Emergency and Scheduled Respite Care for Caregivers of Persons with Dementia: A Model

Background: As the population of elderly citizens in the U.S. continues to expand paralleled by an increase in the prevalence of dementia, the role of respite care within the healthcare system will increase in importance. Respite care is defined as providing the primary caregiver with relief, or a reprieve, from care commitments on a short-term or emergency basis. The need for caregiver respite is well-documented; has been shown to decrease emotional stress,burnout, anxiety and depression; and is considered vital to the overall well-being of the caregiver. While studies have shown that respite care is effective, there is an unmet need for more flexibility in existing programs to improve utilization rates and availability. We attempted to address this issue by adapting an existing model to increase respite care options available to caregivers in our region.https://scholarworks.uvm.edu/comphp_gallery/1044/thumbnail.jp

Creating an Online CME Module: Early Detection and Diagnosis of Dementia and Alzheimer’s Disease

Introduction. The number of individuals living with dementia and Alzheimer’s disease (AD) in the United States is growing annually; only 40% are properly diagnosed. Primary care providers should identify individuals with cognitive impairment and provide options for care; early diagnosis of dementia and AD helps patients and families plan for the future, increases quality of life, and allows for treatment options.https://scholarworks.uvm.edu/comphp_gallery/1192/thumbnail.jp

Emergency and Scheduled Respite Care for Caregivers of Persons with Dementia: A Proposed Program

Introduction: Respite care is defined as providing the primary caregiver with relief or a reprieve from care commitments on a short-term or emergency basis. Despite a demonstrated interest in and need for respite care programs, our research has shown that scarce resources exist via a statewide dementia respite program administered by Vermont’s five Area Agencies on Aging. Grants are small and many families do not fall within the eligibility requirements. In FY2010, only 290 families across the state met eligibility requirements (physicians’ diagnosis of dementia, income less than 300% of poverty line, unpaid caregiver, primary residence in VT) and were awarded limited funding for the provision of outside care (up to $750.00 each). For many of these families, this money is typically used to provide substitute care when the primary caregiver is not available. To date, there is no true emergency respite program in place for caregivers. This has placed a strain on families and day facilities, particularly when situations arise in which a caregiver is unable to pick up their family member due to an emergency situation. Our goal was to demonstrate the feasibility of a respite program to address this need.https://scholarworks.uvm.edu/comphp_gallery/1061/thumbnail.jp

Screening for Alzheimer’s Disease in Vermont Primary Care Practice

Introduction: • Alzheimer’s Disease (AD) is a form of progressive dementia that affects 5.3 million Americans and is the sixth leading cause of death in the US. • Age is a major risk factor for disease , and 1 in 8 Americans over 65 can expect to develop AD. • The U.S. healthcare system spends $172 billion/year on patients with AD and dementia, more than half of the Medicare budget. This cost is estimated to increase to over$1 trillion by 2050. • In 2003, the US Preventative Services Task Force (USPSTF) concluded that screening older adults for dementia is ineffective due to insufficient means of preventing or slowing its progression. • In 2011, the National Institute on Aging published new diagnostic criteria for AD. • In accordance with these guidelines the Centers for Medicare and Medicaid Services released rules for the new Annual Wellness Visit that include the detection of cognitive impairment. • Our goal was to identify the attitudes and practices of primary care physicians (PCPs) in Vermont (VT) related to screening for AD and dementia.https://scholarworks.uvm.edu/comphp_gallery/1063/thumbnail.jp

Promoting Screening of Cognitive Impairment and Dementia in Vermont: A proposal for ongoing continuing medical education (CME)

In 2010, 11,382 Vermonters were diagnosed with dementia, many of whom had Alzheimer’s disease (AD). In 2025, an estimated 1 in 8 Vermonters aged 65 or older will have some form of dementia. Reported rates of overlooked dementia are between 35% and 90% or greater. Clinical presentations of dementia are often insidious and attributed to aging, making an accurate diagnosis difficult. Because of the challenges of dementia screening and diagnosis, primary care physicians (PCPs) are often unwilling to diagnose, discuss, and treat dementia due to AD.3 Although physicians are reluctant to screen for dementia, research in Vermont (VT) has shown a clear preference by patients and their families for earlier diagnosis. A timely diagnosis allows the patient and their family to plan for the future and start treatment earlier. Our research demonstrated PCPs may be misinformed about the usefulness and implications of dementia screening and diagnosis. In an effort to further educate physicians, we propose instituting a mandatory continuing medical education (CME) hour focused on screening for dementia. Our project surveyed 72 physicians to determine their attitudes towards screening, the assessment tools they use, and their attitudes towards a required CME hour.https://scholarworks.uvm.edu/comphp_gallery/1079/thumbnail.jp

Money Follows the Person: Transitioning Nursing Home Residents into the Community

Introduction. Research has shown that admission to nursing homes (NH) is associated with decline in several measures of well-being; transitioning out of a NH into the community is a positive predictor for quality of life. Currently, the State of Vermont offers several housing options for Medicaid eligible NH residents; however, there are very few opportunities to fully integrate into the communityhttps://scholarworks.uvm.edu/comphp_gallery/1090/thumbnail.jp

Evaluating Research and Impact: A Bibliometric Analysis of Research by the NIH/NIAID HIV/AIDS Clinical Trials Networks

Evaluative bibliometrics uses advanced techniques to assess the impact of scholarly work in the context of other scientific work and usually compares the relative scientific contributions of research groups or institutions. Using publications from the National Institute of Allergy and Infectious Diseases (NIAID) HIV/AIDS extramural clinical trials networks, we assessed the presence, performance, and impact of papers published in 2006–2008. Through this approach, we sought to expand traditional bibliometric analyses beyond citation counts to include normative comparisons across journals and fields, visualization of co-authorship across the networks, and assess the inclusion of publications in reviews and syntheses. Specifically, we examined the research output of the networks in terms of the a) presence of papers in the scientific journal hierarchy ranked on the basis of journal influence measures, b) performance of publications on traditional bibliometric measures, and c) impact of publications in comparisons with similar publications worldwide, adjusted for journals and fields. We also examined collaboration and interdisciplinarity across the initiative, through network analysis and modeling of co-authorship patterns. Finally, we explored the uptake of network produced publications in research reviews and syntheses. Overall, the results suggest the networks are producing highly recognized work, engaging in extensive interdisciplinary collaborations, and having an impact across several areas of HIV-related science. The strengths and limitations of the approach for evaluation and monitoring research initiatives are discussed

The neutron and its role in cosmology and particle physics

Experiments with cold and ultracold neutrons have reached a level of precision such that problems far beyond the scale of the present Standard Model of particle physics become accessible to experimental investigation. Due to the close links between particle physics and cosmology, these studies also permit a deep look into the very first instances of our universe. First addressed in this article, both in theory and experiment, is the problem of baryogenesis ... The question how baryogenesis could have happened is open to experimental tests, and it turns out that this problem can be curbed by the very stringent limits on an electric dipole moment of the neutron, a quantity that also has deep implications for particle physics. Then we discuss the recent spectacular observation of neutron quantization in the earth's gravitational field and of resonance transitions between such gravitational energy states. These measurements, together with new evaluations of neutron scattering data, set new constraints on deviations from Newton's gravitational law at the picometer scale. Such deviations are predicted in modern theories with extra-dimensions that propose unification of the Planck scale with the scale of the Standard Model ... Another main topic is the weak-interaction parameters in various fields of physics and astrophysics that must all be derived from measured neutron decay data. Up to now, about 10 different neutron decay observables have been measured, much more than needed in the electroweak Standard Model. This allows various precise tests for new physics beyond the Standard Model, competing with or surpassing similar tests at high-energy. The review ends with a discussion of neutron and nuclear data required in the synthesis of the elements during the "first three minutes" and later on in stellar nucleosynthesis.Comment: 91 pages, 30 figures, accepted by Reviews of Modern Physic

Genetic mechanisms of critical illness in COVID-19.

Host-mediated lung inflammation is present1, and drives mortality2, in the critical illness caused by coronavirus disease 2019 (COVID-19). Host genetic variants associated with critical illness may identify mechanistic targets for therapeutic development3. Here we report the results of the GenOMICC (Genetics Of Mortality In Critical Care) genome-wide association study in 2,244 critically ill patients with COVID-19 from 208 UK intensive care units. We have identified and replicated the following new genome-wide significant associations: on chromosome 12q24.13 (rs10735079, P = 1.65 × 10-8) in a gene cluster that encodes antiviral restriction enzyme activators (OAS1, OAS2 and OAS3); on chromosome 19p13.2 (rs74956615, P = 2.3 × 10-8) near the gene that encodes tyrosine kinase 2 (TYK2); on chromosome 19p13.3 (rs2109069, P = 3.98 ×  10-12) within the gene that encodes dipeptidyl peptidase 9 (DPP9); and on chromosome 21q22.1 (rs2236757, P = 4.99 × 10-8) in the interferon receptor gene IFNAR2. We identified potential targets for repurposing of licensed medications: using Mendelian randomization, we found evidence that low expression of IFNAR2, or high expression of TYK2, are associated with life-threatening disease; and transcriptome-wide association in lung tissue revealed that high expression of the monocyte-macrophage chemotactic receptor CCR2 is associated with severe COVID-19. Our results identify robust genetic signals relating to key host antiviral defence mechanisms and mediators of inflammatory organ damage in COVID-19. Both mechanisms may be amenable to targeted treatment with existing drugs. However, large-scale randomized clinical trials will be essential before any change to clinical practice

Multiorgan MRI findings after hospitalisation with COVID-19 in the UK (C-MORE): a prospective, multicentre, observational cohort study

Introduction: The multiorgan impact of moderate to severe coronavirus infections in the post-acute phase is still poorly understood. We aimed to evaluate the excess burden of multiorgan abnormalities after hospitalisation with COVID-19, evaluate their determinants, and explore associations with patient-related outcome measures. Methods: In a prospective, UK-wide, multicentre MRI follow-up study (C-MORE), adults (aged ≥18 years) discharged from hospital following COVID-19 who were included in Tier 2 of the Post-hospitalisation COVID-19 study (PHOSP-COVID) and contemporary controls with no evidence of previous COVID-19 (SARS-CoV-2 nucleocapsid antibody negative) underwent multiorgan MRI (lungs, heart, brain, liver, and kidneys) with quantitative and qualitative assessment of images and clinical adjudication when relevant. Individuals with end-stage renal failure or contraindications to MRI were excluded. Participants also underwent detailed recording of symptoms, and physiological and biochemical tests. The primary outcome was the excess burden of multiorgan abnormalities (two or more organs) relative to controls, with further adjustments for potential confounders. The C-MORE study is ongoing and is registered with ClinicalTrials.gov, NCT04510025. Findings: Of 2710 participants in Tier 2 of PHOSP-COVID, 531 were recruited across 13 UK-wide C-MORE sites. After exclusions, 259 C-MORE patients (mean age 57 years [SD 12]; 158 [61%] male and 101 [39%] female) who were discharged from hospital with PCR-confirmed or clinically diagnosed COVID-19 between March 1, 2020, and Nov 1, 2021, and 52 non-COVID-19 controls from the community (mean age 49 years [SD 14]; 30 [58%] male and 22 [42%] female) were included in the analysis. Patients were assessed at a median of 5·0 months (IQR 4·2–6·3) after hospital discharge. Compared with non-COVID-19 controls, patients were older, living with more obesity, and had more comorbidities. Multiorgan abnormalities on MRI were more frequent in patients than in controls (157 [61%] of 259 vs 14 [27%] of 52; p<0·0001) and independently associated with COVID-19 status (odds ratio [OR] 2·9 [95% CI 1·5–5·8]; padjusted=0·0023) after adjusting for relevant confounders. Compared with controls, patients were more likely to have MRI evidence of lung abnormalities (p=0·0001; parenchymal abnormalities), brain abnormalities (p<0·0001; more white matter hyperintensities and regional brain volume reduction), and kidney abnormalities (p=0·014; lower medullary T1 and loss of corticomedullary differentiation), whereas cardiac and liver MRI abnormalities were similar between patients and controls. Patients with multiorgan abnormalities were older (difference in mean age 7 years [95% CI 4–10]; mean age of 59·8 years [SD 11·7] with multiorgan abnormalities vs mean age of 52·8 years [11·9] without multiorgan abnormalities; p<0·0001), more likely to have three or more comorbidities (OR 2·47 [1·32–4·82]; padjusted=0·0059), and more likely to have a more severe acute infection (acute CRP >5mg/L, OR 3·55 [1·23–11·88]; padjusted=0·025) than those without multiorgan abnormalities. Presence of lung MRI abnormalities was associated with a two-fold higher risk of chest tightness, and multiorgan MRI abnormalities were associated with severe and very severe persistent physical and mental health impairment (PHOSP-COVID symptom clusters) after hospitalisation. Interpretation: After hospitalisation for COVID-19, people are at risk of multiorgan abnormalities in the medium term. Our findings emphasise the need for proactive multidisciplinary care pathways, with the potential for imaging to guide surveillance frequency and therapeutic stratification