Assessment and Evaluation of Organized Exercise and Socialization Project on Older Adults

Background and Significance According to Berridge et al. (2020), Covid-19 has created a “double pandemic.” In addition to the virus, significant declines in the physical and mental health of senior community members, the reduction in the management of chronic conditions, and social isolation due to pandemic protocols preventing community members to gather have created a health care crisis. Based on research by Bae et al. (2019) there is evidence that a multicomponent intervention that includes socialization, physical conditioning, and cognitive activities show an improvement in working memory and improved physical conditioning. Problem and Purpose Statement The inability to socially interact during Covid-19 has been reported as being a contributing factor to reduced quality of life, increased depression, and a reduction in physical activity (Lebrasseur et al., 2021). According to Nicholson (2012), social isolation creates a cascade of negative social and physical health outcomes that involve not just loneliness, but declining cognitive function, and frankly, de-conditioning of social abilities. Hanson & Jones (2015) found that walking groups improve older adults\u27 health, quality of life, and compliance with exercise programs. According to Zubala et al. (2017), safe, effective, and inclusive programs that include social support and enjoyable physical activity encourage long-term participation. The purpose of this program is to initiate scheduled socialization events at the clinical site, culminating in a monthly event that combines physical activity and socialization that is within the activity level of the residents to reduce social isolation as well as improve physical conditioning. Methods Using Lewin’s Change Model, the project was organized in a way that would encourage a letting go, or unfreezing, of old patterns followed by a change period (Lewin, 1947). Finally, relearned replacement behavior would be the new normal. The unfreezing portion of our program included several weeks of socialization and involvement of the residents in the planning. The goal was to reduce individual resistance and build community ownership of the event and improve resident cognition. Residents provided feedback that indicates that they are currently in the change phase of the model with feedback that included a desire to replicate the program and make it a regular event. The refreezing process will occur as the community site takes up the mantle and continues to implement social exercise activities. Using a survey, outcomes were measured only once after exposing the group of participants to the intervention. The objective was to evaluate if the residents were negatively or positively affected by the weekly scheduled social time and if they felt that they had benefited from combining social time with physical activity at the once-monthly exercise intervention. The survey was conducted via electronic format (Google Form). Participants were interviewed and answers were entered by hosts of the event. The survey utilized an evidence-based method to assess participants (Davis et al., 2018) and assessed quantitative data regarding completion of the course loop of walking as well as likelihood to participate again using a Likert scale model for quantitative analysis (Polit et al., 2017). Results/Outcomes The project was successfully implemented in a low-income senior housing facility and has provided important post-intervention assessment information for the development of sustainable social exercise programs. Results were measured by a single post-intervention survey. The total number of survey samples taken from participants was 17. In the survey results, 13 participants (81.3%) agreed that they completed the course loop, and 8 participants (47.1%) agreed that the course loop was enough exercise for the day. In terms of promoting social interaction, 9 participants (52.9%) either met at least one resident or interacted with another resident while they are in the course loop. Lastly, 16 participants (94.1%) overall agreed that they would participate in another Wednesday walk in the future. These percentages reveal that majority of participants successfully completed the exercise program while also socializing with other residents. In the post-intervention survey, participant comments and suggestions include “make the walk longer,” “avoid going down the steep path,” “too many germs,” “I like to walk by myself,” “create groups to walk together would be better,” and “announcement was helpful.” This feedback will be considered when planning an additional walk in the future. Limitations Limitations included communication barriers with residents and site management. There were also language barriers that prevented residents from participating in the project. The cold weather was a big factor in the residents not wanting to participate or do additional laps around the walking course. Another limitation was that residents preferred to go to a location away from the clinical site. The nearby park was considered unsafe to have the event due to a large homeless population that had taken over the grounds, so the event occurred on clinical site grounds. After surveying some of the residents who couldn’t join the event, we found that those residents were not joining due to a schedule conflict where they were trying to do errands and were otherwise occupied. Sustainability Almost all necessary project tools were sourced from the community site, except for poster board, markers, and chalk for advertising. The outlined course for the walk remained on the site grounds. All refreshments, tables, and carafes involved in the event were donated by onsite dining facilities. Therefore, all costs associated with the event were under the $30 allocated budget. Due to the low cost, any replication of the event will have minimal fiscal impact on the organizer. According to the post-test survey administered to staff on site, the staff agreed the walk was successful and made an impact on the community. Additionally, an outline of project interventions, methods for data collection, and sourcing of tools were provided to the community site if replication is desired. Advertising and communication with residents regarding the event were done through previously existing methods of communication in the community: monthly newsletter, morning announcements via PA system, event flyers, and large poster boards. The event activity, budget, and location are replicable using the same communication methods already present at the facility, resulting in this to be a highly replicable and sustainable project. Implications for Practice In the rise of the pandemic, isolation was a strategy that was utilized to prevent the transmission of Covid-19. During these unprecedented times, older adults are at risk for social and physical de-conditioning that negatively impacts their health. Our project’s goal was to create an event that targeted improvement in quality of physical health and social wellbeing. The findings from our research suggest a continuation of a socializing event that promotes physical activity for the residents at the community site. Implications for practice include prioritizing communication with management, utilizing on-site resources, and advertising the event to the residents. A liaison interacting directly with management provides a consistent spokesperson for the project with little error for miscommunication between the team. With a maximum budget of$30 for the project, we highly suggest utilizing resources on-site. To welcome residents to our event, we provided refreshments courtesy of on-site dining services. To announce and advertise our events, we utilized an overhead speaker system to deliver information to the residents, courtesy of security services. We had the desire to invite outside volunteers for more community involvement with the event, however due to time restraints and policies in place for Covid-19, we were unable to do so. In the absence of a pandemic, we recommend incorporating additional community members to assist with the event. Per the feedback from staff and residents, it was suggested that we incorporate a scheduled weekly walk with cascading start times for groups to limit the number of walkers on the course. It was also suggested that we create permanent signage for advertisement and to reflect the conditions of the walk for unpredictable weather. Overall, the organization of an event that promotes physical health and social wellbeing is highly recommended for this population. References Bae, S., Lee, S., Lee, S., Jung, S., Makino, K., Harada, K., Harada, K., Shinkai, Y., Chiba, I., & Shimada, H. (2019). The effect of a multicomponent intervention to promote community activity on cognitive function in older adults with mild cognitive impairment: A randomized controlled trial. https://doi.org/10.1016/j.ctim.2018.11.011 Berridge, C., Parsey, C.M., Ramirez, M., Freitag, C., Johnson, I.M., Allard, S.W. (2020). Caring for Washington’s older adults in the COVID-19 pandemic: Interviews with organization leaders about the state of social and healthcare services. Davis, G.C., Baral, R., Strayer, T., Serrano, E.L. (2018). Using pre- and post-survey instruments in interventions: determining the random response benchmark and its implications for measuring effectiveness. Public Health Nutr. (6):1043-1047. https://doi.org/10.1017/S1368980017003639. Epub 2017 Dec 21. PMID: 29262871 Ettehad, D., Emdin, C. A., Kiran, A., Anderson, S. G., Callender, T., Emberson, J., Rahimi, K. (2016). Blood pressure lowering for prevention of cardiovascular disease and death: a systematic review and meta-analysis. The Lancet, 387(10022), 957–967. https://doi.org/10.1016/s0140-6736(15)01225-8 Hanson, S., & Jones, A., (2015). Is there evidence that walking groups have health benefits? A systematic review and meta-analysis. British Journal of Sports Medicine 49(710-715). Lebrasseur, A., Fortin-Bédard, N., Lettre, J., Raymond E, Bussières, E.L., Lapierre, N., Faieta, J., Vincent, C., Duchesne, L., Ouellet, M.C., Gagnon, E., Tourigny, A., Lamontagne, M.È., Routhierm, F. (2021). Impact of the COVID-19 Pandemic on Older Adults: Rapid Review. JMIR Aging. (2). https://doi.org/10.2196/26474. PMID: 33720839; PMCID: PMC8043147 Lee, L. L., Mulvaney, C. A., Wong, Y. K. Y., Chan, E. S., Watson, M. C., & Lin, H. H. (2021). Walking for hypertension. Cochrane Database of Systematic Reviews, 2. https://doi.org/10.1002/14651858.CD008823.pub2 Lewin, K. (1947). Frontiers in group dynamics: Concept, method and reality in social science; equilibrium and social change. Human Relations 1(1): 5–41. Nicholson, N.R. (2012). A review of social isolation: an important but underassessed condition in older adults. J Prim Prev. 33(2–3):137–52. Polit, D. F., Beck, C. T. (2017). Lippincott CoursePoint for Polit’s Essentials of Nursing Research. https://coursepoint.vitalsource.com/reader/books/9781496375612/epubcfi/6/136[%3Bvnd.vst.idref%3Dch010-sec02]!/4/2[main_container]/2/62/1:183[onl%2Cy. Zubala, A., MacGillivray, S., Frost, H., Kroll, T., Skelton, D. A., Gavine, A., Gray, N. M., Toma, M., & Morris, J. (2017). Promotion of physical activity interventions for community dwelling older adults: A systematic review of reviews. PloS one, 12(7), e0180902. https://doi.org/10.1371/journal.pone.018090

Conversion of an intensified fed-batch to an integrated continuous bioprocess

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Migration and Health: A Framework for 21st Century Policy-Making

In the introductory article to a six-part PLoS Medicine series on Migration & Health, series guest editors Cathy Zimmerman, Mazeda Hossain, and Ligia Kiss outline a migratory process framework that involves five phases: pre-departure, travel, destination, interception, and return

Quality control for unfolded proteins at the plasma membrane

A temperature-sensitive chimeric transmembrane protein reveals a mechanism for disposing misfolded proteins that make it to the plasma membrane

A novel formulation of inhaled sodium cromoglicate (PA101) in idiopathic pulmonary fibrosis and chronic cough: a randomised, double-blind, proof-of-concept, phase 2 trial

Background Cough can be a debilitating symptom of idiopathic pulmonary fibrosis (IPF) and is difficult to treat. PA101 is a novel formulation of sodium cromoglicate delivered via a high-efficiency eFlow nebuliser that achieves significantly higher drug deposition in the lung compared with the existing formulations. We aimed to test the efficacy and safety of inhaled PA101 in patients with IPF and chronic cough and, to explore the antitussive mechanism of PA101, patients with chronic idiopathic cough (CIC) were also studied. Methods This pilot, proof-of-concept study consisted of a randomised, double-blind, placebo-controlled trial in patients with IPF and chronic cough and a parallel study of similar design in patients with CIC. Participants with IPF and chronic cough recruited from seven centres in the UK and the Netherlands were randomly assigned (1:1, using a computer-generated randomisation schedule) by site staff to receive PA101 (40 mg) or matching placebo three times a day via oral inhalation for 2 weeks, followed by a 2 week washout, and then crossed over to the other arm. Study participants, investigators, study staff, and the sponsor were masked to group assignment until all participants had completed the study. The primary efficacy endpoint was change from baseline in objective daytime cough frequency (from 24 h acoustic recording, Leicester Cough Monitor). The primary efficacy analysis included all participants who received at least one dose of study drug and had at least one post-baseline efficacy measurement. Safety analysis included all those who took at least one dose of study drug. In the second cohort, participants with CIC were randomly assigned in a study across four centres with similar design and endpoints. The study was registered with ClinicalTrials.gov (NCT02412020) and the EU Clinical Trials Register (EudraCT Number 2014-004025-40) and both cohorts are closed to new participants. Findings Between Feb 13, 2015, and Feb 2, 2016, 24 participants with IPF were randomly assigned to treatment groups. 28 participants with CIC were enrolled during the same period and 27 received study treatment. In patients with IPF, PA101 reduced daytime cough frequency by 31·1% at day 14 compared with placebo; daytime cough frequency decreased from a mean 55 (SD 55) coughs per h at baseline to 39 (29) coughs per h at day 14 following treatment with PA101, versus 51 (37) coughs per h at baseline to 52 (40) cough per h following placebo treatment (ratio of least-squares [LS] means 0·67, 95% CI 0·48–0·94, p=0·0241). By contrast, no treatment benefit for PA101 was observed in the CIC cohort; mean reduction of daytime cough frequency at day 14 for PA101 adjusted for placebo was 6·2% (ratio of LS means 1·27, 0·78–2·06, p=0·31). PA101 was well tolerated in both cohorts. The incidence of adverse events was similar between PA101 and placebo treatments, most adverse events were mild in severity, and no severe adverse events or serious adverse events were reported. Interpretation This study suggests that the mechanism of cough in IPF might be disease specific. Inhaled PA101 could be a treatment option for chronic cough in patients with IPF and warrants further investigation

Measurement and interpretation of same-sign W boson pair production in association with two jets in pp collisions at s = 13 TeV with the ATLAS detector

This paper presents the measurement of fducial and diferential cross sections for both the inclusive and electroweak production of a same-sign W-boson pair in association with two jets (W±W±jj) using 139 fb−1 of proton-proton collision data recorded at a centre-of-mass energy of √s = 13 TeV by the ATLAS detector at the Large Hadron Collider. The analysis is performed by selecting two same-charge leptons, electron or muon, and at least two jets with large invariant mass and a large rapidity diference. The measured fducial cross sections for electroweak and inclusive W±W±jj production are 2.92 ± 0.22 (stat.) ± 0.19 (syst.)fb and 3.38±0.22 (stat.)±0.19 (syst.)fb, respectively, in agreement with Standard Model predictions. The measurements are used to constrain anomalous quartic gauge couplings by extracting 95% confdence level intervals on dimension-8 operators. A search for doubly charged Higgs bosons H±± that are produced in vector-boson fusion processes and decay into a same-sign W boson pair is performed. The largest deviation from the Standard Model occurs for an H±± mass near 450 GeV, with a global signifcance of 2.5 standard deviations

Search for pair production of squarks or gluinos decaying via sleptons or weak bosons in final states with two same-sign or three leptons with the ATLAS detector

A search for pair production of squarks or gluinos decaying via sleptons or weak bosons is reported. The search targets a final state with exactly two leptons with same-sign electric charge or at least three leptons without any charge requirement. The analysed data set corresponds to an integrated luminosity of 139 fb−1 of proton-proton collisions collected at a centre-of-mass energy of 13 TeV with the ATLAS detector at the LHC. Multiple signal regions are defined, targeting several SUSY simplified models yielding the desired final states. A single control region is used to constrain the normalisation of the WZ + jets background. No significant excess of events over the Standard Model expectation is observed. The results are interpreted in the context of several supersymmetric models featuring R-parity conservation or R-parity violation, yielding exclusion limits surpassing those from previous searches. In models considering gluino (squark) pair production, gluino (squark) masses up to 2.2 (1.7) TeV are excluded at 95% confidence level

Studies of new Higgs boson interactions through nonresonant HH production in the b¯bγγ fnal state in pp collisions at √s = 13 TeV with the ATLAS detector

A search for nonresonant Higgs boson pair production in the b ¯bγγ fnal state is performed using 140 fb−1 of proton-proton collisions at a centre-of-mass energy of 13 TeV recorded by the ATLAS detector at the CERN Large Hadron Collider. This analysis supersedes and expands upon the previous nonresonant ATLAS results in this fnal state based on the same data sample. The analysis strategy is optimised to probe anomalous values not only of the Higgs (H) boson self-coupling modifer κλ but also of the quartic HHV V (V = W, Z) coupling modifer κ2V . No signifcant excess above the expected background from Standard Model processes is observed. An observed upper limit µHH < 4.0 is set at 95% confdence level on the Higgs boson pair production cross-section normalised to its Standard Model prediction. The 95% confdence intervals for the coupling modifers are −1.4 < κλ < 6.9 and −0.5 < κ2V < 2.7, assuming all other Higgs boson couplings except the one under study are fxed to the Standard Model predictions. The results are interpreted in the Standard Model efective feld theory and Higgs efective feld theory frameworks in terms of constraints on the couplings of anomalous Higgs boson (self-)interactions

Comparison of inclusive and photon-tagged jet suppression in 5.02 TeV Pb+Pb collisions with ATLAS

Parton energy loss in the quark–gluon plasma (QGP) is studied with a measurement of photon-tagged jet production in 1.7 nb−1 of Pb+Pb data and 260 pb−1 of pp data, both at sNN=5.02 TeV, with the ATLAS detector. The process pp →γ+jet+X and its analogue in Pb+Pb collisions is measured in events containing an isolated photon with transverse momentum (pT) above 50 GeV and reported as a function of jet pT. This selection results in a sample of jets with a steeply falling pT distribution that are mostly initiated by the showering of quarks. The pp and Pb+Pb measurements are used to report the nuclear modification factor, RAA, and the fractional energy loss, Sloss, for photon-tagged jets. In addition, the results are compared with the analogous ones for inclusive jets, which have a significantly smaller quark-initiated fraction. The RAA and Sloss values are found to be significantly different between those for photon-tagged jets and inclusive jets, demonstrating that energy loss in the QGP is sensitive to the colour-charge of the initiating parton. The results are also compared with a variety of theoretical models of colour-charge-dependent energy loss

Combination of searches for heavy spin-1 resonances using 139 fb−1 of proton-proton collision data at s = 13 TeV with the ATLAS detector

A combination of searches for new heavy spin-1 resonances decaying into different pairings of W, Z, or Higgs bosons, as well as directly into leptons or quarks, is presented. The data sample used corresponds to 139 fb−1 of proton-proton collisions at = 13 TeV collected during 2015–2018 with the ATLAS detector at the CERN Large Hadron Collider. Analyses selecting quark pairs (qq, bb, , and tb) or third-generation leptons (τν and ττ) are included in this kind of combination for the first time. A simplified model predicting a spin-1 heavy vector-boson triplet is used. Cross-section limits are set at the 95% confidence level and are compared with predictions for the benchmark model. These limits are also expressed in terms of constraints on couplings of the heavy vector-boson triplet to quarks, leptons, and the Higgs boson. The complementarity of the various analyses increases the sensitivity to new physics, and the resulting constraints are stronger than those from any individual analysis considered. The data exclude a heavy vector-boson triplet with mass below 5.8 TeV in a weakly coupled scenario, below 4.4 TeV in a strongly coupled scenario, and up to 1.5 TeV in the case of production via vector-boson fusion