Altered place engagement since COVID-19: A multi-method study of community participation and health among older americans.

Little is known about longer-term changes to community participation since the COVID-19 pandemic onset and potential implications for health and wellbeing in later life. This multi-method investigation analyzes national data from the COVID-19 Coping Study. Statistical analyses of survey data (n = 1,630; mean age 67.9 years; data collected April/May 2022) identified that adults residing in the US still tended to stay inside their homes more often since the pandemic onset. Overall, participants decreased their engagement with amenities such as eateries, gyms, and arts and cultural sites. Reflexive thematic analysis of semi-structured in-depth interviews (n = 57; mean age 70.7 years; data collected May-July 2021) identified altered community participation with perceived long-term impacts on physical, mental, and social health and wellbeing. The results provide novel insights about the critical nature of 'third places' to support later life, and policy implications to strengthen community environments. Investment in outdoor, well-ventilated, and distanced third places may support wellbeing.

Using inquiry based stress reduction to address self-stigma in severe spectrum obesity in general practice.

BACKGROUND: Obesity is a driver of multimorbidity. Knowledge regarding individual and population based solutions is evolving in primary care. Stigma/self-stigma are important in developing clinical solutions. Inquiry based stress reduction (IBSR) is emerging as a solution for self-stigma in a range of conditions. This study explores IBSR (also known as The Work of Byron Katie) in obesity self-stigma in the GP setting, with severe obesity, utilising a multidisciplinary approach. AIM: Is it feasible/acceptable to utilise Inquiry Based Stress Reduction in the GP setting for obesity? METHOD: Mixed-method pilot study including a convenience sample of people with severe spectrum obesity from a three-doctor general practice, including use of IBSR provided in both group, partner and individual settings, predominantly online, utilising certified and accredited IBSR facilitators, a clinical psychologist, and participating GPs. Outcomes include pre- and post-intervention surveys (Becks Depression Scale, HRQoL, Weight Bias Internalisation Scale, Weight Self-stigma Questionnaire) and qualitative data from participants. RESULTS: Of 22 initially invited to participate, 14 commenced and 10 completed the intervention. Mean BMI was 42.8, mean age 49 years, female:male = 7:3. Many believed obesity was their own fault, related very difficult interactions with healthcare professionals, and valued opportunity to engage with the intervention. While participants had alarming levels of comorbidity, they were far more concerned regarding stigma and self-stigma. CONCLUSION: Results and experience in practice indicate this approach is feasible and acceptable. Results are valuable in planning a larger study in multiple practices.

"I just can't go back": Challenging Places for Older Americans since the COVID-19 Pandemic Onset.

During the pandemic, many older adults felt 'out of place' in their home, work, and community spaces with potentially long-term consequences for health and wellbeing. Using national data from the COVID-19 Coping Study, thematic analysis of online long-answer responses (n = 1171; mean age 68 years; 71% female; 93% non-Hispanic White; 86% with at least a 4-year college degree; data collected April-June 2022) identified four themes regarding why particular places are challenging since the pandemic onset: (1) viral exposure fears, (2) frustrating regulations, (3) uncomfortable and hostile social dynamics, and (4) 'out of place' negative emotions. Participants also shared how they continuously address or adapt to place-based challenges through lifestyle adjustments and coping strategies. Novel findings may inform multi-scalar policymaking and interventions to support wellbeing in later life in times of stress and instability.

A differentiable simulation package for performing inference of synchrotron-radiation-based diagnostics.

The direction of particle accelerator development is ever-increasing beam quality, currents and repetition rates. This poses a challenge to traditional diagnostics that directly intercept the beam due to the mutual destruction of both the beam and the diagnostic. An alternative approach is to infer beam parameters non-invasively from the synchrotron radiation emitted in bending magnets. However, inferring the beam distribution from a measured radiation pattern is a complex and computationally expensive task. To address this challenge we present SYRIPY (SYnchrotron Radiation In PYthon), a software package intended as a tool for performing inference of synchrotron-radiation-based diagnostics. SYRIPY has been developed using PyTorch, which makes it both differentiable and able to leverage the high performance of GPUs, two vital characteristics for performing statistical inference. The package consists of three modules: a particle tracker, Lienard-Wiechert solver and Fourier optics propagator, allowing start-to-end simulation of synchrotron radiation detection to be carried out. SYRIPY has been benchmarked against SRW, the prevalent numerical package in the field, showing good agreement and up to a 50× speed improvement. Finally, we have demonstrated how SYRIPY can be used to perform Bayesian inference of beam parameters using stochastic variational inference.

Educational Attainment and Later-Life Cognitive Function in High- and Middle-Income Countries: Evidence From the Harmonized Cognitive Assessment Protocol.

OBJECTIVES: Identifying social policies that can promote cognitive health is crucial for reducing the global burden of dementia. We evaluated the importance of educational attainment for later-life cognitive function in various social and geographic settings. METHODS: Using harmonized data for individuals aged ≥65 years from the United States Health and Retirement Study (HRS) and its international partner studies in England, Mexico, China, and India, and each study's respective Harmonized Cognitive Assessment Protocol (HCAP), we conducted a cross-national comparative study to examine the role of educational attainment in later-life cognitive function across countries (n = 14,980, 2016-2019). We used multivariable-adjusted regression to estimate associations between educational attainment and harmonized global cognitive function scores. RESULTS: In Mexico, China, and India, the general cognitive function scores on average are approximately one standard deviation of the HRS-HCAP cognitive function score distribution lower compared to the United States and England, paralleling patterns of educational attainment across countries. In all countries, higher educational attainment was associated with progressively higher later-life cognitive function scores. Population-level differences in educational attainment explained about 50%-90% of the observed differences in cognitive function scores across countries. DISCUSSION: The relationship between education and later-life cognitive function across social and geographic contexts underscores the crucial role of education to promote cognitive health and reduce dementia risk. Continual improvement of educational attainment in low- and middle-income settings may yield a significant pay-off in later-life cognitive health.

Lifetime occupational skill and later-life cognitive function among older adults in the United States, Mexico, India, and South Africa.

INTRODUCTION: We conducted a cross-national comparison of the association between main lifetime occupational skills and later-life cognitive function across four economically and socially distinct countries. METHODS: Data were from population-based studies of aging and their Harmonized Cognitive Assessment Protocols (HCAPs) in the US, South Africa, India, and Mexico (N = 10,037; Age range: 50 to 105 years; 2016 to 2020). Main lifetime occupational skill was classified according to the International Standard Classification of Occupations. Weighted, adjusted regression models estimated pooled and country-specific associations between main lifetime occupational skill and later-life general cognitive function in men and women. RESULTS: We observed positive gradients between occupational skill and later-life cognitive function for men and women in the US and Mexico, a positive gradient for women but not men in India, and no association for men or women in South Africa. DISCUSSION: Main lifetime occupations may be a source of later-life cognitive reserve, with cross-national heterogeneity in this association. HIGHLIGHTS: No studies have examined cross-national differences in the association of occupational skill with cognition. We used data from Harmonized Cognitive Assessment Protocols in the US, Mexico, India, and South Africa. The association of occupational skill with cognitive function varies by country and gender.

Linking vertical movements of large pelagic predators with distribution patterns of biomass in the open ocean.

Many predator species make regular excursions from near-surface waters to the twilight (200 to 1,000 m) and midnight (1,000 to 3,000 m) zones of the deep pelagic ocean. While the occurrence of significant vertical movements into the deep ocean has evolved independently across taxonomic groups, the functional role(s) and ecological significance of these movements remain poorly understood. Here, we integrate results from satellite tagging efforts with model predictions of deep prey layers in the North Atlantic Ocean to determine whether prey distributions are correlated with vertical habitat use across 12 species of predators. Using 3D movement data for 344 individuals who traversed nearly 1.5 million km of pelagic ocean in [Formula: see text]42,000 d, we found that nearly every tagged predator frequented the twilight zone and many made regular trips to the midnight zone. Using a predictive model, we found clear alignment of predator depth use with the expected location of deep pelagic prey for at least half of the predator species. We compared high-resolution predator data with shipboard acoustics and selected representative matches that highlight the opportunities and challenges in the analysis and synthesis of these data. While not all observed behavior was consistent with estimated prey availability at depth, our results suggest that deep pelagic biomass likely has high ecological value for a suite of commercially important predators in the open ocean. Careful consideration of the disruption to ecosystem services provided by pelagic food webs is needed before the potential costs and benefits of proceeding with extractive activities in the deep ocean can be evaluated.

Quantifying longline bycatch mortality for pelagic sharks in western Pacific shark sanctuaries.

Marine protected areas are increasingly touted for their role in conserving large marine predators such as sharks, but their efficacy is debated. Seventeen "shark sanctuaries" have been established globally, but longline fishing continues within many such jurisdictions, leading to unknown levels of bycatch mortality levels. Using public data from Global Fishing Watch and Regional Fisheries Management Organizations, we quantified longline fishing within eight shark sanctuaries and estimated pelagic shark catch and mortality for seven pelagic shark species. Sanctuary mortality ranged from 600 individuals (Samoa) to 36,256 individuals (Federated States of Micronesia), equivalent to ~5% of hypothesized sustainable levels for blue sharks to ~40% for silky sharks, with high mortality levels in the Federated States of Micronesia, Palau, and the Marshall Islands. Unsustainable mortality rates were exceeded for silky sharks in two sanctuaries, highlighting a need for additional stock assessments and implementation of bycatch reduction measures. Big data integration workflows represent a transformative tool in fisheries management, particularly for data-poor species.

Energetic connectivity of diverse elasmobranch populations - implications for ecological resilience.

Understanding the factors shaping patterns of ecological resilience is critical for mitigating the loss of global biodiversity. Throughout aquatic environments, highly mobile predators are thought to serve as important vectors of energy between ecosystems thereby promoting stability and resilience. However, the role these predators play in connecting food webs and promoting energy flow remains poorly understood in most contexts. Using carbon and nitrogen isotopes, we quantified the use of several prey resource pools (small oceanic forage, large oceanics, coral reef, and seagrass) by 17 species of elasmobranch fishes (n = 351 individuals) in The Bahamas to determine their functional diversity and roles as ecosystem links. We observed remarkable functional diversity across species and identified four major groups responsible for connecting discrete regions of the seascape. Elasmobranchs were responsible for promoting energetic connectivity between neritic, oceanic and deep-sea ecosystems. Our findings illustrate how mobile predators promote ecosystem connectivity, underscoring their functional significance and role in supporting ecological resilience. More broadly, strong predator conservation efforts in developing island nations, such as The Bahamas, are likely to yield ecological benefits that enhance the resilience of marine ecosystems to combat imminent threats such as habitat degradation and climate change.

The Association Between Borderline Dysnatremia and Perioperative Morbidity and Mortality: Retrospective Cohort Study of the American College of Surgeons National Surgical Quality Improvement Program Database.

BACKGROUND: Hyponatremia and hypernatremia, as conventionally defined (<135 mEq/L and >145 mEq/L, respectively), are associated with increased perioperative morbidity and mortality. However, the effects of subtle deviations in serum sodium concentration within the normal range are not well-characterized. OBJECTIVE: The purpose of this analysis is to determine the association between borderline hyponatremia (135-137 mEq/L) and hypernatremia (143-145 mEq/L) on perioperative morbidity and mortality. METHODS: A retrospective cohort study was performed using data from the American College of Surgeons National Surgical Quality Improvement Program database. This database is a repository of surgical outcome data collected from over 600 hospitals across the United States. The National Surgical Quality Improvement Program database was queried to extract all patients undergoing elective, noncardiac surgery from 2015 to 2019. The primary predictor variable was preoperative serum sodium concentration, measured less than 5 days before the index surgery. The 2 primary outcomes were the odds of morbidity and mortality occurring within 30 days of surgery. The risk of both outcomes in relation to preoperative serum sodium concentration was modeled using weighted generalized additive models to minimize the effect of selection bias while controlling for covariates. RESULTS: In the overall cohort, 1,003,956 of 4,551,726 available patients had a serum sodium concentration drawn within 5 days of their index surgery. The odds of morbidity and mortality across sodium levels of 130-150 mEq/L relative to a sodium level of 140 mEq/L followed a nonnormally distributed U-shaped curve. The mean serum sodium concentration in the study population was 139 mEq/L. All continuous covariates were significantly associated with both morbidity and mortality (P<.001). Preoperative serum sodium concentrations of less than 139 mEq/L and those greater than 144 mEq/L were independently associated with increased morbidity probabilities. Serum sodium concentrations of less than 138 mEq/L and those greater than 142 mEq/L were associated with increased mortality probabilities. Hypernatremia was associated with higher odds of both morbidity and mortality than corresponding degrees of hyponatremia. CONCLUSIONS: Among patients undergoing elective, noncardiac surgery, this retrospective analysis found that preoperative serum sodium levels less than 138 mEq/L and those greater than 142 mEq/L are associated with increased morbidity and mortality, even within currently accepted "normal" ranges. The retrospective nature of this investigation limits the ability to make causal determinations for these findings. Given the U-shaped distribution of risk, past investigations that assume a linear relationship between serum sodium concentration and surgical outcomes may need to be revisited. Likewise, these results question the current definition of perioperative eunatremia, which may require future prospective investigations.

Tiger sharks support the characterization of the world's largest seagrass ecosystem.

Seagrass conservation is critical for mitigating climate change due to the large stocks of carbon they sequester in the seafloor. However, effective conservation and its potential to provide nature-based solutions to climate change is hindered by major uncertainties regarding seagrass extent and distribution. Here, we describe the characterization of the world's largest seagrass ecosystem, located in The Bahamas. We integrate existing spatial estimates with an updated empirical remote sensing product and perform extensive ground-truthing of seafloor with 2,542 diver surveys across remote sensing tiles. We also leverage seafloor assessments and movement data obtained from instrument-equipped tiger sharks, which have strong fidelity to seagrass ecosystems, to augment and further validate predictions. We report a consensus area of at least 66,000 km2 and up to 92,000 km2 of seagrass habitat across The Bahamas Banks. Sediment core analysis of stored organic carbon further confirmed the global relevance of the blue carbon stock in this ecosystem. Data from tiger sharks proved important in supporting mapping and ground-truthing remote sensing estimates. This work provides evidence of major knowledge gaps in the ocean ecosystem, the benefits in partnering with marine animals to address these gaps, and underscores support for rapid protection of oceanic carbon sinks.

Capture heats up sharks.

Catch-and-release fishing is an important component of ecotourism industries and scientific research worldwide, but its total impact on animal physiology, health and survival is understudied for many species of fishes, particularly sharks. We combined biologging and blood chemistry to explore how this fisheries interaction influenced the physiology of two widely distributed, highly migratory shark species: the blue shark (Prionace glauca) and the tiger shark (Galeocerdo cuvier). Nineteen sharks were caught by drum line or rod-and-reel angling; subcutaneous body temperature measurements were taken immediately upon capture, with six individuals also providing subsequent subcutaneous body temperature measurements via biologging as they swam freely for several hours post-release. We found that short-term capture caused shark body temperature to increase significantly and rapidly, with increases of 0.6°C-2.7°C for blue sharks (mean, 1.2 ± 0.6°C) and 0.5°C-0.9°C for tiger sharks (mean, 0.7 ± 0.2°C) and with capture-induced heating rates of blue sharks averaging 0.3°C min-1 but as high as 0.8°C min-1. Blue shark body temperature was even higher deeper into the white muscle. These heating rates were three to eight times faster than maximum rates encountered by our biologging sharks swimming through thermally stratified waters and faster than most acute heating experiments conducted with ectotherms in laboratory experiments. Biologging data showed that body temperatures underwent gradual decline after release, returning to match water temperatures 10-40 mins post-release. Blood biochemistry showed variable lactate/glucose levels following capture; however, these concentrations were not correlated with the magnitude of body temperature increase, nor with body size or hooking time. These perturbations of the natural state could have immediate and longer-term effects on the welfare and ecology of sharks caught in catch-and-release fisheries and we encourage further study of the broader implications of this reported phenomenon.

Multimorbidity and Mental Health Trajectories Among Middle-Aged and Older U.S. Adults During the COVID-19 Pandemic: Longitudinal Findings From the COVID-19 Coping Study.

Background and Objectives: This study aimed to examine the associations between multimorbidity at the COVID-19 pandemic onset and subsequent longitudinal trajectories of depressive symptoms, anxiety symptoms, and loneliness in middle-aged and older adults over a 12-month follow-up. Research Design and Methods: Data were from monthly online questionnaires in the COVID-19 Coping Study of U.S. adults aged ≥55 from April/May 2020 through April/May 2021 (N = 4,024). Multimorbidity was defined as having ≥2 versus <2 chronic conditions at baseline. Mental health outcomes were assessed monthly as depressive symptoms (8-item Center for Epidemiologic Studies Depression scale), anxiety symptoms (5-item Beck Anxiety Inventory), and loneliness (3-item UCLA Loneliness Scale). We used multivariable-adjusted population- and attrition-weighted mixed-effects linear models to examine the longitudinal associations between multimorbidity and mental health symptoms. Results: Multimorbidity at the pandemic onset was associated with elevated depressive (b = 0.37; 95% CI: 0.16-0.59) and anxiety (b = 0.39; 95% CI: 0.15-0.62) symptoms at baseline. Changes in symptoms for all three mental health outcomes were nonlinear over time, with worsening symptoms over the first 6 months of the pandemic (April/May to September/October 2020), followed by improvement in symptoms over the subsequent 6 months (September/October 2020 to April/May 2021). Middle-aged and older adults with multimorbidity experienced faster rates of change in anxiety symptoms and loneliness than those without multimorbidity, with persistently elevated mental health symptomatology throughout the follow-up. Discussion and Implications: Results highlight the unique and persistent mental health risks experienced by middle-aged and older adults with multimorbidity during the COVID-19 pandemic. The observed improvements in symptoms underscore the mental resilience of these individuals, indicating their adaptation to the ongoing pandemic.

Acute relationships between mental health and cognitive function during the COVID-19 pandemic: Longitudinal evidence from middle-aged and older US adults.

Background: The acute impacts of COVID-19-related mental health concerns on cognitive function among middle-aged and older adults are unknown. We investigated whether between-person (BP) differences and within-person (WP) changes in loneliness, anxiety, and worry about COVID-19 were related to cognitive function and abilities in a longitudinal cohort of middle-aged and older United States (US) adults over a nine-month period during the COVID-19 pandemic. Methods: Data were from bimonthly questionnaires in the nationwide COVID-19 Coping Study from August/September 2020 through April/May 2021 (N = 2262 adults aged ≥55). Loneliness was assessed with the 3-item UCLA Loneliness Scale, anxiety with the 5-item Beck Anxiety Inventory, and COVID-19 worry on a 5-point Likert-type scale. Cognitive outcomes were assessed with the 6-item Patient Reported Outcomes Measurement Information System (PROMIS®) Cognitive Function and Abilities scales. Marginal structural models incorporating inverse probability of treatment and attrition weights as well as sampling weights estimated the BP and WP relationships between the mental health predictors and PROMIS® cognitive scores over time. Results: In any given month, experiencing a loneliness or anxiety symptom score higher than the sample mean (BP difference) or higher than one's personal mean across the nine-month period (WP change) was negatively associated with cognitive function and abilities in that month. The observed magnitudes of associations were stronger for BP differences than for WP changes and were the strongest for anxiety symptom scale scores. Conclusions: Elevated loneliness and anxiety symptoms, both relative to other adults and to one's usual levels, were acutely associated with worse perceived cognitive function and abilities over a nine-month period during the COVID-19 pandemic in the United States. The long-term impacts of mental health symptoms experienced during the pandemic for population cognitive health should be explored.

Physical isolation and mental health among older US adults during the COVID-19 pandemic: longitudinal findings from the COVID-19 Coping Study.

PURPOSE: We investigated the relationships between physical isolation at home during the period when many US states had shelter-in-place orders and subsequent longitudinal trajectories of depression, anxiety, and loneliness in older adults over a 6 month follow-up. METHODS: Data were from monthly online questionnaires with US adults aged ≥ 55 in the nation-wide COVID-19 Coping Study (April through October 2020, N = 3978). Physical isolation was defined as not leaving home except for essential purposes (0, 1-3, 4-6, and 7 days in the past week), measured at baseline (April-May). Outcomes were depressive symptoms (8-item Center for Epidemiological Studies Depression Scale), anxiety symptoms (5-item Beck Anxiety Inventory), and loneliness (3-item UCLA loneliness scale), measured monthly (April-October). Multivariable, population- and attrition-weighted linear mixed-effects models assessed the relationships between baseline physical isolation with mental health symptoms at baseline and over time. RESULTS: Physical isolation (7 days versus 0 days in the past week) was associated with elevated depressive symptoms (adjusted ß = 0.85; 95% CI 0.10-1.60), anxiety symptoms (adjusted ß = 1.22; 95% CI 0.45-1.98), and loneliness (adjusted ß = 1.06; 95% CI 0.51-1.61) at baseline, but not with meaningful rate of change in these mental health outcomes over time. The symptom burden of each mental health outcome increased with increasing past-week frequency of physical isolation. CONCLUSION: During the early COVID-19 pandemic, physical isolation was associated with elevated depressive symptoms, anxiety symptoms, and loneliness, which persisted over time. These findings highlight the unique and persistent mental health risks of physical isolation at home under pandemic control measures.

Loneliness Among US Adults Aged ≥55 Early in the COVID-19 Pandemic : Findings From the COVID-19 Coping Study.

OBJECTIVES: Loneliness is associated with increased risks of adverse health outcomes among middle-aged and older adults. We estimated the prevalence of loneliness and identified key sociodemographic, employment, living, and health-related risk factors for loneliness among adults aged ≥55 during the early phase of the COVID-19 pandemic in the United States, when much of the country was under shelter-in-place orders. METHODS: We collected data from online questionnaires in the COVID-19 Coping Study, a national study of 6938 US adults aged ≥55 from April 2 through May 31, 2020. We estimated the population-weighted prevalence of loneliness (scores ≥6 of 9 on the 3-item UCLA Loneliness Scale), overall and by sociodemographic, employment, living, and health-related factors. We used population-weighted modified Poisson regression models to estimate prevalence ratios (PRs) and 95% CIs for the associations between these factors and loneliness, adjusting for age, sex, race, ethnicity, and education level. RESULTS: Overall, we estimated that 29.5% (95% CI, 27.9%31.3%) of US adults aged ≥55 were considered high in loneliness in April and May 2020. In population-weighted adjusted models, loneliness was the most prevalent among those who reported depression, who were not married or in a relationship, who lived alone, and who were unemployed at the onset of the pandemic. CONCLUSIONS: We identified subpopulations of middle-aged and older adults who were vulnerable to loneliness during a period when COVID-19 shelter-in-place orders were in place across most of the country. These insights may inform the allocation of resources to mitigate an unintended health consequence during times of restricted activity.

Coping During the COVID-19 Pandemic: A Qualitative Study of Older Adults Across the United States.

Objective: Older adults may struggle with stresses and daily life challenges associated with the Coronavirus Disease 2019 (COVID-19) pandemic. Yet they may also utilize emotional and behavioral coping strategies. This qualitative paper aims to identify ways of coping with worries and stress during the pandemic from the perspectives of older adults in the United States. Methods: The COVID-19 Coping Study recruited 6,938 adults aged ≥55 through online multi-frame sampling from April 2-May 31, 2020 across all 50 US states, the District of Columbia, and Puerto Rico. The online questionnaire focused on the effects of COVID-19 on daily life, mental health, and well-being. This included an open-ended question regarding participants' coping strategies. We used qualitative content analysis to identify and code diverse coping strategies. Our general inductive approach enabled findings to emerge from the most frequent and dominant themes in the raw data. Results: A total of 5,180 adults [74% of the total sample; mean age 67.3 (SD 7.9); 63.8% female] responded to the question about using strategies to cope with living through the COVID-19 pandemic. Frequently-reported strategies included exercising and going outdoors, modifying routines, following public health guidelines, adjusting attitudes, and staying socially connected. Some coping strategies were health-limiting (e.g., overeating), while most strategies encouraged self-improvement, positive adjustment, and wellness. Conclusions: This study provides novel qualitative evidence on coping strategies of older adults early in the COVID-19 pandemic. Findings can inform community and clinical interventions to support older adults that harness positive coping strategies such as exercise, modified routines, and social strategies to improve physical and mental health, foster social support, and encourage meaningful daily activities during times of stress and trauma.