Medical and Social Transformations in an Aging World

How do we know and live old age today? What does it mean to be old in a time of the promise of high-tech medical interventions?  Anthropologists and sociologists address the phenomenon of growing old both as experienced by individuals and their families and by the ways in which older lives are embedded in social, historical and political contexts. In recent decades a multitude of factors ensure that the very ideas of ‘aging’ and ‘health’ in late life are being transformed.  As a result many social scientists have turned their attention to global developments in the spread of biomedical knowledge, the impacts of high-tech interventions on the practice of medicine in an aging world and shifting societal expectations about longevity.  

Ordinary medicine

Medicine in the twenty-first century is constituted and propelled by the production of evidence. Once produced, the use of that evidence is complicated by features inherent in the American and global biomedical economy itself. With the exponential rise in the use of cardiac devices as my case study, this think piece traces the links among evidence-based medicine, insurance reimbursement policies, and clinical trial outcomes to reveal how evidence produced by trial findings creates treatment standards. Those standards, in turn, expand what is thought to be ‘treatable’ by reconceptualizing risk as a condition that deserves intervention. Such standards affect what physicians recommend and what patients decide to do. The essay emphasizes that evidence-based medicine can be a source of anxiety that patients and families feel when considering how to proceed. It highlights the debates, increasingly common both within and beyond the health professions, about what is actually best as we grow older. It provides an example of how, today, most deaths, even among the very old, are considered premature. In an aging society, the treatment protocols that fall under the evidence-based medicine umbrella constitute an enormous truth-making regime that determines the goals of medicine and shapes health care consumers’ quandaries about medical intervention, and especially the quandary, for those in later life, about crossing the line of too much treatment

REACH-ing for Our Dreams!

More than half a decade ago, several individuals and agency and organization representatives decided it was time to act upon the belief that conservation and the environment in Iowa needed a more generous and reliable funding source. Representatives of two dozen agencies and organizations, coordinated by the Iowa Natural Heritage Foundation, worked with several key legislators to draft the Resource Enhancement and Protection (REAP) program. The program itself passed the Iowa House and Senate unanimously and, after a little haggling over funding, was signed by Governor Branstad in May 1989

Making longevity in an aging society: Linking technology, policy and ethics

An explosion in the varieties of life-extending medical interventions for older persons is The U.S. and European populations are aging, and trends in health care delivery to older individuals are both a source and consequence of that demographic development. In the context of the growing use of potentially life-extending interventions, even for the very old and those near death, two questions emerge: How do we know and 'live' old age today? What does it mean to be old in a time of high-tech medical interventions? This essay illustrates the socio-medical-ethical pressures for clinical interventions in U.S. society, in which prevention of death is a highly valued social good. An explosion in the varieties of life-extending interventions for older persons is re-shaping medical knowledge and societal expectations about 'normal' old age, longevity and the time for death, perhaps especially in the U.S. There is no doubt tha

Retrain Your Brain: A Systematic Review of Functional Electrical Stimulation’s Effect on ADL Participation Post-Stroke

Primary Focus: Rehab, Disability & Participation Learning Objectives: Learning Objectives: ● Describe the impact of stroke on ADL performance ● Identify the role of OT in stroke rehabilitation ● Explain how Functional Electrical Stimulation (FES) falls within the scope of OT practice ● Interpret the current evidence on how FES influences ADL participation for individuals poststroke Abstract: Stroke is one of the leading causes of long term disability in the United States (Centers for Disease Control and Prevention, 2015). According to HartmanMaeir, Soroker, Ring, Avni, and Katz (2007), 57% of stroke survivors will eventually discontinue their meaningful activities, including activities of daily living (ADLs). Lack of independence in ADLs has a negative psychosocial impact (Kitson, Dow, Calabrese, Locock, & Athlin, 2012), contributes to decreased quality of life, and increased caregiver burden (Rigby, Gubitz, & Phillips, 2009). In this presentation, practitioners will be exposed to the current literature that examines the efficacy of Functional Electrical Stimulation (FES) as an intervention within the scope of occupational therapy practice to improve participation in ADLs in adults with stroke. A systematic review of the literature was conducted by searching PubMed, CINAHL, and Scopus databases. After abstract screening and fulltext rescreening, 13 articles met the inclusion criteria: participants were adults with stroke, the intervention involved electrical stimulation concurrent with a functional task, and ADL performance as an outcome measure. Articles were critically appraised using the Law McDermid Quantitative Review Form and examined for level of evidence. After critical appraisal, 3 themes were evident: FES + additional therapy, location of FES intervention, and frequency of FES intervention. While control groups that received standard therapy demonstrated improvements in ADL performance, treatment groups receiving FES in addition to standard therapy had significantly better ADL performance than control groups (You et al., 2014, Tanovic, 2009, & Tan et al., 2014). Treatments that took place within a clinic demonstrated significantly improved ADL performance (Kowalczewski et al., 2007; Tan et al., 2014; Tanovic, 2009; & You et al., 2014) while homebased treatments did not. Lastly, the only studies that demonstrated a statistically significant improvement in ADL performance consisted of FES conducted 5 or more days a week (Kowalczewski et al., 2007; Tan et al., 2014; Tanovic, 2009; & You et al., 2014). In this session, practitioners will learn how FES can be used in stroke rehabilitation and will apply this insight to guide best practice for clients who have sustained a stroke. Practitioners will understand how setting, frequency and additional therapy influence efficacy of FES for improving ADL participation. Level of material being presented: Introductory Target Audience: OT, OTA, OTS, Researcher References Centers for Disease Control and Prevention. (2015). Stroke Facts. Retrieved from http://www.cdc.gov/stroke/facts.htm Hartman-Maeir, A., Soroker, N., Ring, H., Avni, N., & Katz, N. (2007). Activities, participation and satisfaction oneyear post stroke. Disability and Rehabilitation, 29, 559–566. http://dx.doi.org/10.1080/09638280600924996 Kitson, A. L., Dow, C., Calabrese, J. D., Locock, L., & Athlin, Å. M. (2013). Stroke survivors’ experiences of the fundamentals of care: A qualitative analysis. International journal of nursing studies, 50(3), 392403[ Ma1] . Kowalczewski, J., Gritsenko, V., Ashworth, N., Ellaway, P., & Prochazka, A. (2007). Upperextremity functional electric stimulation–assisted exercises on a workstation in the subacute phase of stroke recovery. Archives of physical medicine and rehabilitation, 88(7), 833839. Rigby, H., Gubitz, G., & Phillips, S. (2009). A systematic review of caregiver burden following stroke. International Journal of Stroke, 4(4), 285292. doi: 10.1111/j.17474949.2009.00289. x Quandt, F., & Hummel, F. C. (2014). The influence of functional electrical stimulation on hand motor recover y i n stroke patients: a review. E xperimental & translational stroke medicine, 6(1), Tan, Z., Liu, H., Yan, T., Jin, D., He, X., Zheng, X., et al. (2014). The effectiveness of functional electrical stimulation based on a normal gait pattern on subjects with early stroke: A randomized controlled trial. BioMed Research International, 2014 doi:10.1155/2014/545408 Tanovic, E. (2009). Effects of functional electrical stimulation in rehabilitation with hemiparesis patients. Bosnian Journal of Basic Medical Sciences / Udruzenje Basicnih Mediciniskih Znanosti = Association of Basic Medical Sciences, 9(1), 4953. You, G., Liang, H., & Yan, T. (2014). Functional electrical stimulation early after stroke improves lower limb motor function and ability in activities of daily living. Neurorehabilitation, 35(3), 381389. doi:10.3233/NRE141129 [doi] Presentation: 38:5

Prenatal Organochlorine Exposure and Measures of Behavior in Infancy Using the Neonatal Behavioral Assessment Scale (NBAS)

Background: Previous literature suggests an association between organochlorines and behavioral measures in childhood, including inattention. Objective: This study was designed to assess whether prenatal organochlorine exposure is associated with measures of attention in early infancy. Methods: We investigated an association between cord serum polychlorinated biphenyls (PCBs) and p,p′-dichlorodiphenyl dichloroethene (DDE) levels and measures of attention from the Neonatal Behavioral Assessment Scale (NBAS) in a cohort of 788 infants born 1993–1998 to mothers residing near a PCB-contaminated harbor and Superfund site in New Bedford, Massachusetts. Results: Medians (ranges) for the sum of four prevalent PCB congeners and DDE levels were 0.19 (0.01–4.41) and 0.30 (0–10.29) ng/g serum, respectively. For the 542 subjects with an NBAS exam at 2 weeks, we observed consistent inverse associations between cord serum PCB and DDE levels and NBAS measures of alertness, quality of alert responsiveness, cost of attention, and other potential attention-associated measures including self-quieting and motor maturity. For example, the decrement in quality of alert responsiveness score was −0.51 (95% confidence interval, −0.99 to −0.03) for the highest quartile of exposure to the sum of four prevalent PCB congeners compared with the lowest quartile. We found little evidence for an association with infant orientation, habituation, and regulation of state, assessed as summary cluster measures. Conclusions: Our findings provide evidence for an association between low-level prenatal PCB and DDE exposures and poor attention in early infancy. Further analyses will focus on whether organochlorine-associated decrements in attention and attention-related skills in infancy persist in later childhood

MetaBAT, an efficient tool for accurately reconstructing single genomes from complex microbial communities

Grouping large genomic fragments assembled from shotgun metagenomic sequences to deconvolute complex microbial communities, or metagenome binning, enables the study of individual organisms and their interactions. Because of the complex nature of these communities, existing metagenome binning methods often miss a large number of microbial species. In addition, most of the tools are not scalable to large datasets. Here we introduce automated software called MetaBAT that integrates empirical probabilistic distances of genome abundance and tetranucleotide frequency for accurate metagenome binning. MetaBAT outperforms alternative methods in accuracy and computational efficiency on both synthetic and real metagenome datasets. It automatically forms hundreds of high quality genome bins on a very large assembly consisting millions of contigs in a matter of hours on a single node. MetaBAT is open source software and available at https://bitbucket.org/berkeleylab/metabat

Skin Bleaching Among African and Afro-Caribbean Women in New York City: Primary Findings from a P30 Pilot Study

© 2019 by the authors. Licensee MDPI, Basel, Switzerland. Coinciding with the increase in sequenced bacteria, mining of bacterial genomes for biosynthetic gene clusters (BGCs) has become a critical component of natural product discovery. The order Myxococcales, a reputable source of biologically active secondary metabolites, spans three suborders which all include natural product producing representatives. Utilizing the BiG-SCAPE-CORASON platform to generate a sequence similarity network that contains 994 BGCs from 36 sequenced myxobacteria deposited in the antiSMASH database, a total of 843 BGCs with lower than 75% similarity scores to characterized clusters within the MIBiG database are presented. This survey provides the biosynthetic diversity of these BGCs and an assessment of the predicted chemical space yet to be discovered. Considering the mere snapshot of myxobacteria included in this analysis, these untapped BGCs exemplify the potential for natural product discovery from myxobacteria