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Faika Zanjani,1,2 Aasha I Hoogland,1 Brian G Downer11Department of Gerontology, 2Building Interdisciplinary Research Careers in Women's Health University of Kentucky, Lexington, KY, USABackground: The objectives of this study were to investigate older adults' knowledge of prescription drug safety and interactions with alcohol, and to identify pharmacists' willingness to disseminate prescription drug safety information to older adults.Methods: The convenience sample consisted of 48 older adults aged 54–89 years who were recruited from a local pharmacy and who completed surveys addressing their alcohol consumption, understanding of alcohol and prescription drug interactions, and willingness to change habits regarding alcohol consumption and prescription drugs. To address pharmacist willingness, 90 pharmacists from local pharmacies volunteered and answered questions regarding their willingness to convey prescription drug safety information to older adults.Results: Older adults reported low knowledge of alcohol and prescription drug safety, with women tending to be slightly more knowledgeable. More importantly, those who drank in the previous few months were less willing to talk to family and friends about how alcohol can have harmful interactions with prescription drugs, or to be an advocate for safe alcohol and prescription drug use than those who had not had a drink recently. Pharmacists reported that they were willing to convey prescription drug safety information to older adults via a variety of formats, including displaying or distributing a flyer, and directly administering a brief intervention.Conclusion: In this study, older adults were found to have inadequate knowledge of prescription drug safety and interactions with alcohol, but pharmacists who regularly come in contact with older adults indicated that they were ready and willing to talk to older adults about prescription drug safety. Future research should focus on interventions whereby pharmacists disseminate prescription drug safety information to older adults in order to improve healthy prescription drug and alcohol behavior and reduce medical and health costs associated with interactions between alcohol and prescription drugs.Keywords: aging, alcohol, drug, pharmacist, prescription drugs, safety

The present study aims to study the role of secure marriage, cognitive flexibility, Hexaco personality dimensions on predicting covid-19 self-care behavior in married women. The method of this study was regression correlation analysis. 202 women were selected through Sampling method available. [ABSTRACT FROM AUTHOR]

The present study examined the congruence of self-reports of current prescription medications with actual prescribed medications. The sample included 1398 HMO members who were participants in the seventh wave of the Seattle Longitudinal Study. Self-reports of current medications were collected during SLS testing and were compared to HMO prescription records for the five weeks prior to testing. The sample had a mean age of 59.96 years (range = 22-96) and was 50.4% female and 94% white. For 12 major drug classes, the percent agreement between self-report and HMO prescription data ranged from 32%-97% for cases with a prescription and from 93%-99% for cases without a prescription. The total number of prescriptions filled (M = 1.7) did not differ significantly from the total number of self-reported prescriptions (M = 1.6). A small but significant (p < .001) difference was found between the total number of drug classes in self-reported medications (M = 1.1) versus the total number of drug classes for pharmacy prescriptions (M = 1.0), and only 68% of participants reported the same number of drug classes as in the pharmacy records for the 12 major drug classes. Finally, older age and having more prescriptions were significantly related to poorer self-report of medications. Congruence of self-reports with actual prescriptions for specific drugs will also be presented.

Objective: This study examined the effectiveness of a telephone-based referral care management (TBR-CM) intervention for improving engagement in psychiatric treatment.Methods: From September 2005 to May 2006, 169 primary care patients at the Philadelphia Veterans Affairs Medical Center completed a psychiatric diagnostic interview and were identified as needing psychiatric care. From this total of eligible patients, 113 (67%) gave informed consent and were randomly assigned to receive either usual care or the intervention. Usual care consisted of participants' being schedule for a behavioral health care appointment, followed by a letter and reminder by telephone. The intervention group received the same, plus one or two brief motivational telephone sessions. Participant interviews and medical records provided study data.Results: Research participants were primarily African American and 22-83 years old. In the sample, 40 patients (39%) had severe depression, 40 (39%) had substance use problems, and 33 (22%) had co-occurring severe depression and substance abuse. Overall, 40 participants (70%) in the intervention group compared with 18 (32%) in the usual care group engaged in at least one psychiatric treatment appointment (p<.001). Analyses also indicated that on average the intervention group attended more appointments (more than three) compared with the usual care group (less than two) (p=.008).Conclusions: The TBR-CM intervention program was effective at improving psychiatric treatment engagement. Future research is necessary to examine effectiveness of TBR-CM in more heterogeneous and larger samples and to evaluate economic benefits versus costs of intervention delivery. [ABSTRACT FROM AUTHOR]

Background and Objectives: Recent guidelines point to lifestyle as a tool for decreasing Alzheimer's disease (AD) risk. To address the limited practice and availability of AD risk reduction interventions, this study aimed to explore the feasibility of a community-level lifestyle intervention targeting high-risk groups., Research Design and Methods: Diverse older adults (60+) living in the Richmond, VA, local area, with the following risk factors, incomes below $12,000/year and managing diabetes or cardiovascular disease, were offered weekly lifestyle telephone health coaching for 12 weeks in 2019-2020 (intervention group). The health coaching sessions provided Alzheimer's disease (AD) lifestyle risk reduction education and goal setting/planning. The intervention sample (n = 40, mean age 68 years (range: 60-76 years), was 90% African American/Black (n = 36) and 45% male (n = 18). Thereafter, in 2021-2022, n = 37 individuals in the same area were recruited as a comparison group and not given health coaching (control group), mean age of 65.5 years (range: 57-83 years), 92% African American/Black (n = 34), and 50% male (n = 18)., Results: Repeated-measures intervention effects were seen for cognitive ability, indicating greater improvement in the intervention group (p < .01). Significant difference scores indicated greater cognitive ability (p < .01) and physical activity (p < .001) gains in the intervention group, with intervention subjects with reported memory problems showed relatively less physical activity gains (p < .05)., Discussion and Implications: This work creates the impetus for future large-scale AD risk reduction investigations to mitigate and improve modifiable risk among diverse older adults. Our positive trends in AD risk reduction support telephone-based health coaching as a feasible AD risk reduction intervention., (© The Author(s) 2024. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)

Objectives: This study compares Special Focus Facilities (SFFs) and Special Focus Facility Candidate Facilities (SFFcs) on organizational traits and quality outcomes to evaluate the effectiveness of the SFF program as a quality improvement intervention and inform potential areas for program reform., Design: This is a retrospective analysis., Settings and Participants: Using data from the Centers for Medicare and Medicaid Services archives for 2020, this retrospective study analyzed 247 nursing facilities (50 SFFs and 197 SFFcs)., Methods: Variables of interest were staffing, profit status, facility size, certification status, number of residents, and complaint citations: t tests, χ 2 , Fisher's Exact test, and multivariate analysis of variance were used to compare the 2 groups., Results: From an organizational perspective, SFFs and SFFcs are minimally different. Both groups had similar facility size, profit status, hospital affiliation, continuing care retirement community status, and Medicare/Medicaid certification. Large and for-profit facilities were overrepresented in both groups. SFFs and SFFcs exhibited statistical differences in the number of complaint deficiencies. The groups had no significant difference in staffing levels, category, severity of complaints, or incident reports., Conclusions and Implication: The study's findings suggest that the SFF program, while resource-intensive, is minimally impactful. The similarities between SFFs and SFFcs raise questions about the program's effectiveness in improving nursing facility care. Previous adjustments to the program may not have successfully achieved the desired quality improvements. This research highlights the need to further evaluate the SFF program's effectiveness as a quality improvement intervention. It also underscores the importance of addressing biases and subjectivity in state survey agency processes, which affect the enrollment of nursing facilities. The study underscores the flaws within the nursing home monitoring system and the 5-star quality rating system, especially when comparing small samples between states., Competing Interests: Disclosure The authors declare no conflicts of interest., (Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.)

Participation of Black American older adults in community-engaged research remains challenging in health sciences. The objectives of this study were to describe the specific efforts, successes, and challenges in recruiting Black American older adults in research led by the Health and Wellness in Aging Across the Lifespan core, part of the Virginia Commonwealth University Institute for Inclusion, Inquiry, and Innovation (iCubed). We conducted a cross-case analysis of 6 community-engaged research projects using the community-engaged research continuum model. Successful recruitment strategies comprised a multifaceted approach to community-based collaboration, including a wellness program with a long standing relationship with the community, engaging key stakeholders and a community advisory board, and building a community-based coalition of stakeholders. Posting flyers and modest monetary compensation remain standard recruitment strategies. The cross-case analysis offered critical lessons on the community's nature and level of engagement in research. Relationship building based on trust and respect is essential to solving complex aging issues in the community., Competing Interests: All authors declare that they have no conflicts of interest., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

Objective: This study aims to determine whether current tobacco and/or alcohol use is associated with setting preferences for seeking support for substance use (SU) and mental health (MH) services to African Americans ages 50 and older., Methods: Data from 368 African American individuals (aged 50+) who participated in a community-based needs assessment survey were used. Preferences included community-based (e.g., health centers) and traditional settings (e.g., doctor's office). SU was measured as a categorical variable detailing past-month use of conventional cigarettes and alcohol graded by risk levels. Logistic regression models tested the associations between SU and setting preference before and after adjusting for the influence of self-reported MH diagnoses., Results: Prior to adjustment for the influence of MH outcomes, high-risk use of tobacco and alcohol in the past month was associated with a lower odds of preferring MH/SU support in traditional settings (OR = 0.23, 95% CI = 0.06-0.85) compared to participants engaged in no-/low- risk substance use. This association was no longer significant after accounting for the influence of mental health symptoms and covariates., Discussion: These results provide preliminary evidence that mental health outcomes mediate the association between substance use and setting preference for seeking MH/SU support in traditional settings., Translational Significance: This exploratory study encourages additional investigation of the association between substance use, setting preferences, and the likelihood of seeking treatment in community health centers using larger sample sizes. Additional opportunities to offer mental health/substance use support to African American older adults within clinical settings should be explored.

Community-level health promotion programs offer opportunities to improve the lives of older adults and improve the cultural narrative about aging. However, age-discrimination, ageism, and negative attitudes about aging, across the systematic ecological community levels have undermined older adult health. While the longevity of a society is a marker for success worldwide, age-discrimination and ageism, seen through limited community-level health advancement opportunities, have thwarted progress toward societal elderhood, even in the most developed and advanced nations. As a society, we need to continue to push for community-level prevention and intervention across the older age spectrum, to continue human advancement through late life.

Older adults and racial minorities are overrepresented in homeless populations. Shelter and housing options for homeless older adults who have complex health and social needs are necessary, but not readily available. Older homeless adults that require, but do not receive, health-sensitive, age-sensitive, and racial equity housing, remain vulnerable to poor outcomes and premature mortality. Accordingly, this study examines the development of a coalition to better address older adult homelessness within a racial equity framework. A community coalition was established to better address older adult homelessness within the lens of age-sensitivity and racial equity, due to a disconnect between healthcare and senior housing placement programs, creating unaddressed multifaceted health issues/complications. The community coalition development is described, including the coalition process, activities, and outcomes. Local rehoused older adults are also interviewed and described to better understand their central life circumstances.

Substance use and mental health problems are associated with academic difficulties among high school and undergraduate students, but little research has been conducted on these relationships among graduate students. The sample consisted of 2,683 graduate students attending two large, public universities. Standard measures were used to collect data on demographic and program characteristics, mental health, substance use, advisor satisfaction, and burnout (i.e., exhaustion, cynicism, and inefficacy). Linear regression models evaluated relationships between each mental health and substance use variable with burnout, as well as the moderating role of advisor satisfaction. Students with a greater number of substance use and mental health problems had higher levels of exhaustion, cynicism, and inefficacy. No statistically significant relationships between substance use and burnout were found. High levels of stress, moderate or severe anxiety symptoms, and moderate or severe depressive symptoms were associated with increased levels of burnout. Advisor support moderated the relationships between stress and both cynicism and inefficacy such that the effects of stress on these dimensions of burnout were lower among those who were satisfied with their advisor. Graduate students with mental health problems might be at increased risk for burnout; however, having a supportive advisor might buffer this association., Competing Interests: Conflicts of Interest/Competing Interests: The authors declare that they have no conflict of interest.

Objectives: Older adults have been disproportionately affected by COVID-19. The primary goal of this study is to determine the socioeconomic effects on psychosocial factors among low-income independent-living older adults, in an urban setting, during the COVID-pandemic., Methods: Participants were recruited through Virginia Commonwealth University's Richmond Health and Wellness Program. Telephone surveys ( n =100) were conducted using the Epidemic - Pandemic Impacts Inventory Geriatric with the Racial/Ethnic Discrimination addendum. Responses were analyzed for income and education effects across seven domains: home life, social activities/isolation, economic, emotional health-wellbeing, physical health, COVID-infection history, and positive change behaviors/experiences., Results: The sample population was between 51 and 87 years of age, 88% were Black, 57% reported incomes of $10,000/year or less, and 60% reported a high-school education or less. There were income effects for social activities/isolation (f = 3.69, p <.05) and positive change (f = 8.40, p <.01), and education effects for COVID History (f = 4.20, p <.04)., Discussion: Overall results highlight the social patterns for a diverse sample of low-income urban older adults; education and income are identified as risk factors for social losses, COVID-infection experiences, racial/ethnic discrimination during the COVID-pandemic, and positive change behaviors., Competing Interests: Declaration Of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2022.)

Taking a phenomenological approach, this qualitative study describes the lived experiences of low-income older adults during the COVID-19 pandemic. A socio-ecological model was used to organize the five identified themes describing the lived experience: socio-economic context, Black Lives Matter and the politics of race, COVID and polarized views of COVID, interpersonal context (social connections), and individual context (feelings, beliefs, and behaviors). Study findings illustrate the intersectionality of contextual influences on the experience of low-income older adults. Study participants demonstrated remarkable resilience and coping strategies developed in response to the challenges they experienced throughout their lifetime which benefited them when faced with the pandemic, social unrest, and political events that took place in 2020. This study highlights the importance of understanding the larger context of COVID-19 which has significant implications for policy makers and public health leaders., Competing Interests: Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2022.)

There is a growing emphasis to use a transdisciplinary team approach to accelerate innovations in science to solve complex conditions associated with aging. However, the optimal organizational structure and process for how to accomplish transdisciplinary team science is unclear. In this forum, we illustrate our team's experience using transdisciplinary approaches to solve challenging and persistent problems for older adults living in urban communities. We describe our challenges and successes using the National Institutes of Health four-phase model of transdisciplinary team-based research. Using a de-identified survey, the team conducted an internal evaluation to identify features that created challenges including structural incongruities, interprofessional blind spots, group function, and group dynamics. This work resulted in the creation of the team's Transdisciplinary Conceptual Model. This model became essential to understanding the complex interplay between societal factors, community partners, and academic partners. Conducting internal evaluations of transdisciplinary team processes is integral for teams to move beyond the multi- and interdisciplinary niche and to reach true transdisciplinary success. More research is needed to develop measures that assess team transdisciplinary integration. Once the process of transdisciplinary integration can be reliably assessed, the next step would be to determine the impact of transdisciplinary team science initiatives on aging communities., (© The Author(s) 2020. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Objective: This study evaluated variation in substance use and mental health among graduate student subgroups., Participants: A sample of 2,683 master's and doctoral students completed an online survey in October 2017., Methods: Subgroup variation in behavioral health by demographic and program characteristics, particularly degree type and academic discipline, was explored., Results: Compared with academic doctoral students (ie, PhD students), professional doctoral students (ie, MD, JD, etc.) were significantly more likely to report high stress levels and moderate or severe anxiety symptoms. Master's students were more likely to report moderate or severe anxiety symptoms and use marijuana than academic doctoral students. Students in the behavioral and social sciences, social work, and arts and humanities disciplines were more likely to use substances and report mental health problems than engineering and business students., Conclusions: These findings highlight graduate student subgroups who might require closer attention with respect to access to behavioral health services.

Older adults (i.e., 60 years and older), are the leading consumers of medications, and consequently are suffering the most from medication-related adverse events. Not only are older adults the largest consumers of medications, they are more likely to experience an adverse drug event contributing to increased hospitalization, utilization of emergency medical services, and mortality. Translational Approaches to Personalized Health (TAPH) is a transdisciplinary team of researchers conducting community-engaged participatory research focused on the discovery and translation of pharmacogenomic (PGx) data to improve health outcomes. Underserved and ethnically diverse older adults living in urban settings are significantly under-represented in PGx studies. To address the issue of under-representation, our study enrolls older African American adults into a community-based PGx study. Therefore, we will characterize the frequency of actionable PGx genotypes and identify novel PGx response genes in our cohort of older community dwelling African Americans. The translational component of our work is to use the PGx findings to improve therapeutic outcomes for medication management in older adults. Such findings will serve as a foundation for translational PGx studies aimed at improving medication efficacy and safety for older adults. In this article, we describe the process for launching the TAPH collaborative group, which includes the transdisciplinary team, community-engaged participatory research model, study measures, and the evaluation of PGx genes., (© 2020 The Authors. Clinical and Translational Science published by Wiley Periodicals LLC on behalf of the American Society for Clinical Pharmacology and Therapeutics.)

Objective: To describe the Healthy Meal Program (HMP), a community-academic partnership that aims to address the food insecurity and social isolation in older adults living in an urban setting., Program Implementation: Low-income older adults were screened for food insecurity and social isolation. A partnership with the food bank and a farm-based organization helped provide a weekly congregate or home-delivered meal, pilot a cooking class, and offer a mobile market selling fresh vegetables at discounted prices., Program Evaluation: Overall, 339 individuals agreed to participate in the screening process. Sixty-eight percent (n = 230) screened positive for food insecurity and 41% (n = 139) screened positive for social isolation. Among individuals who were food insecure, 159 were referred to a food commodity program, 31 to meals on wheels, 23 to Supplemental Nutrition Assistance Program benefits, and 28 to emergency food pantries. The mobile market served 75 participants weekly and 15 individuals took part in cooking classes., Conclusions: Screening for food insecurity and social isolation in the HMP helped to assess the prevalence of these social determinants of health in low-income older adults. Weekly congregate meals, home visits, and group cooking classes were initiatives taken to decrease the impact of food insecurity and social isolation in this vulnerable population., (© 2020 Wiley Periodicals LLC.)

Background: We examined the relationship between alcohol consumption and hip fracture recovery. Methods : Repeated measures analysis was used to analyze Baltimore Hip Studies (BHS) seventh cohort 12-month prospective data of hip fracture patients. The analytical sample was limited to individuals with baseline and follow-up alcohol data, representing n = 278 sample size, 49% male, and mean age 81 years. Results : In the year prior to fracture, sample reporting indicated 45% nondrinking, 48% one to seven drinks per week, and 7% eight or more drinks per week alcohol levels. There were some changes in alcohol status during the study period ( p < .001); 42% remained nondrinkers and 47% remained alcohol consumers, but 8% stopped alcohol use, and 3% reported alcohol consumption after nondrinking at baseline. Alcohol was a predictor ( p < .05) of disability and physical function, not showing worse recovery for drinkers. Conclusion : Almost half of the sample consumed alcohol throughout the study period, with no clear indication of negative effects on hip fracture recovery.

Objective: Opioid harm reduction is increasingly important in the care of the older adults, who are at higher risk for negative opioid-related outcomes due to high prevalence of pain, multimorbidity, polypharmacy, and age-changes in metabolism. Our project aims to develop, implement, and evaluate an interprofessional opioid harm reduction service training. Method: This evaluation occurs in context of the Richmond Health and Wellness Program (RHWP), a community-based interprofessional wellness care coordination equity initiative, within buildings designated for low-income and disabled older adults. The geriatric opioid harm reduction training was delivered online and inperson, and followed up with case-discussions and practice. Findings: Pre ( n = 69)/post ( n = 62) student assessments indicated that after the training, there was an increase in knowledge. At follow-up, 60% recognized tramadol as an opioid, 50% at baseline. About 97% correctly indicated that MME represents morphine milligram equivalent, 80% at baseline. About 93% indicated that 50 MME level greatly increases opioid overdose risk, 62% at baseline. Only 20%, change from 60% at baseline, reported not being able to calculate MME at post assessment. Conclusion: Findings indicate that geriatric opioid harm reduction training within community-based wellness care coordination is feasible. Future works need to explore the impact on student practice in clinical settings and resident health., Competing Interests: Declaration of Conflicting Interests: The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2020.)

The objective of the study is to test a refined measure of attitudes about aging as a multidimensional construct reflective of a relational process that includes personal identity (i.e., beliefs about oneself), social identity (i.e., self-conception based on group membership), and collective identity (i.e., self-conception based on comparison of groups) as well as capturing awareness of ageism and its impact. Researchers refined the Aging Anxiety Scale and recruited a convenience sample of 329 participants via a social media platform. A principal component factor analysis revealed the specification of three latent factors: personal, relational, and collective aging anxiety. Awareness of ageism as a problem in society was lower than awareness of other forms of discrimination, and awareness of the negative impacts of ageism was low. The findings support the incorporation of this new measure of relational aging anxiety as a by-product of social identity and construction in future ageism studies.

Objectives: Prevalent concomitant alcohol and medication use among older adults is placing this group at risk for adverse health events. Given limited existing interventions to address concomitant alcohol and medication risk (AMR), a brief educational intervention was demonstrated. The purpose of the current study was to examine change in AMR behaviors 3 months post-education among older adult drinkers. Methods: A convenience sample of 58 older adult drinkers (mean age = 72) was recruited and followed ( n = 40; 70% at follow-up), from four pharmacies in rural Virginia. Results: Findings indicated decreased alcohol consumption in high-risk drinkers. Conclusion: Future research should explore methods to sustain reduced AMR., Competing Interests: Declaration of Conflicting Interests: The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2020.)

Objective: The purpose of this investigation was to examine the relationships among alcohol use, driving behavior, and indicators of health among older adults., Methods: A sample of 818 adults ages 65 and older were recruited through the state motor vehicle administration and completed an online survey. Regression models were used to assess the associations between alcohol use, driving behaviors, and 6 health indicators., Results: Whereas more frequent alcohol use was associated with fewer health conditions, higher quantity alcohol use was associated with increased likelihood of having at least one health condition. Participants who drove several days a week and those who drove every day had higher perceived health status, a lower number of past-year health conditions, and a lower number of past-year health events when compared to less frequent drivers. Persons who had at least one past-year negative driving behavior or event were significantly less likely to have positive health status, had lower perceived health status, and had a higher number of past-year health conditions and events., Conclusions: High quantity alcohol use and risky driving behavior among older adults are indicative of poorer health. Continued efforts are needed to educate older adults on the relationships among alcohol use, driving behavior, and health., Competing Interests: Conflict of Interest Disclosure Statement The authors have no conflicts of interest to declare.

Objective: Alcohol use among older adults is a major public health concern given potentially negative effects to health and functioning in this population. Little is known about context in which alcohol use among older adults occurs, or how context of use is associated with risk behaviors., Method: Invitation letters were mailed to licensed drivers 65 years and older in Maryland. A total of 825 participants completed an online survey that assessed demographic characteristics, alcohol use, social context of drinking, and driving behaviors., Results: The analytic sample consisted of 604 older adult current drinkers (55% male). A factor analysis revealed three separate contexts of drinking: social facilitation, emotional comfort, and relaxation. Drinking in the context of social facilitation was associated with driving after drinking. Drinking in the context of emotional comfort was associated with getting drunk, driving after drinking, and running a stop sign or red light. Drinking in the context of relaxation was associated with traffic risk behaviors, including running a stop sign or red light and getting in a near crash or collision., Conclusions: Understanding the social context of alcohol use among older adults may be useful for targeting and attempting to modify risky alcohol use and driving behaviors., Competing Interests: Declaration of Competing Interest None.

The availability of massive amounts of data in histopathological whole-slide images (WSIs) has enabled the application of deep learning models and especially convolutional neural networks (CNNs), which have shown a high potential for improvement in cancer diagnosis. However, storage and transmission of large amounts of data such as gigapixel histopathological WSIs are challenging. Exploiting lossy compression algorithms for medical images is controversial but, as long as the clinical diagnosis is not affected, is acceptable. We study the impact of JPEG 2000 compression on our proposed CNN-based algorithm, which has produced performance comparable to that of pathologists and which was ranked second place in the CAMELYON17 challenge. Detecting tumor metastases in hematoxylin and eosin-stained tissue sections of breast lymph nodes is evaluated and compared with the pathologists' diagnoses in three different experimental setups. Our experiments show that the CNN model is robust against compression ratios up to 24:1 when it is trained on uncompressed high-quality images. We demonstrate that a model trained on lower quality images-i.e., lossy compressed images-depicts a classification performance that is significantly improved for the corresponding compression ratio. Moreover, it is also observed that the model performs equally well on all higher-quality images. These properties will help to design cloud-based computer-aided diagnosis (CAD) systems, e.g., telemedicine that employ deep CNN models that are more robust to image quality variations due to compression required to address data storage and transmission constraints. However, the results presented are specific to the CAD system and application described, and further work is needed to examine whether they generalize to other systems and applications.

Objectives: The purpose of this investigation was to determine what older adults find most concerning about driving as they age and how these concerns are related to driving skill, behaviors, and experiences., Methods: In partnership with the Maryland Motor Vehicle Administration, a sample of 751 older adults ages 65 and older completed an online survey between October 2017 and May 2018. A content analysis was used to code open-ended responses about driver concerns, and multivariate logistic regression models were used to analyze the associations between driving concerns and driving skill, behavior, and experiences., Results: Eighty-four percent of participants reported at least one driving concern, with 44% concerned about others' driving, 34% concerned about their own driving, and 24% concerned about driving conditions. The most frequently mentioned driving concerns were other drivers in general, driving at night, visual ability and awareness, and other drivers being aggressive or reckless. Being concerned with their own driving was significantly associated with decreased perceived driving skill and increased odds of experiencing negative driving experiences in the past year. Being concerned about others' driving was associated with increased odds of wearing a seat belt (adjusted odds ratio [AOR] = 2.67; 95% confidence interval [CI], 1.02, 7.00), having high perceived driving skills in emergency situations (AOR = 1.56; 95% CI, 1.14, 2.12), and getting in a near crash or collision in the past year (AOR = 1.50; 95% CI, 1.04, 2.18)., Conclusions: Older adult drivers are frequently concerned about their own driving as well as the driving of others. Implications for future research and health practice are discussed.

Older adults are at high risk for alcohol and medication interactions (AMI). Pharmacies have the potential to act as ideal locations for AMI education, as pharmacy staff play an important role in the community. This study examined the perspectives of pharmacy staff on AMI prevention programming messaging, potential barriers to and facilitators of older adult participation in such programming, and dissemination methods for AMI prevention information. Flyers, telephone calls, and site visits were used to recruit 31 pharmacy staff members who participated in semistructured interviews. A content analysis of interview transcriptions was conducted to identify major themes, categories, and subcategories. The main categories identified for AMI prevention messaging were Informational, Health Significance , and Recommendations . Within barriers to participation, the main categories identified were Health Illiteracy, Personal Attitudes , and Feasibility . The main categories identified for program facilitators were Understanding, Beneficial Consequences , and Practicality . Multimethod dissemination strategies were commonly suggested. This study found positive pharmacy staff perspectives for the planning and implementation of AMI prevention programming, and future development and feasibility testing of such programming in the pharmacy setting is warranted., Competing Interests: Declaration of Conflicting Interests: The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Purpose: During needle interventions, successful automated detection of the needle immediately after insertion is necessary to allow the physician identify and correct any misalignment of the needle and the target at early stages, which reduces needle passes and improves health outcomes., Methods: We present a novel approach to localize partially inserted needles in 3D ultrasound volume with high precision using convolutional neural networks. We propose two methods based on patch classification and semantic segmentation of the needle from orthogonal 2D cross-sections extracted from the volume. For patch classification, each voxel is classified from locally extracted raw data of three orthogonal planes centered on it. We propose a bootstrap resampling approach to enhance the training in our highly imbalanced data. For semantic segmentation, parts of a needle are detected in cross-sections perpendicular to the lateral and elevational axes. We propose to exploit the structural information in the data with a novel thick-slice processing approach for efficient modeling of the context., Results: Our introduced methods successfully detect 17 and 22 G needles with a single trained network, showing a robust generalized approach. Extensive ex-vivo evaluations on datasets of chicken breast and porcine leg show 80 and 84% F1-scores, respectively. Furthermore, very short needles are detected with tip localization errors of less than 0.7 mm for lengths of only 5 and 10 mm at 0.2 and 0.36 mm voxel sizes, respectively., Conclusion: Our method is able to accurately detect even very short needles, ensuring that the needle and its tip are maximally visible in the visualized plane during the entire intervention, thereby eliminating the need for advanced bi-manual coordination of the needle and transducer.

Risk of experiencing alcohol and medication interactions (AMI) is significant among older adults due to the substantial prevalence of alcohol and medication use in this segment of the population. Given the lack of community-level AMI prevention interventions for older adults, this study aimed to examine the immediate effects of a brief, pharmacy-based intervention to prevent AMI among older adults, as well as assess differential effects by past-month drinking status. A convenience sample of 134 adults aged 59 and older was recruited from four pharmacies in rural Virginia. Participants were assessed on their AMI awareness, intentions and importance prior to and immediately after exposure to intervention materials. Findings support immediate, positive intervention effects on AMI awareness, intentions and perceived importance of AMI messaging. Changes from pre to post-test did not differ by drinking status, but participants who consumed alcohol were less likely than non-drinkers to recognize the potential consequential severity of alcohol and medication interactions at both time points. Recommendations and future research to prevent AMI are discussed.

The purpose of this research was to explore primary care providers' willingness and ability to increase HIV prevention efforts among older adults and to gain recommendations for improving HIV prevention in primary care settings. Data were collected through 24 semistructured interviews with primary care providers. The results of the study reveal that the majority of providers find it necessary to increase HIV prevention efforts in primary care settings and are willing to do so; however, they cannot do so without assistance. Providers suggested strategies to increase HIV prevention in primary care, for instance, expanding the use of electronic reminders to include HIV prevention and increasing collaboration among providers of different specialties. As a result of the interviews, additional recommendations for increasing HIV prevention have been identified. These findings will aid in improving the quality of care provided to individuals older than 50 in primary care settings.

Background: The majority of older adults take prescription or over-the-counter medications and about half consume alcohol regularly. Despite high risk for alcohol medication interactions (AMI), few community-level interventions exist to prevent AMI. The current study assessed the acceptability of educational materials created for use in a brief intervention to prevent AMI among older adults., Methods: Older adults from two senior centers reviewed intervention materials (poster, patient and pharmacist brochures, and public service announcement) and participated in a pre and post-test to provide feedback and to assess changes in AMI-related awareness and intentions., Results: Post-test data showed positive feedback and an increase in participant understanding of AMI prevention, with statistically significant changes in perceived importance of messaging surrounding risky alcohol use and potential consequences of AMI., Discussion: The intervention materials were positively received, and participant feedback indicated that the collective presentation of all the materials was the most preferred tool for educating the community. With positive trends in awareness and knowledge, intervention effectiveness needs to be further evaluated in future large-scale studies., Lessons Learned: This study provides health education specialists with tools to prevent alcohol and medication interactions among older adults., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

Background: Older adults are at risk for experiencing alcohol and medication interactions (AMI) given concomitant alcohol and medication use. However, there have been limited efforts to develop and evaluate AMI prevention interventions., Purpose: The current study examined sustained intervention effects on older adults' attitudes, awareness, and intentions regarding AMI., Methods: A sample of N = 134 older adults completed assessments before and after exposure to AMI risk educational materials (Times 1 and 2). N = 97 participants (72%) were reached for a three-month follow-up phone call (Time 3)., Results: There was a positive linear trend over time in the number of identified AMI side effects. While knowledge of intervention messages remained high and stable over time, quadratic trends for perceived importance of AMI messages indicated positive short-term effects that did not sustain over time. Few differences by drinking status were found., Discussion: This intervention had positive short-term effects on AMI awareness, intentions, and perceived messaging importance, but these short-term effects were only maintained over time for awareness., Translation to Health Education Practice: This study provides Certified Health Education Specialists with a model for planning and evaluating a brief intervention to prevent AMI among older adults.

This study sought to understand the medication adherence and quality of life (QOL) of recipients of a pharmacist-based medication management program among independently living older adults. Using a cross-sectional, quasi-experimental study design, we compared older adults enrolled in the program to older adults not enrolled in the program. Data were collected via face-to-face interviews in independent-living facilities and in participants' homes. Independently living older adults who were enrolled in the medication management program ( n = 38) were compared to older adults not enrolled in the program (control group ( n = 41)). All participants were asked to complete questionnaires on health-related quality of life (QOL, using the SF-36) and medication adherence (using the four-item Morisky scale). The medication management program recipients reported significantly more prescribed medications ( p < 0.0001) and were more likely to report living alone ( p = 0.01) than the control group. The medication management program recipients had a significantly lower SF-36 physical functioning score ( p = 0.03) compared to the control group, although other SF-36 domains and self-reported medication adherence were similar between the groups. Despite taking more medications and more commonly living alone, independent living older adults enrolled in a pharmacist-based medication management program had similar QOL and self-reported medication adherence when compared to older adults not enrolled in the program. This study provides initial evidence for the characteristics of older adults receiving a pharmacist-based medication management program, which may contribute to prolonged independent living and positive health outcomes.

Purpose: To explore primary care providers' HIV prevention practices for older adults. Primary care providers' perceptions and awareness were explored to understand factors that affect their provision of HIV prevention materials and HIV screening for older adults., Design and Method: Data were collected through 24 semistructured interviews with primary care providers (i.e., physicians, physician assistants, and nurse practitioners) who see patients older than 50 years., Results: Results reveal facilitators and barriers of HIV prevention for older adults among primary care providers and understanding of providers' HIV prevention practices and behaviors. Individual, patient, institutional, and societal factors influenced HIV prevention practices among participants, for example, provider training and work experience, lack of time, discomfort in discussing HIV/AIDS with older adults, stigma, and ageism were contributing factors. Furthermore, factors specific to primary and secondary HIV prevention were identified, for instance, the presence of sexually transmitted infections influenced providers' secondary prevention practices., Implications: HIV disease, while preventable, is increasing among older adults. These findings inform future research and interventions aimed at increasing HIV prevention practices in primary care settings for patients older than 50., (© The Author(s) 2015.)

Objectives: To examine rural and urban pharmacy staff perceptions on messaging, barriers, and motivators for preventing alcohol and medication interactions (AMI) in older adults (≥65 years of age)., Methods: A survey was distributed through the local pharmacist association and statewide pharmacy registry in Kentucky. A total of 255 responses were received from pharmacists, pharmacy technicians, and pharmacy students., Results: Across rural and urban regions alike, among the AMI prevention messages provided, participants identified the most important messages to be: AMI can be potentially dangerous and life threatening; emergency rooms should be used when experiencing an AMI; and doctors and pharmacists should be consulted about AMI. The most common AMI prevention barriers indicated were stigma, costs, and low perceived risks. The most common AMI prevention motivators indicated were physical health improvement, promoting a healthy lifestyle, convenient setting, and financial incentives., Conclusion: Regardless of geography, participants similarly rated the presented AMI prevention messages, barriers, and motivators. With the use of these findings, the development of an AMI prevention program is suggested to use messaging about AMI threat, behavioral management, and behavioral prevention., (Copyright © 2016 American Pharmacists Association®. Published by Elsevier Inc. All rights reserved.)

Background: Alcohol and medication interactions are projected to increase due to the growth of older adults that are unsafely consuming alcohol and medications. Plus, aging adults who reside in rural areas are at the highest risk of experiencing medication interactions., Objective: Estimate concurrent alcohol and medication (alcohol/medication) hospitalizations in adults 50+ years, comparing age groups and rural/urban regions., Methods: Kentucky nonfederal, acute care inpatient hospital discharge electronic records for individuals aged 50+ years from 2001 to 2012 were examined. Rate differences were estimated across age and regional strata. Differences in the underlying principal diagnosis, intent, and medications were also examined., Results: There were 2168 concurrent alcohol/medication hospitalizations among 50+ year olds identified. There was a 187% increase in alcohol/medication hospitalizations from 2001 (n = 104) to 2012 (n = 299). The per capita alcohol/medication hospitalization rate increased from 8.91 (per 100,000) in 2001 to 19.98 (per 100,000) in 2012, a 124% increase. The characteristics of the hospitalizations included 75% principal diagnosis as medication poisoning, self-harm as the primary intent (55%) in 50-64-year olds, and unintentional intent (41%) in 65+ adults. Benzodiazepines were most often involved in the poisonings (36.5%)., Conclusions: Concurrent alcohol/medication hospitalizations in Kentucky are increasing among aging adults. Greater increases in rural areas and the 65+ aged adults were seen, although there were also higher alcohol/medication hospitalizations in urban and 50-64 aged adults. These findings indicate the need for public-health prevention and clinical intervention to better educate and manage alcohol consuming older adults on safe medication and alcohol practices., Competing Interests: Declaration of interest: The authors report no declarations of interest.

This study utilized data from the Framingham Heart Study Offspring Cohort to examine the relationship between midlife and late-life alcohol consumption, cognitive functioning, and regional brain volumes among older adults without dementia or a history of abusing alcohol. The results from multiple linear regression models indicate that late life, but not midlife, alcohol consumption status is associated with episodic memory and hippocampal volume. Compared to late life abstainers, moderate consumers had larger hippocampal volume, and light consumers had higher episodic memory. The differences in episodic memory according to late life alcohol consumption status were no longer significant when hippocampal volume was included in the regression model. The findings from this study provide new evidence that hippocampal volume may contribute to the observed differences in episodic memory among older adults and late life alcohol consumption status., (© The Author(s) 2014.)

Objective: The aim of this study is to examine the feasibility of Memory Banking (MB), a life story development intervention within the context of aging preparation. Individuals participate in MB to strategically document and share their life story, including mapping out future dreams, aspirations, plans, and decisions., Method: Data (2010-2012) from eight MB workshops were examined to determine the impact of the intervention on mental health, social support, and quality of life., Results: Recruitment efforts resulted in n = 72 participants, primarily female (72%), White/Caucasian (93%), average age of 70 years. Data indicated intervention effects showing improvements in depression (p = .041), mood disturbance (p = .0067), and cognitive performance (p = .0045)., Discussion: MB outcomes indicate that the intervention is promising and supports continued investigation and development in the area of life story development for aging preparation and improving late life mental health distress in a community setting. Future research is needed to examine the versatility and long-term effects of the MB intervention., (© The Author(s) 2014.)

Background: Tracheal intubation is extremely distressing, painful, and may influence heart rate and blood pressure. Sedatives, analgesics, and muscle relaxants are not commonly used for intubation in neonates., Objectives: This study aimed to evaluate the effects of lidocaine spray as a non-intravenous drug before neonatal intubation on blood pressure, heart rate, oxygen saturation and time of intubation., Patients and Methods: In a randomized, controlled study each neonate was randomly assigned to one of the two study groups by staffs who were not involved in the infant's care. The allocation concealment was kept in an opaque sealed envelope, and the investigators, the patient care team, and the assessors were blinded to the treatment allocation. The selected setting was NICU unit of a teaching hospital in Ilam city, Iran and participants were 60 neonates with indication of tracheal intubation with gestational age > 30 weeks. Patients in the treatment group received lidocaine spray and the placebo group received spray of normal saline prior to intubation. Main outcome measurements were the mean rates of blood pressure, heart rate, oxygen saturation, intubation time and lidocaine side effects were measured before and after intubation., Results: Totally 60 newborns including 31 boys and 29 girls were entered into the study (drug group n = 30; placebo group n = 30). Boy/girl ratio in treatment and placebo groups were 1.3 and 0.88, respectively. Mean age ± SD of participants was 34.1 ± 24.8 hours (treatment: 35.3 ± 25.7; placebo: 32.9 ± 24.3; P < 0.0001). Mean weight ± SD of neonates was 2012.5 ± 969 g. Application of lidocaine spray caused a significant reduction of mean intubation time among treatment group compared with placebo group (treatment: 15.03 ± 2.2 seconds; placebo: 18.3 ± 2.3 seconds; P < 0.0001). Mean blood pressure, heart rate and oxygen saturation rate, among neonates in treatment group was reduced after intubation compared with their relevant figures before intubation; however, their differences were not statistically significant except for mean oxygen saturation rate that was reduced significantly in placebo group. No side effects were observed during study., Conclusions: Though the current study revealed some promising results in the application of lidocaine spray during neonatal intubation without any considerable side effects; however, the current investigation could only be considered as a pilot study for further attempts in different locations with higher sample sizes and in different situations.