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Objective: To examine how the relationship between depressive symptoms and disability may vary by nativity status in later life. Method: This nationally representative prospective study of community-dwelling adults age 51 years and older in the Health and Retirement Study (1998-2010) used hierarchical linear modeling to examine how depressive symptoms (Center for Epidemiological Symptoms of Depression) and disability (instrumental activities of daily living [IADL]; activities of daily living [ADL]) vary by nativity status (U.S.- vs. foreign-born), accounting for changes in social support, health behaviors, and health conditions. Results: Depressive symptoms were associated with increased IADL and ADL disability among Latinos compared with Whites; foreign-born Latinos had lower than expected depressive symptom–related IADL and ADL (0.82; p ≤ .001) disability. Discussion: Given that U.S.-born Latinos had similar or poorer depressive symptom–related disability outcomes than Whites, interventions focused on early detection and treatment of depressive symptoms for this group are warranted and may improve disablement outcomes.

This chapter reviews the outline, process, and structure of the LEED Lab course at North Carolina State University (NCSU), which has engaged students from multiple colleges across the University. This chapter will specifically address NCSU's particular approach to teamwork in design education, using an existing building on NCSU's campus and an established assessment framework to provide context. With the LEED for Existing Buildings Operations and Maintenance as a guide, interdisciplinary teams of students worked together to establish recommendations for future operations. Additional teamwork opportunities included the engagement of a number of NCSU facilities departments, including Repairs and Renovation, Energy Services, Waste Reduction and Recycling, and others. Using examples of team-building exercises, integration with NCSU's Facilities Division, in-class hands-on exercises, and in-process photographs, this chapter will walk the reader through the opportunities and challenges of integrating non-traditional teamwork exercises into design education processes.

Objective: To report the implementation/adoption of the Safe Home Program to support caregivers of persons with dementia in (1) ongoing surveillance, (2) provision of care, (3) prevention of injuries, and (4) improving home safety. Methods: For this demonstration project 4 assessment questionnaires (Safety Assessment Scale, Vigilance Scale, Peace of Mind Scale, and Sleep Disorders Inventory) were administered to each dyad to understand their technological needs. After identification and installation of appropriate technologies and education of the caregiver, a final visit (at 3 months) determined whether technologies were useful and being used. Results: The majority of caregivers utilized technologies for ongoing surveillance; other technologies included an identification program and medication organizer. Conclusion: Technologies focused on ongoing surveillance for persons with dementia at the home are needed. These technologies could be quickly adopted by caregivers to ameliorate some of the stress and burden associated with providing care for persons with dementia.

INTRODUCTION In this editorial, we report on the development of a smartwatch designed to enhance the Smart Home at the Department of Veterans Affairs (VA) hospital in Tampa, a project that uses advanced tracking technology to help Veteran patients with traumatic brain injury (TBI) independently plan, organize, and complete everyday activities [1]. The literature is replete with examples of proposed technologies designed to influence or control behavior, the most recent incarnation being "persuasive technologies" [2-3]. While handheld smartphones have been the pervasive device that readers are most likely to have experience with, new devices targeted at the consumer market now include Google Glass and Samsung's Galaxy Gear smartwatch. Both devices attempt to make the interaction with wireless computing infrastructures a ubiquitous experience. Similarly, many new persuasive applications have been developed to run on common devices such as smartphones, PDAs, and standard computer systems. These applications are often designed to prompt for desired behaviors contingent on time of day to provide basic reminder functions. Very few of these applications use global positioning system (GPS) to derive location and far fewer still are based on precise indoor location [4]. A handful of technologies combine time of day with coarse indoor location to provide targeted prompts to individuals, as for example Takeuchi and Sugimoto, who developed a smartphone application that guides and makes purchasing suggestions to shoppers in Japan [5]. The application of precise location-aware technologies to indoor navigation has been difficult to implement because of poor in-building GPS performance and the high cost of constructing indoor reference grids to duplicate the ranging functions performed outdoors by GPS satellites [6]. For certain applications, ultrawideband (UWB) technologies have shown considerable promise, although the implementation costs can be significant [7]. In a prior Journal of Rehabilitation Research and Development editorial, we reported on the James A. Haley Veterans' Hospital Polytrauma Transitional Rehabilitation Program (PTRP) Smart Home [1] that employs a UWB tracking system from Ubisense that is capable of resolving locations to around 20 cm (vs GPS's 3-5 m accuracy) anywhere in the facility. The system's Smart Home technologies permit selective medication prompting, automated check-in and check-out from the facility, and guidance to therapeutic sessions by presenting prompts on wall-mounted, touch-sensitive screens. To date, 30 PTRP patients have firsthand experience with the Smart Home tracking technology. While the Smart Home results have been generally positive, we encountered a human-factors issue while deploying this technology in that Veterans would sometimes miss or ignore a prompting message even though the screen delivering the message was very close to the Veteran. In an effort to address this issue, a metric was added to track the changes in Veterans' location. Confirmation that a Veteran saw and responded to the prompt was presumed when the change in the Veteran's location was to that of the prompted destination. Preliminary examination of the data indicated a nominal prompt compliance rate of 75 percent. While seemingly quite high, this can and should be increased. Providing auditory cues when a message appears on the screen may improve the response rate, but providing multiple auditory cues throughout the facility would be an annoying distraction to others. A more personalized approach might be for the Veteran to wear a wireless prompting device with the capability of providing vibrotactile, auditory, and/or visual alerts based on location context. It is axiomatic that poor compliance with a prompt will occur if the item to be acted on is a large distance away. For example, if a Veteran is prompted to take medication when the pill bottle is not in the immediate vicinity, the Veteran may say, "I must remember to take my medication when I get home. …

Objective To examine how intraindividual changes in ambulation characteristics may be used to predict falls. Design Longitudinal study design. Setting Assisted living facility. Participants Ambulatory older adults (N=26; mean age, 79y). Interventions Not applicable. Main Outcome Measures Continuous measure of average weekly ambulation characteristics (time and distance walked, speed, path measures [eg, path time and distance, number of paths (where a path is at least 60s of uninterrupted walking separated by at least a 30-s stop)]), accounting for weekly changes in these ambulation characteristics on an individual level over time along with falls (yes/no) and cognitive impairment (CI) (measured by the Montreal Cognitive Assessment). Results In hierarchical linear models accounting for intraindividual changes in ambulation characteristics over the 8-month course of the study and level of CI, path distance (odds ratio, 1.02; P ≤.001) was associated with an increased risk of a fall. In the short-term, intraindividual changes in path distance were associated with a fall within the 4-week interval the change was noted. Path distance had fair sensitivity (.74) and specificity (.66) to a fall (area under the curve, .70). Conclusions Study findings suggest that falls may have specific predictors, specifically that older adults with CI are more likely to fall when walking continuously with little/no breaks. Interventions focused on reducing path-associated fatigue may effectively reduce fall incidence in this population.

Purpose. To examine the relationship between vigorous physical activity and dementia risk. Design. Prospective study design utilizing physical activity data from the Health and Retirement Study and cognitive outcome data from the Aging, Demographics, and Memory Study. Setting. Community-based. Subjects. Adults age 71 and over (N = 808) with 3 to 7 years of physical activity information prior to dementia/no dementia diagnosis. Measures. Physical activity was measured by participation in vigorous activities such as aerobics, sports, running, bicycling, and heavy housework three or more times per week (yes/no). Dementia diagnosis was based on an expert panel (e.g., neuropsychologists, neurologists, geropsychiatrists) who performed and reviewed a battery of neuropsychological tests. Analysis. Binary logistic regression models were used to account for demographic characteristics, genetic risk factors (one or two apolipoprotein E ε4 alleles), health behaviors (e.g., smoking, drinking alcohol), health indicators (body mass index), and health conditions (e.g., diabetes, heart disease) in a sequential model-building process. Results. The relationship between vigorous physical activity and dementia risk remained robust across models. In the final model, older adults who were physically active were 21% (p ≤ .05) less likely than their counterparts to be diagnosed with dementia. Conclusion. Vigorous physical activity may reduce the risk for dementia independently of the factors examined here. This study's findings are important given that few preventative strategies for dementia have been explored beyond hormonal therapy and anti-inflammatory drugs.

Objectives. T o prospectively examine the relationship between body weight, frailty, and the disablement process. Method. Longitudinal data from the Health and Retirement Study (1998–2006) were used to examine the relationship between being underweight, overweight, or obese (compared with normal weight) and the onset and progression of functional limitations and disabilities in instrumental activities of daily living (IADL) and activities of daily living (ADL) among a nationally representative sample of community-dwelling older adults (aged 50 and older) with characteristics of frailty (n = 11,491). Nonlinear multilevel models additionally adjusted for demographic characteristics and intra-individual changes in body weight, socioeconomic status, health behaviors, and health conditions over the course of 8 years. Results. Compared with their nonfrail normal weight counterparts, prefrail obese respondents ha ve a 16% (p ≤ 0.001) reduction in the expected functional limitations rate and frail overweight and obese respondents have a 10% (p ≤ 0.01) and 36% (p ≤ 0.001) reduction in the expected functional limitations rate, respectively. In addition, frail obese respondents have a 27% (p ≤ 0.05) reduction in the expected ADL disability rate. Discussion. This study’ s findings suggest that underweight, overweight, and obese status differentially affect the risk for functional limitations and disabilities in IADL and ADL. Among prefrail and frail adults, some excess body weight in later life may be beneficial, reducing the rate of functional limitations and disability.

Objective: The primary aim of this study is to examine the prevalence of and antecedents to missing incidents among community-dwelling persons with dementia. Methods: This prospective study used mailed surveys and telephone interviews. Results: The prevalence of having any incident was 0.46/year; the overall prevalence for missing incidents in this study was 0.65/year. Missing incidents had few antecedents and occurred largely when persons with dementia were performing everyday activities that they normally completed without incident. Conclusion: Given that a missing incident is relatively common among persons with dementia, health care professionals should assist caregivers with a missing incident plan early in the disease process. Also, as missing persons are found by persons other than the caregiver and caregivers underutilize identification devices, health care professionals may recommend the use of identification devices to facilitate a safe return.

Objectives. We used a life course approach to assess the ways in which childhood socioeconomic position may be associated with disability in later life. Methods. We used longitudinal data from the nationally representative Health and Retirement Study (1998–2006) to examine associations between parental education, paternal occupation, and disabilities relating to activities of daily living (ADLs) and instrumental activities of daily living (IADLs). Results. Respondents whose fathers had low levels of education and those whose fathers were absent or had died while they were growing up were at increased risk of disability in later life, net of social, behavioral, and pathological health risks in adulthood. Social mobility and health behaviors were also important factors in the association between low childhood socioeconomic position and ADL and IADL disabilities. Conclusions. Our findings highlight the need for policies and programs aimed at improving the well-being of both children and families. A renewed commitment to such initiatives may help reduce health care costs and the need for people to use health and social services in later life.

Behavioral symptoms of dementia often present the greatest challenge for informal caregivers. One behavior, that is a constant concern for caregivers, is the person with dementia leaving a designated area such that their whereabouts become unknown to the caregiver or a missing incident. Based on an extensive literature review and published findings of their own research, members of the International Consortium on Wandering and Missing Incidents constructed a preliminary missing incidents model. Examining the evidence base, specific factors within each category of the model were further described, reviewed and modified until consensus was reached regarding the final model. The model begins to explain in particular the variety of antecedents that are related to missing incidents. The model presented in this paper is designed to be heuristic and may be used to stimulate discussion and the development of effective preventative and response strategies for missing incidents among persons with dementia.

Common causes of pulmonary-renal syndrome include anti-glomerular basement membrane (anti-GBM) disease anti-neutrophil cytoplasmic antibody (ANCA) positive vasculitis, and systemic lupus erythematosus. We describe a case of life-threatening pulmonary hemorrhage associated with Campylobacter hemolytic uremic syndrome (HUS), which we believe is a new disease entity. We hypothesize that the cause of this pulmonary-renal syndrome was an immunological reaction to Campylobacter; and that the initiation of high-dose steroids was responsible for the rapid reversal of the patient's pulmonary and renal impairment. The aim of this article is to raise awareness of this unusual cause of a pulmonary-renal syndrome, guiding physicians to recognize it as a potential complication, and to consider high-dose steroids in managing the condition.

This study gathered in-depth interview data from a mostly rural sample ( N = 22) of primary spousal caregivers for non-institutionalized persons with Alzheimer's disease (AD) and related dementias. In exploring the ways gender might influence caregiving, we find that husbands and wives both cross gender boundaries in order to give care to their spouses; and such traversing presents different challenges to each. Not only must they take on responsibilities that their spouses used to perform, but we also point to a generally invisible but important form of crossing gender boundaries — the maintenance of the gender identities of their spouses. Doing so involves more than simply performing tasks; it involves an implicit recognition of the other as a gendered being and the importance of masculinity or femininity to personal identity. Uncovering this latter dimension, and understanding how men and women approach their new tasks has important implications for theory and policy, including intervention strategies.

Literature shows that some health outcomes (e.g., eating, breathing, and speaking) are directly related to posture. Evidence of outcomes mediated by wheelchair seated posture is limited to interface pressure, physical function, and wheelchair skills and safety. This study's purpose was to develop and validate a rapid, low-burden, paper-pencil assessment of wheelchair seated posture for research use and to test feasibility of its use with a sample of older adults. We used a prospective design and a convenience sample of older adults who were receiving rehabilitation services in a community living center. Forty-nine older wheelchair users participated. Main measures were the Seated Posture Scale (SPS), Modified Ashworth Scale, Barthel Index, Visual Descriptor Scale, scale-content validity index (S-CVI), Cronbach alpha, and test-retest reliability. Rating by six experts yielded the overall content validity score (S-CVI) of 0.744. Total SPS score correlated positively with physical function (Barthel Index, r = 0.46, p < 0.001) and negatively with muscle tone (Modified Ashworth Scale, r = -0.44, p = 0.001), supporting SPS construct validity. Internal consistency was 0.66 (Cronbach alpha). Test-retest reliability yielded Pearson product-moment correlations of 0.89 to 0.99. We conclude that the SPS has sufficient preliminary validity and reliability to support its use as an evaluation of wheelchair seated posture in outcomes research.

The aim of this study is to describe the process of staff and patient adoption and compliance of a real-time locating system (RTLS) across two health care settings and present lessons learned. While previous work has examined the technological feasibility of tracking staff and patients in a health care setting in real-time, these studies have not described the critical adoption issues that must be overcome for deployment. The ability to track and monitor individual staff and patients presents new opportunities for improving workflow, patient health and reducing health care costs. A RTLS is introduced in both a long-term care and a polytrauma transitional rehabilitation program (PTRP) in a Veterans Hospital to track staff and patient locations and five lessons learned are presented from our experiences and responses to emergent technological, work-related and social barriers to adoption. We conclude that successful tracking in a health care environment requires time and careful consideration of existing work, policies and stakeholder needs which directly impact the efficacy of the technology.

Objectives. Brain reserve theory, typically discussed in relation to dementia, was examined with regard to late-life depression symptomatology and cerebrovascular burden (CVB) in older-old women. Method. It w as predicted that in a 6-year longitudinal sample (Health and Retirement Study) of 1,355 stroke-free women aged 80 years and older, higher levels of depressive symptomatology (8-item Center for Epidemiologic StudiesDepression score) would be predicted by high CVB, less educational attainment, and the education × CVB interaction after controlling for age and cognitive functioning (Telephone Interview for Cognitive Status). A latent growth curve model was used to identify differences in depression symptomatology at baseline and over time. Logistic regression analyses were used to predict clinically significant depressive symptomatology at each wave based on CVB, education, and the education × CVB interaction. Results. Results indicate that among older w omen, greater educational attainment predicted fewer depression symptoms at baseline, but this advantage was partially eroded over time. The education × CVB interaction predicted clinically significant depressive symptoms at baseline when the benefits of education were most robust. Discussion. Brain reserv e, characterized by educational attainment, may counterbalance the effect of high CVB with respect to depressive symptoms, thereby preserving mood in late life. These findings support the application of brain reserve theory to late-life depression.

Objective A laboratory evaluation was conducted on selected commercial technologies designed to prevent or manage dementia-related missing incidents from the home. Methods Fourteen products representing four unique categories (Pressure Activated Systems, Pull Tab Alarms, Audible Alarms, and Optically Activated Alarms) of behavioral management were evaluated under controlled laboratory conditions for: sound pressure levels (dB), power consumption (watts), battery life, and alarm frequency (pitch). Other variables such as activation force and monitoring/tracking capabilities were tested where applicable to the device category. Results There was wide performance variability regardless of device category, indicating that the devices may fail to successfully capture a missing incident. Implications The development of standardized protocols for testing devices intended for use in the home setting coupled with a broader evaluation of existing technologies would provide a more complete understanding of which products may manage or inhibit missing incidents in persons with dementia.

Background/Aims: To examine the cognitive reserve hypothesis by comparing the contribution of early childhood and life course factors related to cognitive functioning in a nationally representative sample of older Americans. Methods: We examined a prospective, national probability cohort study (Health and Retirement Study; 1998-2010) of older adults (n = 8,833) in the contiguous 48 United States. The main cognitive functioning outcome was a 35-point composite of memory (recall), mental status, and working memory tests. The main predictors were childhood socioeconomic position (SEP) and health, and individual-level adult achievement and health. Results: Individual-level achievement indicators (i.e., education, income, and wealth) were positively and significantly associated with baseline cognitive function, while adult health was negatively associated with cognitive function. Controlling for individual-level adult achievement and other model covariates, childhood health presented a relatively small negative, but statistically significant association with initial cognitive function. Neither individual achievement nor childhood SEP was statistically linked to decline over time. Conclusions: Cognitive reserve purportedly acquired through learning and mental stimulation across the life course was associated with higher initial global cognitive functioning over the 12-year period in this nationally representative study of older Americans. We found little supporting evidence that childhood economic conditions were negatively associated with cognitive function and change, particularly when individual-level achievement is considered.

Two clinical cases of the unusual occurrence of cemento-osseous dysplasia in men and the clinical, radiographic and demographic findings that formed the basis for their diagnosis and management are presented.

Based in successful aging theory and terminal cognitive drop research, this paper investigates cerebrovascular burden (CVB), depressive symptoms, and cognitive decline as threats to longevity. A subsample of stroke-free women over the age of 80 was identified in the Health and Retirement Survey (years 2000–2008). Mortality at 2, 6, and 8 year intervals was predicted using CVB (diabetes, heart disease, hypertension), depressive symptoms (Center for Epidemiological Studies Depression Scale), and cognitive decline (decline of 1 standard deviation or more on the 35-point Telephone Interview for Cognitive Status over 2 years). At most waves (2002, 2004, and 2006) mortality was predicted by CVB, depressive symptoms, and cognitive drop measured 2 years prior. CVB and depressive symptoms at the 2000 wave predicted mortality at 6 and 8 years. Older women with the greatest longevity had low CVB, robust cognitive functioning, and few depression symptoms, supporting successful aging theory and terminal cognitive drop.

Objective To determine whether a Real Time Locating System (RTLS) can be used to accurately detect a fall and discuss the application of RTLS as a fall detection system in the home and health care environments. Methods Phase I used a mannequin to determine the feasibility of RTLS to detect a fall from three positional conditions of: standing, seated in a wheelchair, and laying on a bed. Phase II used a human subject to be an ecologically valid simulation of a fall from these conditions. Ten trials of each of these three conditions were conducted across subjects. The observed time of the fall (the ‘gold standard’) was compared with the RTLS tag position. A Receiver Operating Characteristic (ROC) curve was used to report the Area Under the Curve (AUC) with 95% confidence intervals (CI) and Cohen’s kappa (ϰ) was used to examine inter-rater reliability between the observed fall and the fall detected by the RTLS. Results RTLS accurately identified 89% (p≤0.001) of the mannequin falls and 80% (p≤0.001) of the human falls. Across subjects there were low false positive rates (specificity); 17% for the mannequin and 16% for the human. Interrater reliability was very good (ϰ=0.82; CI: 0.80-0.84) for mannequin falls and good (ϰ =0.72; CI: 0.69-0.74) for human falls. Implications RTLS technology may be used to improve caregiver and staff response times, patient-care, and reduce health care costs associated with falls in later life.

Objective: Guided by a life-course approach to chronic disease, this study examined the ways in which childhood deprivation (low parental education and father’s manual occupation) may be associated with coronary heart disease (CHD). Method: Multilevel modeling techniques and a nationally representative sample of Americans above age 50 from the Health and Retirement Study (HRS; N = 18,465) were used to examine childhood and CHD relationships over the course of 6 years (1998-2004). Results: Having a father with ≤8 years of education was associated with 11% higher odds of CHD, accounting for demographic characteristics, adult socioeconomic status (SES; education, income, and wealth), CHD risks (diabetes, hypertension, cigarette smoking, and obesity), and other factors (childhood health, exercise, stroke, and marital status). Discussion: Policies and programs aimed at improving the conditions of poor children and their families may effectively reduce the prevalence of CHD in later life.

Objectives. We compared risk for several medical illnesses between immigrant and US-born older Mexican Americans to determine the relationship between functional health and years of US residency among immigrants. Methods. Cross-sectional, multistage probability sample data for 3050 Mexican Americans aged 65 years or older from 5 US southwestern states were analyzed. Self-rated health, medical illnesses, and functional measures were examined in multivariate regression models that included nativity and years of US residency as key predictors. Results. Self-rated health and medical illnesses of immigrant and US-born groups did not differ significantly. Immigrants with longer US residency had significantly higher cognitive functioning scores and fewer problems with functional activities after adjustment for predisposing and medical need factors. Conclusions. Among older Mexican Americans, immigrant health advantages over their US-born counterparts were not apparent. Immigrants had better health functioning with longer US residency that may derive from greater socioeconomic resources. Our findings suggest that the negative acculturation–health relationship found among younger immigrant adults may become a positive relationship in later life.

Background: Antidepressant drugs are among the most widely prescribed drugs in the United States; however, little is known about their use among major ethnic minority groups. Method: Collaborative Psychiatric Epidemiology Surveys (CPES) data were analyzed to calculate nationally representative estimates of Latino and non-Latino White adults antidepressant use. Setting: The 48 coterminous United States was the setting. Participants: Household residents aged 18 years and older (N=9,250). Main outcome: Past year antidepressant use. Results: Compared to non-Latino Whites, few Latinos, primarily Mexican Americans, with 12-month depressive and/or anxiety disorders reported past year antidepressant use. Mexican Americans (OR=0.48; 95%CI=0.30–0.77) had significantly lower odds of use compared to non-Latino Whites, which were largely unaffected by factors associated with access to care. Over half of antidepressant use was by respondents not meeting 12-month criteria for depressive or anxiety disorders. Lifetime depressive and anxiety disorders explained another 21% of past year antidepressant use, leaving another 31% of drug use unexplained. Discussion: We found a disparity in antidepressant use for Mexican Americans compared to non-Latino Whites that was not accounted for by differences in need and factors associated with access to care. About one third of antidepressant use was by respondents not meeting criteria for depressive or anxiety disorders. Our findings underscore the importance of disaggregating Latino ethnic groups. Additional work is needed to understand the medical and economic value of antidepressant use beyond their primary clinical targets. Depression and Anxiety, 2009. Published 2009 Wiley-Liss, Inc.

In response to environmental and occupational health concerns, many poultry operations treat the litter in their animal buildings with chemicals that decrease its pH, and therefore decrease ammonia (NH3) gas production. However, the possible increase in hydrogen sulfide (H2S) production that may result from a decreased pH has not been adequately studied. An in-lab apparatus was developed to measure the effect of pH and volumetric water content (VWC) changes on the production of NH3 and H2S production from chicken litter. An NH3 analyzer and H2S sensor were used to monitor gas concentrations. The litter was gathered from one of the poultry buildings at the Stephen F. Austin State University (SFASU) Poultry Research Center in Nacogdoches, Texas and had been reused for six flocks over the course of the year. Litter pH was altered using sodium bisulfate. Three pH levels (6.0, 7.0, and 8.0) and three moisture levels (20, 30, and 40%) were tested. The experiment determined that there was no significant difference in NH3 or H2S production between the three pH treatments and no significant difference in H2S production between the three VWC treatments. However, significantly higher concentrations of NH3 were produced in the 40% VWC treatments than in the 20% VWC treatments. Additionally, NH3 production without the sodium bisulfate treatment approached OSHA TWA ceiling levels (22 ppm) in some tests, but were always far below the OSHA requirements once treated, regardless of the pH level. H2S production never approached the OSHA 8-hour TWA of 10 ppm.

Purpose: The purpose of this study was to examine racial/ethnic differences in the relationship between functional disability and the use of health care services in a nationally representative sample of older adults by using the Andersen behavioral model of health services utilization. Design and Methods: The study used 12 years of longitudinal data from the Health and Retirement Study (1992–2004), a nationally representative sample of communitydwelling adults older than 50 in 1992 (N = 8,947). Nonlinear multilevel models used self-reported health care service utilization (physician visits and hospital admissions) to predict racial/ethnic differences in disability (activities of daily living and mobility limitations). The models also evaluated the roles of other predisposing (age and gender), health need (medical conditions and self-rated health), and enabling factors (health insurance, education, income, and wealth). Results: Blacks and Latinos utilizing physician visits and hospital admissions were associated with significantly more activity of daily living disability than Whites (p , .001). Blacks utilizing physician visits (p , .001) and hospital admissions (p , .05) and Latinos utilizing hospital admissions (p , .05) were associated with more mobility disability than Whites. Other predisposing, health need, and enabling factors did not account for these racial/ethnic differences. Implications: Nationally, health care use for Blacks and Latinos was associated with more disabilities than for Whites after we accounted for predisposing, health need, and enabling factors. The findings suggest that improving health care quality for all Americans may supersede equal access to health care for reducing ethnic and racial disparities in functional health.

This study used a life course approach to examine the ways in which childhood socioeconomic status (SES) may account for some of the racial differences in disability in later life. Eight years (5 waves) of longitudinal data from the US Health and Retirement Study (HRS; 1998-2006), a nationally representative sample of community-dwelling Black and White Americans over age 50 (N=14,588), were used in nonlinear multilevel models. Parental education and father's occupation were used to predict racial differences in activities of daily living (ADL) and instrumental activities of daily living (IADL). The role of adult SES (education, income, and wealth) and health behaviors (smoking, drinking alcohol, exercising, and being obese) were also examined and models were adjusted for health conditions (heart problems, diabetes, stroke, hypertension, cancer, lung disease, and arthritis). With the inclusion of childhood SES indicators, racial differences in ADL and IADL disability were reduced. Adult SES and health behaviors mediated some of the relationship between low childhood SES and disability, though low childhood SES continued to be associated with disability net of these. In support of a life course approach, these findings suggest that socioeconomic conditions in early life may have implications for racial differences in disability between older Black and older White adults.

Background/Aims: Inconsistencies in the relationship between depression and cognitive decline may exist because the expected cognitive domains at risk have not been specified in previous study designs. We aimed to examine the relationship between depressive symptoms and verbal episodic memory functioning over time. Methods: Data from a prospective cohort study (Health and Retirement Study; 1998–2004; n = 18,465), a multistage national probability sample of older adults in the United States, were analyzed. Verbal learning and memory of a 10-word list learning task were the main outcomes. Depressive symptoms (Center for Epidemiologic Studies – Depression Scale) constituted the main predictor. Results: Depressive symptoms were associated with significantly lower immediate (–0.05; p < 0.001) and delayed (–0.06; p < 0.001) word list recall scores after controlling for demographics and baseline and time-varying cardiovascular disease risks and diseases. Conclusions: In this US national study of older adults, elevated depressive symptoms were associated with declines in episodic learning and memory over time. These associations were little affected by the demographic or medical conditions considered in this study. The results suggest that learning and memory decline may be a long-term feature associated with depressive symptoms among the nation’s older adult population.

Objectives. This study described activities that older people undertake to reduce the volume of their possessions in the course of a residential move to smaller quarters, a process with practical, cognitive, emotional, and social dimensions. Methods. Qualitative interviews were conducted with members of 30 households who had moved in the prior year. The disbandment period, typically lasting about 2 months, was a particular focus of the interview. Results. The interviews suggested nine reasons why people had accumulated and kept things, which now became problematic for the impending move. The initial steps of disbandment entailed decisions about major furniture and meaningful gifts to family and friends, followed by evaluation of the remaining belongings for retention, sale, further gifts, donation, or discard. Things not divested by one means were reassigned to another strategy. People took pleasure in dispositions that saw their things used, cared for, and valued as they had done, thus fulfilling a responsibility to their belongings. Discussion. Disbandment is an acute episode of a more general, lifelong process of possession management. It is an encounter with things that are meaningful to the self, but as it unfolds, it also makes new meaning for things. ‘‘It’s not a matter of what you can take, but what you can’t take.’’ —Man, age 83, who moved from a house to a two-bedroom duplex

Based on previous observations of the presence of both insulin-like growth factors I and II (IGF-I and IGF-II) in murine saliva (Kerr et al. , Biochem Pharmacol 49 : 1521–1531, 1995), the saliva from BALB/c and Non-obese diabetic (NOD) mice was examined for the presence of insulin-like growth factor binding proteins (IGFBPs). Using a western-blot type ligand binding assay with 125 I-labeled IGF-I, a series of binding proteins with molecular masses ( M r ) between 25 and 45 kDa were detected in the sera, but not saliva, from both BALB/c and diabetic NOD mice. In the diabetic NOD mice, there were detectable changes in the concentrations of several of the IGFBPs relative to BALB/c mice. Using specific antibody to the binding proteins, one of these was identified as IGFBP-2. Gavage administration of [ 125 I]IGF-I indicated substantial uptake from the gastrointestinal tract and significant tissue distribution. There was an increase in serum concentrations of radiolabeled IGF-I in diabetic NOD mice over that in BALB/c mice but less recovered from most of the tissues. Intact 125 I-labeled IGF-I was extracted and purified from various tissues, following gavage, and shown to retain biological activity. Thus, the uptake of biologically active IGFs from saliva would appear to take place independently of specific binding proteins.

The eukaryotic cell cycle is a summary of a complex network of signal transduction pathways resulting in both DNA replication and cell division. Cyclin-dependent kinases (CDKs) control the cell cycle in all eukaryotes, whereas other proteins, known as cyclins, act as their regulatory subunits. Chronic injection with isoproterenol (ISO) can induce acinar cell proliferation in rodent salivary glands. Cyclins and CDK proteins from control and ISO-treated murine parotid acinar cells were detected by using Western blotting techniques. By comparing the expression of these cell cycle regulatory kinases in the parotid acinar cell transition from a quiescent state to a hypertrophic state, we found rapid increases in the protein levels of all CDKs, cyclin D and proliferating cell nuclear antigen (PCNA). The highest protein levels for CDKs and cyclins appeared at about 72 hr of ISO stimulation and were coincident with the highest rate of increase in gland wet weight. After 72 hr, the increase of both cell cycle protein and gland wet weight began to subside. By using a co-immunoprecipitation method, the following cell cycle regulators (CDK-cyclin complexes) were detected, CDK4-cyclin D, CDK2-cyclin E, CDK2-cyclin A, and cdc2-cyclin B, along with an increase in kinase activity over control untreated animals. Additionally, we detected significant decreases in the newly isolated CDK inhibitor (CKI) p27kip but not Wee 1 kinase. The increased levels of CKI correlated with a decrease in kinase activity of CDK/cyclin complexes by 144 hr of chronic isoproterenol treatment. Our data suggest that the holoenzymes for cell cycle control (cyclin-CDK complexes) function as a final regulatory mechanism leading to salivary gland acinar cell proliferation. The gradual decline in protein levels of the CDKs and cyclins after 3 days of chronic treatment further indicates that ISO-induced proliferation of parotid acinar cells is self-limiting and non-tumorigenic.

Louie Mayer. Mrs Woolf always slept outside in the garden room. She would have the breakfast and come in and have a bath. You would think there was somebody else in the bathroom, which there wasn’t — she always talked to herself. And she was on the books all the time. Very much so. But the moment she come down she was quite normal, quite back to herself again. You could always tell, I think, when she was sad because she walked about very slowly, as if she was thinking. She would bump into things, you know; she might walk up in the garden, not realise she was very near a tree or something like that.

In this study inflammatory responses were determined in rat lungs 0, 1, 3, and 8 days following single 2- and 4-hr exposures to 1.8 ppm ozone. Analysis of lavage fluid immediately following exposure demonstrated enhanced lactate dehydrogenase activity and decreased numbers of lavageable macrophages but no alterations in albumin content. Similar analyses at one day postexposure demonstrated 282% and 456% increases in albumin content and enhanced numbers of lavageable neutrophils from a control value of 0.01 +/- 0.01 to 0.27 +/- 0.10 and 0.78 +/- 0.11 million cells per lung for 2-hr and 4-hr exposures, respectively. The observed increased levels of albumin were also present at 3 days, at which time the number of lavageable neutrophils was not significantly different than control. At both one and 3 days postexposure, lavageable lymphocytes were significantly increased 10-fold from a control value of 0.03 +/- 0.01 million cells per lung. However, the number of lavageable macrophages was unaltered on day 1, but enhanced on day 3, giving values of 0.67 +/- 0.05 (control), 2.25 +/- 0.46 (2 hr), and 2.70 +/- 1.05 (4 hr) million cells per lung. By 8 days both inflammatory cell numbers and albumin levels had returned to control values. Since these data demonstrated different time courses for each inflammatory cell type, this reversible model of acute lung injury should be useful for establishing possible involvement of these cells in processes of lung injury.