ABSTRACT IMPACT: This study is designed to address a critical gap in our understanding of how aging patients and caregivers recognize and respond to clinically important changes in heart failure symptoms during vulnerable transitions. OBJECTIVES/GOALS: Research on family involvement in heart failure (HF) symptom response is limited. Our objective is to examine HF symptom monitoring processes in couples after HF hospitalization, and quantify how coupled symptom assessments predict symptom response, patient clinical events, care strain, and dyad health during the high-risk post-discharge period. METHODS/STUDY POPULATION: This is an ongoing T2 translational study that employs an intensive longitudinal design. Adults aged ≥65 years hospitalized for HF and their caregiving spouse/partner are enrolled. The target n is 48 dyads. Over 5 weeks of follow-up, dyads complete daily diaries assessing patient HF symptoms. Clinical biomarkers of HF severity  are also collected. Primary study endpoints are dyads’ HF symptom response behaviors and caregiver strain; secondary endpoints are dyads’ health status and patient clinical events. Dyadic dynamics of symptom assessment will first be characterized using dyadic autoregressive time series models. Subsequently, we will extract cross-partner effect parameters from the time series models and test whether dyadic effects predict the trajectories of each of our endpoints. RESULTS/ANTICIPATED RESULTS: This study is currently underway. In line with our study hypotheses, we anticipate that couples who assess patient symptoms similarly (dyadic agreement), and whose symptom assessments accurately reflect clinical severity, will be more likely to respond to symptoms appropriately with lower stress to the caregiving partner, and have better trajectories of health . Characterizing dyadic symptom dynamics will provide important insight into the day-to-day process of symptom recognition in couples. Further, quantifying dyadic symptom dynamics in relation to our endpoints will provide information on the clinical value of dyadic symptom agreement, and whether it might be a target for future interventions to support better symptom response and health outcomes for both dyad members. DISCUSSION/SIGNIFICANCE OF FINDINGS: This project innovates on existing paradigms by applying family-level theory and techniques to better understand and support interventions for couples during post-discharge HF transitions - a vulnerable period for older adults that has traditionally been studied almost exclusively at the patient-level, with marginal success.


A 33-year-old male presented to the emergency department following a motor vehicle collision with complaints of right eye pain after hitting his head on the steering wheel. Point-of-care ultrasound (POCUS) revealed retinal detachment and an anterior lens dislocation.Lens dislocations following blunt head trauma can often be diagnosed using POCUS. Anterior ocular lens dislocation is a rare but vision-threatening result of head trauma. This case highlights how POCUS can facilitate early detection of ocular pathology, such as lens dislocation, and improves patient outcomes. A 33-year-old man with a history of blindness in his right eye from a congenital cataract presented to the emergency department with blunt head trauma sustained during a motor vehicle collision. He complained of right eye pain and foreign body sensation. On examination, a round white object was visualized within the anterior chamber; his head was otherwise atraumatic. The patient stated that the white spot had been present prior to the accident but had now changed in size and appearance, noting that the spot had enlarged following his injury.Fluorescein staining showed no abnormalities, and intraocular pressures were normal . Light perception was not present. Slit lamp examination demonstrated a round, white-speckled object in the dependent portion of the anterior chamber. Bedside ocular ultrasonography revealed a retinal detachment and an anterior dislocation of a cataract lens through the iris –3. OphthCrystalline lens dislocation, or ectopia lentis, occurs primarily after blunt head trauma.5Patients can present with eye pain and visual changes ranging from light distortion to loss of vision.What do we already know about this clinical entity?Anterior ocular lens dislocation is a potential result of blunt head trauma. If unrecognized, it can block the anterior chamber causing elevated intraocular pressures.What is the major impact of the images?The sonographic appearance of anterior lens dislocation has not been well described in emergency medicine literature. These are some of the first reported images.How might this improve emergency medicine practice?Because anterior lens dislocation can result in vision loss, accurate diagnosis is important. Point-of-care ultrasound can be used to diagnose lens dislocations.Ultrasonography can aid in the diagnosis of all types of lens dislocations and assess for additional ophthalmologic pathology, including retinal detachment and vitreous hemorrhage.


The Weathering Hypothesis states BIPOC face more stressors, by which over a lifetime they are subjected to the negative consequences of stress . Using ecological momentary assessments, we examined whether subtle discrimination moderated the within-person stressor slope on positive and negative affect. We predicted emotional wellbeing would be worse at stressor moments, and those with greater discrimination experience would be more impacted by stressors. Participants were 334 diverse adults  from Bronx, New York. Positive affect decreased and negative affect increased significantly at stressor moments (p<.0001). Unexpectedly, subtle discrimination was not a significant moderator for the within-person stressor slope on positive affect and negative affect. Unlike the predictions of the Weathering Hypothesis, these results show that prior discrimination experiences may not exacerbate responses to stressors and entail additional risk in daily life.


Pain is generally concomitant with an inflammatory reaction at the site where the nociceptive fibers are activated. Rodent studies suggest that a sterile meningeal inflammatory signaling cascade may play a role in migraine headache as well. Experimental studies also suggest that a parenchymal inflammatory signaling cascade may report the non-homeostatic conditions in brain to the meninges to induce headache. However, how these signaling mechanisms function in patients is unclear and debated. Our aim is to discuss the role of inflammatory signaling in migraine pathophysiology in light of recent developments.Rodent studies suggest that a sterile meningeal inflammatory reaction can be initiated by release of peptides from active trigeminocervical C-fibers and stimulation of resident macrophages and dendritic/mast cells. This inflammatory reaction might be needed for sustained stimulation and sensitization of meningeal nociceptors after initial activation along with ganglionic and central mechanisms. Most migraines likely have cerebral origin as suggested by prodromal neurologic symptoms. Based on rodent studies, a parenchymal inflammatory signaling cascade has been proposed as a potential mechanism linking cortical spreading depolarization (CSD) to meningeal nociception. A recent PET/MRI study using a sensitive inflammation marker showed the presence of meningeal inflammatory activity in migraine with aura patients over the occipital cortex generating the visual aura. These studies also suggest the presence of a parenchymal inflammatory activity, supporting the experimental findings. In rodents, parenchymal inflammatory signaling has also been shown to be activated by migraine triggers such as sleep deprivation without requiring a CSD because of the resultant transcriptional changes, predisposing to inadequate synaptic energy supply during intense excitatory transmission. Thus, it may be hypothesized that neuronal stress created by either CSD or synaptic activity-energy mismatch could both initiate a parenchymal inflammatory signaling cascade, propagating to the meninges, where it is converted to a lasting headache with or without aura.Experimental studies in animals and emerging imaging findings from patients warrant further research to gain deeper insight to the complex role of inflammatory signaling in headache generation in migraine. Pain is generally concomitant with an inflammatory reaction of varying intensity at the site where the nociceptive fibers are activated. Migraine is probably no exception; there is ample experimental evidence, mostly from rodents, suggesting that the nociceptive trigeminocervical afferents mediating the headache can be activated by a sterile meningeal inflammatory process . This prProlonged activation and sensitization of primary and central nociceptors within the trigeminocervical complex are thought to underlie the throbbing headache and allodynia during migraine. Rodent experiments suggest that a sterile meningeal inflammation initiated by release of peptides from trigeminocervical C-fibers and activation of resident inflammatory cells  could contribute to sustained activation and sensitization of meningeal nociceptors –17. SuppMeningeal nociceptive fibers can release a number of vasoactive peptides including calcitonin gene-related peptide (CGRP), pituitary adenylate cyclase-activating polypeptide (PACAP), substance P and neurokinin-A upon prolonged activation , 21. By 2 PBR28 PET may also provide insight into the relationship between inflammatory signaling and headache in secondary headache disorders. As in migraine, parenchymal inflammation can also play a role in post-seizure headache, as suggested by studies showing activation of the neuroinflammatory cascade in seizure models , 180. SiIn conclusion, experimental studies in animals and emerging imaging findings from patients warrant further research to gain deeper insight into the complex role of inflammatory signaling in headache generation. Research over the past 50 years have revolutionized our understanding of migraine, however, many unanswered questions and controversies remain. We need cutting-edge tools to directly and comprehensively study the complex nociceptive mechanisms in experimental animals and also high-resolution advanced imaging technologies to assess the significance of basic findings in the clinic. Admittedly, current experimental and clinical methods have shortcomings to provide unequivocal evidence for competing hypotheses.


Panel A) while brain MRI showed no obvious abnormalities in the basal ganglia region. Contrast-enhanced computed tomography showed renal and splenic infarction (Panel B). Moreover, a transoesophageal echocardiogram showed a mobile mass attached to the aortic valve moving back and forth between the ascending aorta and the left ventricular outflow tract . Based on these findings, we concluded that ischaemic stroke due to cardiac mass was the underlying cause of the hemichorea in this patient. During the hospitalization, the patient had an exacerbation of involuntary movements. Repeat echocardiography revealed the reduction in the size of the mass and brain MRI showed acute multiple cerebral infarctions. Therefore, we decided to surgically remove the residual mass to prevent further embolic events. Histopathological examinations with haematoxylin–eosin staining revealed papillary fibroelastoma (Panel D), a rare primary cardiac tumour, with organized thrombus (Panel E). After the surgery, we started anticoagulation with warfarin for the prevention of thrombotic event. His hemichorea disappeared 6 months after the onset of symptoms.A 74-year-old man presented to our hospital with acute onset of right hemichorea. He had no medical history of hereditary disease, inflammatory, or endocrine disorders that could be associated with involuntary movement. Although the patient had no clinical findings suggestive of infective endocarditis, it was not possible to accurately differentiate between tumour, thrombus, and sub-clinical endocarditis. Brain diffusion-weighted magnetic resonance imaging (MRI) revealed multiple cerebellar infarctions  Brain magnetic resonance imaging showing cerebral infarction. (Panel B) Contrast-enhanced computed tomography showing renal and splenic infarction. (Panel C) Echocardiogram showing a mobile mass attached to the aortic valve. (Panels D and E) haematoxylin–eosin staining showing papillary fibroelastoma (Panel D) and organized thrombus (Panel E).(Consent: The authors confirm that written consent for submission and publication of this case report including images and associated text has been obtained from the patient in line with COPE guidance.


Mycobacterium tuberculosis. It may show wide variability of clinical symptoms and imaging appearance, ranging from asymptomatic with a normal radiographic examination to severe joint pain along with joint destruction, osteomyelitis, and abscess formation. This article presents radiographic and MR imaging appearance from a case of tuberculous septic arthritis with large abscess formation mimicking soft tissue tumor.Tuberculous septic arthritis is an infection that occurs inside the joint or synovial fluid and joint tissues caused by We reported a 32-year-old female with a slowly enlarging lump on her right proximal thigh within the last 4 months along with slowly progressing joint pain. Both radiographic and MR images showed destruction of the femoral head and acetabular roof, with a formation of large rim-enhanced abscess that extending superficially and distally until mid-thigh. The patient underwent open drainage surgery and excisional biopsy. Histopathological examination showed chronic granulomatous inflammation caused by tuberculous infection.MR imaging combined with radiographic and clinical information played a very important role in the diagnosis of tuberculous septic arthritis with abscess, and to differentiate it from soft tissue neoplasms. Tuberculosis; Septic arthritis; Infectious arthritis; Abscess In Indo2We reported a 32-year-old female patient who came to the hospital after being referred from another hospital to have further treatment for a soft tissue tumor of her right thigh. She complained of a slowly enlarging lump on her right proximal thigh in the last 4 months, with intermittent sub febrile temperature and mild but slowly progressing pain. She was unable to walk unsupported. Physical examination showed a large fusiform soft tissue mass in the right thigh with a diameter of 84 cm, limited range of motion, moderately firm in palpation, and tenderness of the right hip . In the 2.1An AP radiograph of the right femur was obtained, showed a large lobulated soft tissue mass on the lateral side of the proximal femoral region and was assessed as a soft tissue tumor . HoweverLaboratory test showed microcytic hypochromic anemia, increased white blood cells (WBC) count, , increased c-reactive protein (CRP) , increased erythrocyte sedimentation rate (ESR)  and increased lactate dehydrogenase (LDH) . Other laboratory findings were unremarkable.2.2The large lobulated cystic mass may be consistent with a large abscess formation, and its connection with the abnormality of the right hip may support the diagnosis of chronic infection. Other potential diagnoses related to fluid-filled mass in musculoskeletal lesions were true cystic lesions (such as seroma) and cystic-appearing solid neoplasm (myxofibrosarcoma and myxoid liposarcoma that contain high mucin component).2.3The patient underwent open drainage surgery and excisional biopsy and the specimens were sent to the Pathology Department.2.4The histopathology examination showed chronic granulomatous inflammation caused by tuberculous infection . The pat3Joint destruction with adjacent tumor-like mass has several differential diagnoses, including tuberculous septic arthritis, malignant soft tissue tumor, and pyogenic septic arthritis. Their clinical appearance may look similar, especially with the formation of a large painful mass. It becomes important to differentiate infection from the formation of tumor-like abscess from malignant soft tissue tumor, as they have completely different therapy. Malignant soft tissue tumors should be evaluated with core biopsy so that the clinicians can give appropriate chemotherapy, whereas infection would need immediate abscess drainage, antibiotics and debridement procedures. Delayed management may cause further destruction of the joint and results in irreversible disability, and worsened prognosis.The potential pitfall in the radiographic interpretation, in this case, is the large size of the soft tissue mass, which may divert the reader's attention from the hip joint abnormality. Another potential misinterpretation is whether these two findings are two separate entities or whether they are associated. Without MR imaging, this can be quite challenging since the extent of the mass is quite huge compared to the degree of hip joint destruction.Tuberculous septic arthritis is a chronic disease with long progressive clinical and radiological changes. Saraf SK et al  has intrFluid-filled mass in the musculoskeletal system may have several differential diagnoses, including true cystic lesions (abscess and seroma) and cystic-appearing solid neoplasm (myxofibrosarcoma and myxoid liposarcoma that contain high mucin component) . Seroma Both cystic appearing solid neoplasm and tuberculous septic arthritis may show the same painful mass-forming lesion, with no apparent local infection signs such as redness or warmth on the lump, but MR imaging and blood examination may help to differentiate them. Cystic-appearing solid neoplasm may show heterogeneous signal intensity with inhomogeneous enhancement but without increased leukocyte and CRP level, whereas tuberculous abscess formation will show thin and smooth wall enhancement with the increased number of leukocytes and CRP. Therefore, tuberculous abscess formation is more likely than cystic-appearing solid neoplasm in this patient.Staphylococcus aureus. As the pathogen produces proteolytic enzymes, pyogenic septic arthritis usually has an acute onset, more rapid, and more progressive [Pyogenic septic arthritis can affect all age groups with no specific range of age. The most common pathogen is gressive . It alsogressive  showed bM. tuberculosis does not produce proteolytic enzymes like pyogenic pathogens, it shows less inflammation process and relative joint space preservation compared to pyogenic septic arthritis which is characterized by a more aggressive course, prominent inflammation, and progressive joint space loss [MR imaging and clinical manifestation may help differentiate pyogenic from tuberculous septic arthritis. As ace loss . The mosThe patient had open drainage surgery and excisional biopsy, and histopathology examination showed chronic granulomatous inflammation caused by tuberculous infection. Histopathology examination and good response of clinical condition after the anti-tuberculosis drug combination administration made the diagnosis of tuberculous septic arthritis in this patient.4The presented case was confirmed as tuberculous septic arthritis with large soft-tissue abscess formation. Tuberculous septic arthritis should be considered as one of the differential diagnoses in slow-progressing monoarticular joint pain, especially in endemic countries. As the disease progresses slowly and may cause irreversible joint destruction, early diagnosis is crucial to improve the patient outcome. MR imaging, combined with the radiograph and clinical information, played an important role in the diagnosis of tuberculous septic arthritis and differentiation to pyogenic septic arthritis or other cystic-appearing neoplasms.All authors listed have significantly contributed to the investigation, development and writing of this article.This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.Data will be made available on request.The authors declare no conflict of interest.•The case presented shows variability of clinical symptom and imaging appearance, ranging from asymptomatic with the radiographic presentation could mimicking other abnormalities such as pyogenic septic arthritis and soft tissue tumor lesion.•The patient with monoarticular joint pain that has slow progress symptoms, especially in endemic countries, tuberculous septic arthritis should be considered as one of differential diagnosis•MR imaging can be beneficial to differentiate pyogenic from tuberculous septic arthritis with the most significant imaging characteristic to differentiate tuberculosis from the pyogenic abscess is the abscess wall.No additional information is available for this paper.


Sepsis is a life-threatening syndrome induced by aberrant host response towards infection. The autophagy-lysosomal pathway (ALP) plays a fundamental role in maintaining cellular homeostasis and conferring organ protection. However, this pathway is often impaired in sepsis, resulting in dysregulated host response and organ dysfunction. Transcription factor EB (TFEB) is a master modulator of the ALP. TFEB promotes both autophagy and lysosomal biogenesis via transcriptional regulation of target genes bearing the coordinated lysosomal expression and regulation (CLEAR) motif. Recently, increasing evidences have linked TFEB and the TFEB dependent ALP with pathogenetic mechanisms and therapeutic implications in sepsis. Therefore, this review describes the existed knowledge about the mechanisms of TFEB activation in regulating the ALP and the evidences of their protection against sepsis, such as immune modulation and organ protection. In addition, TFEB activators with diversified pharmacological targets are summarized, along with recent advances of their potential therapeutic applications in treating sepsis. Sepsis is the most common and severe syndrome that can affect a population of critically ill patients . Each yeTranscriptional factor EB (TFEB) is a member of the microphthalmia (MiTF/TFE) transcriptional factor family . TFEB biThe ALP mainly consists of the autophagy machinery and its associated lysosomal degradation processes . This paIt has been extensively demonstrated that the ALP is beneficial for balancing the immune response and protecting organ function during sepsis. A recent review article described autophagy features extensive crosstalk with innate immune cells, thereby exerting influence on phagocytosis in neutrophils, degranulation in mast cells, along with differentiation and migration in NK cells . Researc2+-dependent exocytosis in the lysosomes  bearing the CLEAR element  mRNA has been shown to reduce the expression of TFEB and impair the TFEB-dependent autophagic process , polysaccharides and peptides) can modulate the ALP by activating TFEB . These a2+-calcineurin modulators  agonists  and other natural compounds  have been shown to upregulate the mRNA expression of TFEB, thereby activating the ALP and enhancing the cellular clearance machinery . MoreoveIn addition to small molecular activators, other larger biomolecules, such as polysaccharides, peptides and miRNAs, can also regulate the activity of TFEB. A few recent studies have reported that polysaccharides  and peptides  can activate TFEB and enhance the ALP process by inhibiting mTOR activity  or promoGiven that the impairment of ALP in sepsis results in unresolved infection, inflammation, organ injury, and immunodysfunction, researchers have begun to investigate TFEB modulators in preclinical models to examine their therapeutic efficacy in ameliorating sepsis-induced dysfunction by promoting autophagy and lysosomal functions.Mycobacterium tuberculosis and Salmonella typhimurium). It is notable that opportunistic pathogens, such as mycobacterial species, can commonly induce secondary infection in post-sepsis patients or trigger sepsis in patients who are immunocompromised. Moreover, pathogens like Mycobacterium tuberculosis inhibit autophagy and lysosomal function by inducing miR-33 dependent inactivation of TFEB  instead of endotoxemia models or otherwise tested in clinical settings. Moreover, most TFEB activators target the upstream regulators of TFEB, such as mTORC1 and Car events . Therefor events . Therefo


Various few-shot image classification methods indicate that transferring knowledge from other sources can improve the accuracy of the classification. However, most of these methods work with one single source or use only closely correlated knowledge sources. In this paper, we propose a novel weakly correlated knowledge integration (WCKI) framework to address these issues. More specifically, we propose a unified knowledge graph (UKG) to integrate knowledge transferred from different sources . Moreover, a graph attention module is proposed to sample the subgraph from the UKG with low complexity. To avoid explicitly aligning the visual features to the potentially biased and weakly correlated knowledge space, we sample a task-specific subgraph from UKG and append it as latent variables. Our framework demonstrates significant improvements on multiple few-shot image classification datasets.


Desmosomes are critical adhesion structures in cardiomyocytes, with mutation/loss linked to the heritable cardiac disease, arrhythmogenic right ventricular cardiomyopathy (ARVC). Early studies revealed the ability of desmosomal protein loss to trigger ARVC disease features including structural remodeling, arrhythmias, and inflammation; however, the precise mechanisms contributing to diverse disease presentations are not fully understood. Recent mechanistic studies demonstrated the protein degradation component CSN6 is a resident cardiac desmosomal protein which selectively restricts cardiomyocyte desmosomal degradation and disease. This suggests defects in protein degradation can trigger the structural remodeling underlying ARVC. Additionally, a subset of ARVC-related mutations show enhanced vulnerability to calpain-mediated degradation, further supporting the relevance of these mechanisms in disease. Desmosomal gene mutations/loss has been shown to impact arrhythmogenic pathways in the absence of structural disease within ARVC patients and model systems. Studies have shown the involvement of connexins, calcium handling machinery, and sodium channels as early drivers of arrhythmias, suggesting these may be distinct pathways regulating electrical function from the desmosome. Emerging evidence has suggested inflammation may be an early mechanism in disease pathogenesis, as clinical reports have shown an overlap between myocarditis and ARVC. Recent studies focus on the association between desmosomal mutations/loss and inflammatory processes including autoantibodies and signaling pathways as a way to understand the involvement of inflammation in ARVC pathogenesis. A specific focus will be to dissect ongoing fields of investigation to highlight diverse pathogenic pathways associated with desmosomal mutations/loss. The desmosome is integral for maintaining structural integrity in tissues undergoing constant mechanical stress such as the heart Najor . The carEmerging new evidence has revealed that defects in protein degradation trigger the structural remodeling underlying the desmosomal disease, ARVC  is a multiprotein enzymatic complex consisting of eight subunits (CSN1-8), with known functional roles in controlling ubiquitin-mediated protein degradation as it has been shown to de-neddylate and inactivate cullin RING E3 ubiquitin ligases  and action potential propagation between cardiac muscle cells as a means to synchronize coordinated cardiac muscle contraction  are directly linked to the inherited cardiac arrhythmia, Brugada syndrome  channel to the cardiac intercalated disc -deficient mice, revealing arrhythmogenic pathways in mice distinct from classic desmosomal structural alterations and remodeling  may be an initiating factor to this inflammatory response  resulting in ventricular arrhythmias (ventricular tachycardia) that could be indistinguishable from proven ARVC patients  crossed to the Ribotag mouse as a means to identify ribosome-resident transcriptionally changes in inflammation in cardiomyocytes  to the desmosome and one found in the cytosol ; however, future studies should focus on how these pathways work cooperatively to degrade desmosomal proteins in the context of human ARVC-associated desmosomal mutations. Desmosomes are an essential hub for electrical homeostasis in the cardiomyocyte. Recent work highlights that diverse arrhythmogenic pathways may relate to specific desmosmomal proteins with PKP2 mutations/loss  while other desmosomal proteins, such as DSP may impact classic CX43 channel functions, which may drive electrical dysfunction in the absence of structural disease in ARVC. Further work is required to dissect whether all desmosomal proteins equally impact these distinct channel functions or whether there are adapter proteins associated with the desmosome that may uniquely mediate desmosome-associated arrhythmias. Additional findings suggest that inflammatory signaling pathways may play an important role in the pathogenesis of ARVC associated with desmosomal mutations. Early infiltration of immune cells and autoantibodies provide new evidence for better clinical diagnosis of ARVC; however, there remains limited direct evidence of the relationship  between desmosomal loss/deficiency and recruitment of immune cells in ARVC progression, which should be a focus for future studies.


Laparoscopic surgery has been undermined throughout the COVID-19 pandemic by concerns that it may generate an infectious risk to the operating team through aerosolization of peritoneal particles. There is anyway a need for increased awareness and understanding of the occupational hazard for surgical teams regarding unfiltered escape of pollutants generated by surgical smoke and other microbials. Here, the aerosol-generating nature of this access modality was confirmed through repeatable real-time methodology both qualitatively and quantitively to inform best practice and additional engineering solutions to optimize the operating room environment. Laparoscopic surgery has been undermined throughout the COVID-19 pandemic by concerns that it may generate an infectious risk to the operating team through aerosolization of peritoneal particles. There is anyway a need for increased awareness and understanding of the occupational hazard for surgical teams regarding unfiltered escape of pollutants generated by surgical smoke and other microbials. Here, the aerosol-generating nature of this access modality was confirmed through repeatable real-time methodology both qualitatively and quantitively to inform best practice and additional engineering solutions to optimize the operating room environment. First, formal smoke studies were used to detail room ventilation dynamics around the operating table during surgical simulation scenarios with and without positive-pressure room ventilation (25 room air exchanges per h). For this, an Air-Trace smoke generator  created low levels of isokinetic, isothermal smoke via a 25-mm duct. The scenarios replicated personnel and equipment conditions for surgical procedures with varying complexity of set-up  with the smoke generator hose positioned at the simulated operative site.Thereafter, flow studies were performed during actual elective operations with varying degrees of intraoperative electrocautery . For this, a light sheet generated by a galvanometer optical laser scanner was used to illuminate a two-dimensional (2D) slice of the surgical airspace during surgery and imaged with an 8 K Ultra-High Definition camera  whose absence of diffraction limitation enabled resolution of droplets larger than 2 µm (visible as scintillations within the laser sheet). Simultaneous extracorporeal airspace sampling was performed during these operations after investigator training using a particle counter  to measure 30-s periods both at baseline  and then episodically during the procedure by positioning the device’s isokinetic probe inlet 10 cm from the target areaVideo 1 and Appendix S1). Increased crowding of the operating table with people and equipment caused increased local air stagnation. Intraoperative footage during patient operations showed smoke and particles (evidenced as scintillations) moving similarly during surgery, notable even with the instruments in situ, as well as during manoeuvres including trocar instrumentation, and venting and specimen removal . Aerosol and particle leakage into the OR airspace was most evident during the operative phase of intra-abdominal dissection using hook cautery.Smoke studies revealed effective dissipation of smoke by positive-pressure room ventilation with the OR fully empty, as expected. However, during simulated operative scenarios, smoke behaviour was significantly different, with evident upwards drift from the operating site enveloping members of the surgical team . Counts were particularly increased during electrocautery dissection of the gallbladder from the liver bed during cholecystectomy compared with dissection of the mesoappendix during appendicectomy, which in turn was associated with higher counts than were observed during intra-abdominal reduction of a parastomal hernia (done without cautery dissection). Trocar venting caused the highest concentration of particulate effluvium.Particle counts confirmed increasing particulate concentration after initiation of the operation, reaching extracorporeal airspace levels in excess of 1×10This study focused on establishing methods and indicative data regarding the operative airspace particulate contamination occurring during laparoscopy, using open procedures as control in a simulation study as well as in two common general surgical laparoscopic operations that employ electrocautery to different extents (versus a laparoscopic operation without electrocautery). This is important as many surgical teams feel any such occupational hazard to be either theoretical or mitigated anyway by room ventilation and perhaps standard surgical maskshttps://www.gov.uk/government/collections/health-technical-memorandum-disinfection-and-sterilization) is not powerful enough to counteract the local airspace environment created by surgical teams carrying out their work. This means that there is relative stagnation of haze in the operative airspace above the abdomen during laparoscopic operation, with entrainment towards surgical team members likely induced by movement, body heat, and electrostaticityThe evaluations in this study reflect actual workspace conditions of OR teams, corroborating simulation data with live intraoperative flow visualization and sensitive particle counting . Together, these show that the surgical team is exposed to considerable amounts of particles and pollutants during laparoscopy. Indeed, aerosol (containing gas and particles) leaks continuously from the patient during laparoscopic operations, with such flue comprising the constituents of the pneumoperitoneal gas including any noxious components present. The local OR airspace pollution is particularly marked during the cautery dissection phase of the operation, and occurs constantly rather than just at the time of instrument insertion and removal,,,Although investigation of COVID-19 infectivity owing to laparoscopic access is ongoing, the pandemic has already caused considerable reflection regarding the aerosol-generating capability of laparoscopy, and encouraged re-examination of practice and equipment from this new perspectiveThe implications of the present study regarding aerosolization at laparoscopy extend beyond the present pandemic. The results provide insight into both mechanism and degree as well as assessment methodology for future evaluations, including those of mitigation strategies. Although practice adviceznab114_Supplementary_DataClick here for additional data file.


With the current spotlight on systemic racism and the need to address health inequities, it is critical to develop culturally appropriate strategies for recruiting research study participants from racial/ethnic minority groups. Empirical studies have highlighted that people from racial/ethnic minority groups have poorer health outcomes compared to non-Hispanic Caucasians. However, racial/ethnic minority groups remain underrepresented in healthcare research. Several factors may contribute to the lower participation of racial/ethnic minority groups. Sequelae of atrocities in healthcare research on African American/Black people in the US during slavery and Jim Crow eras were widespread and persistent. Discrimination against people of Hispanic descent and increased anti-Asian discrimination have also been documented. Fear and mistrust of the health system and researchers have been identified as critical barriers to participation in clinical research for these populations. Further, health research teams rarely reflect the racial/ethnic diversity of the US population, hindering diversity in recruiting study participants. Inadequate ethnic/racial minority groups participation in study populations not only weakens external validity of empirical studies, but research interventions and policies being implemented may not be culturally appropriate to all populations. Therefore, systemic strategies to improve recruitment of racial/ethnic minority groups should: 1) increase preferential funding to incentivize research teams becoming more racially/ethnically diverse; 2) increase recruitment of racial/ethnically diverse healthcare researchers; 3) use community-based participatory research designs to build trust among racial/ethnic minority populations; 4) provide training on culturally appropriate research study recruitment strategies to the academic communities; 5) apply a prism of intersectionality for representation throughout the research cycle.


Indoor room transition is an underexplored real-world activity outcome. We estimated the stability and variability of indoor room transitions and their associations with mild cognitive impairment (MCI) in older adults. Older adults living-alone  from the Oregon Center for Aging & Technology (ORCATECH) and the Minority Aging Research Study (MARS) were included. Room transitions were detected using passive infrared motion sensors in bathroom, bedroom, kitchen, and living room. The hourly number of room transitions was used to calculate the interdaily stability and intradaily variability of room transitions. MCI was operationalized by the Clinical Dementia Rating equaled 0.5. Generalized estimating equations models adjusted for demographics, health, and environmental factors revealed that older adults with MCI had a lower interdaily stability of room transitions than cognitive healthy peers . A pervasive-sensing system deployed in homes can obtrusively measure room transition activities to inform cognitive health in older adults.


Existential distress is a significant source of suffering for patients facing life-threatening illness. Psychedelic-Assisted Therapies (PAT) are novel treatments that have shown promise in treating existential distress, but openness to providing PAT may be limited by stigma surrounding psychedelics and the paucity of education regarding their medical use. How PAT might be integrated into existing treatments for existential distress within palliative care remains underexplored.The present study aimed to elucidate the attitudes of palliative care clinicians regarding treatments for existential distress, including PAT. We recruited palliative care physicians, advanced practice nurses, and spiritual and psychological care providers from multiple US sites using purposive and snowball sampling methods. Attitudes toward PAT were unknown prior to study involvement. Semi-structured interviews targeted at current approaches to existential distress and attitudes toward PAT were analyzed for thematic content.Nineteen respondents  were interviewed. Identified themes were 1) Existential distress is a common experience that is frequently insufficiently treated within the current treatment framework; 2) Palliative care providers ultimately see existential distress as a psychosocial-spiritual problem that evades medicalized approaches; 3) Palliative care providers believe PAT hold promise for treating existential distress but that a stronger evidence base is needed; 4) Because PAT do not currently fit existing models of existential distress treatment, barriers remain.PAT is seen as a potentially powerful tool to treat refractory existential distress. Larger clinical trials and educational outreach are needed to clarify treatment targets and address safety concerns. Further work to adapt PAT to palliative care settings should emphasize collaboration with spiritual care as well as mental health providers and seek to address unresolved concerns about equitable access.The online version contains supplementary material available at 10.1186/s12904-021-00889-x. Existenlization , 6. Evidlization  and targlization –13.Psychedelic-assisted therapies (PAT), which apply psychotherapeutic approaches to altered states of consciousness produced by agents such as psilocybin, 3,4-Methylenedioxymethamphetamine (MDMA) or ketamine, may be potent treatments for patients facing existential distress in the setting of LTI. Randomized-controlled crossover trials using psilocybin have demonstrated reduced depression, anxiety and fear of death in patients with cancer- associated anxiety or depression –16, withWhether PAT become broadly implemented within palliative care will depend not only upon the results of larger clinical trials but also the attitudes of health care providers in a position to recommend PAT. Qualitative studies of palliative care providers have identified key themes regarding attitudes toward the use of PAT in palliative settings , 29, as We conducted qualitative semi-structured interviews with palliative care physicians, advanced practice nurses, chaplains, psychologists, and social workers currently working in palliative care settings within the United States.Participants were recruited via email between May 2019 and August 2020 using a combination of purposive and snowball sampling methods. Participants were not selected for knowledge about or known positions regarding PAT. Participants provided informed consent and were not directly compensated; one randomly-selected participant received an online gift card after study completion. Recruitment continued until interviews failed to reveal significant new thematic content.The interview guide was developed by an interdisciplinary team including experts in palliative care (M.L.) and PAT (B.K.) and was directed at two key research questions: (1) How do palliative care providers view their role regarding existential distress and its treatment? (2) What are their attitudes toward PAT as potential treatments for existential distress in LTI? The final interview guide is available in Recorded interviews were conducted by H.N. via phone, Zoom video conferencing software, or in person. Interviews ranged in duration from 32 to 52 min, and concluded once participants had responded to all sections of the semi-structured guide and had been offered the chance to extrapolate further on earlier responses. Recorded audio from each interview was transcribed using Microsoft Word and de-identified prior to qualitative analysis. After the interview, participants completed an online survey covering basic demographics, clinical setting, and health care experience.Transcriptions were uploaded to Dedoose software version 8.3 and coded using a grounded theory approach , 34. IniThemes, subthemes, and representative quotations were then sent to a subset of 5 participants for validation. Criteria for validation was ≥.78 agreement for each individual theme and subtheme.Thematic saturation was achieved after 19 interviews. Table Four major themes and 15 subthemes were identified. All major themes and 13 subthemes met validation criteria, and are featured in Fig. All participants identified existential distress as an important and relevant concept for their clinical palliative care work.Respondents described existential distress as commonly arising both in the anticipation of dying as well as in response to changes in physical and psychosocial capabilities earlier in the course of illness. Existential distress was described as a disruption of, or challenge to, pre-existing sources of meaning or valued identities. Respondents noted a relationship between existential distress and psychiatric illness, though made a clear distinction between the two.The absence of relationships or adequate social support was linked to greater likelihood of a patient meeting difficulty in resolving existential distress. However, concern for unmet emotional, relational, or financial needs for family members was also seen as a source of distress, and LTI was noted to give rise to existential distress through the exacerbation of prior traumas and unresolved interpersonal conflicts.Respondents also described care of patients’ families as a critical part of their clinical role, and noted challenges to identity and meaning among caregivers for those with LTI. Respondents identified their own existential distress as an occupational hazard of working with patients at the end of life.Refractory distress was reported across all types of clinical settings. Factors associated with refractory cases included late referral to palliative care, pre-existing psychiatric illness or trauma history, and young age, especially when the patient was a young parent.Respondents, especially those from smaller hospitals or outpatient groups, pointed to barriers including limited time for visits, absence of specialty interventions and insufficient staffing to meet patient needs. Patient resource limitations were cited as a barrier to effective treatment in all settings.All respondents endorsed existential distress treatment as falling within their scope of practice, with specific roles and degree of involvement differing across professional disciplines.Respondents described existential distress as often overlooked or treated with discomfort by medical practitioners, especially primary consulting teams and oncologists. Physician and advanced practice nursing respondents reported an absence or paucity of training on existential distress treatment prior to specialization in palliative care. Palliative care approaches to existential distress were described as contrasting with a general medical culture focused on biological models of diagnosis and treatment.Participants endorsed therapeutic interpersonal techniques as the primary intervention for existential distress, including active empathic listening and nonjudgmental exploration of patients’ distress. More complicated cases were described as requiring specialist intervention with providers of spiritual care or psychotherapy, of which the most common types were meaning-centered, cognitive behavioral, and mindfulness-based psychotherapies. Helping patients repair or build new personal relationships was seen as integral to reducing existential distress.Respondents expressed interest in expansion of research and clinical access to PAT. However, not all were enthusiastic proponents and reservations or skeptical attitudes were common.PAT was identified as a potentially powerful addition to the palliative care “toolkit” and respondents described PAT as facilitating meaning-making by allowing patients new perspectives through which to reframe their existential struggle. Respondents endorsed the use of PAT through compassionate use provisions, describing PAT as providing hope for patients experiencing refractory existential distress. Respondents saw PAT as an alternative to controversial interventions for end-of-life distress, such as palliative sedation or physician aid-in-dying.At the same time, participants identified the current evidence base as insufficient and cited a need for further PAT research and greater education on PAT within palliative care departments before they could feel confident in its use. Participants described PAT as late-line interventions to be used only after other therapies had failed.Participants also expressed concerns about stigma for patients receiving PAT, as well as fears about stigmatization from other medical providers for providing PAT. Participants reported concerns that use of PAT would trigger relapse for patients with substance use disorders, and expressed worries about lasting psychological harm from dysphoric psychedelic experiences. Attitudes were more negative toward LSD and positive toward psilocybin and ketamine.Participants expressed confidence in the safety of PAT in properly controlled settings. Respondents emphasized key safety considerations for PAT, including rigorous screening for cardiac disease or history of mania or psychosis, skilled supervision during medication-facilitated sessions, and longitudinal psychotherapy follow-up to integrate these experiences.Providers struggled to identify clearly how PAT could fit into the current treatment paradigm, with fundamental questions unanswered regarding for whom PAT might be an appropriate and accessible treatment.There was no clear consensus around the relative benefits of delivering PAT to patients early in their course of LTI, later while admitted as inpatients, or even while on hospice. Respondents similarly failed to present clear agreement about which palliative care patients should be considered for PAT. Some described psychiatric and trauma histories as important indicators of patients who might benefit most from PAT, while others expressed concern regarding PAT for patients with any psychiatric comorbidity.Providers described interest in PAT as concentrated within specific sociocultural groups, such as younger patients in urban settings. Respondents estimated greater interest in West Coast and Northeastern states than in the Southern US. Participants identified patient groups for whom PAT might not be appealing, such as particular religious groups, and described PAT as cost-prohibitive and likely to exclude poor and underserved communities.The present study reports attitudes toward the treatment of existential distress using PAT within a representative sample of palliative care professionals. PAT were seen as holding promise to improve the treatment of existential distress within palliative care settings, especially in refractory cases. Overall, respondents identified further research and outreach as necessary before PAT can be expanded in palliative care settings, and identified several unresolved barriers to implementation of PAT in palliative care settings.One of the most striking features of these interviews was the emphasis on interdisciplinary collaboration within palliative care, a central cultural tenet of the field. Notably, both subthemes that failed validation touched on questions of role boundaries, and likely were rejected due to perceived violations of this core value.Physicians and advanced practice nurses have limited roles in the treatment of existential distress as compared to chaplains and social workers” (Theme 2) was drawn from descriptions of medical providers serving primary screening roles and triaging cases of existential distress to spiritual care or mental health care providers. However, the language of this subtheme was poorly considered, and respondents in the validation sample emphasized a team-based approach to the treatment of existential distress in which distinct roles are equally valuable.““PAT would mark a significant change in how and by whom existential distress is treated” (Theme 4). Feedback on this subtheme suggests that while respondents agree PAT would require greater involvement of psychiatrists and other mental health providers, palliative care providers would prefer to expand the umbrella of palliative care rather than referring cases to outside collaborators. This reflects the growing field of psycho-oncology and the greater incorporation of psychiatric and mental health providers into the multidisciplinary palliative care team. Furthermore, respondents reported strong interest in obtaining training in PAT within palliative care departments, despite no explicit question directed at this topic.Similarly, the second unvalidated subtheme dealt with the possibility of PAT marking a greater involvement of psychiatrists and other mental health practitioners in existential distress care: This study, by exploring current standards of care and attitudes toward PAT in a sample reflective of the interdisciplinary culture of palliative care, improves upon and further contextualizes recent investigations of attitudes toward PAT among palliative care providers. Those studies, which addressed perspectives of a diverse group of experts in palliative care, oncology and PAT  and a smExpansion of research into PAT in palliative care settings will be facilitated by the clear identification of a target population. While some participants reported an ideal of offering access to PAT for all patients facing life-threatening illness, PAT were commonly seen as intensive treatments indicated only after conventional methods have failed. Perceptions of PAT as late-line therapies may be reflective of stigma around psychedelics and thus subject to change with greater education about PAT. Still, many participants saw conventional treatments of existential distress as largely adequate, which invites us to consider the exact treatment gap PAT might fill.The greatest need for PAT may be within populations especially likely to suffer from refractory existential distress, such as younger adults or patients with significant trauma histories. Further research would be best directed at identifying risk factors for poor response to conventional psychotherapy and spiritual counseling. Alternatively, referral to PAT could be triggered by specific shifts in the course of treatment associated with significant unmet existential needs, such as cancer recurrence, hospice enrollment, or transition from standard cancer therapies to phase I clinical trials .Notably, the characteristics of patients with refractory existential distress overlapped with those of patients deemed too ill or unstable to be safely considered for PAT. Further studies are needed to clarify which psychiatric comorbidities are contraindications for PAT. Without this, the great challenge is that the window of opportunity – patients sick enough for PAT but not sick enough to be at risk of destabilization – may be narrow.Similarly, if treatment for existential distress is more limited in less-resourced settings, PAT is not well-situated to amend this treatment gap. Even if PAT are covered by insurance, the significant time demand of treatments may perpetuate problems of power and access that continue to plague American medicine, with marginalized groups unable to benefit equitably from these therapies. Research efforts to date have failed to adequately include diverse samples, with patients of color underrepresented in PAT studies . FurtherRespondents in our sample described meaning-enhancing interpersonal interventions, including both spiritual care and psychotherapeutic frameworks, as the core of conventional existential distress treatment. That meaning-making specifically mediates benefits of some conventional treatments  underscoOur findings suggest that PAT might be most easily integrated into palliative care practice if delivered in a manner consistent with current first-line meaning-enhancing approaches of psychotherapy and spiritual counseling. As researchers explore synergies between PAT and specific therapeutic modalities in other clinical contexts , 42, effBroader collaboration between PAT and faith traditions will not be without challenges. While psychedelic agents are important sacraments for some spiritual communities , 44, resThese findings also suggest the importance of maintaining emphasis on PAT’s meaning-enhancing effects. Psilocybin’s FDA designation as a breakthrough therapy for major depressive disorder , 46, whiPositive and stigmatizing views toward PAT were both common, often co-occurring within the same interview. This demonstrates the complicated way in which providers integrate new information about the therapeutic potentials of PAT with decades-old understandings of psychedelics as dangerous and illegal agents. While concerns about potential risks of PAT for patients with cardiac comorbidities echoe the exclusion criteria of recent studies, respondents also voiced concerns that do not track with recent evidence. Fears that PAT might trigger relapses among patients with substance use disorders contrasts with observations that psychedelics decrease patterns of problematic substance use in naturalistic settings –49; PAT These examples highlight the importance of education to dispel longstanding misconceptions regarding carefully monitored psychedelic use and promote data-driven understandings of the risks associated with PAT. While the present study was underpowered to assess variations in knowledge and attitudes toward PAT across professional classes, further survey-based research should seek to better classify these patterns, as has been demonstrated in larger samples of psychiatrists  and psycConvenience and snowball recruiting methods may have resulted in bias toward the cultures and institutional orthodoxies of included sites. Attitudes may be culturally specific and not necessarily generalizable outside the US. The sample of respondents was skewed toward younger and less experienced clinicians, who may be more likely to have positive views toward psychedelic therapies . While tPalliative care providers describe existential distress as a common source of suffering for patients with LTI. Current treatments emphasize enhancement of sources of meaning and rely on interdisciplinary coordination. Clinicians view PAT as promising treatments for refractory existential distress, though concerns regarding access and exclusionary criteria currently limit their potential scope. Further research and education regarding psychedelic interventions are needed before PAT can be more widely adopted in palliative care settings, especially to address safety concerns and clarify a target population. Close collaboration with spiritual care and mental health providers and adaptations of PAT to existing meaning-focused approaches will facilitate integration into current practice. Educational outreach should address misconceptions regarding risks of substance use and psychological harm. Broader access to PAT research and greater diversity of study samples will improve generalizability and promote equitable treatment outcomes.Additional file 1. Semi-structured interview protocol.


Identifying preference of older adults supports person-centred care. The most sophisticated instrument is the preference for everyday living inventory (PELI). The PELI has been translated into German language and tested in different care settings. For people who experience difficulties communicating their preference the PELI has been combined with photographs. The voice of older immigrants could lead to an enhancement of the PELI as well other preference tools. Thus, our symposium title: Variety of identifying and assessing preferences of everyday living of older adults. Our symposium includes four presentations: Dr. Bergmann will present data from a preference study in three different care settings  in Germany. The results indicate that the importance of certain preferences distinguishes between the care settings. Dr. Vanessa Burshnic will present data from her content validity study of photographs used to supplement the Preferences for Everyday Living Inventory-Nursing Home (PELI-NH) from the perspective of older adults. Content analysis revealed thematic codes describing participants’ photograph preferences including image quality, context, subject diversity, and relevance to long-term care. Mike Rommerskirch-Manietta will present results from a review to identify Instruments which can be used to assess preferences for everyday living of older adults. Interestingly instruments either represent multiple or only one domain. The study from Viktoria Peters-Nehrenheim does focus on preferences of older immigrants. She will present results how older immigrants (first generation) define preferences and how they can be assessed. Prof. Van Haitsma will be our discussant.


The drastic demand for geriatrics-trained providers in medical and mental healthcare persists years after the Institute of Medicine first highlighted this need . New innovative approaches must instead optimize the current workforce through leveraging existing geriatric experts’ knowledge and skills related to working aging adults. This symposium will highlight four approaches spanning post-licensure education to using technology to deliver specialized services and training. First, Dr. Gregg will discuss the evaluation of an advanced topics workshop in Geropsychology which has significantly enhanced depth of Geropsychology competencies for psychologists working in primarily rural areas. Next, Dr. Asghar-Ali will describe the multi-modal interactive geriatric educational opportunities for interprofessional staff developed by the South East Texas Geriatric Workforce Enhancement Program (SETx GWEP). He will discuss how these training opportunities have been tailored to address the impact of COVID-19 and healthcare disparities among older adults. Third, Dr. Filips will present an evaluation of a consultation model in which a geriatric psychiatrist provides tele-consultation in a 5-state region to rural aging Veterans with complex medical and behavioral comorbidities. Finally, Dr. Beaudreau will describe adaptations to a national VA Problem Solving Training program for mental health clinicians of older Veterans with complex comorbidities. Dr. Karel, VA National Geriatric Mental Health Director, will serve as discussant and comment on the ways in which these novel approaches are meeting the ever-growing need for competent geriatric mental health providers.


A 40-year-old man, a laborer from Bihar (eastern India), presented to the surgical department with multiple large nodular swelling and discharging sinuses over the left foot with a duration of six months. These lesions began as small nodules that progressively increased in number and size and developed multiple sinuses. On examination, the swelling was painless and firm. He had no significant medical history. Computed tomography showed extensive osteolytic destruction of the tarsal and metatarsal bones. Magnetic resonance imaging demonstrated involvement of soft tissue with multiple sinus tracts . Gram stMycetoma pedis is used to describe chronic granulomatous disease caused by true fungi (eumycetoma) or filamentous bacteria (actinomycetoma).,The term Madura foot or


Recruiting and enrolling older adults with cognitive impairment is challenging under the best of circumstances. This symposium will begin with an introduction to best practices for recruitment of older adults living with cognitive impairment, followed by four presentations describing recruitment successes and challenges across multiple settings. The first presentation describes COVID-19 pandemic-related factors that have influenced recruitment and enrollment of older adults with cognitive impairment in an intervention study of a physical activity smartphone app. Strategies and procedural alterations to facilitate achievement of enrollment goals for technology-based interventions are discussed. The second presentation describes researchers’ recruiting experiences with older adults with mild cognitive impairment (oaMCI)-care partner dyads for a pilot, platform trial of biopsychosocial interventions. There were differences in study disinterest between oaMCI and study partners that may require specialized communication messaging and strategies for dyad engagement. The third presentation features recruitment adaptations for an Internet-delivered behavioral intervention study with oaMCI and insomnia. Anticipated concerns of oaMCI using technology or accessing the Internet were not significant barriers to recruitment, while fewer oaMCI endorsed sleep concerns than expected. The last presentation demonstrates the potential for telephone-based outreach to increase dementia knowledge and cognitive risk. Working with faith-based health educators to reach rural, ethnically-diverse older adults, researchers will describe how to promote inclusivity and successfully recruit oaMCI within the community. Presenters and participants are encouraged to dialogue on how recruitment and retention barriers may be avoided as well as to share success stories from their own research with oaMCI.


ABSTRACT IMPACT: Successful implementation of this control strategy will result in a commercially available ivermectin-treated birdfeed that the public can use to protect themselves from infection with West Nile virus (WNV) by reducing mosquito survival and thereby suppressing WNV transmission around their homes. OBJECTIVES/GOALS: We assessed the efficacy and feasibility of ivermectin (IVM)-treated birds as a mosquito control strategy for local reduction of West Nile virus (WNV) transmission. We conducted a randomized field trial in backyard chickens and developed a mathematical model informed by field data to predict the impact of treated wild birds on transmission. METHODS/STUDY POPULATION: We placed 48 chickens in four treated and four untreated control flocks in backyards coops across Davis, CA and administered IVM daily in feed to treated flocks (Jul-Sep 2019). We assessed entomological indices weekly  around each coop, monitored serum IVM levels in treated chickens, and tested for WNV antibodies in all chickens. Shifting our focus to wild birds, we developed a spatially-implicit mathematical model of WNV transmission near IVM-treated birdfeeders. Model parameters for bird movement were based on our telemetry of 27 birds in Fort Collins, CO (Aug-Sep 2020). Using the model, we predicted optimal deployment of treated feeders to provide local WNV control. RESULTS/ANTICIPATED RESULTS: WNV seroconversions were reduced in treated vs. untreated flocks, indicating a reduction in WNV transmission intensity at treated coops (P = 0.03). A sustained, but insignificant reduction in number of infected mosquitoes was observed near treated coops (P = 0.59); small sample sizes and below normal WNV prevalence in the study area limited our power. We anticipate that optimal spacing and number of IVM-treated birdfeeders required for effective WNV control in neighborhoods will depend on feeder usage rates by common bird species irrespective of WNV competence; broad availability of IVM-treated bloodmeals to mosquitoes will be more effective in reducing transmission than targeting the few species responsible for viral amplification. DISCUSSION/SIGNIFICANCE OF FINDINGS: IVM is a novel method for controlling zoonotic pathogens in the US and has the potential for targeted mosquito control to reduce pesticide usage. Evaluating spatial deployment of IVM-treated bird feed for local reduction in WNV transmission is a stepping stone to commercial deployment of this WNV control strategy.


A key challenge for scholars who study aging is identifying a pool of research volunteers willing to participate. Toolkits and strategies acknowledge the differences in recruitment needed for older adults relative to younger adults, but there is little information about variations among older adult research volunteers. Based on a community sample of older adults age 60+, this study evaluates differences across seven specific motivators across three broad categories: values/altruism, personal growth/improvement, and immediate gratification. We then identify and evaluate four typologies of older adult volunteers based on the combinations of motivations the older adults in our sample identify as important to participation in research studies. Based on these analyses, we describe how our results might inform recruitment and retention practices in aging studies. Further, we will discuss how these results will help shape our technology-based reminder system with a greater understanding of motivations.


Previous studies suggest that falls among community-dwelling older adults living with dementia (OLWD) harm the health and wellbeing of their family/friend care partners. However, little is known about the process through which falls impact care partners. We conducted a grounded theory analysis using 59 semi-structured interviews with care partners of OLWD who were recently hospitalized and had a history of falls. We identified several areas of care partners’ functioning that were affected by falls in positive and negative ways: everyday life, health management for OLWD, and interactions with healthcare providers. Both the fall events and fall risks had negative consequences of reducing care partners' self-care activities and work productivity. Other adverse consequences of fall risks were (1) care partners’ fatigue and conflicts with OLWD due to the intense requirement of daily monitoring, and (2) hesitance to ask healthcare providers for assistance because clinicians frequently did not teach care partners how to address fall risks and might recommend institutionalization. However, OLWD's fall events became a transition point for some care partners to seek support and gain more information and skills about managing OLWD’s health conditions, which might reduce care partners’ burden in the long term. Because OLWD’s falls may have negative and positive consequences for care partners, both problem-solving and strength-based fall management approaches are needed. These strategies focus on developing and sustaining care partners’ self-care, developing collaborative relationships with OLWD, enhancing successful capacity for OLWD’s health management, and cultivating partnerships with healthcare providers.


Maintaining cognitive function in later life is key to healthy aging because cognitive impairments compromise everyday functional abilities, impeding independent living. Numerous studies have discovered early life experiences and lifestyle behaviors over the lifespan to have substantial influences on cognitive functioning with age. Especially, subtle brain changes related to dementia occur as early as midlife, and lifestyle factors in midlife influence neuropathological development, suggesting that midlife is a critical period for preserving cognitive health in later life. This study investigated the association between lifestyle behaviors in midlife and cognitive performance in later life using 12-year follow-up data from the Korean Longitudinal Study on Aging (KLoSA). Cognitive function was assessed with the Harmonized Cognitive Assessment Protocol (HCAP) for KLoSA. Eight thousand respondents from the KLoSA sample were administered HCAP neuropsychological tests. Hierarchical multiple regression analyses were used to examine whether health-promoting lifestyles at baseline (2006) predicted cognitive function in 2018 after controlling for health-related covariates. We identified a positive influence of health-protective behaviors  at baseline on language abilities in 2018 . In addition, health-promoting behaviors covering interpersonal relationships, social engagement, optimistic outlook, and positive attitudes at baseline were predictive of language abilities , executive function , and the visuospatial ability  in 2018. This study highlights the importance of midlife health-promoting lifestyles in maintaining cognitive health in later life.


This study focuses on long-term care (LTC) state Medicaid policy and its impact on caregiver decisions and experiences. It examines respondents’ general knowledge of LTC state policies and services, challenges with navigating LTC policies and services, and decision-making pathways based on these factors. Using purposive sampling, 63 family caregivers across eight states participated in open-ended qualitative interviews (2019-2020) until thematic saturation was reached. Questions broadly examined caregivers’ experiences and decisions, focusing on decisions made around type of care setting and experiences with LTC state policy. States were selected to represent variation in Home and Community Based Service (HCBS) expenditures as a percentage of total Medicaid long-term services and support expenditures. While LTC policies and services vary significantly by state, we identified many parallels in caregiver experiences and perceptions across states, as respondents often lacked specific knowledge about LTC policies and services and how to access them. Overarching themes include LTC policy navigation challenges, distrust in state-funded LTC services and supports, and moral expectations of caregiving. To manage these challenges, caregivers employed coping strategies such utilizing informal support networks, hiring care coordination assistance, and “stretching things thin” to fill the policy and service gaps. Study findings highlight potential strategies to improve LTC services across states. There is a need to improve community trust with state services by employing transparent regulatory and evaluation procedures for LTC. Wider access to case management may improve communication and knowledge of available services to maximize benefit from HCBS expansions.


The longitudinal associations between hearing impairment and higher-level functional measures and the potential confounding role of vestibular function have not been assessed. We investigated these associations in 831 participants of the Baltimore Longitudinal Study of Aging (2012–2019). Hearing was measured using pure-tone audiometry and categorized using WHO standards. Physical function was assessed with the Health Aging and Body Composition Physical Performance Battery  and walking endurance with time to walk 400 meters. Multivariable regression models tested the hypotheses that participants with hearing impairment have poorer physical outomes. In a subset, we further adjusted for vestibular function. Hearing impairment was associated with decrements in higher-level physical performance and walking endurance, and faster decline over time, regardless of vestibular function. Among participants with any hearing impairment, hearing aid users were faster in the 400-m walk. Early screening for higher-level functional loss among older adults with hearing loss is warranted.


Self-determination is a core value of person-centered care. Research has shown residents and families want to be involved in decisions about care. Care conferences are one existing structure where residents and families can engage in decision-making about care goals. However, there are few tools to support effective engagement. To inform future tool development, this study sought to understand what resident and family stakeholders value about engaging in care conferences. In virtual meetings, 16 stakeholders identified 3 key areas of engagement: being informed about health/well-being, influencing care goals, and advocating for needs. They indicated current approaches do not achieve these engagement goals, which is particularly problematic during COVID when families cannot engage in person. Stakeholders offered ideas for supporting engagement such as provision of data before the conference. The study has implications for individualizing care conferences and encouraging resident and family engagement in decision-making both during and beyond COVID.


This cross-sectional study evaluates the out-of-pocket costs of diagnostic breast imaging services incurred by commercially insured women who underwent additional imaging evaluation and procedures after screening mammography. We performed a retrospective analysis using a national commercial claims database  with individual-level demographic information and inpatient, outpatient, and pharmacy claims for health care plan members residing in all 50 US states. Claims information included both OOPCs for plan members  and total standardized reimbursements.This cross-sectional study was deemed exempt from University of Michigan Institutional Review Board approval owing to use of deidentified data and followed the Strengthening the Reporting of Observational Studies in Epidemiology , ultrasonography (US), magnetic resonance imaging (MRI), and biopsy  were followed by additional breast imaging examinations or procedures. After applying exclusions, the final cohort included 325 900 women with 418 378 additional breast imaging examinations or procedures.Out-of-pocket costs varied substantially across women and type of imaging received and generally increased over time . For exaCost sharing also increased throughout the study period . Among w3Although the ACA largely eliminated OOPCs for screening mammography, our findings suggest that among commercially insured women ages 40 to 64 years, OOPCs for additional breast imaging evaluations and procedures after screening are common, nontrivial, and increasing. This trend coincides with the rapid rise in high-deductible health care plans that has been observed during the same time frame as the study period.This study has some limitations. We did not include OOPCs for related care such as office visits and pathology expenses, likely underestimating the total patient contributions. In addition, we could not distinguish between diagnostic evaluations for abnormal screening vs those for symptoms. We were also unable to discern the number of women who had an abnormal screening but did not undergo a subsequent evaluation or procedure.4 Although the association between OOPCs and receipt of one-time diagnostic testing has not been described (to our knowledge), it is possible that higher cost sharing could deter women from undergoing diagnostic evaluation following screening mammography, thus undermining the goal of the ACA to remove barriers to screening. The benefit design of health care plans must acknowledge that cancer screening often requires multiple steps and remove financial barriers for patients to complete the screening process.Consumer cost sharing is associated with decreased use of evidence-based medical care.


Although African Americans have lower rates of anxiety in childhood than other racial and ethnic minority groups, they seem to experience escalating rates during emerging adulthood. Despite this, few studies have examined factors associated with anxiety during emerging adulthood among African American populations. The current study investigated the extent to which late adolescent family relationships affect anxiety problems among African American emerging adults. Informed by family development theory, family cohesion was hypothesized to indirectly effect anxiety problems through self-regulation. This model was tested with three waves of data  from African Americans participating in the Maryland Adolescent Development in Context Study. Study findings were consistent with the hypothesized model: family cohesion forecasted decreased anxiety problems, indirectly, via increased self-regulation. This finding suggests that families may be an important promotive process for anxiety problems during emerging adulthood. Prevention programs that target family processes may be able to reduce anxiety problems in emerging adult African Americans. Anxiety is characterized by heightened, relentless fears and worries about everyday events . Clinicafamily cohesion in promoting the development of youths’ autonomy and their ability to navigate new contexts.Racial and ethnic group differences in anxiety rates and severity have been observed. Although African Americans have lower rates of anxiety in childhood than other racial and ethnic minority groups, they seem to experience escalating rates during emerging adulthood , 14. MorFamily cohesion describes nurturant communication, warmth, emotional support, and involvement between family members –18. In gAlthough these studies suggest that cohesive families may reduce poor psychological outcomes in emerging adulthood, the extent to which family cohesion is associated with anxiety problems among African American emerging adults is not well studied, despite close family ties being culturally important for many African American families . Data onWe further hypothesized that self-regulation may be a mechanism through which family cohesion affects anxiety problems during emerging adulthood. Self-regulation refers to individuals’ ability to control their emotions, behaviors, and thoughts . EmerginTaken together, theory and extant research suggest that cohesive families may act as an emotional safety net which supports the development of self-regulation during emerging adulthood. With this safety net in place, emerging adults may feel comfortable exploring new opportunities while navigating the potential emotional turmoil of this challenging developmental period. The extent to which family cohesion forecasts self-regulation and reduced anxiety problems among African Americans emerging adults is not well studied. The current study addresses this gap. Informed by family development perspectives and previous research, family cohesion is hypothesized to indirectly effect anxiety problems through self-regulation. This hypothesis was tested via a secondary analysis of three waves of data from African Americans participating in the MADICS Study of Adolescent Development in Multiple Contexts (MADICS) controlling for antecedent family support.Youth and their families were recruited from 23 middle schools in Prince George’s County, Maryland , 46. PriThe MADICS was a longitudinal study investigating psychological and behavioral determinants of developmental trajectories of youth living in Prince George’s County, Maryland, a county located near Washington, D.C. , 46. MADα = .69) and Wave 4 (α = .68). Closeness with family members at Waves 3 and 4 were measured using five items from the Iowa Youth and Family Study  indicated that the indirect effect of family cohesion on anxiety problems through self-regulation was significant.Descriptive statistics and bivariate correlations for the 886 African Americans participating in Wave 4 of MADICS are presented in Informed by family development perspectives on emerging adult mental health, this study investigated the effects of family cohesion during late adolescence on self-regulation and anxiety problems as African Americans transition into emerging adulthood. Three key findings emerged. First, family cohesion in late adolescence was significantly related to increased self-regulation in emerging adulthood. Second, self-regulation was significantly related to reduced anxiety problems in emerging adulthood. Third, family cohesion in late adolescence indirectly effected anxiety problems in emerging adulthood through self-regulation.The first finding suggests that family cohesion during late adolescence is an important process for supporting self-regulation during emerging adulthood. This finding is consistent with and extends previous research on family effects among children and adolescents . In addiOur findings suggest that self-regulation is an important factor in reducing anxiety problems among emerging adults. This is in line with similar findings in investigations of children and emerging adults. For example, a study of children between the ages of 8 to 12 found that highly regulated children were able to manage negative emotions such as worry, sadness, and anger, which suggests that self-regulation may be an important promotive factor for anxiety problems . SimilarThe indirect effect finding suggests that self-regulation may act as a mechanism through which family cohesion during late adolescence affects downstream anxiety. Similar results were reported by Brody and Ge  in a stuStudy findings have several implications for prevention. Prevention programs working to reduce anxiety problems in African Americans prior to and during the transition to adulthood should consider targeting enhancing family cohesion. The Adults in the Making (AIM) prevention program is an example of a program that seeks to increase family cohesion in order to improve emerging adult outcomes . FamilieThe current study has several limitations. First, the sample comprised of African American youth living in Maryland, so these findings may not generalize to African American youth living in other cities or regions of the United States. Second, these findings are correlational. Experimental designs using preventive interventions  could beIn summary, family cohesion in late adolescence was indirectly related to changes in anxiety problems in emerging adulthood through self-regulation. This finding suggests that families continue to serve as important promotive processes for self-regulation and anxiety problems during the transition to emerging adulthood. Prevention programs that incorporate the family may be able to reduce anxiety problems in emerging adult African Americans.S1 Table(DOCX)Click here for additional data file.


Christopher Abbosh and Charles Swanton discuss circulating tumor DNA as a potential biomarker for neoadjuvant treatment response in solid tumors. Three studies presented within this special issue of PLOS Medicine focus on evaluation of circulating tumor DNA (ctDNA) as a response biomarker in early-stage solid tumours. Both Yaqi Wang and Pradeep Chauhan and their respective colleagues evaluate ctDNA as a tool capable of predicting complete pathological response (pCR) in locally advanced rectal cancer (LARC) and muscle invasive bladder cancer (MIBC), respectively ,2. JeannQuantitation of ctDNA kinetics over time can act as a dynamic biomarker of tumour response to targeted therapies, immunotherapy and radiation therapy –6. In a In relation to the latter point, Wang and colleagues draw attention to the potential for deferral of surgery in patients exhibiting complete clinical response  following neoadjuvant chemoradiation treatment for LARC . This isThe study from Wang and colleagues supports prior findings from Murahashi and colleagues who also evaluated post-treatment ctDNA kinetics in patients undergoing neoadjuvant treatment for LARC . In MuraLike the application of ctDNA in LARC, Chauhan and colleagues asked whether evaluation of urinary ctDNA (utDNA) could differentiate pCR from non-pCR in patients being treated with neoadjuvant therapy for MIBC . DevelopTie and colleagues explored ctDNA as a curative-therapy response biomarker in CRLM. Within a cohort of patients who underwent neoadjuvant chemotherapy, they noted a median 40.93-fold decrease in ctDNA levels during treatment with 13 of 18 evaluable patients exhibiting absence of ctDNA detection pre-cycle 4 of treatment: all 4 patients with pCR in the resection specimen experienced ctDNA clearance prior to cycle 3 or 4 of neoadjuvant treatment. However, ctDNA clearance during neoadjuvant chemotherapy had no impact on 5-year relapse free survival (RFS) when compared to lack of ctDNA clearance. In contrast, the team identified that ctDNA detection after surgery was a strong predictor of reduced RFS, with patients who were ctDNA positive following curative therapy (surgery +/- adjuvant therapy) exhibiting a 5-year RFS rate of 0% versus 75.6% in ctDNA negative patients. These data highlight the importance of associating ctDNA clearance dynamics during neoadjuvant treatment with post-operative survival endpoints, since in this study ctDNA clearance with neoadjuvant chemotherapy did not translate into reduced risk of disease recurrence following surgery.Supporting ctDNA as a neoadjuvant response biomarker in other tumor types, data in non-small-cell lung cancer (NSCLC) from the neoadjuvant CheckMate-816 study, a randomized, phase III study comparing neoadjuvant platinum chemotherapy with or without nivolumab in stage IB-IIIA NSCLC, highlighted that ctDNA clearance at day 1 cycle 3 post-combination chemotherapy and immune checkpoint inhibitor treatment associates with pCR . Stage IIn conclusion, the findings presented in this special issue add to an emerging literature highlighting a need to explore the translational potential for ctDNA assessment as a response biomarker in the neoadjuvant setting. These data are particularly relevant in LARC and MIBC where treatment response biomarkers that are not reliant on pathological examination of resection specimens are required to guide non-operative management decisions. The data from Tie and colleagues suggest that the capability of neoadjuvant chemotherapy-induced ctDNA clearance to act as a surrogate of long-term survival benefit from curative intent therapy could be absent in CLRM, however the sample size in this study was modest which may have limited ability to detect an association. It is conceivable that the utility of ctDNA as a neoadjuvant response biomarker may vary by therapeutic class and solid tumour type. To address this issue, it will be important for prospective interventional trials to incorporate ctDNA clearance kinetics as an endpoint to determine surrogacy of these measures for survival across solid-tumour types. Finally, to gain understanding of the relative merits and disadvantages of ctDNA-based response metrics versus conventional clinical measures of response , direct comparison of ctDNA clearance with these approaches is warranted.


Heritability of cognitive ability changes across late adulthood, although whether genetic variance increases or decreases in importance is not understood well. We performed a systematic review of the heritability of cognitive ability derived from longitudinal twin studies of middle-aged and older adult twins. Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, articles were identified in APA PsycINFO and Clarivate Web of Science electronic databases. Identified articles were screened by title and abstract; remaining full-text articles were then fully evaluated. Reference sections served as an additional method for identification of relevant articles. In total, 3,106 articles were identified and screened, 28 of which were included and were based on data from 10 longitudinal twin studies published from 1994-2021. There are large genetic influences on an initial level of cognitive performance across domains whereas there are small to moderate genetic influences on change in performance with age. Evidence was less definitive about whether the same or different genetic factors contribute to both level and change. Non-shared environmental influences appeared to drive individual changes in cognitive performance. Heritability tended to either be stable or decline after 65 years, possibly because of the increasing importance of non-shared environmental influences on cognitive ability. Recent studies report increases in heritability across specific subtests and domains. Shared environmental variance accounted for little variance in cognitive ability. Emerging research questions and future directions for understanding genetic and environment influences in the context of gene-environment interplay are highlighted in this review.


Level of Difficulty: Advanced.)We present 3 cases of superior vena cava (SVC) syndrome following percutaneous right ventricular assist device (RVAD) placement. Each case underscores the importance of early recognition of SVC syndrome in patients with percutaneous RVAD insertion via the internal jugular vein and calls for heightened awareness of device-associated complications. (  At present, device-related SVC syndrome accounts for up to 40% of all cases . PatientSVC syndrome can arise in postsurgical settings or as a consequence of iatrogenic obstruction to venous drainage. Currently, heart transplantation and ventricular assist devices may be used in end-stage heart failure that is unresponsive to interventional treatments. Although bicaval anastomosis during heart transplantation is preferred because of anatomic and hemodynamic benefits, this method effectively limits the distensibility of the SVC to the circumference of the suture line and may precipitate SVC syndrome with post-transplant RVAD use . AlthougAlthough both postsurgical and iatrogenic causes of SVC syndrome can develop secondary to a disruption in hemodynamic stability , scant literature has reported the onset of SVC syndrome after percutaneous RVAD cannulation via the right internal jugular vein . As the A 61-year-old man presented with restrictive cardiomyopathy with biventricular failure and underwent orthotopic heart transplantation (OHT). The patient had a dual-chamber implantable cardioverter-defibrillator (ICD) that was removed following OHT. A postoperative transesophageal echocardiogram (TEE) revealed a moderately dilated right ventricle (RV) with normal function. Postoperative day 2, the patient became profoundly hypotensive and unresponsive to vasopressors, and because of high central venous pressure (CVP) and RV dysfunction, the patient underwent RVAD extracorporeal membrane oxygenation. Approximately 30 hours later, the patient had marked swelling of the head and upper extremities and a CVP of 45 mm Hg . The patA 55-year-old man presented with acute decompensated left ventricular systolic heart failure and cardiogenic shock that required an intra-aortic balloon pump; he underwent LVAD and RVAD implantation. One week before LVAD placement, the patient’s biventricular ICD was removed because of sepsis. Shortly after, central RVAD support was switched to percutaneous support with no complications. Approximately 45 hours following placement of the device, the patient exhibited rapidly progressive head and neck swelling suggestive of SVC syndrome. After removal of a preexisting left internal jugular central venous line, the patient experienced improved facial edema, and signs of SVC syndrome resolved.A 50-year-old man with a history of HeartMate II explant for recovery presented with recurrence of heart failure with a reduced left ventricular ejection fraction of 10% and associated RV dysfunction. After implantation of LVAD and RVAD support, the patient experienced facial edema, orbital swelling, and underwent emergent venogram that showed near occlusion of the SVC  and 2. DThe diagnosis of SVC syndrome is accomplished using clinical picture and supplementary imaging modalities like chest radiography, contrast-enhanced computed tomography scanning, duplex ultrasound, conventional catheter-based digital subtraction venography, and magnetic resonance venography . These tFor nonmalignant causes of SVC syndrome, including placement of a dual-lumen cannula, there are several strategies for preventing venous congestion. In the setting of transplant, preoperative SVC imaging can reveal anatomical variance in caval diameters; significant discrepancy between host and donor may increase risk for bicaval stenosis and subsequent venous congestion. Likewise, we suggest performing a venogram before RVAD placement in patients with preexisting leads or central lines because it may reveal subclinical stenosis. Similarly, venous obstruction can be circumvented via imaging of the SVC-RA junction among patients before device placement; however, this approach poses a significant challenge because of poor validation of ranges for cross-sectional radiographic sizing across different imaging modalities .In addition, the SVC is a compliant vasculature, and its sizing is likely dependent on the hemodynamic status at the time of measurement. More informative imaging techniques may be accomplished via computed tomography venography, but this approach carries a substantial radiation dose and is poorly validated because venous size chiefly depends on intrathoracic pressure and volume status . An alteVenous scarring from preexisting intravascular leads may result in reduced distensibility and may precipitate venous congestion after percutaneous RVAD cannulation. For example, SVC syndrome following pacemaker implantation can occur secondary to the formation of vegetations or via thrombosis after endothelial disruption . In all Here, we describe 3 cases of SVC syndrome following percutaneous dual-lumen cannulation for extracorporeal life support. Patients with signs of SVC syndrome, including facial and chest edema, dyspnea and cough, and nonpulsatile distended neck veins, experienced improvement following either device explantation or removal of the accompanying central venous catheter within the left internal jugular and subclavian venous system. By considering multiple etiologies for SVC syndrome, we hypothesize that appropriate RV support and early recognition of SVC syndrome are critical for preventing venous obstruction.The authors have reported that they have no relationships relevant to the contents of this paper to disclose.


Transgender persons who came of age in the late 1960s are considered LGBTQ+ elders - The Stonewall Generation. These persons experience unique bio-psychosocial challenges, often complicated by a history of a lack of access to good medical care and social supports. Discrimination and bias can influence the provision of care and the protection of privacy for transgender or gender non-conforming persons. Staff training is essential to provide ethical care for aging trans persons who require residential care. This presentation examines current staff training modules of 100 Long Term Care (LTC) facilities, assessing training needs to provide affirming, culturally competent, and ethical care for sexual and gender minorities.Keywords: cultural competence; Long Term Care; staff training; transgender


The present study aims to identify personality and socioeconomic  factors that contribute to midlife cognitive functioning across middle adulthood. Specifically, we examined how the growth trajectories of personality and socioeconomic factors across 12 years predict subsequent cognitive functioning, using data from a large sample of Mexican-origin adults . Personality was assessed using the Big Five Inventory, which assesses the Big Five domains as well as specific facets of each domain; economic stress was assessed using measures of negative economic events  and economic hardship . Cognitive functioning was assessed using the NIH Cognitive Toolbox with measures of memory, language, and executive function. Findings from this work will help identify intervention targets for promoting healthy cognitive aging in midlife and beyond in Mexican-origin adults.


This session will provide updates on how the pandemic led to horrific situations in long-term care facilities and how the pandemic influenced major federal efforts to address elder abuse, neglect, and exploitation.