When I am sixty-four evaluating language markers of well-being in healthy aging narratives.

Natural language use is a promising candidate for the development of innovative measures of well-being to complement self-report measures. The type of words individuals use can reveal important psychological processes that underlie well-being across the lifespan. In this preregistered, cross-sectional study, we propose a conceptual model of language markers of well-being and use written narratives about healthy aging (N = 701) and computerized text analysis (LIWC) to empirically validate the model. As hypothesized, we identified a model with three groups of language markers (reflecting affective, evaluative, and social processes). Initial validation with established self-report scales (N = 30 subscales) showed that these language markers reliably predict core components of well-being and underlying processes. Our results support the concurrent validity of the conceptual language model and allude to the added benefits of language-based measures, which are thought to reflect less conscious processes of well-being. Future research is needed to continue validating language markers of well-being across the lifespan in a theoretically informed and contextualized way, which will lay the foundation for inferring people's well-being from their natural language use.

Quantifying Site Burden to Optimize Protocol Performance.

BACKGROUND: The increase in protocol complexity and the resulting rise in the effort required by investigative sites to implement protocols have been well documented, but existing measures of site burden only offer an incomplete view of the burden experienced by site personnel. The introduction of Decentralized Clinical Trials-trials supported by remote and virtual technologies and services-is expected to impact the burden imposed on sites, but this impact has not yet been systematically measured. METHODS: The Tufts Center for the Study of Drug Development conducted an online survey among clinical research sites worldwide and gathered 355 responses assessing the burden associated with distinct activities and procedures related to the implementation of clinical trial protocols using traditional and decentralized approaches. RESULTS: A high percentage of investigative sites (50.5%) have had no experience with DCT solutions and only a small percentage (6.6%) have participated in fully decentralized clinical trials. Overall, half of respondents view DCT solutions as more burdensome than traditional clinical trials. In general, activities related to operational and managerial aspects of trial implementation were viewed as less burdensome when done remotely, while clinical procedures or elements that require study team-patient interactions were viewed as more burdensome when using DCT approaches versus in-person or traditional methods.

Cardiorespiratory effects of isoflurane and medetomidine-tiletamine-zolazepam in 12 bonobos (Pan paniscus).

BACKGROUND: Cardiovascular disease is a significant cause of mortality in captive great apes. However, data from bonobos are lacking due to a paucity of collections in Europe. Comprehensive preventive screening is required to understand the aetiopathogenesis of cardiovascular disease, but the provision of a stable and predictable anaesthetic protocol with minimal cardiovascular effects is challenging. METHODS: This prospective, observational case series reports anaesthesia of 12 bonobos using hand-injected medetomidine and tiletamine-zolazepam followed by maintenance with isoflurane in oxygen. Comprehensive clinical examinations, including arterial blood gases and echocardiography were undertaken. RESULTS: Induction of anaesthesia with hand injection was successful in all but one individual. Respiratory acidosis with metabolic alkalosis and respiratory alkalosis with metabolic acidosis were documented. Hypochloraemia may have contributed to non-respiratory alkalosis in one individual. Ten bonobos experienced hypotension and required haemodynamic support. Both N-terminal pro b-type natriuretic peptide and troponin I cardiac biomarkers correlated with left ventricular ejection fraction (percentage). Recovery was smooth, rapid and uneventful in all animals. LIMITATIONS: The effects of the anaesthetic must be considered during echocardiographical interpretation. CONCLUSIONS: The anaesthesia protocol provided a safe, predictable induction and recovery, facilitating diagnostics (including echocardiography) and minor surgical procedures. Comprehensive monitoring, including invasive blood pressure monitoring and haemodynamic support, is highly recommended.

GPS-Derived Daily Mobility and Daily Well-Being in Community-Dwelling Older Adults.

INTRODUCTION: Mobility as a multidimensional concept has rarely been examined as a day-to-day varying phenomenon in its within-person association with older adults' daily well-being. This study examined associations between daily mobility and daily well-being in community-dwelling older adults with a set of GPS-derived mobility indicators that were representative of older adults' daily mobility. METHODS: Participants wore a custom-built mobile GPS sensor ("uTrail") and completed smartphone-based experience sampling questionnaires on momentary affective states (7 times per day) and daily life satisfaction (in the evening). Analyses included data across 947 days from 109 Swiss older adults aged 65-89 years. RESULTS: Multilevel modeling showed that, within persons, a day with a larger life space area, more time spent in passive transport modes, and a higher number of different locations was associated with higher daily life satisfaction but not daily positive or negative affect. Follow-up analysis showed that the daily maximum distance from home was positively associated with daily life satisfaction, providing a first indication that exposure to non-habitual environments might be a possible underlying mechanism to explain the effects of mobility. CONCLUSIONS: Traveling a long distance away from home and visiting diverse locations may be a way to improve life satisfaction. Results are discussed in the context of research on healthy aging.

You Do Not Have to Get through This Alone: Interpersonal Emotion Regulation and Psychosocial Resources during the COVID-19 Pandemic across Four Countries.

While experiencing the unpredictable events of the COVID-19 pandemic, we are likely to turn to people in order to regulate our emotions. In this research, we investigate how this interpersonal emotion regulation is connected to affective symptoms, above and beyond intrapersonal emotion regulation. Furthermore, we explore whether perceived psychosocial resources moderate these associations, i.e., if individuals reporting healthier social connections benefit differently from interpersonal emotion regulation. N = 1401 participants from the USA, UK, Germany, and Switzerland completed an online survey that included text samples. Affective symptoms (depression, adjustment disorder, fear of COVID-19) were examined based on self-reported as well as language-based indicators. As psychosocial resources, we examined social support, loneliness, attachment style, and trust. We defined latent variables for adaptive and maladaptive interpersonal emotion regulation and analyzed how they were associated with affective symptoms controlling for intrapersonal emotion regulation. Further, we analyzed how they interacted with psychosocial resources. Maladaptive interpersonal emotion regulation strategies were associated with affective symptoms. With lower psychosocial resources, the associations between interpersonal emotion regulation and depressive symptoms were more pronounced. The results highlight that maladaptive interpersonal emotion regulation is associated with worse mental health. These effects are not buffered by more psychosocial resources and are stronger for people with low psychosocial resources.

Eigenbehaviour as an Indicator of Cognitive Abilities.

With growing use of machine learning algorithms and big data in health applications, digital measures, such as digital biomarkers, have become highly relevant in digital health. In this paper, we focus on one important use case, the long-term continuous monitoring of cognitive ability in older adults. Cognitive ability is a factor both for long-term monitoring of people living alone as well as a relevant outcome in clinical studies. In this work, we propose a new potential digital biomarker for cognitive abilities based on location eigenbehaviour obtained from contactless ambient sensors. Indoor location information obtained from passive infrared sensors is used to build a location matrix covering several weeks of measurement. Based on the eigenvectors of this matrix, the reconstruction error is calculated for various numbers of used eigenvectors. The reconstruction error in turn is used to predict cognitive ability scores collected at baseline, using linear regression. Additionally, classification of normal versus pathological cognition level is performed using a support-vector machine. Prediction performance is strong for high levels of cognitive ability but grows weaker for low levels of cognitive ability. Classification into normal and older adults with mild cognitive impairment, using age and the reconstruction error, shows high discriminative performance with an ROC AUC of 0.94. This is an improvement of 0.08 as compared with a classification with age only. Due to the unobtrusive method of measurement, this potential digital biomarker of cognitive ability can be obtained entirely unobtrusively-it does not impose any patient burden. In conclusion, the usage of the reconstruction error is a strong potential digital biomarker for binary classification and, to a lesser extent, for more detailed prediction of inter-individual differences in cognition.

Clinical research in dementia: A perspective on implementing innovation.

The increasing global prevalence of dementia demands concrete actions that are aimed strategically at optimizing processes that drive clinical innovation. The first step in this direction requires outlining hurdles in the transition from research to practice. The different parties needed to support translational processes have communication mismatches; methodological gaps hamper evidence-based decision-making; and data are insufficient to provide reliable estimates of long-term health benefits and costs in decisional models. Pilot projects are tackling some of these gaps, but appropriate methods often still need to be devised or adapted to the dementia field. A consistent implementation perspective along the whole translational continuum, explicitly defined and shared among the relevant stakeholders, should overcome the "research-versus-adoption" dichotomy, and tackle the implementation cliff early on. Concrete next steps may consist of providing tools that support the effective participation of heterogeneous stakeholders and agreeing on a definition of clinical significance that facilitates the selection of proper outcome measures.

Predicting Working Memory in Healthy Older Adults Using Real-Life Language and Social Context Information: A Machine Learning Approach.

BACKGROUND: Language use and social interactions have demonstrated a close relationship with cognitive measures. It is important to improve the understanding of language use and behavioral indicators from social context to study the early prediction of cognitive decline among healthy populations of older adults. OBJECTIVE: This study aimed at predicting an important cognitive ability, working memory, of 98 healthy older adults participating in a 4-day-long naturalistic observation study. We used linguistic measures, part-of-speech (POS) tags, and social context information extracted from 7450 real-life audio recordings of their everyday conversations. METHODS: The methods in this study comprise (1) the generation of linguistic measures, representing idea density, vocabulary richness, and grammatical complexity, as well as POS tags with natural language processing (NLP) from the transcripts of real-life conversations and (2) the training of machine learning models to predict working memory using linguistic measures, POS tags, and social context information. We measured working memory using (1) the Keep Track test, (2) the Consonant Updating test, and (3) a composite score based on the Keep Track and Consonant Updating tests. We trained machine learning models using random forest, extreme gradient boosting, and light gradient boosting machine algorithms, implementing repeated cross-validation with different numbers of folds and repeats and recursive feature elimination to avoid overfitting. RESULTS: For all three prediction routines, models comprising linguistic measures, POS tags, and social context information improved the baseline performance on the validation folds. The best model for the Keep Track prediction routine comprised linguistic measures, POS tags, and social context variables. The best models for prediction of the Consonant Updating score and the composite working memory score comprised POS tags only. CONCLUSIONS: The results suggest that machine learning and NLP may support the prediction of working memory using, in particular, linguistic measures and social context information extracted from the everyday conversations of healthy older adults. Our findings may support the design of an early warning system to be used in longitudinal studies that collects cognitive ability scores and records real-life conversations unobtrusively. This system may support the timely detection of early cognitive decline. In particular, the use of a privacy-sensitive passive monitoring technology would allow for the design of a program of interventions to enable strategies and treatments to decrease or avoid early cognitive decline.

Periodontal health, neutrophil activity and cardiovascular health in captive chimpanzees.

OBJECTIVE: To investigate the association of dental and cardiac disease in a cohort of captive chimpanzees DESIGN: 12 captive chimpanzees underwent periodontal and cardiac examinations under anaesthesia during a relocation to a new enclosure. Blood samples were taken for analysis of circulating markers of cardiac health, nutritional status and isolation of neutrophils for functional assays. They were then observed for three years for signs of heart disease. RESULTS: Although the chimpanzees displayed large quantities of supragingival plaque, they had low bleeding scores. Peripheral blood neutrophils responded to innate and adaptive immune stimuli. In the follow up period two animals died and post mortem confirmed heart disease. Levels of NT-proBNP were found to be high in chimpanzees that died from heart disease. CONCLUSIONS: Whilst there appeared to be a correlation between probing depth and age, there appeared to be no correlation between dental data and heart data in this cohort.

Charting everyday activities in later life: Study protocol of the mobility, activity, and social interactions study (MOASIS).

Prominent theories of aging emphasize the importance of resource allocation processes as a means to maintain functional ability, well-being and quality of life. Little is known about which activities and what activity patterns actually characterize the daily lives of healthy older adults in key domains of functioning, including the spatial, physical, social, and cognitive domains. This study aims to gain a comprehensive understanding of daily activities of community-dwelling older adults over an extended period of time and across a diverse range of activity domains, and to examine associations between daily activities, health and well-being at the within- and between-person levels. It also aims to examine contextual correlates of the relations between daily activities, health, and well-being. At its core, this ambulatory assessment (AA) study with a sample of 150 community-dwelling older adults aged 65 to 91 years measured spatial, physical, social, and cognitive activities across 30 days using a custom-built mobile sensor ("uTrail"), including GPS, accelerometer, and audio recording. In addition, during the first 15 days, self-reports of daily activities, psychological correlates, contexts, and cognitive performance in an ambulatory working memory task were assessed 7 times per day using smartphones. Surrounding the ambulatory assessment period, participants completed an initial baseline assessment including a telephone survey, web-based questionnaires, and a laboratory-based cognitive and physical testing session. They also participated in an intermediate laboratory session in the laboratory at half-time of the 30-day ambulatory assessment period, and finally returned to the laboratory for a posttest assessment. In sum, this is the first study which combines multi-domain activity sensing and self-report ambulatory assessment methods to observe daily life activities as indicators of functional ability in healthy older adults unfolding over an extended period (i.e., 1 month). It offers a unique opportunity to describe and understand the diverse individual real-life functional ability profiles characterizing later life.

Psychological Balance Scale: Validation Studies of an Integrative Measure of Well-Being.

Studies infer Psychological Balance from the absence of psychopathology. In this article, we investigated this construct as an antecedent of well-being. We present empirical evidence toward the validation of a new theoretical model regarding Psychological Balance, a dynamic state with relatively constant characteristics, comprising Consistency and Flexibility and influenced by a Self/Others Ratio. A battery of 31 items, as indicators of Consistency, Flexibility, and Self/Others Ratio, aided this empirical investigation. In an online study (N = 933), we collected cross-sectional data from the United Kingdom. Results of cross-validation analyses provided evidence toward the validity of the proposed model and the psychometric properties of its instrument. There were statistically significant associations between Consistency (i.e., degree of integration of a universal value structure as self-related characteristics that motivate personal goals and behavior), Flexibility (i.e., degree of ability to re-define meaningful and important goals in response to situational challenge), and five well-being variables (e.g., Meaning in Life). Self/Others Ratio (i.e., ratio of motivation to serve self-interest and the interest of others), operationalized as a binary variable (e.g., close and away from 1), moderated some of these associations. Altogether, this work may contribute toward a nuanced understanding of well-being and form the basis of interventions that aim to decrease emotional discomfort and increase meaning, happiness, and life satisfaction.

Comparison of direct surgical cost for humeral shaft fracture fixation: open reduction internal fixation versus intramedullary nailing.

BACKGROUND AND/OR HYPOTHESIS: Prior literature has supported similar complication rates and outcomes for humeral shaft fractures treated with open reduction internal fixation (ORIF) with a plate/screw construct versus intramedullary nailing (IMN). The purpose of this study is to determine whether surgical encounter total direct costs (SETDCs) differ between ORIF and IMN for these fractures. METHODS: Adult patients (≥ 18 years) treated for isolated humeral shaft fractures by ORIF or IMN between June 18, 2014 and June 17, 2019 at a single tertiary academic center were available for inclusion. SETDCs for ORIF and IMN groups, obtained through our institution's information technology value tool, were adjusted to 2019 US dollars and converted to relative costs per institutional policy. SETDCs for ORIF and IMN were compared using the Wilcoxon rank-sum test. RESULTS: Demographic factors did not differ between ORIF and IMN cohorts with the exception of age (mean of 18.6 years older for IMN; P < .001) and American Society of Anesthesiologist class (higher for IMN; P = .029). Substantial cost variation was observed among the 39 included ORIF and 21 IMN cases. Costs pertaining to operating room utilization (P = .77), implants (P = .64), and the recovery room (P = .27) were similar for ORIF and IMN, whereas supply costs were significantly greater for IMN with a median (interquartile range) of 0.21 (0.17 ∼ 0.28), more than twice the supply costs of ORIF (0.09 [0.05 ∼ 0.13], P < .001). The SETDC of IMN was significantly greater than that of ORIF (median [interquartile range]:1.00 [0.9 to 1.13] vs. 0.83 [0.71∼1.05], respectively; P = .047). DISCUSSION AND/OR CONCLUSION: Our study found that the SETDC for humeral shaft fracture fixation was greater for IMN than for ORIF, although patient cohorts differed significantly with respect to age and the American Society of Anesthesiologist class. Surgeons should take these findings into consideration when consenting patients with humeral shaft fractures for the appropriate fixation type.

Personalized Medicine in Oncology in the Developing World: Barriers and Concepts to Improve Status Quo.

Personalized medicine (PM) has revolutionized oncology management in high human development indexed countries. By interrogating both disease and host factors through a variety of tools, oncologists have been able to better target an individual's cancer, leading to improved outcomes. But both the tools used to define these variables, such as next generation sequencing, large immunohistochemical and fluorescence in situ hybridization (FISH) panels, and the weapons employed against each target are extremely expensive. The expenses have to be measured as not only the direct cost to the patient but also the cost to the system to develop and deploy the necessary infrastructure to optimally use them. However, the concepts of predictive, timely prevention and PM have demonstrated improvement in patient's satisfaction and cost effectiveness. In this paper we will summarize the relevant barriers and challenges that limit the implementation of PM in the developing world with an emphasis on the challenges in Nigeria and Nepal.

Leveraging Daily Social Experiences to Motivate Healthy Aging.

Models of healthy aging highlight the motivating influence of social connections. Social experiences constantly shape our thoughts and behaviors throughout daily life, and these daily processes slowly and consistently influence our health and well-being. In this article, we discuss research that has moved from cross-sectional laboratory designs emphasizing individual behaviors to more naturalistic within-person paradigms linking daily social experiences to emotional, cognitive, and physical well-being. We mention research gaps that need to be filled to advance our knowledge of the powerful forces of the social environment for motivating healthy aging. We also offer future directions to move this research forward. We conclude with an outlook on how to leverage these powerful forces in novel intervention approaches that are sensitive to the constantly changing nature of the person and the environment.

Considering Situational Variety in Contextualized Aging Research - Opinion About Methodological Perspectives.

Due to the increasingly heterogeneous trajectories of aging, gerontology requires theoretical models and empirical methods that can meaningfully, reliably, and precisely describe, explain, and predict causes and effects within the aging process, considering particular contexts and situations. Human behavior occurs in contexts; nevertheless, situational changes are often neglected in context-based behavior research. This article follows the tradition of environmental gerontology research based on Lawton's Person-Environment-Interaction model (P-E model) and the theoretical developments of recent years. The authors discuss that, despite an explicit time component, current P-E models could be strengthened by focusing on detecting P-E interactions in various everyday situations. Enhancing Lawton's original formula via a situationally based component not only changes the theoretical perspectives on the interplay between person and environment but also demands new data collection approaches in empirical environmental research. Those approaches are discussed through the example of collecting mobile data with smartphones. Future research should include the situational dimension to investigate the complex nature of person environment interactions.

Spillover Effects When Taking Turns in Dyadic Coping: How Lingering Negative Affect and Perceived Partner Responsiveness Shape Subsequent Support Provision.

When experiencing personal distress, people usually expect their romantic partner to be supportive. However, when put in a situation to provide support, people may at times (still) be struggling with issues of their own. This interdependent nature of dyadic coping interactions as well as potential spillover effects is mirrored in the state-of-the-art research method to behaviorally assess couple's dyadic coping processes. This paradigm typically includes two videotaped 8-min dyadic coping conversations in which partners swap roles as sharer and support provider. Little is known about how such dyadic coping interactions may feed back into one another, impacting the motivation and ability to be a responsive support provider. In three behavioral studies, we examined how sharers' experiences may spill over to affect their own support provision in a subsequent dyadic coping interaction. We hypothesized that the extent to which sharers perceive their partner as responsive to their self-disclosure increases the quality of their own subsequent support provision (Hypothesis 1), whereas sharers' lingering negative affect reduces the quality of their own subsequent support provision (Hypothesis 2). In line with our first hypothesis, perceived partner responsiveness predicted the provision of higher-quality support, though primarily as perceived by the partner. Sharers who perceived their partner to have been more responsive were somewhat more likely to subsequently engage in positive dyadic coping and were rated as more responsive by their partners. Negative dyadic coping behavior was unaffected. Evidence for our second hypothesis was mixed. While lingering negative affect did not affect positive dyadic coping behavior or perceived support, it did increase the chances of negative dyadic coping behavior. However, given the very low occurrences of negative affect and negative dyadic coping, these findings should be interpreted with caution. Taken together, these findings suggest that support interactions may feed back into one another, highlighting the complex and interdependent nature of dyadic coping. The strongest and most consistent findings concerned the spillover effect of perceived partner responsiveness on subsequent perceived support quality, speaking to the key role of believing that one's partner is responsive to one's needs in promoting healthy relationship functioning.

Longitudinal Within-Person Associations Between Quality of Social Relations, Structure of Social Relations, and Cognitive Functioning in Older Age.

OBJECTIVES: Individuals' social connections and interpersonal experiences can both shape and be shaped by cognitive functioning. This study examines longitudinal within-person associations between quality of social relations, structure of social relations, and cognitive functioning in older age. METHODS: We examined 16-year longitudinal data (3 waves) from 497 older adults (M = 66.07 years, SD = 0.83, range = 64-68 years) from the Interdisciplinary Longitudinal Study of Adult Development and Aging. Quality of social relations was measured by scales on perceived emotional support, instrumental support, and social integration. Structure of social relations was measured by self-reported number of leisure time partner types, indicating social network diversity. Cognitive functioning was assessed as a latent construct consisting of five cognitive tests (i.e., Information, Similarities, Letter Fluency, Picture Completion, Block Design). We used a random intercept cross-lagged panel model in the analysis. RESULTS: At the within-person level, prior quality of social relations, but not structure of social relations, was positively associated with subsequent cognitive functioning. Moreover, prior cognitive functioning was positively associated with subsequent structure of social relations, but not with quality of social relations. DISCUSSION: Quality of social relations is a protective factor of cognitive aging. Additionally, responding to prior lower cognitive functioning, social network diversity reduced, but quality of social relations did not seem to change. Overall, this study suggested that social relations and cognitive functioning mutually influence each other, but different aspects of social relations (i.e., quality, structure) might have different directional associations with cognitive functioning.