Racial/Ethnic and Geographic Disparities in Comorbid Traumatic Brain Injury-Renal Failure in US Veterans and Associated Veterans Affairs Resource Costs, 2000-2020.

Studies have identified disparities by race/ethnicity and geographic status among veterans with traumatic brain injury (TBI) and renal failure (RF). We examined the association of race/ethnicity and geographic status with RF onset in veterans with and without TBI, and the impact of disparities on Veterans Health Administration resource costs. METHODS: Demographics by TBI and RF status were assessed. We estimated Cox proportional hazards models for progression to RF and generalized estimating equations for inpatient, outpatient, and pharmacy cost annually and time since TBI + RF diagnosis, stratified by age. RESULTS: Among 596,189 veterans, veterans with TBI progressed faster to RF than those without TBI (HR 1.96). Non-Hispanic Black veterans (HR 1.41) and those in US territories (HR 1.71) progressed faster to RF relative to non-Hispanic Whites and those in urban mainland areas. Non-Hispanic Blacks (-$5,180), Hispanic/Latinos ($-4,984), and veterans in US territories (-$3,740) received fewer annual total VA resources. This was true for all Hispanic/Latinos, while only significant for non-Hispanic Black and US territory veterans < 65 years. For veterans with TBI + RF, higher total resource costs only occurred ≥ 10 years after TBI + RF diagnosis ($32,361), independent of age. Hispanic/Latino veterans ≥ 65 years received $8,248 less than non-Hispanic Whites and veterans living in US territories < 65 years received $37,514 less relative to urban veterans. CONCLUSION: Concerted efforts to address RF progression in veterans with TBI, especially in non-Hispanic Blacks and those in US territories, are needed. Importantly, culturally appropriate interventions to improve access to care for these groups should be a priority of the Department of Veterans Affairs priority for these groups.

Your phrases matter: Third waves in research approaches and new contexts for formulaic language.

BACKGROUND: This study reports on new contexts in which formulaic language has been used in the years since 2013 when the last synthesis was carried out. The background presents an old but still useful definition and lists themes under which research was arranged in 2013 and which continue to be used. AIMS: This study has a particular emphasis on the relevance of formulaic language to people living with dementia. METHODS: Section 3, identifying new directions, reviews new 'third waves' of research priorities in several fields in which formulaic sequences play a major role, including sociolinguistic variation, corpus-based and corpus-driven analyses, pragmatics, human-computer interaction, and psycholinguistics, all of which are relevant to speech-language therapists. Section 4, outreach and expansions, illustrates new contributions from cognitively impaired person-to-person exchanges in online environments, recent examinations of infant- and pet-directed speech incorporating formulaic language, and online graphic explorations such as emojis. Section 5 focuses on growth of research in theoretical and clinical applications by Van Lancker Sidtis, as illustrated by references to her recent work. MAIN CONTRIBUTION: The paper's main contribution is to summarize the work on formulaic language over the last 10 years, to indicate its continued importance and relevance in ordinary conversation, and especially in allowing people living with dementia to continue to interact with others. CONCLUSION: The paper concludes by suggesting that more focus be placed on the analysis of formulaic language with an emphasis on its relevance for speech-language therapists and other clinicians. WHAT THIS PAPER ADDS: What is already known on the subject Research has been growing since the late 1970s and early 1980s on non-propositional language (as opposed at that time to the Chomskyan paradigm) and especially on lexical bundles, idioms, second language acquisition and multiword expressions. Studies beginning with Hughlings Jackson (1874) have been annotated through early 2012 (Wray, 2013). What this study adds This study examines 'third waves' in pragmatics, sociolinguistics and areas of neurology and speech perception contributing to what Van Lancker Sidtis (2021) calls the third wave of acceptance of the range and depth of formulaic sequences in ordinary or familiar language. What are the clinical implications of this work? Conversations with pet robots or web-based composition with emojis are but two of the developing areas built on formulaic sequences currently being used for communication interventions with persons living with dementia or other major neurocognitive disorder. Overviews of major contributions in theory and social contexts by Wray (2020, 2021) and theoretical and cognitive applications by Van Lancker Sidtis (2021) detail new areas for the study of formulaic sequences and their contributions to a range of neurocognitive disorders.

COVID-19 Vaccine Hesitancy Among Parents: A Qualitative Study.

OBJECTIVES: Addressing parental/caregivers' coronavirus disease 2019 (COVID-19) vaccine hesitancy is critical to improving vaccine uptake in children. Common concerns have been previously reported through online surveys, but qualitative data from KII and focus groups may add much-needed context. Our objective was to examine factors impacting pediatric COVID-19 vaccine decision-making in Black, Spanish-speaking, and rural white parents/caregivers to inform the content design of a mobile application to improve pediatric COVID-19 vaccine uptake. METHODS: Parents/caregivers of children aged 2 to 17 years from groups disproportionately affected by COVID-19-related vaccine hesitancy (rural-dwelling persons of any race/ethnicity, urban Black persons, and Spanish-speaking persons) were included on the basis of their self-reported vaccine hesitancy and stratified by race/ethnicity. Those expressing vaccine acceptance or refusal participated in KII, and those expressing hesitancy in focus groups. Deidentified transcripts underwent discourse analysis and thematic analysis, both individually and as a collection. Themes were revised until coders reached consensus. RESULTS: Overall, 36 participants completed the study: 4 vaccine acceptors and 4 refusers via KIIs, and the remaining 28 participated in focus groups. Participants from all focus groups expressed that they would listen to their doctor for information about COVID-19 vaccines. Infertility was a common concern, along with general concerns about vaccines. Vaccine decision-making was informed by the amount of information available to parents/caregivers, including scientific research; possible positive and negative long-term effects; and potential impacts of vaccination on preexisting medical conditions. CONCLUSIONS: Parents/caregivers report numerous addressable vaccine concerns. Our results will inform specific, targeted interventions for improving COVID-19 vaccine confidence.

Cryptogenic Organizing Pneumonia: A Unique Case and Literature Review.

Pneumonia is one of the most common pathologies seen in the inpatient setting. The rapid response to treat febrile patients with infiltrates on chest x-ray has reduced hospital length of stay and hospital costs. However, the automatic reaction to treat all infiltrates and opacities seen on a chest x-ray as pneumonia can be costly. This report presents the case of a patient suspected initially of having pneumonia, who was unresponsive to broad-spectrum antibiotics. A 58-year-old woman presented with dyspnea on exertion and a nonproductive cough. Her chest x-ray showed dense right-sided coalescent opacities encompassing the entirety of the right lung. Flexible bronchoscopy biopsy specimens revealed the cause to be cryptogenic organizing pneumonia. This case highlights the diverse set of pulmonary pathologies that can mimic pneumonia and should be suspected in cases of antibiotic-resistant suspected pneumonia patients.

Economic impact of comorbid TBI-dementia on VA facility and non-VA facility costs, 2000-2020.

OBJECTIVE: There is evidence Traumatic Brain Injury (TBI) is associated with increased risk of dementia (D). We compared VA and non-VA facility costs associated with TBI+D and each diagnosis alone, relative to neither diagnosis, annually and over time, 2000-2020. METHODS: We estimated adjusted panel models of annual VHA costs in VA and non-VA facilities, stratified by age, and by TBI-dementia status. We also estimated cost for the TBI+D cohort by time since TBI and dementia diagnoses. All costs were 2021 inflation adjusted. RESULTS: Veterans <65 ($30,736) and ≥65 ($15,650) with TBI+D, while veterans <65 ($3,379) and ≥65 ($4,252) with TBI-only had higher annual total VHA costs, relative to neither diagnosis. Veterans with TBI+D < 65 ($42,864) and ≥65 ($72,424) had higher costs in years≥15 after TBI diagnosis, while <65 ($36,431) and ≥65 ($37,589) had higher costs in years ≥10 after dementia diagnosis. CONCLUSIONS: The main cost driver was inpatient non-VA facility costs. Veterans had continuously increasing inpatient care costs in non-VA facilities over time since their TBI and dementia diagnoses. Given budget constraints on the VA system, quality of care in non-VA facilities warrants comparison with VA facilities to make informed decisions regarding referrals to non-VA facilities.

Can the Paro be my Buddy? Meaningful experiences from the perspectives of older adults.

This study aimed to explore meaningful experiences of older Taiwanese adults who had received a Paro (social robot) companion. Semi-structured qualitative interviews elicited the perspectives of 25 older adults living in a long-term care facility after they had interacted with an individual Paro companion for 8 weeks. Thematic analysis was used in this study as it allows for rich, detailed, and complex descriptions of qualitative data. Analysis identified four themes: Bridging my social bonds; Acting as a comfort Buddy; Relieving my emotional distress; and Encountering Paro with distancing. Although Paro's functioning has some limits, such as lacking speech, most participants expressed that the experience was positive. These findings revealed that the meaningful experiences expressed by participants at the end of the intervention with Paro might provide the value of companionship and improve interpersonal relationships for older adults in geriatric nursing.

Enhancing Language Access: A Pilot Study to Examine the Importance of Understanding the Language Preference and Acculturalization Level in the Provision of Healthcare for Hispanics Veterans With Traumatic Brain Injury.

INTRODUCTION: The purpose of this pilot study was to obtain preliminary data to culturally adapt the Veteran Health Administration Traumatic Brain Injury (TBI) assessment instruments for the Hispanic Veteran population. A qualitative analysis explored the cognitive processes used by Hispanic Veterans whose preferred language was Spanish to understand a specific set of screening questions within the Initial TBI Screening, the Comprehensive TBI Evaluation, the Neurobehavioral Symptom Inventory (NSI), and the La Trobe Communication Questionnaire (LTCQ). MATERIALS AND METHODS: A certified translator completed translation of the TBI instruments, an expert panel resolved inadequate expressions of the translations, and translated instruments were back translated. Male and female Hispanic Veterans with a positive TBI screening underwent a recorded administration of the TBI instruments, including LTCQ, followed by systematic debriefing using semi-structured cognitive interviews which then underwent qualitative analysis. The Marin's Short Acculturation Scale for Hispanics, the Tropp's Psychological Acculturation Scale, the English-Language Proficiency Test Series, and the TBI Demographic and Language Preference interview were administered to the subjects. RESULTS: Fifteen subjects were enrolled for the TBI instruments intervention; 11 of them completed all the additional procedures. The TBI instruments intervention seemed to produce very few variations, indicating adequate cultural equivalence. However, the LTCQ instrument showed suggested cultural variations, but did not suggest a lack of understanding or misinterpretation. The population studied displayed preferential connectedness to the Hispanic/Latino culture and to the Spanish language. The LTCQ indicated that subjects perceived themselves as having a worse execution in terms of communication skills than historical control and TBI groups. English-Language Proficiency Test Series found that most of the subject population did not demonstrate mastery of grade-appropriate basic social and academic vocabulary in English. CONCLUSION: Current findings highlight the importance of using linguistically and culturally appropriate materials upon evaluating Hispanic Veterans with a suspected TBI who have Spanish as their primary or preferred language.

Investigating the Feasibility of Using Telemedicine to Deliver a Fall Prevention Program: A Pilot Study.

AIM: This pilot study was designed to examine the feasibility of using telemedicine to deliver a fall prevention program, a modified Otago exercise program, to low-income older adults living independently in affordable housing apartments. METHODS: A mixed-methods feasibility study. Participants were divided into two groups: one group participated in a 12-week modified Otago fall prevention program via telehealth, while the other group participated in the program with an on-site instructor. Performance-based measures of physical function and self-report measures for self-efficacy for exercise and social connectedness were collected pre- and post-intervention and 1 year later. RESULTS: All participants completed the 12-week intervention and expressed satisfaction with both the telehealth program and the on-site instructor-led program. There were no major differences in performance or self-report measures between the two groups, showing that telehealth-delivered applications can be effective. Participants in the on-site instructor-led group performed slightly better on performance-based measures, while those in the telehealth group scored higher on self-report measures of self-efficacy and social network scales. CONCLUSION: A telehealth-delivered exercise program that includes strength and balance exercises and walking was feasible to conduct with a small group of low-income older adults living in a community-based apartment complex. Recruitment and retention of participants for the study was successful, and participants expressed satisfaction with the intervention whether conducted in-person or via telehealth.

Narrative Gerontology in Practice: Students' Experiences With Conducting Autoethnography.

This study examines the benefits of introducing autoethnographic writing as part of an ageism intervention to familiarize students with the life course. In this mixed-methods study, 186 graduate and undergraduate students conducted interviews with a grandparent or older adult and subsequently assumed the identity of the grandparent to write introductions of themselves as if they were that grandparent, using "I" statements in an online discussion forum. Most assumed grandparents were women (78.0%), and White (63.8%) with an average age of 77.3 (SD = 12.3). Emerging themes were categorized into three levels: structural, familial, and individual. The number of times a certain theme was mentioned was counted and major themes were analyzed. Findings indicated how autoethnographic reflections can promote student examination of self-awareness, cultural heritages, and personal growth. This technique is encouraging as an educational ageism intervention and warrants further adaptation and testing.

Direct-to-adolescent text messaging for vaccine reminders: What will parents permit?

BACKGROUND: Direct-to-adolescent text messaging may be a consideration for vaccine reminders, including human papilloma virus (HPV), but no studies have explored the minimum age at which parents would allow adolescents to receive a text message. METHODS: We distributed a survey to parents of 10-17 year olds during any office visit in two practice based research networks in South Carolina and Oklahoma. We asked about parental preference for receiving vaccine reminders for their adolescent, whether they would allow the healthcare provider to directly message their adolescent, and if so, what would be the acceptable minimum age. RESULTS: In 546 surveys from 11 practices, parents of females were more supportive of direct-to-teen text message reminders than were parents of males, (75% v. 60%, p < .001). The median age at which parents would allow direct text messages from physicians' offices was 14 in females compared to 15 in males, p = .049. We found a correlation between the child's age and the youngest age at which parents would allow a direct text message. Of the parents who permitted a text message directly to their adolescent, most reported an allowable age higher than their adolescent's current age until the age of 15. CONCLUSION: Our study suggests that direct-to-adolescent text messaging would be allowed by parents for older adolescents. This supports an intervention aimed at older adolescents, such as for receipt of MCV4 dose #2, delayed HPV vaccine series completion and annual influenza vaccination.

A Triangulated Qualitative Study of Veteran Decision-Making to Seek Care During Heart Failure Exacerbation: Implications of Dual Health System Use.

Among Veterans, heart failure (HF) contributes to frequent emergency department visits and hospitalization. Dual health care system use (dual use) occurs when Veterans Health Administration (VA) enrollees also receive care from non-VA sources. Mounting evidence suggests that dual use decreases efficiency and patient safety. This qualitative study used constructivist grounded theory and content analysis to examine decision making among 25 Veterans with HF, for similarities and differences between all-VA users and dual users. In general, all-VA users praised specific VA providers, called services helpful, and expressed positive capacity for managing HF. In addition, several Veterans who described inadvertent one-time non-VA health care utilization in emergent situations more closely mirrored all-VA users. By contrast, committed dual users more often reported unmet needs, nonresponse to VA requests, and faster services in non-VA facilities. However, a primary trigger for dual use was VA telephone referral for escalating symptoms, instead of care coordination or primary/specialty care problem-solving.

When More Than Exercise Is Needed to Increase Chances of Aging in Place: Qualitative Analysis of a Telehealth Physical Activity Program to Improve Mobility in Low-Income Older Adults.

BACKGROUND: A telehealth-delivered physical activity program was implemented within two low-income older adult housing properties utilizing the Otago exercise program, a physical therapy program endorsed by the Centers for Disease Control and Prevention to improve balance and strengthening in community dwelling older adults and by the National Council on Aging as the highest level of evidence for fall prevention programs. Participants were also given Fitbit activity monitors to help track their activity. OBJECTIVE: The goal of this project was to increase older adults' daily physical activity in hopes of decreasing chronic disease morbidity, disability, and falls, and decrease social isolation. METHODS: The Otago exercise program was conducted via telehealth twice weekly for 12 weeks. Participants also wore Fitbit activity trackers to encourage physical activity outside of the group classes. Postintervention qualitative interviews were conducted, recorded, transcribed, and analyzed using discourse analysis. RESULTS: Twenty-one older adult participants from two low-income properties in Charleston, SC, participated in the 12-week telehealth physical therapy program. Postintervention qualitative interviews revealed that the two sites were very different in their participation in the program and their main concerns surrounding aging in place. One site had a community-oriented outlook and enjoyed participating in physical activity together; whereas, the other site had very few participants and referenced depression and social isolation as main concerns. CONCLUSIONS: A telehealth physical therapy-led intervention to increase physical activity in low-income older adults aging in place was successfully implemented and attended; however, it became clear in postintervention qualitative interviews that social isolation and depression were prevalent and mental health needs to be addressed along with physical health to encourage successful aging in place.

Perceptions of U.S. Veterans Affairs and community healthcare providers regarding cross-system care for heart failure.

OBJECTIVES: This study explores perceptions of US Veterans Affairs (VA) and non-VA healthcare providers caring for Veterans with heart failure (HF) regarding Veteran knowledge and motivations for dual use, provider roles in recommending and coordinating dual use, systems barriers and facilitators, and suggestions for improving cross-system care. METHODS: Twenty VA and 11 non-VA providers participated in semi-structured interviews, which were analyzed using parallel qualitative content and discourse analysis. RESULTS: VA and non-VA providers described variable HF knowledge and self-management among Veterans, and both groups described the need for improved education addressing medication adherence, self-care, and management of acute symptoms. Both groups described highly limited roles for providers in shaping choices surrounding dual use. VA and non-VA providers had significantly different perceptions regarding the availability, quality, and effectiveness of VA HF services. Multiple non-VA providers expressed frustration with and difficulty in contacting VA providers, accessing records, and making referrals into the VA system. Suggestions for improved care focused on patient education and care coordination. DISCUSSION: Dual healthcare system use for Veterans is increasingly common. Similarities and contrasts in perceptions of VA and non-VA providers are instructive and should be incorporated into future policy and program initiatives.

Views on ageing in place from relocated low­income housing residents in the US.

BACKGROUND: Ageing in place (AIP) is the ability to live in one's home and community independently, despite age, ability level or income. AIM: To elicit knowledge and feelings about AIP from low-income older adults relocated to low-income housing. METHOD: Nursing students, supervised by nursing faculty trained in research, conducted semi-structured interviews about AIP with volunteer residents living in a low-income apartment complex in the southern US. FINDINGS: Seven participants discussed common fears and worries as well as needs for AIP in low-income housing. Mental health issues were prominent. CONCLUSION: Mental health warrants consideration along with physical, social and emotional well-being in beginning to identify and address the needs of older people ageing anywhere, perhaps especially in relocated low-income older adults. This information could inform future interventions to encourage AIP in the US and potentially in other countries.

Optical absorption measurements of hydrogen chloride at high temperature and high concentration in the presence of water using a tunable diode laser system for application in pyrohydrolysis non-ferrous industrial process control.

A tunable diode laser (TDL) was used to measure hydrogen chloride (HCl) spectra at 5747 cm(-1) (1.74 µm) and temperatures of 25-950 °C in a quartz cell. The purpose was to evaluate the capability of monitoring HCl concentration under pyrohydrolysis conditions using a near-infrared (NIR) laser. These conditions are characterized by 20-40% HCl, 2-40% H2O, and the presence of metal chloride vapors at temperatures of 600-1000 °C. Spectral peak area measurements of HCl-N2 mixtures at atmospheric pressure and a path length of 8.1 cm showed linear absorption behavior between concentrations of 5-95% and temperatures of 25-950 °C. Results from the addition of 2-40% water (H2O) indicate that the HCl peak area relationships are not affected for temperatures of 350-950 °C. Evaporating NiCl2 within the cell did not show spectral interference effects with HCl between 650 and 850 °C. The results from this work indicate that a near-infrared optical sensor is capable of measuring high HCl concentrations at high temperatures in the presence of high H2O content during pyrohydrolysis process conditions.

Beyond reminiscence: using generic video to elicit conversational language.

Videos and multimedia are increasingly used to stimulate reminiscence in dementia care. However, they are also valuable in eliciting a wide range of language patterns that are not necessarily keyed to reminiscence about self. Low-technology, home-made generic and personalized videos were tested with 2 samples of persons with dementia, to increase engagement and support the retention of identity. Participants showed a slight, though not significant, preference for looking first at personalized videos and produced a wider range of conversational language topics and phrasal patterns in response to the generic videos.

An examination of successful aging among Southern Black and White older adults.

Research on successful aging in minority older adults and those from certain regions of the United States, such as the South, is lacking. It is important to learn whether disparities exist in Southern Black older adults' perceptions of successful aging compared to those of majority older adults. Thus, this study examined successful aging using focus groups to obtain a regionally and racially sensitive understanding of the phenomenon. Focus group sessions were facilitated with Southern Black and White older adults with questions on successful aging, using content analysis to interpret the findings. Four central themes were found: Connecting and Relating; Temporality; Perception and Interpretation; and Activity. Beliefs and decisions about managing oneself through life events, including health problems and disability, may have a major influence on the trajectory of progressive, chronic illness, and consequently, successful aging.

Developing culturally diverse direct caregivers for care work with older adults: challenges and potential strategies.

This discussion presents real-world examples of challenges that occur in geriatric training as a contribution to the ongoing conversation about tailored training for direct caregivers. Numerous discussions are available on the need for more geriatric training in nursing, including aspects of care for patients with dementia, but few if any studies have identified a similar need on behalf of direct care workers, including home health care aides,personal care aides, and nursing assistants who are not part of a licensure track or a baccalaureate-based nursing curriculum. This discussion examines three cultural factors that underlie challenges for nursing educators and supervisors in dementia care who oversee direct care workers: (1) the effect of immigrant cultures and languages; (2) the effect of different intergenerational cultural constructs; and (3) the effect of culturally derived attitudes about aging and dementia. Strategies to address these challenges are offered.