This review focuses on intervention studies that tested whether parent--child reading activities would enhance children's reading acquisition. The combined results for the 16 intervention studies, ...representing 1,340 families, were clear: Parent involvement has a positive effect on children's reading acquisition. Further analyses revealed that interventions in which parents tutored their children using specific literacy activities produced larger effects than those in which parents listened to their children read books. The three studies in which parents read to their children did not result in significant reading gains. When deciding which type of intervention to implement, educators will have to weigh a variety of factors such as the differences in effectiveness across the different types of intervention, the amount of resources needed to implement the interventions, and the reading level of the children.
This feature issue of Optics Express follows the 2020 Imaging and Applied Optics Congress and comprises of articles on the development and use of adaptive optics across the broad range of domains in ...which the technique has been applied - including atmospheric correction, ophthalmology, vision science, microscopy, optical communications and beam control. This review provides a basic introduction to adaptive optics and a summary of the multidisciplinary articles included in this issue.
Older adults (age 65+) with T1D are an understudied population. Though many older adults may have long-standing diabetes and the prevalence of multimorbidity accumulates over the lifespan, the ...prevalence of diabetes-related complications and comorbid conditions in older adults with T1D have not been well-characterized, though these factors can affect quality of life. We analyzed electronic health record (EHR) data from older adults with T1D within a large public hospital system (n=560). We used ICD-10 diagnostic codes and calculated the proportion of the sample with different comorbidities and diabetes-related complications, as well as the average number of total complications and the Charlson Comorbidity Index Score (Table). The mean number of T1D-related complications was 3.93 with 29.6% (n=166) having 6+ concurrent T1D complications. The most common T1D complication was retinopathy or other ophthalmic complication with (72%; n=402). The median Charlson Comorbidity index score was 3. Nearly half of the sample (n=282; 50.4%) had cardiovascular disease and more than one third (n=197; 35%) had renal disease. These data underscore a high burden of diabetes complications and comorbidities among older adults with T1D. Understanding the medical complexity of this population can inform future research and intervention.
Disclosure
A.Kahkoska: None. J.M.Weinstein: Research Support; Dexcom, Inc. R.Muthukkumar: None. L.A.Young: Research Support; Novo Nordisk, Rhythm Pharmaceuticals, Inc., Eli Lilly and Company, Jaeb Center for Health Research, Sanofi, Boehringer-Ingelheim.
Funding
National Institutes of Health (KL2TR002490, UL1TR002489)
Skeletal muscle repair and maintenance are directly and indirectly supported by interstitial cell populations such as vascular cells and fibro-adipogenic progenitors (FAPs), a subset of which express ...Twist2 and possess direct myogenic potential. Furthermore, work in rodents has highlighted the potential of pericytes to act as progenitor cells, giving rise to muscle cells and transdifferentiating into endothelial cells. However, less is understood about these populations in human skeletal muscle. Here, we performed single-cell RNA sequencing (scRNAseq) on ∼2,000 cells isolated from the human semitendinosus muscle of young individuals. This demonstrated the presence of a vascular-related cell type that expressed pericyte and pan-endothelial genes that we localized to large blood vessels within skeletal muscle cross sections and termed endothelial-like pericytes (ELPCs). RNA velocity analysis indicated that ELPCs may represent a "transition state" between endothelial cells and pericytes. Analysis of published scRNAseq data sets revealed evidence for ELPCs in trunk and heart musculature, which showed transcriptional similarity. In addition, we identified a subset of FAPs expressing
mRNA and protein. Human
-expressing cells were anatomically and transcriptionally comparable to mouse Twist2 cells as they were restricted to the myofiber interstitium, expressed fibrogenic genes but lacked satellite cell markers, and colocalized with the FAPs marker PDGFRα in human muscle cross sections. Taken together, these results highlight the complexity of stromal cells residing in human skeletal muscle and support the utility of scRNAseq for discovery and characterization of poorly described cell populations.
Key points
Five days of bed rest resulted in a reduction in leg lean mass and strength in older adults.
After bed rest, older (but not younger) adults had reduced amino acid‐induced anabolic ...sensitivity (blunted muscle protein synthesis; MPS) and enhanced markers associated with the ubiquitin proteasome and autophagy–lysosomal systems (increase in molecular markers related to muscle proteolysis).
Younger adults did not lose leg lean mass (via DXA) after 5 days of bed rest despite blunted amino acid‐induced mTORC1 signalling and increased skeletal muscle REDD1, REDD2 and MURF1 mRNA expression.
Exercise rehabilitation restored bed rest‐induced deficits in lean mass, strength, nutrient‐induced protein anabolism (protein synthesis and mTORC1 signalling) and select muscle proteolytic markers in older adults.
Bed rest‐induced muscle loss and impaired muscle recovery may contribute to age‐related sarcopenia. It is unknown if there are age‐related differences in muscle mass and muscle anabolic and catabolic responses to bed rest. A secondary objective was to determine if rehabilitation could reverse bed rest responses. Nine older and fourteen young adults participated in a 5‐day bed rest challenge (BED REST). This was followed by 8 weeks of high intensity resistance exercise (REHAB). Leg lean mass (via dual‐energy X‐ray absorptiometry; DXA) and strength were determined. Muscle biopsies were collected during a constant stable isotope infusion in the postabsorptive state and after essential amino acid (EAA) ingestion on three occasions: before (PRE), after bed rest and after rehabilitation. Samples were assessed for protein synthesis, mTORC1 signalling, REDD1/2 expression and molecular markers related to muscle proteolysis (MURF1, MAFBX, AMPKα, LC3II/I, Beclin1). We found that leg lean mass and strength decreased in older but not younger adults after bedrest (P < 0.05) and was restored after rehabilitation. EAA‐induced mTORC1 signalling and protein synthesis increased before bed rest in both age groups (P < 0.05). Although both groups had blunted mTORC1 signalling, increased REDD2 and MURF1 mRNA after bedrest, only older adults had reduced EAA‐induced protein synthesis rates and increased MAFBX mRNA, p‐AMPKα and the LC3II/I ratio (P < 0.05). We conclude that older adults are more susceptible than young persons to muscle loss after short‐term bed rest. This may be partially explained by a combined suppression of protein synthesis and a marginal increase in proteolytic markers. Finally, rehabilitation restored bed rest‐induced deficits in lean mass and strength in older adults.
Cellular senescence is the irreversible arrest of normally dividing cells and is driven by the cell cycle inhibitors Cdkn2a, Cdkn1a, and Trp53. Senescent cells are implicated in chronic diseases and ...tissue repair through their increased secretion of pro‐inflammatory factors known as the senescence‐associated secretory phenotype (SASP). Here, we use spatial transcriptomics and single‐cell RNA sequencing (scRNAseq) to demonstrate that cells displaying senescent characteristics are “transiently” present within regenerating skeletal muscle and within the muscles of D2‐mdx mice, a model of Muscular Dystrophy. Following injury, multiple cell types including macrophages and fibrog–adipogenic progenitors (FAPs) upregulate senescent features such as senescence pathway genes, SASP factors, and senescence‐associated beta‐gal (SA‐β‐gal) activity. Importantly, when these cells were removed with ABT‐263, a senolytic compound, satellite cells are reduced, and muscle fibers were impaired in growth and myonuclear accretion. These results highlight that an “acute” senescent phenotype facilitates regeneration similar to skin and neonatal myocardium.
Existing literature has found an increase in the proportion of older adults that enroll in Medicare Advantage (MA) plans relative to those enrolling in traditional Medicare (TMed). Similarly, ...previous studies have shown that individuals with diabetes are more likely to enroll in MA plans than those without diabetes. Our objective was to determine whether trends for enrollment in MA plans among adults with diabetes followed a similar trend to those without diabetes. We used the Medicare Current Beneficiary Survey (MCBS) to calculate the proportion of the Medicare-eligible population enrolling in MA vs. TMed each year from 2015 - 2020. We stratified these rates by diabetes diagnosis (any diabetes vs. no diabetes), and further by diabetes type (Type 1 vs. Type 2). Like previously published literature, we found that those with diagnosed diabetes has higher rates of MA enrollment than those without diabetes. MA enrollment trends followed a similar pattern among those with diabetes compared to those without. Among those without diabetes, MA enrollment rates increased from 34.2% in 2015 to 40.5% in 2020. Among those with Type 1 and Type 2 Diabetes, MA enrollment rates increased from 38.8% to 46.9% and from 38.4% to 45.8%, respectively. In relative terms, MA enrollment increased by 20.9% among those with Type 1 Diabetes, 13.9% among those with Type 2 Diabetes, 15.9% with other diabetes, and 18.3% without diabetes.
Disclosure
J.M.Weinstein: Research Support; Dexcom, Inc. R.Muthukkumar: None. L.A.Young: Research Support; Novo Nordisk, Rhythm Pharmaceuticals, Inc., Eli Lilly and Company, Jaeb Center for Health Research, Sanofi, Boehringer-Ingelheim. A.R.Kahkoska: None.
Funding
National Institutes of Health (KL2TR002490, UL1TR002489)
As T1D treatments improve and the US population ages, there is a growing number of older adults (≥65 years) with T1D. This patient population is distinct from their T2D counterparts yet remains ...understudied. Analyzing routine health care may yield real-world evidence to augment trial data and inform best practices. Yet, it is essential to properly classify patients with T1D vs. T2D. We aimed to assess the extent to which codes for T1D versus T2D overlap in EHR data among older adults with diabetes and assess the implications for identifying older adults with T1D, specifically. We analyzed electronic health record (EHR) data from a large, public health care system in the southeast US, including 12 affiliated hospitals and over 200 academic and community-based practices. We included data from adults ages 65+ years that had at least one code for T1D or T2D. Of the 7,436 patients withT1D or T2D listed among their medical conditions, 7,253 (97.5%) had a diagnostic code for T2D and 895 (12.0%) had a diagnostic code for T1D. Of those with a T1D code, 787 (87.9%) also had at least one T2D code. Among those with a code for T1D, the mean percentage of codes that indicate T1D is 49.4%. There is a high degree of co-occurring T1D and T2D diagnosis codes in EHR profiles of older adults, with implications for clinical care and research. Cohort classification in diabetes-oriented RWE studies warrants further research.
Disclosure
J.M.Weinstein: Research Support; Dexcom, Inc. R.Muthukkumar: None. L.A.Young: Research Support; Novo Nordisk, Rhythm Pharmaceuticals, Inc., Eli Lilly and Company, Jaeb Center for Health Research, Sanofi, Boehringer-Ingelheim. A.R.Kahkoska: None.
Funding
National Institutes of Health (KL2TR002490, UL1TR002489)
There is a dearth of data to quantify the utilization of diabetes technology among the growing population of older adults with T1D. We assessed differences in the use of CGM between those receiving ...endocrine care versus those not. We analyzed electronic health record (EHR) data from a large, public health care system in the southeast US, including 12 affiliated hospitals and over 200 academic and community-based practices. We included data from adults ages 65+ years with T1D in 04/01/2019-2022. We used logistic regression to model the likelihood of using CGM among those who had a visit with endocrinology in the past year versus those who did not. We used entropy balancing weights to create an analytic sample that was balanced on covariates. Our sample included 560 older adults with T1D, comprised of 32% using CGM. Of CGM users, 43% had an endocrinology appointment and 22% did not. Those with endocrine care had higher odds of using CGM compared to those who did not (aOR: 2.38, 95% CI: 1.65, 3.45). In probability terms, those with an endocrinology appointment in the previous year had a 17.8 percentage point (95% CI: 9.9, 25.6) higher probability of using CGM than those who did not (Fig). In a regional sample, we found relatively low CGM utilization and disparities therein across the receipt of endocrine care among older adults with T1D. Limitations include data from one healthcare system only.
Disclosure
A.R.Kahkoska: None. J.M.Weinstein: Research Support; Dexcom, Inc. R.Muthukkumar: None. L.A.Young: Research Support; Novo Nordisk, Rhythm Pharmaceuticals, Inc., Eli Lilly and Company, Jaeb Center for Health Research, Sanofi, Boehringer-Ingelheim.
Funding
National Institutes of Health (KL2TR002490, UL1TR002489)
Abstract Background A growing number of older adults (ages 65+) live with Type 1 diabetes. Simultaneously, technologies such as continuous glucose monitoring (CGM) have become standard of care. There ...is thus a need to understand better the complex dynamics that promote use of CGM (and other care innovations) over time in this age group. Our aim was to adapt methods from systems thinking, specifically a participatory approach to system dynamics modeling called group model building (GMB), to model the complex experiences that may underlie different trajectories of CGM use among this population. Herein, we report on the feasibility, strengths, and limitations of this methodology. Methods We conducted a series of GMB workshops and validation interviews to collect data in the form of questionnaires, diagrams, and recordings of group discussion. Data were integrated into a conceptual diagram of the “system” of factors associated with uptake and use of CGM over time. We evaluate the feasibility of each aspect of the study, including the teaching of systems thinking to older adult participants. We collected participant feedback on positive aspects of their experiences and areas for improvement. Results We completed nine GMB workshops with older adults and their caregivers ( N = 33). Each three-hour in-person workshop comprised: (1) questionnaires; (2) the GMB session, including both didactic components and structured activities; and (3) a brief focus group discussion. Within the GMB session, individual drawing activities proved to be the most challenging for participants, while group activities and discussion of relevant dynamics over time for illustrative (i.e., realistic but not real) patients yielded rich engagement and sufficient information for system diagramming. Study participants liked the opportunity to share experiences with peers, learning and enhancing their knowledge, peer support, age-specific discussions, the workshop pace and structure, and the systems thinking framework. Participants gave mixed feedback on the workshop duration. Conclusions The study demonstrates preliminary feasibility, acceptability, and the value of GMB for engaging older adults about key determinants of complex health behaviors over time. To our knowledge, few studies have extended participatory systems science methods to older adult stakeholders. Future studies may utilize this methodology to inform novel approaches for supporting health across the lifespan.
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