While it is generally understood that Alzheimer's disease (AD) and related dementias (ADRD) is one of the costliest diseases to society, there is widespread concern that researchers and policymakers ...are not comprehensively capturing and describing the full scope and magnitude of the socioeconomic burden of ADRD. This review aimed to 1) catalogue the different types of AD-related socioeconomic costs described in the literature; 2) assess the challenges and gaps of existing approaches to measuring these costs; and 3) analyze and discuss the implications for stakeholders including policymakers, healthcare systems, associations, advocacy groups, clinicians, and researchers looking to improve the ability to generate reliable data that can guide evidence-based decision making. A centrally emergent theme from this review is that it is challenging to gauge the true value of policies, programs, or interventions in the ADRD arena given the long-term, progressive nature of the disease, its insidious socioeconomic impact beyond the patient and the formal healthcare system, and the complexities and current deficiencies (in measures and real-world data) in accurately calculating the full costs to society. There is therefore an urgent need for all stakeholders to establish a common understanding of the challenges in evaluating the full cost of ADRD and define approaches that allow us to measure these costs more accurately, with a view to prioritizing evidence-based solutions to mitigate this looming public health crisis.
Disease resistance (R) genes from wild relatives could be used to engineer broad-spectrum resistance in domesticated crops. We combined association genetics with R gene enrichment sequencing ...(AgRenSeq) to exploit pan-genome variation in wild diploid wheat and rapidly clone four stem rust resistance genes. AgRenSeq enables R gene cloning in any crop that has a diverse germplasm panel.
A combination of cell testing and electrochemical-thermal modeling is used to investigate extreme fast charging (XFC) performance for cells with a low loading of 1.5 mAh.cm−2 and moderate loading of ...2.5 mAh.cm−2. Cells with a low loading of 1.5 mAh.cm−2 withstand XFC performance remarkably well even up to 9C constant current (CC) charging with high charge capacity, high coulombic efficiency and very little apparent lithium plating. For a moderate loading of 2.5 mAh.cm−2, the 6C CC charge capacity is poor with significant amounts of visually observed lithium plating. Simulated electrolyte transport properties are revealed to be insufficient and majorly set limitations for XFC performance in case of the moderate and the only simulated higher loadings (>2.5 mAh.cm-2). Charging at elevated temperature is shown to be an effective strategy for moderate loading cells enabling good 10-min charge capacity, high coulombic efficiency, and mitigating lithium plating. Lastly, an electrochemical model is used to investigate strategies for enabling 4–6C CC charging for cells incorporating loading beyond 3 mAh.cm−2. As a result, the combination of an increased cell temperature, reduced electrode tortuosity, and enhanced ion-transport in the electrolyte are most likely required to facilitate XFC for state of the art and future high energy lithium-ion batteries.
Urban road verges can contain significant biodiversity, contribute to structural connectivity between other urban greenspaces, and due to their proximity to road traffic are well placed to provide ...ecosystem services. Using the UK as a case study we review and critically evaluate a broad range of evidence to assess how this considerable potential can be enhanced despite financial, contractual and public opinion constraints. Reduced mowing frequency and other alterations would enhance biodiversity, aesthetics and pollination services, whilst delivering costs savings and potentially being publically acceptable. Retaining mature trees and planting additional ones is favourable to residents and would enhance biodiversity, pollution and climate regulation, carbon storage, and stormwater management. Optimising these services requires improved selection of tree species, and creating a more diverse tree stock. Due to establishment costs additional tree planting and maintenance could benefit from payment for ecosystem service schemes. Verges could also provide areas for cultivation of biofuels and possibly food production. Maximising the contribution of verges to urban biodiversity and ecosystem services is economical and becoming an increasingly urgent priority as the road network expands and other urban greenspace is lost, requiring enhancement of existing greenspace to facilitate sustainable urban development.
•Urban road verges are often overlooked when discussing urban greenspace.•Verges can contribute significantly to urban biodiversity and ecosystem services.•Contractual obligations and public reaction concerns limit current contributions.•Current planting schemes, and tree species selection, further limit contributions.•Alternative management can cost-effectively enhance biodiversity & ecosystem services.
Addressing social determinants of health (SDOH) in all populations improves patient outcomes, leading to better patient-centered care. Despite known influences of SDOH, little is known about the ...ability of athletic trainers (ATs) to observe SDOH in practice.
To explore ATs' observations of SDOH and describe actions taken at the point of care in collegiate and university settings.
Descriptive via an observational card study.
Athletic training facilities.
Collegiate and university ATs (23 participants across 20 institutions).
The ATs used a modified observation card to document observations of SDOH during patient encounters in the collegiate or university setting. The cards contained instructions for completion and a table with 4 columns: (1) a list of 19 predetermined SDOH, (2) a checkbox for observed SDOH, (3) a checkbox for the perceived negative influence of observed SDOH on patient health, and (4) an open box to write in what actions, if any, were taken to address the observed SDOH.
Overall, 424 cards were collected. Of 725 observed SDOH, access to social media (153/725, 21.1%), academic stressors (131/725, 18.1%), and behavioral health issues (71/725, 9.8%) were the most commonly observed. Nearly 39% (281/725) had a perceived negative influence. Of those, academic stressors (49/281, 17.4%), behavioral health issues (46/281, 16.4%), and transportation issues (32/281, 11.4%) were most common. For the 23.0% (166/725) of SDOH acted upon, ATs used counseling and education (73/166), provided additional resources (60/166), referred to others (29/166), or communicated with others (4/166).
Because ATs are positioned to accurately assess SDOH, they can promote better patient-centered care and improve patient outcomes. Our results suggest that many SDOH observed by ATs in the collegiate or university setting have a negative influence on patient health. Better support for patients with academic stressors and behavioral health issues is important because of these SDOH.
Abstract
Given considerable variation in diagnostic and therapeutic practice, there is a need for national guidance on the use of neuroimaging, fluid biomarkers, cognitive testing, follow-up and ...diagnostic terminology in mild cognitive impairment (MCI). MCI is a heterogenous clinical syndrome reflecting a change in cognitive function and deficits on neuropsychological testing but relatively intact activities of daily living. MCI is a risk state for further cognitive and functional decline with 5–15% of people developing dementia per year. However, ~50% remain stable at 5 years and in a minority, symptoms resolve over time. There is considerable debate about whether MCI is a useful clinical diagnosis, or whether the use of the term prevents proper inquiry (by history, examination and investigations) into underlying causes of cognitive symptoms, which can include prodromal neurodegenerative disease, other physical or psychiatric illness, or combinations thereof. Cognitive testing, neuroimaging and fluid biomarkers can improve the sensitivity and specificity of aetiological diagnosis, with growing evidence that these may also help guide prognosis. Diagnostic criteria allow for a diagnosis of Alzheimer’s disease to be made where MCI is accompanied by appropriate biomarker changes, but in practice, such biomarkers are not available in routine clinical practice in the UK. This would change if disease-modifying therapies became available and required a definitive diagnosis but would present major challenges to the National Health Service and similar health systems. Significantly increased investment would be required in training, infrastructure and provision of fluid biomarkers and neuroimaging. Statistical techniques combining markers may provide greater sensitivity and specificity than any single disease marker but their practical usefulness will depend on large-scale studies to ensure ecological validity and that multiple measures, e.g. both cognitive tests and biomarkers, are widely available for clinical use. To perform such large studies, we must increase research participation amongst those with MCI.
Broad use of global or spatially averaging measurements over a cell to characterize highly localized Li plating phenomena in lithium-ion batteries during fast charging has created a disconnect ...between measurements and the underlying causes. Consequently, the field is missing a clear path to implementing fast charging as well as to expand into extreme fast charging (XFC). Aiming to bridge these gaps, we present a detailed look into local detection of Li plating and the consequent cycle life implications for electrodes and cells under XFC by utilizing electrochemistry and high-energy X-ray diffraction. Significant heterogeneity in Li plating during XFC results in accelerated and non-uniform cycle life losses, in contrast to the prevailing acceptance that C rate is correlated to Li plating for XFC. This behavior is triggered by local electrode heterogeneity, which has yet to be identified and is not apparent in volume-averaged quantifications. A better understanding of these multiscale local electrode heterogeneities is crucial for identifying pathways to enable XFC.
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Extreme fast charging (XFC) of lithium-ion batteries is a key issue for electric vehiclesLocal and global characterizations and analyses for detection of plating and degradationDirect relation between irreversible Li plating and battery performance (degradation)Understanding and tackling variation among similarly cycled cells is key to realize XFC
Linking the global and local behavior of lithium plating using electrochemistry and high-energy X-ray diffraction during fast charging of lithium-ion batteries, Tanim et al. report the consequent cycle life implications. Distinct and highly variable plating triggered by anode heterogeneity limits cycle life. Understanding these heterogeneities is crucial for identifying pathways to enable fast charging.
Fast charging of batteries for electric vehicles is seen as one of the most direct ways to enhance adoption. Currently, fast charging is limited by increased cell aging, which is primarily driven by ...Li plating and degradation of cathode materials. Here, using combined sets of experimental and computational analysis and a suite of different charge protocols, we begin to examine the interplay between failure mode, cell designs, and ultimately aging mechanisms. Slight variation in cell design and the subsequent impacts that charge protocols have on aging can create distinct cell-to-cell variation. As little as 2% difference in porosity change at the cell negative electrode during cycling due to early Li metal plating has been found to alter the aging pathway and either accelerate or inhibit the loss due to Li plating.
INTRODUCTION
Hearing loss is highly prevalent among older adults and independently associated with cognitive decline. The Aging and Cognitive Health Evaluation in Elders (ACHIEVE) study is a ...multicenter randomized control trial (partially nested within the infrastructure of an observational cohort study, the Atherosclerosis Risk in Communities ARIC study) to determine the efficacy of best‐practice hearing treatment to reduce cognitive decline over 3 years. The goal of this paper is to describe the recruitment process and baseline results.
METHODS
Multiple strategies were used to recruit community‐dwelling 70–84‐year‐old participants with adult‐onset hearing loss who were free of substantial cognitive impairment from the parent ARIC study and de novo from the surrounding communities into the trial. Participants completed telephone screening, an in‐person hearing, vision, and cognitive screening, and a comprehensive hearing assessment to determine eligibility.
RESULTS
Over a 24‐month period, 3004 telephone screenings resulted in 2344 in‐person hearing, vision, and cognition screenings and 1294 comprehensive hearing screenings. Among 1102 eligible, 977 were randomized into the trial (median age = 76.4 years; 53.5% female; 87.8% White; 53.3% held a Bachelor's degree or higher). Participants recruited through the ARIC study were recruited much earlier and were less likely to report hearing loss interfered with their quality of life relative to participants recruited de novo from the community. Minor differences in baseline hearing or health characteristics were found by recruitment route (i.e., ARIC study or de novo) and by study site.
DISCUSSION
The ACHIEVE study successfully completed enrollment over 2 years that met originally projected rates of recruitment. Substantial operational and scientific efficiencies during study startup were achieved through embedding this trial within the infrastructure of a longstanding and well‐established observational study.
Highlights
The ACHIEVE study tests the effect of hearing intervention on cognitive decline.
The study is partially nested within an existing cohort study.
Over 2 years, 977 participants recruited and enrolled.
Eligibility assessed by telephone and in‐person for hearing, vision, and cognitive screening.
The ACHIEVE study findings will have significant public health implications.
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