Adult Day Research Articles

Time to surgery after radiological diagnosis of brain tumours in Pakistan: A nationwide cross-sectional study.

To investigate waiting times for brain tumour surgery in Pakistan from a nationwide sample and highlight specific affected patient populations. A nationwide study was conducted as part of the Pakistan Brain Tumour Epidemiology Study; data from 32 high-volume neurosurgical centres were collected. The national sample included 2,750 patients. Time to surgery was calculated by the difference in dates recorded for radiological diagnosis and the date of the first surgery. This was further stratified according to demographic factors, histopathological diagnosis, type of surgical procedure performed and survival outcomes. The data of 1,474 patients for time to surgery was available. Patients travelling to public hospitals had significantly longer mean wait times (94.07 (CI: 85.29, 102.84) vs 75.14 (CI: 54.72, 95.56) days, p<0.001). Significant differences were seen between patients of various age groups, as adolescents (116.63 (CI: 65.27, 167.98) days) and young adults (103.34 (CI: 85.96, 120.72) days) had higher waiting times compared to middle-aged (72.44 (CI: 61.26, 83.61) days) and older (48.58 (CI: 31.17, 65.98) days) adults. No difference was seen between the genders. A significantly longer time to surgery was observed for middle- and lower-socioeconomic class patients. Those undergoing gross total resection of the tumour had significantly (p<0.001) longer waiting times for surgery when compared to STR (sub-total resection), biopsy, and CSF-diversion procedures, for all tumour types. Patients diagnosed with meningioma had the most prolonged waiting periods (106 (CI: 76, 95) days). Gliomas had a mean waiting period of 88 (CI: 73, 103) days across the country. Low-grade gliomas had significantly (p=0.031) longer mean waiting times (99.73 (CI: 61.91, 127.36) days) in comparison to high-grade gliomas (70.13 (CI: 43.39, 89.69 ) days). A significant difference was seen between waiting times for patients who survived surgical procedures for a brain tumour on the most recent follow-up and those who had expired (91.87 (CI: 79, 107.74) vs 77.41 (CI: 59.90, 94.91) days, p<0.001). Prolonged delays to surgery are a significant barrier within low-and-middle-income countries, leading to adverse outcomes for patients. Patients undergoing brain tumour surgery at public hospitals from lower or middle SES and electing for gross resections were more likely to have longer delays.

Engaging cognitive domains of people with dementia during tablet game play

AbstractBackgroundKeeping cognitively active is important for people living with dementia or MCI but finding engaging activities can be challenging. Playing digital games has been shown to engage cognitive processes such as visual attention, working memory, and visuomotor skills, in children and adults. This study explored whether these cognitive domains are engaged when people living with dementia or MCI play digital games.MethodParticipants (n = 32) with dementia or MCI, mean MoCA 13.9, were recruited from adult day programs to play four mainstream games on touchscreen tablets. Each session was recorded and a video coding scheme was developed using behavioral analysis software to map observable behaviors, including eye gaze, hand movements, and game strategy, to five DSM cognitive domains : complex attention, executive function, learning and memory, language, and perceptual motor (DSM‐V, 2013). Five minutes from each initial gameplay session were analyzed to explore the engagement of cognitive domains.ResultsAll five cognitive domains were engaged but varied across the games. For example, a word search games engaged language much more than a jigsaw puzzle game which was higher on perceptual‐motor skills. The most engaged cognitive domain was ‘complex attention’ and the least engaged cognitive domain was ‘language’. All participants demonstrated cognitive engagement whilst playing the games.ConclusionPlaying digital games can provide cognitive engagement for people living with dementia or MCI. Using mainstream games increases accessibility of opportunities for cognitive engagement, in a way which is also immersing and rewarding. Future research incorporating eye tracking will increase understanding of how people living with dementia learn to play digital games and respond to prompts. This study presents huge potential for low cost cognitive activity for people with dementia or MCI.

Culturally and linguistically appropriate home visit intervention for underserved dementia family caregivers: Preliminary results from a randomized controlled trial

AbstractBackgroundFamily caregivers of persons with dementia (PWD) suffer from stress and negative health outcomes related to round‐the‐clock caregiving responsibilities. Often caregivers lack awareness of community resources. Community Health Workers (CHW) have proven effective in educating families and can implement interventions that aim to reduce the impact of stress on their health. To alleviate caregiver burden among dementia family caregivers, this study has CHWs’ visit family caregivers’ homes offering education, stress reduction, and compassionate support/listening.MethodsParticipants were recruited from Southern California via non‐profit organizations, senior centers, and adult day services. Participants were randomly assigned to CHW home‐visit intervention group (IG) or control group (CG) with resource information only. The intervention includes stress reduction techniques of mindful breathing and compassionate support/listening, (2) education on dementia caregiving skills to handle difficult behaviors of PWD, and (3) resource information. The 3‐month intervention is given by bilingual CHWs who speak English, Spanish, Vietnamese, or Korean. A linear mixed model was used to compare differences from baseline to 3‐month on each outcome (caregiver burden, PWD behaviors ‐ memory, distress, disruption) between IG and CG. Exit interviews were conducted for IG participants.Results26 family caregivers participated in the study (12 Korean, 9 Vietnamese, 3 Hispanic, 2 Caucasian); 14 spouses (54%), 12 off‐spring (46%); 18 females (69%), age from 34 to 89 (mean = 66.8 sd = 12.6). IG Participants showed a significant decrease in caregiving burden compared to CG (coefficient = ‐7.68, p = .0041). PWD behaviors were significantly decreased from baseline to 3 months but no difference by group. However, there was a trend for improvement of PWD’s memory problems in the IG compared to the CG (coefficient = ‐2.43, p = .056). Language specific exit interviews showed that educational materials were valuable and communication skills training was helpful as was CHW home visits. Most participants reported the benefit of mindful breathing and practiced it when overwhelmed or having sleep problems. The overall satisfaction of the intervention was high (mean = 4.4 of 5). Recruitment is on‐going but challenging during the pandemic.ConclusionPreliminary results showed the CHW led home‐visit intervention helped improve burden and PWD memory problems and was acceptable by the family caregivers of PWD.

Oral health care services for community-dwelling older people with dementia: A scoping review.

To assess whether, and if so, which oral health care services for community-dwelling older people with dementia are available. Oral health in people with dementia is poor compared with people without dementia. Although multiple oral health care interventions have previously been studied for older people living in nursing homes, little is known about interventions or services for community-dwelling older people with dementia. A literature search was performed in the databases Pubmed, Embase and CINAHL. The following search terms were used: "Dementia", "Oral health", "Dental health services" and "Older person". The term "dental health services" was intended to be an as broad as possible construct because limited search results were expected. The search generated 1624 unique references, of which seven studies were eligible for inclusion (four cohort studies, one cross-sectional study, and two qualitative studies). The included studies described two actual oral health care services: a telephone help line on oral health and dementia, and a mobile geriatric dental programme in adult day health centres. A need was found for services and strategies specific to community-dwelling older people with dementia. One identified solution was an intervention with individually tailored daily oral hygiene self-care supported by the informal caregiver. Furthermore, increasing accessibility of oral health care professionals with treatment at other locations than their own practices, better collaboration between health care professionals and preventive oral health care are highly necessary. There is limited evidence on the availability of oral health care services for community-dwelling older people with dementia, while a need was found for oral health care services that focus on good accessibility, oral hygiene self-care, preventive strategies and collaboration among health care professionals.

"I Didn't Sign Up for This": Perspectives from Persons Living with Dementia and Care Partners on Challenges, Supports, and Opportunities to Add Geriatric Neuropalliative Care to Dementia Specialty Care.

In the United States, dementia specialty centers affiliated with centers of excellence for research hold promise as locations to develop innovative, holistic care in care systems otherwise siloed by discipline or payer. We conducted foundational research to inform development of patient-and family-centered palliative care interventions for dementia specialty centers. We interviewed persons living with dementia (PLWD), current, and former care partners (CP) recruited from a specialty dementia clinic and purposively selected for variation across disease syndrome and stage. A framework method of thematic analysis included coding, analytic matrices, and pattern mapping. 40 participants included 9 PLWD, 16 current CPs, and 15 former CPs of decedents; 48% impacted by Alzheimer's disease dementia. While help from family, support groups and adult day centers, paid caregiving, and sensitive clinical care were invaluable to PLWD, CPs, or both, these supports were insufficient to navigate the extensive challenges. Disease-oriented sources of distress included symptoms, functional impairment and falls, uncertainty and loss, and inaccessible care. Social and relational challenges included constrained personal and professional opportunities. The obligation and toll of giving or receiving caregiving were challenging. Clinical care challenges for PLWD and/or CPs included care fragmentation, insufficient guidance to inform planning and need for expert interdisciplinary clinical care at home. Findings highlight the breadth and gravity of gaps, which surpass the disciplinary focus of either behavioral neurology or palliative care alone. Results can inform the development of novel interventions to add principles of geriatrics and neuropalliative care to dementia care.

National Burden of Encapsulated Bacterial Infections in Sickle Cell Disease

Introduction: Patients with sickle cell disease (SCD) are at much higher risk for infections from encapsulated organisms, particularly Streptococcus pneumoniae (pneumococcus), Neisseria meningitidis (meningococcus), and Hemophilus influenzae. Vaccinations and prophylactic penicillin (for pneumococcus) have declined but not eliminated their incidence. We aim to study the SCD admissions with infections from above mentioned encapsulated organisms. Methods: We performed a retrospective analysis using the National Inpatient Sample (NIS) database from 2016 to 2019 to identify SCD hospitalizations with either S. pneumoniae, N. meningitidis, or H. influenzae infections using appropriate International Classification of Diseases, Tenth Revision, Clinical Modification (ICD 10-CM) codes. SCD included HbSS (D57.0x), HbSC (D57.2x) and others (D57.1, D57.4x and D57.8x). Infections from S. pneumoniae and H. influenzae included sepsis (A40.3, A41.3), pneumonia (J13, J14), meningitis (G00.1, G00.0), and others (M00.1x, B95.3, A49.2, B96.3, and J20.1). N. meningitidis infections were identified by ICD-10-CM code A39.x. Admissions were divided into pediatric (<18 years) and adult (≥18 years) age groups and descriptive analysis was performed to compare demographics, hospital characteristics, and comorbid conditions/complications. We also calculated the annual hospitalization rate for encapsulated organisms per 10,000 SCD admissions. The methodology provided by the HCUP (Healthcare Cost and Utilization Project) was utilized, and weights were applied to produce national estimates. Results: Out of 533,175 SCD admissions from 2016-2019, 830 (0.16%) had an infection from S. pneumoniae or H. influenzae. There were no admissions with N. meningitidis during our study period. The annual hospitalization rate for encapsulated bacterial infection per 10,000 SCD admissions ranged from 15.6/year to 40.6/year for the pediatric population and 11/year to 15.2/year among adults (Figure 1). Overall rate was 30 per 10,000 SCD admissions in pediatric population and 12 per 10,000 in adults (p <0.001). Among S. pneumoniae infections, hospitalizations were highest for children ≤5 years at 64 per 10,000 SCD admissions, followed by 14 per 10,000 in children aged >5 & <18 years and lowest in adults (≥18 years) at 12 per 10,000 (p <0.001). Among 695 SCD admissions with S. pneumoniae, 325 (46.8%) were HbSS, and 65 (9.4%) had HbSC disease. Furthermore, 260 (37.4%) were <18 years and 435 (62.6%) were ≥18 years. The median age for children was 5 (2-10) years and 34 (27-47) for adults (p <0.001). Most admissions were males (56.1%), without significant comorbidities (Charlson comorbidity index 0 in 59.7%) and belonged to lowest income communities (47.8%). More than a quarter of adults (26.4%) had tobacco use disorder, and 8.1% had HIV/AIDS. Incidence of acute respiratory failure and acute kidney failure was higher in adults than in children (25.3% vs. 1.9%; p <0.001 and 29.9% vs. 3.9%; p <0.001 respectively). The median length of stay was 6 (4-11) days for adults and 4 (3-7) days for <18-year-olds (p <0.001). There were 26.4% adults compared to 9.6% children with a length of stay >10 days (p 0.02). Median hospital charges and costs were also higher for adults compared to children. Whereas there were no pediatric discharges requiring home health care, 17.4% of adults had home health care arranged (p 0.01). All-cause-in-hospital mortality was 1.4%. Out of 145 H. influenzae admissions, 40 (27.6%) were <18 years, and 105 (72.4%) were ≥18 years. Like S. pneumoniae, the majority of SCD admissions with H. influenzae admissions were males (65.5%), belonged to the lowest income communities (51.7%), admitted to large (48.3%), teaching hospitals (89.7%), and had no significant comorbidities (Charlson comorbidity index 0 in 55.2%). Around 24.1% stayed in the hospital for >10 days, and 20.7% required invasive mechanical ventilation. The median length of stay was 7 (5-10) days, and all-cause-in-hospital mortality was 3.5% (Table 1). Conclusion: Despite vaccinations and prophylactic penicillin, the burden of encapsulated bacterial infections in pediatric SCD hospitalizations remains disproportionately higher than in adults. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Olverembatinib (HQP1351) Overcomes Ponatinib Resistance in Patients with Heavily Pretreated/Refractory Chronic Myeloid Leukemia (CML) and Philadelphia Chromosome-Positive Acute Lymphoblastic Leukemia (Ph+ ALL)

Background Olverembatinib is a novel third-generation BCR-ABL1 tyrosine kinase inhibitor (TKI) with antitumor activity against CML and Ph+ ALL regardless of genotype and a preliminarily favorable human safety profile. This study is the first to report on the safety, efficacy, and pharmacokinetic (PK) profiles of olverembatinib in patients with CML (all phases) and Ph+ ALL outside China, whose disease failed ponatinib treatment and at least 2 prior TKI treatments. Methods In this multicenter, open-label, randomized trial, olverembatinib is administered orally on alternate days (QOD) in adults with chronic-phase (CP-CML), accelerated-phase (AP-CML), or blast-phase CML (BP-CML) or Ph+ ALL. Enrolled patients have had no fewer than 2 prior TKI failures, except for those whose disease harbors T315I mutation, for whom the number of previous TKIs is not limited. Study participants are randomized 3:3:2 to olverembatinib 30, 40, or 50 mg QOD in 28-day cycles. Results A total of 30 patients have been enrolled, including 23 with CP-CML, 4 with AP-CML, 2 with BP-CML, and 1 with Ph+ ALL. The median (range) treatment duration is 4.8 (0.03-21.29) months and the median (range) interval from CML/Ph+ ALL diagnosis to olverembatinib treatment onset, 7.0 (1.5-24.0) years. Half (15/30) of patients are men, and the median (range) age is 47.0 (21.0-74.0) years. In all, 1 (3.3%), 7 (23.3%), 8 (26.7%), and 9 (30.0%) patients received 2, 3, 4, and ≥ 5 prior TKIs, respectively. A total of 21 (70.0%) patients were pretreated with third-generation TKI ponatinib, including 17 (81.0%) with resistance and 4 (19.0%) with intolerance; a total of 5 (16.7%) were pretreated with asciminib; 12 (40.0%) had T315I mutations; and 13 (43.3%), hypertension. At baseline, all patient BCR-ABL1IS levels were > 1%. Olverembatinib was well tolerated. Twenty-two (73.3%) patients experienced any-grade treatment-related AEs (TRAEs; Table 1), incidences of which tended to be dose-dependent. Most nonhematologic TRAEs were grade 1/2. Common grade 3/4 hematologic TRAEs included thrombocytopenia (7/30; 23.3%), neutropenia (5/30; 16.7%), and decreased leukocyte counts (4/30; 13.3%). In all, 11 (36.7%) of 30 patients experienced serious AEs, of which 6 (20.0%) were considered olverembatinib-related and 1 (3.3%) led to treatment discontinuation. One patient with AP-CML from the 50-mg dose cohort died of progressive disease. Olverembatinib conferred potent antileukemic activity in patients with CML and Ph+ ALL (Table 2). Of 21 efficacy-evaluable patients, 17 were evaluable for cytogenetic response, of whom 10 (58.8%) had complete cytogenetic response (CCyR); 9/21 (42.9%) patients had major molecular responses (MMR). Olverembatinib was effective in patients with either T315I-mutant (62.5%, CCyR; 50%, MMR) or T315IWT (55.6%, CCyR; 38.5%, MMR), and its effectiveness was not compromised by prior use of ponatinib or asciminib. Among patients pretreated with ponatinib with available responses, 5 (55.6%) of 9 patients with ponatinib-resistant disease experienced CCyR and 6 (54.5%) of 11, MMR. Four of 5 patients pretreated with asciminib showed response. PK analyses indicated an approximately dose-proportional increase in olverembatinib plasma exposure from 30 to 50 mg QOD and comparable plasma exposure between Chinese and US CML populations. Conclusions Olverembatinib monotherapy is efficacious and well tolerated in patients with TKI-refractory CML and Ph+ ALL. Even in patients with CML who were ponatinib or asciminib resistant, or who had T315I mutations, olverembatinib showed strong efficacy. This analysis confirms that olverembatinib is a potentially viable treatment option for patients with CML and Ph+ ALL, including those with ponatinib failure or T315I mutation. Internal study identifier: HQP1351-CU101. Clinicaltrials.gov identifier: NCT04260022. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Measuring Physical Activity in Younger and Older Adults with Sickle Cell Disease Using Accelerometers

Background Sickle cell disease (SCD) is a genetic disorder of hemoglobin with hemolysis and vaso-occlusion that leads to pain, joint damage, and impairment in physical function. Advancements in care have increased the lifespan of individuals with SCD. Even with improvements in care, there is limited knowledge regarding how to measure and maintain physical activity in adults with SCD. Wearable devices can remotely track physiologic markers of pain in people with SCD and are used in older adults in the general population to track physical activity and health-related outcomes. Despite the popularity of wearable devices, the feasibility of using accelerometers to measure physical activity in older adults with SCD is unknown. The purpose of this study was to assess the feasibility of the Actigraph accelerometer to objectively measure physical activity in adults with SCD. Methods We enrolled younger adults (age 18-39) and older adults (age ≥ 40 years) with SCD in a prospective cohort study of physical activity using an Actigraph accelerometer. We instructed participants to wear the Actigraph wGT3X-BT or GT9X Link device on their non-dominant wrist for 7 consecutive days during waking hours and to remove it when they showered. If they missed a day of wearing the accelerometer, we asked them to add an additional day to complete 7 days. Activity data was processed in ActiLife Software 6 (ActiGraph, LLC). We defined feasibility endpoints by the percent of participants who returned the accelerometer and percent of participants who wore it for ≥ 3 days for a least 10 hours/day. We analyzed physical activity by measuring steps per day and proportion of wear time spent being sedentary, doing light activity, and doing moderate-vigorous physical activity (MVPA). We assessed relationships between physical activity (steps per day), physical performance measures (six-minute walk distance (6MWD), usual gait speed, Timed-Up and Go (TUG), seated grip strength, and 30-second chair stands), and the 36-item Short Form (SF-36) physical functioning. Results Sixty participants received an accelerometer. Out of these 60 participants, 90% (n=54) returned the accelerometer after 7 days. Among those who returned accelerometers, the mean age was 43 years (range 19 - 71). The mean age was 26 (range 19-36) for younger adults and 54 (range 40- 71) for older adults. The majority (61%) of participants were older adults. Most (56%) participants were female. Most (56%) had HbSS, 6% HbSβ0-thalassemia, 30% HbSC, and 9% HbSβ+-thalassemia. On wear time validation, 83% (n=50) of participants wore the monitor for at least 3 days for at least 10 hours per day. The mean wear time was 7 days (range 0-15 days). The median steps per day for all participants was 7235 (range 0-14916; IQR 5892-9406). The median steps per day for younger adults was 9397 (IQR 6739 - 10578) and 6678 (IQR 5621-8268) for older adults. There was a significant difference in steps per day between younger and older adults (p-value = 0.021). On average, participants were sedentary 39% (±15%) of the time, doing light activity 45% (±14%) of the time, and MVPA 11% (±6%) of the time. The average daily time spent doing MVPA was 111 minutes (± 66 minutes). Physical activity (median steps per day) had moderate correlations with the TUG (rs = -0.3; p=0.03), 6MWD (rs = 0.29; p=0.04), 30-second chair stands (rs = 0.32; p=0.02), and SF-36 (rs = 0.34; p=0.036). When we controlled for age, there no longer was a relationship between steps per day and 6MWD (p=0.99) and TUG (p=0.12); however, the positive correlation between step per day and 30-second chair stands remained (p=0.047). Usual gait speed (rs = 0.056; p=0.69) and seated grip strength (rs =0.17; p=0.23) did not correlate with physical activity. Conclusion The results of the study support accelerometers as a feasible measure of physical activity in younger and older adults with SCD. Most participants wore and were able to return their activity monitors without difficulty. There was a moderate positive correlation between steps per day and physical function that was mostly driven by age. There remained a significant relationship between steps per day and number of chair stands when we controlled for age, which suggests that consistent physical activity may play a role in maintaining lower body strength in adults with SCD. In future studies we will use accelerometers to monitor physical activity in response to geriatric-based interventions for older adults with SCD. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

SEMG-Based Hand Posture Recognition and Visual Feedback Training for the Forearm Amputee.

sEMG-based gesture recognition is useful for human–computer interactions, especially for technology supporting rehabilitation training and the control of electric prostheses. However, high variability in the sEMG signals of untrained users degrades the performance of gesture recognition algorithms. In this study, the hand posture recognition algorithm and radar plot-based visual feedback training were developed using multichannel sEMG sensors. Ten healthy adults and one bilateral forearm amputee participated by repeating twelve hand postures ten times. The visual feedback training was performed for two days and five days in healthy adults and a forearm amputee, respectively. Artificial neural network classifiers were trained with two types of feature vectors: a single feature vector and a combination of feature vectors. The classification accuracy of the forearm amputee increased significantly after three days of hand posture training. These results indicate that the visual feedback training efficiently improved the performance of sEMG-based hand posture recognition by reducing variability in the sEMG signal. Furthermore, a bilateral forearm amputee was able to participate in the rehabilitation training by using a radar plot, and the radar plot-based visual feedback training would help the amputees to control various electric prostheses.

Intergenerational Programming Increases Solid Food Consumption for Adult Day Center Attendees.

We examined whether participation in intergenerational programming would impact daily food and liquid intake for adult day service center (ADSC) participants, many of whom are at risk for malnutrition and dehydration. Data came from 75 ADSC participants who, on average, attended the center for 472.32days between 2007 and 2018. We analyzed daily data using multilevel modeling, nesting attending days within ADSC participants. On days when participants joined intergenerational programming, they consumed significantly more solid food (β = 1.54, SD = .37, p < .001), but no different liquid (β = -.16, SD = .09, p = .06), than their own average across all days they attended the ADSC. Intergenerational programming may be an effective way to support ADSCs participants' nutrition. Future research is needed to determine the longer-term health benefits of daily increases in food consumption and to explore why intergenerational programming may differentially impact eating and drinking.

Characteristics of environmental RNAi in potato psyllid, Bactericera cockerelli (Sulc) (Hemiptera: Psylloidea: Triozidae).

RNA interference (RNAi) has potential to become a major tool for integrated management of insect pests of agricultural crops based on sequence-specificity and low doses of rapidly biodegradable dsRNA. Deploying 'environmental RNAi' for control of insect vectors of plant pathogens is of increasing interest for combatting emerging plant diseases. Hemipteran insect vectors, including psyllids, are vascular feeders, making their development difficult to control specifically by targeting with pesticidal chemistries. Psyllids transmit "Candidatus Liberibacter solanacearum" the causal organism of potato zebra chip and tomato vein greening diseases, transmitted, respectively, by the potato or tomato psyllid (PoP). Until now, the optimal effective concentration(s) of double-stranded RNA (dsRNA) required for significant gene knockdown and RNAi persistence in PoP have not been determined. The objective of this study was to optimize RNAi in young PoP adults and 3rd instars for screening by oral delivery of dsRNAs. The minimal effective dsRNA concentrations required for robust knockdown and persistence were evaluated by delivering seven concentrations spanning 0.1ng/μL to 500ng/μL over post ingestion-access periods (IAP) ranging from 48h to 12days. The PoP gene candidates evaluated as targets were vacuolar ATPase subunit A, clathrin heavy chain, and non-fermenting protein 7, which were evaluated for knockdown by qPCR amplification. The minimum and/or the second most effective dsRNA concentration resulting in effective levels of gene knockdown was 100ng/μL for all three targets. Higher concentrations did not yield further knockdown, indicating potential RISC saturation at the higher doses. Gene silencing post-IAP of 100ng/μL dsRNA persisted for 3-5days in adults and nymphs, with the PoP 3rd instar, followed by teneral and mature adults, respectively, exhibiting the most robust RNAi-response.

The development, reproduction and P450 enzyme of the white-backed planthopper, Sogatella furcifera (Hemiptera: Delphacidae) under the sublethal concentrations of clothianidin

Clothianidin is a second-generation neonicotinoid insecticide that can effectively prevent piercing-sucking pests, such as white-backed planthopper (WBPH), Sogatella furcifera (Horváth). In this study, the sublethal effects of clothianidin on the biological traits of S. furcifera were evaluated via the age-stage, two-sex life table procedure. Our results exhibited that the female adult longevity, fecundity and hatchability of F0 generation were significantly decreased after LC10 and (or) LC30 of clothianidin exposure compared to the control. Transgenerational effects showed that the pre-adult period, female adult longevity, total longevity, oviposition days (Od), fecundity and mean generation time (T) of F1 generation were significantly decreased in the LC10 and LC30 groups compared to the control. Moreover, the development times of the third- and fifth-instar nymphs, total preoviposition period (TPOP) and doubling time (DT) were significantly shorter in the LC10 group than in the control and LC30 groups. Furthermore, the intrinsic rate of increase (ri) and finite rate of increase (λ) values of the LC10 group were significantly higher than those of the control group. However, there was no significant difference in the male adult longevity, adult preoviposition period (APOP) and net reproductive rate (R0) between the treated groups and the control. Enzyme activity and gene expression results showed that the P450 enzyme activity and mRNA levels of many P450 genes were significantly increased by clothianidin treatment. In addition, the knockdown of CYP4CE3 and CYP6FJ3, which showed the highest inducing levels, by RNA interference (RNAi) dramatically increased the toxicity of clothianidin against S. furcifera. These results indicated that sublethal concentrations of clothianidin showed a stimulatory effect on the development, but it could adversely affect the survival and reproduction of S. furcifera. Additionally, CYP4CE3 and CYP6FJ3 might play an important role in the detoxification and evolution of clothianidin resistance in S. furcifera.

Later‐Life Learning Among Latin Americans in Canada: Toward a Critical Pedagogy of Place

This article examines interconnections between place‐based education and the Latin American Canadian migratory life course. It presents findings of a grounded theory study that utilized in‐depth interviews of 15 Latin American Canadian immigrant older adults (55 years and older) who participate in a mobile adult day support programme in northwest Toronto. The study explored the experiences of service‐users of place‐based education aimed at developing or strengthening their livelihood strategies. Findings revealed that many ageing immigrants view place‐based education as a vital resource that supports their ability to access culturally specific and mainstream services, expands their social networks, and can boost their life chances at successive life course stages. However, findings also indicated that immigrants also view place‐based education as inadequate and ill‐timed and would have preferred greater access to education when they first settled in Canada. The article contributes to emergent scholarship on ageing, transnational migration, and localized education for settlement and integration. Conceptually, it advances a life course justice approach to racialized immigrants’ later‐life learning by underscoring the utility of integrating a critical pedagogy of place into community education.

Warning Signs of Acute Infectious Disease-Related Illness in Persons Living With Dementia: Perspectives of Primary Care Providers, Adult Day Service Center Staff, and Family Care Partners.

In the current study, we conducted one-on-one interviews with primary care providers (PCPs) and family care partners (FCPs) and held focus groups with interdisciplinary adult day service center (ADSC) staff to understand the perspectives of care providers across community settings regarding early warning signs of acute illnesses in persons living with dementia (PLWD). We used content analysis to analyze qualitative data. Warning signs of acute illnesses in PLWD fell into one of five categories, including new onset changes in (a) physical functions, (b) moods or behaviors (psychological), (c) social interactions, (d) speech, or (e) appearance. FCPs (n = 11) focused on physical changes, whereas ADSC staff (n = 33) emphasized changes in speech and social interactions in addition to the other categories. Although ADSC staff and PCPs (n = 22) focused on changes in functions and moods, each group described these changes differently. ADSC staff possess rich information that can be used to identify acute changes in PLWD and describe a broader range of warning signs compared to PCPs and FCPs. FCPs may benefit from further training in distinguishing between normal disease progression and acute illness. Future research should focus on the implementation of standardized tools across community-based care providers to simplify the identification and reporting of early warning signs in PLWD. [Journal of Psychosocial Nursing and Mental Health Services, 61(5), 35-43.].

Detection of bisphenols in Indian surface water, tap water, and packaged drinking water using dispersive liquid-liquid microextraction: exposure assessment for health risk.

The prevalence of bisphenols (BPs) has been well documented in the aquatic environment of many countries, but such studies from India are quite limited. The present work aimed to determine the occurrence of BPs in surface water (n = 96), tap water (n = 172), and packaged drinking water (n = 42) and estimate their exposure to humans. For this, a simple, sensitive, cost-effective, and green analytical chemistry method based on dispersive liquid-liquid microextraction (DLLME) was employed. Bisphenol A (BPA) was found as the most prevalent bisphenol (mean concentration range = 980-6470 ng/L) in all the water samples, with a % detection frequency of 17-39%. Bisphenol S (BPS) and bisphenol Z (BPZ) were also detected in all types of water samples. The mean estimated daily intake (EDI) for total BPs (tap water and packaged drinking water) was found to be 474.37 ng/kg b.w./day in adults and 665.65 ng/kg b.w./day in children, respectively. This indicated that the total exposure to all the detected BPs obtained for adults and children was lower than the temporary tolerable daily intake (t-TDI) recommended by the European Food Safety Authority (EFSA) (4 μg/kg b.w./day), thereby posing no substantial risks to humans from consuming water from the tap and/or packaged drinking water.

Treatment of erythema migrans with doxycycline for 7 days versus 14 days in Slovenia: a randomised open-label non-inferiority trial

Lyme borreliosis is the most prevalent vector-borne disease in Europe and the USA. Doxycycline for 10 days is the primary treatment recommendation for erythema migrans. To reduce potentially harmful antibiotic overuse by identifying shorter effective treatments, we aimed to assess whether oral doxycycline for 7 days is non-inferior to 14 days in adults with solitary erythema migrans. In this randomised open-label non-inferiority trial, we enrolled patients with a solitary erythema at the University Medical Centre in Ljubljana, Slovenia. Patients were excluded if they were pregnant or lactating, immunosuppressed, allergic to doxycycline, or had received antibiotics with anti-borrelial activity within 10 days preceding enrolment or had additional manifestations of Lyme borreliosis Adults were randomly allocated 1:1 to receive oral doxycycline 100 mg twice a day for 7 days or 14 days. The primary efficacy endpoint was the difference in proportion of patients with treatment failure, defined as persistent erythema, new objective signs of Lyme borreliosis, or borrelial isolation on skin re-biopsy at 2 months, in a per-protocol analysis (the population that completed the assigned doxycycline regimen according to the study protocol and did not receive any other antibiotics with anti-borrelial activity until the 2-month visit). The non-inferiority margin was 6 percentage points. Safety was assessed in all randomly assigned patients who followed the study protocol and were evaluable at the 14-day visit. This study is registered with ClinicalTrials.gov, NCT03153267. Between July 3, 2017, and Oct 2, 2018, we enrolled 300 patients (150 per group: median age 56 years [IQR 47-65]; 126 [45%] of 300 male; skin culture positive 72 [30%] of 239 assessed). 295 patients completed antibiotic therapy as per protocol and 294 (98%) patients were evaluable 2 months post-enrolment. Five (3%) of 147 patients from the 7-day group versus 3 (2%) of 147 patients from the 14-day group (one patient did not attend the 2-month visit and was unreachable by telephone) had treatment failure manifesting as persistence of erythema (difference 1·4 percentage points; upper limit of one-sided 95% CI 5·2 percentage points; p=0·64). No patients developed new objective manifestations of Lyme borreliosis during follow-up or had positive repeat skin biopsies. Two (1%) of 150 patients in the 7-day and one (1%) of 150 patients in the 14-day group discontinued therapy due to adverse events. Our data support 7 days of oral doxycycline for adult European patients with solitary erythema migrans, permitting less antibiotic exposure than current guideline-driven therapy. Slovenian Research Agency and the University Medical Centre Ljubljana.

Fusion and expansion of vitellogenin vesicles during Caenorhabditis elegans intestinal senescence.

Some of the most conspicuous aging phenotypes of C.elegans are related to post-reproductive production of vitellogenins (Vtg), which form yolk protein (YP) complexes after processing and lipid loading. Vtg/YP levels show huge increases with age, and inhibition of this extends lifespan, but how subcellular and organism-wide distribution of these proteins changes with age has not been systematically explored. Here, this has been done to understand how vitellogenesis promotes aging. The age-associated changes of intestinal vitellogenin vesicles (VVs), pseudocoelomic yolk patches (PYPs), and gonadal yolk organelles (YOs) have been characterized by immuno-electron microscopy. We find that from reproductive adult day 2 (AD 2) to post-reproductive AD 6 and AD 9, intestinal VVs expand from 0.2 to 3-4μm in diameter or by >3000 times in volume, PYPs increase by >3 times in YP concentration and volume, while YOs in oocytes shrink slightly from 0.5 to 0.4μm in diameter or by 49% in volume. In AD 6 and AD 9 worms, mislocalized YOs found in the hypodermis, uterine cells, and the somatic gonadal sheath can reach a size of 10μm across in the former two tissues. This remarkable size increase of VVs and that of mislocalized YOs in post-reproductive worms are accompanied by extensive fusion between these Vtg/YP-containing vesicular structures in somatic cells. In contrast, no fusion is seen between YOs in oocytes. We propose that in addition to the continued production of Vtg, excessive fusion between VVs and mislocalized YOs in the soma worsen the aging pathologies seen in C.elegans.

Adult Day Services, Health Equity for Older Adults With Complex Needs, and the COVID-19 Pandemic.

Morbidity and mortality from COVID-19 have unduly affected older adults from racial and ethnic minority groups. In this article, we highlight the experiences and vulnerabilities of diverse older adults with complex health and social needs when their access to vital, but overlooked, community-based adult day service centers (ADSCs) was abruptly cut off during a pandemic. Pandemic-related ADSC closures left vulnerable older adults and their care partners without essential daily support and services, such as health monitoring and socialization. However, the magnitude of the impact of ADSC closures on well-being, particularly among members of racial/ethnic minority groups, has yet to be measured with any form of "big data" because large-scale, nationally representative data sets consisting of participant-level information and outcomes associated with ADSC participation do not yet exist. Unmet needs of older adults resulting from pandemic-related ADSC closures are underrecognized because of a lack of systematic data collection, undermining efforts to achieve health equity. We call on ADSCs to link rigorous collection of racial and ethnic data to quality measures of access to equitable "age-friendly" care as a means of better supporting diverse community-dwelling older adults beyond the COVID-19 pandemic. (Am J Public Health. 2022;112(10):1421-1428. https://doi.org/10.2105/AJPH.2022.306968).

P.124 EDG-5506 targets fast skeletal myosin and reduces muscle damage biomarkers in a phase 1 trial in Becker muscular dystrophy (BMD)

To assess safety, pharmacokinetics (PK), pharmacodynamics and biomarkers of muscle damage in healthy adults and adults with BMD. Fast (Type II) muscle fibers are affected early and disproportionately in dystrophinopathies. EDG-5506 targets fast skeletal muscle myosin, and in animal models of Duchenne muscular dystrophy (DMD), decreased muscle damage biomarkers and fibrosis, while increasing muscle strength and habitual activity. Ascending EDG-5506 doses (5-40 mg daily) were administered orally for 14 days in healthy adults who underwent assessments of safety, plasma and muscle PK, and biomarkers. Seven ambulatory adults with BMD were enrolled to assess safety, PK and effects of EDG-5506 or placebo in the setting of dystrophic muscle after 14 days. EDG-5506 was well-tolerated at all doses in healthy adults. Most common adverse events were somnolence and dizziness, which were mild and transient. Plasma and muscle exposures exceeded exposures that had demonstrated positive effects in animal models of DMD. In healthy adults and in participants with BMD, muscle concentrations substantially exceeded those in plasma, consistent with high affinity of EDG-5506 for fast fiber myosin. Muscle strength was maintained in all cohorts. In BMD participants, EDG-5506 was well-tolerated and significantly reduced creatine kinase, myoglobin, and fast skeletal muscle troponin I (TNNI2). In a plasma proteomic panel (SOMAscan), proteins associated with muscle damage and muscle metabolism were elevated in participants with BMD when compared to healthy controls. This panel of proteins decreased significantly with EDG-5506, particularly for those proteins that become elevated in response to exercise. EDG-5506 demonstrated favorable safety and PK profiles at dose levels that resulted in robust reductions in muscle damage biomarkers in adults with BMD. By targeting fast skeletal muscle myosin to protect dystrophic muscle, EDG-5506 has potential to be a novel disease-modifying approach in DMD and BMD regardless of mutation type. Phase 2 studies in BMD and DMD are planned.

"The Sun Came Up Because You Got Here…": A Qualitative Exploration of Person-Centered Care Strategies Used by Adult Day Care Centers to Manage Behavioral and Psychological Symptoms of Dementia.

In order to reduce care partner strain and support aging in place for people living with Alzheimer's Disease and Alzheimer's Disease Related Dementias (AD/ADRD), adult day centers (ADCs) must manage behavioral and psychological symptoms of dementia (BPSD). The purpose of this paper is to identify person-centered care strategies used by center staff to manage BPSD. Six focus groups with center staff (n = 31) were conducted. Data were analyzed using directed content analysis guided by Kitwood's conceptual approach to cultivating personhood in dementia care. Themes were identified and organized within Kitwood's framework. The results demonstrate that staff incorporate evidence-based person-centered approaches to AD/ADRD care that align with Kitwood's principles of comfort, attachment, inclusion, and identity. Staff individualize their approach to people with AD/ADRD within a group setting. They monitor, engage, socially stimulate, and, when needed, de-stimulate them. Centers are flexible social environments with underrecognized expertise managing BPSD using person-centered approaches.