Brief Aging Education Impacts Continuing Education Preferences and Behaviors of Mental Health Providers.

BACKGROUND AND OBJECTIVES: This study examined the impact of receiving foundational information about aging on continuing education (CE) interests, preferences, and behaviors of mental health providers. RESEARCH DESIGN AND METHOD: Participants were practicing licensed professional counselors (LPCs; N = 120) recruited from a random sampling of a state registry. The study employed a three-group randomized controlled design with participants assigned to one of three conditions: an aging-specific reading, an Opioid Use Disorder-specific reading, and a CE requirement-specific reading. As outcomes, participants rated their interest in aging-specific CE and selected to receive an aging-specific CE or Motivational Interviewing-specific CE program. RESULTS: Perceived competence for working with older adults, assessed before the experimental manipulation, predicted choice and degree of interest in the aging-specific CE across conditions. Participants in the Aging-Reading condition rated a higher interest in aging-specific CE and were marginally more likely to select the aging-specific CE option than those in the other two conditions. Those in the Aging-Reading condition were also more likely to register for and complete an actual CE program focused on any topic. DISCUSSION AND IMPLICATIONS: Foundational knowledge about aging may increase practitioners' interest and behaviors towards gaining competency for working with older adults, supporting the PEACE model (Levy, 2018) of reducing ageism.

The Impact of Non-opioid Analgesic Usage on Total Opioid Load During Traumatic Brain Injury Rehabilitation: A Retrospective Study.

Background Patients staying in acute rehabilitation often use large amounts of opioids during their stay. There are a number of reasons for this increased opioid exposure, including but not limited to daily exercises with physical and occupational therapists, increased demand on a healing body, and use of previously atrophying musculature. Some physiatrists have noticed that patients who concurrently are prescribed medications such as Robaxin seem to require fewer opioids during their stay in acute rehabilitation. This study aimed to determine the association between non-opioid analgesic use and total opioid load, as measured using morphine milligram equivalents (MMEs), during inpatient rehabilitation for traumatic brain injury. Methodology A retrospective study of individuals with a diagnosis of traumatic brain injury admitted to an acute inpatient rehabilitation program was performed. Non-opioid medications that were reviewed in the study included acetaminophen, amitriptyline, baclofen, diclofenac, gabapentin, ibuprofen, lidocaine, methocarbamol, nortriptyline, and pregabalin. Five of the most-used non-opioid medications (acetaminophen, diclofenac, gabapentin, lidocaine, and methocarbamol) were statistically analyzed using regression and analysis of variance to evaluate for any significant variables. Results Results showed that the average daily dose of acetaminophen has a significant effect on the average daily MME and that the average daily dose of gabapentin and methocarbamol each have a significant effect on the change of daily MME usage from admission to discharge from acute rehab (ΔMME). Results also showed that the mere presence of methocarbamol (regardless of daily or total dosage) had a significant effect on the ΔMME. Conclusions Based on these findings, physicians may want to consider prescribing acetaminophen, gabapentin, or methocarbamol for patients admitted for inpatient rehabilitation following traumatic brain injury who require high amounts of opioids.

Building the Geropsychology Workforce: A National Survey and Virtual Conference Define Critical Obstacles and Steps Forward.

The number of psychologists prepared to work with older adults falls far short of the demand. In the face of perceptions of a worsening geriatric workforce shortage, we describe the process of developing and implementing a national virtual conference aimed at generating solutions. A preconference survey (n = 174) found fewer applicants than desirable for aging-targeted graduate student, trainee, clinician, or academic positions (58.6%) and decreased student interest in aging (43.7%), with downstream consequences of filling age-targeted positions by those without aging backgrounds (32.3%), difficulty securing funding for aging-related positions (28.7%), and loss of aging-related positions (27.0%). Two fifths (40.7%) felt these problems have worsened as compared to 5 years ago. Qualitative responses provide detailed perspectives on these barriers and strategies generally and in particular as relates to racial and ethnic diversity and academic geropsychology. During a 2-day conference, attendees developed and prioritized strategies. Following a postconference survey to ascertain interest in volunteering, seven work groups were formed that have made progress on these issues. A virtual conference provides an inclusive, cost-effective, and fruitful opportunity to discuss workforce concerns in geropsychology and to generate numerous ideas to promote positive change.

Working with older adults impacts training preferences of counselors.

Clinicians specializing in working with older adults make up a very small portion of providers, and the majority of the service provision falls on general practitioners. Licensed Professional Counselors (LPCs) have heavily focused on Multicultural Competency in training and practice, but the profession has not specified standards of competence for work with older adults. Efforts to increase competency for generalists providing care for older adults are needed. A random sampling of LPCs was surveyed regarding demographic variables, work characteristics, perceived competence for working with older adults, and interest in aging-specific continuing education (CE). About half of the sample reported engaging in practice with older adults over the previous year. Counselors who reported practicing with older adults over the last year were more interested in aging-specific CE and reported higher perceived competence for working with older adults.

A United States Fair Lending Perspective on Machine Learning.

The use of machine learning (ML) has become more widespread in many areas of consumer financial services, including credit underwriting and pricing of loans. ML's ability to automatically learn nonlinearities and interactions in training data is perceived to facilitate faster and more accurate credit decisions, and ML is now a viable challenger to traditional credit modeling methodologies. In this mini review, we further the discussion of ML in consumer finance by proposing uniform definitions of key ML and legal concepts related to discrimination and interpretability. We use the United States legal and regulatory environment as a foundation to add critical context to the broader discussion of relevant, substantial, and novel ML methodologies in credit underwriting, and we review numerous strategies to mitigate the many potential adverse implications of ML in consumer finance.

Aesthetic Judgments of Live and Recorded Music: Effects of Congruence Between Musical Artist and Piece.

The COVID-19 pandemic has brought the live music industry to an abrupt halt; subsequently, musicians are looking for ways to replicate the live concert experience virtually. The present study sought to investigate differences in aesthetic judgments of a live concert vs. a recorded concert, and whether these responses vary based on congruence between musical artist and piece. Participants (N = 32) made continuous ratings of their felt pleasure either during a live concert or while viewing an audiovisual recorded version of the same joint concert given by a university band and a United States Army band. Each band played two pieces: a United States patriotic piece (congruent with the army band) and a non-patriotic piece (congruent with the university band). Results indicate that, on average, participants reported more pleasure while listening to pieces that were congruent, which did not vary based on live vs. lab listening context: listeners preferred patriotic music when played by the army band and non-patriotic music when played by the university band. Overall, these results indicate that felt pleasure in response to music may vary based on listener expectations of the musical artist, such that listeners prefer musical pieces that "fit" with the particular artist. When considering implications for concerts during the COVID-19 pandemic, our results indicate that listeners may experience similar degrees of pleasure even while viewing a recorded concert, suggesting that virtual concerts are a reasonable way to elicit pleasure from audiences when live performances are not possible.

Effect of Bacillius Coagulans and Galactomannans on Obese Patients Undergoing Sleeve Gastrectomy, A Randomized-Controlled Clinical Trial.

BACKGROUND: The purpose of this study was to examine the effect of probiotics and prebiotics (LactoWise®) on weight loss, blood pressure, and clinical lab values in morbidly obese patients undergoing laparoscopic sleeve gastrectomy (LSG). MATERIALS METHODS: Sixty patients undergoing LSG were recruited to participate in the study and randomized into either a LactoWise® or placebo group. The LactoWise® group (LWG) received 4.5 billion live cells of bacillus coagulans and galactomannans (300 mg); the placebo group received 600 mg of calcium citrate yielding 126 mg of elemental calcium. Both groups took their assigned capsule daily for 3-months post-surgery. Standard clinical lab values were measured pre-surgery and at 3-months post-surgery. Weight and blood pressures were measured at baseline, 2 weeks, 6 weeks, and 3 months post-surgery. RESULTS: A total of 35 patients with a mean age of 47.7 ± 12.4 years and a mean body mass index (BMI) of 46.6 ± 8.2 kg/m2 completed the study. There was a significant difference in BMI at baseline between the two study groups (43.0 ± 7.0 vs. 49.2 ± 8.3, P = .02). Weight loss was greater in the LWG compared to placebo at 6 weeks but showed no significant difference at 3 months post-op. In addition, there was a significant drop in triglycerides (TG) (P = .02) over time in the LWG (P = .01). The LWG had a significant decrease in AST and LDL compared to the placebo group (P = .03). CONCLUSION: Bariatric surgery (BS) produces positively impacting metabolic results in morbidly obese patients. Our study shows that in the case of triglycerides, LDL, weight loss and AST, administering of a probiotic/prebiotic blend may play a role in improving clinical outcomes of morbidly obese patients undergoing LSG.

Platelet-Rich Plasma Enhances Distal Flap Viability and Underlying Vascularity in a Radiated Rotational Flap Rodent Model.

Importance: Autologous platelet-rich plasma (PRP) has received widespread attention due to its physiologic healing properties, augmenting the body's natural healing process through platelet activation and release of growth factors. The effects of PRP on radiated tissue have been inadequately studied in vivo. Objective: To determine whether PRP can be used to improve viability of radiated tissue subjected to a clinically meaningful stressor, in this case a rotational skin flap. Design, Setting, Participants: This is a prospective trial using a radiated rat abdominal rotational flap model in the laboratory. Male Sprague-Daley rats were used in this study. Harvested PRP or saline control was injected into rotational flaps immediately after surgery. Progression of necrosis was documented with photo analysis. After 1 week, animals were sacrificed and flap tissue was stained and analyzed for presence of vascular tissue. Intervention: PRP versus control injection into radiated skin tissue. Main Outcomes and Measures: Percentage necrosis of rotational flap and number of vascular channels stained with CD31 present in flap tissue. Results: PRP administration helped rescue the distal flap from necrosis, achieving viability similar to nonradiated controls. Superficial vascularity was similarly increased fivefold in radiated tissue if PRP was given postoperatively, mirroring the vascular density of nonradiated tissue. Conclusions and Relevance: PRP may enhance distal rotational flap viability after radiation, possibly by protecting superficial vessels from tissue necrosis when administered at the time of surgery.

Neurocognitive Disorder Diagnoses Matter: A Brief Report on Caregiver Appraisal of Driving Ability.

Background: Age-associated neurocognitive disorders (NCDs) are associated with progressive loss of abilities for instrumental activities of daily living, including driving. This study assesses the impact of NCD diagnosis, while controlling for reported level of cognitive impairment, on family caregiver judgment of driving safety. Method: An intervention sample of 152 intergenerational caregivers who assist an older adult with medical tasks was used. Caregiver's pre-intervention response to a single item of confidence in the older adult driving was used to determine judgment of driving ability. Cognitive impairment was assessed using caregivers' report for Clinical Dementia Rating (CDR) Sum of Boxes score. Results: Older adults with a diagnosis were rated as less capable of driving safely than those without a diagnosis, while controlling for reported level of cognitive impairment. Conclusion: Results of this study highlight the importance of NCD diagnosis on caregiver judgments. Results of this study have implications for health care and driving safety.

Impairment for Medication Management in Older Adults: Validity of a Family Report Measure.

Objectives: Medication nonadherence can have significant consequences for the health of older adults. Difficulty managing medications is often a sign of cognitive impairment, and monitoring is an early caregiving task for family members. This study examined a screening tool for independence in medication management.Methods: Reliability and validity of the screening tool were assessed in a sample of 152 female care partners for a relative aged 65+years.Results: The tool showed sound test-retest reliability, convergent and discriminant validity, and test utility, such that medication assistance was not better predicted by a global rating of cognitive impairment.Conclusions: In context of cognitive impairment, detection of medication mismanagement could be improved in both primary care and specialty health encounters through adoption of this single-item screening tool.Clinical Implications: This single-item report can be used to quickly facilitate discussions of medication management and cognitive impairment screening in office visits. The item also shows promise for efficient measurement of impairment in medication management than typical IADL assessment language.

Comparison of Copper(II)-Ligand Complexes as Mediators for Preparing Electrochemically Modulated Nitric Oxide-Releasing Catheters.

Further studies aimed at examining the activity of different Cu(II)-ligand complexes to serve as electron-transfer mediators to prepare novel antimicrobial/thromboresistant nitric oxide (NO)-releasing intravenous catheters are reported. In these devices, the NO release can be modulated by applying different potentials or currents to reduce the Cu(II)-complexes to Cu(I) species which then reduce nitrite ions into NO(g) within a lumen of the catheter. Four different ligands are compared with respect to NO generation efficiency and stability over time using both single- and dual-lumen silicone rubber catheters: N-propanoate- N, N-bis(2-pyridylethyl)amine (BEPA-Pr), N-propanoate- N, N-bis(2-pyridylmethyl)amine (BMPA-Pr), 1,4,7-trimethyl-1,4,7-triazacyclononane (Me3TACN), and tris(2-pyridylmethyl)amine (TPMA). Of these, the Cu(II)BEPA-Pr and Cu(II)Me3TACN complexes provide biomedically useful NO fluxes from the surface of the catheters, >2 × 10-10 mol·min-1·cm-2, under conditions mimicking the bloodstream environment. Cu(II)Me3TACN exhibits the best stability over time with a steady and continuous NO release observed for 8 d under a nitrogen atmosphere. Antimicrobial experiments conducted over 5 d with NO-releasing catheters turned "on" electrochemically for only 3 or 6 h each day revealed >2 logarithmic units in reduction of bacterial biofilm attached to the catheter surfaces. The use of optimal Cu(II)-ligand complexes within a lumen reservoir along with high levels of nitrite ions can potentially provide an effective method of preventing/decreasing the rate of infections caused by intravascular catheters.

Performance of Amperometric Platinized-Nafion Based Gas Phase Sensor for Determining Nitric Oxide (NO) Levels in Exhaled Human Nasal Breath.

Nitric oxide (NO) levels in exhaled breath are a non-invasive marker that can be used to diagnose various respiratory diseases and monitor a patient's response to given therapies. A portable and inexpensive device that can enable selective NO concentration measurements in exhaled breath samples is needed. Herein, the performance of an amperometric Pt-Nafion-based gas phase sensor for detection of NO in exhaled human nasal breath is examined. Enhanced selectivity over carbon monoxide and ammonia is achieved via an in-line zinc oxide-based filter. Exhaled nasal NO levels measured in 21 human samples with the sensor are shown to correlate well with those obtained using a chemiluminescence reference method (R2 = 0.9836).

A randomized crash injury prevention trial of transitioning high-risk elders from driving.

UNLABELLED: Supplemental digital content is available in the text. BACKGROUND: Older adults with medical conditions that impair function are at risk for experiencing a motor vehicle crash. This randomized controlled trial tested an intervention to reduce crash-related risk among older patients. METHODS: A 2-to-1 allocation ratio resulted in comparisons between 26 intervention and 13 attention control (n = 39) group members who were recruited from inpatient and outpatient settings. The intervention consisted of two sessions of facilitated planning in which participants' health, transportation alternatives, attitudes/emotions regarding a change in mobility, and actions to ensure continued safe mobility were discussed. Moreover, all participants received supportive telephone calls during the 6-month intervention period. RESULTS: Results showed that when compared with the control group, the intervention group had significantly better subjective health, had fewer high-risk driving behaviors, and drove less distance on excursions from home at follow-up. Yet, simple repeated-measures analyses were not significant. CONCLUSION: Results suggest that facilitated planning may help ease the transition to driving retirement among some high-risk older patients. Larger samples and longer study duration are needed to confirm these effects and to measure direct crash and injury outcomes. A significant proportion of high-risk patients do not plan for driving retirement and remain a crash risk. LEVEL OF EVIDENCE: Therapeutic/care management study, level III.

Spatial distribution of Aphis glycines (Hemiptera: Aphididae): a summary of the suction trap network.

The soybean aphid, Aphis glycines Matsumura (Hemiptera: Aphididae), is an economically important pest of soybean, Glycine max (L.) Merrill, in the United States. Phenological information of A. glycines is limited; specifically, little is known about factors guiding migrating aphids and potential impacts of long distance flights on local population dynamics. Increasing our understanding of A. glycines population dynamics may improve predictions of A. glycines outbreaks and improve management efforts. In 2005 a suction trap network was established in seven Midwest states to monitor the occurrence of alates. By 2006, this network expanded to 10 states and consisted of 42 traps. The goal of the STN was to monitor movement of A. glycines from their overwintering host Rhamnus spp. to soybean in spring, movement among soybean fields during summer, and emigration from soybean to Rhamnus in fall. The objective of this study was to infer movement patterns of A. glycines on a regional scale based on trap captures, and determine the suitability of certain statistical methods for future analyses. Overall, alates were not commonly collected in suction traps until June. The most alates were collected during a 3-wk period in the summer (late July to mid-August), followed by the fall, with a peak capture period during the last 2 wk of September. Alate captures were positively correlated with latitude, a pattern consistent with the distribution of Rhamnus in the United States, suggesting that more southern regions are infested by immigrants from the north.

Tretinoin: A Review of Its Anti-inflammatory Properties in the Treatment of Acne.

Tretinoin has been primarily used for the early stages of acne because of its proven comedolytic end benefits. This article reviews and updates the collective body of evidence of tretinoin in the treatment of acne, which suggests that this drug also possesses a broad range of acne-related immunomodulating properties that are capable of disrupting and hindering the various stages of the inflammatory cascade and the production of proinflammatory factors associated with it.

Clindamycin 1.2% Tretinoin 0.025% Gel versus Clindamycin Gel Treatment in Acne Patients: A Focus on Fitzpatrick Skin Types.

BACKGROUND: Acne vulgaris affects individuals of all races and ethnicities. Understanding the safety and efficacy of topical agents benefits the practicing clinician when treating patients with skin of color. PURPOSE: To report observations in acne patients representing all six Fitzpatrick skin types based on a Phase 3 study that evaluated the efficacy and safety of a clindamycin phosphate 1.2% tretinoin 0.025% gel versus a clindamycin phosphate 1.2% gel alone. METHODS: The two treatments were compared in a randomized, double-blind, multicenter, parallel, 12-week study employing a total of 2,010 patients with moderate-to-severe acne. Primary efficacy endpoints were 1) treatment success defined as percentage of patients who were clear or almost clear or achieved at least a 2-grade improvement in Evaluators Global Severity Scores at Week 12 and 2) percent change from baseline versus 12-week scores for noninflamed, inflamed, and total lesions. RESULTS: The 12-week, 37.8-percent Evaluators Global Severity Scores treatment success for clindamycin phosphate 1.2% tretinoin 0.025% gel was greater than the 31.7 percent observed for clindamycin phosphate 1.2% gel alone (P = 0.002). Percent changes from baseline versus 12-week scores for noninflamed, inflamed, and total lesions obtained with clindamycin phosphate 1.2% tretinoin 0.025% gel (49.8, 60.9, and 54.5%, respectively) were significantly greater than those observed for clindamycin phosphate 1.2% gel alone (41.3, 54.8, and 46.9%, respectively); all comparisons P<0.001. CONCLUSION: Use of clindamycin phosphate 1.2% tretinoin 0.025% gel resulted in greater percent reductions of Evaluators Global Severity Scores treatment success scores and acne lesions in patients with all six Fitzpatrick skin types combined than clindamycin phosphate 1.2% gel alone. Both products were well tolerated, with no hypo- or hyperpigmentation noted. Side effects observed were similar to those previously reported for the individual ingredients.

A review of the anti-inflammatory properties of clindamycin in the treatment of acne vulgaris.

This article reviews anti-inflammatory properties of clindamycin, which is often used topically for the management of acne vulgaris, usually in combination with other agents. The efficacy of clindamycin in acne treatment has been shown to be sustained for more than 3 decades. It is likely that anti-inflammatory effects play an important role in the therapeutic activity of topical clindamycin.

Coping with stress: the effectiveness of different types of music.

Listening to classical and self-selected relaxing music after exposure to a stressor should result in significant reductions in anxiety, anger, and sympathetic nervous system arousal, and increased relaxation compared to those who sit in silence or listen to heavy metal music. Fifty-six college students, 15 males and 41 females, were exposed to different types of music genres after experiencing a stressful test. Several 4 x 2 mixed design analyses of variance were conducted to determine the effects of music and silence conditions (heavy metal, classical, or self-selected music and silence) and time (pre-post music) on emotional state and physiological arousal. Results indicate listening to self-select or classical music, after exposure to a stressor, significantly reduces negative emotional states and physiological arousal compared to listening to heavy metal music or sitting in silence.

Alfalfa living mulch advances biological control of soybean aphid.

Despite evidence for biological control in North America, outbreaks of the invasive soybean aphid, Aphis glycines Matsumura (Hemiptera: Aphididae), continue to occur on soybean (Glycine max L. Merr.). Our objectives were to determine whether natural enemies delay aphid establishment and limit subsequent population growth and whether biological control can be improved by altering the within-field habitat. We hypothesized that a living mulch would increase the abundance of the aphidophagous community in soybean and suppress A. glycines establishment and population growth. We measured natural enemy and A. glycines abundance in soybean grown with and without an alfalfa (Medicago sativa L.) living mulch. Soybean grown with an alfalfa living mulch had 45% more natural enemies and experienced a delay in A. glycines establishment that resulted in lower peak populations. From our experiments, we concluded that the current natural enemy community in Iowa can delay A. glycines establishment, and an increase in aphidophagous predator abundance lowered the rate of A. glycines population growth preventing economic populations (i.e., below the current economic threshold) from occurring. Incorporation of a living mulch had an unexpected impact on A. glycines population growth, lowering the aphids' intrinsic rate of growth, thus providing a bottom-up suppression of A. glycines. We suggest future studies of living mulches or cover crops for A. glycines management should address both potential sources of suppression. Furthermore, our experience suggests that more consistent biological control of A. glycines may be possible with even partial resistance that slows but does not prevent reproduction.