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A small percentage of universities and colleges conducted mass SARS-CoV-2 testing. However, universal testing is resource-intensive, strains national testing capacity, and false negative tests can encourage unsafe behaviors.A large urban university campus.Virus control centered on three pillars: mitigation, containment, and communication, with testing of symptomatic and a random subset of asymptomatic students.Random surveillance testing demonstrated a prevalence among asymptomatic students of 0.4% throughout the term. There were two surges in cases that were contained by enhanced mitigation and communication combined with targeted testing. Cumulative cases totaled 445 for the term, most resulting from unsafe undergraduate student behavior and among students living off-campus. A case rate of 232/10,000 undergraduates equaled or surpassed several peer institutions that conducted mass testing.An emphasis on behavioral mitigation and communication can control virus transmission on a large urban campus combined with a limited and targeted testing strategy.

Objective Older adults with knee osteoarthritis (OA) and comorbid subsyndromal depressive symptoms are at elevated risk for incidental major depression or anxiety disorders. Using an indicated prevention paradigm, the authors conducted a sequenced multiple assignment randomized trial (SMART) to: 1) evaluate the effect of cognitive behavioral therapy (CBT) and physical therapy (PT), together with the temporal ordering of these interventions, on patient-reported global impression of change (P-GIC), mood, anxiety, and pain; and 2) compare the strategies’ impact on incidence of common psychiatric disorders over 12-months. Methods This intervention development trial compared four adaptive strategies delivered in two stages (each up to 8 weeks), contrasted with enhanced usual care (EUC). The strategies were CBT followed by an increased dose of CBT (CBT-CBT), CBT followed by PT (CBT-PT), PT followed by an increased dose of PT (PT-PT), and PT followed by CBT (PT-CBT). Participants (n = 99) were aged 60 years and older and met clinical criteria for knee OA and subthreshold depression. Response was defined as at least “much better” on the P-GIC. Participants were assessed quarterly for 12 months for incidence of psychiatric disorders. Results Stage 1 response was higher for PT (47.5%) compared to CBT (20.5%). Non-responders receiving an additional dose of the same intervention experienced a response rate of 73%, higher than for switching to a different intervention. All strategies were superior to EUC (5%). Although not powered to detect effects on disorders, neither intervention strategy nor response status affected 12-month incidence of depression and anxiety disorders. Conclusion As response rates were similar for PT-PT and CBT-CBT, it may be dose and not type of these interventions that are necessary for clinical benefit. For non-responders, this finding may guide providers to stay the clinical course for up to 12 weeks before switching. These results support future trials of SMART designs in late-life depression prevention.

Background We examined the association between improved mobility and distal health outcomes in older adults using secondary analysis of data from a cluster-randomized controlled group exercise trial. Methods Participants were 303 men and women aged ≥65 and older in 32 independent living facilities, senior apartments, and community centers who participated in 12-week group exercise interventions. Included were those who completed ≥1 follow-up phone call regarding outcomes assessment in the following year. Gait speed and 6-minute walk distance (6MWD) were assessed at baseline and immediately after 12-week interventions to determine mobility performance change status. Falls, emergency department (ED) visits, and hospitalizations were assessed monthly for 12 months following the end of interventions via interactive voice response phone calls. Incident rate ratios (IRRs) were calculated to quantify incidence of adverse outcomes with respect to mobility performance change. Results Each 0.05 m/s increase in gait speed resulted in an 11% reduction in falls (IRR = 0.89; 95% confidence interval [CI], 0.84–0.94; p < .0001); a similar decrease was seen for each 20 m increase in 6MWD (IRR = 0.89; 95% CI, 0.83–0.93; p = .0003). Those who improved gait speed had 61 falls per 1,000 person-months versus 135 in those who had no change/a decline. Those who improved 6MWD had 67 falls per 1,000 person-months versus 110 per 1,000 person-months in those who had no change/a decline. Differences in ED visits and hospitalizations were not statistically significant. Conclusion Improvements in mobility performance are associated with lower incidence of future falls. Given the exploratory nature of the findings, further investigation is warranted.

To determine the acceptability of clinical interventions for depression prevention, identifying clinical characteristics associated with its engagement is needed. The purpose of this study is to describe baseline correlates of engagement in Problem Solving Therapy (PST) in adults 60 and older who reported subthreshold depression and high disability burden. PST involved 6–8 sessions in which participants learn skills to solve self-selected problems that are contributing to stress and reduced quality of life. During PST, interventionists completed 3 rating scales that asked about patients’ level of participation in problem solving activities, understanding of the process, and session homework effort in order to measure patients’ engagement with PST. Using multivariate regression, we tested associations among demographics (age, sex, race, education), mental health (depression), physical health (medical illness, gait speed), and cognitive function as correlates of engagement in the PST intervention of our depression prevention trial (n=50). Faster gait speed was significantly associated with more effort and motivation during intervention sessions and greater understanding of PST concepts. Faster gait speed was also significantly associated with more effort in completing homework material, as rated by interventionists. These findings suggest that healthier older adults may be more likely to engage in PST. These findings raise questions about whether therapists should consider gait speed when deciding to offer therapy like PST. Discussion will focus on the role of reporting intervention engagement in the clinical trial literature and whether an indicator of intervention engagement should serve a moderator or a mediator in trial outcome analyses.

Older adults are living longer with obesity and chronic health conditions, which threaten mobility and functional independence. Lifestyle interventions to manage weight, activity and prevent disability are warranted. Further understanding of the baseline associations among BMI, physical performance, and objective physical activity measures in diverse community-recruited samples could help to clarify goals and expectations for such interventions. The Mobility and Vitality Lifestyle (MOVE UP) study examines the impact of a healthy aging/weight intervention delivered by Community Health Workers. Here we report on the 122 MOVE UP participants with SenseWear Armband data, worn ≥ 90% per day for ≥ 3 days, and associated demographic, weight, and physical performance measures at baseline. The sample was 87% female, 33% black/other race. Mean (SD) age was 67.9 (4.2), BMI 34.5 (4.7), and participants had 3.1 (1.5) chronic conditions. This sample spent 21.1 hours/day (2.0) in sedentary activities. Average steps/day were modest, 4455 (2747) as were gait speeds of 0.98 meters/second. Full regression models showed average steps/day were reduced by 233 (55) for each year older (P

After implementation of the Patient Protection and Affordable Care Act (ACA) how will tax-exempt hospitals adjust their community benefit programs to maintain their non-profit status? This literature review categorized existing hospital-based community benefit programs by reviewing published articles that met the following inclusion criteria: affiliated or funded by a hospital; described the program design; focused on community benefit or outreach; evaluated program outcomes; located within the United States. Of 4,917 original citations, we reviewed 265 full-text articles. One hundred and six (106) programs met all inclusion criteria and were used to develop a hospital-based community benefit program taxonomy. Results indicate that programs to enhance patient care, clinic-based programs and programs with a community partner make up the majority of community benefit programs (25%, 28% and 31%, respectively). Few programs were rigorously evaluated or provide evidence of program impact. Hospitals should work with public health professionals to design, implement, and evaluate their community benefit programs.

The 2018 GSA Fellows Symposium features distinguished GSA Fellows from each of the four GSA sections: Biological Sciences (BS), Health Sciences (HS), Behavioral & Social Sciences (BSS), and Social Research, Policy & Practice (SRPP). The theme of the 2018 GSA Fellows Symposium is the “Purposes of Longer Lives.” The “purposes” are multiple and require the full range of disciplines in gerontology. From the biological sciences we can ask what governs length of life and integrity of function in late life. From the health sciences we can ask what constitutes meaningful life in advanced age and how to promote meaningful longevity even in the presence of loss of health, including cognitive decrements. From the behavioral and social sciences, we can ask how we can promote self-direction in late life, who is likely to have longer lives, and what allows us to reach late life. Finally, from policy and practice we can ask what investments allow longer lives and what advantages and challenges come with these lives. Presenters include S. Michal Jazwinski, PhD, FGSA (BS), “Purpose is an emergent property of an aging system”; Ann Kolanowski, PhD, RN, FGSA, FAAN (HS), “Well-being in late stage dementia: How will we know it when we see it?”; Kimberly van Haitsma, PhD, FGSA (BSS), “Preference-based Living: Examining older adults’ preferences for everyday living through the lens of research and practice”; and Jon Pynoos, PhD, FGSA (SRPP), “Housing the Aged: Public Policy at the Crossroads.”

Older adults are particularly vulnerable to the effects of depression, however, they are less likely to seek and engage in mental health treatment. African-American older adults are even less likely than their White counterparts to seek and engage in mental health treatment. This qualitative study examined the experience of being depressed among African-American elders and their perceptions of barriers confronted when contemplating seeking mental health services. In addition, we examined how coping strategies are utilized by African-American elders who choose not to seek professional mental health services.A total of 37 interviews were conducted with African-American elders endorsing at least mild symptoms of depression. Interviews were audiotaped and subsequently transcribed. Content analysis was utilized to analyze the qualitative data.Thematic analysis of the interviews with African-American older adults is presented within three areas: (1) Beliefs about Depression Among Older African-Americans; (2) Barriers to Seeking Treatment for Older African-Americans; and (3) Cultural Coping Strategies for Depressed African-American Older Adults.Older African-Americans in this study identified a number of experiences living in the Black community that impacted their treatment seeking attitudes and behaviors, which led to identification and utilization of more culturally endorsed coping strategies to deal with their depression. Findings from this study provide a greater understanding of the stigma associated with having a mental illness and its influence on attitudes toward mental health services.

In Arizona, the Grand Canyon National Park's south rim experiences severe traffic and parking congestion during the summer. To alleviate the issues, a free pilot shuttle route was operated between the gateway community of Tusayan and the park's information plaza during the 2008 summer season. During the pilot program, a traveler information system consisting of a portable dynamic message sign and highway advisory radio was implemented along Route 64 with the intent to increase shuttle ridership. The objective of this study is to evaluate the impact of the intelligent transportation system on shuttle ridership. Data were collected during the pilot program, before and after the implementation of this system. Different analysis methods including multiple linear regression, backpropagation neural network, and support vector regression were applied for analysis. The results found that the support vector regression method performed best in modeling shuttle ridership and associated explanatory variables (traffic volume and system deployment). The results from support vector regression suggested that the traveler information system increased shuttle ridership by 30%, which was consistent with the results from visitor surveys that were completed at the same time as this study. The study showed that the system was effective in shifting visitors from passenger cars to free shuttle buses.

Planned special events (PSE), such as sporting events and concerts, produce nonrecurring congestion as attendees simultaneously attempt to exit the event and overload the local transportation network. These types of events can have a significant impact on traffic operations, particularly in small urban and rural environments, where limited infrastructure is available to access and egress the PSE venue. The research presented here applied a variety of traffic management strategies to manage congestion resulting from football games at Montana State University in Bozeman, Montana, in fall 2007. These strategies included the provision of real-time travel information, road closures, traffic signal retiming, and real-time traffic monitoring. Results indicated that these strategies could be successfully applied in a rural community to manage the congestion arising from PSEs. For example, results indicated that signal retiming and manual traffic control strategies allowed for improvements in traffic flow on approaches that served game traffic.

Objective To describe the methodology, challenges, and baseline characteristics of a prevention development trial entitled "Reducing Pain, Preventing Depression." Methods A sequential multiple assignment randomized trial (SMART) compared sequences of cognitive behavioral therapy (CBT) and physical therapy for knee pain and prevention of depression and anxiety. Participants were randomized to CBT, physical therapy, or enhanced usual care and followed for 12 months for new-episode depression or anxiety. Participants were age ≥ 60 with knee osteoarthritis and subsyndromal depression, defined as 9-item Patient Health Questionnaire (PHQ-9) score ≥1 (which included the endorsement of one of the cardinal symptoms of depression [low mood or anhedonia]) and no diagnosis of major depressive disorder per the Structured Clinical Interview for DSM-IV. Depression and anxiety severity and characterization of new episodes were assessed with the PHQ-9, Generalized Anxiety Disorder-7, and the PRIME-MD. Knee pain was characterized with the Western Ontario McMaster Arthritis Index. Response was defined as at least "Very Much Better" on a Patient Global Impression of Change. Results At baseline there were 99 patients with an average age of 71; 61.62% were women and 81.8% white. The average PHQ-9 was 5.6 and average Generalized Anxiety Disorder-7, was 3.2. Most were satisfied with the interventions and study procedures. The challenges and solutions described here will also be used in a confirmatory clinical trial of efficacy. Conclusion A SMART design for depression and anxiety prevention, using both CBT and physical therapy, appears to be feasible and acceptable to participants. The methodologic innovations of this project may advance the field of late-life depression and anxiety prevention.

The San Carlos Apache Tribe (Tribe) in the interests of strengthening tribal sovereignty, becoming more energy self-sufficient, and providing improved services and economic opportunities to tribal members and San Carlos Apache Reservation (Reservation) residents and businesses, has explored a variety of options for renewable energy development. The development of renewable energy technologies and generation is consistent with the Tribe’s 2011 Strategic Plan. This Study assessed the possibilities for both commercial-scale and community-scale solar development within the southwestern portions of the Reservation around the communities of San Carlos, Peridot, and Cutter, and in the southeastern Reservation around the community of Bylas. Based on the lack of any commercial-scale electric power transmission between the Reservation and the regional transmission grid, Phase 2 of this Study greatly expanded consideration of community-scale options. Three smaller sites (Point of Pines, Dudleyville/Winkleman, and Seneca Lake) were also evaluated for community-scale solar potential. Three building complexes were identified within the Reservation where the development of site-specific facility-scale solar power would be the most beneficial and cost-effective: Apache Gold Casino/Resort, Tribal College/Skill Center, and the Dudleyville (Winkleman) Casino.

The San Carlos Apache Tribe (SCAT) was awarded $164,000 in late-2011 by the U.S. Department of Energy (U.S. DOE) Tribal Energy Program's "First Steps Toward Developing Renewable Energy and Energy Efficiency on Tribal Lands" Grant Program. This grant funded:  The analysis and selection of preferred form(s) of tribal energy organization (this Energy Organization Analysis, hereinafter referred to as "EOA").  Start-up staffing and other costs associated with the Phase 1 SCAT energy organization.  An intern program.  Staff training.  Tribal outreach and workshops regarding the new organization and SCAT energy programs and projects, including two annual tribal energy summits (2011 and 2012). This report documents the analysis and selection of preferred form(s) of a tribal energy organization.

Osteoarthritis (OA) is the most prevalent form of arthritis and is among the most prevalent chronic conditions in the United States. Because there is no known cure for OA, treatment is directed towards the alleviation of pain, improving function, and limiting disability. The major burden of care falls on the individual, who tailors personal systems of care to alleviate troublesome symptoms. To date, little has been known about the temporal variations in self-care that older patients with OA develop, nor has it been known to what extent self-care patterns vary with ethnicity and disease severity. This study was designed to demonstrate the self-care strategies used by older African Americans and whites to alleviate the symptoms of OA on a typical day and during specific segments of a typical day over the past 30 days. A sample of 551 older adults participated in in-depth interviews, and the authors clustered their responses into six categories. Findings showed that the frequency of particular behaviors varied by time of day, disease severity, and race. Overall, patterns of self-care behaviors were similar between African-Americans and whites, but African-Americans used them in different proportions than whites and in response to disease severity. Knowledge of what strategies persons with OA use to lessen their symptoms at various times of the day may enable practitioners and their patients to improve management of OA symptoms. Recognition that people may choose their strategies to ameliorate their symptoms by race and disease severity may further enable tailored symptom relief.

Ambulance crashes occur with greater frequency and severity than crashes involving vehicles of similar size and weight characteristics. Crashes in rural areas tend to be more severe in terms of injury or death to vehicle occupants. The purpose of this article was to examine the extant literature, as well as summarize and discuss the overlapping findings of that body of literature. A stepwise literature search was conducted using the following MeSH search terms ambulance; accident, traffic; emergency medical technician; occupational health; and rural in descending combination. MEDLINE was used as the primary database but was augmented by searches of Academic Search Premier, Comprehensive Index of Nursing, Allied Health Literature, and ProQuest Dissertation International. The search resulted in 32 article citations, and of these, 28 were included. An annotated bibliography is followed by a discussion and conclusion that identify opportunities for prevention activities in the areas of education, enforcement, and engineering.

1. By direct contact of the mouth to the anus, by direct contact of the mouth to the penis that has been in contact with the anus, and/ or by putting on your fingers in your mouth or in the mouth of your partner(s) after hand contact with the anus 2. By putting a sex toy (dildo, vibrator, butt plug, etc.) in your mouth or in the mouth of your partner(s) after contact with the anus 3. By eating food or drinking water or other beverages that are contaminated with microscopic particles of fecal matter

A REVIEW OF THE FALL 1987 COLLOQUIA SPONSORED BY NEW YORK UNIVERSITY’S INSTITUTE OF FRENCH STUDIES In the past twenty to thirty years, the conception of history in both France and America has changed considerably. The territory covered by the discipline has broadened to encompass elements of various social sciences, such as anthropology and sociology. In the Fall of 1987, four colloquia at New York University’s Institute of French Studies focused on various facets of French history and its study. Louis Bergeron and Jacques Revel both discussed some of the effects of the expansion of the concept of history on their discipline. Tony Judt examined the French Left in the context of European socialist thought after World War II, demonstrating how “historical” analysis is now being applied to periods as recent as 1945-1975. Finally, Charles Tilly described the writing of his latest book, The Contentious French, offering an example of current analytical methods in social history.

Más del 26% de las especies de aves que habitan en México está declinando. Los ornitólogos han propuesto diversas accionespara conservar algunas de ellas; sin embargo, se han hecho pocos esfuerzos por difundirlas. En este escrito, tomando en cuenta lasnueve pláticas presentadas en un simposio científico realizado en 2015, resumimos la información sobre los esfuerzos de conservaciónde aves que se están llevando a cabo en el país. Dividimos los estudios en tres categorías: los que analizan cómo se hacela conservación en México, los que hacen conservación práctica y los que constituyen investigación ecológica básica tendientea la conservación de dichas especies. Concluimos que los esfuerzos de conservación de aves en el país son insuficientes y que senecesitan realizar más acciones para evitar la pérdida de la diversidad de aves en México.