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Abstract Despite the association between cognitive impairment and delirium, little is known about whether genetic differences that confer cognitive resilience also confer resistance to delirium. To investigate whether older adults without postoperative delirium, compared with those with postoperative delirium, are more likely to have specific single nucleotide polymorphisms (SNPs) in the FKBP5, KIBRA, KLOTHO, MTNR1B, and SIRT1 genes known to be associated with cognition or delirium. This prospective nested matched exploratory case–control study included 94 older adults who underwent orthopedic surgery and screened for postoperative delirium. Forty-seven subjects had incident delirium, and 47 age-matched controls were not delirious. The primary study outcome was genotype frequency for the five SNPs. Compared with participants with delirium, those without delirium had higher adjusted odds of KIBRA SNP rs17070145 CT/TT [vs. CC; adjusted odds ratio (aOR) 2.80, 95% confidence interval (CI) 1.03, 7.54; p = 0.04] and MTNR1B SNP rs10830963 CG/GG (vs. CC; aOR 4.14, 95% CI 1.36, 12.59; p = 0.01). FKBP5 SNP rs1360780 CT/TT (vs. CC) demonstrated borderline increased adjusted odds of not developing delirium (aOR 2.51, 95% CI 1.00, 7.34; p = 0.05). Our results highlight the relevance of KIBRA, MTNR1B, and FKBP5 in understanding the complex relationship between delirium, cognition, and sleep, which warrant further study in larger, more diverse populations.

Summary: Background: Crimean-Congo hemorrhagic fever virus is the cause of a severe hemorrhagic fever with cases reported throughout a wide-geographic region. Spread by the bite of infected ticks, contact with infected livestock or in the health care setting, disease begins as a non-specific febrile illness that can rapidly progress to hemorrhagic manifestations. Currently, there are no approved vaccines and antivirals such as ribavirin have unclear efficacy. Thus treatment is mostly limited to supportive care. Methods: In this report we evaluated an alphavirus-based replicon RNA vaccine expressing either the CCHFV nucleoprotein or glycoprotein precursor in a stringent, heterologous lethal challenge mouse model. Findings: Vaccination with the RNA expressing the nucleoprotein alone could confer complete protection against clinical disease, but vaccination with a combination of both the nucleoprotein and glycoprotein precursor afforded robust protection against disease and viral replication. Protection from lethal challenge required as little as a single immunization with 100ng of RNA. Unexpectedly, analysis of the immune responses elicited by the vaccine components showed that vaccination resulted in antibodies against the internal viral nucleoprotein and cellular immunity against the virion-exposed glycoproteins. Interpretation: Cumulatively this vaccine conferred robust protection against Crimean-Congo hemorrhagic fever virus and supports continued development of this vaccine candidate. Funding: This research was supported by the Intramural Research Program of the NIAID/NIH and HDT Bio.

Building trust and rapport is crucial in developing sustainable relationships with communities of color who have suffered historical trauma (Nguyen- Truong, Closner, & Fritz, 2019; 1Nguyen-Truong, 1Leung, & Micky, 2020a). A history of nuclear weapons testing by the United States in Micronesia, and subsequent ill-prepared cleanup efforts, has created a historical trauma for the Micronesian Islander community (Letman, 2013). The purpose of this brief article is to describe a critical foundational engagement project approach when gaining entrée into a Micronesian Islander community-based organization to co-develop the culturally relevant main project to improve rates of Micronesian Islander enrollment in early childhood learning (ECL) programs. Building a sustainable community-academic partnership through culturally responsive team (CRT) building and leveraging the collective strengths, to address a community need, took half a year for relationship building, and shared decision-making.

Background: The purpose of this innovative capacity building pilot project was to develop, implement, and evaluate a nine-workshop curriculum, Rekki Lemnak [Thinking of] Parent Leadership, to prepare community and academic partners for community organizing within the Micronesian Islander community. The purpose of the partnership was to build team leadership and research capacity to lay a foundation for implementing a change in healthcare and school systems. Working collaboratively helped ensure access to shared leadership through the learning by doing approach, enabling a culturally responsive method to build a sustainable partnership. Approach: Community-based participatory research and Popular Education tenets and reflection were used as a guide in the development of the Rekki Lemnak [Thinking of] Parent Leadership curriculum. Nine workshops (two hours for eight workshops and three hours for one workshop) were held over a period of a year. Community and academic partners developed the learning objectives, capacity building topics, experiential activities, and an evaluation on the strengths and areas for improvement. The partnership consisted of seven Micronesian Islander parent leaders who are residents from the community at large, the Micronesian Islander Community organization including the Executive Director who is a community primary researcher and certified community health worker, and a Micronesian Islander-certified community health worker staff member, and the academic primary nurse researcher and another academic nurse researcher from Washington State University. A range from five to 10 partners with an average of eight attended the workshops, of which an average of five Micronesian Islander parent leaders attended the workshops. Community partners from the Micronesian Islander Community organization and the academic primary nurse researcher co-led four workshops. Community partners from the Micronesian Islander Community organization and MI parent leaders led two workshops respectively; academic nurse researcher partners led one workshop. Outcomes: We identified three main themes: initially shy and humble MI parent leaders who through their participation transformed to empowered voices, togetherness—coming from different Islands and academia, and the need for more outreach to Micronesian Islanders. Conclusions: Key elements of the Rekki Lemnak [Thinking of] Parent Leadership curriculum may be translatable to other community and academic partnerships. Culturally responsive research is more than a process in conducting a study. This requires an ongoing investment to establish and sustain authentic partnerships to conduct research with MI communities.

Background: Despite mandates by the United States (U.S.) government to ensure the inclusion of women and minorities in federally funded research, communities of color continue to participate less frequently than non-Latinx Whites. There is limited research that examines maternal health outcomes and early childhood resources. Pacific Islanders (PI) have grown substantially in a county in the Pacific Northwest region of the U.S. (from 4,419 to 9,248, of which 52% are female). About 62.7% of PI women are not accessing prenatal care in the first trimester, and this is substantially higher than the national target of 22.1%. Researchers found that PI children are leaving school to take care of family obligations. The purpose of the educational innovative project, Building Safe Didactic Dialogues for Action model, was to respond to Micronesian Islanders (MI) parent leaders’ need to feel safe and to build a close kinship to encourage dialogue about difficult topics regarding access and utilization of early education systems and prenatal/perinatal health for community-driven model for action planning and solutions. Approach: Popular education tenets were used in the project to be culturally sensitive to the human experience. The MI community health worker outreached to MI parent leaders in an urban area in the Pacific Northwest region of the U.S. Eight partners participated in this project: parent leaders from the MI community-at-large, community partners from the MI Community organization, and academic nurse researchers. Didactic dialogues lasted two hours per session for four. Topics included: collaborative agreements, MI parent leaders’ identified needs and existing resources regarding preschool and immunization, parent–child relationship (stress and trauma, adverse childhood experiences), and MI experience regarding prenatal care access and postpartum depression. Group discussion on reflection was used to evaluate utility. Outcomes: Building Safe Didactic Dialogues for Action model was foundational via mobilizing community with MI, trust and rapport building, and engaging in a safe and courageous space for dialogues for action planning and solutions as community and academic partners as stakeholders. Conclusion: Many previously unspoken issues such as abuse, language, and cultural beliefs including barriers were openly shared among all partners. Dynamic thoughts towards identifying needs for change and then planning steps toward creating positive change created an atmosphere of empowerment for change.

Background: In Oregon in the United States’ Pacific Northwest, Native Hawaiians/Pacific Islanders including Micronesian Islanders (MI) substantially grew by 68%; however, research is sparse. This is often due to data aggregation as Asian and Pacific Islanders and community members’ reluctance and wariness to participate in research due to a history of unethical research in the Pacific. The MI community experienced miscarriages, stillbirths, and intellectual and developmental disabilities. Organizational MI community leaders expressed a need to explore the voices of MI parent leaders (MIPLs). The purpose of the community-based participatory qualitative descriptive pilot study was to explore the perceptions and experiences of MIPLs with maternal and children’s health, the school system, and the influence of culture. Methods: A trained MI community health worker recruited eight MIPLs from an urban area of the Pacific northwest in the United States. A group level assessment included illustrative storytelling and is a participant-driven qualitative method that guided data collection and analysis with real-time involvement with MIPL. The discussions lasted for 90 minutes. MIPL shared stories by writing and drawing pictures onto the flip chart papers, transcribed main points, and analyzed the data with researchers. Researchers recorded field notes of the interactions. Researchers debriefed with MIPL to assure trustworthiness and credibility of the findings. Findings: MIPL are Compact of Free Association citizens. Their age ranged from 26 to 42 years, have lived in the United States an average of 12.63 years, and most reported having less than $15,000 total household income before taxes. Four main themes were identified: MI cultural identity, English language and MI culture disharmony, zero or delayed prenatal care, and uncertainty for the future of MI children who have disabilities or developmentally delayed as they progress through the school system. Conclusion: Health care providers including nurses and school officials need to have a culturally specific understanding of the MI community and must consider their needs, culture, and language barriers.

Mislocalization of the TAR DNA-binding protein 43 (TDP-43; encoded by TARDBP) from the nucleus to the cytoplasm is a common feature of neurodegenerative conditions such as amyotrophic lateral sclerosis (ALS) and frontotemporal lobar degeneration (FTLD). The downstream in vivo cellular effects of this mislocalization are not well understood. To investigate the impact of mislocalized TDP-43 on neuronal cell bodies, axons and axonal terminals, we utilized the mouse visual system to create a new model of TDP-43 proteinopathy. Mouse (C57BL/6J) retinal ganglion cells (RGCs) were transduced with GFP-tagged human wild-type TDP-43 (hTDP-WT-GFP) and human TDP-43 with a mutation in the nuclear localization sequence (hTDP-ΔNLS-GFP), to cause TDP-43 mislocalization, with ∼60% transduction efficiency achieved. Expression of both hTDP-WT-GFP and hTDP-ΔNLS-GFP resulted in changes to neurofilament expression, with cytoplasmic TDP-43 being associated with significantly (P

The voice of diverse communities continues to be minimal in academic research. Few models exist for education and training of new research topics and terminology and building partnership capacity in community-engaged research. Little is known about integrative education and training when building participatory research partnerships for sustainability and developing trust and rapport. Community partners at an Asian community-based health and social services center in a large metropolitan area wanted to explore the cultural context of a health-assistive smart home that monitors and auto-alerts with changes in health. With historical and recent rising trends in culturally insensitive research in several diverse communities, the concept of technology-enabled monitoring in the privacy of one’s home brings uncertainty. Academic nurse researchers and community partners co-created a culturally safe integrative education and training curriculum, the Interactive CO-learning for Research Engagement and Education (I-COREE). The purpose was to design, implement, and evaluate the curriculum to respond to the community partners’ needs to create a culturally safe space through an integrative education and training to facilitate building partnership capacity for research engagement including developing trust and rapport and addressing uncertainties in health-assistive technologies. Popular education tenets informed the curriculum. Twelve academic and community partners participated, four were team teachers who co-led the session. Implementation of the experiential, multimodal co-learning activities were conducted within a half-day. The curriculum evaluation indicated it helped bridge critical conversations about partners’ fears of the unknown, approach culturally sensitive topics safely, and trust and rapport. Key elements may be translatable to other partnerships.

BACKGROUND:: Whether patients who subsequently develop early postoperative delirium have a genetic predisposition that renders them at risk for postoperative delirium has not been determined. METHODS:: The authors conducted a nested cohort study to include patients aged ≥ 65 yr who were scheduled to undergo major noncardiac surgery requiring anesthesia. A structured interview was conducted preoperatively and for the first 2 days postoperatively to determine the presence of delirium, defined using the Confusion Assessment Method. Blood was drawn for measurement of the apolipoprotein genotypes. Bivariate tests of association were conducted between delirium and apolipoprotein genotypes and other potentially important risk factors. Variables that had significant bivariate association with postoperative delirium were entered in a forward multivariable logistic regression model. RESULTS:: Of the 190 patients studied, 15.3% developed delirium on both days 1 and 2 after surgery. Forty-six patients (24.2%) had at least one copy of the apolipoprotein e4 allele. The presence of one copy of the e4 allele was associated with an increased risk of early postoperative delirium (28.3% vs. 11.1%; P = 0.005). Even after adjusting for covariates, patients with one copy of the e4 allele were still more likely to have an increased risk of early postoperative delirium (odds ratio, 3.64; 95% confidence interval, 1.51–8.77) compared with those without the e4 allele. CONCLUSIONS:: Apolipoprotein e4 carrier status was associated with an increased risk for early postoperative delirium after controlling for known demographic and clinical risk factors. These results suggest that genetic predisposition plays a role and may interact with anesthetic/surgical factors contributing to the development of early postoperative delirium. [ABSTRACT FROM AUTHOR]

Project risks must be managed to deliver construction projects on time and within budget. In recent years, the New Engineering Contract (NEC) provides an alternate contracting method for procuring construction projects. As stipulated in the NEC contract, NEC risk register must be used to record any project risks. The risk register is designed to record each risk item in the context of textual description, likelihood, and consequence. However, it is time-consuming to identify, quantify, and analyse NEC project risks based on experience, questionnaire, simulation, and data-mining approach. Any method to fully utilise the records of NEC risk registers of past projects for managing NEC project risks remains unexplored. As such, a data-driven approach is proposed to categorise common risks of NEC projects and to analyse risk rating of risk categories by combining the use of text mining analysis and decision tree analysis. A practical case study in Hong Kong is used to illustrate the method of application. Top four common types of NEC project risks, which are ground and utilities, design information, structures, and workmanship, were identified, quantified, and analysed. The new approach helps NEC project planners to identify, quantify, and analyse NEC project risks time-efficiently.