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Many older adults with dementia require constant assistance from a caregiver when completing activities of daily living (ADL). This study examines the efficacy of a computerized device intended to assist people with dementia through ADL, while reducing caregiver burden. The device, called COACH, uses artificial intelligence to autonomously guide an older adult with dementia through the ADL using audio and/or audio-video prompts.~Background~Background~Six older adults with moderate-to-severe dementia participated in this study. Handwashing was chosen as the target ADL. A single subject research design was used with two alternating baseline (COACH not used) and intervention (COACH used) phases. The data were analyzed to investigate the impact of COACH on the participants' independence and caregiver burden as well as COACH's overall performance for the activity of handwashing.~Methods~Methods~Participants with moderate-level dementia were able to complete an average of 11% more handwashing steps independently and required 60% fewer interactions with a human caregiver when COACH was in use. Four of the participants achieved complete or very close to complete independence. Interestingly, participants' MMSE scores did not appear to robustly coincide with handwashing performance and/or responsiveness to COACH; other idiosyncrasies of each individual seem to play a stronger role. While the majority (78%) of COACH's actions were considered clinically correct, areas for improvement were identified.~Results~Results~The COACH system shows promise as a tool to help support older adults with moderate-levels of dementia and their caregivers. These findings reinforce the need for flexibility and dynamic personalization in devices designed to assist older adults with dementia. After addressing identified improvements, the authors plan to run clinical trials with a sample of community-dwelling older adults and caregivers.~Conclusion~Conclusions [ABSTRACT FROM AUTHOR]

Background: Previous research indicates that older adults have difficulties using winter clothing, which contributes to their risk of isolation during winter. Research has also shown that a winter coat that requires less flexibility, strength, and dexterity would help support this population., Purpose: This pilot study evaluated the measured and perceived effectiveness of a winter coat prototype that had a funnel sleeve design., Methods: Eight older adults trialed three coats (the participant's own coat, a coat fitted with sleeve gripper, and the prototype coat), which were evaluated though shoulder range of motion measurements and by the participant completing a survey., Findings: Less shoulder range of motion was used to put on the prototype coat. Survey findings support range of motion data that Sleeve Gripper has limited utility., Implications: A funnel sleeve design may require less range of motion at the shoulder compared to other coats.

Background: Needle core biopsy, often in conjunction with ultrasonic or stereotactic guided techniques, is frequently used to diagnose breast carcinoma in women. Confocal scanning laser microscopy (CSLM) is a technology that provides real-time digital images of tissues with cellular resolution. This paper reports the progress in developing techniques to rapidly screen needle core breast biopsy and surgical specimens at the point of care. CSLM requires minimal tissue processing and has the potential to reduce the time from excision to diagnosis. Following imaging, specimens can still be submitted for standard histopathological preparation., Methods: Needle core breast specimens from 49 patients were imaged at the time of biopsy. These lesions had been characterized under the Breast Imaging Reporting And Data System (BI-RADS) as category 3, 4 or 5. The core biopsies were imaged with the CSLM before fixation. Samples were treated with 5% citric acid and glycerin USP to enhance nuclear visibility in the reflectance confocal images. Immediately following imaging, the specimens were fixed in buffered formalin and submitted for histological processing and pathological diagnosis. CSLM images were then compared to the standard histology., Results: The pathologic diagnoses by standard histology were 7 invasive ductal carcinomas, 2 invasive lobular carcinomas, 3 ductal carcinomas in-situ (CIS), 21 fibrocystic changes/proliferative conditions, 9 fibroadenomas, and 5 other/benign; two were excluded due to imaging difficulties. Morphologic and cellular features of benign and cancerous lesions were identified in the confocal images and were comparable to standard histologic sections of the same tissue., Conclusion: CSLM is a technique with the potential to screen needle core biopsy specimens in real-time. The confocal images contained sufficient information to identify stromal reactions such as fibrosis and cellular proliferations such as intra-ductal and infiltrating carcinoma, and were comparable to standard histologic sections of the same tissue. Morphologic and cellular features of benign and cancerous lesions were identified in the confocal images. Additional studies are needed to 1.) establish correlation of the confocal and traditional histologic images for the various diseases of the breast; 2.) validate diagnostic use of CSLM and; 3.) further define features of borderline lesions such as well-differentiated ductal CIS vs. atypical hyperplasia.

Objective: To assess feasibility of noninvasive in vivo reflectance confocal microscopy (RCM) of Meissner corpuscles (MCs) as a measure of sensory neuropathy (SN)., Background: MCs are touch-pressure sensation receptors in glabrous skin. Skin biopsy studies suggest that fingertip MC density (MCs/mm(2)) is a sensitive measure of diabetic and idiopathic SN. In vivo RCM of skin is an emerging field, with applications including evaluation of cancer. It is painless and noninvasive. Feasibility of in vivo RCM of MCs has not been explored., Methods: Fifteen adults (10 controls, 5 SN subjects) underwent in vivo RCM at the fingertip (Digit V) and thenar eminence. In vivo RCM was conducted to determine whether MCs were visible within dermal papillae and, if visible, to characterize their imaging appearance and assess MCs/mm(2) at each site., Results: MCs were identified in dermal papillae at all sites in controls. MCs appeared as heterogeneous bright structures within dermal papillae, which appeared as dark "pits." Mean MC density in controls was 12 +/- 5.3/mm(2) (Digit V) and 5.1 +/- 2.2/mm(2) at the thenar eminence. MC density in SN was lower than controls at Digit V (2.8 +/- 5.7/mm(2), p = 0.01) and the thenar eminence (1.4 +/- 1.1/mm(2), p = 0.004). MCs were absent in a sensory neuronopathy; milder reductions in MC density were seen among diabetic and HIV-positive subjects., Conclusions: Meissner corpuscles (MCs) can be visualized and quantitated in controls and sensory neuropathy (SN) using in vivo reflectance confocal microscopy (RCM). In vivo RCM of MCs has potential for noninvasive detection and monitoring of SN, if subsequent studies show that with denervation or reinnervation, reliable and recognizable changes or loss can be detected using our described approaches.

Precision percutaneous needle aspiration biopsy under guidance of computed tomography is facilitated by injection of a small amount of contrast material during the biopsy procedure. CT scan immediately after biopsy clearly documents the biopsy site. There was no adverse effect of the contrast agents on the quality of staining or preservation of cellular architecture. To the contrary, the aspirates obtained after contrast injection were generally better preserved and better stained than the control specimens. This may be due to a decrease in drying, with the more fluid aspirates obtained after contrast injection.

Group B beta-hemolytic Streptococcus, S agalactiae, is an uncommon cause of endocarditis in adults. We present the clinical, laboratory, and postmortem findings of an adult patient with group B streptococcal endocarditis and major arterial emboli. What to our knowledge are previously unreported features are purulent pericarditis and myocardial abscesses. Twenty-five cases of endocarditis caused by group B Streptococcus that are reported in the literature are reviewed.