Staff Perceptions of Adult Day Centers Providing Post-Acute Care for Persons With Dementia.

The purpose of this study was to examine the perception of adult day services (ADS) staff and hospital discharge planners regarding the feasibility of ADS to provide post-acute care (PAC) for persons with dementia. We conducted key informant interviews with emergency department (ED) and inpatient hospital discharge planners (n = 9), and two focus groups with ADS staff (n = 15) representing five ADS programs. Four thematic categories were identified from the discharge planners, including concerns for patients, factors influencing discharge, experience with ADS, and conditions for ADS referrals. Four categories identified from ADS staff interviews include public lack of knowledge of ADS, communication challenges, ADS to prevent hospitalization and ED visits, and barriers to providing PAC. Lack of knowledge about ADS, the role of family in PAC decisions, and the lack of reimbursement for PAC in ADS were identified as the most significant drivers in the ability of ADS to provide PAC.

Microgravity Induction of TRAIL Expression in Preosteoclast Cells Enhances Osteoclast Differentiation.

Evidence indicates that astronauts experience significant bone loss in space. We previously showed that simulated microgravity (µXg) using the NASA developed rotary cell culture system (RCCS) enhanced bone resorbing osteoclast (OCL) differentiation. However, the mechanism by which µXg increases OCL formation is unclear. RANK/RANKL signaling pathway is critical for OCL differentiation. Tumor necrosis factor-related apoptosis inducing ligand (TRAIL) has been shown to increase osteoclastogenesis. We hypothesize that TRAIL may play an important role in µXg enhanced OCL differentiation. In this study, we identified by RT profiler PCR array screening that µXg induces high levels of TRAIL expression in murine preosteoclast cells in the absence of RANKL stimulation compared to ground based (Xg) cultures. We further identified that µXg elevated the adaptor protein TRAF-6 and fusion genes OC-STAMP and DC-STAMP expression in preosteoclast cells. Interestingly, neutralizing antibody against TRAIL significantly reduced µXg induced OCL formation. We further identified that over-expression of pTRAIL in RAW 264.7 cells enhanced OCL differentiation. These results indicate that TRAIL signaling plays an important role in the µXg increased OCL differentiation. Therefore, inhibition of TRAIL expression could be an effective countermeasure for µXg induced bone loss.