Estimating the prevalence of COVID-19 cases through the analysis of SARS-CoV-2 RNA copies derived from wastewater samples from North Dakota.

The SARS-CoV-2 virus was first detected in December 2019, which prompted many researchers to investigate how the virus spreads. SARS-CoV-2 is mainly transmitted through respiratory droplets. Symptoms of the SARS-CoV-2 virus appear after an incubation period. Moreover, the asymptomatic infected individuals unknowingly spread the virus. Detecting infected people requires daily tests and contact tracing, which are expensive. The early detection of infectious diseases, including COVID-19, can be achieved with wastewater-based epidemiology, which is timely and cost-effective. In this study, we collected wastewater samples from wastewater treatment plants in several cities in North Dakota and then extracted viral RNA copies. We used log-RNA copies in the model to predict the number of infected cases using Quantile Regression (QR) and K-Nearest Neighbor (KNN) Regression. The model's performance was evaluated by comparing the Mean Absolute Percentage Error (MAPE). The QR model performs well in cities where the population is >10000. In addition, the model predictions were compared with the basic Susceptible-Infected-Recovered (SIR) model which is the golden standard model for infectious diseases.

Examining the role of different weakness categories for mobility and future falls in older Americans.

BACKGROUND: Recently developed absolute and body size normalized handgrip strength (HGS) cut-points could be used individually and collectively to predict mobility problems and falls. AIMS: We examined the associations of (1) each absolute and normalized weakness cut-point, (2) collective weakness categories, and (3) changes in weakness status on future falls in older Americans. METHODS: The analytic sample included 11,675 participants from the 2006-2018 waves of the Health and Retirement Study. Falls were self-reported. Men were classified as weak if their HGS was < 35.5-kg (absolute), < 0.45 kg/kg (body mass normalized), or < 1.05 kg/kg/m2 (body mass index normalized). While, women were considered weak if their HGS was < 20.0-kg, < 0.337 kg/kg, or < 0.79 kg/kg/m2. Collective weakness categorized those below 1, 2, or all 3 cut-points. The collective weakness categories were also used to observe changes in weakness status over time. RESULTS: Older Americans below each absolute and normalized cut-point had greater odds for future falls: 1.23 (95% confidence interval (CI): 1.15-1.32) for absolute weakness, 1.20 (CI 1.11-1.29) for body mass index normalized weakness, and 1.26 (CI 1.17-1.34) for body mass normalized weakness. Persons below 1, 2, or all 3 weakness cut-points had 1.17 (CI 1.07-1.27), 1.29 (CI 1.18-1.40), and 1.36 (CI 1.24-1.48) greater odds for future falls, respectively. Those in some changing weakness categories had greater odds for future falls: 1.26 (CI 1.08-1.48) for persistent and 1.31 (CI 1.11-1.55) for progressive. DISCUSSION: Collectively using these weakness cut-points may improve their predictive value. CONCLUSION: We recommend HGS be evaluated in mobility and fall risk assessments.

A Matched Cohort Analysis for Examining the Association Between Slow Gait Speed and Shortened Longevity in Older Americans.

This investigation examined the association between slow gait speed, as defined with newly established cut-points, and all-cause mortality in older Americans with a matched cohort analysis. The analytic sample included 10,259 Americans aged ≥65 years from the 2006-2014 waves of the Health and Retirement Study. Walking speed was measured in participant residences. Slow gait speed cut-points of <0.60 and <0.75 m/s were used separately for classifying participants as having slow walking speed. Nearest-neighbor propensity score matching was used to match the slow to the not-slow cohorts separately using both cut-points using relevant covariates. Persons with gait speed <0.60 m/s had a 1.42 higher hazard for mortality (95% CI: 1.28-1.57). Older Americans with gait speed <0.75 m/s had a 1.36 higher hazard for mortality (95% CI: 1.23-1.50). Slow gait speed may represent failing health and addressing how slow gait speed could be improved may help with referrals to appropriate interventions.

The estimated prevalence of no reported dementia-related diagnosis in older Americans living with possible dementia by healthcare utilization.

BACKGROUND: Screening for dementia in relevant healthcare settings may help in identifying low cognitive functioning for comprehensive cognitive assessments and subsequent dementia treatment after diagnosis. AIMS: This study sought to estimate the prevalence of no reported dementia-related diagnosis in a nationally-representative sample of older Americans with a cognitive impairment consistent with dementia (CICD) by healthcare utilization. METHODS: The unweighted analytical sample included 1514 Americans aged ≥ 65 years that were identified as having a CICD without history of stroke, cancers, neurological conditions, or brain damage who participated in at least one-wave of the 2010-2016 waves of the Health and Retirement Study. An adapted Telephone Interview of Cognitive Status assessed cognitive functioning. Those with scores ≤ 6 had a CICD. Dementia-related diagnosis was self-reported. Respondents indicated if they visited a physician, received home healthcare, or experienced an overnight nursing home stay in the previous two years. RESULTS: The prevalence of no reported dementia-related diagnosis in persons with a CICD who visited a physician was 89.9% (95% confidence interval (CI): 85.4%-93.1%). Likewise, the prevalence of no reported diagnosis in those with a CICD who received home healthcare was 84.3% (CI: 75.1-90.5%). For persons with a CICD that had an overnight nursing home stay, the prevalence of no reported dementia-related diagnosis was 83.0% (CI: 69.1-91.4%). DISCUSSION: Although the prevalence of no reported dementia-related diagnosis in individuals with a CICD differed across healthcare settings, the prevalence was generally high nonetheless. CONCLUSIONS: We recommend increased awareness and efforts be given to dementia screenings in various clinical settings.

Handgrip Strength Asymmetry and Weakness Are Associated With Future Morbidity Accumulation in Americans.

ABSTRACT: Klawitter, L, Vincent, BM, Choi, BJ, Smith, J, Hammer, KD, Jurivich, DA, Dahl, LJ, and McGrath, R. Handgrip strength asymmetry and weakness are associated with future morbidity accumulation in americans. J Strength Cond Res 36(1): 106-112, 2022-Identifying strength asymmetries in physically deconditioned populations may help in screening and treating persons at risk for morbidities linked to muscle dysfunction. Our investigation sought to examine the associations between handgrip strength (HGS) asymmetry and weakness on accumulating morbidities in aging Americans. The analytic sample included 18,506 Americans aged ≥50 years from the 2006-2016 Health and Retirement Study. Handgrip strength was measured on each hand with a handgrip dynamometer, and persons with an imbalance in strength >10% between hands had HGS asymmetry. Men with HGS <26 kg and women with HGS <16 kg were considered as weak. Subjects reported the presence of healthcare provider-diagnosed morbidities: hypertension, diabetes, cancer, chronic lung disease, cardiovascular disease, stroke, arthritis, and psychiatric problems. Covariate-adjusted ordinal generalized estimating equations analyzed the associations for each HGS asymmetry and weakness group on future accumulating morbidities. Of those included in our study, subjects at baseline were aged 65.0 ± 10.2 years, 9,570 (51.7%) had asymmetric HGS, and 996 (5.4%) were weak. Asymmetry alone and weakness alone were associated with 1.09 (95% confidence interval [CI]: 1.04-1.14) and 1.27 (CI: 1.11-1.45) greater odds for future accumulating morbidities, respectively. Having both HGS asymmetry and weakness was associated with 1.46 (CI: 1.29-1.65) greater odds for future accumulating morbidities. Handgrip-strength asymmetry, as another potential indicator of impaired muscle function, is associated with future morbidity status during aging. Exercise professionals and related practitioners should consider examining asymmetry and weakness with handgrip dynamometers as a simple and noninvasive screening method for helping to determine muscle dysfunction and future chronic disease risk.

Evaluating 24/7 Sobriety Program participant reoffense risk.

OBJECTIVE: Our study investigated risk factors in survival among a subpopulation of drivers in North Dakota's 24/7 Sobriety Program. Participants mandated for a second driving-under-the-influence of alcohol (DUI) arrest were studied for a three-year interval that commenced with the start date for a 360-day enrollment. METHOD: A Stratified Cox regression model was developed to compute the hazard ratios for survival. A subsequent DUI-related offense as event of interest. Relation to the explanatory variable array that could be construed from administrative records were investigated. RESULTS: Older drivers were 6.31 times more likely to reoffend than the younger driver cohort of 18-35-years. The survival curve slope showed the fastest decline in the 361-day to 730-day interval. Neither gender nor residence region was a significant predictor in DUI reoffense over the three-year monitoring interval. Preliminary work suggests reoffense was more likely if an individual had program history prior to this court mandated 360-day term in the 24/7 Sobriety Program for a second DUI. The program experience finding was unexpected but could not be studied in greater detail due to data and resource limitations. CONCLUSIONS: Administrative records access created a novel opportunity to explore an evolving impaired driving prevention strategy that has shown early promise. Individual driver survival in and after the 24/7 Sobriety Program was studied for three-years. Findings show age, post-program time interval, and possibly program history as areas to explore to improve survival rates. Driver DUI offense were most common shortly after program completion. Although limited to a single state, findings increase knowledge for refining strategies designed to impact driver subpopulations at higher risk for reoffense.

Sleeping time is associated with functional limitations in a national sample of older Americans.

BACKGROUND: Engaging in healthy behaviors may help to preserve function during aging; however, it is not well understood how sleeping time is associated with functional capacity in older adults. AIMS: We sought to determine the association of sleeping time on functional limitation in a national sample of older Americans. METHODS: The analytical sample included 6020 adults aged at least 65 years who participated in the 2007-2016 waves of the National Health and Nutrition Examination Survey. Respondents indicated their hours of sleep/weeknight and were categorized as < 5, 5-6.5, 7-8, 8.5-9, and > 9 h of sleep/weeknight. Ability to complete 19 functional tasks including basic activities of daily living, instrumental activities of daily living, leisure and social activities, lower extremity mobility activities, and general physical activities were also self-reported. A covariate-adjusted logistic model analyzed the associations between each sleeping time category and functional limitation. RESULTS: Relative to those reporting 7-8 h of sleep/weeknight, older Americans reporting < 5, 5-6.5, 8.5-9, and > 9 h of sleep/weeknight had 1.66 [95% confidence interval (CI): 1.05, 2.62], 1.25 (CI: 1.02, 1.52), 1.59 (CI: 1.19, 2.12), and 2.99 (CI: 1.96, 4.56) greater odds for functional limitation, respectively. DISCUSSION: Sleep should be recognized as a health factor that may reflect functional capacity in older adults. Healthcare providers should discuss the importance of optimal sleep with their older patients and older adults should practice healthy sleeping behaviors for preserving function. CONCLUSIONS: Not meeting optimal sleep recommendations is associated with functional limitations in older Americans.

Increasing adult immunization rates in a rural state through targeted pharmacist education.

BACKGROUND: Most immunization rates fall below the Healthy People 2020 goals for adults. Pharmacists have the potential to have a positive effect on immunization rates through vaccine administration. OBJECTIVE: The purpose of this study was to assess if an educational program developed for pharmacists could increase pharmacist-delivered statewide immunization rates. PRACTICE DESCRIPTION: This study was conducted in the state of North Dakota. North Dakota law allows authorized pharmacists to provide any immunization to individuals aged 11 years or older. PRACTICE INNOVATION: In collaboration with the state health department, a needs assessment of North Dakota pharmacists was conducted to determine what resources and education could increase the delivery of immunizations within the pharmacy. The results were used to develop focused continuing pharmacy education material, create an online toolkit, and provide immunization administration certification. EVALUATION: The number and proportion of pharmacist-delivered immunizations and overall adult immunizations rates were compared pre- and postintervention. The North Dakota Immunization Information System was used for data comparison. In addition, the number of pharmacists registered to provide immunizations with the State Board of Pharmacy was tabulated. RESULTS: The number of pharmacist-provided immunizations increased by more than 3900 doses. In addition, the percentage of adult immunizations provided by pharmacists and overall adult immunization rates increased throughout the state. After adjusting for seasonality, there was an increase in the number of pharmacist-delivered pneumococcal polysaccharide vaccine immunizations (P < 0.001). The number of pharmacists registered to provide immunizations increased throughout the study period by 39%. CONCLUSION: This study suggests that focused education and resources delivered to pharmacists can increase pharmacy-based immunization rates and adult immunization rates overall. Improving adult immunization rates through greater pharmacist engagement may help to decrease overall infectious disease threats.

Data Linkage to Improve Geriatric Oncology Research: A Feasibility Study.

Older adults (aged 65 years and older) diagnosed with cancer account for most cancer-related morbidity and mortality in the United States but are often underrepresented on clinical trials. Recent attention from a variety of professional, research, regulatory, and patient advocacy groups has centered on data linkage and data sharing as a means to capture patient information and outcomes outside of clinical trials to accelerate progress in the fight against cancer. The development of a more robust observational research data infrastructure would help to address gaps in the evidence base regarding optimal approaches to treating cancer among the growing and complex population of older adults. To demonstrate the feasibility of building such a resource, we linked information from a sample of older adults with cancer in North Carolina using three distinct, but complementary, data sources: (a) the Carolina Senior Registry, (b) the North Carolina Central Cancer Registry, and (c) North Carolina fee-for-service Medicare claims data. A description of the linkage process, metrics, and characteristics of the final cohort is reported. This study highlights the potential for data linkage to improve the characterization of health status among older adults with cancer and the possibility to conduct passive follow-up for outcomes of interest over time. Extensions of these linkage efforts in partnership with other institutions will enhance our ability to generate evidence that can inform the management of older adults with cancer.

Three-dimensional Anatomical Analysis of Surgical Landmarks for the Middle Cranial Fossa Approach.

This study describes the microsurgical anatomy of the middle cranial fossa approach using temporal bone three-dimensional (3D) computed tomography (CT) reconstruction, which should contribute to determining the drilling point for the internal auditory meatus (IAM) when bony landmarks are absent. Thirty temporal bone CT scans were reviewed retrospectively. We measured the shortest and longest distances to IAM from the petrous ridge, and measured the angle between the facial nerve and various labyrinth structures. Three-dimensional reconstructed images were obtained using high-resolution axial temporal bone CT (0.7-mm-thick slices, FOV 90 × 90, KVp 120, 305 mA, width 2,800, and level 800). The mean shortest and longest distances to IAM from the petrous ridge were 5.22 and 10.1 mm, respectively. The mean distance to the IAM from the cochlea was 9.91 mm. The mean angle between the IAM and superior semicircular canal was 47.21°, which was more acute than previously reported. The mean angle between the IAM and geniculate ganglion (GG) and external auditory canal was 113.8°, and the mean distance from the GG to the IAM was 15.44 mm. Understanding the 3D relationships among the microsurgical structures will help to decide the drilling point for the IAM when bony landmarks are absent. A preoperative evaluation might be useful for preserving important neurovascular structures while approaching the middle fossa.