Depression-related phenotypes at early stages of Aß and tau accumulation in inducible Alzheimer's disease mouse model: Task-oriented and concept-driven interpretations.

Depression is highly prevalent in Alzheimer Disease (AD); however, there is paucity of studies that focus specifically on the assessment of depression-relevant phenotypes in AD mouse models. Conditional doxycycline-dependent transgenic mouse models reproducing amyloidosis (TetOffAPPsi) and/or tau (TetOffTauP301L) pathology starting at middle age (6 months) were used in this study. As AD patients can experience depressive symptoms relatively early in disease, testing was conducted at early, pre-pathology stages of Aß and/or tau accumulation (starting from 45 days of transgenes expression). Tau-related differences were detected in the Novelty Suppressed Feeding task (NSF), whereas APP-related differences were observed predominantly in measures of the Open Field (OF) and Forced Swim tasks (FST). Effects of combined production of Aß and tau were detected in immobility during the 1st half of the Tail Suspension task (TST). These data demonstrate that results from different tasks are difficult to reconcile using task/variable-centered interpretations in which a single task/variable is assigned an ad-hoc meaning relevant to depression. An alternative, concept-oriented, approach is based on multiple variables/tests, with an understanding of their possible inter-dependence and utilization of statistical approaches that handle correlated data sets. The existence of strong correlations within and between some of the tasks supported utilization of factor analyses (FA). FA explained a similar amount of variability across the genotypes (∼80%) and identified two factors stable across genotypes and representing motor activity and anxiety measures in OF. In contrast, variables related to FST, TST, and NSFT did not demonstrate a structure of factor loadings that would support the existence of a single integral factor of "depressive state" measured by these tasks. In addition, factor loadings varied between genotypes, indicating that genotype-specific between-task correlations need to be considered for interpretations of findings in any single task. In general, this study demonstrates that utilization of multiple tasks to characterize behavioral phenotypes, an approach that is finally gaining more widespread adoption, requires a step of data integration across different behavioral tests for appropriate interpretations.

Tetrode recording of rat CA1 place cells in an observational spatial working memory task.

Social observation facilitates spatial learning by activation of hippocampal place cell patterns. Here, we describe an observational spatial working memory task to investigate the neural circuits underlying observational learning. This approach trains observer rats to learn to run a T-maze by observing a demonstrator's spatial trajectory while recording their hippocampal CA1 place cell activities in a course of several hours. The protocol provides a tool to study neural activities at population level in a social setting. For complete details on the use and execution of this protocol, please refer to Mou et al. (2021).

Observational learning promotes hippocampal remote awake replay toward future reward locations.

The neural circuit mechanisms underlying observational learning, learning through observing the behavior of others, are poorly understood. Hippocampal place cells are important for spatial learning, and awake replay of place cell patterns is involved in spatial decisions. Here we show that, in observer rats learning to run a maze by watching a demonstrator's spatial trajectories from a separate nearby observation box, place cell patterns during self-running in the maze are replayed remotely in the box. The contents of the remote awake replay preferentially target the maze's reward sites from both forward and reverse replay directions and reflect the observer's future correct trajectories in the maze. In contrast, under control conditions without a demonstrator, the remote replay is significantly reduced, and the preferences for reward sites and future trajectories disappear. Our results suggest that social observation directs the contents of remote awake replay to guide spatial decisions in observational learning.

Elder Abuse: A Comprehensive Overview and Physician-Associated Challenges.

Elder abuse can present in many forms, including physical abuse, psychological/emotional abuse, sexual abuse, financial abuse, and neglect. Many studies estimate that about 10% of all people over the age of 65 experience some form of abuse. These rates are often higher in long-term care facilities such as nursing homes, despite government regulations aimed toward addressing this issue. Because patients who experience abuse tend to have higher rates of hospitalization and mortality, it is important for physicians to be able to accurately identify cases of abuse. However, many studies have found that healthcare professionals are often undertrained and ill-equipped in diagnosing elder abuse. In this article, we outline tools that may be able to aid healthcare professionals in their diagnoses, such as survey-based methodology and common physical signs of abuse. In addition, we propose evidence-based solutions, including the use of multidisciplinary teams and increased training on the subject, so that healthcare professionals can more easily identify victims of abuse. Essentially, it is our hope that this article further spotlights elder abuse and its challenges, while serving as a guide to healthcare professionals.

Evaluation and Improvement of Bottlenecking in a Multidisciplinary Oncology Clinic: An Electronic Medical Record Intervention.

PURPOSE: Clinic members reported slower patient flow in the mornings at a multidisciplinary oncology clinic. This study identified the causes of clinic bottlenecking via analysis of patient schedules and transit times, then corrected discrepancies through a quality improvement program. METHODS: Transit times were measured using tracking cards handed out at check-in, marked by each clinic member throughout the encounter, and collected upon discharge. Data were analyzed for differences between morning and afternoon patients, and a Pareto chart was formulated to assess for discrepancies in distribution. Repeat plan-do-study-act (PDSA) cycles were conducted, implementing two changes to redistribute appointments to optimize clinic workflow. RESULTS:  A total of 2951 patient appointments were analyzed: 589 at baseline, 277 following an initial intervention, and 2085 following a subsequent intervention. Analysis of patient transit times revealed no significant differences between morning and afternoon patient groups (t-test, p=.13-.99), with no transit interval markedly longer than others (t-test, p=.32-.83). However, upon evaluation of appointment times, a maldistribution was noted with 57% of patients concentrated between 9:00 am to 12:00 pm, accounting for the perception of bottlenecking. An initial intervention offering patients afternoon appointments on a voluntary basis was insufficient for rebalancing distribution (chi-square test, p=.299); however, an electronic medical record (EMR) intervention with rigid appointment templates was successful (chi-square test, p<.001). CONCLUSION: An imbalance of appointment times contributed to the perception of slow clinic throughput. This study emphasizes the importance of systematically investigating even consensus observations for validity prior to costly interventions. Furthermore, these results support the utility of information technology in optimizing clinic workflow.