Psychological Distress, Emergency Room Utilization, and Mortality Risk Among US Adults With History of Prostate Cancer.

PURPOSE: Adults with a history of prostate cancer experience several physical and mental stressors. However, limited information is available about the prevalence of psychological distress in this population and its association with clinical outcomes in a nationally representative sample. METHODS: We identified adults with history of prostate cancer from a nationally representative cohort (2000-2018 US National Health Interview Survey) and its linked mortality files through December 31, 2019. The six-item Kessler Psychological Distress Scale (K6) was used to assess psychological distress. The associations between psychological distress severity, emergency room (ER) usage, and mortality risk were estimated using multivariable logistic and Cox proportional hazards models, which were both adjusted for age, survey year, race/ethnicity, region, education, health insurance, comorbidities, functional limitations, and time since cancer diagnosis. RESULTS: Among the 3,451 adults with history of prostate cancer surveyed, 96 (2.4%), 434 (11.3%), and 2,921 (86.3%) reported severe, moderate, or low/no mental distress, respectively. During the 12 months preceding the survey, 812 (22.8%) adults with history of prostate cancer visited the ER. After a median follow-up of 81 months, 937 (25.5%) deaths occurred. Compared with participants with low/no mental distress, those with severe mental distress reported the highest utilization of the ER (adjusted odds ratio [aOR], 2.57 [95% CI, 1.51 to 4.37]) and exhibited the highest all-cause mortality (adjusted hazard ratio [aHR], 1.83 [95% CI, 1.29 to 2.60]), followed by those with moderate mental distress (ER use aOR, 1.76 [95% CI, 1.29 to 2.42]; all-cause mortality aHR, 1.22 [95% CI, 0.92 to 1.62]). CONCLUSION: Among US adults with history of prostate cancer, psychological distress was associated with increased ER use and mortality risk. Notably, severe psychological distress was correlated with the highest rates of ER visits and mortality risk. However, given the retrospective nature of this study, uncontrolled confounding variables need to be considered when interpreting the findings.

"Live Gerontology": Understanding and Representing Aging, Loneliness, and Long-Term Care Through Science and Art.

This article proposes an expansive conceptualization of gerontological research by engaging with a "live gerontology" that combines sciences and arts to better understand and represent aging and its diverse meanings and contexts. Borrowing the sociological concept of "live methods," we argue that gerontology can benefit from a "live" approach-not only methodologically, but also conceptually. To guide pathways between artistic and gerontological fields and frame its practices and outcomes, we suggest four propositions for a live gerontology: (1) using multiple genres to artfully connect the whole-interweaving micro-, meso-, and macrolevels to contextualize aging within various sociocultural milieus; (2) fostering the use of the senses to capture more than just what people say-what they do, display, and feel; (3) enabling a critical inventiveness by relying on arts' playfulness to design/refine instruments; and (4) ensuring a constant reflection on ethics of representation and public responsibility. To apply and experiment with a live gerontological approach, we describe collaborations with an award-winning writer and an illustrator. The collaborations drew on qualitative data from a study on lived experiences of loneliness in long-term care through ethnography and interviews with residents of 2 Australian facilities. The writer explored participants' accounts as creative stories, which were then illustrated. Motivated by an ethics of representation, we aimed to represent findings without othering or further marginalizing participants. The creative materials offered more than appealing representations, shining new light on the intricate nature of aging, loneliness, institutionalization, and gerontology research and practice.

Pandemic Diaries: Lived Experiences of Loneliness, Loss, and Hope Among Older Adults During COVID-19.

BACKGROUND AND OBJECTIVES: While research on loneliness in later life has increased during the coronavirus disease 2019 (COVID-19) pandemic, we still lack diverse qualitative approaches capturing lived experiences of lonely older adults. Approaches to research with older adults instead of on them are also scant in gerontological literature on loneliness. Through solicited diaries, this study aimed to explore how older Australians who were already lonely before the pandemic managed lockdowns (stay-at-home orders) in Victoria, Australia, which lived through one of the longest lockdowns in the world. RESEARCH DESIGN AND METHODS: This article is based on qualitative diaries completed by 32 older adults (aged 65 and older). Diaries provide a 'live' document where participants become active research partners, recording and sharing their perceptions and experiences. This method is useful to capture sensitive issues, but to the best of our knowledge has not been employed in loneliness studies. Data were thematically analyzed through the identification of themes within and across diaries. RESULTS: Loneliness was defined by participants as a detrimental absence of companionship and meaningful social interactions. For most, lockdowns exacerbated loneliness, presented new triggers, and upended coping strategies. The disruption of the 'emotion work' involved with managing loneliness led to a reconfiguration of response strategies, including through digital technology, which brought both challenges (e.g., digital ageism) and opportunities (e.g., novel communication forms). DISCUSSION AND IMPLICATIONS: Understanding how older people living alone define and respond to loneliness in diverse contexts-for example, before and during a pandemic that restricts social interaction-provides critical insights to inform interventions to tackle loneliness.

Development of a computed tomography method of scoring bone erosion in patients with gout: validation and clinical implications.

OBJECTIVES: To develop a method of scoring bone erosion in the feet of patients with gout using CT as an outcome measure for chronic gout studies, consistent with the components of the OMERACT filter. METHODS: Clinical assessment, plain radiographs and CT scans of both feet were obtained from 25 patients with chronic gout. CT scans were scored for bone erosion using a semi-quantitative method based on the Rheumatoid Arthritis MRI Scoring System (RAMRIS). CT bone erosion was assessed at 22 bones in each foot (total 1100 bones) by two independent radiologists. A number of different models were assessed to determine the optimal CT scoring system for bone erosion, incorporating the frequency of involvement and inter-reader reliability for individual bones. RESULTS: An optimal model was identified with low number of bones required for scoring (seven bones/foot), inclusion of bones over the entire foot, high reliability and ability to capture a high proportion of disease. This model included the following bones in each foot: first metatarsal (MT) head, second to fourth MT base, cuboid, middle cuneiform and distal tibia (range 0-140). Scores from this model correlated with plain radiographic damage scores (r = 0.86, P < 0.0001) and disease duration (r = 0.42, P < 0.05). Scores were higher in those with clinically apparent tophaceous disease than in those without tophi (P < 0.0001). CONCLUSIONS: We have developed a preliminary method of assessing bone erosion in gout using conventional CT. Further testing of this method is now required, ideally in prospective studies to allow analysis of the sensitivity to change of the measure.

"It's the worst bloody feeling in the world": Experiences of loneliness and social isolation among older people living in care homes.

Loneliness and social isolation in later life result in social exclusion, reduced well-being, and significant health problems. Yet, we have a limited understanding of the meanings that older people ascribe to loneliness and social isolation, and how they live through and cope with these issues. The scarce research on the topic largely reflects the experiences of older people living in the community. Less is known about the lived experiences of those in institutionalized settings, despite this group's vulnerability to loneliness and social isolation. To address this gap, we conducted a six-month multi-method qualitative study in two Australian care homes. The study included participant observation and interviews with twenty-two residents experiencing (or at risk) of loneliness and/or social isolation. Our findings show that participants understood loneliness and social isolation as relational and associated with oldering (age-related contexts, norms, status), personal troubles, and sickness. They therefore situated loneliness and social isolation as multidimensional phenomena: related to both structural (e.g., oldering) and agentic (e.g., personal choices) dimensions. Although participants acknowledged the structural aspects of loneliness and isolation, most felt it was their own responsibility to address it. They employed individual and social strategies to cope with and regulate disclosure of loneliness and isolation. Our study drew on interactionism and situationism (Erving Goffman) along with an emotion work approach (Arlie Hochschild) to provide a richer understanding of the lived experiences of loneliness and social isolation among frail older people living in care homes.

LAGO on the unit sphere.

LAGO is an efficient kernel algorithm designed specifically for the rare target detection problem. However, unlike other kernel algorithms, LAGO cannot be easily used with many domain-specific kernels. We solve this problem by first providing a unified framework for LAGO and clarifying its basic principle, and then applying that principle on the unit sphere instead of in the Euclidean space.