ObjectiveTo identify the needs of caregivers of hospitalised adults with dementia in the hospital and during care transitions.DesignPragmatic qualitative inquiry with semi-structured ...interviews.SettingMichael E. DeBakey Veterans Affairs Medical Center in Houston, Texas, USA.Participants12 family caregivers (family member (n=11); friend (n=1)) and 15 health professionals (hospital medicine physicians (n=4), inpatient nurse case managers (n=2), social workers (n=4), outpatient geriatrics providers (n=2), a primary care provider (n=1), geriatric psychiatrists (n=2)) were interviewed. Caregivers were recruited while their care recipient was hospitalised and were interviewed at least 2 weeks after the care recipient was discharged from the hospital. Health professionals were eligible for the study if they provided care to patients with dementia in the inpatient or outpatient setting.ResultsFour recommendations emerged from the analysis: (1) engage caregivers as partners in the care team, (2) provide dementia-specific information and training, (3) connect caregivers to home and community-based services and (4) provide care navigation and support for the caregiver posthospitalisation.ConclusionsHospital care transitions are challenging for caregivers of hospitalised adults living with dementia. Care transition interventions designed to support caregivers with tailored, dementia-specific information and services are needed.
Biological visual systems rely on pose estimation of 3D objects to navigate and interact with their environment, but the neural mechanisms and computations for inferring 3D poses from 2D retinal ...images are only partially understood, especially where stereo information is missing. We previously presented evidence that humans infer the poses of 3D objects lying centered on the ground by using the geometrical back-transform from retinal images to viewer-centered world coordinates. This model explained the almost veridical estimation of poses in real scenes and the illusory rotation of poses in obliquely viewed pictures, which includes the “pointing out of the picture” phenomenon. Here we test this model for more varied configurations and find that it needs to be augmented. Five observers estimated poses of sloped, elevated, or off-center 3D sticks in each of 16 different poses displayed on a monitor in frontal and oblique views. Pose estimates in scenes and pictures showed remarkable accuracy and agreement between observers, but with a systematic fronto-parallel bias for oblique poses similar to the ground condition. The retinal projection of the pose of an object sloped wrt the ground depends on the slope. We show that observers’ estimates can be explained by the back-transform derived for close to the correct slope. The back-transform explanation also applies to obliquely viewed pictures and to off-center objects and elevated objects, making it more likely that observers use internalized perspective geometry to make 3D pose inferences while actively incorporating inferences about other aspects of object placement.
Abstract Background Very little is known about specific trajectories or patterns of falls over time. Using the well-characterized cohort of the Osteoporotic Fractures in Men Study (MrOS), we ...classified individuals by fall trajectories across age and identified predictors of group assignment based on characteristics at baseline. Methods Using an analysis sample of 5976 MrOS participants and 15 years of follow-up data on incident falls, we used group-based trajectory models (PROC TRAJ in SAS) to identify trajectories of change. We assessed the association of baseline characteristics with group assignment using one-way analysis of variance (ANOVA) and chi-square tests. Multivariable logistic regression was used to analyze the outcome of the high risk fall trajectory groups compared to the low risk groups. Results Changes in rates of falls were relatively constant or increasing with five distinct groups identified. Mean posterior probabilities for all five trajectories were similar and consistently above 0.8 indicating reasonable model fit. Among the five fall trajectory groups, two were deemed high risk, those with steeply increasing fall risk and persistently high fall risk. Factors associated with fall risk included body mass index, use of central nervous agents, prior history of diabetes and Parkinson’s disease, back pain, grip strength, and physical and mental health scores. Conclusions Two distinct groups of high fall risk individuals were identified among five trajectory groups, those with steeply increasing fall risk and persistently high fall risk. Statistically significant characteristics for group assignment suggest that future fall risk of older men may be predictable at baseline.
Objective
To investigate Covid‐19 vaccination as a potential secondary public health benefit of case management for Medicaid beneficiaries with health and social needs.
Data Sources and Study Setting
...The CommunityConnect case management program for Medicaid beneficiaries is run by Contra Costa Health, a county safety net health system in California. Program enrollment data were merged with comprehensive county vaccination records.
Study Design
Individuals with elevated risk of hospital and emergency department use were randomized each month to a case management intervention or usual care. Interdisciplinary case managers offered coaching, community referrals, healthcare connections, and other support based on enrollee interest and need. Using survival analysis with intent‐to‐treat assignment, we assessed rates of first‐dose Covid‐19 vaccination from December 2020 to September 2021. In exploratory sub‐analyses we also examined effect heterogeneity by gender, race/ethnicity, age, and primary language.
Data Collection and Extraction Methods
Data were extracted from county and program records as of September 2021, totaling 12,866 interventions and 25,761 control enrollments.
Principal Findings
Approximately 58% of enrollees were female and 41% were under age 35. Enrollees were 23% White, 12% Asian/Pacific Islander, 20% Black/African American, and 36% Hispanic/Latino, and 10% other/unknown. Approximately 35% of the intervention group engaged with their case manager. Approximately 56% of all intervention and control enrollees were vaccinated after 9 months of analysis time. Intervention enrollees had a higher vaccination rate compared to control enrollees (adjusted hazard ratio aHR: 1.06; 95% confidence interval CI: 1.02–1.10). In sub‐analyses, the intervention was associated with stronger likelihood of vaccination among males and individuals under age 35.
Conclusions
Case management infrastructure modestly improved Covid‐19 vaccine uptake in a population of Medicaid beneficiaries that over‐represents social groups with barriers to early Covid‐19 vaccination. Amidst mixed evidence on vaccination‐specific incentives, leveraging trusted case managers and existing case management programs may be a valuable prevention strategy.
Abstract
Family caregivers are essential to safe care transitions for hospitalized adults living with dementia. We aimed to identify resource and training needs of dementia caregivers during care ...transitions. We conducted semi-structured interviews with caregivers (6 Spouses, 5 Children, 1 Friend) of hospitalized Veterans with dementia at the Michael E. DeBakey Veterans Affairs (VA) Medical Center. Interviews were recorded and transcribed verbatim. Rapid qualitative analysis using structured summaries and matrices were conducted. Although caregivers received information about the Veteran’s admitting medical condition, health professionals did not ask about dementia or provide dementia-related health information to the caregiver. Caregivers were willing to assist Veterans with activities of daily living in the hospital; however, caregivers were either prevented from assisting or did not receive training to assist Veterans safely. Caregivers desired information on how to get the Veteran “back on track” and address cognitive and functional declines experienced in the hospital. Although pre-hospital services and supports were easy to restart, caregivers needed earlier and more consistent communication regarding new services and supports starting after discharge, such as rehabilitation at skilled nursing facilities and respite care. Caregivers expressed a need for health professionals to help set “realistic expectations” for post-discharge care as some services and supports did not meet their expectations. Caregivers valued access to support groups for themselves but received inconsistent referrals to the VA Caregiver Support Program. These results will inform the adaptation of a dementia caregiver support intervention for caregivers of hospitalized Veterans living with dementia.
Black carbon (BC) exerts profound impacts on air quality and climate because of its high absorption cross-section over a broad range of electromagnetic spectra, but the current results on absorption ...enhancement of BC particles during atmospheric aging remain conflicting. Here, we quantified the aging and variation in the optical properties of BC particles under ambient conditions in Beijing, China, and Houston, United States, using a novel environmental chamber approach. BC aging exhibits two distinct stages, i.e., initial transformation from a fractal to spherical morphology with little absorption variation and subsequent growth of fully compact particles with a large absorption enhancement. The timescales to achieve complete morphology modification and an absorption amplification factor of 2.4 for BC particles are estimated to be 2.3 h and 4.6 h, respectively, in Beijing, compared with 9 h and 18 h, respectively, in Houston. Our findings indicate that BC under polluted urban environments could play an essential role in pollution development and contribute importantly to large positive radiative forcing. The variation in direct radiative forcing is dependent on the rate and timescale of BC aging, with a clear distinction between urban cities in developed and developing countries, i.e., a higher climatic impact inmore polluted environments. We suggest that mediation in BC emissions achieves a cobenefit in simultaneously controlling air pollution and protecting climate, especially for developing countries.
To identify pathways involved in adult lung regeneration, we employ a unilateral pneumonectomy (PNX) model that promotes regenerative alveolarization in the remaining intact lung. We show that PNX ...stimulates pulmonary capillary endothelial cells (PCECs) to produce angiocrine growth factors that induce proliferation of epithelial progenitor cells supporting alveologenesis. Endothelial cells trigger expansion of cocultured epithelial cells, forming three-dimensional angiospheres reminiscent of alveolar-capillary sacs. After PNX, endothelial-specific inducible genetic ablation of
Vegfr2 and
Fgfr1 in mice inhibits production of MMP14, impairing alveolarization. MMP14 promotes expansion of epithelial progenitor cells by unmasking cryptic EGF-like ectodomains that activate the EGF receptor (EGFR). Consistent with this, neutralization of MMP14 impairs EGFR-mediated alveolar regeneration, whereas administration of EGF or intravascular transplantation of MMP14
+ PCECs into pneumonectomized
Vegfr2/Fgfr1-deficient mice restores alveologenesis and lung inspiratory volume and compliance function. VEGFR2 and FGFR1 activation in PCECs therefore increases MMP14-dependent bioavailability of EGFR ligands to initiate and sustain alveologenesis.
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► Pulmonary capillary endothelial cells (PCECs) support alveologenesis ► Autocrine VEGFR2 and FGFR1 activation in PCECs induces MMP14 expression ► MMP14 unmasks EGF receptor ligands, enhancing epithelial cell proliferation ► Injection of activated PCECs or angiocrine factors accelerates lung regeneration
Capillary endothelial cells support the regeneration of alveolar epithelial cells by secreting a matrix metalloprotease that unmasks cryptic epidermal growth factor receptor ligands.
Phosphorene has attracted great interest due to its unique electronic and optoelectronic properties owing to its tunable direct and moderate band‐gap in association with high carrier mobility. ...However, its intrinsic instability in air seriously hinders its practical applications, and problems of technical complexity and in‐process degradation exist in currently proposed stabilization strategies. A facile pathway in obtaining and stabilizing phosphorene through a one‐step, ionic liquid‐assisted electrochemical exfoliation and synchronous fluorination process is reported in this study. This strategy enables fluorinated phosphorene (FP) to be discovered and large‐scale, highly selective few‐layer FP (3−6 atomic layers) to be obtained. The synthesized FP is found to exhibit unique morphological and optical characteristics. Possible atomistic fluorination configurations of FP are revealed by core‐level binding energy shift calculations in combination with spectroscopic measurements, and the results indicate that electrolyte concentration significantly modulates the fluorination configurations. Furthermore, FP is found to exhibit enhanced air stability thanks to the antioxidation and antihydration effects of the introduced fluorine adatoms, and demonstrate excellent photothermal stability during a week of air exposure. These findings pave the way toward real applications of phosphorene‐based nanophotonics.
Fluorinated phosphorene (FP), a novel phosphorene derivative, is successfully synthesized through an ionic liquid‐assisted electrochemical exfoliation and synchronous fluorination process. FP shows unique optical properties and electrolyte‐concentration‐modulated atomistic fluorination configurations, as revealed by core‐level binding energy shift calculations. In particular, FP exhibits robust environmental and photothermal stability, promising its potential applications in nanophotonics.
Hepatic lipogenesis is aberrantly induced in nonalcoholic fatty liver disease (NAFLD) via activation of the LXR-SREBP1c pathway. To date, a number of protein factors impinging on the transcriptional ...activity of LXR and SREBP1c have been elucidated. However, whether this regulatory axis interfaces with long noncoding RNAs (lncRNAs) remains largely unexplored. Here we show that hepatic expression of the lncRNA Blnc1 is strongly elevated in obesity and NAFLD in mice. Blnc1 is required for the induction of SREBP1c and hepatic lipogenic genes in response to LXR activation. Liver-specific inactivation of Blnc1 abrogates high-fat diet-induced hepatic steatosis and insulin resistance and protects mice from diet-induced nonalcoholic steatohepatitis. Proteomic analysis of the Blnc1 ribonucleoprotein complex identified EDF1 as a component of the LXR transcriptional complex that acts in concert with Blnc1 to activate the lipogenic gene program. These findings illustrate a lncRNA transcriptional checkpoint that licenses excess hepatic lipogenesis to exacerbate insulin resistance and NAFLD.
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