Dynapenic Obesity and the Effect on Long-Term Physical Function and Quality of Life: Data from the Osteoarthritis Initiative

Obesity is associated with functional impairment, institutionalization, and increased mortality risk in elders. Dynapenia is defined as reduced muscle strength and is a known independent predictor of adverse events and disability. The synergy between dynapenia and obesity leads to worse outcomes than either independently. We identified the impact of dynapenic obesity in a cohort at risk for and with knee osteoarthritis on function

Contrast-Enhanced Magnetic Resonance Imaging Confirmation of an Anterior Protein Pathway in Normal Rabbit Eyes

Purpose: Contrast-enhanced proton magnetic resonance imaging ( 1H MRI) has been used as a quantitative, noninvasive method to corroborate a pathway for the diffusion of plasma-derived protein into the aqueous humor in the normal rabbit eye. Methods. T1-weighted magnetic resonance images were produced over 1- to 3-hour periods after the intravenous injection of gadolinium diethylenetriamine-pentaacetic acid. Results. Analysis of the images yielded the time dependence of signal enhancements within the areas of interest. The ciliary body showed an immediate sharp increase, followed by a gradual decrease in signal enhancement with time. Although a gradual increase in signal enhancement was found in the anterior chamber, no significant change occurred in the posterior chamber. A similar MRI experiment with an owl monkey produced parallel, though smaller, signal enhancements in the ciliary body and anterior chamber. Again, however, no significant change was found in the posterior chamber. Conclusions. These results support and extend those of recent fluorophotometric, tracer-localization, and modeling studies demonstrating that in the normal rabbit and monkey eye, plasma-derived proteins bypass the posterior chamber, entering the anterior chamber directly via the iris root

The Impact of Waist Circumference on Function and Physical Activity in Older Adults: Longitudinal Observational Data from the Osteoarthritis Initiative

Background: We previously demonstrated that BMI is associated with functional decline and reduced quality of life. While BMI in older adults is fraught with challenges, waist circumference (WC) is a marker of visceral adiposity that can also predict mortality. However, its association with function and quality of life in older adults is not well understood and hence we sought to examine the impact of WC on six-year outcomes. Methods: We identified adults aged ≥60 years from the longitudinal Osteoarthritis Initiative and stratified the cohort into quartiles based on WC. Our primary outcome measures of function at six year follow-up included: self-reported quality of life [Short Form-12 (SF-12)], physical function [Physical Activity Scale for the Elderly (PASE)] and disability [Late-life Disability Index (LLDI)]. Linear regression analyses predicted 6-year outcomes based on WC quartile category (lowest = referent), adjusted for age, sex, race, education, knee pain, smoking status, a modified Charlson co-morbidity index and baseline scores, where available

Ultrafast Dynamics for Electron Photodetachment from Aqueous Hydroxide

Charge-transfer-to-solvent (CTTS) reactions of hydroxide induced by 200 nm monophotonic or 337 nm and 389 nm biphotonic excitation of this anion in aqueous solution have been studied by means of pump-probe ultrafast laser spectroscopy. Transient absorption kinetics of the hydrated electron, eaq-, have been observed, from a few hundred femtoseconds out to 600 ps, and studied as function of hydroxide concentration and temperature. The geminate decay kinetics are bimodal, with a fast exponential component (ca. 13 ps) and a slower power "tail" due to the diffusional escape of the electrons. For the biphotonic excitation, the extrapolated fraction of escaped electrons is 1.8 times higher than for the monophotonic 200 nm excitation (31% vs. 17.5% at 25 oC, respectively), due to the broadening of the electron distribution. The biphotonic electron detachment is very inefficient; the corresponding absorption coefficient at 400 nm is < 4 cm TW-1 M-1 (assuming unity quantum efficiency for the photodetachment). For [OH-] between 10 mM and 10 M, almost no concentration dependence of the time profiles of solvated electron kinetics was observed. At higher temperature, the escape fraction of the electrons increases with a slope of 3x10-3 K-1 and the recombination and diffusion-controlled dissociation of the close pairs become faster. Activation energies of 8.3 and 22.3 kJ/mol for these two processes were obtained. The semianalytical theory of Shushin for diffusion controlled reactions in the central force field was used to model the geminate dynamics. The implications of these results for photoionization of water are discussed.Comment: 44 pages, 9 figures; supplement: 4 pages, 7 figures; to be submitted to J. Chem. Phy

Use of Amulet in behavioral change for geriatric obesity management

Background: Obesity in older adults is a significant public health concern. Weight-loss interventions are known to improve physical function but risk the development of sarcopenia. Mobile health devices have the potential to augment existing interventions and, if designed accordingly, could improve one’s physical activity and strength in routine physical activity interventions. Methods and results: We present Amulet, a mobile health device that has the capability of engaging patients in physical activity. The purpose of this article is to discuss the development of applications that are tailored to older adults with obesity, with the intention to engage and improve their health. Conclusions: Using a team-science approach, Amulet has the potential, as an open-source mobile health device, to tailor activity interventions to older adults

Technology for Behavioral Change in Rural Older Adults with Obesity

Background: Mobile health (mHealth) technologies comprise a multidisciplinary treatment strategy providing potential solutions for overcoming challenges of successfully delivering health promotion interventions in rural areas. We evaluated the potential of using technology in a high-risk population. Methods: We conducted a convergent, parallel mixed-methods study using semi-structured interviews, focus groups, and self-reported questionnaires, using purposive sampling of 29 older adults, 4 community leaders and 7 clinicians in a rural setting. We developed codes informed by thematic analysis and assessed the quantitative data using descriptive statistics. Results: All groups expressed that mHealth could improve health behaviors. Older adults were optimistic that mHealth could track health. Participants believed they could improve patient insight into health, motivating change and assuring accountability. Barriers to using technology were described, including infrastructure. Conclusions: Older rural adults with obesity expressed excitement about the use of mHealth technologies to improve their health, yet barriers to implementation exist

Electron Photodetachment from Aqueous Anions. II. Ionic Strength Effect on Geminate Recombination Dynamics and Quantum Yield for Hydrated Electron

In concentrated solutions of NaClO4 and Na2SO4, the quantum yield for free electron generated by detachment from photoexcited anions (such as I-, OH-, ClO^4-, and [SO3]^2-) linearly decreases by 6-12% per 1 M ionic strength. In 9 M sodium perchlorate solution, this quantum yield decreases by roughly an order of magnitude. Ultrafast kinetic studies of 200 nm photon induced electron detachment from Br-, HO- and [SO3]^2- suggest that the prompt yield of thermalized electron does not change in these solutions; rather, the ionic strength effect originates in more efficient recombination of geminate pairs. Within the framework of the recently proposed mean force potential (MFP) model of charge separation dynamics in such photosystems, the observed changes are interpreted as an increase in the short-range attractive potential between the geminate partners. Association of sodium cation(s) with the electron and the parent anion is suggested as the most likely cause for the observed modification of the MFP. Electron thermalization kinetics suggest that the cation associated with the parent anion (by ion pairing and/or ionic atmosphere interaction) is passed to the detached electron in the course of the photoreaction. The precise atomic-level mechanism for the ionic strength effect is presently unclear; any further advance is likely to require the development of an adequate quantum molecular dynamics model.Comment: 40 pages, 10 figures + supplement 2 pages, 9 figures; will be submitted, in a modified form, to J. Phys. Chem

Telehealth and Mobile Health Applied To IntegratedBehavioral Care: OpportunitiesFor Progress In New Hampshire

This paper is an accompanying document to a webinar delivered on May 16, 2017, for the New Hampshire Citizens Health Initiative (Initiative). As integrated behavioral health efforts in New Hampshire gain traction, clinicians, administrators, payers, and policy makers are looking for additional efficiencies in delivering high quality healthcare. Telehealth and mobile health (mHealth) have the opportunity to help achieve this while delivering a robust, empowered patient experience. The promise of video-based technology was first made in 1964 as Bell Telephone shared its Picturephone® with the world. This was the first device with audio and video delivered in an integrated technology platform. Fast-forward to today with Skype, FaceTime, and webinar tools being ubiquitous in our personal and business lives, but often slow to be adopted in the delivery of medicine. Combining technology-savvy consumers with New Hampshire’s high rate of electronic health record (EHR) technology adoption, a fairly robust telecommunications infrastructure, and a predominately rural setting, there is strong foundation for telehealth and mHealth expansion in New Hampshire’s integrated health continuum

Integrating Behavioral Health & Primary Care in New Hampshire: A Path Forward to Sustainable Practice & Payment Transformation

New Hampshire residents face challenges with behavioral and physical health conditions and the interplay between them. National studies show the costs and the burden of illness from behavioral health conditions and co-occurring chronic health conditions that are not adequately treated in either primary care or behavioral health settings. Bringing primary health and behavioral health care together in integrated care settings can improve outcomes for both behavioral and physical health conditions. Primary care integrated behavioral health works in conjunction with specialty behavioral health providers, expanding capacity, improving access, and jointly managing the care of patients with higher levels of acuity In its work to improve the health of NH residents and create effective and cost-effective systems of care, the NH Citizens Health Initiative (Initiative) created the NH Behavioral Health Integration Learning Collaborative (BHI Learning Collaborative) in November of 2015, as a project of its Accountable Care Learning Network (NHACLN). Bringing together more than 60 organizations, including providers of all types and sizes, all of the state’s community mental health centers, all of the major private and public insurers, and government and other stakeholders, the BHI Learning Collaborative built on earlier work of a NHACLN Workgroup focused on improving care for depression and co-occurring chronic illness. The BHI Learning Collaborative design is based on the core NHACLN philosophy of “shared data and shared learning” and the importance of transparency and open conversation across all stakeholder groups. The first year of the BHI Learning Collaborative programming included shared learning on evidence-based practice for integrated behavioral health in primary care, shared data from the NH Comprehensive Healthcare Information System (NHCHIS), and work to develop sustainable payment models to replace inadequate Fee-for-Service (FFS) revenues. Provider members joined either a Project Implementation Track working on quality improvement projects to improve their levels of integration or a Listen and Learn Track for those just learning about Behavioral Health Integration (BHI). Providers in the Project Implementation Track completed a self-assessment of levels of BHI in their practice settings and committed to submit EHR-based clinical process and outcomes data to track performance on specified measures. All providers received access to unblinded NHACLN Primary Care and Behavioral Health attributed claims data from the NHCHIS for provider organizations in the NH BHI Learning Collaborative. Following up on prior work focused on developing a sustainable model for integrating care for depression and co-occurring chronic illness in primary care settings, the BHI Learning Collaborative engaged consulting experts and participants in understanding challenges in Health Information Technology and Exchange (HIT/HIE), privacy and confidentiality, and workforce adequacy. The BHI Learning Collaborative identified a sustainable payment model for integrated care of depression in primary care. In the process of vetting the payment model, the BHI Learning Collaborative also identified and explored challenges in payment for Substance Use Disorder Screening, Brief Intervention and Referral to Treatment (SBIRT). New Hampshire’s residents will benefit from a health care system where primary care and behavioral health are integrated to support the care of the whole person. New Hampshire’s current opiate epidemic accentuates the need for better screening for behavioral health issues, prevention, and treatment referral integrated into primary care. New Hampshire providers and payers are poised to move towards greater integration of behavioral health and primary care and the Initiative looks forward to continuing to support progress in supporting a path to sustainable integrated behavioral and primary care

Prevalence Rates of Arthritis Among US Older Adults with Varying Degrees of Depression: Findings from the 2011 to 2014 National Health and Nutrition Examination Survey

Arthritis and depressive symptoms often interact and negatively influence one another to worsen mental and physical health outcomes. Better characterization of arthritis rates among older adults with different levels of depressive symptoms is an important step toward informing mental health professionals of the need to detect and respond to arthritis and related mental health complications. The primary objective is to determine arthritis rates among US older adults with varying degrees of depression. Using National Health and Nutrition Examination Survey 2011 to 2014 data (N = 4792), we first identified participants aged ≥50 years. Measures screened for depressive symptoms and self‐reported doctor‐diagnosed arthritis. Weighted logistic regression models were conducted. Prevalence of arthritis was 55.0%, 62.9%, and 67.8% in participants with minor, moderate, and severe depression, respectively. In both unadjusted and adjusted regression models, a significant association between moderate depression and arthritis persisted. There were also significant associations between minor and severe depression with arthritis. Arthritis is commonly reported in participants with varying degrees of depression. This study highlights the importance of screening for and treating arthritis‐related pain in older adults with depressive symptoms and the need for future geriatric psychiatry research on developing integrated biopsychosocial interventions for these common conditions