Anne Spencer: A Conventional, Yet Unconventional, Harlem Renaissance Poet

A look inside the background of African-American poet, Anne Spencer, and her endeavor to write about racism and female mistreatment. Outside of writing, Anne and her husband were the first to employ a NAACP office in their native city of Lynchburg. Spencer was a writer for the “underdog” but was not afraid to step up to the challenges life, and society, posed at her

Navigating Community-Based Aged Care Services From the Consumer Perspective: A Scoping Review

Background and Objectives: The shift to consumer-directed aged care means that older adults need to play a more active role in navigating the complex aged care system for adequate health and social services. Challenges in the navigation process result in unmet needs and difficulty accessing available resources. This scoping review investigates how aged care navigation is conceptualized in literature and interrogates research on the experiences of older adults navigating community-based aged care services with or without support from their informal carers. Research Design and Methods: This review follows the Joanna Briggs Institute methodological guidelines. PubMed, Scopus, and ProQuest were searched for relevant literature published from 2008 to 2021, supplemented by grey literature and manual reference list searching. Data were extracted using a predefined data-extraction table and synthesized with an inductive thematic analysis. Results: The current conceptualization of aged care navigation focuses on the support provided to older adults, rather than actions taken by older adults themselves. Thematic analysis from the included studies (n = 26) revealed shared themes (lack of knowledge, social networks as information providers, complex care systems) among older adults and informal carers; unique challenges faced by older adults (difficulties with technology, waiting game), and informal carers (structural burden) in aged care navigation. Discussion and Implications: Findings suggest the need to comprehensively assess individual circumstances including social networks and access to informal carers as predictors of successful navigation. Changes that reduce the complexity of the aged care system and improve coordination will relieve the structural burden experienced by consumers

Life expectancy in Australian senior with or without cognitive impairment: the Australia Diabetes, Obesity and Lifestyle Study Wave 3

Objective: To determine prevalence of cognitive impairment (CI) and to estimate life expectancy with and without cognitive impairment in the Australian population over age 60. Method: Adults aged 60 and older participating in the 12 year follow-up of the Australia Diabetes Obesity and Lifestyle Study (AusDiab) were included in the sample (n=1666). The mean age was 69.5 years, and 46.3% of the sample was male. The Mini-Mental State Examination was used to assess cognitive impairment. Logistic regression analysis was used to determine the effect of predictor variables (age, gender, education), measured at baseline, on cognitive impairment status. The Sullivan Method was used to estimate Total Life Expectancy (TLE), Cognitively Impaired (CILE) and Cognitive Impairment-free life expectancies (CIFLE). Results: Odds of CI were greater for males than females (OR 2.1, 95% confidence interval: 1.2-3.7) and among Australians with low education levels compared with Australians with high education levels (OR 2.1, 95% confidence interval: 1.2-3.7). The odds of CI also increased each year with age (OR 1.1, (95% confidence interval: 1.0-1.1). It was found that in all age groups females have greater TLE and CIFLE when compared to their male counterparts.This research was supported by the Australian Research Council Centre of Excellence in Population Aging Research (project number CE110001029). KJA is funded by NHMRC Fellowship #1002560. We acknowledge support from the NHMRC Dementia Collaborative Research Centres. The AusDiab study co-coordinated by the Baker IDI Heart and Diabetes Institute, gratefully acknowledges the support and assistance given by: K Anstey, B Atkins, B Balkau, E Barr, A Cameron, S Chadban, M de Courten, D Dunstan, A Kavanagh, D Magliano, S Murray, N Owen, K Polkinghorne, J Shaw, T Welborn, P Zimmet and all the study participants. Also, for funding or logistical support, we are grateful to: National Health and Medical Research Council (NHMRC grants 233200 and 1007544), Australian Government Department of Health and Aging, Abbott Australasia Pty Ltd, Alphapharm Pty Ltd, Amgen Australia, AstraZeneca, Bristol-Myers Squibb, City Health Centre-Diabetes Service-Canberra, Department of Health and Community Services- Northern Territory, Department of Health and Human Services– Tasmania, Department of Health–New South Wales, Department of Health–Western Australia, Department of Health–South Australia, Department of Human Services–Victoria, Diabetes Australia, Diabetes Australia Northern Territory, Eli Lilly Australia, Estate of the Late Edward Wilson, GlaxoSmithKline, Jack Brockhoff Foundation, Janssen-Cilag, Kidney Health Australia, Marian & FH Flack Trust, Menzies Research Institute, Merck Sharp & Dohme, Novartis Pharmaceuticals, Novo Nordisk Pharmaceuticals, Pfizer Pty Ltd, Pratt Foundation, Queensland Health, Roche Diagnostics Australia, Royal Prince Alfred Hospital, Sydney, Sanofi Aventis, sanofi-synthelabo, and the Victorian Government’s OIS Program

Visual Predictors of Postural Sway in Older Adults

Purpose: Accurate perception of body position relative to the environment through visual cues provides sensory input to the control of postural stability. This study explored which vision measures are most important for control of postural sway in older adults with a range of visual characteristics. Methods: Participants included 421 older adults (mean age = 72.6 ± 6.1), 220 with vision impairment associated with a range of eye diseases and 201 with normal vision. Participants completed a series of vision, cognitive, and physical function tests. Postural sway was measured using an electronic forceplate (HUR Labs) on a foam surface with eyes open. Linear regression analysis identified the strongest visual predictors of postu-ral sway, controlling for potential confounding factors, including cognitive and physical function. Results: In univariate regression models, unadjusted and adjusted for age, all of the vision tests were significantly associated with postural sway (P < 0.05), with the strongest predictor being visual motion sensitivity (standardized regression coefficient, β = 0.340; age-adjusted β = 0.253). In multiple regression models, motion sensitivity (β = 0.187), integrated binocular visual fields (β =−0.109), and age (β = 0.234) were the only significant visual predictors of sway, adjusted for confounding factors, explain-ing 23% of the variance in postural sway. Conclusions: Of the vision tests, visual motion perception and binocular visual fields were most strongly associated with postural stability in older adults with and without vision impairment. Translational Relevance: Findings provide insight into the visual contributions to postural stability in older adults and have implications for falls risk assessment

A Scoping Review of Workplace Interventions to Promote Positive Attitudes Toward Older Workers and Reduce Age-Based Discrimination

Population aging trends have created a need for effective policies to extend adult working lives. Previous research has identified the prevalence of negative attitudes (age-related stereotypes, prejudice, and discriminatory behaviors) directed toward older workers in the workplace context.The current scoping review aimed to describe and assess the current evidence in support of different types of interventions aimed at promoting positive attitudes and reducing age-based discrimination in the workplace context. A search of peer-reviewed and grey literature databases identified 22 relevant studies, including data from 5,078 adult participants, across laboratory and field settings. From examination of these studies, we propose and describe four thematic categories of interventions, as a way of organizing this literature: “de-biasing interventions,” “brief attitudinal interventions,” “age diversity workshop interventions,” and “structural or contextual interventions.” At the current point in time, studies assessing age diversity workshop interventions appear to be the strongest, having a clear theoretical basis, having a focus on interventions that can be delivered in workplace settings, and providing evidence for positive effects on measures that are meaningful for organizations and older workers. While a number of promising interventions have been tested, most studies were only able to demonstrate improvements in explicit measurements of attitudes toward older adults, immediately following the intervention. Collaborative partnerships with organizations and further high-quality studies (particularly in field settings) are required to support the development, evaluation, and implementation of interventions to promote positive attitudes toward older adults in real-world workplace settings

Towards More Data-Aware Application Integration (extended version)

Although most business application data is stored in relational databases, programming languages and wire formats in integration middleware systems are not table-centric. Due to costly format conversions, data-shipments and faster computation, the trend is to "push-down" the integration operations closer to the storage representation. We address the alternative case of defining declarative, table-centric integration semantics within standard integration systems. For that, we replace the current operator implementations for the well-known Enterprise Integration Patterns by equivalent "in-memory" table processing, and show a practical realization in a conventional integration system for a non-reliable, "data-intensive" messaging example. The results of the runtime analysis show that table-centric processing is promising already in standard, "single-record" message routing and transformations, and can potentially excel the message throughput for "multi-record" table messages.Comment: 18 Pages, extended version of the contribution to British International Conference on Databases (BICOD), 2015, Edinburgh, Scotlan

The impact of mild cognitive impairment on decision-making under explicit risk conditions: Evidence from the Personality and Total Health (PATH) Through Life longitudinal study

Objective: Previous research has indicated that cognition and executive function are associated with decision-making, however the impact of mild cognitive impairment (MCI) on decision-making under explicit risk conditions is unclear. This cross-sectional study examined the impact of MCI, and MCI subtypes, on decision-making on the Game of Dice Task (GDT), among a cohort of older adults. Method: Data from 245 older adult participants (aged 72-78 years) from the fourth assessment of the Personality and Total Health Through Life study were analyzed. A diagnostic algorithm identified 103 participants with MCI, with subtypes of single-domain amnestic MCI (aMCI-single; n = 38), multi-domain amnestic MCI (aMCI-multi; n = 31), and non-amnestic MCI (n = 33), who were compared with an age-, sex-, education-, and income-matched sample of 142 cognitively unimpaired older adults. Decision-making scores on the GDT (net score, single number choices, and strategy changes) were compared between groups using nonparametric tests. Results: Participants with MCI showed impaired performance on the GDT, with higher frequencies of single number choices and strategy changes. Analyses comparing MCI subtypes indicated that the aMCI-multi subtype showed increased frequency of single number choices compared to cognitively unimpaired participants. Across the sample of participants, decision-making scores were associated with measures of executive function (cognitive flexibility and set shifting). Conclusion: MCI is associated with impaired decision-making performance under explicit risk conditions. Participants with impairments in multiple domains of cognition showed the clearest impairments. The GDT may have utility in discriminating between MCI subtypes

Variability in the organisation and management of hospital care for COPD exacerbations in the UK

SummaryPrevious smaller UK audits have demonstrated wide variation in organisation, resources, and process of care for acute chronic obstructive pulmonary disease (COPD) admissions. Smallest units appeared to do less well.UK acute hospitals supplied information on (1) resources and organisation of care, (2) clinical data on process of care and outcomes for up to 40 consecutive COPD admissions. Comparisons were made against national recommendations.Eight thousand and thirteen admissions involved 7529 patients from 233 units (93% of UK acute Trusts). Twenty-six percent of units had at most one whole-time equivalent respiratory consultant while 12% had at least four. Thirty percent patients were admitted under a respiratory specialist and 48% discharged under their care whilst 28% had no specialist input at all. Variation in care provision was wide across all hospitals but patients in smaller hospitals had less access to specialist respiratory or admission wards, pulmonary rehabilitation programs, speciality triage or an early discharge scheme. Six percent of units did not have access to NIV and 18% to invasive ventilatory support.There remains wide variation in all aspects of acute hospital COPD care in the UK, with smaller hospitals offering fewest services. Those receiving specialist input are more likely to be offered interventions of proven effect. Management guidelines alone are insufficient to address inequalities of care and a clear statement of minimum national standards for resource provision and organisation of COPD care are required. This study provides a unique insight into the current state of care for patients admitted with COPD exacerbations in the UK

How to write a Critically Appraised Topic: evidence to underpin routine clinical practice

Critically appraised topics (CATs) are essential tools for busy clinicians who wish to ensure that their daily clinical practice is underpinned by evidence-based medicine. CATs are short summaries of the most up-to-date, high-quality available evidence that is found using thorough structured methods. They can be used to answer specific, patient-orientated questions that arise recurrently in real-life practice. This article provides readers with a detailed guide to performing their own CATs. It is split into four main sections reflecting the four main steps involved in performing a CAT: formulation of a focused question, a search for the most relevant and highest-quality evidence, critical appraisal of the evidence and application of the results back to the patient scenario. As well as helping to improve patient care on an individual basis by answering specific clinical questions that arise, CATs can help spread and share knowledge with colleagues on an international level through publication in the evidence-based dermatology section of the British Journal of Dermatolog