Medication Usage in Independent Living: A Continuing Care Retirement Community Aging in Place Initiative

Purpose: The purpose of the study was to identify medication use concerns in this community. Background: In this study, Swedish Geriatric Medicine Fellow partnered with this community to identify medication use concerns in this population. Continuing Care Retirement Communities (CCRCs) are intended to support residents as they age in place. These communities tend to be well resourced but less studied. This survey attempts to identify medication use concerns in this population. Mirabella CCRC has 324 Independent living (IL) residents, 82 of which are couples. The average age is 85 years. The current cost of an IL unit is from $4673- 6545 per month. This survey is part of a larger initiative to better understand barriers to aging in place in this specific population. Methods: A ten-question survey was provided to all 324 residents. Residents self completed the survey. Questions included medication numbers, frequency, aid in administration, ease of access, and ease of self-administration, use of over-the-counter medications, supplements, and future concerns of medication management. Residents could leave comments. Results: There was a response rate of 217 (67%). Thirty eight percent were taking more than 5 medications, 91% took medications once or twice a day, 9% took meds three times a day or more. Eighteen percent had aid in medication management, 22% and 20% had difficulty opening/closing and reading bottles respectively. Medication access was an issue for 1%. Nine percent experienced side effects, 5% of SE were CNS SE. Vitamins or supplements were taken by 85% with 14% taking OTC sleep aids. OTC pain medications (Tylenol, NSAIDS) were taken by 36%. Concerns about managing medicines in the future were noted by 23% with 5% having concerns that cognitive problems may affect self-medication management. Difficulty remembering medications was noted by 12%. Conclusion: CCRCs represent unique communities requiring unique considerations for medication usage. Cost was not noted to be of concern. Opening/closing and reading labels was of concern. The common use of OTC medications for pain and sleep presents a potential area of intervention. Pharmacy involvement (newsletters, online talks) could address non-medication pain reduction, limitation of sleep medications, and aid in providing appropriate medication bottles. Qualitative analysis could be used to further address resident concerns of cognitive decline and ability to self manage medications.https://digitalcommons.psjhealth.org/swedish_learning_day_posters/1002/thumbnail.jp

Vaccinia virus immune evasion: mechanisms, virulence and immunogenicity

Virus infection of mammalian cells is sensed by pattern recognition receptors and leads to an innate immune response that restricts virus replication and induces adaptive immunity. In response, viruses have evolved many countermeasures that enable them to replicate and be transmitted to new hosts, despite the host innate immune response. Poxviruses, such as vaccinia virus (VACV), have large DNA genomes and encode many proteins that are dedicated to host immune evasion. Some of these proteins are secreted from the infected cell, where they bind and neutralize complement factors, interferons, cytokines and chemokines. Other VACV proteins function inside cells to inhibit apoptosis or signalling pathways that lead to the production of interferons and pro-inflammatory cytokines and chemokines. In this review, these VACV immunomodulatory proteins are described and the potential to create more immunogenic VACV strains by manipulation of the gene encoding these proteins is discussed

Assessment of Lotic Macroinvertebrate Assemblage in the Oconaluftee River Basin in Cherokee, North Carolina

Macroinvertebrate assemblage assessments act as useful analysis tools for assessing aquatic ecosystems health. These animals also serve as a base trophic level, acting as a source of food for many other aquatic organisms including fish and salamanders. Obtaining baseline data for monitoring aquatic insects and subsequent river health is vital to understand food chains and river ecological interactions. We sampled macroinvertebrate communities in two streams in the Oconaluftee River basin, in the Cherokee Qualla, North Carolina. Over 600 macroinvertebrates were collected and identified to the lowest taxonomic level possible, providing a macroinvertebrate profile of both riffle and run habitats. We identified over 35 genera and report on functional feeding groups, with biotic indices of water quality. Ephemeroptera, Plecoptera, and Trichoptera values varied, 21% and 65.43% for Raven’s Fork and 22% and 79.06% for the Oconaluftee rivers. This macroinvertebrate community suggests healthy stream aquatic insects and above average water quality, in spite of the urban land use found in the riparian zones of the sample sites. This research can be used as a baseline for future monitoring of aquatic streams in the area of the Cherokee Qualla

The Role of Tourism Impacts on Cultural Ecosystem Services

Parks and protected areas are recognized for the important ecosystem services, or benefits, they provide society. One emerging but understudied component is the cultural ecosystem services that parks and protected areas provide. These cultural ecosystem services include a variety of benefits, such as cultural heritage, spiritual value, recreation opportunities, and human health and well-being. However, many of these services can only be provided if people visit these parks and protected areas through tourism opportunities. However, with this tourism use comes a variety of inevitable resource impacts. This current research connects potential impacts from tourism in parks and protected areas to the health and well-being aspect of cultural ecosystem services. We used an MTurk sample to record affective responses across a range of resource conditions. Results demonstrate that as tourism-related ecological impacts increased, positive affect decreased. Decreases in positive affect were more severe for park and protected area scenes featuring informal and/or undesignated social trails when compared to scenes with increasing levels of trampling/vegetation loss. Collectively, the results show that managing tourism in parks and protected areas in a manner that reduces impact is essential to providing beneficial cultural ecosystem services related to human health and well-being

ISWE: A Case Study of Technology Utilization

The International Space Welding Experiment is a joint project between the E.O. Paton Welding Institute of Kiev, Ukraine and the George C. Marshall Space Flight Center in Huntsville, Alabama. When an international partner is involved in a project, differences in design and testing philosophy can become a factor in the development of the hardware. This report addresses selected issues that arose during the ISWE hardware development as well as the solutions the ISWE team made

Risk of reproductive complications following chlamydia testing:a population-based retrospective cohort study in Denmark

SummaryBackgroundUncertainty in the risk of reproductive complications (pelvic inflammatory disease, ectopic pregnancy, and tubal factor infertility) following chlamydia infection and repeat infection hampers the design of evidence-based chlamydia control programmes. We estimate the association between diagnosed chlamydia and episodes of hospital health care (inpatient, outpatient, and emergency department) for a reproductive complication.MethodsWe constructed and analysed a retrospective population-based cohort of women aged 15–44 years from administrative records in Denmark (1995–2012). We used a subset of the national Danish Chlamydia Study. The master dataset contains all residents of Denmark (including Greenland) who had a positive chlamydia test recorded by a public health microbiology laboratory from Jan 1, 1992, to Nov 2, 2011. Individuals were randomly matched (by age and sex) to four individuals drawn from the population register (Danish Civil Registration System) who did not have a positive chlamydia test during this interval. The outcomes in the study were hospital episodes of health-care (inpatient, outpatient, and emergency department) with a diagnosis of pelvic inflammatory disease, ectopic pregnancy, or tubal factor infertility.FindingsThe 516 720 women (103 344 positive, 182 879 negative, 230 497 never-tested) had a mean follow-up of 7·96 years. Compared with women with only negative tests, the risk of each complication was 30% higher in women with one or more positive tests (pelvic inflammatory disease, adjusted hazard ratio [AHR] 1·50 [95% CI 1·43–1·57]; ectopic pregnancy, AHR 1·31 [1·25–1·38]; tubal factor infertility, AHR 1·37 [1·24–1·52]) and 60% lower in women who were never-tested (pelvic inflammatory disease, AHR 0·33 [0·31–0·35]; ectopic pregnancy, AHR 0·42 [0·39–0·44]; tubal factor infertility AHR 0·29 [0·25–0·33]). A positive test had a minor absolute impact on health as the difference in the lifetime incidence of complications was small between women who tested positive and those who tested negative (pelvic inflammatory disease, 0·6%; ectopic pregnancy, 0·2%; tubal factor infertility, 0·1%). Repeat infections increased the risk of pelvic inflammatory disease by a further 20% (AHR 1·20, 95% CI 1·11–1·31).InterpretationA single diagnosed chlamydia infection increased the risk of all complications and a repeat diagnosed infection further increased the risk of pelvic inflammatory disease. Therefore, control programmes must prevent first and repeat infections to improve women's reproductive health.FundingUnrestricted partial funding from Frederiksberg Kommune, Frederiksberg, Denmark. BD held an Medical Research Council Population Health Scientist Fellowship (G0902120). KT held an National Institute for Health Research Post-Doctoral Fellowship 2009-02-055

Comparison of the Population Excess Fraction of <i>Chlamydia trachomatis</i> Infection on Pelvic Inflammatory Disease at 12-months in the Presence and Absence of Chlamydia Testing and Treatment:Systematic Review and Retrospective Cohort Analysis

Background: The impact of Chlamydia trachomatis (chlamydia) control on the incidence of pelvic inflammatory disease (PID) is theoretically limited by the proportion of PID caused by chlamydia. We estimate the population excess fraction (PEF) of treated chlamydia infection on PID at 12-months in settings with widespread chlamydia control (testing and treatment) and compare this to the estimated PEF of untreated chlamydia. Methods: We used two large retrospective population-based cohorts of women of reproductive age from settings with widespread chlamydia control to calculate the PEF of treated chlamydia on PID at 12-months. We undertook a systematic review to identify further studies that reported the risk of PID in women who were tested for chlamydia (infected and uninfected). We used the same method to calculate the PEF in eligible studies then compared all estimates of PEF. Results: The systematic review identified a single study, a randomised control led trial of chlamydia screening (POPI-RCT). In the presence of testing and treatment <10% of PID at 12-months was attributable to treated (baseline) chlamydia infections (Manitoba: 8.86%(95%CI 7.15-10.75); Denmark: 3.84%(3.26-4.45); screened-arm POPI-RCT: 0.99%(0.00-29.06)). In the absence of active chlamydia treatment 26.44% (11.57-46.32) of PID at 12-months was attributable to untreated (baseline) chlamydia infections (deferred-arm POPI-RCT). The PEFs suggest that eradicating baseline chlamydia infections could prevent 484 cases of PID at 12-months per 100,000 women in the untreated setting and 13- 184 cases of PID per 100,000 tested women in the presence of testing and treatment. Conclusion: Testing and treating chlamydia reduced the PEF of chlamydia on PID by 65% compared to the untreated setting. But in the presence of testing and treatment over 90% of PID could not be attributed to a baseline chlamydia infection. More information is needed about the aetiology of PID to develop effective strategies for improving the reproductive health of women

Impact of Age and HIV Status on Immune Activation, Senescence and Apoptosis

Introduction: Residual immune dysfunctions, resembling those that occur during normal aging, may persist even in well-treated people with HIV (PWH), and accelerated aging has been proposed. We aimed to determine if HIV infection is an independent risk factor for T-cell immune dysfunctions including increased immune activation, senescence and apoptosis. Moreover, in PWH we aimed to identify the associations between age and immune activation, senescence and apoptosis. Materials and Methods: We included 780 PWH with suppressed viral replication (<50 copies/mL) and absence of hepatitis B and hepatitis C co-infection and 65 uninfected controls from the Copenhagen Co-morbidity in HIV Infection (COCOMO) Study. Flow cytometry was used to determine T-cell activation (CD38+HLA-DR+), senescence (CD28-CD57+), and apoptosis (CD28-CD95+). T-cell subsets are reported as proportions of CD4+ and CD8+ T-cells. We defined an elevated proportion of a given T-cell subset as above the 75th percentile. Regression models were used to determine the association between HIV status and T-cell subset and in PWH to determine the association between age or HIV-specific risk factors and T-cell subsets. Furthermore, an interaction between HIV status and age on T-cell subsets was investigated with an interaction term in models including both PWH and controls. Models were adjusted for age, sex, BMI, and smoking status. Results: In adjusted models a positive HIV status was associated with elevated proportions of CD8+ activated (p = 0.009), CD4+ senescent (p = 0.004), CD4+ apoptotic (p = 0.002), and CD8+ apoptotic (p = 0.003) T-cells. In PWH a 10-year increase in age was associated with higher proportions of CD4+ and CD8+ senescent (p = 0.001 and p < 0.001) and CD4+ and CD8+ apoptotic T-cells (p < 0.001 and p < 0.001). However, no interaction between HIV status and age was found. Furthermore, in PWH a CD4+/CD8+ ratio < 1 was associated with elevated proportions of T-cell activation, senescence, and apoptosis. Discussion: We found evidence of residual T-cell immune dysfunction in well-treated PWH without HBV or HCV co-infection, and age was associated with T-cell senescence and apoptosis. Our data supports that HIV infection has similar effects as aging on T-cell subsets. However, since no interaction between HIV status and age was found on these parameters, we found no evidence to support accelerated immunological aging in PWH

Bat IFITM3 restriction depends on S-palmitoylation and a polymorphic site within the CD225 domain

Host interferon-induced transmembrane proteins (IFITMs) are broad-spectrum antiviral restriction factors. Of these, IFITM3 potently inhibits viruses that enter cells through acidic endosomes, many of which are zoonotic and emerging viruses with bats (order Chiroptera) as their natural hosts. We previously demonstrated that microbat IFITM3 is antiviral. Here, we show that bat IFITMs are characterized by strong adaptive evolution and identify a highly variable and functionally important site-codon 70-within the conserved CD225 domain of IFITMs. Mutation of this residue in microbat IFITM3 impairs restriction of representatives of four different virus families that enter cells via endosomes. This mutant shows altered subcellular localization and reduced S-palmitoylation, a phenotype copied by mutation of conserved cysteine residues in microbat IFITM3. Furthermore, we show that microbat IFITM3 is S-palmitoylated on cysteine residues C71, C72, and C105, mutation of each cysteine individually impairs virus restriction, and a triple C71A-C72A-C105A mutant loses all restriction activity, concomitant with subcellular re-localization of microbat IFITM3 to Golgi-associated sites. Thus, we propose that S-palmitoylation is critical for Chiropteran IFITM3 function and identify a key molecular determinant of IFITM3 S-palmitoylation