Pediatric and Young Adult Household Transmission of the Initial Waves of SARS-CoV-2 in the United States: Administrative Claims Study.

BACKGROUND: The correlates responsible for the temporal changes of intrahousehold SARS-CoV-2 transmission in the United States have been understudied mainly due to a lack of available surveillance data. Specifically, early analyses of SARS-CoV-2 household secondary attack rates (SARs) were small in sample size and conducted cross-sectionally at single time points. From these limited data, it has been difficult to assess the role that different risk factors have had on intrahousehold disease transmission in different stages of the ongoing COVID-19 pandemic, particularly in children and youth. OBJECTIVE: This study aimed to estimate the transmission dynamic and infectivity of SARS-CoV-2 among pediatric and young adult index cases (age 0 to 25 years) in the United States through the initial waves of the pandemic. METHODS: Using administrative claims, we analyzed 19 million SARS-CoV-2 test records between January 2020 and February 2021. We identified 36,241 households with pediatric index cases and calculated household SARs utilizing complete case information. Using a retrospective cohort design, we estimated the household SARS-CoV-2 transmission between 4 index age groups (0 to 4 years, 5 to 11 years, 12 to 17 years, and 18 to 25 years) while adjusting for sex, family size, quarter of first SARS-CoV-2 positive record, and residential regions of the index cases. RESULTS: After filtering all household records for greater than one member in a household and missing information, only 36,241 (0.85%) of 4,270,130 households with a pediatric case remained in the analysis. Index cases aged between 0 and 17 years were a minority of the total index cases (n=11,484, 11%). The overall SAR of SARS-CoV-2 was 23.04% (95% CI 21.88-24.19). As a comparison, the SAR for all ages (0 to 65+ years) was 32.4% (95% CI 32.1-32.8), higher than the SAR for the population between 0 and 25 years of age. The highest SAR of 38.3% was observed in April 2020 (95% CI 31.6-45), while the lowest SAR of 15.6% was observed in September 2020 (95% CI 13.9-17.3). It consistently decreased from 32% to 21.1% as the age of index groups increased. In a multiple logistic regression analysis, we found that the youngest pediatric age group (0 to 4 years) had 1.69 times (95% CI 1.42-2.00) the odds of SARS-CoV-2 transmission to any family members when compared with the oldest group (18 to 25 years). Family size was significantly associated with household viral transmission (odds ratio 2.66, 95% CI 2.58-2.74). CONCLUSIONS: Using retrospective claims data, the pediatric index transmission of SARS-CoV-2 during the initial waves of the COVID-19 pandemic in the United States was associated with location and family characteristics. Pediatric SAR (0 to 25 years) was less than the SAR for all age other groups. Less than 1% (n=36,241) of all household data were retained in the retrospective study for complete case analysis, perhaps biasing our findings. We have provided measures of baseline household pediatric transmission for tracking and comparing the infectivity of later SARS-CoV-2 variants.

A nonparametric Bayesian model for estimating spectral densities of resting-state EEG twin data.

Electroencephalography (EEG) is a noninvasive neuroimaging modality that captures electrical brain activity many times per second. We seek to estimate power spectra from EEG data that ware gathered for 557 adolescent twin pairs through the Minnesota Twin Family Study (MTFS). Typically, spectral analysis methods treat time series from each subject separately, and independent spectral densities are fit to each time series. Since the EEG data were collected on twins, it is reasonable to assume that the time series have similar underlying characteristics, so borrowing information across subjects can significantly improve estimation. We propose a Nested Bernstein Dirichlet prior model to estimate the power spectrum of the EEG signal for each subject by smoothing periodograms within and across subjects while requiring minimal user input to tuning parameters. Furthermore, we leverage the MTFS twin study design to estimate the heritability of EEG power spectra with the hopes of establishing new endophenotypes. Through simulation studies designed to mimic the MTFS, we show our method out-performs a set of other popular methods.

Improved Time in Range During 28 Days of Meal Delivery for People With Type 2 Diabetes.

Objective: Nutrition therapy is a cornerstone of care for people with type 2 diabetes, yet starting new, healthy eating behaviors and sustaining them can be challenging. This decentralized, single-arm study assessed the impact of 28 days of home-delivered, pre-portioned meals (three meals per day) on continuous glucose monitoring (CGM)-derived glycemic control and quality of life. Research design and methods: We enrolled 154 people with type 2 diabetes from across the United States. All participants were enrolled in a digital-first type 2 diabetes care center of excellence and had a time in range (TIR) <70% or a glucose management index (GMI) >7%. A total of 102 participants received another set of meals for a household member. Forty-four participants were excluded from CGM-based analysis because of sparse data in the baseline or intervention period. Results: From the baseline through the intervention period, average TIR improved by 6.8% (95% CI 4.0-9.7, P <0.001), average GMI improved by 0.21% (95% CI 0.11-0.32, P <0.001), and participants' odds of achieving ≥70% TIR increased (odds ratio 2.55 [95% CI 0.93-7.80, P = 0.051]). Although average TIR increased rapidly upon initiation of meal delivery, it regressed when the delivery period ended. Conclusion: Home-delivered meals were associated with modest TIR and GMI improvements, but only in the short term. More research is needed to determine whether the effects of nutrition therapy can be extended by providing ongoing meal delivery or additional support such as behavioral intervention.

SARS-CoV-2 transmission during rugby league matches: do players become infected after participating with SARS-CoV-2 positive players?

OBJECTIVES: To examine the interactions between SARS-CoV-2 positive players and other players during rugby league matches and determine within-match SARS-CoV-2 transmission risk. METHODS: Four Super League matches in which SARS-CoV-2 positive players were subsequently found to have participated were analysed. Players were identified as increased-risk contacts, and player interactions and proximities were analysed by video footage and global positioning system (GPS) data. The primary outcome was new positive cases of SARS-CoV-2 within 14 days of the match in increased-risk contacts and other players participating in the matches. RESULTS: Out of 136 total players, there were 8 SARS-CoV-2 positive players, 28 players identified as increased-risk contacts and 100 other players in the matches. Increased-risk contacts and other players were involved in 11.4±9.0 (maximum 32) and 4.0±5.2 (maximum 23) tackles, respectively. From GPS data, increased-risk contacts and other players were within 2 m of SARS-CoV-2 positive players on 10.4±18.0 (maximum 88) and 12.5±20.7 (maximum 121) occasions, totalling 65.7±137.7 (maximum 689) and 89.5±169.4 (maximum 1003) s, respectively. Within 14 days of the match, one increased-risk contact and five players returned positive SARS-CoV-2 reverse transcriptase PCR (RT-PCR) tests, and 27 increased-risk contacts and 95 other participants returned negative SARS-CoV-2 RT-PCR tests. Positive cases were most likely traced to social interactions, car sharing and wider community transmission and not linked to in-match transmission. CONCLUSION: Despite tackle involvements and close proximity interactions with SARS-CoV-2 positive players, in-match SARS-CoV-2 transmission was not confirmed. While larger datasets are needed, these findings suggest rugby presents a lower risk of viral transmission than previously predicted.

A grouped beta process model for multivariate resting-state EEG microstate analysis on twins.

EEG microstate analysis investigates the collection of distinct temporal blocks that characterize the electrical activity of the brain. Brain activity within each microstate is stable, but activity switches rapidly between different microstates in a nonrandom way. We propose a Bayesian nonparametric model that concurrently estimates the number of microstates and their underlying behaviour. We use a Markov switching vector autoregressive (VAR) framework, where a hidden Markov model (HMM) controls the nonrandom state switching dynamics of the EEG activity and a VAR model defines the behaviour of all time points within a given state. We analyze the resting-state EEG data from twin pairs collected through the Minnesota Twin Family Study, consisting of 70 epochs per participant, where each epoch corresponds to 2 s of EEG data. We fit our model at the twin pair level, sharing information within epochs from the same participant and within epochs from the same twin pair. We capture within twin-pair similarity, using an Indian buffet process, to consider an infinite library of microstates, allowing each participant to select a finite number of states from this library. The state spaces of highly similar twins may completely overlap while dissimilar twins could select distinct state spaces. In this way, our Bayesian nonparametric model defines a sparse set of states that describe the EEG data. All epochs from a single participant use the same set of states and are assumed to adhere to the same state switching dynamics in the HMM model, enforcing within-participant similarity.

L'analyse des micro-états d'un électroencéphalogramme (EEG) porte sur une collection de différents blocs temporels caractérisant l'activité électrique du cerveau. L'activité cérébrale est stable à l'intérieur de chaque bloc, mais elle varie rapidement entre les différents micro-états de façon non aléatoire. Les auteurs proposent un modèle bayésien non paramétrique qui estime simultanément le nombre de micro-états et leur comportement sous-jacent. Ils utilisent le cadre de vecteurs autorégressifs (VAR) markoviens commutants où un modèle de Markov caché (MMC) contrôle les dynamiques de commutations non aléatoires de l'activité de l'EEG et le modèle de VAR définit le comportement à travers le temps pour un état donné. Ils analysent des données d'EEG au repos de paires de jumeaux collectées dans l'étude des jumeaux du Minnesota comportant 70 époques de deux secondes d'EEG chacune pour chaque participant. Les auteurs ajustent leur modèle au niveau des paires de jumeaux, partageant les informations d'un participant et de son jumeau pour une même époque. Ils capturent les similarités dans la paire de jumeaux avec un processus du buffet indien afin de constituer une bibliothèque infinie de micro-états et de permettre à chaque participant de choisir un ensemble fini d'états provenant de celle-ci. L'espace d'états de jumeaux très semblables peut se chevaucher entièrement alors que des jumeaux différents pourraient avoir des espaces distincts. Le modèle bayésien non paramétrique des auteurs définit ainsi un ensemble creux d'états qui décrivent les données d'EEG. Toutes les époques d'un même participant utilisent le même ensemble d'états, et elles doivent adhérer au même régime de changement d'état pour leur dynamique de commutation selon le MMC, forçant ainsi une similarité intra-participant.

A longitudinal model for functional connectivity networks using resting-state fMRI.

Many neuroimaging studies collect functional magnetic resonance imaging (fMRI) data in a longitudinal manner. However, the current fMRI literature lacks a general framework for analyzing functional connectivity (FC) networks in fMRI data obtained from a longitudinal study. In this work, we build a novel longitudinal FC model using a variance components approach. First, for all subjects' visits, we account for the autocorrelation inherent in the fMRI time series data using a non-parametric technique. Second, we use a generalized least squares approach to estimate 1) the within-subject variance component shared across the population, 2) the baseline FC strength, and 3) the FC's longitudinal trend. Our novel method for longitudinal FC networks seeks to account for the within-subject dependence across multiple visits, the variability due to the subjects being sampled from a population, and the autocorrelation present in fMRI time series data, while restricting the number of parameters in order to make the method computationally feasible and stable. We develop a permutation testing procedure to draw valid inference on group differences in the baseline FC network and change in FC over longitudinal time between a set of patients and a comparable set of controls. To examine performance, we run a series of simulations and apply the model to longitudinal fMRI data collected from the Alzheimer's Disease Neuroimaging Initiative (ADNI) database. Overall, we found no difference in the global FC network between Alzheimer's disease patients and healthy controls, but did find differing local aging patterns in the FC between the left hippocampus and the posterior cingulate cortex.

Satisfied versus dissatisfied: Experiences of retirement village living.

OBJECTIVE: This study aims to understand and distinguish between satisfied and dissatisfied older people, through a comparison of their lived experience within a retirement village. METHODS: An exploratory qualitative research design was utilized to identify and describe consumer experiences of lifestyle living and how that experience translates to positive or negative satisfaction. The net promoter score (NPS) was employed to identify highly satisfied (Promoters) and highly dissatisfied (Detractors) people. RESULTS: Sixty-two interviews in retirement lifestyle villages were analysed, including satisfied (n = 33) and dissatisfied (n = 29) consumers of the service. Results reveal that satisfied people: (1) feel grateful for a service that exceeds their purchase expectations; (2) feel connected to others inside or (3) outside the lifestyle village; (4) feel 'heard' by the service provider; and (5) feel that they have retained their independence. Dissatisfied people describe: (1) broken promises, specifically those made at the time of purchase; (2) not feeling 'connected' to others inside the village; (3) feeling unheard or ignored by the service provider; and (4) the service not meeting their needs. CONCLUSIONS: Revealing these detailed insights clarified the nuanced, hazy and often ambiguous differences between dissatisfied and satisfied people. It also provided insights into the high priority needs, expectations and choices of people as they transition into and through older age. The research should help industry, government and society in general to provide products and services that fit into this lived experience and better meet the changing needs of older people.

Prediction of movement in handball with the use of inertial measurement units and machine learning.

Inertial Measurement Units (IMU) and machine learning are strong tools in quantifying physical demands in sports, such as handball. However, the detection of both locomotion and throw events simultaneously has not been a topic for much investigation. Wherefore, the aim of this study was to publicise a method for training an extreme gradient boosting model capable of identifying low intensity, dynamic, running and throw events. Twelve adults with varying experience in handball wore an IMU on the back while being video recorded during a handball match. The video recordings were used for annotating the four events. Due to the small sample size, a leave-one-subject-out (LOSO) approach was conducted for the modelling and feature selection. The model had issues identifying dynamic movements (F1-score = 0.66 ± 0.07), whereas throw (F1-score = 0.95 ± 0.05), low intensity (F1-score = 0.93 ± 0.02) and running (F1-score = 0.86 ± 0.05) were easier to identify. Features such as IQR and first zero crossing for most of the kinematic characteristics were among the most important features for the model. Therefore, it is recommended for future research to look into these two features, while also using a LOSO approach to decrease likelihood of artificially high model performance.

Characterizing Diabetes Empowerment and Motivation for Changing Health Behaviors Among People with Type 2 Diabetes: A Cross-Sectional Survey.

INTRODUCTION: Effectively engaging people with type 2 diabetes (T2D) earlier in their health journeys is critical to prevent downstream complications. Digitally based diabetes programs are a growing component of care delivery that have the potential to engage individuals outside of traditional clinic-based settings and use personalized data to pair people to tailored diabetes self-management interventions. Knowing an individuals' diabetes empowerment and health-related motivation can help drive appropriate recommendations for personalized interventions. We aimed to characterize diabetes empowerment and motivation towards changing health behaviors among participants in Level2, a T2D specialty care organization in the USA that combines wearable technology with personalized clinical support. METHODS: A cross-sectional online survey was conducted among people enrolled in Level2 (February-March 2021). Distributions of respondent-reported diabetes empowerment and health motivation were analyzed using Motivation and Attitudes Toward Changing Health (MATCH) and Diabetes Empowerment Scale Short Form (DES-SF) scales, respectively. Associations between MATCH and DES-SF scores with Level2 engagement measures and glycemic control were analyzed. RESULTS: The final analysis included 1258 respondents with T2D (mean age 55.7 ± 8.4 years). Respondents had high average MATCH (4.19/5) and DES-SF (4.02/5) scores. The average MATCH subscores for willingness (4.43/5) and worthwhileness (4.39/5) were higher than the average ability subscore (3.73/5). Both MATCH and DES-SF scores showed very weak correlations with Level2 engagement measures and glycemic control (ρ = - 0.18-0.19). CONCLUSIONS: Level2 survey respondents had high average motivation and diabetes empowerment scores. Further research is needed to validate sensitivity of these scales to detect changes in motivation and empowerment over time and to determine whether differences in scores can be used to pair people to personalized interventions.

Tackle and ball carrier demands of rugby league: a seven-year league-wide study including over 1,000,000 tackle events.

OBJECTIVES: Describe the highest frequency and variability for tackle events in rugby league. Investigate seasonal differences in total tackle events per match over a seven-year period. DESIGN: Retrospective observational. METHODS: Tackle events (i.e., ball carrier events [attacker] and tackler involvements [defender]) from 864 male professional rugby league players competing in 1176 Super League matches from 2014 to 2020 were included. A series of linear mixed effect models were used to determine the frequency and variability during peak 1-, 3-, 5-, 10-, 20-, 40-min and whole-match tackle events per player per match at a positional group level. Differences between seasons for the total number of tackle events per match were compared using a one-way analysis of variance and with Tukey's honestly significant difference test. RESULTS: Tackle events were greatest for Props (51.5 [47.7-55.4] per match). Within-players, between-matches, and between-seasons variability was <10 % for tackle events. There were significantly less tackle events and tackler involvements per match in 2014 and a significantly more tackle events per match in season 2020b when compared with all other seasons. CONCLUSIONS: Large between-position variability in peak tackle events, ball carrier events, and tackler involvements would suggest that coaches should separate players into positional groups and prescribe training accordingly. Total number of tackle events, ball carrier events, and tackler involvements were significantly greater in season 2020b when compared to season 2014 to 2019 (inclusive) which may be a consequence of rule changes introduced to the sport.

Exploration of Residual Confounding in Analyses of Associations of Metformin Use and Outcomes in Adults With Type 2 Diabetes.

Importance: Metformin is often used as a first-line therapy for type 2 diabetes; however, frequent discontinuation with reduced kidney function and increased disease severity indicates that a comparison with any other group (eg, nonusers or insulin users) must address significant residual confounding concerns. Objectives: To examine the potential for residual confounding in a commonly used observational study design applied to metformin and to propose a more robust study design for future observational studies of metformin. Design, Setting, and Participants: This retrospective cohort study with a prevalent user design was conducted using an administrative claims database for Medicare Advantage beneficiaries in the US. Participants were categorized into 2 distinct cohorts: 404 458 individuals with type 2 diabetes and 81 791 individuals with prediabetes. Clinical history was observed in 2018, and end points were observed in 2019. Statistical analyses were conducted between May and December 2021. Exposures: Prevalent use (recent prescription and history of use on at least 90 of the preceding 365 days) of metformin or insulin but not both at the start of the observation period. Main Outcomes and Measures: Total inpatient admission days in 2019 and total medical spending (excluding prescription drugs) in 2019. Each of these measures was treated as a binary outcome (0 vs >0 inpatient days and top 10% vs bottom 90% of medical spending). Results: The study included 404 458 adults with type 2 diabetes (mean [SD] age, 74.5 [7.5] years; 52.7% female). A strong metformin effect estimate was associated with reduced inpatient admissions (odds ratio, 0.60; 95% CI, 0.58-0.62) and reduced medical expenditures (odds ratio, 0.57; 95% CI, 0.55-0.60). However, implementation of additional robust design features (negative control outcomes and a complementary cohort) revealed that the estimated beneficial effect was attributable to residual confounding associated with individuals' overall health, not metformin itself. Conclusions and Relevance: These findings suggest that common observational study designs for studies of metformin in a type 2 diabetes population are at risk for consequential residual confounding. By performing 2 additional validation checks, the study design proposed here exposes residual confounding that nullifies the initially favorable claim derived from a common study design.

'The Big Island Model': Resident experiences of a novel permanent supportive housing model for responding to rural homelessness.

Research on rural homelessness focuses primarily on describing the experiences and prevalence of homelessness in rural contexts, with little focus on intervention strategies. We conducted a case study of the 'Big Island Model' (BIM), a novel approach to providing housing and support to individuals experiencing homelessness that has been developed for, and reflects, a rural context. We interviewed 13 participants (n = 10 men; n = 3 women) supported by the BIM using mixed interviews including qualitative and quantitative components exploring experiences of living within this model and aspects of psychosocial well-being. Descriptive statistics were calculated to represent demographic data and participants' scores on standardised measures. Wilcoxon signed-rank tests were conducted with threshold scores and population norms derived from existing literature to identify any differences between residents' median scores on each standardised scale and scores derived from published literature. Qualitative data were analysed using thematic analysis. On measures of meaningful activity, residents reported significantly lower levels of boredom (p < 0.01) and a greater degree of engagement in productivity (p < 0.01) compared with participants in other studies. Mental well-being was reported to be higher (p < 0.05) and drug use was significantly lower than a low-moderate range (p < 0.01). Community integration scores revealed significantly lower physical integration (p < 0.05) and significantly higher psychological integration than individuals who had transitioned to housing in another study (p < 0.001). Our analysis of qualitative interviews resulted in the identification of a central essence characterising residents' experiences: 'Becoming Through Belonging'. This essence was represented by four distinct themes: (1) the healing qualities of nature; (2) being meaningfully occupied; (3) living in a mutually supportive environment; and (4) this place is here to help.

Longitudinal changes in Super League match locomotor and event characteristics: A league-wide investigation over three seasons in rugby league.

The 2019 and 2020 Super League (SL) seasons included several competition rule changes. This study aimed to quantify the difference between the 2018, 2019 and 2020 SL seasons for duration, locomotor and event characteristics of matches. Microtechnology and match event data were analysed from 11 SL teams, comprising 124 players, from 416 competitive matches across a three-year data collection period. Due to an enforced suspension of league competition as a consequence of COVID-19 restrictions, and subsequent rule changes upon return to play, season 2020 was divided into season 2020a (i.e. Pre-COVID suspension) and season 2020b (i.e. Post-COVID suspension). Duration, locomotor variables, and match events were analysed per whole-match and ball-in-play (BIP) periods with differences between seasons determined using mixed-effects models. There were significant (ρ ≤ 0.05) reductions in whole-match and BIP durations for adjustables and backs in 2019 when compared to 2018; albeit the magnitude of reduction was less during BIP analyses. Despite reduced duration, adjustables reported an increased average speed suggesting reduced recovery time between bouts. Both forwards and adjustables also experienced an increase in missed tackles between 2018 and 2019 seasons. When comparing 2019 to 2020a, adjustables and backs increased their average speed and distance whilst all positional groups increased average acceleration both for whole-match and BIP analyses. When comparing 2020a to 2020b, all positional groups experienced reduced average speed and average acceleration for both whole-match and BIP analyses. Forwards experienced an increased number of tackles and carries, adjustables experienced an increased number of carries, and backs experienced an increased number of missed tackles when comparing these variables between season 2020a and 2020b. Rule changes have a greater effect on whole-match duration and locomotor characteristics than those reported during BIP periods which suggests the implemented rule changes have removed stagnant time from matches. Amendments to tackle related rules within matches (e.g., introduction of the 'six-again' rule) increases the number of collision related events such as carries and tackles.

A comparison of health care worker-collected foam and polyester nasal swabs in convalescent COVID-19 patients.

Both polyester and foam nasal swabs were collected from convalescent COVID-19 patients at a single visit and stored in viral transport media (VTM), saline or dry. Sensitivity of each swab material and media combination were estimated, three by three tables were constructed to measure polyester and foam concordance, and cycle threshold (Ct) values were compared. 126 visits had polyester and foam swabs stored in viral transport media (VTM), 51 had swabs stored in saline, and 63 had a foam swab in VTM and a polyester swab stored in a dry tube. Polyester and foam swabs had an estimated sensitivity of 87.3% and 94.5% respectively in VTM, 87.5% and 93.8% respectively in saline, and 75.0% and 90.6% respectively for dry polyester and foam VTM. Polyester and foam Ct values were correlated, but polyester showed decreased performance for cases with a viral load near the detection threshold and higher Ct values on average.

Inflammation-Related Morbidity and Mortality Among HIV-Positive Adults: How Extensive Is It?

OBJECTIVE: To determine the rate of grade 4, potentially life-threatening events not attributable to AIDS, cardiovascular disease (CVD), or non-AIDS cancer among participants on antiretroviral therapy and to describe associations of these events with interleukin-6 (IL-6) and D-dimer. DESIGN: Cohort study. METHODS: HIV-infected participants on antiretroviral therapy (N = 3568) with an HIV-RNA level ≤ 500 copies/mL were followed for grade 4, AIDS, CVD, non-AIDS cancer, and all-cause mortality events. Grade 4 events were further classified masked to biomarker levels as reflecting chronic inflammation-related disease (ChrIRD) or not (non-ChrIRD). Associations of baseline IL-6 and D-dimer with events were studied using Cox models. RESULTS: Over a median follow-up of 4.3 years, 339 participants developed a grade 4 event (22.9 per 1000 person-years); 165 participants developed a ChrIRD grade 4 event (10.7 per 1000 person-years). Grade 4 events were more common than AIDS (54 participants), CVD (132), and non-AIDS cancer (80) events, any of which developed in 252 participants (17.1 per 1000 person-years). Grade 4 and AIDS events were associated with similar risks of death. Higher IL-6 [hazard ratio (HR) = 1.19 per doubling of biomarker; P = 0.003] and D-dimer (HR = 1.23; P < 0.001) levels were associated with an increased risk of grade 4 events. IL-6 associations were stronger for ChrIRD (HR = 1.38; P < 0.001) than non-ChrIRD grade 4 events (HR = 1.11; P = 0.21). CONCLUSIONS: Morbidity and mortality associated with activation of inflammatory and coagulation pathways include conditions other than AIDS, CVD, and non-AIDS cancer events. Effective inflammation-dampening interventions could greatly affect the health of people with HIV.

Senior friendly health services.

As our population continues to age and to put increasing pressures on the health care system, we need to evolve the system to be sensitive to the unique needs of seniors. There are many examples of innovative, evidence-based strategies that have been shown to improve outcomes for elderly individuals utilizing health services. The association between the physical environment and its negative impact on outcomes for hospitalized geriatric patients is well recognized. The use of strategies such as an audit tool to guide modifications of the physical environment or formal programs such as HELP, are good examples of practical approaches that can be implemented. The challenge today is for leaders in the healthcare system to champion and develop principles and a vision of care that supports implementation of these elder-friendly approaches.

Gerontological nursing roles within the Southeastern Regional Geriatric Program.

This paper looks at the varied roles of Registered Nurses (RNs) within the Southeastern Regional Geriatric Program (SERGP) and how these nursing roles influence client care across the continuum of services. More specifically, this paper describes the clinical services of the SERGP, the roles of RNs within these services, and the principles and dimensions of geriatric nursing assessment, treatment, and rehabilitation. The aim of this article is to promote recognition of the complex and stimulating work of RNs in gerontology. Eliopoulos (1997) states the following that reflects this excitement and complexity: Gerontological nurses help older individuals to achieve a sense of wholeness by guiding them in understanding and finding meaning and purpose in life, facilitating harmony of the mind, body, and spirit, mobilizing their internal and external resources, and promoting self-care behaviours.

CACTIN is an essential nuclear protein in Arabidopsis and may be associated with the eukaryotic spliceosome.

CACTIN is a conserved eukaryotic protein without known functional domains. Previous research revealed that CACTIN is essential in animals and protists and that it may function in inflammation pathways in animals; however, these pathways are not as broadly conserved as CACTIN. Therefore, the ancestral molecular function of CACTIN remains unknown. Our studies using Arabidopsis show that CACTIN is required for embryogenesis. Fluorescently tagged CACTIN localizes to nuclear speckles and colocalizes with known splicing proteins. In yeast-two-hybrid studies, we found that CACTIN binds to a putative component of the spliceosome. These findings support a possible role for CACTIN in splicing.