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Gait speed significantly affects functional status and health outcomes in older adults. This cross-sectional study evaluated cognitive and physical fitness contributors to usual and peak gait speed in persons with Alzheimer's dementia. Multiple hierarchal linear regression was used to obtain squared semipartial correlation coefficients (sr2) and effect sizes (Cohen's ƒ2). Participants (n = 90; 56% male) averaged 77.1 ± 6.6 years of age and 21.8 ± 3.4 on Mini-Mental State Examination. Demographic/clinical, physical fitness, and cognition variables explained 45% and 39% of variance in usual and peak gait speed, respectively. Muscle strength was the only significant contributor to both usual (sr2 =.175; Cohen's ƒ2 = 0.31; p <.001) and peak gait speed (sr2 =.11; Cohen's ƒ2 = 0.18; p <.001). Women who were "slow" walkers (usual gait speed <1.0 m/s) had significantly lower cardiorespiratory fitness and executive functioning compared with "fast" walkers. In conclusion, improving muscle strength may modify gait and downstream health outcomes in Alzheimer's dementia. [ABSTRACT FROM AUTHOR]

Effective disease management in older adults relies on medication adherence to prevent adverse outcomes like hospitalization, particularly among those with cognitive impairment. In this study, we examined the impact of cognitive impairment on medication management, adherence, and hospitalization risk across levels of cognitive function. Analyzing data from 28,558 community-dwelling older adults, we found that those with dementia had the most difficulty managing medications (13.12%), followed by cognitive impairment without dementia (5.80%), and intact cognition (1.96%). Only persons with dementia showed a significant association between medication management difficulty and hospitalization risk (Odds Ratio [OR] = 1.71; 95% Confidence Intervals: 1.08, 2.70; p =.02). Cost-related medication nonadherence was associated with hospitalization risk solely among those with intact cognition (OR = 1.25; 95% CI: 1.07, 1.45; p =.004). Dementia was associated with higher odds of medication management difficulty and subsequently hospitalization risk, underscoring the need for resources to support medication use for this population. [ABSTRACT FROM AUTHOR]

This study aimed to estimate the additive and dominance genetic variance in growth and multiple‐stress tolerance traits in 7‐week‐old and 15‐week‐old Pacific white shrimp Litopenaeus vannamei. Four different animal models were studied by including all or different subsets of the following effects: additive genetic effects (A), additive genetic and common environmental effects (A + C), additive genetic and dominance effects (A + D), and additive, common environmental, and dominance effects (A + D + C). Variance components were estimated using the average information restricted maximum likelihood method. In general, estimates of additive genetic variance were inflated under the simple model (A) and decreased remarkably under the more complex models (A + C, A + D, and A + D + C). The genetic parameters of two‐stage (7‐week and 15‐week shrimp) growth and multiple‐stress tolerance traits were more suitable for estimation using the A + C model. The additive effects (0.311–0.754) of seven traits in 7‐week shrimp were greater than the dominance effects (4.950 × 10−7 to 0.201), whereas the additive effects of the same seven traits in adult shrimp ranged from 7.712 × 10−8 to 0.468 and the dominance effects ranged from 0.074 to 0.577. Except for survival time, carapace length, and carapace width, the additive effects of the other traits were smaller than the corresponding dominance effects. Thus, better genetic improvement of 7‐week and 15‐week shrimp growth and multiple‐stress tolerance can be obtained with selective breeding than with crossbreeding and better genetic improvement of 7‐week shrimp growth traits can be obtained with crossbreeding than with selective breeding. Our study further enriches the database for enhancing growth and stress resistance in Pacific white shrimp and provides reference information for growth improvement and multiple‐stress resistance breeding. [ABSTRACT FROM AUTHOR]

Over half of older adults experience polypharmacy, including medications that may be inappropriate or unnecessary. Deprescribing, which is the process of discontinuing or reducing inappropriate and/or unnecessary medications, is an effective way to reduce polypharmacy. This review summarizes (1) the process of deprescribing and conceptual models and tools that have been developed to facilitate deprescribing, (2) barriers, enablers, and factors associated with deprescribing, and (3) characteristics of deprescribing interventions in completed trials, as well as (4) implementation considerations for deprescribing in routine practice. In conceptual models of deprescribing, multilevel factors of the patient, clinician, and health‐care system are all related to the efficacy of deprescribing. Numerous tools have been developed for clinicians to facilitate deprescribing, yet most require substantial time and, thus, may be difficult to implement during routine health‐care encounters. Multiple deprescribing interventions have been evaluated, which mostly include one or more of the following components: patient education, medication review, identification of deprescribing targets, and patient and/or provider communication about high‐risk medications. Yet, there has been limited consideration of implementation factors in prior deprescribing interventions, especially with regard to the personnel and resources in existing health‐care systems and the feasibility of incorporating components of deprescribing interventions into the routine care processes of clinicians. Future trials require a more balanced consideration of both effectiveness and implementation when designing deprescribing interventions. [ABSTRACT FROM AUTHOR]

Background: Home time is an important patient‐centric quality metric, which has been largely unexamined among assisted living (AL) residents. Our objectives were to assess variation in home time among AL residents in the year following admission and to examine the associations with state regulations for direct care workers (DCW) training and staffing and for licensed nurse staffing. Methods: Medicare beneficiaries who entered AL communities in 2018 were identified, and their home time in the year following admission was measured. Home time was calculated as the percentage of time spent at home per day being alive. Resident characteristics and state regulations in DCW staffing, DCW training, and licensed staffing were measured. We used a multivariate linear regression model with AL‐level fixed effects to estimate the relationship between person‐level characteristics and home time. Linear regression models adjusting for resident characteristics were used to estimate the association between state regulations and residents' home time. Results: The study sample included 59,831 new Medicare beneficiary residents in 12,143 ALs. In the year following AL admission, residents spent 94% (standard deviation = 14.6) of their time at home. Several resident characteristics were associated with lower home time: Medicare–Medicaid dual eligibility, having more chronic conditions, and specific chronic conditions, for example, dementia. In states with greater regulatory specificity for DCW training and staffing, and lower specificity for licensed staffing, residents had longer adjusted home time. Conclusion/Implications: Home time varied substantially among AL residents depending on resident characteristics and state‐level regulatory specificity. AL residents eligible for Medicare and Medicaid had substantially shorter home time than the Medicare‐only residents, largely due to longer time spent in nursing homes. State AL regulatory specificity for DCWs and licensed staff also impacted AL residents' home time. These findings may guide AL operators and state legislators in efforts to improve this important quality of life metric. [ABSTRACT FROM AUTHOR]

Background: Despite the rapid growth of assisted living (AL) communities and the increasing similarity between AL and nursing home (NH) populations, little is known about the characteristics of older adults at the time of AL admission and how these characteristics compare to individuals newly admitted to NH from the community. This study examined the individual, facility, and geographic factors associated with new AL admission. Methods: This retrospective descriptive study used data from the national Medicare enrollment and claims datasets, the Minimum Data Set, and the Medicare Provider Analysis and Review. The study cohort included 158,124 Medicare beneficiaries newly admitted to ALs and 715,261 newly admitted to NHs during 10/2017–10/2019. Multinomial logistic regression analysis and logistic regression analysis were conducted to examine factors associated with new admissions. Results: Demographic, socioeconomic, and health service use characteristics were associated with new admission to long‐term care. Specifically, Medicare fee‐for‐service beneficiaries, those age 75 years and older, male, having one skilled nursing facility (SNF) stay or any hospital stay in the past 6 months are more likely to be newly admitted to AL, whereas those who are dually eligible, racial/ethnic minorities, and having two or more SNF stays in the past 6 months are more likely to be admitted to an NH. Conclusion: There are substantial differences between individuals who are newly admitted from the community to AL versus those to NH. [ABSTRACT FROM AUTHOR]

This paper presents a process for efficiently recovering palladium (Pd) from spent Pd/Al2O3 catalysts used for hydrogenation reactions, using ultrasound-assisted leaching (UAL). A system composed of H2SO4 and NaCl was investigated under ultrasound-enhanced conditions and compared to regular leaching methods to demonstrate the superiority of UAL. Single-factor experiments were conducted to determine the optimal conditions for leaching, which included an ultrasound power of 200 W, a liquid–solid ratio of 5:1, a leaching time of 1 h, a leaching temperature of 60 °C, H2SO4 concentration of 60%, and 0.1 mol of NaCl. The leaching rate under these conditions was found to be 99%. Additionally, kinetic analysis of the UAL process showed that the apparent activation energy of the Pd leaching reaction was 28.7 kJ/mol, and it was found that Pd leaching from spent catalysts was controlled by diffusion. The tailings were analyzed by SEM, revealing that during ultrasonic leaching, the specific surface area of the spent catalyst increased, the mass transfer rate of the solution was accelerated, the passivation film on the surface of the spent catalyst was peeled off, and a new reaction interface was formed. This improved the leaching rate of Pd and provided a new approach to efficiently leach precious metals such as Pd from spent catalysts. [ABSTRACT FROM AUTHOR]

Background: Existing literature on online reviews of healthcare providers generally portrays online reviews as a useful way to disseminate information on quality. However, it remains unknown whether online reviews for assisted living (AL) communities reflect AL care quality. This study examined the association between AL online review ratings and residents' home time, a patient‐centered outcome. Methods: Medicare beneficiaries who entered AL communities in 2018 were identified. The main outcome is resident home time in the year following AL admission, calculated as the percentage of time spent at home (i.e., not in institutional care setting) per day being alive. Additional outcomes are the percentage of time spent in emergency room, inpatient hospital, nursing home, and inpatient hospice. AL online Google reviews for 2013–2017 were linked to 2018–2019 Medicare data. AL average rating score (ranging 1–5) and rating status (no‐rating, low‐rating, and high‐rating) were generated using Google reviews. Linear regression models and propensity score weighting were used to examine the association between online reviews and outcomes. The study sample included 59,831 residents in 12,143 ALs. Results: Residents were predominately older (average 81.2 years), non‐Hispanic White (90.4%), and female (62.9%), with 17% being dually eligible for Medicare and Medicaid. From 2013 to 2017, ALs received an average rating of 4.1 on Google, with a standard deviation of 1.1. Each one‐unit increase in the AL's average online rating was associated with an increase in residents' risk‐adjusted home time by 0.33 percentage points (p < 0.001). Compared with residents in ALs without ratings, residents in high‐rated ALs (average rating ≥4.4) had a 0.64 pp (p < 0.001) increase in home time. Conclusions: Higher online rating scores were positively associated with residents' home time, while the absence of ratings was associated with reduced home time. Our results suggest that online reviews may be a quality signal with respect to home time. See related Editorial by David et al. [ABSTRACT FROM AUTHOR]