Demystifying the Digital Divide: Disparities in Telerehabilitation Readiness Among Older Adults in the United States.

OBJECTIVE: To estimate readiness of older rehabilitation users in the United States to participate in video-based telerehabilitation and assess disparities in readiness among racial and ethnic minoritized populations, socioeconomically disadvantaged populations, and rural-dwelling older adults. DESIGN: Retrospective cohort study using nationally representative survey data from the National Health and Aging Trends Study from 2015 and 2020. Survey-weighted regression models, accounting for complex survey design, were used to generate estimates of readiness and evaluate disparities across racial and ethnic, socioeconomic, and geographic subgroups. Odds ratios (OR) and 95% confidence intervals (CIs) were estimated for each comparison. SETTING: Home or community rehabilitation environments. PARTICIPANTS: A cohort of 5274 home or community-based rehabilitation users aged 70 years or older (N=5274), representing a weighted 33,576,313 older adults in the United States. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE(S): Video-based telerehabilitation readiness was defined consistent with prior work; unreadiness was defined as lacking ownership of internet-enabled devices, limited proficiency of use, or living with severe cognitive, visual, or hearing impairment. Telerehabilitation readiness was categorized as "Ready" or "Unready". RESULTS: Approximately 2 in 3 older rehabilitation users were categorized as ready to participate in video-based rehabilitation. Significantly lower rates of readiness were observed among those living in rural areas (OR=0.75, 95% CI: 0.60-0.94), financially strained individuals (OR=0.37, 95% CI: 0.26-0.53), and among individuals identifying as Black or Hispanic (as compared with non-Hispanic White older adults: Non-Hispanic Black [OR=0.23, 95% CI: 0.18-0.30]; Hispanic [OR=0.17, 95% CI: 0.11, 0.27]). CONCLUSIONS: Our findings highlight significant disparities in the readiness to uptake video-based telerehabilitation. Policy and practice interventions to address telerehabilitation readiness should focus not only on improving broadband access but also on technology ownership and training to ensure equitable adoption in populations with lower baseline readiness.

Quality assessment of variable collagen tissues of sea cucumber (Stichopus japonicus) body wall under different heat treatment durations by label-Free proteomics analysis.

The microstructure of the body wall, body wall composition, and collagen fibers of sea cucumber (Stichopus japonicus) under different heating times (1 h, 4 h, 12 h, and 24 h) was investigated based on heat treatment at 80 °C. A Label-Free proteomics technique was applied to study the proteomic changes in the body wall of sea cucumbers under 4 and 12 h of heat treatment. Compared with the fresh group, 981 proteins were found to be differentially expressed proteins (DEPs) after heat treatment at 80 °C (4 h), and 1110 DEPs were observed after heat treatment at the same temperature for 12 h. There were 69 DEPs associated with mutable collagenous tissues (MCTs) structures. The results of correlation analysis showed that 55 DEPs were correlated with sensory properties, among which A0A2G8KRV2 was significantly correlated with hardness and SEM image texture features (SEM_Energy, SEM_Correlation, SEM_Homogeneity, and SEM_Contrast). These findings could be conducive to further comprehension of the structural changes and mechanisms of quality loss in the body wall of sea cucumbers at different heat treatment times.

Effects and Clinical Value of Peritoneal Dialysis on Water and Water Balance, Adverse Reactions, Quality of Life, and Clinical Prognosis in Patients with Decompensated Chronic Nephropathy: A Systematic Review and Meta-Analysis.

Objective: To systematically evaluate the effects of peritoneal dialysis and hemodialysis on renal function and quality of life in patients with end-stage renal disease. An evidence-based medical rationale would be provided for peritoneal dialysis or hemodialysis treatment in patients with end-stage renal disease. Methods: The PubMed, EMBASE, ScienceDirect, Cochrane Library, China National Knowledge Infrastructure (CNKI), China VIP Database, Wanfang, and China Biomedical Literature Database (CBM) online databases were searched. Comparisons on the effects of peritoneal dialysis on renal function and quality of life were taken between patients with end-stage renal disease (RD). The data were extracted independently by two researchers. The bias-risk-included literatures were assessed according to the Cochrane manual 5.1.0 standard. RevMan 5.4 statistical software was used to analyze the collected data via meta-analysis. Results: Seven RCT articles were finally included. A total of 745 samples were analyzed via meta-analysis. The obvious heterogeneities of serum creatinine (Scr) and blood urea nitrogen (BUN) were discovered (P < 0.00001) in the selective investigations. According to the results of this analysis, it was indicated that the renal function of patients with end-stage renal disease treated by peritoneal dialysis was significantly better than that of hemodialysis. According to the meta-analysis, there was obvious heterogeneity of life quality among the included research data. It was indicated that the score of quality of life of patients with end-stage renal disease treated by peritoneal dialysis was significantly better than that of hemodialysis. Conclusion: Compared with hemodialysis in the treatment of end-stage renal disease, the renal function and quality of life of patients with peritoneal dialysis are better than those of hemodialysis. More further studies and follow-up with higher methodological quality and longer intervention time are still needed for further verification.

What Matters Most? Intersectional Correlates of Caregiver Burdens.

Increasing numbers of older adults require caregiver support from unpaid caregivers. Yet, there is limited research on caregiver burden type and interactions across race, gender, and other sociodemographic characteristics. This quantitative study uses an intersectional framework to examine associations between caregiving burden and sociodemographic factors. Using survey data from the National Survey of Caregiving the sample included unpaid caregivers (N = 1304) of older adult (65+) Medicare beneficiaries. Binary logistic regression analysis revealed that over 40% of the respondents reported emotional difficulties. Correlates to emotional difficulties included race, gender, age, and income with an age by income interaction. For physical difficulties, gender, age, work, and education mattered most, with an age by education interaction. Age and income predicted financial difficulties without interactions. Findings suggest that policymakers target emotional and physical difficulties, attend to age and socioeconomic status, and address the unique challenges faced in midlife by caregivers.

Urban and Rural Differences in Trajectories of Depressive Symptoms in Later Life in the United States.

OBJECTIVE: This research has two primary goals: to examine the relationship between urban residence and trajectories of depressive symptoms and to investigate whether this relationship differs by social isolation and loneliness. METHOD: Data are from 2006, 2008, 2010, 2012, 2014, and 2016 waves of the Health and Retirement Study (HRS), a nationally representative sample of U.S. adults aged 51+ (n = 3,346 females and 2,441 males). We conduct latent growth curve analysis to predict both baseline and trajectories of depression based on urban or rural residency. RESULTS: Residing in urban or rural areas is neither significantly associated with baseline nor the development of late-life depressive symptoms. For females, the relationship between urban residence and baseline depressive symptoms is explained by socioeconomic factors. DISCUSSION: Findings of this study serve to better understand how social and geographic contexts shape long-term well-being of older adults.

Analysis based on Monte Carlo simulation: How effective is tigecycline in routine antimicrobial therapy?

OBJECTIVE: This paper aims to assess the efficacy of tigecycline in the treatment of several different infections from a pharmacokinetic/pharmacodynamic (PK/PD) perspective. MATERIALS AND METHODS: The minimum inhibitory concentration (MIC) test strip test was used to determine the MICs of clinical isolates of tigecycline. A 5,000-subjects simulation was performed by Crystal Ball software to calculate the probability of achieving the required PK/PD exposure. RESULTS: The use of standard tigecycline dosing is predicted to have a good clinical outcome for patients suffering from complicated skin and skin structure infection (cSSSI) with MICs ≤ 0.25 mg×L-1, patients suffering from complicated intra-abdominal infection (cIAI) with MICs ≤ 1 mg×L-1, and patients suffering from hospital-acquired pneumonia (HAP) with MICs ≤ 0.5 mg×L-1. Generally, Gram-positive bacteria are highly sensitive to tigecycline, while Gram-negative bacteria are less sensitive: for patients with HAP and cIAI, the tolerable outcome was achieved using the standard regimen for most Gram-negative pathogens; the desired outcomes could be obtained for the increased-dose treatment; with increasing dose (100 mg every 12 hours), the average cumulative fractions of response (CFRs) markedly increased from 38.18 to 56.21% for cSSSI patients. When tigecycline, a standard regimen, was used to treat carbapenem-resistant Klebsiella pneumoniae (CRKP) and carbapenem-resistant Enterobacter spp. (CRE) infections, the cumulative response scores were 4.96 - 66.39% and 13.14 - 95.18%, respectively, and the CFRs of the increased dose also increased correspondingly. CONCLUSION: Currently, the standard dose of tigecycline is feasible in the treatment of common bacterial infections, and PK/PD indexes are needed to optimize the regimens for refractory carbapenem-resistant bacterial infections.

Lung ultrasound and diaphragmatic excursion assessment for evaluating perioperative atelectasis and aeration loss during video-assisted thoracic surgery: a feasibility study.

BACKGROUND: Although lung-protective strategies are widely used in thoracic surgery, postoperative atelectasis can still occur. Both lung ultrasound (LUS) and diaphragmatic excursion assessments are accurate and noninvasive for bedside imaging and examination. This study aimed to test the feasibility of using LUS during the perioperative period of video-assisted thoracic surgery (VATS) and to continuously evaluate aeration changes through LUS examination and diaphragmatic excursion assessment. METHODS: Between January 2019 and May 2019, data were prospectively collected from patients that were scheduled to undergo a VATS with one-lung ventilation (OLV). LUS was performed at four specific timepoints: before the induction of general anesthesia (timepoint A), 5 minutes after intubation (timepoint B), at the end of surgery (timepoint C), and 15 minutes after extubation (timepoint D). Diaphragmatic excursion assessment was performed only at the first (timepoint A) and last timepoints (timepoint D) for the use of paralytics during surgery. RESULTS: This study included 80 consecutive patients (37 men, 43 women). Among them were patients undergoing lobectomy (14 patients; 17.5%), segmentectomy (35 patients, 43.8%), wedge resection (19 patients; 23.8%), or mediastinal tumor resection (12 patients, 15.0%). LUS was possible for all patients. As a result, LUS helped detect postoperative atelectasis in 12 patients (15.0%). Among them were 4 (33.3%) lung resection patients and 8 (66.7%) mediastinal tumor resection patients. Pneumothorax and small effusions were also diagnosed through LUS examination. There was significant aeration loss throughout the surgery from the start of induction (P<0.001). We discovered that changes in LUS scores were found to be associated with an increase of diaphragmatic excursions after assessment (Spearman's r=-0.54, P<0.001). CONCLUSIONS: LUS is feasible during all phases of the perioperative period in VATS and can facilitate the early investigation of perioperative atelectasis. Perioperative LUS and diaphragmatic excursion assessment are also feasible for the continuous assessment of aeration loss in patients undergoing VATS.

Dermal bioaccessibility and absorption of polycyclic aromatic hydrocarbons (PAHs) in indoor dust and its implication in risk assessment.

Numerous studies have focused on assessing the risk of human exposure to polycyclic aromatic hydrocarbons (PAHs) in indoor dust via dermal contact. However, the dermal bioaccessibility and dermal absorption of PAHs in indoor dust have seldom been reported. In the present study, the effects of temperature, sweat ratio, solid-liquid ratio and incubation time on the dermal bioaccessibility of PAHs were examined. Naphthalene, phenanthrene, pyrene and benzo[a]pyrenewere selected for examination in an absorption assay with keratinocyte cells. The results showed the release of PAHs from indoor dust fitted a first-order one-compartment model. Naphthalene had the highest rate of release, which was consistent with the bioaccessibility assay results. In addition, the absorption rate of naphthalene and phenanthrene by keratinocytes was higher than that of pyrene and benzo[a]pyrene, with the latter being of higher molecular weight. These results indicated that low molecular weight PAHs were much more easily absorbed via dermal contact than were high molecular weight PAHs. The dermal bioavailability of PAHs in indoor dust was estimated by multiplying the bioaccessibility of PAHs in indoor dust by the ratio of dermal absorption by skin cells, and ranged from 0.12 to 51.0%. These data will be useful in risk assessments.

Impacts of risk and competition on the profitability of banks: Empirical evidence from Pakistan.

The purpose of this paper is to investigate the impact of risk and competition on the profitability of the Pakistani banking industry. Data are retrieved from the annual statements of banks, the Ministry of finance Pakistan and the World Bank covering the period of (2007-2017). Two steps Generalized Method of Moments (GMM) with the collapse command is used as an estimation technique to overcome endogeneity, unobserved heterogeneity and autocorrelation problems. The results of the study showed that the liquidity risk has positive while credit risk, insolvency risk and competition hurt negatively the profitability of Pakistani banks. The results of the study also revealed that capitalization, size, taxation and GDP growth rate positively affect the Banks' profits while banking sector development and infrastructure negatively affect banking profitability in Pakistan. The operational cost management positively affects net interest margins but negatively affects ROA and PBT in the Pakistani banking industry.

Dynamic contrast-enhanced MRI for advanced esophageal cancer response assessment after concurrent chemoradiotherapy.

PURPOSE: We aimed to evaluate the treatment response of patients with esophageal cancer after concurrent chemoradiation therapy (CRT) using dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI). METHODS: This retrospective study included 59 patients with histologically confirmed esophageal squamous cell carcinoma. The patients underwent DCE-MRI before and 4 weeks after CRT. Patients with complete response were defined as the CR group; partial response, stable disease, and progressive disease patients were defined as the non-CR group. DCE-MRI parameters (Ktrans, Ve, and Kep) were measured and compared between pre- and post-CRT in the CR and non-CR groups, respectively. Pre-CRT and post-CRT parameters were used to calculate the absolute change and the ratio of change. DCE-MRI parameters were compared between the CR and non-CR groups. Receiver operating characteristic (ROC) curves were used to verify diagnostic performance. RESULTS: Patients with higher T-stage esophageal cancer might present with poorer response. After CRT, the Ktrans and Kep values significantly decreased in the CR group, whereas only Kep value decreased in the non-CR group. The post-Ktrans and post-Kep values were observed to be significantly lower in the CR group than in the non-CR group. The absolute change and ratio of change of both Ktrans and Kep were higher in the CR group than in the non-CR group. Based on ROC analysis, the ratio of change in Ktrans was the best parameter to assess treatment response (AUC= 0.840). CONCLUSION: DCE-MRI parameters are valuable in predicting and assessing concurrent CRT response for advanced esophageal cancer.