Recruitment and Retention of Older People in Clinical Research: A Systematic Literature Review

OBJECTIVE: To identify barriers and solutions for the recruitment and retention of older (aged ≥65 years) people in clinical trials. DESIGN: Systematic literature review. METHODS: Three databases (Medline, Embase, and CENTRAL) were searched for articles reporting on barriers or solutions regarding the recruitment or retention of older people. Only original research articles were included. RESULTS: Fifty eligible articles were identified. Exclusion criteria were the most common cause of poor recruitment of older adults (mainly age and comorbidities). Patients' families or physicians often advised against participation (22% of included studies). Lack of interest (18%) and problems with transportation (18%) were also commonly cited as challenges. Fourteen trials (28%) reported that monitoring and adapting their recruitment methods helped, along with a flexible research team (26%) and provision of transportation (24%). Retention was impaired by death (12%), illness (8%), and loss of interest (6%). Methods with a positive effect on retention included financial incentives and regular information about the progress of the study (12%), a low staff turnover (12%), flexibility in appointment making (10%), and expression of appreciation by the staff through letters, gifts, and cards to the participants (10%). CONCLUSION: We identified several barriers and have listed potential solutions that may improve recruitment and lead to fewer dropouts in trials involving older populations. Implementation of our findings may help mitigate the manifold challenges that come with running a trial with older people

Talking with tact: Polite language as a balance between kindness and informativity

Conveying information in a false or indirect manner in consid-eration of listeners’ wants (i.e. being polite) seemingly contra-dicts an important goal of a cooperative speaker: informationtransfer. We propose that a cooperative speaker considers bothepistemic utility, or utility of providing the listener new and ac-curate information, and social utility, or utility of maintainingor boosting the listener’s self-image (being polite). We for-malize this tradeoff within a probabilistic model of languageunderstanding and test it with empirical data on people’s infer-ences about the relation between a speaker’s goals, utterancesand the true states of the world

Early childhood lung function is a stronger predictor of adolescent lung function in cystic fibrosis than early Pseudomonas aeruginosa infection

Pseudomonas aeruginosa has been suggested as a major determinant of poor pulmonary outcomes in cystic fibrosis (CF), although other factors play a role. Our objective was to investigate the association of early childhood Pseudomonas infection on differences in lung function in adolescence with CF

Ad-hoc implicature in preschool children

Abstract If a speaker tells us that "some guests were late to the party," we typically infer that not all were. Implicatures, in which an ambiguous statement ("some and possibly all") is strengthened pragmatically (to "some and not all"), are a paradigm case of pragmatic reasoning. Inferences of this sort are difficult for young children, but recent work suggests that this mismatch may stem from issues in understanding the relationship between lexical items like "some" and "all," rather than broader pragmatic deficits. We tested children's ability to make non-quantificational pragmatic inferences by constructing contextually-derived "ad-hoc" implicatures, using sets of pictures with contrasting features. We found that four-year-olds and some three-year-olds were able to make implicatures successfully using these displays. Hence, apparent failures in scalar implicature are likely due to difficulties specific to the constructions and tasks used in previous work; these difficulties may have masked aspects of children's underlying pragmatic competence

From partners to populations:A hierarchical Bayesian account of coordination and convention

Languages are powerful solutions to coordination problems: they provide stable, shared expectations about how the words we say correspond to the beliefs and intentions in our heads. Yet language use in a variable and non-stationary social environment requires linguistic representations to be flexible: old words acquire new ad hoc or partner-specific meanings on the fly. In this paper, we introduce CHAI (Continual Hierarchical Adaptation through Inference), a hierarchical Bayesian theory of coordination and convention formation that aims to reconcile the long-standing tension between these two basic observations. We argue that the central computational problem of communication is not simply transmission, as in classical formulations, but continual learning and adaptation over multiple timescales. Partner-specific common ground quickly emerges from social inferences within dyadic interactions, while community-wide social conventions are stable priors that have been abstracted away from interactions with multiple partners. We present new empirical data alongside simulations showing how our model provides a computational foundation for several phenomena that have posed a challenge for previous accounts: (1) the convergence to more efficient referring expressions across repeated interaction with the same partner, (2) the gradual transfer of partner-specific common ground to strangers, and (3) the influence of communicative context on which conventions eventually form.Comment: In press at Psychological Revie

Evaluation of a Graphical Anesthesia Drug Display for Space Travel

As the frequency and duration of space travel increase, the potential need for emergency medical care in space grows, and with it the need for patient monitoring devices supporting therapeutic treatment. Providing emergency care to an injured astronaut may necessitate immediate surgery. During such events, the timely administration of anesthetic agents will need to be performed by someone who is not a formally trained anesthesiologist. The availability of usable real-time displays of intravenous anesthetic concentrations and effects could significantly enhance intraoperative clinical decision-making both in space and on earth. The effectiveness of the real-time anesthesia display on the management of total intravenous anesthesia was determined by 31 anesthesiologists participating in a simulation study. In the presence of the anesthesia drug display, clinicians maintained physiologic indicators such as blood pressure and heart rate closer to baseline levels. Participants also reported an increase in perceived performance when using the drug display. The results indicate that surgeries on earth and in orbit would benefit from the implementation of this display

Pulmonary Metaphor Design and Anesthesia Simulation Testing

Medical decision making is a crucial process to successfully treat a critical medical emergency. During an unexpected medical event, astronauts, like anesthesiologists, must react quickly in a complex environment. Tools, such as the pulmonary metaphor display, were created to aid the medical caregiver\u27s decision making process. The pulmonary metaphor display is designed to help the caregiver collect and integrate pulmonary data to provide a more accurate, quicker diagnosis and treatment. The following outline anesthesiology simulation study will provide the data to prove that the pulmonary metaphor display is beneficial to medical decision making

Neuroimaging Correlates of Suicidality in Decision-Making Circuits in Posttraumatic Stress Disorder

In depression, brain and behavioral correlates of decision-making differ between individuals with and without suicidal thoughts and behaviors. Though promising, it remains unknown if these potential biomarkers of suicidality will generalize to other high-risk clinical populations. To preliminarily assess whether brain structure or function tracked suicidality in individuals with posttraumatic stress disorder (PTSD), we measured resting-state functional connectivity and cortical thickness in two functional networks involved in decision-making, a ventral fronto-striatal reward network and a lateral frontal cognitive control network. Neuroimaging data and self-reported suicidality ratings, and suicide-related hospitalization data were obtained from 50 outpatients with PTSD and also from 15 healthy controls, and all were subjected to seed-based resting-state functional connectivity and cortical thickness analyses using a priori seeds from reward and cognitive control networks. First, general linear models (GLM) were used to evaluate whether ROI-to-ROI functional connectivity was predictive of self-reported suicidality after false discovery rate (FDR)-correction for multiple comparisons and covariance of age and depression symptoms. Next, regional cortical thickness statistics were included as predictors of ROI-to-ROI functional connectivity in follow-up GLMs evaluating structure-function relationships. Functional connectivity between reward regions was positively correlated with suicidality (p-FDR ≤ 0.05). Functional connectivity of the lateral pars orbitalis to anterior cingulate/paracingulate control regions also tracked suicidality (p-FDR ≤ 0.05). Furthermore, cortical thickness in anterior cingulate/paracingulate was associated with functional correlates of suicidality in the control network (p-FDR < 0.05). These results provide a preliminary demonstration that biomarkers of suicidality in decision-making networks observed in depression may generalize to PTSD and highlight the promise of these circuits as transdiagnostic biomarkers of suicidality

Cyclotomic integers, fusion categories, and subfactors

Dimensions of objects in fusion categories are cyclotomic integers, hence number theoretic results have implications in the study of fusion categories and finite depth subfactors. We give two such applications. The first application is determining a complete list of numbers in the interval (2, 76/33) which can occur as the Frobenius-Perron dimension of an object in a fusion category. The smallest number on this list is realized in a new fusion category which is constructed in the appendix written by V. Ostrik, while the others are all realized by known examples. The second application proves that in any family of graphs obtained by adding a 2-valent tree to a fixed graph, either only finitely many graphs are principal graphs of subfactors or the family consists of the A_n or D_n Dynkin diagrams. This result is effective, and we apply it to several families arising in the classification of subfactors of index less then 5.Comment: 47 pages, with an appendix by Victor Ostri