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Background: Implementing the Age‐Friendly Health System (AFHS) framework into dental care provides a significant opportunity to link oral health to healthy aging. This project aimed to implement the AFHS 4Ms (what matters, medications, mentation, and mobility) in the provision of oral health care. This article describes the planning, integration, training development, and outcome measurements supporting a 4Ms approach at an academic dental clinic. Methods: The Eastman Institute for Oral Health (EIOH) implemented screening instruments based on the 4Ms framework recommended for ambulatory care clinics by the Institute for Health Care Improvement (IHI). These ambulatory instruments were integrated into the workflows of a Specialty Care Clinic through the development of a plan–do–study–act cycle, utilization of available clinic resources, and creation of interdisciplinary collaborations. Results: This project demonstrated the feasibility of implementing an AFHS checklist and tracking forms in dental practice by integrating available resources and prioritizing the 4Ms elements. This effort necessitated interdisciplinary collaborations between dental, medical, and social service professionals. It also created a new age‐friendly focused education and training curriculum for dental residents and faculty. Conclusions: This pilot project is the first to establish dental standards for AFHS implementation, adapting the 4Ms assessment and metrics to oral health. This AFHS underscores key oral health processes, including assessment, planning, and personalized oral health care, adapted to the unique needs of the older adult population, especially those with cognitive impairment. [ABSTRACT FROM AUTHOR]

Background: Use of the Project ECHO® (Extension for Community Healthcare Outcomes) model in geriatrics has increased dramatically largely because of the Health Resources and Services Administration‐funded Geriatrics Workforce Enhancement Programs (GWEP) utilizing it as a key tool for age‐friendly, interprofessional workforce development. This manuscript describes the scope and impact of geriatrics ECHOs under the GWEP. Methods: A survey of GWEPs was conducted to measure the reach, foci, evaluation methods, and other characteristics of ECHO networks. Results: All 48 (100%) GWEPs responded to the survey, and 30 (63%) reported using ECHO. GWEP ECHOs have both rural and urban‐underserved reach across the United States, and their hub teams include many health professions. Age‐friendly care is incorporated through multiple methods and is taught across foci including primary care, dementia, long term care, and novel topics. GWEP ECHOs have many academic and community partners including Area Agencies on Aging, and reach varied health professions, trainees, and caregivers. Geriatrics ECHOs collect outcomes across the evidence continuum including the community‐level outcome of Age‐Friendly Health System designation. Conclusions: The ECHO model has been widely adopted by GWEPs as a key approach for workforce training in age‐friendly care. Project ECHO is a valuable tool to expand interprofessional training for the geriatrics workforce, particularly for interprofessional teams in rural and underserved areas. [ABSTRACT FROM AUTHOR]

Aortic stenosis (AS) stands as the most common valvular heart disease in developed countries and is characterized by progressive narrowing of the aortic valve orifice resulting in elevated transvalvular flow resistance, left ventricular hypertrophy, and progressive increased risk of heart failure and sudden death. This narrative review explores clinical challenges and evolving perspectives in moderate AS, where discrepancies between aortic valve area and pressure gradient measurements may pose diagnostic and therapeutic quandaries. Transthoracic echocardiography is the first‐line imaging modality for AS evaluation, yet cases of discordance may require the application of ancillary noninvasive diagnostic modalities. This review underscores the importance of accurate grading of AS severity, especially in low‐gradient phenotypes, emphasizing the need for vigilant follow‐up. Current clinical guidelines primarily recommend aortic valve replacement for severe AS, potentially overlooking latent risks in moderate disease stages. The noninvasive multimodality imaging approach—including echocardiography, cardiac magnetic resonance, computed tomography, and nuclear techniques—provides unique insights into adaptive and maladaptive cardiac remodeling in AS and offers a promising avenue to deliver precise indications and exact timing for intervention in moderate AS phenotypes and asymptomatic patients, potentially improving long‐term outcomes. Nevertheless, what we may have gleaned from a large amount of observational data is still insufficient to build a robust framework for clinical decision‐making in moderate AS. Future research will prioritize randomized clinical trials designed to weigh the benefits and risks of preemptive aortic valve replacement in the management of moderate AS, as directed by specific imaging and nonimaging biomarkers. [ABSTRACT FROM AUTHOR]

Double–double (DD) laminates approach enables the design of mass‐minimized composite structures with number and orientation of plies tailored on the acting loads. Thus, the investigation of the crashworthiness capabilities is crucial in assessing the airworthiness of DD designed structures. In this work, two composite fuselage barrel configurations with conventional and DD designed frames have been compared to study their crashworthiness performance during an impact event. Numerical results highlight that configurations with DD optimized frames exhibit performance in terms of crashworthiness and passive safety for passengers comparable to the one with conventional designed frames while reducing the structure's total mass by up to 13%. [ABSTRACT FROM AUTHOR]

The use of optimization procedures can provide a valuable contribution in optimizing the laminate design of composite components for mass minimization and mechanical performance maximization. Design for weight and strength requirements of composite structures can be efficiently provided with the newly developed double‐double laminates concept, which allows to overcome the conventional 0, 90, and ±45° ply orientations and symmetry requirements in laminates. In the double‐double designed components, composite laminates are made up stacking thin sub‐laminates with four [±Φ, ±Ψ] oriented plies without symmetry requirements. In the present paper, the lay‐up and thickness profile of the composite frames in a fuselage section have been redesigned according to the double‐double design concept taking into account the operating loads. The starting quad configuration has been replaced by an optimized double‐double configuration with suitable lay‐up and thickness profile for each of the frames, while achieving a reduction in the total components mass. Highlights: Double‐double laminates offer a novel approach to composite laminate design.Double‐doubles aim to simplify design with composites as with metals.Laminate optimization performed varying plies orientations and number.Double‐double design of components optimized with respect to the acting loads.In aviation double‐doubles allow lightening of composite laminate components. [ABSTRACT FROM AUTHOR]

Over half of older adults experience polypharmacy, including medications that may be inappropriate or unnecessary. Deprescribing, which is the process of discontinuing or reducing inappropriate and/or unnecessary medications, is an effective way to reduce polypharmacy. This review summarizes (1) the process of deprescribing and conceptual models and tools that have been developed to facilitate deprescribing, (2) barriers, enablers, and factors associated with deprescribing, and (3) characteristics of deprescribing interventions in completed trials, as well as (4) implementation considerations for deprescribing in routine practice. In conceptual models of deprescribing, multilevel factors of the patient, clinician, and health‐care system are all related to the efficacy of deprescribing. Numerous tools have been developed for clinicians to facilitate deprescribing, yet most require substantial time and, thus, may be difficult to implement during routine health‐care encounters. Multiple deprescribing interventions have been evaluated, which mostly include one or more of the following components: patient education, medication review, identification of deprescribing targets, and patient and/or provider communication about high‐risk medications. Yet, there has been limited consideration of implementation factors in prior deprescribing interventions, especially with regard to the personnel and resources in existing health‐care systems and the feasibility of incorporating components of deprescribing interventions into the routine care processes of clinicians. Future trials require a more balanced consideration of both effectiveness and implementation when designing deprescribing interventions. [ABSTRACT FROM AUTHOR]

Aims: Glomerular hyperfiltration characterises the earliest stage of diabetic nephropathy and predicts adverse kidney and cardiovascular outcomes. We aimed to assess the prevalence and risk factors of glomerular hyperfiltration in a population‐based contemporary cohort of individuals with type 2 diabetes (T2D). Materials and Methods: The prevalence of unequivocal glomerular hyperfiltration (defined by an estimated glomerular filtration rate >120 mL/min/1.73 m2) and its associated risk factors were identified in a cohort of 202,068 adult patients with T2D receiving specialist care in 2021–2022, whose center‐aggregated data were automatically extracted from electronic medical records of 75 diabetes clinics in Italy. Results: Glomerular hyperfiltration was identified in 1262 (0.6%) participants. The prevalence of glomerular hyperfiltration varied widely across centers (0%–3.4%) and correlated with mean center age, HbA1c, body mass index (BMI), and low‐density lipoprotein cholesterol. Patients in centers with high glomerular hyperfiltration prevalence (>0.8%) were more often men and had lower age and BMI, but more frequent albuminuria and worse glucose, lipid, and blood pressure control, compared with low‐normal prevalence centers. Conclusions: Unequivocal glomerular hyperfiltration can be identified in up to 3.4% of patients receiving up‐to‐date specialist diabetes care. Glomerular hyperfiltration prevalence varies across centers and substantially increases with suboptimal control of metabolic risk factors, which would require improved management to mitigate the negative health consequences of this pathological condition. [ABSTRACT FROM AUTHOR]

Objective: The objective of this study was to examine the hypothesis that abdominal and gluteal adipocyte turnover, lipid dynamics, and fibrogenesis are dysregulated among insulin‐resistant (IR) compared with insulin‐sensitive (IS) adolescents with obesity. Methods: Seven IS and seven IR adolescents with obesity participated in a 3‐h oral glucose tolerance test and a multi‐section magnetic resonance imaging scan of the abdominal region to examine body fat distribution patterns and liver fat content. An 8‐week 70% deuterated water (2H2O) labeling protocol examined adipocyte turnover, lipid dynamics, and fibrogenesis in vivo from biopsied abdominal and gluteal fat. Results: Abdominal and gluteal subcutaneous adipose tissue (SAT) turnover rates of lipid components were similar among IS and IR adolescents with obesity. However, the insoluble collagen (type I, subunit α2) isoform measured from abdominal, but not gluteal, SAT was elevated in IR compared with IS individuals. In addition, abdominal insoluble collagen Iα2 was associated with ratios of visceral‐to‐total (visceral adipose tissue + SAT) abdominal fat and whole‐body and adipose tissue insulin signaling, and it trended toward a positive association with liver fat content. Conclusions: Altered extracellular matrix dynamics, but not expandability, potentially decreases abdominal SAT lipid storage capacity, contributing to the pathophysiological pathways linking adipose tissue and whole‐body IR with altered ectopic storage of lipids within the liver among IR adolescents with obesity. [ABSTRACT FROM AUTHOR]

Background: Antipsychotic use is a safety concern among older patients in home health care (HHC), particularly for those with Alzheimer's disease and related dementias (ADRD). The objective of this study was to examine the prevalence and predictors of antipsychotic use among older adults with and without ADRD who received HHC, and the association of antipsychotic use with outcomes among patients living with ADRD. Methods: In this secondary analysis of adults ≥65 years receiving care from an HHC agency in New York in 2019 (N = 6684), we used data from the Outcome and Assessment Information Set, Medicare HHC claims, and home medication review results in the electronic HHC records during a 60‐day HHC episode. ADRD was identified by diagnostic codes. Functional outcome was the change in the composite activities of daily living (ADL) score from HHC admission to HHC discharge (measured in 5833 patients), where a positive score means improvement and a negative score means decline. Data were analyzed using logistic (predictors) and linear regression (association with outcome) analyses. Results: The point prevalence of antipsychotic use was 17.2% and 6.6% among patients with and without ADRD, respectively. Among patients living with ADRD, predictors of antipsychotic use included having greater ADL limitations (odds ratio [OR] = 1.30, p = 0.01), taking more medications (OR = 1.04, p = 0.02), having behavioral and psychological symptoms (OR = 5.26, p = 0.002), and living alone (OR = 0.52, p = 0.06). Among patients living with ADRD, antipsychotic use was associated with having less ADL improvement at HHC discharge (β = −0.70, p < 0.001). Conclusions: HHC patients living with ADRD were more likely to use antipsychotics and to experience worse functional outcomes when using antipsychotics. Antipsychotics should be systematically reviewed and, if contraindicated or unnecessary, deprescribed. Efforts are needed to improve HHC patients' access to nonpharmacological interventions and to provide education for caregivers regarding behavioral approaches to manage symptoms in ADRD. [ABSTRACT FROM AUTHOR]

Objective: Postdoctoral dental education in caring for older adults lacks didactic and clinical training in mentation topics, one of the core elements of the Age‐Friendly Health Systems (AFHS) framework. Our primary goal was to launch a pilot project in clinical geriatrics focusing on older adults' mentation concerns, with a secondary goal to improve dental residents' confidence and competence in dental care and oral health. Background: Age‐friendly care elements are not routinely incorporated into the dental education of residents caring for older adults with cognitive impairment or dementia. Therefore, we implemented a pilot educational project, providing the missing educational opportunity for residents in geriatric training covering cognitive impairment and focusing on Alzheimer's disease and related dementias. Materials and Methods: We designed educational sessions through a needs assessment, focus group discussions, and expert validation. We developed three e‐Learning modules covering mentation concerns and dementia screening. We tested the modules in a pilot study of 15 dental postdoctoral residents as an essential part of their clinical practice. Results: The dementia dental learning module increased the residents' satisfaction with didactic preparedness (4.45 ±$ \pm \ $0.97) and knowledge acquisition (4.36 ±$ \pm \ $0.84). Residents strongly believed that learning about the AFHS‐mentation topic would improve patient care. Conclusion: Our pilot study is a pioneer project in support of a new AFHS‐themed dental curriculum for clinical education. Further expansion of the age‐friendly principles to include mobility, medications, and what matters to older adults will establish a model framework of redesigned geriatric dental education for academic centers. [ABSTRACT FROM AUTHOR]

This article explores the role of AU-binding factor 1 (AUF-1) in chronic inflammatory skin conditions such as atopic dermatitis (AD) and psoriasis. The study examines the expression of AUF-1 in skin biopsies of AD and psoriasis patients and investigates the modulation of AUF-1 in vitro using human keratinocyte cell cultures. The results show a different pattern of AUF-1 expression in AD compared to psoriasis, suggesting a potential role of AUF-1 in chronic immune-driven skin inflammation. The findings highlight the importance of understanding endogenous mechanisms involved in resolving AD and identifying new therapeutic targets. [Extracted from the article]

Objective: A high triglyceride (TG) to high‐density lipoprotein cholesterol (HDL) ratio (TG/HDL) predicts atherosclerosis and cardiovascular events. This study examined whether a proatherogenic distribution of plasma lipoprotein subclasses is associated with a high TG/HDL ratio in youths with obesity. Methods: Lipoprotein particle concentration and size were measured by proton nuclear magnetic resonance in a multiethnic cohort of 592 adolescents with overweight/obesity (age 13 ± 3 years, 58% females, BMI z score 2.1 ± 0.8) who were phenotyped with a 3‐hour oral glucose tolerance test and abdominal magnetic resonance imaging. Results: The highest TG/HDL quartile showed a higher particle concentration of very low‐density lipoprotein (VLDL; +178%, p < 0.0001), intermediate‐density lipoprotein (+338%, p < 0.0001), and low‐density lipoprotein (LDL; +42%, p < 0.0001), compared with the lowest quartile. The prevalence of large VLDL, very small LDL, and small HDL progressively increased across TG/HDL quartiles. The TG/HDL ratio correlated positively with the average particle size of VLDL (r = 0.37, p < 0.0001) and negatively with particle size of both LDL (r = −0.51, p < 0.0001) and HDL (r = −0.69, p < 0.0001). These associations were independent of sex, age, race/ethnicity, body mass, fasting plasma glucose, and insulin sensitivity. Conclusions: In youths with obesity, an elevated TG/HDL ratio is associated with high concentrations of proatherogenic lipoprotein subclasses. This phenotype may explain the increased cardiovascular risk associated with a high TG/HDL ratio. [ABSTRACT FROM AUTHOR]

Objective: Nonalcoholic fatty liver disease (NAFLD), the most common liver disease among youth with obesity, precedes more severe metabolic and liver diseases. However, the impact of the Sars‐CoV‐2 global pandemic on the prevalence and severity of NAFLD and the associated metabolic phenotype among youth with obesity is unknown. Methods: Participants were recruited from the Yale Pediatric Obesity Clinic during the Sars‐CoV‐2 global pandemic (August 2020 to May 2022) and were compared with a frequency‐matched control group of youth with obesity studied before the Sars‐CoV‐2 global pandemic (January 2017 to November 2019). Glucose metabolism differences were assessed during an extended 180‐minute oral glucose tolerance test. Magnetic resonance imaging‐derived proton density fat fraction (PDFF) was used to determine intrahepatic fat content in those with NAFLD (PDFF ≥ 5.5). Results: NAFLD prevalence increased in participants prior to (36.2%) versus during the Sars‐CoV‐2 pandemic (60.9%), with higher PDFF values observed in participants with NAFLD (PDFF ≥ 5.5%) during versus before the pandemic. An increase in visceral adipose tissue and a hyperresponsiveness in insulin secretion during the oral glucose tolerance test were also observed. Conclusions: Hepatic health differences were likely exacerbated by environmental and behavioral changes associated with the pandemic, which are critically important for clinicians to consider when engaging in patient care to help minimize the future risk for metabolic perturbations. [ABSTRACT FROM AUTHOR]

To characterize viral hepatitis co‐infections in a cohort of immigrants living in southern Italy. In a prospective multicenter study, all undocumented immigrants and low‐income refugees consecutively evaluated for a clinical consultation at one of the five first‐level clinical centers in southern Italy from January 2012 to February 2020 were enrolled. All subjects included in the study were screened for hepatitis B surface antigen (HBsAg), anti‐hepatitis C virus (HCV) and anti‐HIV; the HBsAg‐positive were screened also for anti‐delta. Of the 2923 subjects enrolled, 257 (8%) were HBsAg‐positive alone (Control group B), 85 (2.9%) only anti‐HCV‐positive (Control group C), 16 (0.5%) HBsAg/anti‐HCV‐positive (Case group BC), and 8 (0.2%) HBsAg/anti‐HDV‐positive (Case group BD). Moreover, 57 (1.9%) subjects were anti‐HIV‐positive. HBV‐DNA positivity was found less frequently in the 16 subjects in Case group BC (43%) and in the 8 in Case group BD (12.5%) than in the 257 in Control group B (76%; p = 0.03 and 0.0000, respectively). Similarly, HCV‐RNA positivity was more frequent in Case group BC than in Control group C (75% vs. 44.7% p = 0.02). The subjects in Group BC had a lower prevalence of asymptomatic liver disease (12.5%) than Control group B (62.2%, p = 0.0001) and Control group C (62.3%, p = 0.0002). Conversely, liver cirrhosis was more frequently identified in Case group BC (25%) than in Control groups B and C (3.11% and 2.35%, p = 0.0000 and 0.0004, respectively). The present study contributes to the characterization of hepatitis virus co‐infections in the immigrant population. [ABSTRACT FROM AUTHOR]

Although these diets may be viewed as an easy shortcut to lose weight rapidly and easily, subjects often use these diets without any medical counselling or nutritional rehabilitation for the long-term management of weight maintenance, which should represent the most important and ambitious goal of VLCKD nutritional therapy. Keywords: carbohydrate restriction; cardiometabolic risk; metabolic rehabilitation; precision nutrition; weight cycling; weight loss EN carbohydrate restriction cardiometabolic risk metabolic rehabilitation precision nutrition weight cycling weight loss 1 3 3 11/06/23 20231101 NES 231101 Very low-calorie ketogenic diets (VLCKDs) are nowadays considered a notable example of a dietary-based treatment with proven efficacy against a variety of conditions. Diets for weight management in adults with type 2 diabetes: an umbrella review of published meta-analyses and systematic review of trials of diets for diabetes remission. [Extracted from the article]

Objective: To assess how age‐friendly deprescribing trials are regarding intervention design and outcome assessment. Reduced use of potentially inappropriate medications (PIMs) can be addressed by deprescribing—a systematic process of discontinuing and/or reducing the use of PIMs. The 4Ms—"Medication", "Mentation", "Mobility", and "What Matters Most" to the person—can be used to guide assessment of age‐friendliness of deprescribing trials. Data Source: Published literature. Study Design: Scoping review. Data Extraction Methods: The literature was identified using keywords related to deprescribing and polypharmacy in PubMed, EMBASE, Web of Science, ProQuest, CINAHL, and Cochrane and snowballing. Study characteristics were extracted and evaluated for consideration of 4Ms. Principal Findings: Thirty‐seven of the 564 trials identified met the review eligibility criteria. Intervention design: "Medication" was considered in the intervention design of all trials; "Mentation" was considered in eight trials; "Mobility" (n = 2) and "What Matters Most" (n = 6) were less often considered in the design of intervention. Most trials targeted providers without specifying how matters important to older adults and their families were aligned with deprescribing decisions. Outcome assessment: "Medication" was the most commonly assessed outcome (n = 33), followed by "Mobility" (n = 13) and "Mentation" (n = 10) outcomes, with no study examining "What Matters Most" outcomes. Conclusions: "Mentation" and "Mobility", and "What Matters Most" have been considered to varying degrees in deprescribing trials, limiting the potential of deprescribing evidence to contribute to improved clinical practice in building an age‐friendly health care system. [ABSTRACT FROM AUTHOR]

Data regarding early predictors of clinical deterioration in patients with infection of severe acute respiratory syndrome coronavirus‐2 (SARS‐CoV‐2) is still scarce. The aim of the study is to identify early symptoms or signs that may be associated with severe coronavirus disease 2019 (COVID‐19). We conducted a multicentre prospective cohort study on a cohort of patients with COVID‐19 in home isolation from March 2020 to April 2021. We assessed longitudinal clinical data (fever, dyspnea, need for hospitalization) through video calls at three specific time points: the beginning of symptoms or the day of the first positivity of the nasopharyngeal swab for SARS‐CoV‐2‐RNA (t0), and 3 (t3) and 7 (t7) days after the onset of symptoms. We included 329 patients with COVID‐19: 182 (55.3%) males, mean age 53.4 ± 17.4 years, median Charlson comorbidity index (CCI) of 1 (0–3). Of the 329 patients enrolled, 171 (51.98%) had a mild, 81 (24.6%) a moderate, and 77 (23.4%) a severe illness; 151 (45.9%) were hospitalized. Compared to patients with mild COVID‐19, moderate and severe patients were older (p < 0.001) and had more comorbidities, especially hypertension (p < 0.001) and cardiovascular diseases (p = 0.01). At t3 and t7, we found a significant higher rate of persisting fever (≥37°C) among patients with moderate (91.4% and 58.0% at t3 and t7, respectively; p < 0.001) and severe outcome (75.3% and 63.6%, respectively; p < 0.001) compared to mild COVID‐19 outcome (27.5% and 11.7%, respectively; p < 0.001). Factors independently associated with a more severe outcome were persisting fever at t3 and t7, increasing age, and CCI above 2 points. Persisting fever at t3 and t7 seems to be related to a more severe COVID‐19. This data may be useful to assess hospitalization criteria and optimize the use of resources in the outpatient setting. [ABSTRACT FROM AUTHOR]

We present a stochastic three‐dimensional cellular automata model of aqueous corrosion. We consider the cathodic reaction with dissolved oxygen and different concentrations of the oxidizer. We study the role and the stability of the passive layer and its effect on the kinetics, surface morphology, and roughness of the metallic surface. The model considers balanced spatially separated anodic and cathodic reactions and is capable of illustrating the cathodic control of the corrosion rate. Besides the electrochemical reactions, we take into account ionic diffusion, and acidic/basic neutralization. Results are compared to the aqueous corrosion of Fe in a near‐neutral solution. [ABSTRACT FROM AUTHOR]

Background: Pain assessment and management of Veterans with Alzheimer's disease and Related Dementia (ADRD) living in Community Living Centers (CLCs) is challenging. Safe and effective use of opioids in the treatment of pain is of great concern to patients and providers promulgating national policies and guidelines. Methods: This study examined long‐stay CLC Veterans with ADRD identified in three regulatory periods (period 1: 10/2012–6/2013, n = 3347; period 2: 1/2014–11/2015, n = 4426; period 3: 1/2017–9/2018, n = 4444; Total N = 12,217).This population‐based observational study used CLC Minimum Data Set (MDS) data in Fiscal Years (FYs) 2013–2018 and VA bar‐code medication administration (BCMA) data. Opioid administration measures included: any opioids, long‐term opioids, high‐dose opioids, and co‐administration with benzodiazepine. Measures were modeled using negative binomial regression with length of stay in CLC as offset adjusting for Veteran predisposing, enabling and need measures from the MDS. Results: Compared to period 1, any opioid administration was 26% lower in period 2, and 34% lower in period 3. Among Veterans who received any opioid medications over the three regulatory periods, high‐dose and long‐term opioid administration were more than 40% lower in periods 2 and 3 compared to period 1. Co‐administration of opioid with benzodiazepine versus no opioid was 11% lower in period 2 and 34% lower in period 3 after adjusting for patient level covariates. Conclusions: All patterns of opioid administration decreased over the four opioid regulations periods when guidelines were promulgated across the VA health system. Further research should clarify whether decreasing opioids among patients with ADRD impacted health outcomes. [ABSTRACT FROM AUTHOR]

Objective: The extent to which weight loss contributes to increases in insulin sensitivity (IS) and β-cell function after surgical or medical intervention has not been directly compared in individuals with impaired glucose tolerance or newly diagnosed type 2 diabetes.Methods: The Restoring Insulin Secretion (RISE) Study included adults in the Beta-Cell Restoration Through Fat Mitigation Study (n = 88 randomized to laparoscopic gastric banding or metformin [MET]) and the Adult Medication Study (n = 267 randomized to placebo, MET, insulin glargine/MET, or liraglutide + MET [L + M]). IS and β-cell responses were measured at baseline and after 12 months by modeling of oral glucose tolerance tests and during arginine-stimulated hyperglycemic clamps. Linear regression models assessed differences between and within treatments over time.Results: BMI decreased in all treatment groups, except placebo, at 12 months. IS increased in all arms except placebo and was inversely correlated with changes in BMI. L + M was the only treatment arm that enhanced multiple measures of β-cell function independent of weight loss. Insulin secretion decreased in the laparoscopic gastric banding arm proportional to increases in IS, with no net benefit on β-cell function.Conclusions: Reducing demand on the β-cell by improving IS through weight loss does not reverse β-cell dysfunction. L + M was the only treatment that enhanced β-cell function. [ABSTRACT FROM AUTHOR]

Aim: To examine the determinants and metabolic impact of the reduction in fasting and postload insulin levels after a low n‐6 to n‐3 polyunsaturated fatty acid (PUFA) ratio diet in obese youth. Materials and Methods: Insulin secretion and clearance were assessed by measuring and modelling plasma insulin and C‐peptide in 17 obese youth who underwent a nine‐point, 180‐minute oral glucose tolerance test (OGTT) before and after a 12‐week, eucaloric low n‐6:n‐3 polyunsaturated fatty acid (PUFA) ratio diet. Hepatic fat content was assessed by repeated abdominal magnetic resonance imaging. Results: Insulin clearance at fasting and during the OGTT was significantly increased after the diet, while body weight, glucose levels, absolute and glucose‐dependent insulin secretion, and model‐derived variables of β‐cell function were not affected. Dietary‐induced changes in insulin clearance positively correlated with changes in whole‐body insulin sensitivity and β‐cell glucose sensitivity, but not with changes in hepatic fat. Subjects with greater increases in insulin clearance showed a worse metabolic profile at enrolment, characterized by impaired insulin clearance, β‐cell glucose sensitivity, and glucose tolerance, and benefitted the most from the diet, achieving greater improvements in glucose‐stimulated hyperinsulinaemia, insulin resistance, and β‐cell function. Conclusions: We showed that a 12‐week low n‐6:n‐3 PUFA ratio diet improves hyperinsulinaemia by increasing fasting and postload insulin clearance in obese youth, independently of weight loss, glucose concentrations, and insulin secretion. [ABSTRACT FROM AUTHOR]

Background: Preterm infants are at risk for metabolic bone disease (MBD). Analysis of donor breast milk (DBM) shows lower levels of macronutrients compared with mother's own milk (MOM). The purpose of this study was to investigate the prevalence of MBD, rate of postnatal growth, and long‐term neurodevelopmental outcomes in infants fed predominantly MOM vs DBM. Methods: Retrospective observational study of infants born <1500g and <32 weeks at New York University Langone Health or Bellevue Hospital from January 2014 to January 2018. Infants were divided into two groups: those who received >70% of feeds with either MOM or DBM by 34 weeks' corrected age (CA). MBD was assessed using alkaline phosphatase (AlkPO4) levels and radiographic findings. Data was also collected on growth, feeding tolerance, and long‐term neurodevelopmental outcomes. Results: A total of 210 infants were included (MOM =156 and DBM =54). The DBM group had higher AlkPO4 levels for the first 3 weeks of life (P <.01). Growth was similar between the groups, and both groups demonstrated catch‐up growth after discharge. No difference was seen in feeding intolerance, incidence of necrotizing enterocolitis, or sepsis. The DBM group had lower cognitive (odds ratio [OR], 0.93 [0.88–0.98]; P <.01) and language (OR, 0.95 [0.90–0.99]; P <.01) scores at 18 months' CA. Conclusion: Infants fed predominantly DBM had elevated AlkPO4 levels suggestive of MBD but did not develop osteopenia. Despite appropriate growth and comparable short‐term outcomes, infants fed DBM had lower cognitive and language scores at 18 months' CA. [ABSTRACT FROM AUTHOR]

Background/objectives: Despite a high prevalence and association with poor outcomes, screening to identify cognitive impairment (CI) in the emergency department (ED) is uncommon. Identification of high‐risk subsets of older adults is a critical challenge to expanding screening programs. We developed and evaluated an automated screening tool to identify a subset of patients at high risk for CI. Methods: In this secondary analysis of existing data collected for a randomized control trial, we developed machine‐learning models to identify patients at higher risk of CI using only variables available in electronic health record (EHR). We used records from 1736 community‐dwelling adults age > 59 being discharged from three EDs. Potential CI was determined based on the Blessed Orientation Memory Concentration (BOMC) test, administered in the ED. A nested cross‐validation framework was used to evaluate machine‐learning algorithms, comparing area under the receiver‐operator curve (AUC) as the primary metric of performance. Results: Based on BOMC scores, 121 of 1736 (7%) participants screened positive for potential CI at the time of their ED visit. The best performing algorithm, an XGBoost model, predicted BOMC positivity with an AUC of 0.72. With a classification threshold of 0.4, this model had a sensitivity of 0.73, a specificity of 0.64, a negative predictive value of 0.97, and a positive predictive value of 0.13. In a hypothetical ED with 200 older adult visits per week, the use of this model would lead to a decrease in the in‐person screening burden from 200 to 77 individuals in order to detect 10 of 14 patients who would fail a BOMC. Conclusion: This study demonstrates that an algorithm based on EHR data can define a subset of patients at higher risk for CI. Incorporating such an algorithm into a screening workflow could allow screening efforts and resources to be focused where they have the most impact. See related editorial by Hirshon in this issue. [ABSTRACT FROM AUTHOR]

During the winter, there is a high occurrence of downy mildew on lettuce caused by Bremia lactucae. This oomycete shows variability in virulence, so understanding the genetic structure of the pathogen population becomes essential for obtaining resistant cultivars. Thus, the objective of this study was to determine sexual compatibility in Brazilian populations of B. lactucae and investigate the occurrence of sexual reproduction of the pathogen on lettuce (Lactuca sativa) and prickly lettuce (Lactuca serriola). Leaf samples were collected in 33 municipalities in seven Brazilian states. The virulence structure of the populations was monitored using the EU‐C sextet code. B. lactucae populations from the states of São Paulo, Paraná, Rio de Janeiro, and Rio Grande do Sul shared six of the 15 virulence factors evaluated. Twenty‐five virulence phenotypes (v‐phenotypes) were found, with the sextet codes 31‐00‐02, 31‐16‐02, 31‐24‐02, and 31‐01‐02 being more frequent. The predominance of some v‐ phenotypes indicates that clonal reproduction is still the main form of B. lactucae propagation. The genes and resistance factors of the cultivars Argelès (Dm38), Balesta, and Bartoli are recommended as suitable sources of lettuce resistance in Brazil. Natural occurrence of oospores was detected in most sampled locations, in lettuce and prickly lettuce plants. Virulence variability of Brazilian isolates is the result of the pathogen's ability to reproduce both sexually and asexually, with a prevalence of homothallic isolates; although the majority were of the predominant B2 mating type, there was a high incidence of predominant B1 in addition to B1 = B2. [ABSTRACT FROM AUTHOR]

Introduction: About half of older adults with impaired cognition who are discharged home from the emergency department (ED) return for further care within 30 days. We tested the effect of an adapted Care Transitions Intervention (CTI) at reducing ED revisits in this vulnerable population. Methods:We conducted a pre-planned subgroup analysis of community-dwelling, cognitively impaired older (age =60 years) participants from a randomized controlled trial testing the effectiveness of the CTI adapted for ED-to-home transitions. The parent study recruited ED patients from three university-affiliated hospitals from 2016 to 2019. Subjects eligible for this sub-analysis had to: (1) have a primary care provider within these health systems; (2) be discharged to a community residence; (3) not receive care management or hospice services; and (4) be cognitively impaired in the ED, as determined by a score >10 on the Blessed Orientation Memory Concentration Test. The primary outcome, ED revisits within 30 days of discharge, was abstracted from medical records and evaluated using logistic regression. Results: Of our sub-sample (N = 81, 36 control, 45 treatment), 57% were female and the mean age was 78 years. Multivariate analysis, adjusted for the presence of moderate to severe depression and inadequate health literacy, found that the CTI significantly reduced the odds of a repeat ED visit within 30 days (odds ratio [OR] 0.25, 95% confidence interval [CI] 0.07 to 0.90) but not 14 days (OR 1.01, 95% CI 0.26 to 3.93). Multivariate analysis of outpatient follow-up found no significant effects. Discussion: Community-dwelling older adults with cognitive impairment receiving the CTI following ED discharge experienced fewer ED revisits within 30 days compared to usual care. Further studies must confirm and expand upon this finding, identifying features with greatest benefit to patients and caregivers. [ABSTRACT FROM AUTHOR]

Background: Improving care transitions following emergency department (ED) visits may reduce post‐ED adverse events among older adults (e.g., ED revisits, decreased function). The Care Transitions Intervention (CTI) improves hospital‐to‐home transitions; however, its effectiveness at improving post‐ED outcomes is unknown. We tested the effectiveness of the CTI with community‐dwelling older adult ED patients, hypothesizing that it would reduce revisits and increase performance of self‐management behaviors during the 30 days following discharge. Methods: We conducted a randomized controlled trial among patients age ≥ 60 discharged home from one of three EDs in two states. Intervention participants received a minimally modified CTI, with a home visit 24 to 72 h postdischarge and one to three phone calls over 28 days. We collected demographic, health status, and psychosocial data at the initial ED visit. Medication adherence and knowledge of red flag symptoms were assessed via phone survey. Care use and comorbidities were abstracted from medical records. We performed multivariate regressions for intention‐to‐treat and per‐protocol (PP) analyses. Results: Participant characteristics (N = 1,756) were similar across groups: mean age 72.4 ± 8.6 years and 53% female. Of those randomized to the intervention, 84% completed the home visit. Overall, 12.4% of participants returned to the ED within 30 days. The CTI did not significantly affect odds of 30‐day ED revisits (adjusted odds ratio [AOR] = 0.97, 95% confidence interval [CI] = 0.72 to 1.30) or medication adherence (AOR = 0.89, 95% CI = 0.60 to 1.32). Participants receiving the CTI (PP) had increased odds of in‐person follow‐up with outpatient clinicians during the week following discharge (AOR = 1.24, 95% CI = 1.01 to 1.51) and recalling at least one red flag from ED discharge instructions (AOR = 1.34 95% CI = 1.05 to 1.71). Conclusions: The CTI did not reduce 30‐day ED revisits but did significantly increase key care transition behaviors (outpatient follow‐up, red flag knowledge). Additional research is needed to explore if patients with different conditions benefit more from the CTI and whether decreasing ED revisits is the most appropriate outcome for all older adults. [ABSTRACT FROM AUTHOR]

BACKGROUND: Microalgae can synthesize starch with productivity higher than conventional terrestrial crops, without the need for arable land. However, little is known about processes to extract starch from microalgae. Here, a biorefinery process is described including microalgal cell disruption followed by extraction of starch and pigments with aqueous two‐phase system (ATPS) using choline chloride and polypropylene glycol 400. Sonication and bead milling were compared for cell disruption rate and starch extraction efficiency. RESULTS: A first order kinetic model described well the cell disruption for both the methods, with a rate 2.6 times higher for bead milling than sonication. By applying ATPS on samples with comparable cell disruption (>93%), starch was separated better after sonication (67% recovery in the pellet) than after bead milling, for which it remained equally distributed between pellet (40%) and choline chloride phase. Pigments were extracted with 42–66% yield irrespective of the cell disruption method. Microalgal starch granules had a normal and narrow distribution for size (0.93 ± 0.14 μm) and a gelatinization temperature between 45–55 °C. CONCLUSION: For the same cell disruption yield, different starch separation efficiencies can be achieved, depending on the cell disruption method applied. Although bead milling was faster than sonication in disrupting cells, it gave worst starch separation efficiency. The properties of the extracted microalgal starch indicate potential technical advantages, with respect to conventional starch sources, for applications in the bioplastic and food sector. © 2021 The Authors. Journal of Chemical Technology and Biotechnology published by John Wiley & Sons Ltd on behalf of Society of Chemical Industry (SCI). [ABSTRACT FROM AUTHOR]

Background Pain management is important to post‐acute functional recovery, yet older persons with Alzheimer's disease and related dementias (ADRD) are often undertreated for pain. The main objectives were (1) to examine the relationship between ADRD and analgesic use among Medicare home health care (HHC) recipients with daily interfering pain, and (2) to examine the impact of analgesic use on functional outcome in patients with and without ADRD. Methods: We analyzed longitudinal data from the Outcome and Assessment Information Set, Medicare HHC claims, and HHC electronic medical records during a 60‐day HHC episode. The sample included 6048 Medicare beneficiaries ≥65 years receiving care from an HHC agency in New York in 2019 who reported daily interfering pain. Analgesic use was assessed during HHC medication reconciliation and included any analgesic, non‐opioid analgesic, and opioid. ADRD was identified from ICD‐10 codes (HHC claims) and cognitive impairment symptoms (Outcome and Assessment Information Set [OASIS]). Functional outcome was measured as change in the composite Activity of Daily Living (ADL) limitation score in the HHC episode. Results: ADRD was related to a lower likelihood of using any analgesic (odds ratio [OR] = 0.66, 95% confidence interval [CI]: 0.49, 0.90, p = 0.008) and opioids (OR = 0.54, 95% CI: 0.47, 0.62, p < 0.001), but not related to non‐opioid analgesic use (OR = 0.94, 95% CI: 0.74, 1.18, p = 0.58). Stratified analyses showed that any analgesic use (β = −0.43, 95% CI: −0.73, −0.13, p = 0.004) and non‐opioid analgesic use (β = −0.31, 95% CI: −0.56, −0.06, p = 0.016) were associated with greater ADL improvement in patients with ADRD, but not in patients without ADRD. Opioid use was not significantly related to ADL improvement regardless of ADRD status. Conclusions: HHC patients with ADRD may be undertreated for pain, yet pain treatment is essential for functional improvement in HHC. HHC clinicians and policymakers should ensure adequate pain management for older persons with ADRD for improved functional outcomes. [ABSTRACT FROM AUTHOR]

Objective: This study investigated whether variations in cell death-inducing DNA fragmentation factor alpha subunit-like effector A (CIDEA) mRNA expression and protein levels are modulated by the pattern of abdominal fat distribution in adolescent girls with obesity. Methods: This study recruited 35 adolescent girls with obesity and characterized their abdominal fat distribution by magnetic resonance imaging. Participants had only a periumbilical/abdominal (n = 14) or a paired abdominal and gluteal subcutaneous adipose tissue (SAT) biopsy (n = 21). CIDEA expression was determined by reverse transcription-polymerase chain reaction, CIDEA protein level by Western blot, and the turnover of adipose lipids and adipocytes by 2H2O labeling. In six girls, a second abdominal SAT biopsy was performed (after ~34.2 months) to explore the weight gain effect on CIDEA expression in abdominal SAT. Results: CIDEA expression decreased in abdominal SAT from participants with high visceral adipose tissue (VAT)/(VAT+SAT); CIDEA inversely correlated with number of small adipocytes, with the increase in preadipocyte proliferation, and with adipogenesis. A strong inverse correlation was found between CIDEA protein level with the newly synthetized glycerol (r = -0.839, p = 0.0047). Following weight gain, an increase in adipocytes' cell diameter with a decrease in CIDEA expression and RNA-sequencing transcriptomic profile typical of adipocyte dysfunction was observed. Conclusions: Reduced expression of CIDEA in girls with high V AT/(VAT+SAT) is associated with adipocyte hypertrophy and insulin resistance. [ABSTRACT FROM AUTHOR]

The impact of shifting disturbance regimes on soil carbon (C) storage is a key uncertainty in global change research. Wildfires in coniferous forests are becoming more frequent in many regions, potentially causing large C emissions. Repeated low‐intensity prescribed fires can mitigate wildfire severity, but repeated combustion may decrease soil C unless compensatory responses stabilize soil organic matter. Here, we tested how 30 years of decadal prescribed burning affected C and nitrogen (N) in plants, detritus, and soils in coniferous forests in the Sierra Nevada mountains, USA. Tree basal area and litter stocks were resilient to fire, but fire reduced forest floor C by 77% (−36.4 Mg C/ha). In mineral soils, fire reduced C that was free from minerals by 41% (−4.4 Mg C/ha) but not C associated with minerals, and only in depths ≤ 5 cm. Fire also transformed the properties of remaining mineral soil organic matter by increasing the proportion of C in a pyrogenic form (from 3.2% to 7.5%) and associated with minerals (from 46% to 58%), suggesting the remaining soil C is more resistant to decomposition. Laboratory assays illustrated that fire reduced microbial CO2 respiration rates by 55% and the activity of eight extracellular enzymes that degrade cellulosic and aromatic compounds by 40–66%. Lower decomposition was correlated with lower inorganic N (−49%), especially ammonium, suggesting N availability is coupled with decomposition. The relative increase in forms of soil organic matter that are resistant to decay or stabilized onto mineral surfaces, and the associated decline in decomposition suggest that low‐intensity fires may promote mineral soil C storage in pools with long mean residence times in coniferous forests. [ABSTRACT FROM AUTHOR]

Transgenic crops expressing Bacillus thuringiensis Berliner (Bt) have been cultivated throughout the world as a great technological tool for developing integrated pest management. We hypothesized that artificial landscapes containing Bt and non‐Bt cotton plants (Gossypium hirsutum L., Malvaceae) at small scales could influence dispersal by ballooning of Spodoptera frugiperda (JE Smith) (Lepidoptera: Noctuidae). We also simulated how ballooning dispersal combined with walking movement could impact resistance evolution in various scenarios of plant mixtures involving non‐Bt and Bt cotton plants with high‐dose and low‐dose events. The ballooning frequency of Cry1F‐resistant larvae in a treatment with non‐Bt cotton as a natal plant and Bt cotton in adjacent sites was two‐fold lower compared to when Bt cotton was the natal plant and non‐Bt cotton was in the adjacent sites. Our model results suggested that the higher rate of walking movement associated with ballooning promoted faster resistance evolution in low‐dose events, and contamination of Bt cotton fields with non‐Bt cotton plants in a high‐dose event showed the longest time to resistance. Therefore, a high rate of walking movement associated with ballooning negatively impacted the time for resistance to evolve in low‐dose events. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to examine the relationship between changes in liver fat and changes in insulin sensitivity and β-cell function 2 years after gastric banding surgery.Methods: Data included 23 adults with the surgery who had prediabetes or type 2 diabetes for less than 1 year and BMI 30 to 40 kg/m2 at baseline. Body adiposity measures including liver fat content (LFC), insulin sensitivity (M/I), and β-cell responses (acute, steady-state, and arginine-stimulated maximum C-peptide) were assessed at baseline and 2 years after surgery. Regression models were used to assess associations adjusted for age and sex.Results: Two years after surgery, all measures of body adiposity, LFC, fasting and 2-hour glucose, and hemoglobin A1c significantly decreased; M/I significantly increased; and β-cell responses adjusted for M/I did not change significantly. Among adiposity measures, reduction in LFC had the strongest association with M/I increase (r = -0.61, P = 0.003). Among β-cell measures, change in LFC was associated with change in acute C-peptide response to arginine at maximal glycemic potentiation adjusted for M/I (r = 0.66, P = 0.007). Significant reductions in glycemic measures and increase in M/I were observed in individuals with LFC loss >2.5%.Conclusions: Reduction in LFC after gastric banding surgery appears to be an important factor associated with long-term improvements in insulin sensitivity and glycemic profiles in adults with obesity and prediabetes or early type 2 diabetes. [ABSTRACT FROM AUTHOR]

BACKGROUND/OBJECTIVES: Care‐partner support affects outcomes among assisted living (AL) residents. Yet, little is known about care‐partner support and its effects on hospitalization during post‐acute care transitions. This study examined the variation in care‐partner support and its impact on hospitalizations among AL residents receiving Medicare home health (HH) services. DESIGN: Analysis of national data from the Outcome and Assessment Information Set, Medicare claims, Area Health Resources File, and the Social Deprivation Index File. SETTING: AL facilities and Medicare HH agencies in the United States. PARTICIPANTS: 741,926 Medicare HH admissions of AL residents in 2017. MEASUREMENTS: Care‐partner support during the HH admission was measured based on the type and frequency of assistance from AL staff in seven domains (i.e., activities of daily living (ADL), instrumental ADLs, medication administration, treatment, medical equipment, home safety, and transportation). Care‐partner support in each domain was measured as "assistance not needed" (reference group), "Care‐partner currently provides assistance," "care‐partner need additional training/support to provide assistance" (i.e., inadequate care‐partner support), and "care‐partner unavailable/unlikely to provide assistance" (i.e., unavailable care‐partner support). Outcome was time‐to‐hospitalization during the HH admission. RESULTS: Among the 741,926 Medicare HH admissions of AL residents, inadequate care‐partner support was identified for all seven domains that ranged from 13.1% (for transportation) to 49.8% (for treatment), and care‐partner support was unavailable from 0.9% (for transportation) to 11.0% (for treatment). In Cox proportional hazard models adjusted for patient covariates and geography, compared with "assistance not needed", having inadequate and unavailable care‐partner support was related to increased risk of hospitalization by 8.9% (treatment (hazard ratio (HR) =1.089, P <.001)) to 41.3% (medication administration (HR =1.413, P <.001)). CONCLUSION: For AL residents receiving HH services, having less care‐partner support was related to increased risk of hospitalization, particularly regarding medication administration, medical equipment, and transportation/advocacy. [ABSTRACT FROM AUTHOR]

BACKGROUND/OBJECTIVES: Home health (HH) is a major type of home‐based skilled care available to Medicare beneficiaries. We examined the association between living situation (home alone, home with others, and assisted living (AL) residence) and utilization and functional outcomes among Medicare HH recipients. DESIGN: Analysis of national data from the Outcome and Assessment Information Set, HH Compare, Medicare claims, and Area Health Resource Files. SETTING: Medicare‐certified HH agencies in the United States. PARTICIPANTS: National population of Medicare beneficiaries ≥65 years old who received HH care in CY 2017 (N = 6,637,496). MEASUREMENTS: Outcomes included time‐to‐event measures of hospitalization and emergency department (ED) visits, and improvement in activities of daily living (ADL) from the start to the end of the HH admission. RESULTS: AL residents (12%) and patients living alone at home (24%) had longer survival time without hospitalization and ED visits than patients living with others at home (64%). Adjusting for covariates and HH agency‐level random effects, and compared with patients living with others, AL residents had lower risk of hospitalization (hazard ratio (HR) = 0.85, P <.001) and ED visit (HR = 0.92, P <.001); however, less ADL improvement (β = 0.29 (29% less of total independence in one ADL)); and patients living alone had lower risk of hospitalization (HR = 0.94, P <.001) and ED visit (HR = 0.93, P <.001), yet more ADL improvement (β = −0.15 (15% more of total independence in one ADL)). CONCLUSION: In the national population of Medicare HH recipients, patients living with others at home had the highest risk of hospitalization and ED visits, whereas AL residents had the lowest risk of hospitalization and patients living alone at home had the lowest risk of ED visits, meaning that combined support from HH and AL reduces acute care admissions. Evidence‐based interventions are needed for HH patients living with others at home to avoid unnecessary acute care use. [ABSTRACT FROM AUTHOR]

Summary: We present a greedy algorithm for computing selected eigenpairs of a large sparse matrix H that can exploit localization features of the eigenvector. When the eigenvector to be computed is localized, meaning only a small number of its components have large magnitudes, the proposed algorithm identifies the location of these components in a greedy manner, and obtains approximations to the desired eigenpairs of H by computing eigenpairs of a submatrix extracted from the corresponding rows and columns of H. Even when the eigenvector is not completely localized, the approximate eigenvectors obtained by the greedy algorithm can be used as good starting guesses to accelerate the convergence of an iterative eigensolver applied to H. We discuss a few possibilities for selecting important rows and columns of H and techniques for constructing good initial guesses for an iterative eigensolver using the approximate eigenvectors returned from the greedy algorithm. We demonstrate the effectiveness of this approach with examples from nuclear quantum many‐body calculations, many‐body localization studies of quantum spin chains and road network analysis. [ABSTRACT FROM AUTHOR]

Reply to 'New-onset cutaneous lichen planus triggered by COVID-19 vaccination' by Merhy et al References 1 Merhy R, Sarkis AS, Kaikati J, El Khoury L, Ghosn S, Stephan F. New-onset cutaneous lichen planus triggered by COVID-19 vaccination. Lichenoid drug reaction following influenza vaccination in an HIV-positive patient: a case report and literature review. [Extracted from the article]

Objective: Older adults discharged from the emergency department (ED) are at high risk for adverse outcomes. Adherence to ED discharge instructions is necessary to reduce those risks. The objective of this study is to determine the individual‐level factors associated with adherence with ED discharge instructions among older adult ED outpatients. Methods: We performed a secondary analysis of data from the control group of a randomized controlled trial testing a care transitions intervention among older adults (age ≥ 60 years) discharged home from the ED in two states. Taking data from patient surveys and chart reviews, we used multivariable logistic regression to identify patient characteristics associated with adherence to printed discharge instructions. Outcomes were patient‐reported medication adherence, provider follow‐up visit adherence, and knowledge of "red flags" (signs of worsening health requiring further medical attention). Results: A total 824 patients were potentially eligible, and 699 had data in at least one pillar. A total of 35% adhered to medication instructions, 76% adhered to follow‐up instructions, and 35% recalled at least one red flag. In the multivariate analysis, no factors were significantly associated with failure to adhere to medications. Participants with poor health status (adjusted odds ratio [AOR] = 0.55, 95% confidence interval [CI] = 0.31 to 0.98) were less likely to adhere to follow‐up instructions. Participants who were older (AORs trended downward as age category increased) or depressed (AOR = 0.39, 95% CI = 0.17 to 0.85) or had one or more functional limitations (AOR = 0.62, 95% CI = 0.41 to 0.94) were less likely to recall red flags. Conclusion: Older adults discharged home from the ED have mixed rates of adherence to discharge instructions. Although it is thought that some subgroups may be higher risk than others, given the opportunity to improve ED‐to‐home transitions, EDs and health systems should consider providing additional care transition support to all older adults discharged home from the ED. [ABSTRACT FROM AUTHOR]

People who use drugs are a key population in global HCV control. We evaluated the efficacy of an innovative model to eliminate HCV infection in a high‐risk population of PWUD in a service for substance use disorder (SUD). Between January 2018 and December 2018, we conducted a prospective, interventional, before and after study, based on audits performed by Infectious Diseases physicians in a SUD facility in Piedimonte Matese, in southern Italy, to improve the knowledge about HCV infection; a shared protocol for screening and linkage to care of patients was implemented. The pre‐intervention period was defined as January‐December 2017 and the post‐intervention period as January‐December 2018. The subjects followed up at SUD facility in the pre‐intervention and post‐intervention periods were 318 and 275, respectively. Compared with the pre‐intervention period, the number of anti‐HCV–positive subjects tested for HCV RNA was higher in the post‐intervention period (91% vs 27%, P <.0001), as was the number who started directly acting antivirals (DAAs). Of the 18 HCV RNA–positive subjects in the pre‐intervention period, only 3 (16.6%) started DAA, a percentage decisively lower than that observed after the start of the programme, 63 (84%) of 75 subjects (P <.0001), and all obtained SVR. The data were similar for people who inject drugs (PWID) and non‐PWID sub‐populations. The use of our innovative model with close interaction between the Infectious Disease Unit and the SUD facility determined a significant increase in HCV RNA testing, linkage to care and the start of DAA in the PWUD population. [ABSTRACT FROM AUTHOR]

To address the expanding needs to acquire the necessary skill sets for managing a wide array of transcatheter interventions, a 3D visualization system that integrates into the training platform would significantly enhance the trainee's capacity to comprehend the spatial relationships of various cardiac structures and facilitate the learning process. In addition to procedural training, the same technology may potentially help formulate treatment strategies in preprocedural planning especially in complex anatomy. Herein, a hybrid simulator for structural heart disease interventions is demonstrated by using the combination of a mixed reality (MR) display and 3D printing. The system consists of a 3D printed phantom heart model, a catheter with real‐time tracking using electromagnetic sensors, and the stand‐alone MR display for rendering 3D positions of the catheter within the heart model, along with quantitative feedback. The phantom heart model is generated by 3D printing technology using a segmented geometry from a human cardiac computed tomography (CT) scan. The catheter is coupled with electromagnetic sensors that allow real‐time tracking of their 3D positions and orientations. Custom software and algorithms to coregister and display the catheter's position relative to the phantom heart model are developed to interface with commercial software provided with the tracking sensors and MR display such that updates occur seamlessly in real time. Prespecified target crossings in the fossa ovalis during a transcatheter septal puncture procedure are demonstrated in the training scene. This hybrid training system will be used for training and educating transcatheter septal puncture procedure and other structural heart interventions. [ABSTRACT FROM AUTHOR]

BACKGROUND Microalgae are a promising resource to produce carotenoids for food/feed applications. However, energy‐intensive pre‐treatments such as drying and cell destruction can hinder the sustainability of the process. Direct extraction from wet biomass may reduce energy consumption, but the residual water can reduce the effectiveness of the organic solvents used for the extraction. In this work, the extraction of lutein and β‐carotene from wet untreated microalgal biomass is investigated. The process includes a sequence of successive extraction stages with methanol. RESULTS: We show that the sequential extraction can effectively overcome the reduced extraction efficiency induced by the residual water in the biomass. The biomass was dehydrated during the first extraction stage, which increased the efficiency starting from the second stage. This allowed an extraction yield of >95% to be attained for both lutein and β‐carotene after five extraction stages. A mathematical model was developed by coupling mass balances with a linear equilibrium model, satisfactorily describing the partition of the two carotenoids between the solid and the solvent phase. By fitting the model to the data obtained by the first extraction stage, liquid–solid partition coefficients (Kd) equal to 2.0 × 10−3 and 1.1 × 10−4 were estimated for lutein and β‐carotene, respectively. The Kd of both carotenoids increased to ≈10−2 during the six subsequent extraction stages without water. CONCLUSIONS: Direct solvent extraction from wet untreated microalgal biomass is a promising strategy to produce carotenoids. The described model can provide guidelines to design industrial processes. © 2020 Society of Chemical Industry [ABSTRACT FROM AUTHOR]

Fires shape the biogeochemistry and functioning of many ecosystems, and fire frequencies are changing across much of the globe. Frequent fires can change soil carbon (C) and nitrogen (N) storage by altering the quantity and chemistry of plant inputs through changes in plant biomass and composition as well as the decomposition of soil organic matter. How decomposition rates change with shifting inputs remains uncertain because most studies focus on the effects of single fires, where transient responses may not reflect responses to decadal changes in burning frequencies. Here, we sampled seven sites exposed to different fire frequencies. In four of the sites, we intensively sampled both soils and plant communities across four ecosystems in North America and Africa spanning tropical savanna, temperate coniferous savanna, temperate broadleaf savanna, and temperate coniferous forest ecosystems. Each site contained multiple plots burned frequently for 33–61 years and nearby plots that had remained unburned over the same period replicated at the landscape scale. Across all sites, repeatedly burned plots had 25–185% lower bulk soil C and N concentrations but also 2–10‐fold lower potential decomposition of organic matter compared to unburned sites. Soil C and N concentrations and extracellular enzyme activities declined with frequent fire because fire reduced both plant biomass inputs into soils and dampened the localized enrichment effect of tree canopies. Examination of soil extracellular enzyme activities revealed that fire decreased the potential turnover of organic matter in the forms of cellulose, starch, and chitin (P < 0.0001) but not polyphenol and lignin (P = 0.09), suggesting a shift in soil C and N cycling. Inclusion of δ13C data from three additional savanna sites (19–60 years of altered fire frequencies) showed that soil C losses were largest in sites where estimated tree inputs into soils declined the most (r2 = 0.91, P < 0.01). In conclusion, repeated burning reduced C and N storage, consistent with previous studies, but fire also reduced potential decomposition, likely contributing to slower C and N cycling. Trees were important in shaping soil C and N responses across sites, but the magnitude of tree effects differed and depended on how tree biomass inputs into soil responded to fire. [ABSTRACT FROM AUTHOR]

Classical organic acidemias (OAs) result from defective mitochondrial catabolism of branched‐chain amino acids (BCAAs). Abnormal mitochondrial function relates to oxidative stress, ectopic lipids and insulin resistance (IR). We investigated whether genetically impaired function of mitochondrial BCAA catabolism associates with cardiometabolic risk factors, altered liver and muscle energy metabolism, and IR. In this case‐control study, 31 children and young adults with propionic acidemia (PA), methylmalonic acidemia (MMA) or isovaleric acidemia (IVA) were compared with 30 healthy young humans using comprehensive metabolic phenotyping including in vivo 31P/1H magnetic resonance spectroscopy of liver and skeletal muscle. Among all OAs, patients with PA exhibited abdominal adiposity, IR, fasting hyperglycaemia and hypertriglyceridemia as well as increased liver fat accumulation, despite dietary energy intake within recommendations for age and sex. In contrast, patients with MMA more frequently featured higher energy intake than recommended and had a different phenotype including hepatomegaly and mildly lower skeletal muscle ATP content. In skeletal muscle of patients with PA, slightly lower inorganic phosphate levels were found. However, hepatic ATP and inorganic phosphate concentrations were not different between all OA patients and controls. In patients with IVA, no abnormalities were detected. Impaired BCAA catabolism in PA, but not in MMA or IVA, was associated with a previously unrecognised, metabolic syndrome‐like phenotype with abdominal adiposity potentially resulting from ectopic lipid storage. These findings suggest the need for early cardiometabolic risk factor screening in PA. [ABSTRACT FROM AUTHOR]

Aim: To evaluate whether intrahepatic fat accumulation contributes to impaired insulin clearance and hepatic insulin resistance across different ethnic groups. Methods: The intrahepatic fat content (HFF%) was quantified by magnetic resonance imaging in a multi‐ethnic cohort of 632 obese youths aged 7‐18 years at baseline and after a 2‐year follow‐up. Insulin secretion rate (ISR), endogenous insulin clearance (EIC) and hepatic insulin resistance index (HIRI) were estimated by modelling glucose, insulin and C‐peptide data during 3‐hour, 9‐point oral glucose tolerance tests. Results: African American youths exhibited the lowest HFF% and a prevalence of non‐alcoholic fatty liver disease (NAFLD) less than half of that shown by Caucasians and Hispanics. Furthermore, African Americans had lower EIC and glucose‐stimulated ISR, despite similar HIRI and plasma insulin levels, compared with Caucasians and Hispanics. EIC and HIRI were markedly reduced in individuals with NAFLD and declined across group‐specific HFF% tertiles in all ethnic groups. Consistently, the HFF% correlated with EIC and HIRI, irrespective of the ethnic background, after adjustment for age, sex, ethnicity, adiposity, waist‐hip ratio, pubertal status and plasma glucose levels. An increased HFF% at follow‐up was associated with decreased EIC and increased HIRI across all groups. Conclusions: Intrahepatic lipid accumulation is associated with reduced insulin clearance and hepatic insulin sensitivity in obese youths, irrespective of their ethnic background. [ABSTRACT FROM AUTHOR]