. 64%), more educated, and less cognitively impaired. The overall change in OARS at 6 months was -0.31/28 points (95% CI: -0.55; -0.28) with no difference across groups after adjustment. Subgroup analyses among frail seniors showed that physiotherapy users maintained their function while non-users lost clinically significant function (-0.02 vs. -1.26/28 points, p = 0.03). Among the severely injured (Injury Severity Scale ≥ 5), physiotherapy users’ results were higher by almost 1/28 points (p = 0.03) compared to non-users. Conclusion: These results suggest that among seniors discharged home after consulting the ED for minor injuries, the frail and severely injured may benefit from being systematically referred to physiotherapy services.

Freshwater and anadromous fishing in Ice Age Beringia.

While freshwater and anadromous fish have been critical economic resources for late prehistoric and modern Native Americans, the origin and development of fishing is not well understood. We document the earliest known human use of freshwater and anadromous fish in North America by 13,000 and 11,800 years ago, respectively, from primary anthropogenic contexts in central Alaska (eastern Beringia). Fish use appears conditioned by broad climatic factors, as all occurrences but one are within the Younger Dryas chronozone. Earlier Bølling-Allerød and later early Holocene components, while exhibiting similar organic preservation, did not yield evidence of fishing, suggesting that this was a response to changing environmental factors, perhaps reductions in higher ranked resources such as large terrestrial mammals. Late Pleistocene and recent Indigenous peoples harvested similar fish taxa in the region (salmon, burbot, whitefish, and pike). We characterize late Pleistocene fishing in interior Beringia as an important element of broad-spectrum foraging rather than the intensive communal fishing and storage common among recent peoples.

Machine learning functional impairment classification with electronic health record data.

Poor functional status is a key marker of morbidity, yet is not routinely captured in clinical encounters. We developed and evaluated the accuracy of a machine learning algorithm that leveraged electronic health record (EHR) data to provide a scalable process for identification of functional impairment. We identified a cohort of patients with an electronically captured screening measure of functional status (Older Americans Resources and Services ADL/IADL) between 2018 and 2020 (N = 6484). Patients were classified using unsupervised learning K means and t-distributed Stochastic Neighbor Embedding into normal function (NF), mild to moderate functional impairment (MFI), and severe functional impairment (SFI) states. Using 11 EHR clinical variable domains (832 variable input features), we trained an Extreme Gradient Boosting supervised machine learning algorithm to distinguish functional status states, and measured prediction accuracies. Data were randomly split into training (80%) and test (20%) sets. The SHapley Additive Explanations (SHAP) feature importance analysis was used to list the EHR features in rank order of their contribution to the outcome. Median age was 75.3 years, 62% female, 60% White. Patients were classified as 53% NF (n = 3453), 30% MFI (n = 1947), and 17% SFI (n = 1084). Summary of model performance for identifying functional status state (NF, MFI, SFI) was AUROC (area under the receiving operating characteristic curve) 0.92, 0.89, and 0.87, respectively. Age, falls, hospitalization, home health use, labs (e.g., albumin), comorbidities (e.g., dementia, heart failure, chronic kidney disease, chronic pain), and social determinants of health (e.g., alcohol use) were highly ranked features in predicting functional status states. A machine learning algorithm run on EHR clinical data has potential utility for differentiating functional status in the clinical setting. Through further validation and refinement, such algorithms can complement traditional screening methods and result in a population-based strategy for identifying patients with poor functional status who need additional health resources.

Peter E. Hamilton. Made in Hong Kong: Transpacific Networks and a New History of Globalization.

In Peter E. Hamilton’s history of Hong Kong, he coins the word kuashang, or “straddling merchants”(17), a play on the familiar term huashang, which refers to Chinese businessmen in the diaspora. Hamilton’s kuashang are generations of Hong Kong elites who first fled to the British colony in the wake of the Chinese Communist Party’s rise to power in the 1940s and 1950s, linking Hong Kong to the wider world in two significant ways. First, the kuashang led a turn away from British institutions towards American education, resources, and business practices. Secondly, the kuashang brought global capital, technology, and business to China during its era of reform and opening. For Hamilton, kuashang describes both a class of individuals and their strategies to advance their families and accumulate wealth. Made in Hong Kong: Transpacific Networks and a New History of Globalization is first and foremost a prosopography of the elites—both businessmen and academics—who drove Hong Kong’s development of light industry, built its system of higher education, and initiated China’s reengagement with global capitalism.

Representation of Russia and the USA in the global online information space and on Russian and American resources

For the first time the quantitative representation of Russia and the USA in 2021 is considered: in the global online information space on the corpus of texts of the monitoring system Factiva, numbering over 106 million publications, posted on more than 23 thousand online resources in 26 languages; on the sub-corps of Russian media in Russian (over 1,000 online resources); on the sub-corps of American media in English (over 5,000 online resources). It was found that in the texts in 26 languages publications mentioning Russia were the most frequent, publications mentioning the USA came second. In terms of agenda theory (M. McCombs, D. Shaw), this fact is interpreted as a manifestation of a higher importance of Russia for the world press than the USA. In the sub-corpus of Russian Russian-language texts, this trend has been maintained. In a sub-corpus of US English-language texts, the US was on the first place, while Russia was ranked only 13th, which indicates a relatively low importance of Russia for the US press. The thematic areas that were most frequently associated with Russia and the US in 2021 were established. Factiva is strongly oriented towards economic information, and therefore topics such as company profiles, corporate and industry news were the most frequently encountered in a total of 26 languages. Next in line are stories about the domestic politics of countries. Similar trends can be observed in the analysed sub-corps of texts from Russian and US resources. At the same time, there is an asymmetry in the topics of materials mentioning Russia and the United States. Thus, in Russian sources in Russian language Russia is more frequently mentioned in the context of economic content, while the US is more frequently linked to international politics. In the US sources in English the US is more frequently mentioned in the economic context, while Russia is more frequently mentioned in the materials related to scientific and technical developments, as well as domestic and foreign policy.

Communicating Native American Cancer Efforts and Resources in the Great Plains.

American Indians' cancer disparities vary by region, signifying the importance of understanding community-specific levels of readiness to address cancer. Twenty-four key respondents from an urban American Indian community in the Great Plains, community leaders (n = 8), educators (n = 8), and students (n = 8), were interviewed following the Community Readiness Model. Using framework analysis, we qualitatively examined data related to efforts and resources in interview transcripts. One overarching emergent theme and three subthemes were identified. We found that communication of efforts and resources is critical to increasing community readiness to address cancer and is most successful when the community (1) prioritizes cancer as an issue in the community, (2) cultivates trusting relationships among stakeholders, and (3) practices cultural responsiveness in efforts. These findings emphasize the need for better communication of cancer efforts and resources and can inform strategic efforts to promote cancer prevention, treatment, and research among American Indians/Alaska Natives in the Great Plains.