Effects of familiar music exposure on deliberate retrieval of remote episodic and semantic memories in healthy aging adults.

Familiar music facilitates memory retrieval in adults with dementia. However, mechanisms behind this effect, and its generality, are unclear because of a lack of parallel work in healthy aging. Exposure to familiar music enhances spontaneous recall of memories directly cued by the music, but it is unknown whether such effects extend to deliberate recall more generally - e.g., to memories not directly linked to the music being played. It is also unclear whether familiar music boosts recall of specific episodes versus more generalised semantic memories, or whether effects are driven by domain-general mechanisms (e.g., improved mood). In a registered report study, we examined effects of familiar music on deliberate recall in healthy adults ages 65-80 years (N = 75) by presenting familiar music from earlier in life, unfamiliar music, and non-musical audio clips across three sessions. After each clip, we assessed free recall of remote memories for pre-selected events. Contrary to our hypotheses, we found no effects of music exposure on recall of prompted events, though familiar music evoked spontaneous memories most often. These results suggest that effects of familiar music on recall may be limited to memories specifically evoked in response to the music (Preprint and registered report protocol at https://osf.io/kjnwd/).

Redesigning Care in the PACU With an Adult-Gerontology Acute Care Nurse Practitioner (A-GACNP).

The adult-gerontology acute care nurse practitioner (A-GACNP) engages in all levels of care within the acute care setting. The postanesthesia care unit (PACU), a specialized entity within the acute care environment, encounters patients at their most vulnerable through various stages of awakening. The evolving state in the health care system today creates opportunity for innovations in the hospital setting that have yet to see the advantages of the nurse practitioner. The A-GACNP possesses the education, training, and skill necessary to treat patients in the critical stages of recovery from anesthesia. This article provides the rationale for incorporating the A-GACNP into the PACU. A systematic review of the literature will examine the benefits of the nurse practitioner in the acute care setting, the A-GACNP competencies, and propose a transformation of care in the PACU where the A-GACNP has an exclusive role.

Risk-standardized Acute Admission Rates Among Patients With Diabetes and Heart Failure as a Measure of Quality of Accountable Care Organizations: Rationale, Methods, and Early Results.

BACKGROUND: Population-based measures of admissions among patients with chronic conditions are important quality indicators of Accountable Care Organizations (ACOs), yet there are challenges in developing measures that enable fair comparisons among providers. METHODS: On the basis of consensus standards for outcome measure development and with expert and stakeholder input on methods decisions, we developed and tested 2 models of risk-standardized acute admission rates (RSAARs) for patients with diabetes and heart failure using 2010-2012 Medicare claims data. Model performance was assessed with deviance R; score reliability was tested with intraclass correlation coefficient. We estimated RSAARs for 114 Shared Savings Program ACOs in 2012 and we assigned ACOs to 3 performance categories: no different, worse than, and better than the national rate. RESULTS: The diabetes and heart failure cohorts included 6.5 and 2.6 million Medicare Fee-For-Service beneficiaries aged 65 years and above, respectively. Risk-adjustment variables were age, comorbidities, and condition-specific severity variables, but not socioeconomic status or other contextual factors. We selected hierarchical negative binomial models with the outcome of acute, unplanned hospital admissions per 100 person-years. For the diabetes and heart failure measures, respectively, the models accounted for 22% and 12% of the deviance in outcomes and score reliability was 0.89 and 0.81. For the diabetes measure, 51 (44.7%) ACOs were no different, 45 (39.5%) were better, and 18 (15.8%) were worse than the national rate. The distribution of performance for the heart failure measure was 61 (53.5%), 37 (32.5%), and 16 (14.0%), respectively. CONCLUSION: Measures of RSAARs for patients with diabetes and heart failure meet criteria for scientific soundness and reveal important variation in quality across ACOs.

Assessing the cognitive and work load of an inpatient safety dashboard in the context of opioid management.

For health information technology to realize its potential to improve flow, care, and patient safety, applications should be intuitive to use and burden neutral for frontline clinicians. We assessed the impact of a patient safety dashboard on clinician cognitive and work load within a simulated information-seeking task for safe inpatient opioid medication management. Compared to use of an electronic health record for the same task, the dashboard was associated with significantly reduced time on task, mouse clicks, and mouse movement (each p < 0.001), with no significant increases in cognitive load nor task inaccuracy. Cognitive burden was higher for users with less experience, possibly partly attributable to usability issues identified during this study. Findings underscore the importance of assessing the usability, cognitive, and work load analysis during the design and implementation of health information technology applications.

Architectural trends in the human normal and bicuspid aortic valve leaflet and its relevance to valve disease.

The bicuspid aortic valve (AV) is the most common cardiac congenital anomaly and has been found to be a significant risk factor for developing calcific AV disease. However, the mechanisms of disease development remain unclear. In this study we quantified the structure of human normal and bicuspid leaflets in the early disease stage. From these individual leaflet maps average fiber structure maps were generated using a novel spline based technique. Interestingly, we found statistically different and consistent regional structures between the normal and bicuspid valves. The regularity in the observed microstructure was a surprising finding, especially for the pathological BAV leaflets and is an essential cornerstone of any predictive mathematical models of valve disease. In contrast, we determined that isolated valve interstitial cells from BAV leaflets show the same in vitro calcification pathways as those from the normal AV leaflets. This result suggests the VICs are not intrinsically different when isolated, and that external features, such as abnormal microstructure and altered flow may be the primary contributors in the accelerated calcification experienced by BAV patients.

Does rapid response to two group psychotherapies for binge eating disorder predict abstinence?

OBJECTIVE: Extend understanding of a rapid response (RR) to treatment by examining its prognostic significance at end-of-treatment (EOT) and 1 year follow-up within two group treatments for binge eating disorder (BED): Dialectical Behavior Therapy for BED (DBT-BED) and an active comparison group therapy (ACGT). METHODS: 101 adults with BED randomized to 20-weeks DBT-BED versus ACGT (Safer, Robinson, & Jo, 2010). RR defined as ≥65% reduction in the frequency of days of binge eating by week 4. RR across and within treatment conditions used to predict binge eating abstinence and secondary outcomes (e.g., binge eating pathology, treatment attrition) at EOT and 1 year follow-up. RESULTS: (1) Significantly higher binge eating abstinence for rapid responders (RR; n = 41) vs. non-rapid responders (non-RRs; n = 60) at EOT (70.7% vs. 33.3%) and 1 year follow-up (70.7% vs. 40.0%), respectively, as well as improvement on most secondary measures (2) Significantly less attrition among RRs vs. non-RRs (3) Significantly higher binge eating abstinence rates at both time points for DBT-RRs vs. DBT-non-RRs, but not for ACGT-RRs vs. ACGT-non-RRs. CONCLUSIONS: Current study extends prognostic significance of RR to 1 year follow-up. RR more prominent for those randomly assigned to DBT-BED than ACGT. Implications discussed.

Life-long sustained mortality advantage of siblings of centenarians.

Although survival to old age is known to have strong environmental and behavioral components, mortality differences between social groups tend to diminish or even disappear at older ages. Hypothesizing that surviving to extreme old age entails a substantial familial predisposition for longevity, we analyzed the pedigrees of 444 centenarian families in the United States. These pedigrees included 2,092 siblings of centenarians, whose survival was compared with 1900 birth cohort survival data from the U.S. Social Security Administration. Siblings of centenarians experienced a mortality advantage throughout their lives relative to the U.S. 1900 cohort. Female siblings had death rates at all ages about one-half the national level; male siblings had a similar advantage at most ages, although diminished somewhat during adolescence and young adulthood. Relative survival probabilities for these siblings increase markedly at older ages, reflecting the cumulative effect of their mortality advantage throughout life. Compared with the U.S. 1900 cohort, male siblings of centenarians were at least 17 times as likely to attain age 100 themselves, while female siblings were at least 8 times as likely.