Long-Term Care Resident Health and Quality of Care During the COVID-19 Pandemic: A Synthesis Analysis of Canadian Institute for Health Information Data Tables.

Objective: Long-term care (LTC) homes ("nursing homes") were challenged during the first year of the COVID-19 pandemic in Canada. The objective of this study was to measure the impact of the COVID-19 pandemic on resident admission and discharge rates, resident health attributes, treatments, and quality of care. Design: Synthesis analysis of "Quick Stats" standardized data table reports published yearly by the Canadian Institute for Health Information. These reports are a pan-Canadian scorecard of LTC services rendered, resident health characteristics, and quality indicator performance. Setting and participants: LTC home residents in Alberta, British Columbia, Manitoba, and Ontario, Canada that were assessed with the interRAI Minimum Data Set 2.0 comprehensive health assessment in fiscal years 2018/2019, 2019/2020 (pre-pandemic period), and 2020/2021 (pandemic period). Methods: Risk ratio statistics were calculated to compare admission and discharge rates, validated interRAI clinical summary scale scores, medication, therapy and treatment provision, and seventeen risk-adjusted quality indicator rates from the pandemic period relative to prior fiscal years. Results: Risk of dying in the LTC home was greater in all provinces (risk ratio [RR] range 1.06-1.18) during the pandemic. Quality of care worsened substantially on 6 of 17 quality indicators in British Columbia and Ontario, and 2 quality indicators in Manitoba and Alberta. The only quality indicator where performance worsened during the pandemic in all provinces was the percentage of residents that received antipsychotic medications without a diagnosis of psychosis (RR range 1.01-1.09). Conclusions and implications: The COVID-19 pandemic has unveiled numerous areas to strengthen LTC and ensure that resident's physical, social, and psychological needs are addressed during public health emergencies. Except an increase in potentially inappropriate antipsychotic use, this provincial-level analysis indicates that most aspects of resident care were maintained during the first year of the COVID-19 pandemic.

Unsupervised high-frequency smartphone-based cognitive assessments are reliable, valid, and feasible in older adults at risk for Alzheimer's disease.

OBJECTIVE: Smartphones have the potential for capturing subtle changes in cognition that characterize preclinical Alzheimer's disease (AD) in older adults. The Ambulatory Research in Cognition (ARC) smartphone application is based on principles from ecological momentary assessment (EMA) and administers brief tests of associative memory, processing speed, and working memory up to 4 times per day over 7 consecutive days. ARC was designed to be administered unsupervised using participants' personal devices in their everyday environments. METHODS: We evaluated the reliability and validity of ARC in a sample of 268 cognitively normal older adults (ages 65-97 years) and 22 individuals with very mild dementia (ages 61-88 years). Participants completed at least one 7-day cycle of ARC testing and conventional cognitive assessments; most also completed cerebrospinal fluid, amyloid and tau positron emission tomography, and structural magnetic resonance imaging studies. RESULTS: First, ARC tasks were reliable as between-person reliability across the 7-day cycle and test-retest reliabilities at 6-month and 1-year follow-ups all exceeded 0.85. Second, ARC demonstrated construct validity as evidenced by correlations with conventional cognitive measures (r = 0.53 between composite scores). Third, ARC measures correlated with AD biomarker burden at baseline to a similar degree as conventional cognitive measures. Finally, the intensive 7-day cycle indicated that ARC was feasible (86.50% approached chose to enroll), well tolerated (80.42% adherence, 4.83% dropout), and was rated favorably by older adult participants. CONCLUSIONS: Overall, the results suggest that ARC is reliable and valid and represents a feasible tool for assessing cognitive changes associated with the earliest stages of AD.

Both Feline Coronavirus Serotypes 1 and 2 Infected Domestic Cats Develop Cross-Reactive Antibodies to SARS-CoV-2 Receptor Binding Domain: Its Implication to Pan-CoV Vaccine Development.

The current study was initiated when our specific-pathogen-free laboratory toms developed unexpectedly high levels of cross-reactive antibodies to human SARS-CoV-2 (SCoV2) receptor binding domain (RBD) upon mating with feline coronavirus (FCoV)-positive queens. Multi-sequence alignment analyses of SCoV2 Wuhan RBD and four strains each from FCoV serotypes 1 and 2 (FCoV1 and FCoV2) demonstrated an amino acid sequence identity of 11.5% and a similarity of 31.8% with FCoV1 RBD (12.2% identity and 36.5% similarity for FCoV2 RBD). The sera from toms and queens cross-reacted with SCoV2 RBD and reacted with FCoV1 RBD and FCoV2 spike-2, nucleocapsid, and membrane proteins, but not with FCoV2 RBD. Thus, the queens and toms were infected with FCoV1. Additionally, the plasma from six FCoV2-inoculated cats reacted with FCoV2 and SCoV2 RBDs, but not with FCoV1 RBD. Hence, the sera from both FCoV1-infected cats and FCoV2-infected cats developed cross-reactive antibodies to SCoV2 RBD. Furthermore, eight group-housed laboratory cats had a range of serum cross-reactivity to SCoV2 RBD even 15 months later. Such cross-reactivity was also observed in FCoV1-positive group-housed pet cats. The SCoV2 RBD at a high non-toxic dose and FCoV2 RBD at a 60-400-fold lower dose blocked the in vitro FCoV2 infection, demonstrating their close structural conformations essential as vaccine immunogens. Remarkably, such cross-reactivity was also detected by the peripheral blood mononuclear cells of FCoV1-infected cats. The broad cross-reactivity between human and feline RBDs provides essential insights into developing a pan-CoV vaccine.

Cytoscape stringApp 2.0: Analysis and Visualization of Heterogeneous Biological Networks.

Biological networks are often used to represent complex biological systems, which can contain several types of entities. Analysis and visualization of such networks is supported by the Cytoscape software tool and its many apps. While earlier versions of stringApp focused on providing intraspecies protein-protein interactions from the STRING database, the new stringApp 2.0 greatly improves the support for heterogeneous networks. Here, we highlight new functionality that makes it possible to create networks that contain proteins and interactions from STRING as well as other biological entities and associations from other sources. We exemplify this by complementing a published SARS-CoV-2 interactome with interactions from STRING. We have also extended stringApp with new data and query functionality for protein-protein interactions between eukaryotic parasites and their hosts. We show how this can be used to retrieve and visualize a cross-species network for a malaria parasite, its host, and its vector. Finally, the latest stringApp version has an improved user interface, allows retrieval of both functional associations and physical interactions, and supports group-wise enrichment analysis of different parts of a network to aid biological interpretation. stringApp is freely available at https://apps.cytoscape.org/apps/stringapp.

Examining the Effect of the First Wave of the COVID-19 Pandemic on Home Care Recipients' Instrumental Activities of Daily Living Capacity.

OBJECTIVE: To examine the effect of the pandemic on, and factors associated with, change in home care (HC) recipients' capacity for instrumental activities of daily living. DESIGN: Retrospective cohort study. SETTING AND PARTICIPANTS: HC recipients in Ontario, Canada, between September 1, 2018, and August 31, 2020, who were not totally dependent on others and not severely cognitively impaired at baseline. METHODS: Data were collected with the interRAI Home Care assessment. Outcomes of interest were declines in instrumental activities of daily living. Factors hypothesized to be associated with declining function were entered as independent variables into multivariable generalized estimating equations, and results were expressed as odds ratios (ORs) with 95% confidence intervals (CIs). Those significant at P < .01 were retained in the final models. RESULTS: There were 6786 and 5019 HC recipients in the comparison and pandemic samples, respectively. Between baseline and follow-up for the 2 groups, 34.1% and 42.1% of HC recipients declined in shopping, whereas 25.2% and 30.5% declined in transportation capacity in the comparison and pandemic sample, respectively. For shopping, those with cognitive impairment (OR 0.83, 95% CI 0.76-0.89) and receiving formal care (OR 0.72, 95% CI 0.62-0.85) were less likely to decline, whereas those who were older (OR 1.91, 95% CI 1.69-2.16) and had unstable health (OR 1.31, 95% CI 1.16-1.48) were more likely. For transportation, those receiving informal (OR 0.71, 95% CI 0.61-0.81) or formal care (OR 0.56, 95% CI 0.47-0.67) were less likely to decline, whereas those who were older (OR 1.81, 95% CI 1.58-2.07) and had unstable health (OR 1.35, 95% CI 1.119-1.54) were more likely. CONCLUSIONS AND IMPLICATIONS: The pandemic was associated with a decline in HC recipients' capacity for shopping and transportation. HC recipients who are older and have unstable health may benefit from preventive strategies.

Politics or need? Explaining state protective measures in the coronavirus pandemic

Objective We explain evolving policy choices made by all 50 states in response to the coronavirus (COVID-19) pandemic in the United States against the background of each state's political and public health landscape. Method We create an index of eight state preventative measures and explain variation in that index by infection and death rates, vaccination rates, support for President Trump in 2020, and the political party of the governor. We control for population density and the health vulnerability of each state. Results State response was largely driven by three factors: the death rate from COVID-19, Trump votes in 2020 and Republican control of the governorship. Conclusion Understanding state response to the pandemic requires going beyond a partisan lens and considering the shifting onus of responsibility for taking action to protect against the virus from states to individual citizens in an increasingly politicized sphere of pandemic response.

Mood Disturbances Across the Continuum of Care Based on Self-Report and Clinician Rated Measures in the interRAI Suite of Assessment Instruments.

Background: Mood disturbance is a pervasive problem affecting persons of all ages in the general population and the subset of those receiving services from different health care providers. interRAI assessment instruments comprise an integrated health information system providing a common approach to comprehensive assessment of the strengths, preferences and needs of persons with complex needs across the continuum of care. Objective: Our objective was to create new mood scales for use with the full suite of interRAI assessments including a composite version with both clinician-rated and self-reported items as well as a self-report only version. Methods: We completed a cross-sectional analysis of 511,641 interRAI assessments of Canadian adults aged 18+ in community mental health, home care, community support services, nursing homes, palliative care, acute hospital, and general population surveys to develop, test, and refine new measures of mood disturbance that combined clinician and self-rated items. We examined validity and internal consistency across diverse care settings and populations. Results: The composite scale combining both clinician and self-report ratings and the self-report only variant showed different distributions across populations and settings with most severe signs of disturbed mood in community mental health settings and lowest severity in the general population prior to the COVID-19 pandemic. The self-report and composite measures were strongly correlated with each other but differed most in populations with high rates of missing values for self-report due to cognitive impairment (e.g., nursing homes). Evidence of reliability was strong across care settings, as was convergent validity with respect to depression/mood disorder diagnoses, sleep disturbance, and self-harm indicators. In a general population survey, the correlation of the self-reported mood scale with Kessler-10 was 0.73. Conclusions: The new interRAI mood scales provide reliable and valid mental health measures that can be applied across diverse populations and care settings. Incorporating a person-centered approach to assessment, the composite scale considers the person's perspective and clinician views to provide a sensitive and robust measure that considers mood disturbances related to dysphoria, anxiety, and anhedonia.

Bridging the Technological Divide: Stigmas and Challenges With Technology in Digital Brain Health Studies of Older Adults.

The COVID-19 pandemic has increased adoption of remote assessments in clinical research. However, longstanding stereotypes persist regarding older adults' technology familiarity and their willingness to participate in technology-enabled remote studies. We examined the validity of these stereotypes using a novel technology familiarity assessment (n = 342) and with a critical evaluation of participation factors from an intensive smartphone study of cognition in older adults (n = 445). The technology assessment revealed that older age was strongly associated with less technology familiarity, less frequent engagement with technology, and higher difficulty ratings. Despite this, the majority (86.5%) of older adults elected to participate in the smartphone study and showed exceptional adherence (85.7%). Furthermore, among those enrolled, neither technology familiarity, knowledge, perceived difficulty, nor gender, race, or education were associated with adherence. These results suggest that while older adults remain significantly less familiar with technology than younger generations, with thoughtful study planning that emphasizes participant support and user-centered design, they are willing and capable participants in technology-enabled studies. And once enrolled, they are remarkably adherent.

A biomedical open knowledge network harnesses the power of AI to understand deep human biology.

Knowledge representation and reasoning (KR&R) has been successfully implemented in many fields to enable computers to solve complex problems with AI methods. However, its application to biomedicine has been lagging in part due to the daunting complexity of molecular and cellular pathways that govern human physiology and pathology. In this article we describe concrete uses of SPOKE, an open knowledge network that connects curated information from 37 specialized and human-curated databases into a single property graph, with 3 million nodes and 15 million edges to date. Applications discussed in this article include drug discovery, COVID-19 research and chronic disease diagnosis and management.

Social Engagement and Distress Among Home Care Recipients During the COVID-19 Pandemic in Ontario, Canada: A Retrospective Cohort Study.

OBJECTIVES: To examine factors associated with distressing social decline and withdrawal during the COVID-19 pandemic for home care recipients. DESIGN: Retrospective cohort. SETTING AND PARTICIPANTS: Home care recipients age 18 years or older in Ontario, Canada without severe cognitive impairment with an assessment and follow-up between September 1, 2018 and August 31, 2020. METHODS: Data were collected using the interRAI home care. Outcomes of interest were distressing decline in social participation and social withdrawal. Independent variables were entered into multivariable longitudinal generalized estimating equations. Interaction terms with the pandemic were tested. Those significant at P < .01 were retained in final models and reported as odds ratios (ORs), 95% confidence intervals (CIs). RESULTS: We compared 26,492 and 19,126 home care recipients before and during the pandemic, respectively. The pandemic was associated with greater odds of experiencing distressing social decline (OR 1.28, 95% CI 1.22‒1.34) and withdrawal (OR 1.09, 95% CI 1.04‒1.15). Living alone (OR 1.13, 95% CI 1.05‒1.22), frailty (OR 3.21, 95% CI 2.76‒3.73), health instability (OR 2.22, 95% CI 2.02‒2.44), and depression (OR 2.14, 95% CI 2.01‒2.29) increased the odds of distressing social decline. Older age (OR 0.71, 95% CI 0.65‒0.77), functional impairment (OR 0.58, 95% CI 0.51‒0.67), and receiving caregiving (OR 0.73, 95% CI 0.67‒0.79) decreased the odds. Home care recipients with mild/moderate dementia were less likely to experience distressing social decline during the pandemic. Those who lived alone were more likely. Frailty (OR 9.49, 95% CI 7.69‒11.71) and depression (OR 2.76, 95% CI 2.55‒3.00) increased the odds of social withdrawal. Functional impairment (OR 0.32, 95% CI 0.27‒0.39), congestive heart failure (OR 0.77, 95% CI 0.70‒0.84), and receiving caregiving (OR 0.50, 95% CI 0.46‒0.55) decreased the odds. Home care recipients age 18‒64 years and older than 75 years were less likely to experience social withdrawal during the pandemic. CONCLUSIONS AND IMPLICATIONS: Social support interventions should focus on supporting those living alone, with frailty, health instability, or depression.

COVID-19 and preclinical Alzheimer disease: Driving, mobility, activity and experiences of older adults in the United States

Background As the world grapples with the COVID-19 pandemic, there have been widespread disruptions to everyday life due to social distancing. Older adults with Alzheimer disease (AD) are at increased risk of morbidity and mortality from COVID-19. It is unknown how COVID-19 affects the mobility patterns of older adults with preclinical AD. Since before the pandemic, we have been monitoring the driving behaviors of older adults, enabling us to evaluate the impact of the pandemic on individuals with and without preclinical AD. Method We used in-vehicle Global Positioning System (GPS) devices to study driving behaviors of 115 older adults enrolled in the DRIVES study (aged 65+) from 1/1/2019 to 31/12/2020. The cohort included 62 individuals with preclinical AD (PreAD) and 53 without preclinical AD (CTL), as determined by cerebrospinal fluid biomarkers. All participants completed an online survey about their overall experiences during the pandemic. Using the GPS data, we determined the average monthly distance travelled, and the number of visitations to destinations categorized as food shopping, place of worship, restaurant, leisure, or health. All measures were computed monthly. Result oth groups experienced an approximate 40% decline in average monthly distance travelled overall after the start of the pandemic (PreAD: 1287.92 to 783.38 km vs. CTL: 1751.26 to 1053.29 km). Visits to places of worship, restaurants, leisure and health places declined by 70%, 46%, 23%, and 23% for the PreAD group, and by 48%, 31%, 48%, and 22% for the CTL group, respectively. However, the pandemic did not result in a significant decline in Food Shopping among either of the groups. Overall, compared to the CTL group, the PreAD group experienced a higher level of stress in response to the recommendations for socially distancing (p<0.01), more uncertainty about their risk of COVID-19 (p<0.05), more decline in trips for worship (p<0.05) and less decline in trips for leisure (p<0.01). Conclusion Our findings indicate decreased mobility in all older adults during the pandemic, with the preclinical AD group exhibiting more decline in trips to places of worship, less decline in leisure activities, and increased stress and uncertainty in response to COVID-19.

Increasing the low-risk threshold for patients with upper gastrointestinal bleeding during the COVID-19 pandemic

IntroductionIn light of the COVID-19 pandemic, speciality groups have recommended down-scaling endoscopy (OGD) provision to true emergencies only. Following review of a large UK study on Upper Gastrointestinal Bleeding (UGIB), we extended the threshold for patients not requiring inpatient OGD from Glasgow Blatchford Score (GBS) 0-1 to GBS 0-3. We studied the safety and efficacy of this change in practice.MethodsOver 3 months (01/04/20 – 30/06/20), we prospectively collected data on consecutive unselected patients with UGIB at 5 large Scottish hospitals. All patients were followed up for 30 days. Data collected included patient characteristics, referral source, GBS, COVID-19 status, endoscopic findings and interventions, length of stay, rebleeding and mortality. We compared data with pre-pandemic prospective data on UGIB available in 3 of the centres.Results397 patients were included. 69 (17.3%) were pre-existing inpatients. 288 (72.5%) patients received OGD. 36.5% patients had endoscopic intervention at index OGD. Mean length of stay was 7 days. Overall 30-day all-cause mortality rate was 13.1% (53/397) and 33.3% (23/69) for pre-existing inpatients. Bleeding related mortality was 5% (20/397). Overall 30-day rebleeding rate was 6.3% (25/397). On comparison with pre-pandemic data in 3 centres, there was a fall in mean number of UGIB presentations per week (26 vs 19;p=0.004) and a lower proportion of GBS 0-3 presentations (33.3% vs 21.5% p=0.003) during the pandemic, with a rise in mean GBS (6.5 vs 8.3;p<0.001) and all-cause mortality (6.8% vs 12.2% p=0.02). On logistic regression analysis, predictors of all-cause mortality were: cirrhosis, GBS >9, pre-existing inpatient status, age >70, and confirmed COVID-19. 84 (21.2%) patients had GBS 0-3, of whom 19 (22.6%) received inpatient OGD due to clinical concern, with endotherapy used once. Of all GBS 0-3 patients, none had rebleeding, none represented requiring OGD at a later date, and one died due to sepsis. 82 patients were clinically suspected to have COVID-19 at presentation, but only 14 were confirmed on testing. The 30-day all-cause mortality in this group was 20.7% (17/82), and 35.7% in the 14 confirmed cases.ConclusionDuring periods of severe pressure from COVID-19, extending the low-risk threshold for inpatient endoscopy in acute UGIB to GBS 0-3 appears safe. The higher GBS and mortality of patients with UGIB during the pandemic is likely due to non-presentation of lower risk patients as a secondary effect.

Seeking patterns in chaos: Transactional federalism in the Trump administration's response to the COVID-19 pandemic

The federal government's response the novel coronavirus (COVID-19) pandemic has been marked by a series of apparently disjointed, chaotic, and confusing statements and actions on the part of both the White House and federal agencies charged with coordinating the federal response. These actions have left many state governors (and citizens) in a position to address the effects of the pandemic in a haphazard and atomistic manner. In this essay, we contend that the actions of the Trump administration, and its relationships with states and local governments, can best be understood through a lens of what we refer to as "transactional federalism," in which federalism relationships are governed by a set of exchanges between the president and states, and between states. We conclude by discussing the ramifications of this form of federalism. (PsycInfo Database Record (c) 2021 APA, all rights reserved)

Lessons from the COVID-19 Pandemic for Federalism and Infrastructure: A Call to Action

The COVID-19 pandemic has presented many challenges to governments around the world. The federal structure within the United States has further complicated effective responses to mitigate the personal and economic effects of COVID. Here, we argue that the Trump administration?s approach to federalism?highlighted by the pandemic?is incapable of efficiently and effectively addressing state needs and those needs are only going to grow as a result, further exacerbating the problem. This form of federalism, which we dub ?transactional federalism,? is likely to have deleterious effects on state infrastructure, much of which is already in need. The long-term effects of transactional federalism are likely to weaken state efforts to address critical infrastructure needs.

Seeking Patterns in Chaos: Transactional Federalism in the Trump Administration’s Response to the COVID-19 Pandemic

The federal government?s response the novel coronavirus (COVID-19) pandemic has been marked by a series of apparently disjointed, chaotic, and confusing statements and actions on the part of both the White House and federal agencies charged with coordinating the federal response. These actions have left many state governors (and citizens) in a position to address the effects of the pandemic in a haphazard and atomistic manner. In this essay, we contend that the actions of the Trump administration, and its relationships with states and local governments, can best be understood through a lens of what we refer to as ?transactional federalism,? in which federalism relationships are governed by a set of exchanges between the president and states, and between states. We conclude by discussing the ramifications of this form of federalism.

Central banks: Climate governors of last resort?

The global and regional leadership of central banks in response to the COVID-19 pandemic has heightened public and political debates over their role in the governance of an arguably more fundamental planetary crisis: the climate crisis. Strategically harnessing the resources and reach of central banks would seem crucial to achieving a genuine step-change in the governance of the climate crisis. We consider how critical social scientists might contribute to debates over the potential of central banks to act as ?climate governors of last resort?.