Long-term Trajectories Research Articles

Impact of Silent Cerebral Embolism during and after Left Atrial Appendage Occlusion on Long-Term Cognitive Function.

Left atrial appendage occlusion (LAAO) was associated with a high incidence of procedure-related silent cerebral embolism (SCE). There are limited data regarding the long-term cognitive trajectory of patients undergoing LAAO. The aim of our study was to comprehensively assess the acute and long-term impact of SCE during and after LAAO. Consecutive patients with atrial fibrillation referred for LAAO from the First Affiliated Hospital with Nanjing Medical University between February 2021 and February 2023 were included. All patients underwent magnetic resonance imaging and cognitive assessments before and within 48 hours after the procedure. These evaluations were also repeated at 45-day, 3-month, 6-month, and 1-year follow up. Out of 75 patients included in the final analysis, 29 (38.7%) patients suffered from new SCE during LAAO. Patients with SCE exhibited a significant decline in cognitive function (Mini-Mental State Examination) immediately after the procedure (P<0.001), which was not reversible during 1-year follow-up (P<0.001). Additionally, with time going on, the gap in cognitive function between patients with and without SCE became wider (SCE × 1 year: B=-4.81 [95% CI, -5.58 to -4.05]; P<0.001). New-onset SCE was detected in 11 (14.7%) patients during the follow-up magnetic resonance imaging, which also showed a decline in cognitive function (P=0.004). The results in Montreal Cognitive Assessment scores were consistent with Mini-Mental State Examination. LAAO-related SCE is associated with a marked impairment in cognitive function immediately after the procedure and is irreversible over a 1-year follow-up. New magnetic resonance-detected SCE during follow-up after LAAO would also be associated with a decline in cognitive function.

Longitudinal outcomes of a parent-administered sensorimotor intervention in preterm infants at 4 and 18months.

Despite the increasing focus on early parent-delivered interventions in neonatal intensive care units to enhance infant development, there remains a research gap concerning the sustained benefits of such interventions in preterm infants. This study evaluated the impact of the parent-administered sensorimotor intervention (PASI) on developmental outcomes of infants previously enrolled in a randomized clinical trial (RCT). A prospective longitudinal follow-up study following the RCT at 4 and 18months corrected gestational age (CGA) was conducted. A blinded examiner conducted the follow-up assessments. The study outcomes developmental outcome at both time points and the child's health-related quality of life at 18months CGA using various means: Test of Infant Motor Performance (TIMP), the Feeding and Developmental Milestone Questionnaire (FDM), diagnosis of severe neurological disorder, the Infant Development Inventory (IDI) and Pediatric Quality of Life Inventory (PedsQL). At 4months CGA, 47 infants participated in the follow-up, with more infants in the experimental group receiving direct breastfeeds compared to the control group (38% vs. 12%, p=0.032). At 18months CGA, 51 infants were followed, showing no significant differences in developmental outcomes or health-related quality of life between groups. However, more parents in the control group reported developmental concerns about their child compared to those in the experimental group. The PASI appears to have lasting positive effects on breastfeeding outcomes for infants and on parents' perceptions of developmental concerns. These findings underscore the importance of early postnatal experiences in influencing the long-term developmental trajectories of infants born preterm.

Association of Longitudinal Trajectories of Physical Frailty With Dementia Status in Older Adults: A National Cohort Study.

The longitudinal patterns of change in physical frailty and their associations with the subsequent dementia risk remain unclear. This study aimed to (1) explore the long-term trajectories of physical frailty over a 6-year period in older adults without dementia at baseline; (2) identify the socio-demographic and health-related factors associated with different physical frailty trajectories; and (3) examine the longitudinal relationships between different physical frailty trajectories and subsequent risk of dementia. This national cohort study used data from the National Health and Aging Trends Study (NHATS) conducted in the United States from 2015 to 2021 and included adults aged ≥65 without dementia (n=2245) at baseline in 2015. Group-based trajectory modeling was used to describe the longitudinal changes. Socio-demographic and health-related characteristics were compared across the identified physical frailty trajectories using bivariate analyses, employing Rao-Scott chi-square tests for categorical variables and design-based F-tests for continuous variables. Multinomial logistic regression analyses were conducted to examine the relationships between different frailty trajectories and subsequent dementia status. Three frailty trajectories were identified: low-stable (74.00%), low-increasing (21.14%), and high-level (4.86%). Participants in the low-increasing and high-level groups were predominantly older, female, minorities, unmarried, and less educated and had a lower income, more comorbidities, and greater anxiety and depression symptoms (p<0.001). Compared with the low-stable group, older adults in the low-increasing group had higher risk of possible dementia (RRR: 2.37, 95% CI: 1.41-3.97, p<0.001) and probable dementia (RRR: 1.71, 95% CI: 1.08-2.73, p=0.02); similarly, older adults in the high-level group had higher risks of possible dementia (RRR: 4.24, 95% CI: 1.74-10.36, p<0.001) and probable dementia (RRR: 2.99, 95% CI: 1.32-6.76, p=0.01). No significant differences were found in the risk of dementia between the high-level frailty group and the low-increasing frailty group (p>0.05). This study highlighted the importance of regular frailty monitoring for early detection and informed future interventions that could delay frailty progression and potentially reduce dementia risk.

Trajectory of the arterial-alveolar oxygen gradient in COPD for a decade.

Chronic respiratory failure (CRF) is a critical complication in patients with chronic obstructive pulmonary disease (COPD) and is characterized by an increase in the arterial-alveolar oxygen gradient (A-aDO2). The long-term trajectory and prognostic significance remain unclear. This study aimed to assess the prognostic impact of A-aDO2 and elucidate its trajectory over ten years. We enrolled 170 outpatients with COPD from a prospective cohort study. Arterial blood gas (ABG) analyses were conducted annually for ten years while monitoring the development of CRF. 157 patients completed the observation period, of whom 21 developed CRF (CRF group) and 136 did not (non-CRF group). In the CRF group, there was a gradual increase in A-aDO2 along with decreases in partial pressure of oxygen (PaO2) and partial pressure of carbon dioxide (PaCO2) over ten years, although there were no changes in the non-CRF group. The CRF group had higher baseline A-aDO2 and higher ΔA-aDO2 in the first year than the non-CRF group (3.76 vs. 0.42 Torr/year, p = 0.030). Kaplan-Meier analyses, and multivariate Cox proportional hazards analysis revealed that both baseline A-aDO2 and ΔA-aDO2 were significantly associated with the development of CRF. Retrospective tracking from the initiation of long-term oxygen therapy (LTOT) revealed significant increases in A-aDO2 from 5 years prior to LTOT initiation in the CRF group when compared to the non-CRF group. An increasing trend in A-aDO2 may be a significant sign for the future development of CRF. A transition of the annual change of A-aDO2 from a stable state to a deterioration phase can serve as a prognostic factor for developing CRF within 5 years.

P-496. Trajectory of Veterans Aging Cohort Study Index Score in People Living with HIV

Abstract Background HIV infection weakens human immunity and also causes chronic inflammation. Effective antiretroviral therapy (ART) restores cellular immunity but its ability to reverse chronic inflammation is limited. The Veterans Aging Cohort Study (VACS) is a longitudinal, prospective observational cohort study and used routinely obtained generic data during clinic follow to generate the VACS index which was correlated with poor outcomes. The present study aims to describe the long-term VACS index trajectory pattern of PLWH and to identify the possible factors associated with the unfavorable trajectory of PLWH. Trajectories of the VACS index and the confidence intervals over up to 7 years of follow-up (n=1677) Methods This was a retrospective cohort study enrolling adult PLWH who received HIV care regularly for more than one year in a single medical center and data were retrieved from the electronic medical system. The VACS index for each patient every half year was calculated during 2016∼2022 and collected for group-based trajectory analysis (GBTA). All these analyses were done using the SAS software (9.4 version, SAS Institute Inc., Cary, NC, USA). Multivariate odds ratio with 95% confidence intervals of factors associated with unfavorable trajectory in PLWH by the logistic regression method (n=1677) Results A total of 1677 PLWH with 13366 VACS index records were analyzed through GBTA and categorized into three trajectories: consistently low VACS index with a median VACS index score of 0 points (40.4%), consistently medium scores (median score, 16) of the VACS index (48.2%), and consistently high scores (median score, 52 ) of the VACS index (11.4%) The medium score distribution of the VACS index in the three groups remained unchanged even though the proportion of ART prescriptions increased during the entire follow-up. Age, HIV exposure other than male-to-male sexual contact, baseline CD4 count, Hb level, renal function, FIB-4, and HCV co-infection were significantly associated with the unfavorable trajectory in the multivariate model. Conclusion The present study showed that the VACS index is a relatively stable indicator and could be used as an outcome indicator and also provided physicians with an understanding of the long-term trajectories of the VACS index in PLWH. Physicians could identify the high-risk PLWH quickly by using the VACS index. For the PLWH with the consistently high VACS index, physicians need to consider more evaluations or interventions to assure drug adherence to address HIV control. Disclosures All Authors: No reported disclosures

Long-term antibody trajectories after PPSV23 in elderly: Results from a 4-year follow-up study.

The 23-valent pneumococcal polysaccharide vaccine (PPSV23) is recommended for standalone or sequential use in the elderly in many countries to prevent pneumococcal disease, making it crucial to assess vaccine response and long-term persistence. We aimed to describe the trajectories of circulating antibody levels to the PPSV23 in the elderly following immunization. Eligible individuals aged 65 to 70years were enrolled and vaccinated with one dose of PPSV23. Blood samples were collected at baseline (day 0), 4-6weeks, one year, two years, three years, and four years after vaccination from November 2019 to December 2023. Serotype-specific IgG antibodies were measured for 7(4,6B,9V,14,18C,19F and 23F) out of the 23 vaccine serotypes. Group-based trajectory modeling (GBTM) was applied to identify distinct trajectories of IgG concentration at each visit after immunization. A total of 237 participants completed all six visits over the four-year follow-up period, and the geometric mean concentrations (GMC) of antibodies against the seven serotypes remained elevated above the baseline levels by the fourth year. Females and those with a body mass index (BMI) over 25 have generally higher antibody levels pre- and post-immunization across the seven serotypes, with serotypes 6B, 18C show significant difference in higher BMI individuals, and serotype 9V show significant difference in females after immunization. Based on GBTM, we identified two or three distinct trajectory types of IgG concentration changes across serotypes, with the exception of serotype 4, and we found that participants who showed a more rapid decline in antibody levels two years after vaccination had significantly higher baseline antibody levels. Pneumococcal IgG antibody levels persist for a minimum of four years post-vaccination; Our findings indicate that BMI, gender, and pre-vaccination antibody concentrations should be considered when developing vaccination and revaccination strategies in the elderly.

Association between non-insulin-based insulin resistance indicators and frailty progression: a national cohort study and mendelian randomization analysis

BackgroundInsulin resistance (IR) is linked to an increased risk of frailty, yet it remains unclear whether the non-insulin-based IR indicators are associated with frailty trajectories and physical function decline. It aimed to examine the associations of triglyceride-glucose (TyG) index, metabolic score for insulin resistance (METS-IR), estimated glucose disposal rate (eGDR) and with long-term deficit-accumulation frailty trajectories and physical function decline.MethodsData from 6722 participants in the China Health and Retirement Longitudinal Study (CHARLS) were analyzed. Baseline TyG index, METS-IR, eGDR, along with the frailty index (FI) over nine years, were calculated. FI trajectories were assessed using group-based trajectory model (GBTM). Logistic regression models were used to analyze the associations between IR indicators with FI trajectory and frailty risk. Restricted cubic splines (RCS) models were utilized to detect potential dose-response associations. Linear mixed-effects model was used to evaluate associations with FI development speed. Age, gender, educational level, marital status, smoking status, drinking status, life satisfaction, social activity and sleep duration were adjusted. Additionally, a two-sample Mendelian randomization (MR) was performed to assess the causality of observed associations.ResultsThree FI trajectories including low-stable frailty, moderate-increasing frailty, and accelerated rising frailty were identified. Regarding the frail risk, each SD increment in TyG index was associated with a 16.1% increase in the risk of frailty (OR = 1.161; 95%CI: 1.092, 1.235). An inverse association was observed for eGDR with the OR (95%CI) being 0.741 (0.696, 0.788). A linear relationship was observed between baseline TyG index and frailty risk (P nonlinear = 0.696), but nonlinear association patterns for eGDR (P nonlinearity < 0.010) and METS-IR (P nonlinearity < 0.010). Each SD increment of TyG index was associated with greater FI increase (β = 0.005 SD/y; 95%CI = 0.002, 0.008 SD/y; P < 0.001). A similar association pattern was observed for METS-IR, and participants in the highest quartile of METS-IR showed significantly greater FI progression, with β value of 0.013 (95% CI = 0.004, 0.022). Each SD increment of eGDR was associated with a slower increase in FI (β=-0.006 SD/y, 95% CI=-0.009, -0.003 SD/y; P < 0.001). Participants in the highest quartile of eGDR presented a lower annual change in FI compared with participants in quartile 1 group during follow-up (β=-0.013 SD/y, 95% CI=-0.022, -0.005 SD/y; P for trend = 0.001). Similar findings were observed for physical function decline. Findings from MR analysis showed a causal relationship between higher TyG index and increased risk of frailty (β = 0.214, 95% CI = 0.079, 0.349; P = 0.002).ConclusionsThe non-insulin-based IR indicators, including TyG index, METS-IR and eGDR, were independently associated with the frailty progression and physical function decline. Monitoring and managing abnormal glucose metabolism should be recommended as a part of comprehensive strategies to prevent or delay the progression of frailty.

Nature and prevalence of long-term conditions in people with intellectual disability: retrospective longitudinal population-based study

ObjectiveExplore the nature and prevalence of long-term conditions in individuals with intellectual disability.DesignRetrospective longitudinal population-based study.SettingPrimary and secondary care data across the population of Wales with the Secure Anonymised Information...

Machine Learning-based Cluster Analysis Identifies Three Unique Phenotypes of Patients With Adult Spinal Deformity With Distinct Clinical Profiles and Long-term Recovery Trajectory: A Development Study.

A retrospective review of a prospective adult spinal deformity data. To identify distinct patient clinical profiles and recovery trajectories in patients with adult spinal deformity (ASD). Patients with ASD exhibit a diverse array of symptoms and significant heterogeneity in clinical presentations, posing challenges to precise clinical decision-making. Accurate patient selection may provide further insight to personalized management strategies. Latent profile analysis (LPA) was performed to determine possible patient phenotype. Goodness-of-fit indices were used to determine the optimal cluster profiles. Outcome differences were evaluated using Analysis of Variance (ANOVA) and subsequent post hoc Tukey's test, while significant predictors of group membership were identified through multinomial logistic regression. A total of 204 ASD patients (mean age of 60.3 ± 11.8 years, comprising 62.3% females) with complete 1-year and 2-year follow-up outcome were included. LPA identified three phenotypes: 51 patients in phenotype 1, 73 patients in phenotype 2 and 80 patients in phenotype 3, respectively. Each phenotype exhibited a unique symptom profile and distinct functional recovery trajectories. Patients in phenotype 3, although demonstrated the worst Scoliosis Research Society-22 questionnaire (SRS-22r) domains at baseline, patients in this cluster exhibited the most substantial Δchange in SRS-22r domains except for self-image at both 1-year and 2-year follow-up. Remarkably, a relative large proportion of patients (58.8%) who were dissatisfied at 1-year follow-up transited to satisfied at 2-year follow-up. Advanced age, longer symptom duration, severe preoperative pelvic incidence-lumbar lordosis (PI-LL) mismatch, higher preoperative sagittal vertical axis (SVA), fusion extending to sacrum/pelvis and grade ≥ 3 osteotomy predicted membership in the phenotype 3. LPA enabled the delineation of three distinct phenotypes among ASD patients, each characterized by unique clinical profiles and distinct long-term recovery trajectories. By pinpointing the crucial variables that uniquely distinguish and predict membership in different phenotypes, the study provides valuable guidance for patient stratification.

Control-Oriented Real-Time Trajectory Planning for Heterogeneous UAV Formations

Aiming at the trajectory planning problem for heterogeneous UAV formations in complex environments, a trajectory prediction model combining Convolutional Neural Networks (CNNs) and Long Short-Term Memory networks (LSTM) is designed, and a real-time trajectory planning method is proposed based on this model. By pre-training trajectory prediction networks for various types of UAVs, the traditional physics-based models are replaced for flight trajectory prediction. Inspired by Model Predictive Control (MPC), in the trajectory planning stage, the method generates multi-step trajectory points using an improved artificial potential field (APF) method, estimates the actual formation trajectory using the prediction network, and optimizes the trajectory through a multi-objective particle swarm optimization (MOPSO) algorithm after evaluating the planning costs. During actual flight, the optimized parameters generate trajectory points for the formation to follow. Unlike conventional path planning based on simple constraints, the proposed method directly plans trajectory points based on trajectory tracking performance, ensuring high feasibility for the formation to follow. Experimental results show that the CNN-LSTM network outperforms other networks in both short-term and long-term trajectory prediction. The proposed trajectory planning method demonstrates significant advantages in formation maintenance, trajectory tracking, and real-time obstacle avoidance, ensuring flight stability and safety while maintaining high-speed flight.

Neuropsychological Profile in Older Adults with End-Stage Kidney Disease during Kidney Transplantation Evaluation.

End-stage chronic kidney disease (CKD) is a significant concern for older adults and is often associated with cognitive impairment (CI). The origin of this CI is multifactorial, involving vascular and metabolic factors. Additionally, renal treatments, including dialysis, may affect cognition. This study aimed to assess the neuropsychological profiles of these patients and understand the effects of dialysis treatment. We conducted an observational retrospective study including older adults with end-stage CKD attending for kidney transplantation (KT). Comprehensive neuropsychological assessments were conducted. Composite cognitive scores were computed. Multivariate regression models were used to assess associations between cognition and dialysis status. We included 223 patients (151 treated with dialysis, 72 with conservative management), mean age of 73.5 ± 3.4. We observed a high prevalence of CI, around 30% for global cognition and affecting all neuropsychological domains. Patients treated with dialysis exhibited lower cognitive performance compared to those not undergoing dialysis, particularly in episodic (p = .031) and working memory (p = .024). This study confirms the high prevalence of CI in end-stage CKD, with dialysis being associated with worse episodic and working memory compared to non-dialyzed participants. Future investigations are needed to track the long-term cognitive trajectory of patients on the KT waiting list and post-transplantation. Retrospectively registered, no 22-808 on July 7th, 2022, CNIL register number 22-5808.

Long-term pulse pressure trajectories and risk of incident atrial fibrillation: the Tromsø Study.

Sex-based differences in the association of long-term trends in pulse pressure with future risk of atrial fibrillation (AF) have been explored using data from the population-based Tromsø Study 1986-2016. Women (n = 8331) and men (n = 7638) aged ≥20 years who attended at least two of the three Tromsø Study surveys conducted between 1986 and 2001 (the exposure period) were followed up for incident AF throughout 2016 (the follow-up period). Pulse pressure ≥60 mmHg was considered elevated. Group-based trajectory modelling and Cox regression were used for statistical analyses. Three long-term trajectory groups for pulse pressure were identified: Group 1 had normal pulse pressure throughout the exposure period, Group 2 had normal pulse pressure at the beginning and elevated pulse pressure at the end of the exposure period, and Group 3 had elevated pulse pressure throughout. Over the follow-up period, 568 (6.8%) women and 798 (10.5%) men developed AF. After adjustment for potential confounders at baseline, the long-term trajectory groups for elevated pulse pressure were associated with increased risk of AF in women, but not in men. In women, the adjusted hazard ratios of AF were 1.60 (95% confidence interval: 1.23, 2.09) for trajectory Group 2 and 2.78 (1.93, 4.02) for trajectory Group 3, compared with Group 1. Long-term elevated pulse pressure trajectories were independently associated with increased risk of AF in women, but not in men. Our findings call for further investigations to understand the mechanisms behind these sex-based differences.

A Trajectory Prediction Method for Reentry Glide Vehicles via Adaptive Cost Function

This paper proposes a trajectory prediction method via the adaptive cost function to address the difficulties in inferring the attack intention and maneuver mode, as well as the accumulation of prediction error during the trajectory prediction of reentry glide vehicles. Firstly, the vehicle guidance task is divided into two distinct categories: conventional guidance and no-fly zone avoidance guidance. A task-matched time-varying parameter prediction model set is then constructed. Secondly, taking into account the maneuverability, guidance intent, and battlefield situation of the vehicle, an adaptive intent cost function adapted to the guidance task is proposed, which avoids the estimation failure problem caused by manually setting cost coefficients in traditional methods. Finally, long-term trajectory prediction of vehicles is achieved using Bayesian theory to infer the attack intent and parametric model with the maximum a posteriori probability. The results of the simulations demonstrate that the proposed prediction method is capable of accurately inferring the vehicle’s attack intention and parameter model, and of effectively reducing the accumulation of prediction errors and the time required for the algorithmic process compared to existing methods.

Leisure travel and life satisfaction in a Dutch sample

People generally go on vacation to improve their life satisfaction. However, the association between life satisfaction and leisure travel is poorly understood, partly because of methodological limitations in previous research. In the present study, we examined the longitudinal association between life satisfaction and leisure travel using data from a representative Dutch sample ( N = 12,027) gathered annually over 8 years. We specifically compared travelers and non-travelers on their levels and growth in life satisfaction over time using a growth model framework. We also examined whether more frequent and international (vs. domestic) travel was associated with life satisfaction among travelers. Travelers and non-travelers were similar in levels and changes in life satisfaction. Traveling more frequently and internationally was related to greater life satisfaction during the year of travel, but not stable levels or long-term trajectories. Our findings suggest that vacations are only positively linked to life satisfaction in the short term.

Long-term Cognitive Trajectories in Older Adults After Surgery: A Population-based Cohort Study.

Postoperative cognitive decline (POCD) is a common, but often unrecognized condition after surgery. We evaluate postsurgical cognitive changes in a longitudinal population-based study. The study cohort comprises an age-stratified population-based random sample of individuals aged 65+ years from a small-town region of the United States. We identified as cases those participants who, during annual assessments, self-reported having undergone surgery under general anesthesia during the preceding year. We identified as controls those who reported no surgery for at least 6 consecutive years. The outcome variable changed over time (4y) in annual cognitive test composite scores encompassing the domains of attention/processing speed, executive function, memory, language, and visuospatial functions, which were modeled using Generalized Estimating Equations. A total of 436 participants had the required cognitive data; 179 participants (cases) had undergone surgery, while 257 participants (controls) had not undergone surgery. After adjusting for age, years of education, gender, race, heart failure, irregular heartbeat, and stroke, participants who underwent surgery had a greater decline in executive function, memory, and attention over a 2-year period. Participants who underwent surgery had a significant subsequent decline in cognitive function over the long term.

Pre-biologic disease trajectories are associated with morbidity burden and biologic treatment response in severe asthma.

Biologics can induce remission in some patients with severe asthma, however, little is known about pre-biologic disease trajectories and their association with outcomes from biological treatment. We aimed to identify long-term trajectories of disease progression in patients initiating biologics and investigate trajectory associations with disease burden and impact on biologic therapy efficacy. Patients in the Danish Severe Asthma Registry initiating biologic therapy between 2016-2022 were included and followed retrospectively in prescription databases starting 1995. We performed sequence analysis for inhaled corticosteroid (ICS) treatment intensity over time combined with unsupervised trajectory clustering. In total, 755 patients were included and three pre-biologic disease trajectories were identified: Chronic severe asthma (26%), Gradual onset severe asthma (35%), Recent, sudden onset severe asthma (39%). Chronic severe asthma patients were older, had the longest disease duration (35 years), the most impaired pulmonary function, the highest comorbidity prevalence and the lowest employment rate. Recent, sudden onset severe asthma patients were younger, had shorter disease duration (5 years), more tobacco exposure and the least impaired lung function. Gradual onset severe asthma had an intermediate burden of disease. The Chronic severe asthma cluster demonstrated the lowest prevalence of remission (17%) compared to the Gradual onset severe asthma (29%) and Recent onset severe asthma (32%) clusters. Three pre-biologic disease trajectories were identified, with increased disease duration and activity associating with asthma- and comorbidity burden. Early intervention may be key to prevent irreversible adverse outcomes for patients with severe asthma.

Long-Term Trajectories of Older Adults Served by an Emergency Department/Hospital-Based Elder Mistreatment Response Program.

An emergency department (ED) visit or hospitalization provides an opportunity to identify elder mistreatment and initiate intervention, but this seldom occurs. To address this, we developed the Vulnerable Elder Protection Team (VEPT), a novel interdisciplinary consultation service. We explored the long-term trajectories of patients receiving VEPT evaluation and intervention. We followed up at multiple intervals for 12 months older adults seen by VEPT from 9/1/2020-3/27/2023 with high or moderate concern for mistreatment who were discharged to the community, an elder abuse shelter, or rehabilitation facilities. We collected information through telephone calls to the older adult and others involved. We also analyzed separately cases in which the patient re-presented to the ED/hospital with VEPT consultation during the follow-up period. A total of 157 older adults met criteria for follow-up, and 30 of these (16.4%) died within 12 months. At 1 month, elder mistreatment was no longer occurring in 47.5% and still occurring but reduced in 20.3%, with 29.7% having no contact with the perpetrator and 17.8% having reduced contact. At 12 months, elder mistreatment was no longer occurring in 60.9% and still occurring but reduced in 14.5%, with 34.8% having no contact with the perpetrator and 17.4% having reduced contact. During the 12-month follow-up period, 16 (10.2%) patients re-presented to the ED with VEPT consultation, with 12 having persistent concern for ongoing elder mistreatment. Reasons included older adults/caregivers not accepting intervention or being willing to separate as well as VEPT reliance on community-based agencies and programs after discharge. We observed improved post-discharge safety for elder mistreatment victims who engaged with the VEPT program, with this increased safety durable over 1 year. Re-presentations highlighted the complexity of elder mistreatment intervention. Overall, these findings demonstrate the potential value of an ED/hospital-based elder mistreatment response team, a promising new geriatric care model.

Intersectionality in a Sociogenomic World: How do Race, Disability, Socioeconomic Status, and Polygenic Prediction Interact to Impact Perceptions of Educational Trajectories?

Education is important for life-long skills and economic growth, but student placement decisions may be shaped by social biases. As genomic information captured via polygenic scores becomes more available, it may also inform student placement decisions. We assessed the intersectional effects of polygenic scores, race, disability, and socioeconomic status on US adults' views about educational trajectories using an online experimental survey design. 1,367 US adults were randomized to one of 16 conditions and prompted to read a short vignette about a boy named "Michael," also depicted in an image. Each condition varied Michael's race (Black/White), disability (wheelchair-user/no), socioeconomic status (high/low), and polygenic score (high/low) for educational attainment (EA-PGS). After reading the vignette, respondents were asked to answer multi-choice questions about Michael's immediate and long-term educational trajectories. Variation in Michael's EA-PGS strongly influenced participants' expectations regarding: 1) the most appropriate immediate educational program for Michael (i.e., general, 'special', or gifted education); 2) whether he would graduate high school; and, if so, 3) the highest educational degree he would complete in his lifetime (Associates, Bachelors, Masters, or PhD). Across these responses, high EA-PGS was associated with more socially desirable outcomes and the opposite was the case for low EA-PGS. Depicting Michael in a wheelchair significantly influenced respondents' expectation that his most appropriate immediate educational trajectory would be 'special' education. There were significant interactions between Michael's race, disability, socioeconomic status, and EA-PGS. Information about a child's EA-PGS may impact views about their immediate and long-term educational trajectories. The negative impacts of a low EA-PGS are comparable to the positive impacts of a high EA-PGS. EA-PGS may be interpreted in ways that compound existing stereotypes related to a child's race, disability, and socioeconomic status.

Four-Dimensional Aircraft Trajectory Prediction with a Generative Deep Learning and Clustering Approach

Medium- and long-term four-dimensional (4D) aircraft trajectory prediction (TP) is a critical technology in air traffic management (ATM). This paper addresses the issue of existing medium- and long-term TP methods that are difficult to accurately fit aircraft trajectory data distributions. We propose a 4D TP method based on K-medoids clustering and conditional tabular generative adversarial networks (CTGAN), called C-CTGAN. Comparative experiments with four long short-term memory (LSTM)-based models and the original CTGAN model show that the proposed model’s TP accuracy is significantly higher than others when predicting medium- and long-term trajectories. When using the trajectory datasets without holding and a prediction time span of 10 min, compared to the convolutional neural network (CNN)-LSTM model, the C-CTGAN model reduces the mean absolute errors (MAEs) of core trajectory parameters, such as latitude, longitude, geometric altitude, and ground speed, by 69.89, 15.00, 74.07, and 84.21%, respectively. Compared to the original CTGAN model, the MAE is reduced by 20.43, 39.09, 31.98, and 17.07%, respectively. When using the trajectory datasets with holding, compared to the CNN-LSTM model, the C-CTGAN model shows MAE reductions of 14.08, 23.68, 31.46, and 2.86%, respectively. Compared to the original CTGAN, the reduction is 34.88, 2.69, 23.16, and 73.91%, respectively.

The year of a leaf: Tracking the fate of leaf litter and its nutrients during aquatic decomposition and consumption.

Temperate streams are subsidized by inputs of leaf litter peaking in fall. Yet, stream communities decompose dead leaves and integrate their energy into the aquatic food web throughout the whole year. Most studies investigating stream decomposition largely overlook long-term trajectories, which must be understood for an appropriate temporal upscaling of ecosystem processes. Using mesocosms, we quantified changes in carbon, nitrogen, and phosphorus content of three leaf species during decomposition at weekly to multi-month intervals for up to a year; then, we tested how decomposition duration affected the subsequent consumption by a keystone amphipod macroinvertebrate. Over a year, nitrogen and phosphorus percentage increased across all leaf species, but only the recalcitrant species maintained initial levels of absolute nitrogen and phosphorus. Prolonged decomposition barely affected or impaired amphipod consumption of labile leaf species, whereas it enhanced feeding on the recalcitrant species. Overall, we demonstrate that recalcitrant leaves might serve as longer stored potential resources for when labile species have already been consumed and that their increasing palatability observed over multi-month intervals of sustained decomposition may stabilize fluctuations in the rates of leaf litter integration into aquatic food webs. This yearlong perspective highlights the relevancy of slow-decomposing leaves for aquatic detrital communities.