Stem cell therapy: a new hope for stroke and traumatic brain injury recovery and the challenge for rural minorities in South Carolina.

Stroke and traumatic brain injury (TBI) are a significant cause of death and disability nationwide. Both are considered public health concerns in rural communities in the state of South Carolina (SC), particularly affecting the African American population resulting in considerable morbidity, mortality, and economic burden. Stem cell therapy (SCT) has emerged as a potential intervention for both diseases with increasing research trials showing promising results. In this perspective article, the authors aim to discuss the current research in the field of SCT, the results of early phase trials, and the utilization of outcome measures and biomarkers of recovery. We searched PubMed from inception to December 2023 for articles on stem cell therapy in stroke and traumatic brain injury and its impact on rural communities, particularly in SC. Early phase trials of SCT in Stroke and Traumatic Brain injury yield promising safety profile and efficacy results, but the findings have not yet been consistently replicated. Early trials using mesenchymal stem cells for stroke survivors showed safety, feasibility, and improved functional outcomes using broad and domain-specific outcome measures. Neuroimaging markers of recovery such as Functional Magnetic Resonance Imaging (fMRI) and electroencephalography (EEG) combined with neuromodulation, although not widely used in SCT research, could represent a breakthrough when evaluating brain injury and its functional consequences. This article highlights the role of SCT as a promising intervention while addressing the underlying social determinants of health that affect therapeutic outcomes in relation to rural communities such as SC. It also addresses the challenges ethical concerns of stem cell sourcing, the high cost of autologous cell therapies, and the technical difficulties in ensuring transplanted cell survival and strategies to overcome barriers to clinical trial enrollment such as the ethical concerns of stem cell sourcing, the high cost of autologous cell therapies, and the technical difficulties in ensuring transplanted cell survival and equitable healthcare.

Geographical location as a determinant of caregiver burden: a rural-urban analysis of the informal caregiving, health, and healthcare survey in Ghana.

BACKGROUND: The caregiving scholarship widely acknowledges informal caregivers' contributions to maintaining older adults' health and well-being. However, informal caregivers encounter economic, physical, social, financial and psychological challenges when caring for older adults. The caregiving literature has shown variations in caregiving intensity and motivation between rural and urban informal caregivers of older adults. This situation is likely to result in rural-urban disparities in caregiver burden. However, the literature on predictors of caregiver burden is more focused on demographic, socio-economic, caregiving and health-related factors with very little attention to geographical dynamics. For this reason, the effects of demographic, socio-economic, caregiving, and health-related factors on the variations in caregiver burden between rural and urban informal caregivers of older adults are yet to be known in the sub-Saharan African context, including Ghana. Notably, the impact of geographical location on caregiver burden is mainly missing in the informal caregiving literature in Ghana. Situated within the stress process model, we determine the association between geographical location and caregiver burden among informal caregivers of older adults in Ghana. METHODS: This study employed data from a large cross-sectional survey on informal caregiving, health, and healthcare among caregivers of older adults aged 50 years or above (N = 1,853) in Ghana. We selected the World Health Organization Impact of Caregiving Scale to measure caregiver burden. Generalized multivariable linear regression models were employed to determine the association between geographical location and caregiver burden among informal caregivers of older adults. We reported beta values and standard errors with significance levels of 0.05 or less. RESULTS: The results showed that rural informal caregivers of older adults significantly have a decreased caregiver burden compared to urban informal caregivers (ß = -1.64; SE = 0.41). Also, participants across all the self-rated health categories (poor/very poor: ß = 12.63; SE = 1.65; fair: ß = 9.56; SE = 1.07; good: ß = 11.00; SE = 0.61, very good: ß = 7.03; SE = 0.49) have a significantly increased caregiver burden for the full sample and for both rural (poor/very poor: ß = 13.88; SE = 2.4; fair: ß = 6.11; SE = 1.62; good: ß = 9.97; SE = 0.96, very good: ß = 6.06; SE = 0.71) and urban (poor/very poor: ß = 11.86; SE = 2.25; fair: ß = 12.33; SE = 1.42; good: ß = 11.80; SE = 0.79, very good: ß = 7.90; SE = 0.67) participants. This study further revealed that participants with no financial support needs reported a decreased caregiver burden compared to those with financial support needs for the full sample (ß = -2.92, p-value < 0.01) and for both rural (ß = -3.20; p-value < 0.01) and urban (ß =-2.70; p-value < 0.01) participants. CONCLUSION: The findings from this study underscore geographical location differences in caregiver burden among informal caregivers of older adults in Ghana. Given these findings, the need to consider geographical location variations in providing welfare and health support programs to lessen caregiver burden among informal caregivers of older adults is welcomed. In line with the stress process model, such welfare and health programs should consider background, context, and stressor factors that contribute to variations in caregiver burden between rural and urban informal caregivers of older adults in Ghana and other sub-Saharan African countries.

Urban 3D building morphology and energy consumption: empirical evidence from 53 cities in China.

The impact of building morphology on building energy consumption has been extensively studied. However, research on how 3D building morphology affects energy consumption at a macroscopic scale is lacking. In this study, we measured the mean building height (BH), mean building volume (BV), and mean European nearest neighbor distance (MENN) of the city to quantify the 3D building morphology. We then used a spatial regression model to analyze the quantitative impact of urban 3D building morphology on per capita electricity consumption (PCEC). Results indicate that at the macroscopic scale of the city, the BH and the MENN have a significant positive impact on the PCEC, while the BV has a significant negative impact on the PCEC. Moreover, the inclusion of the 3D building morphology greatly improves the model's ability to explain building energy efficiency, surpassing the impact of traditional economic factors. Considering the 3D building morphology indicators together, buildings with a lower height, a larger volume, and a more compact 3D morphology have greater potential for energy savings and are more conducive to electricity conservation. This study offers valuable insights for the energy-efficient arrangement of buildings.

Environmental health, economy, and amenities interactively drive migration patterns among China's older people.

The increasing number of older adult migrants is rapidly changing regional demographic and social structures in China. There is an urgent need to understand the spatial patterns and factors that influence older adults to migrate, especially the role of environmental health. However, this issue has been under-studied. This study focused on intra-provincial and inter-provincial older adult migrants as research subjects, estimated their spatial concentration index based on the iterative proportional fitting approach, and explored the factors influencing their migration using the GeoDetector Model. The results showed the following: (1) In 2015, more than 76% of inter-provincial older adult migrants were distributed in Eastern China, and most intra-provincial older adult migrants were scattered in sub-provincial cities. (2) Compared to factors relating to economy and amenities, environmental health by itself played a relatively weak role in the migration of older adults, but the interaction among environmental health, economy, and amenities was a key driving force of older adult migration. (3) There were significant differences in the dominant environmental health factors between inter-provincial migration and intra-provincial migration, which were temperature and altitude, respectively. Our findings can help policymakers focus on the composition of older adult migrants based on urban environmental health characteristics and rationally optimize older adult care facilities to promote supply-demand matching.

Caregiver burden and health-related quality of life: A study of informal caregivers of older adults in Ghana.

BACKGROUND: Similar to many developing countries, caregiver burden remains high in Ghana which may affect informal caregivers of older adults' health-related quality of life (HRQoL). However, no study has examined the association between caregiver burden and HRQoL among informal caregivers of older adults in Ghana to date. Understanding this association may well help to inform health and social policy measures to improve HRQoL among  informal caregivers of older adults in Ghana. Situated within a conceptual model of HRQoL, the purpose of this study was to examine the relationship  between caregiver burden and HRQoL among informal caregivers of older adults in Ghana. METHODS: We obtained cross-sectional data from informal caregiving, health, and healthcare (N = 1853) survey conducted between July and September 2022 among caregivers (≥ 18 years) of older adults (≥ 50 years) in the Ashanti Region of Ghana. The World Health Organization Impact of Caregiving Scale was used to measure caregiver burden. An 8-item short form Health Survey scale developed by the RAND Corporation and the Medical Outcomes Study was used to measure HRQoL. Generalized Linear Models were employed to estimate the association between caregiver burden and HRQoL. Beta values and standard errors were reported with a significance level of  0.05 or less. RESULTS: The mean age of the informal caregivers was 39.15 years and that of the care recipients was 75.08 years. In our final model, the results showed that caregiver burden was negatively associated with HRQoL (ß = - .286, SE = .0123, p value = 0.001). In line with the conceptual model of HRQoL, we also found that socio-economic, cultural, demographic and healthcare factors were significantly associated with HRQoL. For instance, participants with no formal education (ß = -1.204, SE= .4085, p value = 0.01), those with primary level of education (ß = -2.390, SE= .5099, p value = 0.001) or junior high school education (ß = -1.113, SE= .3903, p value= 0.01) had a significantly decreased HRQoL compared to those with tertiary level of education. Participants who were between the ages of 18-24 (ß = 2.960, SE= .6306, p value=0.001), 25-34 (ß = 1.728, SE= .5794, p value = 0.01) or 35-44 (ß = 1.604, SE= .5764, p value= 0.01) years significantly had increased HRQoL compared to those who were 65 years or above. Also, participants who did not utilize healthcare services in the past year before the survey significantly had increased HRQoL compared to those who utilized healthcare services five or more times in the past year (ß = 4.786, SE=. 4610, p value= 0.001). CONCLUSION: Consistent with our hypothesis, this study reported a significant negative association between caregiver burden and HRQoL. Our findings partially  support the conceptual model of HRQoL used in this study. We recommend that health and social policy measures to improve HRQoL among  informal caregivers of older adults should consider caregiver burden as well as other significant socio-economic, cultural, demographic, and healthcare factors.

Medical ethics of long-duration spaceflight.

With the advent of novel and emerging technologies, long duration spaceflight will become more common; along with it, an increase in its inherent health risks. However, health-related ethical issues arising during long-duration spaceflight remain poorly characterized, uncertain and unpredictable. Medical ethics is defined as a set of moral principles, beliefs and values that guides choices about medical care. This set of principles, founded in our sense of right and wrong, helps us make fair and just decisions. The paper conceptually and analytically investigates the ethical issues likely to arise from medical complications during spaceflight, mapping unfilled gaps of the current status quo. Furthermore, this paper explores broad ethical themes of autonomy, nonmaleficence, beneficence and justice, while also delving deeper into specific scenarios within each theme. The manuscript represents an up-to-date review of the available literature in the field of space medical ethics and recommends guiding ethical principles and a framework for their application to negotiate the resolution of complex ethical scenarios during long-duration spaceflight.

Healthcare utilization among informal caregivers of older adults in the Ashanti region of Ghana: a study based on the health belief model.

BACKGROUND: Existing global evidence suggests that informal caregivers prioritize the health (care) of their care recipients (older adults) over their own health (care) resulting in sub-optimal health outcomes among this population group. However, data on what factors are associated with healthcare utilization among informal caregivers of older adults are not known in a sub-Saharan African context. Guided by the Health Belief Model (HBM), the principal objective of this study was to examine the association between the dimensions of the HBM and healthcare utilization among informal caregivers of older adults in the Ashanti Region of Ghana. METHODS: Data were extracted from a large cross-sectional study of informal caregiving, health, and healthcare survey among caregivers of older adults aged 50 years or above (N = 1,853; mean age of caregivers = 39.15 years; and mean age of care recipients = 75.08 years) in the Ashanti Region of Ghana. Poisson regression models were used to estimate the association between the dimensions of the HBM and healthcare utilization among informal caregivers of older adults. Statistical significance of the test was set at a probability level of 0.05 or less. RESULTS: The results showed that 72.9% (n = 1351) of the participants were females, 56.7% (n = 1051) were urban informal caregivers and 28.6% (n = 530)  had no formal education. The results further showed that 49.4% (n = 916) of the participants utilized healthcare for their health problems at least once in the past year before the survey. The final analysis showed a positive and statistically significant association between perceived susceptibility to a health problem (ß = 0.054, IRR = 1.056, 95% CI = [1.041-1.071]), cues to action (ß = 0.076, IRR = 1.079, 95% CI = [1.044-1.114]), self-efficacy (ß = 0.042, IRR = 1.043, 95% CI = [1.013-1.074]) and healthcare utilization among informal caregivers of older adults. The study further revealed a negative and statistically significant association between perceived severity of a health problem and healthcare utilization (ß= - 0.040, IRR = 0.961, 95% CI= [0.947-0.975]) among informal caregivers of older adults. The results again showed that non-enrollment in a health insurance scheme (ß= - 0.174, IRR = 0.841, 95% CI= [0.774-0.913]) and being unemployed (ß= - 0.088, IRR = 0.916, 95% CI= [0.850-0.986]) were statistically significantly associated with a lower log count of healthcare utilization among informal caregivers of older adults. CONCLUSION: The findings of this study to a large extent support the dimensions of the HBM in explaining healthcare utilization among informal caregivers of older adults in the Ashanti Region of Ghana. Although all the dimensions of the HBM were significantly associated with healthcare utilization in Model 1, perceived barriers to care-seeking and perceived benefits of care-seeking were no longer statistically significant after controlling for demographic, socio-economic and health-related variables in the final model. The findings further suggest that the dimensions of the HBM as well as demographic, socio-economic and health-related factors contribute to unequal healthcare utilization among informal caregivers of older adults in the Ashanti Region of Ghana.

Mobile point-of-care MRI demonstration of a normal volunteer in a telemedicine-equipped ambulance.

OBJECTIVE: Several centers have implemented ambulances equipped with CT scanners and telemedicine capabilities, known as mobile stroke units (MSU), to expedite acute stroke care delivery in the pre-hospital setting. While MSUs have been shown to improve outcomes compared with standard emergency medical management, there are limitations to incorporating CT, including radiation exposure to emergency medical services personnel. Recently, a portable, low-field strength MRI (Swoop®, Hyperfine, Inc., Guilford, CT) received FDA clearance for in-hospital use. Here, as proof-of-concept, we explore the possibility of performing MRI in a telemedicine-equipped ambulance during active transport. MATERIALS AND METHODS: In this initial technical demonstration, we imaged an MR phantom and a normal human volunteer using a standard stroke protocol during active ambulance transport. RESULTS: Images of the MR phantom and volunteer were successfully obtained and were immediately available for viewing in the hospital PACS system. The images were deemed of diagnostic quality by the radiologist. Active motion correction maintained superior image quality despite vehicle and scanner motion. In-plane, low contrast resolution of greater than 4 × 4 mm was achieved. Average transmit speeds were calculated to be 3.54 Megabits/second and upload data rates varied while in transit ranging from 8.54 to 4.13 Megabits/second. CONCLUSION: While MRI is not yet ready for clinical use in the MSU setting, our initial experience suggests potential technological feasible of this approach following future technical and MRI sequence development. Additional studies, incorporating patients, would be required to determine clinical feasibility.

Early-life air pollution and green space exposures as determinants of stunting among children under age five in Sub-Saharan Africa.

BACKGROUND: Childhood malnutrition is a major public health issue in Sub-Saharan Africa (SSA) and 61.4 million children under the age of five years in the region are stunted. Although insight from existing studies suggests plausible pathways between ambient air pollution exposure and stunting, there are limited studies on the effect of different ambient air pollutants on stunting among children. OBJECTIVE: Explore the effect of early-life environmental exposures on stunting among children under the age of five years. METHODS: In this study, we used pooled health and population data from 33 countries in SSA between 2006 and 2019 and environmental data from the Atmospheric Composition Analysis Group and NASA's GIOVANNI platform. We estimated the association between early-life environmental exposures and stunting in three exposure periods - in-utero (during pregnancy), post-utero (after pregnancy to current age) and cumulative (from pregnancy to current age), using Bayesian hierarchical modelling. We also visualise the likelihood of stunting among children based on their region of residence using Bayesian hierarchical modelling. RESULTS: The findings show that 33.6% of sampled children were stunted. In-utero PM2.5 was associated with a higher likelihood of stunting (OR = 1.038, CrI = 1.002-1.075). Early-life exposures to nitrogen dioxide and sulphate were robustly associated with stunting among children. The findings also show spatial variation in a high and low likelihood of stunting based on a region of residence. IMPACT STATEMENT: This study explores the effect of early-life environmental exposures on child growth or stunting among sub-Saharan African children. The study focuses on three exposure windows - pregnancy, after birth and cumulative exposure during pregnancy and after birth. The study also employs spatial analysis to assess the spatial burden of stunted growth in relation to environmental exposures and socioeconomic factors. The findings suggest major air pollutants are associated with stunted growth among children in sub-Saharan Africa.

Epidemiological characteristics and spatiotemporal patterns of hand, foot, and mouth disease in Hubei, China from 2009 to 2019.

BACKGROUND: Hand, foot, and mouth disease (HFMD) is a public health issue in Hubei and studies of- spatiotemporal clustering at a fine scale are limited. The purpose of this research was to analyze the epidemiological characteristics, temporal variation characteristics, and spatiotemporal clustering of HFMD cases at the town level from 2009 to 2019 to improve public health outcomes. METHODS: Mathematical statistics, a seasonal index, wavelet analysis, and spatiotemporal scans were used to analyze epidemiological characteristics, time series trends, and spatiotemporal clusters of HFMD in Hubei. RESULTS: EV-A71 (Enterovirus A71) and CVA16 (Coxsackievirus A16) constitute the two primary pathogens of the HFMD epidemic in Hubei, among which EV-A71 is the dominant pathogen, especially in 2016. In terms of age distribution, a major peak occurred at 0-5 years and a very small increase appeared at 25-35 years, with the former having a higher incidence among males than females and the latter having the opposite difference between males and females. The number/rate of HFMD cases exhibited a considerable increase followed by a moderate decline from 2009 to 2019, with the first large peak in April-July and a smaller peak in November-December. HFMD in Hubei exhibited the characteristics of a 270-day cycle with multiscale nesting, which was similar to the periodicity of HFMD cases caused by EV-A71 (9 months). Cities with a higher incidence of HFMD formed a part of an "A-shaped urban skeleton". Subdistricts had the highest incidence of HFMD, followed by towns and villages. The spatiotemporal scan results showed one most likely cluster and 22 secondary clusters, which was consistent with the geographic location of railways and rivers in Hubei. CONCLUSIONS: These findings may be helpful in the prevention and control of HFMD transmission and in implementing effective measures in Hubei Province.

Negotiating precarity: Recent immigrants' perceptions of waiting for public healthcare in Ontario, Canada.

Canada is widely known for its universal publicly funded health care system. While its health care system is an important part of Canadian identity, recent immigrants living in some provinces and territories are not covered by the publicly funded healthcare system until they have met a minimum residency requirement. This article seeks to understand the multiple manifestations of financial and emotional precarity that recent immigrants face as they navigate a lack of access to health care during their first three months of arrival in Ontario. This paper draws on qualitative semi-structured interview data from 46 recent immigrants who came from 12 different countries and had been living in Ontario, Canada. We found that the wait period to obtain health care often added to the prohibitive costs associated with immigration and settlement. During the wait period, recent immigrants faced financial burdens and their inability to access publicly funded hospitals and medical services when needed which resulted in feelings of vulnerability, anxiety, and emotional hardship. Given the financial and emotional precarities faced by recent immigrants during the wait period, we argue that the Canadian 'universal' healthcare system excludes and creates barriers to timely and equitable access to healthcare services for recent immigrants. We recommend to permanently eliminate the wait period policy to ensure the health and wellbeing of recent immigrants.

Factors Associated With Health Care Professionals' Choice to Practice in Rural Minnesota.

Importance: Rural health inequities are due in part to a shortage of health care professionals in these areas. Objective: To determine the factors associated with health care professionals' decisions about where to practice. Design, Setting, and Participants: This prospective, cross-sectional survey study of health care professionals in Minnesota was administered by the Minnesota Department of Health from October 18, 2021, to July 25, 2022. Advanced practice registered nurses (APRNs), physicians, physician assistants (PAs), and registered nurses (RNs) renewing their professional licenses were eligible. Exposures: Individuals' ratings on survey items related to their choice of practice location. Main Outcomes and Measures: Rural or urban practice location as defined by the US Department of Agriculture's Rural-Urban Commuting Area typology. Results: A total of 32 086 respondents were included in the analysis (mean [SD] age, 44.4 [12.2] years; 22 728 identified as female [70.8%]). Response rates were 60.2% for APRNs (n = 2174), 97.7% for PAs (n = 2210), 95.1% for physicians (n = 11 019), and 61.6% for RNs (n = 16 663). The mean (SD) age of APRNs was 45.0 (10.3) years (1833 [84.3%] female); PAs, 39.0 (9.4) years (1648 [74.6%] female); physicians, 48.0 (11.9) years (4455 [40.4%] female); and RNs, 42.6 (12.3) years (14 792 [88.8%] female). Most respondents worked in urban (29 456 [91.8%]) vs rural (2630 [8.2%]) areas. Bivariate analysis suggested that family considerations are the most important determinant of practice location. Multivariate analysis revealed that having grown up in a rural area was the strongest factor associated with rural practice (odds ratio [OR] for APRNs, 3.44 [95% CI, 2.68-4.42]; OR for PAs, 3.75 [95% CI, 2.81-5.00]; OR for physicians, 2.44 [95% CI, 2.18-2.73]; OR for RNs, 3.77 [95% CI, 3.44-4.15]). When controlling for rural background, other associated factors included the availability of loan forgiveness (OR for APRNs, 1.42 [95% CI, 1.19-1.69]; OR for PAs, 1.60 [95% CI, 1.31-1.94]; OR for physicians, 1.54 [95% CI, 1.38-1.71]; OR for RNs, 1.20 [95% CI, 1.12-1.28]) and an educational program that prepared for rural practice (OR for APRNs, 1.44 [95% CI, 1.18-1.76]; OR for PAs. 1.70 [95% CI, 1.34-2.15]; OR for physicians, 1.31 [95% CI, 1.17-1.47]; OR for RNs, 1.23 [95% CI, 1.15-1.31]). Autonomy in one's work (OR for APRNs, 1.42 [95% CI, 1.08-1.86]; OR for PAs, 1.18 [95% CI, 0.89-1.58]; OR for physicians, 1.53 [95% CI, 1.31-1.78]; OR for RNs, 1.16 [95% CI, 1.07-1.25]) and a broad scope of practice (OR for APRNs, 1.46 [95% CI, 1.15-1.86]; OR for PAs, 0.96 [95% CI, 0.74-1.24]; OR for physicians, 1.62 [95% CI, 1.40-1.87]; OR for RNs, 0.96 [95% CI, 0.89-1.03]) were important factors associated with rural practice. Lifestyle and area considerations were not associated with rural practice; family considerations were associated with rural practice for RNs only (OR for APRNs, 0.97 [95% CI, 0.90-1.06]; OR for PAs, 0.95 [95% CI, 0.87-1.04]; OR for physicians, 0.92 [95% CI, 0.88-0.96]; OR for RNs, 1.05 [95% CI, 1.02-1.07]). Conclusions and Relevance: Understanding the interconnected factors involved in rural practice requires modeling relevant factors. The findings of this survey study suggest that loan forgiveness, rural training, autonomy, and a broad scope of practice are factors associated with rural practice for most health care professionals. Other factors associated with rural practice vary by profession, suggesting that there may not be a one-size-fits-all approach to recruitment of rural health care professionals.

Crystalline sirolimus-coated balloon (cSCB) angioplasty in an all-comers, patient population with stable and unstable coronary artery disease including chronic total occlusions: rationale, methodology and design of the SCORE trial.

BACKGROUND: A decade ago, the iopromide-paclitaxel coated balloon (iPCB) was added to the cardiologist's toolbox to initially treat in-stent restenosis followed by the treatment of de novo coronary lesions. In the meantime, DES technologies have been substantially improved to address in-stent restenosis and thrombosis, and shortened anti-platelet therapy. Recently, sirolimus-coated balloon catheters (SCB) have emerged to provide an alternative drug to combat restenosis. METHODS: The objective of this study is to determine the safety and efficacy of a novel crystalline sirolimus-coated balloon (cSCB) technology in an unselective, international, large-scale patient population. Percutaneous coronary interventions of native stenosis, in-stent stenosis, and chronic total occlusions with the SCB in patients with stable coronary artery disease or acute coronary syndrome were included. The primary outcome variable is the target lesion failure (TLF) rate at 12 months, defined as the composite rate of target vessel myocardial infarction (TV-MI), cardiac death or ischemia-driven target lesion revascularization (TLR). The secondary outcome variables include TLF at 24 months, ischemia driven TLR at 12 and 24 months and all-cause death, cardiac death at 12 and 24 months. DISCUSSION: Since there is a wealth of patient-based all-comers data for iPCB available for this study, a propensity-score matched analysis is planned to compare cSCB and iPCB for the treatment of de novo and different types of ISR. In addition, pre-specified analyses in challenging lesion subsets such as chronic total occlusions will provide evidence whether the two balloon coating technologies differ in their clinical benefit for the patient. TRIAL REGISTRATION NUMBER: ClinicalTrials.gov Identifier: NCT04470934.

Reimagining Nephrology Fellowship Education to Meet the Future Needs of Nephrology: A Report of the American Society of Nephrology Task Force on the Future of Nephrology.

The American Society of Nephrology (ASN) Task Force on the Future of Nephrology was established in April 2022 in response to requests from the American Board of Internal Medicine and the Accreditation Council for Graduate Medical Education regarding training requirements in nephrology. Given recent changes in kidney care, ASN also charged the task force with reconsidering all aspects of the specialty's future to ensure that nephrologists are prepared to provide high-quality care for people with kidney diseases. The task force engaged multiple stakeholders to develop 10 recommendations focused on strategies needed to promote: ( 1 ) just, equitable, and high-quality care for people living with kidney diseases; ( 2 ) the value of nephrology as a specialty to nephrologists, the future nephrology workforce, the health care system, the public, and government; and ( 3 ) innovation and personalization of nephrology education across the scope of medical training. This report reviews the process, rationale, and details (the "why" and the "what") of these recommendations. In the future, ASN will summarize the "how" of implementing the final report and its 10 recommendations.

The perception and utilization of community care services by older persons in the new urban areas of Beijing, China: A cross-sectional study.

Background and Aims: In recent years, Beijing, similar to many other large cities in China, has experienced rapid urbanization in many new areas. These have often been locations of population aging but have not had concomitant development of required community care services for older persons. This study aims to understand the perception and utilization of newly developed community care services by the older persons living in this region for providing knowledge to improve the services. Methods: Applying Andersen's behavior model, this study used binary logistic regression of the factors influencing the perception and utilization of community care services and analyzed data collected by questionnaires to 301 older persons in the new urban areas of Beijing. Results: Education, income, activities of daily living, instrumental activities of daily living, mental health, and economic needs are statistically significant factors affecting older persons' perception of community care services. Age, perception of community care services, income, neighborhood relationships, mental health, and emotional needs are significant factors affecting older persons' utilization of community care services. Conclusion: Demographic characteristics, health status, social support, and care needs were significant factors in the perception and utilization of community care services, after controlling for many variables. Improving older persons' perceptions of community care services is likely to promote their access to the services, which should help meet the challenges of rapid population aging in providing community care services to support aging in place in the new urban areas of Beijing, China.

'Enabling places': Rethinking 'community' in ageing-in-community in Beijing, China.

OBJECTIVE(S): To understand how community as 'enabling places' is experienced by older people and brings about enabling resources for supporting ageing in community (AIC). METHODS: From a health geographical perspective, we conceptualize community as enabling places that are produced by the interaction of material, social, and symbolic resources. Focusing on a community-based care centre (CBCC) in Beijing, China, we conducted semi-structured interviews with 17 older persons to examine how a CBCC enabled AIC. RESULTS: The CBCC site created three interdependent spaces and material/social/affective resources for enabling AIC: (1)living space (residential care beds) to create a sense of connection and safety; (2) a CBCC-supported care space at home to create an atmosphere of trust and safety; and (3) a social space to create feelings of belonging and contribution. Variations in how the three resources interacted produced not only different spaces at the same site for various users but also different AIC experiences for the same user. CONCLUSIONS: Community is not simply a static research context or spatial container. Rather, community as an enabling place involves a dynamic process in which spatial/social/affective resources are encountered and interact. Older people's AIC experiences change as their encounters change in the three types of resources we described and thus their capacities for ageing well change correspondingly. Furthermore, the binary idea of community versus institution needs to be expanded to explore how home, community, and institution are related, in order to create enabling spaces for AIC.

A systematic review examining associations between physical activity, sedentary behaviour, and sleep duration with quality of life in older adults aged 65 years and above.

This systematic review examined the associations between movement behaviours (i.e., physical activity, sedentary behaviour, and sleep duration) and quality of life (QOL) in adults ≥65 years of age. Four databases were searched in June 2021. Studies were eligible for inclusion if published within the last 20 years, peer-reviewed, examined apparently healthy older adults, and analysed ≥2 movement behaviours together. QOL was represented by the World Health Organization Quality of Life measure which conceptualizes QOL by distinct domains. Study results were categorized and presented by domain. Risk of bias was completed for all included studies using methods described in the Cochrane Handbook. Thirty-one studies with 307 292 participants were included that examined QOL outcomes across seven domains: superdomain (composite measures), perceived physical health, mental and psychological states, level of independence, social relationships, environment, and general health. Findings indicated that moderate-to-vigorous intensity physical activity was favourably associated with QOL. Time re-allocation studies that showed moving time into physical activity from sedentary behaviour were associated with favourable QOL changes. The evidence regarding sedentary behaviour and sleep duration was inconsistent. The quality of evidence was very low for all domains. In conclusion, there is consistent evidence that physical activity improves QOL in adults ≥65 years of age. International Prospective Register of Ongoing Systematic Reviews (PROSPERO) registration No.: CRD42021260566.

[Recommendations of the S3 Guideline "Use of Extracorporeal Circulation (ECLS/ ECMO) for Cardiac and Circulatory Failure" of the Association of Scientific Medical Societies in Germany]. / Empfehlungen der S3-Leitlinie (AWMF) "Einsatz der extrakorporalen Zirkulation (ECLS/ECMO) bei Herz- und Kreislaufversagen".

In recent years, the use of mechanical support for patients with cardiac or circulatory failure has continuously increased, leading to 3,000 ECLS/ECMO (extracorporeal life support/extracorporeal membrane oxygenation) implantations annually in Germany. Due to the lack of guidelines, there is an urgent need for evidence-based recommendations addressing the central aspects of ECLS/ECMO therapy. In July 2015, the generation of a guideline level S3 according to the standards of the Association of the Scientific Medical Societies in Germany (AWMF) was announced by the German Society for Thoracic and Cardiovascular Surgery (GSTCVS). In a well-structured consensus process, involving experts from Germany, Austria and Switzerland, delegated by 16 scientific societies and the patients' representation, the guideline "Use of extracorporeal circulation (ECLS/ECMO) for cardiac and circulatory failure" was created under guidance of the GSTCVS, and published in February 2021. The guideline focuses on clinical aspects of initiation, continuation, weaning and aftercare, herein also addressing structural and economic issues. This article presents an overview on the methodology as well as the final recommendations.