Recommendations for meeting the mobility needs of older adults in rural Michigan

The populations of the United States (US) and Michigan are aging. This demographic trend will continue to have a significant impact on society for the next few decades, particularly in the area of safe mobility in rural areas. As the population of Michigan’s rural older adults continues to grow, it is becoming increasingly crucial that the Michigan Department of Transportation (MDOT) understand the mobility needs and issues of rural older adults, including the issues faced by Indian Tribes in rural Michigan, and be proactive in addressing these needs and issues in their activities. This project provides the background and suggestions to help MDOT identify areas where they significantly impact the safe mobility of Michigan’s rural older adults. The overall goal of the project is to help maintain the safety and well-being of Michigan’s rural older adult residents by providing recommendations on how current alternative transportation services could be improved to be more attractive to older adults while addressing cultural and psychological barriers to using these services. This goal was achieved through a literature review, an analysis of demographic data, a statewide survey of older adults living in six rural counties of Michigan, structured interviews with public and community transportation providers, and group discussions with representatives of three Indian Tribes located in rural Michigan. The complete results of these research activities, a list of recommendations for improving rural older adult mobility in Michigan, and an implementation plan are included in this report.Michigan Department of Transportationhttp://deepblue.lib.umich.edu/bitstream/2027.42/95709/1/102924.pd

The genetic architecture of the human cerebral cortex

The cerebral cortex underlies our complex cognitive capabilities, yet little is known about the specific genetic loci that influence human cortical structure. To identify genetic variants that affect cortical structure, we conducted a genome-wide association meta-analysis of brain magnetic resonance imaging data from 51,665 individuals. We analyzed the surface area and average thickness of the whole cortex and 34 regions with known functional specializations. We identified 199 significant loci and found significant enrichment for loci influencing total surface area within regulatory elements that are active during prenatal cortical development, supporting the radial unit hypothesis. Loci that affect regional surface area cluster near genes in Wnt signaling pathways, which influence progenitor expansion and areal identity. Variation in cortical structure is genetically correlated with cognitive function, Parkinson's disease, insomnia, depression, neuroticism, and attention deficit hyperactivity disorder

Albiglutide and cardiovascular outcomes in patients with type 2 diabetes and cardiovascular disease (Harmony Outcomes): a double-blind, randomised placebo-controlled trial

Background: Glucagon-like peptide 1 receptor agonists differ in chemical structure, duration of action, and in their effects on clinical outcomes. The cardiovascular effects of once-weekly albiglutide in type 2 diabetes are unknown. We aimed to determine the safety and efficacy of albiglutide in preventing cardiovascular death, myocardial infarction, or stroke. Methods: We did a double-blind, randomised, placebo-controlled trial in 610 sites across 28 countries. We randomly assigned patients aged 40 years and older with type 2 diabetes and cardiovascular disease (at a 1:1 ratio) to groups that either received a subcutaneous injection of albiglutide (30–50 mg, based on glycaemic response and tolerability) or of a matched volume of placebo once a week, in addition to their standard care. Investigators used an interactive voice or web response system to obtain treatment assignment, and patients and all study investigators were masked to their treatment allocation. We hypothesised that albiglutide would be non-inferior to placebo for the primary outcome of the first occurrence of cardiovascular death, myocardial infarction, or stroke, which was assessed in the intention-to-treat population. If non-inferiority was confirmed by an upper limit of the 95% CI for a hazard ratio of less than 1·30, closed testing for superiority was prespecified. This study is registered with ClinicalTrials.gov, number NCT02465515. Findings: Patients were screened between July 1, 2015, and Nov 24, 2016. 10 793 patients were screened and 9463 participants were enrolled and randomly assigned to groups: 4731 patients were assigned to receive albiglutide and 4732 patients to receive placebo. On Nov 8, 2017, it was determined that 611 primary endpoints and a median follow-up of at least 1·5 years had accrued, and participants returned for a final visit and discontinuation from study treatment; the last patient visit was on March 12, 2018. These 9463 patients, the intention-to-treat population, were evaluated for a median duration of 1·6 years and were assessed for the primary outcome. The primary composite outcome occurred in 338 (7%) of 4731 patients at an incidence rate of 4·6 events per 100 person-years in the albiglutide group and in 428 (9%) of 4732 patients at an incidence rate of 5·9 events per 100 person-years in the placebo group (hazard ratio 0·78, 95% CI 0·68–0·90), which indicated that albiglutide was superior to placebo (p<0·0001 for non-inferiority; p=0·0006 for superiority). The incidence of acute pancreatitis (ten patients in the albiglutide group and seven patients in the placebo group), pancreatic cancer (six patients in the albiglutide group and five patients in the placebo group), medullary thyroid carcinoma (zero patients in both groups), and other serious adverse events did not differ between the two groups. There were three (<1%) deaths in the placebo group that were assessed by investigators, who were masked to study drug assignment, to be treatment-related and two (<1%) deaths in the albiglutide group. Interpretation: In patients with type 2 diabetes and cardiovascular disease, albiglutide was superior to placebo with respect to major adverse cardiovascular events. Evidence-based glucagon-like peptide 1 receptor agonists should therefore be considered as part of a comprehensive strategy to reduce the risk of cardiovascular events in patients with type 2 diabetes. Funding: GlaxoSmithKline

Applying systems thinking to improve the safety of work-related drivers : A systematic review of the literature

Introduction: Light vehicles (<4.5 tons) driven for work purposes represent a significant proportion of the registered motor vehicles on our roads. Drivers of these vehicles have significant exposure to the dangers of the road transport environment. To optimize safety for these workers, it is critical to understand the factors contributing to risk of being involved in an incident. This information can then be used to inform the review and revision of existing risk controls and the development of targeted prevention activities. Method: The aim of the study was to undertake a systematic review of the literature to identify the factors associated with work-related driving incidents. The factors identified in the review were represented within an adapted version of Rasmussen's risk management framework (Rasmussen, 1997). Fifty studies were analyzed following data screening and review of full text. The highest proportion of risk factors were categorized at the lower levels of the system, including the ‘Drivers and Other Road Users’ level (n = 20, 44.4%) and the ‘Equipment, Environment, and Meteorological Surroundings’ level (n = 19, 42.2%). There were no risk factors identified at the ‘Regulatory and Government Bodies’ levels of the framework, confirming the narrow investigative scope of past research and the need to acknowledge a broader range of factors within and across higher levels of the system. Conclusions: The findings of this study inform the direction of future research and design of targeted prevention activities capable of creating system change for the safety of work-related drivers.</p

Safer drivers smart options: keys to lifelong mobility

The population of Michigan is growing older. Older adults age 60 or older will represent about 25% of Michigan’s population by 2030. Older adults consider mobility and independence to be essential aspects of maintaining quality of life. In response to this pressing societal issue, the Michigan Department of Transportation (MDOT) sought to plan, test, and implement an effective, sustainable statewide safety education and intervention strategy for helping drivers age 60 or older continue driving for as long they can safely do so, retire from driving when appropriate, and stay safely mobile after stopping driving. MDOT’s vision was to have an integrated statewide strategy that promoted practices for older adult mobility targeted at the older adults themselves, the families and friends of older adults, and the professionals that work with these two groups on transportation and mobility issues. The strategy was envisioned to be comprised of three components: education, direct intervention, and administration/collaboration. MDOT contracted with the University of Michigan Transportation Research Institute (UMTRI) to perform a variety of activities to assist in the development, implementation, and evaluation of the strategy in a three-phase (3 year) project. In Phase 1, potential models and design alternatives for a sustainable statewide strategy were identified. In Phase 2, the strategy elements were developed, tested, and named Safe Drivers Smart Options (SDSO): Keys to Lifelong Mobility. In Phase 3, the strategy was implemented and evaluated. The development and initial implementation of the SDSO has been a success, despite the relatively low awareness of SDSO among Michigan's older adults and informal caregivers at this time. Recommendations for SDSO continued implementation are presented.Michigan Department of Transportationhttp://deepblue.lib.umich.edu/bitstream/2027.42/134057/1/103249.pdf-1Description of 103249.pdf : Final repor

Data from: Staying close to home? Genetic differentiation of rough-toothed dolphins near oceanic islands in the central Pacific Ocean

Rough-toothed dolphins have a worldwide tropical and subtropical distribution, yet little is known about the population structure and social organization of this typically open-ocean species. Although it has been assumed that pelagic dolphins range widely due to the lack of apparent barriers and unpredictable prey distribution, recent evidence suggests rough-toothed dolphins exhibit fidelity to some oceanic islands. Using the most comprehensively extensive dataset for this species to date, we assess the isolation and interchange of rough-toothed dolphins at the regional and oceanic scale within the central Pacific Ocean. Using mtDNA and microsatellite genotyping (nDNA), we analyzed samples of insular communities from the main Hawaiian (Kaua‘i n = 93, O‘ahu n = 9, Hawai‘i n = 57), French Polynesian (n = 70) and Samoan (n = 16) archipelagos, and pelagic samples off the Northwestern Hawaiian Islands (n = 18). An overall AMOVA indicated strong genetic differentiation among islands (mtDNA FST = 0.265; p < 0.001; nDNA FST = 0.038; p < 0.001), as well as among archipelagos (mtDNA FST = 0.299; p < 0.001; nDNA FST = 0.055; p < 0.001). Shared haplotypes (n = 4) between the archipelagos may be a product of a relatively recent divergence and/or periodic exchange from poorly understood pelagic populations. Analyses using STRUCTURE and GENELAND identified four separate management units among archipelagos and within the Hawaiian Islands. These results confirm the presence of multiple insular populations within the Pacific and island-specific genetic isolation among populations attached to islands in each archipelago. Insular populations seem most prevalent where oceanographic conditions indicate high local productivity or a discontinuity with surrounding oligotrophic areas. Our findings have important implications for a little studied species that faces increasing anthropogenic threats around oceanic islands

Pathways activated during human asthma exacerbation as revealed by gene expression patterns in blood

This study has shown that analysis of PBMCs reveals systemic changes accompanying asthma exacerbation and has laid the foundation for future comparative studies using PBMCs

Snowmass 2021 CMB-S4 White Paper

This Snowmass 2021 White Paper describes the Cosmic Microwave Background Stage 4 project CMB-S4, which is designed to cross critical thresholds in our understanding of the origin and evolution of the Universe, from the highest energies at the dawn of time through the growth of structure to the present day. We provide an overview of the science case, the technical design, and project plan