Development and Validation of eRADAR: A Tool Using EHR Data to Detect Unrecognized Dementia.

ObjectivesEarly recognition of dementia would allow patients and their families to receive care earlier in the disease process, potentially improving care management and patient outcomes, yet nearly half of patients with dementia are undiagnosed. Our aim was to develop and validate an electronic health record (EHR)-based tool to help detect patients with unrecognized dementia (EHR Risk of Alzheimer's and Dementia Assessment Rule [eRADAR]).DesignRetrospective cohort study.SettingKaiser Permanente Washington (KPWA), an integrated healthcare delivery system.ParticipantsA total of 16 665 visits among 4330 participants in the Adult Changes in Thought (ACT) study, who undergo a comprehensive process to detect and diagnose dementia every 2 years and have linked KPWA EHR data, divided into development (70%) and validation (30%) samples.MeasurementsEHR predictors included demographics, medical diagnoses, vital signs, healthcare utilization, and medications within the previous 2 years. Unrecognized dementia was defined as detection in ACT before documentation in the KPWA EHR (ie, lack of dementia or memory loss diagnosis codes or dementia medication fills).ResultsOverall, 1015 ACT visits resulted in a diagnosis of incident dementia, of which 498 (49%) were unrecognized in the KPWA EHR. The final 31-predictor model included markers of dementia-related symptoms (eg, psychosis diagnoses, antidepressant fills), healthcare utilization pattern (eg, emergency department visits), and dementia risk factors (eg, cerebrovascular disease, diabetes). Discrimination was good in the development (C statistic = .78; 95% confidence interval [CI] = .76-.81) and validation (C statistic = .81; 95% CI = .78-.84) samples, and calibration was good based on plots of predicted vs observed risk. If patients with scores in the top 5% were flagged for additional evaluation, we estimate that 1 in 6 would have dementia.ConclusionThe eRADAR tool uses existing EHR data to detect patients with good accuracy who may have unrecognized dementia. J Am Geriatr Soc 68:103-111, 2019

Supportive Care in Older Adults with Cancer: Across the Continuum

Supportive care is an essential component of anti-cancer treatment regardless of age or treatment intent. As the number of older adults with cancer increases, and supportive care strategies enable more patients to undergo treatment, greater numbers of older patients will become cancer survivors. These patients may have lingering adverse effects from treatment and will need continued supportive care interventions. Older adults with cancer benefit from geriatric assessment (GA)-guided supportive care interventions. This can occur at any stage across the cancer treatment continuum. As a GA commonly uncovers issues potentially unrelated to anti-cancer treatment, it could be argued that the assessment is essentially a supportive care strategy. Key aspects of a GA include identification of comorbidities, assessing for polypharmacy, screening for cognitive impairment and delirium, assessing functional status, and screening for psychosocial issues. Treatment-related issues of particular importance in older adults include recognition of increased bone marrow toxicity, management of nausea and vomiting, identification of anemia, and prevention of neurotoxicity. The role of physical therapy and cancer rehabilitation as a supportive care strategy in older adults is important regardless of treatment stage or intent

Aluminum cladding oxidation of prefilmed in-pile fueled experiments

A series of fueled irradiation experiments were recently completed within the Advanced Test Reactor Full size plate In center flux trap Position (AFIP) and Gas Test Loop (GTL) campaigns. The conduct of the AFIP experiments supports ongoing efforts within the global threat reduction initiative (GTRI) to qualify a new ultra-high loading density low enriched uranium-molybdenum fuel. This study details the characterization of oxide growth on the fueled AFIP experiments and cross-correlates the empirically measured oxide thickness values to existing oxide growth correlations and convective heat transfer correlations that have traditionally been utilized for such an application. This study adds new and valuable empirical data to the scientific community with respect to oxide growth measurements of highly irradiated experiments, of which there is presently very limited data. Additionally, the predicted oxide thickness values are reconstructed to produce an oxide thickness distribution across the length of each fueled experiment (a new application and presentation of information that has not previously been obtainable in open literature); the predicted distributions are compared against experimental data and in general agree well with the exception of select outliers

Persistent Polypharmacy and Fall Injury Risk: The Health, Aging and Body Composition Study

Background Older adults receive treatment for fall injuries in both inpatient and outpatient settings. The effect of persistent polypharmacy (i.e. using multiple medications over a long period) on fall injuries is understudied, particularly for outpatient injuries. We examined the association between persistent polypharmacy and treated fall injury risk from inpatient and outpatient settings in community-dwelling older adults. Methods The Health, Aging and Body Composition Study included 1764 community-dwelling adults (age 73.6 ± 2.9 years; 52% women; 38% black) with Medicare Fee-For-Service (FFS) claims at or within 6 months after 1998/99 clinic visit. Incident fall injuries (N = 545 in 4.6 ± 2.9 years) were defined as the initial claim with an ICD-9 fall E-code and non-fracture injury, or fracture code with/without a fall code from 1998/99 clinic visit to 12/31/08. Those without fall injury (N = 1219) were followed for 8.1 ± 2.6 years. Stepwise Cox models of fall injury risk with a time-varying variable for persistent polypharmacy (defined as ≥6 prescription medications at the two most recent consecutive clinic visits) were adjusted for demographics, lifestyle characteristics, chronic conditions, and functional ability. Sensitivity analyses explored if persistent polypharmacy both with and without fall risk increasing drugs (FRID) use were similarly associated with fall injury risk. Results Among 1764 participants, 636 (36%) had persistent polypharmacy over the follow-up period, and 1128 (64%) did not. Fall injury incidence was 38 per 1000 person-years. Persistent polypharmacy increased fall injury risk (hazard ratio [HR]: 1.31 [1.06, 1.63]) after adjusting for covariates. Persistent polypharmacy with FRID use was associated with a 48% increase in fall injury risk (95%CI: 1.10, 2.00) vs. those who had non-persistent polypharmacy without FRID use. Risks for persistent polypharmacy without FRID use (HR: 1.22 [0.93, 1.60]) and non-persistent polypharmacy with FRID use (HR: 1.08 [0.77, 1.51]) did not significantly increase compared to non-persistent polypharmacy without FRID use. Conclusions Persistent polypharmacy, particularly combined with FRID use, was associated with increased risk for treated fall injuries from inpatient and outpatient settings. Clinicians may need to consider medication management for FRID and other fall prevention strategies in community-dwelling older adults with persistent polypharmacy to reduce fall injury risk

Studying animal innovation at the individual level: a ratings-based assessment in capuchin monkeys (Sapajus [Cebus] sp.)

Large-scale studies of individual differences in animal innovation are rare firstly because discovery behaviour itself is often rare, and secondly because of logistical difficulties associated with obtaining observational data on a large number of innovative individuals across multiple groups and locations. Here we take a different approach, using observer ratings to study innovative behaviour in 127 brown capuchin monkeys (Sapajus [Cebus] sp.) from 15 social groups and 7 facilities. Capuchins were reliably rated by 1 to 7 raters (mean 3.2 ± 1.6 raters/monkey) on a 7-point Likert scale for levels of innovative behaviour, task motivation, sociality, and dominance. In a subsample, we demonstrate these ratings are valid: rated innovation predicted performance on a learning task, rated motivation predicted participation in the task, rated dominance predicted social rank based on win/loss aggressive outcomes, and rated sociality predicted the time that monkeys spent in close proximity to others. Across all 127 capuchins, individuals that were rated as being more innovated were significantly younger, more social, and more motivated to engage in tasks. Sociality, task motivation, and age all had independent effects on innovativeness, whereas sex, dominance and group size were non-significant. Our findings are consistent with long-term behavioural observations of innovation in wild white-faced capuchins. Observer ratings may therefore be a valid tool for studies of animal innovation, and our findings highlight in particular several possible scenarios through which innovative behaviour might be selected for among capuchins

Radial distribution of stars, gas and dust in SINGS galaxies. I. Surface photometry and morphology

We present ultraviolet through far-infrared surface brightness profiles for the 75 galaxies in the Spitzer Infrared Nearby Galaxies Survey (SINGS). The imagery used to measure the profiles includes GALEX UV data, optical images from KPNO, CTIO and SDSS, near-IR data from 2MASS, and mid- and far-infrared images from Spitzer. Along with the radial profiles, we also provide multi-wavelength asymptotic magnitudes and several non-parametric indicators of galaxy morphology: the concentration index (C_42), the asymmetry (A), the Gini coefficient (G) and the normalized second-order moment of the brightest 20% of the galaxy's flux (M_20). Our radial profiles show a wide range of morphologies and multiple components (bulges, exponential disks, inner and outer disk truncations, etc.) that vary not only from galaxy to galaxy but also with wavelength for a given object. In the optical and near-IR, the SINGS galaxies occupy the same regions in the C_42-A-G-M_20 parameter space as other normal galaxies in previous studies. However, they appear much less centrally concentrated, more asymmetric and with larger values of G when viewed in the UV (due to star-forming clumps scattered across the disk) and in the mid-IR (due to the emission of Polycyclic Aromatic Hydrocarbons at 8.0 microns and very hot dust at 24 microns).Comment: 66 pages in preprint format, 14 figures, published in ApJ. The definitive publisher authenticated version is available online at http://dx.doi.org/10.1088/0004-637X/703/2/156

Urinary antihypertensive drug metabolite screening using molecular networking coupled to high-resolution mass spectrometry fragmentation

Introduction Mass spectrometry is the current technique of choice in studying drug metabolism. High-resolution mass spectrometry in combination with MS/MS gas-phase experiments has the potential to contribute to rapid advances in this field. However, the data emerging from such fragmentation spectral files pose challenges to downstream analysis, given their complexity and size. Objectives This study aims to detect and visualize antihypertensive drug metabolites in untargeted metabolomics experiments based on the spectral similarity of their fragmentation spectra. Furthermore, spectral clusters of endogenous metabolites were also examined. Methods Here we apply a molecular networking approach to seek drugs and their metabolites, in fragmentation spectra from urine derived from a cohort of 26 patients on antihypertensive therapy. The mass spectrometry data was collected on a Thermo Q-Exactive coupled to pHILIC chromatography using data dependent analysis (DDA) MS/MS gas-phase experiments. Results In total, 165 separate drug metabolites were found and structurally annotated (17 by spectral matching and 122 by classification based on a clustered fragmentation pattern). The clusters could be traced to 13 drugs including the known antihypertensives verapamil, losartan and amlodipine. The molecular networking approach also generated clusters of endogenous metabolites, including carnitine derivatives, and conjugates containing glutamine, glutamate and trigonelline. Conclusions The approach offers unprecedented capability in the untargeted identification of drugs and their metabolites at the population level and has great potential to contribute to understanding stratified responses to drugs where differences in drug metabolism may determine treatment outcome

Ancestry reported by white adults with cutaneous melanoma and control subjects in central Alabama

BACKGROUND: We sought to evaluate the hypothesis that the high incidence of cutaneous melanoma in white persons in central Alabama is associated with a predominance of Irish and Scots descent. METHODS: Frequencies of country of ancestry reports were tabulated. The reports were also converted to scores that reflect proportional countries of ancestry in individuals. Using the scores, we computed aggregate country of ancestry indices as estimates of group ancestry composition. HLA-DRB1*04 allele frequencies and relationships to countries of ancestry were compared in probands and controls. Results were compared to those of European populations with HLA-DRB1*04 frequencies. RESULTS: Ninety evaluable adult white cutaneous melanoma probands and 324 adult white controls reported countries of ancestry of their grandparents. The respective frequencies of Ireland, and Scotland and "British Isles" reported countries of ancestry were significantly greater in probands than in controls. The respective frequencies of Wales, France, Italy and Poland were significantly greater in controls. 16.7% of melanoma probands and 23.8% of controls reported "Native American" ancestry; the corresponding "Native American" country of ancestry index was not significantly different in probands and controls. The frequency of HLA-DRB1*04 was significantly greater in probands, but was not significantly associated with individual or aggregate countries of ancestry. The frequency of DRB1*04 observed in Alabama was compared to DRB1*04 frequencies reported from England, Wales, Ireland, Orkney Island, France, Germany, and Australia. CONCLUSION: White adults with cutaneous melanoma in central Alabama have a predominance of Irish, Scots, and "British Isles" ancestry and HLA-DRB1*04 that likely contributes to their high incidence of cutaneous melanoma

Can a Multifaceted Intervention Including Motivational Interviewing Improve Medication Adherence, Quality of Life, and Mortality Rates in Older Patients Undergoing Coronary Artery Bypass Surgery? A Multicenter, Randomized Controlled Trial with 18-Month Follow-Up.

BACKGROUND: Patients undergoing coronary artery bypass graft (CABG) surgery are required to take a complex regimen of medications for extended periods, and they may have negative outcomes because they struggle to adhere to this regimen. Designing effective interventions to promote medication adherence in this patient group is therefore important. OBJECTIVE: The present study aimed to evaluate the long-term effects of a multifaceted intervention (psycho-education, motivational interviewing, and short message services) on medication adherence, quality of life (QoL), and mortality rates in older patients undergoing CABG surgery. METHODS: Patients aged over 65 years from 12 centers were assigned to the intervention (EXP; n = 144) or treatment-as-usual (TAU; n = 144) groups using cluster randomization at center level. Medication adherence was evaluated using the Medication Adherence Rating Scale (MARS), pharmacy refill rate, and lipid profile; QoL was evaluated using Short Form-36. Data were collected at baseline; 3, 6, and 18 months after intervention. Survival status was followed up at 18 months. Multi-level regressions and survival analyses for hazard ratio (HR) were used for analyses. RESULTS: Compared with patients who received TAU, the MARS, pharmacy refill rate, and lipid profile of patients in the EXP group improved 6 months after surgery (p < 0.01) and remained so 18 months after surgery (p < 0.01). QoL also increased among patients in the EXP group as compared with those who received TAU at 18 months post-surgery (physical component summary score p = 0.02; mental component summary score p = 0.04). HR in the EXP group compared with the TAU group was 0.38 (p = 0.04). CONCLUSION: The findings suggest that a multifaceted intervention can improve medication adherence in older patients undergoing CABG surgery, with these improvements being maintained after 18 months. QoL and survival rates increased as a function of better medication adherence. ClinicalTrials.gov NCT02109523

Capabilities, Performance, and Status of the SOFIA Science Instrument Suite

The Stratospheric Observatory for Infrared Astronomy (SOFIA) is an airborne observatory, carrying a 2.5 m telescope onboard a heavily modified Boeing 747SP aircraft. SOFIA is optimized for operation at infrared wavelengths, much of which is obscured for ground-based observatories by atmospheric water vapor. The SOFIA science instrument complement consists of seven instruments: FORCAST (Faint Object InfraRed CAmera for the SOFIA Telescope), GREAT (German Receiver for Astronomy at Terahertz Frequencies), HIPO (High-speed Imaging Photometer for Occultations), FLITECAM (First Light Infrared Test Experiment CAMera), FIFI-LS (Far-Infrared Field-Imaging Line Spectrometer), EXES (Echelon-Cross-Echelle Spectrograph), and HAWC (High-resolution Airborne Wideband Camera). FORCAST is a 540 m imager with grism spectroscopy, developed at Cornell University. GREAT is a heterodyne spectrometer providing high-resolution spectroscopy in several bands from 60240 m, developed at the Max Planck Institute for Radio Astronomy. HIPO is a 0.31.1 m imager, developed at Lowell Observatory. FLITECAM is a 15 m wide-field imager with grism spectroscopy, developed at UCLA. FIFI-LS is a 42210 m integral field imaging grating spectrometer, developed at the University of Stuttgart. EXES is a 528 m high-resolution spectrograph, developed at UC Davis and NASA ARC. HAWC is a 50240 m imager, developed at the University of Chicago, and undergoing an upgrade at JPL to add polarimetry capability and substantially larger GSFC detectors. We describe the capabilities, performance, and status of each instrument, highlighting science results obtained using FORCAST, GREAT, and HIPO during SOFIA Early Science observations conducted in 2011